BACKGROUND: Care for prehospital cardiac arrest is one of the major concerns of emergency medical services. But, in Korea, prehospital emergency medical service systems are not yet well established. We tried to offer one of the fundamental data for development of these systems. METHODS: After application of exclusion criteria, 183 patients who transferred to emergency center of our hospital after cardiac arrest in consecutive 24 months from Jan,1,1994 to Dec,31,1995 were included in this study. Retrospective review of the hospital charts of these patients was done. For statistical analysis, we divided patients to some categories. t-test or chi-square analysis was used. RESULTS: 24 patients of the 183 patients were secondary visitors(cardiac arrest was occurred during transfer from other hospitals), 159 patients were primary visitors. In the primary visitor group, only one third was ambulance visitors, and there is no statistical differences between arrest time of ambulance visitors and non-ambulance visitors(35+/-27 vs 37+/-24 min, p=NS). No organized bystander CPR was done. After arrival, 131 patients received CPR and 87 patients(66.4%) were not responded, 31 patients(23.1%) experienced transient ROSC, 13 patients(10.0%) survived until discharge, and only 2 patients(1.5%) were returned to their lives. CONCLUSION: We failed to find significant statistical survival differences between ambulance visitors and non-ambulance visitors, between presumed cardiac etiology group and non-cardiac etiology group. Survival rate was high in witnessed arrest group than unwitnessed arrest group(14.5% vs 2.1%, p=0.015).
Ambulances ; Cardiopulmonary Resuscitation ; Emergencies ; Emergency Medical Services ; Heart Arrest* ; Humans ; Korea ; Retrospective Studies ; Survival Rate

The reliability of emergency ultrasonographic(US) detection of hemoperitoneum and solid organ injury in blunt abdominal trauma was evaluated retrospectively. From October 1,1995 to August 31,1996,90 patients were included in the study. Ultra- sonographic findings showed a sensitivity, specificity, and accuracy of 97.6%, 97.9%, and 98.1%, respectively, in detecting intraabdominal fluid collection. We believe that US in an emergency center is a quick, safe screening method in the evaluation of blunt abdominal trauma. In our department, US has replaced diagnostic peritonaeal lavage(DPL) and computed tomography(CT) as the screening study of first choice.
Emergencies* ; Hemoperitoneum* ; Humans ; Mass Screening ; Retrospective Studies ; Sensitivity and Specificity ; Ultrasonography*

BACKGROUND: The advantages of epidural anesthesia for Caesarean section are well documented. However, its disadvantages include a slow onset time, which preclude its use for urgent procedures. The object of this clinical trial was to ascertain if a useful reduction in onset time may be obtained by fentanyl supplementation versus plain ropivacaine. METHODS: Twenty healthy women scheduled for Caesarean section were allocated randomly to receive 20 ml of 0.75% ropivacaine with normal saline 1 ml (group 1) or 20 ml of 0.75% ropivacaine with fentanyl 50 mcg (group 2) via a epidural catheter inserted 3 cm into the epidural space, identified by the loss of resistance technique using a midline approach at the L3-4 interspace. After insertion of the catheter, and with the patient supine, a test dose of 3 ml of the solution was given, and then the remainder was injected at a rate of 10 ml/min. The time for sensory block to develop at T8 by loss of cold discrimination using an alcohol sponge was defined as the onset time. Onset of block was timed from the end of the last injection. If a sensory block of T6 or higher was not present at 30 min, 5 ml of 2% lidocaine mixed with 0.5 ml of 8.4% sodium bicarbonate were administered until an adequate height of block had been achieved. After surgery had started and discomfort was felt, 50 mcg of i.v. fentanyl was administered repeatedly after delivery. Side effects (hypotension, nausea/vomiting, shivering, bradycardia, respiratory depression) during surgery were recorded, and the upper limit of sensory analgesia to the alcohol sponge was determined. RESULTS: The onset time was 8.7 +/- 4.3 min in group 1 and 11.9 +/- 5.4 min in group 2, respectively. No significant difference was evident between the two groups in terms of onset time to the sensory block to T8. The number of patients that required supplementary analgesia and experiencing side effects was similar. The maximum upper level observed in any patient was C6 in group 1 and C4 in group 2. CONCLUSIONS: The combined use of ropivacaine and fentanyl did not reduce sensory onset or produce an unnecessarily extended sensory block level.
Analgesia ; Anesthesia, Epidural* ; Bradycardia ; Catheters ; Cesarean Section* ; Discrimination (Psychology) ; Epidural Space ; Female ; Fentanyl ; Humans ; Lidocaine ; Porifera ; Pregnancy ; Shivering ; Sodium Bicarbonate

Pseudo-kaposi's sarcoma is a vasoproliferative disorder that may resemble Kaposi's sarcoma, clinically and histologically. In most cases, it has been associated with congenital or iatrogenic arteriovenous fistula and chronic venous insuffiency. We present a 36-year-old male patient with pseudo-Kaposi's sarcoma caused by a deed vein thrombosis in the absence of any detectable underlying etiologic factors.
Adult ; Arteriovenous Fistula ; Humans ; Male ; Sarcoma ; Sarcoma, Kaposi* ; Thrombosis ; Veins ; Venous Thrombosis*

This study was done on the 209 expired patients among 2,480 pediatric intensive care patients who were admitted to pediatric intensive care unit (PICU), Seoul National University Children's Hospital (SNUCH) from 1986 to 1988. The overall fatality rates were 7.5%, 8.3%and 9.3%in 1986, 1987 and 1988 respectively. The fatality rate in cardiothoracic surgery increased year by year, which were 6.0%, 6.2 %and 9.7% in 1986, 1987 and 1988. The abrupt rise of fatality rate in cardiothoracic surgery in 1986 might be related to the increase of total number of complex heart diseases which required more urgent surgical interventions in their early ages. The fatality rate was inversely proportional to age. Moreover, patients under 1 month and between 1 month and 1 year showed 16.0% and 12.1% of fatality rate respectively. The patients staying for more than 8 days showed the highest fatality rate (13.8%), which might be partially related to increased incidence of complications. We conclude that fatality rate in PICU will not be easily decreased due to increased number of complex congenital heart diseases and medical insurance in Korea.
Heart Diseases ; Humans ; Incidence ; Insurance ; Intensive Care Units ; Critical Care* ; Korea ; Seoul

BACKGROUND: During coronary angiography, some electrocardiographic changes occured due to contrast media, which do life threatening influences. METHODS: We compared the electrocardiographic changes which were induced by injection of three radiopaque contrast media during selective coronary angiography in 49 patients with chest pain. One of the contrast media was high osmolar ionic(Urografin_76) and the another was low osmolar ionic(Hexabrix) and the last was non-ionic(Ioversol). Electrocardiograms were obtained before, during and after selective coronary angiography. RESULTS: The changes of S-T segment or T were decreased in non-ionic group rather than high osmolar or ionic group. And there was significant Q-Tc interval prolongation among all three groups except comparision of low osmolar ionic contrast dye and non-ionic contrast dye in left coronary angiography. CONCLUSION: Non-ionic low osmolar contrast media was safer than high osmolar or ionic contrast medial because of lesser change of Q-Tc interval during selective coronary angiography.
Chest Pain ; Contrast Media* ; Coronary Angiography* ; Diatrizoate Meglumine ; Electrocardiography* ; Humans ; Ioxaglic Acid ; Osmolar Concentration

Jimson weed, also known as Datura stramonium, is a member of the Solanaceae family. Jimson weed was used by American Indians for medicinal and religious purposes. All parts of the Jimson weed plant are poisons, containing the alkaloids atropine, hyoscyamine and scopolamine. So, it is caused by these components to make a anticholinergic toxicity within 6h after ingestion. Initial manifestations include dry mucus membrane, blurred, vision, thirst, difficulty swallowing and speaking, and photophobia, and may be followed by hyperthermia, confusion, agitation, combative behavior, hallucination, urinary retention, seizure and coma. We experienced two patients who developed combative behavior and agitation with pupil dilation caused by Jimson weed. They discharged with improvement after supportive for 2days.
Alkaloids ; Animals ; Atropine ; Coma ; Comb and Wattles ; Datura stramonium* ; Deglutition ; Dihydroergotamine ; Eating* ; Fever ; Hallucinations ; Humans ; Hyoscyamine ; Indians, North American ; Membranes ; Mucus ; Photophobia ; Plants ; Poisons ; Pupil ; Scopolamine Hydrobromide ; Seizures ; Solanaceae ; Thirst ; Urinary Retention

The validation study for two STR loci on X-chromosome, DXS7132 and GATA31D10, was done including allelic distribution and frequency of each allele to use these results for individual identification and paternity testing. For 496 unrelated Koreans, above two STR loci were amplified simultaneously using duplex PCR amplification method. The amplified products were analyzed by polyacrylamide gel electrophoresis followed by silver staining. In male DXS7132 locus revealed 7 different alleles ranging from 276bp to 300bp. The largest allele was consisted of 14 repetition of [TCTA] unit and took 0.3417. The allele 15 followed next as 0.3165 and allele 13 as 0.1726. In female general distribution was same except one allele, allele 18 was found additionally. The heterozygosity was 0.7706 and 23 different genotypes were found. Polymorphism information content(PIC) was 0.727. Two cases of mutation were noted in DXS7132 locusIn both male and female 7 different alleles were noted in GATA31D10 locus and the alleles ranged from 195bp to 231bp. The allele 15(199bp) took the majority of all as 0.825. The other alleles showed rather relatively low frequency. The heterozygosity was 0.2385 and 11 different genotypes were found. PIC was 0.2521, and no mutation was noted in GATA31D10 locus. Considering these two loci together, 22 different halpotype were noted.
Alleles ; Electrophoresis, Polyacrylamide Gel ; Female ; Genotype ; Haplotypes ; Humans ; Male ; Paternity ; Polymerase Chain Reaction ; Silver Staining

Central venous catheterization has been widely used in the management of critically ill patients and anesthetic management for the cases associated with severe hemodynamic changes. But this procedures may associate with life-threatening complications. In this case we experienced a hydrothorax following subclavian vein catheterization and we discussed the points that should be kept in mind to prevent the serious complications of central venous catheterization.
Catheterization* ; Catheterization, Central Venous ; Catheters* ; Central Venous Catheters ; Critical Illness ; Hemodynamics ; Humans ; Hydrothorax* ; Subclavian Vein

Caveolae are flask-shaped cell-surface membranes, which consist of cholesterol, sphingolipids and caveolin proteins. In a microarray analysis, we found that caveolin-1 (Cav-1) was upregulated by receptor activator of NFkappaB ligand (RANKL), the osteoclast differentiation factor. Silencing of Cav-1 inhibited osteoclastogenesis and also decreased the activation of mitogen-activated protein kinase and the induction of NFATc1 by RANKL. Cav-1 knockdown suppressed the expression of cFms and RANK, two major receptors for osteoclastogenesis. Interestingly, cFms expression was decreased only at the protein level, not at the messenger RNA (mRNA) level, whereas RANK expression was decreased at both the mRNA and protein levels. Furthermore, Cav-1 deficiency increased the lysosomal degradation of cFms. Taken together, these results demonstrate that Cav-1-dependent cFms stabilization contributes to efficient osteoclastogenesis.