BACKGROUND: We reviewed retrospectively the clinical features and contrast material-enhanced computed tomography(CT) after blunt abdominal trauma demonstrated a characteristic hypoperfusion complex. Our purpose were to evaluate the hypothesis that children with this 'hypoperfusion complex' CT finding were associated with a tenuous hemodynamic state, severe injury and a poor outcome. METHODS: Between January 1996 and December 1999, 39 consecutive children who sustained blunt trauma and were suspected clinically of having intraabdominal injury underwent CT. Demographic data, blood pressure, indication for CT, pediatric trauma score(PTS) and Glasgow coma score(GCS) were recorded at the time of the initial examination. RESULTS: Three of the 39 children(8%) demonstrated a characteristic finding at CT which was described as the hypoperfusion complex. The 'hypoperfusion complex' was present in the 3 of the 39 traumatized children(8%), but was the main radiographic finding in the 3 of the 14 children with a severe pediatric trauma score(PTS<8) and in the 3 of the 6 children with a Glasgow coma score(GCS<8) who were examined with CT. CONCLUSION: The CT finding in all children with the hypoperfusion complex by definition included marked, diffuse dilatation of the intestine with fluid; abnormally intense contrast enhancement of the bowel wall, mesentery, kidney and/or pancreas; decreased caliber of the abdominal aorta and inferior vena cava(IVC); and moderate to large peritoneal fluid collection. This 'hypoperfusion complex' is a relatively rarely observed in injured children but appears to be associated with severe injury and a poor outcome. The pediatric trauma score provides a useful profile of injury severity in children. Prompt diagnosis of hypovolemic shock is important so that supportive therapy can be instituted to prevent further metabolic abnormalities and their potential cardiotoxic effects. In summary, the intense multiorgan enhancement pattern seen in the hypoperfusion complex indicates tenuous hemodynamic stability and is associated with a poor outcome.
Aorta, Abdominal ; Ascitic Fluid ; Blood Pressure ; Child* ; Coma ; Diagnosis ; Dilatation ; Hemodynamics ; Humans ; Hypovolemia* ; Intestines ; Kidney ; Mesentery ; Pancreas ; Retrospective Studies ; Shock* ; Tomography, X-Ray Computed*

BACKGROUND: Scuba diving has become increasingly popular in Korea. Medical problems are common with dives, especially decompression sickness(DCS). This study was performed to obtain an useful information of hyperbaric oxygen therapy in DCS in Korea. METHOD: We reviewed the 62 cases of Korean divers, who were diagnosed as DCS and received recompression therapy according to U.S. Navy Standard Recompression Treatment Table at Ocean and Underwater Medical Research and Training Center of ROK Navy, for 6 years from Jan. 1993 to Nov. 1998. RESULT: 1) the mean no-decompression limit excess time between type I DCS group(72.7 min.) and type II DCS group(92.8min.) showed significant difference. 2) The rate of symptoms appeared on surfacing and within 10min. after surfacing of type I and type II DCS were 41.4%and 72.7% respectively. 3) The cure late of type I and type II were 75.9%and 42.4% respectively. In type II DCS group, the cure rate of the group within 12 hour-delayed recompression treatment and the group above 12 hour-delayed treatment were 64.3%and time 26.3% respectively, and in type I DCS group, 100% and 66.7% respectively. CONCLUSION: These findings suggest that the education of safety, the strict observance of the standard decompression table, and the avoidance of excessive repeated diving are important for reducing the risk of diving related disease. And to offer proper management of DCS, there should be more multiplace hyperbaric oxygen chambers, the suitable transport system, and the specialist of diving medicine or hyperbaric medicine in Korea.
Decompression Sickness* ; Decompression* ; Diving ; Education ; Hyperbaric Oxygenation* ; Korea ; Oxygen ; Specialization

The incidence of cervical pregnancy and the number of combined intrauterine pregnancy and ectopic pregnancy seems to be increasing. So the possibility of heterotopic pregnancy should always be considered by every gynecologist, especially those who treat infertility problem. We experience a case of a heterotopic pregnancy coexisting of an intrauterine pregnancy and a cervical pregnancy after in-vitro fertilization and embryo transfer, and was successfully managed by transcervical evacuation and resulted in a normal intrauterine pregnancy. Here we present the case with review of literatures.
Embryo Transfer ; Female ; Fertilization ; Fertilization in Vitro* ; Incidence ; Infertility ; Pregnancy* ; Pregnancy, Ectopic ; Pregnancy, Heterotopic*

A complete hydatidiform mole coexisting with a fetus is a rare condition, particularly when diagnosed after IVF-ET. In spite of the wide spread use of assisted reproductive technology, there have been, to our knowledge, only few reported cases of molar pregnancy after IVF-ET. At present, there are limited data to guide the antenatal management of a complete hydatidiform mole coexisting with fetuses. A complete mole can coexist with a normal, healthy fetus who can be carried to term, with good outcome. But, patients who desire to continue the pregnancy after such a diagnosis must be cautioned about the potential for severe medical complications and developing persistent gestational trophoblastic tumor. We report here a case of complete hydatidiform mole in a triplet pregnancy coexistent with two live fetuses following in IVF-ET.
Diagnosis ; Embryo Transfer* ; Embryonic Structures* ; Female ; Fertilization in Vitro* ; Fetus ; Humans ; Hydatidiform Mole* ; Pregnancy ; Pregnancy, Triplet* ; Reproductive Techniques, Assisted ; Triplets* ; Trophoblastic Neoplasms

The brachial plexus may be visualized simply as beginning with five nerves and terminating in five nerves. It begins with the anterior rami of C5, C6, C7, C8, and the first thoracic nerve. It terminates with the formation of the musculocutaneous, median, ulnar, axillary, and radial nerves. The anatomy of the brachial plexus can be confusing, especially because of frequent variations in the length and the caliber of each of its components. The most common type of injury is one involving a motorcycle or bicycle crash in which a forceful impact on the shoulder depresses the entire shoulder girdle and avules a portion of the plexus. The injuried area is usually the upper trunk althrough the lower trunk can be involved either in addition to or as the main site of injury. Our case involves brachial plexus injury due to physical restraint that had been used to avoid using a pharmachologic restraint.
Brachial Plexus* ; Motorcycles ; Radial Nerve ; Restraint, Physical* ; Shoulder ; Thoracic Nerves

Objective: If the size of an intracranial aneurysm is below 3 mm, clinicians rarely treat them because of the low risk of rupture. But subarachnoid hemorrhage (SAH) due to the rupture of very small intracranial aneurysm (VSIA) (saccular aneurysm sized less than 3 mm) may lead to many critical neurological complications. So we analyzed the characteristics and differences between the ruptured VSIA group and the ruptured non-VSIA group. Methods: 421 saccular aneurysms from patients with SAH between January 2016 and December 2019 were included. Patient information including age, sex, and medical history and information about the aneurysm including location, size, aspect ratio, inflow angle, and height-width ratio were collected. And we compared the VSIA group with non-VSIA group about these characteristics Results: 12.1% (51/421) of the aneurysms were included in the VSIA group, while the non-VSIA group consisted of 87.9% of the aneurysms (370/421). The female predominance was significantly higher in the VSIA group than that in the non-VSIA group (p=0.011). No significant difference was observed in location, medical history, height-width ratio between the groups. The mean value of the inflow angle in the VSIA group was much lower than that in the non-VSIA group, but no statistically significant association between rupture risk and the inflow angle was observed. The average aspect ratio was significantly lower than that in the non-VSIA group. Conclusions Ruptured VSIA group has higher percentage of females and lower aspect ratio than ruptured non-VSIA group. Further studies regarding the characteristics of ruptured and unruptured VSIA patients is required for assistance in clinical decision related to treatment of VSIA group before the aneurysmal sac rupture.

Objective: If the size of an intracranial aneurysm is below 3 mm, clinicians rarely treat them because of the low risk of rupture. But subarachnoid hemorrhage (SAH) due to the rupture of very small intracranial aneurysm (VSIA) (saccular aneurysm sized less than 3 mm) may lead to many critical neurological complications. So we analyzed the characteristics and differences between the ruptured VSIA group and the ruptured non-VSIA group. Methods: 421 saccular aneurysms from patients with SAH between January 2016 and December 2019 were included. Patient information including age, sex, and medical history and information about the aneurysm including location, size, aspect ratio, inflow angle, and height-width ratio were collected. And we compared the VSIA group with non-VSIA group about these characteristics Results: 12.1% (51/421) of the aneurysms were included in the VSIA group, while the non-VSIA group consisted of 87.9% of the aneurysms (370/421). The female predominance was significantly higher in the VSIA group than that in the non-VSIA group (p=0.011). No significant difference was observed in location, medical history, height-width ratio between the groups. The mean value of the inflow angle in the VSIA group was much lower than that in the non-VSIA group, but no statistically significant association between rupture risk and the inflow angle was observed. The average aspect ratio was significantly lower than that in the non-VSIA group. Conclusions Ruptured VSIA group has higher percentage of females and lower aspect ratio than ruptured non-VSIA group. Further studies regarding the characteristics of ruptured and unruptured VSIA patients is required for assistance in clinical decision related to treatment of VSIA group before the aneurysmal sac rupture.

PURPOSE: To compare the efficacy and safety of photorefractive keratectomy with laser epithelial keratomileusis, for low to moderate myopia. METHODS: Patients with a manifest refraction less than -6.0 diopters were enrolled in this study. Patients were treated with photorefractive keratectomy (47 eyes) or laser epithelial keratomileusis (42 eyes). Preoperative and postoperative uncorrected visual acuity, refractive errors, keratometry, residual central corneal thickness, epithelial healing time, and corneal haze were evaluated for a 1 year follow-up period. RESULTS: There were no significant differences between photorefractive keratectomy and laser epithelial keratomileusis in uncorrected visual acuity, refractive errors or correction of refractive errors. Residual central corneal thickness increased until 6 months postoperative and thereafter in both photorefractive keratectomy and laser epithelial keratomileusis groups. There were no significant changes in keratometry after postoperative 1 month. Epithelial healing time of photorefractive keratectomy was shorter than that of laser epithelial keratomileusis. Corneal haze score had a peak at 1 month postoperative and then decreased rapidly until 3 months postoperative, it was stable after 6 months. Corneal haze score at 1 month was less than 0.5 in both groups and did not disturb visual acuity. CONCLUSIONS: Photorefractive keratectomy and laser epithelial keratomileusis have an equal effect in correction of visual acuity and refractive errors. They have equivalent levels of safety as measured by postoperative residual central corneal thickness and corneal haze. Both procedures are effective methods to correct low to moderate myopia.
Follow-Up Studies ; Humans ; Myopia* ; Photorefractive Keratectomy* ; Refractive Errors ; Visual Acuity

PURPOSE: To investigate the effects of long-term contact lens (CL) wearing on corneal thickness, curvature, and endothelium. METHODS: Using ultrasonic pachymetry, Orbscan topography and specular microscopy, we evaluated the cornea of 53 subjects who had used soft CL for more than 5 years compared with 47 controls who had never used CL. RESULTS: There was a significant decrease of central corneal thickness in CL wearers. The difference of central corneal thickness between the two groups was 16.39 micrometer. The percentage of central corneal thickness less than 500 micrometer was 24.5% in the CL wearers and 12.2% in the controls. The mean corneal thickness of the CL wearers in the center and eight peripheral areas, as measured with Orbscan topography, was significantly reduced by about 7.28 to 17.87 micrometer compared with that of the controls. The corneal curvature and elevation were significantly steeper in the CL wearers than in the controls but no difference in the mean corneal astigmatism was found between the two groups. Endothelial density and percentage of hexagonal cells were decreased and the coefficient of cell area variation was increased in the CL wearers compared to the controls. The percentage of endothelial cell densities less than 2500 cells/mm2 was 24.5% in the CL wearers and 4.25% in the controls. CONCLUSIONS: Long-term soft contact lens use may have a significant effect on corneal thickness, curvatures and endothelial morphology.
Astigmatism ; Contact Lenses, Hydrophilic* ; Cornea ; Endothelial Cells ; Endothelium* ; Endothelium, Corneal ; Microscopy ; Ultrasonics

BACKGROUND: The coronary collateral circulation has been frequently observed in significant coronary artery disease and its protective role in ischemic myocardium is still remained unclear. But the study on the anti-ischemic effect in human model of ischemic myocardium is rare. METHODS: To observe the anti-ischemic role of coronary collateral circulation in ischemic myocardium, perfusion defect areas were measured during PTCA(percutaneous transluminal coronary angioplasty) in angina patients with single vessel disease and analyzed according to the grade of collateral circulation. The 99mTc-MIBI myocardial scanning images were obtained at 24 hours before PTCA with dipyridamole stress, at ballooning during PTCA and at 24 hours after the opening of the artery and perfusion defect volume ratios(DVR) were measured in each of the images of the patient with angina and single vessel disease. RESULTS: 1) Studied subjects were 14 patients(10 male, 4 female, mean age : 56.6+/-103) and subdivided into two groups. All patients had angina with single vessel disease, 7 proximal left anterior descending artery(LAD) stenosis, 4 middle LAD stenosis, 1 middle right coronary artery(RCA) stenosis and 2 proximal left circumflex artery(LCX) stenosis. Group A was composed of 7 patients with angina and coronary collateral circulation more than grade 1. Group B was 7 patients with angina and grade 0 collateral. 2) Mean age of group A was 62.4+/-8.2 years, 5 male and 2 female patients, That of group B was 56.6+/-8.9 years and all male patients. Group A was composed of 7 patients ; 5 unstable and 2 stable angina ; 2 proximal LAD stenosis, 3 midddle LAD stenosis, 1 middle RCA stenosis and 1 proximal LCX stenosis. One patients had grade 1, two patients grade 2 and four patients grade 3 coronary collateral circulation. All of the patients were unstable angina in group B showing 5 proximal LAD stenosis, 1 middle RCA stenosis and 1 proximal LCX stenosis. No collateral circulation was demonstrated in group B. 3) In group A, DVR was 17.5+/-13.9% on stress image before PTCA and 7.1+/-1.4% on the ballooning image during PTCA. DVR was smaller in ballooning image than in stress image(p<0.01). 4) In group B, DVR was 12.4+/-16.0% on stress image before PTCA and 26.6+/-10.0% on ballooning image during PTCA. DVR was larger in ballooning image than in stress image(p<0.001). 5) DVR on stress image and open image were not different in both groups, but DVR on ballooning image were 7.1+/-4.7% in group A and 26.6+/-10.0% in group B, which was larger than in group A(p<0.01). CONCLUSION: These results suggest that myocardial perfusion defect area may be smaller in angina patients with good collateral circulation than patients with no collateral, and coronary collateral circulation have a protective role on the jeopardized myocardium during coronary artery occlusion.
Angina Pectoris* ; Angina, Stable ; Angina, Unstable ; Arteries ; Collateral Circulation* ; Constriction, Pathologic ; Coronary Artery Disease ; Coronary Vessels ; Dipyridamole ; Female ; Humans ; Male ; Myocardium ; Perfusion*