This is a case of an accidental prolonged tourniquet application on the lower extremity. A 31 year old, well developed male had an open reduction for a clavicle fracture and nerve graft of the injured arm. To obtain the nerve from the leg, a tourniquet was applied and remained on the right lower extremity for 4hours. Post-operatively, he developed severe edema with paralysis of that leg. Thereafter, progressively he had signs of acute tubularnecrosis with oliguria, myoglobinuria, elevation of BUN and creatinine, and finally pulmonary edema. He recovered graually from the renal failure, pulmonary edema and paralysis of the leg as he received intermittent peritoneal dialysis for renal failure and intensive respiratory care for pulmonary edema. He went home in good condition only with a slight residual sensory loss of the injured leg 90 days after his admission.
Adult ; Arm ; Clavicle ; Creatinine ; Edema ; Humans ; Leg* ; Lower Extremity ; Male ; Myoglobinuria ; Oliguria ; Paralysis* ; Peritoneal Dialysis ; Pulmonary Edema ; Renal Insufficiency* ; Tourniquets* ; Transplants

BACKGROUND: Obesity is known to influence on physical, mental, functional health problems but there have been no study of relationship between body mass index (BMI) and quality of life (QOL) in Korean elderly. METHODS: A total of 216 elderly who had been attending two geriatric welfare facilities in Seoul answered the Korean version of obesity-related quality of life (KOQOL) questionnaire. Height, weight, waist circumference were measured. Body fat (%) was measured with HTM20 by impedance technique. Sociodemographic and medical factors were interviewed. QOL was assessed using KOQOL (ver.1) after excluding two sexual life related questions and one work related question. The total score is 48 points. The higher is the score, the poorer is the QOL. RESULTS: In multivariable analysis, BMI, age, history of diabetes mellitus, history of osteoarthritis were associated with KOQOL score. Especially, BMI was significantly associated with KOQOL score after adjusting for waist circumference, body fat (%) (P = 0.002). CONCLUSION: The more BMI increases, the worse the obesity related QOL is in Korean ambulatory elderly.
Adipose Tissue ; Adult ; Aged ; Body Mass Index ; Diabetes Mellitus ; Electric Impedance ; Humans ; Obesity ; Osteoarthritis ; Quality of Life ; Waist Circumference ; Surveys and Questionnaires

From January, 1972 to August 1983, 12 cases of ovarian pregnancy out of 1202 total ectopic pregnancy were studied and the incidence constituted 0.9%. The gross and microscopic findings were reviewed according to gross description and gross photographs, and microscopic description and reviewing all microscopic slides. All cases were shown to meet Spiegelberg's criteria for primary ovarian pregnancy.
Pregnancy ; Female ; Humans ; Incidence

Ectopic pancreas is commonly located at stomach, duodenum and jejunum. It is a relatively rare entity and is usually of no clinical importance which especially is a very rare source of massive upper gastrointestinal bleeding. We have recently experienced a case of an ectopic pancreas in the second portion of the duodenum which was proven to be a source of massive gastrointestinal bleeding by duodenoscopy and was confirmed by surgical exploration.
Duodenoscopy ; Duodenum* ; Esophagus* ; Hemorrhage* ; Intestines* ; Jejunum ; Pancreas* ; Stomach*

Pulmonary edema in surgical patients is known to be a complication resulting from various causative factors. We have analysed 10 cases observed in the Dong San Medical Center and 18 cases reported in the Journal of the Korean Society of Anesthesiologists in terms of sex, age, causing factor, onset, therapy etc. As a result of this study, the summary is as follows: 1) The most common causes of pulmonary edema in surgical patients were overloading, followed by heart failure, hypoalbuminemia, sepasis, severe trauma and unknown causes in that order. 2) Pulmonary edema can develop in any surgical patient without a direct realtionship to age, sex or type of peration. 3) The incidence tended to be higher in emergency patients than in elective patients because their general condition was worse and the surgical procedures were done in such haste. 4) The onset of pulmonary edema seems to occur commonly at the end of surgery, particularly when the patients were extubated and then followed by endotracheal suction because negative pressure is applled for suction as the positive pressure was removed for extubation. 5) Active therapy for pulmonary edema has been generally successful because of advanced respiratory care with various sophisticated respirators.
Emergencies ; Heart Failure ; Humans ; Hypoalbuminemia ; Incidence ; Pulmonary Edema* ; Suction ; Ventilators, Mechanical

The prevalence of pediatric obstructive sleep apnea syndrome (OSAS) is approximately 3% in children. Adenotonsillar hypertrophy is the most common cause of OSAS in children, and obesity, hypotonic neuromuscular diseases, and craniofacial anomalies are other major risk factors. Snoring is the most common presenting complaint in children with OSAS, but the clinical presentation varies according to age. Agitated sleep with frequent postural changes, excessive sweating, or abnormal sleep positions such as hyperextension of neck or abnormal prone position may suggest a sleep-disordered breathing. Night terror, sleepwalking, and enuresis are frequently associated, during slow-wave sleep, with sleep-disordered breathing. Excessive daytime sleepiness becomes apparent in older children, whereas hyperactivity or inattention is usually predominant in younger children. Morning headache and poor appetite may also be present. As the cortical arousal threshold is higher in children, arousals are not easily developed and their sleep architectures are usually more conserved than those of adults. Untreated OSAS in children may result in various problems such as cognitive deficits, attention deficit/hyperactivity disorder, poor academic achievement, and emotional instability. Mild pulmonary hypertension is not uncommon. Rarely, cardiovascular complications such as cor pulmonale, heart failure, and systemic hypertension may develop in untreated cases. Failure to thrive and delayed development are serious problems in younger children with OSAS. Diagnosis of pediatric OSAS should be based on snoring, relevant history of sleep disruption, findings of any narrow or collapsible portions of upper airway, and confirmed by polysomnography. Early diagnosis of pediatric OSAS is critical to prevent complications with appropriate interventions.
Achievement ; Adult ; Appetite ; Arousal ; Child ; Dihydroergotamine ; Early Diagnosis ; Enuresis ; Failure to Thrive ; Headache ; Heart Failure ; Humans ; Hypertension ; Hypertension, Pulmonary ; Hypertrophy ; Neck ; Neuromuscular Diseases ; Obesity ; Polysomnography ; Prevalence ; Prone Position ; Pulmonary Heart Disease ; Risk Factors ; Sleep Apnea Syndromes ; Sleep Apnea, Obstructive ; Snoring ; Somnambulism ; Sweat ; Sweating

OBJECTIVES: The study was carried out to evaluate the work-relatedness and the occupational distribution in 147 carpal tunnel syndrome(CTS) cases diagnosed at a university hospital from May 1996 to May 1998. METHODS: We obtained the information on disease appearance, occupational history including job content and other life style by medical records and telephone interviews. RESULTS: Of the 147 patients with carpal tunnel syndrome, 51 patients(34.7 %) were shown to be work-related. Work-related CTS were most frequent in elementary workers (21 case, 41.2%). The other eases were 15(29.4%) workers in service and shop and market sales, 9(17.6%) workers in craft and related traders, 4(7.8%) workers in skilled agriculture and fishery. Only two workers had claimed to the Industrial Accident Compensation Insurance, but no one has been admitted as an occupational CTS yet. CONCLUSIONS: It is suggested that arrangements of surveillance system for adequate control of occupational CTD is neccessity.
Accidents, Occupational ; Agriculture ; Carpal Tunnel Syndrome* ; Commerce ; Compensation and Redress ; Fisheries ; Humans ; Insurance ; Interviews as Topic ; Life Style ; Medical Records

OBJECTIVES: The objective of this study is to clarify the family environments, parent-adolescent communication, family violence, parental conflict, parental alcohol drinking that contribute to internet use of adolescent. METHODS : Subjects were middle and high school students in Gang-seo gu, Seoul city (N=998). Self-rating questionnaire included demographic data, internet addiction scale, family adaptability cohesion evaluation scale III, parent-adolescent communication inventory, conflict tactics scales 2 and children of alcoholics screening test. RESULTS : 1) There were statistically significant differences in CAST, family violence, communication between family members and family adaptability cohesion scale between addicted group and non-addicted group. 2) Most significantly correlated variants for internet addiction were problematic communication of parents and psychological aggression. 3) Multiple regression analysis showed that problematic communication of parents, psychological aggression and CAST could explain 10.1% of internet addictions. CONCLUSION : This study was designed specifically to focus on the various domains of adolescents' family environment that may influence the overuse of internet. It proved that moderate level of adaptability, cohesion and open communication in a parentchild relationship can prevent the overuse of internet. On the other hand, aggressive language spoken between the two parents and their alcohol abuse can aggravate the overuse of internet.
Adolescent* ; Aggression ; Alcohol Drinking ; Alcoholics ; Alcoholism ; Child ; Domestic Violence ; Family Conflict ; Hand ; Humans ; Internet* ; Mass Screening ; Parents ; Surveys and Questionnaires ; Seoul ; Weights and Measures

OBJECTIVES: There is now some evidence that, in humans, psychological stress may affect immune and neuroendocrine system. In stress response, cytokines are known to orchestrate the cellular interaction of immune system and act as a major messenger in a communication with CNS. Specifically, IL1beta has been reported to be colsely related with stress induced behavior change, such as depression. Accordingly, we assessed cytokine production by peripheral blood mononuclear cells (PBMC) before and after an academic examination in 45 healthy medical students. Furthermore the possibility that IL1beta TaqI polymorphism may be associated with stress response of IL1beta production was investigated. METHODS: Blood samples were collected on the day of examination and at the second week after examination. For cytokine assay seperated PBMC were incubated for 3 days at 37 degrees C, 5% CO2. DNA was prepared by Ficoll-paque method and polymorphic region was amplified by PCR. After TaqI restriction, products were seperated by 15% polyacrylamide gel electrophoresis. RESULTS: IL1beta production and stress score were significantly higher on the examination day. The change of stress score was significantly correlated with the change of IL1beta production. However, the frequency of allele A2 was too low that the significance of genetic association could not be properly estimated. CONCLUSION: This study reports that psychological stress is accompanied by an increased production of IL1 beta with significant correlation.
Alleles ; Cytokines ; Depression ; DNA ; Electrophoresis, Polyacrylamide Gel ; Humans ; Immune System ; Monocytes* ; Neurosecretory Systems ; Polymerase Chain Reaction ; Stress, Psychological ; Students, Medical

The mission of psychiatric practice is rangesing from alleviating the distress and impairment caused by psychiatric disorders to promoting a state of well-being in order to cope with the normal stresses of life and for to improvement of social functioning. Various factors, including social changes in general and the change of Psychiatry is are grounded in clinical neuroscience and public health. The authors are to review the determinants of changes in clinical practice of psychiatry and to review plausible areas of new clinical practice in psychiatryic both from both a clinical neuroscience and a public health perspective.
Humans ; Missions and Missionaries ; Neurosciences ; Public Health ; Social Change