Some patients with depression require electroconvulsive therapy performed undergeneral anesthesia. This requires rapid loss of consciousness, with minimal interferencefrom seizure activity, appropriate muscle relaxation status, prevention of hyperdynamicresponses to the electrical stimulus, and proper recovery of spontaneous ventilationand consciousness. The authors report the first case of electroconvulsive therapy performedwith the patient under general anesthesia at the Ewha Womans UniversityMedical Center, Korea.

PURPOSE: This study was designed to evaluate the effect of emergency department (ED) overcrowding on the outcome of patient care. METHODS: A retrospective review of medical records was obtained from Order Communicating System in the adult ED at a tertiary care teaching hospital from September 1, 2001 to November 30, 2001. For the overcrowding index, the length of stay in the ED and the time from registration to order were calculated. The outcome was defined as the result of care done in the ED or during hospitalization. The overcrowding effect on the outcome was tested by using a multivariate logistic regression analysis. Compared with the survival group, the odds ratio (OR) and 95% confidence interval (95% CI) of the death group was calculated with adjustments for gender, age, arrival time in the ED, arrival day of the week, clinical department, operation, hospitalization in the intensive care unit, and injury or disease. RESULTS: The number of total cases was 5,852. Of these, 3,046 was males and 2,806 females. Of these, the number of mortality cases in the ED was 106. A total of 2,025 patients were hospitalized. Of all the hospitalization cases, 161 died on the ward in spite of management. The length of stay in the ED, and adjusted OR were significantly increased in the total death cases and in the death cases on the ward compared to those of the survival cases. For time, from registration to order above 10 minute, compared to those below 10 minute, the adjusted OR for death in the ED was significantly increased. CONCLUSION: The overcrowding indices, such as the length of stay or the time from registration to order, were related with the outcome, that is, total death and death in the ED or on the ward.
Adult ; Emergencies* ; Emergency Service, Hospital* ; Female ; Hospitalization ; Hospitals, Teaching ; Humans ; Intensive Care Units ; Length of Stay ; Logistic Models ; Male ; Medical Records ; Mortality ; Odds Ratio ; Patient Care* ; Pilot Projects* ; Retrospective Studies ; Tertiary Healthcare

PURPOSE: In previous studies, therapeutic hypothermia (HT) in hemorrhagic shock (HS) had beneficial effects on the hemodynamic and metabolic parameters, and on the survival. The mechanism is uncertain. We hypothesized that the suppression of inducible nitric oxide synthase (iNOS) and NF-kappaB could be associated with the beneficial effects of therapeutic HT in HS. METHODS: Sixteen male Sprague-Dawley rats were randomized to normothermia (36~37degrees C, NT group) or moderate hypothermia (27~30degrees C, HT group). They underwent volumecontrolled (2 ml/100 g weight) HS (90 minutes) and partial resuscitation with shed blood (1 ml/100 g). RESULTS: In the HS and post-resuscitation phase, the mean arterial pressures were higher in the HT group than in the NT group and PaO2 was higher in the HT group than in the NT group. The lactate level was lower in the HT group than in the NT group (1.1+/-1.1 nmol/L vs 6.4+/-5.0 nmol/L, p=0.021). Serum concentrations of IL-1 beta and IL-6 and activated p65 NF-kappaB levels in the lung tissue were higher in NT group than in the HT group (p<0.05). Lung malondialdehyde contents and the expression of iNOS mRNA were significantly decreased in the HT group compared to the NT group (63.8+/-6.2 nmol/g vs 44.6+/-4.5 nmol/g, p<0.001; 1313.0+/-924.4 vs 9088.4+/-3984.0 arbitrary units, p<0.001, respectively). CONCLUSION: These data suggest that in HS, therapeutic HT inhibits lipid peroxidation, activation of NF-kappaB, and gene expression of iNOS in the lung. These factors might be the mechanism of the beneficial effects of HT in HS.
Animals ; Arterial Pressure ; Cytokines ; Gene Expression ; Hemodynamics ; Humans ; Hypothermia ; Interleukin-1beta ; Interleukin-6 ; Lactic Acid ; Lipid Peroxidation ; Lung ; Male ; Malondialdehyde ; NF-kappa B ; Nitric Oxide Synthase Type II ; Rats ; Rats, Sprague-Dawley ; Resuscitation ; RNA, Messenger ; Shock, Hemorrhagic

Chronic cough is common in the community and causes significant morbidity. Several factors may underlie this problem, but comorbid conditions located at sensory nerve endings that regulate the cough reflex, including rhinitis, rhinosinusitis, asthma, eosinophilic bronchitis, and gastroesophageal reflux disease, are considered important. However, chronic cough is frequently non-specific and accompanied by not easily identifiable causes during the initial evaluation. Therefore, there are unmet needs for developing empirical treatment and practical diagnostic approaches that can be applied in primary clinics. Meanwhile, in referral clinics, a considerable proportion of adult patients with chronic cough are unexplained or refractory to conventional treatment. The present clinical practice guidelines aim to address major clinical questions regarding empirical treatment, practical diagnostic tools for non-specific chronic cough, and available therapeutic options for chronic wet cough in children and unexplained chronic cough in adults in Korea.
Adult* ; Asthma ; Bronchitis ; Child* ; Cough* ; Eosinophils ; Evidence-Based Medicine ; Gastroesophageal Reflux ; Humans ; Korea* ; Referral and Consultation ; Reflex ; Rhinitis ; Sensory Receptor Cells