BACKGROUND: Emergency Medical Technicians can do emergency care only under the control of the physicians. Emergency medical services system(EMSS) in Korea is now extended from the level of basic life support(BLS) to advanced life support(ALS). Unfortunately we don't have any official medical control system yet. We and regional EMSS, 119 rescue team(BLS), have had monthly joint meeting to validate and improve the prehospital care since August, 1998. METHODS: From August, 1998 to February, 1999, 1,708 patients were transported to Ewha Mokdong Hospital by regional 119 rescue team. Eight hundred and six(47.2%) run record were collected and analyzed. The appropriateness of the prehospital care were evaluated based on the comparison of assessment data and treatment data in each run record. The run record were divided into 5 groups; 1) necessary-adequate, 2) necessary-inadequate, 3) necessary-undo, 4) unnecessary-done, and 5) unnecessary-undo. 1) and 5) were judged as acceptable, and 2), 3), and 4) as unacceptable. RESULTS: Among 806 transported patients, 60.8% required one or more emergency care. 21.0% of required care were not provided, and 20.7% of provided care were not adequate. 78.8% of unprovided and 75.9% of inadequate care were 'airway and oxygen supply'. Overall unacceptable rate was decreased from 31.7% to 17.0% during first 5 months, but it rose up again to 24.7% after 2 months. Cardiopulmonary resuscitation(CPR) was performed in 29 prehospital cardiac arrest victims and admitted to ICU in 5 cases. CPR was not provided in 8 necessary situations, and unnecessary CPR was done in 3 cases. CONCLUSION: EMSS in Korea also need a kind of medical control system, even for BLS level. Major portion of the quality assurance program could be 'airway and oxygen supply', but attention should be focused in cardiac arrest victims and CPR. Record keeping and reliance of run record data are now pending problems. Fire department should develop a formal medical control system and the referring hospital should have an organization for maintaining the quality of prehospital care.
Cardiopulmonary Resuscitation ; Emergency Medical Services* ; Emergency Medical Technicians ; Fires ; Heart Arrest ; Humans ; Joints ; Korea ; Oxygen ; Retrospective Studies*

Blood glucose levels were measured in 89 healthy term neonates during the first 72 hours using the SureStep, a newly developed reagent test strip method by LifeScan. The blood samples were obtained by heel-stick puncture and blood glucose concentrations were monitored at birth(0), 2, 4, 6, 12, 24, 48, and 72 hours after birth. Mean and standard deviation of their measurement were compared according to postnatal hours and type of delivery. Comparison of significance between mean plasma glucose levels were made with the Wilcoxon rank sum test and significance level of 0.05 was used to determine which pair-wise comparisons were significantly different. The mean plasma glucose concentrations of first 6 hours were significantly lower than those of 12, 24, 48, 72 hours. This finding indicates that plasma glucose stabilization in healthy fullterm neonates can be expected with the feedings. The mean plasma glucose concentration at birth in the neonates of cesarean section (64.5+-8.06 mg/dl) was significantly lower than that of vaginal delivery (80.3+-20.7 mg/dl), but there were no significant differences after 2 hours. This may be due to the difference in prenatal care of obstetric department of Horamae hospital (C/S: midnight NPO and Hartmann solution, V/D: NPO with labor pain and 5% dextrose solution intravenously). In summary, the changes in perinatal care, especially prenatal fluid therapy and time of first feeding should be considered in defining neonatal hypoglycemia. Our data suggest that hypoglycemia should he defined as below 40 mg/dl during the first 6 hours and below 55 mg/dl thereafter.
Blood Glucose* ; Cesarean Section ; Female ; Fluid Therapy ; Glucose ; Humans ; Hypoglycemia ; Infant, Newborn* ; Labor Pain ; Parturition ; Perinatal Care ; Plasma* ; Pregnancy ; Prenatal Care ; Punctures ; Reagent Strips*

No abstract available.
Breast Neoplasms* ; Breast* ; Drug Resistance, Multiple* ; Genes, MDR*

Congenital pseudarthrosis is frequently associated with various stigmata of neurofibromatosis, particularly Cafe-Au-Lait spots and,subcutaneous nodules and in these patients, it is noteworthy that the treatment is very difficult even with extensive operative approach. Also it is interesting to find many controversies on etiological relation between neurofibroma and pseudarthrosis, per se and even the existance of nerve element in and around the tissue of pseudarthrosis. A thirteen years old female patient with definite neurofibromatosis associated with congenital tibial pseudarthrosis treated by intramedullary nailing and massive bone graft is reported.
Cafe-au-Lait Spots ; Christianity ; Female ; Fracture Fixation, Intramedullary ; Humans ; Neurofibroma ; Neurofibromatoses ; Pseudarthrosis ; Transplants

The Dichloromethane(methylene chloride) is a highly volatile liquid used as a solvent, extraction medium, and paint remover. The most significant route of intoxication to dichloromethane is generally inhalation at work site or home, but ingestion is rare. The main toxicological harvard insults from in vivo conversion of dichloromethane to carbon monoxide. We present a case of dichloromethane intoxication following ingestion. A 71 years old male patient ingested 60-70cc of dichloromethane was brought to emergency department after stomach washout via nasogastric tube at other hospital. On arrival at emergency department(approximately 19 hours after ingestion), he was stuporous with a blood pressure 140/90mmHg, heart rate of 92 beats/min, dyspneic, respiratory rate of 24/min and body temperature 36.8 degrees C. His Pupils were isocoric, miotic, and sluggishly reactive. There were mucosal bums and significant secretion in oral cavity. On auscultation, breathing sound was coarse without role on both lung field. The COHb levels were 6.3%at 32 hours after ingestion and normalized to 0.6%at 44 hours after ingestion. Patient was transfered to intensive care unit and supportive care was started with 100% oxygen. On ingestion 4th day, chest X-ray showed pulmonary edema and acute respiratory distress syndrome developed. Patient regained the consciousness on the 11th day. On the 30th day, respiratory function improved and the ventilator was removed. Alveolitis and mild pulmonary fibrosis developed and mild dyspnea was continued. On the 36th day, gastroscopic examinations showed ulceration of esophagus and stomach. On the 76th day, patient was discharged after pulmonary rehabilitation.
Aged ; Auscultation ; Blood Pressure ; Body Temperature ; Carbon Monoxide ; Consciousness ; Dyspnea ; Eating* ; Emergencies ; Emergency Service, Hospital ; Esophagus ; Heart Rate ; Humans ; Inhalation ; Intensive Care Units ; Lung ; Male ; Methylene Chloride* ; Mouth ; Oxygen ; Paint ; Pulmonary Edema ; Pulmonary Fibrosis ; Pupil ; Rehabilitation ; Respiratory Distress Syndrome, Adult ; Respiratory Rate ; Respiratory Sounds ; Stomach ; Stupor ; Thorax ; Ulcer ; Ventilators, Mechanical ; Workplace

Although the distribution of locus ceruleus terminals has been demonstrated in the fundus striati[nucleus accumbens septi] by light microscopy[Jones & Moore, 1977 ; Mason & Fibiger, 1979 ; Streit or et al., 1979 ; Groenewegen et al., 1980], the synaptic organization of its terminals was not clarified. The purpose of the present investigation was to demonstrate the direct monosynaptic connection of the locus ceruleus terminals to the neuronal elements of the fundus stirati, and to clarify the synaptic structures of its terminals by electron microscopy two days after unilateral electric coagulation of the locus ceruleus. In the ipsilateral fundus striati, many axon terminals undergone dark degeneration were observed. These degenerating terminals containing small clear vesicles have asymmetric synaptic contacts with dendritic spines. Already two days after locus ceruleus lesion, distinct features of terminal degenerations appeared in the fundus striati ; enlarged axon terminals with altered synaptic vesicles, decrease of synaptic vesicles detached from the synaptic site, multiplication of dense bodies and infiltration of floccular material. At the same time, a regressive change occurred in which astrocytic processes encircled totally degenerated synapses spiraled around the synaptic remnants. These observations indicate that monosynaptic noradrenertic afferent connections to the fungus striati are confirmed, and the locus ceruleus terminals characterized by small round vesicles might be formed asymmetrical axo-spinous synapses with spiny neurons in the fundus striati.
Animals ; Cats* ; Dendritic Spines ; Fungi ; Locus Coeruleus* ; Microscopy, Electron ; Neurons ; Presynaptic Terminals ; Synapses ; Synaptic Vesicles

A putative polypeptide hormone identified as amylin[islet amyloid polypeptide] is synthesized and co-localized with insulin in B cells of pancreatic islets in several animal species including man. However, there is growing evidence that somatostatin cells are also expressed and contained amylin in the pancreatic islets of the rat The aim of the present study was to investigate the immunocytochemical expression of the amylin within the endocrine pancreas of the man, rabbit and guinea pig, with special reference to the possible ability of islet cells other than insulin cells to synthesize amylin. For this purpose serial sections of the pancreatic islets were stainedimmunocytochemically using anti-amylin, anti-insulin, anti-glucagon, anti-somatostatin antisera. In serial sections of pancreatic islets of the man and rabbit, it was shown that amylin immunoreactivity occurred in insulin-reactive B cells predominantly located in interior of the islets. In contrast, amylin immunoreacivity appeared in glucagon-reactive A cells peripherally located in the islets of the guinea pig. These results suggest that in both the man and rabbit, amylin is synthesized by B cells for subsequent co-secretion with insulin, and that in guinea pig, amylin is synthesized by A cells for co-secretion with glucagon. It thus appears that amylin release may be mediated by different secretory mechanisms according to animal species.
Amyloid ; Animals ; B-Lymphocytes ; Glucagon ; Guinea Pigs* ; Guinea* ; Immune Sera ; Immunohistochemistry ; Insulin ; Islet Amyloid Polypeptide* ; Islets of Langerhans* ; Rats ; Somatostatin-Secreting Cells

Oxyen consumption of surgical patients was measured by McKesson Metabolar (Model 185) on the Recording Metabolar Chart (M-147) in four groups: group A, at resting state immediately before preanesthetic medication; group B, immediately following induction of anesthesia with thiopental (10 mg./kg.); group C. 30 minutes after surgical ether anesthesia; and group D, when conciousness returned during the stay in the recovery room. The results are as follows: (1) Thiopental reduced oxygen consumtion by 25 per cent. (2) Ether anesthesia reduced, oxygen consumption by 59 per cent. (3) During recovery from anesthesia, oxygen consumption was 28 per cent below the control. (4) Comparing with other data, ether anesthesia reduced oxygen consumption significantly more than fluothane or nitrous oxide did.
Anesthesia ; Anesthesia, General* ; Ether ; Halothane ; Humans ; Nitrous Oxide ; Oxygen Consumption* ; Oxygen* ; Preanesthetic Medication ; Recovery Room ; Thiopental

Moyamoya disease is a rare occlusive cerebrovascular disease characterized by stenosis or occlusion of the main cerebral arteries. It has a tendency for multifactorial inheritance and familial occurrence, although its pathogenesis is not clear. We observed this disease in two girls from the same family:one was eight years old and the other was 45 months. They presented with transient ischemic attacks. We performed cerebral angiography on both patients and magnetic resonance angiography (MRA) on the younger. Both approaches showed the typical features of moyamoya disease, and MRA successfully revealed abnormal findings specific for the disease in the second child. Both children received encephaloduroarteriosynangiosis (EDAS) and this produced good results. MRA is thus a powerful and noninvasive way of detecting individuals at high risk of developing this disease. Considering the reported familial incidence of moyamoya disease in Japan, a careful search for family members using MRA would probably reveal many more such cases in Korea.
Cerebral Angiography ; Cerebral Arteries ; Child ; Constriction, Pathologic ; Female ; Humans ; Incidence ; Ischemic Attack, Transient ; Japan ; Korea ; Magnetic Resonance Angiography ; Moyamoya Disease* ; Multifactorial Inheritance

No abstract available.
Gestational Age* ; Humans ; Infant, Newborn*