No abstract available.
Emergencies* ; Emergency Service, Hospital* ; Humans

No abstract available.
Electrocardiography*

BACKGROUND: There have been no studies of airway management strategies for difficult intubation and cannot intubate, cannot ventilate (CICV) situations in Korea. This study was intended to survey devices or methods that Korean anesthesiologists and intensivists prefer in difficult intubation and CICV situations. METHODS: A face-to-face questionnaire that consisted of a doctor's preference, experience and comfort level for alternative airway management devices was presented to anesthesiologists and intensivists at study meetings and conferences from October 2014 to December 2014. RESULTS: We received 218 completed questionnaires. In regards to difficult intubation, the order of preferred alternative airway devices was a videolaryngoscope (51.8%), an optical stylet (22.9%), an intubating laryngeal mask airway (11.5%), and a fiber-optic bronchoscope (10.6%). One hundred forty-two (65.1%) respondents had encountered CICV situations, and most of the cases were identified during elective surgery. In CICV situations, the order of preferred methods of infraglottic airway management was cricothyroidotomy (CT) by intravenous (IV) catheter (57.3%), tracheostomy by a surgeon (18.8%), wire-guided CT (18.8%), CT using a bougie (2.8%), and open surgery CT using a scalpel (2.3%). Ninety-eight (45%) of the 218 respondents were familiar with the American Society of Anesthesiologists' difficult airway algorithm or Difficult Airway Society algorithm, and only 43 (19.7%) had participated in airway workshops within the past five years. CONCLUSION: The videolaryngoscope was the most preferred device for difficult airways. In CICV situations, the method of CT via an IV catheter was the most frequently used, followed by wire-guided CT method and tracheostomy by the attending surgeon.
Airway Management ; Bronchoscopes ; Catheters ; Congresses as Topic ; Education ; Intubation* ; Intubation, Intratracheal ; Korea* ; Laryngeal Masks ; Methods ; Surveys and Questionnaires ; Tracheostomy

A histopathological study of erythema nodosum-like lesions in Behcet's disease was performed on 55 patients with incomplete and suspect types of Behcet's disease. Relatively common characteristics in histopathology of erythema nodosum-like lesions could be found in the patients with incomplete type of Behcet's disease. The histopathologic findings of erythema nodosum-like lesions in 21 patients with incomplete type of Behcet's disease were as follows : l. A moderate lymphocytic infiltration was found around the blood vessels and the sweat glands in the dermis. In the subcutaneous tissue, besides lymphohistiocytic infiltration, neutrophils were present in significant number in 9 cases (42.9%) 2. Vasculitis of small vessels was found within the periphery of fat lobules in 7 cases (81.0%), Five cases (23.8%) also showed thrombophlebitis. Seven cases (33.3%) showed histiocytic granuloma formation within the fat lobules. Microabscess formation in the subcutaneous tissue was seen in 5 cases (23.8 %), but it was not certain whether this was the charateristic feature.
Blood Vessels ; Dermis ; Erythema Nodosum* ; Erythema* ; Granuloma ; Humans ; Neutrophil Infiltration ; Subcutaneous Tissue ; Sweat Glands ; Thrombophlebitis ; Vasculitis

BACKGROUND: The skin of patients with atopic dermatitis (AD) exhibits a striking susceptibility to colonization with Staphylococcus aureus (S. aureus). Superantigens produced by S. aureus and their specific IgE antibodies are thought to be important precipitating factors of AD, but there are few reports evaluating these 2 factors at the same time, particularly in adult AD patients. OBJECTS: Our purpose was to investigate the differences in the culture degree of S. aureus from the lesion, non-lesion, and control group of child and adult AD patients, to research the correlation between the exotoxin production, total IgE, anti-SEA IgE and the disease severity by SCORAD index, to ascertain the differences between child and adult AD patients. METHODS: The clinical severity of 30 child (2 to 15 years of age) and 30 adult patients (16 to 40 years of age) with AD was evaluated by using SCORAD index. S. aureus was isolated from lesional and non-lesional skin of AD patients, and from healthy controls. Staphylococcal exotoxins were detected by using reversed passive latex agglutination toxin detection kits. Anti-SEA IgE antibody was determined by using AlaSTATt assay RESULTS: S. aureus colonizations were found in 11 (36.7%) of the lesional skin, in 5 (16.7%) of the non-lesional skin of 30 child AD patients, and in 26 (86.7%), in 20 (66.7%) of 30 adult AD patients, respectively. The colonization rates of S. aureus in child patients were much lower than those in adult patients, both form lesional skin and non-lesional skin. Staphylococcal exotoxins were detected in 5 (45.5%) of the 11 colonizations from lesional skin, in 2 (40%) of the 5 colonizations from non-lesional skin of children, and in 10 (38.5%) of the 26 colonizations, in 9 (45%) of the 20 colonizations of adults, respectively. Staphylococcal enterotoxin A (SEA) was most frequently detected in both groups. S. aureus colonization was correlated with the severity of AD in childhood, but not in adulthood. However, there were no statistical significances between severity of AD and others such as exotoxin production, and the level of total IgE and anti-SEA IgE in both groups. CONCLUSION: The colonization of S. aureus was more common in adult AD patients than child AD patients. Anti-SEA IgE level was much higher in adult AD patients than in child AD patients. It is tempting to speculate that the colonization of S. aureus and exotoxin production might be related to the disease. duration rather than clinical severity of AD.
Adult ; Agglutination ; Antibodies ; Child ; Colon ; Dermatitis, Atopic* ; Enterotoxins* ; Exotoxins* ; Humans ; Immunoglobulin E* ; Latex ; Precipitating Factors ; Skin ; Staphylococcus aureus ; Strikes, Employee ; Superantigens

No abstract available.
Thanatophoric Dysplasia*

Increasing numbers of atypical subtrochanteric fractures have been reported among long-term bisphosphonate users. However, the nature and extent of the problem are unknown despite recent investigations. The task force of American Society for Bone and Mineral Research (ASBMR) defined major and minor features of complete and incomplete atypical femoral fractures; transverse or short oblique orientation, minimal or no associated trauma, a medial spike when the fracture is complete, and absence of comminution. Minor features include their association with cortical thickening, a periosteal reaction of the lateral cortex, prodromal pain, bilaterality, delayed healing, comorbid conditions, and concomitant drug exposures, including bisphosphonate, glucocorticoids, and proton pump inhibitors. Based on published data, the incidence of atypical femoral fractures associated with bisphosphonate therapy for osteoporosis appears to be very low, particularly compared with the number of vertebral, hip, and other fractures that are prevented by bisphosphonate. Physicians and patients should be aware of the possibility of atypical femoral fractures and of the potential for bilaterality.
Advisory Committees ; Diphosphonates ; Femoral Fractures ; Glucocorticoids ; Hip ; Hip Fractures ; Humans ; Incidence ; Orientation ; Osteoporosis ; Proton Pump Inhibitors

The femoral neck in children is dense and is small in diameter and its periosteum is thicker and stronger than that of an adult. Thus, fractures of the femoral neck in children, unlike the 60-year-old woman, are rare and usually require severe violence and this accounts for the high frequency of associated injuries. Since these fractures are rare and the femoral neck in children has many anatomic and physiologic differences, we have to consider some factors that work against treatment of these fractures. Twenty seven cases of fractures of the femoral neck in children which were treated at Severance Hospital, Yonsei University College of Mediicne from Jan. 1971 to Dec. 1980 were analyzed both clinically and radiologically and the following results were obtained. 1. Among the 27 patients, the ratio of boys and girls was 2:1 and the highest incidence was between the ages of 3 and 5 years. 2. The main course of fractures was traffic accidents, 14 cases (51.9%) and the other causes were falling from a height (37.0%) and a few cases of a slip and a fall. 3. According to the classification of Delbet and Colonna, the cervico-trochanteric fracture (40.8%) was the commonest type and 13 cases (48.1%) were displaced fractures. 4. Common associated injuries were pelvic bone fractures, skull fractures, cerebral concussion and soft tissue injuries. 5. Fifteen cases (55.6%) were treated by conservative treatment and ten cases (37.0%) by closed reduction & internal fixation. 6. 23 of the 27 cases were followed for from 6 months to 10 years, average 19 months. The results were analyzed according to Ratliffs assessment and 14 cases (60.9%) showed good results. 7. Total cases with complications were 14 (60.9%), the commonest complication being coxa vara (40.8%) and the other main complications being premature epiphyseal closure (39.1%) and avascular necrosis (30.1%). 8. Secondary treatment was done in 6 cases and correction osteotomy was done in 4 cases which had showed a poor result. 9. Finally, factors affecting results were type of fracture, degree of displacement, maintenance of reduction, interval between injury and treatment, complications and patients age. 10. The authors recommend closed reduction and internal fixation with some threaded pins for all type II and type III fractures.
Accidental Falls ; Accidents, Traffic ; Adult ; Brain Concussion ; Child ; Classification ; Clinical Study ; Coxa Vara ; Female ; Femur Neck ; Humans ; Incidence ; Middle Aged ; Necrosis ; Osteotomy ; Pelvic Bones ; Periosteum ; Skull Fractures ; Soft Tissue Injuries ; Violence

The internal jugular and subclavian veins are considered as satisfactory intravenous routes for rapid blood and fluid replacement. To determine whether these venous pressures can be used as reliable guides for central venous pressure monitoring, simultaneous measurements of the Rt. internal jugular venous pressure and central venous pressure (CVP), or Rt. subclavian venous pressure and CVP using long 14 gauge catheter were made in 20 patients undergoing cardiac anesthesia. The results were as follows: l. Each mean value of the Rt. internal jugular venous pressure and CVP was 10.64+/-5.43 cm H2O and 10.05+/-5.55cm H2O (Mean+/-SD) respectively in first 10 patients. Pressure difference was 0.59+/-0.39cm H2O (p<0.005). 2. Each mean value of the Rt. subclavian venous pressure and VP was 7.77+/-3.37 cm H 0 and 7.05+/-3.49cm H2O (Mean+/-SD) respectively in second 10 patients. Pressure difference was 0.73+/-0.59cm H2O (p<0.005). 3. There were significant correlations between Rt. internal jugular venous pressure and CVP (r=0. 99, p<0.005) as well as between Rt. subclavian venous pressure and CVP (r=0.98, p<0.005). The results suggest that Rt. internal jugular or subclavian vein catheterized with short intravenous catheter during Anesthesia can be used as effective and reliable guides for CVP monitoring because pressure differences with CVP were small and consistant.
Anesthesia ; Catheters ; Central Venous Pressure* ; Humans ; Subclavian Vein ; Venous Pressure

PURPOSE: Presence of a cephalomedullary nail (CMN) in the medullary canal has been thought as advantageous in the control of femoral neck shortening (FNS) and lag screw sliding in trochanteric fracture compared to extramedullary fixation system. However, researches on the factors that influence the degree of FNS after cephalomedullary nailing are lacking. MATERIALS AND METHODS: We observed 95 patients (mean age, 75+/-2.8 years) with trochanteric fractures who were treated with a CMN, and evaluated the relationship between FNS and patient factors including age, gender, fracture type (AO/OTA), bone mineral density, medullary canal diameter, canal occupancy ratio (COR=nail size/canal diameter), and tip-apex distance using initial, immediate postoperative, and follow-up radiography. RESULTS: Univariate regression analyses revealed that the degree of FNS was significantly correlated with fracture type (A1 versus A3, p<0.001), medullary canal diameter (p<0.001), and COR (p<0.001). Multiple regression analyses revealed that FNS was strongly correlated with fracture type (p<0.001) and COR (p<0.001). CONCLUSION: Presence of a CMN in the medullary canal could not effectively prevent FNS in patients with low COR and in A3 type fracture.
Aged ; *Bone Nails ; Female ; Femur Neck/*radiography ; Hip Fractures/radiography/*surgery ; Humans ; Male ; Orthopedic Procedures/*methods ; Regression Analysis