PURPOSE: The purpose of this study is to document the impact of computed tomography (CT) performed in the emergency department on elderly patients presenting with nontraumatic acute abdominal pain. METHODS: Forty patients were enrolled in this prospective study. Using a structured data collection instrument recording three primary endpoints before and after CT, emergency physicians were required to report their most likely diagnoses, levels of diagnostic certainty, and the treatment plans for their patients. The changes in the frequencies of each of these three endpoints from pre- to post-CT comprised the target variables. RESULTS: CT altered the treatment plan in 42.5% of the 40 patients, altered the clinical diagnosis in 40% of patients, and increased the diagnostic certainty in 57.5% of patients. Planned admission before CT was 36 patients; after CT, it was 28 patients. Planned surgery before CT was 13 patients, and after CT, it was 10 patients. Thus, the net effect of abdominal CT scanning was to avert 8 (22.2%) of 36 possible hospital admissions, and 3 (23%) of 13 possible surgeries. CONCLUSION: Abdominal CT performed in the emergency department significantly alters decision making when treating elderly patients with acute nontraumatic abdominal pain.
Abdominal Pain* ; Aged* ; Data Collection ; Decision Making ; Diagnosis ; Emergencies ; Emergency Service, Hospital ; Humans ; Prospective Studies ; Tomography, X-Ray Computed*

Many treatment approaches of Cl III malocclusion have been introduced and the choice of treatment should be a function of the individual problem, not of the clinician(personal preference, experience and success rate of the operator). Therefore a function of the individual problem should be analysed exactly. Much has been written in the orthodontic literature concerning the nature of Cl III malocclusion. It has been reported by many investigators that a Cl III malocclusion occurs in a variety of skeletal and dental configurations by differences of race and age. Lateral cephalometric radiographs of 125 individuals were studied for the presence and distribution of four horizontal components and one vertical component in a manner similar to McNamara. The results were as follows 1. Cl III malocclusion is not a single clinical entity. It can result from numerous combinations of skeletal and dental components. 2. Maxillary skeletal retrusion was the most common single characteristic of the Cl III sample. 3 Only a small percentage or the cases in this cases in this study exhibited maxillary dentoalveolar protrusion. 4. Only a small percentage of the cases in this study exhibited mandibular dentoalveolar dentoalveolar retrusion. 5. Mandible was usually well-positioned, but a wide variation was observed. 6. A large percentage of the cases in this study exhibited excessive vertical development. Thus, it appears that in designing the ideal treatment regime, those approaches which might restrict vertical development and promote maxillary horizontal growth could be more appropriate in many cases.
Child* ; Continental Population Groups ; Humans ; Malocclusion* ; Mandible ; Research Personnel

Diaphragm injuries are very important because, if both thoracic and abdominal viscera are damaged, a combination of shock and acute respiratory distress may develop. It can be highly lethal. This evaluation was based on the reviews of 17 cases of traumatic diaphragm injuries treated at the Department of Cardiovascular Surgery, Seoul Adventist Hospital during 5 years from March 1993 to February 1997. The mean age of the patients was 37.2 years and sex ratio was 3.2:1 with male dominance. Blunt trauma(N=5, Rt.=4, Lt.=1) was 29.5%, penetrating trauma(N=12, Rt.=5, Lt.=7) was 70.5%. Dyspnea(76%) was the most common symptom. Blunt trauma(9.8 3.7 Cm) was larger than the penetrating trauma(3.2 1.3 Cm)(P<0.05) in the size(mean SD) of the injury. All of the patients had associated injuries and repaired immediatley with thoracic approach 11 cases(64%), abdominal approach 3 cases(18%) and thoracoabdominal approach 3 cases(18%). 5 cases of penetrating diaphragmatic trauma was diagnosed on the operation of other organ injury. Now we suggest that diaphragmatic injury should be suspected in all patients with penetrating as well as blunt injury of the chest and abdomen to protect the patient from its late complications.
Abdomen ; Diaphragm ; Humans ; Male ; Seoul ; Sex Ratio ; Shock ; Thorax ; Viscera ; Wounds, Nonpenetrating

Spontaneous intraperitoneal hemorrhage from uterine leiomyomas is rarely encountered. The cause of hemorrhage is mainly trauma and torsion of myoma. Massive intraperitoneal hemorrhage from spontaneous rupture of a superficial uterine vein overlying a subserous myoma is extremely rare. A 48-year-old woman complained general weakness, lower abdominal discomfort and lower back pain. On admission to the hospital, hypovolemic shock, severe anemia and ascites were noticed. Ultrasonography and CT scan showed huge pelvic mass and much amount of fluid in the pelvic cavity. During emergent laparotomy, 3,500 mL of blood were drained from the abdominal cavity and a ruptured superficial vein was noted, located on the serosal surface of a fundal myoma. We report one case of massive intraperitoneal hemorrhage and hypovolemic shock due to spontaneous rupture of a superficial uterine vein overlying a subserous myoma.
Abdominal Cavity ; Anemia ; Ascites ; Female ; Hemoperitoneum ; Hemorrhage ; Humans ; Laparotomy ; Leiomyoma ; Low Back Pain ; Middle Aged ; Myoma ; Rupture ; Rupture, Spontaneous ; Shock ; Veins

Ulcerative colitis has been recognized as a premalignant condition because a considerable proportion of patients with colitis eventually develop colorectal carcinoma at the site of the inflammatory disease. Malignant lymphoma occurring in cases of long-standing ulcerative colitis is rare. Cancer risk is positively correlated with duration and anatomic extent of colitis, but do not appear to be increased by early age at onset of disease. Patients with chronic ulcerative colitis should have periodic rectal and colonoscopic biopsies, and those with moderate to marked dysplasia require colectomy because of the increased risk of colon carcinoma. We report a case of malignant lymphoma in patient with ulcerative colitis.
Biopsy ; Colectomy ; Colitis ; Colitis, Ulcerative* ; Colon ; Colorectal Neoplasms ; Humans ; Lymphoma* ; Ulcer*

The expectoration of blood is always a fearful experience for the patient and a matter of grave concern to the attending physician, because it may be the warning sign of serious diseases. When such bleeding occurs, the possibility of its being due to pulmonary tuberculosis, bronchiectasis or carcinoma of the lung is promptly suggested. Nowadays, with the advance of modern diagnostic studies, differential diagnosis has become possible for the hemoptysis patients to have appropriate treatment. This evaluation is based on the review of 75 cases of patients whom we performed emergency open thoracotomies for 6 years from March 1992 to February 1997 in the Department of Thoracic and Cardiovascular Surgery, Seoul Adventist Hospital. The mean age of the patients was 36.6 years old with a range from 19 to 68, and most prevalent age group was thirties. The most common underlying lung disease causing hemoptysis was tuberculosis(44%). Most accurate diagnostic study was bronchoscopy during hemoptysis(95%) and right middle and lower lobe(17.3%) was the most common site of lesion. Lobectomy(50%) was the most frequent operative method and recurrent hemoptysis(31.6%) was the most common postoperative complication. But most of the patients(82.6%) were completely recovered by surgical treatment. Now we concluded that the proper management of hemoptysis was completed by surgical approach with definite diagnosis and supportive medication.
Bronchiectasis ; Bronchoscopy ; Diagnosis ; Diagnosis, Differential ; Emergencies ; Hemoptysis* ; Hemorrhage ; Humans ; Lung ; Lung Diseases ; Postoperative Complications ; Seoul ; Thoracotomy ; Tuberculosis, Pulmonary

Polymyositis is one form of inflammatory myopathy. In some patients, this disease does not entirely respond to conventional initial therapy with glucocorticoid, methotrexate and azathioprine. Multiple options exist for treating these patients, but only intravenous immune globulin has been subjected to a randomized clinical trial. We report here on a case of polymyositis that did not respond to multiple drug therapy, but it did respond to tacrolimus. After treatment with tacrolimus, the patient's disease has been well controlled for many years.
Azathioprine ; Humans ; Immunoglobulins, Intravenous ; Methotrexate ; Myositis ; Polymyositis ; Tacrolimus

This study was designed to investigate the effect of cholestyramine on the formation of pigment gallstones in high carbohydrate diet-fed hamsters and whether that effect occurred because of cholecystokinin action. Forty seven hamsters were divided into three groups: group I(n = 16) was fed on normal rodent chow(43% carbohydrate), group II(n = 14) was fed on a high CHO diet(65% carbohydrate), group III(n = 17) was fed on a high CHO diet containing 4% cholestyramine. Gallstones developed in 0% of group I, 42.9% of group II and 5.9% of group III(P< 0.05, group II vs III). To evaluate the chronic status of cholecystokinin level, the wet weight of pancreas and the average area of pancreatic acinar in microscopic high power field were measured. There was no significant difference between group II and group III in pancreatic weight and average area of pancreatic acinar(P> 0.05). In gallbladder bile analysis, there was also no significant difference between group II and group III in cholesterol, phospholipid, total calcium, total bilirubin and bile acid levels. In conclusion, cholestyramine decreases the frequency of pigment gallstone formation in high CHO diet-fed hamsters, but it is not clear whether the mechanism of cholestyramine decreasing the gallstone formation is due to the action of cholecystokinin.
Animal ; Bilirubin/metabolism ; Cholecystokinin/*analysis ; Cholelithiasis/*pathology ; Cholesterol/metabolism ; Cholestyramine/*administration & dosage ; Dietary Carbohydrates/*administration & dosage ; Female ; Gallbladder/*metabolism/pathology ; Hamsters ; Male ; Mesocricetus ; Organ Weight ; Pancreas/physiopathology ; Phospholipids/metabolism ; Pigmentation ; Support, Non-U.S. Gov't

PURPOSE: Pneumonia is one of the most common infections in children who visit emergency Department(ED), but standard clinical guidelines for children with pneumonia in Korea have not been studied. This study was performed to collect and evaluate a data-base of children with pneumonia for establishing clinical guidelines in ED. METHODS: This study reviewed 304 children who were diagnosed and treated for pneumonia in the ED at one tertiary hospital between January 2003 and December 2003 retrospectively by reviewing the charts and analyzing the clinical characteristics, laboratory findings, and radiologic findings between an admission group and a discharge group. RESULTS: The 2 year-5 year age group was the top of age distribution and the peak incidence of monthly distribution was December. Two hundred forty seven(81.3 percent) children were hospitalized(admission group), and the mean length of hospitalization was 7.24+/-3.24 days. The most common indications of admission were fever, tachypnea and an age of less than three months. There was statistical differences in the outpatient department follow-up between the two groups(85.8 percent in admission group vs 35.1 percent in discharge group). CONCLUSION: More prospective studies are needed to establish clinical standard guidelines for children with pneumonia. This will be helpful in ED management and will aid the prevention of pneumonia.
Age Distribution ; Child* ; Emergencies* ; Emergency Service, Hospital* ; Fever ; Follow-Up Studies ; Hospitalization ; Humans ; Incidence ; Korea ; Outpatients ; Pneumonia* ; Retrospective Studies ; Tachypnea ; Tertiary Care Centers

PURPOSE: To valuate the value of goose neck snare in removal of foreignbody in endovascular system. METHODS & MATERIAL: Foreignbody removal in endovascular system using goose neck snare were done in 4 cases. In one case, a broken guide-wire was located in left subclaviar vein and in three cases, guide-wires were located in vena cava. RESULTS: Technical success was achieved in all four cases. CONCLUSION: Goose neck snare technique is safe and effective in removal of Foreignbody in endovascular system.
Neck ; SNARE Proteins ; Veins