No abstract available.
Dentition*

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

No abstract available.
Electrocardiography*

In evaluating the early state of shock patients and their response to treatment, generally vital signs or additional hemodynamic values were used. Vital signs are easily obtained and repetitious values or continous monitoring is possible, whereas it cannot evaluate the patient's status properly nor is it a good prognostic factor. Meanwhile, additional hemodynamic values are obtained from pulmonary artery catheterization. But this procedure is difficult to proceed in the emergency room. Since central venous oxygen saturation has the advantage of being easily obtained and acts as a good prognostic factor for shock patients, we intended to prove its efficacy. From 1997 May to October, 50 patients admitted to Yonsei University Young Dong Severance Hospital in shock state, with systolic blood pressure below 90mmHg, were evaluated. Central venous catheter was inserted to obtain central venous oxygen saturation, serum lactate, base excess value, and its' initial value compared with the prognosis. The central venous oxygen saturation and base excess were low, while serum lactate value was high in the nonsurvival group. And in ROC(relative operating characteristic) curve, the AUC(area under curve) of central venous oxygen saturation was larger than the others. In comparing the MOF(multi-organ failure) group with the non-MOF group, the MOF group had a lower central venous oxygen saturation and base excess, and a higher serum lactate level, whereas in ROC curve, the AUC of base excess was larger than the others. Therefore, in estimating the prognosis of shock patients, the early central venous oxygen saturation proved to be a good prognostic factor.
Area Under Curve ; Blood Pressure ; Catheterization, Swan-Ganz ; Central Venous Catheters ; Emergency Service, Hospital ; Hemodynamics ; Humans ; Lactic Acid ; Oxygen* ; Prognosis ; ROC Curve ; Shock* ; Vital Signs

This study was done to examine changes of plasma homovanillic, acid(HVA), 5-hydroxyindoleacetic acid(5-HIAA), and HVA/5-HIAA ratio during an 8-week clozapine trial and to investigate the relationship between the plasma monoamine metabolites and treatment responses. Twenty-seven chronic schizophrenic patients were treated for 8 weeks with clozapine. The psychopathology was assessed at baseline just clozapine trial and then every 2 weeks until the end of 8-week clozapine treatment using the positive and Negative Syndrome Scale(PANSS) and the Clinical Global Impression scale(CGI). The plasma HVA and 5-HIAA levels were measured also biweekly using high preformance liquid chromatography with electrochemical detection method. Plasma HVA and 5-HIAA levels were significantly decreased during a 8-week chozapine treatment, although plasma HVA/5-HIAA ratio showed no significant change. The changes of plasma HVA levels were in significant correlations with the changes of PANSS positive scores, of general psychophathology scores, and changes of total scores. The changes of plasma 5-HIAA levels were in significant correlations with the changes of PANSS negative scores. But the changes of plasma HVA/5-HIAA ratio had no significant correlation with any PANSS subscale score changes. 48% of the patients treated with clozapine was categorized as responders, who showed at least a 20% decrease in PANSS total score and a CGI severity score of mildly ill or less(< or =3) of the end pint of the study. The baseline plasma HVA levels and HVA/5-HiAA) ratio were significantly higher in responders(N=13) than in nonresponders(N=14). But no significant difference in the change of plasma HVA between responders(40.3% decrement) and nonresponders(3.1% increment). But no significant difference in the change of plasma 5-HIAA and the change of plasma HVA/5-HIAA ratio between responders and nonresponders were observed. These results suggest that the antipsychotic effect of clozapine on positive symptoms may be associated with dopaminergic blocking activity, and that on negative symptoms may be associated with serotonergic blocking activity. The baseline plasma HVA levels and the change of HVA levels from baseline may be useful predictors of treatment response with clozapine.
Antipsychotic Agents ; Chromatography, Liquid ; Clozapine ; Homovanillic Acid* ; Humans ; Hydroxyindoleacetic Acid ; Plasma* ; Psychopathology ; Schizophrenia*

No abstract available.
Humans

BACKGROUND: We designed this study to determine whether trauma history and initial assessment anticipate the injury severity of the free-fall patient. METHODS: Two hundred patients who admitted emergency department of Severance hospital because of the fall from a height were enrolled in this study. The height of fall, the body orientation, and the characteristics of impacted material, and the Injury Severity Score(ISS) were evaluated by retrospective chart reviews. And regression equations were determined for predicting ISS on the basis of clinical parameters using multiple regression analysis. RESULTS: According to the characteristics of impacted material, the ISS was higher in the hard surface(13.7+/-9.5) than the sort surface(10.5+/-8.8)(p<0.05). There were correlations between height of fall and ISS(p<0.01, r=0.5). To the body orientation, the ISS was higher in the head-to-feet orientation(18.211.7) than the feet-to-head(10.9+/- 7.0) or other position(8.5+/-5.8)(p<0.01). The regression equations were as follows, ISS=2 +0.082xage(year)-1.54x(Glasgow Coma Scale)-3x(feet-to-head orientation)+0.65x height of fall(m)+2.7 x (hand surface)(p<0.01, R2=0.53). CONCLUSION: This study suggest that the injury severity of patient with free fall are significancy related to the height of fall, the characteristics of impacted material and the body orientation.
Coma ; Emergency Service, Hospital ; Humans ; Retrospective Studies

No abstract available.
Humans ; Prothrombin Time* ; Prothrombin*

This study is concerned with a comparison of lower tibial and fibular epiphyseal growth and deformities of the ankles in normal and paralysed children. The data were based on 87 children with residual paralysis due to poliomyelitis an 20 non-paralysed children who were admitted to Severance Hospital and Sam Yook Children's Rehabilitation Center. The difference in level between the lower tibial and fibular ends and between the lower epiphysial lines of the tibia and fibula in X-rays of the ankles were measured in order to investigate the growth pattern of the lower tibio-fibular epiphysis. The difference between the level of the lower ends of the fibula was an avergage of 15.3mm in the normal and 6.2mm in paraysed children. Thus the fibular ends in paralysed limbs was an average of 9.1mm less than that of the normal. The difference between the level of the lower epiphyseal lines of the tibia and the fibula was an average of 13.7mm in normal and 5.5mm in paralysed children. Therefore, the level of the fibular epiphyseal lines in paralysed limbs was sn average of 8.2mm less than that of normal. In paralysed limbs, the lower tibial epiphyses showed lateral epical wedge shaped deformities. The tilting angle of the ankles and the wedging angle of the of the lower tibial epiphyses were measured in erder to investigate the degree of deformities of the ankles and the lower tibial epiphyses in paralysed limbs. The tilting angle of the ankles averaged 1.3° in normal and 7.6° in paralysed limbs. The wedging angle of the lower tibial epiphyses averaged 3.7° in normal and 11.5° in paralysed limbs. In paralysed children, muscle strength examination was performed to clarify the relationship between the degree of growth disturbance and the severity of the muscular paraysis. This lead us to conclude that: 1. In paralysed children, the growth disturbance of the lower fibular epiphyses was greater than that of the lower tibial epiphyses. 2. The difference of the growth disturbance between the tibial and fibular epiphyses was not due to muscle imbalance of the foot invertors and evertors but to muscle weakness. 3. In paraysed children, the shape of the lower tibial epiphyses changed to a wedge shape, a deformity which might be considered secondary to growth disturbance of the fibula. 4. In paralysed children, the lower tibial ends were tilted upward and laterally. This was thought to be the cause of valgus deformities of the ankles. 5. The relationship between the degree of muscle paralysis and the deformities of the ankles was not proved in this study.
Ankle ; Child ; Congenital Abnormalities ; Epiphyses ; Extremities ; Fibula ; Foot ; Humans ; Muscle Strength ; Muscle Weakness ; Paralysis ; Poliomyelitis ; Rehabilitation Centers ; Tibia

BACKGROUND: Teamwork and leadership training have been shown to improve subsequent resuscitation performance in a variety of clinical situations. Critical care nurses, in addition to those who may be part of resuscitation team leaders and members, have also the need for such training. This study examines the teamwork and leadership skills of critical care nurses and their perceptions of the need for teamwork and leadership training. METHODS: We developed a pilot, interactive 3-hour teamwork, and the leadership training program based on the objectives and teaching methods of the Advanced Life Support (ACLS) course. Participants completed a 1-hour lecture, and discussion for team roles and obstacles, 30 min of script-based role play in resuscitation team training, and finally, a 2-hour simulation-based team training program. Before the completion of the course, participants were anonymously surveyed on the perceived educational value of the teamwork and leadership program. Expert raters reviewed videos of simulated resuscitation events in the course, and scored each video by two existing checklist for the team dynamic. RESULTS: Fifty-one nurses voluntarily participated and six videotaped simulation were rated by an expert rater. Most of the students believed the course was delivered at an appropriate level for them, and that it is a necessary training in their continuing professional education. The video rated average scores were from 68.5 to 72.9 according to the checklists. CONCLUSIONS: Critical care nurses can learn teamwork and leadership skills from appropriately designed programs, and believe it is a necessity in their training.
Anonyms and Pseudonyms ; Cardiopulmonary Resuscitation ; Checklist ; Critical Care ; Education, Professional ; Humans ; Leadership ; Pilot Projects ; Resuscitation ; Teaching