OBJECTIVE: Outbreaks of transmissible respiratory infection are suspected to have significant effects on the health of pediatric and geriatric patients. The objective was to assess the impact of the Middle East respiratory syndrome (MERS) outbreak on the use of emergency resources. METHODS: An ecologic analysis of emergency department (ED) records between September and December 2015, was performed. Data was obtained from the National Emergency Department Information System database for Korea. All demographic and diagnostic data from patients presenting with febrile symptoms as a main complaint were collected. The data were compared to the equivalent period in the three years preceding the MERS outbreak in Korea. RESULTS: Following the MERS outbreak, there was an increase in overall ED visits by febrile patients and the proportion of visits by febrile patients, relative to total ED attendances. This effect was more prominent in the children under five years. The duration of the chief complaint before ED arrival and the length of ED stay were significantly increased among younger pediatric patients. Decreased body temperature on arrival was observed in younger pediatric patients. CONCLUSION: MERS outbreak appears to have had a significant effects on ED use by febrile patients. The use of emergency care services by pediatric patients makes them more vulnerable to an outbreak of a transmissable disease. An effective strategy to control emergency center visits by non-urgent febrile patients and provide proper medical services is urgently needed.
Body Temperature ; Child ; Coronavirus Infections* ; Disease Outbreaks ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital ; Fever ; Humans ; Information Systems ; Korea ; Middle East Respiratory Syndrome Coronavirus ; Middle East* ; Overall

PURPOSE: Therapeutic hypothermia (TH) has become a standard strategy for reducing brain damage in the postresuscitation period. The aim of this study is to investigate the outcomes and current performance of TH with out-of-hospital cardiac arrest (OHCA) survivors through the Korean hypothermia network (KORHN) registry. METHODS: We used the KORHN registry, a web-based, multicenter registry that includes 24 participating hospitals throughout the Republic of Korea. Adult comatose OHCA survivors treated with TH from 2007 to 2012 were included. The primary outcomes were neurologic outcome at hospital discharge and in-hospital mortality. The secondary outcomes were TH performance and adverse events during TH. RESULTS: A total of 930 patients were included; of these, 556 (59.8%) patients survived to discharge and 249 (26.8%) were discharged with good neurologic outcomes. The median time from return of spontaneous circulation (ROSC) to the start of TH was 101 (interquartile range (IQR): 46-200) minutes. The induction, maintenance, and rewarming durations were 150 (IQR: 80-267) minutes, 1440 (IQR: 1290-1440) minutes, and 708 (IQR: 420-900) minutes, respectively. The time from the ROSC to coronary angiography was 1,045 (IQR: 121-12,051) hours. Hyperglycemia (46.3%) was the most frequent adverse event. CONCLUSION: Over one quarter of OHCA survivors (26.8%) were discharged with good neurologic outcome. TH performance was managed appropriately in terms of the factors related to the timing of TH, which were the start time for cooling and the rewarming duration.
Adult ; Brain ; Coma ; Coronary Angiography ; Hospital Mortality ; Humans ; Hyperglycemia ; Hypothermia* ; Hypothermia, Induced ; Korea ; Out-of-Hospital Cardiac Arrest* ; Registries ; Republic of Korea ; Rewarming ; Survivors

PURPOSE: Emergency physicians (EPs) are exposed to radiation in the emergency department (ED). However, EPs are not followed with dosimeter measurements of radiation exposure because of the common belief that EPs have a low exposure to radiation. This study was performed to investigate the recognition of EPs' level of radiation exposure. METHODS: Data were collected from direct interviews with questionnaires administered at five ED's medical conference from November, 2007 to March, 2008. One hundred and twenty-one EPs were surveyed with questionnaires. The questionnaires consisted of six items on the patient characteristics, rate of radiation exposure, recognition of radiation exposure, knowledge of radiation exposure, patient exposure, and education. Some questions were graded on a five point Likert scale. The average and standard deviation were calculated. RESULTS: There were 58.3% of the EPs that reported that they were exposed to portable X-rays more than three times per day; 58.8% of the answers showed that the EPs did not escape from exposure to the portable X-rays. For 87.3% of the EPs, they did not wear lead aprons during the portable X-rays. There were 51.1% of answers that severely underestimated the radiation dose from a CT. The recognition and knowledge of radiation exposure among ED residents increased as there level of training increased, but this was not the case for the board certified emergency physicians (p=0.016). The radiation exposure to the patients was not accurately estimated by EP scores, regardless of their level of experience. CONCLUSION: The lack of knowledge and recognition of the exposure to radiation by EPs expose them and their patients to potentially dangerous levels of radiation that might increase their lifetime cancer risk. We recommend that EPs should be educated regarding their radiation exposure as well as their patients and followed by dosimeter evaluations to minimize radiation exposure.
Emergencies ; Humans ; Occupational Exposure ; Surveys and Questionnaires ; United Nations

PURPOSE: To describe systemic complications of unconscious patients' survival six hours following cardiopulmonary resuscitation (CPR), and to evaluate the relationship between several variables and death. METHODS: We conducted a retrospective analysis of 153 cases of non-traumatic cardiac arrest that received CPR in a tertiary emergency department from April 1997 to June 2007. We carried out analyses on survival cases, and studied general characteristics and systemic complications to ascertain relationships between the survival and death groups. RESULTS: Sixty of 153 patients initially survived, but the survival rate quickly decreased to 30.1% within the first three days and then decreased slowly thereafter. In the 153 patients, hyperamylasemia occurred in 101 patients (66.0%), acute liver injury in 75(49.0%), sepsis in 67(43.8%), seizure and refractory shock in 66(43.1%), pneumonia in 65(42.5%), acute renal failure (ARF) in 64(41.8%), acute respiratory distress syndrome (ARDS) in 30(19.6%), and disseminated intravascular coagulation (DIC) in 26(17.0%). Of nine types of complications encountered, the incidences of hyperamylasemia, ARDS, ARF, refractory shock and DIC were significantly higher in patients who died than in those who survived (73.1% vs 55.0%, 28.0% vs 6.7%, 54.8% vs 21.7%, 66.7% vs 6.7%, and 23.7% vs 6.7%, respectively). CONCLUSION: Systemic complications occurred with high frequency in comatose survivors after cardiopulmonary resuscitation. Hyperamylasemia, ARDS, ARF, refractory shock and DIC were significantly associated with death.
Acute Kidney Injury ; Cardiopulmonary Resuscitation ; Coma ; Dacarbazine ; Disseminated Intravascular Coagulation ; Emergencies ; Heart Arrest ; Humans ; Hyperamylasemia ; Incidence ; Liver ; Pneumonia ; Respiratory Distress Syndrome, Adult ; Retrospective Studies ; Seizures ; Sepsis ; Shock ; Survival Analysis ; Survival Rate ; Survivors ; Unconscious (Psychology)

The purpose of this study was to evaluate the stability and efficacy of biologic membrane made of freeze-dried cartilage as a barrier to facilitate guided bone regeneration in experimental non-healing bone defects in the rat mandible. Nine adult Sprague-Dawley rats (400-500g) were used in experiment. 5.0mm in diameter were created on the mandibular angle area by means of slow-speed trephine drill. In microscopic examination, dynamic immature bone forming at 2 weeks and its calcification at 4 weeks were observed. The membrane made of lyophilized cartilage taken from human costal cartilage seems to be very effective for guided bone regeneration as a biologic membrane and the scaffold for attachment of cells or local drug delivery system of growth factor, which may meet the ideal requirement of a barrier membrane and graft materials.
Adult ; Animals ; Bone Regeneration* ; Cartilage ; Drug Delivery Systems ; Humans ; Mandible ; Membranes* ; Rats ; Rats, Sprague-Dawley ; Transplants

PURPOSE: Human tooth proteins are highly heterogeneous, comprising diverse proteins derived from a number of genes. The attempts to identify protein for activity of tooth matrix proteins have been defied by several factors. First, the amount of proteins within teeth is very small relative to many extracellular matrix proteins of other tissues. Second, the bioassay system is tedious and needed for long time. Therefore we tried to find easy techniques, which increase the product rate, and an assay of small proteins, with which amino acid sequence is possible without additional procedures. Materials and METHODS: Total protein were extracted from 300 g enamel removed teeth and 600 g teeth with 4 mol/L guanidine HCl and purified by gel chromatography. Aliquot of proteins was implanted into muscle pouches in Sprague-Dawley rats for bioassay. By SDS-PAGE and membrane blotting, molecular weight of each protein was estimated and a partial amino acid sequence was obtained. Each fraction blotted on the membrane was cut out and inserted in rat ectopic model. RESULTS: In dissociative method, total tooth proteins were obtained 1mg/ml from enamel removed teeth and 3.5 mg/ml from teeth. In SDS-PAGE, four clear bands at the sites corresponding to 66, 40, 20 and 18 kD. Especially The 66 kD band was clearly exhibited. Amino acid sequencing from tooth could be possible using PVDF membrane blotting technique. In amino acid sequencing, 66 kD protein was identified as albumin. CONCLUSION: Compared with conventional method for extraction of teeth protein and bioassay of proteins, the methods in this study were easy, time-saving and more productive technique. The matured tooth proteins omitting additional procedure of mechanical removal of enamel were simply analyzed using blotted PVDF membrane. This method seems to make a contribution as a technique for bioassay and amino acid sequencing of protein.
Amino Acid Sequence ; Animals ; Biological Assay* ; Chromatography, Gel ; Dental Enamel ; Electrophoresis, Polyacrylamide Gel ; Extracellular Matrix Proteins ; Guanidine ; Humans* ; Membranes* ; Molecular Weight ; Rats ; Rats, Sprague-Dawley ; Sequence Analysis, Protein ; Tooth*

The purpose of this study was to evaluate the resistant force of medial pterygoid muscles against the mandibular advancement and distraction to anterior, and inquire into the relationship between medial pterygoid muscles and cephalometric variables. Sixty six patients with class III malocclusion underwent bilateral sagittal splitting of ramus with intraoralvertico-sagittal ramus osteotomy for mandibular set-back. The spring scale was used to measure the resistance of medial pterygoid muscles after splitting of ramus. Skeletaldental cephalometric analysis was made and statistic package was used for correlation between resistance and cephalometric variables. The resistant force of the right medial pterygoid muscle was greater than the left one in Koreans with class III malocclusion, and the force had a linear regression relationship with facial depth. The results suggested that facial depth has significant correlation with the resistance of medial pterygoid muscle, which can be acquired from patient's cephalometric analysis.
Humans ; Linear Models ; Malocclusion ; Mandibular Advancement ; Osteotomy ; Pterygoid Muscles*

Esthetics ; Facial Asymmetry ; Genioplasty ; Humans ; Jaw ; Orthognathic Surgery ; Osteotomy ; Rhinoplasty ; Seoul ; Surgery, Oral ; Surgery, Plastic

Ameloblastomas are generally considered to be benign tumors of odontogenic epithelial origin with high local recurrence. Rarely ameloblastomas exhibit malignant behavior with development of metastases. In this report, we present a 19-year-old woman with ameloblastoma in the right ascending ramus and multiple recurrences. Eleven years after first therapy, ameloblastoma metastasized to ipsilateral submandibular lymph node. We also review literature about cause, treatment and work-up of malignant ameloblastoma.
Ameloblastoma* ; Female ; Humans ; Lymph Nodes* ; Mandible* ; Neoplasm Metastasis* ; Recurrence ; Young Adult

The incident of false aneurysm of internal maxillary artery in the oral and maxillofacial region is known to be very rare. One case of false aneurysm in the internal maxillary artery is presented, which was experienced in our department. The etiology of this case is regarded as the mandibular condyle fracture, and/or iatrogenic trauma during open reduction. Clinically, there were systolic bruit on auscultation, pulsation and massive bleeding during operation. The lesion was finally diagnosed with angiography and treated by embolization procedure. False aneurysm can cause so massive bleeding as to threat the life of the patients. Therefore accurate diagnosis and treatment is very important. Angiography enables the solid diagnosis for the clinical one. And as the embolization has many advantages over the ligation, it can be a good treatment method.
Aneurysm, False* ; Angiography ; Auscultation ; Diagnosis ; Hemorrhage ; Humans ; Ligation ; Mandibular Condyle ; Maxillary Artery*