PURPOSE: Urinalysis is one of the best methods for early detection of renal disease and recent wide- spread use of mass screening led to increasing prevalence of asymptomatic urinary abnormalities. Usually, primary chronic glomerulonephritis first presents with asymptomatic urinary abnormalities and chronic glomerulonephritis commonly causes end-stage renal disease. However, clinical outcome of asymptomatic urinary abnormalities in adults is not well known. METHODS: Between Jan 1995 to Aug 2009, 333 patients with asymptomatic urinary abnormalities who underwent percutaneous renal biopsy were enrolled. A retrospective study was performed to clarify the prognostic factors and the long-term renal outcome of this disease. RESULTS: According to clinical manifestation, there were 79 (23.7%) of isolated microscopic hematuria, 30 (9.0%) of isolated proteinuria and 224 (67.3%) of mixed hematuria and proteinuria. The patients were significantly younger in case with microscopic hematuria. Group with microscopic hematuria had significantly shorter follow up period (p=0.013). In pathologic diagnosis, IgA nephropathy was most common with 244 patients (73.3%). The proteinuria group and mixed group showed significantly higher rate of progression to chronic renal failure than the microscopic hematuria group (p=0.015). The group that 24-hour proteinuria was more than 0.5 g/day showed significantly higher progression rate to chronic renal failure (p<0.000). Using univariate regression analysis, 3 risk factors for progression to chronic renal failure were identified: age, serum creatinine, 24-hour total urine protein. In multivariate regression analysis, only 24-hour proteinuria was the independent prognostic factor for progression to chronic renal failure. CONCLUSION: IgA nephropathy is the most common cause of asymptomatic urinary abnormalities in adults. The group of proteinuria has higher progression rate to chronic renal failure than other groups. Over 0.5 gm of 24-hour proteinuria is a significant risk factor for progression to chronic renal failure in multivariate regression analysis.
Adult ; Biopsy ; Creatinine ; Follow-Up Studies ; Glomerulonephritis ; Glomerulonephritis, IGA ; Hematuria ; Humans ; Kidney Failure, Chronic ; Mass Screening ; Prevalence ; Proteinuria ; Renal Insufficiency ; Retrospective Studies ; Risk Factors ; Urinalysis

A spontaneous subcapsular hematoma in an allograft kidney is a rare condition with only a few cases reported in the literature. Common causes of subcapsular hematoma of an allograft include trauma, post-biopsy status, occult malignancy, vascular diseases, and infection. Chronic allograft dysfunction related to spontaneous subcapsular hematoma is extremely rare. We report a case of spontaneous subcapsular hematoma in a patient who underwent a renal transplant 14 years ago in which we could not find an associated condition.
Hematoma ; Humans ; Kidney ; Transplantation, Homologous ; Transplants ; Vascular Diseases

PURPOSE: Peritoneal dialysis (PD) catheter removal is regarded as an important index of patient morbidity. The aim of this study was to evaluate factors influencing catheter loss following peritonitis in PD patients. METHODS: We retrospectively reviewed 917 episodes of peritonitis in 621 new CAPD patients from Jan 2001 to Feb. 2009 in Dongsan Medical center. Episodes requiring PD catheter removal were compared by both univariate and multivariate analyses with those in which PD catheters were preserved. RESULTS: When peritonitis episodes requiring PD catheter removal (n=80) were compared to catheter preserved peritonitis episodes (n=837), the incidence of PD catheter loss increased as the duration on PD preceding the peritonitis were longer (p<0.000). Also, PD catheter removal was more likely to occur after peritonitis episodes with low serum albumin level (p=0.009) and high serum CRP level (p<0.000), those with long duration of PD effluent leukocyte count remaining above 100/mm3 (p<0.000), those with concomitant exit site/tunnel infection (p=0.043), and those with presence of abdominal pathology (p<0.000). The microbiological determinants of PD catheter loss included two or more bacteria cultured (p=0.002) and fungi (p<0.000). In multivariate analysis, the duration of PD effluent leukocyte count remaining above 100/mL and the number of organism cultured were independent risk factors of PD catheter removal in peritonitis episodes. CONCLUSION: Duration of PD effluent leukocyte count remaining above 100/mm3, and the number of organisms cultured were independent risk factors for catheter removal following peritonitis.
Bacteria ; Catheters ; Device Removal ; Fungi ; Humans ; Incidence ; Leukocyte Count ; Multivariate Analysis ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis ; Retrospective Studies ; Risk Factors ; Serum Albumin

Objective: This study aimed at analyzing the clinical characteristics of patients visiting the emergency department (ED) and pre-triage clinic during the coronavirus disease 2019 (COVID-19) pandemic era in Daegu, South Korea. Methods: We conducted a retrospective observational study by using the medical records of patients who visited the ED and pre-triage clinic from February 22 to March 31, 2020 and comparing them with the corresponding period in 2019. Results: The number of patients visiting the ED per day decreased from 122 (115-138) to 77 (66-93). The percentage of patients with respiratory infection increased from 6.6% to 15.4% (P<0.001). The length of the ED stay increased from 269 (150-562) to 559 (293-941) minutes, especially in patients with fever (P<0.001). The rate of injured and less urgent patients decreased from 24.7 to 13.2 and 53.4% to 50.2%, respectively (P<0.001). Sixty-one-point nine percent of patients visiting the ED were triaged and discharged at the pre-triage clinic without entering the ED. Conclusion In the COVID-19 pandemic era, there was an increase in the proportion of patients with fever and respiratory symptoms and a decrease in the proportion of injured patients. At the pre-triage clinic, a significant number of patients with suspected COVID-19 or less urgent conditions were treated and discharged without their having to enter the ED.

Objective: A regional pandemic may result in a crisis in providing emergency care to the community and disrupt emergency medical services. This study examined how the recent coronavirus disease 2019 pandemic impacted emergency department (ED) preparedness nationwide by describing the current ED operations. Methods: A cross-sectional survey was developed and distributed nationwide to emergency physicians. All 57 severe emergency care centers and 35 selected local emergency medical institutions nationwide were invited to participate. The survey consisted of basic ED information, infection guidelines, and operations for ED, preemptive pretriage area details, ED quarantine area details, cohort isolation and preemptive quarantine area, and difficulties or problems in treating infectious patients. Results: Forty-nine severe emergency care centers (86%) and 24 (68.6%) local emergency medical institutions answered the survey. Most EDs (95.9% and 91.7% of severe emergency care centers and local emergency medical institutions, respectively) operated under infection guidelines. In addition, 51% and 72.3% of preemptive pretriage areas in severe emergency care centers and local emergency medical institutions, respectively, placed doctors. Both negative and normal pressurized ED quarantine areas were more placed in severe emergency care centers (3 and 3 vs. 0.5 and 1 of severe emergency care centers and local emergency medical institutions, respectively). In severe emergency care centers, the preemptive quarantine areas were operated more than the cohort isolation areas (63.3% vs. 40.8%). Common difficulties expressed by EDs were delayed polymerase chain reaction test results (4.5 and 4.1 of severe emergency care centers and local emergency medical institutions, respectively) and a fear of infection with ED shutdown (4.4 and 4.1 of severe emergency care centers and local emergency medical institutions, respectively). Conclusion This study surveyed how ED care was changed by the pandemic and how current resources are redeployed nationwide. These results may be used as a basis for future ED pandemic preparedness.

BACKGROUND: The determination of blood donor eligibility has become critical and challenging to blood operators as so many conditions and restrictions should be considered to correctly decide the donor eligibility. Since the launching of the BIMS (Blood Information Management System) in May 2003, the demand of developing a more intelligent system to assist the determination of donor eligibility has been growing. The Korean Red Cross Blood Service intended to develop an expert system for donor eligibility determination with high efficiency and ease of use. METHODS: The content of the system was determined through the activity of a team consisting of medical doctors, nurses, safety managers, and the system developers. Algorithms were developed according to the donor history taking process. The efficiency of the system was tested by the comparison of the time needed for inquiries and the number of inappropriate blood collections before and after the implementation of the new system. RESULTS: The new system's user interface integrated many complicated work processes with a user-friendly flexibility. The types of decision included the restricted donations. The donor interviewers were highly satisfied with the system because almost all cases were correctly determined in a relatively short time. Using this system, the number of inappropriate blood collections was significantly lowered. CONCLUSION: We developed an expert system that can aide the donor eligibility determination process and prevent the violation of the related regulations. This system will contribute to enhancement of the blood safety as well as donor protection for our blood services.
Blood Donors ; Blood Safety ; Eligibility Determination ; Expert Systems ; Humans ; Information Management ; Pliability ; Red Cross ; Social Control, Formal ; Tissue Donors

BACKGROUND: The determination of blood donor eligibility has become critical and challenging to blood operators as so many conditions and restrictions should be considered to correctly decide the donor eligibility. Since the launching of the BIMS (Blood Information Management System) in May 2003, the demand of developing a more intelligent system to assist the determination of donor eligibility has been growing. The Korean Red Cross Blood Service intended to develop an expert system for donor eligibility determination with high efficiency and ease of use. METHODS: The content of the system was determined through the activity of a team consisting of medical doctors, nurses, safety managers, and the system developers. Algorithms were developed according to the donor history taking process. The efficiency of the system was tested by the comparison of the time needed for inquiries and the number of inappropriate blood collections before and after the implementation of the new system. RESULTS: The new system's user interface integrated many complicated work processes with a user-friendly flexibility. The types of decision included the restricted donations. The donor interviewers were highly satisfied with the system because almost all cases were correctly determined in a relatively short time. Using this system, the number of inappropriate blood collections was significantly lowered. CONCLUSION: We developed an expert system that can aide the donor eligibility determination process and prevent the violation of the related regulations. This system will contribute to enhancement of the blood safety as well as donor protection for our blood services.
Blood Donors ; Blood Safety ; Eligibility Determination ; Expert Systems ; Humans ; Information Management ; Pliability ; Red Cross ; Social Control, Formal ; Tissue Donors

BACKGROUND: The inferior alveolar nerve (IAN) may be injured during extraction of the mandibular third molar, causing severe postoperative complications. Many methods have been described for evaluating the relative position between the mandibular third molar and the inferior alveolar canal (IAC) on panoramic radiography and computed tomography, but conventional radiography provides limited information on the proximity of these two structures. The present study assessed the benefits of three-dimensional computed tomography (3D-CT) prior to surgical extraction of the mandibular third molar, to prevent IAN damage. METHODS: This retrospective study included 4917 extractions in 3555 patients who presented for extraction of the mandibular third molars. The cases were classified into three groups, according to anatomical relationship between the mandibular third molars and the IAC on panoramic radiography and whether 3D-CT was performed. Symptoms of IAN damage were assessed using the touch-recognition test. Data were compared using the chi-square test and Fisher's exact test. RESULTS: Among the 32 cases of IAN damage, 6 cases were included in group I (0.35 %, n = 1735 cases), 23 cases in group II (1.1 %, n = 2063 cases), and 3 cases in group III (0.27 %, n = 1119 cases). The chi-square test showed a significant difference in the incidence of IAN damage between groups I and II. No significant difference was observed between groups I and III using Fisher's exact test. In the 6 cases of IAN damage in group I, the mandibular third molar roots were located lingual relative to the IAC in 3 cases and middle relative to the IAC in 3 cases. The overlap was > or =2 mm in 3 of 6 cases and 0-2 mm in the remaining 3 cases. The mean distance between the mandibular third molar and IAC was 2.2 mm, the maximum distance 12 mm, and the minimum distance 0.5 mm. Greater than 80 % recovery was observed in 15 of 32 (46.8 %) cases of IAN damage. CONCLUSIONS: 3D-CT may be a useful tool for assessing the three-dimensional anatomical relationship and proximity between the mandibular third molar and IAC in order to prevent IAN damage during extraction of mandibular third molars.
Humans ; Incidence ; Mandibular Nerve* ; Molar, Third* ; Postoperative Complications ; Radiography ; Radiography, Panoramic ; Retrospective Studies ; Tomography, Spiral Computed ; Tooth Extraction