It is socially fortunate that there is little chance in the civil hospital to experience the victims of high velocity missiles. However it is reasonable thought to educate doctors about the gunshot and explosive injuries who might be mobilized in emergency condition. Authors have experiences to treat the high velocity missile wounds. In order to provide valid data to be an educational material, we clinically analyzed 41cases of those injuries who were treated at the Capital Armed Forces General Hospital from 19xx to 19xx. The results obtained were as follows: 1. In 15 cases there were only soft tissue injuries, The remaining 26 cases had the bone injuries and six of them had two injury sites. 2. In 28 cases the lower extremities were injuried, and they out-numbered the injury of upper extremities. The most frequent site of injuries was the thigh (31.7%). 3. Most common associated injuries were the periphenal nerve injuries, which numbered 10 cases. 4. The early operative treatments were given in 5 out of 32 cases having bone injuries. And the secondary operations, including bone graft and intemal fixation, had to be done in 10 out of the remaining 27 cases due to delayed union or nonunion. 5. There was no infection in cases having only the soft tissue injuries. But the localized osteomyelitis occurred in 4 cases among the cases having bony injuries. 6. Factors affecting the result of high velocity missile wounds were presence of bony involvement, site and extent of injuries, associated thoracoabdominal injuries and presence of peripheral nerve injuries and infection. 7. The evacuation time, chance of early adequate wound management, site of injury and extent of injury were the important factors in deciding the method of treatment. We suggest that the more selective and aggressive measures should be taken in the management of bony injuries.
Arm ; Emergencies ; Extremities ; Hospitals, General ; Lower Extremity ; Methods ; Osteomyelitis ; Peripheral Nerve Injuries ; Soft Tissue Injuries ; Thigh ; Transplants ; Upper Extremity ; Wounds and Injuries

OBJECTIVES: This study was designed to evaluate the problems of pre-hospital Emergency medical care system (EMS) in workplace. We analysed 25 fatal work-place injuries during the recent 4 years and the work-place EMS of 8 enterprises located in Masan-city, Changwon-city and Kuje-island. METHODS: The safety managers and the members of Dept. of safety in the labor unions were interviewed about the work-place EMS. And we investigated on the injury reports, the work-place medical-room records and the medical records of emergency center for fatal 25 cases. RESULTS: The enterprises had the at-risk machines and processes, volatile materials and high-altitude working processes. There were duty doctors in only 3 enterprises but a few duty nurses or health-care providers in the others. The time spent for the education to the workers on safety was 24hrs/yr in 3 enterprises in 1998 but less than Bhrs in the others. There were medical service center in all enterprises but the ambulances in three. The time for activation of the ambulance was ranging from 5 minutes to 10 minutes in 6 enterprises, and from 10 minutes to 30 minutes in two. The patient transportation to the emergency center was possible within 30 minutes in all enterprises but there were no equipments for airway maintenance and shock management in all enterprises. The 15 (60%) fatal injuries were occurred at one enterprise. The 64% of casualties had the duration of job-employment more than 10yrs and the 68% were suffered the typical type of work-place injury as descending injuries, collisions and falls. Most of all primary calls for rescue were concentrated on the fire-service agencies. But in 85% of fatal injtories, the tome for the activation of ambulance was more than 10 minutes and no emergency care was taken in the field in 48 percent of casualtles. The transportation time to the emergency center was more than 30 minutes in 50 percent. It toolk from injury to death was less than one hour in the 40 percent of all cases, and from one hour to four in the 50 percent. The causes of death in the 68 percent were the head-and-neck injuries or thoracic injuries. CONCLUSIONS: We found that there was Insufficiency of the education associated with work-place injury for workers, manpower and facilities, equipments related to the work-place EMS, the problems of the delay in transportation system.
Ambulances ; Cause of Death ; Education ; Emergencies* ; Emergency Medical Services* ; Humans ; Labor Unions ; Medical Records ; Shock ; Thoracic Injuries ; Transportation

No abstract available.
Intracranial Aneurysm*

Parenteral reserpine was given intramuscularly to 32 hospitalized hypertensive patients: 10 hypertensive patients without renal insufficiency, 3 hypertensive patients with heart failure, 10 hypertensive patients of malignant phase or with uremia, and 9 hypertensive patients with cerebrovascular accident. Follwoings were the result. 1. In the majority of patients, the effective dose of reserpine was 2 to 3 mg. 2. Reserpine given intramuscularly lowered blood pressure in 2 to 4 hours, had its maximum effect in 3 to 6 hours and had a duration of 3 to more than 24 hours (average 9 hours). 3. When effective dose of reserpine was given, blood pressure was lowered significantly (more than 30mmHg in mean blood pressure) in 18 patients (81.7%) of 22 hypertensive patients without renal insufficiency, and in 4 patients (40%) of 10 hypertensive patients with renal insufficiency. 4. Major side effect was drowsiness which was more evident in the patients with renal insufficiency. 5. Reserpine administered parenterally is an effective and safe agent for the treatment of hypertensive emergencies on a short term basis especially in the patient without renal insufficiency.
Blood Pressure ; Emergencies ; Heart Failure ; Humans ; Renal Insufficiency ; Reserpine* ; Sleep Stages ; Stroke ; Uremia

PURPOSE: To report a rare case of lymphocytic hypophysitis in a 31-year-old woman who presented with gradually progressive bilateral visual loss during the third trimester of pregnancy. METHODS: Ophthalmologic examination revealed best corrected visual acuity of 0.02 OD and counting fingers at 20 cm OS. Pupil examination revealed no relative afferent pupillary defect in either eye and intraocular pressure was normal in both eyes. A visual field test revealed nearly total visual defect sparing superotemporal area OD and total defect OS. An MRI of the head was performed. RESULTS: At the time of transsphenoidal surgery following the patient's delivery, a frozen biopsy of the lesion revealed diffuse lymphocytic infilteration and fibrosis of the pituitary gland consistent with the diagnosis of lymphocytic hypophysitis. Postoperatively the patient was treated for hypopituitarism. At 5 weeks postoperative, her best corrected visual acuity was 1.0 OU, and visual field defects resolved in both eyes. On follow-up by telephone for postoperative 7 months, the patient remained visually asymptomatic. CONCLUSIONS: The clinical presentation of lymphocytic hypophysitis may mimic pituitary adenoma, lymphoma, germinoma, and histiocytosis. The diagnosis should be suspected in any pregnant or postpartum patient with an intrasellar or suprasellar mass.
Adult ; Biopsy ; Diagnosis ; Female ; Fibrosis ; Fingers ; Follow-Up Studies ; Germinoma ; Head ; Histiocytosis ; Humans ; Hypopituitarism ; Intraocular Pressure ; Lymphoma ; Magnetic Resonance Imaging ; Pituitary Gland ; Pituitary Neoplasms ; Postpartum Period ; Pregnancy Trimester, Third ; Pregnancy* ; Pupil ; Pupil Disorders ; Telephone ; Visual Acuity ; Visual Field Tests ; Visual Fields

A case is reported ofsystemic toxicity by topically applied podophyllin. The patient was a 18-year-old girl who was treated at private gynecological clinic with 25% podophyllin resin for multiple vulval condyloma acuminata. Her apparent podophyllin toxicity begun 4 hours after topical application, presenting gastrointestinal symptoms such as nausea, vomiting, diarrhea and abdominal distension, followed by tingling sensation on hands and feet with motor weakness predominantly of distal limbs. She had never experienced disturbance of consciousness or other CNS symptoms. The symptoms of severe peripheral neuropathy had been improved by 72 days followup when she had mild impairement of vibration and position sense and mild dorsiflexion weakness of the feet.
Adolescent ; Consciousness ; Diarrhea ; Extremities ; Female ; Follow-Up Studies ; Foot ; Hand ; Humans ; Nausea ; Peripheral Nervous System Diseases ; Podophyllin ; Podophyllum* ; Polyneuropathies* ; Proprioception ; Sensation ; Vibration ; Vomiting

Acquired port-wine stain is rare. It mimics a congenital port-wine stain morphologically but the pattern of onset is acquired after birth. It represents a progressive ectasia of vessels located in the superficial vascular plexus. The exact mechanism is unknown but some reported cases have occurred after trauma. We herein report five cases of acquired port-wine stains and they were idiopathic in nature.
Dilatation, Pathologic ; Parturition ; Port-Wine Stain*

The authors have used a B-mode real-time sector scanner and a 10-MHz probe for measurement of the skin thickness at 21 different sites in healthy Koreans. Subjects consisted of 35 adults(17 males, 18 females) who were divided into three age groups .' young(20 39 years, 12 subjects), middle-aged(40 59 years, 13 subjects), and old(over 60 years, 10 subjects). The results were as follows. 1, The measurements of the skin thickness in examined sites varied from 1.99 to 4.59 milimeters . flexor aspect of the upper arm, dorsum of the hand, extensor aspect of the forearm and flexor aspect of the forearm were thinner, and heel, upper back, metatarsus were thicker than other sites. 2, The skin thickness in males was generally thicker than that in females '. cheek, extensor aspect of the thigh were highly significantly thicker (p<0.01), and chest, upper back, lower back, flexor aspect of the upper arm and extensor aspect of the lower leg were significantly thicker(p< 0.05) in males than in females, 3. The skin was thickest in the old age groups.
Arm ; Cheek ; Female ; Forearm ; Hand ; Heel ; Humans ; Leg ; Male ; Metatarsus ; Skin* ; Thigh ; Thorax ; Ultrasonography*

A clinical study was done on 161 patients (male 94, female 67) with the first onset of seizure over the age of 16 who were admitted to Keimyung University Hospital from 1979 to 1983 in order to analyze the causative factors, the age distribution at onset, the seizure pattern and E.E.G. findings. The results were summarized as follows. 1. The etiological factors of 161 seizure patients revealed metabolic encephalophaties 75 cases (46.6%), cerebrovascular disease 26 cases (16.2%), unknown cause 21 cases (13%), CNS infectious disease 17 cases (10.6%), posttraumatic seizure 12 cases (7.5%), brain tumor proved by brain biopsy 8 (5%) and hysteric seizure 2 cases in order of frequency. 2. Among the 75 cases of metabolic encephalopathies, the most common cause was drug intoxication (34 cases), followed by alcohol withdrawal seizure (21 cases), water intoxication (5 cases), uremia and hypocalcemia (4cases respectively), hepatic encephalopathies (3 cases) and then hypoglycemia and anoxia (2 cases respectively) in order of frequency. Among the 26 cases of cerebrovascular disease, spontaneous subarachnoid hemorrhage was presented in 9 cases, intracerebral hemorrhage and cerebral infarction in 7 cases respectively and arteriovenous malformation in 3 cases. Among the 17 cases of CNS infectious diseae, meningitis was presented in 9 cases, Japanese B encephalitis in 3 cases, paragonimiasis in 2 cases, and then cerebral cysticercosis, tuberculoma, and focal cerebritis in 1 case respectively. Among the 8 cases of brain tumor, meningioma was presented in 5 cases, oligodendroglioma, glioblastoma multiforme and epidermoid cyst in 1 case respectively. 3. The mean age at the onset of each causes of seizure revealed metabolic encephalopathies 38 yrs. CNS infectious disease 33 yrs, posttraumatic seizure 34 yrs, arteriovenous malformation 23 yrs, brain tumor 42 yrs, and cerebrovascular disease 54 yrs. 4. The most frequent seizure pattern of 161 patients was the generalized seizure in 126 cases (78.3%) followed by the partial elementary seizure in 29 case and the partial seizure with secondary generalization in 6 cases. The incidence of partial seizure was slightly higher than the generalized seizure in brain tumor and CNS infectious disease. 5. There were no correlation between the E.E.G. degree and causative factors of seizure.
Adult* ; Age Distribution ; Alcohol Withdrawal Seizures ; Anoxia ; Arteriovenous Malformations ; Biopsy ; Brain ; Brain Diseases, Metabolic ; Brain Neoplasms ; Cerebral Hemorrhage ; Cerebral Infarction ; Communicable Diseases ; Cysticercosis ; Encephalitis, Japanese ; Epidermal Cyst ; Female ; Generalization (Psychology) ; Glioblastoma ; Hepatic Encephalopathy ; Humans ; Hypocalcemia ; Hypoglycemia ; Incidence ; Meningioma ; Meningitis ; Oligodendroglioma ; Paragonimiasis ; Seizures* ; Subarachnoid Hemorrhage ; Tuberculoma ; Uremia ; Water Intoxication

A clinical study was done on 16 cases of cerebellar hemorrhage and 3 cases of cerebellar infarction which were diagnosed with brain CT scan at Keimyung university Dongsan hospital from July 1981 to June 1985 and conclusions obtained are as follows. 1. The incidence of cerebellar hemorrhage and infarction was 3.5% and 0.6% of all spontaneous intracranial parenchymal hemorrhage and infarction, respectively. 2. The most prevalent age group was 7th decade and sex ratio was higher in male in cerebellar stroke. 3. Major single percipitating factor of cerebellar stroke was hypertension. 4. Most of cerebellar stroke showed catastrophic or sudden onset type. 5. The most common initial symptoms of cerebellar stroke were nausea and vomiting, followed by headache and dizziness or vertigo, in order of frequency. 6. The most common neurologic signs on admission were impaired consciousness, constricted pupil with preserved light reflex and cerebellar signs. 7. The common site of cerebellar hemorrhage was right hemisphere, followed by vermis and left hemisphere, in order of frequency, and that of cerebellar infarction was right posterior hemisphere. 8. The better the consciousness on admission, the better the outcome of cerebellar stroke. 9. The following parameters indicated good prognosis with medical therapy, so called benign cerebellar hemorrhage: clear consciousness on admission, gradual onset type, less than 20cc of hematoma, no or mild hydrocephalus, no ventricular hematoma, no vermis involvement on CT scan.
Brain ; Consciousness ; Dizziness ; Headache ; Hematoma ; Hemorrhage ; Humans ; Hydrocephalus ; Hypertension ; Incidence ; Infarction ; Male ; Miosis ; Nausea ; Neurologic Manifestations ; Prognosis ; Reflex ; Sex Ratio ; Stroke ; Tomography, X-Ray Computed ; Vertigo ; Vomiting