The authors report a case of monostotic eosinophilic granuloma which occured in the skull. A 37 year-old woman was presented with headache and soft mass in the occipital region. Plain skull X-ray showed a "punched out" osteolytic lesion in the right paramedian posterior parietal bone. Computed tomography shows a soft tissue mass and irregular bone destruction in corresponding region. On magnetic resonance image, the mass was of high signal intensity, with subgaleal extension and looks like a shirt stud or "collar button" on T2-weighted image. Total excision of the tumor and postoperative radiotherapy(1000cGy) were performed. The woman had no headache complains nor showed any focal neurologic deficit during the six months follow-up period. We report a case of monostotic eosinophilic granuloma of the skull with review of the pertinent literatures.
Adult ; Eosinophilic Granuloma* ; Eosinophils* ; Female ; Follow-Up Studies ; Headache ; Humans ; Neurologic Manifestations ; Parietal Bone ; Skull*

The auther studied 54 lumbar spondylolisthesis patients diagnosed and treated with transpedicular screw fixation and bony fusion at our Hosptial between January 1990 and December 1994, and analysed the outcome. The results may be summarized as follows: 1) Of the 54 cases, 17 were degenerative spondylolisthesis and 37 were spondylolytic spondylolisthesis. Occurrence peaked during the fifth and sixth decades. 2) Posterolateral fusion(P.L.F) was performed in 37 cases and posterior lumbar interbody fusion(P.L.I.F) in eight ; P.L.F and P.L.I.F in combination was performed in nine cases. The mean follow-up period was 25 months. 3) In no patients was significant neurologic injury or functional root loss seen. Complications included two instrument failures and one wound infection. 4) Radiologic and clinical outcome was better in degenerative than in spondylolitic spondylolisthesis. 5) The radiologic and clinical outcome of bony fusion types P.L.F and P.L.I.F was the same. 6) The surgical result as evaluated by Mc.Nab's criteria was satisfactory in 81% of patients.
Follow-Up Studies ; Humans ; Spine* ; Spondylolisthesis* ; Wound Infection

PURPOSE: This study was designed to evaluate the educational effects of cardiopulmonary resuscitation (CPR) instruction to elementary school children and the perspectives of students and teachers about such instruction. METHODS: A total of 34,232 5th and 6th grade students from 998 elementary schools were instructed using a two-hour CPR lesson from each school teacher using CPR Anytime(R). The school teachers also were instructed by the same lesson from BLS instructors. Survey questionnaires were distributed to students involved. CPR skills were tested using a checklist during the class. We calculated the multiply effect that how many people were instructed CPR secondarily by student after the lesson and analyzed results by grade and gender. RESULTS: Most students (82%) said that CPR was easy to learn; 81% indicated a willingness to do CPR on a stranger. CPR skills were tested in 11,529 students (34%), and 10,269 (89%) passed. Assessment of respiration was the most commonly omitted procedure. The multiply effect was 1.54, and was higher in the 5th grade and among girls. CONCLUSION: This study suggests that the CPR instruction to 5th or 6th grade students in an elementary school setting is feasible and effective. Although the quality of instruction may be low, the children performed CPR on their family and friends.
Cardiopulmonary Resuscitation ; Checklist ; Child ; Friends ; Health Education ; Heart Arrest ; Humans ; Manikins ; Surveys and Questionnaires ; Respiration

PURPOSE: The emergency department (ED) has been considered highly stressful environment to work in. However, there has been no study evaluating the stresses endured by emergency staffs in Korea. This study aims to evaluate the cause and effect of stress, and coping methods used by doctors and nurses under stress from working in an emergency department. METHODS: Interns, residents and nurses of an emergency center were given questionnaires that included general health questionnaire (GHQ)-12 scale and modified Holmes & Rahe (HR) scale to examine the cause and effect of stress, and determine the coping methods they used to alleviate stress. A score of greater than 20 in the GHQ-12 scale and greater than 80 in the HR scale were considered as significant for stress. The stress scales were compared among the three groups using analysis of variance and chisquare test. RESULTS: A total of 111 participants consisting of 46 interns, 19 residents, and 46 nurses were surveyed. While the GHQ-12 score showed no difference between groups, the HR score showed significant differences among residents (82.4+/-23.0), nurses (73.6+/-13.2), and interns (70.1+/-17.7). Each stress score did not differ according to the age, gender, marital status, or presence of lover. Most frequently recorede effects of stress were difficulty waking up and fatigue. Most frequent coping methods employed were sleeping and smoking. CONCLUSION: This study suggests that ED staffs, especially residents, were exposed to significant amount of stress.
Adaptation, Psychological ; Emergencies ; Fatigue ; Korea ; Marital Status ; Surveys and Questionnaires ; Weights and Measures

Placntal site trophoblastic tumor (PSTT) has been demonstrated to be a rare form of gestational trophoblastic tumor (GTT). Kurman (1976) et al recognized this disease as Trophoblastic pseudotumor and they thought it to be a benign exaggerated placental site reaction, but Twiggs et al (1981) reported a patient who died of widespread metastasis. Death has been reported in 2 of 14 cases due to metastatic disease, and therefore it is thought to have a malignant course and metastatic potential. It may occur at any age during the reproductive age but usually occurs in relation to second or subsequent pregnancies (a normal pregnancy, an abortion, or a molar pregnancy) rather than primipara. PSTT can metastasis to the brain, lung, liver, vagina and bladder. Larsen et al (1991) report metastasis rate about 10%. It produces little hCG and larger quantities of hPL. We experienced a case of PSTT after normal delivery, which was diagnosed and operated on in our hospital, and report this case with a brief review of literatures.
Brain ; Humans ; Liver ; Lung ; Molar ; Neoplasm Metastasis ; Pregnancy ; Trophoblastic Neoplasms ; Trophoblastic Tumor, Placental Site* ; Trophoblasts ; Urinary Bladder ; Vagina

OBJECTIVE: This study assesses the hypothesis that preeclampsia is associated with the change of oxidative system balance by measuring the lipid peroxidation and antioxidant activity in preeclampsia. METHOD: Venous blood samples were collected from twenty women with preeclampsia and twenty women with uncomplicated pregnancies. Total lipid peroxidation, total antioxidant activity, antioxidant enzyme activity and antioxidant concentration were measured using flow injection-chemiluminescent method. RESULTS: 1. Total lipid peroxidation(PCOOH) was higher in preeclampsia(717.22+/-93.08 pmol/ml) than in normal pregnant(486.86+/-43.15 pmol/ml) (P<0.05). 2. Total antioxidant activity was significantly higher in preeclampsia(46.02+/-5.95 % inhibition) than in normal pregnant(38.59+/-7.57 % inhibition) (P<0.05).3. Antioxidant enzyme, catalase activity in RBC was lower in preeclampsia(346.59+/-82.84 unit/gHb) than in normal pregnant(440.62+/-72.8 unit/gHb) (P<0.05).4. Antioxidant, alpha-tocopherol concentration in RBC was slightly lower in preeclampsia(33.21+/-7.82 ng/gHb) than in normal pregnant(36.06+/-6.86 ng/gH), but there was no statistically significant difference (P<0.05). CONCLUSION: This data seems to show that preeclampsia is associated with an imbalance between the lipid peroxidation and the antioxidant system.
alpha-Tocopherol ; Catalase ; Female ; Free Radicals ; Humans ; Lipid Peroxidation ; Pre-Eclampsia* ; Pregnancy

Background and Objectives: Although the adverse cardiovascular effect of anemia has been well described, the effect of polycythemia on the incident atrial fibrillation (AF) remain unclear. The objective of this study is to identify the association between increased hemoglobin and incident AF. Methods: This was a retrospective-cohort study with 434,269 subjects who underwent national health examinations from the Korean National Sample Cohort. We estimated the risk of incident AF according to hemoglobin-based four-categories. Results: During 3.9-year of follow-up, polycythemia group showed higher incidences of AF (hazard ratio[HR] with 95% confidence interval[CI], 1.50 [1.28–1.76] and 1.69 [1.13–2.56]; in men and women, respectively) than normal hemoglobin group (each p<0.001). In the normal hemoglobin and polycythemia groups, a 1 g/dL increase in hemoglobin level was associated with increased risks of incident AF (1.12 [1.07–1.17] and 1.18 [1.10–1.26] in men and women, each p<0.001). To investigate the specific hemoglobin concentration related to greater AF incidence, we analyzed the sensitivity/specificity of different hemoglobin levels: ≥16.0 g/dL in men and ≥14.5 g/dL in women showed the highest Youden's index, with c-indices of 0.83 and 0.82, respectively. Kaplan-Meier cumulative-event curves according to these specific hemoglobin levels (≥16.0 g/dL in men and ≥14.5 g/dL in women) also showed consistent results in both sexes (each p<0.05). Conclusions Even in the Korean general population, increased hemoglobin was significantly associated with higher rate of incident AF. Especially, subjects with hemoglobin levels ≥14.5 g/ dL in women and ≥16.0 g/dL among men were associated with increased risk of incident AF.

Objectives: This study aimed to quantify the relationship between proximal humeral rotation and the lateral border of the bicipital groove on fluoroscopic imaging. Methods: A composite normal humerus with a marker placed on the lateral border of the bicipital groove was affixed to a custom rotation device at the proximal cut segment. Consecutive fluoroscopic images were captured from −60° to 60° in 5° increments and from −15° to 15° in 1° increments. The index value was calculated by taking the ratio of the distance from the medial boundary of the proximal humerus to the lateral border of the bicipital groove to the distance between the medial and lateral boundaries of the proximal humerus. The correlation between the humeral rotation and the index value was determined. Results: The index value showed a strong positive linear correlation position during internal rotation of the humerus across the entire range (r=0.998, P<0.001), as well as when the humerus was externally rotated, ranging from 15° of internal rotation to 15° of external rotation (r=0.991, P<0.001). Conclusion The lateral border of the bicipital groove may serve as a useful intraoperative landmark for assessing proximal humeral rotation. This could potentially enhance the outcomes of humeral fracture repair and upper arm arthroplasty.

BACKGROUND: Although a few previous studies have analyzed the role of reduced lung function in predicting atrial fibrillation (AF), the relationship between the incidence of AF and comorbid chronic obstructive pulmonary disease (COPD) is unclear. We hypothesized that COPD is associated with the occurrence of new-onset AF and clinical outcomes in AF patients. METHODS: We analyzed the development of new-onset AF in 501,668 patients without AF and clinical outcomes in 4,541 patients with AF using Korean National Health Insurance Service-National Sample Cohort (NHIS-NSC). RESULTS: Comorbid COPD was found in 4.8% (11,442 of 501,668) of non-AF patients and 18.6% (820 of 4,541) of AF patients. The incidence of AF in COPD patients was significantly higher compared to non-COPD patients (2.6% vs. 0.6%, p < 0.001) over the follow-up period (45.5±14.9 months). In a multivariate Cox regression analysis, COPD predicted higher risk of AF independently from other risk factors (HR: 1.41, 95% CI: 1.25-1.60, p < 0.001). The allcause mortality of AF patients with COPD was significantly higher in patients who used b-blockers (20.6% vs 13.1% during follow-up, p < 0.008). Multivariate Cox regression analysis showed that COPD is still an independent risk factor for all-cause mortality (HR: 1.25, 95% CI: 1.03–1.51, p=0.022), and stroke (HR: 1.19, 95% CI: 1.00–1.41, p=0.039). CONCLUSION: The presence of COPD is an independent risk factor for new-onset AF. COPD is independently associated with all-cause mortality and stroke in AF patients.
Atrial Fibrillation* ; Cohort Studies ; Follow-Up Studies ; Humans ; Incidence ; Lung ; Mortality* ; National Health Programs ; Pulmonary Disease, Chronic Obstructive* ; Risk Factors ; Stroke

Cephalosporins are commonly used antibiotics in treatment of clinical infection. They frequently cause a positive direct antiglobulin test, but rarely cause hemolysis. The authors report a case of immune hemolytic anemia due to a second-generation cephalosporin, cefuroxime, by the drug adsorption mechanism.
Adsorption ; Anemia, Hemolytic* ; Anti-Bacterial Agents ; Cefuroxime* ; Cephalosporins ; Coombs Test ; Hemolysis