Five hundred and thirty five cases of patients who were transferred to the Department of Emergency Medicine in Pusan University Hospital from Aug 1, 1997 to Aug 31, 1997 and from Oct 1, 1997 to Oct 31, 1997 were studied prospectively. The results were as follows: 1. Total 535 patients were transferred to the emergency department of PNUH(Pusan National University Hospital) for 2 months(average 8.2 a day). Male to female ratio was 1.58:1 and peak age group was 6th decade(17.0% of total). 2. In distribution about arrival time of transferred patients, 40.7% was from 08:00 to 16:00, 39.3% was from 16:00 to 24:00 and 20.0% was from 0:00 to 8:00. 3. Cases that were communicated with the emergency department of PNUH were 7.7%, cases that were communicated with other departments of PNUH were 10.1%, and 82.2% of total cases were transferred without any communication. 4. A 40.7% of patients was transferred by a hospital ambulance, 33.1% of patients used non-emergency vehicles such as taxis or buses, 25.3% of patients was transferred by an 119 or 129 rescue ambulance, and 0.9% was transferred by on foot or others. 5. Transferring hospital was divided into 3 groups: primary hospital, secondary hospital, and university hospital. The majority was secondary hospital(83.6%). 6. The cases that patients wanted to be treated in PNUH were the greatest in number as 55.5%, the cases transferred due to emergency surgery were 9.3%, the cases transferred without specialized department concerned were 28.6%, the cases transferred because of bed deficit were 1.7% and the cases transferred due to other cause were 4.9%. 7. Traumatic patients were 32.5%, and among them 9.9% was due to motor vehicle accident, among these 78.5% was mild patients. Non-traumatic patients were 67.5% and among them 74.2% was mild patients. 8. Among all transferred patients, 75.7% was admitted for general care, emergency operation, and ICU care. The percentage of discharge was 19.1%, the percentage of death was 2.4%, and the percentage of transfer to other hospital was 2.8%. Generally, because of bed deficit and of availability of operation room, patients were transferred to other hospital. 9. Among specialized departments, the proportion of the department of internal medicine, neurosurgery and pediatrics was 29.3%, 17.2% and 11.4% respectively. In conclusion, it is considered that proper patient transfer and effective medical service can be achieved through the well-organized EMSS, and cooperative interhospital communication.
Ambulances ; Busan* ; Emergencies* ; Emergency Medicine ; Emergency Service, Hospital ; Female ; Foot ; Humans ; Internal Medicine ; Male ; Motor Vehicles ; Neurosurgery ; Patient Transfer ; Pediatrics ; Prospective Studies

BACKGROUND: The prehospital care system in the Pusan area is primitive in organization, and the emergency medical system of every hospital needs to be developed. A analysis of patients who were treated in emergency rooms and who died is necessary in order to establish an emergency medical service system which is appropriate for the community. METHOD: The authors reviewed the records of 117 patients who died in the emergency room of Pusan National University Hospital from January 1998 to December 1998. RESULTS: 1) Among the 117 patients, 68 patients were male (58.1%) and 49 patients were female (41.9%). The incidence of patients over the age of 70 was very high (33 cases, 28.2%). 2) Among the 117 patients, 99 patients died due to disease (84.6%), 16 due to trauma, and 2 due to intoxication. The most prevalent disease was cardiovascular disease. 3) Among the 117 patients, 63 patients arrived voluntarily (53.8%); the remainder were transferred from other hospitals. Forty-eight patients were transported by 119 ambulance (41.0%), and 41 patients were transported by hospital ambulance. 4) As for consciousness level, 52 patients (44.4%) were alert upon arrival at the emergency room, but 42 patients (35.9%) were unresponsive. 5) In 53 patients, the intervals between arrival at the emergency room and the onset of cardiac arrest were from 2 to 24 hours (45.3%). 6) Cardiac arrest was most frequent between 10:00 pm and 8:00 am. 7) Cardiopulmonary resuscitation was done in 74 patients (63.2%), and the mean duration was from 30 minutes to 1 hour. 8) Sixty-six patients were patients of internal medicine, and their mean stay time was 17 hours 27 minutes. CONCLUSION: These results suggest that systematic education in advanced cardiopulmonary resuscitation, expansion of emergency physicians, an increase in the number of intensive care units are required.
Ambulances ; Busan ; Cardiopulmonary Resuscitation ; Cardiovascular Diseases ; Consciousness ; Education ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital* ; Female ; Heart Arrest ; Humans ; Incidence ; Intensive Care Units ; Internal Medicine ; Male

OBJECTIVE: This study was undertaken to compare the diagnostic performances of magnetic resonance imaging (MRI), MR myelography (MRM) and myelography in young soldiers with a herniated lumbar disc (HLD). METHODS: Sixty-five male soldiers with HLD comprised the study cohort. A visual analogue scale for low back pain (VAS-LBP), VAS for leg radiating pain (VAS-LP), and Oswestry disability index (ODI) were applied. Lumbar MR, MRM, and myelographic findings were checked and evaluated by four independent radiologists, respectively. Each radiologist was asked to score (1 to 5) the degree of disc protrusion and nerve root compression using modified grading systems devised by the North American Spine Society and Pfirrmann and the physical examination rules for conscription in the Republic of Korea. Correlated coefficients between clinical and radiological factors were calculated. Interpretational reproducibility between MRI and myelography by four bases were calculated and compared. RESULTS: Mean patient age was 20.5 +/- 1.1. Mean VAS-LBP and VAS-LP were 6.7 +/- 1.6 and 7.4 +/- 1.7, respectively. Mean ODI was 48.0 +/- 16.2%. Mean MRI, MRM, and myelography scores were 3.3 +/- 0.9, 3.5 +/- 1.0, and 3.9 +/- 1.1, respectively. All scores of diagnostic performances were significantly correlated (p < 0.05). However, none of these scores reflected the severity of patients' symptoms. There was no statistical difference of interpretational reproducibility between MRI and myelography. CONCLUSION: Although MRI and myelography are based on different principles, they produce similar interpretational reproducibility in young soldiers with a HLD. However, these modalities do not reflect the severity of symptoms.
Cohort Studies ; Humans ; Leg ; Low Back Pain ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets ; Male ; Military Personnel ; Myelography ; Physical Examination ; Radiculopathy ; Republic of Korea ; Spine

Hemobilia is a disease caused by injury or conditions that cause the abnormal communication between intrahepatic blood vessels and biliary tract, resulting in leakage of blood into the biliary tract. In the past, trauma had been the most common cause of hemobilia. However, with the increasing invasive procedures in the hepatobiliary tract, iatrogenic origin has become the major cause of hemobilia. Also, non-traumatic etiologies of hemobilia include vascular malformation such as aneurysm, gallstone, inflammation, biliary tumor, hepatocellular carcinoma and coagulopathy. Among these non-traumatic etiologies, choledocholithiasis is a rare cause of hemobilia. The authors have experienced two cases of hemobilia caused by choledocholithiasis, which was diagnosed by abdominal ultrasonography, abdominal CT and duodenoscopy. Both patients were treated by the endoscopic sphincterotomy and stone removal with basket.
Aneurysm ; Biliary Tract ; Blood Vessels ; Carcinoma, Hepatocellular ; Choledocholithiasis ; Common Bile Duct* ; Duodenoscopy ; Gallstones ; Hemobilia* ; Humans ; Inflammation ; Sphincterotomy, Endoscopic ; Tomography, X-Ray Computed ; Ultrasonography ; Vascular Malformations

Necrotizing fasciitis is a rapidly progressing soft-tissue infection that affects the subcutaneous fascia and dermis, and characteristically spares the underlying muscle. Most cases represent a synergistic or mixed bacterial infection of aerobes and anaerobes. A variety of etiologies have been reported. Herein, two cases of necrotizing fasciitis of the right thigh secondary to perforated appendicitis, an extremely rare complication, are reported. Both cases recovered following aggressive surgical and medical therapies. The delay in diagnosis and radical surgical excision are frequent and significant contributory factors in the high reported mortality rate. A high index of suspicion, followed by prompt surgical intervention with broad-spectrum antibiotic therapy, seems to be the most important prognostic factor in these difficult cases.
Appendicitis* ; Bacterial Infections ; Dermis ; Diagnosis ; Fascia ; Fasciitis, Necrotizing* ; Mortality ; Thigh

Diffuse esophageal spasm, an uncommon esophageal motility disorder, has recently been defined using high-resolution manometry. Patients with distal esophageal spasm usually complain of chest pain or dysphagia. The etiology and pathophysiology of this disorder are poorly known, and treatment options are limited. However, some options to improve symptoms are available, including endoscopic injection of botulinum toxin. Nevertheless, few reports have described the effects of endoscopic injection of botulinum toxin in patients with symptomatic diffuse esophageal spasm with clear endoscopic and high-resolution manometry images. Here, we report a case of diffuse esophageal spasm diagnosed with high-resolution manometry and treated by endoscopic injection of botulinum toxin with good results at the 7-month follow-up.
Aged ; Anti-Dyskinesia Agents/*therapeutic use ; Botulinum Toxins/*therapeutic use ; Endoscopy, Digestive System ; Esophageal Spasm, Diffuse/radiography/*therapy ; Female ; Humans ; Manometry ; Tomography, X-Ray Computed

OBJECTIVES: The aim of this study was to evaluate the association between cigarette smoking and total mortality, cancer mortality and other disease mortalities in Korean adults. METHODS: A total of 14 161 subjects of the Korean Multi-center Cancer Cohort who were over 40 years of age and who were cancer-free at baseline enrollment reported their lifestyle factors, including the smoking status. The median follow-up time was 6.6 years. During the follow-up period from 1993 to 2005, we identified 1159 cases of mortality, including 260 cancer mortality cases with a total of 91 987 person-years, by the national death certificate. Cox proportional hazard regression model was used to estimate the hazard ratio (HR) of cigarette smoking for total mortality, cancer mortality and disease-specific mortality, as adjusted for age, gender, the geographic area and year of enrollment, the alcohol consumption status, the education level and the body mass index (BMI). RESULTS: Cigarette smoking was significantly associated with an increased risk of total mortality, all-cancer mortality and lung cancer mortality (p-trend, <0.01, <0.01, <0.01, respectively). Compared to non-smoking, current smokers were at a higher risk for mortality [HR (95% CI)=1.3 (1.1-1.5) for total mortality; HR (95% CI)=1.6 (1.1-2.2) for all-cancer mortality; HR (95% CI)=3.9 (1.9-7.7) for lung cancer mortality]. CONCLUSIONS: This study's results suggest that cigarette smoking might be associated with total mortality, all-cancer mortality and especially lung cancer mortality among Korean adults.
Aged ; Cohort Studies ; Female ; Health Behavior ; Humans ; Life Style ; Male ; Middle Aged ; Neoplasms/mortality ; Proportional Hazards Models ; Republic of Korea/epidemiology ; Smoking/*mortality

A 27-year-old woman presented with epigastric pain. Abdominal computed tomography revealed an irregular ulcer with circumferential thickening of the gastric antral wall. An endoscopy suggested advanced gastric cancer or gastric lymphoma. Biopsy of the lesion showed an inclusion body of the cytomegalovirus and positive immunohistochemical staining of the infected cell for cytomegalovirus. A thorough evaluation of her immune system revealed no abnormality. General supportive treatment for gastric ulcer did not relieve her symptoms. Intravenous infusion of ganciclovir improved her symptoms and healed the ulcer. We report a case of cytomegalovirus-associated gastric ulcer mimicking malignancy in an immunocompetent woman.
Adult ; Biopsy ; Cytomegalovirus* ; Endoscopy ; Female ; Ganciclovir ; Humans ; Immune System ; Inclusion Bodies ; Infusions, Intravenous ; Lymphoma ; Stomach Neoplasms* ; Stomach Ulcer* ; Ulcer

Diabetic gastroparesis is a pathologic condition of delayed gastric emptying with gastrointestinal symptoms such as nausea, early satiety and vomiting in the absence of mechanical obstruction in patients with diabetes mellitus. We report a case of diabetic gastroparesis who had diabetes mellitus for 13 years and suffered from nausea and vomiting with marked gastric dilatation of acute onset. Blood glucose level of the patient was very high and any mechanical obstruction was not found by gastroduodenal endoscopy, hypotonic duodenography, celiac angiography, electrogastrography and CT scan. Acute gastric dilatation was resolved with conservative treatment of gastric drainage, glucose control and hydration. Gastrointestinal symptoms of nausea and vomiting improved and diet was well tolerated thereafter.
Angiography ; Blood Glucose ; Diabetes Mellitus ; Diet ; Drainage ; Endoscopy ; Gastric Dilatation* ; Gastric Emptying ; Gastroparesis* ; Glucose ; Humans ; Nausea ; Tomography, X-Ray Computed ; Vomiting

PURPOSE: Case-control and cohort studies have reported inconsistent findings for the association between gender and mortality from a traumatic brain injury. We investigated the effect and association of gender on moderate to severe traumatic brain injury using meta-analysis. METHODS: We searched electronic health care databases including MEDLINE (Pubmed), the Cochrane Library, CINAHL, and Koreamed (January 2001 to December 2009) in August 2010. The keywords searched included traumatic brain injury or traumatic head injury, gender, and mortality. Two independent investigators selected and reviewed articles according to predefined inclusion and exclusion criteria. The quality of selected articles was evaluated by applying the Newcastle Ottawa scale. Data were abstracted by predetermined criteria. Odds ratios were calculated and combined using fixed and random effect models. RESULTS: Of 130 articles, four case-control studies and three cohort studies were included in the final analysis. In total, 89,335 patients were included(26,287 females and 63,048 males). Compared with the mortality of male patients, the combined odds ratio for the mortality of female patients was 1.074(95% confidence interval [CI], 1.027~1.124) in a fixed effect model, and 1.319(95% CI, 1.104~1.576) in a random effects model, respectively. The heterogeneity of all participants was severe, so the results were discarded and a subgroup analysis was conducted. The total number of participants was divided into premenopausal and postmenopausal groups by the menopausal age defined in each article. The pooled odds ratio of the premenopausal group was 1.014(95% CI, 0.949~1.083) in the fixed effect model and that of the postmenopausal group was 1.237(95% CI, 0.895~1.712) in the random effects model. The pooled estimate of the random effect model was adopted because of the severe heterogeneity of the postmenopausal group. CONCLUSION: We found no distinct effect of gender on moderate to severe traumatic brain injury. Large-scaled prospective studies based on female hormone levels are needed.
Brain ; Brain Injuries ; Case-Control Studies ; Cohort Studies ; Craniocerebral Trauma ; Delivery of Health Care ; Electronics ; Electrons ; Female ; Humans ; Male ; Odds Ratio ; Population Characteristics ; Research Personnel