Objective: This study aimed to identify the appropriateness of the Korean Triage and Acuity Scale (KTAS) for dizziness without neurological symptoms, which was level 3. Methods: Using the registry of the National Emergency Department Information System (NEDIS), data regarding consecutive emergency patients from January 2016 to July 2018, who were aged 15 years and older, were reviewed retrospectively. The data were classified using KTAS and Dizziness KTAS level 3 were compared with non-dizziness KTAS level 3 including age, total admission rate, intensive care unit (ICU) admission rate, discharge rate, hospital cost, and length of stay in the emergency department (length of stay [LOS]). Results: Of the 76,153 emergency patients, 345 (0.5%) had a KTAS level 1, 4,593 (6.0%) had a KTAS level 2, 21,561 (28.3%) had a KTAS level 3, 45,390 (59.6%) had a KTAS level 4, and 4,264 (5.6%) had a KTAS level 5. As the patient’s triage score decreased, the total admission rate, ICU admission rate, hospital cost, and LOS decreased. Patients discharged to home also had the same result. Dizziness KTAS level 3 had a significantly lower rate of total admission (23% vs. 56.2%, P<0.001) and ICU admission (0.9% vs. 6.2%, P<0.001) compared with non-dizziness KTAS level 3. On the other hand, the hospital cost and LOS were higher when patients were discharged to their home. The predictors of the admission rate of dizziness KTAS level 3 were the transportation method using a private ambulance service and older age, but older age was only slightly associated. Conclusion This study showed that KTAS level 3 for dizziness needs to be adjusted because of lower severity than other level 3. Old age and the transportation method should be considered factors.

As the survival rate of patients with complex congenital heart disease has improved and the number of adult patients with congenital heart disease has risen, arrhythmias and heart failure have become important issues in these patients. Cardiac implantable electronic devices, including pacemakers, are also on the rise. Transvenous implantation or epicardial pacemaker implantation is challenging in patients with complex congenital heart disease. Here we report a case in which a dual-chamber pacing, dual-chamber sensing, dual response and rate-adaptive (DDDR) pacemaker was implanted transvenously into a patient with congenital heart disease. A 34-year-old male with extracardiac conduit Fontan circulation complained of dizziness; an electrocardiogram revealed junctional bradycardia. We performed transvenous implantation of a DDDR pacemaker via trans-conduit puncture. In conclusion, transvenous implantation of a pacemaker is feasible in patients with extracardiac conduit Fontan circulation.
Adult ; Arrhythmias, Cardiac ; Bradycardia ; Dizziness ; Electrocardiography ; Fontan Procedure ; Heart Defects, Congenital ; Heart Failure ; Humans ; Male ; Pacemaker, Artificial ; Punctures ; Sick Sinus Syndrome ; Survival Rate

Behcet's disease (BD) is a multi-systemic inflammatory disease of unknown origin that affects nearly all organs. Recent reports of BD with myelodysplastic syndrome (MDS) often note an association with gastrointestinal involvement and trisomy 8. We herein report on a case of a 51-year-old man who had refractory schizophrenia and developed gastrointestinal BD and MDS with trisomy 8 and 9. He visited our hospital due to fever and abdominal pain. Multiple ulcerations in the colorectum were observed on colonoscopy, and he was diagnosed with intestinal BD. During the treatment of intestinal BD, anemia and thrombocytopenia developed. His bone marrow study revealed myelodysplastic syndrome (refractory anemia with ringed sideroblast) with trisomy 8 and trisomy 9. We report a rare case of intestinal BD accompanied by schizophrenia and myelodysplastic syndrome with trisomy 8 and 9.
Abdominal Pain ; Anemia ; Bone Marrow ; Colonoscopy ; Fever ; Humans ; Middle Aged ; Myelodysplastic Syndromes* ; Schizophrenia* ; Thrombocytopenia ; Trisomy* ; Ulcer

Gastrocolic fistula is a fistulous communication between the stomach and the colon. It is a passage between the gastric epithelium and the colonic epithelium. This uncommon complication is caused by benign and malignant diseases of the stomach or the colon. Its clinical manifestations include weight loss, diarrhea and fecal vomiting; occasionally, anemia, poor oral intake, fatigue and dizziness; and very rarely, gastrointestinal bleeding. In this paper, an unusual case of gastrocolic fistula accompanied by hematochezia, which was revealed to have been caused by colon cancer invasion, is described.
Anemia ; Colon ; Colonic Neoplasms ; Diarrhea ; Epithelium ; Fatigue ; Fistula ; Gastrointestinal Hemorrhage ; Hemorrhage ; Intestinal Fistula ; Stomach ; Weight Loss

The aim of this study was to elucidate the epidemiology of traumatic head injury (THI) among Korean children. A prospective, in-depth trauma survey was conducted in five teaching hospitals. Data from all of the children who attended the emergency department (ED) were analyzed. From June 2008 to May 2009, 2,856 children with THI visited the 5 EDs. The average age of the subjects was 5.6 (SD +/- 4.9) yr old, and 1,585 (55.5%) were 0-4 yr old. The male-to-female ratio was 2.3 to 1 (1,979 vs 877). Consciousness levels of the subjects were classified according to the Glasgow Coma Scale (GCS), and 99.1%, 0.6%, and 0.4% were determined as mild, moderate, or severe injury, respectively, according to the GCS categorization. Most injuries occurred at home (51.3%), and the most common mechanism of injury was collision (43.2%). With regard to outcome, 2,682 (93.9%) patients were sent home, and 35 (1.2%) were transferred to another hospital. A total of 133 (4.7%) patients were hospitalized, and 38 (1.3%) underwent surgery. The incidence and characteristics of pediatric THI in Korea are affected by sex, location and injury mechanism.
Adolescent ; Child ; Child, Preschool ; Craniocerebral Trauma/*epidemiology/radiography ; Female ; Glasgow Coma Scale ; Humans ; Infant ; Infant, Newborn ; Male ; Prospective Studies ; Republic of Korea/epidemiology ; Severity of Illness Index ; Sex Factors

PURPOSE: To compare immunogenicity and reactogenicity of a combined diphtheria-tetanus-acellular pertussis-inactivated poliovirus vaccine (DTPa-IPV, Infanrix(TM) IPV, GlaxoSmithKline Biologicals) with co-administration of commercially available DTPa and IPV vaccines at separate injection sites (DTPa+IPV). METHODS: A total of 458 infants aged 8-12 weeks were randomized to receive three-dose primary vaccination at 2, 4 and 6 months with DTPa-IPV or DTPa+IPV. Blood samples were collected pre and post vaccination for measurement of immune responses. Reactogenicity was assessed following each dose using diary cards. RESULTS: One month post-dose 3, seroprotection rates for anti-diphtheria, anti-tetanus and anti-poliovirus types 1, 2 and 3 were > or =99.5% and vaccine response rates to pertussis antigens were at least 98.6% in both DTPa-IPV and DTPa + IPV groups. Non-inferiority between the groups was demonstrated based on pre-defined statistical criteria. Incidences of both local and systemic symptoms were within the same range across both groups with grade 3 symptoms reported following no more than 4.3% of DTPa-IPV doses and 4.5% of DTPa + IPV doses. Two serious adverse events (both pyrexia) after DTPa-IPV administration were considered vaccine-related. Both infants recovered fully. CONCLUSION: Combined DTPa-IPV vaccine was immunogenic and well tolerated when used as a three-dose primary vaccination course in Korean infants. DTPa-IPV could be incorporated into the Korean vaccination schedule, reducing the number of injections required to complete primary immunization.
Aged ; Appointments and Schedules ; Humans ; Immunization ; Incidence ; Infant ; Pentetic Acid ; Poliovirus ; Vaccination ; Vaccines ; Whooping Cough

Gallbladder diverticula have the appearance of hernia-like protrusions of the gallbladder wall. This disorder may not be diagnosed until surgically resected because it has no clinical significance unless there are associated diseases. Gallbladder pseudodiverticula have an acquired cause, multiple fundal lesions, an association with gallstones, internal saccular lesions without external hernia-like protrusions, and little to no smooth muscle in the gallbladder wall. We report a unique anomaly of multiple pseudodiverticula presenting with calculous cholecystitis, which was pathologically different from true diverticula and had a unique shape similar to a bunch of grapes and a septation infilling pattern on endoscopic retrograde cholangiography.
Cholangiography ; Cholecystitis ; Diverticulum ; Gallbladder ; Gallstones ; Muscle, Smooth ; Vitis

OBJECTIVE: Extracranial-intracranial(EC-IC) bypass procedures have proved to be useful and safe in selected patients for revascularization. We have performed EC-IC bypass procedures in 170 patients with atherosclerotic cerebral ischemia and moyamoya disease. We analyzed the cases that had permanent complications after performing EC-IC bypass procedures in these 170 patients. METHODS: We performed ECIC bypass surgery during the recent 10 years for augmenting the cerebral blood flow in 170 patients with atherosclerotic cerebral ischemia and moyamoya disease. Of the 170 patients, the pathologic lesions were atherosclerotic cerebral ischemia in 125 and moyamoya in 45. All the patients were symptomatic and in a hemodynamic cerebral ischemic state, as diagnosed by the acetazolamide loading test. Superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis was performed in 158 cases and graft bypass with using the saphenous vein or radial artery was done in 12 cases. RESULTS: Of 170 patients who underwent bypass surgery, twenty four patients had postoperative neurologic deficits. Of these 24 patients, the neurologic deficits of 17 patients resolved completely within 3 weeks, but the remaining 7 patients (moyamoya in 5 patients and 2 patients were atherosclerotic) had permanent deficits. The probable causes of the permanent neurologic deficits were that bypass was done too soon after an ischemic attack or hemorrhage (3 cases), intracerebral steal phenomenon during anesthesia (2 case), postbypass thrombotic occlusion of the prebypass stenotic artery (1 case) and postbypass thromboembolism (1 case) CONCLUSION: Permanent neurologic deficits could complicate some cases following bypass surgery. The suggested causes of neurologic deficit were hypoperfusion and inappropriate CO2 tension in the blood and fluctuation of the blood pressure during the perioperative period. To prevent complications, maintain an appropriate perfusion pressure and blood pressure control and follow this with antiplatelet or anticoagulation therapy as soon as possible.
Acetazolamide ; Anesthesia ; Arteries ; Blood Pressure ; Brain Ischemia ; Cerebral Arteries ; Hemodynamics ; Hemorrhage ; Humans ; Ischemia ; Moyamoya Disease ; Neurologic Manifestations ; Perfusion ; Perioperative Period ; Radial Artery ; Saphenous Vein ; Thromboembolism ; Transplants

BACKGROUND/AIMS: Endoscopic submucosal dissection (ESD) has become a widely accepted method for treating early gastric cancer (EGC) in Korea. However, there is not an established guideline for indications of ESD. The objective of this study was to assess the current status and practice patterns regarding indications for ESD in Korea. METHODS: A 17-item questionnaire about indications for ESD in EGC was presented to the participants of the 2nd joint symposium of the Gastrointestinal Pathology Study Group of the Korean Society of pathologists. Keypad-based anonymous voting was carried out and the entire process was recorded. RESULTS: Endoscopic submucosal dissection for EGC fulfilling the classical indications was widely accepted as an effective therapeutic strategy comparable to surgery (114/115, agreement 99.5%). In our survey, Japanese extended criteria for ESD was still debated (70/111, 63.6%), but most respondents had performed ESD selectively in EGC corresponding to the extended criteria (105/109, 96.3%). They agreed that the current criteria for ESD would possibly require a revision considering various clinical indicators. CONCLUSIONS: Our survey shows that there is still no consensus about indications for ESD in EGC. Therefore, more clinical outcome data with a long-term follow-up are needed to establish evidence-based consensus and guidelines for ESD indications in Korea. (
Anonyms and Pseudonyms ; Asian Continental Ancestry Group ; Consensus ; Surveys and Questionnaires ; Follow-Up Studies ; Humans ; Joints ; Korea ; Politics ; Stomach Neoplasms

Biliary stent-related enteric perforations are very rare complications that are caused by the sharp end of a metallic stent, stent migration, or tumor invasion. Moreover, the choledochoduodenal fistula resulting from metallic biliary stent-induced perforation is extremely rare. Here, we report a case in which a spontaneous choledochoduodenal fistula occurred after biliary metallic stent placement in a patient with an Ampulla of Vater carcinoma but was successfully managed by supportive treatments, including nasobiliary drainage. This case might have occurred as the result of a rupture of the bile duct following pressure necrosis and inflammation caused by impacted calculi and food materials over the tumor ingrowth in the uncovered biliary stent.
Ampulla of Vater ; Bile Ducts ; Calculi ; Drainage ; Fistula ; Humans ; Inflammation ; Necrosis ; Rupture ; Stents