BACKGROUND: In 1996, our emergency department(ED) had 148.4 patients per day and an average time for managing simple and uncomplicated patients was 248 minutes. To relieve congestion, delay and conflict in ED, we have developed Fast Track to treat patients with minor illness rapidly and effectively. The Fast Track area is located in a separate area in front to the main department. The efficiency and effectiveness of new system and patients satisfaction were investigated. METHODS: All ambulatory patients(> 15 years of age) were triaged and treated at Fast Track by emergency physicians. Patients, triaged as severe illness, were moved directly to main ED and the other patients with minor illness were managed in Fast Track. We analysed the patients who were managed at Fast Track from Jan. 1st 1997 through Nov. 30th 1997. The total time staying in Fast Track from beginning of trige to final decision such as discharge or admission was recorded retrospectively. A questionnaire was obtained from random patients in the same period to evaluate the patient's satisfaction. RESULTS: The number of patients who were managed in Fast Track was 13,378, and it was 55.8% of all adult patients who visited ED during the period. The average staying time was decreased significantly with time, (140.9+/-2.9 minutes in June, 125.4+/-2.8 minutes in July, and 97.7+/-1.0 minutes after July). The 75 percentile weighted average time was also decreased significantly; 196 minutes in June, 107 minutes in July, 135 minutes from August to November(p<0.01). The questionnaire were obtained from 107 patients. The results were revealed that 90 of 107 patients(84.1%) were satisfied with emergency care at Fast Track, and the remaining patients expressed unsatisfied comments such as long waiting time(4.7%), overcrowding(1.9%), unsatisfactory care(1.9%). CONCLUSION: The Fast Track system could decrease patient's staying time and improve patient's satisfaction. In addition, the efficiency and effectiveness of the acute care in ED would be enhanced by managing minor illness in Fast Track rapidly and effectively.
Adult ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital* ; Estrogens, Conjugated (USP) ; Humans ; Surveys and Questionnaires ; Retrospective Studies ; Tertiary Care Centers*

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*

BACKGROUND : The proportion and absolute number of older patients admitted through the emergency department (ED) are increasing yearly. As people getting older, they are more likely to suffer from emergency situation of disease, disability, and trauma. Combining with the decrease in physiologic reserve, these added burdens make the elderly more vulnerable to any of the additional situations. Understanding the implications of these facts is crucial to one who is providing optimal triage and emergency care to elderly (aged 65 years or older) and adults (between 15year of age and 64 years of age). METHODS : We conducted an observational survey of emergency patients age 15 or older who admitted to emergency department of Asan Medical Center. A convenience sample of 3,481 were divided into 2 groups by 65 years of age, and final results (admission vs. discharge) after emergency care was compared. The admission rate according to between two groups. We calculated odds ratios of important outcomes by pooling data from individual trials using logistic regression analysis. RESULTS : Admission rate of elderly was higher than adults as 59.2% versus 36.4% (odds ratio=2.32) 95% CI=1.21~3.24). Although vital signs were within normal ranges, admission rate of elderly was significantly higher than adults as follows; normal range of systolic blood pressure (56.0% vs. 35.5%), normal range of respiration rate per minute (55.4% vs. 36.4%), alert status of mentality (34.2% vs. 54.7%). CONCLUSION : We could not define the severity of emergency patients only by using vital signs and/or clinical symptoms, especially to the elderly patients. Even though the vital signs of elderly patients. emergency physician should manage them carefully because of the high severity of clinical condition in elderly then we expected. Emergency Geriatric Assessment tools must be developed differently from general triage tools.
Adult ; Aged* ; Blood Pressure ; Chungcheongnam-do ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital* ; Geriatric Assessment ; Humans ; Logistic Models ; Odds Ratio ; Reference Values ; Respiratory Rate ; Triage ; Vital Signs

BACKGROUNDS: Headache is one of the common symptoms complained by patients at the emergency department. Postural headache is the characteristic symptom that is aggravated at upright position and relieved at recumbent position. This postural headache is associated with low cerebrospinal fluid (CSF) pressure. Spontaneous intracranial hypotension(SIH) is an unusual syndrome of postural headache and low CSF pressure without a precipitating event. The diagnosis of SIH is confirmed by 60mmH2O or less CSF opening pressure on lumbar puncture. However, the cases of SIH with normal CSF opening pressure have been reported. so it is needed to complement the diagnostic criteria of SIH. METHODS: A retrospective descriptive study with reviewing medical records of 10 patients who had been admitted at Asan Medical Center from Apr. 1995 to Jul. 1999 was done. Analyses were done on 22 variables of age, sex, clinical symptoms, spinal analysis findings, radiologic findings and therapeutic modality. Fisher's exact test and Mann-Whitney test were applied for statistical analysis (p-value < 0.05). RESULTS: 1. The male to female ratio was 3 : 7, and the mean age was 37.30+/-5.96 years. 2. Postural headache was characteristic symptom & complained by all patients. 3. The mean CSF pressure was 22.8+/-30.8 mmH2O. 4. Brain MRI demonstrated the pachymeningeal enhancement in all patients. 5. Radioisotope cisternography demonstrated slow ascent of tracer to the cerebral convexity in 88.9% patients, early soft tissue uptake suggestive of CSF leakage & rapid urinary accumulation of tracer in 66.7% patients, respectively. 6. 90.0% of all patients were recovered with autologous epidural blood patches, and 10.0% were recovered with conservative management. CONCLUSION: The SIH is an unusual syndrome. but we can diagnose the SIH in the patient, complains of a postural headache, if any following two or more criteria are present. 1. 60mmH2O or less CSF opening pressure on lumbar puncture. 2. Brain MRI finding : the pachymeningeal enhancement. 3. Cisternography findings : slow ascent of tracer to the cerebral convexity, early soft tissue uptake suggestive of CSF leakage & rapid urinary accumulation of tracer.
Blood Patch, Epidural ; Brain ; Cerebrospinal Fluid ; Chungcheongnam-do ; Complement System Proteins ; Diagnosis ; Emergency Service, Hospital ; Female ; Headache ; Humans ; Intracranial Hypotension* ; Magnetic Resonance Imaging ; Male ; Medical Records ; Retrospective Studies ; Spinal Puncture

BACKGROUND: Because systolic and diastolic dysfunction frequently coexist in acute myocardial infarction(AMI), we hypothesize that a combined measure of ventricular performance using Doppler echocardiography may be more sensitive and time-saving diagnostic tool for the evaluation of patients presenting with cardiogenic chest pain. METHOD AND RESULTS: Seventy-one patients with AMI (47 male, 59+/-11 years) and 45 patients with normal coronary artery (29 male, 52+/-11 years) were included in the study for measurement of cardiac performance index and established parameters of ventricular function using conventional echo-Doppler methods. a new derived index of cardiac performance: (ICT+IRT)/ET, was obtained by subtracting ejection time(ET) from the interval between cessation and onset of the mitral inflow velocity to give the sum of isovolumic contraction time(ICT) and isovolumic relaxation time(IRT). The mean value of the index was significantly different between normal and AMI(p<0.01). The degree of inter-group overlap was smaller for the index compared to other parameters. within functional groups, the value of the index did not appear to be related to heart rate, mean arterial pressure and the degree of mitral regurgitation. CONCLUSION: cardiac performance index is a conceptually new, simple and reproducible Doppler index of combined systolic and diastolic myocardial performance, and it is useful as screening test for patients with cardiac dysfunction due to AMI.
Arterial Pressure ; Chest Pain ; Coronary Vessels ; Echocardiography, Doppler ; Heart Rate ; Humans ; Male ; Mass Screening* ; Mitral Valve Insufficiency ; Myocardial Infarction* ; Relaxation ; Ventricular Function

Succinylcholine is a depolarizing neuromuscular blocking agent(NMB) and is used in induction of anesthesia. Succinylcholine-assisted endotracheal intubation has been routinely used in the operating room and rapid sequence incubation with NMB agent has been the method for airway management in emergency department(ED). Adverse effects of succinylcholine are hyperkalemia, malignant hyperthermia, transient hypotension, arrhythmia, and increased intracranial, intraocular and gastric pressure, etc. This study carried out the change of serum potassium as an adverse effects of succinylcholine during endotracheal intubation in ED. A prospective, noncontrolled design was used to study serial serum potassium levels in pre- and postendotracheal intubation(5min) from February 1996 to August 1996. Succinycholine was selectively used in patient with a problem of difficult endotracheal intubation (alert to drowsy mental status with intact gag reflex). The dose of succinylcholine was 1.5 mg/kg and injected into intravenous line during preoxygenation with bag-valve-mask device. Student's two-tailed t-test was used and p-value was < 0.05. Among the total of 48 patients(male 27, female 21), the postintubation level of the serum potassium of 25 patients were increased and those of 21 persons were decreased compared with preintubation level. Two patients showed no change in amount. The average serum potassium indicated 3.7+/-.8 mEq/L before the injection of the succinylcholine and 3.8+/-.9 mEq/L 5 minutes after its injection. P-value showed more than 0.05 and as the result statistically there was no noteworthy difference. All patients were intubated within 30 sec and no patients were failed. We concluded that succinylcholine-assisted endotracheal incubation is a rapid and safe method as an endotracheal incubation practiced in ED and succinylcholin-induced hyperkalemia is minimal and no adverse effect.
Airway Management ; Anesthesia ; Arrhythmias, Cardiac ; Emergencies* ; Emergency Service, Hospital* ; Female ; Humans ; Hyperkalemia ; Hypotension ; Intubation, Intratracheal* ; Malignant Hyperthermia ; Neuromuscular Blockade ; Operating Rooms ; Potassium* ; Prospective Studies ; Succinylcholine*

The writers have conducted the investigation to assess the nutritional status of young rural Korean children aged form 0 to 4 years old in August 1971. The survey areas were Kaejong-myon, Daeya-myon, Okku-gun, Jeonra-bukdo, Korea. These survey areas were typical agriculture plain areas. The total numbers of children examined were 2,706 comprising 1,394 male and 1,312 female. the weight, height, and chest circumference of children were measured and means and standard deviations were calculated for each measurement. In addition, the nutritional status of each child was classified by the four levels of malnutrition and the Gomez classification. The examination of red blood cell count, haematocrit value, and intestinal parasite infection were carried out at the same time. In general, recent work tend to suggest that environment influences, especially nutrition, are of great importance than genetic background or other biological factors for physical growth and development. Certainly the physical dimensions of the body are much influenced by nutrition, particularly in the rapidly growing period of early childhood. Selected body measurements can therefore give valuable information concerning protein-calory malnutrition. Growth can also be affected by bacterial, viral, and parasite infection. For the field workers in a developing country, therefore, nutritional anthropometry appears to be of greatest value in the assessment of growth failure and undernutrition, principally from lack of protein and calories. In order to compare and evaluate the data obtained, the optimal data of growth from the offspring of the true well-fed, medically and socially protected are needed, So-called "Standards" that have been compiled for preschool children in Korea, However, are based on measurement of children from middle or lower socio-economic groups, sho are in fact, usually undernourished from six months of age onwards and continuously exposed to a succession of infective and parasitic diseases. So that, the Harvard Standards which os one of the international reference standards was used as the reference standards in this study. Findings of the survey were as follows: A. Anthropometric data: 1) Comparing the mean values for body weight obtained with the Korean standard weight of the same age, the rural Korean children were slightly haevier than the Korean standard values in both sexes. Comparing with the Japanese children values, the rural Koran children were slightly haevier in male and in the infant period of female but lighter in female of the period of 1 to 4 years old than Japanese children. 2) Comparing the mean values for height obtained with the Korean standard height of the same age, the rural Korean children were taller than the Korean standard values except the second half of infant period in both sexes. Comparing with the Japanese children, the rural Korean children were slightly smaller than Japanese children except the first half of infant period in both sexes. 3)Mean values of chest circumference of rural Korean children obtained were less than the Korean standard values of the same ages in birth sexes. B. Prevalence of Protein-Calory Malnutrition: Children examined were divided into two groups, i. e. , infant (up to the first birthday) and toddler (1 to $ years old). 1) Percentage of four levels of malnutrition: a) when the nutritional status of each child was classified (1) by body weight value, the percentages for male and female of children attained standard value, the percentages for male and female of children attained standard growth were 52.8%(infant 83.3%, toddler 44.4%) and 39.7%(infant 74.5%, toddler 30.5%), the first level of malnutrition were 31.9% (infant 13.7%,toddler 36.9%) and 31.7%(infant 15.3%, toddler 36.0%), the second level of malnutrition were 12.3%(infant 1.7%, toddler 15.3%) and 23.3% (infant 7.7%, toddler 27.5%), the third level of malnutrition were 2.7%(infant 0.7%, toddler 3.2%) and 4.6%(infant 1.8%, toddler 5.3%) the fourth level of malnutrition were 0.3% (infant 0.7%, toddler 0.2%) and 0.7%(0.7% for infant and toddler) respectively. (2)by height value, the percentages for male and female of children attained standard growth were 80.3%(infant 97.3%, toddler 75.6%) and 75.1%(infant 96.4%, toddler 69.5%), the first levels of malnutrition were 17.9%(infant 2.0%, toddler 22.3%) and 23.6%(infant 3.6%, toddler 28.8%), the second level of malnutrition were 1.2%(infant 0.3%, toddler 1.5%) and 1.1%(infant 0%, toddler 1.4%), the third level of malnutrition were 0.4%(infant 0.3%, toddler 0.5%) and 0.2%(infant 0%, toddler 0.3%), the fourth level of malnutrition were 0.1%(infant 0%, toddler 0.1%) and 0% respectively. (3) By body weight in relation to height, the percentages for male and female of children attained standard growth were 87.9%(infant 77.6%, toddler 87.9%) and 78.2%(infant 77.4%, toddler 78.2%), the first level if malnutrition were 12.2%(infant 18.4%, toddler 10.6%) and 18.2%(infant 17.9%, toddler 18.3%), the second level of malnutrition were 1.9%(infant 3.3%, toddler 1.5%) and 3.0%(infant 3.3%, toddler 2.9%), the third level of malnutrition of malnutrition were 0.1%(infant 0.7%, toddler 0%)and 0.3%(infant 1.5%, toddler 0%) respectively. b) When the nutritional status of each child according to the mother's aged mother (31 to 40 years old) and old aged mother (41 years of above) was classified. (1) By body weight, among infants and toddlers, at each year of age, with increasing the mother's age, there was an increase in percentage of subjects underweight. This tendency of increasing percentage f underweight was more significant in the infant period than the toddler period. (2) By height value, no significant differences between each mother's age group were found. c) When the nutritional status of each child according to the birth rank, i. e. , lower birth rank(first to third) an higher birth rank(fourth of above) was classified. (1) By weight value, children of higher birth rank were slightly more often underweight than those of lower birth rank, but not significant. (2) By height value, no differences were found between children of lower and higher birth rank. 2) Gomez Classification: When the nutritional status of each child was classified a) By body weight value, the percentages for male and female of children, attained standard growth were 53.1%(infant 82.6%, toddler 44.9%) and 39.2%(infant 73.4%, toddler 30.1%), the first degree of malnutrition were 39.4%(infant 14.7%, toddler 46.2%) and 47.1%(infant 21.9%, toddler 53.8%), the second degree of malnutrition were 7.3%(infant 2.3%, toddler 8.6%) and 12.9%(infant 4.0%, toddler 15.2%), and the third degree of malnutrition were 0.2%(infant 0.3%, toddler 0.2%) and 0.8%(infant 0.7%, toddler 0.9%) respectively. b)By body weight value, the percentages for male and female of children, attained standard growth were 80.8%(infant 97.0%, toddler 76.3%) and 73.8%(infant 95.6%, toddler 68.0%), the first degree of malnutrition were 18.5%(infant 2.7%, toddler 22.9%) and 24.6%(infant 4.4%, toddler 30.0%), the second degree of malnutrition were 0.6%(infant 0.3%, toddler 0.7%) and 0.5%(infant 0.1%, toddler 0.7%), and the third degree of malnutrition were 0.1%(infant 0%, toddler 0.1%) and 1.1%(infant 0%, toddler 1.3%) respectively. C. Results of clinical laboratory examination: 1) Red blood cells: The range of mean red blood counts for male and female were 3,538,000/m3 to 4,483,000/m3 respectively. The lowest red cell counts were seen at the age of 0-3 months for male and 1-2 months for female. 2) Haematocrit value: The ranges of haematocrit value of male and female were 35.1% to 38.8% and 34.7% to 38.8% respectively. The lowest haematocrit values were seen at the age of 2-3 months for male and 1-2months for female. 3)The prevalence rates of intestinal parasites for male and female children with Ascaris lumbricoides were 34.1%(infant 18.8%, toddler 38.1%) and 36.0%(infant 18.4%, toddler 40.7%), with Trichocephalus trichiuris were 6.8%(infant 2.9%, toddler 7.9%) and 9.0%(infant 3.0%, toddler 10.6%), with Hookworm were 0.3%(infant 0.5%, toddler 0.2%)and 0.3%(infant 0.5%, toddler 0.3%), with Clonorchis sinensis were 0.4%(infant 0%, toddler 0.5%) and 0.1%(infant 0%, toddler 0.1%)respectively.
Agriculture ; Ancylostomatoidea ; Anthropometry ; Ascaris lumbricoides ; Asian Continental Ancestry Group ; Biological Factors ; Body Weight ; Cell Count ; Child* ; Child, Preschool ; Classification ; Clonorchis sinensis ; Developing Countries ; Erythrocyte Count ; Erythrocytes ; Female ; Growth and Development ; Health Personnel ; Humans ; Infant ; Korea* ; Male ; Malnutrition ; Mothers ; Nutritional Status* ; Parasites ; Parasitic Diseases ; Parturition ; Prevalence ; Thinness ; Thorax ; Trichuris

No abstract available.
Dwarfism*

Curcumin, a natural compound extracted from rhizomes of Curcuma longa, has been shown to possess potent antiinflammatory and anti-tumor activity. The mechanism by which curcumin initiates apoptosis remains poorly understood. In this study, we investigated the effects of curcumin on caspase-3 activity and protein expression of procaspase-3, Bcl-2, Bax, total Akt and phosphorylated Akt in SW480 human colon cancer cell. We cultured SW480 cells in the presence of various concentrations(0, 10, 20 or 30 uM) of curcumin. Curcumin inhibited colon cancer cell growth in a dosedependent manner (p < 0.05). Caspase-3 activity was significantly increased dose-dependently in cells treated with curcumin (p < 0.05), concisely procaspase-3 expression was significantly decreased. Bcl-2 levels were decreased dosedependently in cells treated with curcumin (p < 0.05), but Bax remained unchanged. In addition, phosphorylated Akt levels and total Akt levels were markedly lower in cells treated with 20 uM of curcumin treatment (p < 0.05). In conclusion, we have shown that curcumin inhibits cell growth and induces apoptosis in SW480 human colon cancer cell lines via Akt signal pathway.
Apoptosis* ; Caspase 3 ; Cell Line* ; Colon* ; Colonic Neoplasms* ; Curcuma ; Curcumin* ; Humans* ; Rhizome ; Signal Transduction

BACKGROUND: Previous studies have indicated adenosine triphosphate (ATP) is as potent coronary vasodillator as adenosine (A). We designed this study to compare the vasomotion of coronary artery (CA) between the infusion of ATP and that of A (1). METHOD AND RESULTS: Ten patients with normal CA (6 male and 4 female) age ranging from 41 to 74 years (57+/-11) were studied at LAD and RCA for measurement of coronary flow reserve (CFR), time to maximum effect (Tmax), time to baseline (TBL) in CA during ATP and A infusion. Tmax was achieved earlier with ATP than A, and these results suggest that maximum vasodilation occurs faster with ATP. Side effect profile was similar in 2 patients with mild chest pain with ATP and A. CONCLUSION: Since it has appeared that vasodilatory effect of ATP was comparable to A which has been used in pharmacological stress test in many diagnostic modalities, ATP can be used safely in many clinical setting where A has been used.
Adenosine Triphosphate* ; Adenosine* ; Chest Pain ; Coronary Vessels ; Exercise Test ; Humans ; Male ; Vasodilation