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.
Vagina*

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

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: In the past patients who needed ventilatory care were treated in the hospital but now, thanks to advanced technology, those patients can be treated at their homes. This study was done to evaluate the clinical course of each patient and the effectiveness of home ventilatory care program. METHODS: We reviewed ten cases of ventilator - dependent children who were discharged from the pediatric intensive care unit since we started a home ventilatory care program. RESULTS: Six patients remained ventilator - dependent, three patients died and one patient cannot be reached. The clinical courses before home ventilatory care was decided were diverse. None of the patients needed hospital care related to complications of mechanical ventilatory care. CONCLUSIONS: Despite the small number of patients and the short follow up duration, we concluded that ventilator-dependent children can be successfully managed at their homes.
Child ; Follow-Up Studies ; Humans ; Intensive Care Units ; Respiration, Artificial* ; Ventilators, Mechanical

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

We report a case of pulmonary edema developed in a 33-year-old female who underwent two-stage bilateral carotid body tumor excision. About 1 month ago, she had undergone a left carotid body tumor excision. After the operation, her tongue was deviated to left side. Bilateral hypoglossal nerve injury was suspected. These injuries should be carefully monitored in patients who will undergo a similar procedure on both sides because a bilateral deficit of the hypoglossal nerve is poorly tolerated, resulting potentially serious pulmonary edema. In recovery room, she became pale and SpO2 was fall down. We reintubated her immediately and the pulmonary edema was treated using a supportive management. She was discharged without any signs of dyspnea or airway obstruction, but hypoglossal nerve injury remained. We discuss the possible etiology of the upper airway obstruction after the neck surgery and review the literatures associated with the pulmonary edema following upper airway obstruction.
Adult ; Airway Obstruction ; Carotid Body Tumor* ; Carotid Body* ; Dyspnea ; Female ; Humans ; Hypoglossal Nerve ; Hypoglossal Nerve Diseases ; Hypoglossal Nerve Injuries ; Neck ; Pulmonary Edema* ; Recovery Room ; Tongue

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

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