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

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

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

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*

The reduction of nasal bone fracture has been done by a simple procedure. The nasal bone fracture was not a serious problem and patients are usually treated as outpatients. However it is causing increased demand for medical services far cosmetic reasons. We studied the nasal bone fracture by retrospective analysis, it comprising 606 patients with nasal bone fractures in various accidents and treated of Chonnam University Hospital from March 1995 to February 1998. We reviewed and analyzed the medical records and facial bone CT scans of 606 patients. The following results were obtained. 1. The prevalent age group was in the third decade, the most common cause was traffic accidents, while nasal swelling, tenderness, nasal deviation and crepitation were examined 2. The classification of nasal bone fracture was done by facial bone CT. Class 1: Nasal tip depressed fracture(16%) Class 2: Displaced nasal bone fracture without depression(30%) Class 3: Displaces nasal bone fracture with depression(12%) Class 4: Comminuted nasal bone fracture (10%) Class 5: Simple fracture of nasal bone and frontal process of maxilla(14%) Class 6: Comminuted fracture of nasal bone and frontal process of maxilla(11%) Class 7: Nasal bone fracture without displacement(9%) .
Accidents, Traffic ; Classification* ; Facial Bones ; Fractures, Comminuted ; Humans ; Jeollanam-do ; Medical Records ; Nasal Bone* ; Outpatients ; Retrospective Studies ; Tomography, X-Ray Computed

There is increasing evidence that inactivation of tumor-suppressor genes can promote tumor growth. Retinoblastoma protein (pRb) is the product of the retinoblastoma gene located on chromosome 13q14. pRb negatively regulates cell growth when functioning normally. Mutational inactivation of the Rb gene has been observed in retinoblastomas, osteosarcomas and soft tissue sarcomas. Recently, several other human cancers have also been shown to carry abnormalities of the Rb gene. The potential role of the Rb gene in cutaneous squamous cell carcinomas (SCCs) and basal cell caicinomas (BCCs), has not been determined and was the focus of this study. Immunohistochemical expression of pRb in 16 cutaneous SCCs and 17 BCCs was examined. The expression of PCNA was studied in parallel to assess the cellular proliferation rate in these lesions. The pRb and PCNA immunoreactivity were localized to the nuclei of tumor cells. A few pRb and PCNA positive cells were seen in normal squamous epithelium, sebaceous glands, sweat glands and hair follicles. The loss of expression of pRb was seen in 3 of 16 SCCs(18.8%) and 6 of 17 BCCs (35.3%). PCNA immunoreactivity was slightly high in pRb-negative or lower-positive cases. PCNA immunoreactivity was similar to that produced by pRb in some cases. These results suggest that mutational inactivation of the Rb gene may be related to the carcinogenesis of cutaneous SCC and BCC, though the frequency is relatively low.
Carcinogenesis ; Carcinoma, Basal Cell* ; Carcinoma, Squamous Cell* ; Cell Proliferation ; Epithelium ; Genes, Retinoblastoma ; Hair Follicle ; Humans ; Osteosarcoma ; Proliferating Cell Nuclear Antigen ; Retinoblastoma Protein* ; Retinoblastoma* ; Sarcoma ; Sebaceous Glands ; Sweat Glands

BACKGROUND: The causes of chest pain vary but the leading cause of chest pain is ischemic heart disease. Mortality from ischemic chest pain has increased more than two fold over the last ten years. The purpose of this study was to determine the data necessary for rapid treatment of patients with signs and symptoms of ischemic chest pain in the emergency department (ED). MATERIALS AND METHODS: We interviewed 170 patients who had ischemic chest pain in the emergency department of Yeungnam University Hospital over 6 months with a protocol developed for the evaluation. The protocol used included gender, age, arriving time, prior hospital visits, methods of transportation to the hospital, past medical history, final diagnosis, and outcome information from follow up. RESULTS: Among 170 patients, there were 118 men (69.4%) and the mean age was 63 years. The patients diagnosed with acute myocardial infarction (AMI) were 106 (62.4%) and with angina pectoris (AP) were 64 (37.6%). The patients who had visited another hospital were 68.8%, twice the number that came directly to this hospital (p<0.05). The ratio of patients who visited another hospital were higher for the AMI (75.5%) than the AP (59.4%) patients (p<0.05). The median time spent deciding whether to go to hospital was 521 minutes and for transportation was 40 minutes. With regard to patients that visited another hospital first, the median time spent at the other hospital was 40 minutes. The total median time spent before arriving at our hospital was 600 minutes (p>0.05). The patients who had a total time delay of over 6 hours was similar 54.8% in the AMI group and 57.9% in the AP group (p>0.05). As a result, only 12.2% of the patients with an AMI received thrombolytics, and 48.8% of them had a simultaneous percutaneous coronary intervention (PCI). In the emergency department 8.5% of the patients with an AMI died. CONCLUSION: Timing is an extremely important factor for the treatment of ischemic heart disease. Most patients arrive at the hospital after a long time lapse from the onset of chest pain. In addition, most patients present to a different hospital before they arrive at the final hospital for treatment. Therefore, important time is lost and opportunities for treatment with thrombolytics and/or PCI are diminished leading to poor outcomes for many patients in the ED. The emergency room treatment must improve for the identification and treatment of ischemic heart disease so that patients can present earlier and treatment can be started as soon as they present to an emergency room.
Angina Pectoris ; Chest Pain* ; Diagnosis ; Emergencies* ; Emergency Service, Hospital* ; Follow-Up Studies ; Humans ; Male ; Mortality ; Myocardial Infarction ; Myocardial Ischemia ; Percutaneous Coronary Intervention ; Thorax* ; Transportation