The successful cardiac transplantation depends partly on the donor heart preservation by a solution that will ensure recovery of myocardial function. The purpose of this study was to perform the evaluation of various preservation solutions and to accumulate the data on the requisites for ideal preservation solution. The experimental setup was the constant pressure Langendorff's perfusion system. Isolated rabbit hearts were perfused for 20minutes with warm Krebs-Henseleit solution, stored for 4 hours in cold preservation solution after cardioplegia, and then were reperfused for 20minutes. The 4 experimental groups were prepared : Hartmann's solution group (group I, control), modified Euro-collins' solution group (group II, MEC), modified University of Wisconsin group (group III , MUW), and CK solution(made by the author) group (group IV, CK). The parameters for assessing the preservation ability were levels of enzymes in freezed myocardial tissues (lactate, creatine kinase-MB and adenosine deaminase), coronary flow, left ventricular developing pressure and dp/dt. In conclusion, the ability of preservation for isolated rabbit heart was excellent in CK solution and modified University of Wisconsin solution, and poor in modified Euro-collins' solution, compared with Hartmann solution. CK solution has low potassium concentrations(34.2mEq/L) and includes various substrates to be salutary on myocardial preservation. This fact may indicates the necessity of further refinements in selection or composition of electrolytes and substrates.
Adenosine ; Creatine ; Electrolytes ; Heart Arrest, Induced ; Heart Transplantation ; Heart* ; Humans ; Myocardial Ischemia ; Perfusion ; Potassium ; Tissue Donors ; Wisconsin

After a penetrating thoracic injury early detection of intracardiac injury and early surgical repair when indicated are essential. A case presenting severe respiratory distress two weeks after a penetrating thoracic injury is reported. Transesophageal echocardiography showed massive pericardial effusion ventricular septal defect and mirtal regurgitation, The infundibular ventricular septal perforation was repaired using a Dacron patch the anterior mitral leaflet by interrupted sutures and the ruptured chordae of the posterior leaflet by a new chordae formation.
Echocardiography, Transesophageal ; Heart Septal Defects, Ventricular* ; Mitral Valve Insufficiency* ; Pericardial Effusion ; Polyethylene Terephthalates ; Sutures ; Thoracic Injuries ; Ventricular Septal Rupture ; Wounds, Penetrating

PURPOSE: The osmolar gap increases in proportion to the ethanol level. Some previous studies have shown that the correlation between the osmolar gap and the ethanol level is weak in trauma patient by using an indirect comparison with other patients. We conducted a direct comparison of the correlation of the osmolar gap to the ethanol level between trauma patients and non-trauma patients. We also analyzed the accuracy of the estimated ethanol level between the two groups. METHODS: The research candidates were adult patients who had visited the emergency department of our hospital from December 2003 to November 2008. By using a retrospective chart review, we classified them into three subgroups: non-trauma without shock, trauma without shock, and trauma with shock. In each group, we compared the correlation between the osmolar gap and the measured ethanol level, and we analyzed the accuracy of the estimated ethanol level by using Lin's concordance correlation coefficient. RESULTS: Four hundred forty-seven patients were enrolled in this study. For correlation of the osmolar gap and the measured ethanol level, Pearson's correlation coefficient was 0.916 in all patients, 0.939 in non-trauma without shock patients, 0.917 in trauma without shock patients, and 0.844 in trauma with shock patients. In the analysis of the accuracy of the estimated ethanol level by using Lin's concordance correlation coefficient, the accuracy in trauma with shock patients was lower than that in non-trauma without shock patients. CONCLUSION: We found that the correlation between the osmolar gap and the measured ethanol level in the patient group with trauma was lower than it was in the patient group without trauma. Moreover trauma patients with shock had a lower accuracy of the estimated ethanol level than non-trauma patients.
Adult ; Emergencies ; Ethanol ; Humans ; Osmolar Concentration ; Retrospective Studies ; Shock

OBJECTIVES: The clinical manifestations of gout in Korea would be changed lately according to the rapid economical development and the development of diagnostic methods. This study was done to reveal the late clinical features of gout in Korea. METHODS: A retrospective study was done for the 90 gout patients who had been treated in Seoul Paik Hospital from March 1974 to August 1994. Age of onset, sex, duration of disease, serum uric acid level, uric acid concentration of 24 hour urine, joint of first attack, recurrently involved joints, X-ray of involved joint, frequency of tophi, renal ultrasonography, and associated diseases were analyzed. The uric acid levels of the 808 civilians who visited our hospital for the periodic health examination were used as a control value. RESULTS: 1) The serum uric acid level in Korean adults was 5.2+/-1.1mg/dL in male, 3.8+/-0.7mg/dL in female, and 4.7mg/dL in general. The serum uric acid concentration of the gout patients was 8.6+/-2.2mg/dL in male, 6.1+/-2.1mg/dL in female, and 8.5+/-2.3mg/dL in general. The age of onset was 46.4+/-12.9 years old and male to female ratio was 44: 1 2) The renal excretion of uric acid was 470+/-173 mg/day in gout patients. 3) The sites of first attack were first MTP joint(76%), tarsal joint(13%), knee(5%), and other MTP joints(5%) 4) The involved joints during the repeated attacks were first MTP joint(84%), tarsal joint(23%), and fingers(23%), The duration of disease was significantly longer and the serum uric acid concentration was higher in the patients with tophi than they are in the patients without. 5) The 4l% of patients showed hone change in X-ray. 6) The renal ultrasound examinations were abnormal in 42% of the patients and the serum uric acid concentrations were significantly higher. 7) Obesity was found in 68% of patients, hypertension in 39%, hyperlipidemia in 16%, and chronic renal disease in 12%. CONCLUSION: The clinical features of gout in our study were similar to those of others done in and out of Korea, except that the frequency of hypertringlyceridemia was much lower than that of the foreign countries.
Adult ; Age of Onset ; Arthritis, Gouty ; Female ; Gout* ; Humans ; Hyperlipidemias ; Hypertension ; Hyperuricemia ; Joints ; Korea* ; Male ; Obesity ; Renal Insufficiency, Chronic ; Retrospective Studies ; Seoul ; Ultrasonography ; Uric Acid

PURPOSE: This study was aimed to investigate the relationship between the mandibular asymmetry and the internal derangement of temporomandibular joint. MATERIALS AND METHODS: One hundred and sixty eight patients had been assessed through clinical examinations, panoramic radi-ographs and magnetic resonance imagings (MRIs), were selected. The samples were classified into three subgroups according to the severity of the mandibular asymmetries in the panoramic radiographs and the status of TMJ discs on the MRI were compared among each groups. RESULTS: In an apparent asymmetry group, there was a significant difference in the number of temporomandibular disk displacement without reduction between the long and short side (66.7%, 18/27 joints on the short side) when the ratio of condylar process and coro-noid process was used (P<0.05), but there was no statistically significant difference when the ratio of condyle and ramus was used. CONCLUSION: The probability of the disc displacement without reduction was higher at the side with relatively shorter condylar process on the panoramic radiograph, and also it might be more effective to use ratio of condylar process and coronoid process in the assessment of mandibular asymmetry. Therefore, a careful assessment on the temporomandibular disorders is necessary to diagnose and establish the treatment plans for the patients with a mandibular asymmetry and the panoramic radiograph can be used effectively on that way.
Humans ; Joints ; Magnetic Resonance Imaging* ; Temporomandibular Joint Disc* ; Temporomandibular Joint Disorders ; Temporomandibular Joint*

PURPOSE: Until recently, three variants of benign paroxysmal positional vertigo (BPPV) have been recognized: the first is posterior-canal canalolithiasis, the second is horizontal-canal canalolithiasis, and the last is horizontal-canal cupulolithiasis. However, the last two types of BPPV have not been introduced into the textbook of Emergency Medicine yet. The otolith repositioning maneuvers are effective treatments for BPPV, but in emergency medicine, there has been little interest in and research on them. Our goals were to determine the efficacies of these treatments and to examine the clinical features of each types of BPPV. METHODS: We performed a 6-month prospective study on forty-one patients (47 cases) who presented with a history and physical examination consistent with active BPPV to the emergency departments of a secondary hospital and a tertiary hospital (Dec. 2001-May. 2002). The patients were treated with a modified Epley canalith repositioning maneuver for posterior-canal BPPV, a modified Barbecue rotation for horizontal-canal canalolithiasis, and the maneuver of Jo et al. for horizontal-canal cupulolithiasis. RESULTS: A resolution attributable to the first intervention was obtained in 71.4% of the posterior-canal BPPV cases by using the modified Epley maneuver and in 73.1% of the horizontal-canal BPPV cases by using a modified Barbecue rotation and the maneuver of Jo et al. CONCLUSION: The otolith repositioning maneuvers result in a resolution of vertigo in the majority of patients (84.8% of the cases) immediately after treatment. They are safe and require no special equipment or investigations. They should be established as the treatments of choice for BPPV in emergency department.
Emergency Medicine ; Emergency Service, Hospital ; Humans ; Otolithic Membrane* ; Physical Examination ; Prospective Studies ; Tertiary Care Centers ; Vertigo*

We report a non-puerperal uterine inversion with nulliparous women caused by huge pedunculated submucosal fibroid. Massive bleeding from protruding mass through vagina brought the heart to stop in 42-year-old nulliparous woman. She became cardiopulmonary resuscitation survivor in emergency room and then underwent laparotomy which ended in successful myomectomy rather than hysterectomy considering her demand for future fertility. Meticulous and adequate fluid therapy and transfusion was also administered to recover from hypovolemic status. Pathologic report confirmed benign submucosal fibroid with degeneration, necrosis and abscess formation. Thus, clinician should be aware of uterine inversion when encountered with huge protruding vaginal mass and consider uterus-preserving management as surgical option when the future fertility is concerned.
Abscess ; Adult ; Cardiopulmonary Resuscitation ; Emergency Service, Hospital ; Female ; Fertility ; Fluid Therapy ; Heart ; Hemorrhage ; Humans ; Hypovolemia* ; Hysterectomy ; Laparotomy ; Leiomyoma ; Necrosis ; Shock* ; Survivors ; Uterine Inversion* ; Vagina

BACKGROUND: The cause and clinical course of the postoperative ARDS is, as of yet, not very well understood. The current study is a review of our experience on patients with ARDS after thoracotomy. MATERIAL AND METHOD: Between Jan. 1996 to Aug. 2001, a retrospective analysis was conducted on 32 post-thoracotomy ARDS patients among 4018 patients receiving thoracotomy inclusive of thoracoscopic surgery. RESULT: The incidence of ARDS after pneumonectomy cases was 5.3%(13/245), 1.3% after lobectomy(9/ 710), and 4.4% after esophageal surgery(10/226). Of the 32 ARDS patients, 31 had malignant disease. The remaining 1 patient had aspergillosis. In the majority, the cause of ARDS was unknown. The average onset was on the 7.4th postoperative day. In 10 cases, the initial lesion was in the right lower lung field(31.2%), in the left lower lung field in 9(28.1%), and in both lower lung fields in 12(37.5%) cases. In all, the initial lesion was in the lower lung fields in 96.9% of the cases(31/32). There was a significant relationship between the development of ARDS and intraoperative I/O balance. The overall mortality rate was 65.6%(21/32). In the earlier period of the study(1996-Jun, 1998) the mortality rate was 100%, but in the latter period(July, 1998-Aug, 2001) it was significantly reduced to 47.6%. CONCLUSION: The current data showed a higher incidence of postoperative ARDS in patients with malignant disease and in those receiving extensive lymph node dissection with either lobectomy or pneumonectomy, and also in patients receiving esophageal surgery. In addition, introperative fluid overload was also associated with an increased incidence of ARDS. Treatment outcome could be improved with prone positioning and NO gas inhalation
Aspergillosis ; Humans ; Incidence ; Inhalation ; Lung ; Lymph Node Excision ; Mortality ; Pneumonectomy ; Respiratory Distress Syndrome, Adult* ; Retrospective Studies ; Thoracoscopy ; Thoracotomy* ; Treatment Outcome

PURPOSE: The aim of this study was to evaluate whether or not the early use of steroid is useful for treating Mycoplasma pneumoniae pneumonia. METHODS: A prospective study was conducted on 85 patients with M. pneumoniae pneumonia admitted to Gwangju Christian Hospital between September 2015 and April 2016. A total of 85 patients were enrolled. Of these, 33 were treated with steroids (methyl-prednisolone 1 mg/kg/day), while 52 were not; both were treated with macrolides. The overall duration of fever was compared between the 2 groups and findings on chest radiographs were evaluated for their deterioration. RESULTS: The duration of fever after admission (1.36±0.92 days vs. 2.17±1.30 days, P=0.003) and the overall duration of fever (4.42±2.13 days vs. 6.07±2.59 days, P=0.003) were significantly lower in the steroid group. The duration of fever before admission was not different between the steroid and macrolide groups (3.06±1.74 days vs. 3.90±2.21 days, P=0.068). On chest radiographs taken 3 days later, 1 of 33 patients in the steroid group and 5 of 50 patients in the macrolide group worsened, although there was no statistically significant difference between the 2 groups (P=0.395). There was no significant difference in the duration of hospitalization between the 2 groups (6.72±1.54 days vs. 6.92±1.87 days, P=0.618). CONCLUSION: Early administration of steroids on patients with M. pneumoniae pneumonia reduced the duration of fever, but there was no difference in duration of admission and x-ray deterioration.
Fever ; Gwangju ; Hospitalization ; Humans ; Macrolides ; Mycoplasma pneumoniae* ; Mycoplasma* ; Pneumonia* ; Pneumonia, Mycoplasma* ; Prospective Studies ; Radiography, Thoracic ; Steroids

OBJECTIVE: The objective of this study was to investigate changes in the posterior cranial fossa in patients with symptomatic Chiari malformation type I (CMI) compared to a control group. METHODS: We retrospectively reviewed clinical and radiological data from 12 symptomatic patients with CMI and 24 healthy control subjects. The structures of the brain and skull base were investigated using magnetic resonance imaging. RESULTS: The length of the clivus had significantly decreased in the CMI group than in the control group (p=0.000). The angle between the clivus and the McRae line (p<0.024), as the angle between the supraocciput and the McRae line (p<0.021), and the angle between the tentorium and a line connecting the internal occipital protuberance to the opisthion (p<0.009) were significantly larger in the CMI group than in the control group. The mean vertical length of the cerebellar hemisphere (p<0.003) and the mean length of the coronal and sagittal superoinferior aspects of the cerebellum (p<0.05) were longer in the CMI group than in the control group, while the mean length of the axial anteroposterior aspect of the cerebellum (p<0.001) was significantly shorter in the CMI group relative to control subjects. CONCLUSION: We elucidate the transformation of the posterior cranial fossa into the narrow funnel shape. The sufficient cephalocaudal extension of the craniectomy of the posterior cranial fossa has more decompression effect than other type extension of the craniectomy in CMI patients.
Arnold-Chiari Malformation ; Brain ; Cerebellum ; Congenital Abnormalities ; Cranial Fossa, Posterior* ; Decompression ; Decompressive Craniectomy ; Embryology ; Humans ; Magnetic Resonance Imaging ; Retrospective Studies ; Skull Base