BACKGROUND: The goal of this study is to identify the factors that predict mortality in elderly trauma patients. METHOD: We reviewed retrospectively the medical record of 144 cases of geriatric trauma admitted to Kyungpook National University Hospital firm January 1998 to December 1998. We evaluated the general characteristics, mechanisms of injury, Revised Trauma Score(RTS), Injury Severity Score(ISS), Probability of survival(Ps) by TRISS(Trauma and Injury Severity Score) method, amount of blood transfused, preexisting disease, complications, length of stay, and mortality. RESULTS: 1. The mean age was 75.39+/-7.89 years old, and male to female ratio was 0.89 : 1. 2. The mechanisms of injury were primarily frills(56.3%) followed by bicycle or motorcycle(13.9%), and pedestrian injuries(13.2%) and motor vehicle accidents(6.9%). 3. The mean Glasgow Coma Scale(GCS), RTS and ISS ate 13.3+/-3.5, 7.2+/-1.4 and 14.2 +/-11.6 respectively. 4. The actual mortality rate was 18.1% (26/144). But by TRISS method, predicted mortality rate was 9.3%(12.5/144), excess mortality rate was 108% and Z score was 3.99 indicating that actual number of death exceed predicted number of death. 5. Between the survivors and nonsurvivors, the insults were significantly different as follows ; systolic blood pressure(141.9+/-28.3 vs. 116.8+/-48.7 mmHg), GCS(14.3+/-2.0 vs. 9.0 +/-5.1), RTS(7.8+/-0.7 vs 5.4+/-2.3), ISS(11.3+/-5.6 vs 27.2+/-20.2), Ps by TRISS(0.97+/-0.06 vs 0.65+/-0.37), preexisting diseases(50.8 vs 69.8%). CONCLUSION: Geriatric patients are more likely to die after trauma than other age groups. The cause of higher actual mortality rate compared to predicted mortality rate was considered as the higher incidence of delayed death due to sepsis or multiple organ failure. In order to reduce the mortality, even with relatively stable initial vile sign, invasive hemodynamic monitoring and intensive treatment are recommended and also, prevention and treatment of nosocomial infection are very important.
Aged ; Coma ; Cross Infection ; Female ; Gyeongsangbuk-do ; Hemodynamics ; Humans ; Incidence ; Length of Stay ; Male ; Medical Records ; Mortality* ; Motor Vehicles ; Multiple Organ Failure ; Preexisting Condition Coverage ; Retrospective Studies ; Sepsis ; Survivors

BACKGROUND: This study was aimed to investigate the perception on working conditions and utilization of clinical research coordinators (CRCs) among investigators and sponsors. METHODS: The participants of this cross-section study were 114 investigators and 138 sponsors including clinical research associates (CRAs) who have worked with CRCs. Data was collected with paper or electronic form of self-administered questionnaires and analyzed with descriptive statistics and chi2 test or t test. RESULTS: Among investigators and sponsors, 56.1 % and 95.0 % perceived regular full-time positions as proper type of CRC employment, respectively. Those who perceived monthly salary with incentive as proper payment system were 67.5 % of investigators and 68.8 % of sponsors. The proper salary for 2-year CRCs and 5-year CRCs were significantly higher in sponsors than investigators. Investigators perceived CRCs could handle 3 studies as the same time and 5 studies per year. In regard to the difficulty in utilizing CRCs, 68.4 % of investigators perceived lack of experienced CRCs and 84.8 % of sponsors did frequent turnover. Those who responded pooling CRCs by hospital or clinical trial centers as a good solution to hire CRCs easily were 81.6 % of investigators and 58.0 % of sponsors. CONCLUSION: Almost all investigators and sponsors perceived CRCs were helpful for improving the quality of clinical trials. We recommend each institution or clinical trial centers could introduce the central CRCs' employment and management with proper salary and workload based on the results to maintain experienced CRCs and lessen the turnover of CRCs.
Calcium Hydroxide ; Electronics ; Electrons ; Employment ; Humans ; Motivation ; Surveys and Questionnaires ; Research Personnel ; Salaries and Fringe Benefits ; Zinc Oxide

Various methods of nasal reconstruction were performed over time. The physiology and anatomy of nose were clarified and its aesthetic subunits were employed, more improvement and modification were performed. The bilobed flap is particularly suitable for reconstruction of small or medium sized nasal defect up to 1.5 cm in diameter. Authors performed 6 cases of the bilobed flap for the defect of nasal dorsum (4 cases: basal cell carcinoma, 2 cases: compound nevus) from March 2000 to February 2001. The bilobed flap was medially based and second lobe was positioned on the nasal alar groove. This flap results in little or no distortion around tissue, by which scars of nasal dorsum and dog-ear deformity are reduced. Moreover we could achieve better cosmetic results for the scar, primary repair site of the second lobe, which is concealed by nasal alar groove.
Carcinoma, Basal Cell ; Cicatrix ; Congenital Abnormalities ; Nose ; Physiology

BACKGROUND: Activation of the c-Met pathway is involved in cancer progression and the prognosis. We aimed to identify any association of c-Met protein expression with a number of clinicopathologic variables including infection of human papillomavirus and Epstein-Barr virus (EBV) in head and neck carcinomas (HNCa). METHODS: Eighty-two cases were enrolled in this study. Expression of c-Met and p16 was investigated immunohistochemically. EBV was detected by in situ hybridization and amplification of the c-Met gene by fluorescence in situ hybridization. RESULTS: The c-Met protein was expressed in 41.5% (34/82), and gene amplification was found in 1.4% (1/71). High expression of c-Met was associated with the primary location of the tumor; the hypopharynx showed the highest expression, followed by the oral cavity, larynx, and nasal cavity. Squamous cell carcinoma expressed c-Met more frequently than undifferentiated carcinoma. Also, p16 immunoreactivity or EBV infection was associated with the tumor location and well-differentiated histologic type, but were not linked to c-Met expression. The patients with positive c-Met expression showed frequent lymph node metastasis. CONCLUSIONS: Activation of the c-Met pathway might be involved in a subset of HNCa. Cases showing positive c-Met expression should be carefully monitored because of the high probability of lymph node metastasis.
Carcinoma ; Carcinoma, Squamous Cell ; Epstein-Barr Virus Infections ; Fluorescence ; Gene Amplification ; Head ; Head and Neck Neoplasms ; Herpesvirus 4, Human ; Humans ; Hypopharynx ; In Situ Hybridization ; Larynx ; Lymph Nodes ; Mouth ; Nasal Cavity ; Neck ; Neoplasm Metastasis ; Prognosis ; Proto-Oncogene Proteins c-met

PURPOSE: A nationwide hepatitis B vaccination publicity campaign and program was launched in 1988 in Korea. This survey was designed to evaluate the recent changes of the positive rates of hepatitis B surface antigen and antibody in sampled preschool children living in Seoul, 1995. METHODS: Study population consisted of 218 preschool children aged 2 to 5 years. Most of them had been immunized against hepatitis B in accordance with the schedule in early infancy. Blood samples were tested for HBsAg, HBsAb and HBcAb by radioimmunoassay. RESULTS: Of 218 children, 214(98.2%) had received hepatitis B vaccination. Two of 218(0.9%) was surface antigen positive. The positive rates of HBsAb in age groups were 68.2, 73.6, 71.6, and 66.7% from 2 to 5 years, respectively (mean 70.6%). They showed no significant difference with aging. One(0.6%) of 154 who were HBsAb positive was HBcAb positive. CONCLUSIONS: Most of the children who were HBsAb positive acquired the antibodies by immunization, and vertical transmission is rare recently. Our findings suggest that the effective administration of vaccination with the help of publicity campaign lowers HBV transmission and increases positive rate of HBsAb.
Aging ; Antibodies ; Antigens, Surface ; Appointments and Schedules ; Biomarkers* ; Child ; Child, Preschool* ; Hepatitis B Surface Antigens ; Hepatitis B* ; Hepatitis* ; Humans ; Immunization ; Korea ; Prevalence* ; Radioimmunoassay ; Seoul ; Vaccination

Objective: This study aimed to determine the factors that affect successful esophageal foreign body (FB) removal using a Foley catheter and to identify methods to increase the success rate. Methods: In this retrospective, cross-sectional study, we included pediatric patients who presented with esophageal FB impaction that was removed using a Foley catheter in the emergency departments of tertiary care and academic hospitals. We analyzed the effect of the patients’ age, sex, and symptoms; FB type, size, and location; Foley catheter size; complications during FB removal; duration between FB ingestion and removal; operator’s years of training; sedation; success rate of FB removal; endoscopy; and patient’s posture during FB removal on the success of Foley catheter-based FB removal. Results: Of the 43 patients we enrolled, Foley catheter-based FB removal was successful in 81.4% (35/43) but failed in 18.6% (8/43) of patients; no FB-removal-related complications were reported. There was no significant association between the success rate of Foley catheter-based FB removal and any study variable. A higher number of years in training tended to increase the success rate of Foley catheter-based FB removal, although statistical significance was not achieved. Conclusion Children’s esophageal FB removal is a practical challenge in the emergency rooms, and using a Foley catheter is associated with a high success rate of the removal and low occurrence of complications. In this study, no single variable was found correlated with the success rate of Foley catheter-based esophageal FB removal in pediatric patients, which may indicate multiple variables interacting with one another to affect the success rate.

Objective: This study aimed to determine the factors that affect successful esophageal foreign body (FB) removal using a Foley catheter and to identify methods to increase the success rate. Methods: In this retrospective, cross-sectional study, we included pediatric patients who presented with esophageal FB impaction that was removed using a Foley catheter in the emergency departments of tertiary care and academic hospitals. We analyzed the effect of the patients’ age, sex, and symptoms; FB type, size, and location; Foley catheter size; complications during FB removal; duration between FB ingestion and removal; operator’s years of training; sedation; success rate of FB removal; endoscopy; and patient’s posture during FB removal on the success of Foley catheter-based FB removal. Results: Of the 43 patients we enrolled, Foley catheter-based FB removal was successful in 81.4% (35/43) but failed in 18.6% (8/43) of patients; no FB-removal-related complications were reported. There was no significant association between the success rate of Foley catheter-based FB removal and any study variable. A higher number of years in training tended to increase the success rate of Foley catheter-based FB removal, although statistical significance was not achieved. Conclusion Children’s esophageal FB removal is a practical challenge in the emergency rooms, and using a Foley catheter is associated with a high success rate of the removal and low occurrence of complications. In this study, no single variable was found correlated with the success rate of Foley catheter-based esophageal FB removal in pediatric patients, which may indicate multiple variables interacting with one another to affect the success rate.

Many risk factors for atherosclerosis have been proposed to identify high risk individuals. We conducted a retrospective study to determine the risk factors for development of carotid stenosis (CS) in Koreans. Database of 2,805 subjects who underwent a check up of carotid artery for health examination were analyzed. Stenosis (%) of common carotid artery or proximal internal carotid artery was examined with ultrasonography. Subjects were divided into 2 groups (Group I; CS <10%, Group II; CS > or =30%). We compared demographic, laboratory and clinical data between 2 groups to determine the risk factors of CS. One hundred ninety seven subjects (7.0%) were categorized as Group II. At age- and sex-adjusted multivariate analysis, diabetes mellitus, hypertension, cerebrovascular disease, ischemic heart disease, hyperlipidemia, aspirin medication, current smoking, fasting glucose, total cholesterol, low density lipoprotein-cholesterol (LDL-C) and leukocyte count were significant risk factors of CS. At stepwise logistic regression analysis, age, hypertension, hyperlipidemia, LDL-C and leukocyte count were independent risk factors. At subgroup analysis by smoking, age and leukocyte count were independent risk factors in smoker and age and hypertension in nonsmoker.
Adult ; Age Factors ; Aged ; Carotid Stenosis/blood/*epidemiology/etiology ; Cholesterol/blood ; Comparative Study ; Female ; Humans ; Korea/epidemiology ; Lipoproteins, LDL Cholesterol/blood ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Prevalence ; Retrospective Studies ; Risk Factors ; Smoking/adverse effects

Previous reports raised question as to whether 8-chloro-cyclic adenosine 3,5-monophosphate (8-Cl-cAMP) is a prodrug for its metabolite, 8-Cl-adenosine which exerts growth inhibition in a broad spectrum of cancer cells. The present study was carried out to clarify overall cellular affects of 8-Cl-cAMP and 8-Cl-adenosine on SK-N-DZ human neuroblastoma cells by ystematically characterizing gene expression using radioactive human cDNA microarray. Microarray was prepared with PCR-amplified cDNA of 2,304 known genes spotted on nylon membranes, employing (1)P-labeled cDNAs of SK-N-DZ cells as a probe. the expression levels of approximately 100 cDNAs, representing about 8% of the total DNA elements on the array, were altered in 8-Cl-adenosine- or 8-Cl-cAMP-treated cells, respectively. The genome-wide expression of the two samples exhibited partial overlaps; different sets of up-regulated genes but the same set of down-regulated genes. 8-Cl-adenosine treatment up- egulated genes involved in differentiation and development (LIM protein, connexin 26, neogenin, neurofilament triplet L protein and p21( WAF1/CIP1)) and immune response such as natural killer cells protein 4, and down-regulated ones involved in proliferation and transformation (transforming growth factor-beta, DYRK2, urokinase-type plasminogen activator and proteins involved in transcription and translation) which were in close parallel with those by 8-Cl-cAMP. Our results indicated that the two drugs shared common genomic pathways for the down-regulation of certain genes, but used distinct pathways for the up-regulation of different gene clusters. Based on the findings, we suggest that the anti-cancer activity of 8-Cl-cAMP results at least in part through 8-Cl-adenosine. Thus, the systematic use of DNA arrays can provide insight into the dynamic cellular pathways involved in anticancer activities of chemotherapeutics.
2-Chloroadenosine/*analogs & derivatives/chemistry/*pharmacology ; 8-Bromo Cyclic Adenosine Monophosphate/*analogs & derivatives/chemistry/*pharmacology ; Antineoplastic Agents/chemistry/*pharmacology ; Blotting, Western ; *Gene Expression Profiling ; Gene Expression Regulation, Neoplastic/*drug effects ; Genome, Human ; Human ; Neuroblastoma/*genetics ; Oligonucleotide Array Sequence Analysis ; Reproducibility of Results ; Tumor Cells, Cultured ; Up-Regulation/drug effects

Infectious mononucleosis is an acute infectious disease occurring predominantly in older children and young adults due to primary Epstein-Barr virus infection. The clinical picture is extremely variable in both severity and duration. The disease in children is generally mild. It is characterized clinically by fever, exudative or membranous pharyngitis, generalized lymphadenopathy, and splenomegaly. Rarely, it complicates neurologic involvement such as cranial nerve palsy, meningoencephalitis, and transverse myelitis, hematologic involvement such as hemolytic anemia, immune thrombocytopenic purpura, and aplastic anemia, rupture of spleen, myocarditis, interstitial pneumonia, and orchitis, etc. We experienced a case of infectious mononucleosis with pleural effusion and ascites in a 5-year-old male with the chief complaint of fever, sore throat and vomiting 3 days prior to admission. The diagnosis was made on the clinical findings, immunologic findings and the typical findings of peripheral blood smear. On peripheral blood smear, leukocytosis with atypical lymphocytosis were seen. On immunologic study, anti-VCA IgM and IgG were positive by ELISA method. We reported this case and reviewed related literatures briefly.
Anemia, Aplastic ; Anemia, Hemolytic ; Ascites* ; Child ; Child, Preschool ; Communicable Diseases ; Cranial Nerve Diseases ; Diagnosis ; Enzyme-Linked Immunosorbent Assay ; Fever ; Herpesvirus 4, Human ; Humans ; Immunoglobulin G ; Immunoglobulin M ; Infectious Mononucleosis* ; Leukocytosis ; Lung Diseases, Interstitial ; Lymphatic Diseases ; Lymphocytosis ; Male ; Meningoencephalitis ; Myelitis, Transverse ; Myocarditis ; Orchitis ; Pharyngitis ; Pleural Effusion* ; Purpura, Thrombocytopenic, Idiopathic ; Rupture ; Spleen ; Splenomegaly ; Vomiting ; Young Adult