Determinant of Quality of Life in Patients with Chronic Cerebral Infarct

This study investigated how physical and cognitive function and psychological factors affected the health-related quality of life (HRQoL, hereafter HQ) of stroke patients in South Korea. The study enrolled 32 right-handed subjects with chronic cerebral infarction with disability and preserved cognitive function (Mini-Mental State Examination ≥ 20). Physical disability was assessed using the modified Rankin Scale (mRS) and Korean modified Barthel Index (KMBI). Quality of life was measured using the World Health Organization Quality of Life-Abbreviated form (WHOQOL-BREF, hereafter WB) and the 36-Item Short-form Health Survey (SF-36) in face-to-face interviews. Psychological distress was investigated using the Beck Depression Inventory Scale-II. The associations of each domain of WB and SF-36 were investigated using Pearson correlation analyses. Physical disability was negatively correlated with HQ in the SF-36. The physical function and bodily pain scales of the SF-36 were negatively correlated with physical disability. The general health domain of the SF-36 was negatively correlated with psychological scores. Emotional status was associated with physical health, social relationships, and general health in HQ. In summary, the severity of physical disability was associated with the patient's general and physical health and body pain. These findings suggest the importance of psychological, cognitive, and physiological interventions for improving the quality of life of patients after cerebral infarction.

Determinant of Quality of Life in Patients with Chronic Cerebral Infarct

This study investigated how physical and cognitive function and psychological factors affected the health-related quality of life (HRQoL, hereafter HQ) of stroke patients in South Korea. The study enrolled 32 right-handed subjects with chronic cerebral infarction with disability and preserved cognitive function (Mini-Mental State Examination ≥ 20). Physical disability was assessed using the modified Rankin Scale (mRS) and Korean modified Barthel Index (KMBI). Quality of life was measured using the World Health Organization Quality of Life-Abbreviated form (WHOQOL-BREF, hereafter WB) and the 36-Item Short-form Health Survey (SF-36) in face-to-face interviews. Psychological distress was investigated using the Beck Depression Inventory Scale-II. The associations of each domain of WB and SF-36 were investigated using Pearson correlation analyses. Physical disability was negatively correlated with HQ in the SF-36. The physical function and bodily pain scales of the SF-36 were negatively correlated with physical disability. The general health domain of the SF-36 was negatively correlated with psychological scores. Emotional status was associated with physical health, social relationships, and general health in HQ. In summary, the severity of physical disability was associated with the patient's general and physical health and body pain. These findings suggest the importance of psychological, cognitive, and physiological interventions for improving the quality of life of patients after cerebral infarction.

Determinant of Quality of Life in Patients with Chronic Cerebral Infarct

This study investigated how physical and cognitive function and psychological factors affected the health-related quality of life (HRQoL, hereafter HQ) of stroke patients in South Korea. The study enrolled 32 right-handed subjects with chronic cerebral infarction with disability and preserved cognitive function (Mini-Mental State Examination ≥ 20). Physical disability was assessed using the modified Rankin Scale (mRS) and Korean modified Barthel Index (KMBI). Quality of life was measured using the World Health Organization Quality of Life-Abbreviated form (WHOQOL-BREF, hereafter WB) and the 36-Item Short-form Health Survey (SF-36) in face-to-face interviews. Psychological distress was investigated using the Beck Depression Inventory Scale-II. The associations of each domain of WB and SF-36 were investigated using Pearson correlation analyses. Physical disability was negatively correlated with HQ in the SF-36. The physical function and bodily pain scales of the SF-36 were negatively correlated with physical disability. The general health domain of the SF-36 was negatively correlated with psychological scores. Emotional status was associated with physical health, social relationships, and general health in HQ. In summary, the severity of physical disability was associated with the patient's general and physical health and body pain. These findings suggest the importance of psychological, cognitive, and physiological interventions for improving the quality of life of patients after cerebral infarction.

Delayed Extensive White Matter Injury Caused by a Subdural Hemorrhage and Role of Corticospinal Tract Integrity

A subdural hemorrhage (SDH) is a common disorder with usually good prognosis. Most SDHs resolve with or without with minimal sequelae. We present a case report of a patient with SDH, who had delayed extensive white matter injury with disruptions of corticospinal tracts (CSTs) by diffusion tensor imaging (DTI) and showed abysmal prognosis, despite long-term rehabilitation. A 62-year-old man with an SDH underwent burr hole trephination for hematoma removal. Within 7 days, the hemorrhage diminished. At 12 weeks after the onset, the patient's weakness did not improve, and a follow-up magnetic resonance imaging revealed extensive leukomalacia, especially in the white matter. The DTI for CST revealed severe injury of CST integrity. He did not re-gain muscle strength and functional independence, despite 3 months of inpatient rehabilitation. This case describes SDH with delayed extensive white matter injury and exceptional poor prognosis and urges caution in that the SDH may induce very variable functional recovery. Besides, DTI for CST would be useful in predicting the long-term functional prognosis in extensive white matter injury.

Emergency Cesarean Section Rescue of a Fetus from Maternal Severe Drug Intoxication

Herein, we report a case of emergency cesarean section after severe maternal drug intoxication in late pregnancy. At a 38-week-gestation, a 32-year-old woman with a 10-year history of bipolar disorder took olanzapine (200 mg), diazepam (20 mg), and zolpidem (200 mg) as part of a suicidal attempt. Given her unconscious state and the evident concern regarding the toxic effects of the drugs on the fetus, a cesarean section was performed immediately. The patient gave birth to a male baby with Apgar scores of 5 at 1 and 8 at 5 minutes. The baby showed dyspnea and decreased activity directly after birth. After supportive care, the condition of both mother and baby improved and both were discharged.

Application of Sequential Organ Failure Assessment (SOFA) Score in the Prognostic Prediction of Paraquat Poisoning

PURPOSE: To assess the ability of the Sequential Organ Failure Assessment (SOFA) score to predict the prognosis and organ dysfunction in the paraquat poisoning. METHODS: We retrospectively evaluated 281 paraquat poisoning patients who arrived at Soonchunhyang University Cheonan Hospital between Sep 2007 and Dec 2008. Sixty eight patients (68) were excluded due to missing data. Finally, 213 patents were included in this study. We investigated the degree of paraquat exposure, the Glasgow coma scale, vital signs, blood laboratory tests, calculated SOFA score, and Yamaguchi Index on first hospital day. The prognostic prediction was compared between SOFA score and Yamaguchi Index. RESULTS: The urine dithionite test, the amount of paraquat ingestion, arrival interval, aerum paraquat, Glasgow coma scale, HCO3-, potassium, and creatinine were significantly different between survivors and non-survivors. The Hosmer and Lemeshow Goodness-of-Fitness test of SOFA score (p=0.419) and Yamaguchi Index (p=0.084) indicated a good model performance. In the logistic regression analysis, p values the SOFA score and for the Yamaguchi Index were lower than 0.05 and the odds ratios were 1.930 and 0.108. At c-statistics, the area under receiver operator characteristic curve of SOFA score was 0.807 and Yamaguchi Index was 0.865. 95% confidence SOFA score and Yamaguchi Index Intervals of did not include 0.5. CONCLUSION: The SOFA score on the first day of hospital visit could reliably describe organ dysfunction and could distinguish survivors and non-survivors with reliable accuracy, as well as the Yamaguchi Index did in the case of paraquat poisoning.

Multimedia Message Service (MMS) Improves Comprehension of Discharge Instruction in the Patients with Lacerations

PURPOSE: This study was carried out to determine whether the use of multimedia message service (MMS) as discharge instructions about post-suture care improves patient's comprehension for those information. METHODS: One hundred nineteen (119) patients with lacerations and their caregivers who visited the Emergency Room at Soonchunhyang University Cheonan Hospital were included in this study. Participants were randomly assigned to receive MMS (n=66) or paper (n=53) discharge instructions after providing informed consent to engage in this study. Within 48 hours of discharge, an investigator called each participant by phone and asked a series of questions designed to test the participant's comprehension of their discharge instructions. In addition, participants were asked to complete questionnaires about confidence, accessibility, compliance, and the usefulness of discharge instructions. RESULTS: There were no differences in age, sex, educational background and subject (patient or caregiver) between the MMS and the paper group. In both groups, the mean and standard deviation in comprehension score was 8.1+/-1.3 and 6.6 +/-1.8, respectively. The difference was statistically significant (p<0.001). 'Yes' group of MMS and paper was 40(60.6%) and 16(30.2%) in accessibility, 39(59.1%) and 19(35.8%) in compliance, 26(39.3%) and 20(37.7%) in usefulness, respectively. CONCLUSION: The use of MMS as discharge instructions for patients with laceration improves patient comprehension.

Increase of Vertical Evacuation Interval in Proportion to the Number of Stories in High-rise Buildings

PURPOSE: The purpose of this study is to determine whether the vertical evacuation interval, the required time for an ambulance to be dispatched after contact from a patient, increases with the number of stories above ground of a patient requesting evacuation from a high-rise building. METHODS: The rescue diary of a 119 ambulance team dispatched to Jae-Song-Dong, Busan was retrospectively reviewed for 9 months for the period from April 1 to December 31, 2006. A total of 422 cases were included as subjects in the study. Median values of the vertical evacuation intervals collected from four building story groups were evaluated and the changing trend of the vertical evacuation intervals was analyzed. RESULTS: Amang all cases, the median value of the vertical evacuation intervals and the inter-quartile range were 5.0+/-5.0 minutes. A comparison of the vertical evacuation intervals by the Kruskal-Wallis test revealed statistically significant differences between the four different story groups (p<0.001). An increase in building story number was shown to affect the vertical evacuation interval. The y-intercept was found to be 4.885, the regression coefficient was 0.133 (p<0.001), and the r-square value was 0.181. A similar result was found for patients having emergency symptoms. CONCLUSION: These results confirm that there is an increase in vertical evacuation intervals depending upon the number of stories above ground of a patients requesting emergency medical service in high-rise buildings.

A Case of Thyroid Storm Presented as Infectious Gastroenteritis

It is difficult to diagnose thyroid storm in an emergency room, especially in cases when there is no past history of thyroid disease or specific symptoms such as thyroid hypertrophy and exophthalmia. Nevertheless, thyroid storm is a medical emergency threatening the patient's life, and immediate diagnosis and intensive treatment are critical to the patient's well-belling. We experienced a case of thyroid storm with comparatively rare symptoms in an emergency department. A 29-yearold male was taken to the emergency room with diarrhea, vomiting and fever. Initially, the patient's symptoms were attributed to acute gastroenteritis. As time passed, consciousness decreased and tachycardia appeared, and we ultimately suspected thyroid storm because of the atypical symptoms and were able to cure the patient with early treatment.

Clinical Characteristics of Emergency Patients with Asthenia Universalis: Elderly Versus Adult Patients

PURPOSE: Asthenia universalis is a common symptoms complaint found in the emergency department (ED) especially among the elderly. However, emergency physicians often find it difficult to initiate evaluation given lack of research in this field. The aim of this study is to evaluate the clinical characteristics of asthenia universalis in elderly patients and compare them to adult patients presenting to the ED for similar complaints. METHODS: Patients who presented to the ED with asthenia universalis between March 2004 through February 2005 were obtained using data warehouse from electronic medical records. We excluded patients with underlying illness such as neurosis, organic diseases, depression, in addition to patients who refused to participate. Characteristics of the elderly group (> 64 years) were compared with the adult group (15~64 years) based on clinical and laboratory findings. Chi-square test a Fisher's test was used for nominal variables and a Mann-Whitney U test or Students t-test for continuous variables was used. RESULTS: During the study period asthenic patients comprised 0.81% (566/ 69,922) of total ED visits. Of those 566 patients, 82 patients were included in the study of which 25 were male and 56 female. Both genders were equally distributed between the two groups studied (elderly vs. adult). 58.3% of patients had an underlying medical illness (elderly group 81.1%, adult group 46.2%). The clinical impressions included infections or inflammation disorders (30.5%), endocrine disorders (17.1%), and psychiatric illnesses excluding depression (15.9%). Laboratory findings revealed a higher prevalence of hyponatremia (p=0.008), hypokalmia (p=0.033) and hypoalbuminemia (p=0.036) in the elderly group. CONCLUSION: In elderly patients presenting with asthenia universalis to the ED, a higher prevalence of underlying infections and endocrine disorders were present compared to adult patients presenting with asthenia universalis. In addition, the elderly more frequently had associated laboratory abnormalities to include hyponatremia, hypokalemia, hypoalbuminenia when compared to the adult patients.

Independent Prognosis Predictor for In-hospital Pediatric Cardiopulmonary Resuscitation

PURPOSE: Investigations of in-hospital pediatric cardiopulmonary resuscitation (CPR) have been of limited value because of the retrospective nature of the studies, the small sample sizes, and inconsistent definitions of cardiac arrest and CPR. The purpose of this study was to prospectively describe in-hospital pediatric CPR by using the Utstein guidelines and to confirm prognosis predictors. METHODS: All 168 in-hospital pediatric CPRs involving 115 patients, at Asan Medical Center from January 1, 2002, to December 31, 2003 were prospectively described and evaluated by using Utstein reporting guidelines. Uniform reports were made out after the CPRs and were supplemented with chart reviews. The outcome variables included sustained return of spontaneous circulation (ROSC), the survival rate at 24 hrs, the survival discharge rate, and the pediatric overall performance category scale (POPC) after CPR. RESULTS: All of the 115 patients who received CPRs, 65 (56.5%) patients had sustained ROSC, 54 (47.0%) patients were alive at 24 hrs, and 33 (28.7%) patients were discharged alive. The most common underlying disease was cardiovascular disease (45.2%), and the most common precipitating cause of CPR was shock (48.7%). The most common initial cardiac rhythm was bradycardia with poor perfusion (41.7%). A multiple logistic regression analysis revealed that death at discharge was independently associated with a higher POPC score before CPR, a longer duration of CPR, and repeated CPR. CONCLUSION: Independent prognosis predictors of in-hospital pediatric CPR were the POPC score before CPR, the duration of CPR, and repeated CPR.

A Case of Pelvic Actinomycosis / 대한산부인과학회잡지

Actinomycosis is an oppoturnistic infection of actinomyces, which are relatively avirulent endogenous oral commensals. After trauma or infection, they breach the normally protective mucosal barriers to invade adjacent soft tissue structures. Lesions routinely contain other bacteria, the normal resident flora at the site of primary infection, which act synergistically with actinomyces species to provoke this unique infection, which range from an acute suppurative process to a chronic fibrotic process. According to epidemic studies about pelvic actinomycosis, it should be significantly related to IUD(intrauterine device). It is accounted that IUD cause chronic intrauterine infection, tissue injury and act as nucleus for parasitic infestation. Here we present a case of pelvic actinomycosis related to IUD with brief review of the concerned literature.