No abstract available.
Child* ; Humans ; Tuberculosis, Renal*

The extended medical insurance system has resulted in increasing numbers of patients who go directly to specialists in the general hospitals via consultation of general practice physicians in local clinics as well as on the patient's own decision. In order to classify and evaluate the patients, who come to the emergency room of the general hospital, whether the patient's disease status truely needed emergency treatment or whether the patients were treated adequately or not at the emergency room, we reviewed retroscpectively 3,775 patients who came to the emergency room of Kang Nam St. Mary's hosptial Between January and July 1984. We classified them according to their age, sex, department, the status of disease(emergency or not) and evaluated the adequacy of emergency treatment and the prognosis. We concluded as follows: 1) Every emergency room shoul be prepared with adequate equipment and operated by sufficient numbers of well trained medical personnel. 2) It is necessary that the medical personnel who work at the emergency room should be continuously educated and trained for adequate care of the patients with central nervous system, respiratory system, gastrointestinal system and cardiovascular system problems. 3) Our review revealed that it seems necessary that the specialists in emergency care, including cardiopulmonary resuscitation, should be stationed at emergency room. 4) For the more efficient operation of the emergency room, the establishment of a medical delivery system is necessary.
Cardiopulmonary Resuscitation ; Cardiovascular System ; Central Nervous System ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital* ; Emergency Treatment ; General Practitioners ; Hospitals, General ; Humans ; Insurance ; Prognosis ; Respiratory System ; Specialization

No abstract available.
Kyphosis* ; Spine* ; Tuberculosis*

PURPOSE: Long-term exposure to extremely low-frequency (60 Hz) electromagnetic fields (ELF-EMF) raises the questions of the induction of biological effects including tumorigenesis. One mechanism through which ELF-MFS could influence neoplastic development is the imbalance of cellular proliferation and cell apoptosis. The present study investigated the effect of ELF-EMF on chemically-induced thyroid carcinogenesis in a rat. METHODS: We examined cellular proliferation index measured by anti-Ki-67 antigen, apoptosis, apoptosis related proteins such as caspase 3 and p53, and cell cycle-related proteins (cyclin D1 and p21(WAF1/Cip1)). Forty Male F344 rats received a subcutaneous N-bis(2-hydroxypropyl)nitrosamine (DHPN, 2,800 mg/kg) injection, and 1 week later were allowed free access to drinking water containing sulfadimethoxine (0.1%) for 12 weeks. Twenty rats were exposed by ELF-EMF. During the carcinogenesis, sequential histological changes from hyperplasia, adenoma, and ultimately to overt carcinomas were noted. RESULTS: The exposure group of ELF-EMF, significantly increases the number size of carcinomas. Also, the proliferative and apoptotic indices were significantly increased in the ELF-EMF exposure group than in the control group. The caspase 3 protein expression did not show any significant changes between ELF-EMF group and control group. The p53 protein was not detected in both ELF-EMF exposure and control group. Among the cell cycle related proteins, cyclin D1, not p21(WAF1/Cip1), was significantly increased in adenomas and carcinomas in ELF-EMF exposure group compared with the control group. CONCLUSION: Exposure of ELF-EMF effects on chemically-induced rat thyroid carcinogenesis as results of altered increase of cellular proliferation, apoptosis, and cyclin D1 expression.
Adenoma ; Animals ; Apoptosis ; Caspase 3 ; Cell Cycle ; Cell Proliferation ; Cell Transformation, Neoplastic ; Cyclin D1 ; Drinking Water ; Electromagnetic Fields ; Humans ; Hyperplasia ; Male ; Nitrosamines ; Proteins ; Rats ; Rats, Inbred F344 ; Sulfadimethoxine ; Thyroid Gland

OBJECTIVE: This study was performed to evaluate the status of p16 tumor suppressor gene in 25 endometrial carcinomas (ECs) and to correlate the loss of heterozygosity (LOH) at p16 locus, the presence of inactivating mutations, the methylation status of the promotor, and the expression of p16 protein with clinicopathological parameters. METHODS: Methylation-specific PCR (MSP) distinguishes unmethylated from methylated alleles in a given gene on sequence changes produced after bisulfite treatment of DNA. Allelic losses were determined at two polymorphic dinucleotide repeat microsatellite markers of the p16 gene on chromosome 9p21 that included D9S974 and D9S1748 at CDKN2A. Mutations were analyzed by exons 1 and 2 of p16 PCR-SSCP. Immunohistochemical staining for p16 protein was performed. The associations between genetic alterations of the p16 and the clinicopathological parameters of ECs were evaluated by chi-squared or Fisher's extraction tests. RESULTS: The median age of the 25 cases was 52 years, ranging from 32 to 72. The median tumor size was 3.6 cm, ranging from 0.8 to 9.5 cm. Histologically, the ECs were 21 endometrioid, 2 adenosquamous, 1 secretory and 1 papillary serous types. Nine cases of p16 protein staining were negative or minimal positive in 25 ECs (36%). Allelic losses were found in 6 loci (66.7%) of 5 ECs without p16 protein expression (Fisher's extraction test, p=0.0029), In this study, only 2 of 25 ECs (8%) disclosed mutations. Non-endometrioid (secretory and adenosquamous) carcinomas showed more frequent mutation and methylation than endometrioid carcinomas (p=0.043) and high grades (G3, p=0.018) showed more frequent mutation and methylation than low grade ECs. CONCLUSION: This study suggests that methylation of p16 promoter region seems not to be common (only 9.5% in our present series) and not to be associated with loss of nuclear p16 protein expression. Loss of p16 protein indicates a higher frequency of LOH, which contributes to the development of high grade or aggressive ECs. The mechanism of p16 inactivation is not clear, so other genetic or nongenetic mechanisms for inactivation should be further studied.
Alleles ; Carcinoma, Endometrioid ; Dinucleotide Repeats ; DNA ; Endometrial Neoplasms* ; Exons ; Female ; Genes, p16 ; Genes, Tumor Suppressor ; Loss of Heterozygosity ; Methylation ; Microsatellite Repeats ; Polymerase Chain Reaction ; Promoter Regions, Genetic*

BACKGROUND: The isolation rate of nontuberculous mycobacteria (NTM) in clinical laboratories and the incidence of NTM infections are on the increase recently in Korea, but there have been only a few studies that reveal the general aspect of NTM isolation or species distribution. Therefore, this study was performed to examine the isolation rate of NTM, species identification, and the clinical significance of mycobacterial cultures. METHODS: From August 2004 to May 2005, we examined mycobacterial isolates by AccuProbe test to differentiate NTM from Mycobacterium tuberculosis complex. NTM was then identified by polymerase chain reaction-restriction fragment length analysis (PCR-RFLP). RESULTS: A total of 6,742 specimens from 2,784 patients were requested for mycobacterial culture. Mycobacteria were isolated from 776 specimens (11.5%). The isolation rates of NTMs among the total culture positive specimens and culture positive sputum specimens were 24.4% (189/776) and 25.3% (169/667), respectively. Fourteen species of NTM identified in 172 of the 175 specimens tested included M. avium (39.0%), M. intracellulare (22.7%), and M. abscessus (19.8%). CONCLUSIONS: Using AccuProbe tests and PCR-RFLP method for mycobacterial cultures processed in a clinical laboratory, we were able to identify NTMs to the species level. The isolation rate of NTM in this study was similar to that reported in past studies in Korea. In addition, we found that some of the NTMs isolated in this study could cause pulmonary diseases.
Humans ; Incidence ; Korea ; Lung Diseases ; Mycobacterium tuberculosis ; Nontuberculous Mycobacteria* ; Polymerase Chain Reaction ; Polymorphism, Restriction Fragment Length ; Sputum

Three trials of external quality assessment for clinical microbiology laboratory were performed in 2002. A total of 19 specimens were distributed. Five specimens were distributed to 241 laboratories with 222 returns in Trial I, seven specimens to 241 laboratories with 232 returns in Trial II, and seven specimens to 245 laboratories with 220 returns in Trial III. The percentages of fully correct results of Plasmodium falciparum, P. malariae, P. vivax, gram-positive rods, group 5, S. aureus, E. faecium, Leuconostoc spp. Aeromonas hydrophila, Alternaria spp. S. aureus, E. coli, K. pneumoniae, E. faecalis, P. aeruginosa, E. coli, and K. pneumoniae were 38%, 66%, 68%, 85%, 68%, 94%, 76%, 51%, 86%, 76%, 100%, 99%, 93%, 79%, 86%, 95% and 96%, respectively. The acceptable percentages on disk-diffusion antibacterial susceptibility tests against oxacillin and vancomycin of S. aureus (M0206) were 99% and 94%, respectively. Those against vancomycin and teicoplanin of E. faecium (M0208) were 99% and 94%, respectively. Those against vancomycin, oxacillin, penicillin G, clindamycin, erythromycin, ciprofloxacin, gentamicin and teicoplanin of S. aureus (M0213) were 87%, 95%, 93%, 93%, 93%, 82%, 92%, 99%, and 95%, respectively. The acceptable percentages on disk diffusion test against ciprofloxacin, imipenem, ampicillin, cefotaxime, and cephalothin of E. coli (M0214) were 98%, 100%, 98%, 96%, and 87%, respectively. Those against ciprofloxacin, imipenem, ampicillin, cefotaxime, and cephalothin of K. pneumoniae (M0215) were 96%, 100%, 98%, 93% and 99%, respectively. Those against vancomycin, ciprofloxacin, ampicillin, penicillin G, erythromycin, and teicoplanin of E. faecalis (M0216) were 91%, 85%, 94%, 87%, 97%, and 100%, respectively. Those against ciprofloxacin, gentamicin, imipenem, ceftazidime, and piperacillin of P. aeruginosa (M0217) were 89%, 99%, 100%, 100%, and 100%, respectively. Those against amikacin, ciprofloxacin, gentamicin, imipenem, ampicillin, cefotaxime, and cephalothin of E. coli (M0218) were 98%, 98%, 98%, 100%, 98%, 100% and 90%, respectively. Those against amikacin, ciprofloxacin, gentamicin, imipenem, ampicillin, cefotaxime, and cephalothin of K. pneumoniae (M0219) were 97%, 97%, 98%, 100%, 99%, 99% and 99%, respectively. Twenty laboratories on Trial III had reported the both results of disk diffusion and MIC methods. The performance on the automated or E-test susceptibility tests was generally good, except in case of teicoplanin, showing the lower MIC in 63% of 51 participants. The susceptibility against teicoplanin should be confirmed by disk diffusion method in case of vancomycin-resistant Enterococcus in the laboratories using automated MIC methods. In conclusion, it is necessary that the quality assurance of the individual laboratories should be improved in the identification of malaria and Enterococcus spp., and in susceptibility tests against vancomycin, erythromycin and ciprofloxacin of S. aureus, and cephalothin of E. coli in case of disk diffusion method, and teicoplanin of Enterococcus in the laboratories using automated MIC methods.
Aeromonas hydrophila ; Alternaria ; Amikacin ; Ampicillin ; Cefotaxime ; Ceftazidime ; Cephalothin ; Ciprofloxacin ; Clindamycin ; Diffusion ; Enterococcus ; Erythromycin ; Gentamicins ; Gram-Positive Rods ; Imipenem ; Korea* ; Leuconostoc ; Malaria ; Oxacillin ; Penicillin G ; Piperacillin ; Plasmodium falciparum ; Pneumonia ; Teicoplanin ; Vancomycin

OBJECTIVE: To evaluate the efficacy of radiofrequency ablation (RFA) in the treatment of loco-regional, recurrent, and well-differentiated thyroid carcinoma. MATERIALS AND METHODS: Thirty-five recurrent well-differentiated thyroid carcinomas (RTC) in 32 patients were treated with RFA, between March 2008 and October 2011. RTCs were detected by regular follow-up ultrasound and confirmed by biopsy. All patients had fewer than 3 RTCs in the neck and were at high surgical risk or refused to undergo repeated surgery. Average number of RFA sessions were 1.3 (range 1-3). Post-RFA biopsy and ultrasound were performed. The mean follow-up period was 30 months. Pre- and post-RFA serum thyroglobulin values were evaluated. RESULTS: Thirty-one patients with 33 RTCs were treated with RFA only, whereas 1 patient with 2 RTCs was treated with RFA followed by surgery. At the last follow-up ultrasound, 31 (94%) of the 33 RTCs treated with RFA alone completely disappeared and the remaining 2 (6%) RTCs showed decreased volume. The largest diameter and volume of the 33 RTCs were markedly decreased by 93.2% (from 8.1 +/- 3.4 mm to 0.6 +/- 1.8 mm, p < 0.001) and 96.4% (from 173.9 +/- 198.7 mm3 to 6.2 +/- 27.9 mm3, p < 0.001), respectively. Twenty of the 21 RTCs evaluated with post-RFA biopsies (95%) were negative for malignancy. One (5%) showed remaining tumor that was removed surgically. The serum thyroglobulin was decreased in 19 of 26 patients (73%). Voice change developed immediately after RFA in 6 patients (19%) and was spontaneously recovered in 5 patients (83%). CONCLUSION: Radiofrequency ablation can be effective in treating loco-regional, recurrent, and well-differentiated thyroid carcinoma in patients at high surgical risk.
Adult ; Aged ; Aged, 80 and over ; Carcinoma/*pathology/surgery/ultrasonography ; Catheter Ablation ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Thyroglobulin/blood ; Thyroid Neoplasms/*pathology/surgery/ultrasonography ; Tomography, X-Ray Computed

Two trials of external quality assessment for clinical microbiology laboratory were performed in 2005. A total of 12 specimens were distributed. Six specimens were distributed to 308 laboratories with 272 (88.3%) returns in Trial I and 276 (89.6%) returns in Trial II. The acceptable percentages of Gram-stain were relatively good. The acceptable percentages of bacterial identification on Acinetobacter baumannii, Staphylococcus aureus, Streptococcus pyogenes, Aeromonas hydrophila, Enterococcus casseliflavus, Brucella species (Trial I) were 80.1%, 98.3%, 87.6%, 81.3%, 55.5%, 38.1%, respectively. The acceptable percentages of bacterial identification on Klebsiella pneumoniae, Enterococcus faecalis, Brahamella catarrhalis, Burkholderia cepacia, Campylobacter fetus, Rhodoccus equi (Trial II) were 97.5%, 85.9%, 71.0%, 85.9%, 8.3%, 51.0%, respectively. The acceptable percentages for antimicrobial susceptibility tests on Acinetobacter baumannii, Staphylococcus aureus and Klebsiella pneumoniae were relatively high, but those on Klebsiella pneumoniae for ESBL and Enterococcus faecalis for vancomycin-resistance were not high. In conclusion, the acceptable percentages of bacterial stain and identification were relatively good except C. fetus. However, it is necessary that the quality assurance of the individual laboratories should be improved for antimicrobial susceptibility tests, and the selection of the most appropriate antimicrobial agents to test should be also considered.
Acinetobacter baumannii ; Aeromonas hydrophila ; Anti-Infective Agents ; Brucella ; Burkholderia cepacia ; Campylobacter fetus ; Enterococcus ; Enterococcus faecalis ; Fetus ; Klebsiella pneumoniae ; Korea* ; Staphylococcus aureus ; Streptococcus pyogenes

BACKGROUND: Alveolar recruitment (RM) is one of the primary goals of respiratory care for an acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). The purposes of alveolar recruitment are an improvement in pulmonary gas exchange and the protection of atelectrauma. This study examined the effect and safety of the alveolar RM using pressure control ventilation (PCV) in early ALI and ARDS patients. METHODS: Sixteen patients with early ALI and ARDS who underwent alveolar RM using PCV were enrolled in this study. The patients' data were recorded at the baseline, and 20 minutes, and 60 minutes after alveolar RM, and on the next day after the maneuver. Alveolar RM was performed with an inspiratory pressure of 30 cmH2O and a PEEP of 20 cmH2O in a 2-minute PCV mode. The venous O2 saturation, central venous pressure, blood pressure, pulse rate, PaO2/FiO2 ratio, PEEP, and chest X-ray findings were obtained before and after alveolar RM. RESULTS: Of the 16 patients, 3 had extra-pulmonary ALI/ARDS and the remaining 13 had pulmonary ALI/ARDS. The mean PEEP was 11.3 mmHg, and the mean PaO2/FiO2 ratio was 130.3 before RM. The PaO2/FiO2 ratio increased by 45% after alveolar RM. The PaO2/FiO2 ratio reached a peak 60 minutes after alveolar RM. The PaCO2 increased by 51.9 mmHg after alveolar RM. The mean blood pressure was not affected by alveolar RM. There were no complications due to pressure injuries such as a pneumothorax, pneumomediastinum, and subcutaneous emphysema. CONCLUSION: In this study, alveolar RM using PCV improved the level of oxygenation in patients with an acute lung injury and acute respiratory distress syndrome. Moreover, there were no significant complications due to hemodynamic changes and pressure injuries. Therefore, alveolar RM using PCV can be applied easily and safely in clinical practice with lung protective strategy in early ALI and ARDS patients.
Acute Lung Injury* ; Blood Pressure ; Central Venous Pressure ; Heart Rate ; Hemodynamics ; Humans ; Lung ; Mediastinal Emphysema ; Oxygen ; Pneumothorax ; Pulmonary Gas Exchange ; Respiratory Distress Syndrome, Adult* ; Subcutaneous Emphysema ; Thorax ; Ventilation*