BACKGROUND: Provision of early adequate chest compression remains a standard of care for optimal outcome in cardiopulmonary arrest. Inadequate chest compression during CPR may result in the insufficient blood flow to preserve critical organ function. Therefore, authors performed this study to characterize fatigue-induced deterioration in the adequacy of closed-chest compression performed over period 5 minutes and to determine whether CPR providers recognize the effects of fatigue on compression adequacy. METHOD: Prospectively we carried out the study with an electronic CPR teaching mannequin(ResusciAnnie with Skillmeter; Laerdal) placed on a patient stretcher. The mannequin was equipped with a real-time remote display that records the numbers of total and correct compressions. Compression are judged as correct by the mannequin if both depth and placement are appropriate in keeping with standard advanced cardiac life support guidelines. Our study subjects were 27 nurses and doctors, each with certification of BLS and experience of CPR in ED. Each subject performed a 5 minute session of chest compressions. Also subjects were asked to verbally indicate the point during their 5 minute compression period at which they felt too fatigued to provide effective compressions. For statistical analysis, one-way repeated-measures ANOVA and regression test was used. RESULT: The number of total compressions attempted per minute did not decrease significantly(P=.565). But we found 81.0% of compressions performed during the first 1 minute to be correct. The percentages for minutes 2 through 5 were decreased significantly as follows: 73.0%, 68.0%, 65.0%, 57.0%(P=.0003). Regression analysis revealed a decrement in compression adequacy of 13.0% per minutes after the first 1 minute of compression. The time of indicated fatigue was 220+/-29 seconds(mean+/-SD) CONCLUSION: Although compression rate was maintained over time, chest compression quality declined significantly over the study period. Because CPR providers could not recognize their ability to provide proper compression, cardiac arrest team leaders should carefully monitor compression adequacy and change the CPR providers each 3 minutes during CPR to assure maximally effective care for patients receiving CPR.
Advanced Cardiac Life Support ; Cardiopulmonary Resuscitation* ; Certification ; Fatigue ; Heart Arrest ; Humans ; Manikins ; Prospective Studies ; Standard of Care ; Thorax

No abstract available.
Breast Feeding* ; Breast Neoplasms* ; Breast* ; Case-Control Studies* ; Female ; Humans ; Korea*

BACKGROUND: Dizziness is a common complaint in patients presenting at emergency departments. Dizziness is difficult to assess because it is a subjective complaint that cannot be measured. We report a clinical analysis of patients with acute dizziness: type, duration, symptom, incidence, etc. METHODS: We reviewed the clinical details and the results of vestibular function tests for 106 acutely dizzy patients who visited the Emergency Department of Wonkwang University Hospital during the period of Jul. 1999 through Dec. 1999. RESULTS: The most common etiology of acute dizziness was the peripheral vestibular system(66%). The most common disease of the peripheral vestibular system was benign paroxysmal positional vertigo(52.9%), and the second most one was vestibular neuronitis(42.9%). In the central nervous system, cerebrovascular accident(63.6%) was the most common cause. All of the patients had experienced a previous vertigo attack, and 42.4% of them had frequent attacks. Dizziness of the cochlear systems were usual in peripheral vertigo. The usual underlying diseases related with vertigo were hypertension, cerebral infarction and diabetes mellitus. CONCLUSION: Dizziness is a complex and frustrating symptom with numerous possible causes. In case with suspected central disorders, CT and MRI have a great diagnostic significance.
Central Nervous System ; Cerebral Infarction ; Diabetes Mellitus ; Dizziness* ; Emergencies* ; Emergency Service, Hospital ; Humans ; Hypertension ; Incidence ; Magnetic Resonance Imaging ; Vertigo ; Vestibular Function Tests

No abstract available.
Clonidine* ; Depression* ; Growth Hormone* ; Humans ; Panic Disorder* ; Panic*

Aneurysm of the splenic artery are the third most common intra-abdominal aneurysm, following aneurysms of the infrarenal aorta and iliac arteries. Splenic artery aneurysms (SAA) are the most frequent visceral artery aneurysms and account for more than two thirds of all lesions. Incidence of SAA are rare clinical entities(0.01-0.2%) that carry risk of rupture and fatal hemorrhage(35-100%). Fibroblastic dysplasia and atherosclerosis is fecund in the majority, and the fact that these aneurysms developes more commonly in female. Most patients are asymptomatic and the diagnosis is generally made incidentally. The treatment of patient with known SAA is dictated by several factors, including location, age, sex, present of symptom, size, pregnancy. We report ruptured splenic artery aneurysm with hemoperitoneum and review of the literature.
Aneurysm* ; Aorta ; Arteries ; Atherosclerosis ; Diagnosis ; Female ; Fibroblasts ; Hemoperitoneum ; Humans ; Iliac Artery ; Incidence ; Pregnancy ; Rupture ; Splenic Artery*

Eleven patients underwent posterior sagittal anorectoplasty(PSARP) as a secondary procedure. Two of them had rectovaginal fistula and another two had rectocutaneous fistula. Six of the rest complained of frequent fecal soiling and the last one had severe anorectal stricture after perineal anoplasty. Five patients had lived with colostomy until the second operations were carried out. The ages at the time of the secondary PSARP were between 7 months and 29 years. Distal colostogram and MRI were taken to evaluate distal colon, position of the rectum and voluntary muscle. All patients had normal sacrum except one who had anorectal stricture. Seven patients, six with fecal incontinence and the other one with rectovaginal fistula had mislocated anorectums. Three patients, two with rectocutaneous fistula, the other one with anorectal stricture, had abdominal approach to obtain enough length of colon for pull-through procedure. With the posterior midsagittal approach, we could manage all the problems, rectovaginal fistulas, rectocutaneous fistulas, strictures and malpositioned rectums, without difficulty. No patients had serious complications except wound infection in one. All patients were satisfied with the results after redo-PSARPs even though normal continence has been achieved in only one patient. Seven patients who had continuous soiling or rectocutaneous fistula, needed no more diapers even though four of them showed fecal staining under stressful condition and the other three showed intermittent fecal leaking less than once a day. The rest three of the patients maintained their continence with support of drugs and/or enemas because of constipation. The PSARP is a popular procedure as a primary operation; however, our results suggested that this procedure also gave us a good opportunity for management of serious complication developed after primary anoplasties.
Colon ; Colostomy ; Constipation ; Constriction, Pathologic ; Enema ; Fecal Incontinence ; Fistula ; Humans ; Magnetic Resonance Imaging ; Muscle, Skeletal ; Rectovaginal Fistula ; Rectum ; Sacrum ; Soil ; Wound Infection

No abstract available.
Cicatrix* ; Contracture* ; Forearm* ; Hand*

It is generally accepted that fractures should be treated by closed methods, however for certain femoral fractures in adults, closed methods yields an unacceptable high incidence of nounlon, malunion, delayed unlon, and disability. For these fractures various methods of open reduction and internal fixation have been recommended, but unfortunately, there are frequent reports of complications and failures. The recently developed association for study of Internal fixation (ASIF) compression plating apparatus, seems to satisfy the basic objectives of internal flxatlons: namely
Adult ; Femoral Fractures ; Femur ; Follow-Up Studies ; Humans ; Incidence ; Joints ; Walking

Author take off the pelvic bone from the cadaver and made the accruate reconstructed the pelvic bone as well as normal bone. Then author setted the pelvic bone into the specialized acrylic globe as the normal person erect position. For the acetabular posterior wall, projected the radiologic beam from the 0°to 45°cephalad direction and then pelvic bone rotated internally 0°~45°, each section is 5°. For acetabular anterior wall, projected the radiologic beam from 0° to 45° caudal direction and pelvic bone rotated externally 0°~45°, each section is 5° too. From the pelvic bone experiments, author get on the good radiologic angle for acetabular anterior and posterior wall. Ane then make the radiologic projection for normal person as the pelvic experiment. In pelvic bone model experiment, For acetabular anterior wall and anterior colum, external rotation 20°~30° caudal tilting 30°~45° angle projection has good visualization. For acetabular posterior wall and posterior column (including anterior column partially), internal rotation 15°~20° cephalad tilting 15°~30°angle projection has the good visualization. In normal person experiment, For acetabular anterior wall and anterior column, external rotation 20°caudal tilting 30°angle projection shows the good visualization. For acetabular posterior wall and column (including anterior column partially) internal rotation 20°cephalad tilting 30°angle projection shows good visualization. From the pelvic bone model and normal person experiments, the following conclusion are obtained. 1. For posterior wall and posterior column(including anterior column partially), internal rotation 20°, cephalad tilting 30°view is good. 2. For anterior wall and anterior column, external rotation 20°, caudal tilting 30°view is good.
Acetabulum ; Cadaver ; Humans ; Pelvic Bones

It is well known that fractures around the knee joint are usually combined with ligament injuries but it is easy to miss the ligament injuries during the treatment of fractures. The invention of the MRI and the development of arthroscopic techniques has made it easy to diagnose and care for ligament injuries. Authors reviewed the patients who had fractures around the knee joint to evaluate the frequencies, types, treatments and the results of combined ligaments injuries. There were 57 cases with the fracture of the proximal tibia and fibula which could be follwed up at least one year: from January 1992 to June 1995. There were 19 cases (33%) which had combined ligament injuries. The ligament injuries were diagnosed by stress X-ray & MRI evaluation and confirmed by arthroscopic examination. Single lateral rim avulsion fracture of proximal tibia was the most common type of fractures (7 cases, 37%). There were 11 cases (57%) of combined injuries of anterior cruciate ligament and medial collateral ligament. It was the most common combined ligament injury. Except for one, eleven cases that were combined with lateral rim avulsion of proximal tibia had anterior cruciate ligament injury. There were ten cases (53%) of fibula head and neck fractures which were combined with ligament injuries. The total number of the injured ligament was 35 and the common rupture sites of the injured ligaments was the attachment site of femur (13 cases) and tibia (16 cases). There were seven meniscal injury cases (37%). The interval from injury to operation averaged 14.1 days because many cases were acute injuries. Primary repairs for ruptured ligament were done in 31 cases (88%) because of their attachment site injuries. There were no instabilities except one case which was treated with posterior cruciate ligament reconstruction using semitendinosus ligament. It had a grade I posterior instability at the last follow-up. Early diagnosis and proper treatment on the ruptured ligaments and the torn meniscus combined with proximal tibia and fibular fractures seem to be important for a good prognosis.
Anterior Cruciate Ligament ; Collateral Ligaments ; Early Diagnosis ; Femur ; Fibula* ; Follow-Up Studies ; Head ; Humans ; Inventions ; Knee ; Knee Joint ; Ligaments* ; Magnetic Resonance Imaging ; Neck ; Posterior Cruciate Ligament ; Prognosis ; Rupture ; Tibia*