PURPOSE: Recently, randomized controlled trials have reported that conservative therapy can be a treatment option in patients with noncomplicated appendicitis. However, preoperative diagnosis of noncomplicated appendicitis is difficult. In this study, we determined predictive factors to distinguish patients with noncomplicated appendicitis from those with complicated appendicitis. METHODS: A total of 351 patients who underwent surgical treatment for acute appendicitis from January 2011 to December 2012 were included in this study. We classified patients into noncomplicated or complicated appendicitis groups based on the findings of abdominal computed tomography and pathology. We performed a retrospective analysis to find factors that could be used to discriminate between noncomplicated and complicated appendicitis. RESULTS: The mean age of the patients in the complicated appendicitis group (54.5 years) was higher than that of the patients in the noncomplicated appendicitis group (40.2 years) (P < 0.001), but the male-to-female ratios were similar. In the univariate analysis, the appendicocecal junction's diameter, appendiceal maximal diameter, appendiceal wall enhancement, periappendiceal fat infiltration, ascites, abscesses, neutrophil proportion, C-reactive protein (CRP), aspartate aminotransferase, and total bilirubin were statistically significant factors. However, in the multivariate analysis, the appendiceal maximal diameter (P = 0.018; odds ratio [OR], 1.129), periappendiceal fat infiltration (P = 0.025; OR, 5.778), ascites (P = 0.038; OR, 2.902), and CRP (P < 0.001; OR, 1.368) were statistically significant. CONCLUSION: Several factors can be used to distinguish between noncomplicated and complicated appendicitis. Using these factors, we could more accurately distinguish patients with noncomplicated appendicitis from those with complicated appendicitis.
Abscess ; Appendectomy ; Appendicitis* ; Ascites ; Aspartate Aminotransferases ; Bilirubin ; C-Reactive Protein ; Diagnosis ; Humans ; Multivariate Analysis ; Neutrophils ; Odds Ratio ; Pathology ; Retrospective Studies

OBJECTIVES: The purpose of this study was to examine the psychiatric characteristics of outpatients with tinnitus. METHODS: A total of 88 subjects were included in this study. According to Tinnitus Handicap Inventory (THI) scores, the subjects were classified into two group ; a mild tinnitus symptoms (mild-tinnitus) group and a severe tinnitus symptoms (severe-tinnitus) group. A questionnaire was used for an assessment of demographic characteristics, and the THI, the Visual Analogue Scale (VAS) about tinnitus, the Beck Depression Inventory (BDI), and the Beck Anxiety Inventory (BAI) are applied for evaluation of other clinical psychiatric characteristics. RESULTS: Higher THI scores were positively correlated with tinnitus course, the number of accompanying symptoms, and the VAS. BDI total scores, BDI factors, and BAI total scores were significantly higher in the severe-tinnitus group than in the mild-tinnitus group. Also suicidal ideation, interpersonal problems, sleep problems, occupational impairment, and fatigue were significantly higher in the severe-tinnitus group than in the mild-tinnitus group. CONCLUSIONS: Tinnitus is a common disorder of hearing which is associated frequently with psychiatric problems. This study suggests that psychiatric interventions should be taken into consideration in the treatment of patients suffering from tinnitus.
Anxiety ; Depression ; Fatigue ; Hearing ; Humans ; Outpatients ; Suicidal Ideation ; Tinnitus*

Gender dysphoria is very rare, but has frequent psychiatric comorbidity. In addition, risk of suicide is higher in patients with gender dysphoria than for the general population. Treatment of gender dysphoria is not determined, and more aggressive treatment is required for patients with suicidal ideation. No case involving electroconvulsive therapy of a gender dysphoria patient has been reported in South Korea. We discuss a 24 year-old man given electroconvulsive therapy for gender dysphoria with severe mood dysregulation and suicidal ideation.
Comorbidity ; Electroconvulsive Therapy* ; Humans ; Republic of Korea ; Suicidal Ideation* ; Suicide ; Young Adult

BACKGROUND: Ferulic acid (FA) is a naturally occurring nutritional compound. Although it has been shown to have antihypertensive effects, its effects on vascular function have not been intensively established. The aim of this study was to assess the vasoreactivity of FA in chronic two-kidney, one-clip (2K1C) renal hypertensive rats. METHODS: Hypertension was induced in 2K1C rats by clipping the left renal artery and age-matched rats that received a sham treatment served as a control. Thoracic aortas were mounted in tissue baths to measure isometric tension. The effects of FA on vasodilatory responses were evaluated based on contractile responses induced by phenylephrine in the aortic rings obtained from both 2K1C and sham rats. Basal nitric oxide (NO) bioavailability in the aorta was determined by the contractile response induced by NO synthase inhibitor NG-nitro-L-arginine methyl ester (L-NAME). RESULTS: FA induced concentration-dependent relaxation responses which were greater in 2K1C hypertensive rats than in sham-clipped control rats. This relaxation induced by FA was partially blocked by the removal of endothelium or by pretreating with L-NAME. L-NAME-induced contractile responses were augmented by FA in 2K1C rats, while no significant differences were noted in sham rats. FA improved acetylcholine-induced endothelium-dependent vasodilation in 2K1C rats, but not in sham rats. The simultaneous addition of hydroxyhydroquinone significantly inhibited the increase in acetylcholine-induced vasodilation by FA. CONCLUSION: These results suggest that FA restores endothelial function by altering the bioavailability of NO in 2K1C hypertensive rats. The results explain, in part, the mechanism underlying the vascular effects of FA in chronic renal hypertension.
Animals ; Aorta ; Aorta, Thoracic ; Baths ; Biological Availability ; Coumaric Acids ; Endothelium ; Hydroquinones ; Hypertension ; Hypertension, Renal ; NG-Nitroarginine Methyl Ester ; Nitric Oxide ; Nitric Oxide Synthase ; Phenylephrine ; Placebos ; Rats ; Relaxation ; Renal Artery ; Salicylamides ; Vasodilation

PURPOSE: The aim of this study was to evaluate the quality of the trauma care system of our hospital, in which emergency physicians care for major trauma patients in the emergency intensive care unit (ICU) in consultation with intervention radiologists and surgeons. METHODS: This was a retrospective observational study conducted in an emergency ICU of a tertiary referral hospital. We enrolled consecutive patients who had been admitted to our emergency ICU with major trauma from March 2007 to September 2010. We collected data with respect to demographic findings, mechanisms of injury, the trauma and injury severity score (TRISS), emergency surgery, angiographic intervention, and 6-month mortality. Then, we compared the observed and predicted survivals of the patients. The Hosmer-Lemeshow test and calibration plots by using 10 groups, one for each decile, of predicted mortality were used to evaluate the fitness of TRISS. P-values of greater than 0.05 represent a fair calibration. RESULTS: Among 116 patients, 12 (10.34%) were dead within 6 months after admission to the ICU, and 29 (25.00%) and 38 (32.80%) patients received emergency surgery and angiographic intervention, respectively. The mean injury severity score and revised trauma score were 36.97+/-17.73 and 7.84+/-6.75, respectively. The observed survival and the predicted survival of the TRISS were 89.66% (95% confidence interval [CI]: 84.03~95.28%) and 69.85% (95% CI: 63.80~75.91%), respectively. The calibration plots showed that the observed survival of our patients was consistently higher than the predicted survival of the TRISS (p<0.001). CONCLUSION: The observed survival for the trauma care system of our hospital, in which emergency physicians care for major trauma patients in the emergency ICU in consultation with intervention radiologists and surgeons, was higher than the predicted survival of the TRISS.
Calibration ; Critical Care ; Emergencies ; Emergency Medicine ; Humans ; Injury Severity Score ; Intensive Care Units ; Radiology, Interventional ; Retrospective Studies ; Tertiary Care Centers

Moyamoya disease is a rare progressive cerebrovascular disorder caused by blocked arteries at the base of the brain in an area called the basal ganglia. The etiology and pathogenesis are unknown. Clinically, this disease is found with a higher incidence in young female, but there are few cases of moyamoya disease in pregnancy. The disease primarily affects children, but it can also occur in adults. in children. The first symptom of moyamoya disease is often stroke, or recurrent transient ischemic attack, frequently accompanied by muscular weakness or paralysis affecting one side of the body, or seizures. Adults most often experience a hemorrhagic stroke due to recurring blood clots in the affected brain vessels. The diagnosis of moyamoya disease is made on the basis of angiographic findings and threatment of Moyamoya disease is surgery, or conservative management. We report a case of moyamoya disease that presented as intracerebral hemorrhage and intraventricular hemorrhage during pregnancy complicating severe preeclampsia.
Adult ; Arteries ; Basal Ganglia ; Brain ; Cerebral Hemorrhage ; Cerebrovascular Disorders ; Child ; Diagnosis ; Female ; Hemorrhage ; Humans ; Incidence ; Ischemic Attack, Transient ; Moyamoya Disease* ; Muscle Weakness ; Paralysis ; Pre-Eclampsia* ; Pregnancy ; Seizures ; Stroke

Moyamoya disease is a rare progressive cerebrovascular disorder caused by blocked arteries at the base of the brain in an area called the basal ganglia. The etiology and pathogenesis are unknown. Clinically, this disease is found with a higher incidence in young female, but there are few cases of moyamoya disease in pregnancy. The disease primarily affects children, but it can also occur in adults. in children. The first symptom of moyamoya disease is often stroke, or recurrent transient ischemic attack, frequently accompanied by muscular weakness or paralysis affecting one side of the body, or seizures. Adults most often experience a hemorrhagic stroke due to recurring blood clots in the affected brain vessels. The diagnosis of moyamoya disease is made on the basis of angiographic findings and threatment of Moyamoya disease is surgery, or conservative management. We report a case of moyamoya disease that presented as intracerebral hemorrhage and intraventricular hemorrhage during pregnancy complicating severe preeclampsia.
Adult ; Arteries ; Basal Ganglia ; Brain ; Cerebral Hemorrhage ; Cerebrovascular Disorders ; Child ; Diagnosis ; Female ; Hemorrhage ; Humans ; Incidence ; Ischemic Attack, Transient ; Moyamoya Disease* ; Muscle Weakness ; Paralysis ; Pre-Eclampsia* ; Pregnancy ; Seizures ; Stroke

BACKGROUND: The most commonly used regimen for the eradication of Helicobacter pylori is combination of a proton pump inhibitor, clarithromycin, and two other antibiotics, metronidazole and amoxicillin. The increase in resistance to antibiotics seems to result in a decrease in eradication efficacy for H.pylori. We investigated the prevalence of antibiotic resistance in H.pylori isolated in Daejeon area. METHODS: A total of 31 clinical isolates of H.pylori were collected from the patients who underwent upper gastrointestinal endoscopy in Keonyang University Hospital during the period from March to July 2004. Antibiotic susceptibility tests for metronidazole, amoxicillin, and clarithromycin were performed by the E test (AB Biodisk, Sweden) on an egg yolk medium containing triphenyltetrazolium. The resistance break points for amoxicillin, metronidazole, and clarithromycin were defined as 0.5 microgram/mL, 8 microgram/mL, 1 microgram/mL, respectively. RESULTS: Resistance to amoxicillin, metronidazole, and clarithromycin was detected in 7.4% (2/27), 25.8% (8/31), 3.6% (1/28), respectively. CONCLUSION: The resistance to amoxicillin and clarithromycin was uncommon in Daejeon area.
Amoxicillin ; Anti-Bacterial Agents ; Clarithromycin ; Drug Resistance, Microbial ; Egg Yolk ; Endoscopy, Gastrointestinal ; Helicobacter pylori* ; Helicobacter* ; Humans ; Metronidazole ; Prevalence* ; Proton Pumps

Separation of symphysis pubis during vaginal delivery is rare condition with incidence ranging from 1/500 to 1/30000 deliveries. The injury is caused by fetal head exerting pressure on pelvic ligaments that have been relaxed by progesterone and relaxin. The separation might be associated with considerable pain, swelling and tenderness over the pubic area. Diagnosis is based on clinical findings and X-ray findings. The condition is treated conservatively with bed rest, analgesics and physical therapy. Prognosis is exellent. We experienced 3cases of separation of symphysis pubis during vaginal delivery and report these cases with a brief review of literature.
Analgesics ; Bed Rest ; Diagnosis ; Head ; Incidence ; Ligaments ; Progesterone ; Prognosis ; Relaxin

OBJECTIVE: To evaluate the association of level of CA-125 and severity of dysmenorrhea with lesion depth in adenomyosis. METHODS: Sixty-eight women who had undergone hysterectomy and were found to have pure adenomyosis on histopathologic examination were reviewed retrospectively. Specimens were stratified according to the degree of adenomyosis penetration into 4 groups: group A consisted of specimens with adenomyosis penetration into myometrium of up to 25%; group B, 26-50%; group C, 51-75%, and group D, >75%. All women were submitted to serum determination of CA-125. Severity of dysmenorrhea was assessed by means of a modification of 10-point verbal rating scale. RESULTS: Each group was not correlated with severity of dysmenorrhea (p=0.7394 Fisher's exact test). The means of serum CA-125 levels was increased corresponding to depth of adenomyosis (p=0.0441 ANOVA test). CONCLUSION: In this study, serum CA-125 level is associated with the depth lesion and severity of dysmenorrhea is not. Therefore, the level of serum CA-125 might be useful indicator in management of adenomyosis before surgery.
Adenomyosis* ; Animals ; Dysmenorrhea* ; Female ; Humans ; Hysterectomy ; Mice ; Myometrium ; Retrospective Studies