The almost existing commercial HL7 interface engines apply the string array method which is run in the main memory to HL7 message parsing process. But, if the HL7 message is big, this method will be possible to cause the computer system to raise critical and fatal problems because a long string array can carry a too heavy load to the main memory and the processor. Therefore, the image and the multi-media data which are needed for the modern medical records could be limited to be included into a HL7 message because the size is usually too big in comparison with the main body of a HL7 message and in result, it make the size of the HL7 message expanded. The purpose of this study is to suggest a new HL7 interface algorithm which can solve this problem by the method of the 'Streaming Algorithm'. This new method for HL7 message parsing apply the character-stream object which process character by character between the main memory and hard disk device with the consequence that the processing load on main memory could be alleviated. The main functions of this new engine are generating, parsing, validating, browsing, sending, and receiving of message. And also, this can parse and generate XML-formated HL7 message. This engine had been practically tested in the Discharge Summary Information Exchange System between Kyungpook National University Hospital and Chonnam National University Hospital for the purpose of proofing its usability for a month. Overall, the preliminary results of this test is considered as good, but it is pointed out that some improvement is needed relating to the speed of parsing which was predicted because this engine partly used the memory of hard disk device instead of the main memory.
Computer Systems ; Gyeongsangbuk-do ; Jeollanam-do ; Medical Records ; Memory ; Rivers*

We have developed a prototype HL7(Health Level 7) message browser for web based healthcare networking. Because most of commercial HL7 interface tools have high price, the purpose of this study is to provide a message tool for those who are willing to exchange clinical data in an e fficient and cost-effective manner. The present development is based on HL7 v. 2.3.1 using HTML and JAVA servlet to be implemented on web environment. The preliminary results include 1) input message, 2) parsing and inter pretation via web browse r with HTML and XML, and 3) transf erring message to another site through the socket communication. Although we have found more efficient performance than we expected with numerous encouraging results, error correcting mechanism needs to be improved continuously throughout the on-going project development.

Craniosynostosis refers to the premature fusion of single or multiple sutures of the cranial base or vault. It causes restriction of cranium and brain growth and variable morphologic deformity. Inadequate intracranial volume for rapid brain growth brings about increased intracranial pressure and functional impairment. To solve this problem, the key is the surgical decompression and insurance of adequate intracranial volume. Traditional surgical approach is frontal advancement with cranial vault remodeling, but has drawbacks such as invasiveness, long operation time, large amount of hemorrhage, difficult postoperative care, and frequent complications. Recently, distraction osteogenesis is used for the treatment of craniosynostosis. So, we compared cranial distraction osteogenesis with traditional cranioplasty about merits and drawbacks and present the effectiveness of cranial distraction osteogenesis. In a comparative study of cranioplasty and distraction osteogenesis, clinical documents and pre/ postoperative X-ray and CT scans of 12 brachycephaly patients were reviewed. From April, 1994 to October, 2001, 8 patients were treated with traditional cranioplasty and 4 patients were treated with distraction osteogenesis. We achieved not only an increase in intracranial volume but also merits such as a reduction in operation time and bleeding, easy postoperative care and low complication rate with distraction osteogenesis.
Brain ; Congenital Abnormalities ; Craniosynostoses* ; Decompression, Surgical ; Hemorrhage ; Humans ; Insurance ; Intracranial Pressure ; Osteogenesis, Distraction* ; Postoperative Care ; Skull ; Skull Base ; Sutures ; Tomography, X-Ray Computed

The nose is the most 3-dimensional structure located on the central area of the face. Rhinoplasty using autogenous tissues and alloplastic materials has been performed for augmentation of nasal tip and dorsum in Asia. For batten graft, spreader graft, columellar strut and/or tip plasty, autogenous tissue especially nasal septal cartilage is very useful. Sometimes surgeon is faced to the situation when usable septal cartilage is too small so other tissues or materials are needed during the operation. The purpose of this study is that we should predict the amount of obtainable septal cartilage by variant measurements of the nose and investigated relationship each other. From December 2002 to February 2004, on the 31 cases that operated rhinoplasty using septal cartilage, we took variable measurements such as nasal length, tip width, nasal basal width, nasal height, columellar width and length of nostril long axis preoperatively. Then we investigated the relationship with amount of actual harvested septal cartilage. As a result, the nasal length was the most correlated with cartilage amount statistically and tip and base width were correlated as well. In this study we concluded that nasal length was the most indicating parameter to predict amount of septal cartilage.
Asia ; Axis, Cervical Vertebra ; Cartilage* ; Nose* ; Rhinoplasty ; Transplants

OBJECTIVES: The aim of this study was to investigate the clinico-radiologic features and microbiologic data of patients with SPE in a tertiary care hospital in Busan. METHODS: We retrospectively analyzed clinical and radiologic features of 6 cases with septic pulmonary embolism that occurred from March 2009 to March 2011 in Dong-A university medical center. RESULTS: The mean age of the study population was 58 years, and two men and four women were included. Clinical symptoms included general weakness (5 patients), febrile sensation (4 patients) and pleuritic chest pain (2 patients). Underlying conditions were chemoport infection (4 patients), dental abscess (1 patients), and cellulitis of hip (1 patient). Chest computed tomography revealed bilateral multiple nodular opacities in most patients, and cavitation, central necrosis, feeding vessels were identified. All patients received parenteral antimicrobial therapy with or without central catheter removal, drainage of the extrapulmonary infection. Causative organisms were Pseudomonas aeruginosa (2 patients), Candida albicans (1 patient), Bacillus species (1 patient), and Klebsiella pneumonia (1 patient). CONCLUSIONS: Clinical and radiologic features of septic pulmonary embolism were various and nonspecific. The diagnosis was usually suggested by the presence of a predisposing factor of septic pulmonary embolism and CT findings of bilateral multiple nodular opacities in patients with infectious signs and symptoms. Most important underlying condition was intravascular device infection.
Abscess ; Bacillus ; Candida albicans ; Catheters ; Cellulitis ; Chest Pain ; Drainage ; Female ; Hip ; Humans ; Klebsiella ; Male ; Necrosis ; Pneumonia ; Pseudomonas aeruginosa ; Pulmonary Embolism ; Retrospective Studies ; Sensation ; Sepsis ; Tertiary Healthcare ; Thorax

BACKGROUND/AIMS: The relationships between the hepatic venous pressure gradient (HVPG) and the status of cirrhosis, complications of portal hypertension and the severity of cirrhosis are not clear. The aim of this study was to determine the relationships between HVPG and the complications or status of cirrhosis. METHODS: The HVPG, gastroesophageal varices, Child-Pugh score, Model for End-Stage Liver Disease (MELD) score, presence of ascites, recent bleeding history and the status of cirrhosis were assessed in a cohort of 172 patients (156 males, 16 females) with liver cirrhosis. RESULTS: The HVPG was 15.6+/-5.1 (mean+/-SD) mmHg (4-33 mmHg) and was significantly higher in patients in the decompensated stage than in those in the compensated stage (16.6+/-4.3 vs. 10.8+/-6.1 mmHg, respectively; P<0.01). HVPG was higher in bleeders than in nonbleeders (16.9+/-4.5 vs. 12.8+/-5.3 mmHg, respectively; P<0.01), and in patients with ascites than in those without ascites (16.4+/-4.1 vs. 14.5+/-6.2 mmHg, respectively; P<0.05). HVPG was significantly lower in the presence of gastric varices than in their absence (14.0+/-3.4 vs. 16.0+/-5.3 mmHg, respectively; P<0.05); however, no significant correlation was detected between HVPG and the grade of esophageal varices (P>0.05). HVPG was significantly higher in Child's B cirrhosis (n=87, 15.6+/-4.7 mmHg) and Child's C cirrhosis (n=36, 18.4+/-4.7 mmHg) than in Child's A cirrhosis (n=49, 13.7+/-5.1 mmHg; P<0.01). HVPG also was strongly correlated with the MELD score (P<0.01). The time required to measure the HVPG was 11.2+/-6.4 min, and only three cases of minor complication occurred during the procedure. CONCLUSIONS: HVPG was correlated with the severity of liver cirrhosis, presence of ascites, and risk of variceal bleeding in patients with liver cirrhosis.
Adult ; Ascites/*complications ; Cohort Studies ; Data Interpretation, Statistical ; Esophageal and Gastric Varices/*complications/diagnosis ; Female ; Hepatic Veins/*physiopathology ; Humans ; Hypertension, Portal/complications/*physiopathology ; Korea ; Liver Cirrhosis/complications/*diagnosis/physiopathology ; Male ; Middle Aged ; Predictive Value of Tests ; ROC Curve ; Severity of Illness Index ; Venous Pressure

Sinus of Valsalva aneurysms are rare cardiac anomalies. They can be congenital or acquired, and mainly involve the right or non-coronary sinuses. Unruptured aneurysms are usually asymptomatic unless they compress other structures or produce thrombi. A sinus of Valsalva aneurysm can also produce myocardial infarction through thrombus formation secondary to the turbulent flow in the Valsalva aneurysm. We report a case of a huge sinus of Valsalva aneurysm involving the noncoronary sinus, which was diagnosed as the presumed source of acute myocardial infarction.
Aneurysm ; Heart Atria ; Myocardial Infarction ; Sinus of Valsalva ; Thrombosis

BACKGROUND: Although the prevalence of pulmonary tuberculosis has progressively decreased all over the world, drug-resistant tuberculosis is major obstacle in treating tuberculosis. This study was performed to examine the current prevalence and risk factors of drug resistant tuberculosis in a single tertiary hospital in Busan, Korea. METHODS: We enrolled 367 patients with active pulmonary tuberculosis on a retrospective basis who had undergone mycobacterium culture and drug sensitivity tests between January 2005 and December 2009. We analyzed all clinical and radiographic parameters to find predictors related to drug resistant tuberculosis. RESULTS: At least one incident of drug resistance was found in 75 (20.4%) patients. Isoniazid (18.8%) was the most frequent resistant drug, followed by rifampin (10.9%), ethambutol (7.1%), streptomycin (4.9%), and fluoroquinolone (2.7%). Resistance to second-line drugs was found in 37 (10.1%) patients. Multidrug resistance and extensively drug resistance was evident in 39 (10.6%) and 4 (1.1%) patients, respectively. Using multiple logistic regression analysis, history of previous treatment including relapse (odd ratio [OR], 11.3; 95% confidence interval [CI], 4.92~26.08; p<0.01), treatment failure (OR, 24.1; 95% CI, 5.65~102.79; p<0.01) and an age of below 46 years-old (OR, 3.8; 95% CI, 1.62~8.65; p<0.01) were found to be independent predictors of multidrug resistant tuberculosis. CONCLUSION: We found that the prevalence of drug resistant tuberculosis was considerably high. A careful consideration for possible drug resistant tuberculosis is warranted in patients with a history of previous treatment or for younger patients.
Drug Resistance ; Drug Resistance, Multiple ; Ethambutol ; Humans ; Isoniazid ; Logistic Models ; Mycobacterium ; Prevalence ; Recurrence ; Retrospective Studies ; Rifampin ; Risk Factors ; Streptomycin ; Tertiary Care Centers ; Treatment Failure ; Tuberculosis ; Tuberculosis, Multidrug-Resistant ; Tuberculosis, Pulmonary

BACKGROUND: The purpose of this study was to assess the effect of our new video-assisted asthma education program on patients' knowledge regarding asthma and asthma control. METHODS: Adult asthmatics who were diagnosed by primary care physicians and followed for at least 1 year were educated via smart devices and pamphlets. The education sessions were carried out three times at 2-week intervals. Each education period lasted at most 5 minutes. The effectiveness was then evaluated using questionnaires and an asthma control test (ACT). RESULTS: The study enrolled 144 patients (mean age, 56.7±16.7 years). Half of the patients had not been taught how to use their inhalers. After participating in the education program, the participants' understanding of asthma improved significantly across all six items of a questionnaire assessing their general knowledge of asthma. The proportion of patients who made errors while manipulating their inhalers was reduced to less than 10%. The ACT score increased from 16.6±4.6 to 20.0±3.9 (p<0.001). The number of asthmatics whose ACT score was at least 20 increased from 45 (33.3%) to 93 (65.3%) (p<0.001). The magnitude of improvement in the ACT score did not differ between patients who received an education session at least three times within 1 year and those who had not. The majority of patients agreed to the need for an education program (95.8%) and showed a willingness to pay an additional cost for the education (81.9%). CONCLUSION: This study indicated that our newly developed education program would become an effective component of asthma management in primary care clinics.
Adult ; Asthma* ; Education* ; Humans ; Nebulizers and Vaporizers ; Pamphlets ; Physicians, Primary Care ; Primary Health Care*