BACKGROUND: The improved technique for cardiopulmonary resuscitation(CPR) has resulted in the survival of many patient who experienced cardiac arrest. However, mortality in resuscitated patients is high, and the survival rate without brain damage is very low. Various neurological examination models, neuro-imaging techniques, electrophysiological procedures, and biochemical tests have been studied with respect to the detection of cerebral damage and outcome, but an early, reliable prediction of individual outcomes is still uncertain. METHODS: We studied twenty patient who had been in a coma for more than 24 hours after CPR, Somatosensory evoked potentials(SEP) were measured within the first three days after CPR. RESULTS: Of the twenty patients, seven patients(35%) had a good outcome, and thirteen patients(65%) had a bad outcome. Of the eleven patients with loss of the cortical evoked potential's N20 peak, all had a bad outcome. CONCLUSION: SEPs are of great benefit in prognostic evaluation after CPR.
Brain ; Cardiopulmonary Resuscitation* ; Coma* ; Evoked Potentials, Somatosensory* ; Heart Arrest ; Humans ; Mortality ; Neurologic Examination ; Survival Rate

Lawsonia intracellularis is not culturable with a standard bacteriologic culture. One step PCR assay as a clinical diagnostic method was developed for the rapid detection of porcine proliferative enteritis (PPE) caused by L. intracellularis. Primers were designed based on the p78 DNA clone of L. intracellularis. The one step PCR resulted in the formation of a specific 210-bp DNA product derived from L. intracellularis. The nonspecific amplification product was not detected with swine genomic DNA or other bacterial strains causing similar symptoms to L. intracellularis infection. The one step PCR was as sensitive as 100 pg of L. intracellularis genomic DNA. We applied this method to field specimens diagnosed as PPE by macroscopic observation. Of 17 mucosal scraping specimens, 16(94%) were identified as positive to PPE and 15(88%) of 17 feces specimens. These results suggest that the one step PCR can be used as a rapid diagnostic method for L. intracellularis infection.
Animals ; Base Sequence ; DNA Primers ; Desulfovibrionaceae Infections/diagnosis/*veterinary ; Ileum/microbiology/pathology ; Intestinal Mucosa/microbiology/pathology ; Lawsonia Bacteria/genetics/*isolation & purification ; Polymerase Chain Reaction/*methods ; Reproducibility of Results ; Sensitivity and Specificity ; Swine ; Swine Diseases/*diagnosis/microbiology

BACKGROUND: Tumor necrosis factor-alpha(TNF-alpha) has been thought to play a major role in neurological injury during global brain ischemia and subsequent reperfusion following resuscitation in cardiac arrest. So, we hypothesized that the elevation in TNF-alpha was dependent upon the duration of the global brain ischemia, and related to delayed neuronal damage. METHODS: Fourteen rats were divided two groups ; 1 minute-cardiac arrest group(n=7) and 3 minute-cardiac arrest group(n=7). we induced cardiac arrest by chest compression and damping of tracheal tube for 1 minute and 3 minutes respectively. And then, resuscitation was initiated. To measure the plasma activity of TNF-alpha, blood samples were drawn before and at the end of cardiac arrest, and 30, 60, 90, and 120 minutes after initiation reperfusion. At 72 hours after resuscitation, the ND(neurologic deficit) score was determined and the histopathologic outcome of hippocampal CA1 neuron was observed by the percent dead hippocampal CA1 neurons. RESULTS: 1. TNF-alpha level during the early reperfusion period(<2h) was significantly increased in 3 min-cardiac arrest group compared with 1 min-cardiac arrest group(p=0.0001). 2. There was a no significant difference of neurologic deficit score between 1 min- and 3 min-cardiac arrest. 3. Percent dead hippocampal neurons were significantly increased in 3 min-cardiac arrest group compared with 1 min-cardiac arrest group(9.1+/-1.2% vs 1.2+/-0.9%, p<0.05). CONCLUSION: The results suggest that longer duration of global brain ischemia causes a more profound increase in plasma TNF-alpha level during the early reperfusion period(<2h) and more delayed neuronal damage than lessor duration of global brain ischemia, and that increase in TNF-alpha level during the early reperfusion period(<2h) is related to delayed neuronal damage.
Animals ; Brain Ischemia ; Brain* ; Heart Arrest* ; Heart Arrest, Induced ; Necrosis ; Neurologic Manifestations ; Neurons ; Plasma ; Rats* ; Reperfusion ; Reperfusion Injury* ; Resuscitation ; Thorax ; Tumor Necrosis Factor-alpha*

PURPOSE: This study identifies the effects of the educational leadership of nursing unit managers on team effectiveness and the mediating effects of organizational communication satisfaction; it highlights the importance of educational leadership and organizational communication and provides the data needed to enhance the education capacity of managers. METHODS: The participants were 216 nurses working at unit with nursing unit managers of staff nurses at a tertiary hospital located in Cheongju city, South Korea, and nurses who had worked for more than 6 months at the same unit. This study was conducted using questionnaires on educational leadership, team effectiveness, and organizational communication satisfaction. Data analysis was performed with a t test, analysis of variance, Scheffé test, Pearson's correlation coefficient, and simple and multiple regression analyses using SPSS, version 23.0. Mediation analysis was tested using Baron and Kenny's regression analysis and a Sobel test. RESULTS: The mean score for the educational leadership of nursing unit managers was 3.74 (±0.68); for organizational communication satisfaction, 3.14 (±0.51); and for team effectiveness, 3.52 (±0.49). Educational leadership was significantly positively correlated with team effectiveness and organizational communication satisfaction. Organizational communication satisfaction demonstrated a complete mediating effect on the relationship between educational leadership and team effectiveness (β = .61, p < .001) and was significant (Sobel test; Z = 7.40, p < .001). CONCLUSION: The results indicate that the educational leadership of nursing unit managers increases communication satisfaction among nurses; this supports the idea that educational leadership can contribute to team effectiveness. This suggests that the educational leadership and communication capacity of nursing unit managers must be improved to enhance the performance of nursing organizations.
Chungcheongbuk-do ; Education ; Humans ; Korea ; Leadership* ; Negotiating* ; Nurse Administrators ; Nursing* ; Statistics as Topic ; Tertiary Care Centers

PURPOSE: Amiodarone (AD) is a potent and effective anti-dysrhythmic drug, but some literature reports that it 's long-term use is associated with the development of potentially life-threatening amiodarone-induced pulmonary toxicity (AIPT). Until now, oxygen free radical theory has been the most probable hypothesis for the development of AIPT. We investigated the protective effect of two potent antioxidants, N-acetylcysteine(NAC) and vitamin E, against AIPT. METHODS: Twenty-six (26) Hamsters were divided into a sham-operation group(n=2) and the following 4 groups: AD-induced effects without antioxidants (group 1, n=6), with NAC (group 2, n=6), with vitamin E (group 3, n=6), and with both NAC and vitamin E (group 4, n=6). Vitamin E (100 mg/kg) was injected intramuscularly into the hind leg once a day. At day 21, amiodarone (1.83 umol) was administered by transoral intratracheal instillation. NAC (300 mg/kg) was injected intraperitoneally just after amiodarone instillation. At day 28, amiodarone and NAC were administered again. Twenty-one (21) days after instillation of the second dose of amiodarone, the hamsters were sacrificed, and the lung fibrosis index and the hydroxyproline content were assessed. RESULTS: In the NAC-treated group (group 2), there was no significant decrease in either the lung fibrosis index, as determined by microscopic evaluation, or the lung hydrox-yproline content (p > 0.05). But there were significant decreases in the fibrosis index and the lung hydroxyproline content in the vitamin E-treated groups (group 3 and 4 ) (p < 0.05). CONCLUSION: Although vitamin E and NAC are both potent antioxidants, we found that AD-induced lung fibrosis was significantly decreased by only vitamin E and that there was no synergistic effect between vitamin E and NAC. It is possible that AIPT is developed by some other mechanisms rather than oxygen free radical injury. Vitamin E may have some other path for decreasing lung fibrosis. Further studies are warranted.
Acetylcysteine ; Amiodarone ; Animals ; Antioxidants ; Cricetinae* ; Fibrosis ; Hydroxyproline ; Leg ; Lung ; Oxygen ; Pulmonary Fibrosis* ; Vitamin E* ; Vitamins*

Body lateropulsion is a common manifestation of lateral medullary infarction (LMI), and usually associated with vertigo, limb ataxia, sensory disturbance, and Horner's syndrome. However, isolated body lateropulsion as a presenting symptom of LMI is rare, and the responsible lesion for lateropulsion remains uncertain. We report a 71-year-old woman who showed isolated body lateropulsion as a presenting symptom of LMI. Ipsilateral body lateropulsion in our patient may be ascribed to the involvement of the ascending dorsal spinocerebellar tract rather than the descending lateral vestibulospinal tract, which runs more ventromedially.
Ataxia ; Female ; Horner Syndrome ; Humans ; Infarction ; Spinocerebellar Tracts ; Vertigo

BACKGROUND: The present study was performed in order to evaluate the duration-dependent neuroprotective effect of post-ischemic mild hypothermia against delayed neuronal damage following transient global ischemia and to estimate the optimal duration of brief post-ischemic mild hypothermia. METHODS: Post-ischemic mild hypothermia of different duration(1 hour, 3 hours, and 6 hours) was performed immediately after 10-minute global ischemia in gerbils, and the hippocampal CA1 cell loss after 3 days was evaluated. The duration-dependent neuroprotective effect of post-ischemic mild(33-34degrees C) hypothermia of each duration was compared to the normothermic control by using histopathological methods. RESULTS: 1, 3 and 6 hours of mild hypothermia immediately following reperfusion resulted in progressively increased protection from ischemic damage, 10.0+/-8.2%, 33.7+/-21.9%, and 75.9+/-13.4%, respectively. The 3-hour and the 6-hour post-ischemic mild hypothermia groups revealed significant decreases in hippocampal CA1 area cell loss compared to the normothermic control group(9.0+/-7.7%, p<0.05), and the 6-hour group had a greater preservation than the 3-hour group(p<0.05). CONCLUSION: The results suggest that post-ischemic mild hypothermia protects against delayed neuronal damage in the hippocampal CA1 area following 10-minute transient global ischemia: 3-hour post-ischemic mild hypothermia provides a potential reduction of neuronal damage, but a 6-hour treatment is more effective in preventing neuronal damage than a 3-hour one.
Brain Ischemia ; Gerbillinae* ; Hypothermia* ; Ischemia ; Neurons ; Neuroprotective Agents* ; Reperfusion

PURPOSE: No proven neuroprotective treatment exists for ischemic brain damage after cardiac arrest (CA). Although several animal studies have shown that mild to moderate hypothermia markedly mitigates ischemic brain damage after CA, the clinical safety and efficacy of mild hypothermia remain unproven. We conducted this preliminary study to evaluate the clinical feasibility and safety of mild resuscitative hypothermia (RH) for comatose patients of out-of-hospital CA. METHODS: We performed prospectively a preliminary, non-randomized, uncontrolled, clinical feasibility trial over four years in a university-based hospital. Consecutive patients admitted or transferred to the emergency medical center after out-of-hospital CA who met inclusion and exclusion criteria were enrolled. Hypothermia was induced as soon as possible after return of spontaneous circulation (ROSC) by using external surface cooling methods and cold saline gastric lavage at the target temperature (34 degrees C) and was maintained for 24 hours by using external surface cooling methods, which was followed by passive rewarming. RESULTS: Twelve patients were enrolled. Mean arrest time was 20+/-12 minutes (range 2 to 40); the mean advanced cardiac life support (ACLS) time was 12+/-8 minutes (range 4 to 27) and the mean time from start of ACLS to initiation of RH was 129 +/-113 minutes (range 40 to 420). Achieving the target temperature took 160+/-79 minutes (range 80 to 330) and the mean rewarming time was 605+/-190 minutes (range 360 to 960). One patient developed transient atrial fibrillation and premature ventricular complex during the induction period. Hypotension developed in six patients during hypothermia, pneumonia associated with induced hypothermia developed in four patients. Other complications, such as myoclonus (n=4), increased serum amylase (n=7), increased serum creatinine (n=2), and potassium abnormalities (n=2), also occurred. These complications occurred more frequently in patients with poor cardiac function after ROSC. No serious complications, such as ventricular fibrillation, bleeding, or sepsis, occurred. CONCLUSION: Mild RH after CA appears clinically feasible. However, induction with surface external cooling methods is slow, and maintenance of mild hypothermia was difficult. Future efforts to shorten the induction time and to develop more effective maintenance methods and more cautious applications to patients with poor cardiac function after ROSC are needed. Furthermore, well-designed, prospective, randomized, and controlled, multi-center efficacy trials are needed to evaluate the effect of mild RH.
Advanced Cardiac Life Support ; Amylases ; Animals ; Atrial Fibrillation ; Brain ; Coma* ; Creatinine ; Emergencies ; Gastric Lavage ; Heart Arrest ; Hemorrhage ; Humans ; Hypotension ; Hypothermia* ; Hypothermia, Induced ; Myoclonus ; Out-of-Hospital Cardiac Arrest* ; Pneumonia ; Potassium ; Prospective Studies ; Rewarming ; Sepsis ; Ventricular Fibrillation ; Ventricular Premature Complexes

Overcrowding of emergency department is a serious and growing problem at St. Mary's Hospital. This has motivated the development of short-stay unit(SSU) as an alternative ward to routine hospital admission and ED discharge. In our hospital a SSU begun to admit patients in January 6, 1997. the SSU received 247 patients from the ED during the eight month interval(January 6, 1997 to August 31, 1997). To examine the utilization of the SSU in ED, we retrospectively analyzed 247 patients admired in SSU from the ED, and compared the average hours per patient with acute gastroenteritis spent in the ED doing the 2-month intervals before(July-August 1996) and after(July-August 1997) the establishment of the SSU. The following results were obtained; 1. The total patients consist of EM 92(37.2%), GS 48(19.4%), IM 24(9.7%), PS 21(8.5%), OS 20(8.1%), OBGY 14(5.7%) and others 28(11.3%). 2. The results of EM patients admitted in SSU from ED 1) Sex ratio of male to female was 1:1.1 and the mean age was 37.3+/-16 years. 2) In diagnosis, acute gastroenteritis was 29 cases(31.5%), multiple contusion 14 cases(15.2%), drug intoxication 12 cases(13%), limb laceration 6 cases(6.5%), tendon rupture offhand 6 cases(6.5%), and others 19 cases(20.6%). 3) Mean length of stay in ED was 9.18 hours. 4) Among 92 patients to the SSU, 79 patients(85.9%) were discharged, 11 patients(11.9%) formally admired to hospital and 2 patients(2.2%) transferred to otherhospital. The mean hospital stay time of the patients admitted to SSU was 2.6 days. 3. There was a significant reduction in the average stay time spent in the ED by treat-and-releasing patients with acute gastroenteritis after the establishment of the SSU(from 14.65+/-9.6 to 7.52+/-5.4 hr/patient, p<0.001). Conclusively, the establishment of the SSU can shorten the average stay time that treat-and-releasing patients spend in the ED, and reduce the number of admixed patients waiting in the ED.
Contusions ; Diagnosis ; Emergencies* ; Emergency Service, Hospital* ; Extremities ; Female ; Gastroenteritis ; Humans ; Lacerations ; Length of Stay ; Male ; Retrospective Studies ; Rupture ; Sex Ratio ; Tendons

Malaria is the world's most important parasitic infec tion. Although it has been eradicated from temperate zones including Korea , increasing numbers of travellers visit tropical malarious countries and imported malaria becomes important medical problem in the developed countries. In Korea with increasing travellers to malaria endemic area, the incidence of imported malaria shows rising tendency same as the developed countries. It beco mes important to provide general personal protective me asures and chemoprophylaxis to trevellers, when employed in appropriate manner, that can be highly effective in preventing malaria . We recently experienced a case of imported Plasmodium vivax malaria with delayed mani festations due to inadequate chemoprophylaxis. A 53- year-old woman with history of trevel to East Africa 4 months ago and chief complaint of fever was diagnosed as tertian malaria. She had irregularly taken prophylatic antimalarial during travel and had not taken it after return but should have taken it at least 4 weeks after return.
Africa, Eastern ; Chemoprevention* ; Developed Countries ; Female ; Fever ; Humans ; Incidence ; Korea ; Malaria ; Malaria, Vivax* ; Plasmodium vivax* ; Plasmodium*