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

Intussusception is a condition of invagination of the proximal segment of bowel into the more distal receiving bowel. Intussusception is one of the common pediatric and surgical emergencies of infancy and childhood in Korea. Intussusception is the most common cause of acquired intestinal obstruction in infancy and childhood, and it needs emergency treatment. 1) On the age and sex distribution, the age under 15 month was the most common(70.6%), and the peak incidence was 3-12 months of age(60.1%). In sex distribution, male to female ratio was 1.25:1. 2) The seasonal distribution was summer(27.4%), spring, autumn and winter in order of frequency. 3) As to the etiology of Intussusception treated by surgery, idiopathic was the most common(75%). 4) The cardinal symptoms and signs were vomiting(72.5%), bloody or bloody mucoid stool(57.5%), abdominal pain(49.7%), abdominal distention(20.9%), abdominal mass(19.6%) and others in order of frequency. 5) On the hematologic finding, 60.8% revealed leukocytosis above 10,000/mm3. 6) As to the duration from the onset of the symptom to admission, 84.2% was within 24 hours, 9.8% was from 24 hours to 48 hours, and 5% was over 48 hours. 7) The common anatomical types were ileocolic(73.2%), and ileocecal(17.0%). 8) The success rate of air reduction was 84.3%. 9) In the method of operation, manual reduction was performed in 91.7% and intestinal resection in 8.3%. 10) The recurrence rate after air reduction was 12.4% and after operative manual reduction was 8.3%.
Emergencies* ; Emergency Service, Hospital* ; Emergency Treatment ; Female ; Humans ; Incidence ; Intestinal Obstruction ; Intussusception* ; Korea ; Leukocytosis ; Male ; Recurrence ; Seasons ; Sex Distribution

PURPOSE: It is known that PCNA (proliferating cell nuclear antigen) is associated with cell proliferating activity and nm23 with so called 'anti-metastatic' activity. We tried to elucidate the relationships of PCNA labeling index and nm23 expression in carcinoma cells with survival rates of patients with invasive colorectal carcinoma. METHODS: Immunohistochemical study was performed using monoclonal antibodies for PCNA and nm23 gene products on 45 cases of paraffin-embedded tissue made of invasive colorectal cancer. RESULTS: Five-year survival rate was lower in the group with high PCNA labeling index than that with low one, but PCNA labeling index was not associated with the tumor stages. Expression of nm23 was not associated with survival rate, tumor stage, site, and PCNA labeling index. CONCLUSIONS: Although PCNA labeling index was not associated with tumor stages, this study suggests that PCNA labeling index will be a good prognostic factors in invasive colorectal carcinoma.
Antibodies, Monoclonal ; Colorectal Neoplasms* ; Humans ; Proliferating Cell Nuclear Antigen* ; Survival Rate

We described a case of a 30-year-old female patient with bipolar disorder who experienced the anticonvulsant hypersensitivity syndrome (AHS) during treatment with lamotrigine and aripiprazole. She developed fever (38.4 degrees C), leukopenia, skin rash, and elevated serum transaminase levels on the 11th day of lamotrigine treatment (20th day of aripiprazole). Hypersensitivity to lamotrigine was suspected; lamotrigine was discontinued and prednisolone (30 mg/day) was administered to the patient. The clinical manifestations and laboratory findings showed improvement. However, on the 11th day of lamotrigine discontinuation (7th day of prednisolone treatment), she developed maculopapular skin rash over the entire body except the mucosa. There were no other symptoms and the laboratory findings were within normal limits. Skin biopsy showed erythema multiforme. After prescribing 55 mg/day of predisolone for additional 8 days, the recovery was uneventful, and it took 4 weeks from the onset of the second skin rash. Lamotrigine induced AHS showed broad spectrum of presentation and some manifestations can be flared up several days after discontinuation as did in this case. If unexplained systemic symptoms or a skin rash of unknown cause develop during the use of lamotrigine, clinicians should discontinue lamotrigine promptly and monitor the patient carefully at least for several weeks.
Adult ; Biopsy ; Bipolar Disorder ; Erythema Multiforme ; Exanthema ; Female ; Fever ; Humans ; Hypersensitivity* ; Leukopenia ; Mucous Membrane ; Prednisolone ; Skin ; Aripiprazole

Pigmented lesions of palmar and plantar skin may cause diagnostic problems, because some features of benign lesions in these sites may raise the suspicion of melanoma if considered alone. Transepidermal elimlnation is a mechanism by which a substance is eliminated through the epidermis, and it is apt to be confused with a feature of melanoma that tumor cells are located at all layers of the epidermis. We report a case of transepidermal elimination of nevus cells in acral letiginous nevus which needs a differential dignosis of melanoma.
Epidermis ; Melanoma ; Nevus* ; Skin

No abstract available.
Allopurinol* ; Animals ; Liver* ; Rats* ; Reperfusion Injury* ; Verapamil*

No abstract available.

Purpose: To investigate the pathway and effects of minoxidil on trabecular outflow in cultured human trabecular meshwork (TM) cells. Methods: After exposing primarily cultured TM cells to 0, 10, 50, or 100 µM minoxidil sulfate (MS), trabecular outflow was assessed by measuring TM cell monolayer permeability to carboxyfluorescein and transepithelial electrical resistance. To assess the pathway of permeability changes, caveolin-1, occludin, and claudin-5 levels were measured via western blot. Generation of reactive oxygen species (ROS) was measured using the dichlorofluorescein diacetate assay. To assess the involvement of nitric oxide (NO) in minoxidil-induced permeability increase, the degrees of endothelial nitric oxide synthase mRNA expression and NO production were measured with reverse transcription polymerase chain reaction and Griess assays, respectively. Permeability was also measured with co-exposure to 50 µM N-acetyl cysteine. Results: MS significantly increased TM cell monolayer permeability (p < 0.05) and decreased transepithelial electrical resistance (p < 0.05). MS decreased the degree of endothelial nitric oxide synthase mRNA expression but did not affect NO production. MS decreased occludin and claudin-5 levels but did not affect caveolin-1 level. MS at 100 µM increased the generation of ROS, and MS-induced permeability increase was attenuated after co-exposure to 50 µM N-acetyl cysteine. Conclusions Minoxidil may preferentially increase trabecular permeability via a paracellular pathway by downregulation of tight junction proteins. This minoxidil-induced permeability through the TM may be mediated by generation of ROS.

BACKGROUND: To assess the current level of development of emergency medicine (EM) systems in Asia. METHOD: Survey of EM professionals from 12 Asian countries during a 90-day period from August to November 1998. 12 EM professionals from 12 Asian countries completed the survey. All participants were physicians. 7 participants (58%) gave presentations at an international EM conference during the study period. Respondents completed a 103 question questionnaire about the status of EM specialty, academic, patient care, information and management systems and the factors influencing the future of EM in their countries. RESULTS: 92% of respondents stated that their countries have hospital-based emergency departments (ED). More than 80% of respondents reported that their countries have EMS systems and ED systems for trauma care and patient transfer. More than 70% stated that their countries have national EM organizations, EM research, national EMS activation phone numbers, ED systems for pediatric emergency care, emergency physician (EP) training in ACLS and ATLS and peer review. More than 60% reported official recognition of EM as an independent specialty status, ED triage systems and systems for customer service. More than 50% reported EM residency training programs, EM journals and EP ability to perform rapid sequence intubation (RSI). 50% reported EP ability to perform thrombolysis for acute MI and 33% reported EP ultrasonography. 92% felt that a lack of funding posed a moderate or great obstacle to the future development of EM in their countries. CONCLUSION: Many essential systems of EM now exist throughout Asia. In the systems of administration and emergency medical information in many countries, there are some parts to be developed further.
Asia ; Asian Continental Ancestry Group* ; Surveys and Questionnaires ; Education ; Emergencies* ; Emergency Medical Services ; Emergency Medicine* ; Emergency Service, Hospital ; Financial Management ; Humans ; Internship and Residency ; Intubation ; Patient Care ; Patient Transfer ; Peer Review ; Triage ; Ultrasonography

OBJECTIVES: The patient with alcohol dependence needs continuing care in an outpatient treatment setting. This naturalistic retrospective study is the first report investigating the long-term follow-up rate and predictors of outcome in outpatient-based alcoholism treatment in Korea. METHODS: We conducted a chart review of patients, who visited a university-affiliated hospital alcohol clinic from 2005 to 2007. All patients diagnosed with alcohol dependence were enrolled. Patients were evaluated using a customized alcoholism evaluation package. Demographic factors, clinical data and self rating scales were included in the evaluation form. RESULTS: Of 109 patients, 27 (24.8%) adhered to our outpatient-based treatment for 30 months. The mean follow-up duration of participants was 11.1 months. A Kaplan-Meier survival analysis showed that comorbidity, initial treatment on admission, previous treatment history and family history made a significant difference to follow-up duration. Age, sex, alcohol history, motivation, AUDIT-K, BDI, BAI and RTCQ-TV were not significantly associated with follow-up duration. CONCLUSION: Comparing to outcomes of previous inpatient alcohol treatment in Korea, long term follow-up rate in outpatient treatment was superior, and abstinence/controlled drinking rate is not inferior. This finding suggests that outpatient based alcoholism treatment has sufficient efficacy.
Alcoholism ; Comorbidity ; Demography ; Drinking ; Follow-Up Studies ; Humans ; Inpatients ; Korea ; Motivation ; Outpatients ; Retrospective Studies ; Weights and Measures