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

PURPOSE: To evaluate 5-year survival rate, patterns of failure and complications of cervical cancer treatment, fifty nine patients treated by curative cancer were analyzed retrospectively. METHODS AND MATERIALS : From March 1986 to May 1990, fifty nine patients with histologically proven uterine cervical cancer were analyzed. According to FIGO stage, there were 2 patients (3.4%) in stage Ib, 2 patients (3.4%) in stage IIa, 31 patients (52.5%) in stage IIb, 15 patients (25.4%) in stage IIIb, 9 patients (15.3%) in stage IV, External RT was per formed by 6 MVLINAC with daily 1.8 Gy, 5 times per week and followed by ICR, A point dose of ICR was calculated to 30-43.66 Gy (median : 34.6Gy). These techniques delivered total A point dose of 80.4 to 109.8 Gy (median : 85Gy). Patients had been followed up from 2 to 110 months (median : 61 months) RESULTS: The overall 5-year survival rate & disease free survival rate were 55.9% and 55.0 % respectively. According to FIGO stage, the 5-year survival rate for less than Iia, IIb, IIIb, IV were 75.0%, 74.8%, 26.7%, 33.3%, respectively. In univariate analysis, the 5-year survival rate for stage IIb and below versus stage llla and above revealed 74.8%, 29.2% respectively (p<0.005). According to FIGO stage, the 5-year survival rate for less than lla, llb, lllb, IV were 75.0%, 74.8%, 26.7%, 33.3%, respectively. In univariate analysis, the 5-year survival rate for stage llb and below versus stage llla and aboce revealed 74.8%, 29.2% respectively (p<0.005). According to the hemoglobin level during RT, the 5-year survival rate of was 73.3% for patients with Hg 10 gm/dL or higher, in contrast to 0% for those with lower than 10 gm/dL (p<0.005). In 18 patients with nonbulky tumor (<5 cm), the 5-year survival rates were 71.8%. The 5-year survival rates for 18 patients with 5 cm or greater in tumor diameter were 22.2% (p<0.005). The 5-year survival rate for patient age of above 50 years and below were 65.3%, 34.2% respectively (p<0.05). ECOG performance status, pathologic finding, total dose, total treatment time were not statistically significant factors. The significant prognostic factors affecting overall 5-year survival rate by multicariate analysis showed the hemoglobin level during RT (p=0.0001), tumor size (p=0.0390), FIGO stage (p=0.0468) Total recurrence rate was 23.7%; local failure 15.2% (9/59), distant metastasis 6.8% (4/59), local and distant metastasis 1.7% (1/59). According to the RTOG/EORTC Soma Scales, the late complication rate was 23.8% (14/59). The late complication rate of colorectum and genitourinary tract were 15.3% (9/59), 8.5% (5/59), respectively : 10 patients(17.0%) were grade 2, 3 patients (5.1%) were grade 3 and one patient (1.7%) (1/59). According to the RTOG/EORTC Soma Scales, the late complication rate was 23.8% (14/59). The late complication rate of colorectum and genitourinary tract were 15.3% (9/59), 8.5% (5/59), respectively : 10 patients (17.0%) were grade 2,3 patients (5.1%) were grade 3 and one patient(1.7%) was grade 4. The late complications were radiation proctitis, rectal bleedint, radiation colitis, diarrhea and radiation cystitis in decreasing order. CONCLUSION: For improvement of therapeutic results, prospective randomized trials are recommended to discover new prognostic factors and more aggressive radiation therapeutic methods are needed for poor prognostic patients. The adjuvant chemotherapy or radiation-sensitizing agents must be considered to inhibit regional and distant metastasis.
Carisoprodol ; Chemotherapy, Adjuvant ; Colitis ; Cystitis ; Diarrhea ; Disease-Free Survival ; Humans ; Neoplasm Metastasis ; Proctitis ; Radiation-Sensitizing Agents ; Radiotherapy* ; Recurrence ; Retrospective Studies ; Survival Rate ; Uterine Cervical Neoplasms* ; Weights and Measures

PURPOSE: To investigate whether combined beta-carotene with X-irradiation has more enhanced radition response than X-irradiation or not, we performed a experiment about in vitro cytotoxicity of beta-carotene and/or X-irradiation in the fibrosarcoma cells, tumor growth delay of combined beta-caroten with/or X-irradiation in the mouse fibrosarcoma. MATERIALS AND METHODS: 2% emulsion of beta-carotene was serially diluted and used. X-irradiation was given by 6 MeV linear accelerator. The cytotoxicity of beta-carotene in vitro was evaluated from clonogenic assay. To compare the cytotoxicity between combined beta-carotene with X-irradiation and X-irradiation group, 2 mg/ml of beta-carotene was contacted to fibrosarcoma (FSaII) cells for 1 hour before X-irradiation. For the tumor growth delay, single 20 Gy was given to FSaII tumor bearing C3H/N mice whic was classified as beta-crotene with X-irradiation group (n=6) and X-irradiation alone group (n=5). 0.2 ml of 20 mg/kg of beta-carotene were i.p. injected to mice 30 minute before X-irradiation in the beta-crotene with X-irradiation group. The tumor growth delay defined as the time which reach to 1,000 mm3 of tumor volume. RESULT: (1) Cytotoxicity in vitro; 1) survival fraction at beta-carotene concentration of 0.002, 0.02, 0.2 and 2 mg/ml were 0.69+/-0.07, 0.59+/-0.08, 0.08+/-0.008 and 0.02+/-0.006, respectively. 2) each survival fraction at 2, 4, 6 and 8 Gy in the 2 mg/ml of beta-carotene + X-irradiation group were 0.13+/-0.05, 0.03+/-0.005, 0.01+/-0.002 and 0.009+/-0.0008, respectively. But each survival fraction at same irradiation dose in the X- irradiation group were 0.66+/-0.05, 0.40+/-0.04, 0.11+/-0.01 and 0.03+/-0.006, respectively( p<0.05). (2) The time which reach to 1,000 mm3 of tumor volume of beta-carotene + X-irradiation group and X-irradiation alone group were 18, 19 days, respectively( p>0.05). CONCLUSION: The contact of beta-caroten to FSaII cells showed mild cytotoxicity which was increased according to concentration. The cytotoxicity of combined beta-carotene with X-irradiation more increased than that of X-irradiation, additionaly. And there was significant difference of cytotoxicity between two groups. But there were no significant difference of the growth delay of fibrosarcoma between two groups.
Animals ; beta Carotene* ; Fibrosarcoma* ; Mice* ; Particle Accelerators ; Tumor Burden

BACKGROUND: The purpose of this study was to analyze the endotracheal intubation cases performed in the emergency department. METHODS: We investigated retrospectively 326 cases of endotracheal intubation performed in the emergency department of a tertiary care center from April 1, 1998 to March 31, 1999. We focused on operators, medications used, its success rate and immediate complications, and the relationship between its success rate and medications. RESULTS: Of 326 consecutive intubations, 193 patients(59.2%) were done by emergency medicine residents or attending physician. While 320 patients(98.2%) were successfully intubated, 6 patients could not be intubated and 2 patients underwent tracheostomy. Of 50 cases of intubations(15.3%) attempted with paralyzing agents, 48 cases were done with succinylcholine and 46 cases underwent by emergency physicians. Intubations with neuromuscular paralysis resulted in high success rates at the first attempt. Of 55 immediate adverse events were encountered in 47 patients(desaturation=17, bronchial intubation=15, hypotension=8, bradycardia=4, cardiac arrest=2, others=5). CONCLUSION: At this institution, paralyzing agents were used infrequently, but almost all of them were used by emergency physicians.
Emergencies* ; Emergency Medicine ; Emergency Service, Hospital* ; Humans ; Intubation ; Intubation, Intratracheal* ; Paralysis ; Retrospective Studies ; Succinylcholine ; Tertiary Care Centers* ; Tertiary Healthcare* ; Tracheostomy

The authors have intended to measure intrinsic dose distribution by Farmer dosimeter in irregularly shaped fields such as L.M. and T shape models in order to determine dose in homogeneity in those models. We made 2 off-xis points in each model and measured the depth dose at 1.5, 5 and 9cm below surface. The results showed 1~3% dose discrepancy between 2 points. We also measured the depth dose by geometric approximation and computer calculation in those models, and came to the conclusion that computer calculation using Clarkson's principle is simpler and the measurements are closer to the ideal data obtained by the experiment in three models of irregularly shaped fields than those of geometric approximation method.

To evaluate radiation effect on the hematopoietic system, we analyzed 44 patients who were treated with conventionally fractionated radiation therapy (RT) at Chonbuk National University Hospital. According to the treatment sites, we classified them into three groups: group I as head and neck, group II as thorax, and group III as pelvis. White blood cell, lymphocyte, platelet and hemoglobin were checked before and during RT The results were as follow; 1. White blood cell (WBC) and lymphocyte count were declined from the first week of RT to the third week, and then slightly recovered after the third or fourth week. There was prominent decrease in lymphocyte counts than WBC. 2. Platelet counts were declined until the second week of the RT, showed slight recovery at fourth week in all groups. Hemoglobin values were slightly decreased in the first week and then recovered the level of pretreatment value, gradually. 3. Lymphocyte count were declined significantly on group III(p<0.01), WBC and platelet counts were decreased on group II but statistically not significant.
Blood Cells* ; Blood Platelets ; Head ; Hematopoietic System ; Humans ; Jeollabuk-do ; Leukocytes ; Lymphocyte Count ; Lymphocytes ; Neck ; Pelvis ; Platelet Count ; Radiation Effects* ; Thorax

PURPOSE: We analyzed the incidence and related factors of radiation dermatitis; at first, to recognize whether a decrease in radiation dermatitis is possible or not in breast cancer patients who received radiation therapy. MATERIALS AND METHODS: Of 338 patients, 284 with invasive breast cancer who received breast conservation surgery with radiotherapy at Chonbuk National University Hospital from January 2007 to June 2009 were evaluated. Patients who also underwent bolus, previous contralateral breast irradiation and irradiation on both breasts were excluded. For patients who appeared to have greater than moderate radiation dermatitis, the incidence and relating factors for radiation dermatitis were analyzed retrospectively. RESULTS: A total of 207 and 77 patients appeared to have RTOG grade 0/1 or above RTOG grade 2 radiation dermatitis, respectively. The factors found to be statistically significant for the 77 patients who appeared to have greater than moderate radiation dermatitis include the presence of lymphocele due to the stasis of lymph and lymph edema which affect the healing disturbance of radiation dermatitis (p=0.003, p=0.001). Moreover, an allergic reaction to plaster due to the immune cells of skin and the activation of cytokine and concomitant hormonal therapy were also statistically significant factors (p=0.001, p=0.025). CONCLUSION: Most of the breast cancer patients who received radiation therapy appeared to have a greater than mild case of radiation dermatitis. Lymphocele, lymphedema, an allergy to plaster and concomitant hormonal therapy which affect radiation dermatitis were found to be significant factors. Consequently, we should eliminate lymphocele prior to radiation treatment for patients who appear to have an allergic reaction to plaster. We should also instruct patients of methods to maintain skin moisture if they appear to have a greater than moderate case of radiation dermatitis.
Breast ; Breast Neoplasms ; Dermatitis ; Edema ; Humans ; Hypersensitivity ; Incidence ; Lymphedema ; Lymphocele ; Skin

PURPOSE: To describe the surgical treatment of the complex dorsal metacarpophalangeal dislocations and its results, emphasizing on the modified volar approach with A1 pulley release. MATERIALS AND METHODS: We experienced 6 cases of dorsal dislocation of the metacarpophalangeal joint. We performed open reduction with the modified volar approach described by Eaton and Dray. Postoperatively posteroanterior and lateral radiographs of the index finger metacarpophalangeal joint and metacarpophalangeal joint range of motion was followed. RESULTS: One case with a large osteochondral fracture was operated with volar and doral approach both. Overall end results were good without any significant restriction of motion and stability of the fingers. CONCLUSION: Modified volar approach with A1 pulley release is an excellent method for complex dorsal metacarpophalangeal dislocations without osteochondral fracture.
Benzodiazepines ; Dislocations ; Fingers ; Metacarpophalangeal Joint ; Range of Motion, Articular

PURPOSE: We evaluated retrospectively the outcome of locally advanced non-small cell lung cancer patients treated with definitive radiotherapy to find out prognostic factros affecting survival. MATERIALS AND METHODS: 216 cases of stage IIIB non-small cell lung cancer were with treated radiotherapy at our Hospital between 1991 to 2002 and reviewed retrospectively. Cases were classified by mode of treatment and response to treatment. Patients showing complete response or partial response to treatment were included in the "response group", while those showing stable or progressive cancer were included in the "non-response group". RESULTS: 30 patients completed the planned radiotherapy treatments and 39 patients completed combined treatments or chemoradiotherapy. Median survival was 4.6 months for patients treated with radiotherapy and 9.9 months for those undergoing combined radiotherapy and chemotherapy. Survival rates for the first year were 13.3% with radiotherapy and 35.9% with chemoradiotherapy. In the second year, 3.3% of the radiotherapy patients survived and 20.5% of the patients receiving chemoradiotherapy survived. By the third year, 15.4% of the patients receiving the combined treatments survived. None of the patients treated with radiotherapy alone lived to the third year, however. Overall survival was significantly different between the radiotherapy patients and the combined chemoradiotherapy patients (p<0.001). In the response group, median survival was 7.2 months with radiotherapy and 16.5 months with combined therapy. In the non-response group, median survival was 4.4 months with radiotherapy and 6.7 months with combined treatments. Severe acute complications (grade 3) occurred in 2 cases using radiotherapy, and in 7 cases using combined therapy. CONCLUSION: When the patients with stage IIIB non-small cell lung cancer received chemoradiotherapy, treatment response rate and overall survival was greater than with radiation alone.
Carcinoma, Non-Small-Cell Lung* ; Chemoradiotherapy ; Drug Therapy ; Humans ; Radiotherapy ; Retrospective Studies ; Survival Rate ; Treatment Outcome*

PURPOSE: We evaluated the failure pattern of the celiac axis, gastric lymph node, and treatment outcome in the upper and mid-esophageal region of cancer patients treated by definitive radiotherapy, except when treating the celiac axis and gastric lymph node for treatment volume, retrospectively. MATERIALS AND METHODS: The study constituted the evaluation 108 patients with locally advanced esophageal cancer receiving radiotherapy or a combination of radiotherapy and chemotherapy at Chonbuk National University Hospital from January 1986 to December 2006. In total, 82 patients treated by planned radiotherapy, except when treating the celiac axis and gastric lymph node for treatment volume, were analysed retrospectively. The study population consisted of 78 men and 2 women (mean age of 63.2 years). In addition, 51 patients received radiotherapy alone, whereas 31 patients received a combination of radiation therapy and chemotherapy. The primary cancer sites were located in the upper portion (17 patients), and mid portion (65 patients), respectively. Further, the patients were in various clinical stages including T1N0-1M0 (7 patients), T2N0-1M0 (18 patients), T3N0-1M0 (44 patients) and T4N0-1M0 (13 patients). The mean follow up period was 15 months. RESULTS: The various treatment outcomes included complete response (48 patients), partial response (31 patients) and no response (3 patients). The failure patterns of the lymph node were comprised of the regional lymph node (23 patients) and the distance lymph node which included celiac axis and gastric lymph node (13 patients). However, metastasis was not observed in the regional and distant lymph node in 10 patients, whereas 36 patients were not evaluated. Furthermore, of the 13 patients who developed celiac axis and gastric lymph node metastases, 3 were in stage T1N0-1M0 and 10 were in stage T2-4N0-1M0. A complete response appeared in 12 patients, whereas a partial response appeared in 1 patient. The mean survival time of the patients who appeared for regional and distant lymph node metastasis was 14.4 and 7.0 months, respectively. CONCLUSION: In locally advanced esophageal cancer patients, who were treated by definitive radiotherapy without celiac axis and gastric lymph node irradiation, the distant lymph node metastasis rate was high and the overall survival rate was lower compared to the regional lymph node metastasis. The incidence of regional and distant lymph node metastasis was high in patients who appeared beyond clinical stage T2 and received radiotherapy alone.
Axis, Cervical Vertebra ; Esophageal Neoplasms ; Female ; Follow-Up Studies ; Humans ; Incidence ; Lymph Nodes ; Male ; Neoplasm Metastasis ; Retrospective Studies ; Survival Rate ; Treatment Outcome