Imaging studies using MRI, PET, and/or MEG have been primary evaluation methods to quantitatively assess cognitive function. Recent advances in computational technology and information technology may allow a novel evaluation methodology to quantitate cognitive function more cost-effectively. In this study, we developed a software package composed of a series of tests to evaluate cognitive ability combined with a user-friendly touch screen input device. This cognitive assessment tool can quantitate concentration, numeric memory, associative memory, topological memory, visual and muscular reaction, and acoustic reaction over a relatively short testing time. We performed an empirical study on eighty normal subjects aged 20 and 59 years old using the developed evaluation methods. Age-related cognitive deterioration after 40 years old was confirmed. There was no difference in cognitive ability between male and female in the same age group. This study demonstrates the feasibility of a simple but effective evaluation software tool to quantitatively assess cognitive ability. This methodology may provide improved accessibility and reduced costs to perform cognitive function studies to compare between various subject groups.
Acoustics ; Aged ; Evaluation Studies as Topic ; Female ; Humans ; Male ; Memory ; Software

Diagnostic peritoneal lavage is a accurate and safe method confirming the intraabdominal injury with head trauma, unstable multiple injuried patients. But the development of imaging technique and the trend in noninvasive diagnostic value is decreasing now. In the emergency room, the emergency physicians are required the rapidity and accuracy' in intial assessment and the decisions for the operation or not. So emergency physicians have been investigating the diagnostic method for intraabdomial injury that is more rapid, safe and accurate. Many diagnostic tools are developed and now accepted and used widely, among them the diagnostic peritoneal lavage is still the best method for unsatble or head injuries patients. But the positive diagnostic criterias are variable by many authors and still remain imperfectly. So our study was reviewed by medical record of patients who were undertaken the diagnostic peritoneal lavage for the diagnosis intraabdominal injury and statistical analyasis was done compared with many criteria of red blood cell and white blood cell for the more actuate way. A retrospective study of diagnostic peritoneal lavage was done of 90 patients with blunt abdominal trauma during 2 years from January, 1996 to December, 1997 and summerized our experience. The results were as follows; 1) There are 73 males and 17 females in sex. The most common type of injury was the traffic accident. 2) With many variable criteria of RBC and WBC, the accuracy and the false positive and false negative were not different in statistical results. The average accuracy was 80.1%. 3) The operations were done in 30(33.3%) cases, and the most frequent injuried organ was the small bowel, 20 cases(66.7%).
Accidents, Traffic ; Craniocerebral Trauma ; Diagnosis ; Emergencies ; Emergency Service, Hospital ; Erythrocytes ; Female ; Humans ; Leukocytes ; Male ; Medical Records ; Peritoneal Lavage* ; Retrospective Studies

STATEMENT OF PROBLEM: Mechanisms of tissue-implant interaction and the effect of the implant surface on the behavior of cells has not yet been clarified. PURPOSE: This study was performed to investigate the tissue reaction to the titanium alloy submerged into rat peritoneum in vivo. MATERIALS AND METHODS: Titanium alloys (titanium-13Zirconium-6Niobium) were inserted inside the peritoneal cavity of Sprague Dawley rats. After 3 months, the tissue formed around the inserted titanium alloys were examined with a light-microscope. Tissue reaction around the material was analyzed by confocal microscopy to evaluate their biocompatibility in a living body. RESULTS: In in vivo study, foreign body type multinucleated giant cells were found in the fibrous tissue formed as a reaction to the foreign material (4 in 20 cases), but the inflammatory reaction was very weak. After experiment, the contaminants of biomaterials was removed from living tissue. In confocal microscopy, we observed that the staining of vinculin and actin showed mixed appearance. In a few cases, we found that the staining of vinculin and beta-catenin showed the prominent appearance. CONCLUSION: We found that titanium-13Zirconium-6Niobium alloy was an excellent biomaterial.
Actins ; Alloys* ; Animals ; beta Catenin ; Biocompatible Materials ; Foreign Bodies ; Giant Cells ; Microscopy, Confocal ; Peritoneal Cavity ; Peritoneum ; Rats ; Rats, Sprague-Dawley ; Titanium* ; Vinculin

BACKGROUND: Laparoscopic cholecystectomy has become the gold-tandard treatment for symptomatic gallbladder diseases. The evaluation and the treatment of common duct pathology is an essential component in the surgical management of biliary tract disease. The purpose of the present study was to identify the value and the importance of laparoscopic cholangiography compared to endoscopic retrograde cholangiography (ERC) in a laparoscopic cholecystectomy and to suggest the role of laparoscopic cholangiography in the management of patients undergoing laparoscopic cholecystectomy. METHODS: A laparoscopic cholecystectomy was attempted in two hundred six consecutive patients treated at Hallym University between January 1993 and December 1996. Patients were divided into three groups: In group I, 167 patients were examined with preoperative ERC while in group II, 17 patients were examined with laparoscopic cholangiography; Group III included 22 patients who were not examined with preoperative ERC or laparoscopic cholangiography. RESULTS: The average age was 52.78 years in group I, 45.62 years in group II, and 49.22 years in group III. The average operative time was 76.88 minutes in group I, 131.47 minutes in group II, and 85.22 minutes in group III. The operative time in group II was longer than that in group I (p<0.001). The duration of postoperative hospitalization was 4.9 days in group I and 4.11 days in group II, but this difference was not statistically significant (p=0.166). Conversion to an open cholecystectomy was 17/167 (10%) in group I, 1/17 (5%) in group II and 5/22 (22%). No complications or deaths occurred that were due to laparoscopic cholangiography. The postoperative complications in group I/II/III included bile leakage (3/0/2), bleeding in the bed of the gallbladder (5/0/0), wound bleeding (2/1/1), recurrent common duct stones (2/0/0), subcutaneous emphysema (4/1/0), shoulder pain (12/3/0), and wound infections (15/2/1). CONCLUSIONS: Although cholangiography may not be indicated for all patients undergoing a laparoscopic cholecystectomy, it will eventually be required. We conclude that laparoscopic cholangiography, as well as ERC, is a good method for evaluating the biliary tree. Laparoscopic cholangiography is clinically useful in patients who have negative ultrasonography and a dilated bile duct. Also, laparoscopic cholangiography has many advantages, especially at a teaching hospital: it outlines the anatomy of the extrahepatic biliary tree, identifies anomalies of surgical importance in time before iatrogenic damage is inflicted, detects stones in the cystic duct, discovers unsuspected stones, and develops experience with the technique. However, it is technically diffult to cannulate cystic duct and extends the operating time.
Bile ; Bile Ducts ; Biliary Tract ; Biliary Tract Diseases ; Cholangiography* ; Cholecystectomy ; Cholecystectomy, Laparoscopic* ; Cystic Duct ; Gallbladder ; Gallbladder Diseases ; Hemorrhage ; Hospitalization ; Hospitals, Teaching ; Humans ; Operative Time ; Pathology ; Postoperative Complications ; Shoulder Pain ; Subcutaneous Emphysema ; Ultrasonography ; Wound Infection ; Wounds and Injuries

Meckel's diverticulum is an embryologic derivative of the omphalomesenteric duct and the most commonly encountered congenital anomaly of the gastrointestinal tract, affecting 1% to 2% of the general population. Although this prevalence is relatively low, Meckel's diverticulum is occasionally encountered as an incidental identification during abdominal exploration and can be associated with several life-threatening disease states, such as massive intestinal bleeding, intestinal obstruction, or on rare occasion, perforation. The management of a Meckel's diverticulum found incidentally on laparotomy is controversial because the rate of complications developing from the diverticulum remains uncertain. The data in this report are based on 18 cases of Meckel's diverticulum which were treated at the Department of Surgery, InJe University Sanggye Paik Hospital, during the 7 years between January 1990 and December 1996. The results are as follows: 1) The overall sex ratio of males to females was 5 : 1 and in the symptomatic group, the ratio was 6 : 1. 2) Ninety percent of the patients were under 40 years of age, and 56% were under 10. 3) The diverticula were located from 20 cm to 100 cm proximal to the ileocecal valve, and the average range was 53 cm from the ileocecal valve. Fifteen cases were located at the antimesenteric border, and 3 cases at the mesenteric border of the ileum. 4) The lengths of the diverticula ranged from 1cm to 6cm, and the diameters ranged from 0.5 cm to 4.5 cm. 5) Appendicitis and intestinal obstruction were the most frequent preoperative diagnoses in the symptomatic group. 6) The common complications were intestinal obstruction and inflammation. 7) Heterotopic tissues were found in three patients and all of them were ectopic gastric mucosa. 8) The treatment was a diverticulectomy or a segmental resection of the involved bowel. 9) Postoperative complications were found in three of the asymptomatic group: two early intestinal obstructions and one wound infection.
Appendicitis ; Choristoma ; Diagnosis ; Diverticulum ; Female ; Gastric Mucosa ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Ileocecal Valve ; Ileum ; Inflammation ; Intestinal Obstruction ; Laparotomy ; Male ; Meckel Diverticulum* ; Postoperative Complications ; Prevalence ; Sex Ratio ; Vitelline Duct ; Wound Infection

PURPOSE: Despite radical lymph node dissections and combined resections, experiences of recurrent gastric carcinomas are not infrequent. The prognosis of a recurrent gastric carcinoma has not improved despite the considerable recent progress in their treatment. This study was designed to investigate the correlation between the clinicopathological characteristics and recurrence patterns in gastric cancer following a curative resection. METHODS: The medical records of 1, 163 patients, who had undergone curative resection for primary gastric cancer, in Department of Surgery, Keimyung University School of Medicine, between January 1990 and December 1996, were retrospectively reviewed. The clinicopathological characteristics, relationship of each factor with the pattern of recurrence and the rate of recurrence were analyzed. RESULTS: Recurrent gastric cancer was confirmed in 350 patients (30.09%). The mean time interval to recurrence was 20.41+/-15.94 months. Of the patients with a recurrence, 231 (66.0%), 109 (31.1%) and 10 (2.9%) were early (0~2 years), intermediate (2~5 years) and late (more than 5 years) recurrences, respectively. 180 (51.4%), 90 (25.7%), 51 (14.6%) and 29 (8.3%) were peritoneal, loco-regional, distant and mixed recurrences, respectively. The recurrence patterns after a curative resection for a gastric carcinoma were related to the tumor location, differentiation, N-category and TNM stage. In a multivariate analysis, the size of tumor, Borrmann's classification, T-category, N-category, vascular invasion and Stage were found to be independent prognostic factors for a recurrence. CONCLUSION: Most recurrences of gastric carcinomas, following a curative resection, were found within 24 months. Therefore, the close follow up, with clinicopathological factors, is very important during this period, and might facilitate the early detection of a recurrence.
Classification ; Follow-Up Studies ; Humans ; Lymph Node Excision ; Medical Records ; Multivariate Analysis ; Prognosis ; Recurrence ; Retrospective Studies ; Stomach Neoplasms*

BACKGROUND: When managing patients who require repeated venous access, gaining a viable intravenous route has been problematic. To improve the situation, various studies on techniques for venous access have been conducted. The aim of this study is to evaluate the clinical results of complications following totally implanted central venous access port (TICVAP) insertion. METHODS: A retrospective analysis was conducted on 163 patients, from December 2008 to March 2013. The occurrence of complications was studied in three separate periods of catheter use: the intraoperative period, postoperative period, and period during the treatment. RESULTS: A total of 165 cases of TICVAP insertions involving 156 patients were included in the final analysis. There were 35 complications (21%) overall. Among these, 31 cases of complications (19%) occurred during the treatment period and the other 4 cases were intraoperative and postoperative complications (2%). There were no statistically significant differences in age and gender of the patients between the two groups to be risk factors (p=0.147, p=0.08). Past history of chemotherapy, initial laboratory findings, and the locations of TICVAP insertion also showed no statistical significance as risk factors (p>0.05). CONCLUSION: Because the majority of complications occurred after port placement and during treatment, meticulous care and management and appropriate education are necessary when using TICVAPs.
Catheters ; Chemotherapy, Adjuvant ; Drug Therapy ; Education ; Humans ; Intraoperative Complications ; Intraoperative Period ; Postoperative Complications ; Postoperative Period ; Retrospective Studies* ; Risk Factors

PURPOSE: Maintaining the quality of CPR is connected with improvement in survival rates, but CPR performance in the field does not always fulfill the guidelines. Therefore, many ways to obtain the quality of CPR have been studied and tried, including CPR education, manikin training, mechanical CPR, audio-visible feedback system, and video-recording system, et cetera. The aim of our study is to determine how CPR procedures are actually performed on the scene by real-time video recording. METHODS: Digital video of CPR cases was obtained from April 2014 to March 2015 in a wide regional emergency medical center. The video was analyzed by two physicians in the emergency department. We evaluated quality of major CPR variables including compression rate, hands-off time, chest compression fraction, ventilation rate, et cetera. RESULTS: A total of 52 cases were analyzed. Mean chest compression rate was 122.43+/-10.74/min, and mean ventilation rate was 7.47+/-2.58/min. Performance of adequate compression-to-ventilation ratio before insertion of advanced airway was 37%. Mean recognition to compression time was 31.31+/-27.32 seconds, and proportion of chest compression interruption time exceeding 10 seconds was 7.6%. Mean chest compression fraction was 91.12+/- 0.4%. In five out of 25 cases of defibrillation, chest compression was interrupted during charging, resulting in prolongation of chest compression interruption time. CONCLUSION: In this study, overall performance met the qualification of AHA guidelines. However, poor compliance was observed for some parameters. Continuous education and feedback are required in order to make an improvement in these areas.
Cardiopulmonary Resuscitation* ; Compliance ; Education ; Emergencies* ; Emergency Service, Hospital ; Manikins ; Quality Improvement ; Survival Rate ; Thorax ; Ventilation ; Video Recording*

PURPOSE: The objective of this study was to investigate the diagnostic accuracy of multi-detector computerized tomography urography (MDCTU) for the detection of bladder tumors. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 143 patients who were scanned by use of 64-channel MDCTU and who underwent cystoscopy due to painless hematuria or a clinical suspicion of bladder tumor. We examined the accuracy of MDCTU for the detection of bladder tumors by comparing the results obtained by MDCTU with those obtained by cystoscopy. The associations between tumor characteristics, frequency of transurethral resection (TUR), and bladder volume and detectability of bladder tumors on MDCTU were also analyzed. RESULTS: Of 143 patients, 50 patients had a history of urothelial carcinomas. In these patients, the sensitivity and specificity of MDCTU were 60.0% and 80.0%, respectively. In 93 patients without previous urothelial carcinomas, the sensitivity and specificity of MDCTU were 86.7% and 96.8%, respectively. Falsely diagnosed cases had a smaller distended bladder volume (p=0.014) and a smaller tumor size (p=0.022) than did true diagnosed cases. The false-negative rate increased when the bladder tumor was located at the bladder neck. In the univariate analysis, the tumor location, size, frequency of TUR, bladder volume, and initial hematuria were associated with detectability by MDCTU (p<0.05). CONCLUSIONS: To improve the accuracy of MDCTU for diagnosing bladder tumors, bladder filling is recommended. Thus, cystoscopy should be considered as a standard diagnostic tool for bladder tumors even in patients with normal MDCTU results, especially in the evaluation of recurrent, bladder neck-located, small, or sessile bladder tumors.
Cystoscopy ; Hematuria ; Humans ; Medical Records ; Neck ; Retrospective Studies ; Sensitivity and Specificity ; Tomography, Spiral Computed ; Urinary Bladder ; Urinary Bladder Neoplasms ; Urography

Adenosquamous carcinoma, a rare malignant tumor of the stomach, is characterized by the presence of two different cell components, one adenomatous and the other squamous. Adenosquamous carcinoma of the stomach tends to show more aggressive clinicopathologic features than common adenocarcinoma. There are few reports about radiologic features of adenosquamous carcinoma of the stomach. We experienced a case of a primary adenosquamous carcinoma of the stomach in a 67-year-old man, and report here the ultrasonographic and computed tomographic (CT) findings.
Adenocarcinoma ; Aged ; Carcinoma, Adenosquamous* ; Cellular Structures ; Humans ; Stomach*