PURPOSE: Asphyxia is the most common cause of neurologic sequelae in perinatal period. We hoped to help other clinicians by investigating factors affecting neurologic outcome in asphyxiated term babas. METHODS: A clinical study of factors affecting neurologic outcome was made on 120 patients, who were asphyxiated term baby. They admitted to neonatal intensive care unit of Chungnam National University Hospital from January, 1995 to December, 1996. RESULTS: There was no significant correlation in neurologic outcome and gestational age, delivery type, sex, birth weight, one minute Apgar score. Five minute Apgar score had influence on neurologic outcome. Presence of acidemia had influence on neurologic outcome. Mental status and seizure influenced on neurologic outcome. Poor neurologic outcome was prone to come in the presence of prolonged duration of abnormal mental function or a repetitive seizure not controlled immediately. There was poor neurologic outcome in the patients who have abnormal findings on EEG, CT, and neurosonography. In addition, there was poor neurologic outcome in congenital heart disease patients. All of above had statistical significance. CONCLUSION: Now, we can obtain much benefit by monitoring clinical course such as five minute Apgar score, mental change, and seizure. And, we can obtain much benefit by monitoring acidemia and perform EEG, CT and neurosonography.
Apgar Score ; Asphyxia ; Birth Weight ; Chungcheongnam-do ; Electroencephalography ; Gestational Age ; Heart Defects, Congenital ; Hope ; Humans ; Infant, Newborn ; Intensive Care, Neonatal ; Seizures

OBJECTIVE: To estimate the predictive value of initial serum B-hCG and progesterone measurement for pregnancy outcome in IVF-ET. METHODS: Serum B-hCG at 11-12th day after embryo transfer and progesterone at 7th day after oocyte aspiration were measured in 48 successful pregnant IVF-ET cases from July 1993 to June 1997. RESULTS: Of 48 cases, 26 cases (54.2%) successfully carried to sustaining gestation and 22 cases (45.8%) failed to sustain gestation. The estimated initial serum B-hCG levels in the normal sustaining pregnancy group (132.28+ 22.42 mlU/ml) were statistical significantly higher than 29.43+8.08 mIU/ml in the failed sustaining pregnancy group (p<0.001), while the estimated initial serum progesterone levels showed no significant differences (p=0.159). In order to determine the predictive values using the Receiver Operator Curve (ROC), an appropriate cutoff value of 38 mIU/ml for initial serum B-hCG was obtained. In IVF-ET pregnancies, the estimated serum B-hCG levels in cases of chemical abortion in failed sustaining pregnancy were significantly lower compared to the normal sustaining pregnancy group (p<0.001). CONCLUSION: The initial serum B-hCG levels at 11 days after embryo transfer could be used to predict the pregnancy outcome in an IVF program. An initial progesterone level acquired on the 7th day after oocyte retrieval is not a useful indicator to predict pregnancy outcome.
Chorionic Gonadotropin* ; Embryo Transfer* ; Embryonic Structures* ; Female ; Humans* ; Oocyte Retrieval ; Pregnancy ; Pregnancy Outcome* ; Pregnancy* ; Progesterone*

A 70-year-old woman with Parkinson disease was admitted to the emergency department with altered consciousness, fever and convulsive movements without experiencing withdrawal from antiparkinsonian medication. Six hours after the emergency department visit, the patient had a hyperpyrexia (>40℃) and a systolic blood pressure of 40 mmHg. There was no evidence of bacterial infection based on extensive workups. The patient was discharged without aggravation of Parkinson disease symptoms after treatment that included administration of dantrolene sodium, enforcement of continuous renal replacement therapy and cooling blankets. Malignant syndrome should be suspected if high fever occurs in Parkinson disease patients without evidence of a definitive infection.
Aged ; Bacterial Infections ; Blood Pressure ; Consciousness ; Dantrolene ; Dehydration ; Emergency Service, Hospital ; Female ; Fever ; Humans ; Parkinson Disease* ; Renal Replacement Therapy

We performed tendon transfer with a microvascular free flap for recovery of handicapped function and reconstruction for the skin and soft tissue loss. We review the clinical data of 11 children who underwent these operation due to injured foot by pedestrian car accident from January, 1986 to June, l994. The mean age of patients was 5.6 years old (3-8). Five cases underwent tendon transfer and microvascular free flap simultaneously. Another 6 cases underwent operations separately. The time interval between tendon trasnfer and microvascular free flap was average 5.8 months (2-15 months). The duration between initial trauma and tendon transfer was average 9.6 months (2-21 months). The anterior tibial tendon was used in 6 cases. Among these, the technique of splitting the anterior tibial tendon was used in 5 cases. The posterior tibial tendon was used in 3 cases and the extensor digitorum longus tendon of the foot in 2 cases. Insertion sites of tendon transfer were the cuboid bone in 3 cases, the 3rd cuneiform bone in 3 cases, the 2nd cuneiform bone in I case, the base of 4th metatarsal bone in I case, and the remnant of the extensor hallucis longus in 3 cases. The duration of follow-up was average 29.9 months (12-102 months). The clinical results were analyzed by Srinivasan criteria. Nine cases were excellent and 2 cases were good. The postoperative complications were loosening of the tranferred tendon in 2 cases, plantar flexion contracture in l case, mild flat foot deformity in I case and hypertrophic scar in 2 cases. So we recommend the tendon transfer with a microvascular free flap in the case of injured foot of children combined with nerve injury and extensive loss of skin, soft tissue and tendon.
Child* ; Cicatrix, Hypertrophic ; Congenital Abnormalities ; Contracture ; Disabled Persons ; Flatfoot ; Follow-Up Studies ; Foot* ; Free Tissue Flaps* ; Humans ; Metatarsal Bones ; Postoperative Complications ; Skin ; Tarsal Bones ; Tendon Transfer* ; Tendons*

A 43-year-old woman presented with numerous cutaneous neurofibromas, limited to the left anterior chest(T2-3) and the right lower back(L1-2). These had been present for 10 years. Neither cafe-au-lait spot, intertriginous freckle, nor Lisch nodule was found. The family history was negative for neurofibromatosis. Biopsy specimens showed circumscribed, nonencapsulated neurofibromas. The present case was a rare form of bilateral segmental neurofibromatosis in that while most of the reported cases involved the same dermatome bilaterally, she had bilaterally different dermatomal neurofibromas.
Adult ; Biopsy ; Cafe-au-Lait Spots ; Female ; Humans ; Melanosis ; Neurofibroma ; Neurofibromatoses*

BACKGROUND: The purpose of this study was to analyze the endotracheal intubation cases performed in the emergency department. METHODS: We investigated retrospectively 326 cases of endotracheal intubation performed in the emergency department of a tertiary care center from April 1, 1998 to March 31, 1999. We focused on operators, medications used, its success rate and immediate complications, and the relationship between its success rate and medications. RESULTS: Of 326 consecutive intubations, 193 patients(59.2%) were done by emergency medicine residents or attending physician. While 320 patients(98.2%) were successfully intubated, 6 patients could not be intubated and 2 patients underwent tracheostomy. Of 50 cases of intubations(15.3%) attempted with paralyzing agents, 48 cases were done with succinylcholine and 46 cases underwent by emergency physicians. Intubations with neuromuscular paralysis resulted in high success rates at the first attempt. Of 55 immediate adverse events were encountered in 47 patients(desaturation=17, bronchial intubation=15, hypotension=8, bradycardia=4, cardiac arrest=2, others=5). CONCLUSION: At this institution, paralyzing agents were used infrequently, but almost all of them were used by emergency physicians.
Emergencies* ; Emergency Medicine ; Emergency Service, Hospital* ; Humans ; Intubation ; Intubation, Intratracheal* ; Paralysis ; Retrospective Studies ; Succinylcholine ; Tertiary Care Centers* ; Tertiary Healthcare* ; Tracheostomy

In single atrial and ventricular cells isolated from the guinea-pig and the rabbit heart, action potentials and membrane currents were recorded by using the whole cell voltage clamp technique. In rabbit atrial cells the repolarization showed two distinctive phases, referred as the early and late phases(early and late plateau phase), but in guinea-pig atrial cells there was a maintained plateau and less distinctive two phases of repolartization. Increasing intracellular sodium or reducing external sodium by replacement with lithium suppressed the late phase of the action potential in rabbit atrial cells and shortened the plateau of action potential in rabbit ventricle and guinea-pig atrial cells. Reducing external sodium decreased Ca-current and late inward current in voltage clamp. Ouabain in the concentration of 10(-5)M shortened the duration of action potential and shifted the holding current level to outward direction, decreased Ca-current and moved late inward current to outward direction. Ryanodine 10(-6)M which is known to be an inhibitor of Ca-release in the intracellular store, suppressed the late phase of action potential in rabbit atrial cells and shortened the plateau of action potential in rabbit ventricular cells. Ryanodine also decreased Ca-current and shifted late inward current to outward direction. It is concluded that an inward current activated by intracellular calcium contributes to the late Phase of the action potential in rabbit atrial cells and to the late plateau in rabbit ventricular cells and in guinea-pig atrial cells. It may be carried by the Na-Ca exchange precess and/or by calcium-activated non-specific channels but preferably Na-Ca exchange machanism.
Action Potentials* ; Calcium ; Heart* ; Lithium ; Membranes* ; Myocytes, Cardiac ; Ouabain ; Ryanodine ; Sodium

No abstract available.
Female ; Nifedipine* ; Obstetric Labor, Premature* ; Pregnancy ; Ritodrine*

PURPOSE: To study theeffect of micro incision (1.8 mm) and small incision (2.2 mm and 2.8 mm) coaxial phacoemulsification on surgically induced astigmatism (SIA) and high-order aberrations (HOA) of anterior and posterior corneal surface. METHODS: The present randomized clinical study included 32 eyes having a 1.8-mm, 38 eyes having a 2.2-mm, and 30 eyes having a 2.8-mm corneal incision. SIAs were measured at 1 and 3 months postoperatively. HOAs included coma, trefoil, and spherical aberration. The coma-root mean square (RMS) and trefoil-RMS were evaluated at 1 month after the cataract operation. RESULTS: Surgically induced astigmatisms were 0.41 +/- 0.30 diopter (D) in the 1.8-mm incision group, 0.47 +/- 0.21 D in 2.2-mm group and 0.71 +/- 0.50 D in the 2.8-mm group. The SIA of the 1.8-mm group was smaller than the other groups (p = 0.002). There was no statistically significant difference in coma, spherical aberration of the corneal anterior surface and trefoil, or spherical aberration of the posterior surface among the 3 groups at 1 month after surgery. CONCLUSIONS: Incision size contributes to postoperative corneal astigmatism. Phacoemulsification cataract surgery with less than 2.8-mm incision does not significantly influence the corneal aberrationsof anterior and posterior corneal surfaces.
Astigmatism ; Cataract ; Coma ; Eye ; Lotus ; Phacoemulsification

Left ventricular false tendon, also called moderator bands, anomalous cords, accessory bands or false chordae tendinae, has been known as simple anatomical without clinical importance. But the possible relationship with Still's type murmur and ventricular arrhythmia were reported recently. The incidence of false tendon was known as 0.5-6.1% variably. In Korea, there are no reports about left ventricular false tendon till now. The authors examined 2,052 patients' echocaediograms and clinical manifestations retrospectively to find the incidence and potent clinical significance of false tendons. The incidence in present study was 1.02% and there was no specific relationship between false tendon and cardiovascular diseases. The authors observed Still's type musical murmur in 5 patients out of 21 and ventricular premature beats in 2 patients out of 10 without other cardiovascular diseases. One of them showed nonsustained ventricular tachycaedia during Holter ECG monitoring. The most frequent echocardiographic site of attachment was from basal inter-ventricular septum to lelft ventricular free wall and false tendon attached to papillary muscle was least frequently observed.
Arrhythmias, Cardiac ; Cardiac Complexes, Premature ; Cardiovascular Diseases ; Echocardiography ; Electrocardiography ; Humans ; Incidence ; Korea ; Music ; Papillary Muscles ; Retrospective Studies ; Tendons*