Spontaneous subarachnoid hemorrhage(SAH) is a cause of high mortality and morbidity in the emergency department. Rebleeding has been well investigated, and it is now recognized that early operation can prevent rebleeding. However, ultra-early rebleeding, which may occur prior to early operation(within 24 hours after admission), worsens the clinical outcome of patients with SAH. To determine the risk factors of ultra-early rebleeding in patients with spontaneous SAH before early operation, we analyzed the cases of 383 patients admitted within 24 hours after their last attack of SAH between 1994 to 1996. In this analysis, diagnosis of rebleeding before admission was defined only if the patients experienced a definite clinical deterioration once more after an attack suggesting SAH. After admission patients who observed a sudden neurological deterioration were subject to repeat CT scanning and rebleeding was diagnosed only when new hemorrhage was observed on the CT scan in comparison with the previous scan. 45 cases(11.7%) of 383 patients had ultra-early rebleeding. The incidence of ultra-early rebleeding significantly increased in the patients who admitted hospital within 2 hours after attack. The incidence of ultra-early rebleeding also increased in the old-age group(70 years or more), patients with high systolic blood pressure, those who underwent angiography within 6 hours of the last SAH, and patients who had poor neurological condition.
Angiography ; Blood Pressure ; Diagnosis ; Emergency Service, Hospital ; Hemorrhage* ; Humans ; Incidence ; Mortality ; Risk Factors* ; Tomography, X-Ray Computed

The reliability of emergency ultrasonographic(US) detection of hemoperitoneum and solid organ injury in blunt abdominal trauma was evaluated retrospectively. From October 1,1995 to August 31,1996,90 patients were included in the study. Ultra- sonographic findings showed a sensitivity, specificity, and accuracy of 97.6%, 97.9%, and 98.1%, respectively, in detecting intraabdominal fluid collection. We believe that US in an emergency center is a quick, safe screening method in the evaluation of blunt abdominal trauma. In our department, US has replaced diagnostic peritonaeal lavage(DPL) and computed tomography(CT) as the screening study of first choice.
Emergencies* ; Hemoperitoneum* ; Humans ; Mass Screening ; Retrospective Studies ; Sensitivity and Specificity ; Ultrasonography*

Jimson weed, also known as Datura stramonium, is a member of the Solanaceae family. Jimson weed was used by American Indians for medicinal and religious purposes. All parts of the Jimson weed plant are poisons, containing the alkaloids atropine, hyoscyamine and scopolamine. So, it is caused by these components to make a anticholinergic toxicity within 6h after ingestion. Initial manifestations include dry mucus membrane, blurred, vision, thirst, difficulty swallowing and speaking, and photophobia, and may be followed by hyperthermia, confusion, agitation, combative behavior, hallucination, urinary retention, seizure and coma. We experienced two patients who developed combative behavior and agitation with pupil dilation caused by Jimson weed. They discharged with improvement after supportive for 2days.
Alkaloids ; Animals ; Atropine ; Coma ; Comb and Wattles ; Datura stramonium* ; Deglutition ; Dihydroergotamine ; Eating* ; Fever ; Hallucinations ; Humans ; Hyoscyamine ; Indians, North American ; Membranes ; Mucus ; Photophobia ; Plants ; Poisons ; Pupil ; Scopolamine Hydrobromide ; Seizures ; Solanaceae ; Thirst ; Urinary Retention

Rheumatic manifestations in non-Hodgkin's lymphoma (NHL) are common but actual arthritis as a presenting feature appears to be very rare. We experienced a case of NHL presenting as polyarthritis in a 24-year-old woman. Eight months ago she was admitted to the hospital due to polyarthritis and skin rash. She had pleural and pericardial effusion. Antinuclear antibody was positive and rheumatoid factor was negative. Joint X-ray showed periarticular osteopenia at both knees, wrists, hands and feet. Prednisolone, salsalate and anti-tuberculosis drugs were administered under the impression of either probable lupus or rheumatoid arthritis and pleural tuberculosis. After then pleuropericardial effusion and skin rash improved. But polyarthralgia persisted and she developed right cervical lymphadenopathy. On her second admission she was found to have a round mass in left lower lung field and multiple mediastinal lymph node enlargement. Cervical lymph node biopsy revealed non-Hodgkin's lymphoma. She received 8 cycles of systemic chemotherapy until 1996 July. NHL was remitted completely and polyarthralgia disappeared. We report a case of non-Hodgkin's lymphoma presenting as polyarthritis and literatures are reviewed.
Antibodies, Antinuclear ; Arthralgia ; Arthritis* ; Arthritis, Rheumatoid ; Biopsy ; Bone Diseases, Metabolic ; Drug Therapy ; Exanthema ; Female ; Foot ; Hand ; Humans ; Joints ; Knee ; Lung ; Lymph Nodes ; Lymphatic Diseases ; Lymphoma, Non-Hodgkin* ; Pericardial Effusion ; Prednisolone ; Rheumatoid Factor ; Tuberculosis, Pleural ; Wrist ; Young Adult

Hysteroscopic procedure can be complicated by intravascular absorption of irrigating fluid. The clinical features of this complication are similar to transurethral resection of the prostate (TURP) syndrome. There have been few reports on hypocalcemia during endoscopoic surgery and clinical implications of hypocalcemia in TURP syndrome have been underestimated. We report a case of TURP syndrome association with a decreased ionized calcium concentration of 0.53 mM/L after the absorption of a large amount of sorbitol-mannitol solution during hysteroscopy. The hypotension which occurred in TURP syndrome did not respond to vasopressor and inotropic agent but responded to the administration of calcium. This case was also accompanied by hyponatremia, hyperglycemia and lactic acidosis through the metabolism of sorbitol.
Female ; Humans ; Hypocalcemia/*chemically induced/*diagnosis/therapy ; *Hysteroscopy ; Intraoperative Care ; Irrigation ; Mannitol/*adverse effects ; Middle Aged ; Pulmonary Edema/radiography ; Sorbitol/*adverse effects

Finite element analyses were performed to study effects on stress distribution generated in jaw bone for various shapes of dental implants: plateau type, plateau with small radius of curvature, triangular thread screw type in accordance with ISO regulations and square thread screw filleted with small radius partially. It was found that square thread screw filleted with small radius was more effective on stress distribution than other dental implants used in analyses. Additional analyses were performed on the implant with square thread screw filleted with small radius for verying design parameters, such as the width of thread end, the height of the thread of the implant and load direction, to determine the optimum dimensions of the implant. The highest stress concentration occurred at the region in jaw bone adjacent to the first thread of the implant. The maximum effective stress induced by a 15 degree oblique load of 100 N was twice as high as the maximum effective stress caused by an equal amount of vertical load. Stress distribution was more effective in the case when the width of thread end and the height of thread were p/2 and 0.46p, respectively, where p is the pitch of thread. At last, using tensile force calculated from the possible insert torque without breading bone thread, finite element analysis was performed on the implant to calculate pre-stress when the primary fixation of the implant was operated in jaw bone. The maximum effective stress was 136.8 MPa which proven to be safe.
Bread ; Dental Implants ; Finite Element Analysis ; Jaw ; Radius ; Social Control, Formal ; Torque

We analyzed records at Chonnam university hospital from Sep. 1. 1993 to Aug. 31. 1996 to assess clinical significance of the foreign body in the gastrointestinal tract. There were 133 episodes consisting of 79 pediatric and 54 adult patients as possible to review. In the pediatric patients, the coin was the most common cause of foreign body ingestion, while adult patients were usually caused by bones and meat. We removed foreign bodies in the oral cavity and oropharynx in 12 cases using direct laryngophanmgoscpy and forcep. Endoscopy was performed successfully in 47 of 51 patients in which was attempted; there were two complications composed of an aspiration pneumonia and a mediastinitis due to esophageal perforation. There were spontaneous passage of foreign bodies in 48 cases. We observed complications in 6 cases in which 4 cases needed operations due to complications. Foreign bodies which pass into the stomach can be observed for development of complications, as 94% of foreign bodies which reach the stomach spontaneously pass. Only 4 patients required interventions, which was done without mortality.
Adult ; Eating* ; Endoscopy ; Esophageal Perforation ; Foreign Bodies* ; Gastrointestinal Tract ; Humans ; Jeollanam-do ; Meat ; Mediastinitis ; Mortality ; Mouth ; Numismatics ; Oropharynx ; Pneumonia, Aspiration ; Stomach ; Surgical Instruments

BACKGROUND: To decide the optimal antibiotics and application of chest tube, examination of pleural fluid is fundamental in the management of empyema. Some criteria for drainage of pleural fluid have been recommended but some controversies have been suggested. Recently, newer radiologic methods including ultrasound and computed tomography scanning, have been applied to the diagnosis and management of pleural effusions. We undertook a retrospective analysis of 30 patients with pleural effusion who had CT scans of the chest in order to apply the criteria of Light et at retrospectively to patients with loculation and to correlate the radiologic appearance of pleural effusions with pleural fluid chemistry. METHOD: We analyzed the records of 30 out of 147 patients with pleural effusion undergoing chest CT scans. RESULTS: 1) Six of the pleural fluid cultures yielded gram negative organisms and three anaerobic bacterias and one Staphylococcus aureus and one non-hemolytic Streptococci. No organism was cultured in nineteen cases(63.0%). 2) The reasons for taking chest CT scans were to rule out malignancy or parenchymal lung disease(46.7%), Poor response to antibiotics(40.0%), hard to aspirate pleural fluid(10.0%) and to decide the site for chest tube insertion(3.3%). 3) There was no significant correlations between ATS stages and loculation but there was a tendency to Inoculate in stage III. 4) There was a significant inverse relationship between the level of pH and loculation(P<0.05) but there appeared to be no relationship between pleural fluid, LDH, glucose, protein, loculation and pleural thickening. 5) In 12 out of 30, therapeutic measures were changed according to the chest CT scan findings. CONCLUSION: We were unable to identify any correlations between the plerual fluid chemistry, ATS stages and loculations except pH, and we suggest that tube thoracotomy should be individualized according to the clinical judgement arid serial observation. All patients with empyema do not need a chest CT scan but a CT scan can provide determination of loculation, guiding and assessing therapy which should decrease morbidity and hospital stay.
Anti-Bacterial Agents ; Bacteria, Anaerobic ; Chemistry ; Chest Tubes ; Diagnosis ; Drainage ; Empyema* ; Glucose ; Humans ; Hydrogen-Ion Concentration ; Length of Stay ; Lung ; Pleural Effusion ; Retrospective Studies ; Staphylococcus aureus ; Thoracotomy ; Thorax* ; Tomography, X-Ray Computed* ; Ultrasonography

BACKGROUND: Propofol and remifentanil are both rapid and short-acting drugs that can be used for sedation and analgesia during monitored anesthesia care (MAC). This study was designed to determine the optimal infusion rates of remifentanil during propofol anesthesia in patient undergoing the varicose vein endovenous laser therapy. METHODS: In this randomized, double-blind study, we evaluated the effects of different remifentanil infusion rates on the requirement doses of propofol, level of sedation, intraoperative recall, respiratory and cardiovascular variables, and recovery. Forty consenting ASA physical status I or II patients undergoing endovenous laser therapy with 1% lidocaine skin infiltration were randomly assigned to one of two treatment groups. All patients received midazolam 0.05 mg/kg intravenously for premedication. Remifentanil was infused at 0.05 or 0.10microgram/kg/min during the anesthesia. Sedation was evaluated using the Observer's Assessment of Alertness/Sedation (OAA/S) scale at 5 min intervals by a blinded observer and continuous BIS monitor. The propofol infusion was started from the rate, 3 mg/kg/hr, and subsequently varied to maintain patient comfort, sedation, stable cardiovascular and respiratory function. RESULTS: Higher infusion rates of remifentanil (0.10microgram/kg/min) produced significant respiratory depression (P < 0.05). The infused total doses of propofol were not different from each other significantly. CONCLUSIONS: This study demonstrated that administration of propofol at 3.4 +/- 1.3 mg/kg/hr with a remifentanil infusion at 0.05microgram/kg/min is the optimal dosing regimen to provide sedation, analgesia and amnesia with a low incidence of side effects, such as respiratory depression in the patients premedicated with midazolam undergoing varicose vein endovenous laser therapy.
Amnesia ; Analgesia ; Anesthesia ; Double-Blind Method ; Humans ; Incidence ; Laser Therapy ; Lidocaine ; Midazolam ; Organothiophosphorus Compounds ; Piperidines ; Premedication ; Propofol ; Respiratory Insufficiency ; Skin ; Varicose Veins

OBJECTIVE: The aim of this study is to evaluate of the significance of intraoperative electrophysiologic monitoring and follow up electrophysiologic study at seven days after microvascular decompression(MVD) for hemifacial spasm(HFS). METHODS: Thirty nine patients with hemifacial spasm were included in this study and were treated with MVD of the facial nerve from Jun 1990 to May 2001. The patients were divided into a monitoring group and a non-monitoring group. We compared the surgical outcomes, operation related complications between two groups. The abnormal muscle response(AMR) of preoperative electromyographic recording appeared on the mentalis muscle during stimulation of the zygomatic branch of the facial nerve was compared with those of changed during operation, immediately after operation and at postoperative 7th day(POD 7). The relationship between degree of AMR disappearance and surgical outcome was analyzed. RESULTS: There was no difference in surgical outcomes but significant difference in the incidence of operation-related complications between two groups. The results of electrophysiologic study at POD 7 were significantly correlated with surgical outcome in the monitoring group. CONCLUSION: The electrophysiologic study is helpful for identifying the offenders, determining the adequacy of vascular decompression and decrease of operation-related complications. The clinical and electrophysiologic status of HFS after MVD has continuously changed, and therefore the results of eletrophysiologic study at POD 7 are useful for predicting the surgical outcome.
Criminals ; Decompression ; Electromyography* ; Facial Nerve ; Follow-Up Studies* ; Hemifacial Spasm* ; Humans ; Incidence ; Microvascular Decompression Surgery*