We analyzed parasitic diseases diagnosed by tissue biopsy specimens at KyungHee Medical Center (KMC) from 1984 to 2005. The total number of parasite infection cases was 150 (0.07%) out of the total 211,859 biopsy specimens submitted for histopathological examinations. They consisted of 62 cysticercosis, 23 sparganosis, 16 paragonimiasis, 15 amebiasis, 11 anisakiasis, 11 clonorchiasis, 3 ascariasis, 2 scabies, 2 enterobiasis, 2 trichuriasis, 1 leishmaniasis, 1 taeniasis, and 1 thelaziasis. Out of 62 cysticercosis cases, 55 were detected in subcutaneous tissues or the central nerve system. Eighteen out of 23 sparganosis cases were involved in muscular and subcutaneous tissues. In most anisakiasis cases, the involved organ was the stomach. The lung and the pleura were the most common site of paragonimiasis. The incidence of parasitic diseases during the first 5 years (1984-1988) was the highest of all observed periods. After 1989, similar incidences were shown throughout the period. Whereas cysticercosis was diagnosed in 34 cases during 1984-1988, no case has been diagnosed since 2000. In the case of sparganosis, the chronological incidence was almost uniform throughout the period 1984-2005. Paragonimiasis showed a similar tendency to cysticercosis. In gender and age distribution of parasitic diseases, men showed higher incidence rates than females, and the age groups of the 40s or older indicated higher infection frequencies than other age groups. Therefore, these results are a significant report to appear the tendency of human parasitic disease diagnosed by tissue biopsy in association with parasitosis at KMC in Seoul.
Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; *Biopsy ; Child ; Child, Preschool ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Parasitic Diseases/*diagnosis/*epidemiology ; Republic of Korea/epidemiology ; Sex Factors ; Young Adult

PURPOSE: We planned to determine the diagnostic capability of focused assessment with sonography for trauma (FAST) in cases of blunt abdominal injury (BAI). METHODS: A retrospective analysis of FAST sheets was performed from April 2002 to December 2004. During the study period, 135 BAI patients were evaluated with FAST at the Emergency Department of Bundang CHA Hospital. Of this group, twenty-eight patients were excluded, leaving 107 patients for analysis. Abdomen CT (computerized tomography) or exploratory laparotomy confirmed the presence of hemoperitoneum. At the secondary survey, patients underwent a three-view FAST examination (LogicQ; General Electric, Waukesha, USA) by an emergency physician, followed within 2 hours by an abdomen CT or exploratory laparotomy. The FAST examination was considered positive if it demonstrated evidence of free intra-abdominal fluid. RESULTS: There were 45 true-positive FAST examination, 57 true-negatives, 1 false-positive, and 4 false negatives (sensitivity 91.8%, specificity 98.3%, positive predictive value 97.8%, negative predictive value 93.4%). The area under the ROC curve was 0.951 for the FAST examination. CONCLUSION: FAST is a highly reliable method for screening patients suspected of having BAI for the presence or absence of hemoperitoneum.
Abdomen ; Abdominal Injuries ; Emergencies ; Emergency Service, Hospital ; Hemoperitoneum ; Humans ; Laparotomy ; Mass Screening ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Tomography, X-Ray Computed

PURPOSE: We planned to determine the diagnostic capability of focused assessment with sonography for trauma (FAST) in cases of blunt abdominal injury (BAI). METHODS: A retrospective analysis of FAST sheets was performed from April 2002 to December 2004. During the study period, 135 BAI patients were evaluated with FAST at the Emergency Department of Bundang CHA Hospital. Of this group, twenty-eight patients were excluded, leaving 107 patients for analysis. Abdomen CT (computerized tomography) or exploratory laparotomy confirmed the presence of hemoperitoneum. At the secondary survey, patients underwent a three-view FAST examination (LogicQ; General Electric, Waukesha, USA) by an emergency physician, followed within 2 hours by an abdomen CT or exploratory laparotomy. The FAST examination was considered positive if it demonstrated evidence of free intra-abdominal fluid. RESULTS: There were 45 true-positive FAST examination, 57 true-negatives, 1 false-positive, and 4 false negatives (sensitivity 91.8%, specificity 98.3%, positive predictive value 97.8%, negative predictive value 93.4%). The area under the ROC curve was 0.951 for the FAST examination. CONCLUSION: FAST is a highly reliable method for screening patients suspected of having BAI for the presence or absence of hemoperitoneum.
Abdomen ; Abdominal Injuries ; Emergencies ; Emergency Service, Hospital ; Hemoperitoneum ; Humans ; Laparotomy ; Mass Screening ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Tomography, X-Ray Computed

PURPOSE: At the Emergency Department (ED), echocardiography of patients with chest pain, dyspnea, and syncope is essential to identify the underlying etiology such as acute coronary diseases or other cardiac diseases. Therefore, we studied the accuracy and the clinical value of echocardiography for use by the emergency physician as a tool for the identification and evaluation of cardiac diseases. METHOD: From first, September, 2003 to first, November, 2003, we collected the case histories of 40 patients with suspected cardiac diseases, on whom formal echocardiography had been performed within 2 hours after their initial ED echocardiography. The emergency physicians had a 4-hour didactic training course by cardiologists and 1 month of practical training at a formal echocardiography center, then, they performed the echocardiography using an Acuson ASPENT M ultrasound system with a 3.5-MHz phased-array transducer. Data from the emergency physicians and from the formal echocardiographers were analyzed using the wilcoxson sign test, and the correlation coefficient and p value were calculated. RESULT: There were 28 male patients (70.0%) and 12 female patients (30.0%) and the average age of all patients was 60.9+/-15.5 years. The left ventricular end diastolic diameters (LVEDD) from ED and formal echocardiography were, respectively, 44.6+/-7.9 mm and 48.7+/-6.6 mm (p=0.000), the interventricular septum thicknesses (IVS) were 11.6+/-3.6 mm and 10.9+/-3.0 mm (p=0.064), the left ventricular posterior wall thicknesses (LVPW) were 10.9+/-3.4 mm and 10.1+/-2.00 mm (p=0.178), the ejection fractions (EF) were 59.7+/-15.8% and 60.0+/-16.4%(p=0.312), the left atrium diameters were 36.5+/-6.3 mm and 37.0+/-5.8 mm (p=0.770), the aortic root diameters were 29.2+/-4.0 mm and 33.6+/-3.7 mm (p=0.001), and the inferior vena cava diameters (IVC) were 15.9+/-8.1 mm and 13.3+/-2.5 mm (p=0.444). Except for the LVEDD and the aortic root diameters, there were no significant differences between ED and formal echocardiography, and the presences of regional wall motion abnormalities (RWMA), relaxation abnormalities, right atrium enlargement (RAE), and right ventricle abnormalities were all concordant between the two groups. The correlation coefficients and the p values between ED and formal echocardiography were, respectively, 0.806 and 0.000 for LVEDD, 0.662 and 0.000 for IVS thickness, 0.725 and 0.000 for LVPW thickness, 0.922 and 0.000 for EF, 0.729 and 0.001 for left atrium diameter, 0.331 and 0.037 for aortic root diameter, and 0125 and 0.443 for IVS diameter. CONCLUSION: We suggest that ED echocardiography, like formal echocardiography, with additional focused training can measure and assess the structural and the functional parameters of the heart.
Chest Pain ; Coronary Disease ; Dyspnea ; Echocardiography* ; Emergencies* ; Emergency Medicine* ; Emergency Service, Hospital ; Female ; Heart ; Heart Atria ; Heart Diseases ; Heart Ventricles ; Humans ; Male ; Relaxation ; Syncope ; Transducers ; Ultrasonography ; Vena Cava, Inferior

PURPOSE: This study was performed to determine whether the anion gap, the base excess, the lactate, and the strong ion gap obtained in the emergency department correlate with the prognosis and whether the strong ion gap is the most useful marker compared to the prognostic ability of the anion gap, the base excess, and the lactate. METHODS: We reviewed the records of 106 patients admitted to the intensive care unit via the emergency department. We measured the anion gap, the base excess, and the lactate and we calculated strong anion gap by using a formula. We divided the patients into survivors and nonsurvivors and compared the prognostic abilities of the four variables by using the Student's t-test and receiver operator characteristic curves. RESULTS: The mean age of the patients was 67+/-14, and the numbers of males and females were similar (58 males vs 48 females). The number of survivors was 92 (86.7%), and that of nonsurvivors was 14 (3.2%). The anion gap ( 24.8+/-8.8 vs. 16.4+/-4.8 mmol/L, p value=0.000), the base excess (-11.9+/-8.7 vs. -3.49+/-6.5 mmol/L, p value = 0.001), the lactate (9.1+/-7.7 vs. 4.5+/-3.1 mmol/L, p value = 0.011 ) and the strong ion gap (16.6+/-3.6 vs. 10.9+/-3.7, p value=0.000) of the nonsurvivors were higher. All of the four varibles were associated with the prognosis, but among them, the strong ion gap discriminated most strongly with an area under the receiver operator characteristic curve of 0.866 (95% confidence interval, 0.787 to 0.92). CONCLUSION: The initial emergency-department acid-base variables, the anion gap, the base excess, the lactate and the strong ion gap have prognostic abilities, but the strong ion gap is the variable that most strongly predicts of mortality.
Acid-Base Equilibrium ; Critical Illness* ; Emergencies* ; Emergency Service, Hospital* ; Female ; Humans ; Intensive Care Units ; Lactic Acid ; Male ; Mortality ; Prognosis ; Survivors

Venomous snakes are estimated to inflict 400,000 bites annually, resulting in approximately 40,000 deaths. There are nearly 3,500 known species of snakes worldwide, and three species exist in Korea. Venom contains toxins that effect the cardiovascular system, the kidneys, the respiratory system and the muscles. There are many modalities in treating snake bites, but most of all, neutralization of the venom is the most important. however, many doctors in Korea hesitate in using antivenom. The reason is that there are no specific antivenoms against Korean venous snakes. In this case, a 2-year-old female child with a snake bite vistied our hospital Korea via a local clinic. Severe systemic symptoms and local symptoms, including compartment syndrome, were observed. When we tried antivenom, the result was satisfactory.
Agkistrodon* ; Antivenins ; Cardiovascular System ; Child ; Child, Preschool ; Compartment Syndromes ; Female ; Humans ; Kidney ; Korea ; Muscles ; Respiratory System ; Snake Bites* ; Snakes* ; Venoms

PURPOSE: Acute otitis media(AOM) has variable clinical symptoms and is diagnosed with injection, bulging, and decreased mobility of tympanic membrane. There are many misdiagnoses because children who are suspected of having acute otitis media are uncooperative during diagnosis with an otoscope. An inaccurate diagnosis of acute otitis media when using an otoscope results in wasted of medical resourses and increased tolerance to antibiotics. Therefore, this study was conducted to evaluate the usefulness of a video otoscope as a tool of diagnosis of acute otitis media. METHODS: Among 416 patients who visited Pundang Jesaeng Hospital Emergency Medical Center with a complaint of otalgia from 1 October 2002 to 30 September 2003, we studied 51 patients who were followed up at the otorhinolaryngology depatment. Emergency Medicine residents recorded the findings for tympanic membrane by using an otoscope and by using a video otoscope. we used kappastatistics to carry out a prospective study in which the accuracy of diagnosis of AOM was analyzed by comparison with the confirmed diagnosis by an otolaryngologic specialist. RESULTS: In this study, the number of males was 24 (47%) and that of females was 27 (53%). Of the 51 Patients, 22 (43%) presented with rhinorrhea, 15 (29%) with cough, 11 (22%) with sputum, 10 (20%) with fever, 8 (16%) with a sore throat, 7 (14%) with otorrhea, 4 (8%) with hearing difficulty, 3 (6%) with irritability, 3 (6%) with tinnitus, 3 (6%) with vomiting and 2 (4%) with dizziness. A comparison of the diagnostic accuracy of AOM between otolaryngologic specialist and residents in emergency department, when was undertaken by using kappa statistics, and a diagnostic agreement of 65% (kappa=0.28) for the otoscope, and 76 %( kappa=0.45) for the video otoscope. The diagnostic sensitivity of acute otitis media by video otoscope was 75%, and specificity was 82%. CONCLUSION: When the tympanic membrane of the patient suspected of a having AOM is examined in an emergency medical center, video otoscopy should be a useful diagnostic tool for AOM owing to its high diagnostic accuracy.
Anti-Bacterial Agents ; Child ; Cough ; Diagnosis* ; Diagnostic Errors ; Dizziness ; Earache ; Emergencies ; Emergency Medicine ; Emergency Service, Hospital ; Female ; Fever ; Hearing ; Humans ; Male ; Otitis Media* ; Otitis* ; Otolaryngology ; Otoscopes* ; Otoscopy ; Pharyngitis ; Prospective Studies ; Sensitivity and Specificity ; Specialization ; Sputum ; Tinnitus ; Tympanic Membrane ; Vomiting

PURPOSE: This retrospective study was performed to investigate epidemiological characteristics in terms of the ageand the sex-specific incidences in patients with perforated or nonperforated appendicitis. METHOD: The study population comprised 314 patients who underwent appendectomies for suspected acute appendicitis between March 2002 and August 2003. This study used the student t-test, the coefficient of correlation, and the Cochran-Mantel-Haenszel Chi-square statistics. RESULTS: The incidence of nonperforated appendicitis was higher. Perforated appendicitis occurred at almost the same incidence in both sexes. However, the incidence of perforated appendicitis was high in small children and the elderly. The statistics of this study proved that the incidence of perforated appendicitis of the elderly was considerable. CONCLUSIONS: We suggest that the elderly need careful examination and rapid evaluation. Also, we suggest that since perforated appendicitis has a long duration of treatment, diagnostic accuracy is needed.
Aged ; Appendectomy ; Appendicitis* ; Child ; Humans ; Incidence* ; Retrospective Studies

PURPOSE: This study was conducted to derive and validate a clinical prediction rule for blood cultures obtained in the emergency department. METHODS: We conducted a retrospective chart review of patients with a fever who underwent blood cultures from August 2002 through July 2003. The student t-test, coefficient of correlation, ROC (receiver operatics characteristic) curve, and Chi-square statistics were used for the analyses. RESULTS: Included in the study were 108 patients, of whom 47 were men and 61 were women. The mean age was 45.30+/-26.21 years old. The most common diagnoses were pneumonia and acute gastroenteritis. The usefulness of blood cultures in the emergency department was statistically significant in patients with fever or with higher levels of band form. CONCLUSION: We determined that blood cultures are uncommonly useful for febrile patients and that a need rule is needed for the use of blood cutures in the emergency department
Decision Support Techniques ; Diagnosis ; Emergencies* ; Emergency Service, Hospital* ; Female ; Fever ; Gastroenteritis ; Humans ; Male ; Pneumonia ; Retrospective Studies

PURPOSE: Childhood acute immune thrombocytopenic purpura (ITP) is a benign hematologic disease. Therapy does not affect the natural history of the illness. We evaluated the clinical and laboratory findings, treatment and prognosis of childhood acute ITP in Korea through a retrospective multicenter study. METHODS: We analyzed retrospectively the data of 1, 829 children with acute ITP through survey of 33 hospitals among 43 hospitals in Korea from Sep. 1992 to Aug. 2001. RESULTS: Male to female ratio was 1.3: 1 and the median age at the diagnosis of ITP was 2.9 (0.1 17) years. Median duration of follow up was 6 months. One hundred and forty nine cases of the total 1, 829 patients (8.1%) received no treatment. The initial median platelet count of the non-treated group was 42, 500/mm3. Among the 861 cases who were followed up over 6 months, 315 cases (36.6%) progressed into chronic ITP. Associated with this high rate of chronicity of childhood acute ITP patients in Korea, we must consider the fact that acute ITP patients with fast improvement in the first episode tend not to follow up. Considering that fact, the rate of chronicity becomes 17.2% of the 1, 829 acute ITP patients. The treated group used many kinds of treatment methods. Intravenous immunoglobulins (IVIG) with or without prednisolone (PD) (67.5%) were the most commonly used regimens. In the group treated with IVIG alone, the platelet count began to rise above 50, 000/mm3 at 2.6 days, 100, 000/mm3 at 3.7 days and 150, 000/mm3 at 4.9 days. Four hundred and twenty two cases of the 1, 686 (25.0%) cases followed up after first episode of ITP relapsed. The relapse rate was significantly higher in older patients and in girls than in younger patients and in boys (P< 0.05). The chronicity of ITP statistically increased with age (P< 0.05) and that was the only valuable factor. CONCLUSION: Despite the fact that childhood acute ITP is a pretty common disaese, there is no agreement on the best treatment method for this disease. The establishment of Korean treatment guideline of childhood acute ITP, based on an analysis of multicenters, seems to be needed.
Child ; Diagnosis ; Female ; Follow-Up Studies ; Hematologic Diseases ; Humans ; Immunoglobulins, Intravenous ; Korea* ; Male ; Natural History ; Platelet Count ; Prednisolone ; Prognosis ; Purpura, Thrombocytopenic, Idiopathic* ; Recurrence ; Retrospective Studies