New Integrated Information System for Pusan National University Hospital / 대한의료정보학회지

OBJECTIVES: This study presents the information system for Pusan National University Hospital (PNUH), evaluates its performance qualitatively, and conducts economic analysis. METHODS: Information system for PNUH was designed by component-based development and developed by internet technologies. Order Communication System, Electronic Medical Record, and Clinical Decision Support System were newly developed. The performance of the hospital information system was qualitatively evaluated based on the performance reference model in order to identify problem areas for the old system. The Information Economics approach was used to analyze the economic feasibility of hospital information system in order to account for the intangible benefits. RESULTS: Average performance scores were 3.16 for input layer, 3.35 for process layer, and 3.57 for business layer. In addition, the cumulative benefit to cost ratio was 0.50 in 2011, 1.73 in 2012, 1.76 in 2013, 1.71 in 2014, and 1.71 in 2015. The B/C ratios steadily increase as value items are added. CONCLUSIONS: While overall performance scores were reasonably high, doctors were less satisfied with the system, perhaps due to the weak clinical function in the systems. The information economics analysis demonstrated the economic profitability of the information systems if all intangible benefits were included. The second qualitative evaluation survey and economic analysis were proposed to evaluate the changes in performance of the new system.

PGE2 Regulates Pacemaker Currents through EP2-Receptor in Cultured Interstitial Cells of Cajal from Murine Small Intestine

The interstitial cells of Cajal (ICCs) are the pacemaker cells in gastrointestinal tract and generate electrical rhythmicity in gastrointestinal muscles. Therefore, ICC may be modulated by endogenous agents such as neurotransmitter, hormones, and prostaglandins (PGs). In the present study, we investigated the effects of prostaglandins, especially PGE2, on pacemaker currents in cultured ICCs from murine small intestine by using whole-cell patch clamp techniques. ICCs generated spontaneous slow waves under voltage-clamp conditions and showed a mean amplitude of -452+/-39 pA and frequency of 18+/-2 cycles/min (n=6). Treatments of the cells with PGE2 (1muM) decreased both the frequency and amplitude of the pacemaker currents and increased the resting currents in the outward direction. PGE2 had only inhibitory effects on pacemaker currents and this inhibitory effect was dose-dependent. For characterization of specific membrane EP receptor subtypes, involved in the effects of PGE2 on pacemaker currents in ICCs, EP receptor agonists were used: Butaprost (1muM), EP2 receptor agonist, reduced the spontaneous inward current frequency and amplitude in cultured ICCs (n=5). However sulprostone (1muM), a mixed EP1 and EP3 agonist, had no effects on the frequency, amplitude and resting currents of pacemaker currents (n=5). SQ-22536 (an inhibitor of adenylate cyclase; 100muM) and ODQ (an inhibitor of guanylate cyclase; 100muM) had no effects on PGE2 actions of pacemaker currents. These observations indicate that PGE2 alter directly the pacemaker currents in ICCs, and that the PGE2 receptor subtypes involved are the EP2 receptor, independent of cyclic AMP- and GMP-dependent pathway.

Expression of Bradykinin Receptors and Effects of Bradykinin in the Interstitial Cells of Cajal from Mouse Small Intestine / 체질인류학회지

Interstitial Cells of Cajal (ICC) are pacemaker cells that generates slow waves and drive spontaneous mechanical contractions of gastrointestinal smooth muscle. Slow waves are generated the periodic activation of spontaneous inward currents (pacemaker currents). We studied the modulation of pacemaker activities by bradykinin (10-8 M) in cultured ICC with the whole cell patch-clamp technique, and the localization of bradykinin-2 receptor-immunoreactivity using double labelling immunohistochemistry in the murine small intestine. Externally applied bradykinin produced membrane depolarization in current-clamping mode. At a -70 mV of holding potential bradykinin increased tonic inward pacemaker currents. Double labelling with bradykinin-2 receptor and and c-kit was shown that ICC expressed the bradykinin-2 receptor-immunoreactivity. These results suggest that bradykinin modulates electrical activities of ICC via bradykinin-2 receptor, which may regulate gastrointestinal motility.

A Case of Suspected Post-Irradiation Delayed Necrotizing Leukoencephalopathy

Therapeutic irradiation may produce a variety of adverse side effects on the central and the peripheral nervous systems. These adverse effects are divided into two main groups; transient and permanent. Four major clinical syndromes have been described in relation to permanent radiation injury of the nervous system: encephalopathy, cranial neuropathy, myelopathy, and peripheral neuropathy. Among them, delayed encephalopathy represents the major hazard in CNS irradiation. The characteristic MR imaging pattern of radiation induced delayed necrotizing leukoencephalopathy is symmetric, high-signal foci on T2WI in the periventricular white matter. We report a case of suspected post-irradiation leukoencephalopathy showed progressive mental change, quadriparesis, and urinary incontinence with characteristic MR findings who had taken therapeutic irradiation 12 months ago.

Intravenous Immunoglobulin Therapy in Guillain-Barre Syndrome

High dose intravenous immunoglobulin (IVIg) therapy can improve the clinical course of several immune mediciated diseases. We evaluated clinical effects and side effects of IVIg in Guillain-Barre syndrome (GBS). 19 Patients with GBS were studied prospectively in a placebo-controlled trial. 11 Patients were received high dose IVIg (400mg/kg for 5 days) and controls received only conservative treatment. The disability scores using modified Rankin scores before and after treatment of each group were compared. Four weaks later, mean Rankin Score of IVIg group was 2.5 + 0.7 and control group was 3.3+ 0.5which showed significant difference(p<0.05). There were no serious advers effer of promote early improvement with safety in acute phase of Guillan-Barre syndrome.

A Study on the Prevalence of Dementia and its Related Factors in the Rural Elderly

For the purpose of investigation of prevalence, etiology and its related factors of the dementia in the rural elderly, the author examined 650 elderly people aged 60 years or more via cluster sampling by using a door to door 2 phase design from June 1992 to July 1992. The cognitive impairment was assessed by MMSEK in the first screening phase, and in the second phase 252 people in the dementia suspected group (MMSEK score 24) were taken to the clinical examination for the diagnosing dementia. The results were as follows; 1. The prevalence rate of dementia was 21.3% in the rural elderly, and was higher in females (31.1%) than in males (10.7%) (p<0.01). 2. The prevalence rates of dementia in males aged 60-69, 70-79 and over 80 were 4.1%, 16.7% and 50.0% respectively and those in female were 8.7%, 49.3%, 72.2% respectively. The rates increased significantly with increasing age in both sexes (p<0.01). 3. The prevalence rates of the mild, moderate and severe dementia were 8.4%, 9.3% and 3.6% respectively and increased significantly with increasing age in females (p<0.001). 4. The proportional distribution of dementia type by etiological classification was 63.6% senile dementia of Alzheimer's type, 17.7% vascular dementia, 10.4% mixed dementia, 4.2% alcoholic dementia, 1.0% posttraumatic dementia and 3.1% for others. 5. In multiple logistic regression analysis for affecting factors of the dementia, the significant variables were level of physical activity, age, education and sex. The Odds ratios in factors were low level of physical activity 6.0 x (95% CI 2.4-15.1), age over 70 4.8 x (95% CI 2.2-10.7), no formal education 3.9 x (95% CI 1.1-13.8), and female sex 2.2 x (95% CI 1.0-5.0).

A Case of EIEE (Early Infantile Epileptic Encephalopathy)

The EIEE is defined by very early onest, within the first few months of life. Frequent tonic spasms, and suppression burst of EEG pattern in both waking and sleeping state. Its etiology and underlying pathology are obscure. The prognosis is usually grave with severe psychomotor retardation and intractable seizures. Occassionaly it may evolve into the West syndrome. We report a case of 3-month-old female delivered by Casesarean section, who showed typical features of EIEE disorder, with the review of literatures.

A Case of Extrapontine Myelinolysis Without Central Pontine Myelinolysis Following Hyponatremia

Central pontine myelinolysis (CPM) is characterized by regions of demyelination throughout the brain but most prominent in the pons. The symptoms of CPM include rapidly evolving quadriplegia, pseudobulbar palsy and varying degree of altered consciousness. The exact pathogenesis is unknown. We report a rare case of extrapontine myelinolysis (EPM) without CPM; A 49-year-old man with chronic alcoholism and chronic type B hepatitis were presented with clinical symptoms of rapidly progressive quadriplegia and pseudobulbar palsy preeded by hyponatremia. Magnetic resonance imaging in this patient showed bilateral increased T2-weighted signals in the caudate nucleus and the putamen.

A Case of Absence Status as Initial Manifestation of Brainstem Infarction

Absence status consists of prolonged episodes during which there is a disturbance of mental function in association with a continuous repetitive or intermittent spike and wave pattern on the electroencephalography. We report a 14 year-old male who had previous history of partial to secondiary generalized seizure, showed absence status during acute phase of brainstem infarction.