Heat stroke, a medical emergency, occurs when the body's thermal regulation is upset and unable to dissipate adequate amounts of heat with a rise in body temperature. It is characterized by hyperyrexia, with a core temperature of 40degrees C or more, hot dry skin, and central nervous system disturbance and usually results in rhabdomyolysis and multiorgan failure. Our case, a 43-year-old healthy male, was caused by a marathon, half course, on a sunny day in late summer. He suddenly fell down on the road and was delivered to a nearby hospital, where a seizure developed. He was transfered to our hospital and then displayed Central Nervous System disturbance, hot dry skin, acute liver failure, rhabdomyolysis, anuric acute renal failure, and disseminated intravasculular coagulopathy. He was treated with general supportive care and hemofiltration. Despite the aggressive management, he died of shock on the fifth day after admission.
Acute Kidney Injury ; Adult ; Body Temperature ; Central Nervous System ; Emergencies ; Heat Stroke* ; Hemofiltration ; Hot Temperature* ; Humans ; Liver Failure, Acute ; Male ; Rhabdomyolysis ; Seizures ; Shock ; Skin

No abstract available.

The femoral neck in children is dense and is small in diameter and its periosteum is thicker and stronger than that of an adult. Thus, fractures of the femoral neck in children, unlike the 60-year-old woman, are rare and usually require severe violence and this accounts for the high frequency of associated injuries. Since these fractures are rare and the femoral neck in children has many anatomic and physiologic differences, we have to consider some factors that work against treatment of these fractures. Twenty seven cases of fractures of the femoral neck in children which were treated at Severance Hospital, Yonsei University College of Mediicne from Jan. 1971 to Dec. 1980 were analyzed both clinically and radiologically and the following results were obtained. 1. Among the 27 patients, the ratio of boys and girls was 2:1 and the highest incidence was between the ages of 3 and 5 years. 2. The main course of fractures was traffic accidents, 14 cases (51.9%) and the other causes were falling from a height (37.0%) and a few cases of a slip and a fall. 3. According to the classification of Delbet and Colonna, the cervico-trochanteric fracture (40.8%) was the commonest type and 13 cases (48.1%) were displaced fractures. 4. Common associated injuries were pelvic bone fractures, skull fractures, cerebral concussion and soft tissue injuries. 5. Fifteen cases (55.6%) were treated by conservative treatment and ten cases (37.0%) by closed reduction & internal fixation. 6. 23 of the 27 cases were followed for from 6 months to 10 years, average 19 months. The results were analyzed according to Ratliffs assessment and 14 cases (60.9%) showed good results. 7. Total cases with complications were 14 (60.9%), the commonest complication being coxa vara (40.8%) and the other main complications being premature epiphyseal closure (39.1%) and avascular necrosis (30.1%). 8. Secondary treatment was done in 6 cases and correction osteotomy was done in 4 cases which had showed a poor result. 9. Finally, factors affecting results were type of fracture, degree of displacement, maintenance of reduction, interval between injury and treatment, complications and patients age. 10. The authors recommend closed reduction and internal fixation with some threaded pins for all type II and type III fractures.
Accidental Falls ; Accidents, Traffic ; Adult ; Brain Concussion ; Child ; Classification ; Clinical Study ; Coxa Vara ; Female ; Femur Neck ; Humans ; Incidence ; Middle Aged ; Necrosis ; Osteotomy ; Pelvic Bones ; Periosteum ; Skull Fractures ; Soft Tissue Injuries ; Violence

BACKGROUND: There have been no studies of airway management strategies for difficult intubation and cannot intubate, cannot ventilate (CICV) situations in Korea. This study was intended to survey devices or methods that Korean anesthesiologists and intensivists prefer in difficult intubation and CICV situations. METHODS: A face-to-face questionnaire that consisted of a doctor's preference, experience and comfort level for alternative airway management devices was presented to anesthesiologists and intensivists at study meetings and conferences from October 2014 to December 2014. RESULTS: We received 218 completed questionnaires. In regards to difficult intubation, the order of preferred alternative airway devices was a videolaryngoscope (51.8%), an optical stylet (22.9%), an intubating laryngeal mask airway (11.5%), and a fiber-optic bronchoscope (10.6%). One hundred forty-two (65.1%) respondents had encountered CICV situations, and most of the cases were identified during elective surgery. In CICV situations, the order of preferred methods of infraglottic airway management was cricothyroidotomy (CT) by intravenous (IV) catheter (57.3%), tracheostomy by a surgeon (18.8%), wire-guided CT (18.8%), CT using a bougie (2.8%), and open surgery CT using a scalpel (2.3%). Ninety-eight (45%) of the 218 respondents were familiar with the American Society of Anesthesiologists' difficult airway algorithm or Difficult Airway Society algorithm, and only 43 (19.7%) had participated in airway workshops within the past five years. CONCLUSION: The videolaryngoscope was the most preferred device for difficult airways. In CICV situations, the method of CT via an IV catheter was the most frequently used, followed by wire-guided CT method and tracheostomy by the attending surgeon.
Airway Management ; Bronchoscopes ; Catheters ; Congresses as Topic ; Education ; Intubation* ; Intubation, Intratracheal ; Korea* ; Laryngeal Masks ; Methods ; Surveys and Questionnaires ; Tracheostomy

The objectives of this study are to investigate the prevalence of occupation related carpal tunnel syndrome(CTS) among workers in a condom industry; to analyse the sensitivity and specificity of clinical signs or symptoms such as hand diagram, Tinel's sign and Phalen's sign in carpal tunnel syndrome; and to test vibration threshold test using audiometry as a technically easy and noninvasive method in the diagnosis of carpal tunnel syndrome in stead of nerve conduction velocity(NCV). The study group was divided into exposed group(39 cases)and non-exposed group(48 cases) based on whether or not excessive use of wrist movements exist. 1. There are statistically significant differences in symptoms and signs of carpal tunnel syndrome such as hand diagram, Tinel's sign and Phalen's sign between exposed and non-exposed group(p<0.05). 2. Six cases(9 hands) were confirmed as carpal tunnel syndrome by NCV. Five cases(7 hands) belonged to exposed group, 1 case(2 hands) to nonexposed group. As there are significant differences in prevalence of carpal tunnel syndrome between two groups(p<0.05), excessive use of wrist in occupation is a risk factor of carpal tunnel syndrome. 3. When we use NCV as a gold standard in the diagnosis of carpal tunnel syndrome, sensitivity and specificity of hand diagram, Tinel's sign and Phalen's sign is as followed; hand diagram; sensitivity 88.9%, specificity 84.2%. Tinel's sign; sensitivity 55.6%, specificity 72.8%. Phalen's sign; sensitivity 14.3%, specificity 88.4%. Among above clinical signs and symptoms, hand diagram is the best clinical screening test. 4. The differences of vibration threshold between median and ulnar nerve at the same time are useful in the diagnosis of carpal tunnel syndrome but the time change of vibration threshold of median nerve over time are not sensitive enough. It is concluded that vibration threshold between median and ulnar nerve at the same time can be used as a supplementary or alternative criterion to indicate that the nerve dysfunction is located in the carpal tunnel.
Audiometry ; Carpal Tunnel Syndrome* ; Condoms* ; Diagnosis ; Hand ; Mass Screening ; Median Nerve ; Neural Conduction ; Occupations ; Prevalence ; Risk Factors ; Sensitivity and Specificity ; Ulnar Nerve ; Vibration ; Wrist

BACKGROUND: Overweight and obesity are associated with increased mortality and morbidity. Obesity is influenced by multiple factors, both genetic and environmental factors. We investigated the relationship between socioeconomic, behavioral, dietary, reproductive factors and body mass index(BMI). METHODS: The subject were 3000 adults who had visited the Health Screening and Diagnosis Center of Yeungnam University School of Medicine from February to June, 1997. We evaluated BMI and occupation, exercise, smoking, alcohol intake, total calory intake, fat and carbohydrate intake in both gender and reproductive factors in women. Then, we analyzed the association between BMI and such variables as above. RESULTS: 1629 men and 1371 women were analyzed. The mean BMI was 23.4+/- 2.8kg/M(2) in men, 22.9+/- 3.1kg/M(2) in women. In both gender, 9.7% of our population had BMl over 27. Mean BMI increased with age. Those who were active and light smokers( 20cigarette/day) had the lowest BMI in men. But no relationship was observed between BMI and exercise, smoking in women. Heavy alcohol drinkers(> 1cup/day) had higher BMI than other group in both gender. We found significant correlation between BMI and total calory intake, calory intake to recommended calory ratio in both gender. In women, the group whose number of parity was above 3 had significantly higher BMI than the other. And age at first birth was significantly correlated with BMI in a negative direction. CONCLUSIONS: Our results showed that BMI was associated with age, smoking, alcohol, total calory intake, calory intake to recommended calory ratio, parity, age at first birth. Socioeconomic class, exercise and diet composition appeared to have little influence.
Adult* ; Birth Order ; Body Mass Index* ; Diagnosis ; Diet ; Female ; Humans ; Male ; Mass Screening ; Mortality ; Obesity ; Occupations ; Overweight ; Parity ; Smoke ; Smoking ; Social Class

PURPOSE: To evaluate the relationship between the hormone receptor status, histologic grade and, the film-mammographic findings in primary breast cancer. MATERIALS AND METHODS: 198 breast cancer patients with hormonal receptor assay were included in this study. Estrogen receptor (ER) and progesterone receptor (PR) were determined by immunohistochemical method and enzyme-immunoassay. And film-mammographic findings were evaluated to disclose the relationship among the three variables (film-mmamographic findings, histologic grade and hormonal receptor status). Film- mammographic findings of the breast cancer are classified as spiculation, increased parenchymal density, calcification and mass. RESULTS: There is no correlation between estrogen receptor and histologic grade in 154 patients. Some correlation between estrogen receptor by enzyme-immunoassay and by immunohistochemistrical methods with 28 available data were observed (R=0.428). Among high estrogen receptor (ER) patients, there is a high possibility of spiculation or mass in mammography with 79 available data (Modified t-test, P<0.01). CONCLUSION: Spiculation or/and mass of the mammography can be related to the high possibile factor of the positive estrogen receptor or high level of estrogen receptor in primary breast cancer.
Breast Neoplasms* ; Breast* ; Estrogens ; Humans ; Mammography ; Receptors, Progesterone

PURPOSE: To determine the in vivo bone formation on an osteoblastic cells-scaffold composite and the best scaffold for bone formation. This study focused on the three-dimensional culture of osteoblastic cells using various tissue-engineered scaffolds and compared the suitability of those scaffolds. MATERIALS AND METHODS: Mesenchymal stem cells were harvested from New Zealand white rabbits and were differentiated into osteoblastic cells. The expression of osteogenic proteins in osteoblastic cells was observed by RT-PCR and a phase of mineralization was checked using von Kossa staining. In addition, three-dimensional cultured osteoblastic cells-scaffolds composites using a variable scaffold were observed by scanning electron microscopy. The cell-scaffold composites were transplanted into athymic nude mice. X-ray, a histochemical study, and immunohistochemistry were used to evaluate the in vivo bone formation. RESULTS: The mesenchymal stem cells proliferated quite well in the early phase and differentiated into osteoblastic cells by an inducing substance. The osteoblastic cells were observed as spindle and polygonal shapes and were mineralized. Expression of the osteoblastic proteins was observed continuously after 2-3 weeks. The amount of osteocalcin secretion increased for 6-7 weeks. The osteoblastic cells adhered more to the human and porcine bone than to the hydroxyapatite-scaffold. In the case of the PLGA scaffold, the cells proliferated and formed a net-like structure but did not adhere well. No Living cells were observed in the calcium alginate scaffold. However, after the in vivo transplant, abundant cells and new tissue were observed within the human bone, porcine bone, hydroxyapatite, and PLGA but not within the calcium alginate scaffold. CONCLUSION: In the three-dimensional cultures, natural bone was found to be a more effective and suitable scaffold for cell culture than the various synthetic polymers.
Animals ; Bone Marrow* ; Calcium ; Cell Culture Techniques ; Durapatite ; Humans ; Immunohistochemistry ; Mesenchymal Stromal Cells ; Mice ; Mice, Nude ; Microscopy, Electron, Scanning ; Osteoblasts ; Osteocalcin ; Osteogenesis ; Polymers ; Rabbits

OBJECTIVES: The purpose of the present study was to evaluate the whitening effect, morphological and structural changes, and remineralization of the enamel induced by 3 combined agents: amorphous calcium phosphate (ACP), hydroxyapatite (HA), and tetrasodium pyrophosphate (TSP). METHODS: The study was performed on 90 bovine enamel slabs, which were divided into the 6 groups: negative control-distilled water (Group 1); positive control-opalescence F (Group 2); 10% mixed agent (Group 3); 25% mixed agent (Group 4); 50% mixed agent (Group 5); and 100% mixed agent (Group 6). Changes in the shade of the enamel slabs were evaluated using Shade Eye-NCC. Morphological changes were assessed by scanning electron microscopy (SEM) and confocal laser scanning microscopy (CLSM) was used to determine the remineralizing effect of the three agents on enamel slabs. RESULTS: The change in shade of the enamel (ad*) was noted to increase significantly with increase in whitening frequency in all groups. The value of Δn* was significantly greater in all groups except for the negative control group (P<0.001). SEM revealed that the control group, Group 5, and Group 6 had similar morphologies. The fluorescence lesion areas in the 4 mixture-treated group were significantly smaller than those in the positive control group (P<0.001). CONCLUSIONS: These results showed that the mixture of ACP, HA, and TSP was highly effective for bovine enamel whitening and acted by inducing the remineralization of enamel. CLINICAL SIGNIFICANCE: We evaluated the applicability of a new mixture containing ACP, HA, and TSP. This mixture would be highly useful in aesthetic dentistry because of its whitening efficiency, which does not compromise the enamel's integrity.
Calcium* ; Dental Enamel* ; Dentistry ; Durapatite* ; Fluorescence ; Microscopy, Confocal ; Microscopy, Electron, Scanning ; Water

OBJECTIVES: The prejudice against the mentally deranged persons has an effect on the treatment of the mental illness and is one of the reasons why they have difficulties in social adaptation and rehabilitation. We intended to examine the characteristics and expression of the anger in schizophrenic patients to find how much anger they feel compared with general population. And we tried to find the basis on which the prejudice can be corrected. METHOD: 105 schizophrenic patients were selected according to DSM-IV. Control groups were 43 patients who were admitted to the department of internal medicine in university hospital and 65 healthy adults. The experiences and expressive patterns of anger were surveyed by State-Trait Anger Expression Inventory, Korean edition. And the characteristics of the anger in the schizophrenic patients were compared with those in controls and analyzed. RESULTS: Stateanger was significantly higher in the schizophrenic patients group than in healthy control group and trait-temperament was significantly lower in schizophrenic patients group than in other two control groups. Among the anger expression scales, anger-in and anger-control were significantly lower in schizophrenic patients group than in healthy control group. But trait-reaction and angerout showed no significant difference among three groups. And no significant difference was shown among the anger scales of three groups according to the presence of insight of the disorder. CONCLUSION: It is shown that schizophrenic patients have considerably much anger when compared to healthy control group and insufficient ability to suppress and control the anger. But it may be said that the expressions of anger in schizophrenic patients are not apparent. These results may be due to either the weakness of ego function, which is one of the symptoms of schizophrenia, or negative symptoms following chronicity of the disorder. Unex-pected aggressiveness or violence of them may be triggered by stimuli from the circumstances, if they are not in acute phase. And the misunderstanding of general public that schizophrenic patients are dangerous unconditionally should be corrected by the education. We can't develop the appropriate strategy to cope with the anger of the schizophrenic patients until we under-stand well the characteristics of anger in them.
Adult ; Anger* ; Diagnostic and Statistical Manual of Mental Disorders ; Education ; Ego ; Humans ; Internal Medicine ; Prejudice ; Rehabilitation ; Schizophrenia* ; Violence ; Weights and Measures