Objective: Coronavirus disease 2019 (COVID-19) has notably altered the emergency department isolation protocol, imposing stricter requirements on probable infectious disease patients that enter the department. This has caused adverse effects, such as an increased rate of leave without being seen (LWBS). This study describes the effect of fever/respiratory symptoms as the main cause of isolation regarding LWBS after the COVID-19 pandemic. Methods: We retrospectively analyzed emergency department visits before (March to July 2019) and after (March to July 2020) the COVID-19 pandemic. Patients were grouped based on existing fever or respiratory symptoms, with the LWBS rate as the primary outcome. Logistic regression analysis was used to identify the risk factors of LWBS. Logistic regression was performed using interaction terminology (fever/respiratory symptom patient [FRP] × post–COVID-19) to determine the interaction between patients with FRPs and the COVID-19 pandemic period. Results: A total of 60,290 patients were included (34,492 in the pre–COVID-19, and 25,298 in the post–COVID-19 group). The proportion of FRPs decreased significantly after the pandemic (P < 0.001), while the LWBS rate in FRPs significantly increased from 2.8% to 19.2% (P < 0.001). Both FRPs (odds ratio, 1.76; 95% confidence interval, 1.59–1.84 (P < 0.001) and the COVID-19 period (odds ratio, 2.29; 95% confidence interval, 2.15–2.44; P < 0.001) were significantly associated with increased LWBS. Additionally, there was a significant interaction between the incidence of LWBS in FRPs and the COVID-19 pandemic period (P < 0.001). Conclusion The LWBS rate has increased in FRPs after the COVID-19 pandemic; additionally, the effect observed was disproportionate compared with that of nonfever/respiratory symptom patients.

OBJECTIVE: Several studies have reported that patients with diabetes mellitus (DM) are vulnerable to infection. However, the mechanism underlying this remains unclear. We hypothesized that preoperative blood glucose levels in patients with DM may be a risk factor for surgical site infection (SSI). We aimed to investigate the relationship between hemoglobin A1c (HbA1c) level and SSI incidence following single-level spinal fusion surgery. METHODS: Patients with DM who underwent single-level lumbar posterior fusion surgery were retrospectively reviewed. Ninety-two patients were included and classified into the SSI and SSI-free groups. Clinical data with demographic findings were obtained and compared. The HbA1c cut-off value was defined using receiver operating characteristic (ROC) and area under the curve (AUC) analyses, which showed a significantly increased SSI risk. Potential variables were verified using multiple logistic regression analysis. RESULTS: Among the enrolled patients, 24 had SSI and 68 did not within 1 year. The preoperative HbA1c level was higher in patients with SSI (6.8%) than in the non-infected patients (6.0%; p=0.008). ROC analysis showed that if the HbA1c level is higher than 6.9%, the risk of SSI significantly increases (p=0.003; AUC, 0.708; sensitivity, 62.5%; specificity, 70.6%). The preoperative HbA1c level was significantly correlated with SSI incidence, after adjusting for potential variables (p=0.008; odds ratio, 4.500; 95% confidence interval, 1.486–13.624). CONCLUSION: The HbA1c level, indicating glycemic control, in patients with DM may be a risk factor for SSI in single-level lumbar spine posterior fusion.
Area Under Curve ; Blood Glucose ; Diabetes Mellitus ; Hemoglobin A, Glycosylated ; Humans ; Incidence ; Logistic Models ; Odds Ratio ; Retrospective Studies ; Risk Factors ; ROC Curve ; Sensitivity and Specificity ; Spinal Fusion ; Spine ; Surgical Wound Infection

PURPOSE: To evaluate the clinical outcome of high-dose-rate (HDR) interstitial brachytherapy (IBT) in patients with oral cavity cancer. MATERIALS AND METHODS: Sixteen patients with oral cavity cancer treated with HDR remote-control afterloading brachytherapy using 192Ir between 2001 and 2013 were analyzed retrospectively. Brachytherapy was administered in 11 patients as the primary treatment and in five patients as salvage treatment for recurrence after the initial surgery. In 12 patients, external beam radiotherapy (50-55 Gy/25 fractions) was combined with IBT of 21 Gy/7 fractions. In addition, IBT was administered as the sole treatment in three patients with a total dose of 50 Gy/10 fractions and as postoperative adjuvant treatment in one patient with a total of 35 Gy/7 fractions. RESULTS: The 5-year overall survival of the entire group was 70%. The actuarial local control rate after 3 years was 84%. All five recurrent cases after initial surgery were successfully salvaged using IBT +/- external beam radiotherapy. Two patients developed local recurrence at 3 and 5 months, respectively, after IBT. The acute complications were acceptable (< or =grade 2). Three patients developed major late complications, such as radio-osteonecrosis, in which one patient was treated by conservative therapy and two required surgical intervention. CONCLUSION: HDR IBT for oral cavity cancer was effective and acceptable in diverse clinical settings, such as in the cases of primary or salvage treatment.
Brachytherapy* ; Humans ; Mouth Neoplasms ; Mouth* ; Radiotherapy ; Recurrence ; Retrospective Studies

Sometimes serious tension occurs in the radial nerve when doing internal fixation for distal humerus shaft fracture or neurorrhaphy for radial nerve injury. Medial transposition of radial nerve on fracture site can avoid direct radial nerve injury by fracture fragment, radial nerve tension by plating for distal humerus shaft fracture, and also safe from neural tension during neurorrhaphy of damaged radial nerve. We reported here total 6 cases of backward transposition of radial nerve including 2 cases of radial nerve injury associated with humerus fracture and 4 cases of comminuted fracture of humerus shaft.
Fractures, Comminuted ; Humerus ; Radial Nerve

BACKGROUND: The prevalence of obesity is increasing year after year in Korean; and gastroesophageal reflux disease(GERD) is increasing in this population as well. The aim of this study is to assess the association between age, body mass index(BMI) and GERD in healthy Korean adults. METHODS: Analysis was done on 1,016 subjects who had not had malignancy, uncontrolled metabolic disease, enteric surgery and organic esophageal disease. They completed a questionnaire that included past history and reflux symptoms. Endoscopy was performed by two gastroenterologists who were not given any patient information. Existence of GERD was determined by the esophageal syndrome criteria of the Montreal guidelines. Subjects were categorized by BMI, initially as: underweight, normal(18.5< or =BMI<25), overweight(25< or =BMI<30) and obese by the WHO criteria, and then as: underweight, normal(18.5< or =BMI<23), overweight(23< or =BMI<25) and obese by the Asian-Pacific criteria. RESULTS: The overall[is this correct] prevalence of GERD in our subjects was 15.5%. Age and sex were not correlated factors for GERD. By the WHO and the Asian-Pacific criteria, GERD was present in underweight(10.0%, 12.1%), normal(13.9%, 14.4%), overweight(18.6%, 13.0%) and obese groups(21.0%, 18.8%). No meaningful association was seen between BMI and GERD in either of the classified groups. Erosive GERD was seen in 83 subjects (8.2%) on endoscopy. The obese(BMI> or =25) group(12.1%) showed a meaningful increment in the prevalence of erosive GERD compared to the non-obese(BMI<25) group(6.2%)(p value 0.002). CONCLUSION: The prevalence of GERD in healthy Korean adult subjects was not closely associated with obesity and age[according to BMI]; however, erosive GERD was found to have a strong association with obesity.
Adult ; Body Mass Index ; Endoscopy ; Esophageal Diseases ; Gastroesophageal Reflux ; Humans ; Metabolic Diseases ; Obesity ; Prevalence ; Surveys and Questionnaires ; Thinness

This study compares the sexual differences among rectal prolapse patients regarding the clinical and the physiologic characteristics with emphasis on males. METHODS: The clinical data, functional status and operative records of 43 patients, who had completed both clinical and functional evaluations were collected in a prospective database and were analyzed according to sex. The functional status of the patients was evaluated by Wexner's constipation score (0~30), Wexner's incontinence score (0~20), anorectal manometry, and pudendal nerve terminal motor latency (PNTML). RESULTS: The incidences of rectal prolapse in males (n=22) and in females (n=21) were similar. The age of onset for males was lower (mean standard deviation, 19.6 19.59 (50% in childhood) vs 52.0 20.75 years; p=0.001) and the duration of symptoms was longer (31.5+/-19.87 vs 12.5+/-14.31 years; p<0.001). Surgery in males was most commonly performed during the sexually active years (51.2+/-16.34 vs 64.5+/-13.19; p=0.006). The incidence of mucosal prolapse in males was higher (10/22 vs 4/17; p=0.065). The incidences and the severities of defecation difficulty in males and females were similar (n=12, mean Wexner score=8.4 vs n=12, mean Wexner score=9.9; p=NS) but, the incidences and the severities of fecal incontinence were lower in males (n=4, mean Wexner score=4.3 vs n=17, mean Wexner score= 14.2; p<0.001). The maximum resting pressure was higher in males (39.2+/-21.46 vs 26.3+/-19.98 mmHg; p=0.049), and the maximum squeezing pressure was better preserved (131.2+/-62.63 vs 67.5+/-37.99 mmHg; p<0.001). No significant difference existed in the PNTML. Female patients underwent abdominal resection rectopexy (n=6), perineal rectosigmoidectomy with lavatoroplasty (n=11), and Delorme's procedure (n=4), but all male patients preferred the perineal approach (rectosigmoidectomy with lavatoroplasty (n=8), Delorme's procedure (n=14)) for fear of sexual dysfunction after the abdominal approach. CONCLUSIONS: These findings suggest that the mechanism for developing rectal prolapse in male and female may be different and that surgical treatment should be tailored to the patient.
Age of Onset ; Constipation ; Defecation ; Fecal Incontinence ; Female ; Humans ; Incidence ; Male* ; Manometry ; Prolapse ; Prospective Studies ; Pudendal Nerve ; Rectal Prolapse*

BACKGROUND/AIMS: Magnifying colonoscopy was developed for detailed examination of the surface of colorectal neoplastic lesions. While magnifying colonoscopy is useful for differentiating neoplastic lesions from nonneoplastic ones, for evaluating early colorectal cancers, it still has limits in practice. This study was designed to clarify the usefulness and the limits of magnifying colonoscopy. METHODS: Three hundred and fifty-two lesions, which were observed using magnifying colonoscopy from July to August 1999 and whose histologies were proven, were analyzed according to their pit patterns. The pit patterns are I, normal round pits; II, large starry-shaped pits; IIIs, small round pits; IIIL, large round or rod-shaped pits; IV, branched or gyrus-like pits; and V, irregularly shaped or nonstructural pits. In cases where a pit pattern was hard to read, the pattern was classified as 'D'. RESULTS: The dominant pit pattern for protruded lesions was IIIL, accounting for 44.6%. In diminutive lesions (< or =5 mm), II and IIIL were equally common, 40% of the total for those lesions, respectively. In medium-sized lesions (from 6 to 10 mm), IIIL was the major pit pattern, 45.6% of the total for that type of lesion. In lesions larger than 10 mm, IIIL and IV were the most common pit patterns, each accounting for 26.7% of the total. The overall accuracy ratio of pit pattern diagnoses was 79.5%. The frequency of difficult pit patterns to read was 6.3%. Among them, 77.3% were due to difficulty in interpreting the pit patterns, and 22.7% were due to an inability to clarify the pit pattern because of poor staining. Ninety-one percent of the difficult cases to read involved diminutive lesions, and 86% of those difficult cases involved tubular adenomas. CONCLUSIONS: The 80% accuracy rate for pit pattern diagnosis suggests that magnifying colonoscopy is probably useful, but problems, such as poor staining due to mucus and difficulty with interpretation, still exist.
Adenoma ; Colonoscopy* ; Colorectal Neoplasms ; Diagnosis ; Mucus

Systemic lupus erythematosus (SLE) which is thought to be autoimmune in nature affects multiple organs and produces a diversity of signs and symptoms. However, cardiovascular manifestations of SLE are manifested more frequently by autopsy. Recently, with the prolonged survival and improvement of diagnostic methods in SLE including echocardiography, the morbidity and mortality associated with cardiovascular manifestations of SLE became more apparent and increased. Simultaneous involvement of the pulmonary artery and the myopericardium in SLE is known to be rare. Pulmonary hypertension is known to be associated with poor prognosis. We report a 27 year-old female patient of SLE with pulmonary hypertension, pericarditis and left ventricular systolic dysfunction.
Adult ; Autopsy ; Echocardiography ; Female ; Humans ; Hypertension, Pulmonary* ; Lupus Erythematosus, Systemic* ; Mortality ; Pericarditis* ; Prognosis ; Pulmonary Artery

BACKGROUND: QT dispersion (QTd) in 12-lead ECG, a noninvasive parameter of the degree of inhomogeneous myocardial repolarization, has been reported useful in assessing the risk of ventricular tachyarrhythmias and sudden cardiac death in patients with coronary artery disease. Restenosis after coronary stenting was not infrequent. However, there was no reliable ECG predictor for stent restenosis. This study was performed to evaluate the value of QTd as a predictor of coronary artery stent (CAS) restenosis. METHODS: One hundred eighty eight patients who underwent both successful coronary artery stenting for significant coronary artery stenosis and follow-up coronary artery angiography were included in this study. QTcd (difference of maximum and minimum QTc intervals) was measured in the 12-lead surface ECG, which was recorded 6-12 hours after the successful CAS and 12-18 hours before the follow-up coronary angiography, which was performed 1-12 months (Group I: 6+/-3 months: Group II: 7+/-2 months, p=NS) after CAS. The follow-up coronary angiography demonstrated no restenosis of the stented coronary artery in 122 patients: Group I: 97 men, 25 women: 58+/-13 years), but restenosis in 66 patients:(Group II: 58 men, 8 women: 61+/-13 years). RESULTS: There were no significant differences in the distribution of the target vessels between the two groups. The minimal luminal diameters of the target vessels were similar in the two groups before and after CAS (0.99+/-0.49 mm vs. 0.92+/-0.51 mm: 2.94+/-0.71 mm vs. 2.71+/-0.79, respectively). QTcd after CAS was 52.6+/-22.0 ms in the Group I and 51.6+/-30.5 ms in the Group II, with no significant difference between the two groups. QTcd at the follow-up examination was 50.0+/-19.8 ms in the Group I and 58.3+/-21.6 ms in the Group II, showing a significant difference between the two groups (p<0.05). The change in QTcd (DQTcd) during the follow-up period was significantly different between the two groups: QTcd significantly increased in the Group II, particularly in patients with angina pectoris, single or two-vessel disease, or left coronary artery stenosis, compared with the Group I (Group I:-2.18+/-22.11 ms, Group II: 8.77+/-28.82 ms, p<0.05). The sensitivity, specificity, negative predictive value, positive predictive value and diagnostic accuracy of DQTcd (cut-off value, 7 ms) in predicting coronary artery stent restenosis were 64%, 65%, 77%, 49%, and 64%, respectively. CONCLUSION: The change of QTc dispersion according to restenosis was significantly different, but its clinical usefulness is limited due to low positive predictive value.
Angina Pectoris ; Angiography ; Coronary Angiography ; Coronary Artery Disease ; Coronary Stenosis ; Coronary Vessels* ; Death, Sudden, Cardiac ; Electrocardiography ; Female ; Follow-Up Studies ; Humans ; Male ; Phenobarbital ; Sensitivity and Specificity ; Stents* ; Tachycardia

Air can be introduced into the epidural space during the loss of resistance technique used to identify needle entry into the epidural space. Complications resulting from the injection of air into the epidural space include pneumocephalus, spinal cord and nerve root compression, retroperitoneal air collection, subcutaneous emphysema, venous air embolism, and possibly, incomplete analgesia and anesthesia. We experienced a case of a large epidural collection of air following epidural anesthesia attempted one month before. The CT scan revealed epidural air extending from L1-S1 with moderate compression of nerve root at L4-5.
Anesthesia and Analgesia ; Anesthesia, Epidural ; Embolism, Air ; Epidural Space ; Needles ; Pneumocephalus ; Radiculopathy ; Spinal Cord ; Subcutaneous Emphysema ; Tomography, X-Ray Computed