Objective: This study aimed to investigate the impact of reduced bed capacity in the intensive care unit (ICU) on emergency department (ED) length of stay (LOS) and prognosis of critically ill patients. Methods: This retrospective observational study included patients who presented to a university hospital ED and were admitted to the ICU between August 2017 and July 2019. In our center, the number of beds in the traumatic ICU was maintained, while the number of beds in the non-traumatic ICU was reduced. We comparatively assessed ED LOS and the mortality rate between traumatic and non-traumatic patients over 2 years (1 year before and after the reduced number of beds in the non-traumatic ICU) to determine the impact of reduced ICU bed capacity. Also, a multivariate logistic regression analysis was performed to identify the risk factors related to in-hospital mortality. Results: A total of 2,945 patients were included in this study. In the traumatic ICU patient group, the ED LOS did not change (2.62 [1.95-3.72] hours vs. 2.78 [2.01-3.92] hours, P=0.079) after reducing the number of ICU beds; and no significant difference in mortality rate was noted (19.5% vs. 17.6%, P=0.417). In the non-traumatic ICU patient group, both ED LOS (prolonged by 1.69 hours, 3.46 [2.17-5.66] hours vs. 5.15 [3.43-8.37] hours, P<0.001) and mortality rate (21.6% vs. 25.8%, P=0.003) were significantly increased after reducing the number of ICU beds. In the multivariate logistic regression analysis, ED LOS was identified as a risk factor for in-hospital mortality (odds ratio, 1.035; P<0.001). Conclusion In this study, the reduced ICU bed capacity resulted in prolonged ED LOS of critically ill patients, which consequently contributed to increased in-hospital mortality.

Objective: This study aimed to investigate the impact of reduced bed capacity in the intensive care unit (ICU) on emergency department (ED) length of stay (LOS) and prognosis of critically ill patients. Methods: This retrospective observational study included patients who presented to a university hospital ED and were admitted to the ICU between August 2017 and July 2019. In our center, the number of beds in the traumatic ICU was maintained, while the number of beds in the non-traumatic ICU was reduced. We comparatively assessed ED LOS and the mortality rate between traumatic and non-traumatic patients over 2 years (1 year before and after the reduced number of beds in the non-traumatic ICU) to determine the impact of reduced ICU bed capacity. Also, a multivariate logistic regression analysis was performed to identify the risk factors related to in-hospital mortality. Results: A total of 2,945 patients were included in this study. In the traumatic ICU patient group, the ED LOS did not change (2.62 [1.95-3.72] hours vs. 2.78 [2.01-3.92] hours, P=0.079) after reducing the number of ICU beds; and no significant difference in mortality rate was noted (19.5% vs. 17.6%, P=0.417). In the non-traumatic ICU patient group, both ED LOS (prolonged by 1.69 hours, 3.46 [2.17-5.66] hours vs. 5.15 [3.43-8.37] hours, P<0.001) and mortality rate (21.6% vs. 25.8%, P=0.003) were significantly increased after reducing the number of ICU beds. In the multivariate logistic regression analysis, ED LOS was identified as a risk factor for in-hospital mortality (odds ratio, 1.035; P<0.001). Conclusion In this study, the reduced ICU bed capacity resulted in prolonged ED LOS of critically ill patients, which consequently contributed to increased in-hospital mortality.

OBJECTIVE: Our hospital's policy is to perform history-indicated cerclage (HIC) for pregnant patients with 1 or more second-trimester pregnancy losses. Recently, the American College of Obstetricians and Gynecologists (ACOG) guideline regarding indications for HIC was changed from 3 or more previous second-trimester fetal losses to one or more. In this study, we aimed to evaluate the efficacy of the revised guideline and to investigate the association between previous preterm history and cerclage outcome. METHODS: We conducted a retrospective observational study of cases of HIC in singleton pregnancies performed at our hospital between January 2007 and June 2016. We compared the perioperative complications and incidences of preterm delivery in patients with one previous second-trimester pregnancy loss against those in patients with ≥2 losses. RESULTS: The incidence of preterm delivery (< 32 weeks) was significantly lower in patients with one previous second-trimester pregnancy loss than in those with ≥2 losses (15/194 [8%] vs. 28/205 [14%]). In the 1 loss and ≥2 losses groups, the rates of preterm premature rupture of membranes (PPROM) were 7% and 8%, the rates of PPROM at < 32 weeks 2.1% and 3.4%, and the ratios of neonatal intensive care unit admission 10% and 17%, respectively. CONCLUSION: Comparison of HIC in one previous second-trimester pregnancy loss group with HIC in the 2 or more previous second-trimester pregnancy loss group found no difference in pregnancy outcome. This finding supports the amended ACOG guideline for HIC indications. Based on our results, we also propose development of a new protocol for HIC-related complications.
Cerclage, Cervical ; Female ; Humans ; Incidence ; Infant, Newborn ; Intensive Care, Neonatal ; Membranes ; Observational Study ; Pregnancy ; Pregnancy Outcome ; Premature Birth ; Retrospective Studies ; Rupture ; Uterine Cervical Incompetence

OBJECTIVES: Diabetes and obesity each increases mortality, but recent papers have shown that lean Asian persons were at greater risk for mortality than were obese persons. The objective of this study is to determine whether an interaction exists between body mass index (BMI) and diabetes, which can modify the risk of death by cardiovascular disease (CVD). METHODS: Subjects who were over 20 years of age, and who had information regarding BMI, past history of diabetes, and fasting blood glucose levels (n=16 048), were selected from the Korea Multi-center Cancer Cohort study participants. By 2008, a total of 1290 participants had died; 251 and 155 had died of CVD and stroke, respectively. The hazard for deaths was calculated with hazard ratio (HR) and 95% confidence interval (95% CI) by Cox proportional hazard model. RESULTS: Compared with the normal population, patients with diabetes were at higher risk for CVD and stroke deaths (HR, 1.84; 95% CI, 1.33 to 2.56; HR, 1.82; 95% CI, 1.20 to 2.76; respectively). Relative to subjects with no diabetes and normal BMI (21 to 22.9 kg/m2), lean subjects with diabetes (BMI <21 kg/m2) had a greater risk for CVD and stroke deaths (HR, 2.83; 95% CI, 1.57 to 5.09; HR, 3.27; 95% CI, 1.58 to 6.76; respectively), while obese subjects with diabetes (BMI > or =25 kg/m2) had no increased death risk (p-interaction <0.05). This pattern was consistent in sub-populations with no incidence of hypertension. CONCLUSIONS: This study suggests that diabetes in lean people is more critical to CVD deaths than it is in obese people.
Aged ; Blood Glucose/analysis ; *Body Mass Index ; Cardiovascular Diseases/etiology/*mortality ; Cohort Studies ; Diabetes Complications ; Diabetes Mellitus/*pathology ; Female ; Humans ; Male ; Middle Aged ; Proportional Hazards Models ; Risk Factors ; Stroke/etiology/mortality

Metastasis to the skin from internal malignant neoplasms is an uncommon event. Although carcinoma of the ovary is the second most common malignancy in women, cutaneous involvement originating from ovarian cancer is particularly unusual. A 30-year-old woman had been treated with chemotherapy for ovarian cancer 4 years previously. She showed an erythematous indurated subcutaneous nodule on her left shoulder and scalp. Histopathologic findings showed multiple cribriform pattern cellular masses and some cords or tubular structures floating on a mucinous pool, which were similar to primary mucinous cystadenocarcinoma. We report this case of cutaneous metastasis from ovarian cancer.
Female ; Humans ; Neoplasm Metastasis ; Ovarian Neoplasms

Mucormycosis is a rare invasive fungal infection that chiefly occurs in immunocompromized patients and the outcome is generally fatal. Primary cutaneous mucormycosis is a rare phenotype of mucormycosis, and it usually follows direct inoculation of fungi on damaged skin. Many cutaneous infections mimic sprotrichosis, including virus, bacteria, acid-fast bacilli, fungi and protozoa, yet mucormycosis is very rare. We report on a case of cutaneous mucormycosis that mimicked sporotrichosis in a 77 years old woman.
Bacteria ; Female ; Fungi ; Humans ; Hydrazines ; Mucormycosis ; Phenotype ; Skin ; Sporotrichosis ; Viruses

Tinea capitis is rare in Korea, especially in adults. Microsporum canis has been the most common cause of tinea capitis in Korea from the middle of the 1970s. The infection may occur from animal to man (zoophilic). We report two cases of tinea capitis occurring in a 60-year-old female and a 73-years-old female who developed a kerion celci form and seborrheic dermatitis-like form. From the two patients Microsporum canis was isolated.
Adult ; Animals ; Female ; Humans ; Korea ; Microsporum ; Middle Aged ; Tinea ; Tinea Capitis

BACKGROUND: Actinic keratoses (AK) have been recognized as precancerous lesions, they have been recently considered to be an early in situ squamous cell carcinoma (SCC). However, there have been few studies to determine the clinical and histopathological characteristics of AK, and especially in the Province of Chungcheongnam-do. Objective: The purpose of this study was to evaluate the clinicopathological characteristics of 80 cases of AK in the province of Chungcheongnam-do. METHODS: The authors evaluated the clinical and histopathological features of 80 patients with AK at Soonchunhyang University Hospital in Cheonan from January 1998 to December 2008. RESULTS: The ratio of male to female patients was 1:4.7. The age distribution ranged from 42 to 93 years old. Single lesions are more common than multiple lesions. The duration of lesions was variable with a mean duration of 25.1 months. The most commonly involved sites were the face and especially the cheek. The color was erythematous in 63.3% of the cases, brownish in 24.5%, dark-brownish in 9.5% and gray in 2.7%. Crust and scale were noted in 37.4% and 22.4% of the cases, respectively. SCC was associated with AK in 6.3% of the cases, basal cell carcinoma was associated with AK in 1.3%, and keratoacanthoma in 1.3%. The most common histopathological types of AK were atrophic types in 20.6%, and this was followed by the hypertrophic types in 18.6% of the cases and the hypertrophic and atrophic types in 14.7% of the cases. CONCLUSION: Our results are similar to those of the previous reports. In addition, we observed a consistently higher incidence in females than males in the Korean reports and a more frequent incidence of single lesions than multiple lesions in the Asian reports. We found that AK is not easily distinguishable from SCC both clinically and cytologically. Thus, we suggest that biopsies and active treatments should be performed on AK lesions.
Actins ; Age Distribution ; Asian Continental Ancestry Group ; Biopsy ; Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Cheek ; Female ; Humans ; Incidence ; Keratoacanthoma ; Keratosis, Actinic ; Male

BACKGROUND: Actinic keratoses (AK) have been recognized as precancerous lesions, they have been recently considered to be an early in situ squamous cell carcinoma (SCC). However, there have been few studies to determine the clinical and histopathological characteristics of AK, and especially in the Province of Chungcheongnam-do. Objective: The purpose of this study was to evaluate the clinicopathological characteristics of 80 cases of AK in the province of Chungcheongnam-do. METHODS: The authors evaluated the clinical and histopathological features of 80 patients with AK at Soonchunhyang University Hospital in Cheonan from January 1998 to December 2008. RESULTS: The ratio of male to female patients was 1:4.7. The age distribution ranged from 42 to 93 years old. Single lesions are more common than multiple lesions. The duration of lesions was variable with a mean duration of 25.1 months. The most commonly involved sites were the face and especially the cheek. The color was erythematous in 63.3% of the cases, brownish in 24.5%, dark-brownish in 9.5% and gray in 2.7%. Crust and scale were noted in 37.4% and 22.4% of the cases, respectively. SCC was associated with AK in 6.3% of the cases, basal cell carcinoma was associated with AK in 1.3%, and keratoacanthoma in 1.3%. The most common histopathological types of AK were atrophic types in 20.6%, and this was followed by the hypertrophic types in 18.6% of the cases and the hypertrophic and atrophic types in 14.7% of the cases. CONCLUSION: Our results are similar to those of the previous reports. In addition, we observed a consistently higher incidence in females than males in the Korean reports and a more frequent incidence of single lesions than multiple lesions in the Asian reports. We found that AK is not easily distinguishable from SCC both clinically and cytologically. Thus, we suggest that biopsies and active treatments should be performed on AK lesions.
Actins ; Age Distribution ; Asian Continental Ancestry Group ; Biopsy ; Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Cheek ; Female ; Humans ; Incidence ; Keratoacanthoma ; Keratosis, Actinic ; Male

BACKGROUND: Epidermal cysts are the most common type of epithelial cysts of the skin. There have been a few studies to determine the clinical and histopathological characteristics of epidermal cysts. OBJECTIVE: The purpose of this study was to evaluate the clinicopathological characteristics of 243 cases of epidermal cysts in the province of Chungcheongnam-do. METHODS: We retrospectively evaluated the clinical and histopathological features of 243 cases of epidermal cysts at Soonchunhyang University Hospital in Cheonan from January 1998 to December 2008. RESULTS: The ratio of male to female patients was 1.7:1. The age distribution of subjects at the first visit ranged from 11 months to 83 years. The most common site of occurrence was the face. The most common histopathological change of the cystic wall was atrophy. Cystic contents such as calcifications, parakeratotic cells, red blood cells as well as keratinous material were observed. We found stromal changes such as foreign body reactions, fibrosis and granulation tissue. Forty-seven cases were clinically misdiagnosed as other diseases, but subsequent histopathological findings demonstrated the presence of epidermal cysts. No particular relationship was found among duration, size, atrophy of the cyst wall and calcification of keratin material. CONCLUSION: We reaffirmed contiguity with previous reports. In addition, we found some cases could have been clinically misdiagnosed as other diseases. In addition, there was a poor relationship between the duration of the lesion and other variables such as the size of the lesion, the degree of atrophy of the cyst wall and calcification of keratin material.
Age Distribution ; Atrophy ; Epidermal Cyst ; Erythrocytes ; Female ; Fibrosis ; Foreign Bodies ; Granulation Tissue ; Humans ; Keratins ; Male ; Retrospective Studies ; Skin