No abstract available.
Acetazolamide* ; Aneurysm* ; Brain* ; Humans ; Perfusion* ; Subarachnoid Hemorrhage* ; Tomography, Emission-Computed, Single-Photon*

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: To determine if positive pressure pneumoperitoneum has adverse effects on autonomic nervous system function, we examined baroreflex sensitivity (BRS) during carbon dioxide pneumoperitoneum in patients undergoing laparoscopic surgery. METHODS: Twenty adult patients scheduled for laparoscopic gynecologic surgery were selected for the study. After general anesthesia was induced with sevoflurane, continuous electrocardiography and blood pressure were monitored. Spontaneous BRS was achieved using sequence method immediately before, and 5 minutes after, pneumoperitoneum. Heart rate variability (HRV) was also determined. RESULTS: After pneumoperitoneum, BRS decreased from 12.9 +/- 1.8 ms/mmHg to 8.1 +/- 1.1 ms/mmHg (P < 0.05), and the power of the high frequency band decreased from 237.8 ms2/Hz to 49.6 ms2/Hz (P < 0.05). CONCLUSIONS: Compared to recordings obtained before pneumoperitoneum, BRS was decreased during pneumoperitoneum. This may predispose patients undergoing laparoscopic surgery to hemodynamic instability in addition to pneumoperitoneum itself.
Adult ; Anesthesia, General ; Autonomic Nervous System ; Baroreflex ; Blood Pressure ; Carbon ; Carbon Dioxide ; Electrocardiography ; Female ; Gynecologic Surgical Procedures ; Heart Rate ; Hemodynamics ; Humans ; Laparoscopy ; Methyl Ethers ; Pneumoperitoneum

BACKGROUND: We conducted this study to investigate the financial burden of terminal cancer patient's family and to identify factors influencing their economic burden. METHODS: We approached 187 family members supporting their famly member with terminal cancer who was enrolled in four hospice and palliative care program. We constructed a questionnaire examining the impact of illness on their family. With multiple logistic analysis, we examined the patients' and family members' demographic and the patients' clinical factors associated with the burden caused by terminal cancer. RESULTS: The majority of families reported the loss of savings (54%), the need to make major life changes in order to care for the patient (50%), the loss of incomes (34%), the inability to function normally because of the stress of the illness (27%). Many families had to move to a less expensive home (18%), delay medical care for other family members (12%), or change educational plans for other family members (13%). Families that cared for patients who wanted to be cared for at institution (odds ratio: 2.72, 95% confidential interval: 1.19~6.19), patients with liver cancer (3.61, 1.53~8.57), and families who were poor caregivers (2.97, 1.24~7.10), or primary caregiver was a spouse (3.57, 1.47~8.68) were more likely to lose savings. Families that were in 'new couple' in family life cycle stages (3.91, 1.04~14.63), 'birth of the first child' (8.34, 2.74~25.32), and 'the adolescent family or the launching family' (10.56, 4.07~27.33), were more likely to lose savings than 'the empty family or the aging family'. CONCLUSION: Many families reported severe caregiving and economic burdens. Social and financial support need to be given to families with predictors of high economic burdens.
Adolescent ; Aging ; Caregivers ; Climacteric ; Financial Support ; Hospices ; Humans ; Income ; Liver Neoplasms ; Palliative Care ; Spouses ; Surveys and Questionnaires

BACKGROUND: Sometimes adequate pulmonary venous flow signal could not be obtained in transthoracic echocardiogram. It has been reported that contrast agent that has transpulmonary passage capability could be used in the enhancement of Doppler signal in the left side of the heart. We evaluated the Levovist(R)-enhanced pulmonary vein flow signals obtained by transthoracic echocardiogram and compared with those obtained by transesophageal echocardiogram. METHOD: Ten patients(male 8, female 10, mean age 46+/-11) with sinus rhythm who underwent transesophageal echocardiogram were enrolled. Spectral Doppler signal intensity(score; 0-5), systolic time velocity integral(Stvi), diastolic time velocity integral(Dtvi) of pulmonary vein flow before and after intravenous injection of the contrast were obtained and compared with those obtained by transesophageal echocardiogram. RESULTS: There was no serious side effect related to Levovist(R). Spectral Doppler signal intensity score of pulmonary vein flow with nonenhanced transthoracic echocardiogram was 2.1 / 5, and adequate Doppler signal could not be obtained in two patients. After contrast enhancement, Doppler signal intensity score rose up to 4.3 / 5 and adequate Doppler signal could be obtained in all patients. Time velocity integrals of systolic and diastolic pulmonary vein flow obtained by transthoracic echocardiogram correlated well with those obtained by transesophageal echocardiogram. CONCLUSION: Contrast enhancement of Doppler signal with the agent that has transpulmonary passage capability(Levovist(R)) is useful in the evaluation of pulmonary vein flow in patient whose transthoracic echocardiographic Doppler signal is inadequate.
Echocardiography ; Female ; Heart ; Humans ; Injections, Intravenous ; Pulmonary Veins*

PURPOSE: The accurate and timely diagnosis of malignant pleural effusion (MPE) in lung cancer patients is important because MPE has a poor prognosis and is classified as stage IV disease. Molecular biomarkers for pleural effusion, such as circulating extracellular microRNAs (miRNAs) isolated from pleural fluid, may help in the diagnosis of MPE. The present study examined whether miRNAs that are deregulated in lung cancer (miR-134, miR-185, and miR-22) can serve as diagnostic markers for lung adenocarcinoma-associated MPE (LA-MPE). MATERIALS AND METHODS: Real-time reverse transcription quantitative polymerase chain reaction was used to measure the expression of the three miRNAs in samples from 87 patients with pleural effusion comprising 45 LA-MPEs and 42 benign pleural effusions (BPEs). The area under the receiver operating characteristic curve (AUC) was then used to evaluate the diagnostic performance of each of the three miRNAs and compare it with that of the common tumor marker, carcinoembryonic antigen (CEA). RESULTS: The expression of all three miRNAs was significantly lower in LA-MPE than in BPE (p <0.001). The AUCs for miR-134, miR-185, miR-22, and CEA were 0.721, 0.882, 0.832, and 0.898, respectively. Combining CEA with the three miRNAs increased the diagnostic performance, yielding an AUC of 0.942 (95% confidence interval, 0.864 to 0.982), with a sensitivity of 91.9% and a specificity of 92.5%. CONCLUSION: The present study suggests that the expression levels of circulating extracellular miR-134, miR-185, and miR-22 in patients with pleural effusion may have diagnostic value when differentiating between LA-MPE and BPE.
Adenocarcinoma ; Area Under Curve ; Biomarkers ; Carcinoembryonic Antigen ; Diagnosis ; Humans ; Lung Neoplasms ; Lung* ; MicroRNAs ; Pleural Effusion ; Pleural Effusion, Malignant* ; Polymerase Chain Reaction ; Prognosis ; Reverse Transcription ; ROC Curve ; Sensitivity and Specificity

PURPOSE: This study aims to investigate how variability of bystander cardiopulmonary resuscitation (CPR) willingness may change depending on special situations and to find out factors that enhance CPR willingness in each situation and ways to increase the ratio of bystander CPR. METHODS: A population-based, nationwide study using a structured questionnaire via telephone survey regarding CPR was done in 2015 (n=1,000). A stratified cluster sampling was conducted to assess the impact of age and gender on CPR willingness. The contents of the questionnaire consisted of basic characteristics, CPR training experience, and status. Additionally, respondents were presented with five hypothetical scenarios of cardiopulmonary arrest; family member, stranger, elderly person, preschool child, and pregnant woman. RESULTS: Willingness to perform CPR was low for pregnant women (52.1%) or elders (59.3%), moderate for strangers (73.3%) or children (71.3%), but high for a family members (90.4%). Age, awareness of CPR, training experience of CPR, CPR training by manikin practice, recent CPR training (≤2 years), experience of bystander CPR, family history of severe illness, and awareness of Good Samaritan law all influenced the willingness to perform CPR on bystander in each scenario. CONCLUSION: The willingness of bystander CPR decreased in special situations, especially for elderly and pregnant woman. However, recent CPR training group were more willing in the elderly, and CPR experienced group also showed increased tendency in pregnant woman. It is expected that the rate of bystander CPR can be increased by emphasizing that performing bystander CPR for children, pregnant women, and elders is not different from the general population.
Aged ; Attitude to Health ; Cardiopulmonary Resuscitation* ; Child ; Child, Preschool ; Female ; Heart Arrest ; Humans ; Jurisprudence ; Manikins ; Pregnant Women ; Surveys and Questionnaires ; Telephone

BACKGROUND: Verrucous hemangioma (VH) and angiokeratoma (AK) are vascular birthmarks of an unclear nosology and these birthmarks commonly show a superficial hyperkeratotic vascular component. There are both similarilities and differences between VH and AK with some confusion concerning their overlapping features. OBJECTIVE: This study was undertaken to review the clinicopathological features of VHs and AKs and to determine the similarilities and differences between them. METHODS:We retrospectively reviewed 11 VHs and 7 AKs at the Vascular Anomaly Clinic of our hospital over the past 10 years. They were evaluated from the clinicopathologic point of view for factors such as the age of onset, location, size, symptoms, the histopathological epithelial change and involvement of deeper tissue. RESULTS: These birthmarks share common clinical features with the exception of gender and lesion size. Histopathologically, hyperkeratosis, acanthosis and capillary dilatation in the upper dermis were commonly seen. Yet lobular proliferation and dilatation of blood vessels in the deep dermis, or more importantly, the subcutis were detected in VH only. Furthermore there was a case of VH that showed diffusely scattered increased blood vessels in the subcutis, suggesting an evolving stage of VH and there was another case of VH that was erroneously diagnosed as AK via the initial biopsy, and the final diagnosis was changed according to the excised lesion. CONCLUSION:The two diseases share most of their clinicopathological features, but small parts of features like gender, the clinical size and the histological deep dermis/subcutis involvement were differences. Making the correct differential diagnosis between VH and AK through a deep biopsy with appropriate timing and long-term follow-up and/or radiological examination is helpful to avoid erroneous management.
Age of Onset ; Angiokeratoma ; Biopsy ; Blood Vessels ; Capillaries ; Dermis ; Diagnosis, Differential ; Dilatation ; Follow-Up Studies ; Hemangioma ; Retrospective Studies

To support the ovarian hormone hypothesis in the etiology of breast cancer, a hospital-based case-control study with community controls was conducted to evaluate the relationship of intervals among menstrual and reproductive events to the risk of breast cancer in Korea. The cases were 190 breast cancer patients, who had been histologically diagnosed at Seoul National University Hospital from Jan. 1, 1993 to Jun. 30, 1994. Included were cancer-free women, who had undertaken the Gynecological examination at the same hospital (n=190). Women recruited for a survey of diabetes prevalence in Yonchon County, adjacent to Seoul City, were taken as a community control group (n=190). Information on menstrual and reproductive factors with other life-styles was collected through a direct interview by the well-trained interviewers. The adjusted odds ratios and the 95% confidence intervals were based on the unconditional logistic regression model. Likelihood ratio test for trend was applied for the ordinal variables. Early age at menarche, late age at natural menopause, late age at first full term pregnancy, and fewer number of full term pregnancies are independently associated with the high risk of breast cancer in Korea. Moreover, the interval between the age at menarche and the age at natural menopause of community controls (29.9+/-6.15 years) was significantly shortened compared to breast cancer cases (34.9+/-4.42 years). Particularly noteworthy was that intervals between the age at menarche and the age at first full term pregnancy of both control groups (9.0+/-3.72 years for hospital controls; 7.2+/-4.04 years for community controls) were significantly shortened compared to breast cancer cases (11.0+/-4.51 years). These findings support the hypothesis that the longer exposure to ovarian hormones during the reproductive years, the higher the risk of breast cancer.
Adult ; Age Factors ; Aged ; Breast Neoplasms/*epidemiology ; Case-Control Studies ; Female ; Human ; Korea/epidemiology ; Menstruation/*physiology ; Middle Age ; Pregnancy ; Reproduction/*physiology ; Risk Factors

To support the ovarian hormone hypothesis in the etiology of breast cancer, a hospital-based case-control study with community controls was conducted to evaluate the relationship of intervals among menstrual and reproductive events to the risk of breast cancer in Korea. The cases were 190 breast cancer patients, who had been histologically diagnosed at Seoul National University Hospital from Jan. 1, 1993 to Jun. 30, 1994. Included were cancer-free women, who had undertaken the Gynecological examination at the same hospital (n=190). Women recruited for a survey of diabetes prevalence in Yonchon County, adjacent to Seoul City, were taken as a community control group (n=190). Information on menstrual and reproductive factors with other life-styles was collected through a direct interview by the well-trained interviewers. The adjusted odds ratios and the 95% confidence intervals were based on the unconditional logistic regression model. Likelihood ratio test for trend was applied for the ordinal variables. Early age at menarche, late age at natural menopause, late age at first full term pregnancy, and fewer number of full term pregnancies are independently associated with the high risk of breast cancer in Korea. Moreover, the interval between the age at menarche and the age at natural menopause of community controls (29.9+/-6.15 years) was significantly shortened compared to breast cancer cases (34.9+/-4.42 years). Particularly noteworthy was that intervals between the age at menarche and the age at first full term pregnancy of both control groups (9.0+/-3.72 years for hospital controls; 7.2+/-4.04 years for community controls) were significantly shortened compared to breast cancer cases (11.0+/-4.51 years). These findings support the hypothesis that the longer exposure to ovarian hormones during the reproductive years, the higher the risk of breast cancer.
Adult ; Age Factors ; Aged ; Breast Neoplasms/*epidemiology ; Case-Control Studies ; Female ; Human ; Korea/epidemiology ; Menstruation/*physiology ; Middle Age ; Pregnancy ; Reproduction/*physiology ; Risk Factors