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

BACKGROUND: Osteoarthritis(OA) of the knee represents a common chronic disease, especially in the elderly, leading to functional impairment and disability. And OA patients have depressive symptoms frequently. Several factors contribute to the level of depressive symptoms. Authors tried to assess these factors and show effect of these factors to depressive symptoms. Through this study in the future physicians must consider psychiatric problems besides the pain itself in the treatment of OA patients. METHODS: Subjects included in this study were 64 knee joint OA patients. We obtained depressive symptoms from the CES-D(The Korean version of the Center for Epidemiological Studies-Depression Scale), level of pain, stiffness, functional disability from KWOMAC(WOMAC Korean Version 2, The Korean version of Western Ontario and Macmaster Osteoarthritis Index Score) and other factors able to contribute to depressive symptoms. RESULT: We divided the patients into two groups using CES-D cut-off score of 21. Each group consists of 46(CES-D<21) and 18(CES-D> or =21) patients. Frequency of sleep disturbance and pain consistency and level of pain, stiffness and functional disability were different significantly between two groups(p<0.0l). Through the correlation analysis level of pain, stiffness and functional disability were associated with CES-D score significantly(p<0.0l). And through the stepwise multiple regression analysis we demonstratred that the CES-D score influenced by level of functional disability, BMI, disease duration and, pain but only level of functional disability and BML were statistically significant(p<0.0l). Level of functional disability explained 46% of CES-D score(partial R2=0.46) so influenced on depressive symptoms most effectively. CONCLUSION: This study suggested that functional disability was most important factors to explain depressive symptoms of knee joint OA patients.
Aged ; Chronic Disease ; Depression ; Humans ; Knee Joint* ; Knee* ; Ontario ; Osteoarthritis*

BACKGROUND: Osteoarthritis(OA) has become one of the most important medical problem among the old age because it causes severe functional disability, but, up to date, the therapeutic methods for OA have not been so satisfactory to the patients with OA. Authors have investigated the effectiveness of intramuscular stimulation(IMS) therapy as an substitutive therapy for the relief of pain and dysfunction in patients with OA of the knee. METHODS: Eighteen patients who had visited the department of family medicine, Korea university anam hospital, with symptomatic OA of the knee during the period from March 1 to May 31. 2001 were included in this study and treated with IMS therapy on the quadriceps and hamstring muscles four times during two weeks. Patients self-scored Korean Western Ontario and McMaster universities Osteoarthritis Index (KWOMAC) at baseline and after the last therapy. The result was analysed by paired t-test and ANOVA. RESULT: Patients improved on KWOMAC scales for pain, stiffness, function and total scores after IMS therapy(p<0.05). The demographic characteristics such as body mass index (BML), duration of disease, affected site, radiologic finding did not have influence on the result of this study. No adverse effects of IMS therapy were reported. CONCLUSION: In this study, the improvement of pain, stiffness, and function of knee joint after treatment was reported. This study suggest that IMS is an effective and safe substitutive therapy for patients with OA of Knee.
Body Mass Index ; Humans ; Knee Joint* ; Knee* ; Korea ; Muscles ; Ontario ; Osteoarthritis* ; Weights and Measures

BACKGROUNDS: Gamma band oscillatory activity is considered to be related to congnitive functions and illustrates that the concept of event-related oscillations bridges the gap between single neurons and neural assemblies. An event-related gamma oscillation is the time - locked responses of specific frequency, and can be identified by computing the amplitude frequency characteristics of the averaged event-related potentials(ERPs) after stimulation. OBJECTIVES: We purposed to present experimental paradigm to investigate @-band oscillation activities from the recording of ERPs by using auditory oddball paradigm and investigate the difference of @-band activity between schizophrenia and normal controls. METHODS: The ERPs resulting from auditory stimuli with oddball paradigm in a group of schizophrenics(n=11) and also a group of age-, sex- and handedness matched normal controls, were recorded by 128 channel EEG. The @-band oscillatory activities were calculated by using time-frequency wavelet decomposition of the signal between 20 and 80Hz. The @-band oscillatory activities of both groups were compared by t-test. RESULTS: The @-band oscillatory of the leads Fz,Gz and Pz of both groups were represented well in the time - frequency maps. Significant increases of the @-band activity in normal controls compared with schizophrenics were observed around 160 msec. 350msec. and 800 msec after stimulation. CONCLUSIONS: Our results suggested that the increment in @-band oscillatory activity during cognitive operations and decreased @-band activity in schizophrenics may be associated with the cognitive dysfunctions and the pathophyiology of the schizophrenia.
Electroencephalography ; Evoked Potentials* ; Functional Laterality ; Neurons ; Schizophrenia

Bosworth fracture, fracture-dislocation of ankle with entrapment of fibula behind the tibia, is a rare condition. Diagnosis of this fracture-dislocation may not he easy, and closed reduction of this injury is difficult because of entrapment of fibula by the tieht interosseous membrane. We report a case of Bosworth fracture treated with the anti-glide plate technique.
Ankle ; Diagnosis ; Fibula ; Membranes ; Tibia

No abstract available.
Autoantibodies* ; Humans*

PURPOSE: The aim of the present study was to assess the clinicopatholgical significance of Bcl-2 oncoprotein expression in childhood non-Hodgkin's lymphoma (NHL). METHODS: We have assessed 16 cases of childhood NHL during last 6 years from 1990 to 1995. Bcl-2 oncoprotein expression has been semiquantitatively analyzed in paraffin sections from 16 cases of childhood NHL with 39 control cases of adult NHL. The expression of Bcl-2 oncoprotein was correlated with histologic grade, immunophenotype, proliferative activity as measured by immunostain of Ki-67 antigen, clinical stage, and survival rate (event free survival rate, EFS). RESULTS: 1) Bcl-2 oncoprotein expression significantly decreased according to increase of histological grade (P<0.05). 2) High Bcl-2 oncoprotein expression was more frequent in B-cell NHL than T-cell NHL (P<0.05). 3) Proliferative activity as measured by immunostain of Ki-67 antigen was negatively correlated with Bcl-2 oncoprotein expression (P<0.05). 4) Bcl-2 oncoprotein expression was not correlated with clinical stage (P>0.05). 5) EFS of patients was significantly correlated with Bcl-2 oncoprotein expression, that is, reduced EFS was demonstrated in the patients with low Bcl-2 oncoprotein expression (P<0.05). CONCLUSIONS: Thus Bcl-2 oncoprotein, as demonstrated immunohistochemically in routinely paraffin embedded tissue, can be restrictively used in prediction of prognosis and grade of childhood NHL, in aggrement with the role of Bcl-2 oncoprotein in blocking of apoptosis and indirect contribution to increase of cellular proliferative activity of NHL.
Adult ; Apoptosis ; B-Lymphocytes ; Child ; Humans ; Ki-67 Antigen ; Lymphoma, Non-Hodgkin* ; Paraffin ; Prognosis ; Survival Rate ; T-Lymphocytes

Primary non-Hodgkin' lymphomas of the liver, an organ normally devoid of a native lymphoid tissue, are very rare. We recently experienced a case of a primary low-grade hepatic B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) type in a 36-year-old woman. The ultrasonography revealed a 5 cm sized mass in the right lobe of the liver. A right segmentectomy of the liver was done and showed a relatively well-circumscribed brownish yellow lobulated homogenous mass, measuring 5.5x4.5 cm in size. Histologic sections of liver mass revealed large lymphoid follicles with reactive germinal centers, follicular colonization by centrocyte-like cells (CCL cells), and lymphoepithelial lesions. The CCL cells were positive for B-cell (CD20), LCA (CD45RA), Bcl-2 oncoprotein, and lambda light chain.
Adult ; B-Lymphocytes ; Colon ; Female ; Germinal Center ; Humans ; Liver* ; Lymphoid Tissue ; Lymphoma* ; Lymphoma, B-Cell ; Mastectomy, Segmental ; Ultrasonography

We examined the association between heart rate variability (HRV) and survival duration to evaluate the usefulness of HRV as a prognostic factor for hospice cancer patients. In terminally ill cancer patients who visited the Hospice clinic, we checked demographic data, Karnofsky performance scale (KPS), HRV, dyspnea, anorexia, as well as fasting blood glucose and total cholesterol. After following up their duration of survival, we examined meaningful prognostic factors for predicting life expectancy through the survival analysis. A total of 68 patients were included in final analysis. As KPS was lower, or when combined with dyspnea or anorexia, the survival duration was much shorter. HRV parameters except heart rate were all impaired in most patients. In particular, the group with mean heart rate of 100 or more beats per minute and the group with standard deviations of normal-to-normal R-R intervals (SDNN) of 21.3 ms (75 percentile) or less showed significantly shorter survival duration. The final multivariate analysis adjusting for age, gender, fasting blood glucose, and total cholesterol showed that KPS, dyspnea, anorexia, and SDNN were significant prognostic factors in survival duration. For the first time, we report that SDNN is a prognostic factor in terminal cancer patients.
Adult ; Aged ; Aged, 80 and over ; Female ; Heart Rate/*physiology ; Hospices ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasms/*mortality ; Prognosis ; Survival Analysis ; Terminal Care

BACKGROUND: Myocardial contrast two-dimensional echocardiography(MC-2DE) has been known to have the real time capabilities for repeat in vivo assessment of ischemic risk areas and for evaluation of the myocardial perfusion. The aims of this investigation are (1) to evaluate the feasibility of MC-2DE for the delineation and quantitation of the area at risk. (2) to determine the relationship between the extent of the echocontrast defect area(EDA) during reperfusion and the size of myocardial infarction as determined by post-mortem tissue examination, and (3) to observe serial changes in the time echo-intensity characteristics of MC-2DE during coronary occlusion and reperfusion. METHODS: Myocardial contrast echocardiographic images were made by injecting bolus 5mL of two-syringe-agitated mixture of sodium meglumine ioxaglate(Hexabrix(R)) and normal saline(2 : 3 by volume) into the aortic root before and during coronary occlusion of the left anterior descending coronary artery, distal to the first diagonal branch and during reperfusion on eight open-chest dogs. Two-dimensional echocardiographic short axis views were obtained at four anatomic levels : the apex, the low papillary muscle, the high papillary muscle and the mitral valve. The changes in EDA and echo-intensity with its wash-out half time(WHT) at the high papillary muscle level during coronary occlusion and reperfusion were measured every 15 minutes. The total EDA was measured by planimetry at 3 minutes after coronary occlusion and at 60 minutes after reperfusion. Evans blue or methylene blue were used for the measurement of the anatomic area at risk and triphenyl-tetrazolium chloride(TTC) for the measurement of the infarct area. RESULTS: The EDA measured 30 minutes after coronary occlusion(19.6%) was smaller than that at 3 minutes after coronary occlusion(24.0%, p<0.01). Then EDA at 3 minutes occlusion was strongly predictive of the anatomic extent of area at risk(EDA=0.48 Area at risk+16.95, r=0.84, p<0.05). The EDA at 60 minutes after reperfusion, which showed an irregular margin and was located within the subendocardium of the area at risk, also correlated well with the infarct area(IA)(EDA=0.78 IA+3.32, r=0.82, p=0.09). The peak echo-intensity in the ischemic area during coronary occlusion was significantly low(14.2+/-6.5 vs 73.8+/-31.7 in the non-ischemic area, p<0.01) and the WHT was delayed more in the ischemic area than in the non-ischemic area(23.2+/-2.8 sec vs 8.1+/-3.3sec, p<0.01). During the period of reperfusion, WHT in the previously ischemic area was markedly delayed compared to that in the non-ischemic area (p<0.01), although the peak echo-intensity in the ischemic area at 3 minutes after reperfusion increased modestly compared to that in the non-ischemic area(80.9+/-22.8 vs 72.7+/-8.4), suggesting the impairment in the transit of microbubbles is probably due to microvascular damage after reperfusion. There were no adverse hemodynamic or electrocardiographic effects after injection of the contrast agent. CONCLUSIONS: These findings suggest that myocardial contrast echocardiography was useful as a non-invasive technique, first, to delineate the area at risk in vivo during coronary occlusion and, after reperfusion, the infarct area, and secondly, to evaluate indirectly the state of myocardial perfusion during coronary occlusion and reperfusion.
Animals ; Axis, Cervical Vertebra ; Coronary Occlusion* ; Coronary Vessels ; Dogs ; Echocardiography* ; Electrocardiography ; Evans Blue ; Hemodynamics ; Meglumine ; Methylene Blue ; Microbubbles ; Mitral Valve ; Myocardial Infarction ; Papillary Muscles ; Perfusion* ; Reperfusion* ; Sodium