BACKGROUND: We studied the incidence of trauma caused by alcohol related accidents, and the effects that has on the occurrence, the extent, and the outcome to the patient. METHODS: In our study we studied trauma patients excluding pediatric patients(15 years old and under) who came to the Emergency department of Korea University Medical School Anam Hospital from the 1st of january 1996 to 30th of June 1996, looked into their medical records, and studied the records in a retrospective manner. The trauma patients were divided into two groups, a) alcohol-related and b) alcohol-non-related. The two groups were then subdivided according to their sex, age, the time they came in, the anatomical part of the trauma, the mechanism of their injury, the extent of the injury, the length of their hospital stay, the length of their ED stay and were seperately compared and analysed. Statistically, ANOVA and logistic regression analysis using SAS were used in the study and then was assessed in Chi-square analysis methods. RESULTS: The total of the trauma patients, added up to 832 people, 577: male and 255: female. Among this sum, 16 trauma patients were alcohol related(male:127 & female 36). 115 people were in the age group of 21-40. Compared to the non-alcohol related trauma group, the alcohol-related group had more facial & scalp injuries and tended to come in the hours between 0-6 AM. The cause of the injuries were mossy by fast-fighting and suicide, compared to mostly accidental-slipping injuries in the non alcohol-related group. There were no difference in the degree of the injury(ISS) and the length of hospital stay between the two groups, whereas the length of the stay at the ED was longer alcohol-related trauma patients. CONCLUSION: Alcohol related trauma patients were mostly in their 20s and 30s, came to the hospital at a late time it the reason for their visit were mossy because of fist fighting. In the Emergency department, because prompt and correct diagnosis is quite difficult to make in this group, their ED stay tended to be longer. We can conclude that measuring the blood alcohol level of these patients, continuing the psychological therapy and educating people is needed.
Diagnosis ; Emergency Service, Hospital ; Female ; Humans ; Incidence ; Korea ; Length of Stay ; Logistic Models ; Male ; Medical Records ; Retrospective Studies ; Scalp ; Schools, Medical ; Suicide

MRI(Magnetic Resonance Imaging) have provided for greater image resolution, detailed tissue contrast without use of contrast media and images acquired in any plane. The purpose of this study was to examine the anatomy and dimension of the epidural space using MRI(Magnetic Resonance Imaging) and to compare the information obtained with that from other investigative technique. The anatomy of the lumbar epidural space was studied retrospectively using lumbar MRI scans of 90 patients. The epidural width(E.W.) is divided into three distance between the anterior surface of the ligamentum flavum and the dura at the caudal end of the lumbar segment(A), at the mid point of the ligamentum flavum(B) and at the cranial end of the lumbar segment(C). The distance from skin to supraspinous ligament(S-L) and from supraspinous ligament to epidural space(L-E) were measured. And then with adding both the distance, We measured the distance from skin to epidural space(S-E). Results were as follows; I) Posterior to the dural sac, epidural fat which is of high signal(white) on Tlw(T1 weighted) image is demonstrated at levels Tl I-T12 to L5-Sl giving 'Saw toothed' pattem to the epidural space. The fat is divided into segments by the interposing laminar, and the epidural space is deeper at cranial end than caudal end. 2) It was the relatively wide epidural space in L2-3 and L3-4 level, and the narrowest epidural space in L5-Sl level. 3) The distance from skin to supraspinous ligament was noted marked variation(2-40mm) according to the individual disparity. And the distance from supraspinous ligament to epidural space is 17-43mm. In distance from skin to epidural space, the most narrow place is Ll-21evel (37.95+/-7.65mm). The most deep place is IA-5 level(46.35+/-7.20mm). As the age increase, epidural width is decreased at L3-4 level (p<0.05).
Contrast Media ; Epidural Space* ; Humans ; Investigative Techniques ; Ligaments ; Ligamentum Flavum ; Magnetic Resonance Imaging* ; Retrospective Studies ; Skin

Endovascular procedures are becoming the standard type of care for the management of hemodialysis vascular access dysfunction. As with any type of medical procedure, these techniques can result in procedure-related complications, although the expected number of complications is low. The clinical extent of these complications varies from case to case. Management of these cases depends on the clinical presentation. Major complications such as vein rupture, arterial embolism, remote site bleeding or hematoma, symptomatic pulmonary embolism and puncture site complications necessitating treatment require major therapy. Minor complications such as non-flow compromising small puncture site hematoma or pseudoaneurysms require little or no therapy. It is essential that the interventionist be prepared to manage these complications appropriately when they arise.
Veins ; Stents ; Rupture, Spontaneous ; Retrospective Studies ; Renal Dialysis/*methods ; Postoperative Complications/therapy ; Middle Aged ; Male ; Humans ; Female ; Extravasation of Diagnostic and Therapeutic Materials/therapy ; Embolism/therapy ; *Arteriovenous Shunt, Surgical ; Aged ; Adult

PURPOSE: A new quantitative tumor marker, based on the combined measurement of urinary fragments of cytokeratin 8 and 18, namely the urinary bladder cancer antigen (UBCTM) test, has been proposed for the detection of bladder cancer. We compared the results of the UBC test, with voided urine cytology, for the diagnosis of bladder cancer to evaluate its diagnostic performance. MATERIALS AND METHODS: The UBC concentrations were measured, using an immunoradiometric assay, in the urine of 15 healthy subjects (group I), 26 patients with other urological disease except bladder cancer (group II), 40 patients with active bladder cancer (group III) and 17 patients free of bladder cancer, as confirmed by cystoscopy at follow-up (group IV). The differences in the UBC test, with regard to stage, grade, tumor size, focality and history of recurrence, were also evaluated. RESULTS: The mean UBC concentrations were 3.52micro gram/l, 45.76micro gram/l, 92.80micro gram/l and 20.51micro gram/l, for group I to IV, respectively, which were statistically different (p<0.05). There were significant differences regarding stage (p=0.044) and tumor size (p=0.036). However, no differences were founded in relation to the grade, shape, focality or history of recurrence. The optimal threshold for the UBC test, and the area under the ROC curve, were 12.8micro gram//l and 0.684, respectively. The sensitivity, specificity, positive and negative predictive values for the UBC test and urine cytology in groups III and IV were 50.0 and 30.0%, 88.2 and 100%, 90.9 and 100%, and 42.9 and 37.0%, respectively. CONCLUSIONS: The UBC test appears to be useful for the detection of bladder cancer in terms of its superior sensitivity and negative predictive value over those of urine cytology. Further studies will be required for the clinical utility of the UBC test in the diagnosis and follow-up of bladder cancer.
Cystoscopy ; Diagnosis* ; Follow-Up Studies ; Humans ; Immunoradiometric Assay ; Keratin-8 ; Recurrence ; ROC Curve ; Sensitivity and Specificity ; Urinary Bladder Neoplasms* ; Urinary Bladder* ; Urologic Diseases

BACKGROUND: Predicting outcome after head trauma is of great interest for clinicians, especially in the early stage. It may provide a basis for therapeutic strategies and may be helpful to select different approaches. But, reliable outcome prediction from head trauma is still unresolved. The purpose of this study is to determine which clinical parameters can be used effectively after an event of head trauma. METHODS: In our study we studied head trauma patients who came to the Emergency department of Korea University Medical School Anam Hospital from the 1st of June 1998 to 31th of January 2000, looked into medical records, and studied the records in a retrospective manner. The head trauma patients were divied into two group, a) favourable outcome-related and b) unfavourable outcome-related. The two groups were then subdivided according to their sex, age, the mechanism of their injury, the time they came in, alcohol drinking, loss of consciousness, vomiting, pupil change, previous medical illness, associated injuries and were seperately compared and analyzed. And the factors affecting Glasgow Outcome Scale(GOS) were analyzed in the parameters of Injury Severity Score(ISS), Revised Trauma Score(RTS), Glasgow Coma Scale(GCS), motor score of GCS(mGCS), Marshall Computed Tomographic Classification(MCTC). Statistically, t-test and Mann-Whistney rank sum test using Jandelsigma were used in the study and then were assessed in Chi-square analysis methods. The statistical significance was determined at a level of p less than 0.05. RESULTS: The total of the head trauma patients, added up to 129 people, 99:males and 30:females. Among this sum, 99 patients showed a favourable outcome and 30 patients showed an unfavourable outcome at discharge. The causes of injury included: automobile accident in 42 cases; falls in 26; assaults in 6; and accidental-slipping injury etc in 55 cases. 12 patients had bilateral unreactive pupils on admission, 2 had unilateral reactive pupils, and 113 had bilateral reactive pupils. Compared to the favourable outcome-related head trauma group, the unfavourable outcome-relared head trauma group had more history of loss of consciousness, unreactive pupils and tended to have previous medical illness. There were no difference in alcohol related, vomiting and associated injuries between two groups(favourable outcome-related head trauma group: unfavourable outcome-related head trauma group). Substantial difference were observed in GCS, mGCS, ISS, RTS, MCTC between two groups. Patients with unfavourable outcome had a significantly higher ISS, lower RTS, lower mGCS. After MCTC, patients with mass lesion had unfavourable outcome than patients with diffuse injury. CONCLUSION: Age, history of loss of consciousness, previous medical illness and unreactive pupil change are predictives of outcomes of head trauma patients with respect to Glasgow outcome scale. The lower GCS, lower RTS, lower mGCS, higher ISS, mass lesion based on CT scan provide poorer prognostic outcome in patients with head trauma. Use of prognostic factors thorough complete history taking and physical examination would provide useful prognostic information and facilitate improved therapeutic decision-making in head-injuried patients.
Alcohol Drinking ; Automobiles ; Coma ; Craniocerebral Trauma* ; Emergency Service, Hospital ; Glasgow Outcome Scale ; Head* ; Humans ; Korea ; Medical Records ; Physical Examination ; Pupil ; Retrospective Studies ; Schools, Medical ; Tomography, X-Ray Computed ; Unconsciousness ; Vomiting

PURPOSE: A retroperitoneal laparoscopy, by providing direct access to the retroperitoneal cavity, is useful as an approach to urological surgery. Here, our initial experience of retroperitoneal laparoscopic radical nephrectomies, in 18 consecutive patients with renal cell carcinomas, is reported. MATERIALS AND METHODS: The records of 18 consecutive patients, with renal cell carcinomas, that underwent a retroperitoneal laparoscopic radical nephrectomy between June 2000 and September 2002, were reviewed. RESULTS: The retroperitoneal laparoscopic radical nephrectomies, for the renal cell carcinomas, were successfully performed in all but 3 patients. These 3 were converted to an open technique due to severe adhesion in 1 and bleeding in the other 2. Of the 15 renal cell carcinomas, the final pathological stages were pT1N0M0 in 14 and pT2N0M0 in 1. The mean tumor size and specimen weight were 4.3cm, ranging from 2 to 7.5cm and 258gm, ranging from 203 to 372gm, respectively. The tumors involved the upper pole, the mid pole and the lower pole in 5, 6 and 4 cases, respectively. The mean operative time and estimated blood loss were 195 minutes, ranging from 160 to 260 minutes, and 181.3cc, ranging from 50 to 500cc, respectively. In 4 of the 15 patients, Patient-Controlled Analgesia (PCA) were used for the control of post operative pain, the other 11 required minimal postoperative analgesics. The mean interval to resuming oral intake and hospital stay were 2.3 days, ranging from 2 to 3 days, 5.4 days, ranging from 4 to 7 days, respectively. Complications occurred in 2 patients, and included partial atelectasis in 1 and pulmonary edema in the other. Neither local recurrence nor distant dissemination was observed during the mean follow-up of 13.6 months (range 4 to 25). CONCLUSIONS: A retroperitoneal laparoscopic radical nephrectomy is a safe and effective alternative, to an open radical nephrectomy, in patients with a localized renal cell carcinoma.
Analgesia, Patient-Controlled ; Analgesics ; Carcinoma, Renal Cell* ; Follow-Up Studies ; Hemorrhage ; Humans ; Kidney ; Laparoscopy ; Length of Stay ; Nephrectomy* ; Operative Time ; Pulmonary Atelectasis ; Pulmonary Edema ; Recurrence

Polypoid cystitis is an unusual benign lesion characterized by the edema, congestion and inflammation elevating the vesical mucosa into papillary projections. It is rare in the absence of one of the following 3 recognizable causes: indwelling catheters, vesical fistula or chronic bladder irritation. We report a case of a rapidly growing, huge polypoid cystitis without identifiable cause in a 17-year-old female, who was managed by cystectomy with uterus preservation and orthotopic bladder substitution.
Adolescent ; Catheters, Indwelling ; Cystectomy ; Cystitis* ; Edema ; Estrogens, Conjugated (USP) ; Female ; Humans ; Inflammation ; Mucous Membrane ; Urinary Bladder Fistula ; Urinary Bladder* ; Uterus

Sclerosing lymphangitis of the penis is a rare condition involving the distal lymphatics that is characterized by cord-like lesions on the shaft or coronal sulcus. Although the etiology is unknown, its association with mechanical trauma, anatomic variants, or infection has been shown. Clinically, the patient notices a painless, firm, cord-like lesion just proximal to the sulcus. Histologic study reveals hypertrophy and sclerosis of lymphatic vessel walls and, in some cases, thrombus formation within the dilated vessels. Most cases are self-limited, and conservative management is indicated, but surgical excision is warranted for persistently symptomatic lesions. We report three cases of sclerosing lymphangitis of the penis that required treatment by surgical excision.
Humans ; Hypertrophy ; Lymphangitis* ; Lymphatic Vessels ; Male ; Penis* ; Sclerosis ; Thrombosis

Flexible fiberoptic colonoscopy is extensively used for the diagnosis and management of colorectal disease. Many possible complications can occur. The most common and most serious complications are hemorrhage, perforation and respiratory problems. Colonic perforation usually results in a fatal and emergent condition. However, management of iatrogenic colonic perforation has been controversial. The choice between the medical versus the surgical approach has been dependent on the mechanism of the perforation, bowel preparation, location, size of the defect and severity of symptoms. We report here a case where colonic perforation emerged during endoscopic submucosal resection of a rectal tumor. The rectal perforation was accompanied with pneumoperitoneum, subcutaneous emphysema, pneumoretroperitoneum and pneumomediastinum. As the bowel preparation was excellent, intravenous antibiotics and total parenteral nutirition were administered. The patient was treated successfully without any complications.
Anti-Bacterial Agents ; Colon ; Colonoscopy ; Diagnosis ; Hemorrhage ; Humans ; Mediastinal Emphysema* ; Pneumoperitoneum* ; Rectal Neoplasms ; Retropneumoperitoneum* ; Subcutaneous Emphysema*

Flexible fiberoptic colonoscopy is extensively used for the diagnosis and management of colorectal disease. Many possible complications can occur. The most common and most serious complications are hemorrhage, perforation and respiratory problems. Colonic perforation usually results in a fatal and emergent condition. However, management of iatrogenic colonic perforation has been controversial. The choice between the medical versus the surgical approach has been dependent on the mechanism of the perforation, bowel preparation, location, size of the defect and severity of symptoms. We report here a case where colonic perforation emerged during endoscopic submucosal resection of a rectal tumor. The rectal perforation was accompanied with pneumoperitoneum, subcutaneous emphysema, pneumoretroperitoneum and pneumomediastinum. As the bowel preparation was excellent, intravenous antibiotics and total parenteral nutirition were administered. The patient was treated successfully without any complications.
Anti-Bacterial Agents ; Colon ; Colonoscopy ; Diagnosis ; Hemorrhage ; Humans ; Mediastinal Emphysema* ; Pneumoperitoneum* ; Rectal Neoplasms ; Retropneumoperitoneum* ; Subcutaneous Emphysema*