PURPOSE: For appropriate triage of chest pain patients in the emergency room (ER), We verified whether or not a new chest pain protocol, which is a combination of Goldman algorithm Cardiac STATus(r) adequately reflects the risk of a major cardiac event in patients with acute chest pain. METHODS: All patients arriving at the ER were divided into 4 risk group based on the Goldman MI probability and on the result of cardiac STATus(r). one month later, we collected information on whether the patients had undergone major cardiac event or death. We analyzed relative risk (RR) of cardiac event by using a logistic regression and we compare the event-free survival rates and survival lengths. RR=2 mean that the risk of cardiac events is high by two folds than control group. RESULTS: There were 31 major cardiac events. the relative risk of major events of each group compared to group 4 were 40.1 for group 1, 51.9 for group 2 and 27.4 for group 3. Group 4 patients experienced one cardiac event and no deaths. The survival time without a cardiac event of group 4 patients approach 30 days within experimental error. The survival rate without a cardiac event is 0.98+/-0.02. Therefore, the patients in group 4 had life expectancies similar to those of normal persons. CONCLUSION: This chest pain protocol adequately reflects the chances of cardiac event, so patients who show a negative result in cardiac STATus(r) and a low Goldman MI probability can be safely discharged from ER and followed up in outpatient clinic.
Ambulatory Care Facilities ; Chest Pain* ; Disease-Free Survival ; Emergency Service, Hospital ; Humans ; Life Expectancy ; Logistic Models ; Prospective Studies* ; Survival Rate ; Thorax* ; Triage

PURPOSE: This study examined the influence of meteorological phenomena on the development of spontaneous pneumothorax (SP). METHODS: We conducted this study from January to November 2004. We obtained the daily SP incidence from data requested by the National Health Insurance office from general hospital in Daejon, and we got the meteorological data from the Daejon Regional Meteorologic office. The difference in meteorological phenomena between cluster days (3 or more SP) and no SP days was analyzed using a generalized additive model (GAM) that used a specialized form of the non-parametric, non-linear regression test. RESULTS: Five hundred sixty-six SP patients were included. There were 369 male patients and 74 female patients. SP patients were associated with significantly lower atmospheric pressure and with broad swings of daily atmospheric pressure for 4-7 days prior to the hospital visits. More clouds had gathered for several days before cluster days than had gathered on days with no SP. CONCLUSION: Development of SP is related with meteorological phenomena. SP occurs when lower atmospheric pressure, broad swings of atmospheric pressure, and cloudy weather are collectively exprienced for several days before the hospital visit.
Atmospheric Pressure ; Daejeon ; Female ; Hospitals, General ; Humans ; Incidence ; Male ; Meteorological Concepts ; National Health Programs ; Pneumothorax* ; Weather

The incidence of difficult intubation varies from 1.5% to 13%, and failed intubation has been identified as one of the anesthesia-related causes of death or permanent brain damage. The Intubating Laryngeal Mask Airway (ILMA) is a new modified laryngeal mask airway with the capability for guided tracheal intubation while maintaining ventilation. The ILMA was designed to improve blind endotracheal intubation through a laryngeal mask airway. It does not require head and neck manipulations on insertion. The success rate of blind intubation using the ILMA was up to 99.3% in patients with or without airway problems. We experienced two cases of the difficult endotracheal intubation due to cervical spine 1 2 fractured 34 years old female patient and cervical spine 5 6 fractured 62 years old female patient were done successful awake airway management through the ILMA with superior laryngeal nerve block with pharyngeal and endotracheal topical spray of lidocaine. These cases suggest that awake tracheal intubations through the ILMA is a safe and useful method for airway management in anesthetic care of cervical spine fracture patients.
Adult ; Airway Management ; Brain ; Cause of Death ; Female ; Head ; Humans ; Incidence ; Intubation* ; Intubation, Intratracheal ; Laryngeal Masks ; Laryngeal Nerves ; Lidocaine ; Masks* ; Middle Aged ; Neck ; Spine ; Ventilation

BACKGROUND: This research is to determine the chief complaints and related features of elderly patients who are presented to emergency department with medical problems. METHODS: Medical records of patients, 65 years or above, who visited Uijeongbu Hospital Emergency Center between January 1, 2012 and June 30, 2012 were reviewed retrospectively. Age, gender, mode of transportation to the hospital, chief complaints, and diagnosis were among the subjects analyzed. RESULTS: Elderly patients with medical problems, 3,468 visited the emergency department, constituting 12.66% from 27,396 patients in total during the research period. Patients aged 70 to 74 were 28.45%, composing the most among the age groups. Ambulance was the mode of transportation used by 43.06% of the patients and 42.96% of them stayed overnight, while 11.13% stayed in the intensive care units. The most frequent chief complaints were abdominal pain (16.81%), dyspnea (13.96%), and fever (11.16%). The most common diagnosis for patients with abdominal pain was gastritis (20.75%), chronic heart failure (26.03%) for dyspnea, and pneumonia (28.96%) for fever. The main diagnoses of in-patients according to the order of frequency were cerebral vascular accident (16.38%), pneumonia (12.48%), and chronic heart failure (6.04%). CONCLUSION: The number of elderly patients who stayed overnight and stayed in the intensive care units have increased comparing to younger patients. The top 10 most frequent chief complaints accounted for 78.92% by medical elderly patients. The results of this research could be used for the development of geriatric emergency medicine training programs and critical pathway for interns and residents.
Abdominal Pain ; Aged ; Ambulances ; Critical Pathways ; Dyspnea ; Emergencies ; Emergency Medicine ; Fever ; Gastritis ; Heart Failure ; Humans ; Intensive Care Units ; Medical Records ; Pneumonia ; Retrospective Studies ; Transportation

BACKGROUND AND OBJECTIVES: In recent years, the emphasis on medical care has shifted from symptom scores and objective test results to the patient-centered assesment of effect of disease or response to treatment. So, we compared, before and after endoscopic sinus surgery (ESS), the relationship between 7 nasal symptom scores and quality of life scores measured with RSDI and the SF-36v2(TM) questionnaires, which have been verified by many articles. SUBJECTS AND METHOD: Subjects were 50 patients diagnosed as chronic sinusitis and who underwent ESS from November 2005 to Oct 2006. Patients filled out two questionnaires and checked a visual analogue scale at admission for surgery, and at 2, 4, 8 and 32 weeks postoperatively. Two questionnaires are the Rhinosinusitis Disability Index (RSDI) questionnaire, the SF-36v2(TM) questionnaire, and the visual analogue scale (VAS) is composed of nasal obstruction, rhinorrhea, postnasal drip, sneezing, cough, headache and facial pain. So, we compared each score of the SF-36v2(TM) (PCS and MCS) and RSDI with symptom scores of VAS. RESULTS: In comparing the scores of the RSDI with the symptom scores of VAS, statistically significant relationship was noted with respect to nasal obstruction, headache, and rhinorrhea continuously. But in comparing the scores of the SF-36v2(TM) (PCS and MCS) with the symptom scores of VAS, no statistically significant relationships was observed. CONCLUSION: With respect to the relationship between the quality of life after ESS and symptom severity, RSDI was found to be more effective than SF-36v2(TM). However, because results showed up differently in the two different kinds of questionnaire, it is important that we should use several different verified questionnaires in order to assess patient-centred response to ESS.
Cough ; Endoscopy ; Equidae ; Facial Pain ; Headache ; Humans ; Nasal Obstruction ; Quality of Life ; Surveys and Questionnaires ; Sinusitis ; Sneezing

A congenital nasolacrimal duct cyst is a very rare cause of respiratory distress and feeding difficulty in the newborn who is an obligate nasal breather. A case of bilateral nasolacrimal duct cysts (NLDC) without an associated congenital dacryocele was first reported in 1993. The authors present a case of a newborn with bilateral NLDC with intranasal extension causing respiratory distress, but with no evidence of dacrocystitis. Diagnostic studies included intranasal endoscopy and CT scanning of the nasolacrimal system and nose. The patient was treated by endoscopic marsupialization of the cysts. After six months of treatment, there was no evidence of recurrence.
Dacryocystitis* ; Endoscopy ; Humans ; Infant, Newborn ; Lacrimal Duct Obstruction ; Nasolacrimal Duct* ; Nose ; Recurrence ; Respiratory Insufficiency ; Tomography, X-Ray Computed

Duodenal diverticulum usually originates in the second portion of the duodenum and occasionally causes duodenal obstruction, hemorrhage, perforation and diverticulitis. A bleeding from Dieulafoy's lesion in a duodenal diverticulum is rare. It is not easily dignosed and treated by forward viewing endoscopy. Recently, a case was reported describing the hemorrhage from the Dieulafoy's lesion in a duodenal diverticulum which was treated by hemoclip with forward viewing endoscopy. Hemoclip application is considered to be the most appropriate endoscopic treatment, because sclerotherapy, electrocoagulation or band ligation for Dieulafoy's lesion in the duodenal diverticulum may increase risk of duodenal perforation. We report a case of duodenal perforation due to hemoclip application for the treatment of Dieulafoy's lesion in a duodenal diverticulum.
Diverticulitis ; Diverticulum* ; Duodenal Obstruction ; Duodenum ; Electrocoagulation ; Endoscopy ; Hemorrhage ; Ligation ; Sclerotherapy

Hemobilia is a disease caused by injury or conditions that cause the abnormal communication between intrahepatic blood vessels and biliary tract, resulting in leakage of blood into the biliary tract. In the past, trauma had been the most common cause of hemobilia. However, with the increasing invasive procedures in the hepatobiliary tract, iatrogenic origin has become the major cause of hemobilia. Also, non-traumatic etiologies of hemobilia include vascular malformation such as aneurysm, gallstone, inflammation, biliary tumor, hepatocellular carcinoma and coagulopathy. Among these non-traumatic etiologies, choledocholithiasis is a rare cause of hemobilia. The authors have experienced two cases of hemobilia caused by choledocholithiasis, which was diagnosed by abdominal ultrasonography, abdominal CT and duodenoscopy. Both patients were treated by the endoscopic sphincterotomy and stone removal with basket.
Aneurysm ; Biliary Tract ; Blood Vessels ; Carcinoma, Hepatocellular ; Choledocholithiasis ; Common Bile Duct* ; Duodenoscopy ; Gallstones ; Hemobilia* ; Humans ; Inflammation ; Sphincterotomy, Endoscopic ; Tomography, X-Ray Computed ; Ultrasonography ; Vascular Malformations

BACKGROUND: The best way of delivering drugs for the treatment of asthma and chronic obstructive pulmonary disease (COPD) is via the inhaled route of administration. However, many patients use inhaler devices incorrectly. To augment the proper use of inhalation medicine and to improve knowledge of the disease and compliance, we have developed a "Computerized Respiratory Service Program" and applied the use of this program to educate patients. METHODS: Prospectively, this study was performed in 164 patients with asthma or COPD prescribed with inhaled medication. When inhalation medication was first prescribed, education using a drug model was conducted two times and thereafter every month. In addition, education using a drug model was conducted and the ability of the patient to use inhalation medicine properly was evaluated. RESULTS: A total of 164 patients participated in the sessions more than two times and received education. Fifty-seven patients participated in three sesions. After the patients received education one time, the ability of these patients to use an inhaler had an average score of 20.6. After the patients received education two times, the average score was 21.9. After the patients received education three times, the average score was 22.3, a further increase. The compliance of using the inhaler was 70.1% at the second session and increased to 81.8% at the third session. CONCLUSION: Feedback education using the "Computerized Respiratory Service Program" will increase the ability of the patient to use an inhaler and consistent education can maintain patient compliance with inhaler use.
Asthma ; Compliance ; Education* ; Humans ; Inhalation* ; Nebulizers and Vaporizers ; Patient Compliance ; Prospective Studies ; Pulmonary Disease, Chronic Obstructive

BACKGROUND: Blood pressure is clinically used for monitoring shock patients and as a therapeutic indicator for them. Non-invasive blood pressure measurement has weak points such as the use of a cuff and it is a discontinuous measurement. A method of measuring the blood pressure by using the PWTT (pulse wave transit time) has been studied to make up for those weak points. If blood pressure monitoring can be done by using the difference of the PWTT between different points in the body, then this method will be a quite useful to monitor the BP of seriously ill patients. This study aimed to verify whether or not the PWTT has a significant correlation with the blood pressure of shock patients who received vasopressor infusion and whether this method is clinically applicable. METHODS: The study subjects were 20 shock patients who were hospitalized in intensive care units and they had received vasopressor, and we measured the PWTT and we analyzed its correlation with the SBP (systolic blood pressure) and DBP (diastolic blood pressure), as measured by non-invasive monitoring. We then determined the effects of the PWTT on the SBP and DBP. RESULTS: From the results of correlation analysis between the PWTT and the SBP and DBP, the SBP displayed a statistically significant negative correlation with the PWTT of 18 patients, while no significant correlation between the PWTT and DBP was observed. At the same time, from the results of the regression analysis of the blood pressures and the PWTT of each patient, it was found that the PWTT had a negative effect on the SBP of all the patients, except two. CONCLUSIONS: The PWTT has a negative correlation with the SBP of the patients who received vasopressor infusion.
Blood Pressure ; Blood Pressure Monitors ; Humans ; Intensive Care Units ; Organothiophosphorus Compounds ; Pulse Wave Analysis ; Shock