Recently, it becomes conspicuous that the network should have enough communication bandwidth and be organized with steadiness to operate and support hospital information system successfully. Seoul National University Hospital completed to reconstruct legacy network which had been used since 1995. We had a consultation to diagnose the current problems and reconstructed the network according to the consultation. The design of network architecture was mainly focused on the circuit route in case of error condition and the suitable bandwidth for the easy communication. We also regulated the use of unsuitable protocols which might broadcast inappropriate data packets over the whole network. After 6 months of operation we evaluated the performance of newly constructed network. The average traffic rate from the input port of main servers was 0.5% and that from the output port was 6% separately. The average traffic rate on the overall ATM backbone showed around 1 %.From the result, we concluded that the newly constructed network had such an enough capability supporting hospital information system without any interruption. Furthermore, we expect that it will be sufficient to support the additional traffic increment by PACS and group ware applications.
Hospital Information Systems ; Hospitals, General* ; Information Services* ; Information Systems* ; Seoul*

In cleft palate surgery, the environment is especially critical when suturing. Encum-bered, obstructive space in the environment can hinder a suture while using the Dingman mouth gag. We introduced a novel but simple draping technique. A simple hand towel is placed over the gag. A hole is cut out in the middle according to each patient's mouth. After making the hole, the hand towel is soaked in water and gently squeezed. Then the towel is properly placed over the Dingman mouth gag. Dripping water on the hand towel during the suture helps keep it in place. Using this draping technique, we cut 14 minutes of operation time compared to the average operation time of the past 2 years. There were several disadvantages in previous draping method. First, long suture material may easily get caught. Second, the operation field can easily be contaminated. Third, focusing on the operation becomes difficult due to the obstruction. This draping technique can compensate for the disadvantages of the previous Dingman mouth gag.
Cleft Palate ; Hand* ; Mouth* ; Oral Surgical Procedures ; Surgical Drapes ; Sutures ; Water

Background: Chronic glucocorticoid exposure is associated with resistance to nondepolarizing neuromuscular blocking agents. Therefore, we hypothesized that sugammadex-induced recovery would occur more rapidly in subjects exposed to chronic dexamethasone compared to those who were not exposed. This study evaluated the sugammadex-induced recovery profile after neuromuscular blockade (NMB) in rats exposed to chronic dexamethasone. Methods: Sprague–Dawley rats were allocated to three groups (dexamethasone, control, and pair-fed group) for the in vivo study. The mice received daily intraperitoneal dexamethasone injections (500 μg/kg) or 0.9% saline for 15 days. To achieve complete NMB, 3.5 mg/kg rocuronium was administered on the sixteenth day. The recovery time to a train-of-four ratio ≥ 0.9 was measured to evaluate the complete recovery following the sugammadex injection. Results: Among the groups, no significant differences were observed in the recovery time to a train-of-four ratio ≥ 0.9 following sugammadex administration (P = 0.531). The time to the second twitch of the train-of-four recovery following rocuronium administration indicated that the duration of NMB was significantly shorter in Group D than that in Groups C and P (P = 0.001). Conclusions Chronic exposure to dexamethasone did not shorten the recovery time of sugammadex-induced NMB reversal. However, the findings of this study indicated that no adjustments to sugammadex dosage or route of administration is required, even in patients undergoing long-term steroid treatment.

Electrocardiographic changes frequently occur after severe physical or emotional stress. Such changes can mimic acute ST-segment elevation myocardial infarction with elevated serum cardiac-specific markers (CK-MB, Troponin I), segmental wall motion abnormalities, and myocardial dysfunction. Several reports, however, have found that coronary angiography revealed no significant stenosis. We present a 70-yearold female with a traumatic subdural hematoma testing positive for cardiac enzymes, and ECG changes suggestive of acute ST-segment elevation myocardial infarction. Such a case, however, fits the diagnostic parameters of Tako-tsubo cardiomyopathy, or Tako-tsubo syndrome; even though its etiology, pathophysiology, diagnosis, and treatment remain uncertain. Tako-tsubo syndrome is characterized by a distinctive form of systolic dysfunction that predominantly affects the distal LV chamber, but a favorable outcome with appropriate medical therapy is expected. Because of its unusual nature and favorable prognosis, it is clear that Tako-tsubo syndrome is an important affliction that should be recognized by any emergency department.
Constriction, Pathologic ; Coronary Angiography ; Electrocardiography ; Emergencies ; Female ; Hematoma, Subdural ; Humans ; Hydrazines ; Myocardial Infarction ; Prognosis ; Stress, Psychological ; Takotsubo Cardiomyopathy ; Troponin

OBJECTIVE: To investigate the effectiveness of an upper limb rehabilitation robot therapy on hemispatial neglect in stroke patients. METHODS: Patients were randomly divided into an upper limb rehabilitation robot treatment group (robot group) and a control group. The patients in the robot group received left upper limb training using an upper limb rehabilitation robot. The patients sat on the right side of the robot, so that the monitor of the robot was located on the patients' left side. In this position, patients could focus continuously on the left side. The control group received conventional neglect treatment, such as visual scanning training and range of motion exercises, administered by occupational therapists. Both groups received their respective therapies for 30 minutes a day, 5 days a week for 3 weeks. Several tests were used to evaluate treatment effects before and after the 3-week treatment. RESULTS: In total, 38 patients (20 in the robot group and 18 in the control group) completed the study. After completion of the treatment sessions, both groups showed significant improvements in the Motor-Free Visual Perception Test 3rd edition (MVPT-3), the line bisection test, the star cancellation test, the Albert's test, the Catherine Bergego scale, the Mini-Mental State Examination and the Korean version of Modified Barthel Index. The changes in all measurements showed no significant differences between the two groups. CONCLUSION: This present study showed that the upper limb robot treatment had benefits for hemispatial neglect in stroke patients that were similar to conventional neglect treatment. The upper limb robot treatment could be a therapeutic option in the treatment of hemispatial neglect after stroke.
Exercise ; Humans ; Perceptual Disorders* ; Range of Motion, Articular ; Rehabilitation* ; Robotics ; Stroke* ; Upper Extremity* ; Visual Perception

No abstract available.
Hematoma*

Gastric carcinoid tumor is a rare neoplasm that occupies less than 1% of total gastric tumor. Especially, gastric carcinoid tumor with hemorrhage has been very rare. A sixty-three-year old male patient was admitted to the hospital because of hematemesis and melena. On the endoscopic examination, a 2 cm-long polypoid mass with central ulcer and hemorrhagic erosions was seen on the anterior wall of the mid-body without active bleeding. Endoscopic ultrasonography revealed that the lesion was limited to submucosa without evidence of metastasis to adjacent lymph node. We experienced a case of gastric carcinoid tumor accompanied with upper gastrointestinal bleeding. The patient underwent extended wedge resection and omentectomy under the diagnosis of type 3 carcinoid tumor. This tentative diagnosis was based on clinical and pathological findings. We report a case of gastric carcinoid with bleeding that is probably type 3.
Carcinoid Tumor* ; Diagnosis ; Endosonography ; Hematemesis ; Hemorrhage* ; Humans ; Lymph Nodes ; Male ; Melena ; Neoplasm Metastasis ; Ulcer

OBJECTIVE: To determine factors associated with motor recovery of the upper extremity after repetitive transcranial magnetic stimulation (rTMS) treatment in stroke patients. METHODS: Twenty-nine patients with subacute stroke participated in this study. rTMS was applied to the hand motor cortex for 10 minutes at a 110% resting motor threshold and 10 Hz frequency for two weeks. We evaluated the biographical, neurological, clinical, and functional variables, in addition to the motor-evoked potential (MEP) response. The Manual Function Test (MFT) was performed before, immediately after, and two weeks after, the treatment. Patients were divided into a responder and non-responder group according to their respective improvements on the MFT. Data were compared between the two groups. RESULTS: Patients with exclusively subcortical stroke, absence of aphasia, the presence of a MEP response, high scores on the Mini-Mental Status Examination, Motricity Index arm score, Functional Independence Measure, and Functional Ambulatory Classification; and a shorter period from stroke onset to rTMS were found to be significantly associated with a response to rTMS. CONCLUSION: The results of this study suggest that rTMS may have a greater effect on upper extremity motor recovery in stroke patients who have a MEP response, suffer an exclusively subcortical stroke, mild paresis, and have good functional status. Applying rTMS early would have additional positive effects in the patients with the identified characteristics.
Aphasia ; Arm ; Classification ; Hand ; Humans ; Motor Cortex ; Paresis ; Stroke* ; Transcranial Magnetic Stimulation* ; Upper Extremity*

OBJECTIVE: To investigate how much formal caregivers know about caring for stroke patients, and whether they adequately provide it. METHODS: Formal caregivers, who worked for stroke patients at 8 hospitals (including 4 university hospitals, 2 rehabilitation hospitals, and 2 convalescent hospitals) participated in this study. The survey was based on a self-report questionnaire, with 6 categories containing a total of 48 questions about the specific care of stroke patients: the demographic characteristics of the caregivers, bed positioning, the provision of meals, position changes and transfers, the range of motion exercises, and caregiver training. RESULTS: A total of 217 caregivers were surveyed, and they were distributed as follows: 41% came from the university hospitals, 35% came from the rehabilitation hospitals, and 24% came from the convalescent hospitals. The percentages of correct answers were distributed as follows: 64.3% for bed positioning, 74.3% for providing meals, and 62.4% for position change and transfer. The total and subscale scores of the caregivers working at convalescent hospitals were significantly lower than those of the caregivers working at the other types of hospitals (p<0.05). Only 7.8% of the total participants received training on a regular basis. The caregivers obtained most of the information from caregiver associations (58.1%), and the majority of the caregivers (65.4%) were willing to receive training. CONCLUSION: About one third (33.8%) of caregivers did not have adequate knowledge of how to properly care for stroke patients; in fact, a significant number of caregivers demonstrated inappropriate and insufficient knowledge in several areas. It is assumed that the provision of regular training, by rehabilitation experts, will improve the professionalism and knowledge of the caregivers, and positively affect patient outcomes.
Caregivers ; Education ; Exercise ; Hospitals, Convalescent ; Hospitals, University ; Humans ; Meals ; Nursing Care ; Range of Motion, Articular ; Rehabilitation ; Stroke*

The goal of periodontal treatment is predictable periodontal regeneration. But until now, many products including GTR materials and growth factors are beyond of complete regeneration. BMP can induce ectopic bone formation when implanted into sites such as rat muscle and can greatly enhance healing of bony defects when applied exogenously. BMP can promote periodontal regeneration by their ability to stimulate new bone and new cementum formation. But little is known about optimal conditions required for the application. Root conditioning is used for bioactive root change so altered root surface provides a substrate that promotes chemotaxis, migration and attachment of peridontal cells encouraging connective attachment to the denuded root surface. The aim of this study is to investigate whether the acid conditioning change effect of rhBMP-2 on human periodontal ligament cell and osteoblast cell line. 288 periodontally involved root dentin slices are divided into 6 groups, each 48, 1)control, 2)treated with BMP, 3)treated with citric acid 4)treated with citric acid+BMP 5)treated with tetracycline 6)treated with TC+BMP. Each group was devided half, so 12 root dentin slices were seeded with periodontal ligament cells and 12 were seeded with osteoblasts. At day 2 and 7, cell number, protein assay, ALP activity was measured. To investigate morphology of cultured cells, SEM was employed. Statistical analysis was performed with SPSS 8.0 either t-test or ANOVA test. The results are ; Protein assay and cell number was slightly decreased in CA+BMP group compared to CA group but it was not statistically significant and ALP activity was much more increased in CA+BMP group compared to CA group so there was no statistically significance between BMP and CA+BMP group and statistically significant compared to control group. Cell number and protein assay was slightly increased in TC group and ALP activity was much less than BMP group and CA group. Cell number and protein and ALP activity was not much increased in TC+BMP group. TC group and TC+BMP group showed cell morphology change in SEM. This results suggested that application of root surface with citric acid before BMP treatment might give better result in periodontal regeneration.
Animals ; Cell Count ; Cell Line ; Cells, Cultured ; Chemotaxis ; Citric Acid* ; Dental Cementum ; Dentin ; Fibroblasts* ; Humans* ; Intercellular Signaling Peptides and Proteins ; Osteoblasts* ; Osteogenesis ; Periodontal Ligament* ; Rats ; Regeneration ; Tetracycline*