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

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

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: 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

We recently encountered an interesting case of acute inferior ST segment elevation myocardial infarction (STEMI). This patient had a rare anatomic variation, single coronary artery. The right coronary artery originate from the left circumflex proper artery, not from aorta, was totally obstructed with thrombi. Though it took more time to figure out the patient's coronary anatomy and the culprit lesion, we successfully performed primary percutaneous coronary intervention within the guideline-recommended time period. We performed left coronary angiography at the beginning. This strategy could be helpful in determining the culprit lesion and preventing unnecessary procedural delay in acute inferior STEMI.
Anatomic Variation ; Aorta ; Arteries ; Coronary Angiography ; Coronary Vessel Anomalies ; Coronary Vessels* ; Humans ; Myocardial Infarction* ; Percutaneous Coronary Intervention

Two quadruplex PCR reactions were designed for 7 tetrameric (D3S2406, D4S2368, D5S818, D7S821, D9S925, D13S317, D19S253) and one trimeric (D6S1043) short tandem repeats loci to study the allele frequency and the applicability of genetic variation in these loci in forensic case works. For 310 unrelated Koreans DNA was isolated from peripheral blood using phenol/chloroform method. Quadruplex I was consisted of D4S2368, D6S1043, D7S821, D9S925 and quadruplex II D3S2406, D5S818, D13S317, D19S253. The amplified products were analyzed by 5%polyacrylamide gel electrophoresis followed by silver staining. The heterozygosity in each loci ranged 92.91-66.13%, and PD(Power of Discrimination) was above 0.85 in each loci. Every loci except D6S1043 followed hardy-Weinberg expectation. The cumulative PI was low as 1.65x10-10. Two mutations were noted, one in D19S253 and the other in D9S925 among 234 gametes. With these results above eight STR loci studied here proved to be highly polymorphic enough to be used in forensic field. This study provides valuable population data in these loci for Korean.
DNA ; Electrophoresis ; Gene Frequency ; Genetic Variation ; Germ Cells ; Microsatellite Repeats ; Polymerase Chain Reaction* ; Silver Staining

Two quadruplex PCR reactions were designed for 7 tetrameric (D3S2406, D4S2368, D5S818, D7S821, D9S925, D13S317, D19S253) and one trimeric (D6S1043) short tandem repeats loci to study the allele frequency and the applicability of genetic variation in these loci in forensic case works. For 310 unrelated Koreans DNA was isolated from peripheral blood using phenol/chloroform method. Quadruplex I was consisted of D4S2368, D6S1043, D7S821, D9S925 and quadruplex II D3S2406, D5S818, D13S317, D19S253. The amplified products were analyzed by 5%polyacrylamide gel electrophoresis followed by silver staining. The heterozygosity in each loci ranged 92.91-66.13%, and PD(Power of Discrimination) was above 0.85 in each loci. Every loci except D6S1043 followed hardy-Weinberg expectation. The cumulative PI was low as 1.65x10-10. Two mutations were noted, one in D19S253 and the other in D9S925 among 234 gametes. With these results above eight STR loci studied here proved to be highly polymorphic enough to be used in forensic field. This study provides valuable population data in these loci for Korean.
DNA ; Electrophoresis ; Gene Frequency ; Genetic Variation ; Germ Cells ; Microsatellite Repeats ; Polymerase Chain Reaction* ; Silver Staining