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: Cosmetics are one of the common causes of contact dermatitis and many new cosmetic products are being introduced rapidly into our market. OBJECTIVE: Our purpose was to investigate the as is patch test result by several factors including age, cosmetic product and atopic diseases, and to compare as is patch result with those of standard and cosmetic patch tests. METHODS: The records of 240 patients were reviewed who had been patch tested with their own cosmetics and toiletries with a clinical impression of cosmetic contact dermatitis at the patch clinic of Kangnam St. Mary's Hospital in the period of 1991-1995. RESULTS: Of the 95 patients who were tested with European standard series 54 (56.8%) showed a positive reaction and nickel sulfate was the most common allergen. Eighteen (38.3%) of the 47 patients tested with a cosmetic series revealed a positive reaction and imidazolidinyl urea and dodecyl gallate were the most common allergens. In as is patch test, 99 (41.3%) of the 240 patients showed a positive reaction to 248 (7.3%) of the 3403 cosmetics. Common cosmetic products showing positive reactions were skin care products (26.2%), face make-ups (19.8%), and hair preparations (16.9%). There was no statistically significant difference in the positive reaction rate between atopy and non-atopy patients. The positive correlation rate of as is test with standard and cosmetic series was relatively low. CONCLUSION: Commercial standard patch test series including cosmetic series are not enough to detect causative allergen in cosmetic contact dermatitis. As is patch test should be encouraged to detect new allergens, because many cosmetic ingredients are developed and introduced in market.
Allergens ; Dermatitis, Contact* ; Hair Preparations ; Humans ; Nickel ; Patch Tests* ; Skin Care ; Urea

No abstract available.
Blood Transfusion* ; Female ; Humans

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

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

Benign hemangioma of the mediastinum is rare. This slowly growing tumor is described as well circumscribed, cystic, hemorrhagic tumor. Histologically it can be differentiated into capillary or cavernous form. We present a case of mediastinal hemangioma. A 20-year-old-man was presented with a slowly growing posterior mediastinal mass of 6 years duration, 8x6 cm in size. The mass was relatively well defined but focally invasive. Microscopically, it was differentiated into vessels of capillary, cavernous, and venous patterns. A solid cellular proliferation with inconspicuous capillary lumens was focally seen. The stroma between variable-sized vessels showed marked myxoid change associated with some smooth muscle bundles and adipose tissue. Ultrastructurally, areas of solid cellular proliferation showed formation of lumens. These lumens were lined by active endothelial cells showing plasmalemmal vesicles and Weibel-Palade bodies on the abluminal surface.
Adipose Tissue ; Capillaries ; Cell Proliferation ; Endothelial Cells ; Hemangioma* ; Mediastinum ; Muscle, Smooth ; Weibel-Palade Bodies

No abstract available.
Humans ; Infant, Newborn* ; Membranes* ; Rupture*

No abstract available.
Choriocarcinoma* ; Female ; Pregnancy ; Pregnancy*