BACKGROUND: Unexpected deaths of the patients at ED are surprising to the medical staffs as well as the families. It may also increase the possibilities of medico-legal problems. This study was conducted to review the unexpected death in ED and find the predictive factors leading patients to unexpected death. METHODS: A retrospective study with reviewing available medical records of 183 patients who were expired at ED of Shinchon Severance Hospital from Mar. 1997 to Feb. 1998 and 103 patients of Youngdong Severance Hospital from Mar. 1996 to Feb. 1998 was done. Analyses were 4one on 30 variables of physical findings, laboratory results, procedures and therapies. We used univariate analysis, such as t-test and x2-test and multiple logistic regression analysis. RESULTS: Of the total 286 deaths in ED, 153 cases were enrolled in this analysis. The number of unexpected deaths were 76. Age, mental status, fraction of neutrophil count, BUN level, whether endotracheal incubation was done, use of inotropics were the factors with statistical ,significance on the univariate analysis, but only comatose mentality, endotracheal incubated case, and use of the inotropics were significant on logistic regression analysis. The longer the ED length of stay, the higher the rate of mortality and unexpected death. CONCLUSION: This result suggest that medical attention is needed on the patients with comatose decreased mental stylus, endotracheally intubated case and needing inotropic agents to prevent unexpected deaths. Shortening the ED length of stay may also be a factor for decrease the unexpected death rate.
Coma ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Length of Stay ; Logistic Models ; Medical Records ; Medical Staff ; Mortality ; Neutrophils ; Retrospective Studies

Many tumor markers in relation to renal cell carcinoma (RCC) have been evaluated for detecting and monitoring diseases outcomes. However, none of these biomarkers reported to date has shown sufficient sensitivity and specificity for as a detector and prognosticator of the whole spectrum of RCC in routine clinical practice. The limited value of the established prognostic markers requires analysis of new molecular parameters of interest in predicting the prognosis of RCC patients; in particular, the high-risk patient groups at risk of recurrence and progression. Abnormal methylation of CpG islands can efficiently repress transcription of the associated gene in a manner akin to mutations and deletions. Recent progress in the understanding of epigenetic modification and gene silencing has provided new opportunities for the detection, treatment, and prevention of cancer. Methylation is an important molecular mechanism in RCC and could be used as a diagnostic and prognostic marker. Aberrant patterns of epigenetic modification would be, in near future, crucial parameters in cancer diagnosis, prognosis and a good target for developing novel therapies while maintaining the quality of life. This review discusses the epigenetic issues involved in the detection and prediction of prognosis in RCC.
Biomarkers ; Carcinoma, Renal Cell* ; CpG Islands ; Diagnosis ; Epigenomics ; Gene Silencing ; Humans ; Methylation* ; Prognosis ; Quality of Life ; Recurrence ; Sensitivity and Specificity ; Biomarkers, Tumor

BACKGROUND: The goal of this study is to identify the factors that predict mortality in elderly trauma patients. METHOD: We reviewed retrospectively the medical record of 144 cases of geriatric trauma admitted to Kyungpook National University Hospital firm January 1998 to December 1998. We evaluated the general characteristics, mechanisms of injury, Revised Trauma Score(RTS), Injury Severity Score(ISS), Probability of survival(Ps) by TRISS(Trauma and Injury Severity Score) method, amount of blood transfused, preexisting disease, complications, length of stay, and mortality. RESULTS: 1. The mean age was 75.39+/-7.89 years old, and male to female ratio was 0.89 : 1. 2. The mechanisms of injury were primarily frills(56.3%) followed by bicycle or motorcycle(13.9%), and pedestrian injuries(13.2%) and motor vehicle accidents(6.9%). 3. The mean Glasgow Coma Scale(GCS), RTS and ISS ate 13.3+/-3.5, 7.2+/-1.4 and 14.2 +/-11.6 respectively. 4. The actual mortality rate was 18.1% (26/144). But by TRISS method, predicted mortality rate was 9.3%(12.5/144), excess mortality rate was 108% and Z score was 3.99 indicating that actual number of death exceed predicted number of death. 5. Between the survivors and nonsurvivors, the insults were significantly different as follows ; systolic blood pressure(141.9+/-28.3 vs. 116.8+/-48.7 mmHg), GCS(14.3+/-2.0 vs. 9.0 +/-5.1), RTS(7.8+/-0.7 vs 5.4+/-2.3), ISS(11.3+/-5.6 vs 27.2+/-20.2), Ps by TRISS(0.97+/-0.06 vs 0.65+/-0.37), preexisting diseases(50.8 vs 69.8%). CONCLUSION: Geriatric patients are more likely to die after trauma than other age groups. The cause of higher actual mortality rate compared to predicted mortality rate was considered as the higher incidence of delayed death due to sepsis or multiple organ failure. In order to reduce the mortality, even with relatively stable initial vile sign, invasive hemodynamic monitoring and intensive treatment are recommended and also, prevention and treatment of nosocomial infection are very important.
Aged ; Coma ; Cross Infection ; Female ; Gyeongsangbuk-do ; Hemodynamics ; Humans ; Incidence ; Length of Stay ; Male ; Medical Records ; Mortality* ; Motor Vehicles ; Multiple Organ Failure ; Preexisting Condition Coverage ; Retrospective Studies ; Sepsis ; Survivors

INTRODUCTION: In traditional society, the roles of housewives were to do housework, to look after her children and to give her family emotional stability. With rapid social and economic change, the traditional sense of value changes and the concepts of sexual roles, too. However, they are in a transition period yet. These discord and tension followed by role change appeared as the form of psychological instability or social pathological problem in modern family. Thus, this study aimed to avaluate the effect of employment on depression of housewives who play importent roles in family and their commumity. METHODS: From May to July 1996, the questonnaires were distributed to 179 housewives who have university education background(including community college), and have one or more children and live in Bundang-Ku of Sungnam city, making a distinction between working housewives and nonworking housewives. Regarding the subjects of this study, the non-working housewives are restricted to full-time housewives who have no job, and working housewives who have full-time job. As tools of measurement, we used BDI questionnaires consisted of 15 items in Korean. We performed statistical analysis among the data by means of SPSS/PC+. We analyzed statistical data for significance using one-way ANOVA and analyzed categorical data for significance using S-test. RESULTS: The average score on BDI for working housewives was 12.22(standard deviation 7.42) and this is rather higher than that of non-working housewives(10.80, standard deviation : 7.42). But the number of children increased, the BDI score were higher significantly in both groups. And the BDI score was high in working Housewives groups whose husbands had professional job or dommerce job, whose family system is a multi-generation family, and who feel a lot of fatigue after work. In case of non-working housewives, the BDI score was high with age(especially between 50-59), duration of marriage, lower income and Duvalls family life cycle 6, 7. CONCLUSIONS: There is no difference in depression tendency between working housewives and nonworking housewives. But in case of working housewives, some factors have influence on their depression tendency, the number of children, husbands job, family type, degree of fatigue after work. And in case of non-working housewives, the factors are the number of children, age, duration of marriage, income, family life cycle.
Child ; Depression* ; Education ; Employment ; Fatigue ; Gyeonggi-do ; Housekeeping ; Humans ; Marriage ; Seoul* ; Spouses ; Surveys and Questionnaires

Multiple primary lung cancer is not common and classified as a synchronous primary lung cancer and a metachronous primary lung cancer. We experienced one case of the triple synchronous primary lung cancer of different cell types. We conducted right pneumonectomy for preoperative diagnosed neuronendocrine tumor of the RUL and adenocarcinoma of the RLL. Pathologic examination revealed the carcinoid tumor of RUL bronchus, the squamous carcinoma of the RML and the adenocarcinoma of the RLL.
Adenocarcinoma ; Bronchi ; Carcinoid Tumor ; Carcinoma, Squamous Cell ; Lung Neoplasms* ; Lung* ; Pneumonectomy

Diffuse large B-cell lymphoma that arises from the gallbladder is extremely rare, and the associated studies are not well described in the literature. We report our experience that diffuse large B-cell lymphoma of the gallbladder was diagnosed by histological findings after laparoscopic cholecystectomy in a 75-year-old man. The patient was diagnosed with stage IV lymphoma, and chemotherapy was performed following surgery. The abdominal, chest, neck computed tomography (CT) and positron emission tomography (PET)-CT were performed after chemotherapy, and the results showed that there were no multiple lymphadenopathies. The patient was considered to have achieved complete remission. Diffuse large B-cell lymphoma of the gallbladder is extremely rare and never been diagnosis preoperatively. Pathological examination of the cholecystectomy specimen is important. This will be very helpful for identifying patients who need additional treatment.
Aged ; B-Lymphocytes ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Diagnosis ; Drug Therapy ; Gallbladder ; Humans ; Lymphoma ; Lymphoma, B-Cell ; Neck ; Positron-Emission Tomography ; Thorax

BACKGROUNDS/AIMS: The objective of this study was to evaluate the relationship between initial personal experiences with distal pancreatectomy and perioperative risk factors, outcomes, and management of pancreatic fistulas. METHODS: Between May, 2007 and May, 2010, a total of 28 patients who had undergone elective distal pancreatectomy were evaluated for this study. Perioperative factors and the occurrence of pancreatic fistula were analyzed on the basis of International Study Group of Pancreatic Fistula (ISGPF) criteria. RESULTS: There were sixteen cases of benign neoplasms and twelve cases of malignant tumors. The remnant pancreas was manually sutured with ligation of the pancreatic duct (n=14), auto-suture stapling along with manual sutures (n=12), or stapling alone (n=2). According to the ISGPF classification, morbidity and mortality associated with pancreatic fistulas was 42.9% (n=12) and 0%, respectively. These pancreatic fistulae were classified as grade A in 8 cases (28.6%), grade B in 3 cases (10.7%), and grade C in one case (3.6%). All patients with pancreatic fistula were treated conservatively. CONCLUSIONS: Perioperative factors do not affect the risk of pancreatic fistula. Adequate drainage is the most effective method for management of a pancreatic fistula after distal pancreatectomy.
Drainage ; Humans ; Ligation ; Pancreas ; Pancreatectomy ; Pancreatic Ducts ; Pancreatic Fistula ; Risk Factors ; Sutures

We present a patient with moyamoya disease and a ruptured superior cerebellar artery aneurysm that was managed by endovascular embolization. A 53-year-old man with sudden onset severe headache and altered mental status was referred to our hospital. Computed tomography revealed a subarachnoid hemorrhage. Cerebral angiography showed evidence of moyamoya disease and a 7 mm saccular aneurysm at the origin of the right superior cerebellar artery. Endovascular coil embolization was performed successfully without posterior cerebral artery and superior cerebellar artery obliteration. Endovascular treatment with microcoils appear particularly safe for moyamoya patients with cerebral saccular aneurysms.
Aneurysm ; Arteries ; Cerebral Angiography ; Headache ; Humans ; Middle Aged ; Moyamoya Disease ; Polyenes ; Posterior Cerebral Artery ; Subarachnoid Hemorrhage

Tracheo-innominate artery fistula is a rare, but it is one of the gravest complications next to tracheostromy. Early recognition and prompt surgical management is mandatory. The patient was a 66 year old women with MCA infarct who maintained tracheostomy for lyear. She had respiratory arrest due to the excessive bleeding through the tracheostomy site. We report an successful experience for control of bleeding by an innominate artery fistula division and primay suture closure under direct digital compression.
Aged ; Arteries* ; Brachiocephalic Trunk ; Female ; Fistula* ; Hemorrhage ; Humans ; Sutures ; Tracheostomy

BACKGROUND AND OBJECTIVES: The myogenic response was originally described as a contraction of a blood vessel that occurred following an increase in intravascular distending pressure. Conversely, a reduction in intravascular pressure produces myogenic vascular relaxation. Recent attention has focused on the potential role of this myogenic mechanism in the control of tone in the resistance vasculature, and in particular on how this mechanism may contribute to the increased vascular resistance seen in hypertension. Therefore, in the present study, we investigated the role of myogenic tone in the generation and/or maintenance of hypertension. MATERICAL AND METHODS: Myogenic tone was developed by stretching of the basilar arteries of WKY (istar Kyoto rat) and SHR (spontaneously hypertensive rats). Contractile responses, PKC (protein kinase C) immunoblots and translocation of PKC and RhoA were measured. In the presence of extracellular Ca2+ the stretching of the resting vessel evoked a myogenic contraction in the basilar arteries of SHR and WKY. Myogenic tone was significantly greater in SHR than in WKY. However, in the absence of extracellular Ca2+, stretching evoked a myogenic contraction in SHR, but not in WKY. The stretch-induced myogenic tone was inhibited by nifedipine. The effect of nifedipine was similar in both SHR and WKY rats. H-7, calphostin C and Y-27632, also inhibited stretch-induced myogenic tone in both SHR and WKY. The inhibitory effects of these drugs were greater in SHR than in WKY. Immunoblotting showed rho A and PKC alpha were translocated from the cytosol to the cell membrane with stretching in both SHR and WKY. PKC beta, however, was translocated to the cell membrane with stretching in SHR, but not in WKY. CONCLUSION: These results suggest that stretch-induced myogenic tone is significantly greater in SHR than in WKY. Furthermore, the increase in amount and/or activity of PKC beta and ROK (rhoA-associated kinase) may be a key mechanism accounting for the enhanced myogenic tone in SHR.
1-(5-Isoquinolinesulfonyl)-2-Methylpiperazine ; Basilar Artery ; Blood Vessels ; Cell Membrane ; Cytosol ; Hypertension ; Immunoblotting ; Nifedipine ; Phosphotransferases ; Protein Kinase C* ; Protein Kinases* ; Rats, Inbred SHR* ; Rats, Inbred WKY ; Relaxation ; rhoA GTP-Binding Protein ; Vascular Resistance