To evaluate the risk factors affecting mortality in blunt abdominal injury we prospectively analysed 149 abdominal traumatic patients, who were performed laparotomy in 84 cases and conservative management in 65 cases, from January 1st. 1995 to September 30th. 1996. The liver was most frequently injured intraabdominal organ(46.3%), followed by spleen(32.9%), kidney(23.5%), small intestine(16.1%) and mesentery(13.4%). Mortality rate was 19.5%. The cause of death was hemorrhagic shock and its complications in 11 cases, craniocerebral injuries in 7 cases, pulmonary complications in 6 cases, and septic shock in 5 cases. The presence of hypotension(less than 90mmHg), head trauma(above 3 in severity code of abbreviated injury scale(AIS)) and chest trauma(hemothorax and/or pneumothorax) was associated with a high mortality rate(88.9%), but the mortality rate for the patients neither hypotension nor head and chest trauma was very low(1.8%). The mortality in the blunt abdominal injuries was highly influenced by hypotension, head injury and multiple intraabdominal injuries(p<0.05). Of the above influencing risk factors, the associated head injury was the most powerful determinant in the prognosis in the patients of blunt abdominal injuries.
Abdominal Injuries ; Cause of Death ; Craniocerebral Trauma ; Head ; Humans ; Hypotension ; Laparotomy ; Liver ; Mortality* ; Prognosis ; Prospective Studies ; Risk Factors ; Shock, Hemorrhagic ; Shock, Septic ; Thorax

We studied the contents of referral sheets of the patients transferred to DMC Emergency Center from Jan 1, 1999 to Jan 31, 1999. The study far the completion and chief complaints in the referral sheets shows the followings. 1. Examining the referral sheets status of disease, name and age record of 5 major items grade 0.92, the highest point, examining item and laboratorial record grade 0.72, dignosis record grades 0.38, and patients condition and diagnosis opinion record grade 0.10. 2, Name and age item had high completion score in referral sheets from local clinic and hospital for secondary referral level. For address item, however, local clinic scored 0.63 and hospital for secondary referral level scored 0.28, which showed statistically significant difference(P<0.001). 3. In the aspect of severity, name and age record leveled 0.94 to the non emergency patient, 0.92 to the emergency patient, 0.91 urgent patient, showed and no statistic significant difference. 4. The major 10 symptoms of the complaints were these the pain of abdomen and pelvis(25.2%), somnolence and stupor, coma(13.6%), headache(10.9%), and open wound of head(4.0%), ranked 10th common symptom level.
Abdomen ; Diagnosis ; Emergencies ; Humans ; Referral and Consultation* ; Stupor ; Wounds and Injuries

BACKGROUND: Tsutsugamushi disease, Leptospirosis, and Hemorrhagic fever with renal syndrome(HFRS) are an acute febrile illness of autumn-winter type which are characterized by fever, headache, myalgia in acute stage. We reported the clinical and laboratory characteristics of 49 cases under investigation far febrile illness in rural communities of Korea in order to differentiate the diagnosis among Tsutsugamushi disease, Leptospirosis, and HFRS. METHODS: This study was done retrospectively by investigation of patient's age, occupation, symptom, laboratory findings and chest X-ray findings of Tsutsugamushi disease, Leptospirosis, and HFRS. All patients was seen in our hospital between September and November in 1997 and 1998 consecutive year. RESULTS: The most characteristic symptoms and signs of Tsutsugamushi disease were eschar(90.1%), and skin rash(70%). The epidemiological and laboratory characteristics of Tsutsugamushi disease were age 40 or more, farmer(90.1%), s-GOT(serum glutamic oxaloacetic transaminase) and s-GPT(serum glutamic pyruvic transaminase) elevation. The most characteristic symptoms and signs of Leptospirosis were sputum and cough(75%). The epidemiological and laboratory characteristics of Leptospirosis were all farmers(100%), hyperbilirubinemia(1.67 mg/dl). The most characteristic symptoms and signs of HFRS were gastrointestinal disturbance(100%), flank pain(66.7%). The epidemiological and laboratory characteristics of HFRS were leukocytosis, thrombocytopenia, azotemia, proteinuria (91.6%), and hematuria (83.3%). CONCLUSION: As the clinical feature, presence of eschar and skin rash were suggestive of Tsutsugamushi disease. As the clinical feature, presence of cough and sputum and laboratory finding such as elevation of bilirubin level were suggestive of Leptospirosis. As the clinical feature, presence of gastrointestinal disturbance, flank pain and laboratory finding of thrombocytopenia, and renal dysfunction were suggestive of HFRS.
Azotemia ; Bilirubin ; Cough ; Diagnosis ; Exanthema ; Fever ; Flank Pain ; Headache ; Hematuria ; Hemorrhagic Fever with Renal Syndrome ; Humans ; Korea* ; Leptospirosis ; Leukocytosis ; Myalgia ; Occupations ; Proteinuria ; Retrospective Studies ; Rural Population* ; Scrub Typhus ; Skin ; Sputum ; Thorax ; Thrombocytopenia

PURPOSE: In the prethrombolytic era, patients with non-Q myocardial infarction (non-MI) exhibited a lower short-term mortality, but were at higher risk for inhospital and long-term reinfarction, leading to a higher long-term mortality rate than for patients with Q MI. The objective of this study was to determine whether the incidence of non-Q MI among and the prognosis for patients with ST-segment elevation and thrombolytic therapy were different from those among patients who did not have thrombolytic therapy. METHODS: A retrospective chart review was done for 222 patients of acute myocardial infarction with ST-segment elevation The analysis compared the rate of transformation of ST-elevation to Q MI and non-Q MI and the clinical outcome (30-day mortality, reinfarction, recurrent angina, left ventricular (LV) dysfunction, and new congestive heart failure (CHF)) of patients who subsequently developed a Q or non-Q MI postthrombolysis to those for the controls. RESULTS: The rate of non-Q MI was not significantly higher among patients receiving thrombolysis than among the control (31% vs 25%, p>0.1). Among patients receiving thrombolysis, the 30-day mortality (2.6% vs 0%), the inhospital reinfarction (10.3% vs 11.5%), and recurrent angina (20.6% vs 14.5%) were not significantly lower for those who developed a non-Q MI compared with either those who developed a Q MI or the control patients who developed non-Q MI, but left ventricular dysfunction (35.9% vs 55.2%) and new congestive heart failure (0 vs 10.3%) were significantly lower compared with those who developed Q MI. CONCLUSION: Patients receiving thrombolysis do not necessarily develop a non-Q MI and do not have a better prognosis than those who either develop a postthrombolysis Q MI or a non-Q MI after no thrombolysis.
Heart Failure ; Humans ; Incidence ; Mortality ; Myocardial Infarction* ; Prognosis* ; Retrospective Studies ; Thrombolytic Therapy ; Ventricular Dysfunction, Left

BACKGROUND: Infiltration of eosinophils and activated T cells into the airway is a characteristic feature of allergic inflammation such as asthma. IL-4 has been shown to mediate adhesion of eosinophils and T cells to endothelial cells by inducing VCAM-1 expression on endothelial surface. IL-13 shares a number of biologic properties with IL-4. OBJECTIVE: We aimed to investigate the effects of IL-13 on the adhesion of eosinophils to human umbilical vein endothelial cells (HUVEC) and on the expression of VCAM-1 in HUVEC. METHOD: HUVEC was incubated for 24h with IL-13 (10ng/ml), IL-4 (10ng/ml) and TNF-a (10ng/ml). Surface expression of VCAM-1 in HUVEC was detected using irnmuno-cytochemical stain and reverse transcription-polymearse chain reaction (RT-PCR), and the adhesion of eosinophils to HUVEC was quantitated using eosinophil peroxidase (EPO) assay. RESULTS: The VCAM-1 expression on IL-13-treated HUVEC increased more than in the expression on medium-treated HUVEC (p<0.05). The adhesion of eosinophil to IL-13- treated HUVEC also increased more than in the adhesion to medium-treated HUVEC (p<0.05). The VCAM-1 expression was synergistically induced by TNF-a and IL-13 (p<0.05). IL-13 induced VCAM-1 expression and adhesion of eosinophils to HUVEC, similar to IL-4. IL-13 also induced VCAM-1 mRNA expression, with greater expression than with medium and TNF-a(p<0.05). IL-13-induced surface VCAM-1 was associated with expression of mRNA transcripts and adhesion of eosinophils to HUVEC(r=0.89, r=0.93, p<0.05). CONCLUSION: These findings demonstrate that IL-13 stimulates HUVEC to express surface VCAM-1 and has a possible role in promoting VCAM-1/VLA-4 dependent accumulation of eosinophils during allergic and other inflammatory responses.
Asthma ; Endothelial Cells* ; Eosinophil Peroxidase ; Eosinophils* ; Human Umbilical Vein Endothelial Cells ; Inflammation ; Interleukin-13* ; Interleukin-4 ; RNA, Messenger ; T-Lymphocytes ; Vascular Cell Adhesion Molecule-1

BACKGROUND: N-acetylcysteine(ACE) is used both orally and intravenously in a variety of experimental pathologies resembling human disease states which exhibit endothelial toxicity as a result of oxidative stress, including acute pulmonary oxygen toxicity, septicemia and endotoxin shock. Despite these observations in vivo, it is not certain how this thiol drug produces its protective effects. ACE is a cysteine derivative which is able to directly react with oxygen radicals and may also act as a cysteine and glutathione(GSH) precursor following deacetylation. In this paper, we tried to know whether the therapeutic doses of ACE can modify the inflammatory function of the neutrophils and can increase the glutathione level of plasma in chronic obstructive pulmonary disease(COPD) patients. In addition, the effect of ACE to the purified neutrophil in terms of superoxide release and glutathione synthesis were observed. METHOD: Firstly, we gave 600mg of ACE for seven days and compare the release of superoxide, luminol-enhanced chemiluminescence from the neutrophils, neutrophil chemotaxis, and plasma GSH levels before and after ACE treatment in COPD patients. Secondly, we observed the dose dependent effect of ACE to the purified neutrophil's superoxide release and GSH levels in vitro. RESULTS: 1) Usual oral therapeutic doses(600mg per day) of ACE for seven days did affect neither on the neutrophils superoxide release, chemiluminescence, chemotaxis, nor on the plasma GSH concentration in the COPD patients. 2) ACE decreases the purified neutrophil's superoxide release and increase the GSH production in dose dependent fashion in vitro. CONCLUSION: Despite the fact that oral ACE treatment did not affect on the neutrophil's inflammatory function and plasma GSH concentration in COPD patients in usual therapeutic doses, it decreases the superoxide release and increases the GSH production from the isolated neutrophils in high molar concentrations. These findings suggest that to obtain an antioxidative effects of ACE, it might be needed to increase the daily dosage of ACE or therapeutic duration or change the route of adminisration in COPD patients.
Acetylcysteine* ; Chemotaxis* ; Cysteine ; Glutathione* ; Humans ; Luminescence ; Molar ; Neutrophils* ; Oxidative Stress ; Oxygen ; Pathology ; Plasma* ; Pulmonary Disease, Chronic Obstructive ; Reactive Oxygen Species ; Sepsis ; Shock ; Superoxides*

No abstract available.
Diskectomy*

This study was designed to investigate clinical characteristics and outcome of patient with suicidal attempt. A retrospective analysis by chart review of 130 cases of patients with suicidal attempt who visited emergency department of Dankook University Hospital from January 1998 to December 1998. The results were as follows; 1. The ratio of patients with suicidal attempt to total patients who visited emergency department was 0.7%. The highest suicidal attempt rates were among aged 20-39. The gender ratio is similar. 2. Suicidal attempt were more common in summer, July, Friday, evening. 3. The most common place of suicidal attempt was home. 4. Drug ingestion was the most common method of suicidal attempt. Drug used for suicidal attempt were agricultural drug including organic phosphorus and carbamate, and therapeutic drug. 5. Common motives of suicidal attempt were marriage conflict, family conflict. 6. The intensity of will to die was more strong in old aged male. 7. Suicidal attempt associated with alcohol drinking was 39.2%. 8. Common symptoms or signs of intoxication were neurological and gastrointestinal.
Alcohol Drinking ; Eating ; Emergency Service, Hospital ; Family Conflict ; Humans ; Male ; Marriage ; Phosphorus ; Retrospective Studies

Four hundred and fifty patients of cerebrovascular accident who underwent computerized tomographic scanning during the 45 months, from January 1978 to October 1981, at department of internal medicine, Kyung Hee University Hospital, were studied and following results were obtained. 1. In Korea, intracerebral hematoma(48.2%) is more common than cerebral infarction(27.6%). 2. 87.3% of intracerebral hemorrhage were comfirmed while 61.5% of cerebral infarction were identified by brain CT. 3. Cerebrovascular accidents are definitely developing in 6th decade(40.6%) and male is more often affected. 4. hypertension is the most common underlying disease(72.3%) of cerebral hemorrhage, 52.4% of cerebral infarction. 5. hematoma occurs most frequently in basal ganglia(40.6%) and cerebral infarction occurs most frequently in global area(48.4%). 6. Changes of consciousness level were observed in 54.2% of the cases of mild degree hematoma. Mortality was 6.2% in mild degree hematoma and 88.2% in severe degree hematoma. 7. In 26.2% of cerebral hematoma, inital CSF findings were normal in spite of the evidence of cerebral hematoma confirmed by CT scanning.
Brain* ; Cerebral Hemorrhage ; Cerebral Infarction ; Classification* ; Consciousness ; Hematoma ; Humans ; Hypertension ; Internal Medicine ; Korea ; Male ; Mortality ; Stroke* ; Tomography, X-Ray Computed

PURPOSE: Outcome for critically ill patients often depends on time-sensitive critical care interventions. Thus we examined the effects of time on the mortality and the factors affecting emergency department length-of-stay (EDLOS) in hypotensive patients needing laparotomy in an emergency department. METHODS: ED records were reviewed for documentation of factors that might be associated with prolonged EDLOS, such as computed tomography, the number of standard radiographs, overcrowding, special procedures, and consultations. EDLOS was considered to consist of the time from arrival in the ED to departure from the ED. To assess the effect of multiple simultaneous factors a Cox proportional hazard model was created and a risk ratio (RR) was used to assess the effect of time on mortality. Risk ratio for death was equal to the percentage of patients with tested attributes among patients who died divided by the percent with those attributes among survivors. RESULTS: One-hundred sixteen patients met the inclusion criteria. Average time to the ED was 199.7+/-100.0 minutes. Using a Cox proportional hazards model, the independent predictors of prolonged EDLOS were determined to be additional CT for other areas outside of the abdomen, the number of standard radiographs, whether the patients had a weekend visit, and overcrowding. The risk ratio for time spent in the ED before laparotomy increased up to a time of 120 minutes, then significantly decreased below all earlier values on patients with hypotension and unreponsive to fluid therapy. The risk ratio increased after 240 minutes in patients with hypotension and responsive to fluid therapy. CONCLUSION: The probability of death showed a relationship to the EDLOS for patients who were in the EDLOS for 120 minutes or less in hypotensive abdominal injury patients needing laparotomy in the emergency department.
Abdomen ; Abdominal Injuries ; Critical Care ; Critical Illness ; Emergencies ; Fluid Therapy ; Hemorrhage ; Humans ; Hypotension ; Laparotomy ; Length of Stay ; Odds Ratio ; Proportional Hazards Models ; Referral and Consultation