BACKGROUND: Assessing and securing airway is the beginning of the treatment for emergency patients. Rapid Sequence Intubation is a technique that uses sedatives and neuromuscular blockers to perform endotracheal intubation. This is a basic technique that all emergency physicians must master. Therefore, we investigated the recent circumstance of Rapid Sequence Intubation in patients at the emergency department. METHODS: Ten-item surveys were mailed to the board certified emergency physicians in the emergency department of 45 hospitals. Among the 45 surveys, 37 surveys were returned. The rate of reply was 82.2%. RESULTS: Throughout the hospital, 35/37 of the endotracheal intubation was performed in the emergency department. Anesthesiologists were not called for endotracheal intubation in 34/37 emergency department, and anesthesiologists were not called for the use of neuromuscular blockers in 36/37 emergency departments. 35 emergency departments used sedatives. The sedatives used were as follows : midazolam(48.6%), diazepam(25.7%), thiopental sodium(22.9%), and ketamine(2.9%). 30 emergency departments used neuromuscular blockers. The neuromuscular blockers used were as fallows : succinylcholine(46.7%), vecuronium(43.3%), and pancuronium(10.0%). The rate of Rapid Sequence Intubation was 33.8%. Various monitoring devices were used during Rapid Sequence Intubation ; cardiac monitors 90.5%, pulse oximeters 80.4%, noninvasive blood pressure monitors 64.9% and ETCO2/ 12.8%. Only 6 of 37 hospitals had the assessment program far endotracheal intubations and 60% was the assessment rate in these hospitals, however, there was no proctocol for the quality assurance assessment. CONCLUSION: Emergency endotracheal intubation was performed independently by the physician of the emergency department. The Rapid Sequence Intubation was effective and had low adverse effect. We recommended that Rapid Sequence Intubation should be used more aggressively in patients. Also, applying these assessment proctocol in patients, we could improve the quality of assurance assessment.
Blood Pressure Monitors ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Hypnotics and Sedatives ; Intubation* ; Intubation, Intratracheal ; Neuromuscular Blockade ; Neuromuscular Blocking Agents ; Postal Service ; Thiopental

BACKGROUND: The fast EMS helicopter was introduced to Korea in 1996 and from Dec. 1. 1997, it was used far transporting emergent patients. Authors, here upon, report the transporting experiences. METHODS: From Dec. 1, 1996 to Dec. 31,1997, Samsung Medical Centers EMS helicopter was used for air evacuation of critically ill patients. The patients data prospectively analyzed. RESULT: A total of 65 patients were transported. Male to female ratio was 1.95 : 1. The mean transport time was 64.1min(10-160 min). Majority of the evacuated patients was surgical patients (General Surgery'16, Orthopedic surgery : 10, Neurosurgery : 6, Infernal medicine 13, Pediatrics : 3, and others : 3). Twenty-one of the 65 patients transported were admitted to ICU and 31 did not require ICU care. During the air evacuation, one physician and one nurse trained for air evacuation amended The patients. No medical problems or deaths developed during the air evacuation period. CONCLUSION: The first EMS helicopter was introduced to Korea in 1996. From Dec. 1, 1996 to Dec. 31, 1997, Samsung Medical Center's EMS helicopter was used for air evacuation of critically ill patients. The patients data reported.
Aircraft* ; Critical Illness ; Emergencies* ; Female ; Humans ; Korea ; Male ; Neurosurgery ; Orthopedics ; Pediatrics ; Prospective Studies

BACKGROUND: The purpose of this study was to analyze the endotracheal intubation cases performed in the emergency department. METHODS: We investigated retrospectively 326 cases of endotracheal intubation performed in the emergency department of a tertiary care center from April 1, 1998 to March 31, 1999. We focused on operators, medications used, its success rate and immediate complications, and the relationship between its success rate and medications. RESULTS: Of 326 consecutive intubations, 193 patients(59.2%) were done by emergency medicine residents or attending physician. While 320 patients(98.2%) were successfully intubated, 6 patients could not be intubated and 2 patients underwent tracheostomy. Of 50 cases of intubations(15.3%) attempted with paralyzing agents, 48 cases were done with succinylcholine and 46 cases underwent by emergency physicians. Intubations with neuromuscular paralysis resulted in high success rates at the first attempt. Of 55 immediate adverse events were encountered in 47 patients(desaturation=17, bronchial intubation=15, hypotension=8, bradycardia=4, cardiac arrest=2, others=5). CONCLUSION: At this institution, paralyzing agents were used infrequently, but almost all of them were used by emergency physicians.
Emergencies* ; Emergency Medicine ; Emergency Service, Hospital* ; Humans ; Intubation ; Intubation, Intratracheal* ; Paralysis ; Retrospective Studies ; Succinylcholine ; Tertiary Care Centers* ; Tertiary Healthcare* ; Tracheostomy

Periampullary diverticulum is commonly found during endoscopy and can occur at any age although its prevalence increases with age. Periampullary diverticular bleeding is a rare and difficult to diagnose during clinical practice because of its unique appearance and location. This often can lead to massive bleeding and interfere with adequate bleeding control. Endoscopic management on duodenal diverticular bleeding is limited compared to colonic diverticular bleeding due to lack of experience. Herein, we report a case of active bleeding from a periampullary diverticulum during bile duct stone extraction diagnosed by side-viewing endoscope and successfully controlled using hemoclips without any complications.
Aged ; Ampulla of Vater/surgery ; Cholangiopancreatography, Endoscopic Retrograde ; Diverticulum/*diagnosis/surgery ; Gastrointestinal Hemorrhage/etiology/*therapy ; Humans ; Male ; Surgical Instruments ; Tomography, X-Ray Computed

OBJECTIVES: Nowadays most infants on exclusively breast feeding have vitamin D deficiency due to the increase of breast feeding. However, domestic research lacks appropriate materials. Therefore, we researched practical clinical aspects of vitamin D deficiency related to breast milk feeding for infants who have a high amount of alkaline phosphatase (> 500 IU/L). METHODS: The subjects of the study were 31 infants with high alkaline phosphatase level. We tested with 25-hydroxycholecalciferol (25-OHD3), parathyroid hormone, calcium, ionized calcium, phosphorus in their blood and with a wrist x-ray. Then, we divided them into two groups of breast feeding and formula feeding and compared the results. RESULTS: Eighteen infants (58%) out of 31 infants that have high alkaline phosphatase were vitamin D insufficiency or deficiency, and 16 (100%) breast feeding infants of them showed vitamin D deficiency or insufficiency. However, only 2 (13%) of 15 formula feeding infants were at insufficiency. There was a correlation between alkaline phosphatase and 25-OHD3 concentration in multiple regression analysis, but no correlation in other variables was found in group of breast milk feeding infants. There was neither correlation between vitamin D concentration and alkaline phosphatase nor other correlated variables in the group of formula milk feeding infants. CONCLUSIONS: In this study, there was a high probability of vitamin D deficiency in the breast feeding infants with a high alkaline phosphatase level. Therefore, it is considered to be worth utilizing alkaline phosphatase as a screening test for vitamin D deficiency or rickets for breast feeding infants.
Alkaline Phosphatase ; Breast Feeding ; Calcifediol ; Calcium ; Humans ; Infant ; Mass Screening ; Milk ; Milk, Human ; Parathyroid Hormone ; Phosphorus ; Rickets ; Vitamin D ; Vitamin D Deficiency ; Vitamins ; Wrist

Acute recurrent pancreatitis has a variety of etiologies. We experienced a case of a tumor-forming pancreatitis in a 49 year old Korean woman who also had pancreatic intraepithelial neoplasm III (PanIN-III), and this manifested just like recurrent pancreatitis. She had a history of recurrent pancreatitis. She was found to have an early stage of pancreatic cancer via computed tomography and magnetic resonance cholangiopancreatography. EUS guided fine needle aspiration (FNA) showed only many acinar cells of the pancreas. But due to the possibility of her having pancreatic carcinoma, she underwent distal pancreatectomy and splenectomy with lymph node dissection. Pathologically, the tumor of the pancreatic body showed secondary changes with focal fibrosis from the localized chronic pancreatitis. PanIN-III was observed in the pancreatic duct within the tumor, and there were no cancerous findings in the 13 dissected lymph nodes.
Acinar Cells ; Biopsy, Fine-Needle ; Carcinoma in Situ ; Cholangiopancreatography, Magnetic Resonance ; Female ; Fibrosis ; Humans ; Lymph Node Excision ; Pancreas ; Pancreatectomy ; Pancreatic Ducts ; Pancreatic Neoplasms ; Pancreatitis ; Pancreatitis, Chronic ; Splenectomy

BACKGROUND: Limited exercise capacity is common in the elderly. Kinetics of recovery oxygen consumption plays an important role in determining exercise capacity. This study was performed to evaluate the kinetics of recovery oxygen consumption as well as peak oxygen consumption during exercise and recovery in the elderly. METHODS: Thirty healthy volunteers were included for this study. They were divided into three groups according to their ages(20 to 39; 40 to 59; and over 60). All subjects performed symptomlimited maximal treadmill exercise. RESULTS: Peak oxygen consumption(pVO2, ml/min/kg) was gradually decreased with the age. Half-recovery time of peak oxygen consumption(T1/2VO2) was maintained from third to sixth decades without significant changes, and then rapidly delayed in the elderly. CONCLUSION: Kinetics of recovery oxygen consumption was rapidly and markedly delayed in the elderly and this may result in the exercise intolerance.
Aged* ; Healthy Volunteers ; Humans ; Kinetics* ; Oxygen Consumption* ; Oxygen*

PURPOSE: We have evaluated characteristics of adrenal masses incidentally observed in nonenhanced F-18 FDG PET/CT of the oncologic patients and the diagnostic ability of F-18 FDG PET/CT to differentiate malignant from benign adrenal masses. MATERIALS AND METHODS: Between Mar 2005 and Aug 2008, 75 oncologic patients (46 men, 29 women; mean age, 60.8+/-10.2 years; range, 35-87 years) with 89 adrenal masses incidentally found in PET/CT were enrolled in this study. For quantitative analysis, size (cm), Hounsfield unit (HU), maximum standardized uptake value (SUVmax), SUVratio of all 89 adrenal masses were measured. SUVmax of the adrenal mass divided by SUVliver, which is SUVmax of the segment 8, was defined as SUVratio. The final diagnosis of adrenal masses was based on pathologic confirmation, radiologic evaluation (HU<0 : benign), and clinical decision. RESULTS: Size, HU, SUVmax, and SUVratio were all significantly different between benign and malignant adrenal masses.(P < 0.05) And, SUVratio was the most accurate parameter. A cut-off value of 1.0 for SUVratio provided 90.9% sensitivity and 75.6% specificity. In small adrenal masses (1.5 cm or less), only SUVratio had statistically significant difference between benign and malignant adrenal masses. Similarly a cut-off value of 1.0 for SUVratio provided 80.0% sensitivity and 86.4% specificity. CONCLUSION: F-18 FDG PET/CT can offer more accurate information with quantitative analysis in differentiating malignant from benign adrenal masses incidentally observed in oncologic patients, compared to nonenhanced CT.
Adrenal Gland Neoplasms ; Diagnosis, Differential ; Humans ; Male ; Neoplasm Metastasis ; Sensitivity and Specificity

PURPOSE: To determine optimal imaging time for diagnostic I-123 whole body scan in the follow-up of patients with differentiated thyroid cancer (DTC), we compared the image quality of 6- and 24-hour images of the same subjects. MATERIALS AND METHODS: Four hundred ninety-eight patients (M:F=55:443, Age 47.6+/-12.9 years) with DTC who had undergone total thyroidectomy and I-131 ablation therapy underwent diagnostic whole body scanning 6 hour and 24 hour after oral ingestion of 185 MBq (5 mCi) of I-123. Serum thyroglobulin measurement and ultrasonography of the neck were performed at the time of imaging. In 40 patients underwent additional I-131 therapy, post-therapy I-131 images were obtained and compared with diagnostic I-123 images. RESULTS: In 440 patients (88.4%), 6- and 24-hour diagnostic I-123 images were concordant, and 58 patients (11.6%) showed discordant findings. Among 58 discordant patients, 31 patients showed abnormal tracer uptake on only 6-hour image, which turned out false-positive findings in all cases. In 12 patients with positive findings on only 24-hour image, remnant thyroid tissue (4 patients) and cervical lymph node metastasis (3 patients) were presented. Among 40 patients underwent additional I-131 therapy, 6-hour and 24-hour images were discordant in 13 patients. All 5 patients with abnormal uptake on only 6-hour image revealed false-positive results, whereas most of 24-hour images were concordant with post-therapy I-131 images. CONCLUSION: I-123 imaging at 24-hour could reduce false-positive findings and improve diagnostic accuracy, compared with 6-hour image in the follow-up of patient with DTC.
Eating ; Follow-Up Studies ; Humans ; Lymph Nodes ; Neck ; Neoplasm Metastasis ; Thyroglobulin ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy ; Whole Body Imaging

PURPOSE: Early detection of recurrence is an important factor for long term survival of patients with colorectal cancer. Measurement of serum levels of CEA, CA 19-9, CT and PET/CT has been commonly used in the postoperative surveillance of colorectal cancer. The purpose of this study was to compare the diagnostic ability of PET/CT, tumor marker and CT for recurrence in colorectal cancer patients after treatment. MATERIALS AND METHODS: F-18 FDG PET/CT imaging was performed in 189 colorectal cancer patients who underwent curative surgical resection and/or chemotherapy. Measurement of serum levels of CEA, CA 19-9 and CT imaging were performed within 2 months of PET/CT examination. Final diagnosis of recurrence was made by biopsy, radiologic studies or clinical follow-up for 6 months after each study. RESULTS: Overall sensitivity, specificity of PET/CT was 94.7%, 91.1%, while those of serum CEA were 44.7% and 97.3%, respectively. Sensitivity and specificity were 94.2%, 90.4% for PET/CT and better than those of combined CEA and CA 19-9 measurement (52.1%, 88.5%) in 174 patients measured available both CEA and CA 19-9 data. In 115 patients with both tumor markers and CT images available, PET/CT showed similar sensitivity but higher specificity (92.9%, 91.3%) compared to combination of tumor markers and CT images (92.9%, 74.1%). CONCLUSION: PET/CT was superior for detection of recurred colorectal cancer patients compared with both CEA, CA 19-9, and even with combination of both tumor markers and CT. Therefore PET/CT could be used as a routine surveillance examination to detect recurrence or metastasis of colorectal cancer.
Biopsy ; Carcinoembryonic Antigen ; Colorectal Neoplasms ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Recurrence ; Sensitivity and Specificity ; Biomarkers, Tumor