BACKGROUND: In the most of emergency department, the diagnosis of appendicitis has been carried by clinical history, physical examination and plain X-ray. But the diagnostic accuracy by these methods was so low that unnecessary operation was common performed, and sometimes the operation was delayed till the physicians could confirm the acute appendicitis clinically. Although many kinds of diagnostic tools such as CT scan, laparoscope, and etc, we believe that ultrasonography(US) would be a quick and sensitive diagnostic method for the evaluation of acute appendicitis in the Emergency Department. METHODS: Forty-seven patients who were clinically suspected as acute appendicitis were evaluated with the grayscaled US by emergency physician. The probe of US was placed on maximal tender point of abdomen, and the appendix image was evaluated while probe was pressed deeply and gentry. When the blind loop was fecund at maximal tender point of abdomen, we evaluated the diameter of appendix, the presence of compressibility, peri-aspen-diceal fluid collection and other mass effect. As soon as the ultrasonographic evidences of the appendicitis were noticed, the operations were done and pathologic report were reviewed later. RESULTS: Among the forty-seven patients, forty patients were diagnosed as a appendicitis by US, and most common ultrasonic findings were as follows; 1) non-compressible blind loop larger than 5 mm in diameter, 2) wall thickening more than 3 mm, 3) peri-appendiceal fluid collection, 4) periappendiceal mass. Among remaining 7 patients in whom we could not get any positive findings of appendicitis, abdominal CT scan was carried in 2 cases who had direct and rebound tenderness on right lower abdomen, and CT scan showed the evidences of the appendicitis. The other 5 cases without rebound tenderness were observed far 2 hours, and abdominal pain was disappeared lately. Finally forty-two patients were operated and confirmed as acute appendicitis by pathologic reports; 24 were reported as suppurative appendicitis, and 12 cases of gangrenous appendicitis, 3 cases of perforated appendicitis, and 3 cases were peri-appendiceal abscess. The specificity of US in the diagnosis of acute appendicitis was 71.4%, and the sensitivity was 95.2%. CONCLUSIONS : In some patients suspected appendicitis, emergency physicians could diagnosis acute appendicitis accurately and rapidly by use of ultrasonography. Although the US was an actuate imaging modality to diagnosis acute appendicitis and evaluate its complications, we recommend a laparotomy or abdominal Cf scan in the patients with negative US findings in spite of presence of peritoneal irritation signs such as rebound tenderness and/or muscle guarding on right lower abdomen.
Abdomen ; Abdominal Pain ; Abscess ; Appendicitis* ; Appendix ; Diagnosis ; Early Diagnosis* ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Laparoscopes ; Laparotomy ; Physical Examination ; Sensitivity and Specificity ; Tomography, X-Ray Computed ; Ultrasonics ; Ultrasonography*

BACKGROUND: Because systolic and diastolic dysfunction frequently coexist in acute myocardial infarction(AMI), we hypothesize that a combined measure of ventricular performance using Doppler echocardiography may be more sensitive and time-saving diagnostic tool for the evaluation of patients presenting with cardiogenic chest pain. METHOD AND RESULTS: Seventy-one patients with AMI (47 male, 59+/-11 years) and 45 patients with normal coronary artery (29 male, 52+/-11 years) were included in the study for measurement of cardiac performance index and established parameters of ventricular function using conventional echo-Doppler methods. a new derived index of cardiac performance: (ICT+IRT)/ET, was obtained by subtracting ejection time(ET) from the interval between cessation and onset of the mitral inflow velocity to give the sum of isovolumic contraction time(ICT) and isovolumic relaxation time(IRT). The mean value of the index was significantly different between normal and AMI(p<0.01). The degree of inter-group overlap was smaller for the index compared to other parameters. within functional groups, the value of the index did not appear to be related to heart rate, mean arterial pressure and the degree of mitral regurgitation. CONCLUSION: cardiac performance index is a conceptually new, simple and reproducible Doppler index of combined systolic and diastolic myocardial performance, and it is useful as screening test for patients with cardiac dysfunction due to AMI.
Arterial Pressure ; Chest Pain ; Coronary Vessels ; Echocardiography, Doppler ; Heart Rate ; Humans ; Male ; Mass Screening* ; Mitral Valve Insufficiency ; Myocardial Infarction* ; Relaxation ; Ventricular Function

No abstract available.

BACKGROUND/AIMS: In Korea, the incidence and modality of gallstones has changed, since meal have become westernized and the socioeconomic status has improved. Choledocholithiasis and intrahepatic duct stone have high incidence rate in Korea and are difficult to treat as a result of retained stones. This report deals with a clinical analysis of recent trends in gallstone disease and approachs to ideal method of treatment. METHODS: A retrospective analysis was done on 122 biliary tract stone patients who had undergone operations at the Department of Surgery, Seoul Red Cross Hospital, from July 1994 to June 2000. RESULTS: The results are as follows 1) The male to female ratio was 1:1.7, and the most common age group were 7th decade. 2) The most common location of stones were GB and CBD in 40 cases(32.8%). 3) The most common method of operation were cholecystectomy with CBD exploration in 35 cases(28.7%). 4) The incidence of retained stones was 39.3%(48 out of 122 cases). The prevalent site of retained stones was common bile duct(23.0%). Other common locations were in CBD and left hepatic duct(11.8%), Lt. intrahepatic duct(4.1%). 5) In order to remove retained stones, total 92 choledochoscopic stone removal was performed. Average number of choledochoscopic stone removal was 2.1 times per patient(range:1-5). 6) The complete removal of retained stones was possible in 35 cases out of total 44 cases showing 79.5% of sucess rate. 7) Postoperative complication was developed in 40cases(32.8%) and the most common postoperative complications was wound infection(11.5%). The postoperative mortality rate was 4.1%.
Bile ; Biliary Tract* ; Cholecystectomy ; Choledocholithiasis ; Female ; Gallstones ; Humans ; Incidence ; Korea ; Male ; Meals ; Mortality ; Postoperative Complications ; Red Cross ; Retrospective Studies ; Seoul ; Social Class ; Wounds and Injuries

Nerve conduction studies help delineate the extent and distribution of the neural lesion. The nerve conduction was studied on upper (median, ulnar and radial nerves) and lower (personal, posterior tibial and sural nerves) extremities in 83 healthy subjects 23 to 66 years of age, and normal values were established (Table 1). The mean motor terminal latency (TL): median, 3.6 (±0.6) milliseconds; ulnar, 2.9 (±0.5) milliseconds; radial nerve, 2.3 (±0.4) milliseconds. Mean motor nerve conduction velocity (MNCV) along distal and proximal segments: median, 61.2 (±9.1) (W-E) and 57.8 (±13.2) (E-Ax) meters per second; ulnar, 63.7 (±9.1) (W-E) and 50.6 (±10.0) meters per second. Mean sensory nerve conduction velocity (SNCV): median, 34.7 (±6.7) (F-W), 63.7 (±7.1) (W-E) and 62.8 (±12.3) (E-Ax) meters per second; ulnar, 38.0 (±6.7) (F-W), 63.4 (±7.5) (W-E) and 57.0 (±10.1) (E-Ax) meters per second; radial, 45.3 (±6.8) (F-W) and 64.2 (±11.0) (W-E) meters per second; sural nerve, 43.4 (±6.1) meters per second. The amplitudes of action potential and H-reflex were also standardized. Mean H latency was 28.4 (±3.2) milliseconds. And, the fundamental principles, several factors altering the rate of nerve conduction and clinical application of nerve stimulation techniques were reviewed.
Action Potentials ; Adult* ; Extremities ; H-Reflex ; Healthy Volunteers ; Humans ; Neural Conduction* ; Radial Nerve ; Reference Values ; Sural Nerve

OBJECTIVE: This study was performed to evaluate the effects of mutiple indications and age on the likelihood of finding cervical lesion in large loop excision of transformation zone(LLETZ). METHOD: We reviewed the medical records of 471 evaluable LLETZ of cervix for cervical neoplasia at the Yonsei University College of Medicine, from April 1996 to August l998. The indications for the LLETZ were grouped as being for treatment(biopsy-proven disease)(indication A), significant discrepancy among cytologic and histologic results(indication B), unsatisfactory colposcopic finding(transformation zone not fully visualized)(indication C), possible microinva- sion(indication D), and combinations of the above. RESULTS: The prevalence rates of cervical lesion in performed LLETZ for indication A alone, for indication B alone, for a combination of indication A and C, for a combination B and C, and for indication D alone were 85.7%, 56.5%, 82.3%, 42.6%, 95%, respectively. The data were then reanalyzed to determine the likelihood of finding high-grade disease on LLETZ specimen. Overall, those with preoperative high-grade cytologic or histologic characteristics were much more likely to have high grade disease(78.1%) than were those with preoperative low-grade cytologic or histologic characteristics(27.2%)(p<0.001). The influence of age on the likelihood of identifying diasease on the LLETZ is undertermined. CONCLUSION: Neither age nor the preoperative grade of disease are good discriminators of the likelihood that disease will be found on a LLETZ specimen, However, patients with preoperative high-grade disease are much more likely than those with preoperative low-grade disease to have high-grade dysplasia or invasive cancer on LLETZ.
Cervix Uteri ; Female ; Humans ; Medical Records ; Prevalence

The purpose of this study was to survey the ability of nurses to perform endotracheal suction to provide basic data on correct endotracheal suction. The participants in this study were 181 intensive care unit nurses in two university hospitals and one general hospital located in Daegu, one university hospital and two general hospitals located in Pohang, one university hospital located in Gyeongju. These data were collected from February 1, 2001 to March 10, 2001 using self reported questionnaires.The study instrument, which was developed by these investigators, included questions on general characteristics and performance of endotracheal suction. The results of this study are as follows : 1.Of the participants 71.3% recognized correct endotracheal suctioning and 23.2% did not. 2.The greatest number, 57.5%, acquired knowledge about endotracheal suctioning at conferences on practice or education for staff. 3.There were significant differences in scores on performance of endotracheal suction according to department (F=2.60, P=.05) and hospitals (F=3.24, P=.01) among the general characteristics. 4. Slightly less than half of the participants, 47.8%, averaged correct scores for endotracheal suctioning procedures. Ventilator O2 supply had the highest score (84.0%), normal saline exchange time, the lowest (14.4%). From the results, we suggest that education is needed to increase the knowledge and correct performance of endotracheal suction. Further study including direct observation of performance of endotracheal suction is also needed.
Congresses as Topic ; Daegu ; Education ; Gyeongsangbuk-do ; Hospitals, General ; Hospitals, University ; Humans ; Intensive Care Units ; Research Personnel ; Self Report ; Suction* ; Ventilators, Mechanical

Hydroxyapatite is generally used as an orbital implant which is biocompatible. It is considered esthetically and functionally better than traditional measure. We performed hydroxyapatite implantation using autogenous temporalis muscle fascia for 4 eyes of 4 phthisis patients by truma. Hydroxyapatite implants wrapped with autogenous temporalis muscle fascia were inserted into all eyes after enucleation. Follow-up for 12-15 months [mean:13.4 months] showed less inflammatory reaction. There were has no wound dehiscence, implant protrusion and migration. MRI showed a goodfibrovascular proliferation at 4-5 months postoperatively, so we performed drilling. Temporalis muscle fascia is easily obtained and there is no esthetic problem because scar at scalp is covered by hair.
Cicatrix ; Durapatite* ; Fascia* ; Follow-Up Studies ; Hair ; Humans ; Magnetic Resonance Imaging ; Orbital Implants ; Scalp ; Wounds and Injuries

We did clinical analysis on the macular circulatory state in 34 patients(34 eyes)who were diagnosed to have branch retinal vein occlusion and followed for over 6 months. After dividing them into two groups according to their occlusion sites, we evaluated the differences of foveal capillary ring state and size of macular ischemic area between the ones who had vein occlusion in their first retinal branches and the others in their second and the rest retinal branches. We were unable to find any differences between them. However, we could find statistical correlation between their visual acuities in acute stage of the disease and macular circulatory states even though we could not find any differences between their final visual acuities or degree of their visual improvement and circulatory states during follow up period.
Capillaries ; Follow-Up Studies ; Retinal Vein Occlusion ; Retinaldehyde ; Veins ; Visual Acuity

Anthors have evaluated postoperative visual outcome and complications on 60 high myopic patients who had underwent extracapsular cataract extraction (ECCE) with or without posterior chamber intraocular lens (PC IOL) implantation, retrospectively. The average axial length of eyeballs of patients underwent only ECCE and ECCE with PC IOL were 30.7 mm and 27.04 mm, respectively. Corrected visual acuity was improved in 56 eyes (91.5%) after cataract sugery. 19 eyes (63.6%) out of 30 aphakia and 11 eyes(36.2%) out of 30 pseudophakia showed better than 20/40 and this difference was statistically significant (p< 0.05). Posterior capsular opacity and cystoid macular edema (CME) were founf in 7 eyes (23.3%) and in 2 eyes (6.6%) of 30 aphakia, while those were in 2 eyes (6.6%) and 1 eye (3.3.%) of 30 pseudophakia, respectively. However, these complications did not decrease a visual acuity and there was no retinal detachment in both aphakia and pseudophakia, with these resuls, it was founf that the clinical results of ECCE with PC IOL was more effective in visual improvement and prevention of posterior capsular opacity than only ECCE for high myopic patients.
Aphakia* ; Cataract Extraction ; Cataract* ; Humans ; Lenses, Intraocular ; Macular Edema ; Myopia* ; Pseudophakia* ; Retinal Detachment ; Retrospective Studies ; Visual Acuity