Background: Readmissions related to lack of quality care harm both patients and health insurance finances. If the factors affecting readmission are identified, the readmission can be managed by controlling those factors. This paper aims to identify factors that affect readmissions of convalescent rehabilitation patients. Methods: Health Insurance Review and Assessment Service claims data were used to identify readmissions of convalescent patients who were admitted in hospitals and long-term care hospitals nationwide in 2018. Based on prior research, the socio-demographics, clinical, medical institution, and staffing levels characteristics were included in the research model as independent variables. Readmissions for convalescent rehabilitation treatment within 30 days after discharge were analyzed using logistic regression and generalization estimation equation. Results: The average readmission rate of the study subjects was 24.4%, and the risk of readmission decreases as age, length of stay, and the number of patients per physical therapist increase. In the patient group, the risk of readmission is lower in the spinal cord injury group and the musculoskeletal system group than in the brain injury group. The risk of readmission increases as the severity of patients and the number of patients per rehabilitation medicine specialist increases. Besides, the readmission risk is higher in men than women and long-term care hospitals than hospitals. Conclusion “Reducing the readmission rate” is consistent with the ultimate goal of the convalescent rehabilitation system. Thus, it is necessary to prepare a mechanism for policy management of readmission.

Background/Aims: The objective of this study was to determine the more appropriate wound-closure method by comparing the effectiveness of two methods in a group of patients who underwent ileostomy repair. Methods: The study conducted after obtaining the approval of the Institutional Review Board (IRB) included 58 patients ≥19 years of age who underwent ileostomy at the Department of Surgery at the Presbyterian Medical Center. This was a retrospective, single-center trial. Patients who underwent ileostomy closure between January 2011 and September 2017 were assigned to the primary wound-closure (PC, n=25) group and the purse-string wound-closure (PSC, n=33) group. Post-repair complications, such as wound infection, delayed healing, and patient satisfaction related to wound management, were investigated and compared according to the wound-closure method. Results: The PSC group had a significantly lower surgical site infection rate than the PC group (0% vs. 44%, p<0.001). The wound-healing period was also significantly different between the PC and PSC groups (mean 27.18 days vs. 20.96 days, p=0.023). However, the postoperative wound-healing delay of >30 days was not significantly different (39% vs. 20%, p=0.114). In addition, there were no significant differences in the response to questionnaires on patient satisfaction between the two groups. Conclusions PSC has a lower surgical site infection rate and the wound-healing delay was not very different from that of PC. Therefore, if patients are at risk of wound infection, such as in severe wound contamination, long operating time, and immunocompromised conditions, we should consider PSC as a wound closure method of choice.

Kommerell diverticulum is a rare congenital anomaly of the aortic arch characterized by dilation at the proximal descending aorta, which gives rise to an aberrant subclavian artery. Kommerell diverticulum is usually asymptomatic, but can also be associated with symptoms due to compression of the esophagus or trachea, and can rarely be fatal due to dissection or rupture of the diverticulum. Here, we report a rare case of dysphagia caused by compression of the esophagus by Kommerell diverticulum originating from the right-sided aortic arch.

BACKGROUND: Perfusion scintigraphy with dipyridamole have been reported to be useful for diagnosis of coronary artery disease and the assessment of the presence and extent of myocardium at ischemic risk, especially in patients who can not undergo dynamic exercise testing. Dipyridamole, pharmacologic coronary vasodilator, also induces fall in blood pressure and rise in heart rate. The purpose of this study was to answer the question if dipyridamole induced peripheral hemodynamic responses were related to chest pain, ST changes on EKG, scintigraphic defect or extent of coronary stenosis. METHODS: Dipyridamole 99mTc-MIBI myocardial scintigraphy and coronary angiography on 43 subjects who were suspected to have coronary artery disease. The peripheral hemodynamic response was graded as absent(group 0) if there was a < or =10mm fall in systolic blood pressure (SBP) and/or < or =10 beats/min rise in geart rate(HR) ; moderate(group 1) if there was >10 but < or =20mm fall in SBP and/or >10 but < or =20 beats/min rise in HR ; and marked (group 2) if there was >20mm fall in SBP and/or >20 beats/min rise in HR. RESULTS: The overall diagnostic sensitivity and specificity for coronary artery disease of dipyridamole perfusion scintigraphy were 68%, 83% while per vessel sensitivity and specificity for coronary artery disease were 66%, 97%. The numbers of induced chest pain and ischemic ST changes among hemodynamic subgroups, were 40%, 40% in group 0, 33%, 27% in group 1 and 50%, 40% in group 2 without significant difference in each hemodynamic subgroups. Either the numbers of diseased coronary arteries or the numbers of patients demonstrationg reversible scintigraphic defects were not statically different among each subgroups. CONCLUSION: Although the peripheral hemodynamic response dose not always correlate with its central coronary effect but dipyridamlole 99mTc-MIBI myocardial perfusion scintigraphy is an useful test for diagnosis of coronary artery disease.
Blood Pressure ; Chest Pain ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Stenosis ; Coronary Vessels* ; Diagnosis ; Dipyridamole* ; Electrocardiography ; Exercise Test ; Heart Rate ; Hemodynamics* ; Humans ; Myocardial Perfusion Imaging ; Myocardium ; Perfusion Imaging ; Sensitivity and Specificity

OBJECTIVE: To find simple screening method for assessment of patients with diabetic neuropathy by use of brief questionnaire, scored physical examination including vibration perception threshold, and mixed median conduction study. METHOD: Subjects were 24 patients with diabetes mellitus. Conventional nerve conduction study was performed in 24 patients and the patients were divided into two groups: 11 patients with polyneuropathy; 13 patients of normal findings. The questionnaires were given for evaluation of sensory function in all the subjects. The questionnaires were followed by physical examination including two point discrimination, vibration perception threshold by using biothesiometer, 10 gram filament test, pin prick test, DTR check, and muscle strength test. Abnormality was determined by the number of positive responses or abnormal clinical findings. Finally, we recorded the conduction velocity and amplitude of median mixed nerve and compared these parameters to values of 20 normal adults. RESULTS: The questionnaire and physical exam scores were higher in patients with polyneuropathy (p<0.01). The patients with polyneuropathy showed higher vibration perception threshold values (p<0.01) and slower conduction velocity and smaller amplitude of median mixed nerve (p<0.05). In correlation with conventional nerve conduction study, the median mixed nerve conduction velocity had higher kappa value than amplitude in screening for diabetic polyneuropathy. CONCLUSION: We suggest the questionnaires, scored physical examination, vibration perception threshold, and median mixed nerve conduction velocity to be a simple screening method for assessment of patients with diabetic plyneuropathy.
Adult ; Diabetes Mellitus* ; Diabetic Neuropathies ; Discrimination (Psychology) ; Humans ; Mass Screening ; Muscle Strength ; Neural Conduction* ; Physical Examination* ; Polyneuropathies ; Surveys and Questionnaires* ; Sensation ; Vibration

The diagnosis of gallstone ileus is occasionally challenging due to the variability of its presentation. We herein present a very rare case of gallstone ileus inducing obstructive jaundice at the afferent loop of Roux-en-Y hepaticojejunostomy after 10 years of bile duct cancer surgery. We describe the case of a 74-year-old Korean woman with obstructive jaundice, treated conservatively. She showed severely impaired liver function test and obstructive jaundice. The computed tomography (CT) scan led to a diagnosis of very rare type of gallstones ileus at the afferent jejunal loop. Since the clinical manifestation was improved, we decided to observe her closely. On the next follow-up CT scan, the gallstone disappeared with mild distension of the afferent bowel loop, implicating spontaneous passage of the gallstone. She recovered and returned to normal life after 10 days of initiation of clinical manifestations. We presume that the gallstone may enter the afferent jejunal loop through the hepaticojejunostomy and later increase in size. The presence of narrow tract of intestine may facilitate the incidence of gallstone ileus. It appears to be the first report on this rare type of gallstone ileus inducing obstructive jaundice.
Aged ; Bile Duct Neoplasms* ; Diagnosis ; Female ; Follow-Up Studies ; Gallstones* ; Humans ; Ileus* ; Incidence ; Intestines ; Jaundice, Obstructive* ; Liver Function Tests ; Tomography, X-Ray Computed

Posterior reversible encephalopathy syndrome (PRES) is a rare clinico-radiological syndrome that is characterized by an acute onset of headache, vomiting, visual abnormalities, confusion, and/or seizures and is typically accompanied with edema of predominantly posterior portions of the cerebral hemispheres. Here, we report a case of PRES with cerebral hemorrhage that occurred in a female pediatric patient with uncontrolled nephrotic syndrome. The patient's magnetic resonance imaging (MRI) studies showed asymmetric white matter abnormalities, cerebral hemorrhage, and restricted diffusion. After controlling her hypertension and nephrotic syndrome, her neurologic symptoms improved, and follow-up MRI findings revealed interval resolving of the white matter lesions.
Cerebral Hemorrhage* ; Cerebrum ; Child* ; Diffusion Magnetic Resonance Imaging ; Diffusion* ; Edema ; Female ; Follow-Up Studies ; Headache ; Humans ; Hypertension ; Magnetic Resonance Imaging ; Nephrotic Syndrome* ; Neurologic Manifestations ; Posterior Leukoencephalopathy Syndrome* ; Seizures ; Vomiting ; White Matter

PURPOSE: Papillary thyroid cancer with level VII (anterior superior mediastinal lymph nodes) lymph node metastasis belongs to Stage IV a according to the Americal Joint Committee on Cancer cancer staging. The aim of our study was to identify clinicopathologic factors that are related to level VII cervical lymph node metastasis and to suggest recommendations for level VII dissection. METHODS: We reviewed 195 patients with papillary thyroid carcinoma who had their initial operation containing level VII dissection from April 2006 to June 2007. Level VII dissection involved lymph nodes in the anterior superior mediastinum and tracheoesophageal grooves, extending from the suprasternal notch to the innominate artery. Clinicophathologic factors, such as gender, age and lateral neck metastasis, related to Level VII metastasis were analyzed by tumor size, multifocality of tumor, extrathyroidal extension and lymphovascular invasion. RESULTS: Nine (4.6%) of 195 patients with papillary thyroid carcinoma had level VII metastasis. Clinicopathologic factors that were related to level VII metastasis included lateral neck metastasis (P < 0.01), tumor size (P < 0.01) and lymphovascular invasion (P < 0.05). CONCLUSION: If preoperatively, the tumor size is over 1.5 cm, or there is lateral neck metastasis, level VII dissection must be considered. If there is lymphovascular invasion pathologic findings postoperatively, special attention should be paid for detection of level VII recurrence.
Brachiocephalic Trunk ; Carcinoma ; Humans ; Joints ; Lymph Nodes ; Mediastinum ; Neck ; Neoplasm Metastasis ; Neoplasm Staging ; Recurrence ; Thyroid Gland ; Thyroid Neoplasms

Collapsing glomerulopathy (CG) has become an important cause of end-stage renal disease (ESRD). First delineated from other proteinuric glomerular lesions in the 1980s, CG is now recognized as a common, distinct pattern of proliferative parenchymal injury that portends a rapid loss of renal function and poor responses to empirical therapy. The first cases in the literature trace back to human-immunodeficiency-virus (HIV)-negative patients who underwent biopsy in 1979. A 45-year-old male patient complained of hematuria and proteinuria eight years ago. He showed an abrupt serum creatinine increase from 1.75 to 2.65mg/dL in the last preceding months. Afterwards, his serum creatinine progressively increased up to 6.82mg/dL. Moreover, his 24 h urine protein level was determined to have reached 6,171 mg/day, as opposed to 670 mg/day a year earlier. Consequently, renal biopsy was performed, and its result showed collapsing glomerulopathy, compatible with the diagnosis. He has undergone continuous ambulatory peritoneal dialysis as renal replacement therapy. Thus, it is reported herein that a patient clinically diagnosed with chronic kidney disease eight years ago showed a sudden renal-function decrease and was clinicopathologically diagnosed with collapsing glomerulopathy based on the results of his renal biopsy.
Biopsy ; Creatinine ; Glomerulosclerosis, Focal Segmental ; Hematuria ; Humans ; Kidney Failure, Chronic ; Male ; Peritoneal Dialysis, Continuous Ambulatory ; Proteinuria ; Renal Insufficiency, Chronic ; Renal Replacement Therapy

Pacemaker implantation for patients with mechanical tricuspid valve is quite challengeable because lead insertion through prosthetic tricuspid valve may cause valve dysfunction or lead impingement. Also complications due to interrupt of anticoagulation should be considered. A 65 years old woman received AAI (atrium paced, atrium sensed, inhibited) pacemaker for sick sinus syndrome and mechanical mitral valve replacement for severe mitral steno-insufficiency at the same time 16 years before. She needed to undergo mechanical tricuspid valve replacement (TVR) because of severe tricuspid regurgitation despite of medical therapy. Complete atrioventricular block developed during the TVR operation and it was not recovered even after several days of temporary pacing. We decided left ventricular pacing through coronary sinus because ventricular lead could not pass mechanical tricuspid or mitral valve and also planned to continue oral anticoagulation therapy. We could find a place where high pacing output did not pace phrenic nerve with acceptable sensing, pacing threshold. The patient recovered well without any periprocedural complications. Left ventriclcular pacing lead implantation through coronary sinus without interruption of anticoagulation can be an alternative to epicardial pacing for patients with mechanical tricuspid valve.
Atrioventricular Block ; Coronary Sinus ; Female ; Humans ; Mitral Valve ; Phrenic Nerve ; Sick Sinus Syndrome ; Tricuspid Valve Insufficiency ; Tricuspid Valve*