PURPOSE: Rural emergency medical service (EMS) is inferior to urban EMS. In creating and providing emergency patient care, in rural areas, it is important to consider resources, patient volumes, geography, technology challenges, volunteer and provider issues, medical oversight, polities, education, communications, and financial concerns. In the current environment in Korea, it is necessary to design tailored and self-supporting rural EMS systems. For the development of a self-supporting model for EMS systems in rural areas, we have studied the EMS system in one rural area, Goheung County. METHODS: We obtained data from a health institute center, the Gwangju emergency medical information center, three emergency medical centers, and the fire station in Goheung county. In order to survey resident's perceptions about the local EMS system, we provided a questionnaire to 324 residents in Goheung County in March 2005. The advisory council for the EMS system analyzed problems at each step or component of the EMS service delivery process and suggested a model for self-supporting EMS service in Goheung County. RESULTS: The status of the EMS system in Goheung County is inferior to urban systems. A lack of appropriately trained emergency personnel at every level of care has been identified in this area. It is hard to find public education programs. There are few communication systems available for emergency medical care and there are extended transport times and distance, both for responding to and transporting patients. Resident's perceptions of the EMS system is unfavorable. The advisory council suggested an optimized plan to address the problems of the EMS system in Goheung County. A self-supporting model is suggested by the council. It is necessary to consider residents' participation and to apply available resources in Goheung County. CONCLUSION: An ideal EMS system in Goheung County will be a self-supporting model requiring participation of residents and wise application of available sources. The first consideration in this model is institution of a public education program and recruitment and education of first responders in every village is suggested. The model recommends integration of the EMS communication system to provide quality emergency medical care.
Emergencies ; Emergency Medical Service Communication Systems ; Emergency Medical Services ; Fires ; First Aid ; Geography ; Humans ; Information Centers ; Korea ; Patient Care ; Surveys and Questionnaires ; Rural Health Services

A spontaneous tension hemothorax due to the rupture of an intercostal artery aneurysm is a rare complication of type I neurofibromatosis. Until now, around 23 cases have been reported. The patient reported here presented with a spontaneous tension hemothorax. At the emergency department, we were faced with a rapidly aggravating hemodynamic compromise after chest tubing. An emergent thoracotomy revealed an actively bleeding huge intercostal artery aneurysm. We intended primarily to repair the bleeding aneurysm, but we failed with because of vascular fragility. Thus we present this case to share our terrible experience to other physicians.
Aneurysm* ; Arteries* ; Emergency Service, Hospital ; Hemodynamics ; Hemorrhage ; Hemothorax* ; Humans ; Neurofibromatoses* ; Rupture* ; Thoracotomy ; Thorax

Purpose: Dental implant-associated medication-related osteonecrosis of the jaw has been frequently reported in patients administered bisphosphonates (BPs) to prevent osteoporosis. The aim of this study was to investigate the effect of intermittent administration of parathyroid hormone (PTH) on peri-implant bone in the maxillae of ovariectomized rats systemically administered BPs. Methods: Thirty 8-week-old female Sprague-Dawley rats were randomly divided into 3 groups. The OVX-ZP group included ovariectomized rats administered 60 μg/kg of zoledronate once a week for 6 weeks and 30 μg/kg PTH after implant installation. The OVX-Z group included ovariectomized rats administered 60 μg/kg of zoledronate once a week for 6 weeks and saline after implant installation, and the control group included rats that underwent a sham operation and were then administered saline. Rats were sacrificed 4 weeks after implant placement for histomorphometric and micro-computed tomography (CT) analyses. Results: The average bone area percentage was greater in the OVX-ZP group than in the OVX-Z group (53.4%±4.0% vs. 28.9%±9.5%, P=0.01). The bone-to-implant contact ratio was 50.8%±1.4% in the OVX-ZP group and 16.9%±2.4% in the OVX-Z group (P=0.012). The average bone volume ratio as shown on micro-CT was 31.3%±19.8% in the OVX-ZP group and 19.4%±9.3% in the OVX-Z group (P=0.045). The OVX-ZP and OVX-Z groups displayed similar trabecular thickness (0.06±0.004 mm vs. 0.06±0.002 mm) (P>0.05) and trabecular separation (0.21±0.02 mm vs. 0.29±0.13 mm) (P>0.05). However, the number of trabeculae in the OVX-ZP group was significantly higher than that in the OVX-Z group (4.3±1.33/mm3 vs. 2.2±0.19/mm3) (P=0.024). Conclusions The present findings indicate that intermittently-administered PTH can promote peri-implant bone formation and suggest that PTH administration may aid in effective treatment for medication-related osteonecrosis of the jaw after dental implantation.

BACKGROUND: The associations between preterm labor or premature rupture of membrane (PROM) and urogenital infections of pregnant women are reported. Ureaplasma urealyticum and Mycoplasma hominis are well known as important pathogens of urogenital infections in pregnant women. In routine clinical laboratory, conventional culture for these microorganisms has not been made generally because of the requirements for strict growth condition. MYCOFAST(R) Evolution 2 is an easy and rapid liquid microculture method using metabolism of these microorganisms. Author investigated the relationship between U. urealyticum or M. hominis infections and preterm labor or PROM by MYCOFAST Evolution 2 and PCR. Also it was reviewed that the possibility of substitution of MYCOFAST Evolution 2 for conventional culture method by comparing with PCR methods. METHODS: This study was done on 91 pregnant women. They were composed of two groups; group I(n=48) had full-term delivery and group II(n=43) had preterm labor or PROM before the 37th week.Two cervical swabs were made each time. One was used for MYCOFAST(R) Evolution 2 and the other for PCR. RESULTS: The positivity of U. urealyticum was 39.6% in group Iand 58.1% in group IIby MYCOFAST Evolution 2 and 39.6% and 58.1% by PCR method, respectively. The positivity of M. hominis was 4.2% in group Iand 11.6% in group IIby MYCOFAST Evolution 2 and 4.2% and 7.0% by PCR method, respectively. The positivity of U. urealyticum and M. hominis in group IIwas higher than that in group Ibut was not significant statistically. The concordance rates between two methods were 86.8% for U. urealyticum and 97.8% for M. hominis. It showed good correlation between two methods (U. urealyticum, r=0.736; M. hominis, r=0.835). CONCLUSIONS: The infections of U. urealyticum and M. hominis were related to preterm labor or PROM. Considering vertical transmission to fetus or neonates resulting in perinatal morbidity or mortality, the detection of these microorganisms is important. MYCOFAST(R) Evolution 2 was an easy, rapid and reliable method substituting conventional culture method.
Female ; Fetus ; Humans ; Infant, Newborn ; Membranes ; Metabolism ; Mortality ; Mycoplasma hominis* ; Mycoplasma* ; Obstetric Labor, Premature ; Polymerase Chain Reaction* ; Pregnancy ; Pregnant Women* ; Rupture ; Ureaplasma urealyticum* ; Ureaplasma*

Duodenal intramural hematoma is mostly caused by blunt abdominal trauma. It is also less commonly reported as a complication of anticoagulation therapy or as a blood dyscrasia, and as a complication of diagnostic/ therapeutic endoscopy. The presentation of these patients is abdominal pain, vomiting, fever and hematochezia, and this is rarely accompanied with intestinal obstruction, severe pancreatitis and acute peritonitis as its complications. The diagnosis is made clear by performing abdominal ultrasonography and abdominal computed tomography. We reported here on one case of intramural duodenal hematoma and hemoperitoneum after performing endoscopic hemostasis in a chronic renal failure patient who was on maintenance hemodialysis.
Abdominal Pain ; Diagnosis ; Duodenum ; Endoscopy* ; Fever ; Gastrointestinal Hemorrhage ; Hematoma* ; Hemoperitoneum* ; Hemostasis, Endoscopic ; Humans ; Intestinal Obstruction ; Kidney Failure, Chronic* ; Pancreatitis ; Peritonitis ; Renal Dialysis ; Ultrasonography ; Vomiting

BACKGROUND: We investigated the interactions between spontaneous apoptosis-induced neutrophils and autoantibodies with attention to the reactivities of each autoantibody against intracellular antigenssuch as the antinuclear antibody (ANA) and the anti-neutrophil cytoplasmic antibody (ANCA) and the applicability as a conventional test for autoantibody detection. METHODS: The 127 serum samples from patients with autoimmune disease were mixed with whole blood from healthy donors and incubated for 20 hours. The bound antibody against substrate neutrophils was detected with anti-IgG-FITC by flow cytometry. The results of this anti-long incubated neutrophil antibody (ALINA) testing were compared with ANA, ANCA and clinical manifestations. RESULTS: The positivity rate was significantly higher in the 20 hour incubation than that of a 30 minute incubation (100% and 18%, respectively; P<0.000005). Agreement analyses between ANCA and ALINA (k=0.34) and between ANA and ALINA (k=0.39) were poor. In comparison, among the autoimmune diseases, systemic lupus erythematosus had a significantly higher ALINA positivity rate than did other diseases (P<0.000005). In patients with SLE, higher mean fluorescence intensity was significantly associated with the presence of lupus nephritis (11/12 cases vs. 2/10 cases, P<0.005). CONCLUSIONS: We detected antibodies against neutrophil antigens expressed by long incubation with patient sera. Those detected autoantibodies were significantly associated with SLE, especially lupus nephritis. Therefore, further studies are necessary to devise optimal protocols and to clarify specificities for detected autoantibodies or their target antigens.
Antibodies* ; Antibodies, Antineutrophil Cytoplasmic ; Antibodies, Antinuclear ; Autoantibodies ; Autoimmune Diseases ; Flow Cytometry* ; Fluorescence ; Humans ; Lupus Erythematosus, Systemic ; Lupus Nephritis ; Neutrophils* ; Tissue Donors

BACKGROUND: We investigated the interactions between spontaneous apoptosis-induced neutrophils and autoantibodies with attention to the reactivities of each autoantibody against intracellular antigenssuch as the antinuclear antibody (ANA) and the anti-neutrophil cytoplasmic antibody (ANCA) and the applicability as a conventional test for autoantibody detection. METHODS: The 127 serum samples from patients with autoimmune disease were mixed with whole blood from healthy donors and incubated for 20 hours. The bound antibody against substrate neutrophils was detected with anti-IgG-FITC by flow cytometry. The results of this anti-long incubated neutrophil antibody (ALINA) testing were compared with ANA, ANCA and clinical manifestations. RESULTS: The positivity rate was significantly higher in the 20 hour incubation than that of a 30 minute incubation (100% and 18%, respectively; P<0.000005). Agreement analyses between ANCA and ALINA (k=0.34) and between ANA and ALINA (k=0.39) were poor. In comparison, among the autoimmune diseases, systemic lupus erythematosus had a significantly higher ALINA positivity rate than did other diseases (P<0.000005). In patients with SLE, higher mean fluorescence intensity was significantly associated with the presence of lupus nephritis (11/12 cases vs. 2/10 cases, P<0.005). CONCLUSIONS: We detected antibodies against neutrophil antigens expressed by long incubation with patient sera. Those detected autoantibodies were significantly associated with SLE, especially lupus nephritis. Therefore, further studies are necessary to devise optimal protocols and to clarify specificities for detected autoantibodies or their target antigens.
Antibodies* ; Antibodies, Antineutrophil Cytoplasmic ; Antibodies, Antinuclear ; Autoantibodies ; Autoimmune Diseases ; Flow Cytometry* ; Fluorescence ; Humans ; Lupus Erythematosus, Systemic ; Lupus Nephritis ; Neutrophils* ; Tissue Donors

BACKGROUND: Analysis of reticulated platelets (RPs) is useful for discriminating the causes of thrombocytopenia and monitoring the thrombopoiesis. In the patients with severe thrombocytopenia, we evaluated the thrombopoiesis-discriminating ability of several indices applying forward scatter (FSC) and thiazole orange (TO) fluorescence in addition to the percentage of reticulated platelets (RPs%). METHODS: Forty cases with decreased thrombopoiesis, twenty cases with increased thrombopoiesis and twenty cases with liver cirrhosis were selected. By flow cytometry with two analytic methods, dependent on or independent of the staining of CD41-PE as a platelet marker, the primary parameters including RPs% were measured and the applied parameters were calculated from them. And we compared the diagnostic efficiency of each parameter and analyzed the purity of platelet light scatter gate. RESULTS: The purity of platelet light scatter gate was significantly lower in patients with severe thrombocytopenia than in healthy persons with normal platelet counts (P<10(-6)), so the use of CD41-PE for platelet gating improved the diagnostic efficiency of RPs%. Compared to the primary parameters, the applied parameters originated from RPs%, FSC and TO fluorescence improved diagnostic efficiency significantly (RPs%: 55%, RPs%xs delta MFI: 80%) between decreased and increased thrombopoiesis groups. CONCLUSIONS: In the patients with severe thrombocytopenia, the estimate of the thrombopoiesis by a flow cytometric analysis can be more predictable by using platelet markers and by considering the fluorescence intensity of TO together with the RPs%.
Blood Platelets ; Citrus sinensis ; Flow Cytometry ; Fluorescence ; Humans ; Liver Cirrhosis ; Platelet Count ; Thrombocytopenia* ; Thrombopoiesis*

Hydrogen sulfide is a by-product of decayed organic material and is ubiquitously found as an ingredient of manufacturing reagents or as an undesirable by-product of the manufacturing or industrial processing. Hydrogen sulfide is a chemical asphyxiant and interferes with cytochrome oxidase and aerobic metabolism. It has thus been deemed an important cause of work-related sudden death. This gas is particularly insidious due to the unpredictability of its presence and concentration and its neurotoxicity at relatively low concentrations, causing olfactory nerve paralysis and loss of the warning odor. Here, we report two cases of comatose patients presenting after accidental exposure to hydrogen sulfide gas.
Coma ; Death, Sudden ; Electron Transport Complex IV ; Humans ; Hydrogen ; Hydrogen Sulfide ; Indicators and Reagents ; Occupations ; Odors ; Olfactory Nerve ; Paralysis ; Prognosis

PURPOSE: The principle of prehospital transport is that the patient should be transported to the nearest hospital that is suitable for the severity of the illness. Therefore, out-of-jurisdiction transport is improper. The purpose of this study was to understand the present situation and evaluate the appropriateness of out-of-jurisdiction prehospital transport by the 119 rescue group. METHODS: Between January and December 2009 we enrolled patients who were transported to the Gwangju Regional Emergency Medical Center by the 119 rescue group, which belongs to Jeolla province. The appropriateness of out-of-jurisdiction transport was based on the transport chart and medical record of the 119 rescue group and categorized into three groups. RESULTS: The total number of patients transported was 440: 78 (17.7%) were appropriate; 329 (74.8%) were inappropriate; 33 (7.5%) patients were very inappropriate. Of the 440, 156 (35.5%) were emergency cases, 147 (33.4%) were sub-emergency cases, and 137 (31.1%) were non-emergency cases. Comparing these data with the triage by the 119 rescue group, the kappa value was 0.368 (p<0.001). The patients or their guardians selected the hospital to which the patient was be transported in 382 (86.8%) cases. The actual transport distance was 40.0 km (range: 26.0 to 50.0) and was significantly longer than the nearest distance to a local emergency center which was 10.0 km (4.0 to 18.0) (p<0.001). CONCLUSION: Inappropriate out-of-jurisdiction transporting of patients is done frequently. Therefore, guidelines for prehospital transportation according to the triage is necessary. Additionally, the medical director and emergency medicine information center could play a role in selecting a hospital. A fee or a fine of transporters who do not observe the guidelines might limit the proportion of inappropriate transport cases.
Ambulances ; Emergencies ; Emergency Medical Services ; Emergency Medicine ; Fees and Charges ; Humans ; Information Centers ; Medical Records ; Physician Executives ; Transportation ; Transportation of Patients ; Triage