No abstract available.
Heart Failure* ; Heart*

BACKGROUND: Oxygen free radicals may play important role in coronary reperfusion resulting in cell death or dysfunction, and they believed that one specific mechanism for producing oxygen free radicals in myocardium is the xanthine oxidase system. Allopurinol, inhibitor of xanthine oxidase system, may limit myocardial dysfunction and injury produced by oxygen free radicals during coronary reperfusion. METHODS: Thirty isolated rabbit hearts undertook the retrograde nonworking perfusion for 15 minutes and followed by 15 minutes of working mode. After measurement of the hemodynamic values as baseline, all heart were arrested with cold cardioplegic solution for 60 minutes. Hearts were then revived with 15 minutes period of nonworking reperfusion, followed by 30 minutes of working reperfusion. The hemodynamic values were measured again at 20 minute of working period and expressed as percent of baseline values. Oxygen content of arterial perfusate and coronary effluent were measured and leakage of creatine kinase was measured from coronary effluent for 15 minutes of nonworking reperfusion. Wet and dry weight of the heart were obtained to determine for tissue water and water content. Animals were randomized as followings ; control(n=10), allopurinol PO(n=10, 100mg/kg before 24hr.), allopurinol IV(n=10, 10mg/kg before 1 hr.) RESULTS: 1) There were no significant differences in recovery of aortic pressure and heart rate between 3 groups. But there were significant differences in percent recovery of aortic flow, coronary flow, cardiac output and stroke volume between control group and allopurinol groups. 2) The leakage of creatine kinase following ischemic arrest was significantly lower in the allopurinol groups than the control group(control : 36.8+/-6.2IU, PO:19.7+/-3.1IU, IV : 22.2+/-4.6IU, p<0.001). 3) The allopurinol groups were significantly increased in oxygen extraction and oxygen consumption compared with the control((p<0.002, p<0.004)). 4) The tissue water and water content were significantly diminished in the allopurinol groups compared with the control group(p<0.003, p<0.001). 5) The electron micrograph showed more considerable structural damages of myocardial cell in the control group than the allopurinol groups. CONCLUSION: It is suggested from the results that allopurinol, inhibitor of xanthine oxidase, plays a inhibiting role in the production of oxygen free radicals, and improves myocardial protection during global ischemia and reperfusion in the isolating working rabbit heart model.
Allopurinol* ; Animals ; Arterial Pressure ; Cardiac Output ; Cardioplegic Solutions ; Cell Death ; Creatine Kinase ; Free Radicals ; Heart Rate ; Heart* ; Hemodynamics ; Ischemia ; Myocardial Reperfusion ; Myocardium ; Oxygen ; Oxygen Consumption ; Perfusion ; Reperfusion ; Stroke Volume ; Xanthine Oxidase

While Joint Commission on Accreditation of Healthcare Organizations(JCAHO) and American College of Surgeon(ACS) have identified certain audit filters in trauma care, there are few studies to substantiate the value of these audit filters. Some researchers found that audit filters qualifiers were significantly associated with adverse outcomes, however, others were unable to reproduce such association. It is also necessary to test their validity and applicability in Korea. The purpose of this present study was to validate two trauma audit filters proposed by the JCAHO and the ACS, through the analysis of the relationship between timeliness of operation and risk-adjusted mortality. Among trauma audit filters, timeliness of operation in epidural or subdural hematoma(EDH/SDH) and intraabdominal injury were selected. By stratified random cluster sampling, 19 emergency medical centers (EMCs) were selected from 30 EMCs and all patients who received craniotomy or laparotomy in 1996 were evaluated in each hospital. Six medical records administrators reviewed medical records of 463 patients with EDH/SDH and of 508 patients with intraabdominal injury retrospectively. In other to adjust risk of mortality, timeliness of operation, age, Revised Trauma Score(RTS), ICD-9CM based ICISS, and experiences of transfer were included in logistic regression model. In the logistic regression models of all EDH/SDH or intraabdominal injury patients, timeliness of operation was not significant predictor of mortality. However, if patients who have been operated later than 12 hours were excluded from the statistical model, timeliness of operation showed significant or marginally significant relationship with mortality in the following situations; craniotomy > 4 hours in EDH(OR=30.46, p=0.032), craniotomy > 8 hours in SDH(OR=6.50, p=0.020), laparotomy > 2 hours in shock patients(OR=9.26, p=0.055). In addition to timeliness of operation, RTS and ICISS were significant variables in every logistic regression model, and experience of transfer and types of EMC were significant or marginally significant only in EDH. Timeliness of operation as audit filters for trauma care could not be applied to all cases. Early operations seem to improve clinical outcome only in the patients for whom emergent craniotomy or laparotomy were indicated. It could be interpreted as a phenomenon of 'confounding by indication'. Additional studies to establish more objective eligibility criteria for these audit filiters are needed.
Accreditation ; Administrative Personnel ; Craniotomy ; Delivery of Health Care ; Emergencies ; Humans ; Joint Commission on Accreditation of Healthcare Organizations ; Joints ; Korea ; Laparotomy ; Logistic Models ; Medical Records ; Models, Statistical ; Mortality ; Retrospective Studies ; Shock

Sixteen cases under the age of 19 were underwent surgical treatment for hernlated lumbar intervertebral disc over 10 years of period in the Department of Orthopaedic Surgery,Catholic Medical College. The results were obtained as follows: 1. The incidence was 5.2% of all herniated lumbar intervertebral disc patients who treated surgically, but no sexual predilection. 2. Nine cases (56.3%) had a definite previous history of injuries. 3. Average intervals between the onset of clinical symptoms and the operation were 9.2 months. 4. Neurologic deficits are less severe and frequent (8 cases, 50%) but the clinical symptoms do not differ from than that of the adult. 5. 7 cases (43.8%) revealed definite reptured lumbar intervertebral discs and 5 cases (31.3%) are diffuse buldging of annular fibers in operative findings. 6. According to histopathological study, 8 cases show degenerative fibrocartilagenous changes in surgical specimen. 7. The radiological abnormalities of lumbar spine are less common than that of the adult. 8. Excellent or good results were found in 12 cases (75%) but two cases required a further surgical procedure. 9. In generally, hernlated Iumbar intervertebral disc in teenagers show better results and more rapid recovery of clinical symptoms by surgical treatment, and less residual symptoms than that of the adult.
Adolescent ; Adult ; Clinical Study ; Humans ; Incidence ; Intervertebral Disc ; Neurologic Manifestations ; Spine

No abstract available.
Blepharoplasty* ; Blepharospasm* ; Eyelids*

BACKGROUND: Studies of human coronary plaque specimens have shown that T lymphocytes and macrophages are present in all types of lesions, from fatty streaks to advanced plaques. There is growing evidence for a pathogenic role for immune response in progression of atherosclerosis. This study was designed to investigate cytokine production by mononuclear leukocytes from patients with myocardial infarction. METHOD: We measured the kinetics of secretion of tumor necrosis factor-alpha (TNF-alpha) and interferon-r (IFN-r) by mononuclear leukocytes from 8 control subjects and 12 patients with acute myocardial infarction. Mononuclear leukocytes were isolated and incubated with plant lectin mitogen concanavalin-A for 24 and 48 hours. TNF-alpha and IFN-r secretions were measured by ELISA. RESULTS:There were no significant differences between TNF-alpha and IFN-r secretions by mononuclear leukocytes at and before 24 hours of incubation from both patients and control subjects, but TNF-alpha and IFN-r secretions at 48 hours of incubation were higher (p<0.005, p<0.05) in patients when compared with control subjects. TNF-alpha and IFN-r secretions by mononuclear leukocytes after incubation correlated with the peak level of creatine phosphokinase (CK) and CK-MB. CONCLUSION: Increased cytokine secretory capacity of mononuclear leukocytes may be due to the acute inflammatory response of myocardial infarction. Further trials may be needed to determined the effects of increase in secretory capacity of mononuclear leukocytes before myocardial infarction.
Atherosclerosis ; Creatine Kinase ; Enzyme-Linked Immunosorbent Assay ; Humans ; Kinetics ; Leukocytes, Mononuclear* ; Macrophages ; Myocardial Infarction* ; Plants ; T-Lymphocytes ; Tumor Necrosis Factor-alpha*

Using the APCHE III tool, this study was about the factors related to the death of ICU-patients. From 1999. 12. 1 to 2000. 9. 30, the 284 patients admitted to ICU at P university who were over 15 years of age were selected for the subjets. The data was analyzed through SPSS WIN program for frequency, percentile, x2-test, t-test and logistic regression. The results are summarized as follows: 1) Of the 284 patients, 88died. The mortality is 31.0 percent. The average APACHE III point was 48.62 +/- 32.32. The average point of non-survivors was higher than that of survivors. 2) There are the significant difference between APACHE III marks and mortality. The mortality rate were over 50 percent 60 points of the mark. When the marks were over 100 points, the mortality were over 90 percent. Below 40 points, the mortality was below 10 percent. Among the variables in the APACHE III, the most significant variables in explaining death were neurologic abnormalities, pulse, PaO2/ AaDO2, creatinine, sodium, glucose, chronic health state and age. According to the variables, the models explained the 42.43 percent of the variance in patient's death. In conclusion, the APACHE III tool can be used to predict the progress of ICU patients, and can also be used for the selection of patients for ICU admission/discharge criteria.
APACHE* ; Creatinine ; Glucose ; Humans ; Logistic Models ; Mortality ; Sodium ; Survivors

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*

Granuloma gluteale infantum is a granulomatous lesion in the diaper area of infants. Athough usually seen in infants, it has been described in incontinent elderly patients. The causes of granuloma gluteale infantum are not clear, although child care equipment(ditergents1, diapers2, and starch3), corticosteroids2,4,5,6, candidial infection3 urine and feces7 have been postulated for its etiology. We report a case of granuloma gluteale infantum in a 5-month-old boy. He was healthy except for an asymtomatic 1.5×1.5cm sized, round, Rat-topped brownish and firm nodule on the perianal area, and two, 1×3cm and 1×6cm sized brownish plaques on the intertriginous area of the neck. The lesions were resistant to the treatment of systemic antibiotics. These nodules completely resolved in the three months after we tried to keep the diaper area clean without using any corticosteroids or other ointments and after changing from plastic diapers to cotton o A histological examination of the nodule on the perianal area showed mild hyperkeratosis, spongiosis, and focal infiltration of neutrophils in the epidermis. In the dermis, an inflammatory infiltrate composed of many lymphocytes, eosinophils, plasma cells, and histiocytes was
Adrenal Cortex Hormones ; Aged ; Anti-Bacterial Agents ; Child ; Child Care ; Dermis ; Eosinophils ; Epidermis ; Granuloma* ; Histiocytes ; Humans ; Infant ; Lymphocytes ; Male ; Neck ; Neutrophils ; Ointments ; Plasma Cells ; Plastics

No abstract available.
Gastrointestinal Stromal Tumors*