BACKGROUND: Ketamine use in emergency room has been increased. It has rapid onset of action and appropriate duration of action. It does not need endotracheal intubation and produces potent analgesia, sedation, and amnesia. The object of this study is to determine the safety and the degree of physician's satisfaction in relation to ketamine use. MATERIALS AND METHODS: This is a prospective study using protocol. Pediatric trauma patients who need sedation were given IM ketamine(4mg/kg) and atropine(0.01mg/kg) in a same syringe. Monitoring of patients was done by EM residents and complications of ketamine use were recorded. Physician's satisfaction was also recorded after the procedure. RESULTS: Intramuscular ketamine was administered 54 times, mainly for laceration repair. Physicians completed protocol for 51 of treated children. The median time for onset of sedation was 6.5+/-2.4 min, and duration of action was 32.4+/-10.8 min. Hypersalivation occurred in 9.8%(n=5); random movement 3.9%(n=2), emesis during procedure(n=1), emesis at home(n=1), and transient oxygen desaturation(n=1). All were quickly identified and treated without specific airway management and sequelae. Of 84% of physicians was satisfied with ketamine use for pediatric sedation. CONCLUSION: Intramuscular ketamine can be administered safely and satisfactorily in emergency room to facilitate pediatric procedures in conjunction with a defined protocol and appropriate monitoring.
Airway Management ; Amnesia ; Analgesia ; Child ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Intubation, Intratracheal ; Ketamine* ; Lacerations ; Oxygen ; Prospective Studies ; Sialorrhea ; Syringes ; Vomiting

No abstract available.
Polyesters* ; Urinary Incontinence*

We report the CT findings of diffuse esophageal spasm (DES) in a patient with dysphagia. Although an uncommon condition, DES should be included in the differential diagnosis if relatively long and symmetric segmental esophageal wall thickening and an epiphrenic esophageal diverticulum are noted at CT.
Deglutition Disorders ; Diagnosis, Differential ; Diverticulum, Esophageal ; Esophageal Spasm, Diffuse* ; Humans

PURPOSE: To describe MR findings of recurred giant cell tumor of bone. MATERIALS AND METHODS: MR imagings of ten cases of pathologically proven recurrence of giant cell tumor were retrospectively analyzed. Location of recurrence, multiplicity of recurred tumor, signal intensity and homogeneity, pattern of gadolinium enhancement, soft tissue and articular surface involvement were evaluated. RESULTS: Tumors were located in peripheral portion of previous operation site(80%). Six cases recurred as multiple lesions. Tumor showed low signal intensity on T1 weighted images(100%), high signal intensity on T2 weighted images(100%) and inhomogeneous peripheral rim enhancing pattern(75%). Soft tissue and articular surface involvement were also demonstrated. CONCLUSION: We concluded that characteristic MR findings of recurred giant cell tumor could be helpful in early detection and precise evaluation of tumor recurrence.
Gadolinium ; Giant Cell Tumor of Bone ; Giant Cell Tumors* ; Giant Cells* ; Recurrence ; Retrospective Studies

No abstract available.
Coinfection* ; Female ; Herpes Zoster Ophthalmicus* ; Herpes Zoster* ; Humans

Here we report a case of the classical inclusion body myositis. The muscle pathology in a 61-year-old male patient with slowly progressive proximal muscle weakness and atrophy revealed basophilic rimmed vacuoles on light microscope and intracytoplasmic filamentous inclusions with membranous whorls through electron microscope. He did not respond to steroid therapy.
Atrophy ; Basophils ; Humans ; Inclusion Bodies* ; Male ; Middle Aged ; Muscle Weakness ; Myositis, Inclusion Body* ; Pathology ; Vacuoles

OBJECTIVE: To compare the efficacy of epidural injection in accordance the distribution of dye in the epidural space for low back pain patient. METHOD: Twenty nine patients with herniated nucleus pulposus or spinal stenosis confirmed by the radiologic studies were treated with epidural injection of steroid. The patients were divided into two groups: 1) patients whose distribution of dye was in the posterior part of epidural space and 2) patients whose distribution of dye was in the anterior and posterior parts of epidural space. RESULTS: The efficacy of epidural injection was assessed using the visual analog scale (VAS) and straight leg raising test (SLR) on pre-treatment and post-treatment. The VAS and SLR change of pre-treatment and post-treatment in the first group was from 7.81 +/- 1.54 and 50.00 +/- 18.97 degrees to 4.45 +/- 2.16 and 75.00 +/- 17.61 degrees (p<0.05), respectively. The VAS and SLR change of pre- and post-treatment in the second group was from 7.72 +/- 1.56 and 43.33 +/- 15.28 degrees to 3.72 +/- 1.64 and 60.00 +/- 10.00 degrees (p<0.05), respectively. The VAS and SLR change between groups has no statistically significant difference (p>0.05). CONCLUSION: The different distribution of dye in epidural space had no significant difference in treating patients with low back pain.
Epidural Space* ; Humans ; Injections, Epidural* ; Leg ; Low Back Pain ; Spinal Stenosis ; Visual Analog Scale

BACKGROUND: A habit of lying-down after eating is known as a risk factor of reflux esophagitis. However the association between gastrointestinal disorders and a postprandial lying-down habit has not yet been identified. Some people believe that lying-down after meals is helpful for their health. We intended to investigate the relationship between such a habit and the health lifestyles, gastrointestinal symptoms, disorders using a questionnaires and gastrofiberscopic results of patients who visited our general health screening center. METHODS: We examined 1,030 subjects (the frequent postprandial lying-down group was 576 persons (57.7%), the rare group was 436 persons (42.3%) who visited our general health screening center for a routine check-up including a gastrofiberoscopy during the period between January 2001 to December 2002. After frequency matching by age and sex, health lifestyles (such as smoking, alcohol consumption, exercise, eating habits, night time sleep duration and awakening frequency, nap, and coffee intake), gastrointestinal symptoms (dyspepsia, epigastric pain, heart burn, chest pain, and constipation) and gastrofiberoscopic findings were compared using results from the questionnaires and gastrofiberscopic findings. Factors such as gastritis and reflux esophagitis were set as dependent variables, while postprandial lying-down was set as an independent variable. The frequent postprandial lying-down group and the rare group were analysed through stepwised multiple logistic regression analysis. RESULTS: Subjects with a frequent postprandial lying- down habit showed a significantly greater degree in alcohol consumption (P=0.010), irregular eating habits (P<0.001), eating between meals (P<0.001), napping (P<0.001), and night time awakening frequency (P= 0.016) than the rare group did. In addition, chest pain (P=0.031) and constipation (P=0.010) were more common in the frequent postprandial lying-down group. However, prevalence of dyspepsia (P=0.147), epigastric pain (P=0.085), and heartburn (P=0.700) showed no differences between the two groups. Being controlled with age, sex, education level, body mass index, and life style factors, postprandial lying-down group showed higher prevalence ratios in erythematous gastritis (OR 1.59; P=0.090), atrophic gastritis (OR 1.71; P= 0.059), and reflux esophagitis (OR 1.78; P=0.103). CONCLUSION: A postprandial lying-down habit is associated with undesirable lifestyles and some gastrointestinal disorders. Therefore, a modification of the postprandial lying-down habit should be recommended. Further investigation is needed to clarify the causal relationships between a postprandial lying down habit and gastrointestinal symptoms and disorders.
Alcohol Drinking ; Body Mass Index ; Burns ; Chest Pain ; Coffee ; Constipation ; Deception ; Dyspepsia ; Eating ; Education ; Esophagitis, Peptic ; Gastritis ; Gastritis, Atrophic ; Heart ; Heartburn ; Humans ; Life Style* ; Logistic Models ; Mass Screening ; Meals ; Prevalence ; Risk Factors ; Smoke ; Smoking

Water beads are dangerous foreign bodies causing intestinal obstruction in young children because the beads absorb water and are radiolucent. Although the features lead to progressive intestinal obstruction, it is difficult to diagnose ingestion of the beads by imaging studies. For the diagnosis, ultrasonography is safe, fast, and accurate. The imaging modality can show intestinal water beads as spherical, anechoic, smoothly demarcated cysts. This characteristic finding may be more useful in rapid and accurate diagnosis than computed tomography scan. We report a case of an 8-month-old boy who obtained a timely sonographic diagnosis of water bead-induced small bowel obstruction in the emergency department.

PURPOSE: To evaluate the usefulness of cervicothoracic spine sagittal T2-weighted images (CT SAG T2WIs) included in routine lumbar spine MRI. MATERIALS AND METHODS: Institutional review board approval was obtained and informed consents were waived for this retrospective study. The study group comprised 2,113 patients who underwent lumbar spine MRI from January 2005 to December 2005. CT SAG T2WIs were added in the routine lumbar spine MRIs. Radiologic reports were reviewed retrospectively for pathologic lesions on CT SAG T2WIs by one radiologist. Information of additional cervical or thoracic spine MRI and/or CT for further evaluation of positive findings on CT SAG T2WIs and their treatment were collected by retrospectively reviewing medical records. RESULTS: The CT SAG T2WIs revealed 142 pathologic lesions in 139 (6.58%) of the 2,113 patients. They were easily obtained without positional change in a scan time of less than 2 minutes. Additional cervical or thoracic spine MRI and/or CT for positive findings on CT SAG T2WIs were performed in 13 patients. Seven patients underwent surgical treatment. CONCLUSION: CT SAG T2WIs included in routine lumbar spine MRI were useful in finding the pathologic lesions in cervicothoracic spine for the patients who assumed to have lesions in lumbar spine.
Ethics Committees, Research ; Humans ; Retrospective Studies ; Spine