STUDY OBJECT: To date, the study of critical illness in the emergency department has been limited. The purpose of this study was to determine the length of stay and procedures performed on critical care patient in ED, and to be help to establish Emergency physicians' education program. METHOD: We reviewed patient's medical record, who visited ED, Korea Univ. Hospital from Jan. 1996 to Jun. 1996 and admitted to ICU. We analyzed data to age, sex, clinical diagnosis, length of stay, and critical procedures in ED. RESULTS: The 12,721 patients visited ED during the study period, the 441 of 12,721 (3.50%) patients admitted to ICU. 56 patients were excluded whose medical re cords were incomplete. The study populations consisted of 165 women and 220 men. The mean age were 52 year old (median,58 year old). The mean length of stays were 606.1 (1445.9 minutes (median, 180 minutes)). One hundred sixty one of these patients (41.8 %) received one or more critical procedures. The medical critical patients were 252 cases, and surgical critical patients were 133 cases. The mean length of stay of medical critical patients was 738.8 (1748.9 minutes (median, 177.5 minutes)) in medical department,44.0% of them received critical procedures in ED. The surgical critical patients averaged 354.9 (410.7 minutes (median, 190 minutes)) and 37.6% received critical procedures. CONCLUSION: Critical ill patients stay in the ED with a substantial amount of time, before addition to the ICU. Critical ill patients who have hemodynamiccal unstable conditions, compromised cardiopulmonary functions, and neurologic deficities, were managed in ED frequently. Typical critical care procedures are commonly performed by emergency physicians. Therefore, it is important for emergency physician to prepare to critical ill patients.
Critical Care* ; Critical Illness ; Diagnosis ; Education ; Emergencies* ; Emergency Service, Hospital* ; Female ; Humans ; Korea ; Length of Stay ; Male ; Medical Records ; Middle Aged

Tularemia is a zoonosis caused by Francisella tularensis. It is primarily a disease of wild animals. Human infection is incidental and usually results from interaction with biting or blood-sucking insects, wild or domestic animals, or the environment. An increasing number of cases have been reported in several countries. However, in Korea it has not been reported until now. A 40-year old male patient visited our department on Jan 13, 1997, complaining of multiple swollen lymph-nodes on his axillae and reddish swollen left upper arm which contained an abscess at its central portion for about ten days. On Dec 25, 1996, he found a dead wild rabbit on a nearby mountainside, ate it after cooking it by himself with his hands injured. His abscess was drained and microbiologic examination was done. However no microorganism was isolated. His lymph nodes were surgically removed from both axillae, and we investigated them microbiologically and pathologically. On microbiologic examination, small aerobic gram negative coccobacilli were grown on a chocolate agar plate in an aerobic condition with 5% CO2 at 37 degrees centigrade. On H & E staining, the lymph node showed chronic granulomatous inflammation. We sent the microorganism and lymph nodes to the Centers for Disease Control and Prevention in the United States of America for the definitive diagnosis. Finally the microorganism was identified as F. tularensis by culture morphology, biological tests and immunohistochemical staining. We report the first case of F. tularensis in Korea.
Abscess ; Adult ; Agar ; Americas ; Animals ; Animals, Domestic ; Animals, Wild ; Arm ; Axilla ; Cacao ; Centers for Disease Control and Prevention (U.S.) ; Cooking ; Diagnosis ; Francisella tularensis ; Hand ; Humans ; Inflammation ; Insects ; Korea ; Lymph Nodes ; Male ; Tularemia* ; United States

PURPOSE: To compare the outcomes of phacovitrectomy and vitrectomy only for treatment of primary rhegmatogenous retinal detachment. METHODS: The anatomical success, functional success, and complications between Group I patients who underwent vitrectomy only and Group II patients who underwent phacovitrectomy for primary rhegmatogenous retinal detachment were retrospectively compared. RESULTS: Twenty-one eyes (84.0%) in Group I had reattachment after vitrectomy only, and 27 eyes (90.0%) in Group II had reattachment after phacovitrectomy. However, the differences in the measures attributes were not statistically significant (p = 0.271). The logMAR visual acuity improved in both groups with no statistically significant difference between the two groups (p = 0.102). Postoperative complications included cataract progression in 20 eyes (80.0%) in Group I and 17 of the 20 eyes (68.0%) underwent cataract surgery within one year after the first surgery. CONCLUSIONS: Phacovitrectomy, irrespective of severe lens opacity, is a relatively effective combined surgical procedure in older patients with primary rhegmatogenous retinal detachment and impending presbyopia. The procedure allows for easy access to the periphery during vitreous shaving and prevents the need for a second cataract operation.
Cataract ; Eye ; Humans ; Phacoemulsification ; Postoperative Complications ; Presbyopia ; Retinal Detachment ; Retinaldehyde ; Retrospective Studies ; Visual Acuity ; Vitrectomy

To evaluate a relationship of lumbar lordosis between asymptomatic group and low back pain group, lumbar lordotic angle was measured from standing lateral lumbosacral roentogenogram of 360 men and women between 20 and 49 years of age. We excluded the patients with back deformity, moderate to severe degenerative change of lumbosacral spine, leg length discrepency, and degenerative change of lower leg in both groups. The lumber lordodsis angle was measured with two ways, lumbosacral angle and lumbolumbar angle respectively. Two angles have a line parallel to the top of second lumbar vertebra as the proximal boundary. The distal border of the lumbosacral angle is a line parallel to the top of sacrum. The distal border of the lumbolumbar angle is a line parallel to the bottom of fifth lumbar vertebra. With statistical analysis of the results, we came to followiing conclusion: 1. The mean lumbolumbar angle was 33.62° +0.62° (SEM: standard error of the mean) and the mean lumbosacral angle was 49.91° +0.59° in asymptomatic group. 2. The mean lumbolumbar angle was 34.79° +0.68° and the mean lumbosacral angle was 50.35° +0.76° in low back pain group. 3. No significant difference in lumbosacral and lumbolsacral angle between asymptomatic and low back pain group was identified using general linear models procedure(P>0.5). 4. Analyzing the data by sex, no significant difference in lumbosacral and lumbosacral angle was identified using general linear models procudure(P>0.05). 5. Analyzing the data by age group, no significant difference in lumbosacral angle was identified (P>0.05), but significant difference in lumbolsacral angle was identified using general linear models procedure(P=0.0045).
Animals ; Congenital Abnormalities ; Female ; Humans ; Leg ; Linear Models ; Lordosis ; Low Back Pain ; Male ; Sacrum ; Spine

In 1971, Harris introduced a metal backed acetabular cup to allow replacement of worn polyethylene cups and it has been popularly used now. In metal backed acetabular cup, dissociation between metal shell and polyethylene liner usually occurs with hip dislocation. We report a case of dissociation of polyethylene liner in metal bacded cup not associated with hip dislocation.
Acetabulum ; Hip Dislocation ; Hip ; Polyethylene

Since the use of Charnley hip prosthesis, total hip arthroplasty has been used for the treatment of coxarthrosis. However, aseptic lossening of the acetabular cup component in total hip arthroplasty remains the most common cause of failure and most serious complication. Cementless acetabular cup fixation in total hip arthroplasty is increasingly popular because of the high failure rates of cemented components, particularly in younger and more active patients. We have experienced 62 cases of CLS expansion acetabular cup developed by L. Spontorno, from January 1992 to January 1994. We analysed 41 CLS expansion acetabular cup components in 38 patients performed at the Department of Orthopedic Surgery, Kang Nam General Hospital with minimum follow up lyear(average 17.3 months). The object of this study is to evaluate the radiographic change of the cup inclination, horizontal and vertical migration of the CLS expansion acetabular cup by methods of Engh et al, and Callagham et al. The results were as follows: 1. The initial adequate contact fit were 39 hips and inadequate fit in 2 hips. 2. The initial acetabular inclination between 35 degrees and 55 degrees were 38 hips. 3. Vertical and/or horizontal migration was not occurred, except 2 hips which were complicated by deep infection. 4. Change of acetabular cup inclination than 5 degrees were not occurred. 5. Radiolucent line wider than 2mm was not found. 6. In final follow up of out 41 hips optimal stability was obtained in 39 hips, suboptimal stability was obtained in 2 hips, and definite instability was not found.
Acetabulum ; Arthroplasty, Replacement, Hip ; Follow-Up Studies ; Hip ; Hip Prosthesis ; Hospitals, General ; Humans ; Orthopedics ; Osteoarthritis, Hip

Purpose: To compare visual outcomes over 6 months between intravitreal anti-vascular endothelial growth factor (VEGF) therapy with or without pneumatic displacement in patients who were diagnosed with submacular hemorrhage secondary to polypoidal choroidal vasculopathy (PCV). Methods: This retrospective observational study included 12 eyes that underwent pneumatic displacement followed by anti-VEGF therapy (combined treatment group) and 17 eyes that underwent anti-VEGF monotherapy (anti-VEGF monotherapy group) for submacular hemorrhage secondary to PCV and were followed for at least 6 months. The best-corrected visual acuity (BCVA) was measured at diagnosis and at 1, 3, and 6 months. The BCVA at 6 months and degree of BCVA improvement during the 6 months of follow-up were compared between the 2 groups. Results: In the combined treatment group, the mean (± standard deviation) logarithm of minimal angle of resolution BCVA values at the defined periods were 1.40 ± 0.54, 1.08 ± 0.63, 0.83 ± 0.57, and 0.79 ± 0.64, respectively. In the anti-VEGF monotherapy group, the mean BCVAs were 1.48 ± 0.47, 1.31 ± 0.48, 1.13 ± 0.52, and 1.04 ± 0.67, respectively. BCVA was significantly improved in both the combined treatment group (p = 0.012) and the monotherapy group (p = 0.026). Neither the BCVA at 6 months nor the degree of improvement in the BCVA was different between the 2 treatment groups (p = 0.269 and p = 0.300, respectively). Conclusions No notable difference in efficacy was observed between intravitreal anti-VEGF therapy with or without pneumatic displacement in treating submacular hemorrhage secondary to PCV.

Purpose: This study evaluated changes in growth and nutritional status using the first basic and the second repeated surveys on children from North Korean refugee families who settled in South Korea. Methods: A total of 337 children were included in the survey. Using a structured questionnaire, the data collected included sex, date of birth, country of birth, date of entry to South Korea, and birth parents’nationality. The prevalence of stunting, underweight, wasting, and obesity were evaluated using the 2017 Korean National Growth Chart for Children and Adolescents. Results: The prevalence of stunting decreased from 7.9% in the first survey to 6.9% in the second survey; that of underweight decreased from 6.0% to 4.7%; and that of wasting decreased from 6.3% to 3.5%; however, these changes were not statistically significant. The prevalence of obesity significantly increased from 8.0% to 13.2% in the first and second surveys, respectively (p=0.037). There was no significant difference in the prevalence of malnutrition according to the length of stay in South Korea or the children’s country of birth. However, the prevalence of obesity was significantly higher in children with longer lengths of stay and in those born in South Korea. Conclusion Although children from North Korean refugee families have settled in South Korea for a long time, the rate of malnutrition is still high, and the prevalence of obesity continuously increases.

The ovarian hyperstimulation syndrome (OHSS) is a rare but serious complication of ovulation induction therapy with gonadotropin. The pathogenesis of OHSS is unclear, but the proposed mechanisms are the production of vasoactive substances that increase local capillary permeability resulting in shifting of fluid from the intravascular space to the third space. The clinical manifestations varies from ascites, hypovolemia, oliguria, hemoconcentration, thromboembolism, and even death. We have experienced a case of severe OHSS with severe ascites, pleural effusion and bilateral enlarged ovaries associated with spontaneous pregnancy without any ovarian stimulation for ovulation induction.
Ascites ; Capillary Permeability ; Female ; Gonadotropins ; Hypovolemia ; Oliguria ; Ovarian Hyperstimulation Syndrome* ; Ovary ; Ovulation Induction* ; Ovulation* ; Pleural Effusion ; Pregnancy* ; Thromboembolism

BACKGROUND: Although pulmonary artery catheters are useful to monitor hydration, these devices may be associated with severe morbidity and are not routinely used in kidney transplantation. A central venous pressure (CVP) catheter is preferred rather than a pulmonary artery catheter. Noninvasive continuous blood pressure monitors may substitute for intraarterial catheters, thereby preserving the radial artery in kidney transplantation patients should it be needed later to create an arteriovenous fistula. If there is a relationship between central venous and radial arterial blood for acid-base (pH, BE, HCO3(-)), we can use the blood sample from a CVP catheter instead of arterial blood from aradial artery catheter for testing acid-base and it can help patients. METHODS: A central venous catheter and radial artery catheter was inserted in 67 patients while undergoing kidney transplantation. To assess arteriovenous differences in acid-base status at operation start, before reperfusion of the transplanted kidney, after reperfusion, we measured the pH, BE and HCO3(-) simultaneously from the arterial and central venous circulation. RESULTS: Aacid-base using arterial and central venous samples at operation start, before reperfusion and after reperfusionb was evaluated. We found the relationship as follows: pH between arterial (pHa) and central venous blood (pHcv) in each: linear regression equation; pHcv = 0.668 + (0.906 X pHa), pHcv = 0.225 + (0.965 X pHa), pHcv = 0.646 + (0.908 X pHa), determination coefficient; 0.908, 0.926, 0.888, P values < 0.001 in each period. Base excess (BE) between BEa and BEcv in each period: linear regression equation; BEcv = 0.483 + (0.952 X BEa), BEcv = 0.032 + (0.939 X BEa), BEcv = 0.008 + (0.954 X BEa), determination coefficient; 0.844, 0.954, 0.962 P values < 0.001 in each period. HCO3(-) concentration between HCO3(-)a and HCO3(-)cv in each period: linear regression equation; HCO3(-)cv = 2.434 + (0.937 X HCO3(-)a), HCO3(-)cv = 2.093 + (0.942 X HCO3(-)a), HCO3(-)cv = 1.755 + (0.954 X HCO3 a), determination coefficient; 0.950, 0.925, 0.932 P values < 0.001 in each period. CONCLUSIONS: The acid base status of arterial blood is similar to that of central venous blood. Central venous blood gas values (pH, BE, HCO3(-)) may be an acceptable alternative to arterial blood gas values in kidney transplantation patients.
Arteries ; Arteriovenous Fistula ; Blood Pressure Monitors ; Catheters ; Central Venous Catheters ; Central Venous Pressure ; Humans ; Hydrogen-Ion Concentration ; Kidney ; Kidney Transplantation ; Linear Models ; Pulmonary Artery ; Radial Artery ; Reperfusion