BACKGROUND: Care for prehospital cardiac arrest is one of the major concerns of emergency medical services. But, in Korea, prehospital emergency medical service systems are not yet well established. We tried to offer one of the fundamental data for development of these systems. METHODS: After application of exclusion criteria, 183 patients who transferred to emergency center of our hospital after cardiac arrest in consecutive 24 months from Jan,1,1994 to Dec,31,1995 were included in this study. Retrospective review of the hospital charts of these patients was done. For statistical analysis, we divided patients to some categories. t-test or chi-square analysis was used. RESULTS: 24 patients of the 183 patients were secondary visitors(cardiac arrest was occurred during transfer from other hospitals), 159 patients were primary visitors. In the primary visitor group, only one third was ambulance visitors, and there is no statistical differences between arrest time of ambulance visitors and non-ambulance visitors(35+/-27 vs 37+/-24 min, p=NS). No organized bystander CPR was done. After arrival, 131 patients received CPR and 87 patients(66.4%) were not responded, 31 patients(23.1%) experienced transient ROSC, 13 patients(10.0%) survived until discharge, and only 2 patients(1.5%) were returned to their lives. CONCLUSION: We failed to find significant statistical survival differences between ambulance visitors and non-ambulance visitors, between presumed cardiac etiology group and non-cardiac etiology group. Survival rate was high in witnessed arrest group than unwitnessed arrest group(14.5% vs 2.1%, p=0.015).
Ambulances ; Cardiopulmonary Resuscitation ; Emergencies ; Emergency Medical Services ; Heart Arrest* ; Humans ; Korea ; Retrospective Studies ; Survival Rate

BACKGROUND/AIMS: Combined esophageal variceal ligation and sclerotherapy has been hypothesized to be more effective for the control of bleeding esophageal varices than ligation alone. The present study was to compare the combined therapy with ligation alone in terms of variceal eradication, rebleeding, complication and survival rates in patients with bleeding esophageal varices. METHODS: Thirty-eight patients with bleeding esophageal varices were randomly assigned to receive ligation alone in 20 patients or the combined therapy in 18 patients. The clinical and endoscopic characteristics of patients in the ligation group were similar to those of patients in the combination group. In the combination group, 1-3 mL of ethanolamine was injected proximal to each ligated site. Treatments were repeated every 2- to 3-month until varices were eradicated. RESULTS: No significant differences were found between the ligation and combination groups in variceal eradication rates (70% vs. 72%), numbers of endoscopic sessions required to achieve eradication (3.5+/-0.33 vs. 3.3+/-0.31), rebleeding rates (30% vs. 28%) or 2-yr cumulative survival rates (95% vs. 75%). There were significantly more complications in the combination group (25% vs. 89%, p=0.001). CONCLUSION: Ligation alone is recommended rather than the combined ligation and sclerotherapy because of its lower complication rates.
Esophageal and Gastric Varices* ; Ethanolamine ; Hemorrhage* ; Humans ; Ligation* ; Sclerotherapy* ; Survival Rate ; Varicose Veins

BACKGROUND/AIMS: Combined esophageal variceal ligation and sclerotherapy has been hypothesized to be more effective for the control of bleeding esophageal varices than ligation alone. The present study was to compare the combined therapy with ligation alone in terms of variceal eradication, rebleeding, complication and survival rates in patients with bleeding esophageal varices. METHODS: Thirty-eight patients with bleeding esophageal varices were randomly assigned to receive ligation alone in 20 patients or the combined therapy in 18 patients. The clinical and endoscopic characteristics of patients in the ligation group were similar to those of patients in the combination group. In the combination group, 1-3 mL of ethanolamine was injected proximal to each ligated site. Treatments were repeated every 2- to 3-month until varices were eradicated. RESULTS: No significant differences were found between the ligation and combination groups in variceal eradication rates (70% vs. 72%), numbers of endoscopic sessions required to achieve eradication (3.5+/-0.33 vs. 3.3+/-0.31), rebleeding rates (30% vs. 28%) or 2-yr cumulative survival rates (95% vs. 75%). There were significantly more complications in the combination group (25% vs. 89%, p=0.001). CONCLUSION: Ligation alone is recommended rather than the combined ligation and sclerotherapy because of its lower complication rates.
Esophageal and Gastric Varices* ; Ethanolamine ; Hemorrhage* ; Humans ; Ligation* ; Sclerotherapy* ; Survival Rate ; Varicose Veins

A neurilemmoma is a rare nerve sheath tumor in dermatology. The tumors are usually solitary and affect woman more frequently than men, but with no particular affinity for any age group. It occurs commonly along the main nerve trunks of the extremities, especially the flexor surface of the arms, wrists, and knees. We report a case of neurilemmoma on the left nasal vestibule of 47-years old woman. The tumor was a solitary, pinkish, polypoidal papule which gradually increased in size. A review of the literature revealed extremely rare documented cases of neurilemmoma occurring in the nasal vestibule.
Arm ; Dermatology ; Extremities ; Female ; Humans ; Knee ; Male ; Middle Aged ; Neurilemmoma* ; Wrist

We analyzed the result of the tests about HBs Ag, HCv Ag, HIV Ag and VDRL in the blood of the donor and evaluated sex and age distribution, cause of death of the donor, which were obtained from Central Eye Bank at St. Mary's Hospital from January 1, 1993 to December 31, 1994. 1. Hepatitis B surface Ag in the blood was positive in 13 donors(4.80%) and Hepatitis C Ag was in 4 donors(1.48%). 2. VDRL test in the blood was positive in 11 donors(4.06%) and HIV Ag was in 1 donor(0.37%). 3. In sex and age distribution, 128 donors(47.23%) were male and 3 donors(52.77%) were from 71 to 80 years was the major group of donors(67 donors: 24.72%). 4. The most common cause of death was respiratory disease(94 donors: 34.69%) and then tumor(76 donors: 28.04%), circulatory disease(66 donors: 24.35%), metabolic disease (19 donors: 7.01%), infection(9 donors: 3.32%) and trauma(7 donors: 2.58%).
Age Distribution ; Cause of Death ; Eye Banks ; Hepatitis B ; Hepatitis C ; HIV ; Humans ; Male ; Metabolic Diseases ; Tissue Donors*

Differences in ability to produce the specific phenolic glycolipid-Tb (PGL-Tb) antigen among Mycobacterium tuberculosis strains have been reported. One of the explanations would be the genotypic variation between the strains. In this study, we compared the DNA fragment patterns after digestion of DNA with various restriction enzymes between the PGL-Tb producing and non-producing strains of M. tuberculosis. Three clinical isolates of M. tuberculosis producing the PGL-Tb antigen detectable by thin-layer chromatography, and M. tuberculosis H37Rv and M. bovis BCG not producing the antigen were grown in Sauton medium. The chromosomal DNA was digested with the restriction endonucleases, Eco RI, Sau3A I, BamH I, Xho I, Sma I, Pst I, Hinc II, and Bst EII. Most of the restriction enzymes used gave no clear DNA bands or no DNA fragment common just to the PGL-Tb producing strains. When DNAs were digested with Bst EII, however, there was a 13 kb DNA fragment common to the PGL-Tb producing isolates of M. tuberculosis and not present in the H37Rv strain and M. bovis BCG. This study thus suggests that there might be differences in DNA fragment patterns between the PLG-Tb producing and non-producing strains of M. tuberculosis.
Base Sequence ; Comparative Study ; DNA Restriction Enzymes ; DNA, Bacterial/*metabolism ; Glycolipids/*biosynthesis ; Molecular Sequence Data ; Mycobacterium tuberculosis/*genetics/metabolism ; Support, Non-U.S. Gov't ; Tuberculosis/microbiology

BACKGROUND: Coronary artery target lesion calcification may be an important determinant of the arterial response to catheter therapy for coronary arterial disease. The excimer laser coronary angioplasty(ELCA) has been reported to be a promising treatment for complex coronary artery disease. However, the effects of ELCA is not well known against the calcified target lesion. METHODS: To assess the arterial and plaque remodeling in calcified lesions after excimer laser coronary angioplasty, we used a comprehensive intravascular ultrasound(IVUS) imaging system(25MHz rotation transducer, 3.9 Fr monorail imaging sheath, motorized transducer pull back at 0.5mm/sec and quantification) to study 23 patients(1 left main, 10 LAD, 4 LCX, 6 RCA, 2 SVG) before and immediately after ELCA(the AIS 308nm XeCl excimer laser, pulse width >200nsec, pulse frequency 20Hz, energy density 35-65mJ/mm2). Paired before and after ELCA image slices were analysed ; and extermal elastic membrane, lumen, plaque+media(P+M) and calcium cross-sectional area(CSA) measured; and their differences after ELCA calculated. RESULTS: The IVUS results about the therapeutic effects of ELCA showed the enlargement of lumen CSA from 1.5+/-0.4 to 3.2+/-0.9mm2(p<0.001) and decreased of P+M CSA from 14.6+/-3.8 to 13.4+/-3.6mm2(p<0.001) without arterial expansion. The decrease of calcium CSA from 1.8+/-0.7 to 1.5+/-0.6mm2(p<0.001) and the formation of small, superficial fissures within the calcified plaque(15/23 lesions) were noted. The number of small fissures correlate with the calcium CSA significantly(r=0.61, p<0.001). CONCLUSION: The plaque and calcium ablation is the main effects of ELCA in calcified lesion, and the calcium ablation and fissure formation after ELCA may contribute to decrease the dissection and improve the success after ajunctive PTCA.
Angioplasty* ; Calcium ; Catheters ; Coronary Artery Disease ; Coronary Vessels ; Lasers, Excimer* ; Membranes ; Transducers ; Ultrasonography*

Percutaneous transluminal renal angioplasty(PTRA) has become the treatment of choice for major renal artery stenosis. Nonetheless, about 10% of renal artery stenosis could not be properly dilated and 10-15% had a recurrence among the parients successfully dilated. Especially, PTRA in Takayasu's arteritis has technical diffculties due to the tough, noncompliant nature of the stenosis, which art difficult to cross and resist the respeated, prolonged balloon inflations. Intraluminal renal artery stent placement in unsuccessful balloon angioplasty and unsuitable lesions to PTRA may be an attractive approach to improve flow conditions. We report two cases of proximal renal artery stenosis caused by Takayasu's arteritis, who treated with intraluminal renal stenting(Palmaz-Schatz biliary stent). In both cases, clinical and angiographical improvement was achieved.
Angioplasty, Balloon ; Constriction, Pathologic ; Recurrence ; Renal Artery Obstruction* ; Renal Artery* ; Stents* ; Takayasu Arteritis*

A 21-year-old woman found to be hypertensive was referred for hypertension. On examination, blood pressure was 170/110mmHg in the right arm, 160/100mmHg in left arm,and 120/70mmHg in legs. A grade 2/6 systolic ejection murmur was present at the left upper sternal border, and a chest x-ray revealed a rib notching on the inferior margin of 4th rib. Two-dimensional echocardiogram showed the coarctation of aorta beyound the origin of the left subclavian artery. Biplane TEE demonstrated a discrete narrowing of the descending aorta at the site of coarctation. The blood pressure was 169/86mmHg in ascending aorta and 118/84mmHg in descending aorta. Aortogram showed a localized coarcted aortic segment of 7mm in diameter and 5mm long just distal to the left subclavian artery. Balloon coarctation angioplasty was performed with 7F 30x15mm pediatric balloon dilatation catheter. Balloon position was confirmed on fluoroscopy by the hourglass appearance of the balloon inflation and thereafter, the balloon was inflated until the waist of the balloon disappeared. After procedure, a pull back pressure tracing across the coarctation of aorta revealed no pressure gradient between ascending and descending aorta with 141/90mmHg. Aortogram showed an increase in diameter of the coarctation of aorta to 18mm with aneurysmal formation. 3 months later, follow up aortogram showed no significant change in diameter of coarctation of aorts or aneurysmal formation. Nonsurgical balloon coarctation angioplasty appears to be an alternative therapy for the coarctation of aorta in adults.
Adult* ; Aneurysm ; Angioplasty* ; Angioplasty, Balloon ; Aorta ; Aorta, Thoracic ; Aortic Coarctation* ; Arm ; Blood Pressure ; Catheters ; Dilatation ; Female ; Fluoroscopy ; Follow-Up Studies ; Humans ; Hypertension ; Inflation, Economic ; Leg ; Ribs ; Subclavian Artery ; Systolic Murmurs ; Thorax ; Young Adult

Inflammatory linear verrucous epidermal nevus(ILVEN) is a relatively rare skin disorder, characterized by chronic inflammatory psoriasiform pattern. This chronic skin disorder is generally believed to be resistant to various treatments, although some authors have reported success with 13-cis-retinoic acid and 585 nm pulsed laser therapy. We experienced a 15-month aged female ILVEN patient who has been suffered from linear erythematous verrucous pathes mainly located on left inguinal area, hand, and foot with persistent itching sense. This skin lesion have been developed at birth, and more spread out toward right extremity after 1 year old age . We initially treated this skin lesion with topical corticosteroids and oral anti-histamines, but this treatment was not successful. So we retreated this patient with etretinate(oral retinoid) and topical 13-cis-retinoic acids, we found that therapeutic responses to these applications were more remarkable. Now, we closely observe this patient's clinical course further more.
Adrenal Cortex Hormones ; Etretinate ; Extremities ; Female ; Foot ; Hand ; Humans ; Isotretinoin ; Laser Therapy ; Nevus, Sebaceous of Jadassohn* ; Parturition ; Pruritus ; Skin