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

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

Whiplash injury in low-speed traffic accidents are not objectively verified by medical equipment, thereby creating scope for misuse, which has resulted in huge social losses worldwide. The aim of this study was to examine the influence of low-speed vehicular rear-impact collisions on middle-aged men, and to analyze the head and neck injury criteria for the symptomatic human volunteers. Data was examined from the results of 50 dynamic sled tests, originally performed by Hong et al. (2012). In the previous tests, 50 men aged 30~50 years were exposed to an impulse equivalent to a bumper-to-bumper rear collision under medical supervision, and no resulting whiplash injury was identified. In this study, for 6 subjects who experienced dull aches over their bodies, head injury criteria (HIC15) and neck injury criteria (N(km)) were calculated according to the accelerations, forces, and moments at the occipital condyle measured by motion capture system. Although there were no changes in magnetic resonance imaging findings in all subjects at the pre-/post-test orthopedic examination, 6 subjects revealed mild aches around the shoulder, back, or lumbar area, and their symptoms disappeared within 2 days. The head and neck injury criteria, HIC15 (3.086 +/- 2.942) and N(km) (0.077 +/- 0.064) were obtained, and the maximum HIC15 and N(km) were found to be significantly lower than the critical injury assessment reference values (HIC15: 700, N(km): 0.3). Moreover, even though 2 subjects were exposed to the same level of change of velocity (7.9 km/h), each N(km) was significantly different (0.179, 0.057). One can therefore conclude that N(km) can vary according to voluntary movements in the human subject.
Acceleration ; Accidents, Traffic ; Aged ; Automobiles ; Craniocerebral Trauma ; Head ; Human Experimentation ; Humans ; Magnetic Resonance Imaging ; Male ; Neck ; Neck Injuries ; Organization and Administration ; Orthopedics ; Reference Values ; Shoulder ; Whiplash Injuries

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

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

STATEMENT OF PROBLEM: While patient-centered outcomes are usually not reported, these may represent major aspects of the implant success for the patient. Use of a well-designed patient survey form can be an invaluable asset to the implant practitioners. PURPOSE: The objective of this study was to investigate patient satisfaction after implant therapy by means of a questionnaire. MATERIAL AND METHODS: South Korean patients (n = 100), who visited the dental examination center of Soon Chun Hyang university hospital, were asked to fill out the satisfaction questionnaire regarding aspects of cost, comfort, esthetics, chewing, gingival health, food impaction, phonetic aspect, screw loosening, and general satisfaction. Responses to statements were given on the Likert response scale. Four experimental groups of patients were distinguished with various location (A1, A2, A3), year (B1, B2, B3), number of implant replacements (C1, C2, C3), and treatment cost (D1, D2, D3). The reliability of the response scales was measured by calculation of its internal consistency, expressed as Cronbach's alpha. The scales were distinguished by means of factor analysis method. Possible differences in scale scores among the groups were assessed by One-way ANOVA (alpha = 0.05). RESULTS: Patients responded to most of the statements with high satisfaction. But the mean scale score of statement about cost was low. After the verification of internal consistency and factor analysis, five components, e.g. general satisfaction, comfort, chewing efficiency, esthetics, and phonetic aspect were grouped together. These components could be explained with common meaning and the first factor was named as 'general satisfaction' . Differences in patient satisfaction on the scale with esthetics were present between patients who have been wearing the implant prosthesis less than three years and those more than seven years (B1 < B3). CONCLUSION: The patients were generally satisfied with the outcome of implant treatment. But the patients' major complaint was high cost and while the statistically significant difference was not shown, the satisfaction scale about food impaction and esthetics was low. So the continuing efforts to make improvements about these problems are needed for the implant practitioners.
Dental Implants ; Esthetics ; Factor Analysis, Statistical ; Health Care Costs ; Humans ; Mastication ; Patient Satisfaction ; Prostheses and Implants ; Surveys and Questionnaires ; Weights and Measures

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