Sixty-three patients with permanent sigmoid colostomy were surveyed to evaluate their satisfaction and complications with the "irrigation technique" and the "atural evacuation" of the colostomy management (irrigation technique; 32 patients, natural evacuation; 31 patients). All patients had colostomy for at least 12 months without disease recurrence. Each patient was interviewed in addition to standard questionnaire. The irrigation was not associated with any major complication including colonic perforation. The irrigation was used younger age group than the natural evacuation (53+/-10 vs. 62+/-12, P=0.01). The frequency of bowel movement was lower in the irrigation than in the natural evacuation (5.1+/-2.5/wk vs. 10.8+/-9.0/wk, P=0.04). Five patients (16%) of the irrigation experienced spontaneous bowel action but only one patient suffered from it. The time spent for managing irrigation was 59+/-13 minutes. Twenty-three patients (74%) of the natural evacuation suffered from one or moreproblems such as expensive apparatus, leakage, skin irritation or odor. Sixteen patients (52%) of the natural evacuation and 2 patients (6%) of the irrigation were restricted in social activity (P=0.0001). Thirteen patients (42%) of the natural evacuation and 1 patient (3%) of the irrigation were dissatisfied with colostomy management (P=0.002). Thus, the irrigation technique seems to be more effective and satisfactory method for managing colostomy without compromising patient's social activity when it is performed in appropriately selected patients.
Colon ; Colon, Sigmoid ; Colostomy* ; Humans ; Odors ; Surveys and Questionnaires ; Rectal Neoplasms ; Recurrence ; Skin

This study was undertaken to investigate the degree of asymmetry in each part of the head in skeletal craniofacial asymmetric patients, and secondarily to determine the nature of difference existed between asymmetric patients and normal persons. The subjects consisted of 49 asymmetric adult patients and 52 normal adults, and the average ages were 21 years 5 months and 23 years 5 months, respectively. The computerized analyses of 33 linear measurements, 12 angular. measurements, and 8 surface areas from posteroanterior cephalometric radiograph were carried out. The conclusions were as follows; 1. Asymmetry was a common finding in both normal and asymmetric group. 2. When the analyses were undertaken after the head was divided into 3 parts anteroposteriorly and superoinferiorly in the asymmetric patients, there were significant asymmetries in all parts excepts in the cranial base region. 3. When the analyses were undertaken after the head was divided into respective 3 parts anteroposteriorly in the asymmetric patients, the more posterior part showed relative stability than the more anterior part. 4. When the analyses were undertaken after the head was divided into 3 parts superoinferiorly in the asymmetric patients, the more superior part showed relative stability than the more inferior part. 5. Twelve variables indicating asymmetry were selected and the highest ranked variable was Me-Mid-sagittal reference line.
Adult ; Head ; Humans ; Skull Base

No abstract available.

This study was designed to investigate force systems and tooth movements produced by retraction archwire during retraction of four maxillary incisors after the maxillary canine retraction into the maxillary first premolar extraction space using the computer-aided three-dimensional finite element method. A three-dimensional finite element model, consisting of 2248 elements and 3194 nodes, was constructed. The model consisted of maxillary teeth and surrounding periodontal membranes, .022" x .028" -slot brackets, and 5 types of retraction archwires(.019" x .025" stainless steel archwire) modeled using the beam elements. The contact between the wire and the bracket slot was modeled using the gap elements because of the non-linear elastic behaviors of the contact between them. The forces and moments, and displacements produced by retraction archwire were measured at various conditions to investigate the difference according to types of loops, magnitudes of activation force, gable angle, and anterior lingual root torque. The results were expressed quantitative and visual ways in the three-dimensional method. The following conclusions can be drawn from this study: 1. When the tear-drop loop archwire was activated, the mesio-distal and lingual translational movements of the teeth helped to close the extraction space, but unwanted movements of the teeth including intrusions and extrusions, and rotational movements in each direction occurred. 2. Activation of T-loop archwire compared with those of other types of retraction archwires produced the least translational movements of the teeth helped to space closure and also the least unwanted movements of the teeth. 3. Increasing amount of activation in the tear-drop archwire led not only to increase of translational movements of the teeth helped to space closure, but also to increase of unwanted movements of the teeth. 4. Addition of gable bend in the tear-drop archwire helped anterior teeth to translational movements in the mesio-distal direction, but increased unwanted movements of the teeth. 5. Addition of anterior lingual root torque in the tear-drop archwire helped central and lateral incisor to improve their facio-lingual inclination, but increased unwanted movements of the teeth.
Bicuspid ; Finite Element Analysis* ; Gravitation ; Incisor* ; Membranes ; Stainless Steel ; Tooth ; Tooth Movement ; Torque

PURPOSE: We have evaluated type of medical errors and severity of results in the emergency department (ED). We also analyze the contributory factors of medical errors for the patient's safety and the quality improvement. METHODS: This study the was prospectively performed from May to August 2005. Medical errors that occurred in the ED were reported anonymously by emergency physicians. The type of medical errors and contributory factors were reported. The severity levels of errors were categorized into 5 levels: level 1- life threatening consequences; level 2- potentially life or limbs threatening consequences; level 3- serious failure or delay of diagnosis or treatment; level 4- inappropriate or unnecessary delay or treatment; level 5- no harm. RESULTS: The total number of patients admitted in the ED during the study period was 16,513, and 177 errors (1.5 errors/day) reported in 160 patients (9.7/1,000 patients). The most frequently occurring medical error was order omission (18.0%), but interpretation errors (11.3%) resulted in the most serious consequences (3.6+/-1.2). More than half of medical errors were no harm (51.4%). Educational and environmental (61 errors) factors were the most frequent causes of medical errors. CONCLUSION: Medical errors frequently occur in the ED. Reducing ED errors will require the improvement of ED environments, better communication, and reinforcement of education by supervising faculty members.
Anonyms and Pseudonyms ; Diagnosis ; Education ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital* ; Extremities ; Humans ; Medical Errors* ; Prospective Studies ; Quality Improvement

Intravascular papillary endothelial hyperplasia (IPEH) is an exuberant intravascular endothelial proliferation that in many respects mimics an angiosarcoma. A 78-year-old woman complained of a several month history of left-side nasal obstruction and frequent epistaxis. Preoperative endoscopic examination demonstrated a dark red mass occupying the left nasal cavity. The nasal cavity mass was completely removed under endonasal endoscopy. During the six-month follow-up, the patient had no evidence of recurrent disease. We present here a rare case of IPEH within the nasal cavity that demonstrated the reactive nature of this affliction.
Aged ; Endoscopy ; Epistaxis ; Female ; Follow-Up Studies ; Hemangiosarcoma ; Hematoma ; Humans ; Hyperplasia ; Nasal Cavity ; Nasal Obstruction

PURPOSE: Our society is becoming more interested in domestic violence and proper care of those victims is required. This study was designed to develop a model of countermeasure against domestic violence that can be used in emergency department. METHODS: This prospective, clinical study was performed from Dec. 2000 to Aug. 2001 at the emergency department, Ewha Womans University Mokdong Hospital. Fifty-five patients of the 1665 female trauma patients were found to be victims of domestic violence during study period. We investigated the frequency of domestic violence in the patient's past, whether a weapon had been used, whether the assailant was an alcohol abuser, and whether he assaulted the victim in a drunken state or not. We analyzed correlation between these factors and severity injury of the patients. RESULTS: The average ISS of patients was 2.90+/-2.82, and 14 patients(25.8%) were admitted to hospital for treatment. Eighteen victims were reported to the police. Fourteen patients were injured with weapons, and in those cases, ISS and the hospital admission rates were marginallly higher than those not involving weapons(p=0.099). Police report rates in the weapon-using cases were 64.3%(9 people), which was considerably higher than those of nonweapons cases, 22.0%(p=0.007). No significant correlations exsisted between severity of patient's injury and frequency of domestic violence experienced in her past, assailant's alcohol history, and drunken assaulter. CONCLUSION: When weapons were involved, the police report rates were considerably higher. The medical personnel should immediately evaluate the patients's condition and provide a plan for her safety.
Domestic Violence* ; Emergencies* ; Emergency Service, Hospital* ; Female ; Humans ; Police ; Prospective Studies ; Weapons

Skin is an emerging target tissue in pharmaceutical and cosmetic science. Safety assessment for dermal toxicity is a critical step for development of topically applicable pharmaceutical agents and ingredients in cosmetics. Urgent needs exist to set up toxicity testing methods for dermal safety, and identification of novel biomarkers for pathological cutaneous alteration is highly required. Here we will discuss if vascular endothelial growth factor (VEGF) has a potential as a biomarker for dermal impairment. Experimental and clinical evidences for induction of keratinocytic VEGF under pathological conditions will be reviewed.
Biomarkers ; Skin* ; Toxicity Tests ; Vascular Endothelial Growth Factor A*

BACKGROUND: In recent years, there has been increasing interest in the use of capnometry, the noninvasive, continuous measurement of end-tidal carbon dioxide(ETCO2) in expired air during CPR. The purpose of this study is to determine the significance of ETCO2 monitoring according to immediate cause of arrest during CPR as a prognostic indicator of successful resuscitation and survival. METHODS: A prospective, clinical study was performed from May 1997 to December 2000 at the Department of Emergency Medicine, Ewha Womans University Mokdong Hospital. The study included 220 patients(231cases). All patients were immediately connected to a mainstream capnometer sensor between the tube and the bag after endotracheal intubation using an infrared capnometer. RESULTS: The 107 patients(46.3%) with return of spontaneous circulation(ROSC) had higher maximal ETCO2 during CPR than the 113 patients without ROSC(31.0+/-19.4 vs 11.7+/-9.4 mmHg, P=0.000). The ETCO2 was not significantly different in relation to age, initial rhythm, and survival time after ROSC, but there was a significant difference in the immediate cause of arrest in the ROSC group(respiratory arrest: 4 0 . 2+/-23.5 mmHg, P=0.000). In case of cardiac arrest due to trauma, maximal ETCO2 was not significant in the ROSC group compared with the non-ROSC group(18.2+/-16.6 vs 10.8+/-7.5 mmHg, P=0.208). When maximal ETCO2 was less than 10 mmHg, we observed a sensitivity of 94.4% and a specificity of 39.5% in predicting ROSC. There were 6 patients with ROSC even though the maximal ETCO2 was less than 10 mmHg. CONCLUSION: Continuous ETCO2 monitoring during CPR may be noninvasive and valuable predictor of successful resuscitation and survival from cardiac arrest. However, ETCO2 should not be used as a single indicator for either cardiac arrest due to trauma or withdrawal of CPR.
Carbon ; Cardiopulmonary Resuscitation* ; Emergency Medicine ; Female ; Heart Arrest ; Humans ; Intubation, Intratracheal ; Prospective Studies ; Resuscitation* ; Sensitivity and Specificity

PURPOSE: To assess the indication and effect of screw fixation in the transverse patellar fractures. MATERIALS AND METHODS: We analysed the results of 14 transverse patellar fractures fixed with screws from January 1991 to May 2005. Mean follow-up period was 47 months (range, 12~143 months). We analysed the radiologic union, operation time, ROM and postoperative Lysholm score. RESULTS: All fractures healed uneventfully. The mean displacement was decreased from 2.2 mm preoperatively to 0.3 mm postoperatively (p=0.001, Wilcoxon signed rank test). The mean operation time was 34 minutes (range, 20 to 60 minutes). Normal range of motion was achieved in 13 knees (92.9%). Average Lysholm score was 95.9 at final follow-up. CONCLUSION: Screw fixation seemed to be useful for treatment of transverse patellar fracture even in comminuted fractures with large fragments. The advantage of this technique was the preservation of extensor mechanism, simplicity, short operation time and good cosmesis.
Follow-Up Studies ; Fractures, Comminuted ; Knee ; Patella ; Reference Values