BACKGROUND: Almost every study of rib fractures in the elderly show associated injuries resulting in admission to thoracic or cardiovascular surgery. In Korea, no studies have compared these elderly patients with younger patients. METHODS: This study is based on patients who were diagnosed as having rib fracture at the Emergency Department of the Seoul Medical Center from March 2013 to April 2011. The medical records and radiological examinations of 192 cases were reviewed. Two groups were created-older than 65 years and younger than 64 years. Comparisons were made between the two groups including place of injury, time of injury, associated injuries, and the final result in the Emergency Department. RESULTS: The final patient sample size was 192. The elderly group had 142 patients with the average age being 48.77+/-9.70 years and 75.4% males. The young group had 50 patients with the average age at 75.90+/-7.21 years and 25% males. The most common place of injury was road (p=0.007) in the young group and home (p=0.002) in the elderly group. The most common mechanisms of injury were slipping (47.4%), traffic accidents (18.2%), falling (14.1%), and assault (9.4%). Falling was more prevalent in the young group than in the elderly group (p=0.011). Rib fractures occurred at night (p<0.001), on Saturdays, on Sundays, and in the winter in the young group and in the morning(p=0.002), on Mondays, on Fridays, and in the winter in the elderly group. Associated injuries, in descending order, were chest, limb, head, and spine. CONCLUSION: This study found that several selected factors of an injury-place, mechanism, time, and associated injuries, differ by age.
Accidents, Traffic ; Aged ; Emergency Service, Hospital* ; Extremities ; Head ; Humans ; Korea ; Male ; Medical Records ; Rib Fractures* ; Sample Size ; Seoul ; Spine ; Thorax

We have experienced a rare case of progressive supranuclear palsy with hallucination and delusion. The common manifestations of progressive supranuclear palsy are gait disturbance, mental change and sign of vertical ophthamoplegia but no efficacious therapy has been known. Neuropsychiatric symptom clusters include cognitive impairment, affective and behavioral changes, sleep disturbance, and psychotic symptoms. Though schizophrenia-like psychosis has been reported but this is certainly rare. Addressing a case of progressive supranuclear palsy, in whom parkisonian symptoms appeared with concurrent psychotic symptoms, we emphasize accurate diagnosis.
Delusions ; Diagnosis ; Gait ; Hallucinations ; Psychotic Disorders ; Supranuclear Palsy, Progressive*

OBJECTIVES: The purpose of this study was to investigate the prevalence of erectile dysfunction (ED) in a rural area of Korea and to examine the relationship between the prevalence and correlates of subjects. METHOD: This study was done as a part of the chronic disease survey of rural area by the Asan Foundation. Among 30 years or older population from Jung Eup, a rural area of Korea, 711 male subjects were sampled using a cluster probability sampling method. Trained interviewers visited and interviewed subjects aged 30 years or older with a structured interview. ED was categorized as 'none', 'mild', 'moderate', or 'severe' according to the ability to 'attain and/or maintain an erection satisfactory for sexual intercourse'. Response rate was 54.3% (N=386). RESULTS: The age weighted prevalence of ED was 27.2% (minimal 14.1%, moderate 7.6%, severe 5.5%). Prevalence and severity increased with age. Liver disease and underweight were significantly (p<0.05) associated with ED. Smoking seemed to be correlated with ED, but did not reach statistically significant level. CONCLUSION: ED was highly prevalent in the rural community of Korea. Medical, sociodemographic, and lifestyle variables associated with ED may alert physicians to patients at risk for ED and offer insight to its etiology.
Chronic Disease ; Chungcheongnam-do ; Epidemiology* ; Erectile Dysfunction* ; Humans ; Korea ; Life Style ; Liver Diseases ; Male ; Prevalence ; Risk Factors ; Rural Population* ; Smoke ; Smoking ; Thinness

PURPOSE: This study was conducted in order to evaluate the effect of a newly developed explanation handout in the emergency department (ED) between patient and guardian. METHODS: From August 24, 2013 to September 24, 2013, interviews were conducted to patient accompanying guardian, discharged from Seoul Medical Center ED. Four groups were divided according to non-handout or handout in addition to patient or guardian. Each group consisted of 50 candidates and allocated according to a random table. The explanation handout could be easily applicable automatically through the Electronic Medical Record. It contains the results of laboratory tests along with cautions by diagnosis. After discharge explanation, a survey was conducted in each group using questionnaires for evaluation of the effect on medical service satisfaction. RESULTS: A total of 97 candidates(49 patients, 48 guardians) in the non-handout group, and 99 candidates(50 patients, 49 guardians) in the handout group were enrolled. No statistical difference in epidemiology, except explanation time, was observed between the two groups. The handout group showed a higher score in all factors, however, explanation by physician (p<0.001), mean 3.61(+/-0.72) to 3.87(+/-0.73), understanding of medical status (p<0.001), mean 3.51(+/-0.75) to 4.11(+/-0.71), medical evaluation and treatment (p=0.001), mean 3.59(+/-0.72) to 3.92(+/-0.75), kindness of physician (p<0.001), mean 3.74(+/-0.81) to 4.09(+/-0.67), overall satisfaction (p<0.001), mean 3.60(+/-0.75) to 3.97(+/-0.75), willingness of revisit (p=0.023), mean 3.87(+/-0.73) to 4.09(+/-0.61), and willingness of recommendation (p<0.001), mean 3.66(+/-0.82) to 4.09(+/-0.66) showed statistically meaningful results. In a sub-analysis, statistically meaningful results were reanalyzed between patient and guardian. In the non-handout group, guardian showed higher scores in mean value in all factors, however, statistically meaningful results were observed for all factors, except understanding of medical status and medical evaluation and treatment. By application of the handout, 99 patients and 97 guardians showed higher scores in mean value in all factors. Patients showed statistically meaningful results in all factors but just in understanding of medical status in guardian. CONCLUSION: Results of this study showed that the explanation handout effectively increased medical service satisfaction. The effect of the explanation handout was more prominent in patients than guardians.
Diagnosis ; Electronic Health Records ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital ; Epidemiology ; Humans ; Patient Satisfaction ; Surveys and Questionnaires ; Seoul

PURPOSE: This study was conducted in order to evaluate the effect of a newly developed explanation handout in the emergency department (ED) between patient and guardian. METHODS: From August 24, 2013 to September 24, 2013, interviews were conducted to patient accompanying guardian, discharged from Seoul Medical Center ED. Four groups were divided according to non-handout or handout in addition to patient or guardian. Each group consisted of 50 candidates and allocated according to a random table. The explanation handout could be easily applicable automatically through the Electronic Medical Record. It contains the results of laboratory tests along with cautions by diagnosis. After discharge explanation, a survey was conducted in each group using questionnaires for evaluation of the effect on medical service satisfaction. RESULTS: A total of 97 candidates(49 patients, 48 guardians) in the non-handout group, and 99 candidates(50 patients, 49 guardians) in the handout group were enrolled. No statistical difference in epidemiology, except explanation time, was observed between the two groups. The handout group showed a higher score in all factors, however, explanation by physician (p<0.001), mean 3.61(+/-0.72) to 3.87(+/-0.73), understanding of medical status (p<0.001), mean 3.51(+/-0.75) to 4.11(+/-0.71), medical evaluation and treatment (p=0.001), mean 3.59(+/-0.72) to 3.92(+/-0.75), kindness of physician (p<0.001), mean 3.74(+/-0.81) to 4.09(+/-0.67), overall satisfaction (p<0.001), mean 3.60(+/-0.75) to 3.97(+/-0.75), willingness of revisit (p=0.023), mean 3.87(+/-0.73) to 4.09(+/-0.61), and willingness of recommendation (p<0.001), mean 3.66(+/-0.82) to 4.09(+/-0.66) showed statistically meaningful results. In a sub-analysis, statistically meaningful results were reanalyzed between patient and guardian. In the non-handout group, guardian showed higher scores in mean value in all factors, however, statistically meaningful results were observed for all factors, except understanding of medical status and medical evaluation and treatment. By application of the handout, 99 patients and 97 guardians showed higher scores in mean value in all factors. Patients showed statistically meaningful results in all factors but just in understanding of medical status in guardian. CONCLUSION: Results of this study showed that the explanation handout effectively increased medical service satisfaction. The effect of the explanation handout was more prominent in patients than guardians.
Diagnosis ; Electronic Health Records ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital ; Epidemiology ; Humans ; Patient Satisfaction ; Surveys and Questionnaires ; Seoul

PURPOSE: In recent years, the number of elderly patients visiting from residential aged care facilities (RACFs) has been increasing. We analyzed a comparison of characteristics between patients who visited the ER with diseases from RACFs and those who visited from home. METHODS: A retrospective study was conducted in a public hospital between January 2013 and December 2014. The subjects included patients who visited the ED from RACFs and elderly patients who visited the ED from home. Comparisons of the following parameters were made between the two groups: gender, age, mode of insurance, mode of ED visit, mobile status, Charlson comorbidity index (CCI), chief complaint, final results in the ED, and length of stay (LOS) in the ED and hospital. RESULTS: A total of 7,603 patients were enrolled during the study period. There were 6,401 elderly patients who visited from home and 1,202 patients who visited from RACFs. Patients from RACFs were older than those from home (79.90±8.01 vs. 75.78±7.26, p<0.001). More patients from RACFs were on Medicaid (56.6% vs. 27.9%, p<0.001), took more ambulance (86.3% vs. 49.4%, p<0.001), more bedridden (68.2% vs. 6.4%, p<0.001), and higher CCI (2.38±1.99 vs. 1.45±1.84, p<0.001). Compared with patients from home, those from RACFs showed a significantly higher proportion of admission (63.2% vs. 32.9%, p<0.001), ED LOS (403.03±361.77 vs. 277.07±258.82, p<0.001), and hospital LOS (19.65±18.58 vs. 15.67±15.63, p<0.001). Patients from RACFs showed especially longer ED LOS from discharged ED than those from home (388.87±422.88 vs. 221.90±215.30, p<0.001). CONCLUSION: Compared with elderly patients from home, patients from RACFs also had higher admission rate and longer ED LOS, as well as hospital LOS. Patients from RACFs had long ED LOS. The findings in this study suggest that there could be ED overcrowding in the near future.
Aged* ; Ambulances ; Comorbidity ; Emergencies* ; Emergency Service, Hospital* ; Hospitals, Public ; Humans ; Insurance ; Length of Stay ; Medicaid ; Nursing Homes ; Residential Facilities ; Retrospective Studies

PURPOSE: This study aimed to explore the association between increased level of ambient particulate matter and emergency room visits for chronic obstructive pulmonary disease (COPD) exacerbations. METHODS: A retrospective study was conducted. We enrolled patients who lived in Seoul, Korea and were diagnosed with COPD in the emergency room between January 2012 and December 2014. Meteorological factors [daily highest temperature, lowest temperature, mean temperature, diurnal temperature, rainfall, relative humidity, amount of sunshine and particulate matter less than 10 µm (PM 10)] between December 2011 and December 2014 in Seoul were acquired from the Korea Meteorological Administration. We used a multiple Poisson regression model with daily patient's number of COPD as a response variable and meteorological factors as explanatory variable. Variable selection was done via an Elastic net. RESULTS: There was a total of 1,179 emergency visits for acute exacerbations of COPD patients. PM10 (before 4, 10, 11, 15, 16, 17, 22, 24, 27, 28 day), rainfall (before 1, 6, 8, 16, 18 day), relative humidity (before 2, 8), and daily temperature difference (5, 10, 15 day) had a relationship and a lag effect with COPD exacerbations. CONCLUSION: This study showed that an increased concentration of PM10 was associated with COPD exacerbations. A future study that reinforces the limitation of this study is necessary to get a helpful index for an adequate response of medical institution and efficient placement of medical personnel.
Emergencies* ; Emergency Service, Hospital* ; Humans ; Humidity ; Korea ; Lung Diseases ; Meteorological Concepts ; Particulate Matter* ; Pulmonary Disease, Chronic Obstructive* ; Regression Analysis ; Retrospective Studies ; Seoul ; Sunlight

PURPOSE: Radial head fractures are the most common elbow fractures in adults, and are often accompanied with elbow dislocation resulting in various complications. This study examined the outcome of surgical treatment of a radial head fracture and its prognostic factors. MATERIALS AND METHODS: From January 1997 to February 2004, a retrospective analysis was performed on 25 radial head fracture patients with an elbow dislocation, also including elbow fracture, whose follow-up data could be obtained for more than 12 months. The surgical results were evaluated according to the prognostic factors and the Mayo Elbow Performance Index, which assessed the elbow joint function and pain. RESULTS: According to the Mayo Elbow Performance Index, the results were excellent in 11 cases, good in 5 cases, fair in 5 cases, and poor in 4 cases. Cases with post-surgical elbow joint instability showed statistically meaningful poor outcomes. However, there were good in the groups without an accompanied fracture, with no open fracture, type II and III Mason classification, and fixation period 4 weeks or less. Correlation analysis revealed a younger age and shorter immobilization period to have better results, and the immobilization period showed the strongest correlations with the Mayo Elbow Performance index. CONCLUSION: In conclusion, younger age, less severe injury in the initial event and a shorter immobilization period are good prognostic factors in radial head fractures combined elbow dislocations.
Adult ; Classification ; Dislocations* ; Elbow Joint ; Elbow* ; Follow-Up Studies ; Fractures, Open ; Head* ; Humans ; Immobilization ; Retrospective Studies

GIST is a rare neoplasm, the majority of GISTs are located in the stomach and small intestine. Most GISTs are diagnosed histopathologically after resection because of submucosal location. A 37-year-old female patient presented with a 2-weeks history of generalized weakness, nausea accompanied by intermittent passage of black, tarry stools. Esophagogastroduodenoscopy and ERCP showed a large round mass measuring 5 cm in diameter in the ampulla of Vater with ulcer crack. Endoscopic multiple biopsies from the mass including ulcer base were taken. Light microscopic findings showed spindle-shaped and epitheloid tumor cells having high cellularity and frequent mitotic figures. On immunohistochemical stainings, the tumor cells were positive for CD34 and smooth muscle actin. Based on these preoperative findings, a diagnosis of malignant GIST of the ampulla of Vater was made probably. After operation, immunohistochemical studies revealed positive reaction for c-kit and vimentin, as well as focally reactive for CD34 and smooth muscle actin. We report a case of GIST in the ampulla of Vater presenting with melena that was diagnosed preoperatively and postoperatively.
Adult ; *Ampulla of Vater ; Common Bile Duct Neoplasms/*diagnosis/pathology ; Female ; Gastrointestinal Stromal Tumors/*diagnosis/pathology ; Humans

Sump syndrome is one of the late complications of a side to side choledochoduodenostomy, but it is a rare malady. The anastomosis of the bile duct and small bowel results in exclusion of the distal limb of the common bile duct from drainage of bile with the potential formation of a sump. Food material and bile sludge may accumulate in distal segment of common bile duct and so this cause recurrent bile duct stones. Bezoars frequently result from disturbed passage of the gastrointestinal tract, especially after surgery, and it may develop various symptoms by irritating or obstructing the gastrointestinal tract. The bezoar accompanied with sump syndrome after choledochoenterostomy has not yet been reported in the literature. We report here on a case of small intestinal obstruction due to bezoars accompanied with sump syndrome.
Bezoars ; Bile ; Bile Ducts ; Choledochostomy ; Common Bile Duct ; Drainage ; Extremities ; Gallstones ; Gastrointestinal Tract ; Intestinal Obstruction ; Postcholecystectomy Syndrome ; Sewage