OBJECTIVES: The purpose of this study was to define the underserved emergency medical services (EMS) areas in Daejeon metropolitan city, as well as to identify their distinctive characteristics in public health perspectives. METHODS: An underserved EMS area was operationally defined as an area in which it is difficult to arrive at an emergency medical center within 30 minutes. Using a cost-weighted distance algorithm with a geographic information system (GIS), the underserved EMS area was calculated. The characteristics of the underserved areas were analyzed by the Chi-square test. The SPSS statistical software package was used to perform the statistical analysis. All statistical tests were two-sided, and a p-value<0.05 was considered statistically significant. RESULTS: Twelve administrative sectors ('Dong' in Korean) were included in the underserved areas, accounting for a population of approximately 8,100 citizens. The relationships between underserved EMS area and populations of agriculture, fishery, and forestry; citizens who are recipients of national basic livelihood security program; disabled; or aged 65 or older were statistically significant. CONCLUSION: It was found that 12 administrative sectors were included in the underserved EMS areas. Revealing underserved EMS areas using GIS analysis based on a cost-weighted distance algorithm of road data was an effective analytic method. However, as this study was confined to Daejeon City, South Korea, a nation-wide study should be performed to provide a more accurate conclusion.
Accounting ; Aged ; Agriculture ; Emergencies ; Emergency Medical Services ; Fisheries ; Geographic Information Systems ; Humans ; Public Health ; Republic of Korea

PURPOSE: To describe plain radiographic and thin-section CT findings of hematogenous candida pneumonia in major burn patients. MATERIAL AND METHOD: We reviewed nine cases of hematogenous candida pneumonia in major burn patients who had positive blood culture for candida and findings of pneumonia on plain chest radiograph. On five of nine cases, thin-section CT was done. We evaluated retrospectively nine cases for onset, the pattern, distribution, and size of lesions on plain chest radiograph and thin-section CT. RESULTS: On plain chest radiograph, randomly distributed 2-10mm nodules were seen in six cases(66%) and randomly distributed 10-15mm consolidations in remaining three cases{33% ). Lesion occured in 11th to 75th post-burn day{average, 34th post-burn day). Other findings were cardiomegaly in three cases, atelectasis in three cases, and pulmonary edema in one case. Thin-section CT showed variable shaped subpleural nodules in all five cases. The size of nodules were 1-5mm in two cases(40%) and 5-10mm(60% ) in three cases. Feeding vessel signs were seen in two cases. Other findings were atelectasis in three cases, cardiomegaly in three cases, ground-glass opacity and interlobular septal thickenings by pulmonary edema in two cases. CONCLUSION: Plain chest radiographic findings of hematogenous candida pneumonia in major burn patients are randomly distributed nodules or consolidations of variable size. Thin-section CT findings are variable shaped subpleural nodules less than 1 cm.
Burns* ; Candida* ; Cardiomegaly ; Humans ; Pneumonia* ; Pulmonary Atelectasis ; Pulmonary Edema ; Radiography, Thoracic* ; Retrospective Studies ; Thorax*

OBJECTIVE: Reflex sympathetic dystrophy (RSD) is a syndrome of post-traumatic neuropathic pain in association with dystrophic changes and signs of sympathetic overactivity. Pain following spinal cord injury occurs frequently, but RSD is not usually considered as one of the common sources of pain. There have only been a few reports of RSD in spinal cord injured patients, although this condition is well-known in the painful upper extremity of hemiplegia due to stroke. The purpose of this study was to investigate the rate of occurrence, characteristic clinical features and more objective evaluation tools for the diagnosis of RSD in cervical cord injured patients. METHOD: Thirty-two cervical cord injured patients were evaluated for hand pain, swelling, vasomotor changes and dystrophic skin or nail changes. The patients were evaluated with studies such as three phase bone scintigrathy, digital infrared thermographic imaging (DITI) and plain roentgenograms of the hands. RESULTS: Eighteen patients (56.3%) were diagnosed as RSD based on the clinical symptoms and findings of three phase bone scintigraphy. Characteristic symptoms were hand pain, edema and dystrophic skin or nail changes, in the order of frequency. In patients with spasticity of the upper extremity, the incidence of RSD was higher than in patients without spasticity. CONCLUSION: We should consider RSD as a cause of upper extremity pain in cervical cord injured patients. This will lead to early diagnosis and treatment of the condition and it will be helpful in preventing various complications.
Diagnosis ; Early Diagnosis ; Edema ; Hand ; Hemiplegia ; Humans ; Incidence ; Muscle Spasticity ; Neuralgia ; Radionuclide Imaging ; Reflex Sympathetic Dystrophy* ; Reflex* ; Skin ; Spinal Cord ; Spinal Cord Injuries ; Stroke ; Upper Extremity

OBJECTIVE: To assess the relationship between vaginal cytology and bone mineral density in postmenopausal women. METHODS: In 93 postmenopausal women, vaginal cytology smears were taken for maturation index, serum estradiol level and bone mineral density were also taken. the percentage of each cell type found By vaginal cytology was multiplied to its specific value:superficial cells, 1.0; intermediate cell, 0.6; parabasal cell, 0.2 and modified to maturation value. Bone mineral density was measured at lumbar spine using DEXA. RESULTS: The mean bone mineral density was 0.88+/-0.14g/cm2. Mean maturation value was 50.53+/-20.74 and it was related with age and bone mineral density. CONCLUSION: Maturation value of vaginal epithelial cell represents the influence of estrogen on bone mineral density.
Bone Density* ; Epithelial Cells ; Epithelium* ; Estradiol ; Estrogens ; Female ; Humans ; Spine

PURPOSE: The prevalence of developmental delay is 5-10% of the total pediatric population and early diagnosis and proper intervention are essential but a challenge for clinicians. We performed this study for several purposes. First is to know the distribution & characteristics of developmental disorders in Korea. Second is to identify all possible causes of these disorders through a multidisciplinary diagnostic approach, and thus to find out the clinical variables that are helpful in finding the etiology. And finally to develop a useful protocol that eliminates the cost of unnecessary tests and raises the diagnostic rate of the cause. METHODS: 518 patients(M 349, F 169) were studied who visited Ilsan Hospital Developmental Disorder Clinic(DDC) for the evaluation of developmental delay from April 2001 to Jan 2005. RESULTS: The mean age was 51.5+/-32.9 months, ranging from 2 months to 16.0 years of age with a majority of the preschool children(<6 yr)(79.3%). Phenomenological diagnosis consisted of 133 cases of mental retardation, 122 cases of autistic disorders, 101 cases of delayed language disorders, 27 cases of cerebral palsies, and 91 cases labeled as simple developmental delay requiring follow up due to age less than 2 years of age. Etiologic diagnosis was obtained in 119 cases(22.9%) out the 518 cases of developmental delays. 37 cases of chromosomal anomalies, 23 cases of Periventricular leukomalacia and hypoxic ischemic encephalopathy, 21 cases of syndromes, 7 cases of malformation of cortical development, 4 cases of myopathies, 4 cases of neuropathies, and 4 cases of cerebral infarctions were found. Among the clinical variables, low birth weight, facial dysmorphism, hypotonia, focal neurologic signs, and abnormalities in MRI, chromosome, EEG and EMG studies contributed to the yields of etiologic diagnosis significantly. CONCLUSION: Possible etiology was determined in about 23% of the subjects. The most important part of the assessment for the identification of etiology is thorough history taking, physical and neurologic examination. Neuroimaging study is useful in case of micro or macrocephaly, focal neurologic signs. Genetic studies increasingly produce a yield, when there is family history of inherited disorder and there are dysmorphic features. Routine metabolic screening test has limited utility. Development of a useful screening protocol adequate for Korean situation is required.
Cerebral Infarction ; Diagnosis ; Early Diagnosis ; Electroencephalography ; Follow-Up Studies ; Humans ; Hypoxia-Ischemia, Brain ; Infant, Low Birth Weight ; Infant, Newborn ; Intellectual Disability ; Korea ; Language Disorders ; Leukomalacia, Periventricular ; Macrocephaly ; Magnetic Resonance Imaging ; Mass Screening ; Muscle Hypotonia ; Muscular Diseases ; Neuroimaging ; Neurologic Examination ; Neurologic Manifestations ; Paralysis ; Prevalence

PURPOSE: The purpose of this study to access MR findings of the lipomatous soft tissue tumor based on histopathologic correlation and its predictability of the histopathologic diagnosis. MATERIALS AND METHODS: We retrospectively analyzed the MR findings and photomicrographs of 9 patients with histopathologically proven lipomatous soft tissue tumors as follows;classic lipoma(4), fibrolipoma(1), lipoblastoma(2), atypical l ipoma(1) and well-differentiated liposarcoma(1). RESULTS: All cases of lipoma showed the same signal intensities as subcutaneous fat which is composed of mature fat cells. Linear low signal intensity lesions corresponded to fibrous connective tissues within lipomas. Two cases of lipoblastoma showed heterogeneous signal intensity with areas of high signal intensity brighter than subcutaneous fat on T2WI, corresponding to myxoid matrix of cytoplasm of immature lipoblasts, and the areas of myxoid degeneration within tumors. Both atypical lipoma and liposarcoma showed heterogeneous signal intensity with ill-defined margins due to presence of lipoblasts and infiltration to adjacent muscle bundles. CONCLUSION: MR image findings were well correlated with histopathologic findings of lipomatous soft tissue tumor, especially with maturity of fat cells and the signal intensity of mesenchymal components within the tumors. MR may predict the pathologic diagnosis of lipoblastoma by presence of myxoid degeneration within Ihe tumor, but atypical lipoma and liposarcoma revealed similar MR findings.
Adipocytes ; Connective Tissue ; Cytoplasm ; Diagnosis ; Humans ; Lipoblastoma ; Lipoma ; Liposarcoma ; Magnetic Resonance Imaging* ; Retrospective Studies ; Subcutaneous Fat

To evaluate the refractive error and glasses wering state, we performed screening eye examination on elementary school children living in rural area. Among 1254 shcool children(male : 542, female : 712), 352(28.1%) children were emmetropia and 902(71.9%) children ametropia. Three hundred ninety two(72.3%) of 542 male students and 510(71.6%) of 712 female students were not emmetropia. There was no statistical significance in sexual difference of refractive errors. As refractive errors, 38.3%(481) were myopia, 27.8%(348) hyperopia, and 5.8%(73( mixed astigmatism respectively. In diopteric distribution of refractive errors, refractive error under +/-2.0D was 72.0%(650/902). Among children with refractive errors, 333(36.9%) children did not require glasses, but rest of childfen needed glasses. Three hundred nine(34.3%) children did not wear glasses inspite of refractive errors, 33(3.7%) children were wearing incorrect glasses and 2 children were wearing glasses unnecessarily. In children, early eye examination is essential for their eye health. Therefore attention to early eye examination and correct glasses wearing seem to be very important especially for child living in rural area.
Astigmatism ; Child* ; Emmetropia ; Eyeglasses ; Female ; Glass ; Humans ; Hyperopia ; Male ; Mass Screening ; Myopia ; Refractive Errors

The majority of the cysts developed in pancreas are inflammatory pseudocyst but neoplastic cysts are rarely encountered Especially, mucinous cystadenoma which was begun and originated from epithelial cell of pancreatic duct is difficult to differentiate from pseudocysts by preoperative clinical, laboratory and radiologic findings. Mucinous cystadenoma has a malignant potentiality, so complete excision of cystadenoma is the treatment of choice. Recently, we experienced one case of mucionus cystadenoma in 37 year-old female, we report it with a review of the literature.
Adult ; Cystadenoma ; Cystadenoma, Mucinous* ; Epithelial Cells ; Female ; Humans ; Mucins* ; Pancreas* ; Pancreatic Ducts

Unilateral nevoid telangiectasia is a rare but clinica.lly distinct dermatosis first deacribed by Zeisler in 1922. It had been also called as linear telangiectasia or unilateral telangiectasia. Wilkin suggested the term unilateral dermatomal superficial telangiectasia, in 1977. There are some reports of congenital unilateral nevoid telangiectasia but it usually occurs in women during the puberty and the third decade. Clinically it is characterized by superficial telangiectatic lesions distributed along the dermatomes uniIaterally and usually on the upper part of the body. It was reported that unilateral nevoid telangiectasia was related with elevated serum estrogen level in the many cases. We present two patients, 23-year and 25-year-old male soldiers, whose leaions were consistent with unilateral nevoid telangiectasia elinically and histopathologically.
Adolescent ; Adult ; Estrogens ; Female ; Humans ; Male ; Military Personnel ; Puberty ; Skin Diseases ; Telangiectasis*

It is said that respiratory failure as an initial manifestation is extremely rare in adult polymyositis. Respiratory failure has been reported in the terminal stage of polymyositis and usually unresponsive to steroid therapy. We experienced two cases of polymyositis presenting with respiratory failure at onset due to respiratory muscle weakness. On admission they had only short history of increasing dyspnea and mild limb weakness before respiratory failure. Diagnosis of polymyositis was established by muscle enzyme, electromyography and muscle biopsy. Oral steroid therapy was initiated with assisted ventilation which resulted in good recovery. Although respiratory failure due to preferential respiratory muscle involvement is very rare, polymyositis should be considered as one of underlying diseases causing severe respiratory failure.
Adult ; Biopsy ; Diagnosis ; Dyspnea ; Electromyography ; Extremities ; Humans ; Polymyositis* ; Respiratory Insufficiency* ; Respiratory Muscles ; Ventilation