The purpose of this study is to examine the factors influencing the allergic rhinitis patients' satisfaction with laser surgery. The data were collected by telephone interviews with 211 patients who visited E university hospital. The statistical methods used for the analysis were factor analysis, reliability test, and hierarchical multiple regression. We find that satisfaction level is a function of not only the surgery outcome but also the socio-psychological experience during treatment. With the improvement in nasal allergic condition, patients were more likely to be satisfied with medical services. And patients who had positive experience with physicians and facilities reported higher satisfaction level. While the surgery outcome explained 68% of the variation of satisfaction level, socio-psychological experience explained 23% of it. This result clearly shows that physicians need to pay attention to the socio-psychological aspect as well as the technical aspect of medical services.
Humans ; Interviews as Topic ; Laser Therapy* ; Patient Satisfaction* ; Rhinitis*

The authors reviewed 11 consecutive patients with hemorrhage in pituitary adenomas, which were treated by transsphenoidal approach from Jan. 1992 to Dec. 1997. We evaluated nine cases of female and 2 cases of male patients(mean age: 43.4 years old). The diagnosis of pituitary apoplexy was made by severe neurologic sign with sudden onset of headache and visual disturbance, in the setting of hemorrhage in the pituitary adenoma on computed tomographic or magnetic resonance imaging scans. Two cases were diagnosed as pituitary apoplexy and the remaining cases were diagnosed as intratumoral hemorrhages. In our series, the most common symptoms were headache(81.8%) and visual disturbance(81.8%). Other symptoms and signs were hormonal symptoms(63.6%) due to preexisting tumor, cranial nerve signs(18.2%) and alteration of mentality(18.2%). Radiologic findings were changes of sellar contour(double floor sign, widened sellae and obliteration of anterior or posterior clinoid processes) on plain skull X-ray, high density lesion in sellar area on computed tomographic scan. The magnetic resonance images were taken in all patients. Among 11 patients, 9 cases showed subacute hemorrhage(high signal intensity on T1 weighted image) and 2 showed that of chronic stage(iso signal intensity on T1 image and high signal intensity on T2 image). According to the hormonal type, the most common type of tumors associated with intratumoral hemorrhage was non-functioning adenoma(7 cases) compared to other types(GH secreting: 2, ACTH secreting: 1, Prolactin secreting: 1). All patients showed significant improvement of symptoms after surgery(average follow-up, 12.5 months). Rapid diagnosis with computed tomography and/or magnetic resonance imaging, hormonal replacement and transsphenoidal decompression constituted effective therapy.
Adrenocorticotropic Hormone ; Cranial Nerves ; Decompression ; Diagnosis ; Female ; Follow-Up Studies ; Headache ; Hemorrhage* ; Humans ; Magnetic Resonance Imaging ; Male ; Neurologic Manifestations ; Pituitary Apoplexy ; Pituitary Neoplasms* ; Prolactin ; Skull

No abstract available.
Animals ; Hypothermia* ; Rats*

BACKGROUND: Transcatheter closure of patent ductus arteriosus, using the Rashkind double umbrella occluder system, had been attempted in mulitcenter since non-surgical closure of patent ductus arteriosus by Rashkind. METHODS: Between July 1991 and June 1993, transcatheter closure of patent ductus arterious was attempted in 20 adult patients(21 trials). RESULTS: Seventeen female and 3 male patients was consisted of the study. The patient age ranged from 17 to 54 years(mean 30+/-9 years). Mean pulmonary artery pressure before closure was 18.5+/-6.0mmHg(range from 10mmHg to 30mmHg). The diameter of ductus ranged from 3.5mm to 8.0mm(mean 5.2+/-1.5mm), as determined by contrast injection through 11F Mullin sheath or 7F catheter. There was significant decrease of Qp/Qs from 2.6+/-1.1 to 1.5+/-0.4 immediately after transcatheter closure of ductus(p<0.01). There was significant decrease of left ventricular end-diastolic dimension by echocardiogram from 58.7+/-7.6mm to 53.6+/-6.5mm after transcatheter closure of ductus(p<0.01). Among the 21 cases, 16 cases(76.2%) had the clinical improvement without the support of surgical closure. One 17mm Rashkind umbrella was retrieved because of position and problem of deployment. There was no device embolic experience in 21 cases. There were 2 cases of hemolytic anemia during the follow-up period ; one case was surgically ligated and another 17mm device was implanted in the other case. CONCLUSIONS: Transcatheter closure of patent ductus arteriosus in adult patients can replace the surgical correction in selected patients.
Adult* ; Anemia, Hemolytic ; Catheters ; Ductus Arteriosus, Patent* ; Female ; Follow-Up Studies ; Humans ; Male ; Pulmonary Artery

OBJECTIVE: To elucidate the problems that must be dealt with in the prognosis of patients with severe head injury and to find out the prognosis factors related to severe head injury. METHODS: A clinical analysis was carried out retrospectively with 292cases of severe head- injured patients (Glasgow coma scale score 3-8) admitted to the our department for 10 years from January 1987 to December 1996. RESULTS: Patients who were classified as having severe brain injury belonged to 13.1% of all craniocerebral trauma cases among which sixty-three cases had diffuse brain injury. The causes of head injuries were motor vehicle accident, falls from heights, bicycle and other causes in order of frequency. Pediatric patients showed better outcome(51.4%), compared with only 28.1% of all adult cases(p<0.0001). The patients with high initial GCS score(6-8, 47.9%) had significantly better outcome than the patients with low initial GCS socre(3-5, 16.9%) (p<0.0001). Fifty point three percents of patients with good motor response had good outcome, whereas only 15.8 percent in patients with poor motor response. The cases with diffuse head injury without basal cistern compression had significantly higher percentage of good outcome(74.0%) than those with basal cistern compression(16.9%, p<0.0001). The cases with normal pupillary reaction had significantly higher percentage of good outcome(50.3%) than those with bilateral oculomotor nerve palsy(18.4%, p<0.0001). The patients with skull fracture had good outcome(48.1%), compare to 20.3% of patients without skull fracture(p<0.0017). CONCLUSION: The good prognostic factors in this study were young age, initial high Glasgow coma scale, good motor response, diffuse brain injury type I, II, bilaterally intact light reflex, with skull fracture. Individual prognostic factor is significant to indicate the patient's outcome and may be utilized for assessing the relative efficacy of the alternative treatment and prognosis.
Adult ; Brain Injuries ; Coma ; Craniocerebral Trauma* ; Fibrinogen ; Glasgow Coma Scale ; Head* ; Humans ; Motor Vehicles ; Oculomotor Nerve ; Prognosis ; Reflex ; Retrospective Studies ; Skull ; Skull Fractures

OBJECTIVE: The purpose of this retrospective study is to review the clinical results, fusion rate, quality of reduction and stabilization and effects of cages in the intervertebral space in spondylolisthesis. METHODS: Authors reviewed retrospectively 30 patients who were treated with instrumentation and posterior lumbar interbody fusion(PLIF) between April 1996 to December 1997. RESULTS: Among 30 patients, 13 patients were degenerative type and 17 were isthmic types. The most commonly involved level was L4-5(16cases, 53.3%). Fusion was obtained in 29 patients(96.7%). Clinically, 14 of 17 patients(82.3%) showed excellent or good results in isthmic group, and 11 of 13 patients(84.6%) showed excellent or good results in degenerative group. Postoperative complications developed in three cases(10%), wound infection two cases(6.6%), cage retrodisplacement one case(3.3%). CONCLUSION: PLIF combined with transpedicular instrumentation in lumbar spondylolisthesis showed in all clinical results and fusion rate.
Humans ; Postoperative Complications ; Retrospective Studies ; Spondylolisthesis* ; Wound Infection

Coxiella burnetii is the etiological agent of Q fever, that may occur either acutely or the chronically. To understand the seroepidemiological patterns of C. burnetii infection in Korea, we examined a total of 3,178 sera from patients with acute febrile episodes by using indirect immunofluorescence assay (IFA) for detectable antibodies to C. burnetii and other eight rickettsial antigens. The IFA seropositivity>or=1:20 for C. burnetii phase II was 11.5% (368 out of 3,178 sera). The co-existence of antibodies to other rickettsial antigens was found in 216 out of the 368 positive sera. Thirty-seven point five percent (n=138) had antibodies to R. tsutsugamushi (cutoff>or=1:20), 16% (n=59) to Ehrlichia sennetsu, 14.9% (n=55) to Rickettsia typhi, 13.5% (n=50) to R. akari, 11.4% (n=42) to R. japonica, 8.9% (n=33) to R. prowazekii, 7.6% (n=28) to R. sibirica, and 6.7% (n=25) to R. conorii by IFA, respectively. These results are consistent with previous reports documenting diverse serum cross-reactivity in chronic Q fever. Therefore we excluded the samples that reacted to other rickettsial antigens at same or higher titers than to C. burnetii, resulting in the seropositive rate of 4.1%. The serological prevalence was 2% (n=64) when the conventional cut-off titer of 1:80 was used. Our results suggest that infections with C. burnetii are more prevalent than expected previously and should be differentially diagnosised for febrile illness occurring after exposure to ticks or other vectors.
Antibodies ; Coxiella burnetii* ; Coxiella* ; Diagnosis ; Fluorescent Antibody Technique, Indirect ; Humans ; Korea ; Neorickettsia sennetsu ; Prevalence ; Q Fever ; Rickettsia ; Rickettsia typhi ; Seroepidemiologic Studies* ; Ticks

PURPOSE: In outbreaks of infectious disease, medical students are easily overlooked in the management of healthcare personnel protection although they serve in clinical clerkships in hospitals. In the early summer of 2015, Middle East respiratory syndrome (MERS) struck South Korea, and students of Sungkyunkwan University School of Medicine (SKKUSOM) were at risk of contracting the disease. The purpose of this report is to share SKKUSOM's experience against the MERS outbreak and provide suggestions for medical schools to consider in the face of similar challenges. METHODS: Through a process of reflection-on-action, we examined SKKUSOM's efforts to avoid student infection during the MERS outbreak and derived a few practical guidelines that medical schools can adopt to ensure student safety in outbreaks of infectious disease. RESULTS: The school leadership conducted ongoing risk assessment and developed contingency plans to balance student safety and continuity in medical education. They rearranged the clerkships to another hospital and offered distant lectures and tutorials. Five suggestions are extracted for medical schools to consider in infection outbreaks: instant cessation of clinical clerkships; rational decision making on a school closure; use of information technology; constant communication with hospitals; and open communication with faculty, staff, and students. CONCLUSION: Medical schools need to take the initiative and actively seek countermeasures against student infection. It is essential that medical schools keep constant communication with their index hospitals and the involved personnel. In order to assure student learning, medical schools may consider offering distant education with online technology.
Clinical Clerkship ; Communicable Diseases ; Communicable Diseases, Emerging ; Coronavirus Infections* ; Decision Making ; Delivery of Health Care ; Disease Outbreaks ; Education ; Education, Medical ; Humans ; Korea ; Leadership ; Learning ; Lectures ; Middle East* ; Risk Assessment ; Schools, Medical* ; Students, Medical

Background/Aims: Although mucosal healing (MH) is acknowledged as the treatment target in the treat-to-target era, there are limitations on repeated endoscopic examinations, especially in pediatric patients. We aimed to investigate whether fecal calprotectin (FC) could serve as a surrogate marker for the assessment of MH in pediatric patients with Crohn’s disease (CD) who have achieved sustained clinical remission (CR) while treated with anti-tumor necrosis factor (TNF) agents. Methods: This multicenter retrospective cross-sectional study included pediatric CD patients who had sustained a CR for at least 6 months with anti-TNF agents and who simultaneously underwent ileocolonoscopy and FC tests during follow-up. MH was defined as the absence of any ulcer on ileocolonoscopy. Results: A total of 131 patients were included in this study. MH was observed in 87 patients (66.7%). The FC level was significantly lower in patients with MH than in those without MH (median 49.0 mg/kg vs 599.0 mg/kg; p<0.001). According to the multivariate logistic regression analysis, FC was the only factor associated with MH (odds ratio, 0.62; 95% confidence interval [CI], 0.52 to 0.73; p<0.001). According to the receiver operating characteristic curve analysis, the optimal cutoff value for FC for the association with MH was <140 mg/kg (area under the curve 0.890, 95% CI 0.829 to 0.951, sensitivity 78.2%, specificity 88.6%, p<0.001). Conclusions FC was associated with MH in pediatric patients with CD who had achieved a sustained CR for at least 6 months with anti-TNF agents. In these patients, FC can be used to stratify patients and guide decisions regarding ileocolonoscopy in the treat-to-target era.

OBJECTIVE: To evaluate the accuracy of a computer-aided evaluation program (CAE) of breast MRI for the assessment of residual tumor extent and response monitoring in breast cancer patients receiving neoadjuvant chemotherapy. MATERIALS AND METHODS: Fifty-seven patients with breast cancers who underwent neoadjuvant chemotherapy before surgery and dynamic contrast enhanced MRI before and after chemotherapy were included as part of this study. For the assessment of residual tumor extent after completion of chemotherapy, the mean tumor diameters measured by radiologists and CAE were compared to those on histopathology using a paired student t-test. Moreover, the agreement between unidimensional (1D) measurement by radiologist and histopathological size or 1D measurement by CAE and histopathological size was assessed using the Bland-Altman method. For chemotherapy monitoring, we evaluated tumor response through the change in the 1D diameter by a radiologist and CAE and three-dimensional (3D) volumetric change by CAE based on Response Evaluation Criteria in Solid Tumors (RECIST). Agreement between the 1D response by the radiologist versus the 1D response by CAE as well as by the 3D response by CAE were evaluated using weighted kappa (k) statistics. RESULTS: For the assessment of residual tumor extent after chemotherapy, the mean tumor diameter measured by radiologists (2.0 +/- 1.7 cm) was significantly smaller than the mean histological diameter (2.6 +/- 2.3 cm) (p = 0.01), whereas, no significant difference was found between the CAE measurements (mean = 2.2 +/- 2.0 cm) and histological diameter (p = 0.19). The mean difference between the 1D measurement by the radiologist and histopathology was 0.6 cm (95% confidence interval: -3.0, 4.3), whereas the difference between CAE and histopathology was 0.4 cm (95% confidence interval: -3.9, 4.7). For the monitoring of response to chemotherapy, the 1D measurement by the radiologist and CAE showed a fair agreement (k = 0.358), while the 1D measurement by the radiologist and 3D measurement by CAE showed poor agreement (k = 0.106). CONCLUSION: CAE for breast MRI is sufficiently accurate for the assessment of residual tumor extent in breast cancer patients receiving neoadjuvant chemotherapy. However, for the assessment of response to chemotherapy, the assessment by the radiologist and CAE showed a fair to poor agreement.
Adult ; Antineoplastic Combined Chemotherapy Protocols/*therapeutic use ; Breast Neoplasms/*diagnosis/drug therapy/surgery ; *Diagnosis, Computer-Assisted ; Humans ; *Magnetic Resonance Imaging ; Middle Aged ; *Neoadjuvant Therapy ; Neoplasm, Residual ; Young Adult