Medical Centers In Korea Research Articles

Clinicopathologic Manifestations of Patients with Fordyce's Spots

Editor: In 1896, Fordyce1 described whitish spots on the vermilion border of the lips, oral mucosa and, rarely, genital mucosa. Fordyce's spots are ectopically located sebaceous glands1-4. To date, few reports have been published to describe the clinicopathologic study of Fordyce's spots in the Korean population. We herein review the clinicopathologic characteristics of Korean patients with Fordyce's spots. Data were collected retrospectively from the medical records of patients diagnosed with Fordyce's spots between January 2000 and December 2009 in the Department of Dermatology of 4 medical centers in Korea. We reviewed biopsy slides, treatment regimens, and other relevant information. Sixteen patients were finally enrolled in this study. All patients were confirmed with Fordyce's spots following biopsy. This study was approved by the Institutional Review Board of the Catholic University of Korea. Distribution of the patients' age, sex, incubation period, symptoms, signs, anatomical locations, and treatment were evaluated. Histopathologically, the morphology of Fordyce's spots, distribution, and existence of sebaceous ducts-whether they opened onto the skin surface or not-were investigated. The male to female ratio was 11 : 5. The average patient age was 34.3 years and ranged from 17~67 years (mean±S.D., 34.3±15.0 years). The average age was 41.1 years old in men and 19.4 years old in women. Duration of illness prior to diagnosis ranged from several days to five years, and the mean incubation period was 1.9 years. Most patients were asymptomatic. However, one patient with concurrent contact dermatitis complained of pruritus. The observed lesions were multi-centric and whitish to yellowish in color. Slightly elevated papules and plaques with sizes ranging from 1 to 3 mm were seen. In 8 patients, the lesions were found on the upper lip (50%), on both lips in 4 (25%), and on the lower lip in two (12.5%) (Fig. 1A, B). The spots mostly presented on the vermilion portion of the lips. The lesions in one patient presented on the buccal mucosa (Fig. 1C) and glans penis, respectively. The family history of the patient was unknown. Two patients were treated with a carbon dioxide (CO2) laser, 1 with electrodessication (E/D), 5 with excision of the lesions, and 7 were put on observation. Among those treated, no recurrence was reported (Table 1). Fig. 1 Multiple, pin-head-sized, whitish to yellowish papules on the vermilion border of both lips in case 9 (A), upper lip in case 11 (B), and buccal mucosa in case 8 (C). Table 1 Epidemiologic and clinical characteristics of 16 study patients with Fordyce's spots Histologically, the size of sebaceous glands ranged from 1.62±0.55 mm. The glands were located in both the upper dermis (81.3%) and lower dermis (18.7%). The sebaceous glands of Fordyce's spots mostly do not associate with hair follicles. Sebaceous ducts of Fordyce's spots have been observed to open directly onto the surface of the skin (81.3%, Fig. 2). Fig. 2 Sebaceous glands in the dermis on the lip in case 11 (A) and in case 13 (B). Fordyce's spots open directly onto the surface and do not associate with hair follicles (H&E, ×100).

Clinical characteristics and outcomes of primary bone lymphoma in Korea

BackgroundThis study evaluates the effectiveness of immunochemotherapy and radiation therapy in the treatment of patients with primary bone lymphoma (PBL).MethodsWe retrospectively reviewed the medical records of 33 patients with PBL who were treated at 6 medical centers in Korea from 1992 to 2010. Clinicopathological features and treatment outcomes were analyzed.ResultsThe median age of the patients participating in our study was 40 years. The most common sites of involvement were the pelvis (12.36%) and femur (11.33%). CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone) or CHOP-like regimens were administered to 20 patients (61%), and R-CHOP (rituximab plus CHOP) was administered to the remaining 13 patients (39%). The overall response rate was 89% (complete response, 76%; partial response, 12%). The overall survival (OS) of patients with solitary bone lesions was longer than that of patients with multiple bone lesions (median OS: not reached vs. 166 months, respectively; P=0.089). Addition of rituximab to CHOP did not significantly affect either OS or progression-free survival (P=0.53 and P=0.23, respectively). Combining radiation therapy with chemotherapy also did not improve the OS or progression-free survival of patients with solitary bone lesions.ConclusionConventional cytotoxic chemotherapy remains an effective treatment option for patients with PBL. Additional benefits of supplementing chemotherapy with either rituximab or radiation therapy were not observed in this study. Further investigation is needed to characterize the role of immunochemotherapy in treating patients with PBL.

Itemized Hospital Charges for Acute Cerebral Infarction Patients Influenced by Severity in an Academic Medical Center in Korea

Background and PurposeStroke imposes a major burden on patients, their families, and the national healthcare system. The purpose of this study was to determine the itemized hospital charges in acute ischemic stroke patients according to their severity by partitioning the charges in detail and then examining whether stroke severity was a significant contributor to these charges.MethodsThis study analyzed data of first-time acute ischemic stroke patients who had been admitted to an academic medical center between September 2003 and April 2009. The patients' demographic and clinical characteristics were analyzed descriptively, and then eight categorized hospital charges as well as the total charge were compared among patients grouped according to stroke severity, using analysis of variance. Multiple regression analyses were conducted to test the influence of stroke severity on itemized hospital charges as well as the total charge, while controlling for other related factors.ResultsMore-severe strokes were associated with a higher total charge. Significantly higher charges were associated with patients with more-severe strokes regarding all charged items except imaging studies. The charges for imaging studies were similar across all severities of stroke. While controlling for other factors, a significant impact of stroke severity was found in both the total hospital charge and most itemized charges.ConclusionsItemized hospital charges for inpatients with acute ischemic stroke varied according to stroke severity. Stroke severity was a significant factor influencing the itemized charges of acute hospitalization of ischemic stroke patients.

Cytomegalovirus Infection according to Cell Source after Hematopoietic Cell Transplantation in Pediatric Patients

PurposeThis study was performed in order to evaluate the incidence and characteristics of cytomegalovirus (CMV) infection in children with acute leukemia according to donor source and graft type.Materials and MethodsWe retrospectively identified children with acute leukemia who had received allogeneic hematopoietic cell transplantation at Samsung Medical Center in Korea from October 1998 to December 2009.ResultsIn total, 134 recipients were identified. The patients were classified into the following three groups: unrelated cord blood (CB, n=36), related bone marrow or peripheral blood stem cells (RD, n=41), and unrelated bone marrow or peripheral blood stem cells (UD, n=57). The 365-day cumulative incidence of CMV antigenemia was not significantly different among the three groups (CB 67% vs. RD 49% vs. UD 65%, p=0.17). However, CB recipients had the highest median value of peak antigenemia (CB 160/2×105 leukocytes vs. RD 7/2×105 leukocytes vs. UD 19/2×105 leukocytes, p<0.01) and the longest duration of CMV antigenemia than the other stem cell source recipients (CB 87 days vs. RD 17 days vs. UD 28 days, p<0.01). In addition, the 730-day cumulative incidence of CMV disease was the highest in the CB recipients (CB 36% vs. RD 2% vs. UD 5%, p<0.01). Thirteen CB recipients developed CMV disease, in which five of them had more than one organ involvement. Two patients, who were CB recipients, died of CMV pneumonia.ConclusionThis study suggests that CB recipients had both longer and higher cumulative incidences of CMV infection. Therefore, a more aggressive and effective strategy of CMV management should be considered in CB recipients.

Korean Guideline for Colonoscopic Polypectomy

There is indirect evidence to suggest that 80% of colorectal cancers (CRC) develop from adenomatous polyps and that, on average, it takes 10 years for a small polyp to transform into invasive CRC. In multiple cohort studies, colonoscopic polypectomy has been shown to significantly reduce the expected incidence of CRC by 76% to 90%. Colonoscopic polypectomy is performed frequently in primary outpatient clinics and secondary and tertiary medical centers in Korea. However, there are no evidence-based, procedural guidelines for the appropriate performance of this procedure, including the technical aspects. For the guideline presented here, PubMed, Medline, and Cochrane Library literature searches were performed. When little or no data from well-designed prospective trials were available, an emphasis was placed on the results from large series and reports from recognized experts. Thus, these guidelines for colonoscopic polypectomy are based on a critical review of the available data as well as expert consensus. Further controlled clinical studies are needed to clarify aspects of this statement, and revision may be necessary as new data become available. This guideline is intended to be an educational device to provide information that may assist endoscopists in providing care to patients. This guideline is not a rule and should not be construed as a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment. Clinical decisions for any particular case involve a complex analysis of the patient's condition and the available courses of action.

Titrating Optimal Dose of Osmotic-Controlled Release Oral Delivery (OROS)-Methylphenidate and Its Efficacy and Safety in Korean Children with ADHD: A Multisite Open Labeled Study.

ObjectiveThis study was aimed to determine effectiveness and tolerability of Osmotic-controlled Release Oral delivery (OROS) methylphenidate (MPH) and its optimal dose administered openly over a period of up to 12 weeks in drug naïve Korean children with ADHD.MethodsSubjects (n=143), ages 6 to 18-years, with a clinical diagnosis of any subtype of ADHD were recruited from 7 medical centers in Korea. An individualized dose of OROS-MPH was determined for each subject depending on the response criteria. The subjects were assessed with several symptom rating scales in week 1, 3, 6, 9 and 12.Results77 of 116 subjects (66.4%) achieved the criteria for response and the average of optimal daily dose for response was to 30.05±12.52 mg per day (0.90±0.31 mg/kg/d) at the end of the study. Optimal dose was not significantly different between ADHD subtypes, whereas, significant higher dose was needed in older aged groups than younger groups. The average of optimal daily dose for response for the subjects aged above 12 years old was 46.38±15.52 per day (0.81±0.28 mg/kg/d) compared to younger groups (p<0.01). No serious adverse effects were reported and the dose did not have a significant effect on adverse effects.ConclusionOptimal mean dose of OROS-MPH was significantly different by age groups. Higher dose was needed in older aged groups than younger groups. Effectiveness and tolerability of OROS-MPH in symptoms of ADHD is sustained for up to 12 weeks.

The comparison of clinicopathological characteristics in primary malignant mixed műllerian tumour with epithelial endometrial carcinoma

We performed an age-matched case-control study to compare the clinical and pathology outcomes between histologically diagnosed primary malignant mixed műllerian tumour (MMMT) of the uterus and endometrial carcinoma. Thirty-two women were treated for primary MMMT at seven tertiary medical centres in Korea from 2000 to 2006. For each woman with MMMT, four women with endometrioid and two with non-endometrioid endometrial carcinoma were selected as age-matched controls for analysis. Medical records were retrospectively reviewed to obtain outcome data. The incidence of MMMT was 2.57% (32/1244). In comparison with women with endometrioid endometrial cancer, those with MMMT were characterised by large tumour size, higher incidence of adnexal involvement and lymph node metastases, leading to advanced disease stage. Despite the frequent use of adjuvant treatment, the 5-year survival rate of women with MMMT was significantly poorer than those with endometrioid endometrial cancer. However, women with MMMT were not significantly different from those with non-endometrioid endometrial cancer in terms of important pathologic variables, apart from larger tumour size. In addition, the 5-year survival rate of women MMMT was poorer than that those with non-endometrioid endometrial cancer, but the difference was not statistically significant. Malignant mixed műllerian tumour is characterised by a high incidence of lymph node metastases and advanced stage at diagnosis, leading to poorer overall survival than other subtypes of endometrial carcinoma. Clinical trials for MMMT are critical for improving treatment strategies.

Comparison of Aortic Dissection in Korean Patients With Versus Without the Marfan Syndrome

Among the cardiovascular manifestations in the Marfan syndrome (MFS), aortic dissection stands out as a major cause of early mortality. The aim of this study was to test the hypothesis that patients with the MFS who experience aortic dissection differ in clinical features and outcomes from those with aortic dissection not related to the MFS. Data from patients diagnosed with aortic dissection from December 1994 to March 2009 at 1 of the major medical centers in Korea were reviewed. The clinical presentations, dissection characteristics, and outcomes of patients with and those without the MFS in a Korean population were compared. Of 445 patients with aortic dissection, 46 (10%) had the MFS. Compared to non-MFS patients, those with the MFS developed aortic dissection at younger ages (33 ± 10 vs 57 ± 13 years, p <0.001) and were less frequently hypertensive (11% vs 73%, p <0.001). During the follow-up period, patients with the MFS more often developed aortic dilatation and expansion of the dissection (39% vs 18%, p = 0.003) and showed a higher rate of reoperation (30% vs 9%, p <0.001). In conclusion, in Korean patients, aortic dissection with the MFS had different characteristics and poorer outcomes than aortic dissection without the MFS. These findings underscore the importance of accurate diagnosis and surveillance of this condition in the MFS.

PCN191 Economic Evaluation of XELOX vs FOLFOX4 as Adjuvant Treatment for Patients with Stage III Colon Cancer in south Korea

To compare the costs of XELOX (Xeloda + Oxaliplatin) and FOLFOX4 (5-FU + Oxaliplatin + Leucovorin) for adjuvant treatment of stage III colon cancer in a South Korean setting. Based on the equivalence in efficacy of XELOX from NO16968 trial and FOLFOX4 from MOSAIC trial (the 5 yrs disease free survival rates were very similar 66.1% for XELOX and 66.4% for FOLFOX4), a cost-minimization approach was chosen. The model adopts a payers perspective. Efficacy/Safety data and protocol information were acquired from NO16968 for XELOX, and from the MOSAIC trial for FOLFOX4. As no direct comparison of XELOX and FOLFOX4 for this indication is available, we collected several medical resource use data for these two regimens, which were chemotherapy drug doses, adverse events, hospitalization-ambulatory visits, and drug administration methods. The medical costs for FOLFOX4 were acquired from real world claims data (electronic data interchange, EDI); Catholic medical center in Korea. The direct medical costs for XELOX were also estimated by EDI from Catholic medical center with NO16968 trial. Also, health care utilizations were measured. All data analyses were performed using STATA software. The total direct medical costs for XELOX were estimated to be 13,884,894 KRW and for FOLFOX4 14,509,341 KRW per patient for 24weeks of chemotherapy treatment at same body surface area. The drug costs of XELOX were 12,468,748 KRW and of FOLFOX4 10,831,699 KRW. The line costs and drug administration costs were 82,960 KRW for XELOX and, 943,176 KRW for FOLFOX4, respectively. XELOX is more expensive in terms of drug acquisition costs. However, this is more than compensated by cost savings for drug administration, ambulatory encounters, AE medications, costs for central venous lines, and hospitalization. Additional incidence of hospitalization for FOLFOX4 was 2.3 times greater than for XELOX related hospitalization. XELOX offers cost savings of 644,447 KRW (about 585 US $) per patient compared to FOLFOX4 from the payers perspective in South Korean Universal Health Insurance System.

Use of acupuncture therapy as a supplement to conventional medical treatments for acute ischaemic stroke patients in an academic medical centre in Korea

Acupuncture has served as a major complementary and alternative therapy that supplements conventional medicine and is the subject of growing public interest. This study was conducted to estimate the usage rate of acupuncture as a supplemental treatment in acute ischaemic stroke patients and to identify factors associated with the choice to use this therapy. Using the registry of stroke patients admitted to an academic medical centre in Korea, the use of acupuncture therapy was recorded and analysed, along with the patients' socio-demographic characteristics, hospital access variables, risk factors for ischaemic stroke and clinical characteristics. The data were analysed using descriptive statistics, chi-square tests and multiple logistic regression analyses. Of 2167 patients, 18% received acupuncture therapy. The choice of acupuncture therapy was significantly associated with stroke severity as well as gender, age, geographical residence and previous history of stroke. After controlling for other significant factors, there was an approximately 3.4-fold greater usage in patients with moderately severe strokes (95% confidence interval (CI)=2.5-4.6) and 4.1-fold greater usage in patients with severe strokes (95% CI=2.7-6.4). The findings provide a better understanding of patients' utilization of acupuncture therapy as a supplement to conventional medical treatments and of factors associated with the utilization of acupuncture in patients with acute ischemic stroke. Strategic implications of acupuncture therapy are suggested for both health-care providers and policy makers.

Molecular Features of Colorectal Hyperplastic Polyps and Sessile Serrated Adenoma/Polyps From Korea

Abundant recent data suggest that sessile serrated adenoma/polyp (SSA/P) is an early precursor lesion in the serrated pathway of carcinogenesis. It is believed that SSA/Ps develop cancer by an SSA/P-dysplasia-carcinoma sequence. Hyperplastic polyps (HPs) share some histologic and molecular characteristics with SSA/P, but it is unclear whether SSA/Ps are derived from HPs or whether they develop by a different pathogenetic pathway. Previous studies have shown that serrated polyps from Korean patients show different prevalence rates of certain molecular abnormalities compared with similar lesions from American patients, and this suggests that lifestyle and dietary factors may influence the serrated neoplasia pathway. The purpose of this study was to evaluate the molecular features of HPs and SSA/Ps, the latter both with and without dysplasia, from Korean patients and to compare the findings with similar lesions from American patients. One hundred and eleven serrated polyps, consisting of 45 HPs (30 microvesicular, 11 goblet cell, 4 mucin depleted) and 56 SSA/Ps (36 with dysplasia, 20 without dysplasia), were retrieved from the pathology files of a large medical center in Korea and 38 SSA/P from American patients were evaluated for BRAF and KRAS mutations, microsatellite instability, and hypermethylation of O6-methylguanine-DNA methyltransferase (MGMT), hMLH1, adenomatous polyposis coli (APC), p16, methylated in tumor-1 (MINT-1), MINT2, and MINT31. Methylation of hMLH1 was performed using 2 different sets of primers. Twenty-three conventional adenomas from Korean patients were included as controls. The data were compared between polyp subtypes and between polyps in the right versus the left colon. With regard to HP, KRAS mutations were present in 31.1% of polyps and BRAF mutations in 46.7% of polyps. KRAS mutations were significantly more common in goblet cell HP and BRAF in microvesicular HP (MVHP). Methylation of MGMT, hMLH1, APC, p16, MINT1, MINT2, and MINT31 were present in 42.2%, 64.4% (and 24.4%), 37.8%, 60%, 68.9%, 51.1%, and 60% of HPs. CpG island methylator phenotype high was noted in 60% of HPs. Methylation of hMLH1, p16, MINT2, and MINT31 were more frequent in MVHPs compared with other types of HPs. In contrast, SSA/Ps showed KRAS and BRAF mutations in 12.5% and 60.7% of cases, respectively. Methylation of all tumor-related genes, except hMLH1 (23.2% using 1 type of primers) and APC (37.5%), occurred in >50% of lesions, and CpG island methylator phenotype (CIMP) high was noted in 76.8% of cases. None of the molecular findings were significantly more common in SSA/P with, versus those without, dysplasia, but only 2 of the 36 polyps with dysplasia were of the conventional adenomatous type; the remainder (34 of 36) was of the serrated type. Nevertheless, both SSA/P with conventional adenomatous dysplasia showed methylation of MGMT, APC, MINT1, and MINT31 and were CIMP high. BRAF mutations, methylation of most tumor related genes, and CIMP high occurred more frequently in HPs and SSA/Ps in the right colon, compared with the left colon. In fact, no significant differences were observed between HPs and SSPs of the right colon and HPs and SSA/Ps from the left colon. Furthermore, compared with American patients, Korean male individuals were affected more frequently than female individuals, and both BRAF mutations and hMLH1 methylation were less frequent in the latter compared with the former. We conclude that HPs and SSA/Ps in Korean patients share some, but not all, clinical and molecular characteristics to those that occur in Americans. The data support the theory that the right and left colon are biologically different with regard to susceptibility to serrated cancer, and that anatomic location (right vs. left) may be a more significant risk factor of progression than the histologic type of polyp. Our data also support the theory that right-sided MVHPs may be a precursor to SSA/P.

Validation of the seventh edition of the American Joint Committee on Cancer tumor-node-metastasis (AJCC TNM) staging in patients with stage II and stage III colorectal carcinoma: analysis of 2511 cases from a medical centre in Korea

The sixth and seventh editions of the American Joint Committee on Cancer (AJCC) tumor-node-metastasis (TNM) system for patients with stage II and stage III colorectal carcinoma (AJCC-6 and AJCC-7) were compared. Between 2000 and 2007, 2511 stage II/III colorectal carcinoma patients received primary surgical resection at the Asan Medical Center (Seoul, Korea). All patients were staged using AJCC-6 and AJCC-7 TNM systems. Patients with synchronous or other cancers, those given preoperative chemotherapy or radiotherapy and those in whom fewer than 12 lymph nodes were resected, were excluded. Overall survival (OS) and disease-free survival (DFS) were compared. Of 2511 patients, 255 (10.2%) had different stages in the AJCC-6 and AJCC-7. For the AJCC-7, the 5-year OS by stage was 94.2% for stage IIA, 88.8% for stage IIB, 83.5% for stage IIC, 91.8% for stage IIIA, 81.8% for stage IIIB and 72.0% for stage IIIC. The OS and the DFS were not significantly different for the new substages IIB (n = 57) and IIC (n = 34) (P = 0.34 and P = 0.87, respectively). For the 187 patients with stage T3N2a cancer, the OS and the DFS were significantly different from stage IIIB other than T3N2a (P = 0.008 and P = 0.01, respectively) and there were no statistically significant differences in OS between the T3N2a group and the IIIC group (P = 0.46). The study indicates that AJCC-7 has better prognostic validity than AJCC-6 for staging of patients with stage II and stage III colorectal carcinoma.

(A140) An Analysis of National Survey on Disaster Drill by Emergency Medical Centers in Korea

IntroductionDisaster drills have been performed officially for disaster medical preparedness by wide regional emergency medical centers in Korea. Government evaluates these disaster drills every year, but this evaluation is performed based on administrative aspect not disaster medical aspect. Also there are insufficient number of research on disaster drill not on disaster itself, especially national level. So these disaster medical drills were analyzed and reevaluated.MethodsDisaster drills performed by wide regional emergency medical centers in Korea were evaluated and analyzed from August 2006 to July 2008. Disaster drill planning, performance, kinds of disaster drill, contents of drill and resources of drill were collected and analyzed in medical aspect based on the disaster drill report and additional compensation of incomplete data by direct contact with the participating institutions. The appropriateness and evaluation results referred to the guideline of National Emergency Medical Center of Korea.ResultsAll the wild regional emergency medical centers had their own disaster drill planning and resource application planning for drills and real disasters. Most of disaster drill planning were appropriate, but disaster facility was the weakest point in the planning. Types of disasters in disaster drills were fire and structural collapse(44.4%), special disaster(13.7%), natural disaster(1.7%). Average duration of disaster drills were 6.12 hours and 1.26 days. Real field drill rate was 80.3%. Sixty five percent of drills were connected to multiple institutions or organizations other than hospitals. Number of participating persons from wide regional emergency medical centers were 21 on average.ConclusionsMedical situation on disaster drills is that there are various levels and kinds of disaster drills done by wide regional emergency medical centers, so the quality and quantity should be enforced in low level centers. It is recommended that international situation or database can be extracted based on this research.

Clinical Significance of a Large Difference (≥ 2 points) between Biopsy and Post-prostatectomy Pathological Gleason Scores in Patients with Prostate Cancer

We investigated the clinical significance of large difference (≥ 2 points) between biopsy-derived (bGS) and post-prostatectomy Gleason scores (pGS). At 14 medical centers in Korea, 1,582 men who underwent radical prostatectomy for prostate cancer were included. According to the difference between bGS and pGS, the patients were divided into three groups: A (decreased in pGS ≥ 2, n = 30), B (changed in pGS ≤ 1, n = 1,361; control group), and C (increased in pGS ≥ 2, n = 55). We evaluated various clinicopathological factors of prostate cancer and hazards for biochemical failure. Group A showed significantly higher mean maximal percentage of cancer in the positive cores (max%) and pathological T stage than control. In group C, the number of biopsy core was significantly smaller, however, tumor volume and max% were significantly higher and more positive biopsy cores were presented than control. Worse pathological stage and more margin-positive were observed in group A and C than in control. Hazard ratio for biochemical failure was also higher in group A and C (P = 0.001). However, the groups were not independent factors in multivariate analysis. In conclusion, large difference between bGS and pGS shows poor prognosis even in the decreased group. However it is not an independent prognostic factor for biochemical failure.

Critically Ill Patients with Pandemic Influenza A/H1N1 2009 at a Medical Center in Korea

Results: 27 patients with confirmed pandemic Influenza A/H1N1 2009 were admitted to the intensive care unit (ICU) at the Asan Medical Center (AMC). The median age (IQR) was 59 years (41∼67), and 66.7% of the patients were older than 51 years. A total of 81.5% of the patients had 2 or more co-morbidities. The median time (IQR) from symptom onset to presentation was 2 days (1∼4), and the median time from presentation to ICU admission was 0 days (0∼1.5). All patients received oseltamivir (300 mg/day) and 13 patients received triple combination therapy (oseltamivir, amantadine, ribavirin). Twelve patients required mechanical ventilation on the first day of ICU admission. A total of 6 patients (22.2%) died within 28 days of admission. The patients who died had significantly higher acute physiology and chronic health evaluation (APACHE) II and sequential organ failure assessment (SOFA) scores at presentation. There were no significant differences in age, co-morbidities, or antiviral regimens between survivors and non-survivors. Conclusion: Critical illness related to pandemic Influenza A/H1N1 2009 was common in elderly patients with chronic co-morbidities. All patients were given high-dose oseltamivir or triple combination antiviral therapy. Nonetheless, patients with critical illnesses associated with pandemic Influenza A/H1N1 2009 had a death rate of 22.2%.

일반인 응급 상황 경험자의 심폐소생술 교육 및 수행에 대한 특성 고찰

The concern regarding inability to perform CPR properly was widespread, and few studies, however, have queried bystanders regarding their responses to an actual emergency. This study assessed how often CPR was performed by CPR-trained bystanders and what factors were associated with the performance and nonperformance of CPR by trained bystanders. From a 2,000 sample survey of the National Emergency Medical Center in Korea (2008), it extracted object persons who actually experienced an emergency situation, and examined closely the relationship of CPR education experience and CPR performance in an emergency. 169 completely interviewed, 23(13.6%) had CPR education experience and performed CPR in an actual emergency, 40(23.6%) had CPR education experience but didn`t performed, 12 (7.1%) didn`t have CPR education experience but performed, and 94(55.6%) neither had CPR education experience nor performed. Specifically, within bystanders who had CPR education experience, those who CPR was performed were different from those who CPR was not on medical emergency-related characteristics such as CPR knowledge(p

Analysis of systemic corticosteroid usage and survival in patients requiring mechanical ventilation for severe community-acquired pneumonia

We evaluated the clinical data in patients who required mechanical ventilation for severe community-acquired pneumonia (CAP) and compared survival with and without the use of systemic corticosteroids. This retrospective study examined 97 patients with severe CAP in the MICU of the Asan Medical Center in Korea between January 2002 and November 2006. We collected data from medical charts about clinical and laboratory data, as well as 28-day and 3-month survival rates. Clinical baseline characteristics and scores on the Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment were similar in the corticosteroid and noncorticosteroid groups. The 28-day and 3-month survival rates were 59.8% and 47.4% in all patients (56.7% and 45% in corticosteroid group and 64.9% and 54.3% in noncorticosteroid group, P>0.05, respectively). Multivariate logistic regression analysis revealed that female sex [odds ratio (OR) 24.052], younger age (OR, 0.714), absence of acute respiratory distress syndrome (ARDS) (OR, 1.019e(4)), and absence of neoplasm (OR, 0.002) were associated with increased survival at 3 months. However, systemic corticosteroid was not associated with improving 28-day and 3-month survival rates.

Association of Hospital Arrival Time with Modified Rankin Scale at Discharge in Patients with Acute Cerebral Infarction

This study evaluated the time interval from the development or recognition of a symptom to hospital arrival and investigated its association with the modified Rankin Scale (mRS) at discharge in patients with acute cerebral infarction. A registry was established with ischemic stroke patients admitted to an academic medical center in Korea from January 2005 to March 2009. The time interval between symptom onset and hospital arrival was recorded for each patient and analyzed along with the patient’s clinical characteristics and mRS at discharge. Regardless of initial severity at admission, mRS was significantly different between two groups of hospital arrival: within 3 h and beyond 3 h. Multiple regression analysis also showed more positive mRS scores for patients within the 3-hour arrival, controlling for other significant factors. The findings provided patients’ initiatives for early hospital arrival.

Comparing the Managerial Efficiencies of Gunsan and Nawon Medical Centers in Korea

Comparing the Managerial Efficiencies of Gunsan and Nawon Medical Centers in Korea

The Role of Mean Platelet Volume as a Predicting Factor of Asymptomatic Coronary Artery Disease

Background: Platelet has been known as an implicating factor in the pathophysiology of atherosclerotic disease. Larger platelets are more reactive and produce more prothrombotic factors. Several studies have shown relationship between mean platelet volume (MPV) and coronary artery disease. The present study has been designed to investigate association of MPV and subclinical CAD (coronary artery disease; abnormal finding in coronary multidetector computed tomography [MDCT] in asymptomatic individual). Methods: This cross sectional study was carried out in 103 men and 72 women (over 40 years old) who underwent coronary MDCT as screening test for disease prevention in the health examination center of Hanyang University Medical Center in Korea from January 1 to April 30, 2009. Subclinical CAD was defined when either of the following findings are present in asymptomatic patients: 1) plaque or calcification, 2) stenosis of any level. After adjustment for age, gender, hypertension, diabetes, BMI, smoking (pack-years), LDL cholesterol, odds ratios (ORs) for the prevalence of the subclinical CAD were calculated for quintiles of MPV using logistic regression analysis. Results: After adjustment for age, gender, hypertension, diabetes, BMI, smoking (pack-years), LDL cholesterol, the OR for subclinical CAD, comparing the fifth quintile of MPV with the first quintile, was 5.83 (95% confidence interval, 1.51 to 22.42; P = 0.010). Conclusion: Highest level of MPV is independently associated with the prevalence of the subclinical CAD after adjusting for other risk factors.