Appropriateness of triage by emergency medical technician using the Korean Triage and Acuity Scale

Objective@#Appropriate triage in emergency rooms is fundamental. This study assessed the appropriateness of the triage results using the Korean Triage and Acuity Scale (KTAS) by emergency medical technicians (EMT) by comparing an emergency physician and a KTAS instructor. @*Methods@#The medical records of patients who presented to a local emergency room for a month were analyzed retrospectively. This study compared the triage results using KTAS among EMTs, an emergency physician, and a KTAS instructor. @*Results@#Among 2,248 patients, consistent KTAS codes of 1,453 patients (64.6%) were obtained between the EMTs and emergency physicians. In addition, a KTAS instructor had agreed with the results of EMT for 1,686 patients (75%). The Kappa value to evaluate the agreement between an emergency physician and a KTAS instructor was 0.72 (95% confidence interval, 0.55-0.89). @*Conclusion@#The results of triage using KTAS by EMT was appropriate because substantial agreement existed between an emergency physician and KTAS instructor. On the other hand, there were some inappropriate results of triage, and it is proposed that the results would be reflected in KTAS provider education programs aimed at EMTs. It is expected that qualified KTAS providers will be produced, and the quality of triage can be controlled and improved.

Safety and efficacy of polycaprolactone copolymer nanosphere hydrogel injected into the scalp dermal tissue of rats

BACKGROUND: Currently, dermal fillers need to be 25 µm or larger to reduce in vivo degradation by macrophages. However, the large size of fillers may cause side effects, including interruption of blood flow and nodule formation. Therefore, using rats, we tested a polycaprolactone copolymer hydrogel with nanoscale particles that could maintain a low in vivo degradation rate. METHODS: Thirty-six 6-week-old Sprague-Dawley rats were divided into group A (normal saline), group B (polycaprolactone microsphere filler), and group C (polycaprolactone copolymer nanosphere hydrogel). The corresponding materials were injected into the dermal layer of the scalp of the rats. At 4, 8, and 12 weeks after injection, blood biochemical and kidney and liver histological analyses were performed. Tissues were examined using hematoxylin-eosin staining to observe tissue infiltration of materials. Collagen formation in the dermal tissue of the scalp was observed with Masson trichrome staining and the collagen content was quantified using a soluble collagen assay kit. RESULTS: The histologic examination for organ infiltration showed no abnormal findings. All blood test results were within the normal ranges. The amount of collagen at 12 weeks increased by 1.22 mg/g in group C and by 0.6 mg/g in group B. CONCLUSIONS: The results reveal that the nanosphere complex near the injection site induced collagen formation. Regardless of the sphere size, aggregation of the copolymer prevented macrophage phagocytosis. The polycaprolactone copolymer nanosphere hydrogel was effective for more than 3 months when injected in the scalp dermal tissue of Sprague-Dawley rats and can be used safely.

An in vitro study of mesenchymal stem cell proliferation on titanium discs coated with rhTGF-β2/PLGA by electrospray / 대한치과보철학회지

PURPOSE: The purpose of this study is to identify the effect of mesenchymal stem cell proliferation on recombinant human transforming growth factor-beta (rhTGF-β2) / poly (D,L-lactide-co-glycolide) (PLGA) treated titanium discs by electrospray. MATERIALS AND METHODS: Anodized titanium surface coated with PLGA was used for a control group to compare anodized titanium surface coated with 125 ng/ml and 500 ng/ml rhTGF-β2 as test groups. Atomic force microscope (AFM) test was utilized to determine the difference in coating surface roughness, and field-emission scanning electron microscopy (FE-SEM) was taken to visualize even distribution of coating particles on titanium discs. The mesenchymal stem cell proliferation was tested by using MTT (3-(4,5-dimethylthiazol-2-yl)-2,5 diphenyl-tetrazolium bromide) assay on 1st, 4th, 7th days. RESULTS: According to AFM results, there was no statistically significant difference in titanium discs treated with PLGA and with rhTGF-β2/PLGA (P>.05). MTT assay test results showed that there was statistically significant difference in mesenchymal stem cell proliferation on test groups compared to control groups at 7th day, and cell viability on discs coated with rhTGF-β2 was significantly higher than control groups (P<.05). CONCLUSION: Titanium surface coated with rhTGF-β2/PLGA shows statistically significant higher cell proliferation and the titanium surface coated with the higher concentration of rhTGF-β2 presents faster cell growth activity.

Osseointegration of the titanium implant coated with rhTGF-beta2/PLGA particles by electrospray: a preliminary microCT analyzing rabbit study / 대한치과보철학회지

PURPOSE: This preliminary rabbit study was conducted to evaluate the effect of recombinant human transforming growth factor-beta2 (rhTGF-beta2)/poly lactic-co-glycolic acid (PLGA) coating on osseointegration of the titanium (Ti) implant. MATERIALS AND METHODS: Eight Ti implants were anodized with 300 voltages for three minutes. Four of those were coated with rhTGF-beta2/PLGA by an electrospray method as the experimental group. The implants were placed into tibiae of four New Zealand rabbits, two implants per a tibia, one implant per each group. After 3 and 6 weeks, every two rabbits were sacrificed and micro-computed tomography (microCT) was taken for histomorphometric analysis. RESULTS: In scanning electron microscope (SEM) image, the surface of rhTGF-beta2/PLGA coated Ti implant showed well distributed particles. Although statistically insignificant, microCT analysis showed that experimental group has higher bone volume / total volume (BV/TV) and trabecular thickness (Tb.Th) values relatively. Cross sectional view also showed more newly formed bone in the experimental group. CONCLUSION: In the limitation of this study, rhTGF-beta2/PLGA particles coating on the Ti implant show the possibility of more favorable quantity of newly formed bone after implant installation.

The Effect of Videotaping Students' Interviews with Patients for Interview Skill Education / 가정의학회지

BACKGROUND: The importance of communication between patients and physicians has been proven in many previous studies. The authors analyzed the effect of interview skill education through videotapes which recorded students' interviews with real patients in the outpatient department of family medicine. METHODS: This study was conducted with all students who chose the elective course of family medicine and one randomly selected student every week from an 'infectious internal medicine' class at Dongguk University Ilsan Hospital during the period from December 2008 to March 2011. All students performed a preliminary examination of a new patient at the outpatient department of family medicine. All consultations were videotaped. Feedback to the student was given on the same day by viewing the videotape together. After feedback, all students performed another preliminary examination of one new patient at the department of family medicine the same week. Three family medicine residents scored all videotapes using 10-item interview skill checklists. Many parts of the checklists were modified using the Arizona Clinical Interview Rating Scales. RESULTS: Thirty-three students participated. Of 10 items, nine showed increased scores after feedback. There was a significant change in four items after feedback: 'type of question' (before 2.36 +/- 0.60, after 2.73 +/- 0.72), 'timeline' (before 2.82 +/- 0.68, after 3.18 +/- 0.73), 'positive verbal reinforcement' (before 2.24 +/- 0.56, after 2.61 +/- 0.90), and the total score (before 21.70 +/- 2.62, after 23.39 +/- 3.13) (P < 0.05). CONCLUSION: Giving feedback to medical school students on medical interview skills using videotapes of students' preliminary consultations with real patients in outpatient settings, was effective in improving the interview areas of 'type of question,' 'timeline,' 'positive verbal reinforcement,' and the total interview scores.

Effective Reduction of the Frontal Process of the Maxillary Fracture Segment Using Intermaxillary Fixation Screw

PURPOSE: It is relatively unusual that infraorbital rim fracture is accompanied by nasal bone fracture. In order to correct effectively, subciliary approach and intranasal manipulation are applied simultaneously. But if reduction is not successful, intranasal manipulation may become aggressive and this often causes complications. We introduce a method using intermaxillary fixation screws for decreasing such complications and effective reduction of fracture. METHODS: Total seven patients with fracture of frontal process of maxilla were treated with this method. The fracture site was exposed through the subciliary approach, and one or two screws were inserted into the displaced fracture fragment. During the traction of the screws using the wire, the fracture fragment was pushed upward from the intranasal side using an elevator supplementarily and fixed with a plate and the screws. RESULTS: In all patients, the fracture fragment was reduced successfully and no complication occurred during one year's postoperative follow-up. CONCLUSION: When reduction cannot be attained through a bone hook or an elevator alone, reduction of fracture fragment can be done easily using intermaxillary fixation screws. This method is less likely to cause a mucosal injury because intranasal manipulation is not aggressive. Furthermore, as the screw can be inserted and removed easily, this method is considered effective not only for fracture of frontal process of maxilla but also for fractures in other regions.

Three Cases of Traumatic Pulmonary Pseudocysts in Old Age

In old age, a traumatic pulmonary pseudocyst is an extremely rare condition that generally develops after blunt chest trauma. It is more common among pediatric and young adult patients. We report three elderly patients who presented with chest symptoms after blunt chest trauma and whose computed tomography showed post-traumatic pulmonary pseudocysts.

Bronchopulmonary Sequestration with Dual Arterial Supply from Celiac Artery and Thoracic Aorta / 결핵및호흡기질환

Bronchopulmonary sequestration (BPS) is a rare congenital malformation of the lower respiratory tract. Most intralobar BPSs are provided with an arterial blood via the thoracic or abdominal aorta but such a supply is rarely found in patients older than 50 years. We report a case of an intralobar BPS with a dual arterial supply from the celiac artery and thoracic aorta in a 50-year-old man presenting with a respiratory tract infection and haemoptysis. To our knowledge, this is the first case report of a BPS supplied by the celiac artery and thoracic aorta in a 50-year-old man.

Effective Reconstruction of Extensive Orbital Floor Fractures Using Rapid Prototyping Model

PURPOSE: Orbital bone is one of the most complex bones in the human body. When the patient has a fracture of the orbital bone, it is difficult for the surgeon to restore the fractured orbital bone to normal anatomic curvature because the orbital bone has complex curvature. We developed a rapid prototyping model based on a mirror image of the patient's 3D-CT (3 dimensional computed tomography) for accurate reduction of the fractured orbital wall. METHODS: A total of 7 cases of large orbital wall fracture recieved absorbable plate prefabrication using rapid prototyping model during surgery and had the manufactured plate inserted in the fracture site. RESULTS: There was no significant postoperative complication. One patient had persistent diplopia, but it was resolved completely after 5 weeks. Enophthalmos was improved in all patients. CONCLUSION: With long term follow-up, this new method of orbital wall reduction proved to be accurate, efficient and cost-effective, and we recommend this method for difficult large orbital wall fracture operations.

A Case of Myofascial Pain Syndrome of the Iliopsoas Muscle Undiagnosed for 3 Years with Chronic Abdominal Pain / 가정의학회지

Abdominal pain is one of the most common symptoms we encounter in primary care clinics, and the patients being hospitalized for abdominal pain account for 5-6% of all the inpatients. Careful history taking and physical exams are always necessary for the diagnosis of patients having abdominal pain, because their problems may be transient and insignificant but also can be severe. For the elderly patients, common causes of abdominal pain are unspecific abdominal pain, functional disease, constipation, kidney stone, urinary tract infection, inflammatory bowel disease, biliary tract disease, acute appendicitis, diverticulitis, abdominal aortic aneurysm, peptic ulcer, intestinal obstruction, mesenteric ischemia, malignant tumor, gastroenteritis, etc. and myofacscial pain can also be the cause. We treated an elderly female patient who had suffered severe abdominal pain due to myofascial pain syndrome of the iliopsoas muscle undiagnosed for over 3 years. Therefore we report this case with review of several literatures.

Two Cases of Postintubation Tracheoesophageal Fistula in Patients with a History of Tracheostomy: Case Report / 대한구급학회지

Common causes of acquired tracheoesophageal (T-E) fistula are blunt trauma on the neck or chest, malignancy, long-term mechanical ventilation, and post-intubation injury. Most of the cases are fatal due to severe respiratory infection. We experienced two cases of post-intubation T-E fistula in patients with a history of tracheostomy that developed earlier than usual. One case was caused by excessive cuff pressure and the other by avulsion injury during endotracheal intubation. We can get instructions from these cases that how to prevent T-E fistula because it is hard to treat and causes severe outcomes.

Successful Treatment of Hypercalcemia During Continuous Renal Replacement Therapy in Patient with Rhabdomyolysis Following Cardioversion and Cardiopulmonary Resuscitation / 대한신장학회지

Rhabdomyolysis is a common clinical and laboratory syndrome resulting from reversible skeletal muscle injury, with release of muscle cell contents into the plasma. Cardioversion, and cardiopulmonary resuscitation may produce rhabdomyolysis and myoglobinuria. We report a 5-year-old boy surviving after cardiopulmonary resuscitation and repeated 5 times of cardioversion. He showed elevated serum BUN and creatinine levels, requiring hemodialysis treatment. We had tried 5 times of intermittent hemodialysis, but oliguria was continued and there was no change of serum BUN and creatinine. His urine output was less than 100 cc per day and he showed severe edema and weight gain of 7 kg, and so we started the continuous renal replacement therapy (Prismaflex(R), gambro). After 12 days of continuous venovenous hemodiafiltration (CVVHDF), his urine output recovered and his BUN, creatinine, liver enzyme, creatine kinase, and lactate dehydrogenase levels returned to normal. During the treatment of CVVHDF, he had shown persistent hypercalcemia, and so we changed dialysate and replacement solution from hemosol B0 to calcium free solution. The hypercalcemia was controlled successfully using this calcium free pharmacy-made bicarbonate solution.

Increase of Angiogenesis and Neurogenesis, and Neurobehavioral Recovery by Transplanted Mesenchymal Stem Cells in the Ischemic Rat Brain / 대한뇌혈관외과학회지

OBJECT: In this study, murine mesechymal stem cells (MSC) was grafted to cerebral ischemia rats, the differentiation of the transplanted MSC was assessed, and at that time, the association of the level of the recovery of neurological function. METHODS: As experimental animals, the transient middle cerebral artery occlusion (MCAo) rat model was used, and MSC collected from the bone marrow of C57/Bl6 mice were cultured, 5microliter(105 microliter) cells marked with the fluorescent substance 3.3'-dilinoleyloxacarbocyanine(DIO) were transplanted into the ischemic cortex. Angiogenesis and neurogenesis were examined and the neurobehavioral evaluation were done. To assess the differentiation level of MSC, and it was evaluated as the percentage of the mean area of stained cells within each region of interest (ROI). RESULTS: In the MCA transplanted group, Neurobehavioral score was improved to twelve points one hour, one day, and three days after transplant, and seven days and fourteen days after transplant, to eleven points and nine points, respectively. The result of immunohistochemical staining showed that the angiogenesis on the day seven was 3.15% and on the day fourteen was 4.26%, the neurogenesis on the day seven was 2.29% and on the day fourteen was 3.82%. CONCLUSION: On the day seven and fourteen after MCS transplantation, the phenomenon of the actively ongoing angiogenesis and neurogenesis was detected, and it was found that at that time, the recovery of neurological function occurred. However, the level of differentiation from MSC was small, and thus it was not statistically significant.

Clinical Analysis of 329 Cases of Total Gastrectomy / 대한암학회지

PURPOSE: This study was designed to evaluate the safety including the morbidity and mortality of total gastrectomy and combined organ resection, to examine the survival rate and the prognostic factors of gastric cancer following the total gastrectomy and to assess the prognostic predictability of new UICC staging system after surgery in gastric cancer patients. MATERIAL AND METHOD: To evaluate demographic features, clinical presentations, preoperative diagnostic accuracy, postoperative complications and prognostic factors, we analyzed 329 patients who underwent the total gastrectomy or the total gastrectomy with combined resection for gastric malignancy at KCCH from Jan. 1990 to Dec. 1993 retrospectively. RESULTS: The early postoperative complication rates of overall patients and combined resection group were 9.1% and 8.9%. Mortality of these were 0.9% and 1.1%(p>0.05). The overall 5YSR was 52.8% and there was no significant differrence in the survival rate between the total gastrectomy only group and the combined resection group. The accuracy of preoperative UGIS and abdominal CT for determiantion of resectability were over 80%. The depth of invasion and lymph node metastasis were independent prognostic factors. CONCLUSION: The total gastrectomy with combined resection should be considered when indicated, because the postoperative morbidity and mortality is low and long term survival is expected. The new UICC staging system seems to be good to predict prognosis in gastric cancer patients.