Tetanus is a rare disease in the developed countries, including Korea, as a result of nearly universal active immunization. Because many physicians have little experience with its diagnosis and management, misdiagnosis and therapeutic delay may result in catastrophic consequences. We report one case of generalized tetanus. A previously healthy 35-year-old man was admitted to the emergency department because of stiffness on jaw and neck. board-like abdomen, extended and rigid both legs, chest tightness, and dyspnea. Seven days before admission, he was injured on the right thing at work. In the emergency department, he was given 5,000 units of human tetanus immunoglobulin intramuscularly, as well as diazepam 2 mg/hr intravenously. On the second hospital day, tracheostomy was performed. Ten days later, his condition was improved. Twenty eight days after admission, he was discharged without any complication.
Abdomen ; Adult ; Developed Countries ; Diagnosis ; Diagnostic Errors ; Diazepam ; Dyspnea ; Emergency Service, Hospital ; Humans ; Immunoglobulins ; Jaw ; Korea ; Leg ; Neck ; Rare Diseases ; Tetanus* ; Thorax ; Tracheostomy ; Vaccination

PURPOSE: It is important for the physician and a rape counselor to understand epidemiology studies of the incidence, prevalence, spread, prevention, and control of sexual assault in a local community or a specific group of individuals. We did this study in order to find an effective treatment for the sexual assault victims and to establish a data base on them. METHODS: We prospectively evaluated sexually assaulted patients who visited the Medical Supportive Center for Women at the National Police Hospital from Oct. 11, 2001, to Oct. 10, 2002. The data were obtained from the records of the ER (emergency room) and OB & GY (obstetric & gynecologic) clinic; a total of 169 patients were evaluated. RESULTS: The mean age was 20.1 years old. The age distribution of sexual assault victims was divided into four: 14 cases under 7 years of age (8.3%), 26 cases between ages 7 and 13 years (15%), 43 cases between ages 14 and 19 years (26.3%), and 86 cases over 20 years of age (52.6%). Of the patients, 157 (92.9%) were unmarried and 117 (69.2%) were examined within 1 hour after visiting the hospital. The physical injuries were 15 vaginal injuries (26.9%), 34 ruptures of the hymen (16.9%), 1 sexually transmitted disease (0.6%), 57 abnormal sensations of the genital organ (28.3%), and 55 minor injuries including abrasions, contusions, and lacerations (27.3%). The psychological injuries were 105 phobias (21.4%), 92 anxieties (18.8%), 68 angers (13.9), 51 guilts (10.4%), and the like. Eighty-eight patients (52.1%) were acquainted with the assailant. CONCLUSION: Optimal management of sexual assault victims should involve continuous epidemiologic analysis and the estalishment of an assault-victim data base.
Age Distribution ; Anger ; Anxiety ; Contusions ; Counseling ; Epidemiology ; Female ; Genitalia ; Guilt ; Humans ; Hymen ; Incidence ; Lacerations ; Phobic Disorders ; Police ; Prevalence ; Prospective Studies ; Rape ; Rupture ; Sensation ; Sexually Transmitted Diseases ; Single Person

No abstract available.
Pregnancy*

Cases of sexual assault are often difficult to investigate and prosecute. The collection of evidence is a crutial factor when determining if such a case will go forward. Evidence contained in a rape kit plays a significant role in whether or not a crime of sexual assault can be prosecuted. It is important not only that the evidence be collected properly but also that the kit itself provide for the proper collection of evidence and materials. Because most hospital emergency departments throughout the country use their own kits, or none at all, there is a vast inconsistency in evidence collection. Different kits collect different amounts of evidence. For this reason, we established a kit committee to evaluate the contents of victim evidence collection kits. We propose that most hospital emergency departments and some clinics across the country be provided with rape kits to be used during forensic medical examinations of sexual assault victims and that those kits should be supplied the Sexual Assault Evience Collection (SAEC) Program, commonly referred to as the Rape Kit Program.
Crime ; Emergency Service, Hospital ; Rape

Idiopathic hypereosinophilic syndrome (IHES) is a rare disease characterized by peripheral blood eosinophilia and eosinophilic infiltration of multiple organs, including the nervous system. The neurologic manifestations in hypereosinophilic syndrome are variable, but eosinophilic meningitis as a manifestation has not been well documented in IHES. We report a case of eosinophilic meningitis associated with IHES, which showed a good response to steroid treatment.
Eosinophilia ; Eosinophils* ; Hypereosinophilic Syndrome* ; Meningitis* ; Nervous System ; Neurologic Manifestations ; Rare Diseases

OBJECTIVE: Obtaining real-time image is essential for neurosurgeons to minimize invasion of normal brain tissue and to prompt diagnosis of intracranial event. The aim of this study was to report our three-year experience with a mobile computed tomography (mCT) for intraoperative and bedside scanning. METHODS: A total of 357 mCT (297 patients) scans from January 2009 to December 2011 in single institution were reviewed. After excluding post-operative routine follow-up, 202 mCT were included for analysis. Their medical records such as diagnosis, clinical application, impact on decision making, times, image quality and radiologic findings were assessed. RESULTS: Two-hundred-two mCT scans were performed in the operation room (n=192, 95%) or intensive care unit (ICU) (n=10, 5%). Regarding intraoperative images, extent of resection of tumor (n=55, 27.2%), degree of hematoma removal (n=42, 20.8%), confirmation of catheter placement (n=91, 45.0%) and monitoring unexpected complications (n=4, 2.0%) were evaluated. A total of 14 additional procedures were introduced after confirmation of residual tumor (n=7, 50%), hematoma (n=2, 14.3%), malpositioned catheter (n=3, 21.4%) and newly developed intracranial events (n=2, 14.3%). Every image was obtained within 15 minutes and image quality was sufficient for interpretation. CONCLUSION: mCT is feasible for prompt intraoperative and ICU monitoring with enhanced diagnostic certainty, safety and efficiency.
Brain ; Catheters ; Decision Making ; Follow-Up Studies ; Hematoma ; Intensive Care Units ; Korea ; Medical Records ; Neoplasm, Residual

This study was undertaken to evaluate the tensile bond strength of In-Ceram alumina core treated by ion assisted reaction(IAR). Ion assisted reaction is a prospective surface modification technique without damage by a keV low energy ion beam irradiation in reactive gas environments or reactive ion itself. 120 In-Ceram specimens were fabricated according to manufacturer's directions and divided into six groups by surface treatment methods of In-Ceram alumina core. SD group(control group): sandblasting SL group: sandblasting + silane treatment SC group: sandblasting + Siloc treatment IAR I group: sandblasting + Ion assisted reaction with argon ion and oxygen gas IAR II group: sandblasting + Ion assisted reaction with oxygen ion and oxygen gas IAR III group: sandblasting + Ion assisted reaction with oxygen ion only For measuring of tensile bond strength, pairs of specimens within a group were bonded with Panavia 21 resin cement using special device secured that the film thickness was 80micrometer. The results of tensile strength were statistically analyzed with the SPSS release version 8.0 programs. Physical change like surface roughness of In-Ceram alumina core treated by ion assisted reaction was evaluated by Contact Angle Measurement, Scanning Electron Microscopy, Atomic Force Microscopy; chemical surface change was evaluated by X-ray Photoelectron Spectroscopy. The results as follows: 1. In tensile bond strength, there were no statistically significant differences with SC group, IAR groups and SL group except control group(P<0.05). 2. Contact angle measurement showed that wettability of In-Ceram alumina core was enhanced after IAR treatment. 3. SEM and AFM showed that surface roughness of In-Ceram alumina core was not changed after IAR treatment . 4. XPS showed that IAR treatment of In-Ceram alumina core was enabled to create a new functional layer. A keV IAR treatment of In-Ceram alumina core could enhanced tensile bond strength with resin cement. In the future, this ion assisted reaction may be used effectively in various dental materials as well as in In-Ceram to promote the bond strength to natural tooth structure.
Aluminum Oxide ; Argon ; Dental Materials ; Microscopy, Atomic Force ; Microscopy, Electron, Scanning ; Oxygen ; Photoelectron Spectroscopy ; Resin Cements ; Tensile Strength ; Tooth ; Wettability

OBJECTIVE: With improved technology, the values of intraoperative computed tomography (iCT) have been reevaluated. We describe our early clinical experience with a mobile CT (mCT) system for iCT and discuss its clinical applications, advantages and limitations. METHODS: Compared with intraoperative magnetic resonance imaging, this mCT system has no need for major reconstruction of a preexisting operating room for shielding, or for specialized instruments or equipment. Patients are placed on a radiolucent head clamp that fits within the gantry. Because it consists simply of a scanner and a workstation, it can be moved between locations such as an operating room, an intensive care unit (ICU) or an emergency room without difficulty. Furthermore, it can achieve nearly all types of CT scanning procedures such as enhancement, temporal bone imaging, angiography and three-dimensional reconstruction. RESULTS: For intracranial surgery, mCT can be used for intraoperative real-time neuronavigation by interacting with preoperative images. It can also be used for intraoperative confirmation of the extent of resection of intracranial lesions and for immediate checks for preventing intraoperative unexpected accidents. Therefore, the goals of maximal resection or optimal treatment can be achieved without any guesswork. Furthermore, mCT can achieve improved patient care with safety and faster diagnosis for patients in an ICU who might be subjected to a ventilator and/or various monitoring devices. CONCLUSION: Our initial experience demonstrates that mCT with high-quality imaging offers very useful information in various clinical situations.
Angiography ; Emergencies ; Head ; Humans ; Intensive Care Units ; Korea ; Magnetic Resonance Imaging ; Neuronavigation ; Operating Rooms ; Patient Care ; Temporal Bone ; Ventilators, Mechanical

PURPOSE: The aim of this study was to study the effect of hydroxyapatite (HA) coating crystallinity on the proliferation and differentiation of human osteosarcoma cells. MATERIALS AND METHODS: Surface roughness of the titanium disks increased by anodizing treatment and then HA was coated using ion beam-assisted deposition (IBAD). HA coating was crystallized by heat-treated at different temperature (100degrees C, 300degrees C, 500degrees C, 800degrees C). According to the temperature, disks were divided into four groups (HA100, HA300, HA500, HA800). With the temperature, crystallinity of the HA coating was different. Anodized disks were used as control group. The physical properties of the disk surface were evaluated by surface roughness tests, XRD tests and SEM. The effect of the crystallinity of HA coating on HOS cells was studied in proliferation and differentiation. HOS cells were cultured on the disks and evaluated after 1, 3, 5, and 7 days. Growth and differentiation kinetics were subsequently investigated by evaluating cell proliferation and alkaline phosphatase activity. RESULTS: Regardless of the heat-treated temperature, there is no difference on the surface roughness. Crystallinity of the HA was appeared in the groups of HA500, HA800. HOS cells proliferation, ALP activity were higher in HA500 and HA800 group than HA100 and HA300. CONCLUSION: Within the results of this limited study, heat treatment at 500degrees C of HA coating produced by IBAD has shown greater effect on proliferation and differentiation of HOS cells. It is considered that further in vivo study will be necessary.
Alkaline Phosphatase ; Cell Proliferation ; Crystallins ; Crystallization ; Durapatite ; Hot Temperature ; Humans ; Kinetics ; Osteosarcoma ; Titanium

OBJECTIVE: The purpose of this study was to evaluate victims of child sexual abuse and assess the similarities and differences between them. METHODS: The authors studied retrospectively 55 patients among 230 sexual abuse victims between the ages 2 and 13 who visited and were treated at the Department of Obstetrics and Gynecology, National Police Hospital between the dates Oct, 13, 2001 and Mar, 25, 2003 were followed and observed. RESULTS: Female infants and children composed 94.5% instances of sexual abuse were most common between 4 and 7 o'clock in the afternoon. Unlike adult cases, assailants were in most cases acquaintances (55.5%), and the crimes were committed most often at the homes of either victim or assailant (50.9%). 38.2% of victims had been directed to the National Police Hospital from police stations, 21.8% from other hospitals. Diagnosis resulted in 5.5% of cases with no observable symptoms, 18.2% with lacerations, among these cases 1 instance (1.8%) requiring surgical repair. 1 case each of Gonorrhea and genital herpes were found, with no instances of pregnancy. CONCLUSION: Child sexual abuse results in life-long bodily and psychological stress for both the victim and his/her family. Witnesses are in some cases unable to testify in legal proceedings, and the gathering of evidence is more difficult than in adult cases. This could lead to frequent social and legal negligence. Cooperation among such numerous and various professional institutions as hospitals, child guidance clinics, child psychiatrists, police, prosecutory offices and the courts is requisite to the settlement of these cases. Since the gynecologist plays the leading role in the identification and treatment of child and infant sexual abuse victims, and is often the first to come in contact with these cases, careful attention is required in the processes of inspection, inquiry, evidence collection, treatment and diagnosis.
Adult ; Child ; Child Abuse, Sexual* ; Child Guidance Clinics ; Child* ; Crime ; Diagnosis ; Female ; Friends ; Gonorrhea ; Gynecology ; Herpes Genitalis ; Humans ; Infant ; Lacerations ; Malpractice ; Obstetrics ; Police ; Pregnancy ; Psychiatry ; Retrospective Studies ; Sex Offenses ; Stress, Psychological