No abstract available.
Dyspnea* ; Hypothyroidism*

A 70-year-old female Patient was admitted due to the impression of lung abscess via local clinic. Chest P-A showed air shadow containing huge mass lesion in the right lower lung field, pericardio phrenic angle. But the patient complained of only mild upper respiratioy tract infection symptoms and the laboratory tests were within normal limits. Barium enema and chest C-T taken right after barium enema were performad in suggesting of the diaphragmatic hernia. Barium tilled transverse colon and associated omentum were in the right anterior hemithorax surrounded by the hernial sac. The mass lesion shown in the chest P-A was compatible with the diaphragmatic hemia, Morgagni type. Operative reduction of the herniated bowel and simple closure of the diaphragm was performed.
Aged ; Barium ; Colon, Transverse ; Diaphragm ; Enema ; Female ; Hernia, Diaphragmatic ; Humans ; Lung ; Lung Abscess ; Omentum ; Thorax*

Hemorrhagic complications associated with aspirin use occur primarily at skin or gastrointestinal sites but can occasionally occur in the central nervous system. In particular, spontaneous spinal epidural hemorrhage (SSEH) associated with aspirin is very rare. We report a case of low-dose (100 mg daily) aspirin-related SSEH that was successfully treated with medical management. Our case indicates that low-dose aspirin could induce SSEH and that conservative treatment with close observation and repeated imaging studies should be considered in cases with neurological improvement or mild deficits.
Aspirin ; Central Nervous System ; Hematoma ; Hematoma, Epidural, Spinal ; Skin

BACKGROUND: The aims of this study were to test if amrinone or milrinone reverses cardiac depression induced by the exposure to isoflurane in the isolated heart and to determine whether amrinone or milrinone dilates the coronary artery directly. METHODS: Using the isolated Sprague-Dawley rat hearts, heart rate, left ventricular pressure, dp/dt (differentiated rate of pressure development), O2 delivery(DO2), myocardial oxygen consumption(MVO2), and percent O2 extraction were measured. After the isolated hearts were exposed to isoflurane at 1.2 vol% during 10 min, amrinone(10, 50, 100 M) or milrinone(1, 5, 10 M) was separately given to six groups. RESULTS: Amrinone and milrinone reversed, not statistically significant, the depression of cardiac contractility induced by isoflurane, while the isoflurane-induced bradycardia substantially returned to normal by amrinone 100 M. And amrinone and milrinone elevated coronary flow, DO2, MVO2, while isoflurane increased in coronary flow and DO2, except MVO2. CONCLUSIONS: These results suggest that amrinone and milrinone did not counteract the isoflurane-induced cardiac depression and indirectly increased in coronary blood flow through the elevation of cardiac work.
Amrinone* ; Animals ; Bradycardia ; Coronary Vessels ; Depression ; Heart Rate ; Heart* ; Isoflurane ; Milrinone* ; Myocardium* ; Oxygen ; Rats* ; Rats, Sprague-Dawley ; Ventricular Pressure

Solar urticaria is a rare skin disease characterized by urticarial reactions immediately following exposure to sunlight or artificial radiation. A 24-yr-old man had solar urticaria that was activated by visible light. Positive result of passive transfer of the reactivity with the patients serum to the skin of normal recipient suggested that his condition was attributable to an allergic response. Result of reverse passive transfer studies was negative. We report a case of solar urticaria which appeares to belong to type N in the classification of Harber.
Classification ; Humans ; Light ; Skin ; Skin Diseases ; Sunlight ; Urticaria*

A perplexing developmental error is 46,XX congenital absence of vagina ( Mayer-Rokitan-sky-Kster-Hauser syndrome, Mullerian dysgenesis, vaginal aplasia ). The Mayer-Rokitansky-Kster-Hauser syndrome refers to the climical entity consisting of primary amenorrhea associated with congenital absence of the vagina, 46,XX karyototype, a rudimentary uterus or complete absense, normal overian function and normal ovulation, normal female breast development, body proprotion and body hair, frequent association of renal, skeletal and other cpngenital anomalies. This syndrome results from agenesis of both Mllerian ducts or from a failure of the Mllerian ducts to estavlish a proper communication with that part of the vagina from the urogenital sinus. A case of mayer-Rokitansky-Kster-Hauser syndrom was reviewed briefly.
Amenorrhea ; Breast ; Female ; Hair ; Humans ; Ovulation ; Uterus ; Vagina

The authors reviewed 3145 pediatric patients who visited the emergecy room in this hospital during 3yrs period from Jan. 1989 to Dec. 1991. 1) Among the patients visiting the emergency room, the patients under 15 years of age were 26.4% (3145) of total emergency patients (11930). 2) yearly distribution of patients were decreased 17% between 1989 and 1991. 3) Monthly distribution of visits showed higher incidence in June and July. The male to female ratio was 1.5:1. 4) Weekly distribution of visits showed higher incidence on Sunday and Saturday, relatively. 5) Most popular time of visiting the emergency room was between 8:00 PM to 12:00 PM during which time 29.5% of all pediatric patient were seen. 6) Distribution of age showed peak incidence between 6 and 12 years of age (30.9%). 7) 65.18% of total emergency room isits were pediatric patients. 8) Distribution of cases was as follows: Respiratory disease 37%, accident, GI disease in turn listed respectively in ecreasing order of freqency. 9) The admission rate through emergency was 8.5% of total pediatric emergency patients. 10) 82.3% of total emergency visits had medical insurance coverage, 7% had no insurance and 10.7% were on medical aid program.
Emergencies* ; Emergency Service, Hospital* ; Female ; Humans ; Incidence ; Insurance ; Insurance Coverage ; Male

Osteoporosis represents a reduced amount of bone tissue as compared with controls of same age and sex, and common feature of osteoporosis is a state of skeletal fragility leading to various fractures such as Colles' fracture, vertebral compression fracture, femur neck fracture, generally due to an inadequate amount of normally mineralized bone tissue, making the skeleton incapable of supporting normal mechanical demand. However it is difficult to quantify precisely its magnitude because of the variety of techniques used and the many bone sampling sites concerned. In 1970, Singh and associates(24.25) developed a method for grading the trabecular structure of the proximal end of the femur and reported that the femoral trabecular pattern index can clearly separate persons with osteoporosis from normal individuals. Cameron and its associstes developed an accurste method of determining bone mineral content by means of I-125 photon absorptiometry(5. 28). This method is consistently reproducible at the 98% level and has demonstrated agreement with ash measurement of cadaver bones at the 97% level. A comparative study of the usefulness of the femoral trabecular pattern index(Singh Index) and rsdial bone mineral content measurement by photon absorption was performed in 75 Kroean persons above forty years old. 25 of 75 persons were fracture patients due to osteoporosis. The results were as follows. 1. A significant difference in Singh index was noted between the fracture group snd control group. 2. A significant difference in bone mineral density was noted between the fracture group and control group. 3. A positive correlation was noted between the bone mineral denisty and Singh Index. 4. A significant difference in bone mineral density was noted between the fracture group and the control group which have same grade of Singh Index. So, we believe that bone mineral density is more objective and accurate than Singh Index. 5. We believe that both Singh Index and bone densitometer is useful in diagnosis and grading of osteoporosis.
Absorption ; Bone and Bones ; Bone Density ; Cadaver ; Colles' Fracture ; Diagnosis ; Femoral Neck Fractures ; Femur ; Fractures, Compression ; Humans ; Methods ; Miners ; Osteoporosis ; Skeleton

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) has become a one of the most important causes of nosocomial infections, and use of vancomycin for the treatment of MRSA infection has increased. Unfortunately, vancomycin-resistant enterococcus have been reported, as well as vancomycin-resistant S. aureus. Arbekacin is an antibacterial agent and belongs to the aminoglycoside family of antibiotics. It was introduced to treat MRSA infection. We studied the clinical and bacteriological efficacy and safety of arbekacin compared to vancomycin in the treatment of infections caused by MRSA. MATERIALS AND METHODS: This was a retrospective case-control study of patients who were admitted to tertiary Hospital from January 1st, 2009 to December 31st, 2010, and received the antibiotics arbekacin or vancomycin. All the skin and soft tissue MRSA infected patients who received arbekacin or vancomycin were enrolled during the study period. The bacteriological efficacy response (BER) was classified with improved and failure. The improved BER was defined as no growth of MRSA, where failure was defined as growth of MRSA, culture at the end of therapy or during treatment. Clinical efficacy response (CER) was classified as improved and failure. Improved CER was defined as resolution or reduction of the majority of signs and symptoms related to the original infection. Failure was defined as no resolution and no reduction of majority of the signs and symptoms, or worsening of one or more signs and symptoms, or new symptoms or signs associated with the original infection or a new infection. RESULTS: Totally, 122 patients (63/99 in arbekacin, 59/168 in vancomycin group) with skin and soft tissue infection who recieved arbekacin or vancomcyin at least 4 days were enrolled and analysed. The bacteriological efficacy response [improved, arbekacin vs vancomycin; 73.0% (46/63), 95% confidence interval (CI) 60.3 to 83.4% vs 83.1% (49/59), 95% CI 71.0 to 91.6%] and clinical efficacy response [improved, arbekacin vs vancomycin; 67.2% (41/61), 95% CI 52.0 to 76.7% vs 78.0% (46/59), 95% CI 65.3 to 87.7%] were similar between the two groups (P=0.264, 0.265). The complication rate was significantly higher in the vancomycin group [29/59(49.2%), 95% CI 35.9 to 62.5%] than arbekacin [10/63(15.9%), 95% CI 8.4 to 29.0%] (P<0.001). CONCLUSIONS: Arbekacin could be considered as an alternative antibiotics for vancomycin in skin and soft tissue infection with MRSA. However, further prospective randomized trials are needed to confirm this finding.
Anti-Bacterial Agents ; Case-Control Studies ; Cross Infection ; Dibekacin ; Enterococcus ; Humans ; Methicillin-Resistant Staphylococcus aureus ; Retrospective Studies ; Skin ; Soft Tissue Infections ; Tertiary Care Centers ; Vancomycin

OBJECTIVE: Especially in emergency departments (EDs), a lack of internal medicine (IM) residents in charge causes difficulties in medical care and ED overcrowding. Thus, protocols without IM residents in EDs is needed. This study aimed to investigate changes in medical care when emergency medicine residents replaced the roles of IM residents. METHODS: This study was conducted at a single-site ED of a university medical center. The study group contained patients admitted to the IM department between September and December 2015, during which IM residents were absent in the ED. The control group contained patients admitted to the IM department between September and December 2014, during which IM residents were present in the ED. Changes in medical care between the presence and absence of IM residents in the ED were studied by comparing admission rates from the ED, length of ED stay, duration of hospitalization, and concordance of diagnoses between admission and discharge by the IM department. RESULTS: The study group contained 2,341 patients; the control group contained 2,215 patients. Admission rates from the ED increased by 53.4% (95% confidence interval [CI], P < 0.001); lengths of stay decreased by 15.1% (95% CI, P < 0.001); and durations of hospitalization in the pulmonology department decreased by 38.4% (95% CI, P=0.001). Concordance of diagnoses between admission and discharge decreased by 14.2% in the cardiology department (95% CI, P=0.021). CONCLUSION: Lengths of stay were reduced without critical declines in diagnostic concordance rates when emergency medicine physicians, instead of IM residents in the ED, decided upon admissions of IM patients.
Academic Medical Centers ; Cardiology ; Diagnosis ; Emergencies* ; Emergency Medicine ; Emergency Service, Hospital* ; Hospitalization ; Humans ; Internal Medicine* ; Length of Stay ; Pulmonary Medicine