PURPOSE: A stapler hemorrhoidectomy (hemorrhoidopexy) does not excise hemorrhoid tissue, but instead re-positions the prolapsed hemorrhoid. We introduced a hand-sewn circumferential mucosectomy under direct vision as a new hemorrhoidectomy method and evaluated its safety and effectiveness for the surgical treatment of hemorrhoids. METHODS: We performed 108 hand-sewn circumferential mucosectomies between June 2003 and December 2006. We evaluated the operating time, the postoperative course, and the complications. Pain was evaluated using a visual analog scale. RESULTS: The mean patient age was 48 years, and the numbers of males and females were similar. The most common indication was third-degree hemorrhoids. The mean operating time was 37.7 minutes, and most operations took between 20 and 40 minutes. The average postoperative pain score was 5.0 on the day of surgery and 3.9 on the second postoperative day. The time to the first bowel movement and the length of the hospital stay averaged 1.3 and 2.5 days, respectively. The mean time to return to work was 5.2 days. There were no serious complications with the hand-sewn circumferential mucosectomy. Postoperative complications occurred in 31.5% of the cases. Urinary complications were the most common. CONCLUSIONS: A hand-sewn circumferential mucosectomy is safe for the treatment of hemorrhoids, and there are no serious complications. The operative pain, the postoperative course, the time to return to work, and the nature of complications are acceptable, although the operating time is longer. A hand-sewn circumferential mucosectomy is considered to be an effective new alternative for the surgical treatment of hemorrhoids.
Female ; Hemorrhoidectomy ; Hemorrhoids ; Humans ; Length of Stay ; Male ; Pain, Postoperative ; Postoperative Complications ; Return to Work ; Vision, Ocular

PURPOSE: Acute appendicitis is the most common cause of an acute abdomen that needs an emergency operation. However, the preoperative diagnosis is difficult. The purpose of this study is to assess the diagnostic efficacy of the Alvarado score by a comparison with CT and to determine the indication of CT evaluation. METHODS: From August 2006 to October 2006, 111 consecutive patients were admitted to Chung-Ang University hospital under the impression of acute appendicitis, and a CT scan was done. The Alvarado score, which consists of migration, anorexia, nausea-vomitig, tenderness, rebound tenderness, fever, leukocytosis, and left shift, was applied to the patients. RESULTS: Of the 111 patients, 85 patients underwent an operation, and 26 were discharged without an operation on the basis of the CT finding. The negative appendectomy rate were 4.7%. CT showed a sensitivity, of 0.90 a specificity of 0.97 and an accuracy rate of 0.92. Tenderness and leukocytosis were confirmed as the most important tests and showed accuracy rates of 0.73 and 0.70, respectively. The sensitivity was 0.90 at score 5 and 0.85 at score 7. Therefore, there was no single cut-off score that satisfied all diagnostic values. CONCLUSIONS: The Alvarado score alone is not a satisfactory diagnostic method acute appendicitis. Of the appendicitis patients, 90% might be included in the diagnosis for Alvarado scores above 5, and the negative appendectomy could be as high as 15% for Alvarado scores above 7, which is the score generally accepted for a diagnosis of appendicitis.
Abdomen, Acute ; Anorexia ; Appendectomy ; Appendicitis ; Emergencies ; Fever ; Humans ; Leukocytosis ; Sensitivity and Specificity

Superior mesenteric vein thrombosis and portal vein thrombosis are rare conditions that are difficult to diagnose due to vague symptoms, but they are usually fatal when they occur. Appendicitis is the one of the most common causes of superior mesenteric vein thrombosis, via venous drainage from the appendiceal area into the portal system. We report a case of superior mesenteric vein thrombosis and portal vein thrombosis secondary to appendicitis presenting with diarrhea, low abdominal pain, and jaundice. The patient was treated with antibiotics and anticoagulants, without fatal complications, but developed a chronic sequela of portal vein thrombosis. It is important to consider thrombosis of the superior mesenteric vein and portal vein in patients who have intra-abdominal infection with specific or non-specific symptoms.
Abdominal Pain ; Anti-Bacterial Agents ; Anticoagulants ; Appendicitis ; Diarrhea ; Drainage ; Humans ; Intraabdominal Infections ; Jaundice ; Mesenteric Veins ; Portal System ; Portal Vein ; Thrombosis

Acute pancreatitis due to organophosphate intoxication is a known risk, but acute parotitis due to organophosphate intoxication is rare. We describe the case of a 74-year-old man who had acute organophosphate intoxication-induced ipsilateral parotitis. He developed ipsilateral parotid gland swelling and elevated serum amylase on the second day of the poisoning. However, serum lipase did not elevate and amylase isoenzyme predominated over S-type. Thus, we suggest that acute parotitis can develop due to organophosphate intoxication, and that this possibility should be checked by serial serum amylase, serum lipase, and amylase isoenzyme testing.
Aged ; Amylases ; Humans ; Lipase ; Pancreatitis ; Parotid Gland ; Parotitis

PURPOSE: The aim of this study was to improve overcrowding in an emergency department with the six sigma process. The authors evaluated possible factors that might delay patients' length of stay and suggest possible means for improvement. METHODS: We measured time spent in each step of emergency clinic care and investigated possible reasons for delay. The time spent in each step was measured again after change were made to address possible causes of delay. The difference in time between before and after the change were analyzed. RESULTS: According to the steps of 'measure' and 'analyze' in six sigma, greatest delays occurred in obtaining laboratory test results and explaining overall status to patients. After practicing an improvement plan, total time spent in the emergency department decreased from 467 minutes to 364 minutes (p=0.000), and the six sigma level increased from 1.145 to 1.450. Defects per million opportunities (DPMO) decreased from 638,554 to 520,095. CONCLUSION: Through six sigma improvement, the length of stay in an emergency department can be reduced. This can not only bring more satisfaction to patients, but it can also improve overcrowding of emergency department clinics through increased hospital bed turnover.
Emergencies ; Humans ; Length of Stay

PURPOSE: Emergency physicians (EP) are vulnerable to radiation exposure while on duty in the emergency department (ED). Although many studies have been reported abroad, there have been few studies of radiation exposure to EP in Korea. This study was performed to determine the present radiation exposure conditions of EP in Korea. METHODS: A prospective study was conducted from April 1, 2007 to June 30, 2007 at ED in three teaching hospitals. Eighteen interns and 19 residents were selected. Each wore thermoluminescent personal radiation dosimetry monitors at near the thyroid while working in the ED. We estimated the radiation exposure dose of these EP for three months and compared the results with those obtained for radiologists. RESULTS: The average radiation exposure dose of EP over three months was 0.257+/-0.391 mSv, and that of radiologists was 0.184+/-0.273 mSv. These results were below the recommended occupational dose limit of 5 mSv per 3 months. The radiation exposure dose of EP was higher than that of radiologists, but the difference was not statistically significant (0.280+/-0.303 vs 0.075+/-0.981 mSv, p=0.042). CONCLUSION: We recommend that the use of dosimetry by EP needs to be reviewed. EP should be aware of radiation exposure risks and minimize radiation exposure.
Emergencies ; Hospitals, Teaching ; Humans ; Korea ; Occupational Exposure ; Prospective Studies ; Radiometry ; Thyroid Gland

PURPOSE: The purpose of this study was to verify objectively whether abdominal ultrasonography performed by emergency physicians (EP) in emergency departments (ED) immediately after history taking and physical examination could give effective diagnostic information and to check the feasibility and usefulness of the COUCH method. METHODS: From May 1, 2005 to September 30, 2005 we recruited 368 patients who complained of abdominal pain in the ED. Senior level emergency physicians (EP) conducted history taking and physical examinations, following which they were asked for their suspected diagnosis and their level of confidence (from maximum 5 to minimum 1) regarding each diagnosis. The same EP then performed abdominal ultrasonography (US), using the COUCH method and were again asked for their suspected diagnosis and level of confidence. We compared the suspected diagnoses and levels of confidence before and after abdominal US by using the t-test. RESULTS: A total of 106 patients (55 male, 51 female, average age 35.46+/-18.11 years) were enrolled. The number of patients with a suspected diagnosis of after history taking and physical examination only (2.43+/-0.5) was significantly greater than after abdominal US (1.34+/-0.5) (p<0.01). The level of confidences of suspected diagnosis of after history taking and physical examination only (3.43+/-1.14), by contrast, was less than after abdominal US (4.40+/-1.22) (p<0.01). Each year of postgraduate residents could have the same results after US. CONCLUSION: We found that abdominal ultrasonography could give EP more informations for pronouncing a correct diagnosis for patients with abdominal pain in the ED, and the COUCH method could lead the EP to get better training for ultrasonography and to diagnose more rapidly and accurately.
Abdominal Pain ; Diagnosis, Differential ; Emergencies ; Female ; Humans ; Male ; Physical Examination

PURPOSE: The supply of fluids is a major consideration in modern medicine. When fluid is needed, flow regulators are extensively used. But no research or study of flow regulators has yet been performed in Korea. We researched the accuracy of flow regulators that are commonly used in domestic medicine. METHODS: We collected and studied the fluid pumped for an hour through four kinds of flow regulators that are used domestic ally. Infusion rates were 10, 20, 30, 40, 60, 80, 100, 150, and 200 ml/hr. For each rate, the height of the fluid between the point of infusion and the outlet was evaluated in 10 cm increments within the range 30 cm to 120 cm. RESULTS: Among the four products tested, one product injected the fluid three times at the standard height of 80~100 cm, an error of <10%. Two other products injected within the standard range once each, and the fourth product failed to inject within range even once. CONCLUSION: The accuracy of flow regulators in the domestic market was exceedingly low.
Arylsulfonates ; Fluid Therapy ; History, Modern 1601- ; Infusion Pumps ; Korea

PURPOSE: Escalator-related injuries have been considered uncommon and most likely to occur to children. We set out to describe the epidemiology of these injuries with focus on the aging population in order to determine whether or not escalators are safe for the aged, and in order to obtain information to help in preventing escalator-related injuries. METHODS: A prospective survey was undertaken to identify the number and nature of these injuries from May 2004 to June 2006. We enrolled patients who had sustained escalated- related injuries and a standard list of questions and answers were recorded by the emergency physician. A total of 54 Such questionnaires were completed during the study period. Data were analyzed using SPSS 12.0K. RESULTS: The average patient age 63.40+/-20.92 years (range 3-94). There were 18 (33.3%) males. Only 4 (7.4%) were younger than their sixteen year, but 36 (66.7%) were over age 65 and 17 of those were injured from standing on escalators. However of 18 patients younger than age 65, 13 were injured from walking on moving escalators. CONCLUSION: Escalator-related injuries are not as uncommon as previously believed and the aged population over 65 years old is the highest risk group. Additionally, walking on moving escalator was a cause of injuries. Therefore, two orimary prevention strategies are needed. Provision of alternatives to escalators for people over 65 and keeping passengers from walking on escalators.
Aged ; Aging ; Child ; Elevators and Escalators ; Emergencies ; Humans ; Male ; Prospective Studies ; Surveys and Questionnaires ; Walking

PURPOSE: To evaluate the prognostic value of multimodal evoked potentials in predicting both awakening and failure to awake from coma due to cardiac arrest. METHODS: Multimodal evoked potentials composed of somatosensory evoked potentials (SEPs), visual evoked potentials (VEPs) and brainstem auditory evoked potentials (BAEPs) were recorded for 46 patients with anoxicischemic encephalopathy who had coma duration>24 h. Patients with trauma, stroke, malignancy, or age<14 y were excluded. Outcomes were categorized as awakening (GOS 3-5) vs. vegetative state or death (GOS 1-2). RESULTS: Forty-one percent of patients regained consciousness, and 59% died or remained vegetative. Bilaterally absent SEP N20 peaks predicted non-awakening with a sensitivity of 52% and a specificity of 100%. Unilaterally or bilaterally absent BAEP III-V predicted non-awakening with a sensitivity of 12% and a specificity of 100%. Using bilaterally absent SEP N20 peaks, unilaterally or bilaterally absent BAEP III-V, or both of the above predicted non-awakening with a sensitivity of 56% and a specificity of 100%. Bilaterally present SEP N20 peaks predicted awakening with a sensitivity of 100% and a specificity of 63%. However, the combination of bilateral presence of SEP N20 and VEP P100 in predicting awakening increased the specificity to 74%, reaching a sensitivity of 89%, a PPV of 71% and a NPV of 91%. CONCLUSION: Non-awakening in postanoxic coma can be reliably predicted with SEPs and BAEPs. Bilaterally preserved SEPs and VEPs predicted awakening with an accuracy of 80% at 1~4 days after cardiopulmonary resuscitation.
Coma ; Consciousness ; Evoked Potentials ; Evoked Potentials, Auditory, Brain Stem ; Evoked Potentials, Somatosensory ; Evoked Potentials, Visual ; Heart Arrest ; Humans ; Persistent Vegetative State ; Prognosis ; Sensitivity and Specificity ; Stroke ; Survivors