ABSTRACT
BACKGROUND: Advanced information technology can be used when developing diagnostic and treatment strategies to provide better care for diabetic patients. However, the levels of need and demand for the use of technological advances have not been investigated in diabetic patients. We proposed and developed an individualized, ubiquitous (U)-healthcare service using advanced information technology for more effective glucose control. Prior to our service initiation, we surveyed patient needs and other pertinent information. METHODS: During August 2009, we conducted a 34-item questionnaire survey among patients with diabetes who were older than 40 years in two certain hospitals in Korea. RESULTS: The mean age of the 228 participants was 61.2+/-9 years, and males made up 49.1% of the sample. Seventy-one percent replied that they wanted individualized healthcare service, and they also wanted their health information to be delivered through mobile devices such as a cellular phone or a personal digital assistant (40.4%). Most patients had never heard of U-healthcare services (81.1%); however, after explaining the concept, 71.1% of participants responded that they would use the service if it was provided. Despite their willingness, participants were concerned about technical difficulty in using the service (26.3%) as well as the cost of the service (29.8%). CONCLUSION: The current study suggests that more than 70% of diabetic patients are interested in using U-healthcare services. To encourage widespread use, the application program or device of U-healthcare services should be simple, easy to use and affordable while also including a policy for the protection of private information.
Subject(s)
Humans , Male , Blood Glucose , Cell Phone , Computers, Handheld , Delivery of Health Care , Diabetes Mellitus , Glucose , Surveys and QuestionnairesABSTRACT
PURPOSE: Since 2002, Department of Surgery, Yonsei University Wonju College of Medicine attempted to revise the evaluation method of surgical clerkship program. The purpose of this study was to analyze the effect after change of evaluation method. METHODS: Major changes in current revisions were summarized as follows; (1) multiple evaluator, (2) student's attitude evaluated by rating scale method, (3) attendance and procedure evaluation were measured in numbers according to the fixed criteria, (4) addition of clinic-based items such as problem-solving items in the final written examination. We compared the measurement of revised evaluation at 2002 with those at 1999. And the correlation or simple linear regression analysis between score of clerkship and student academic grade score were taken. RESULTS: The clerkship score of students at 2002 showed more powerful discrimination between high performance group and poor group than that of 1999's. Even though the subject score of clerkship was significantly correlated with grade score regardless of evaluation method of clerkship, the subject score of clerkship at 2002 was more closely correlated with a grade score than 1999's. The score of knowledge-based items from final written examination is not correlated with clerkship score, but on the other hands, there was significant correlation between score of clinic-based items and clerkship score. CONCLUSION: In conclusion, variable measurements under the exact guideline and principle are more reliable method in evaluation of surgical clerkship.
Subject(s)
Humans , Discrimination, Psychological , Hand , Linear ModelsABSTRACT
Although Leuconostoc species with intrinsic high-level vancomycin resistance have rarely been isolated from clinical specimens, this organism may cause serious invasive infections such as bacteremia and meningitis in immunocompromised hosts or patients with a wide spectrum of underlying diseases including alcoholic liver diseases and gastrointestinal diseases. Predisposing factors of Leuconostoc bacteremia include intravenous or enteral feeding catheters, other invasive access devices such as tracheostomy, gastrostomy or endotracheal tubes, and previous antimicrobial treatment. This low prevalence may be due, in part, to the inability of automated systems to recognize this organism. It is important that all Leuconostoc isolates obtained from clinical specimens that are related to serious infections should be identified to species level for appropriate antibiotic therapy. We report two cases of Leuconostoc bacteremia occurring in a 65-year-old male with variceal bleeding, and in a 5 month child with ileostomy receiving total parenteral nutrition therapy.
Subject(s)
Aged , Child , Humans , Male , Bacteremia , Catheters , Causality , Enteral Nutrition , Esophageal and Gastric Varices , Gastrointestinal Diseases , Gastrostomy , Ileostomy , Immunocompromised Host , Leuconostoc , Liver Diseases, Alcoholic , Meningitis , Parenteral Nutrition, Total , Prevalence , Tracheostomy , Vancomycin ResistanceABSTRACT
Hirschsprung's disease (HD) is usually diagnosed in the newborn period and early infancy. The common presentation of HD in newborns consists of a history of delayed passage of meconium within the first 48 hours of life. The differential diagnosis in newborns is one of the clinical challenges of this disorder. A number of medical conditions which cause functional obstruction of the intestines are easily excluded. Neonates with meconium ileus, meconium plug syndrome, distal ileal atresia and low imperforate anus often present in a manner similar to those with HD in the first few days of life. Abdominal radiographs may help to diagnose complete obstruction such as intestinal atresia. Microcolon on contrastenema can be shown in cases with total colonic aganglionosis, ileal atresia or meconium ileus. Suction rectal biopsy or frozen section biopsy at operation is essential for differential diagnosis in such cases. HD is also considered in any child who has a history of constipation regardless of age. Older children with functional constipation may have symptoms that resemble those of HD and contrast enema is usually diagnostic. However, children with other motility disorders generally referred to as chronic idiopathic intestinal pseudoobstruction present with very similar symptoms and radiographic findings. These disorders are classified according to their histologic characteristics.; visceral myopathy, visceral neuropathy, intestinal neuronal dysplasia (IND), hypoganglionosis, immature ganglia, internal sphincter achalasia. Therefore, the workup for motility disorders should include rectal biopsy not only to confirm the presence of ganglion cells but also evaluate the other pathologic conditions.
Subject(s)
Child , Humans , Infant, Newborn , Anus, Imperforate , Biopsy , Constipation , Diagnosis, Differential , Enema , Esophageal Achalasia , Frozen Sections , Ganglia , Ganglion Cysts , Hirschsprung Disease , Ileus , Intestinal Atresia , Intestinal Pseudo-Obstruction , Intestines , Meconium , Neurons , SuctionABSTRACT
The etiology of several motility disorders, including persistent megacolon after definitive surgery for Hirschsprung's disease, meconium ileus which is not associated with cystic fibrosis and idiopathic megacolon, is still unclear. Interstitial cells of Cajal (ICC) are thought to modulate gut motility as gastrointestinal pace maker cells. The aim of this study was to evaluate the role of ICC in the bowel walls of the patients (n=15) who had variable motility disorders. The ICC were identified by immunohistochemical staining using an anti-C-Kit antibody and the results were compared with control specimens (n=2). The control group (G1) showed evenly distributed ICC in their bowel walls. The second group (G2, n=5) who had normal bowel movements after Duhamel procedures and the third group (G3, n=4) who had persistent megacolon after Duhamel procedures showed absent or scarcely distributed ICC in their aganglionic bowels. The ICC were identified by immunohistochemical staining using an anti-C-Kit antibody and the results were compared with control specimens (n=2). The control group (G1) showed evenly distributed ICC in their bowel walls. The second group (G2, n=5) who had normal bowel movements after Duhamel procedures and the third group (G3, n=4) who had persistent megacolon after Duhamel procedures showed absent or scarcely distributed ICC in their aganglionic bowels. Whereas ICC were evenly distributed in the ganglionic bowels of G2, they were not seen or scarecely distributed in the ganglionic bowels of G3. Two patients (G4) who suffered from idiopathic megacolon showed absence or decrease of ICC in spite of presence of ganglion cells in their colons. Four neonates (G5) who underwent ileostomy because of meconium obstruction showed absent or markedly decreased ICC in the colon at the time of ileostomy and the distribution of ICC was changed to a normal pattern at the time of ileostomy closure between 39-104 days of age and their bowelmotility were restored after that. The results suggest that lack of ICC caused reduce motility in the ganglionic colons and it may be responsible for the development of various motility disorders. Delayed maturity of ICC may also play a role in the meconium obstruction of neinates.
Subject(s)
Humans , Infant, Newborn , Colon , Cystic Fibrosis , Ganglion Cysts , Hirschsprung Disease , Ileostomy , Ileus , Interstitial Cells of Cajal , Meconium , MegacolonABSTRACT
This study was performed to develop the basic technique for standardization that will be used in the medical environment. The following paper describes the design and implementation of a software framework that could be used to construct an HL7 message server. HL7 message server is combined with existing HIS and generates the corresponding HL7 messages automatically whenever the predefined events occur. We developed HL7 message server modules which can automatically link patient data to the appropriate message component in order to populate ADT and ORU messages. The key modules are UIT monitor, message generator and TCP/IP connection module. UIT is designed to integrate all data items needed to create a message in this HIS database table. The UIT monitor module checks regularly the occurrences of predefined events in HIS. The message generator module links the UIT data to the appropriate message generating functions to create a message. And the TCP/IP connection module works as a socket module for the stable network connection. The prototype of HL7 message server showed the performance of creating 100 messages in a second. This evaluation result confirmed that our HL7 message server presents a promising model for the incorporation of HL7 standard into existing Korean HIS.
Subject(s)
Humans , Information DisseminationABSTRACT
This study was performed to integrate the results of previous studies that investigated the relationship between body mass index (BMI) and prognosis in breast cancer. We reviewed the English literatures using the MEDLINE database from 1966 to 1999. The materials included 12 published articles with a total of 8,029 cases of breast cancer. The effect size was obtained from hazard ratio in each study. Homogeneity test was conducted before the integration of each effect size and the result demonstrated that the studies were heterogeneous. A random effect model was used to integrate the overall effect size. The integrated effect size was 1.56 (95% confidence interval, 1.22-2.00). In addition, publication bias should be accounted for because each published study was asymmetric in shape revealed by funnel plot. These results suggest that BMI have a prognostic significance in breast cancer. We believe that well-designed longitudinal studies, involving a large number of samples are required to resolve these issues.
Subject(s)
Female , Humans , Body Mass Index , Breast Neoplasms/mortality , PrognosisABSTRACT
Intussusception in adults, a rare disease, constitutes approximately 5% of all intussusceptions and accounts for 5% of all cases of intestinal obstruction. In the pathologic findings of the causative lesion, metastatic tumors of the small intestine with intussusception are extremely rare. Because of the high prevalence of underlying lesions in intussusception in adults, surgical management is mandatory. We report two cases of intussusception; one was an adult patient who developed an ileo-ileal type, metastasis from lung cancer, and the other patient was an adult who was developed jejuno-jejunal type, metastasis from a malignant melanoma of the thumb.
Subject(s)
Adult , Humans , Intestinal Obstruction , Intestine, Small , Intussusception , Lung Neoplasms , Melanoma , Neoplasm Metastasis , Prevalence , Rare Diseases , ThumbABSTRACT
Injured spleens have been successfully managed without operation in a number of children; however, splenectomy or splenic-conserving surgery may not be avoided because of exsanguinating hemorrhage. This study was performed to evaluate the efficacy of splenic arterial embolization (SAE) to control hemorrhage from injured spleens in children. We compared the outcomes of two groups of children with splenic injury. The first group (G1) consisted of eighteen children who were managed with conventional selective nonoperative treatment between 1993 and 1994. The second group (G2) consisted of 23 children prospectively studied from 1996 to 1997 after SAE was added in the management protocol of splenic injury. The criteria for SAE were grade III or IV injury, extravasation of contrast material revealed by CT, or unstable vital signs without evidence of associated injuries. Laparotomy was performed in 6 patients of G1 (33.3%), 2 of whom had associated injuries. Five underwent splenectomy and the overall salvage rate in G1 was 72.2% (13/18). In G2, eight patients (34.8%) had SAE, which stopped bleeding successfully in all patients. Two of G2 (8.7%) had laparotomy because of associated injuries. Only one patient underwent splenectomy and the salvage rate was 95.6% (22/23). No patients required transfusion after SAE. In conclusion, the SAE effectively controlled hemorrhage from injured spleens. More spleens were salvaged with a reduced laparotomy rate after application of SAE in splenic injury.
Subject(s)
Child , Humans , Exsanguination , Hemorrhage , Laparotomy , Prospective Studies , Spleen , Splenectomy , Vital SignsABSTRACT
A recent application of anal endosonography has been popularized in adult patients to access staging of the rectal cancer and other lesions of the anorectum; however, this study has not been familiar to pediatric surgeons. We performed anal endosonography in 30 children without anorectal disease in order to obtain standard morphology of the anorectum. Internal anal sphincter (IAS) was clearly identified as a homogeneous hypoechoic circular band, extending caudally to a level just proximal to anal verge. The external anal sphincter (EAS) showed mixed echogenicity and different architecture along anal canal ; the EAS had U-shape in the upper canal and it showed circular pattern in the lower canal. In the upper canal of girls, the perineal body and the vagina were shown just anterior of the anal canal, which made the U shape of the EAS, whereas in male the sphincter tapered anteriorly into two arcs that met in the midline. The perineal body was prominent in female. Posteriorly, the anococcygeal ligament showed triangular shadow in both sex. The thickness of the IAS was measured in 3 directions, left, right and posterior, at 3 levels, upper, middle and lower of the anal canal. The average thiskness was 0.86-2.40mm between 6 and 18 months of age (Group 1), 0.88-3.20mm between 19 and 36 (Group 2), 1.07-2.20mm between 37 and 54 (Group 3) and 1.18-2.42mm more than 54-month-old (Group 4). The thickness was correlated wtih the age of the children only in the right upper(p=0.008) and the left middle portion (p=0.015). We could obtain standard morphologic features of normal anal canal in children with anal endosonography and we also believe that this technique is a safe and an effective procedure to evaluate anorectal lesions in children.
Subject(s)
Adult , Child , Female , Humans , Male , Anal Canal , Endosonography , Ligaments , Rectal Neoplasms , VaginaABSTRACT
BACKGROUND: This study was to access the hemostatic effectiveness of transcatheter arterial embolization (TAE) in a blunt splenic injury. We evaluated the efficacy of using detailed angiographic examnination and embolization for the nonsurgical management of patients with spleen injury. METHODS: Blunt splenic injuries diagnosed by Computed tomography (CT) between January 1997 and December 1997 were prospectively studied according to our management algorithm. The first group (G1) consisted of patients who were observed only, the second grourp (G2) with consisted of patients receving a TAE, and the third group (G3) consisted of those receving a laparotomy. The criteria for a TAE were: 1) Type III or IV injury and 2) extravasation of contrast material revealed by CT. RESULTS: Of the total 46 patients with blunt splenic injury, 17 underwent emergency laparotomies because of associated injuries or unstable vital signs after resuscitation. Fourteen of the 17 had splenectomies and the other three had splenorrhaphies. The remaining 29 patients were considered for nonoperative management (63%), and 13 of them were selected for a TAE. Splenic angiography showed active bleeding in 12 and minor bleeding in one. The bleeding was successfully controlled by TAE in all 13 patients. Abdominal CT and scintigraphy taken after TAE disclosed well functioning spleens. The total splenic salvage rate was 63% in our patients. CONCLUSION: We could reduce the laparotomy rate and could preserve more spleens after application of TAE. Our success rate for splenic salvage should encourage more extensive use of a TAE for splenic injury.
Subject(s)
Humans , Angiography , Emergencies , Hemorrhage , Laparotomy , Prospective Studies , Radionuclide Imaging , Resuscitation , Spleen , Splenectomy , Tomography, X-Ray Computed , Vital SignsABSTRACT
Eleven patients underwent posterior sagittal anorectoplasty(PSARP) as a secondary procedure. Two of them had rectovaginal fistula and another two had rectocutaneous fistula. Six of the rest complained of frequent fecal soiling and the last one had severe anorectal stricture after perineal anoplasty. Five patients had lived with colostomy until the second operations were carried out. The ages at the time of the secondary PSARP were between 7 months and 29 years. Distal colostogram and MRI were taken to evaluate distal colon, position of the rectum and voluntary muscle. All patients had normal sacrum except one who had anorectal stricture. Seven patients, six with fecal incontinence and the other one with rectovaginal fistula had mislocated anorectums. Three patients, two with rectocutaneous fistula, the other one with anorectal stricture, had abdominal approach to obtain enough length of colon for pull-through procedure. With the posterior midsagittal approach, we could manage all the problems, rectovaginal fistulas, rectocutaneous fistulas, strictures and malpositioned rectums, without difficulty. No patients had serious complications except wound infection in one. All patients were satisfied with the results after redo-PSARPs even though normal continence has been achieved in only one patient. Seven patients who had continuous soiling or rectocutaneous fistula, needed no more diapers even though four of them showed fecal staining under stressful condition and the other three showed intermittent fecal leaking less than once a day. The rest three of the patients maintained their continence with support of drugs and/or enemas because of constipation. The PSARP is a popular procedure as a primary operation; however, our results suggested that this procedure also gave us a good opportunity for management of serious complication developed after primary anoplasties.
Subject(s)
Humans , Colon , Colostomy , Constipation , Constriction, Pathologic , Enema , Fecal Incontinence , Fistula , Magnetic Resonance Imaging , Muscle, Skeletal , Rectovaginal Fistula , Rectum , Sacrum , Soil , Wound InfectionABSTRACT
During a 6-year period, from January 1990 to December 1995, 101 neonates with congenital anomalies were admitted to the division of pediatric surgery of Youngdong Severance Hospital. Fifty eight of them had prenatally detectable anomalies by ultrasonography and all of them had prenatal screening more than once with ultrasound. The abnormalities were prenatally detected in 24 neonates (41%). The detection rate was 70% in patients who had the prenatal screening at our hospital, whereas, the rate was 24% when it was performed at other medical facilities. Duodenal and jejunoileal atresias showed the highest detection rate (86%) and the next was the abdominal mass. The esophageal atresia was suggested by maternal polyhydramnios in 3 patients (25%). The only one patient with diaphragmatic hernia (17%) and no patients with gastroschisis were prenatally detected. The mean interval from birth to operation was 32 hours in the prenatally detected patients and 50 hours in the nondetected. The complication rate and the mortality after emergency operation were 20% and 7% in the detected group and 58% and 23% in the nondetected, respectively. The average period of the hospitalization was 20 days in the detected group and 39 days in the nondetected. We conclude that the prenatal detection of anomalies was necessary in order to give adequate care to the mothers and the babies, including early transfer to the tertiary care hospital, the decision of the optimal timing of delivery and of the timing of operation for babies. The prenatal diagnosis was also helpful to reduce the operative complication and the mortality.
Subject(s)
Humans , Infant, Newborn , Diagnosis , Emergencies , Esophageal Atresia , Gastroschisis , Hernia, Diaphragmatic , Hospitalization , Mortality , Mothers , Parturition , Polyhydramnios , Prenatal Diagnosis , Tertiary Healthcare , Ultrasonography , Ultrasonography, PrenatalABSTRACT
In a retrospective study, the prognostic value of monitoring the decay of alpha-fetoprotein (AFP) was assessed. Serum AFP was determined serially in 18 children with malignant germ cell tumors or malignant hepatic tumors: Fifteen children had malignant germ cell tumors (endodermal sinus tumor;7, embryonal carcinoma;3, malignant teratoma;5). Two children had hepatoblastoma and a third had hepatocellular carcinoma. The actual half-life (AHL) of AFP was computed according to the formula after the surgical resection of the tumor. In group 1, which had a complete resection and no recurrence during follow-up (n=13), the AHL of AFP was 4.0+/-0.9 days. In group 2, which had a incomplete resection or recurrence during follow-up (n=5), the AHL of AFP was 24.8+/-20 days. The AHL of group 2 was significantly longer than that of group 1 (p = 0.0026). The increased AHL of AFP indicated the residual active tumor after surgical resection. The AHL of AFP may be more sensitive than the serial monitoring of AFP in detecting the preclinical recurrence after surgical resection of AFP secreting tumors. Treatment strategies can be based on AFP clearance and prospective clinical trials are warranted.