BACKGROUND: Brief episode of coronary artery occlusion (i.e., ischemic preconditioning) makes the heart more resistant to injury from a subsequent ischemic insult. Although a great deal of effort has been made in studying ischemic preconditioning, the underlying mechanism of ischemic preconditioning and its effect on hypothermic insult has not been elucidated. This study was performed to see whether ischemic preconditioning protects against the depression of cardiac contractility induced by hypothermic cardioplegic arrest/reperfusion. And recently, adenosine was known to have some correlation with the mechanism of preconditioning. If so, does this effect remain after the blockade of adenosine receptor by 8-phenyl theophylline? METHOD: Twenty-four Sprague-Dawley rat weighed 250-350g were used and divided into three groups. Rat hearts were removed rapidly, and each isolated heart paced with a rate of 180/min was perused by modified Krebs-Hensleit buffer(KHB) solution on a Langendorff apparatus far an hour. After obtaining baseline data including left ventricular pressure(LVP), dp/dt, and coronary flow, cardiac arrest was induced by perfusion of 0degrees C crystalloid cardioplegic(St Thomas) solution. After that, all hearts were stored in the same St Thomas solution at salute temperature far 2 hours. In group I (control group), the hear was reperfused by KHB solution. In group II(preconditioning group), the heart was subjected to two 2-minute episode of global ischemia followed by 5 minute reperfusion with KHB solution(preconditioning) before cardiac arrest. In group III(phenyl theophylline group), the heart was subjected to preconditioning procedure and 8-phenyl theophylline at 10muM in concentration was added to KHB solution at time of reperfusion. Observing parameter was obtained in each group at 10, 20, 40 and 60 minutes after starting reperfusion and compared statistically by use of one way ANOVA test(STASTICA, release 4.5). P-value less than 0.05 was considered significant. RESULTS: Although depressed LVP, dp/dt, and Coronary flow were seen in all groups during the reperfusion period, the preconditioned group showed more effective recovery of LVP than that of the control group, especially at 10, 20 and 40 minutes(p<.05). We failed to demonstrate the difference between the phenyl theophylline group and the control group(p=NS). CONCLUSION: These results suggest that ischemic preconditioning has protective effect on recovery state of hypothermic cardioplegic arrest/reperfusion. Its protective effect was limited during early reperfusion stage and was blocked by adenosine blocker.
Adenosine ; Animals ; Coronary Vessels ; Depression ; Heart Arrest ; Heart* ; Ischemia ; Ischemic Preconditioning* ; Myocardium* ; Perfusion ; Rats ; Rats, Sprague-Dawley ; Receptors, Purinergic P1 ; Reperfusion ; Theophylline

One of the patellar function is to protect the femoral condyle from direct blowing to knee, so it is known that ligament injuries of the knee are rare in the presence of patellar fracture. We experienced four cases of posterior cruciate ligament injury associated with patellar fracture. Unfortunately, three cases were initially neglected, and one case was identified by visualization on avulsed posterior tibial spine in plain X-ray film. We reviewed these cases and obtained several results as follows; 1. Among four cases, three cases(75%) are fractured at the lower pole of patella without displacement and one case is a longitudinal fracture. 2. We consider possible two mechanisms of this injury; first, in flexed knee, posteriorly directed force on the proximal tibia produces posterior cruciate ligament injury followed by avulsed fracture at the lower pole of patella. Second, by fall on a flexed knee, the load is sustained on the inferior pole of the patella first and continuously drives the tibia backwards producing posterior cruciate ligament injury. We recommend that all surgeon should be aware of possibility of the ligament injury in the presence of patellar fracture, especially in lower pole fracture.
Knee ; Ligaments ; Patella ; Posterior Cruciate Ligament ; Spine ; Tibia ; X-Ray Film

No abstract available.
Breast Neoplasms* ; Breast*

Aortic transection or interruption is a rare condition which developed after an acute deceleration injury. Its occurrence depends on the location and direction of the force applied and is usually from motor vehicle accident or falling down. The exact incidence of aortic transection in trauma is not known but, when develops, only about 10-15% of the victims can furtive and be transported to the hospital. Even in the survivors, majority of them will be fatal within a few days if a prompt diagnosis and surgical treatments are not made. Aggressive diagnostic work-up is recommended for the patients with high suspicious index, which would salvage the victims with this fatal condition. We report the experience of two cases of aortic transection or interruption following motor vehicle accidents.
Deceleration ; Diagnosis ; Early Diagnosis* ; Humans ; Incidence ; Motor Vehicles ; Survivors ; Thorax* ; Wounds and Injuries*

Angel's trumpet is a poisonous shrub recently imported to Korea for ornamental PURPOSE. It contains tropane alkaloids and the ingestion of any part of the plant can cause serious anticholinergic toxicity. Not only accidental ingestion, intentional intake as hallucinogen is not uncommon in the United States and Europe. We report a woman who ingested angel's trumpet by mistake and showed anticholinergic syndrome. The potential public medical harm of this widespread plant should be reported in the media, along with the associated dangers from misuse as a hallucinogen.
Alkaloids ; Datura ; Eating ; Europe ; Female ; Humans ; Korea ; Plants ; Solanaceous Alkaloids ; United States

PURPOSE: The objectives of this study were (1) to observe the problems in the management of trauma death and to estimate the preventable death rate and (2) to provide guidelines for the analysis of trauma mortality, which is a part of the program to monitor the quality levels of emergency departments(ED). METHODS: The records of patients who died at the ED or after admission due to trauma at two tertiary and four secondary hospitals between Jan. 1997 and Dec. 1998 were retrospectively reviewed. The medical records of 210 patients were reviewed, and those of 131 patients, i.e., 62.4%, could be used to evaluate preventability. RESULTS: The preventable death rate was 40.5%, which exceeded the rate of 25% before the implementation of the trauma care system. The preventable death rate of secondary hospitals was 46.5% and that of tertiary hospitals was 28.9%. The number of problems per one death was 5.74, and among them 2.82 problems were related to death. Fifty-two percent of those problems occurred in the ED, 13.9% in the prehospital caie, and 18.9% during transportation between hospitals. When the problems were classified into six categories, treatment problems accounted for 73.4% and system inadequacy for 18.7%. Especially, problems related to resuscitation were 40% of all treatment problems. Delay in transportation or delay in diagnosis also accounted for a significant portion of the problems. CONCLUSION: The preventable death rate in korea was much higher than the in developed countries, especially for the secondary hospitals. Improving efforts should be focused to the management in the prehospital arena and the ED. Standardization and training for trauma resuscitation still require much effort. The most important thing in a hospital is a trauma care team that can carry out professional treatment promptly.
Developed Countries ; Diagnosis ; Emergencies ; Humans ; Korea ; Medical Records ; Mortality ; Resuscitation ; Retrospective Studies ; Tertiary Care Centers ; Transportation

Traditionally, the Rhododendron species has been used in gastrointestinal disorder or hypertension. Grayanotoxin exists in honey, flowers, pollen, and the nectar of the Rhododendron species. We experienced 3 cases of Grayanotoxin intoxication. The symptoms of intoxication were nausea, vomiting, hypotension, bradycardia, diplopia, dizziness, and chest discomfort. Generally, the treatment for Grayanotoxin intoxication is fluid resuscitation and injection of atropine sulfate. The patients who were intoxicated with Grayanotoxin were discharged without complication after supportive care.
Atropine ; Bradycardia ; Diplopia ; Dizziness ; Flowers ; Honey ; Humans ; Hypertension ; Hypotension ; Nausea ; Plant Nectar ; Pollen ; Resuscitation ; Rhododendron ; Thorax ; Vomiting

Occult bladder injury may sometimes go unrecognized during tension-free vaginal tape (TVT) procedures. We report a case of occult intraperitoneal bladder injury that occurred during a TVT procedure. There was no sign of bladder perforation on the initial cystoscopy, which was performed just after the insertion of the trocar. Signs of general peritonitis appeared after the patient started to void the next day. A postoperative cystogram and cystoscopy showed an intraperitoneal bladder injury and a pinhead-sized ulcerative lesion in the right lateral wall of the bladder. We suspect that at the time of initial cystoscopy, the trocar passed through the submucosal area without violating the bladder mucosa. The occult bladder injury may have been caused after the initial cystoscopy by advancing the rough edge of the prolene tape during the extraction of the trocar. This report is the first description of such an occult bladder injury during a TVT procedure.
Vagina/surgery ; Urologic Surgical Procedures/adverse effects ; Urinary Incontinence, Stress/*surgery ; Urinary Bladder/*injuries/radiography ; *Postoperative Complications ; Peritonitis/diagnosis/etiology ; Humans ; Female ; Cystoscopy ; Adult

Traumatic asphyxia is a clinical symptom complex characterized by craniofacial cyanosis, subconjunctival hemorrhage, and head and neck vascular engorgement due to sudden compressive injury on the thoracic cage. It is occasionally combined with mental deterioration, lung contusion, and edema. It is considered due to increased intrathoracic pressure in state of closed epiglottis. Recently, we had experienced three cases of traumatic asphyxia of which clinical courses were somewhat different. The first case developed by a compression between a elevator and the ground while the victim did not realized the accident happening, and the patient showed nonspecific facial edema and ecchymosis but mental deterioration and ultimate respiratory failure. The second case by a compression between cars, while the impending accident was noticed by the victim, showed full-blown asphyxia without mental or respiratory symptoms. The last case by forceful coughing and vomiting showed facial edema and ecchymosis without any other symptoms. Hospital courses of all cases were uneventful. We believe that 'fear response' or 'closure of the epiglottis' might be an important mechanism on developing symptom of traumatic asphyxia.
Asphyxia* ; Contusions ; Cough ; Cyanosis ; Ecchymosis ; Edema ; Elevators and Escalators ; Epiglottis ; Head ; Hemorrhage ; Humans ; Lung ; Neck ; Respiratory Insufficiency ; Vomiting

PURPOSE: The purpose of this study is to document the impact of computed tomography (CT) performed in the emergency department on elderly patients presenting with nontraumatic acute abdominal pain. METHODS: Forty patients were enrolled in this prospective study. Using a structured data collection instrument recording three primary endpoints before and after CT, emergency physicians were required to report their most likely diagnoses, levels of diagnostic certainty, and the treatment plans for their patients. The changes in the frequencies of each of these three endpoints from pre- to post-CT comprised the target variables. RESULTS: CT altered the treatment plan in 42.5% of the 40 patients, altered the clinical diagnosis in 40% of patients, and increased the diagnostic certainty in 57.5% of patients. Planned admission before CT was 36 patients; after CT, it was 28 patients. Planned surgery before CT was 13 patients, and after CT, it was 10 patients. Thus, the net effect of abdominal CT scanning was to avert 8 (22.2%) of 36 possible hospital admissions, and 3 (23%) of 13 possible surgeries. CONCLUSION: Abdominal CT performed in the emergency department significantly alters decision making when treating elderly patients with acute nontraumatic abdominal pain.
Abdominal Pain* ; Aged* ; Data Collection ; Decision Making ; Diagnosis ; Emergencies ; Emergency Service, Hospital ; Humans ; Prospective Studies ; Tomography, X-Ray Computed*