No abstract available.

No abstract available.

Pulmonary thrombo-embolism in operating room is one of the important cause of morbidity and mortality in patients undergoing femur neck fracture surgery. However, the diagnosis of pulmonary thromboembolism may not be easy because sudden shock can have many different causes (e.g. myocardial infarction, hypovolemia, pneumothorax, non-cardiogenic pulmonary edema, pulmonary thrombo- embolism) and specialized diagnostic tools are not readily available in the operating room. Rapid and accurate diagnosis of pulmonary thromboembolism is very important in outcome of patients. We report a case in which pulmonary thromboembolism under spinal anesthesia occured just before the beginning of operation.
Anesthesia, Spinal* ; Diagnosis ; Femoral Neck Fractures ; Humans ; Hypovolemia ; Mortality ; Myocardial Infarction ; Operating Rooms ; Pneumothorax ; Pulmonary Edema ; Pulmonary Embolism* ; Shock

No abstract available.
Perfusion*

Abdominal oblique muscle injuries are relatively common in professional baseball players and can result in substantial loss of playing time. It is usually caused by a sudden movement of the torso in sports involving repetitive activity requiring trunk rotation and it tend to occur on the contralateral side of the dominant arm. We report a unique case of sequentially occurred bilateral abdominal internal oblique muscle rupture in a right-handed professional baseball batter over two seasons. Each internal oblique rupture had a different mechanism of the injury, the non-dominant side occurred during bat swing and the dominant side during bent leg sliding. After rest and rehabilitation, each injury was recovered to play in about 1 month.

Traditional soft tissue Bankart repair has high failure rates in the setting of a critical glenoid bone defect in recurrent shoulder dislocation.Hence, coracoid transfer, particularly the Latarjet procedure, can be performed to reduce the recurrence. A commercialized guide can be used during the Latarjet procedure. On the other hand, it is difficult to handle the guide parallel to the glenoid articular surface because of the predetermined fixed direction of the guide, and the guide pin is so thin that it can be broken in the wrong direction of insertion. Screw holes can also be drilled using the free hand technique without a guide, but it is inaccurate in maintaining a parallel direction or constant spacing between the screw holes. This study devised an instrument by cutting a 3.5 mm locking compression plate used in fracture surgeries, and the Latarjet procedure was performed relatively easily.

PURPOSE: To evaluate the safety of transgression of the bowel during intraperitoneal percutaneous catheter placement in an animal model. MATERIALS AND METHODS: Eight 8-F straight catheters were percutaneously insertedinto the small and large bowel of eight rabbits. In four animals, the catheters were left in place until autopsy, whereas in the remaining four, the catheters were withdrawn five days after insertion. Autopsy was performed inall animals ten days after catheter placement, and gross and microscopic examination was carried out. RESULTS: Transgressing the bowel during intraperitoneal percutaneous catheter placement did not contribute to any clinically significant complications. At autopsy, there was no bowel leakage, peritonitis, or abscess, although peritoneal adhesions were found around the catheter tract. CONCLUSION: Although further study is warranted, ourstudy with an animal model indicated that transgression of the intestine during percutaneous placement of an intraabdominal catheter did not produce significant complications.
Abscess ; Animals ; Autopsy ; Catheters* ; Drainage* ; Intestinal Perforation* ; Intestines ; Models, Animal ; Peritonitis ; Rabbits

PURPOSE: To compare the effectiveness of embolization of the bronchial artery embolization for the management of hemoptysis in pulmonary tuberculosis cases with the severity of lung parenchymal injury and pleural infiltration, as seen on plain chest radiographs, and with the findings of angiography of the bronchial artery. MATERIALS AND METHODS: Among 265 patients with hemoptysis due to pulmonary tuberculosis, the findings of plain chest radiography and angiography of the bronchial artery were comparatively analyzed in the 206 for whom the results of follow up were available. The chest radiographic findings were lassified as follows: Type I refers to simple pulmonary tuberculosis; Type II includes cases in which pulmonary tuberculosis is complicated by bronchiectasis, aspergillosis, or cavitation; Type III is either Types I or II accompanied by pleural infiltrates limited to the lung apex, and Type IV includes cases in which pleural infiltrates have extended beyond the apex in the whole of the lung. Bronchial angiographic findings were divided into four groups : Group I consists of cases which show abnormalities of only the bronchial artery; Group II includes those in which abnormalities are seen in the bronchial artery and either the internal mammary or an ntercostal artery; Group III comprises cases which belong to Group I or II and in which a branch of the subclavian artery is abnormal, and Group IV includes those in which abnormalities occur in at least two branches of the subclavian artery, or there is direct visualization of hypervascularity of this vessel. The initial post-embolic hemostatic effect and the results of follow up were studied over a six-month period. RESULTS: As compared with simple pulmonary tuberculosis (Type I), we found that as the severity of pleural infiltration and complications revealed by plain chest radiographs increased (Type II, III, IV), so did the severity of the manifestation of systemic collateral arteries other than the bronchial artery, as depicted by increase on bronchial angiography. Early post-embolic hemostasis occurred in 96% of Type-I cases (47/49), 82% of Type II (36/44), 70% of Type III (28/40), and 55% of Type IV (40/73). The average success rate was 74% (151/205). During the six month follow-up period, continued hemostasis was found in 80% of Type-I patients (36/45), 75% of Type II (30/40), 59% of Type III (20/34), and 48% of Type IV (20/42). The average long-term hemostasis rate was 66% (106/161). CONCLUSION: Bronchial angiography shows that in systemic collateral arteries circulation increases very substantially, and in cases in which plain chest radiographs depict extensive pleural infiltration or complications associated with pulmonary tuberculosis, it is therefore difficult to expect good hemostatic results after embolization. In such instances we thus recommend aggressive treatment such as surgical intervention.
Angiography* ; Arteries ; Aspergillosis ; Bronchial Arteries ; Bronchiectasis ; Follow-Up Studies ; Hemoptysis* ; Hemostasis ; Humans ; Lung ; Radiography ; Radiography, Thoracic* ; Subclavian Artery ; Thorax* ; Tuberculosis, Pulmonary*

PURPOSE: We prospectively evaluated the usefulness of unenhanced helical computerized tomography (UCT) in patients with acute flank pain in the emergency room. MATERIALS AND METHODS: Between March and July 2001, 57 patients, visiting the emergency room with acute flank pain suggestive of urinary stone by physical examination, urine analysis, plain abdominal radiology (KUB) and clinical history, underwent UCT. This UCT study was evaluated for the presence or absence of urinary stones and secondary signs of ureteral obstruction on UCT (tissue-rim sign, hydronephrosis, hydroureter, strands of perinephric fat). The findings of UCT and intravenous pyelography (IVP) were compared for the presence or absence of ureteral obstruction and delineation of urinary stones according to their sizes and locations. The reading accuracy of urinary stones on UCT of one urologic resident was compared with that of one member of the radiologic staff. RESULTS: Fifty-two of the 57 patients had one or more urinary stones. UCT depicted 66 of 68 stones in the 52 patients. The sensitivity and specificity of UCT were 97% and 100%, respectively. Two cases of urinary stones, which were identified by ureteroscopy and spontaneous passing, couldn't be found on UCT, but hydronephrosis was identified. IVP disclosed 55 of 68 stones, with a sensitivity and specificity of 80% and 83%, respectively. In secondary signs of ureteral obstruction on UCT, stones above 4mm in size showed more frequent secondary signs of ureteral obstruction on UCT than those below 4mm in size. The reading accuracy of the urologic resident improved during the period, being 57% in the first half and 83% in the second half. CONCLUSIONS: UCT was an accurate, safe, and rapid technique to assess acute flank pain in the emergency room. The reading ability to diagnose ureter stones in UCT films required an adequate learning curve. Because not all stones could be identified with UCT, it would not completely replace IVP.
Calculi ; Emergencies* ; Emergency Service, Hospital* ; Flank Pain* ; Humans ; Hydronephrosis ; Learning Curve ; Physical Examination ; Prospective Studies ; Reading ; Sensitivity and Specificity ; Tomography, Spiral Computed* ; Ureter ; Ureteral Obstruction ; Ureteroscopy ; Urinary Calculi ; Urinary Tract ; Urography

BACKGROUND: Organophosphate insecticides poisoning is one of the most common toxicologic emergencies in Korea. There have been few reports of organophosphate intoxication via parenteral route, although many reports on organophosphate intoxication by oral ingestion were present in the literature. This study aimed to validate the clinical characteristics of organophosphage intoxication according to the route of administration to the body. METHOD: Data were collected retrospectively by the review of the medical records from 49 patients with organophosphate intoxication. Severity of intoxication was classified by the Namba's Classification. Collected data were analysed and compared on the clinical features and laboratory findings between the patient intoxicated by inhalation or contact(parenteral group, n=23) and the other oral ingestion(enteral group, n=26). RESULTS: Severity class by clinical features was higher in enteral group than parenteral group. Severity class by serum cholinestetrase level was not positively correlated with severity class by clinical manifestations. Cholinesterase level tended to overestimate the severity of intoxication in parenteral group. Ventilator therapy and admission to intensive care unit were more frequently needed in enteral group than parenteral group in case that the severity class by clinical features was equal. CONCLUSION: In patients with organophosphate intoxication by parenteral route, serum cholinesterase level of the patient had disparity with clinical severity of intoxication. Considering this disparity, clinical severity should be considered as a more important indicator for treatment of organophosphate intoxication including atropinization, rather than serum cholinesterase level in patients intoxicated by parenteral route.
Cholinesterases* ; Classification ; Eating ; Emergencies ; Humans ; Inhalation ; Insecticides* ; Intensive Care Units ; Korea ; Medical Records ; Plasma* ; Poisoning ; Retrospective Studies ; Ventilators, Mechanical