STUDY OBJECT: To date, the study of critical illness in the emergency department has been limited. The purpose of this study was to determine the length of stay and procedures performed on critical care patient in ED, and to be help to establish Emergency physicians' education program. METHOD: We reviewed patient's medical record, who visited ED, Korea Univ. Hospital from Jan. 1996 to Jun. 1996 and admitted to ICU. We analyzed data to age, sex, clinical diagnosis, length of stay, and critical procedures in ED. RESULTS: The 12,721 patients visited ED during the study period, the 441 of 12,721 (3.50%) patients admitted to ICU. 56 patients were excluded whose medical re cords were incomplete. The study populations consisted of 165 women and 220 men. The mean age were 52 year old (median,58 year old). The mean length of stays were 606.1 (1445.9 minutes (median, 180 minutes)). One hundred sixty one of these patients (41.8 %) received one or more critical procedures. The medical critical patients were 252 cases, and surgical critical patients were 133 cases. The mean length of stay of medical critical patients was 738.8 (1748.9 minutes (median, 177.5 minutes)) in medical department,44.0% of them received critical procedures in ED. The surgical critical patients averaged 354.9 (410.7 minutes (median, 190 minutes)) and 37.6% received critical procedures. CONCLUSION: Critical ill patients stay in the ED with a substantial amount of time, before addition to the ICU. Critical ill patients who have hemodynamiccal unstable conditions, compromised cardiopulmonary functions, and neurologic deficities, were managed in ED frequently. Typical critical care procedures are commonly performed by emergency physicians. Therefore, it is important for emergency physician to prepare to critical ill patients.
Critical Care* ; Critical Illness ; Diagnosis ; Education ; Emergencies* ; Emergency Service, Hospital* ; Female ; Humans ; Korea ; Length of Stay ; Male ; Medical Records ; Middle Aged

The purpose of this research is to find out the degree of cartilage regeneration by inserting the atelo- collagen scaffold obtained from dermis of a calf on cartilage defect site. Dissection underneath the perichondrium by the periosteal elevator on both side of ears of six New Zealand white rabbits were made to expose the cartilage, leaving pairs of circular holes 3, 6, 9 mm width with punches. One hole was left for a control, and on the other hole atelo-collagen scaffold of the same size was transplanted. In postoperative 1, 2, 4 weeks, the tissues were dyed. The length of long axis of neocartilage was measured through an optical microscope with a 0.1mm graduation at original magnification, x40. In the first and second week, both group showed no sign of cartilage regeneration. In the fourth week, regeneration on marginal portions was observed on all groups and the average values of length of long axis of neocartilage according to defect size were as follows: In the cases with 3mm defect, it was 0.85+/-0.30mm in the control group, and 1.85+/-0.38mm in the graft group; in the cases with 6 mm defect, 1.33+/-0.58mm in the control group, and 2.25+/-0.46mm in the graft group; and in the cases with 9mm defect, 2.33+/-0.77mm in the control group, and 4.47+/-1.39mm in the graft group. This means that the collagen scaffold has an influence on the regeneration of neocartilage. But the relative ratio of the length of neocartilage to cartilage defect size was not significant in the statistics.
Axis, Cervical Vertebra ; Cartilage* ; Collagen ; Collagen Type I* ; Dermis ; Ear ; Elevators and Escalators ; Rabbits ; Regeneration ; Transplants

A traditional tie-over dressing may be applied to support the take of a skin graft. Although there are many advantage of this method, it has significant disadvantages, including time-consuming application. Furthermore, when the dressing is changed, the gauze becomes hard and can be stuck to the graft, causing damage and pain upon removal. The purpose of our study is to evaluate the effect of semi-occlusive dressing using polyurethane foam and film dressing(Allevyn(R), Opsite(R)) after full thickness skin graft. The authors treated 45 cases including burn scar contracture(n=38), syndactyly (n=1), absence of nipple-areolar complex(n=4), traumatic skin defect(n=1) and contact burn(n=1) with authors' method and 39 patients including burn scar contracture (n=39) with the tie-over dressing between 2000 and 2004. The patients in polyurethane foam and film dressing group ranged from 1 to 62 years of age (mean age, 15.1 years) and the patients in tie-over dressing group ranged from 2 to 60 years of age(mean age, 21.3 years). The postoperative results were analyzed according to the following measures: (1) the duration of graft-taking, (2) the admission period, (3) complications. Compared with the traditional tie-over dressing, polyurethane foam and film dressing was shown to be more successful in a reduced duration of graft-taking, in which was similar to the former in the rate of graft-taking, a reduced admission period and patient's discomfort. We concluded that semi-occlusive dressing using Allevyn(R) and Opsite(R) was an effective method after full thickness skin graft, which was easy to shape to difficult body locations, such as web spaces, fingers and maintains a moist environment for wound healing and does not stick to the wound.
Bandages* ; Burns ; Cicatrix ; Contracture ; Fingers ; Humans ; Occlusive Dressings ; Polyurethanes* ; Skin Transplantation ; Skin* ; Syndactyly ; Transplants* ; Wound Healing ; Wounds and Injuries

Intramedullary spinal cord metastasis is rare, but is being encountered with increasing frequency with the availability of more sensitive imaging techniques. RI is the most sensitive of these techniques, though it cannot differentiate between intramedullary spinal cord metastasis and other cord pathologies. Occasionally, therefore, surgical biopsy is indicated though optimal treatment after diagnosis remains controversial. Radical resection, radiation and chemotherapy significantly prolong survival, but many patients survive less than one year. The authors have encountered two cases of intramedullary spinal cord metastasis of small cell carcinoma of the lung. These are reviewed, together with literature describing adequate evaluation and management.
Biopsy ; Carcinoma, Small Cell ; Diagnosis ; Drug Therapy ; Humans ; Lung ; Neoplasm Metastasis* ; Pathology ; Spinal Cord*

OBJECTIVE: This paper describes our experience and implant technique for cranioplasty of a large cranial defects using a porous polyethylene implant(Medpor) and compares the results with polymethylmethacrylate(PMMA). METHODS: Sixteen cranioplasties were performed using Medpor(n=10) and PMMA(n=6) implants between June 2003 and January 2005. The criterion for patient enrollment was a defect larger than 10cm in diameter. This study compared the operation times and complications. RESULTS: The operation times ranged from 105 to 250minutes(Mean 180 degrees +/-44minutes) in Medpor and from 185 to 460minutes (mean 128minutes) in PMMA. The absolute operation times were shorter using the Medpor implant and the differences were statistically significant(P=0.030). Satisfactory cosmetic results were obtained in all cases using the Medpor implant and with no implant-related complications. Bone ingrowth to the medpor implant was presumed to be the result on an increase in Houndsfield units of the implant, particularly at the marginal areas in the serial follow-up brain computed tomography images. CONCLUSION: It is believed that the properties of a Medpor implant make this implant an good alternative to the existing methods of a cranial contour correction. However, a further follow-up study will be needed.
Brain ; Follow-Up Studies ; Humans ; Polyethylene* ; Polymethyl Methacrylate

This review of upper cervical spine injuries includes 51 patients admitted to Korea University Hospital, Seoul during the period 1 Jan. 1990 to 31 Dec. 1994. The incidence of upper cervical injury was 13.6% in the 375 spine injury cases and 31.7% in the 161 cervical spine injuries. The most common type of injury was odontoid fracture, ie. 16 cases or 31.3%. The male-to-female ratio was 2.6:1 and the 4th decade showed peak incidence. 33 cases(64.7%) of the injuries were caused by traffic accidents. The chief complaints on admission were neck pain with limited range of motion in 39 cases(76.5%), motor weakness in 3 cases(5.9%), and sensory disturbance in 2 cases(3.9%). Operative treatment was performed in 23 patients resulted in neurologic improvement in 22 Cases(95.7%) and 28 patients were managed by conservative treatment with 25 cases(89.3%) of neurologic improvement. Mortality rate of the upper cervical spine injury was 3.9%. The above represents our experience with 51 patients suffering from upper cervical injuries. Management and follow-up guidelines are also reviewed.
Accidents, Traffic ; Follow-Up Studies ; Humans ; Incidence ; Korea ; Mortality ; Neck Pain ; Range of Motion, Articular ; Seoul ; Spine*

Thallium-201 SPECT has shown varing uptakes in tumors, depending on their viability, the type, and degree of malignancy. The authors analyzed Thallium-201 SPECT in brain lesions quantitatively, to predict the degree of malignancy, to differentiate between high and low grade astrocytic tumor by thallium uptake, and to differentiate radiation necrosis from tumor recurrence. The thallium indices were 1.56+/-0.75 in the benign brain tumors and 2.5+/-1.13 in the malignant brain tumors(p<0.05). There was differences in thallium index between high(2.19+/-0.61) and low(1.87+/-0.81) grade astrocytic tumor, however it was not statistically significant(p=0.55). The diagnostic accuracy of thallium index in differentiating benign from malignant was 82.5% by a threshold of 1.5. The mean thallium index of radiation necrosis was lower than that of recurrence(1.33/2.22). In conclusion, Thallium-201 SPECT may be useful for the diagnosis and evaluation of brain tumors to predict the degree of malignancy.
Brain Neoplasms* ; Brain* ; Diagnosis* ; Necrosis ; Recurrence ; Thallium ; Tomography, Emission-Computed, Single-Photon*

OBJECTIVES: The craniopharyngioma is a benign tumor located at least in part in the suprasellar cistern. However, the symptoms and signs from this tumor may be determined not only by the location of the tumor but also by its size and the age of the patient. The objective of our study is to analyze retrospectively the clinical manifestations of craniopharyngiomas with regards to tumor characteristics in children and adults. MATERIALS AND METHODS: Twenty-three patients(16 adults, 7 children) treated for craniopharyngioma between 1990 and 1999 were studied to demonstrate the relationship of tumor size, growth pattern, and its invasiveness with clinical symptoms. As part of the assessment, 16 adults(M:F=8:8, mean age:43.7 years) and 7 children(M:F=5:2, mean age:10.1 years) underwent magnetic resonance(MR) imaging and computerized tomography(CT) scanning with a three-dimensional volume acquisition sequence. RESULTS: The three major cardinal signs were defined to increased intracranial pressure, endocrine dysfunction, and visual problems. The tumor size in child group was larger than that in adult group. Also, visual problems, symptoms of increased intracranial pressure and hydrocephalus were more frequently observed in child group. However, endocrine dysfunction and neuropsychological symptoms related with hypothalamic connections to the thalamus, pituitary, frontal lobe, and other cortical areas were more frequent in adult group. Conclusions: In our series, the tumor size and invasiveness of craniopharyngioma revealed to be relevent with initial symptoms of increased intracranial pressure and visual symptoms which were more frequent in child group. As for the growth pattern, we did not find major difference between adults and children.
Adult* ; Child* ; Craniopharyngioma* ; Frontal Lobe ; Humans ; Hydrocephalus ; Intracranial Pressure ; Retrospective Studies ; Thalamus

Background: Preoperative verification of fracture morphology is essential for determining the definitive fixation strategy in the management of a pilon fracture. This study aimed to determine the correlation between fibular injury patterns and fracture morphologies and introduce clinical implications. Methods: Computed tomography scans of 96 pilon fractures were retrospectively analyzed and divided into three types: intact fibula, simple fracture, and multifragment fracture. The principal fracture line and comminution zones were illustrated on a plafond template and diagrammatized on a 6 × 6 grid using PowerPoint software as fracture mapping. Correlations between fibular injury patterns and fracture morphologies, including comminution zones and principal fracture lines, were analyzed. Results: The thickest comminution zone was most often located in the anterolateral quadrant. According to fibular injury patterns, the comminution zone of the multifragment group was placed two grids more lateral than that of other groups. Lateral exits of the principal fracture line in the multifragment group were much more concentrated within the fibular incisura. Conclusions In pilon fractures, a more complex fibular fracture pattern was related to the valgus position. Moreover, the articular fracture pattern of pilon fractures differed according to coronal angulation and fibular fracture pattern. These differences should influence the operative approach and placement of the plate.

We report here on a rare case of a ruptured basilar tip aneurysm that was successfully treated with coil embolization in the bilateral cervical internal carotid artery (ICA) occlusions with abnormal vascular networks from the posterior circulation. A 43-year old man with a familial history of moyamoya disease presented with subarachnoid hemorrhage. Digital subtraction angiography demonstrated complete occlusion of the bilateral ICAs at the proximal portion and a ruptured aneurysm at the basilar artery bifurcation. Each meningeal artery supplied the anterior cranial base, but most of both hemispheres were supplied with blood from the basilar artery and the posterior cerebral arteries through a large number of collateral vessels to the ICA bifurcation as well as the anterior cerebral and middle cerebral arteries. The perfusion computed tomography (CT) scans with acetazolamide (ACZ) injection revealed no reduction of cerebral blood flow and normal cerebrovascular reactivity to ACZ. An abdominal CT aortogram showed no other extracranial vessel abnormalities. A ruptured basilar tip aneurysm was successfully treated with coil embolization without complications. Endovascular embolization may be a good treatment option with excellent safety for a ruptured basilar tip aneurysm that accompanies proximal ICA occlusion with vulnerable collateral flow.
Acetazolamide ; Aneurysm ; Aneurysm, Ruptured ; Angiography, Digital Subtraction ; Basilar Artery ; Carotid Artery, Internal ; Collateral Circulation ; Glycosaminoglycans ; Meningeal Arteries ; Middle Cerebral Artery ; Moyamoya Disease ; Perfusion ; Posterior Cerebral Artery ; Skull Base ; Subarachnoid Hemorrhage