No abstract available.

BACKGROUND: The fast EMS helicopter was introduced to Korea in 1996 and from Dec. 1. 1997, it was used far transporting emergent patients. Authors, here upon, report the transporting experiences. METHODS: From Dec. 1, 1996 to Dec. 31,1997, Samsung Medical Centers EMS helicopter was used for air evacuation of critically ill patients. The patients data prospectively analyzed. RESULT: A total of 65 patients were transported. Male to female ratio was 1.95 : 1. The mean transport time was 64.1min(10-160 min). Majority of the evacuated patients was surgical patients (General Surgery'16, Orthopedic surgery : 10, Neurosurgery : 6, Infernal medicine 13, Pediatrics : 3, and others : 3). Twenty-one of the 65 patients transported were admitted to ICU and 31 did not require ICU care. During the air evacuation, one physician and one nurse trained for air evacuation amended The patients. No medical problems or deaths developed during the air evacuation period. CONCLUSION: The first EMS helicopter was introduced to Korea in 1996. From Dec. 1, 1996 to Dec. 31, 1997, Samsung Medical Center's EMS helicopter was used for air evacuation of critically ill patients. The patients data reported.
Aircraft* ; Critical Illness ; Emergencies* ; Female ; Humans ; Korea ; Male ; Neurosurgery ; Orthopedics ; Pediatrics ; Prospective Studies

We report a case of delayed rupture of pseudoaneurysm after operation for meningionma. A 68-year-old female presented with mild headache and hemiparesis. Magnetic resonance imaging showed a cystic mass lesion with a solid component, which was attached to dura in the right frontal area. The mass was totally removed, and diagnosed to transitional type meningioma with histopathological examination. Postoperatively, almost of preoperative symptoms were impoved. About a month later, she developed sudden onset deterioration of mental state and hemiparesis. Computed tomography disclosed a large intracerebral hemorrhage at the site of the tumor bed. Emergency operation was performed. During the evacuation of hematoma, we found a ruptured pseudoaneurysm, and secured it with circumferential wrappig and clipping. The patient recovered well and became ambulatory. In case of delayed intracerebral hematoma at the postoperative site, a possibility of the rupture of pseudoaneurysm should be considered.
Aged ; Aneurysm, False* ; Cerebral Hemorrhage ; Emergencies ; Female ; Headache ; Hematoma ; Hemorrhage* ; Humans ; Magnetic Resonance Imaging ; Meningioma* ; Paresis ; Rupture

PURPOSE: To evaluate choroidal thickness in diabetes patients using spectral-domain optical coherence tomography. METHODS: We examined 203 eyes of 203 diabetic participants and 48 eyes of 48 healthy controls. The choroidal thickness at the foveal lesion was measured by enhanced-depth imaging optical coherence tomography. The participants were grouped according to diabetic retinopathy grade: no diabetic change, mild-to-moderate or severe non-proliferative, or proliferative diabetic retinopathy. The study parameters included history, age, axial length, intraocular pressure, central retinal thickness, fasting glucose, and blood pressure. RESULTS: The subfoveal choroidal thickness was thinner in eyes with non-proliferative or proliferative diabetic retinopathy than in normal eyes (p < 0.01). However, there was no difference between eyes with non-proliferative and proliferative diabetic retinopathy or between eyes with no diabetic change and the controls. Eyes exhibiting macular edema showed no significant difference in choroidal thickness compared with eyes having normal macular contours. CONCLUSIONS: The central choroid is thinner when eyes show diabetic changes on the retina. However, the presence of diabetic macular edema or proliferative change is not associated with more pronounced choroidal thinning.
Adult ; Aged ; Choroid/*pathology ; Diabetic Retinopathy/*diagnosis ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Reproducibility of Results ; Retrospective Studies ; Seveso Accidental Release ; Tomography, Optical Coherence/*methods

In this study, we evaluated the effects of fentanyl, midazolam, and fentanyl-midazolam on cardiovascular system and blood glucose during endotracheal intubation in forty normotensive patients scheduled for elective surgery under general anesthesia. The patients were randomly classified into four groups; Group I (control) received tracheal intubation with thiopental 5 mg/kg (n=10), group II received tracheal intubation with fentanyl 6 ug/kg followed by thiopental 2 mg/ kg (n=10), group III received tracheal intubation with midazolam 0.3 mg/kg (n=10), group IV received tracheal intubation with fentanyl 4 ug/kg followed by midazolam 1 mg/kg (n=10). The changes of systolic blood pressure, diastolic blood pressure, mean arterial blood pressurie, heart rate, and blood glucose were compared in each group. The results were as follows; 1) In group I, endotracheal intubation caused a significant rise in SBP, HR and blood glucose. 2) In group II, endotracheal intubation caused little changes in SBP, DBP,MAP and blood glucose but HR was rised. 3) In group III, endotracheal intubation caused little changes in SBP, DBP, MAP, HR and blood glucose. 4) In group IV, endotracheal intubation caused little changes in SBP, DBP, MAP, HR and blood glucose.
Anesthesia, General ; Blood Glucose* ; Blood Pressure ; Cardiovascular System* ; Fentanyl* ; Heart Rate ; Humans ; Intubation ; Intubation, Intratracheal ; Midazolam* ; Thiopental

BACKGROUND AND OBJECTIVE: There has been little clinical data on the treatment outcome of patients with acute asthma attack in Korea. We designed a management protocol of acute asthma, and analyzed clinical p arameters obtained from this protocol. METHOD: A total of 32 cases with acute asthma were treated with oxygen, beta2 agonist, and methylprednisolone. Ipratropium was added in cases of severe attack. After 90 minutes, intravenous aminophylline was given to the patients with poor response. RESULT: Beta2 agonist and methylprednisolone were sufficient for symptom control in 17 cases. Ipratropium and aminophylline were added in 6 and 9 cases, respectively. There was no difference in improvement of PEF, heart rate, respiratory rate, PaO2, PaCO2, and SaO2 at 90 minutes and 8 hours between beta2 agonist inhalation and subcutaneous group. Serum potassium concentration levels significantly decreased in patients treated with ipratropium of aminophylline(n=15, 4.17+/-0.45 vs. 3.99+/-0.35mM/L, p<0.05), compared with patients using only beta2 agonist and methylprednisolone(n=17, 3.89+/-0.30 vs. 4.14+/-0.45mM/L, p>0.05). CONCLUSION: Subcutaneous beta2 agonist may be an alternative to inhalant beta2 agonist for the emergency treatment of acute asthma, and we think a consensus regarding use of aminophylline in the emergency room should be made.
Aminophylline ; Asthma* ; Consensus ; Emergency Service, Hospital ; Emergency Treatment ; Heart Rate ; Humans ; Inhalation ; Ipratropium ; Korea ; Methylprednisolone ; Oxygen ; Potassium ; Respiratory Rate ; Treatment Outcome*

OBJECTIVE: In the present study, we evaluate visual outcomes after surgical removal of craniopharyngiomas and analyze the factors that are considered to affect visual outcomes. METHODS: This study includes 30 patients with craniopharyngioma, who underwent surgery in this clinic during the last 10 years. The changes of visual function (visual acuity and field) of the patients were assessed preoperatively and postoperatively, and paired data of this change were compared. Also, the factors that influence on this change were analysed. RESULTS: Among the 21 patients complaining of decreased vision before the operation, 8 patients were improved (38.0%), and 7 patients were worse (33.3%). However, Four out of 9 patients without any preoperative visual symptoms developed worse vision after the operation (44.4%). The average duration of symptom was 17.2 months in the improved group and 23.6 months in the aggravated group. The tumors recurred in only 5 patients after the gross total resection: Four of them showed the aggravation of visual function after surgical removal and 1 had improvement. CONCLUSION: After removal of craniopharyngiomas, the overall rate of vision improvement, no change and aggravation are 26.6%, 36.7% and 36.7%, respectively. Aggravation of postoperative visual function is higher in males, children and patients with a longer duration of symptom and the tumor recurres more frequently in patients who complained of worsened vision after surgical removal.
Child ; Craniopharyngioma* ; Humans ; Male

The effect of anesthetic volume on the spread of hypobaric tetracaine were sutdied after intrathecal injection in thirty patients with prone jackknife and 15 degree Trendelenburg position for perinal surgery. The patients were assigned randomly into the one of three groups divided by the 3, 4, or 5 ml of volume of anesthetic solution. The results show that the volume of tetracaine in distilled water with hypobaric spinal anesthesia in prone jackknife and l5 degree Trendelenburg position had a important effect on the anesthetic dermatomal levels in spite of slightly rapid onset with large. volume. Therefore, we concluded that for the perianal surgery in prone jackknife position, as the volume of the anes- thetic solution with hypobaric spinal anesthesia, 3 or 4 ml of the volume are sufficient to get the adequate anesthetic levels.
Anesthesia, Spinal* ; Head-Down Tilt ; Humans ; Injections, Spinal ; Tetracaine ; Water

PURPOSE: Staphylococcal bacteremia is a major problem in the neonatal intensive care unit. But, there is little data on staphylococcal bacteremia in the neonatal intensive care unit in Korea. We searched for patterns of staphylococcal infection in neonatal intensive care units. METHODS: A retrospective study was conducted on infants who had staphylococcal bacteremia and were in the neonatal intensive care unit between 2001, February and 2007, May. RESULTS: A total of 48 cases were reviewed (mean gestational age 31 wks [23-40], mean birth weight 1689 g [510-3,920]). The vast majority of cases were coagulase-negative staphylococcus (CoNS) (30 cases, 62.5%). Staphylococcus aureus caused 36.1% of staphylococcal bacteremia (17 cases). Methicillin-resistant staphylococcal aureus (MRSA) (14 cases) caused 77.7% of staphylococcal aureus bacteremia. Peripherally inserted central venous catheters were placed in situ in most patients (MSSA: 75%, MRSA: 88.2%, CoNS: 62.1%). Most of the staphylococcal bacteremia in patients were hospital-acquired (81%). Fifteen cases increased levels of C-reactive protein (CRP) (31%). (Mean CRP : MSSA 1.07 mg/dL, MRSA 3.64 mg/dL, CoNS 0.54 mg/dL). Exclusively MRSA had focal complications (osteomyelitis/arthritis: 3 cases). Vancomycin was used in 47.4% in MRSA and 52.6% in CoNS. Four patients (8.3%) died, but all were not directly attributable. CONCLUSION: The staphylococcal bacteremia was generally observed to be a hospital- acquired infection in the neonatal intensive care unit. MRSA caused more elevation of CRP levels and focal complication. To know exactly that what the pattern of staphylococcal bacteremia in Korea is, more research is needed in other neonatal intensive care unit.
Bacteremia ; Birth Weight ; C-Reactive Protein ; Central Venous Catheters ; Gestational Age ; Humans ; Infant ; Infant, Newborn ; Intensive Care Units, Neonatal ; Intensive Care, Neonatal* ; Korea ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Retrospective Studies ; Staphylococcal Infections* ; Staphylococcus ; Staphylococcus aureus ; Vancomycin

Background/aims: Contradictory findings on the association between cholecystectomy and cancer have been reported. We aimed to investigate the risk of all types of cancers or site-specific cancers in patients who underwent cholecystectomy using a nationwide dataset. Methods: Subjects who underwent cholecystectomy from January 1, 2007, to December 31, 2014, who were older than 20 years and who underwent an initial baseline health check-up within 2 years were enrolled. Those who were diagnosed with any type of cancer before the enrollment or within 1 year after enrollment were excluded. Ultimately, patients (n=123,295) who underwent cholecystectomy and age/sex matched population (n=123,295) were identified from the database of the Korean National Health Insurance Service. The hazard ratio (HR) and 95% confidence interval (CI) for cancer were estimated, and Cox regression analysis was performed. Results: The incidence of cancer in the cholecystectomy group was 9.56 per 1,000 person-years and that in the control group was 7.95 per 1,000 person-years. Patients who underwent cholecystectomy showed an increased risk of total cancer (adjusted HR, 1.19; 95% CI, 1.15 to 1.24; p<0.001), particularly leukemia and malignancies of the colon, liver, pancreas, biliary tract, thyroid, pharynx, and oral cavity. In the subgroup analysis according to sex, the risk of developing cancers in the pancreas, biliary tract, thyroid, lungs and stomach was higher in men than in women. Conclusions Physicians should pay more attention to the possibility of the occurrence of secondary cancers among patients who undergo cholecystectomy.