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*

No abstract available.
Humans* ; Incidence* ; Papilloma*

No abstract available.
Female ; Gonadotropin-Releasing Hormone* ; Humans ; Leiomyoma* ; Single Person*

No abstract available.
Vagina*

OBJECTIVES: Fatigue is a primary human factor for decreased job performance in the workplace. It is well documented that drowsiness is a typical symptom of fatigue and is closely associated with commercial drivers'safety and well-being. However, few studies have been conducted to develop or validate fatigue symptom instruments for a working population. The main purpose of this study was to develop a general fatigue checklist and a driving fatigue checklist for Korean commercial drivers. METHODS: A total of 287 bus drivers in a commercial transportation company participated in a self-administered survey that was designated Study 1. Based on the statistical results of Study 1, a focus meeting with 16 professional consultants was conducted to revise the fatigue symptom instrument for Study 2. In Study 2, 288 commercial drivers (156 bus drivers and 132 truck drivers) participated in the revised questionnaire survey. All collected responses were entered into a SPSS worksheet and the data analysis was conducted using SPSS software 11.1. The exploratory factor analysis used in this study followed the principle component factoring rule and the varimax rotation method for factor extraction. The criteria for item selection were an Eigen value of 1.0 or greater, a communality score of .50 or greater, and no 'fence rider'property over the extracted factors. RESULTS: Through Study 1, the consultant meeting, and Study 2, a general fatigue checklist was developed with a total of 3 factors and 11 items, and a driving fatigue checklist was developed with 2 factors and 10 items. The 3 factors of the general fatigue checklist were physical fatigue, psychological fatigue, and chronic tiredness. The two factors of the driving fatigue checklist were physical fatigue and perceptive and functional fatigue. CONCLUSIONS: The primary contents of general fatigue were different from those of driving fatigue according to the two fatigue instrument factors developed in this study. The primary fatigue symptoms of the commercial driving population were identified as physical fatigue and perceptive and functional fatigue.
Checklist* ; Consultants ; Fatigue* ; Humans ; Motor Vehicles ; Questionnaires ; Sleep Stages ; Statistics as Topic ; Transportation

BACKGROUND: Although concerns exist as to the safety of placing central venous catheters via the internal jugular or subclavian veins, central venous catheterization is often performed in pediatric patients undergoing cardiac surgery and cardiopulmonary bypass. We hypothesized that central venous pressures (CVP) measured in the inferior vena cava by the femoral venous approach accurately reflect those in the superior vena cava. METHODS: We simultaneously measured CVP at the superior vena cava and at the abdominal vena cava or common iliac vein in 56 children scheduled for cardiac surgery. A total of 133 data pairs were collected. A single lumen, femoral catheter and an intrathoracic catheter, according to patient weight were placed intraoperatively in all patients. RESULTS: The ages of the patients ranged from 5 days to 84 months (mean 13.1 months), and heights from 44 to 111 cm (mean 71.8 cm). Measurements of the central venous pressure in the inferior vena cava and in the superior vena cava correlated well (r = 0.93 for spontaneous ventilation, r = 0.85 for mechanical ventilation with a closed sternum, r = 0.69 for mechanical ventilation with an open sternum). CONCLUSIONS: We conclude that while central venous pressures measured in the inferior and superior vena cava are not statistically identical, that differences between the two are well within clinically acceptable limits.
Cardiopulmonary Bypass ; Catheterization, Central Venous ; Catheters ; Central Venous Catheters ; Central Venous Pressure ; Child ; Humans ; Iliac Vein ; Respiration, Artificial ; Sternum ; Subclavian Vein ; Thoracic Surgery ; Vena Cava, Inferior ; Vena Cava, Superior ; Ventilation

OBJECTIVE: The aim of this study was to analyze a relation between the recurrence of cervical intraepithelial neoplasia (CIN) and the detection of high-risk human papillomavirus (HPV) DNA after loop electrosurgical excision procedure (LEEP), and to evaluate the clinical efficacy of HPV DNA test by Hybrid Capture Assay as a predictor of the recurrence of CIN after LEEP. METHODS: From January 2000 through March 2003, the charts of 238 women diagnosed as CIN and treated with LEEP were reviewed retrospectively. HPV DNA test (Hybrid Capture System I) for high-risk HPV was performed in all patients before LEEP. They were followed up with Papanicolaou smears and HPV DNA tests at the interval of 3 months during the first 6 months and then at the interval of 6 months. The Chi-square test was used for the statistical analysis. RESULTS: The rate of detection of high-risk HPV declined chronologically after LEEP. A higher recurrence rate was noted in the HPV DNA positive group after LEEP, comparing with the negative group, at 3 months (54.5% in positive vs. 6.5% in negative; p<0.05), at 6 months (61.1% in positive vs. 5.4% in negative; p<0.05), at 12 months (50.0% in positive vs. 14.0% in negative; p<0.05), and at 18 months (50.0% in positive vs. 15.2% in negative; p<0.05). The negative predictive value was high at 3 months (93.5%), at 6 months (94.6%), at 12 months (86.0%), and at 18 months (84.6%). There were significant associations between the recurrence of CIN and positive resection margin except for glandular involvements. CONCLUSION: The detection of high-risk HPV is a risk factor for the presence of CIN after LEEP. HPV DNA test by Hybrid Capture Assay after LEEP may be useful marker for the negative prediction of recurrence of CIN after LEEP.
Cervical Intraepithelial Neoplasia* ; DNA* ; Female ; Human Papillomavirus DNA Tests ; Humans* ; Papanicolaou Test ; Recurrence ; Retrospective Studies ; Risk Factors

Much attention has been paid to the insertion of central venous catheter(CVC) but their removal is a subject discussed rarely. After removal of a central venous catheter, rare but potentially life-threatening, transient cardiopulmonary collapse or neurological dysfunction had developed. The failure to appreciate these complications may be a significant factor in their high mortality. Early recognition and treatment may be made possible by a high index of suspicion. In this report, the clinical courses of two patients with central venous catheter removal distress syndrome are reviewed. Also guidelines for safe removal of CVC are formulated. An awareness of potential CVC removal complications is most important for their prevention and timely treatment. CVCs should be removed with the same degree of meticulous attention to detail that accompanies their insertion. Medical personnel should be reminded that removal of the catheter is an integral component of CVC management.
Catheters ; Central Venous Catheters* ; Humans ; Mortality

Vagally mediated atrioventricular (AV) block is a condition which a paroxysmal AV block occurs with the slowing of the sinus rate. Owing to its unpredictability and benign nature, it often goes unrecognized in clinical practice. We present the case of a 49-year-old man who suddenly lost consciousness when he assumed a prone position for hemorrohoidectomy under spinal anesthesia; continuous electrocardiographic recording revealed AV block with ventricular asystole. He was completely recovered after returning to a supine position. This case calls our attention to fatal manifestation of vagally mediated AV block leading to syncope.
Anesthesia, Spinal ; Atrioventricular Block* ; Consciousness ; Electrocardiography ; Heart Arrest* ; Humans ; Middle Aged ; Prone Position* ; Supine Position ; Syncope ; Syncope, Vasovagal

PURPOSE: Tuberculosis of the thyroid gland is very rare and some cases were reported in Korea since 1968. We experienced a case of tuberculous thyroiditis and found a old case in our medical center. This report is about the two case and the review of all cases reported about tuberculosis of the thyroid gland in Korea. METHODS: We present the case of a 55-year-old woman with thyroid tuberculosis who has been treated with antituberculous medication because of tuberculous meningitis during 6 months. We performed thyroid isthmectomy and she is now taking the antituberculous drugs. We found a case of 40- year-old woman who underwent extended thyroid lobectomy, Lt. in 1985 at our medical center. We reviewed the 18 literatures with 29 cases of tuberculosis of the thyroid gland reported in Korea and analyzed total 31 cases (reported 29 cases and our 2 cases). RESULTS: 28 patients were women and only 2 patients were over 60 years old. 26 patients had complained the neck mass. Duration of symptoms were below 6 months in 18 cases. There were associated symptoms like as weight loss, easy fatigue or generalized weakness, dysphagia, palpitation, fever, chills and/or anorexia. Only 9 patients had underlying tuberculosis - 2 meningitis, 2 pneumonia, 3 lymphadenopathy and 2 pneumonia combined with meningitis. But 3 patients were newly diagnosed as old or active pulmonary tuberculosis at the time of diagnosis of thyroid tuberculosis. Thyroid function was normal in 9 cases and abnormal in 5 cases. 3 cases were diagnosed nonoperatively and 15 patients of surgically treated 28 cases were underwent lobectomy. AFB stain was positive in only 13 cases and 2 cases were positive of culture with negative AFB stain. All of cases were diagnosed by pathology as granulomatous tuberculosis with caseous necrosis. CONCLUSION: Either surgical resection plus antituberculous medications or only medications are effective and recurrences were not reported after any initial treatments. So preoperative evaluation is very important and will guide the patient and the surgeon to the most effective management.
Anorexia ; Chills ; Deglutition Disorders ; Diagnosis ; Fatigue ; Female ; Fever ; Humans ; Korea ; Lymphatic Diseases ; Meningitis ; Middle Aged ; Neck ; Necrosis ; Pathology ; Pneumonia ; Recurrence ; Thyroid Gland* ; Thyroiditis ; Tuberculosis* ; Tuberculosis, Meningeal ; Tuberculosis, Pulmonary ; Weight Loss