• Journal of Trauma and Injury
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• v.24 no.1
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• pp.25-30
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• 2011

Purpose: Major trauma patients should be transferred to a definitive care facility as early as possible because prompt management will prevent death. This study was designed to discover the obstacles leading to delayed transfers under the current emergency medical system in Korea and whether there are any negative outcomes associated with conducting procedures at primary care hospitals prior to transferring patients to higher levels of care. Methods: The medical records of major trauma patients with an Injury Severity Score above 15 within the past year were reviewed. Patients were divided three groups as follows: (A) came directly to our emergency center, (B) were transferred without CT or MRI scan at the primary care hospital and (C) transferred with CT or MRI scans. The transfer time of each group were compared and analyzed statistically. Additionally, the number and type of imaging performed at the primary care hospital were analyzed. Results: All qualified patients (n=276) were enrolled in this study: 121 patients in group A; 104 in group B; 51 in group C. There was a statistically significant difference in the transfer time between the three groups (p-value<0.001), and 79 (28.6%) were transferred to an emergency medical center within one hour. In group C, CT or MRI scans were performed an average of 1.86 times at the primary care hospital, and the median transfer time was 4 hours 5 minutes. Conclusion: Only 28.6% of the cases in the study arrived within the golden hour at a definitive care facility. Such delays are in part the result of prolonged times at the primary care hospital for radiologic examinations, such as CT or MRI scans. Major multiple trauma patients should be transferred to a definitive care facility directly or as soon as the primary survey and the resuscitation of Advanced Trauma Life Support guideline are completed at the primary care hospital.

• Journal of Yeungnam Medical Science
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• v.16 no.1
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• pp.69-75
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• 1999

Imidapril(Tanatril$^{(R)}$), a newly developed ACE inhibitor, has been used to treat hypertension and congestive heart failure. This study was designed to assess the antihypertensive effect and safety of Imidapril(Tanatril$^{(R)}$) in patients with essential hypertension. 5-10mg of imidapril(Tanatril$^{(R)}$) was administered once a day in 30 patients with essential hypertension and followed up for 8 weeks. We tested the drug's effectiveness, safety, and the incidence of imidapril induced dry coughs. After 8 weeks of treatment with imidapril, 76.2%(16/21) of patients showed lowered blood pressure and 47.6% showed normal blood pressure. The overall incidence of adverse effects was 33.3%(7/21), and among these adverse effects, dry cough was shown in only 9.5%. Thus, we concluded that imidapril(Tanatril$^{(R)}$) is as safe and effective as other ACE inhibitors, especially with imidapril showing very little incidence of dry cough compared to other ACE inhibitors.

• Journal of Korean Neurosurgical Society
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• v.30 no.3
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• pp.295-306
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• 2001

Objectives : The management of massive brain swelling remains an unsolved problem in neurosurgical field. Despite newly developed medical and pharmacological therapy, the mortality and morbidity due to massive brain swelling remains high. According to many recent reports, surgical decompression with dura expansion is superior to medical management in patients with massive brain swelling. We performed surgical treatment on the first line of treatment, and followed medical management in case with refractory increased intracranial pressure(ICP). To show the quantitative effect of decompressive surgery on the intracranial pressure, we performed ventricular puncture and checked the ventricular ICP continuously during the decompressive surgery and postoperative period. Materials and Methods : Fifty-one patients with massive brain swelling, undergoing bilateral decompressive craniectomy with dura expansion, were studied in this study. In all patients, ventricular puncture was performed at Kocher's point on the opposite side of massive brain swelling. The ventricular pressure was monitored continuously, during the bilateral decompression procedures and postoperative period. Results : The initial ventricular ICP were varied from 13mmHg to 112mmHg. Immediately after the bilateral craniectomy, mean ventricular ICP decreased to $53.1{\pm}15.8%$ of the initial ICP(ranges from 5mmHg to 87mmHg). Dura opening decreased mean ICP by additional 36.7% and made the ventricular pressure $16.4{\pm}10.5%$ of the initial pressure (ranges from 0mmHg to 28mmHg). Postoperatively, ventricular pressure was lowered to $20.2{\pm}22.6%$(ranged from 0mmHg to 62.3mmHg) of the initial ICP. The ventricular ICP value during the first 24 hours after decompressive surgery was found to be an important prognostic factor. If ICP was over 35mmHg, the mortality was 100% instead of additional medical(barbiturate coma therapy and hypothermia) treatments. Conclusion : Bilateral decompression with dura expansion is considered an effective therapeutic modality in ICP control. To obtain favorable clinical outcome in patients with massive brain swelling, early decision making on surgical management and proper patient selection are mandatory.

• Journal of Trauma and Injury
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• v.23 no.1
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• pp.6-15
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• 2010

Purpose: Trauma is one of the leading causes of death, especially among young people. Life-threatening conditions are very common in multiple-traumatized patients due to concurrent multi-organ injuries. Treating such severely injured patients is time critical. However, in Korea, the transfer of severely injured patients is not uncommon due to the lack of a mature trauma care system. In developed countries, the preventable trauma death rate is very low, but the rate is still very high in Korea. This study's objective was to demonstrate the current serious state in which severely injured patients have to be transferred from a Regional Emergency Medical Center even though it actually serves as a trauma center. Methods: Ajou University Medical Center is a tertiary hospital that serves as a trauma center in Gyeonggido. The medical records at Ajou University Medical Center for a 1-year period from January 1, 2008, to December 31, 2008, were retrospectively reviewed. A severely injured patient was defined as a patient who showed more than 15 point on the ISS (injury severity score) scale. We investigated the clinical characteristics of such patients and the causes of transfer. Results: Out of 81,718 patients who visited the Regional Emergency Medical Center, 19,731 (24.1%) were injured patients. Among them, 108 severely-injured patients were transferred from one Regional Emergency Medical Center to other hospitals. The male-to-female ratio was about 3.5:1, and the mean ISS was 23.08. The most common mechanism of injury was traffic accidents (41.7%). A major cause of transfer was the shortage of intensive care units (44.4%); another was for emergent operation (27.8%). Most of the hospitals that received the severely-injured patients were secondary hospitals (86.1%). Conclusion: Although the Regional Emergency Medical Center played a role as a trauma center, actually, severely-injured patients had to be transferred to other hospitals for several reasons. Most reasons were related with the deficiencies in the trauma care system. If a mature trauma care system is well-organized, the numbers of transfer of severely injured patients will be reduced significantly.

• Tuberculosis and Respiratory Diseases
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• v.70 no.5
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• pp.416-422
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• 2011

Background: Inhaled corticosteroids (ICSs) are the most essential medication for asthma control. Many reports suggest that the usage of ICSs improves not only the control of asthma symptoms but also prevents exacerbation. We investigated whether increases in ICS prescriptions are associated with decreases in asthma exacerbation in the clinical practice setting. Methods: We retrospectively analyzed the database of adult asthma patients who had visited a tertiary referral hospital, the Asan Medical Center between January 2000 and December 2009. The number of emergency department (ED) visits, admissions, intensive care unit (ICU) care, deaths, and ICS prescriptions were analyzed to evaluate the time trend of asthma exacerbation as a function of the ICS prescription rate during the ten years. Results: The numbers of ED visits, admissions, and episodes of ICU care decreased during the ten years (p<0.001, p=0.033, p=0.001, respectively) while the number of ICS prescriptions increased (p<0.001). We found a correlation between the number of ICS prescriptions and the number of ED visits, admissions, or ICU care. For these outcomes, the correlation coefficients were r=-0.952, p<0.001; r=-0.673, p=0.033; r=-0.948, p<0.001, respectively. Conclusion: The number of ICS prescriptions increased during the past ten years while the number of asthma exacerbations decreased. Our results also showed a negative correlation between the ICS prescription rate and asthma exacerbation in the clinical practice setting. In other words, an increase in ICS prescription may be a major cause of a decrease in asthma exacerbations.

• Korean Journal of Clinical Pharmacy
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• v.22 no.3
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• pp.251-259
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• 2012

Ulcerative colitis (UC) is characterized by a life-long chronic course with remissions and exacerbations. Use of biological therapies may reduce or delay the surgical procedures in patients with UC. The aim of this study was to determine the impact of infliximab (IFX) use on the rate of remission, surgical interventions, and the effect on quality of life in patients with moderate to severe UC. Literature was searched for studies that investigated the efficacy of IFX on the rate of remission, colectomy and quality of life (QoL) between January 1990 and June 2012 at MEDLINE, January 1988 and June 2012 at EMbase and others. Eleven trials were included in the meta-analysis; divided into placebo controlled 8 trials and intravenous corticosteroid controlled group 3 trials. In comparison to placebo control groups, patients who received IFX had an odds ratio (OR) of 3.712 (95% CI: 2.714, 5.079) for the short-term clinical remission, and 3.053 (95% CI: 2.044, 4.559) for the rate of long-term remission. In colectomy rate and quality of life (QoL), odds ratio were 0.566(95% CI: 0.387, 0.827) and 0.658 (0.505, 0.811) respectively. Any adverse reactions including infections, infusion reaction, rash and arthralgia were equivalent in both groups. Compared with intravenous corticosteroid controlled group, patients who received IFX had lower remission rate with short-term odds ratio 0.227 (95% CI: 0.033, 1.556) and long-term odds ratio 1.054 (95% CI: 0.317, 3.502) respectively. However, statistical significance was not showed with both two analyses. The higher adverse drug reaction (ADR) rates were occurred in the corticosteroid controlled groups. 73.3% of patients treated corticosteroid reported Cushing-like syndrome with moon face. In conclusion, IFX does increase remission rate and decrease the rate of colectomy in patients with UC without elevating any adverse reactions significantly. IFX also improves QoL in moderate to severe UC patients. It would not exceed the efficacy of intravenous corticosteroid, whereas intravenous corticosteroid also reported high rate of adverse reactions.

• Pediatric Infection and Vaccine
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• v.21 no.2
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• pp.144-149
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• 2014

Acute otitis media (AOM) is one of the most common childhood infectious diseases. Despite antibiotic treatment for AOM, AOM and its complication still continue to develop. Acute mastoiditis is a serious complication of AOM and epidural abscess constitutes the commonest of all intracranial complication of AOM. Neurological complication of acute mastoiditis are rare but can be life threatening. Their presentation may be masked by the use of antibiotics. We report the rare case of acute otitis media progressing to acute mastoiditis, epidural abscess formation and lateral sinus thrombophlebitis caused by Streptococcus pneumoniae in a child. She was admitted with acute otitis media with fever. Despite proper antibiotics, acute mastodititis and epidural abscess were developed, and after surgical drainage and antibiotics therapy she was recovered without sequalae.

• Tuberculosis and Respiratory Diseases
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• v.71 no.5
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• pp.335-340
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• 2011

Background: Community-acquired pneumonia (CAP) is an important cause of morbidity and mortality throughout the world in all age groups. Viral causes of CAP are less well characterized than bacterial causes. We analyzed the characteristics of hospitalized patients with CAP who had a viral pathogen detected by multiplex polymerase chain reaction (PCR). Methods: Multiplex real-time PCR was performed for respiratory viruses in samples collected from 520 adults who developed CAP at Chungnam National University Hospital. Clinical, laboratory, and radiological features at presentation as well as other epidemiological data were analyzed. Results: Of 520 patients with CAP, a viral pathogen was detected in 60 (11.5%), and influenza A was the most common. The virus detection rate in patients with CAP was highest in November. Two or more pathogens were detected in 13 (21.7%) patients. Seven patients had severe disease and were administered in the intensive care unit. Most patients (49/60, 81.7%) had comorbidities. However, nine (15%) patients had no comorbidities, and their age was <60 years. The ground glass opacity pattern was the most common radiological feature. Seven (11.7%) patients died from CAP. Conclusion: Viral pathogens are commonly detected in patients with CAP, and a respiratory virus may be associated with the severity and outcome of pneumonia. Careful attention should be paid to the viral etiology in adult patients with CAP.

• Investigative Magnetic Resonance Imaging
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• v.14 no.1
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• pp.21-30
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• 2010

Purpose : To examine the imaging findings of mucinous breast carcinoma and to evaluate the difference in these findings based on the histopathologic grade. Materials and Methods : We retrospectively analyzed the imaging features according to BI-RADS in 29 patients with surgically proven mucinous carcinoma. The histopathologic grade was classified as well-differentiated, moderately-differentiated and poorly-differentiated. Based on these criteria, the differences in imaging findings were statistically analyzed. Results : Mammography was available in 20 cases, which contained 17 mass lesions (85%) and 3 cases of normal findings. On ultrasonography (27 cases), mucinous carcinoma was observed as a mass with an oval shape (59.3%), a microlobulated margin (55.6%) or an inhomogeneous isoechogenicity (74.1%). On MRI (21 cases), mucinous carcinoma was commonly observed to have a lobular shape (76%), smooth margin (86%) or heterogeneous contrast-enhancement (61.9%). On the kinetic curve, there was a delayed wash-out pattern (52.3%). There were no significant differences in the imaging findings for each histopathologic grade except that a welldifferentiated tumor had an abrupt interface. Conclusion : A well-differentiated mucinous carcinoma tended to have an abrupt interface on ultrasonography, as compared with the moderately-differentiated one. Mucinous carcinoma showed a heterogeneous enhancement and a delayed washout kinetic curve pattern on dynamic MRI.

• Journal of Trauma and Injury
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• v.22 no.1
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• pp.71-76
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• 2009

Purpose: The goal of this study was to compare the outcome of the after trauma team (AfterTT) group to the before trauma team (BeforeTT) group. Methods: All trauma patients who visited to emergency room (ER) between July 1, 2006 and February 29,2008 based on trauma registry, with systolic blood pressure (SBP) < 90 mmHg or GCS < 9 were included in this study. We compared the amount of packed RBC transfusion, the ER stay time, the ER visit to CT evaluation time, the ER visit to operation time, the length of ICU stay, the length of hospital admission and the survival discharge rate between the AfterTT group and the BeforeTT group. Patients with brain injuries had little chance of survival. Burn patients, who visited the ER 24 hours after injury and patients who were dead on arrival (DOA) were excluded from this study. Results: Total of 93 patients were included in this study: 42 in the AfterTT group and 51 in the BeforeTT group. The AfterTT group and the Before TT group showed no differences in Revised Trauma Score (RTS) and mean age. The amount of packed RBC transfusion was lower in the AfterTT group, but no statistically significant difference was noted (AfterTT 11${\pm}$11units, BeforeTT 16${\pm}$15units, p=0.136). The ER visit to operation time was shorter in the AfterTT group, but there were no statistically significant difference between the groups (AfterTT 251${\pm}$223 minutes, BeforeTT 486${\pm}$460 minutes, p=0.082). The length of ICU stay was shorter in the AfterTT group, but the difference was not statistically significant (AfterTT 11${\pm}$12 days, Before TT 15${\pm}$30 days, p=0.438). The length of Hospital admission was shorter in the AfterTT group (AfterTT 43${\pm}$37 days, BeforeTT 68${\pm}$70 days, p=0.032), but this difference was not statistically significant. Conclusion: Simple Trauma team activation criteria decreased the amount of packed RBC transfusion and the hospital admission duration. Hemodynamic instability (SBP < 90 mmHg) and decreased mental state (GCS<9) are good indices for activating the trauma team.