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: This study was purposed to find out the differences in the lymphocyte subsets and differential cell counts of the bronchoalveolar lavage (BAL) fluid in patients with interstitial lung disease (ILD) and to analyze the differences according to their ages, gender and smoking habits. METHODS: BAL fluid samples of 141 ILD patients were examined for lymphocyte subsets and differential cell counts, and the differences among the patients were analyzed according to their diseases. Then, within the three most common disease groups, the differences were further analyzed by the age, gender and smoking habit of the patients. RESULTS: There were no statistically significant differences in total cell counts (per millimeters of BAL fluid) among the patient groups with each ILD. However, significant differences were observed in the percentages of neutrophils, lymphocytes, eosinophils, and macrophages of BAL fluid. Also, in lymphocyte subset analyses, the percentages of total T cells, B cells, CD4+ T cells, CD8+ T cells, CD4/CD8 T cell ratios, and NK cells were significantly different among the patients with each ILD. However, within the same disease group, there were no differences in differential cell counts and lymphocyte subset analyses according to the age, smoking habit, and gender of the patients. CONCLUSIONS: Although the age, smoking habit and gender did not have an effect on the BAL fluid analyses among the patients with the same ILD, there were significant differences among the patients with each ILD; therefore, the differential cell counts and lymphocyte subset analyses of BAL fluid can be useful in differential diagnosis for determining the types of ILD.
Adult ; Aged ; Bronchoalveolar Lavage Fluid/*cytology ; Diagnosis, Differential ; Female ; Humans ; Lung Diseases, Interstitial/diagnosis/*epidemiology/etiology ; Lymphocyte Count ; Lymphocyte Subsets/immunology ; Male ; Middle Aged ; Smoking

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: TT virus (TTV), isolated initially from a Japanese patient with posttransfusion hepatitis of unknown etiology, was suggested to be a new causative agent of hepatitis. However, it has been found to infect both healthy and diseased individuals and numerous studies have raised questions about its pathogenic role in hepatitis. In order to study its prevalence and clinical impact on hepatitis, we assessed the frequency of TTV DNA. METHODS: Serum samples were obtained from 60 cases of the controls, 77 cases of chronic liver diseases, 44 cases of hemodialyzed patients, and 65 cases of transfused patients. TTV DNA was detected using nested polymerase chain reaction and alanine aminotransferase (ALT), aspartate aminotransferase (AST), and hepatitis B surface antigen (HBsAg) were measured. RESULTS: TTV DNA was detected in 41.7% of the controls, 51.9% of patients with chronic liver diseases, 68.2% of hemodialyzed patients and 61.5% of transfused patients. Comparison between patients with or without TTV revealed no significant differences in AST, ALT, and HBsAg test results. CONCLUSION: The prevalance of TTV infection in patients with chronic liver diseases was similar to that in the controls. TTV infection was not related to abnormal liver function findings and HBsAg positivity. We found no relationship between TTV infection and chronic liver diseases.
Alanine Transaminase ; Asian Continental Ancestry Group ; Aspartate Aminotransferases ; DNA ; Hepatitis ; Hepatitis B Surface Antigens ; Humans ; Liver Diseases* ; Liver* ; Polymerase Chain Reaction ; Prevalence ; Renal Dialysis* ; Torque teno virus*

PURPOSE: Pneumonia is a common complication of organophosphate poisoning and increases the incidence of respiratory failure and the duration of mechanical ventilator support. Therefore, we investigated the clinical characteristics of pneumonia as a complication of organophosphate insecticide poisoning and then determined the factors related to the development of pneumonia. METHODS: A retrospective study was performed on patients with organophosphate insecticide poisoning, who were treated at our hospital with medical records and chest radiograph of patients. From January 1, 2001, to July 31, 2004, eighty five patients were included in this study. RESULTS: 1) Thirty-two (71% of the patients developing pneumonia) patients developed pneumonia later than 48 hours from admission and twenty-five (55.6% of the patients developing pneumonia) patients developed pneumonia later than 48 hours after mechanical ventilatory support. 2) The mean onset of pneumonia resistant to initial empirical antibiotics was 4.8 days from admission, and that of susceptible pneumonia was 3.7 days from admission. 3) Patients with pneumonia as a complication needed larger doses of atropine and more 2-pralidoxime injections, as well as longer mechanical ventilatory support, ICU admission, and total hospital admission. CONCLUSION: Most Pneumonia in organophosphate poisoning patients were nosocomial pneumonia & ventilator-associated pneumonia. Thus, to reduce the incidence of pneumonia complication in organophosphate poisoning patients, Physicians must take measures, such as hand-washing and careful periodic drainage of tubing condensate, etc., to reduce the incidence of nosocomial pneumonia. In selecting empirical antibiotics for pneumonia complicating organophosphate poisoning patients, physicians should take regional prevalence of nosocomial pathogens into consideration. In late-onset ventilator-associated pneumonia, physicians must consider pneumonia caused by organisms resistant to commonly used empirical antibiotics.
Anti-Bacterial Agents ; Atropine ; Drainage ; Humans ; Incidence ; Medical Records ; Organophosphate Poisoning ; Pneumonia* ; Pneumonia, Aspiration* ; Pneumonia, Ventilator-Associated ; Poisoning* ; Prevalence ; Radiography, Thoracic ; Respiratory Insufficiency ; Retrospective Studies ; Ventilators, Mechanical

In acute phase, cerebral infartion is usually hypodense on CT and hyperintense on T2-weighted MR image. This hyperintensity on T2-weighted MR image gradually approaches an isointensity stage after 2 or 3 weeks of onset. In the later stage, cerebral infarction is observed hyperintense on T2-weighted MR image. This sequential phenomenon is so-called "fogging effect". We experienced two cases of "fogging effect". The first case did not show abnormal signal intensity on TI or T2 weighted MR images taken after 14 days of onset and the second case also did not show abnormal signal intensity after 17 days of onset. Each case revealed hyperintense in T2-weighted image with contrast enhancement taken after 20 weeks and 8 weeks of onset, respectively. We present two cases with MRI and brief review of literatures.
Cerebral Infarction ; Magnetic Resonance Imaging ; Weather*

BACKGROUND/AIMS: In head and neck squamous cell carcinoma, second primary gastrointestinal tumors are not uncommon. However, it is unclear whether a screening endoscopy is needed for detecting gastrointestinal neoplasm in patients with head and neck cancer. Therefore, we analyzed the prevalence and independent risk factors for second primary gastrointestinal neoplasm in head and neck squamous cell carcinoma. METHODS: A consecutive series of 328 patients with primary head and neck squamous cell carcinoma that underwent esophagogastroduodenoscopy or colonoscopy were included using our registry. An age- and sex-matched group of 328 control subjects was enrolled. We assessed risk factors of synchronous gastrointestinal cancer. RESULTS: The prevalence of esophageal cancer with head and neck squamous cell carcinoma was significantly higher than that of the control group (1.5% vs. 0.0%, p=0.011). An age of 54 years or more (OR, 1.033; 95% CI, 1.008-1.059; p=0.009) and male gender (OR, 4.974; 95% CI, 1.648-15.013; p=0.004) were risk factors for concomitant colorectal cancer or adenomas in the head and neck squamous cell carcinoma patients. CONCLUSIONS: Preoperative colonoscopy can be recommended for detecting synchronous second primary colorectal lesions in head and neck squamous cell carcinoma patients with male sex regardless of age, and esophagogastroduodenoscopy is necessary in all head and neck squamous cell carcinoma patients for detecting esophageal cancer.
Adenoma ; Carcinoma, Squamous Cell ; Colonoscopy ; Colorectal Neoplasms ; Diagnosis ; Endoscopy ; Endoscopy, Digestive System ; Endoscopy, Gastrointestinal* ; Esophageal Neoplasms ; Gastrointestinal Neoplasms ; Head and Neck Neoplasms* ; Head* ; Humans ; Male ; Mass Screening ; Neck ; Neoplasms, Second Primary* ; Prevalence ; Risk Factors

PURPOSE: Consensus guidelines clearly define how cardiopulmonary resuscitation (CPR) is to be performed, but the parameters of CPR in actual practice are not routinely measured, nor is the quality known. We sought to investigate the actual quality of CPR performed by trained hospital staffs and to determine whether metronome guidance improved the quality of CPR. METHODS: A prospective study was performed on 26 out of hospital cardiac arrest patients who received CPR at an emergency department (ED). In the ED, resuscitation efforts were recorded by using a camcorder. Using the recorded data, we analyzed the parameters of CPR quality such as ventilation and chest compression rates. RESULTS: In the 26 cardiac arrests, the first nine cases constituted group I. The subsequent nine cases, after the rescuers had been re-trained to provide CPR according to the guideline, constituted group II. The final eight cases after the rescuers had been trained to use metronome guidance constituted group III. The average ventilation rate in group I was 30.7 ventilations/min. Although the average ventilation rate in group II was lower than that of group I, it was still higher than the recommended rate. After metronome guidance, the ventilation rate was significantly reduced and approached to the rate of the present guideline. The average chest compression rate in group I was higher than the rate recommended in the present guideline and was significantly reduced after metronome guidance. CONCLUSION: We strongly believe that further study should be performed to consider the survival benefit of good-quality CPR. Devices providing feedback to alert rescuers may be useful for improving the quality of CPR.
Cardiopulmonary Resuscitation* ; Consensus ; Emergency Service, Hospital ; Heart Arrest ; Humans ; Out-of-Hospital Cardiac Arrest ; Prospective Studies ; Resuscitation ; Thorax ; Ventilation