BACKGROUND: Plasmodium vivax malaria was recently re-presenting infectious disease in Korea since was being controlled for about 10 years age, but has been increasing years by year in the soldiers or farmers working at the near Demilitarized Zone(DMZ). So we analyzed the Characteristics of the patients diagnosed as malaria since 1997 in Yeungnam university hospital. METHODS: From January 1997 to August 1999, the 23 patients complainted of the febrile and chilly sense were diagnosed as Plasmodium vivax malaria in Yeungnam university hospital. We analyzed the patient's records for clinical findings(i.e. clinical symptoms and signs), occupation and regions of working or visiting, laboratory findings, treatment and its results, etc. RESULTS: Male patients were 21 and female patients were 2 among the total 23 patients, the 19 of 21 male patients were soldiers discharged from military services. All patients had been visited or worked near the DMZ, as the northern part of Kyungki-do(21 cases) or Kangwon-do(2 cases). And all patients complainted of delayed onset(means 6 months) of fever and chills after working or visiting at this zones. On physical examination, liver or spleen were palpated initially at least 1 finger breadth in 9 cases(39.1%), and peripheral blood smears showed the infected RBCs(i.e. gametocyte, ring form, schizont, trophozoite) in all cases, and 21 cases(91.3%) showed thrombocytopenia. All patients were treated by the combined regimen of 2-days hydroxychloroquine and 14-days primaquine. All cases showed clinical and laboratory improvement initially, but 5 cases were recurred after 2 months and showed re-improvement. And none of 23 cases showed the significant complications and deaths after medical treatment. CONCLUSION: Plasmodium vivax malarial infection is currently re-presenting disease near the DMZ. So we should consider the active prevention and management of malaria.
Chills ; Communicable Diseases ; Female ; Fever ; Fingers ; Humans ; Hydroxychloroquine ; Korea ; Liver ; Malaria ; Malaria, Vivax* ; Male ; Military Personnel ; Occupations ; Physical Examination ; Plasmodium vivax* ; Plasmodium* ; Primaquine ; Schizonts ; Spleen ; Thrombocytopenia

BACKGROUND: The medicolegal problems can be occurred in all medical field, Especially ED can be more exposed to the legal claims due to the very nature of ED business and characteristics of ED patient (or their family member). All emergency physicians, as a ED manager, should be concerned about the law associated with emergency cairo for handling the medicolegal problem. So they can deal with and prevent the legally risky situations that may be occurred in ED practice. Ultimately we can reduce the risk of a malpractice lawsuit and provide good emergency care services. SUGGESTION: The authors would like to suggest several items that we have thought the ED physicians and managers always have to remember to manage the medicolegally risky situations. 1. Every member of ED health care team must be trained in understanding the patients' wants and desires. 2. The emergency physicians and nurses must realize that they are the best risk management tools in the hospital. 3. ED physician should have the knowledge of the law associated with emergency health care. 4. Develop the system that can share the informations about the medicolegal events which were experienced by each ED health care providers of every health care institutes. 5. We should never forget the time honored sentences, 'Good medicine is good law'.
Academies and Institutes ; Commerce ; Delivery of Health Care ; Emergencies ; Emergency Medical Services ; Empathy* ; Health Personnel ; Humans ; Jurisprudence ; Malpractice ; Patient Care Team ; Risk Management

Emergency medicine(EM) is the specialty of evaluating, stabilizing and initiating treatment for patients with life or limb-threatening illnesses or injuries. Techniques unique to the specialty of EM are the triage systems, quick stabilization methods, and emergency surgery procedures. The field of EM encompasses areas such as emergency department management, disaster planning and management, the management of emergency medical service(EMS) systems, research into such areas as brain and heart resuscitation, trauma and disaster management, survival medicine, and environmental emergencies(cold and heat injuries, poisioning, decompression sickness and barotrauma). Today, in addition to providing emergency care, the emergency specialists have moral and legal obligations to assess and report probable cases of child and spouse abuse, sexual assault, and alcohol and drug abuse. Future, the EM should provide surveillance, identification, intervention, and evaluation of injury and disease, therefore EM will remain as a key component of evolving community health care system.
Brain ; Child ; Community Health Services ; Decompression Sickness ; Disaster Planning ; Disasters ; Emergencies* ; Emergency Medical Services ; Emergency Medicine* ; Emergency Service, Hospital ; Heart ; Hot Temperature ; Humans ; Jurisprudence ; Resuscitation ; Specialization ; Spouse Abuse ; Substance-Related Disorders ; Triage

Chilaiditis syndrome is very rare clinical condition that interposed of the hepatic flexure of large bowels between the liver and diaphragm. Clinically it is characterized by abdominal pain that becomes increasingly worse during the day and is often accentuated by deep breathing. On radiologic studies, it shows gas within the hepatic flexure interposed between the liver and diaphragm, which is simulating a pneumoperitoneum. A case was admitted at emergency care center of Yeungnam university hospital and we report it.
Abdominal Pain ; Chilaiditi Syndrome* ; Diaphragm ; Emergency Medical Services ; Liver ; Pneumoperitoneum* ; Respiration

Erythema multiforme(EM) is related disorders of skin and mucous members which is typically associated with antecedent medications or infections, etc. EM is an erythematous maculopapular cutaneous eruption of variable form. However, the pathophysiology of the EM remains obscure. Treatment at present is symptomatic and supportive. In conclusion, the authors report two cases of EM that complained of the erythematous maculopapular cutaneous eruption following antibiotics treatment with the review of literatures.
Anti-Bacterial Agents* ; Erythema Multiforme* ; Erythema* ; Skin

No abstract available.
Extremities*

Ulcerative colitis is diffuse inflammatory condition at mucosal lining of the colon & rectum and rare in Korea but there are no pathognomonic features or specific diagnostic tests. However, recently the diagnostic methods for ulcerative colitis are much developed and the incidence of ulcerative colitis is increased in Korea. Therefor, an analysis of 31 cases of ulcerative colitis which was diagnosed and treated in the department of the YeungNam University Hospital from May l983 to April 1991 was reviewed. The results were as following: 1) The sex distribution assumed a ratio of 1 to 2.1 and the age distribution was vqriable but the most prevalent age group was 5th decade(29.0%). 2) The most common clinical manifestations were abdominal pain & bloody diarrhea. 3) As to the extent of disease determined by the barium enema & endoscopy, rectum or rectosigmoid colon was involved in majority of the cases 22.6%, 41.9 (respectively). 4) Significant laboratory findings were elevated ESR, anemia, leukocytosis, hypoalbuminemia. 5) The endoscopic examination was performed in all 31 cases and showed sinificant findings such as hyperemia, mucosai edema, superficial ulceration & mucosal friability. 6) 23 of 26 cases treated by sulfasalazine medication showed improved, and 3 cases were improved by steriod medication and the surgical operation was indicated in 1 case.
Abdominal Pain ; Age Distribution ; Anemia ; Barium ; Colitis, Ulcerative* ; Colon ; Diagnostic Tests, Routine ; Diarrhea ; Edema ; Endoscopy ; Enema ; Humans ; Hyperemia ; Hypoalbuminemia ; Incidence ; Korea ; Leukocytosis ; Rectum ; Sex Distribution ; Sulfasalazine ; Ulcer*

BACKGROUND: Acute appendicitis is very not uncommon disease and has many difficulties in the diagnosis of disease. So we should evaluate the significance of diagnosis by "MANTRELS" score which is very simple and easily accessible tools in patients of right lower quadrant abdominal pain. METHODS: We studied 164 patients initially complainted of right lower quadrant abdominal pain from Jan 1 to Jun 30. 1997 in emergency department of Yeungnam university hospital. At first, "MANTRELS" scores was calculated and we evaluated the final diagnosis, surgically operated or not, transferred or not, etc, retrospectively. Next, two groups were divided each that group A was surgically operated, group B was not surgically operated. And then the statistical significance and accuracy rate according to scores and cut-off values in each groups were evaluated. RESULTS: All 164 patients was admitted in emergency department of Yeungnam University hospital and male to female ratio was 1:0.98, mean ages was 35.3 years old. The incidences according to each items of "MANTRELS" were as follows; most in Tenderness and Shift to left, Migration of pain in group A and most in Tenderness and Anorexia. Nausea in group B. As the results according to each scores in both group, score 8; 25 cases, score 7; 14 cases in group B were showed and the correlation coefficients was 0.979. And as the results according to cut-off value in both groups. it's sensitivity and negative predictability. false negative, positive joint probability were decreased and others were increased as the cut-off values, respectively. The diagnostic weight was most highest(75.0%) when the cut-off value was 7. CONCLUSION: The authors would authorize that "MANTRELS" score is very simple scoring system and have diagnostic values in differentiating between acute appendicitis and other diseases complaining of right lower quadrant abdominal pain.
Abdominal Pain ; Anorexia ; Appendicitis* ; Diagnosis* ; Emergency Service, Hospital ; Female ; Humans ; Incidence ; Joints ; Male ; Nausea ; Retrospective Studies

BACKGROUND: The EMSS can be defined as the complete chain of human and physical resources that provides patient care in cases of sudden illness and injury. To provide effective emergency care through the EMSS in a region, the organized EMSS should be periodically evaluated and improved in both aspects of quality and number on the detected portions of defect. The EMSS in Taegu has been systematically developed since the gas explosion disaster happened at Sangin Dong, on 28th April, 1995. After then, many institutes have been organized, and various plans for improving Taegu regional EMSS have been suggested. The training of EMTs for operating the systems and various equipments which are needed for performing prehospital care and transporting the patient to hospital also has been undertaken. METHOD: We reviewed the effectiveness and problems of each EMSS elements established and operated during the past five years in Taegu by looking over the documents related to EMSS in the institutes concerned and accomplishing written survey from prehospital care providers belonged to Fire-Fight department. RESULT: Although the regional EMSS in Taegu has been well developed since 1995 in all its aspects, such as manpower, equipment and control system, but some ineffectiveness in the operation of EMSS and deficits of resources, especially manpower, are found. CONCLUSION: The emergency physicians should have to analyze the problems of their regional EMSS that involved in personally, and reestablish the long term plans for improving the regional EMSS at this point.
Academies and Institutes ; Daegu* ; Disasters ; Emergencies ; Emergency Medical Services ; Explosions ; Humans ; Patient Care

Upper gastrointestinal(UGI) bleeding was critical disease that was commonly found in emergency department and needed more early diagnosis and rapid treatment for decreasing mortality and morbidity. It's causes and frequencies here affected by many factors, but the majorities were caused by peptic ulcers and esophageal-gastric varices. With development of economy and medical services, new drugs and endoscopic interventions, the treatment of patients with UGI bleeding was more improved. So I would like to evaluate the change of causes and frequencies of UGI bleeding and the associated clinical findings. A total of 1,546 patients presented with UGI bleeding in emergency department of Yeungnam university hospital during the five years from Jan. 1991 to Dec. 1995 were clinically reviewed by charts and compared with previous seven years report from Jan. 1984 to Dec. 1990 in the same hospital. The ratio of male to female was 6.1:1 and slightly increased in comparison with previous seven years. The incidences in 6th and 5th decades were highest(54.4%) as like as previous seven years. Age distribution of duodenal ulcer bleeding, Mallory-Weiss tear and acute gastric mucosal lesion were developed in lower decades than the others. The causes of UGI bleeding were caused by esophageal varix(45.4%), peptic ulcer(38.8%), Mallory-Weiss tear(4.3%), gastric cancer(3.8%), others(3.1%), acute gastric mucosal lesion(2.7%), undetermined causes(1.8%) in defending order of frequencies. The proportion of esophageal varices was increased from 36.6% to 45.4%, but that of peptic ulcer was relatively decreased from 47.6% to 38.8%. And the annual distribution of varices was increased, however the annual distribution of peptic ulcers was increased. Although the ranking of annual distribution of gastric ulcers and duodenal ulcers were not changed compared to previous study and the frequency of gastric ulcers was increased since 1992, but additional follow-up was needed. Seasonal variations were found that upper gastrointestinal bleeding was increased in fall and peptic ulcer bleeding was increased significantly in summer and fall, however, varix bleeding was less frequent in summer time as like as previous seven years. Emergency endoscopic examination was performed within 6 hours far 54.5%, 24 hours for 90.8% and this reacts were to be like previous results, 57.5% and 90.7% respectively. Findings of emergency endoscopic examination were active bleeding focus(21.2%), blood clot(7.9%), exposed vessels(13.3%), flat blood spot(6.4%) and lesion without evidence of bleeding(51.3%). Endoscopic findings of active bleeding were easily seton when examination was perfomed within 24 hours. Blood transfusion was performed in 67.3% with average 2.1 units. When the causes of bleeding were due to varix and marginal ulcer, more amounts of blood were transfused than the others. In previous seven years, blood transfusions were performed in 71.2% with average 5 units and more amounts of blood were transfused in gastric cancer and varix bleeding.
Age Distribution ; Blood Transfusion ; Duodenal Ulcer ; Early Diagnosis ; Emergencies ; Emergency Service, Hospital ; Esophageal and Gastric Varices ; Female ; Follow-Up Studies ; Hemorrhage* ; Humans ; Incidence ; Male ; Mallory-Weiss Syndrome ; Mortality ; Peptic Ulcer ; Seasons ; Stomach Neoplasms ; Stomach Ulcer ; Varicose Veins