A New Record and Characterization of Asparagus Purple Spot Caused by Stemphylium vesicarium in Korea

In 2017, small, elliptical, brownish purple spots on spears and ferns of asparagus were found in fields of Gangwon-do. The isolated fungal species was identified as an ascomycete Stemphylium vesicarium based on morphological characteristics and molecular phylogenic analyses including nucleotide sequences of the internal transcribed spacer (ITS), glyceraldehyde-3-phosphate dehydrogenase (GAPDH), and cytochrome b (cytb). A pathogenicity test revealed that S. vesicarium was the causal agent of purple spot disease on asparagus. The occurrence of purple spots caused by S. vesicarium on asparagus is the first report in Korea.

A PAS-Containing Histidine Kinase is Required for Conidiation, Appressorium Formation, and Disease Development in the Rice Blast Fungus, Magnaporthe oryzae

Rice blast disease, caused by the ascomycete fungus Magnaporthe oryzae, is one of the most important diseases in rice production. PAS (period circadian protein, aryl hydrocarbon receptor nuclear translocator protein, single-minded protein) domains are known to be involved in signal transduction pathways, but their functional roles have not been well studied in fungi. In this study, targeted gene deletion was carried out to investigate the functional roles of the PAS-containing gene MoPAS1 (MGG_02665) in M. oryzae. The deletion mutant ΔMopas1 exhibited easily wettable mycelia, reduced conidiation, and defects in appressorium formation and disease development compared to the wild type and complemented transformant. Exogenous cAMP restored appressorium formation in ΔMopas1, but the shape of the restored appressorium was irregular, indicating that MoPAS1 is involved in sensing the hydrophobic surface. To examine the expression and localization of MoPAS1 in M. oryzae during appressorium development and plant infection, we constructed a MoPAS1:GFP fusion construct. MoPAS1:GFP was observed in conidia and germ tubes at 0 and 2 h post-infection (hpi) on hydrophobic cover slips. By 8 hpi, most of the GFP signal was observed in the appressoria. During invasive growth in host cells, MoPAS1:GFP was found to be fully expressed in not only the appressoria but also invasive hyphae, suggesting that MoPAS may contribute to disease development in host cells. These results expand our knowledge of the roles of PAS-containing regulatory genes in the plant-pathogenic fungus M. oryzae.

The Effect of Fungicides on Mycelial Growth and Conidial Germination of the Ginseng Root Rot Fungus, Cylindrocarpon destructans

Ginseng root rot caused by Cylindrocarpon destructans is the most destructive disease of ginseng. Six different fungicides (thiophanate-methyl, benomyl, prochloraz, mancozeb, azoxystrobin, and iprodione) were selected to evaluate the inhibitory effect on the mycelial growth and conidial germination of C. destructans isolates. Benomyl and prochloraz were found to be the most effective fungicides in inhibiting mycelial growth of all tested isolates, showing 64.7% to 100% inhibition at a concentration of 10 µg/mL, whereas thiophanate-methyl was the least effective fungicide, showing less than 50% inhibition even at a higher concentration of 100 µg/mL. The tested fungicides exhibited less than 20% inhibition of conidium germination at concentrations of 0.01, 0.1, and 1 µg/mL. However, the inhibition effect of mancozeb on condium germination of C. destructans was significantly increased to 92% to 99% at a higher concentration of 100 µg/mL, while the others still showed no higher than 30% inhibition.

Effect of Antibiotic Prophylaxis on Early-Onset Pneumonia in Cardiac Arrest Patients Treated with Therapeutic Hypothermia / 대한중환자의학회지

BACKGROUND: Infectious complications frequently occur after cardiac arrest and may be even more frequent after therapeutic hypothermia. Pneumonia is the most common infectious complication associated with therapeutic hypothermia, and it is unclear whether prophylactic antibiotics administered during this intervention can decrease the development of early-onset pneumonia. We investigated the effect of antibiotic prophylaxis on the development of pneumonia in cardiac arrest patients treated with therapeutic hypothermia. METHODS: We retrospectively reviewed the medical records of patients who were admitted for therapeutic hypothermia after resuscitation for out-of-hospital cardiac arrest between January 2010 and July 2015. Patients who died within the first 72 hours or presented with pneumonia at the time of admission were excluded. Early-onset pneumonia was defined as pneumonia that developed within 5 days of admission. Prophylactic antibiotic therapy was defined as the administration of any parenteral antibiotics within the first 24 hours without any evidence of infection. RESULTS: Of the 128 patients admitted after cardiac arrest, 68 were analyzed and 48 (70.6%) were treated with prophylactic antibiotics within 24 hours. The frequency of early-onset pneumonia was not significantly different between the prophylactic antibiotic group and the control group (29.2% vs 30.0%, respectively, p = 0.945). The most commonly used antibiotic was third-generation cephalosporin, and the class of prophylactic antibiotics did not influence early-onset pneumonia. CONCLUSION: Antibiotic prophylaxis in cardiac arrest patients treated with therapeutic hypothermia did not reduce the frequency of pneumonia.

Effect of Antibiotic Prophylaxis on Early-Onset Pneumonia in Cardiac Arrest Patients Treated with Therapeutic Hypothermia / 대한구급학회지

BACKGROUND: Infectious complications frequently occur after cardiac arrest and may be even more frequent after therapeutic hypothermia. Pneumonia is the most common infectious complication associated with therapeutic hypothermia, and it is unclear whether prophylactic antibiotics administered during this intervention can decrease the development of early-onset pneumonia. We investigated the effect of antibiotic prophylaxis on the development of pneumonia in cardiac arrest patients treated with therapeutic hypothermia. METHODS: We retrospectively reviewed the medical records of patients who were admitted for therapeutic hypothermia after resuscitation for out-of-hospital cardiac arrest between January 2010 and July 2015. Patients who died within the first 72 hours or presented with pneumonia at the time of admission were excluded. Early-onset pneumonia was defined as pneumonia that developed within 5 days of admission. Prophylactic antibiotic therapy was defined as the administration of any parenteral antibiotics within the first 24 hours without any evidence of infection. RESULTS: Of the 128 patients admitted after cardiac arrest, 68 were analyzed and 48 (70.6%) were treated with prophylactic antibiotics within 24 hours. The frequency of early-onset pneumonia was not significantly different between the prophylactic antibiotic group and the control group (29.2% vs 30.0%, respectively, p = 0.945). The most commonly used antibiotic was third-generation cephalosporin, and the class of prophylactic antibiotics did not influence early-onset pneumonia. CONCLUSION: Antibiotic prophylaxis in cardiac arrest patients treated with therapeutic hypothermia did not reduce the frequency of pneumonia.

External Validation of Scoring Systems for Pelvic Inflammatory Disease and Acute Appendicitis for Acute Abdominal Pain of Reproductive-aged Women in Emergency Department

PURPOSE: Differential diagnosis of acute abdominal pain of the childbearing age woman is a difficult challenge to the emergency physician. Clinical scoring systems for pelvic inflammatory disease (PID) and acute appendicitis have already been introduced. We want to validate these scoring systems externally. METHODS: This study was conducted at a single urban teaching hospital emergency department from May 2011 to September 2013. Retrospective analysis of a prospectively collected registry for reproductive-aged women was performed. RESULTS: A total of 1432 patients were registered. Among them, 322 patients diagnosed as PID (177 patients) or acute appendicitis (145 patients) were finally analyzed in this study. Among the PID and acute appendicitis scored, lower and higher cut-off points were 3 and 8 for PID risk score, and 6 and 10 for appendicitis risk score. PID risk score of PID patients was 7.0 (+/-1.9), acute appendicitis patients was 4.3 (+/-2.1), and other patients was 4.0 (+/-2.2) (p<0.001). Appendicitis risk score of PID patients was 5.7 (+/-1.9), acute appendicitis patients was 9.0 (+/-2.1), and other patients was 5 (+/-1.6) (p<0.001). The areas under the receiver operating characteristic curves were 0,832 and 0,950 for diagnosis of PID with PID risk score and acute appendicitis with appendicitis risk score, respectively. CONCLUSION: These scoring systems have appropriate diagnostic power for diagnosis of PID and acute appendicitis.

Clinical Predictors for Reproductive-aged Gynecologic Emergency Surgery Candidates Presenting to the Emergency Department with Acute Abdominal Pain

PURPOSE: Differentiating gynecological emergency surgery indications among reproductive-age female patients presenting with acute abdominal pain is challenging for emergency department (ED) physicians. We evaluated the clinical demographics of female patients diagnosed with gynecological surgery indications in the ED and found clinical predictors associated with surgical indications overall and with each surgical indication. METHODS: We conducted a prospective review study of the hospital registries of reproductive-aged women who presented with abdominal pain but without underlying disease from April 2008 to October 2010. These registries included information concerning the patient's basic characteristics, medical history, gynecologic history, symptoms, physician's examination, and laboratory results. Using a multivariate logistic regression analysis, we found a number of statistically significant factors indicating a gynecological emergency necessitating surgery. RESULTS: A total of 1047 cases involving female patients of reproductive age were initially included. We found 89 patients(8.50%) who were diagnosed as having gynecological surgery indications: 50(4.78%) were diagnosed with hemorrhagic ovarian cyst rupture, 16(1.53%) with ectopic pregnancy, and 23(2.20%) with ovarian torsion. Pain of more than 14 days from the last menstrual period (OR, 2.332; 95% CI, 1.406-3.968; p=0.001), bilateral lower abdominal tenderness (OR, 0.467; 95% CI, 0.288-0.758; p=0.002), rebound tenderness (OR, 0.54; 95% CI, 0.329-0.887; p=0.015), normal C-reactive protein value (CRP) (OR, 3.286; 95% CI, 1.717-6.290; p<0.001), and positive human chorionic gonadotropin test (OR, 0.058; 95% CI, 0.024-0.142; p<0.001) were related to gynecologic emergency surgery indication in a patient with abdominal pain. CONCLUSION: Clinical findings of the last menstrual period, bilateral abdominal tenderness, rebound tenderness, CRP value, and urine hCG result can be helpful in exclusion of gynecologic emergency surgical indications.

Clinical Predictors for Reproductive-aged Gynecologic Emergency Surgery Candidates Presenting to the Emergency Department with Acute Abdominal Pain

PURPOSE: Differentiating gynecological emergency surgery indications among reproductive-age female patients presenting with acute abdominal pain is challenging for emergency department (ED) physicians. We evaluated the clinical demographics of female patients diagnosed with gynecological surgery indications in the ED and found clinical predictors associated with surgical indications overall and with each surgical indication. METHODS: We conducted a prospective review study of the hospital registries of reproductive-aged women who presented with abdominal pain but without underlying disease from April 2008 to October 2010. These registries included information concerning the patient's basic characteristics, medical history, gynecologic history, symptoms, physician's examination, and laboratory results. Using a multivariate logistic regression analysis, we found a number of statistically significant factors indicating a gynecological emergency necessitating surgery. RESULTS: A total of 1047 cases involving female patients of reproductive age were initially included. We found 89 patients(8.50%) who were diagnosed as having gynecological surgery indications: 50(4.78%) were diagnosed with hemorrhagic ovarian cyst rupture, 16(1.53%) with ectopic pregnancy, and 23(2.20%) with ovarian torsion. Pain of more than 14 days from the last menstrual period (OR, 2.332; 95% CI, 1.406-3.968; p=0.001), bilateral lower abdominal tenderness (OR, 0.467; 95% CI, 0.288-0.758; p=0.002), rebound tenderness (OR, 0.54; 95% CI, 0.329-0.887; p=0.015), normal C-reactive protein value (CRP) (OR, 3.286; 95% CI, 1.717-6.290; p<0.001), and positive human chorionic gonadotropin test (OR, 0.058; 95% CI, 0.024-0.142; p<0.001) were related to gynecologic emergency surgery indication in a patient with abdominal pain. CONCLUSION: Clinical findings of the last menstrual period, bilateral abdominal tenderness, rebound tenderness, CRP value, and urine hCG result can be helpful in exclusion of gynecologic emergency surgical indications.

Optimal Dose of Antivenin for Asymptomatic or Minor Envenomation Patient with Korean Viperidae Injuries

PURPOSE: The aim of this study was to evaluate the feasibility and safety of our antivenin treatment protocol for patients with Korean Viperidae envenomation. METHODS: We developed an antivenin treatment protocol for Korean Viperidae envenomation, based on previous data, and applied this treatment to the enrolled patients. In brief, antivenin was not used for patients with grade 0. Patients with grade I and II received one vial of antivenin. Those with grade III and IV received two and three vials of antivenin, respectively. Adult patients who visited the emergency department (ED) after receiving a snakebite between July 2008 to August 2010 were included. Follow ups were performed at 24 hours, 7 days, and 28 days after the snakebite. RESULTS: A total of 62 patients were enrolled. At the initial evaluation, 6 patients (9.7%) were grade 0, 47 patients (75.8%) were grade I, and 9 patients (14.5%) were grade II. Upon the follow-up evaluation, 14 patients (29.8%) progressed from grade I to grade II and 2 patients (22.2%) progressed from grade II to III. Coagulopathy developed in 5 patients (8.0%) and rhabdomyolysis in 5 patients (8.0%). Urticaria developed in 2 patients (3.2%) and cellulitis in 3 patients (4.8%) as delayed complications. As an antivenin-related complication, serum sickness developed in only 1 patient (1.6%). There were no severe complications and all clinical and laboratory abnormalities disappeared within 28 days. CONCLUSION: Our antivenin treatment protocol was feasible and safe. To confirm our data, multicenter validation studies are needed.

Prediction Method for Selective Application of a Rapid Tetanus Antibody Test In Patients who Visit the Emergency Department with a Wound

PURPOSE: Tetanus vaccine or immunoglobulin is given routinely to patients with wounds according to immunization history. Our aim is to identify prediction factors that affect tetanus antibody titer, which lead to proper application of an antibody screening test according to the factors. METHODS: Subjects who visited the emergency department after injury from October 2008 to February 2010 were enrolled. The Tetanus Immunoglobulin G ELISA (Enzyme-linked immunosorbent assay) method was used for analysis of serum samples. Using multivariate analysis, we identified statistically significant variables affecting the tetanus antibody titer. And we developed the Boramae Tetanus Score as a screening model. RESULTS: A total of 1218 samples were analyzed. Significant factors affecting tetanus antibody titer were as follows: Age in the twenties, thirties, and fifties, male sex, and experience of military service. We assigned proper scores to each variable using the beta-coefficients. The area under the Receiver Operating Characteristic (ROC) curve of the scoring system was 0.807. Patients were categorized as high risk and low risk groups; 18.0% of the high risk group and 67.7% of the low risk group had serum tetanus antibody titer higher than safe antibody level (0.1 IU/mL). CONCLUSION: The antibody titer of the high risk group was low enough for performance of routine immunization. "In order to prevent unnecessary immunization, patients in the low risk group should undergo screening using proper tools".

A Model for Prediction of Pelvic Inflammatory Disease and Acute Appendicitis in Childbearing-aged Women who Visit the Emergency Department with Abdominal Pain

PURPOSE: We evaluated important factors for pelvic inflammatory disease (PID) and acute appendicitis, respectively, and we developed scoring systems for use in screening for PID or acute appendicitis in childbearing-aged women who visit the emergency department (ED) with abdominal pain. METHODS: By performance of multivariable logistic regression analysis, we found statistically significant factors for PID and acute appendicitis in prospectively collected registries, and we developed scoring systems for screening of each disease. The performances of these scoring systems were compared using the area under the receiver operating characteristics (ROC) curve. RESULTS: A total of 1048 patients were registered. Among them, 279 patients diagnosed as PID (155 patients) or acute appendicitis (124 patients) were finally analyzed in this study. The significant factors that favored PID were a length of pain onset more than two days, a history of coitus within four weeks, fever, a history of abortion, vaginal secretions, taking a painkiller for dysmenorrhea, diffuse low abdominal tenderness, no migration of pain, absence of gastrointestinal symptoms, and no leukocytosis. The significant factors that favored acute appendicitis were directly contrary to the significant factors for PID. Each of these variables was assigned a score of 1 or 2. The ROC areas of PID and acute appendicitis were 0.896 and 0.910, respectively. CONCLUSION: In order to screen for PID and acute appendicitis, among other diseases, using eleven important factors, we developed scoring systems for childbearing-aged women who present with abdominal pain. Conduct of further prospective study that will utilize these scoring systems is needed.

Comparison of Clinical Characteristics of Pulmonary Tuberculosis between General and Homeless Patients

PURPOSE: We compared characteristics and outcomes of pulmonary tuberculosis in homeless and non-homeless patients. METHODS: A retrospective, cross-sectional study was conducted in a Seoul municipal medical center between January 2007 and December 2011. All adult patients diagnosed with pulmonary tuberculosis were included. We classified these patients into homeless and non-homeless and compared the disease characteristics, risk factors, mortality, treatment completion rate, and resistance rate. RESULTS: All 157 patients were diagnosed with pulmonary tuberculosis (75 homeless and 82 non-homeless). Most homeless patients were male (97.3%) and had higher emergency medical service (EMS) use (77.3%). Additionally, most homeless patients used alcohol l(76%) and smoked (77.3%). When compared with the non-homeless group, the homeless group had a higher in-hospital mortality rate (14.7%; adjusted odds ratio (OR), 4.69; 95% confident interval (CI), 1.03-21.34), and were more likely to be admitted for (adjusted OR=3.27(1.07-9.97)), but not to complete tuberculosis treatment (adjusted OR=9.10(2.24-36.98)). CONCLUSION: Pulmonary tuberculosis showed higher mortality in homeless than non-homeless patients. Additionally, homeless had a lower treatment completion rate and fewer resistant microorganisms.

A Multicenter Study on the Tetanus Antibody Titers of Elderly Koreans

BACKGROUND: Although tetanus infections have diminished dramatically since the advent of tetanus vaccination, this disease has not disappeared. Those 60 years and older are still very much at risk for this infection. Thus, we investigated the tetanus antibody titers in people 60 years and older in Korea. METHODS: Our subjects included those visiting eight emergency departments from March 2009 to February 2010 after an injury with stable vital signs and without acute disease. Samples obtained were tested using the tetanus immunoglobulin enzyme-linked immunosorbent assay method. The resultant tetanus antibody titers were analyzed. RESULTS: The number of subjects enrolled was 462. The mean titer was 0.09+/-0.14 IU/mL. Twenty-two percent of the subjects had a safe titer level (>0.1 IU/mL). Males and urban subjects had higher tetanus antibody titers than did females and suburban subjects. Subjects living in Incheon, Gangwon-do, Chungcheong-do, and Jeju-do had lower titers. CONCLUSION: The results of this study showed that Koreans 60 years and older did not have a protective mean level of tetanus antibody titer and that 78% of the subjects did not have a seroprotective level after tetanus exposure. Therefore, a national effort to administer tetanus vaccination to elderly Koreans is needed.

Relative Adrenal Insufficiency in Postresuscitation Patients

PURPOSE: Relative adrenal insufficiency is common in intensive care unit patients. Basal cortisol and the cortisol response following the injection of synthetic corticotropin were prospectively evaluated in postresuscitation patients after cardiac arrest. METHODS: This is a prospective cohort study of relative adrenal insufficiency of patients with return of spontaneous circulation (>24 hours) after cardiac arrest who were admitted to the intensive care unit over three-year period from January 2005 to December 2007. Relative adrenal insufficiency was measured the next day after return of spontaneous circulation following cardiac arrest. RESULTS: Seventy-five patients were included over three years. Relative adrenal insufficiency developed in 41 patients. In patients with relative adrenal insufficiency, SOFA (sequential organ failure assessment) and lactate were elevated (p=0.03, 0.048), mortality was higher (p=0.014) and basal cortisol concentrations were significantly increased (p=0.001). In patients with therapeutic hypothermia, there were no significant differences with or without relative adrenal insufficiency (p=0.847). The factors associated with mortality, as assessed by multiple logistic regression were relative adrenal insufficiency, therapeutic hypothermia and the time from arrest to the start of cardiopulmonary resuscitation. CONCLUSION: Both basal cortisol and the cortisol response after the injection of synthetic corticotropine must be considered in predicting patients outcome. For patients with relative adrenal insufficiency, some specific treatments such as cortisol can be considered. More prospective multicenter study is needed.

The Clinical Features of Patients with Deep Neck Infections Who Were Admitted to the Intensive Care Unit in a Single Emergency Center / 대한구급학회지

BACKGROUND: Deep neck infections are a life-threatening disease that spread to the neck spaces and the mediastinum via neck fascial planes. In spite of using antibiotics, the mortality of deep neck infections is still high. The aim of our study was to analyze the factors related to mortality and morbidity of patients with deep neck infection who were admitted to the intensive care unit. METHODS: This is a retrospective study of patients with deep neck infections who were admitted to the intensive care unit over a 2 year period between June 2006 and May 2008. The various factors related to mortality and morbidity were analyzed. RESULTS: Twenty-four patients were included over 2 years. The median age was 58 years. Eighteen patients (75%) were males and six patients were females. Ten patients (41.7%) had underlying diabetes mellitus. The median white blood cell count and C-reactive protein (CRP) were 14,000/mm3 and 24.1 mg/dl, respectively. The most common cause of deep neck infection was of dental origin (62.5%) and the most common complication was mediastinitis (37.5%). The factors related to mortality were underlying diabetes mellitus, pO2, CRP, sequential organ failure assessment (SOFA) score, gas-forming score (GAS), and complications due to mediastinitis. CONCLUSIONS: It is useful to measure several factors in patients with deep neck infections. The patients with underlying diabetes mellitus, increased CRP, a GAS score of 2, and complications to mediastinitis have a high mortality rate, so active surgical and medical management should be performed.

Qualitative Analysis of the Tetanus Antibody in Korean Army personnel after Visiting a Tertiary Armed Forces Hospital

PURPOSE: In the Korean armed forces, vaccination against tetanus is done when personnel join the military service, but we do not know how many military personnel are vaccinated and how many soldiers have protection against tetanus. We performed a qualitative analysis of the tetanus antibody in Korean military personnel by using the TQS (Tetanus Quick Stick) METHODS: This study used a prospective collection method for military personnel visiting to the emergency department of a tertiary armed forces hospital from July 2005 to January 2007. We performed an analysis by using the TQS and asked whether the personnel had been inoculated during military service. RESULTS: The number of enrolled military personnel was 474. Among them, 412 had been vaccinated against tetanus after entering the military service. The positive rate of TQS was 91.3% (373 patients) after vaccination for tetanus. CONCLUSION: Many military personnel were inoculated with tetanus toxoid during military service and have protective antibodies for tetanus. According as TQS should be used for military personnel who visit the emergency department of an armed forces hospital. Also, anti-tetanus immunoglobulin should not normally be used a positive TQS for tetanus prophylaxis.

Effect of Diazepam on the Expression of Transforming Growth Factor-Beta in Rat Brain Following Transient Cerebral Ischemia / 대한뇌혈관외과학회지

OBJECT: Transforming growth factor-beta (TGF-beta) is involved in many physiological and pathophysiological processes, such as cell growth, differentiation, inflammation, and tissue repair. It is not yet clear whether the presence of this cytokine has deleterious or protective effects for neurons in a given pathophysiological condition. Several authors have demonstrated that TGF-beta has been shown to rescue cultured neurons from excitotoxic and hypoxic cell death and to reduce infarct size after focal cerebral ischemia in mice and rabbits. The present study investigated the effect of diazepam on the expression of TGF-beta in rat brain tissue after inducing transient cerebral ischemia. METHODS: Ten male rats were killed after a mild and reversible ischemic damage produced by a 15-minutes occlusion of both carotid arteries without occlusion of the vertebral arteries. Five ischemia-treated and 5 sham-operated rats were injected with 10 mg/kg diazepam and vehicle, respectively at 30 minutes, and again 90 minutes following the onset of reperfusion. After 1, 2 and 7 days following the reperfusion, brains were removed from control, sham-operated, and ischemia-treated with or without diazepam-injected groups, then immunohistochemistry and Western blotting for TGF-beta were performed. Cerebral cortices and hippocampi were sectioned from ischemia-treated, shamoperated and control group rats, and stained using cresyl violet. RESULTS: When the immunoblot-results of TGF-beta expression were analyzed using a image analysis system, TGF-beta expression were increased in ischemia-treated without diazepam-injected rats, and decreased in ischemia-treated with diazepam-injected rats at 2 and 7 days after reperfusion compared to control and sham-operated groups. Cresyl violet staining became intense in ischemia-treated without diazepam-injected group and became unclear in ischemia-treated with diazepam-injected group compared to sham-operated and control groups, respectively. CONCLUSION: Diazepam influenced the TGF-beta expression in the brain of ischemia-treated rats.

Considerations of Complaints in Four Tertiary Hospital Emergency Centers

PURPOSE: When using the emergency room of a tertiary hospital, both patients and their relatives or friends sometimes experience dissatisfaction and complain. Patient satisfaction deserves attention not only because it is an intrinsically worthy goal but also because it is a potentially significant mediator for promoting health and well-being. This study aims to identify patient's official complaints and to improve the quality of care in the Emergency Department (ED). METHODS: We investigated retrospectively 144 official complaints of visitors in 4 tertiary university hospital emergency centers between January 1, 2001, and December 31, 2003. RESULTS: Among those 144 official complaints from the 4 hospital emergency centers were 116 appropriate complaints, as determined by the inclusion criteria, and 212 detailed descriptions of dissatisfaction. The seven major categories of dissatisfactions were analyzed: rudeness or lack of kindness, delayed waiting time, insufficient explanation of patient condition, distrust of treatment, absence of a specialist, poor emergency-department environment, and high treatment fee. CONCLUSIONS: Dissatisfaction related to the lack of kindness was the most common problem in all four university hospital emergency centers. The next most important problem was the delayed time or distrust of treatment. The concrete causes of the complaints varied with the hospital. To improve the quality of care for patients in the ED, the hospital staff should be more attentive and kind and should explain the patient's condition in more detail. Reducing the waiting time is also important.

The Value of Grading of Pulmonary Contusion by the Chest CT Scanning

PURPOSE: Pulmonary contusion is the most common injury in patients with blunt chest trauma, and reported as 15~20% of multiple traumatic patients. In this study, we would like to predict a prognosis for pulmonary contusion easily at ED through the chest CT scanning. METHODS: We reviewed medical records and chest CT findings of 190 pulmonary contusion patients retrospectively. Both lung were devided into 4 areas, RUL +RML, RLL, LUL, and LLL (RUL: right upper lobe, RML:right middle lobe, LUL:left upper lobe, LLL: left lower lobe). 3 point were given to each area, maximally. In each area, a ratio was measured as the longest pulmonary contusion length per the transverse axis length of lung on the largest pulmonary contusion image of chest CT scan. The score can be obtained by multiplying 3 to the ratio and raising fractions not lower than 0.5 to a unit. We classified to three groups as mild (PCS 0-2), moderate (3-5), and severe (6-12) PCS groups. RESULTS: 179 patients with pulmonary contusion were classified as 94 mild, 52 moderate, 33 severe pulmonary contusion groups by PCS. As PCS was high, PRF (Pao2/ FiO2) was decreasing, number of patients treated with mechanical ventilation was increasing, ICU stay was long, and a complication rate was increasing. CONCLUSION: For patients with blunt chest trauma at ED which classified as severe PCS group (6-12), the patients need ICU admission and active treatment for a long time to reduce the mortality and complication rate.

Usefulness of the serum Helicobtacer Pylori IgG Test in Children Who Visit the Emergency Department with an Unknown Cause of Gastrointestinal Symptoms

PURPOSE: Children visit the emergency department (ED) with more severe abdominal pain, nausea, and vomiting without specific cause than any other outpatients, and many have recurrent abdominal pain (RAP). For that reason, we examined the correlation between Helicobacter pylori (H. pylori) infection and these symptoms. METHODS: From August 2001 to January 2002, serum samples of H. pylori IgG were collected prospectively from 90 children under 17-years old who had visited our ED with the above symptoms. Of these, 40 children satisfying Apley 's criteria were researched. H. pylori infection was defined as a positive result on a CLO test or a C13-Urea Breath test or a modified Giemsa stain. RESULTS: The male-to-female ratio was 1.5 : 1, and the mean age was 8.6 +/- 3.9 years old. The mean value of the IgG level was 16.1 +/- 22.2 U/mL. Seropositive patients accounted for 11 cases (28%). Of the 30 children who had undergone upper endoscopy, 15 children were confirmed as having an H. pylori infection. The sensitivity and the specificity of H. pylori IgG were 47% and 73%. In the school-age group (>or=8 years old), the rates of IgG positivity and infection were 42% (10/24) and 70% (14/20), compared with the preschool age group value of 6% (1/16) and 10% (1/10). The most common upper endoscopy findings was nodular gastritis in 23 patients. CONCLUSION: The rate of H. pylori infection in children visiting the ED with unknown causes of above symptoms was higher than it was in a recent study. In the ED, H. pylori IgG may be required as a screening test in such children.