BACKGROUND: Urography(IVU) is considered the best first investigation in patient with suspected urinary calculi, but recently ultrasonography(USG), combined with a plain film of the abdomen, has been suggested as an alternative. METHODS: We undertaken study to see if this approch can be used in emergency patients and outpatients by radiologists with different amounts of ultrasound experence. Some 192 patients with suspected urinary colic presenting to Koo Hospital Emergency Department and Youngnam Universith Hospital outward Department(IM, URO, FM) over 12-month period were studied. They had a plain abdominal film(KUB) and USG examination of the kidney, ureter, bladder following hydration and subsequently underwent IVU. Of these, 22 patients passed a stone before their IVU. The data analysis was performed on the remaining 170 patients. Urography was used as the gold standard. RESULTS: Some 170 patients subsequently underwent IVU at a mean interval of 1.8 days after the ultrasound examination. In 91 of 170 patients the IVU was positive. In 97 of 170 patients the combination of JUB plus USG was positive, leaving three false negative KUB plus USG. Thus the sensitivity of KUB plus USG was 97%, specificity was 89%, positive predictive value was 91%, and negative predictive value was 96%. CONCLUSIONS: Our findings in this study suggest that in the hydrated patient the combination of KUB plus US is a very sensitive and relative specific screening test. Because of the high negative predictive value of KUB plus US, urography is not likely to be helpful when KUB plus US are negative. Urography is indicated only if KUB plus US findings are equivocal or if intervention is necessa.ry.
Abdomen ; Colic ; Emergencies ; Emergency Service, Hospital ; Humans ; Kidney ; Mass Screening ; Outpatients ; Sensitivity and Specificity ; Statistics as Topic ; Ultrasonography* ; Ureter ; Urinary Bladder ; Urinary Calculi* ; Urography*

Ethical problems in an emergency department (ED) are much more common than is usually recognized. But these difficult ethical dilemmas have not been dealt with by general medical ethicists. Most medical ethics guidelines tend to concentrate on chronic or at least relatively stable situations rather than on the acute, episodic cases that are typical in the ED. most ethical problems such as abortion, euthanasia, and professionalism can be solved after reflection and deliberation, and after a process of communication that reveals the values and interests of the patient or the patient's family. In contrast, when health care professionals in the ED recognize ethical problems, they often don't have enough time for an ethical consultation such as a Hospital Ethics Committee. Ethical principles such as autonomy, beneficence, nonmaleficence, and justice need to be applied to the unique setting of emergency medicine. Hence, it is necessary to develop ethics guidelines in emergency medicine and ethics education for health care professionals in emergency departments. At first, we collected cases involving ethical problems and reviewed the ethical and legal aspects of those cases. In this article, we summarize the ethical issues in emergency medicine, deal with actions in emergency medical services, and also consider the relationships between ethical issues and act on emergency medical services. We want to present the important factors that should be considered in ethical decision making within an emergency medicine department including patient decision making capacity, legal custody, and ethical principles.
Beneficence ; Decision Making ; Delivery of Health Care ; Emergencies ; Emergency Medical Services ; Emergency Medicine ; Ethicists ; Ethics Committees, Clinical ; Ethics, Medical ; Euthanasia ; Humans ; Jurisprudence ; Social Justice

Leiomyoma and adenomyosis of the uterus are the most common gynecologic disorders in an enlarged uterus. The characteristic US and MR findings in differentiation between both lesions were prospectively evaluated in 30 patients. Of 30 patients, 15 were leiomyomas, 6 were adenomyosises, 8 were leiomyomas and adenomyosises, and 1 was a normal pregnancy, histologically. The total number of leiomyom nodules were 49 while adenomyosises were 14 (9 diffuse and 5 focal). Among 49 myomas nodules, 36 were correctly diagnosed by sonography. The characteristic US findings of uterine leiomyoma were well defined nodules (36), hypoechoic peripheral rim (16), and whorl-like internal echoes (13). Forty four of the 49 myoma nodules were correctly diagnosed by MRI. The characteristic MR findings of myoma were well defined nodules (43), peripheral low signal intensity rim on T1WI (13) and T2WI (9), and peripheral high signal intensity rim on T2WI (5). Among 14 adenomyosises, 9 were correctly diagnosed by sonography. The characteristic US findings of adenomyosis were diffuse uterine hypertrophy more than 5.5cm in AP diameter with endometrial displacement and no significant echo change in myometrium All 14 adenomyosis as were correctly diagnosed from MRI. On T2WI, adenomyosis appeared as ill defined localized or diffuse thickening of the junctional zone more than 1cm in thickness. It was our conclusion that to differentiate between leiomyoma and adenomyosis focused on should be the detection of existence of nodule in leiomyoma, the primary sign, not on the secondary indirect sign.
Adenomyosis* ; Animals ; Female ; Humans ; Hypertrophy ; Leiomyoma* ; Magnetic Resonance Imaging ; Mice ; Myoma ; Myometrium ; Pregnancy ; Prospective Studies ; Uterus

BACKGROUND: Pericardiocentesis is not routinely recommended in most patients with pericardial effusion (PE), except for patients with cardiac tamponade. However, the long-term follow-up results in patients with clinically not significant PE are few. METHODS: Sixty-five consecutive patients (mean age:57 yrs, 26 males) out of 87 patients with PE, who were clinically not serious, were studied prospectively once in every two month for mean 6 months (2-12 months) without any specific treatment. The amount of PE was measured at the enddiastole period of parasternal long axis view and apical four chamber view. RESULTS: The incidence of insignificant PE in our echocardiographic laboratory is 3.4% (n=87 from 2461). The maximal accumulation site of PE was posterior (n=51, 79%). The next is anterior (n=11, 17%) and right ventricular side (3, 5%). The amount of PE is less (0.37+/-0.17cm vs 0.64+/-0.54cm, p=0.018) in localized PE (n=24, 37%) than that of diffuse form (n=41, 63%), which spreads to more than 2 chambers. The presumptive etiologies of PE were unknown (n=41), heart failure (n=5), myocardial infarction (n=6), viral (n=3), and others (n=10). The amount of PE was decreased from 0.54+/-0.46 cm to 0.30+/-0.26 cm, 0.23+/-0.24 cm, and 0.21+/-0.23 cm 2, 4, and 6 months after intial evaluation, respectively, without any complication. CONCLUSION: The patients with PE, not combining >KERN= Axis, Cervical Vertebra ; Cardiac Tamponade ; Echocardiography ; Follow-Up Studies* ; Heart Failure ; Humans ; Incidence ; Myocardial Infarction ; Pericardial Effusion* ; Pericardiocentesis ; Prospective Studies

PURPOSE: To investigate the clinical characteristics and treatment methods for pediatric thyroid-associated orbitopathy in pediatric patients with thyroid disorders. METHODS: To determine the prevalence and clinical characteristics of pediatric thyroid-associated orbitopathy, we retrospectively analyzed the medical records of 34 patients admitted to the Pediatrics Department of our institution between September 2010 and September 2012. The patients had been diagnosed with autoimmune thyroid disorder and were admitted for treatment of thyroid-associated orbitopathy. RESULTS: In the 24.1 months of follow-up observation, 14 patients were diagnosed with Graves' disease (41.2%) and 20 patients with Hashimoto's thyroiditis (58.8%). Of the 34 patients, 15 (44.1%) developed eye symptoms. Among the eye symptoms, lid swelling was the most prevalent in 41.2% of patients, followed by eyelid retraction in 23.5%, lid lag in 17.6%, conjunctival injection in 14.7%, proptosis in 8.8%, and extraocular muscle hypertrophy in 17.6%. Severe impairment of visual acuity, visual field, and ocular motility were not observed in our study. Although eyelid surgery was performed in 3 cases, most patients were treated conservatively. CONCLUSIONS: Pediatric thyroid-associated orbitopathy was frequently observed in patients with Graves' disease and Hashimoto's thyroiditis. Compared to adults, children showed milder disease manifestation and progression, and the disease could be managed with conservative treatment.
Adult ; Child ; Exophthalmos ; Eye ; Eyelids ; Follow-Up Studies ; Graves Disease ; Humans ; Hypertrophy ; Medical Records ; Muscles ; Pediatrics ; Prevalence ; Retrospective Studies ; Thyroid Gland ; Thyroiditis ; Visual Acuity ; Visual Fields

PURPOSE: The purpose of this study was to identify changes of symptom distress and quality of life (QOL) in breast cancer patients receiving adjuvant therapy. METHODS: 113 patients with breast cancer were administered the Memorial Symptom Assessment Scale-Short Form and the Functional Assessment of Cancer Therapy-Breast before adjuvant therapy, both a week and 6 months after completing adjuvant therapy. 71 patients (CTx group) were treated with adjuvant chemotherapy and radiotherapy. 42 patients (RTx group) received only adjuvant radiotherapy. Data were analysed using the SPSS/Win 21.0 program. RESULTS: Compared with the RTx group, patients in the CTx group reported higher overall symptom distress and physical symptom distress. The CTx group reported lower scores in overall QOL, physical well-being and the breast cancer specific domain than the RTx group. CONCLUSION: Findings from this study support that chemotherapy results in higher risk for more severe symptoms and leads to impaired QOL for breast cancer patients. Comprehensive symptom management should be implemented for breast cancer patients receiving chemotherapy.
Breast Neoplasms* ; Chemotherapy, Adjuvant ; Drug Therapy ; Humans ; Quality of Life* ; Radiotherapy ; Radiotherapy, Adjuvant ; Symptom Assessment ; Surveys and Questionnaires

PURPOSE: Evidence suggests that some patients with breast cancer experience cognitive difficulties following chemotherapy. This longitudinal study was done to examine the prevalence of cognitive impairment and trajectory of cognitive function over time in women with breast cancer, who received adjuvant chemotherapy. METHODS: Participants were 137 patients with breast cancer. They completed neuropsychological tests and the Functional Assessment of Cancer Therapy-Cognitive Function before adjuvant therapy (pretest), toward the end of adjuvant therapy (posttest), and 6 months after the completion of adjuvant therapy (follow-up test). Of the patients, 91 were treated with adjuvant chemotherapy and 46 patients who did not receive chemotherapy made up the comparison group. A reliable-change index and repeated-measure ANOVA were used for statistical analyses. RESULTS: At the posttest point, over 30% of patients showed complex cognitive impairment and reported greater difficulty in subjective cognitive function. At the follow-up test point, 22.0% of patients exhibited complex cognitive impairment and 30.8% of patients complained of subjective cognitive impairment. Repeated-measure ANOVA showed significant decreases after receiving chemotherapy followed by small improvements 6 months after the completion of chemotherapy in cognitive domains of change for attention and concentration, memory, executive function, and subjective cognitive function. CONCLUSION: These results suggest that chemotherapy in patients with breast cancer may be associated with objective and subjective cognitive impairments. Further studies are needed to explore the potential risk factors and predictor of chemotherapy-related cognitive changes. Also nursing interventions for prevention and intervention of cognitive impairments should be developed and tested.
Adult ; Analysis of Variance ; Antineoplastic Combined Chemotherapy Protocols/adverse effects/*therapeutic use ; Attention/drug effects ; Breast Neoplasms/*drug therapy ; Chemotherapy, Adjuvant ; Cognitive Dysfunction/epidemiology/*etiology ; Female ; Humans ; Longitudinal Studies ; Memory/drug effects ; Middle Aged

No abstract available.
Chronic Disease* ; Risk Factors*

PURPOSE: To perform and compare differential diagnosis of patients with thyroid-associated myopathy, idiopathic orbital myositis and normal controls based on orbital computed tomography. Orbital fat and extraocular muscle densities were quantified using Hounsfield Unit (HU) and their characteristics were compared and analyzed. METHODS: From February 2005 to January 2013, orbital computed tomography was performed on 90 eyes of 47 thyroid-associated myopathy patients, 18 eyes of 14 idiopathic orbital myositis patients and 280 eyes of 140 normal subjects. The average values of orbital fat and extraocular muscle densities were measured and compared using HU. The density differences between the patients with thyroid-associated myopathy and the normal group were analyzed by age, clinical activity score, ocular protrusion and disease duration. RESULTS: In the thyroid-associated myopathy group, orbital fat and extraocular muscle densities were -87.8 +/- 12.5 HU and 48.7 +/- 7.1 HU, respectively. In the idiopathic orbital myositis group, the orbital fat and extraocular muscle densities were 79.9 +/- 9.9 HU and 49.2 +/- 9.1 HU, respectively. There was a statistically significant lower result of orbital fat in the thyroid-associated myopathy group (p = 0.002), however, the extraocular muscle density did not show a statistically significant difference (p = 0.775). The orbital fat and extraocular muscle densities of the normal group were -79.0 +/- 11.2 HU and 54.3 +/- 6.3 HU, respectively. There were significantly lower results in both orbital fat and extraocular muscle densities in the thyroid-associated myopathy group than normal group (p = 0.000). In active cases and those accompanied by ocular protrusion, there was no significant difference in orbital fat density (p = 0.345 and p = 0.952, respectively), while extraocular muscle density significantly decreased (p = 0.007 and p = 0.003, respectively). CONCLUSIONS: A difference between the orbital fat and extraocular muscle densities in thyroid-associated myopathy and idiopathic orbital myositis could be quantitatively found using HU and orbital computed tomography.
Diagnosis, Differential ; Humans ; Muscles* ; Muscular Diseases* ; Orbit* ; Orbital Myositis*

A 4year old female admitted for the management of degloving injury of popliteal area. The patient was injuried by traffic accident, and underwent emergency sugery for irrigation and debriment of wound area under halothane anesthesia. She has the 2nd administration of halothane in a period of 18days Two days after the 2nd anesthesia, the patient began to suffer from acute hepatitis with increasing SGOT/SGPT. The patient was cared for at the department of pediatrics and had 3rd operation after 38days and was discharged after 71 days hospitalization.
Accidents, Traffic ; Anesthesia ; Anesthesia, General* ; Child* ; Emergencies ; Female ; Halothane ; Hepatitis* ; Hospitalization ; Humans ; Pediatrics ; Wounds and Injuries