No abstract available.
Aortic Valve Insufficiency*

PURPOSE: The purpose of this study is to enhance the quality of data by performing a methodological assessment of medical records reviews. METHODS: We reviewed the articles published in the Journal of the Korean Society of Emergency Medicine between January 2001 and December 2003 that used a retrospective medical records review as the study method. We assessed data collector's training, descriptions of inclusion/ exclusion criteria, definitions of important variables, use of standardized case record forms, monitoring the data collectors' performance, blind data collecting, inter-rater reliability/ test of inter-rater agreement, intra-rater reliability/test of intra-rater agreement, selection bias from consent, and rules regarding management of missing data. RESULTS: There were 111 articles that used retrospective medical records reviews during the study period. In 111 (100%) articles, inclusion/exclusion criteria were described, in 98 (88.3%), important variables were defined, and in 4 (3.6%), standardized case record forms were used. However no articles addressed the other items on the checklist. CONCLUSION: Study conductors should design studies to enhance the quality of data, and detailed descriptions are necessary to improve the reproducibility of the study.
Checklist ; Emergencies* ; Emergency Medicine* ; Medical Records* ; Retrospective Studies ; Selection Bias

PURPOSE: The purpose of this study was to assess the statistical methods used in the Journal of the Korean Society of Emergency Medicine (JKSEM) and to identify the types of errors in statistical analysis. METHODS: We reviewed quantitative articles that were published in the JKSEM from January 1998 through December 2002. Editorials, review articles, and case reports were not included in this analysis. A total of 319 articles was reviewed. We focused on the methods of inferential statistics in these articles. We evaluated the adequacy and the validity of the statistical techniques with our criteria, which were established by modifying Ahn's checklist. RESULTS: Of the 319 articles, 222 used inferential statistics. The t-test was the statistic of choice overall (45.1%), followed by the chi-square test (23.9%). Errors of omission (70.3%) were more frequent than errors of commission. Of the errors of omission, incomplete description of the basic data was the most common. CONCLUSION: We found various mistakes or misuses in the applications of statistical methodologies in the articles published in the JKSEM. The present study suggests that additional efforts should be focused on the appropriateness of the statistical analysis used in JKSEM articles to improve their value, and during the review process, editorial attention should be paid to the validity of the statistical methodologies used in the articles.
Checklist ; Emergencies* ; Emergency Medicine*

Polyphenol (-)-epigallocatechin gallate (EGCG), the most abundant catechin of green tea, appears to attenuate myocardial ischemia/reperfusion injury. We investigated the involvement of ATP-sensitive potassium (K(ATP)) channels in EGCG-induced cardioprotection. Isolated rat hearts were subjected to 30 min of regional ischemia and 2 hr of reperfusion. EGCG was perfused for 40 min, from 10 min before to the end of index ischemia. A nonselective K(ATP) channel blocker glibenclamide (GLI) and a selective mitochondrial K(ATP) (mK(ATP)) channel blocker 5-hydroxydecanoate (HD) were perfused in EGCG-treated hearts. There were no differences in coronary flow and cardiodynamics including heart rate, left ventricular developed pressure, rate-pressure product, +dP/dt(max), and -dP/dt(min) throughout the experiments among groups. EGCG-treatment significantly reduced myocardial infarction (14.5+/-2.5% in EGCG 1 micrometer and 4.0+/-1.7% in EGCG 10 micrometer, P<0.001 vs. control 27.2+/-1.4%). This anti-infarct effect was totally abrogated by 10 micrometer GLI (24.6+/-1.5%, P<0.001 vs. EGCG). Similarly, 100 micrometer HD also aborted the anti-infarct effect of EGCG (24.1+/-1.2%, P<0.001 vs. EGCG ). These data support a role for the K(ATP) channels in EGCG-induced cardioprotection. The mK(ATP) channels play a crucial role in the cardioprotection by EGCG.
Animals ; Anti-Arrhythmia Agents/pharmacology ; Antioxidants/*pharmacology ; Catechin/*analogs & derivatives/pharmacology ; Decanoic Acids/pharmacology ; Glyburide/pharmacology ; Heart/*drug effects/physiology/physiopathology ; Hemodynamics ; Humans ; Hydroxy Acids/pharmacology ; KATP Channels/*metabolism ; Male ; Mitochondria, Heart/*drug effects/metabolism ; Myocardial Infarction/*pathology ; Myocardial Ischemia/*pathology ; Potassium Channel Blockers/pharmacology ; Rats ; Rats, Wistar

Ingestion of sodium hypochlorite bleach is usually benign, leading most emergency departments to advocate conservative home management. We report a rare case of household bleach ingestion. A 54- year-old male ingested unintentionally an unknown quantity of household bleach (4% sodium hypochlorite, pH<12). He was transferred to our department for further evaluation and management from a local general hospital because of continuous vomiting and suspicious gastric malignant lesions on the endoscopic findings. The results of repeated gastrointestinal endoscopy were corrosive injury to the stomach and the esophagus. About 60 days following ingestion of the bleach, he underwent a hemigastrectomy due to pyloric stenosis. The literature regarding corrosive injury following bleach ingestion is reviewed.
Eating* ; Emergency Service, Hospital ; Endoscopy, Gastrointestinal ; Esophagus* ; Family Characteristics ; Hospitals, General ; Humans ; Male ; Pyloric Stenosis ; Sodium Hypochlorite* ; Sodium* ; Stomach* ; Vomiting

PURPOSE: Surgical resection for the hepatocellular carcinoma (HCC) is the only proven curative treatment modality. Most of these patients have chronic hepatitis with or without cirrhosis; therefore, curative resection with enough of a safety margin is always challenging for hepatic surgeons. The aim of our retrospective study was to analyze the correlation of the complications with the patient factors, the tumor factors and the surgical factors. MATERIALS & METHOD: A total of 145 patients who had hepatocellular carcinoma were resected surgically during the five year and nine months period between September 2000 and June 2006. We collected the database prospectively and we analyzed the perioperative outcomes from the accumulated database. RESULT: Anatomical resection, standard hemihepatectomy or systematic segmentectomy after injection of methylene blue dye into the portal vein branch was performed in 89 patients, and nonanatomical resection was done in 56 patients. The number of major resections that was more than two sections was 72, and the number of minor resection less than two sections was 73. The mean operative time was 270 minutes, the amount of bleeding was 669ml and the mean time of performing the Pringle maneuver was 31.5 minutes. Perioperative complication were noted in 20.0% of the patients and there were five mortalities (3.4%). The only one significant factor that affected a higher complication rate was the ICG15 and the significant factor that affected the mortality rate was the duration of the Pringle maneuver. CONCLUSION: Type oriented hepatic resection that achieves an adequate surgical resection volume is dependent on the status of the tumor and the hepatic reservoir function with limited bleeding, and these factors will help selected patients obtain a very good outcome with an acceptable complication rate and low mortality.
Carcinoma, Hepatocellular* ; Fibrosis ; Hemorrhage ; Hepatectomy ; Hepatitis, Chronic ; Humans ; Mastectomy, Segmental ; Methylene Blue ; Mortality ; Operative Time ; Portal Vein ; Prospective Studies ; Retrospective Studies

PURPOSE: Unrefined tablets prepared from Aconitum tubers are occasionally used in Korean folk medicine. This study defines the potential sources, clinical toxicology, and treatment of aconitine poisoning. METHODS: A retrospective survey was conducted in 63 patients in the ED of a tertiary University Hospital with suspected toxicity from an unrefined tablet prepared from Aconitum tubers from 1999 to 2007. RESULTS: A total of 63 cases enrolled included 26 men and 37 women, aged 30 to 86 years. Forty-eight patients ingested aconitine tablets as digestives, 26 tablets on average. After a latent period of 30 to 450 minutes, patients developed a combination of neurologic (87.3%), gastrointestinal (82.5%), cardiopulmonary (41.3%), and other (28.6%) features typical of aconitine poisoning. Initial ECG abnormalities revealed dysrhythmia (61.9%), conduction disturbance (42.9%), and abnormal waveforms (39.7%), with 28.6% of patients having normal ECGs. All patients received supportive treatment or close observation regardless of ingestion amounts. Patients with hypotension or ventricular arrhythmia were treated with inotropic agents or amiodarone. CONCLUSION: Toxicologic signs and symptoms can occur after the consumption of aconitine tablets, regardless of ingestion amount. The risk occurs because of inadequately processed aconitine roots. This study will provide important data for public education and distribution regulations for Aconitum sp. in Korea.
Aconitine ; Aconitum ; Aged ; Arrhythmias, Cardiac ; Eating ; Electrocardiography ; Female ; Humans ; Hypotension ; Korea ; Male ; Medicine, Traditional ; Retrospective Studies ; Social Control, Formal ; Tablets ; Toxicology

Objectives: This study was conducted to develop a generalizable annotation tool for bilingual complex clinical text annotation, which led to the design and development of a clinical text annotation tool, ANNO. Methods: We designed ANNO to enable human annotators to support the annotation of information in clinical documents efficiently and accurately. First, annotations for different classes (word or phrase types) can be tagged according to the type of word using the dictionary function. In addition, it is possible to evaluate and reconcile differences by comparing annotation results between human annotators. Moreover, if the regular expression set for each class is updated during annotation, it is automatically reflected in the new document. The regular expression set created by human annotators is designed such that a word tagged once is automatically labeled in new documents. Results: Because ANNO is a Docker-based web application, users can use it freely without being subjected to dependency issues. Human annotators can share their annotation markups as regular expression sets with a dictionary structure, and they can cross-check their annotated corpora with each other. The dictionary-based regular expression sharing function, cross-check function for each annotator, and standardized input (Microsoft Excel) and output (extensible markup language [XML]) formats are the main features of ANNO. Conclusions With the growing need for massively annotated clinical data to support the development of machine learning models, we expect ANNO to be helpful to many researchers.

Objective: The aim of the study was to compare the mortality rates of patients with early-identified (EI) sepsis and late-identified (LI) sepsis. Methods: We performed a retrospective chart review of patients admitted to the emergency department and diagnosed with sepsis. EI sepsis was defined as patients with a Sequential Organ Failure Assessment (SOFA) score ≥2, based on 3 parameters of the SOFA score (Glasgow coma scale, mean arterial pressure, and partial pressure of oxygen/fraction of inspired oxygen ratio), measured within an hour of emergency department admission. The remaining patients were defined as LI sepsis. The primary outcome was in-hospital mortality. Results: Of the total 204 patients with sepsis, 113 (55.4%) had EI sepsis. Overall mortality rate was 15.7%, and EI sepsis group had significantly higher mortality than LI sepsis (23.0% vs. 6.6%, P=0.003). The patients with EI sepsis, compared to those with LI sepsis, had higher SOFA score (median: 4 vs. 2, P<0.001); Acute Physiology and Chronic Health Evaluation (APACHE) II score (median: 14 vs. 10, P<0.001); were more likely to progress to septic shock within 6 hours after admission (17.7% vs. 1.1%, P<0.001); were more likely to be admitted to the intensive care unit (2.2% vs. 1.1%, P=0.001). Conclusion Mortality was significantly higher in the EI sepsis group than in the LI sepsis group.

Intravascular administration of magnesium (Mg) causes vasodilation and increases renal blood flow. The aim of this study was to investigate the renal effect of Mg following unclamping of the supraceliac aorta. Mongrels were divided into two groups, control (group C, n=7) and Mg group (group Mg, n=7). In group Mg, 30 mg/kg MgSO4 was injected as a bolus immediately prior to unclamping the supraceliac aorta and thereafter as an infusion (10 mg/kg/hr). The group C received an equivalent volume of saline solution. Systemic hemodynamics, renal artery blood flow, renal cortical blood flow (RCBF), renal vascular resistance, and renal function were compared. Following the aortic unclamping, cardiac output and RCBF were less attenuated, and the systemic and renal vascular resistance was elevated to a lesser degree in the group Mg compared to the group C. There was no significant difference in the plasma renin activity, serum creatinine and Cystatin-C between the two groups. The present study shows that Mg infusion improves systemic hemodynamics and RCBF after aortic unclamping. However, we did not observe any improvement in renal function when Mg was administered after supraceliac aortic unclamping.
Animals ; Aorta, Abdominal/physiology/*surgery ; Blood Pressure/drug effects ; Calcium/blood ; Cardiac Output/drug effects ; Comparative Study ; Creatinine/blood ; Cystatins/blood ; Dogs ; Female ; Heart Rate/drug effects ; Magnesium/blood ; Magnesium Sulfate/*pharmacology ; Male ; Renal Circulation/*drug effects ; Renin/blood ; Research Support, Non-U.S. Gov't