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

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

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

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

BACKGROUND: Biochemical bone markers have been suggested to reflect postmenopausal high bone turnover. These markers could be useful in following response to hormone replacement therapy (HRT). But we have few studies about the sequential changes of biochemical bone markers and bone mass after HRT in Korean women, and it is unclear whether women with early menopause have different response to HRT from women with normal menopause. The aims of the present study were to see the sequential changes of biochemical bone markers and bone mass after HRT in Korean women, to examine whether a single baseline biochemical bone marker or a change in biochemical bone marker could predict subsequent bone mass, and to determine the difference of response to HRT between women with early menopause and women with normal menopause. METHODS: Postmenopausal women (n=21) were divided with into three groups according to their age at menopause (AAM): the first group with AAM < or = 43 years (early menopause group, n=7), the second group with 43 years < or = AAM < or = 50 years (n=4), and the third group with AAM > or = 50 years (normal menopause group, n=10). For the HRT, conjugated estrogen (0.625mg per day) and continuous or cyclic medroxyprogesterone (2.5-10mg per day) were administered. Bone mineral density (BMD) was measured at baseline and 12 months and biochemical bone markers were measured at baseline and 3, 6, and 12 months during HRT. RESULTS: Deoxypyridinoline, type 1 collagen N-telopeptide, bone alkaline phosphatase, and osteocalcin were significantly decreased at 3 months, and mean percent changes from baseline of bone resorption markers were larger than those of bone formation markers. At 12 months, BMD was significantly increased at lumbar spine and Ward's triangle. But BMD was not significantly increased at femur neck and femur trochanter. Two baseline bone markers (bone alkaline phosphatase and type 1 collagen N-telopeptide) correlated with changes of BMD but any changes of bone markers at 3, 6 months didn't correlate with changes of BMD. In early menopause group, changes of bone markers and BMD were larger than those in normal menopause group, but the difference between the two groups was not significant. CONCLUSION: All four bone markers showed significant reduction at 3 months, but bone resorption markers were decreased more markedly and rapidly, and some baseline bone markers can predict the change of BMD after HRT. The difference of response to HRT between early menopause group and normal menopause group was not significant.
Alkaline Phosphatase ; Bone Density* ; Bone Resorption ; Collagen Type I ; Estrogens ; Female ; Femur ; Femur Neck ; Hormone Replacement Therapy* ; Humans ; Medroxyprogesterone ; Menopause ; Osteocalcin ; Osteogenesis ; Spine

BACKGROUND: In a frontal sinus reconstruction, the literature primarily recommends a surgical approach for definite treatment with the exception of for anterior wall fractures with no dislocation. Many studies have assessed a range of methods for the reduction of frontal sinus fractures. This paper presents a case, in whom the anterior wall of the frontal sinus was reconstructed using an outer table calvarial bone graft in an en bloc manner. PATIENT AND METHODS: A 36-year-old male visited the emergency room with a heavy injury to the forehead. He was diagnosed with fractures of the anterior and posterior wall of the frontal sinus. The neurosurgeon removed the fractured area and repaired the meninges. Afterwards, cranialization was performed and the opening of the nasofrontal duct was obstructed. After fixing the removed bone to its original location, all fragments of fractured anterior wall were purged out and the anterior wall reconstructed using an en bloc calvarial bone graft. RESULTS: In the post-operative 8 months period, there were no complications, the round contour of the forehead was expressed well and the patient was satisfied with the result. CONCLUSION: There are many methods for reconstructing the anterior wall of the frontal sinus. On the other hand, in cases of large fracture sites with many fractured bone fragments, en bloc harvesting of the outer table calvarial bone could be a better choice than making use of only plates and screws because this method shows a good results in terms of aesthetics with a low complication rate.
Adult ; Dislocations ; Emergencies ; Esthetics ; Forehead ; Frontal Sinus ; Hand ; Humans ; Male ; Meninges ; Transplants

PURPOSE: The purpose of this study was to review our clinical experiences of acute mesenteric ischemic disease at the Masan Samsung hospital. METHOD: Retrospectively reviewed the medical records of 20 patients with acute mesenteric ischemic disease from 1998 through 2003 in terms of clinical characteristics, image findings, management and results. RESULT: The mean age of patients was 63.5 years and the male female ratio was 1.5:1. Coexisting diseases were atrial fibrillation (n=10), hypertension (n=9), myocardial infarction (n=2), DM (n=4). The clinical manifestations were abdominal pain, abdominal distension, peritoneal irritation signs, vomiting and melena. The presenting signs were nonspecific. Laboratory findings were nonspecific and not helpful for diagnosis of acute mesenteric ischemia. Abdominal CT and SMA angiography were accurate and sensitive diagnostic tools. Seventeen cases were SMA occlusion (1 case: SMA dissection) and 3 cases were SMV occlusion. Operative procedures were resection of bowel (12 cases) and thromboembolectomy (5 cases). Non operative procedure was anticoagulation (3 cases). One patient refused surgery. CONCLUSION: Both clinical and laboratory data were non-specific and delayed diagnosis was the main cause of the overall mortality rate of 35% (7 cases). The mortality rate for patients undergoing surgery for acute mesenteric ischemic disease was high, but early diagnosis and intensive care may be reduced mortality.
Abdominal Pain ; Angiography ; Atrial Fibrillation ; Critical Care ; Delayed Diagnosis ; Diagnosis ; Early Diagnosis ; Embolism ; Female ; Humans ; Hypertension ; Ischemia* ; Male ; Medical Records ; Melena ; Mesenteric Vascular Occlusion ; Mortality ; Myocardial Infarction ; Retrospective Studies ; Surgical Procedures, Operative ; Thrombosis ; Tomography, X-Ray Computed ; Vomiting