No abstract available.

Information and communication are very important to emergency medicine and large part of recent developments emergency medicine is related to them. So future development of emergency medicine is supposed to be based on information and communication system. Since 1994, hypertex-based multimedia information called World Wide Web has been served in the internet and east access has been allowed. Many researches about medical application of internet has been done, but articles of this application are mainly about medical information collection or use of electronic mail, and no application to specific part of medicine was suggested. So in this article, possibilities and range of application of internet and information super-highway to emergency medicine, suggestion of using internet to emergency phisician, prediction of the future of emergency medicine in relation to information super-highway will be presented. (continue)
Electronic Mail ; Emergencies* ; Emergency Medicine* ; Internet* ; Multimedia

The incidence of ectopic pregnancy is apparently increasing in recent years. In order to gain greater insight into the diagnosis and management of ectopic pregnancies, this study was undertaken on 100 patients with ectopic pregnancy(admitted via ER) who were operated and confirmed by histopathological study at the department of Obstetrics and Gynecology of Hallym University(Kangdong Sacred Heart Hospital) from January, 1996 to June, 1997. The results were as follows; 1. The hospital incidence of ectopic pregnancy was 1 in 11.6 deliveries(168/1954). 2. The most frequent age group was in 25-34 years of ages(58%). 3. Nullipara was 32 cases(32%) and number of cases who had 1, 2 and 3 deliveries were 35(35%), 31(31%) and 2(2%) respectively. 4. The most frequent number of pregnancy was second times(24%) and 65% of cases have been experienced artificial abortion. 5. In the past history, of possible predisposing factors, 65% had at least one abortion, 17% ectopic pregnancy, 17% cesarean section and 13% had previous laparoscopic tubal sterilization, but 19% showed no special distinct. 6. The main clinical symptoms are 96% in lower abdominal pain, 95% in amenorrhea and 65% in vaginal spotting and bleeding. 7. The most frequent interval between LMP and onset of symptoms was 6-8 weeks(49%). 8. Urine hcG test was positive in 94.9% and culdocentesis was positive in 94.3%. 9. In initial hemoglobin level, more than 11.0g% was 55%, however less than 10.0g% was 20%. 10. In initial systolic blood pressure at hospital, most of them were under normal condition, however 30% were under 90mmHg. 11. The amount of intraabdominal hemorrhage under 500cc was 42%(highest rate), 25% under 500cc-1000cc(second rate) and 6 cases overed 200cc. 12. The site of ectopic pregnancy was 88% in fallopian tube, 9% in uterine conus, 2% in intraabdomen and 1% in cervix. 13. The most common surgical procedure was ipsilateral salpingectomy(82%), of which 22 cases were operated by laparoscopy. 14. There was no fatal case in 100 ectopic pregnancy.
Abdominal Pain ; Amenorrhea ; Blood Pressure ; Causality ; Cervix Uteri ; Cesarean Section ; Conus Snail ; Diagnosis ; Emergencies* ; Emergency Service, Hospital* ; Fallopian Tubes ; Female ; Gynecology ; Heart ; Hemorrhage ; Humans ; Incidence ; Laparoscopy ; Metrorrhagia ; Obstetrics ; Pregnancy ; Pregnancy, Ectopic* ; Sterilization, Tubal

BACKGROUND: Infiltration of the skin and subcutaneous tissue with local anesthetic solutions may cause transient pain and discomfort. Heating local anesthetic solutions to body temperature has been suggested as a way of reducing the pain associated with injection. We designed a double blind crossover volunteer study to investigate the effect of warming lidocaine on the pain associated with subcutaneous injection. METHODS: Participants were 40 healthy adult volunteers,22 years of age and older, and they were the medical, nursing stay and medical students. They underwent 1ml subcutaneous injections of the study agent through 25-gauge needles. Following a standard crossover protocol, 'room temperature' lidocaine(20degrees C ) was injected into one midvolar forearm and body temperature' lidocaine(37degrees C ) into the opposite arm. Pain assessed by visual analogue pain scores and 'volunteer's comparison of pain on injection. RESULTS: Twenty-six volunteers thought that lidocaine at 20degrees C was more painful and four thought that lidocaine at 37degrees C was more painful, ten volunteers did not express a difference. Median pain score for injection at 20 degrees C was 37 and at 37 degrees C was 35.5. Difference of two median scores was 6.5. CONCLUSION: The simple procedure of warming to body temperature reduced the pain associated with subcutaneous injection of lidocaine. It is an inexpensive and practical method That should be considered for routine use in the ED.
Adult ; Arm ; Body Temperature* ; Forearm ; Heating ; Hot Temperature ; Humans ; Injections, Subcutaneous ; Lidocaine ; Needles ; Nursing ; Skin ; Students, Medical ; Subcutaneous Tissue ; Volunteers

OBJECTIVE: Sixteen cases of blunt diaphragmatic injury were clinically reviewed during 10 years from Oct.1987 to Jun.1996 at the Kangdong sacred heart hospital. The age and sex distribution were ranged from 3 to 67-old-years. The most common age range was between third decades to fifth decades in 10 cases(62.50%) and occurred predominantly in male, the sex ratio was 4.3 : 1.(M:F 4.3:1) The modes of blunt diaphragmatic injury were due to motor vehicle accidents(MVA), motor cycle accidents(MCA), fall down(FD) and others. Most common injuries were responsible for MVA. MVA were pedestrian traffic accidents 5 cases (41.7%), driver 4 cases(33.3%) passenger 3 cases(25.0%). In the blunt diaphragmatic injury sites, the left-sided diaphragmatic injury had predominant[left-sided cases 10(62.50%), right-sided cases 6(37.50%)]. Cost common symptoms and signs were chest pain or chest discomfort(81.25%) and dyspnea(68.75%), abdominal tenderness(50.00%), decreased bowel sound and breath sound(50.00%) and others. All of 16 cases in blunt diaphragmatic injury were associated with other injuries. The associated injuries were hemopneumothorax 14(87.50%), hemoperitoneum 7(43.759o), liver injury 7(43.75%), orthopedics fracture 14(87.50%), head injury 5(31.25%) and others. The diagnostic methods were used with simple x-ray, ultrasonogram and computed tomogram. The preoperative diagnosis of blunt diaphragmatic injury were suggested in 10 cases(62.509o) and others were confirmed during operation. The thirteen cases of all of sixteen cases were performed emergency operation within eight hours. The herniated intraabdominal organs through ruptured diaphragm were presented in 10cases(62.5%) [stomach 7 cases(43.75%), spleen 6 cases(37.50%), colon 3 cases(18.75%), liver 3 cases(18.75%), small bowel and omentum 2 cases(12.50%), respectively]. The mean size of blunt diaphragmatic injury were 7.7cm, right-sided mean size were 9cm, left-sided mean size were 6.9cm. The most common site of blunt diaphragm- atic injury were presented in anteromedial site 7 cases(43.75%). Simple chest x-ray revealed abnormal finding [hemothorax 10cases(62.50%), pneumothorax 4cases(25.00%), herniated organ into thorax8 cases(50.00%), diaphragm elevation 3 cases(18.75%) and others]. The postoperative complication were associated in 10 cases(62.50%) out of 16 cases. Common complications were pleural effusion 6 cases(37.50%) and atelectasis 3 cases(18.75%). Injury severity score(ISS) value of 16 cases in the blunt trauma ranged from 10 to 59. It was presented with mean value of ISS(35.5),mean value of ISS survivors(35) and nonsurvivors(55.5). Revised trauma score(RTS) value ranged also from 4 to 12. There were revealed with mean value of RTS(9.7),mean value of RTS survivors(10) and nonsurvivors(6.5). All of the blunt traumatic injury, mortality rate was related to the values of ISS and RTS.
Accidents, Traffic ; Chest Pain ; Colon ; Craniocerebral Trauma ; Diagnosis ; Diaphragm ; Emergencies ; Heart ; Hemoperitoneum ; Hemopneumothorax ; Humans ; Liver ; Male ; Mortality ; Motor Vehicles ; Omentum ; Orthopedics ; Pleural Effusion ; Pneumothorax ; Postoperative Complications ; Pulmonary Atelectasis ; Sex Distribution ; Sex Ratio ; Spleen ; Thorax ; Ultrasonography

Conventional posteroanterior chest radiographs of 73 patients with mitral valve disease who had surgery were analyzed, and particular attention was directed to the absence of the convexity of the left lower mid cardiacborder (left atrial segment) and to the relation with duration of illness, atrial fibrillation, pulmonary capillary wedge pressure (PCWP) as well as surgical findings. The results obtained are as follows; 1. The flatness or concavity of this segment, despite other evidence of left atrial enlargement, was observed in eleven (64.7%) of17 patients who had left atrial thrombosis and six(10.7%) of 56 patients who did not have thrombosis(false positive diagnosis). Six (35.3%) of the 17 patients who had left atrial thrombosis did not show this finding on radiographs(false positive diagnosis). Six(35.3%) of the 17 patients who had left atrial thrombosis did not showthis finding on radiographs (false negetive diagnosis). Therefore, the accuracy in the diagnosis of thrombosis of left atrium was 64.7%(eleven of seventeen) for patients who had thrombosis of left atrium. 2. The atrial fibrillation was observed in sixteen (94.1%) of 17 patients who had left atrial thrombosis. So, correlation between the presence of left atrial thrombosis and atrial fibrillation was evident. But there was no correlationbetween the duration of illness or the PCWP of patients and the presence of left atrial thrombosis.
Atrial Fibrillation ; Diagnosis ; Heart Atria ; Humans ; Mitral Valve ; Pulmonary Wedge Pressure ; Radiography, Thoracic ; Thorax ; Thrombosis

PURPOSE: To analyse the parameters of in vivo pharmacokinetics such as absorption, distributionin , and excretion of adriamycin patients with hepatocellular carcinoma, and investigate the stagnation of adriamycin, in the liver. MATERIALS AND METHODS: Five patients in whom hepatocellular carcinoma was diagnosed and who were admitted for transhepatic chemoembolization were involved in this study. Fifty mg of adriamycin was mixed with 2.5 mL of water-soluble contrast material and 12 -15 mL of lipiodol, and the emulsion was injected into a selected tumor-supplying artery using a 3-F catheter. Between 1 minute and 72 hours after chemoembolization, peripheral blood samples were then obtained, and from these the blood concentration curve of adriamycin was calculated and applied to a two-compartment model. Using the model, several pharmacokinetic parameters were estimated. RESULTS: The volume of the central and the peripheral compartment was 45 L and 4090.6 L, respectively. 75.14% of adriamycin was delivered to the liver directly, and the absorption rate constant was 2.448/hr. Distribution clearance was 969.3 L/hr, and excretion and metabolic clearance was 136.4 L/hr. CONCLUSION: Using a two-compartment model, the in vivo pharmacokinetics of adriamycin after hepatic arterial chemoembolization were successfully analyzed. On the basis of the parameters determined, it may be concluded that in these five patients, adriamycin remained in the liver in much greater quantities and for longer. Index words : Liver neoplasms Liver neoplasms, chemotherapeutic embolization Chemotherapy, regional
Absorption ; Arteries ; Carcinoma, Hepatocellular ; Catheters ; Doxorubicin* ; Drug Therapy ; Ethiodized Oil ; Humans ; Liver ; Liver Neoplasms ; Pharmacokinetics*

No abstract available.
Animals ; Cricetinae* ; Fertilization in Vitro* ; Humans*

No abstract available.
Centrifugation, Density Gradient* ; Humans* ; Spermatozoa*

A 63 Year-old-lady has had substernal chest pain on exertion for 8 years. The chest pain has been increased over the last 3 years. A continuous murmur was heard at the left second to third inercostal spaces along the left sternal border. The electrocardiogram showed the inverted T-waves in the precordial leads. The right heart catheterization revealed 5% oxygen step up between RV and PA. The right sided pressures were normal. The coronary arteriography revealed markedly tortuous vessels starting shortly after the left main stem coronary artery was normally originated. One of the large vessel was shown to be drained into the pulmonary artery. In the operation room, without using heart-lung machine this abnormally drained vessel was simply ligated at it's draining site into pulmonary artery. After the operation the patient is feeling well with little symptoms and the continuous murmur is no longer heard.
Angiography ; Arteriovenous Fistula* ; Cardiac Catheterization ; Cardiac Catheters ; Chest Pain ; Coronary Vessels* ; Electrocardiography ; Heart-Lung Machine ; Humans ; Middle Aged* ; Oxygen ; Pulmonary Artery*