A 49 years old male patient suffering from liver cirrhosis and diabetes mellitus was admitted with complaints of chest pain and hematemesis. Three years ago, the patient received a transfusion of unknown blood components, presumed platelet concentrates. During the pretransfusion testing, we found irregular antibodies with the antibody-screening test and identified the antibody as anti-Xga. An antiglobulin test was done as a part of a cross-match and all compatible units of packed red cells were transfused. No transfusion reaction was observed.
Antibodies ; Blood Group Incompatibility ; Blood Platelets ; Chest Pain ; Coombs Test ; Diabetes Mellitus ; Hematemesis ; Humans ; Liver Cirrhosis ; Liver Diseases* ; Liver* ; Male ; Middle Aged

PURPOSE: This study was conducted to assess the appropriateness of emergency department-based triage for determining whether to transfer of burn patients to a burn care specialty center. METHODS: Eligible subjects were enrolled from the EDbased injury surveillance registry from April 2006 to March 2007 in a regional emergency center, which logs more than 42,000 patients annually. To assess the appropriateness of emergency department-based triage for determining whether to transfer patients to a burn center, we used the transfer guidelines recommended by the American Burn Association as the gold standard. Under-triage (defined as non-transfer of a victim who should have been transferred) and the over-triage (defined as transfer of a victim who should not have been transferred) rates were calculated. RESULTS: The total number of burn injury victims was 144 and the male-female ratio was 1:1.15. The mean age was 25.5+/-20.9 years. The numbers of flame, electrical, chemical, inhalation, and other burn injuries were 133 (92.4%), 2 (1.4%), 6 (4.1%), 1 (0.7%), and 2 (1.4%), respectively. Of these 144 patients, 25 (17.4%) were transferred to the ED of a burn center after triage and primary management. The others were discharged and followed up at local clinics. The numbers of major and moderate burns that were indicated for transfer to the burn center were 33 (22.9%) and 3 (2.1%), respectively. The rates of under- and over-triage were 14.6% and 6.9%. CONCLUSION: The proportion of inappropriate disposition of burn injury in a regional emergency center was high (21.5%). Recommended guidelines for triage of burn injuries should be applied more strictly.
Burn Units ; Burns* ; Emergencies* ; Emergency Service, Hospital ; Humans ; Inhalation ; Triage*

BACKGROUND: Chest radiographs (CXR) are the most commonly used imaging techniques by various clinicians and radiologists. However, detecting lung lesions on CXR depends largely on the reader's experience level, so there have been several trials to overcome this problem using post-processing of CXR. We investigated the added value of bone suppression image (BSI) in detecting various subtle lung lesions on CXR with regard to reader's expertise. METHODS: We applied a software program to generate BSI in 1,600 patients in the emergency department. Of them, 80 patients with subtle lung lesions and 80 patients with negative finding on CXR were retrospectively selected based on the subtlety scores on CXR and CT findings. Ten readers independently rated their confidence in deciding the presence or absence of a lung lesion at each of 960 lung regions on the two separated imaging sessions: CXR alone vs. CXR with BSI. RESULTS: The additional use of BSI for all readers significantly increased the mean area under the curve (AUC) in detecting subtle lung lesions (0.663 vs. 0.706; P < 0.001). The less experienced readers were, the more AUC differences increased: 0.067 (P < 0.001) for junior radiology residents; 0.064 (P < 0.001) for non-radiology clinicians; 0.044 (P < 0.001) for senior radiology residents; and 0.019 (P = 0.041) for chest radiologists. The additional use of BSI significantly increased the mean confidence regarding the presence or absence of lung lesions for 213 positive lung regions (2.083 vs. 2.357; P < 0.001) and for 747 negative regions (1.217 vs. 1.195; P = 0.008). CONCLUSION: The use of BSI increases diagnostic performance and confidence, regardless of reader's expertise, reduces the impact of reader's expertise and can be helpful for less experienced clinicians and residents in the detection of subtle lung lesions.
Area Under Curve ; Diagnosis ; Emergency Service, Hospital ; Humans ; Image Processing, Computer-Assisted ; Lung ; Radiography ; Radiography, Thoracic ; Retrospective Studies ; Thorax

BACKGROUND/OBJECTIVES: Athletes generally desire changes in body composition in order to enhance their athletic performance. Often, athletes will practice chronic energy restrictions to attain body composition changes, altering their energy needs. Prediction of resting metabolic rates (RMR) is important in helping to determine an athlete's energy expenditure. This study compared measured RMR of athletic and non-athletic adolescents with predicted RMR from commonly used prediction equations to identify the most accurate equation applicable for adolescent athletes. SUBJECTS/METHODS: A total of 50 athletes (mean age of 16.6 +/- 1.0 years, 30 males and 20 females) and 50 non-athletes (mean age of 16.5 +/- 0.5 years, 30 males and 20 females) were enrolled in the study. The RMR of subjects was measured using indirect calorimetry. The accuracy of 11 RMR prediction equations was evaluated for bias, Pearson's correlation coefficient, and Bland-Altman analysis. RESULTS: Until more accurate prediction equations are developed, our findings recommend using the formulas by Cunningham (-29.8 kcal/day, limits of agreement -318.7 and +259.1 kcal/day) and Park (-0.842 kcal/day, limits of agreement -198.9 and +196.9 kcal/day) for prediction of RMR when studying male adolescent athletes. Among the new prediction formulas reviewed, the formula included in the fat-free mass as a variable [RMR = 730.4 + 15 x fat-free mass] is paramount when examining athletes. CONCLUSIONS: The RMR prediction equation developed in this study is better in assessing the resting metabolic rate of Korean athletic adolescents.
Adolescent* ; Athletes ; Athletic Performance ; Bias (Epidemiology) ; Body Composition ; Calorimetry, Indirect ; Energy Metabolism ; Humans ; Male ; Sports*

BACKGROUND: Recent studies report an association of decreased testosterone levels with type 2 diabetes mellitus, insulin resistance, hyperinsulinemia, dyslipidemia and metabolic syndrome. However, studies on correlations of testosterone with dyslipidemia, insulin resistance and metabolic syndrome in Koreans are scarce. We analyzed the relationship between levels of sex hormones and metabolic syndrome, lipid profiles and insulin resistance in Korean adult males. METHODS: A total of 289 males were selected among the participants in a medical health check-up from June to July 2003 at Kangbuk Samsung Hospital Health Promotion Center. Metabolic syndrome was defined according to the Modified National Cholesterol Education Program-Adult Treatment Panel (NCEP-ATP) III. The serum total testosterone level was measured using a radioimmunoassay and sex hormone binding globulin (SHBG) was measured using a radioimmunometric assay. RESULTS: The prevalence of metabolic syndrome was 15.6% and the total testosterone level showed a significant correlation with the levels of high-density lipoprotein cholesterol, fasting insulin, and uric acid even after adjustment for age and body mass index (BMI). Serum SHBG showed a significant correlation with diastolic blood pressure, uric acid, triglyceride, fasting insulin and insulin resistance indices. In logistic regression analysis in which age, drinking history, and smoking status were adjusted, decreased total testosterone and SHBG levels as well as increased estradiol levels showed significant correlations with an increased prevalence of metabolic syndrome. CONCLUSION: This study shows that decreased total testosterone and SHBG levels and an increased estradiol level were significantly correlated with increased metabolic syndrome prevalence and dyslipidemia in healthy Korean male adults. Further studies are suggested for the association of sex hormone replacement and the changes in the metabolic status.
Adult* ; Blood Pressure ; Body Mass Index ; Cholesterol ; Diabetes Mellitus, Type 2 ; Drinking ; Dyslipidemias ; Education ; Estradiol ; Fasting ; Gonadal Steroid Hormones* ; Health Promotion ; Humans ; Hyperinsulinism ; Insulin ; Insulin Resistance ; Lipoproteins ; Logistic Models ; Male* ; Prevalence ; Radioimmunoassay ; Sex Hormone-Binding Globulin ; Smoke ; Smoking ; Testosterone ; Triglycerides ; Uric Acid

Arginine vasopressin (AVP) is a neuropeptide with vasoconstrictive, antidiuretic, cardiovascular regulative and hepatic glycogenolysis effects, that also affects other behaviors including modulating learning. A number of studies on AVP regulation have been conducted in various metabolic diseases (disorders). In this study, the immunoreactivities of AVP in the paraventricular nucleus (PVN) and supraoptic nucleus (SON) and mRNA expressions in the hypothalamus were investigated by immunohistochemistry and quantitative real-time PCR (RT-qPCR) in stroke-prone spontaneously hypertensive rats at different ages (i.e., at postnatal months [PM] 1, 8, and 12). Blood glucose levels in the PM 8 group were higher than in the other groups. However, cresyl violet positive neurons were detected in the PVN and SON of all animals, and numbers of cresyl violet positive neurons were similar in all aged groups. In addition, AVP immunoreactivity was detected in the PVN and SON of all age groups, and AVP immunoreactivity and mRNA expression levels were found to be increased in proportion to age by immunohistochemistry and RT-qPCR. These results suggest that the diabetic condition is temporally generated after hypertension has developed. Furthermore, our findings suggest that increased AVP expressions in the hypothalamic PVN and SON are associated with hypertension by age.
Aged ; Animals ; Arginine ; Arginine Vasopressin ; Benzoxazines ; Blood Glucose ; Glycogenolysis ; Humans ; Hypertension ; Hypothalamus ; Immunohistochemistry ; Learning ; Metabolic Diseases ; Molybdenum ; Neurons ; Neuropeptides ; Oxides ; Paraventricular Hypothalamic Nucleus ; Rats, Inbred SHR ; Real-Time Polymerase Chain Reaction ; RNA, Messenger ; Supraoptic Nucleus ; Viola

PURPOSE: To determine whether Ultravist(R) test can enable the surgeon to differentiate complete from partial small bowel obstruction in patients with adhesive small bowel obstruction and whether partial small bowel obstruction can be treated nonoperatively. METHODS: Ninety-two patients who had postoperative small bowel obstructions without any toxic signs underwent Ultravist(R) test. Ultravist(R) (40 ml) mixed with 40 ml of distilled water was administrated either orally or via nasogastric tube to each patient. Serial plain abdominal radiographs were taken 4, 6, and 8 hours later. RESULTS: A total of 58 patients (63%) whose contrast medium reached the colon within the first 8 hours were considered to have partial obstruction (test positive) and were successfully treated with intravenous hydration and nasogastric decompression. The remaining 34 patients (36.9%), in whom the contrast medium failed to reach the colon within the first 8 hours (test negative), were regarded as having complete obstruction. Twenty-three of those patients (67.6%) underwent surgery and the other 11 (32.4%) received conservative treatment. Adhesion bands with complete bowel obstruction were observed in all 23 surgical patients during laparotomy. All the patients with partial bowel obstruction were treated successfully with nonoperative methods. Positive Ultravist(R) test as an indicator for nonoperative treatment had a sensitivity of 84.5%, a specificity of 100%, an accuracy of 88% and a false negative rate of 12%. CONCLUSION: Ultravist(R) can be used to differentiate partial from complete intestinal obstruction. All patients with evidence of Ultravist(R) reaching the colon within 8 hours were treated successfully with non-operative methods.
Adhesives ; Colon ; Decompression ; Humans ; Intestinal Obstruction ; Laparotomy ; Sensitivity and Specificity ; Water

Atrial Fibrillation (AF) is thought be caused by oxidative stress. Oxidative stress at the cellular level results from many factors, including exposure to alcohol, medications, cold, toxins or radiation. In this study we investigated gene transcriptional profiles on the human myocardial tissues from AF and oxidative stress conditions. Right atrial appendages were obtained from AF patients (n = 26) undergoing the Maze procedure, and from control patients (n = 26) who were in normal sinus rhythm and undergoing coronary artery bypass graft operation. To examine the effects of oxidative stress on AF, we used radioactive complementary DNA (cDNA) microarrays to evaluate changes in the expression of 1,152 known genes. This technology, which monitors thousands of genes simultaneously, gives us a better picture of the interactions between AF and oxidative stress. Total RNAs prepared from the retrieved tissues were used to synthesize(33)P-labeled cDNAs by reverse transcription and hybridized to cDNA microarrays. Gene expression profiles showed that 30 genes were upregulated and 25 were downregulated in AF patients compared with control patients. Moreover, comparison rank analysis revealed that the expression of five genes related to reactive oxygen species (ROS)-including flavin containing monooxygenase 1, monoamine oxidase B, ubiquitin specific protease 8, tyrosinase-related protein 1, and tyrosine 3-monooxygenase-increased by more than 2.0 of the Z-ratio, and two genes related to anti-oxidants including glutathione peroxidase 1, and heme oxygenase 2-decreased to the Z-ratio levels of <= -2.0. Apparently, a balanced regulation of pro- and anti-oxidation can be shifted toward pro-oxidation and can result in serious damage similar to that of human AF. Western blotting analysis confirmed the upregulation of tyrosinase-related protein 1 and tyrosine 3-monooxygenase and the downregulation of heme oxygenase 2. These results suggested that the gene expression pattern of myocardial tissues in AF patients can be associated with oxidative stress, resulting in a significant increase in ROS. Thus, the cDNA microarray technique was useful for investigating transcription profiles in AF. It showed that the intracellular mechanism of oxidative stress plays a pivotal role in the pathologic progression of AF and offers novel insight into potential treatment with antioxidants.
Atrial Appendage/metabolism ; Atrial Fibrillation/*genetics/*metabolism ; Blotting, Western ; DNA, Complementary/genetics ; *Gene Expression Profiling ; Gene Expression Regulation ; Human ; Myocardium/metabolism ; Oligonucleotide Array Sequence Analysis ; Oxidative Stress/*genetics ; Reactive Oxygen Species/metabolism ; Support, Non-U.S. Gov't

BACKGROUND: These days, lung volume reduction surgery (LVRS) is used as an alternative or a bridge operation to lung transplantation in treating patients with severe emphysema. The procedure can be used in patients with pulmonary nodules combined with severe emphysema. We report the results of 21 months follow up after lung volume reduction surgery in 7 cases including 2 cases of concurrent resection of pulmonary nodules. MATERIAL AND METHOD: Seven patients with emphysema, including 2 cases of preoperatively suspected lung cancer were operated with LVRS technique between July 1996 and June 1997. RESULT: Postoperative mortality was observed in a case of squamous cell carcinoma in LUL with brain metastasis, detected at postoperative 13months. Average of 21months(19-25months) follow up was done for other cases without specific events. CONCLUSION: LVRS is a useful operation in the treatment of patients with severe emphysema, but further evaluation should be done about the long term results and precise criteria for patient selection. Simultaneous LVRS and tumor resection could be done in patients with emphysema with marginal reserve in the hope of maximizing postoperative lung functions.
Brain ; Carcinoma, Squamous Cell ; Emphysema* ; Follow-Up Studies ; Hope ; Humans ; Lung Neoplasms ; Lung Transplantation ; Lung* ; Mortality ; Neoplasm Metastasis ; Patient Selection ; Pneumonectomy*

PURPOSE: This study was designed to determine the epidemiological and clinical characteristics of patients suspected or confirmed with to be infected by the pandemic 2009 H1N1 virus in one emergency medical center. METHODS: This was a prospective observational study. It was conducted between September 1 and November 30, 2009 in one tertiary academic emergency department. We recorded clinical and epidemiologic features of patients infected by the pandemic 2009 H1N1 virus. A follow-up telephone survey was done to determine the final outcome of infection. This survey was conducted by ED personnel 1 week after the initial visit. Multivariate logistic regression analysis was done for the association between disposition or H1N1 influenza diagnosis and potential predictors. RESULTS: During the study period, a total 5,317 patients visited the influenza clinical center of our emergency department. Among them, 1,472 patients (27.7%) were confirmed as influenza A by RT-PCR methods. Among RT-PCR positive patients, 90 (1.7%) were admitted to the ward and 7 to the intensive care unit. Five patients needed mechanical ventilation and one patient was diagnosed as ARDS; the ARDS patient fully recovered. There was no mortality caused by H1N1. The median age of confirmed patients was 9 years (range, 1 month~81 years); 825 patients (56.1%) were male. Incident rates for common symptoms were: fever (92.8%), cough (84.1%), and rhinorrhea (44.0%) by. A total of 40.3% (593/1472) patients were of pre-school age (range, 1 month~7 years, median 4 years). In young patients, clinical characteristics were similar to those of adults. Male, young age, contact history, lack of seasonal influenza vaccination, chronic renal failure, malignancy, and pregnancy were significantly associated with a confirmed diagnosis of H1N1. Hypertension, chronic renal failure, malignancy, neurologic disease, dyspnea, seizure, vomiting, and chest pain were also associated with risk of admission to the hospital. CONCLUSION: Surveillance of H1N1 virus cases shows that the majority of those infected have a mild illness. The 2009 H1N1 virus is common among individuals of pre-school age. Few H1N1-related severe illnesses occur in young individuals.
Adult ; Chest Pain ; Cough ; Disease Outbreaks ; Dyspnea ; Emergencies ; Fever ; Follow-Up Studies ; Humans ; Hypertension ; Influenza A Virus, H1N1 Subtype ; Influenza, Human ; Intensive Care Units ; Kidney Failure, Chronic ; Logistic Models ; Male ; Pandemics ; Pregnancy ; Prospective Studies ; Respiration, Artificial ; Seasons ; Seizures ; Telephone ; Vaccination ; Vomiting