While Joint Commission on Accreditation of Healthcare Organizations(JCAHO) and American College of Surgeon(ACS) have identified certain audit filters in trauma care, there are few studies to substantiate the value of these audit filters. Some researchers found that audit filters qualifiers were significantly associated with adverse outcomes, however, others were unable to reproduce such association. It is also necessary to test their validity and applicability in Korea. The purpose of this present study was to validate two trauma audit filters proposed by the JCAHO and the ACS, through the analysis of the relationship between timeliness of operation and risk-adjusted mortality. Among trauma audit filters, timeliness of operation in epidural or subdural hematoma(EDH/SDH) and intraabdominal injury were selected. By stratified random cluster sampling, 19 emergency medical centers (EMCs) were selected from 30 EMCs and all patients who received craniotomy or laparotomy in 1996 were evaluated in each hospital. Six medical records administrators reviewed medical records of 463 patients with EDH/SDH and of 508 patients with intraabdominal injury retrospectively. In other to adjust risk of mortality, timeliness of operation, age, Revised Trauma Score(RTS), ICD-9CM based ICISS, and experiences of transfer were included in logistic regression model. In the logistic regression models of all EDH/SDH or intraabdominal injury patients, timeliness of operation was not significant predictor of mortality. However, if patients who have been operated later than 12 hours were excluded from the statistical model, timeliness of operation showed significant or marginally significant relationship with mortality in the following situations; craniotomy > 4 hours in EDH(OR=30.46, p=0.032), craniotomy > 8 hours in SDH(OR=6.50, p=0.020), laparotomy > 2 hours in shock patients(OR=9.26, p=0.055). In addition to timeliness of operation, RTS and ICISS were significant variables in every logistic regression model, and experience of transfer and types of EMC were significant or marginally significant only in EDH. Timeliness of operation as audit filters for trauma care could not be applied to all cases. Early operations seem to improve clinical outcome only in the patients for whom emergent craniotomy or laparotomy were indicated. It could be interpreted as a phenomenon of 'confounding by indication'. Additional studies to establish more objective eligibility criteria for these audit filiters are needed.
Accreditation ; Administrative Personnel ; Craniotomy ; Delivery of Health Care ; Emergencies ; Humans ; Joint Commission on Accreditation of Healthcare Organizations ; Joints ; Korea ; Laparotomy ; Logistic Models ; Medical Records ; Models, Statistical ; Mortality ; Retrospective Studies ; Shock

Mass casualty disasters have complex communication requirement. The involvement of many different communication systems and agencies and the difficulty of exchanging information between them is a perplexing problem. This may be compounded by telecommunication systems overload or failure, and electric service disruptions in the disaster area. In addition, emergencies are characterized by a sudden need for an increased information flow, an explosion in the topographical complexity of the information network, and a feeling of intense psychological pressure among the participants. The rescue, treatment, evacuation of a lot of patients from a natural disaster or mass casualties must be performed in accordance to several national agencies. Without an effective communication system, morbidity and mortality will needlessly rise. The stabilization and evacuation off lot of patients in a disaster is a serious and complex medical problem that must be resolved expeditiously. The potential far maximizing care depends on an well-organized rescue. However, without adequate communications, the patient may experience needless delays into the health care system an6 thus compromise prognosis. Established communication systems in most communities consist of private services, provincial and national agencies, and military and amateur radio operator. A disaster situation can severely disrupt routine telephone and radio communication. Customary frequencies may be incompatible with military and emergency civilian frequencies or become overloaded and useless because of intense activity. In a disaster, local telephone communication resources may be destroyed: qualified staffing of communications networks may be inadequate or unavailable to cope with the demands of the emergency. So, we recommend, that Amateur Radio should be provide as a effective emergency communication in a disaster.
Delivery of Health Care ; Disasters* ; Emergencies* ; Explosions ; Humans ; Information Services ; Mass Casualty Incidents ; Military Personnel ; Mortality ; Prognosis ; Telecommunications ; Telephone

No abstract available.
Animals ; Hyperbaric Oxygenation* ; Osteomyelitis* ; Rats*

The posterior fossa, containing roughly 6ne fourth of the intracranial contents, is the site of about 30-35% of the intracranial tumors. The incidence of primary tumors in the posterior fossa is quite different from that of the cerebivm. We analysed 124 cases of posterior fossa tumor, over a 10 year period, to understand the status of posterior fossa tumor and its histologic characteristics. Medulloblastoma was most common(37cases, 29.8%), followed by astrocytoma, hemangiobla-stoma, ependymoma, meningioma, metastatic tumor, arteriovenous malformation and choroid plexus papilloma in descending order of frequency. Tumors were found most frequently between the ages of two and ten years(28.2%) and sixty seven(54.0%) cases were diagnosed before the age of fifteen. The ratio of male to female was 60 : 64. Astrocytoma revealed a characteristic juvenile pilocytic type and a microcystic change. Hemangioblastoma showed higher frequency(17.7%) than previous reports and the origin of tumor cells is still equivocal. Other tumors revealed the same histologic features as other intracranial tumors.
Child ; Adolescent ; Male ; Female ; Humans ; Incidence ; Neoplasm Metastasis

Malignant mixed mullerian tumor (MMMT) is an unusual tumor composed of malignant epithelial and nonepithelial components in the same lesion and is subdivided into homologous and heterologous types. Epidemiologically, these tumors are associated with prior pelvic irradiation, functioning ovarian lesions, exogenous estrogen therapy and rarely endometriosis. We experienced a case of uterine MMMT which arose from adenomyosis in a 47-year-old woman who had no specific past medical history. The posterior uterine corpus showed a 3.5x3.0x2.0 cm sized, relatively well defined tumor mass within the background of the adenomyosis. The tumor was composed of well differentiated endometrial adenocarcinoma and sarcomatous stroma with foci of rhabdomyosarcomatous differentiation confirmed by immunohistochemical and electron microscopic studies. Through the immunohistochemical study, both the epithelial and nonepithelial components were positive for cytokeratin and it suggested that the sarcomatous area originated from metaplasia of the adenocarcinoma component. From the overall findings, it is regarded as an uterine heterologous MMMT which arose from adenomyosis.
Adenocarcinoma ; Adenomyosis* ; Endometriosis ; Estrogens ; Female ; Humans ; Keratins ; Metaplasia ; Middle Aged ; Rhabdomyosarcoma ; Uterus*

No abstract available.
Gastrointestinal Stromal Tumors*

No abstract available.
9,10-Dimethyl-1,2-benzanthracene* ; Carcinogenesis* ; Hyperbaric Oxygenation* ; Submandibular Gland*

The lysozyme activities of knee joint fluid in normal Korean people, patients with rheumatoid arthritis, and patients with degenerative arthritis have been reported by Lee in 1974. This time I have studied the chronologic changes of lysozyme activity of knee joint fluid in patients with rheumatoid arthritis following intra-articular injection of steroid preparation (6-methylprednisolone acetate). The results obtained were as follows. 1. The synovial concentration of lysozyme in patients with rheumatoid arthritis was found to be 10.88 mcg/ml which is higher than normal value of 8.69 mcg/ml. 2. The lysozyme activity of joint fluid obtained 5 days after intra-articular injection of steroid prepatation was variable ranging from 7.40 mcg/ml to 10.0mcg/ml with the average of 8.97 mcg/ml, which corresponded to the relief of clinical manifestations. 3. The lysozyme activity of joint fluid obtained 10 days after intra-articular injection of steroid preparation decreased to 8.36 mcg/ml on average with the range from 7.60 to 9.30 mcg/ml which was in accordance with much relief of clinical manifestations. 4. The lysozyme activity of joint fluid obtained 20 days after intra-articular steroid injection was 9.55 mcg/ml on average with the range from 8.25 to 11.25 mcg/ml which was in accordance with the aggravations of clinical manifestations.
Arthritis, Rheumatoid ; Humans ; Injections, Intra-Articular ; Joints ; Knee Joint ; Muramidase ; Osteoarthritis ; Reference Values

PURPOSE: We investigated the effects of phosphatase and tensin homologue deleted on chromosome 10 gene phosphatase and tensin homologue deleted on chromosome 10 gene (PTEN) expression on the cell proliferation and on the responsiveness of troglitazone in osteosarcoma cells. MATERIALS AND METHODS: Western blotting alnalysis was performed to detect the expression of PTEN in U-2OS cells treated with troglitazone. WST (water-soluble tetrazolium) assay was used to evaluate cell proliferation. Flow cytometry was used to determine cell apoptosis. Further, transfection of wild-type PTEN plasmid DNA was used to upregulate PTEN expression. RESULTS: Troglitazone treatment induced growth inhibition of U2-OS cells in a dose- and time-dependent manner. Troglitazone increased the expression of PTEN in a dose-dependent manner. PTEN upregulation induced by troglitazone treatment resulted in cell growth inhibition and apoptosis in U-2OS cells. PTEN over-expression by plasmid transfection enhanced these effects of troglitazone. Moreover, no changes were observed in the mutant type-PTEN group. CONCLUSION: Upregulation of PTEN is involved in the inhibition of cell growth and induction of cell apoptosis by troglitazone. Further, PTEN over-expression can cause cell growth inhibition in osteosarcoma cells and these cell growth inhibitions could be enhance by troglitazone treatment.
Apoptosis ; Blotting, Western ; Cell Proliferation ; Chromans ; Chromosomes, Human, Pair 10 ; DNA ; Flow Cytometry ; Humans ; Microfilament Proteins ; Osteosarcoma ; Plasmids ; Thiazolidinediones ; Transfection ; Up-Regulation

BACKGROUND: Intravenous urography(IVU) has long been accepted as the primary radiologic study for the diagnosis of renal colic. But the IVU does pose disks of contrast material reactions and exposure to radiation. Recently, IVU has been challenged as a first line modality and ultrasonography proposed as a replacement. We, therefore, felt obliged to re-evaluate the IVU, KUB and ultrasonography as diagnostic tools. METHODS: We evaluate the sensitivity and specificity of ultrasound, IVU and KUB in detecting urinary calculi in suspected acute renal colic, a prospective study of 69 patients, both sides of kidney and ureter, who visited urban university hospital emergency center from September 1997 to January 1998. Our sonographic criteria far a positive examination consisted of visualization of urinary tract calculus and/or hydronephrosis and/or urinoma. RESULTS: In Ultrasonography, the accuracy, sensitivity and specificity were 94, 94 and 94%. In IVU and KUB, they were 90, 81, 98% and 71, 43, 96%. CONCLUSION: Ultrasonography is very useful diagnostic tool in initial evaluation of acute renal colic.
Calculi ; Diagnosis ; Emergencies ; Humans ; Hydronephrosis ; Kidney ; Prospective Studies ; Renal Colic* ; Sensitivity and Specificity ; Ultrasonography* ; Ureter ; Urinary Calculi ; Urinary Tract ; Urinoma