PURPOSE: To evaluate the usefulness of CT for the diagnosis and treatment planning of mechanical intestinal obstruction. MATERIALS AND METHODS: We retrospectively reviewed 38 patients who were clinically suspected of mechanical intestinal obstruction and had undergone abdominal CT. The CT scans were evaluated for the absence or presence, severity, cause and site of intestinal obstruction. CT findings were compared with the results of laparotomy, barium study and clinical course. The absence or presence and severity of intestinal obstruction were classified into no obstruction, partial obstruction, complete obstruction. Diagnosis was estabilished by means of laparotomy in 20 cases, barium study in 9 cases and clinical course in 9 cases. RESULTS: Of 38 cases, 7(18.4%) showed no obstruction, 22(57.9%) showed partial obstruction, and 9(23.7%) showed complete obstruction. The presence or absence and severity on CT scans were corretly predicted in 36 of 38 cases (sensitivity 95%, specificity 97%, accuracy 96%) (in case of no obstruction:sensitivity 100%, specificity 94%, accuracy 95%;in case of partial obstruction:sensitivity 91%, specificity 100%, accuracy 95%;in case of complete obstruction:sensitivity 100%, specificity 100%, accuracy 100%). All 9 cases with complete obstruction underwent prompt and immediate laparotomy. 13 cases, excluding those with mass around the site of transition and adhesion with strangulation, with partial obstruction improved with conservative treatment without laparotomy. The causes of obstruction were adhesion in 13, hernia in 6, primary cancer in 5, metastatic cancer in 3, abscess in 2, intestinal tbc in 1, and Crohn's disease in 1. The cause of obstruction on CT scans were correctly predicted in 27 of 31 cases (87.1%). The sites of obstruction on CT scans were correctly predicted in 22 of 26 cases (84.6%). CONCLUSION: CT is valuable in the evaluation of absence or presence, severity, cause and site of intestinal obstruction, and is considered to be helpful in treatment planning for the patients with intestinal obstruction.
Abscess ; Barium ; Crohn Disease ; Diagnosis ; Hernia ; Humans ; Intestinal Obstruction* ; Laparotomy ; Retrospective Studies ; Sensitivity and Specificity ; Tomography, X-Ray Computed

PURPOSE: The purpose of this study is to analyze and compare the CT findings of gastric adenocarcmoma and gastric lymphoma. MATERIALS AND METHODS: We retrospectively analyzed and compared the CT findings in 46 cases of adenocarcinoma and 12 cases of lymphoma, which were pathologically confirmed by operation and endoscopic biopsy. RESULTS: Antral involvement was more common in adenocarcinoma(71.7%) than in lymphoma(41.7%). Localized involvement was more common in adenocarcinoma(83.7%), while diffuse involvement was more common in lymphoma(55.6%). Adenocarcinoma tended to have smooth inner margin(83.8%), while lymphoma had nodular or irregular inner margin(36.4%). Mean gastric wall thickness of adenocarcinoma was 1.7cm, while mean thickeness of lymphoma was 2.7cm. The involved wall of adenocarcinoma tended to be highly enhanced (59.5%), while lymphoma was moderately enhanced(90.1%). Perigastric lymphadenopathy was present in 40% (group I) and 42%(group II) of adenocarcinoma and 33% of lymphoma(group I and II). Three cases of lymphoma had lymphadenopathy below renal vascular pedicles with no or minimal perigastric lymphadenopathy. When only the distal portion of the stomach was involved, disturbance in passage developed in six adenocarcinoma (12%), while none developed in the lymphoma. CONCLUSION: CT features help to differentiate between gastric adenocarcinoma and gastric lymphoma
Adenocarcinoma* ; Biopsy ; Lymphatic Diseases ; Lymphoma* ; Retrospective Studies ; Stomach

OBJECTIVES: This study was designed to compare the ward atmosphere of an open ward and that of a closed ward as perceived by chronic schizophrenic patients, and to and out whether the perceived ward atmosphere is associated with their quality of life, and also to get some practical suggestions for treatment policies of open wards. METHODS: Fifty-two chronic schizophrenic inpatients were selected, 26 of them were in an open ward and the remaining 26 patients were in a closed ward, in Seoul National Mental Hospital. All the patients were asked to answer the whole items of Ward Atmosphere Scale (WAS) and SCL-90-R. Objective indicators and subjective indicators of their quality of life were scored during a face to face interview using portions of Lehman's Quality of Life Interview. The subjective indicators of quality of life were combined to a single 'global quality-of-life score' and then examined for associations with other variables. All the measures were compared between the two groups. Covariate adjustments were made as needed. RESULTS: The open ward patients reported significantly higher scores on 'support', 'autonomy' and 'practical orientation' subscales among WAS in comparison with closed ward patients. The open ward patients reported higher 'global quality-of-life score' compared with the closed ward patients. These differences were also significant following covariate adjustments for demographic, clinical and objective quality of life variables. Among the WAS subscales 'order and organization'(r=0.49, p <.05) was the highest correlate of 'globol quality-of-life score' in case of open ward patients, and 'support'(r=0.59, p<.01) was the highest correlate in case of closed ward patients. CONCLUSION: The open ward patients reported better satisfaction with life, and their reported satisfaction were associated with their higher ratings on WAS.
Atmosphere* ; Hospitals, Psychiatric ; Humans ; Inpatients ; Quality of Life* ; Seoul

Objective: Emergency department-based screening clinic (ED-BSC) is a new concept. It is a multifunctional clinic at the entrance of the emergency department (ED) that serves as a screening center for suspected coronavirus disease 2019 (COVID-19) patients and triaging patients and provides basic emergency treatment. We aimed to analyze the current status of the COVID-19 ED-BSC and determine the factors when assigning suspected COVID-19 patients to the negative pressure isolation rooms (NPIRs) at the ED. Methods: Data of patients who visited the ED-BSC between February 7, 2020, and April 30, 2020, were obtained retrospectively. The data of the patients who underwent the COVID-19 screening test per the standards of the Korea Disease Control and Prevention Agency were analyzed. Results: A total of 1,378 patients who visited the ED-BSC were included in the study. Of these, 1,226 patients were allowed to go home after the COVID-19 screening test, and 152 patients were assigned to the NPIRs. In univariate analysis, factors influencing the allocation of NPIRs were old age, history of overseas travel within the last 14 days, fever and peripheral oxygen saturation. The multivariate regression analysis confirmed that older adults, history of overseas travel within the last 14 days and fever influenced the allocation of patients to NPIRs. Conclusion This study elucidates the current status of suspected COVID-19 patient visits to an ED-BSC. This study may serve as a basis for the establishment and revision of clinical guidelines for ED-BSC.

PURPOSE: Ultrasound(US) findings of hyperechoic renal medulla in gouty nephropathy were compared with clinical features such as serum uric acid level to evaluate its usefulness in determination of the treatment and prognosis. MATERIALS AND METHODS: A retrospective review of US of 36 cases of gouty arthritis was classified into four groups according to the medullary echogenicity (O:normal, grade 1 :renal medulla as isoechoic as renal cortex, grade 2'heterogeneous increased echogenicity of renal medulla than that of renal cortex, grade 3 :the echogenicity of all renal medulla higher than that of renal cortex with renal contour deformity) which were compared with the serum urate level and associated conditions. Nephrocalcinosis and nephrolithiasis were analyzed through the KUB and the RGP. RESULTS: The degree of hyperechoic renal medulla was related to the level of serum uric acid, and in group IV, six cases of obstructive uropathy (nephrocalcinosis and nephrolithiasis) showed deformed renal contour. Associated conditions such as hypertension, alcoholism, diabetes mellitus and drug abuse were distributed in relation to the degree of hyperechoic renal medullas. CONCLUSION: US findings of hyperechoic renal medulla was related with uric acid level in gouty nephropathy and thus could be valuable for treatment decision and prediction of prognosis.
Alcoholism ; Arthritis, Gouty ; Diabetes Mellitus ; Hypertension ; Nephrocalcinosis ; Nephrolithiasis ; Prognosis ; Retrospective Studies ; Substance-Related Disorders ; Ultrasonography* ; Uric Acid

The 302 patients with head-injured military personnel who had admitted to the Department of neurosurgery, Capital Armed Forces General Hospital were clinicostatistically analysed and discussed with the review of the literatures. The results were as follows: The most common cause of head injury was traffic accident(38.4% of the total cases) and the next were, in order of incidence, simple fall(9.5%), exercise(3.9%), assault(13.5%) and gun shot wound or explosive injury(7.2%). 2) Skull fracture was identified in 214 cases;98 cases of linear, 87 cases of depressed, 4 cases of basal, 2 cases mixed skull fracture. 3) The 85.7% of epidural hematomas were associated with skull fracture and the most common site of hematoma was frontal area. 4) Of all cases of subdural hematoma, acute type was prevalent(67.9%) and its main involved wite was frontotemporoparietal areas. 5) The associated injuries were found in 35.7% of patients. 6) The minor head injury of which GCS is from 13 to 15 was 148 cases, the moderate head injury of which GCS is fromn 9 to 12 was 49 cases, the severe head injury of which GCS is form 3 to 8 was 105 cases. 7) Of 105 cases of severe head injured patients the mortality was 61.9% and good recovery was 7.6%. But outcome was different according not only to GCS but also the type of lesion. 8) The operative morality was 24.1% and the good recovery was achieved 55.2% of patients. The remaining 8.9% resulted in disabled or vegetative state. 9) In the accidents of gun shot wound or explosive injury, operation mortality rate was 31.8%, but 8 cases(36.3%) were seen good recovery.
Arm ; Craniocerebral Trauma ; Glasgow Coma Scale ; Head ; Hematoma ; Hematoma, Subdural, Acute ; Hospitals, General ; Humans ; Incidence ; Military Personnel* ; Morals ; Mortality ; Neurosurgery ; Persistent Vegetative State ; Skull Fractures ; Wounds and Injuries

OBJECTIVE: The mismatch in the demand and supply of emergency medical resources has been a constant issue in Korean emergency departments (EDs). This study analyzed the characteristics and actual utilization of medical bed resources in these EDs. METHODS: The emergency department utilization (EDU) rate was calculated using the Emergency Medical Resource Information System (EMRIS) on the available beds in EDs from April 2014 to January 2015. The EDU rate was analyzed according to the season, day of the week, time of day, and ED type. Furthermore, the ratio between the maximum and minimum EDU rates was also compared between the regions. RESULTS: A total of 14,889,750 data points were included. The EDU rate was relatively high during winter and on Sundays, and was highest between 20:00 and 22:00. The ratio between the maximum and minimum EDU rates according to the time of day was highest in Gyeongbuk (5.4) and lowest in Daegu (1.4). Moreover, the EDU rate according to the ED type was highest in the regional emergency medical center (66.7%). CONCLUSION: Significant differences were observed in the EDU rates according to the season, day of the week, time of the day, region, and ED type. Therefore, EMRIS should allocate resources based on the data on both the hospital and regional characteristics.
Daegu ; Emergencies ; Emergency Service, Hospital ; Gyeongsangbuk-do ; Information Systems ; Seasons

PURPOSE: Antibiotics that kill or suppress the growth of bacteria also affect tumors directly or indirectly. The authors aimed to show whether some antibiotics can improve cancer cell survival under hypoxic conditions, and how the antibiotics improve the cells under hypoxic conditions. METHODS: Human hepatocellular carcinoma cells (HepG2) were grown at 1% oxygen concentration. Cell numbers, glucose concentrations and lactic acid concentrations in the medium were measured at different incubation times, in the absence or presence of aminoglycosides, tetracyclines, quinolones, penicillins, cephalosporins, sulfonamides, or chloramphenicols. DNA fragmentation assay was performed to study the mechanism how some antibiotics improve the cell survival under hypoxic conditions. RESULTS: Of the antibiotics tested, only aminoglycosides, tetracyclines, quinolones and the chloramphenicol improved cell survival under hypoxic conditions. Geneticin (G418), an aminoglycoside chosen as an example, improved cell survival even if glucose in the medium was completely consumed. At the same time, the appearance of DNA ladder was delayed in the presence of geneticin, which was also the same for the other antibiotics that improved cell survival under hypoxic conditions. CONCLUSION: Some antibiotics improved hepatocellular carcinoma cells under ischemic conditions by inhibiting apoptosis. The results implies that the antibiotics might adversely affect solid tumors, by improving cancer cell growth where hypoxic or ischemic conditions occur in the core region. Therefore, we might be cautious in choosing antibiotics for cancer patients with solid tumors, especially when the patients should be treated with antibiotics for a long time.
Aminoglycosides ; Anoxia ; Anti-Bacterial Agents* ; Apoptosis ; Bacteria ; Carcinoma, Hepatocellular* ; Cell Count ; Cell Survival ; Cephalosporins ; Chloramphenicol ; DNA ; DNA Fragmentation ; Glucose ; Humans* ; Lactic Acid ; Oxygen ; Penicillins ; Quinolones ; Sulfonamides ; Tetracyclines

Background: The purpose of this study was to review the nationwide emergency care-related health policies during the coronavirus disease 2019 (COVID-19) pandemic disaster in Korea and to analyze the effects of the policies on the safety of patients who visit emergency departments (EDs) during this period. Methods: This study is a quasi-experiment study. The study population was patients who visited all 402 EDs in Korea between December 31, 2019 and May 13, 2020, using the National Emergency Department Information System (NEDIS) database. The study period was classified into 5 phases according to the level of national crisis warning of infectious disease and the implementation of emergency care-related health policies, and all study phases were 27 days. The primary outcome was in-hospital mortality, and the secondary outcome was length of stay (LOS) in the ED during the COVID-19 outbreak. Results: The number of ED visits during the study period was 2,636,341, and the in-hospital mortality rate was 1.4%. The number of ED visits decreased from 803,160 in phase 1 to 496,619 in phase 5 during the study period. For in-hospital mortality, the adjusted odds ratio (OR) (95% confidence interval) was 0.77 (0.74–0.79) in phase 5 compared to phase 3. Additionally, by subgroup, the ORs were 0.69 (0.57–0.83) for the patients with acute myocardial infarction and 0.76 (0.67–0.87) for severe trauma in phase 5 compared to phase 3. The ED LOS increased while the number of ED visits decreased as the COVID-19 pandemic progressed, and the ED LOS declined after policy implementation (beta coefficient: −5.3 [−6.5 to −4.2] minutes in phase 5 compared to phase 3). Conclusion Implementing appropriate emergency care policies in the COVID-19 pandemic would have contributed to improving the safety of all emergency patients and reducing inhospital mortality by preventing excessive deaths.

Background: The purpose of this study was to review the nationwide emergency care-related health policies during the coronavirus disease 2019 (COVID-19) pandemic disaster in Korea and to analyze the effects of the policies on the safety of patients who visit emergency departments (EDs) during this period. Methods: This study is a quasi-experiment study. The study population was patients who visited all 402 EDs in Korea between December 31, 2019 and May 13, 2020, using the National Emergency Department Information System (NEDIS) database. The study period was classified into 5 phases according to the level of national crisis warning of infectious disease and the implementation of emergency care-related health policies, and all study phases were 27 days. The primary outcome was in-hospital mortality, and the secondary outcome was length of stay (LOS) in the ED during the COVID-19 outbreak. Results: The number of ED visits during the study period was 2,636,341, and the in-hospital mortality rate was 1.4%. The number of ED visits decreased from 803,160 in phase 1 to 496,619 in phase 5 during the study period. For in-hospital mortality, the adjusted odds ratio (OR) (95% confidence interval) was 0.77 (0.74–0.79) in phase 5 compared to phase 3. Additionally, by subgroup, the ORs were 0.69 (0.57–0.83) for the patients with acute myocardial infarction and 0.76 (0.67–0.87) for severe trauma in phase 5 compared to phase 3. The ED LOS increased while the number of ED visits decreased as the COVID-19 pandemic progressed, and the ED LOS declined after policy implementation (beta coefficient: −5.3 [−6.5 to −4.2] minutes in phase 5 compared to phase 3). Conclusion Implementing appropriate emergency care policies in the COVID-19 pandemic would have contributed to improving the safety of all emergency patients and reducing inhospital mortality by preventing excessive deaths.