ABSTRACT
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.
Subject(s)
Humans , Emergencies , Emergency Service, Hospital , Fees and Charges , Friends , Patient Satisfaction , Retrospective Studies , Specialization , Tertiary Care CentersABSTRACT
No abstract available.
Subject(s)
Humans , Spinal Cord Injuries , Spinal Cord , Urinary BladderABSTRACT
PURPOSE: Autonomic dysreflexia represents one of the most serious medical emergencies in the care and rehabilitation of patients with spinal cord injury. We evaluated the effect of terazosin for the prevention of symptoms due to autonomic dysreflexia in patients with spinal cord injury. MATERIALS AND METHODS: The effect of terazosin was evaluated in 20 spinal cord injury patients with autonomic dysreflexia. All patients received terazosin as the only medication for the autonomic dysreflexia. Baseline measurements of blood pressure, the autonomic dysreflexia severity score and autonomic dysreflexia frequency score were recorded before terazoxin medication. Follow-up measurements were taken at 1 week, 1 month and 3 month after medication. All the data were statistically evaluated and the following results were obtained. RESULTS: The majority of patients(95%) had manifested headache and sweating. The autonomic dysreflexia severity score after terazosin medication decreased from an average of 9.0+/-0.6 at baseline to 6.8+/-0.7, 5.2+/-0.7 and 4.9+/-0.6 at 1 week, 1 month and 3 months repectively(p=0.001). And the autonomic dysreflexia frequency score after terazosin medication decreased from an average of 2.4+/-0.5 to 1.2+/-0.4 at 3 months. CONCLUSION: Tetazosin appears to be effective in preventing symptoms due to autonomic dysreflexia.
Subject(s)
Humans , Autonomic Dysreflexia , Blood Pressure , Emergencies , Follow-Up Studies , Headache , Rehabilitation , Spinal Cord Injuries , Spinal Cord , Sweat , SweatingABSTRACT
We report a case of retroperitoneal liposarcoma mimicking lipoma which was found on follow-up studies in a 67-year old man with stomach cancer. Preoperative computerized tomography of abdomen and biopsy confirmed the diagnosis of right retroperitoneal liposarcoma, which was treated with surgery and radiation therapy.
Subject(s)
Aged , Humans , Abdomen , Biopsy , Diagnosis , Follow-Up Studies , Lipoma , Liposarcoma , Stomach NeoplasmsABSTRACT
337 spinal cord injured patients had been followed up for urologic management in Korea Veterans Hospital. 106 spinal cord injured patients, admitted due to urologic complications from 1990 to 1995, were analyzed. The level of cord injury was cervical in 26, thoracic in 63 and lumbar in 17 patients. The voiding method was suprapubic cystostomy in 32, clean intermittent catheterization in 27, self-voiding in 25, condom catheter in 14, urethral catheter in 6 and others in 2 patients. The common urologic complications were acute pyelonephritis, bladder stone, epididymitis, vesicoureteral reflux, low vesical compliance, autonomic dysreflexia and bladder tumor. Medical treatments for urologic complications were performed for 79 cases (46%) and surgical treatments for 92 cases (54%) We conclude that periodic urologic follow-up will be needed for early detection and management of urologic complications due to spinal cord injury.
Subject(s)
Humans , Male , Autonomic Dysreflexia , Catheters , Compliance , Condoms , Cystostomy , Epididymitis , Follow-Up Studies , Hospitals, Veterans , Intermittent Urethral Catheterization , Korea , Pyelonephritis , Spinal Cord Injuries , Spinal Cord , Urinary Bladder Calculi , Urinary Bladder Neoplasms , Urinary Catheters , Vesico-Ureteral RefluxABSTRACT
We report a case of prostatic abscess in a 46-year old man with chronic myelocytic leukemia. Preoperative transrectal ultrasonography and computerized tomography confirmed the diagnosis of prostatic abscess, which was treated with pus drainage via transurethral resection of prostate and broad-spectrum antibiotics.
Subject(s)
Humans , Middle Aged , Abscess , Anti-Bacterial Agents , Diagnosis , Drainage , Leukemia, Myelogenous, Chronic, BCR-ABL Positive , Suppuration , Transurethral Resection of Prostate , UltrasonographyABSTRACT
Long-term indwelling catheters constitute a risk factor for the development of bladder malignancy. Our study was designed to compare the incidence of bladder cancer and histological changes in the urinary bladder of spinal cord injury patients who had been catheterized for more than 11 years (group 1) and less than 10 years (group 2). Mean duration of catheterization was 17.7 years (range 11-38 years) and 6.5 years (range 2-10 years), respectively in both groups. Our study was performed by cystoscopic evaluation and random bladder biopsy in 23 patients in group 1 and 25 patients in group 2 followed at the Korea Veterans Hospital. The follow-up interval, mechanism, level and degree of injury for both groups were similar. The suprapubic cystostomy was the most common voiding method in both groups (73.9% and 60.0%, respectively). Transitional cell carcinoma in one patient and adenocarcinoma in two patients were found in group 1 and transitional cell carcinoma in one patient was found in group 2. Two patients in group 1 showed squamous metaplasia. 18 patients in group 1 and 24 patients in group 2 showed chronic cystitis. Microscopic hematuria (greater than 2-4 RBC/HPF) was present in all patients. IVPs demonstrated no filling defect of upper tracts in all patients. Overall, the incidences of bladder cancer were 13.0% (3/23) in group 1 and 4.0% (1/25) in group 2. But there was no significant difference in the incidence of bladder cancer between both groups (p=0.279). We suggest that any spinal cord injury patient with hematuria needs a complete bladder evaluation and should undergo cystoscopy and random bladder biopsy.
Subject(s)
Humans , Adenocarcinoma , Biopsy , Carcinoma, Transitional Cell , Catheterization , Catheters , Catheters, Indwelling , Cystitis , Cystoscopy , Cystostomy , Follow-Up Studies , Hematuria , Hospitals, Veterans , Incidence , Korea , Metaplasia , Risk Factors , Spinal Cord Injuries , Spinal Cord , Urinary Bladder Neoplasms , Urinary BladderABSTRACT
The synchronous presentation of two separate neoplasms is extremely unusual. In 1921, Graves and Temleton first discovered synchronous two neoplasms in the same kidney. However, almost all reported synchronous tumors arising in a same kidney have been renal cell carcinoma and transitional cell carcinoma. We report a case report of a synchronous renal cell carcinoma and adult Wilms' tumor in a same kidney in a 41-year-old woman which was managed by radical nephrectomy and combination chemotherapy.
Subject(s)
Adult , Female , Humans , Carcinoma, Renal Cell , Carcinoma, Transitional Cell , Drug Therapy, Combination , Kidney , Nephrectomy , Wilms TumorABSTRACT
Although genitourinary leiomyoma may arise in any anatomic structure containing smooth muscle, primary leiomyoma of the bladder is rare. This tumor is usually asymptomatic unless urinary tract function is affected. We experienced a case of leiomyoma of the bladder with back pain in a 42 year old woman.
Subject(s)
Adult , Female , Humans , Back Pain , Leiomyoma , Muscle, Smooth , Urinary Bladder , Urinary TractABSTRACT
One of the most severe complications of pelvic irradiation is radiation-induced bladder injury such as hemorrhagic radiation cystitis. We performed microscopic examination in 36 cases with hemorrhagic radiation cystitis to evaluate the pathologic changes induced by radiation. Transurethral cystoscopic biopsy was performed in 36 cases with hemorrhagic radiation cystilis. Light microscopic examination was done in 36 cases and transmission electron microscopic examination was done in 16 cases. Light microscopy in transitional cell epithelium revealed ulceration and inflammatory cell infiltration in the basal area of ulceration. Light microscopy in lamina propria revealed hyalinization, edema, inflammarory cell infiltration, hemorrhage, telangiectasia and fibrinoid necrosis of endothelial cells. Transmission electron microscopy in stroma revealed increased cellularity in 14 cases, enlargement or ribroblast in 4 cases, dilatation of rough endoplasmic reticulum(RER) in 5 cases, and large nucleoli in 4 cases among 16 cases. Enlargemenr of endothelial cells was found in 10 cases and multiplication or vascular basal lamina around the capillaries was found in 8 cases among 13 cases. We believe this study would be helpful to develop adequate treatment modality for hemorrhagic radiation cystitis.
Subject(s)
Basement Membrane , Biopsy , Capillaries , Cystitis , Dilatation , Edema , Endothelial Cells , Epithelium , Hemorrhage , Hyalin , Microscopy , Microscopy, Electron , Microscopy, Electron, Transmission , Mucous Membrane , Necrosis , Telangiectasis , Ulcer , Urinary BladderABSTRACT
The neutron beam has higher relative biological effectiveness (RBE) than conventional X or gamma ray because it is densely ionizing radiation which is presented by high linear energy transfer (LET). This physical and radiobiological characteristic plays an important role in killing of cancer cells in the state of biologically radio-resistant to the conventional radiation. The rationale of high LET radiation in the application to clinical radiotherapy is summarized as, high oxygen enhancement ratio (OER), less repair of cell damage, and less dependence of radio-sensitivity on cell cycle. Neutron therapy alone or combined with conventional radiotherapy was performed in 12 patients with stage C or D1 prostatic cancer from Mar. 1987 to Dec. 1989 in Korea Cancer Center Hospital. Local control rate at the time of 24 months after therapy was 67% (4/6) in stage C and 67% (4/6) in stage DI. Two-year actuarial survival rate after therapy was 82% in stage C and 67% in stage D1. The problem of neutron therapy was relatively high incidence of major complication rate, but it could be lessened by the accumulation of experience for neutron therapy. We think neutron therapy to be one of adequate treatment modalities for local control of stage C or Dl prostatic cancer.
Subject(s)
Humans , Cell Cycle , Gamma Rays , Homicide , Incidence , Korea , Linear Energy Transfer , Neutrons , Oxygen , Prostatic Neoplasms , Radiation, Ionizing , Radiotherapy , Relative Biological Effectiveness , Survival RateABSTRACT
Spontaneous rupture of the kidney with subcapsular or perinephric hemorrhage usually occurs secondary to various kinds of underlying diseases such as benign malignant tumor. vascular disease and infection etc. We experienced 2 cases of spontaneous rupture of the kidney secondary to renal cell carcinoma in a 44-year-old female and adult Wilms' tumor in a 17-year-old male.
Subject(s)
Adolescent , Adult , Female , Humans , Male , Carcinoma, Renal Cell , Hemorrhage , Kidney , Rupture, Spontaneous , Vascular Diseases , Wilms TumorABSTRACT
Extragonadal germ cell tumors are rare. accounting for approximately 38 of all germ cell tumors. Debate continues over whether these lesions originate from extragonadal site or are metastatic disease from an undetected testis primary tumor. Recently. we experienced a case of extragonadal mixed germ cell tumor in a 26-year-old male who showed complete response by combination chemotherapy with cisplatin. etoposide. and bleomycin(PVpB) and have remained disease tree for about 14 months since diagnosis. Herein we report the case with brief review of the literature.
Subject(s)
Adult , Humans , Male , Cisplatin , Diagnosis , Drug Therapy, Combination , Etoposide , Germ Cells , Neoplasms, Germ Cell and Embryonal , TestisABSTRACT
The majority of metastatic lesions involving the skull arise from carcinoma of the breast and lung. Bone metastass from a wide speculum of malignant neoplasms may be discussed in general as osteoblastic or osteoclastic in type. In osteoblastic from there are carcinoma of the prostate, carcinoma of the breast, carcinoma of the urinary bladder and rarely hypernephroma and cholangiocellular hepatoma. Osteoclastic metastass are characteristically produced by carcinoma of the lung, uterus, gastrointestinal tract, and thyroid and malignant melanoma, and rarely hepatocellular hepatoma, Osteoclastic or osteolytic lesions are much more frequent. Osteolytic metastass to the skull typically present as multiple radiolucenices with ill-defined margin. Metastases may affect any portion of the skull, not only the calvaria but also the base. Recently we experienced a rare case of metastatic hepatocellular carcinoma to the skull. A 51 year old Korean male was admitted to the Dept. of neurosurgery, on Jan. 18, 1975. Patient had complained of headache and mass on the right frontoparietal region for ca 6 weeks and motor weakness on the left extremities for 2 weeks prior to admission. No jaundice and weight loss were complained. The mass on the right frontoparietal region had increased its size gradually and showed adult fist in its size on admission. Neurological examination on admission disclosed that the adult-fist sized mass on the right frontoparietal region was non-tender and palpated soft, and deep tendon reflexes were hyperactive, on the left, and Lt. Superficial reflexes were diminished. No spasticity was noted, and left grasping power was markedly weak. Hypersthesia was felt on the left of the body. No icterus was found. Nor palpable liver neither spleen was found. No tenderness on the abdomen and no palpable masses were noted. Complete blood cell counting was normal. The blood chemistry including the liver function test revealed normal except increased alkaline phosphatase(10.5 Bodansky units). (-feto-protein was negative. Urinalysis and stool examination were normal. X-ray films of simple skull series revealed multiple radiolucencies with ill-defined margins on the right fronto-parietal bone. Right carotid angiograms showed the left square shifting of the right anterior cerebral artery to the left and compressed downward the Rt. Middle cerebral artery, and abnormal vessels in tumor mass were supplied by only the Rt. External carotid artery extracranially and intracranially. Liver scanning was normal. A decompression craniectomy was performed. Extracranially the tumor mass was brownish yellow and soft, which seemed to be the lipoma in character. The skull bone was destroyed multiply. Intracranilly same mass was found. They were removed totally without any bleeding. The operation was finished in usual way, and biopsy was attempted. The post-operative course was usual one except no recovery of the neurologic deficit for 2 weeks. Microscopic examination revealed a metastatic hepatocelluar hepatoma.