BACKGROUND: Recently, the incidence of acute myocardial infaction has been gradually increasing as prolongation of life spans and improvements of diet and life styles in Korea. The rate of mortality and sudden death is higher than other diseases. The purpose of this study is to evaluate factors which can affect on the mortality of AMI during initial 24 hrs. METHODS: A retrospective clinical study was done on 364 consecutive patients with AMI who had been presented to Keimyung University Dong-sang Medical Center from January 1990 to May 1997(M:F ratio=254:110). The subjects were divided two groups. The Group I was patients who had expired during the initial 24hrs period of AMI(47 patients, 13%), the Group II was patients who had survived(317 patients, 87%). We compared clinical features, EKG, laboratory results in both groups and tried to analyse the vulnarable factors. RESULTS: The results were as follows; 1) The mean age in Group I (64.4 yearly) was older than in Group II(61.3 yearly) and female gender was also higher in Group I. The mean systolic/diastolic blood pressures of the Group I(103/61mmHg) were lower than those of the Group II(123/75mmHg). 2) The chest pain and mental change were noted more frequently in Group I than in Group II and the dyspnea was less frequent in Group I than Group II. 3) The higher grades of Killip classification was significantly more frequent in Group I than in Group II. 4) The mean onset to drug time for thrombolytics in Group I and Group II were 14.1 hrs and 6.6 hrs. 5) The mortality rate of the Group I and the Group II were respectively 13%, 6.6%. The most common causes of death were cardiogenic shock and ventricular arrhythmia. CONCLUSION: The mortality rate of initial 24 hrs of onset as form of sudden death was higher than post-24hrs group(66.2%). The factors for the higher mortality group were old age and female gender, and they were unstable in vital signs, higher Killip classifications. Therefore, these groups demand more rapid and aggressive approach than the other groups.
Arrhythmias, Cardiac ; Cause of Death ; Chest Pain ; Classification ; Death, Sudden ; Diet ; Dyspnea ; Electrocardiography ; Female ; Humans ; Incidence ; Korea ; Life Style ; Life Support Care ; Mortality* ; Myocardial Infarction* ; Retrospective Studies ; Risk Factors* ; Shock, Cardiogenic ; Vital Signs

In general, pelvic fracture carries higher mortality especially from motor veicle accident, we have retrospectively reviewed charts and radiographs of 185 patients in order to identify clinical fading, kinds of fracture, hemodynamic changes and associated injuries in patients with pelvic fractures. We attempted to classify pelvic fractures according Young classification. The following results were obtained; 1. On age and sex distribution, the pelvic fractures showed peak incidence between 2nd decade and 5th decade. Male was affected more frequently than female, the ratio being male to female, 2.6 to 1. 2. The mechamisn of injury was motor veicle accident in 155(83.8%), fall in 25(13.5%), others in 5(2.7%). 3. The associated injuries of pelvic fractures: extremity, thoracic, urinary system, intraperitoneal and head injury. 4. Of the 185 cases of the pelvic fractures, simple pelvic fractures are 101 cases(54.6%), lateral compression in 39(21.1%), anteroposterior compression in 18(9.7%), vertical shearing in 17(9.2%), mixed pattern in 10(5.4%). 5. Retroperitoneal hematoma and urinary tracts injuries were the most common associated in mixed pattern. 6. The incidence of hemodynamically unstable fractures were 19.8% in simple pelvic fracture but, as expected was higher in major pelvic ring disruptions except to acetabular fracture(52.4%). 7. Mortality rates were 5.9% in all pelvic fractures but 10.7% in major pelvic ring disruptions except to acetabular fractures. Prognostic factor in pelvic fractures were the amount of hemorrhage and associated injuries, therefore early diagnosis and managements are essential to reduce the mortality in pelvic fracture.
Acetabulum ; Classification* ; Craniocerebral Trauma ; Early Diagnosis ; Extremities ; Female ; Hematoma ; Hemodynamics* ; Hemorrhage ; Humans ; Incidence ; Male ; Mortality ; Retrospective Studies ; Sex Distribution ; Urinary Tract

Functional myelography, applying spinal movements(flexion-extension) in myelography, has been frequently used for accurate diagnosis of posture-related disorders such as herniated lumbar disc or spinal stenosis. Measurements were performed on functional myelographic findings of 62 patients, and in 24 cases surgically verified herniated lumber discs were present. The object of this study was to analyze changes in position and shape of the dural sac in spinal movements and confirm the clinical importance of functional myelography. The present study demonstrated that: 1) The anterior border of the dural sac was straight with flexion, but indented at the level of intervertebral space and this indentation was less prominent at L5-S1. 2) With extension, posterior indentation of the dural sac was more prominent at the level of the intervertebral space than the body, the A-P diameter of the dural sac was narrowed at all levels of the intervertebral spaces except L5-S1, and the dural sac moved anteriorly at the level of L5-S1 and all spinal bodies. 3) In surgically verified disc patients, anterior indentation of the dural sac was persistent in both flexion and extension views, and was more exaggerated with extension, but less prominent at L5-S1. In patient at L5-S1, anterior movement of the anterior dural border at the level of surgery was much decreased.
Diagnosis ; Humans ; Myelography* ; Spinal Stenosis

We analysed ultrasonic findings of 54 brain scan cases(45 cases were performed through the anterior fontanelle and the temporoparietal thin bone and 9 through the surgical bone defect) and comparison of these pictures with those obtained in the same patients by CT scan showed prominent correlation. Ultrasonography was more sensitive to different histologic features and provided a more accurate depiction of the neuropathologic characteristics in most of cases. We conclude that ultrasonography of the brain was proven to be quite useful in the screening and follow up of neonates and infants under 15 months of age, and as a follow up method in post operative patients. It was also more accurate than CT scan in cases of abscesses and cystic lesions.
Abscess ; Brain* ; Cranial Fontanelles ; Follow-Up Studies ; Humans ; Infant ; Infant, Newborn ; Mass Screening ; Tomography, X-Ray Computed ; Ultrasonics ; Ultrasonography

Cervical traction has been widely used as an essential method for the treatment of cervical fracture-dislocation. This report, however, was a case in which hazardous effect of traction due to unreduced huge fragment was demonstrated only by cervical CT scan. Surprisingly plain X-rays could not demonstrated this condition. It was apparent that skeletal traction resulted in further injury of the spinal cord. Surgical removal of unreduced huge fragment was accomplished completely and interbody fusion was followed. Postoperative CT findings showed complete removal of fragment and decompression of the spinal cord as well as gratifying interbody fusion. CT scanning is imperative to evaluate the cervical fracture-dislocation and blind skeletal traction may be hazardous.
Decompression ; Spinal Cord ; Spinal Cord Injuries ; Tomography, X-Ray Computed* ; Traction

A total of 32 cases of cervical myelography via lateral c1-2 puncture using water-soluble metrizamide was evaluated. Twenty seven cases were suspected to have herniated cervical disc and five cases, spinal cord tumor. Patients were placed in prone position with head and neck slightly extended on the radiolucent operating table. Puncture was performed using 22-guage spinal puncture needle placed at the junction of the middle and posterior one-third of the bony spinal canal and 4-6mm inferior to the arch of atlas on lateral projection. The needle was positioned posterior to the spinal cord into the subarachnoid space. The author could obtain more clear images with less amount of contrast medium than doses used in conventional cervical myelography via lumbar route. The were relatively few adverse reactions and no considerable complications have been encountered with a new cervical water-soluble metrizamide myelography via C1-2 puncture.
Head ; Humans ; Metrizamide* ; Myelography* ; Neck ; Needles ; Operating Tables ; Prone Position ; Punctures* ; Spinal Canal ; Spinal Cord ; Spinal Cord Neoplasms ; Spinal Puncture ; Subarachnoid Space

To obtain wider versatility and greater reach in microsurgical lumbar discectomy, modified procedure has been performed on 263 patients in 1979-1983. It consisted of a smaller midline incision, removal of lateral half of the spinous process, partial but sufficient microdrilling of the lamina, use of a modified slender Taylor retractor, flavotomy, preservation of epidural adipose-areolar tissue etc. Particularly a slender Taylor-Chung retractor offered yielding surgical opening and therefore secured free of pituitary forceps to every direction. The microsurgical results including 72 bisegmental and 8 trisegmental discectomies were compared with those of standard operations of same number performed by same surgeon in 1972-1979, for the good contrast. Mean blood loss per operation was 94 ml with the standard discectomy and 46 ml with microsurgery. Dural tear occured in 17 cases undergoing standard operation and in 3 undergoing microsugery. The mean time until return to duty was 8.6 weeks with standard, compared with 4.2 weeks. In the microsurgical group, 3 patients had postoperative discitis while 2 had in the standard. In this series, the results of microsurgery surpasses the standard in the convalescent phase. Major advantages of this modified microsurgical technique were its ability to secure the greater reach to remove disc material as much as possible and to preserve the integrity of normal tissue better.
Discitis ; Diskectomy* ; Humans ; Microsurgery ; Surgical Instruments

The authors experienced on the use of bovine bone in 3 cases of interbody fusion employing the Cloward technique. Two patients were cervical fracture-dislocation and one patient was a case of lumbar spondylolysis. With use of bovine bone, iliac osteotomy is unnecessary, and this procedure is no problem of donor site pain and infection which can be possible in interbody fusion with iliac bone and rib graft. With the use of bovine bone the additional advantages are. 1) The operative procedure is simplified. 2) The time required for the operation is diminished. 3) Patient meralgia is eliminated completely. 4) The surgeon can have uniformly sized bones of a proven hardness on hand. 5) The epidural bleeding is showed through lattice of bovine bone.
Hand ; Hardness ; Hemorrhage ; Humans ; Osteotomy ; Ribs ; Spondylolysis ; Surgical Procedures, Operative ; Tissue Donors ; Transplants

The mean values of the height, depth and lateral shifting of the spinous processes and the height of the intervertebral disc spaces of 100 patients were measured in the lumbar region. The application of microsurgical techniques in the operation for lumbar disc herniation clearly reduced the overall surgical trauma suffered by patient, but the spinous process might disturb the insertional course and multidirectional activities of the pituitary forceps due to a very small skin incision. The purpose of this study was to prove the relationships between intervertebral disc space and spinous process in the lumbar region. The results were as follows; 1) The height of the intervertebral disc space from L3-4 to L5-S1 intervertebral disc space was 12.63mm, 12.57mm and 11.71mm respectively. 2) The depth of the spinous process from L3 to L5 was 28.87mm, 27.87mm and 23.97mm respectively. 3) The lateral shifting of the spinous process from midline to the right side was 4.39mm, 4.35mm and 4.01mm at L3, L4 and L5 spinous process respectively and to the left side was 3.61mm, 3.70mm and 3.69mm at L3, L4 and L5 spinous process respectively. Conclusively, the lower part of the spinous process was overlapped above the intervertebral disc space at L3-4, L4-5 and L5-S1 intervertebral disc space. About 4mm of the lateral shifting of the spinous process was protruded to both right and left side in the insertional course(about 2-3cm) of the pituitary forceps. The spinous process might disturb the multidirectional activities and perpendicular insertion of the pituitary forceps. So, the removal of the spinous process to the midline was recommended to perform the complete removal of disc materials in microlumbar discectomy.
Diskectomy ; Humans ; Intervertebral Disc* ; Lumbosacral Region ; Skin ; Surgical Instruments

Tension pneumocephalus is rare while pneumocephalus is relatively common. The former has sudden or insidious deterioration in neurologic symptoms and signs comparing to self-limited pneumocephalus. This report is of a 19 years old male with tension pneumocephalus in the right frontal lobe two underwent right frontal osteoplastic craniotomy.
Craniotomy ; Frontal Lobe ; Humans ; Male ; Neurologic Manifestations ; Pneumocephalus* ; Young Adult