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

BACKGROUND/AIMS: This study evaluated the eradication rate of levofloxacin-containing rescue therapy by treatment duration in patients in whom previous first- and second-line treatment failed. METHODS: Fifty-five patients with persistent Helicobacter pylori infection after first-line therapy and second-line therapy were studied in a single referral academic center. We compared the eradication rates by the treatment duration of third-line therapy. RESULTS: Of 55 patients, 12 (21.8%) received rescue therapy for seven days, 24 (43.6%) received rescue therapy for 10 days, and 19 (34.5%) received rescue therapy for 14 days. The eradication rates of therapy with levofloxacin were 65.5% in the 55 enrolled patients and 73.5% in the 49 patients who underwent follow-up testing. In cases where follow-up testing was performed, the eradication rate of 7-day therapy was 58.3%, of 10-day 68.2%, and of 14-day therapy 93.3%. Eradication rate of 14-day therapy was higher than 7-day (p=0.06) and 10-day (p=0.108), but chance could not be ruled out in the difference among groups. CONCLUSIONS: This study showed somewhat increasing of H. pylori eradication rate by extending the duration of levofloxacin-containing rescue therapy to 14 days.
Follow-Up Studies ; Helicobacter pylori* ; Helicobacter* ; Humans ; Levofloxacin* ; Referral and Consultation ; Treatment Failure*

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

PURPOSE: Doxylamine is commonly used for relief of insomnia; in addition, it is also a drug that is freguently used for intoxication in Korea. This drug is relatively safe; however, it is known to occasionally induce rhabdomyolysis. We have seen many cases of alcohol ingestion in doxylamine intoxications; however, few previous studies have documented the effects of alcohol on rhabdomyolysis. Therefore, the purpose of this study is to determine the effect of alcohol on rhabdomyolysis in doxylamine intoxicated patients. METHODS: This study was conducted on 91 patients admitted to an emergency department after doxylamine intoxication during the period from January 2001 to March 2012. Using the protocol developed beforehand, the amount of drug ingestion, past history, laboratory results, and whether or not alcohol was ingested were recorded. Rhabdomyolysis was defined as serum creatine kinase (CK) over 1,000 U/L. The SPSS package with logistic regression, t-test, and Fisher's test was used for analysis of data. RESULTS: Alcohol ingestion was detected in 52% of the study patients. The presence of hematuria and alcohol ingestion showed a significant association with development of rhabdomyolysis. CONCLUSION: Doxylamine intoxicated patients with alcohol ingestion may have a high rate of incidence of rhabdomyolysis. Therefore, doxylamine intoxicated patients who drink alcohol at the same time should be aware of rhabdomyolysis.
Creatine Kinase ; Doxylamine ; Eating ; Emergencies ; Hematuria ; Humans ; Incidence ; Korea ; Logistic Models ; Rhabdomyolysis

BACKGROUND/AIMS: The prevalence of occult HBV infection depends on the prevalence of HBV infection in the general population. Hemodialysis patients are at increased risk for HBV infection. The aim of this study was to determine the prevalence of occult HBV infection in hemodialysis patients. METHODS: Total of 98 patients undergoing hemodialysis in CHA Bundang Medical Center (Seongnam, Korea) were included. Liver function tests and analysis of HBsAg, anti-HBs, anti-HBc and anti-HCV were performed. HBV DNA testing was conducted by using two specific quantitative methods. RESULTS: HBsAg was detected in 4 of 98 patients (4.1%), and they were excluded. Among 94 patients with HBsAg negative and anti-HCV negative, one (1.1%) patient with the TaqMan PCR test and 3 (3.2%) patients with the COBAS Amplicor HBV test were positive for HBV DNA. One patient was positive in both methods. Two patients were positive for both anti-HBs and anti-HBc and one patient was negative for both anti-HBs and anti-HBc. CONCLUSIONS: The present study showed the prevalence of occult HBV infection in HBsAg negative and anti-HCV negative patients on hemodialysis at our center was 3.2%. Because there is possibility of HBV transmission in HBsAg negative patients on hemodialysis, more attention should be given to prevent HBV transmission.
Adult ; Aged ; Aged, 80 and over ; Antibodies/blood ; DNA, Viral/analysis ; Feces/*virology ; Female ; Hepatitis B/complications/*epidemiology/transmission ; Hepatitis B Core Antigens/immunology ; Hepatitis B virus/genetics/immunology ; Hepatitis C Antibodies/blood ; Humans ; Kidney Failure, Chronic/*complications/diagnosis ; Male ; Middle Aged ; Polymerase Chain Reaction ; Prevalence ; Renal Dialysis ; Risk Factors

Reactive hemophagocytic syndrome or hemophagocytic lymphohistiocytosis, is characterized by the proliferation of benign histiocytes showing phagocytosis of blood cells in hematopoietic organs including bone marrow, spleen, or lymph nodes, accompanied by fever, hepatosplenomegaly, hepatic dysfunction, pancytopenia, and hypertriglyceridemia. The pathogenesis of reactive hemophagocytic syndrome is unknown. It is often associated with infection, malignant neoplasm, autoimmune disease, drugs and various immunodeficiencies. The prognosis of this syndrome is poor and the causes of death are hemorrhage, infection, or multiorgan failure. We experienced a case of hemophagocytic syndrome with terminal ileal ulcers, not associated with other causes. Thus, we report this case with a review of literatures.
Adult ; Fatal Outcome ; Humans ; Ileal Diseases/complications/*diagnosis ; Lymphohistiocytosis, Hemophagocytic/complications/*diagnosis/pathology ; Male ; Tomography, X-Ray Computed ; Ulcer/complications/*diagnosis

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

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