As the incidence of acute myocardial infarction been increasing with prolongation of life spans, improvement in foods and life styles in Korea, rapid diagnosis and treatment is critical in survival of acute myocardial infarction patient. Most of the acute myocardial infarction result from atherosclerotic plaque forming thrombus and occlusion of coronary artery. Because early thrombolytic therapy is important to maintain the left ventricular function and survival rate, there have been many trials to reperfuse the occluded coronary artery. We have studied the many aspects of acute myocardial infarction such as sex, age, infarction site, chief complaints, change of ECG, change of serum enzyme, time delay on emergency room arrival, and compared the effectiveness of thrombolytic therapy. Total number of patient was 212, and males were 141(66.5%) and females were 71(33.5%). The most common infarction site was ant, fuel wall(102 cases,48%)of the heart and the most common chief complaint was chest pain(204 cases,97%). Among the 106 patients who received thrombolytic therapy, 101 patients(95%) had survived and 5 patients(5%) had died. Among the 64 patients who didn't receive thrombolytic therapy, 56 patients (87.5%) were alived and 8 patients(12.5%) were dead.
Ants ; Coronary Vessels ; Diagnosis* ; Electrocardiography ; Emergency Service, Hospital ; Female ; Heart ; Humans ; Incidence ; Infarction ; Korea ; Life Style ; Life Support Care ; Male ; Myocardial Infarction* ; Plaque, Atherosclerotic ; Survival Rate ; Thorax ; Thrombolytic Therapy ; Thrombosis ; Ventricular Function, Left

Recently with the development of magnetic resonance imaging(MRI) techniques, many reports of radiologic findings in spontaneous intracranial hypotension(SIH) have been reported. However in our review, the pachymeningeal changes within spinal canal secondary to SIH are not reported. In SIH, same mechanisms of it might act in the intraspinal space, which cause pachymeningeal changes of spinal dura and clinical features of spinal involvement. We reports four cases of SIH, in which MRI of the brain and spine reveals diffuse symmetric pachymeningeal enhancement. This is the first report of the spinal images in SIH.
Brain ; Intracranial Hypotension* ; Magnetic Resonance Imaging* ; Spinal Canal ; Spine

Complications of tracheal intubation are well documented. However, iatrogenic aspiration of a broken metallic stylet following tracheal intubation has been infrequently reported. A 60-year-old woman, 10 days after shoulder arthroscopic surgery under endotracheal general anesthesia, was admitted to our hospital because of right chest pain. Chest radiographs showed a 8 cm length of metallic foreign body in the lower lobe of the right lung. Attempts at retrieval, including thoracoscopy, were unsuccessful. Open thoracostomy was performed. The removed foreign body was a part of metallic stylet. We report a case of iatrogenic aspiration of a broken metallic stylet.
Anesthesia, General ; Arthroscopy ; Chest Pain ; Female ; Foreign Bodies ; Humans ; Intubation ; Lung ; Middle Aged ; Radiography, Thoracic ; Shoulder ; Thoracoscopy ; Thoracostomy

BACKGROUND: Phantom limb sensation is an unusual position sense of the extremity during nerve block that the position of extremity is misinterpreted as being flexed, or elevated, when actually they are in neutral position. Whether it is from the fixation of proprioceptive input at the time of motor blockade or from unmasking of the pattern which has been already present in the CNS is still controversial. We perfomed this study under the assumption that phantom limb sensation can still be reproduced without the influence of position at the time of nerve blockade. METHODS: Thirty-six patients scheduled for elective orthopedic surgery were randomly assigned. For 26 patients, spinal anesthesia was performed with hyperbaric 0.5% tetracaine or bupivacaine at lateral decubitus position and the position was changed to supine immediately. Existence of phantom limb sensation and the level of anesthesia was recorded at 10 and 20 minutes after injection of local anesthetics. For 10 patients, same local anesthetics were injected after patient's legs were straightened in lateral decubitus position. RESULTS: Forteen out of 26 patients whose position were changed to supine immediately after the injection of local anesthetics experienced phantom limb sensations. Five out of 10 patients whose legs were kept straight before the injection of local anesthetics experienced phantom limb sensations. Previous history of trauma was positively related to the expression of phantom limb sensation. CONCLUSION: Our data showed that the expression of phantom limb sensation is reproducible. And this was not related to the position at the time of spinal anesthesia. Trauma seems to be an important factor related to the expression of phantom limb sensation.
Anesthesia ; Anesthesia, Spinal* ; Anesthetics, Local ; Bupivacaine ; Extremities ; Humans ; Leg ; Nerve Block ; Orthopedics ; Phantom Limb* ; Proprioception ; Sensation* ; Tetracaine

Primary liposarcoma of the lung is an extremely rare disease. To date, only 14 cases have been reported in the literature. We experienced a case of myxoid liposarcoma of the lung treated by surgery. The tumor was well-defined, solid, lobulated mass measuring 3.5x2 cm, involving the bronchus of the left lower lobe. Microscopically, myxoid liposarcoma was identified. The fluorescence in situ hybridization confirmed the presence of a reciprocal translocation involving DNA damage-inducible transcript 3 (DDIT3) and fused in sarcoma (FUS) genes. The patient is still alive with no recurrence or metastasis at the time of writing this report (on 20 months postoperatively). To our knowledge, this is the first cytogenetic case report of pulmonary myxoid liposarcoma.
Bronchi ; Cytogenetics ; DNA ; Female ; Fluorescence ; Humans ; In Situ Hybridization ; In Situ Hybridization, Fluorescence ; Liposarcoma ; Liposarcoma, Myxoid ; Lung ; Neoplasm Metastasis ; Rare Diseases ; Recurrence ; Sarcoma ; Writing

PURPOSE: This study was performed to evaluate the relation between nodal micrometastasis and tumor angiogenesis, and to assess potential molecular markers pertaining to the development of nodal micrometastasis. MATERIALS AND METHODS: Immunohistochemical studies were performed to evaluate the expression patterns of Phosphatase, and its Tensin homolog, deleted from chromosome TEN (PTEN), and the vascular endothelial growth factor (VEGF) and microvessel density (MVD) in 41 stage I non-small cell lung cancer (NSCLC), using anti-PTEN monoclonal, anti-VEGF polyclonal and anti-CD34 monoclonal antibodies, respectively. The occult micrometastasis in 503 dissected regional lymph nodes were also evaluated using anti-cytokeratin (CK) monoclonal antibody. RESULTS: CK positive cells were identified in 13 (31.7%) of the 41 cases and in 23 (4.6%) of the 503 lymph nodes. There were 19 and 22 cases with positive and negative VEGF expressions, respectively, and 10 (52.7%) and 3 (13.6%) of these, respectively, showed nodal micrometastasis (p<0.05). There were 9 cases with loss of PTEN expression, and 4 of these showed nodal micrometastasis, whereas 9 (21.8%) of 32 positive PTEN expression cases showed nodal micrometastasis (p<0.05). The MVD in the tumors with nodal micrometastasis was 60.4+/-22.6, whereas that in the tumors without nodal micrometastasis was 52.0+/-18.2. The loss of PTEN expression, an increased VEGF expression and a high MVD, within primary tumors, were significantly associated with nodal micrometastasis. CONCLUSION: The results indicate a possible value in using these biological markers, associated with tumor angiogenesis, for predicting the risk of nodal micrometastasis in NSCLC.
Antibodies, Monoclonal ; Biomarkers ; Carcinoma, Non-Small-Cell Lung* ; Humans ; Lymph Nodes* ; Microvessels ; Neoplasm Micrometastasis* ; Vascular Endothelial Growth Factor A

The occurrence of lung cancer in patients suffering with pneumothorax is very rare, especially in the absence of any radiological changes that would suggest neoplasia after the pulmonary reexpansion. We have experienced a case of a 60-year-old male who presented with lung cancer that was discovered by chance after an operation for his pneumothorax. The resected lung tissue showed a 0.3 cm-sized, peripheral squamous cell carcinoma associated with a bulla. The tumor was not macroscopically detected on the first thoracotomy that was performed for the treatment of the pneumothorax. The micronodular cancer was diagnosed after the histological examination of the resected bulla. The patient has been doing well with no evidence of tumor recurrence during the fifteen months follow-up. This case shows that we should always be vigilant for associated lung cancer when we examine the lung tissue after the operation for pneumotherax.
Carcinoma, Squamous Cell* ; Follow-Up Studies ; Humans ; Lung Neoplasms ; Lung* ; Male ; Middle Aged ; Pneumothorax* ; Recurrence ; Thoracotomy

BACKGROUND: Mushroom poisonings are infrequent but potentially fatal. Most fatalities are due to the amatoxin containing species, particularly Amanita phalloides, Amanita virosa, Amanita verna which cause fulminant hepatic failure often with encephalopathy. METHODS: We experienced twenty two patients with acute mushroom poisoning admitted to Dong San hospital, Keimyung University through emergency department between January 1990 and September 1997. RESULTS: Mean age of the patients was 40.0 years and the ratio of male to female was 1 : 0.83. Seasonal distribution is 10 patients in July, 3 in August and 9 in September. The mean interval between ingestion and early symptom onset was 9.7 hours. Most of the patients had early gastrointestinal symptoms; abdominal pain, nausea, vomiting and diarrhea. except for a patient with associated mental change. The subsequent symptoms and signs follow up admission were fulminant hepatic failure(72.7%), renal failure(31.8%), mental change(27.3%), acute pancreatitis(9.1%), pericardial effusion(4.5%) and erythematous rash(4.5%). The outcomes of the patients were recovery(72.7%), death(18.2%) and hopeless discharge(9.1%). CONCLUSION: The patients who have mushroom poisoning are misdiagnosed as having viral gastroenteritis and are discharged frequently. The doctors and people should be educated not to overlook the severity of mushroom poisoning.
Abdominal Pain ; Agaricales* ; Amanita ; Diarrhea ; Eating ; Emergency Service, Hospital ; Female ; Follow-Up Studies ; Gastroenteritis ; Humans ; Liver Failure, Acute ; Male ; Mushroom Poisoning* ; Nausea ; Seasons ; Vomiting

We have reviewed 1211 burn patients who had visited our emergency department of Keimyung University Dongsan medical center between April 1995 to March 1997. The following results were obtained; 1) On age and sex distribution, the highest incidence of age group was under 10 year and old in 321 cases(26.5%). Male was affected more frequently than female, the incidence being 847 cases(70.1%) and 364 cases(29.9%). The ratio of male to female was 2.3:1. 2) No monthly and seasonal differences could be recognized. We found winter season having the highest 319 cases(26.3%), followed by autumn, spring and summer. 3) An analysis of causes in burns showed that flame burns were 527 cases(43.1%), scalding burns, 486 cases(40.2%), electrical burns, 96 cases(8.1%) and chemical burns, 48 cases(4.1%). 4) Domestic accidents accounted for 639 cases(52.7%), occupational for 286 cases(23.6%), traffic accidents for 160 cases(13.2%), suicides for 122 cases(10.1%), formentation for 4 cases(0.4%). 5) Most of patients 699 cases(57.7%) were affected with 2nd degree burn in depth, 1st degree for 413 cases(34.1%) and 3rd degree for 99 cases(8.2%). 6) The trunk was the anatomical region most commonly affected followed by upper and lower limbs. 7) 243 cases(20.5%) of all were accompanied by some complications. The main complications were would infection noted in 212 cases(17.5%), pneumonia in 179 cases(14.8%), acute renal failure in 160 cases(13.2), contracture in 155 cases(13.0), urinary tract infection in 24 cases(2.0%), Curling ulcer in 20 cases(1.6%) in order. 8) The over-all mortality rate was 73 cases(6.1%). The mortality rate of the patients with inhalation injury were 33 cases(45.3%). Causes of death were due to sepsis in 54 cases(4.5%), ARDS in 11 cases(0.9%), acute renal failure in 5 cases(0.4%), upper GI bleeding in 2 cases(0.2%), purmonary edema in 1 cases(0.1%).
Accidents, Traffic ; Acute Kidney Injury ; Burns* ; Burns, Chemical ; Cause of Death ; Contracture ; Duodenal Ulcer ; Edema ; Emergency Service, Hospital ; Female ; Hemorrhage ; Humans ; Incidence ; Inhalation ; Lower Extremity ; Male ; Mortality ; Pneumonia ; Seasons ; Sepsis ; Sex Distribution ; Suicide ; Urinary Tract Infections

This study was designed retrospectively to evaluate Ranson's criteria and APACHE II scores as a predictor of mortality in patients with acute pancreatitis. Acute pancreatitis is a common disorder. From mild disease to multiorgan failure, it is a disorder that has numerous causes, an obscure pathogenesis. An accurate history and through physical examination will often raise clinical suspicion of acute pancreatitis in the differential diagnosis of a patient with acute abdominal pain. The retrospective analysis by chart review of 86 cases of acute pancreatitis who visited emergency department of Dongsan hospital from Jan to Dec 1996. The results were as follows. The majority of the patients with acute pancreatitis presented with chief complaints of abdominal pain. The male patient outnumbered female by the ratio of 2.9:1. The highest incidence of age group was between 40 and 50. The majority of our patients had past histories of either chronic alcoholic or gallbladder problems e.g.. the number being 53 cases(61.6%) and 31 cases(36%) respectively. Among 7 patients who had changes in consciousness, 5 were expired. Of those expired, 3 patients had less than 90 mmHg of systolic blood pressure. The overall mortality rate was 10.5%(9 cases). It has been known that acute pancreatitis would be the results of traumatic and non-traumatic causes. The exact mechanism of its pathophysiolgy has not been known yet, but it has been well known that the majority of patients who in forties and fifties had history of alcoholic abuse, the rest being mainly gallbladder problem and, some other diseases implicated too. The relationship of acute pancreatitis with familiar Ranson's criteria was such that 3 patients of the Ranson's out of 9 death were noted to have more than 3 of the criteria, but another 3 had less than 3. Among the 60 patients in whom the required physiologic variables were available out of total 86 patients studied, 9 were expired and 51 survived, average APACHE II scores for the survival and the expired being 6.92+/-3.99 & 18.11+/-5.68 respectively (P<0.05). We concluded that the APACHE II score could be used to better than Ranson's criteria to predict hospital mortality in patients with acute pancreatitis.
Abdominal Pain ; Alcoholics ; APACHE ; Blood Pressure ; Consciousness ; Diagnosis, Differential ; Emergency Service, Hospital ; Female ; Gallbladder ; Hospital Mortality ; Humans ; Incidence ; Male ; Mortality ; Pancreatitis* ; Physical Examination ; Retrospective Studies