No abstract available.
Child* ; Humans

Fractures of the proximal humerus occur more frequently in older patients but are seen in all ages and emerge epiphyseal separations. The objectives of treatment are restoration of all involved structures to normal anatomical state and a completely functional limb in the shortest time possible. One part and two part fractures were indicated in conservative treatment and surgical treatment in most of three, four part fractures. The results of treatment of forty four cases according to Neer's classification were analysed at the Department of Orthopedic Surgery, Chonbuk National University Hospital from Mar. 1978 to Dec.1985. The results were as follows. 1. The prevalent age distribution was third and fifth decade(48%) . 2. The most common cause of injury was slip down(14 cases, 32%). 3. The most frequent cases of the fractures in Neer's classification were two part fractures(22 cases, 50%). 4. Thirty one cases(71%) were treated by conservative treatment, twelve cases(27%) by open reduction and 1 case(2%) by prosthesis. 5. Good results were in 23 cases(52%) of one and two part fractures, fair in 17 cases(39%) and poor in 4 cases(9%) of two, three and four part fractures.
Age Distribution ; Classification ; Clinical Study ; Extremities ; Humans ; Humerus ; Jeollabuk-do ; Orthopedics ; Prostheses and Implants ; Shoulder Fractures

No abstract available.
Nose*

No abstract available.
Decompression* ; Head* ; Osteonecrosis*

No abstract available.
Resuscitation* ; Shock, Hemorrhagic*

OBJECTIVE: The study was performed to evaluate whether thallium reinjection (RI) distinguishes viable from nonviable myocardium among myocardial segments which showed persistent perfusion defect (PD) in patients with acute myocardial infarction (AMI). MATERIALS AND METHODS: We studied 22 patients underwent PTCA after AMI. SPECT was performed in all patients using dipyridamole stress- 4 hour redistribution (RD) followed by 24 hour RI protocols. Dysfunctional segs were classified into 5 groups: 1) normal, 2) reversible, 3) mild to moderate PD, 4) severe PD and 5) reverse redistribution (RR). All patients underwent follow up echocardiography after 4 months to assess regional wall motion (WM) improvement such as a criteria of viable myocardium. RESULTS: A total of 127 segs with abnormal WM was analyzed. Of 74 segs with PD, 17 (23%) showed enhanced uptake after 24 hour RI. Five of 17 segs (29%) with PD that responded to RI with enhanced thallium uptake showed WM improvement. WM improvement were seen in the 24 of 57 segs (42%) not responding to RI. All four segs (100%) with RR that responded to RI showed improvement. WM improvement were not seen in the 5 of 8 segs (71%) with RR not responding to thallium RI. Eleven (73%) of 15 segs with mild-moderate PD after RI showed improvement, but 33% of segs with severe PD after RI did not showed improvement. Segs with mild-moderate PD after RI and fill in after RI showed improvement in comparison to segs with severe PD after RI(p<0.05). CONCLUSIONS: These data indicate that because only small proportion of PD showed further perfusion improvement after RI and predictive value by the uptake after RI was low, there was limited role of RI after myocardial infarction. Usefulness of RI could be found in segs showing RR responding to RI in AMI reflects viable myocardium.
Dipyridamole ; Echocardiography ; Follow-Up Studies ; Humans ; Myocardial Infarction* ; Myocardium ; Perfusion ; Thallium ; Tomography, Emission-Computed, Single-Photon

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

Pneumomediastinum is a relatively uncommon, infrequently reported entity, In the evaluation of these entity, it is important to exclude pathological causes, including Boerhaave's syndrome which carries a high mortality. Spontaneous pneumomediastinum is related to excessive intraalveolar pressure leading to rupture of perivascular alveoli in the setting of a Valsalva maneuver without communication to gut material. So, it has a benign self-limited course and rarely requires medical intervention. On the contrary, secondary pneumomediastinum caused by instrumental, traumatic, and spontaneous perforation of esophagus. Although the prognosis have been improved since the advent of broad-spectrum antibiotics and nutritional support, pneumomediastinum due to esophageal perforation still has a high morbidity and mortality. The most important prognostic factor is the time interval between perforation and initiation of therapy, and an awareness and a high clinical suspicion is critical in the early diagnosis and treatment. Recently, we have experienced 2 cases of pneumomediastinum, one case was spontaneous pneumomediastinum and the other may be caused by instrumental esophageal perforation. We report the clinical course of the patients with a current literature review.
Anti-Bacterial Agents ; Early Diagnosis ; Esophageal Perforation ; Esophagus ; Fibrinogen ; Humans ; Mediastinal Emphysema* ; Mortality ; Nutritional Support ; Prognosis ; Rupture ; Valsalva Maneuver

OBJECTIVE: As an electronic health record system is implementing in Korean health care sectors, concerns about key functionalities of electronic health record systems are increasing. The purpose of this study was to identify core functions and set the priority in electronic health record systems under the Korean contexts in order to assure and improve the quality of the systems. METHODS: A survey was conducted using questionnaire developed by the study team based on literature review. The subjects were medical record administrators working at medical record department in general hospitals. RESULTS: The response rate was 59.8%(55/92). The functions which more than ninety percent of subjects responded as necessary right now and/or in near future related to 'drug alert', 'clinical guideline', 'chronic disease management', 'automated real-time surveillance', 'coded data', 'result reporting', 'de-identifying data', 'disease registry', and 'provider-provider communication and connectivity'. CONCLUSION: The results showed the high prioritized functions were decision support and health information/data management.
Electronic Health Records* ; Health Care Sector ; Hospitals, General* ; Humans ; Medical Record Administrators ; Medical Records ; Needs Assessment* ; Surveys and Questionnaires

BACKGROUND: Pigment production and acidification of ribose are most frequently used biochemical tests for the differentiation of three enterococcal species carrying vanC genes such as Enterococcus gallinarum, Enterococcus casseliflavus, and Enterococcus flavescens. However, pigment production may occasionally be negative in E. casseliflavus, and some of E. casseliflavus may be negative or delayed reaction with ribose fermentation test. So, we performed this study to find out biochemical tests capable of distinguishing the strains possessing vanC genotypes. METHOD: A total of 17 enterococci composed of 14 clinical isolates with motility or pigment positive strains and three ATCC strains(E. gallinarum ATCC 49573, E. casseliflavus ATCC 25788, and E. flavescens ATCC 49997) Were tested by multiplex PCR of the vanC genes(vanC-1, vanC-2 and vanC-3)and various biochemical tests. RESULTS: Among the 17 isolates including three ATCC control strains, four were genotyped as VanC-1, 11 were VanC-2, one were vanC-2/3, and any of vanC genes were not detected in one clinical isolate, respectively, Among the enterococci with vanC genotype, acid production from alphaD-cyclodextrin and hippurate hydrolysis were positive only in VanC-1 gneotype(E. gallinarum), acid production from glycerol and methyl-alpha-D-mannopyranoside were positive only in vanC-2 genotype(E. casseliflavus), and acid production from rhamnose and pigment production were negative only in VanC-1 genotype. Acid production from alphaD-cyclodextrin was negative only in vanC-2 genotype. The positive rate of ribose fermentation of VanC-1, VanC-2, and VanC-2/3(E. flavescens) genotype were 100%, 82%, and 0%, respectively. CONCLUSION: Acid production from rhamnose, alphaD-cyclodextrin, betaD-cyclodextrin, glycerol and methly-alphaD-mannopyranoside, pigment production, and hippurate hydrolysis test were useful biochemical tests for differentitating E. gallinarum form E. casseliflavus. The production of acid from alphaD-cyclodextrin, glycerol, methyl-alpha-D-mannopyranoside and were suitable biochemical tests for differentiating E. casseliflavus from E. flavescens.
Enterococcus ; Fermentation ; Genotype ; Glycerol ; Hydrolysis ; Multiplex Polymerase Chain Reaction ; Phenotype* ; Rhamnose ; Ribose