BACKGROUND: The differentiation between hemorrhagic(HS) and norhemorrhagic(NHS) stroke is the most important first step in the management of acute stroke because clinical management of the two disorders differs substantially. Neuroimaging studies are useful in diagnosing and distinctioning between HS and NHS. The use of clinical variables, such as Siriraj stroke scores(SSS), has led to good sensitivity, specificity and predictive values. The aim of our study was to evaluate the use of the SSS in the Korean population and assess whether it could aid to expedite treatment decisions. METHODS: We reviewed 111 cases of stroke patients admitted to our hospital via the emergency department over a 6 months period from July to December 1998. Levels of consciousness, vomiting, headache, and atheroma markers used in the SSS were applied to these patients who met the criteria for a stroke. RESULTS: Of the 111 patients, the SSS classified 83 with sensitivities of 81.1%(NHS) and 73.3%(HS) and positive predictive values of 84.3% and 68.8%, respectively. The overall accuracy rate was 78.3%. CONCLUSION: Our results suggest that the SSS is not reliable in distinguishing stroke types in the Korean population. Definite neuroimaging studies are needed prior to thrombolytic therapy.
Consciousness ; Emergency Service, Hospital ; Headache ; Humans ; Neuroimaging ; Plaque, Atherosclerotic ; Sensitivity and Specificity ; Stroke* ; Thrombolytic Therapy ; Vomiting

BACKGROUND: Good documentation of electrical injuries at the time of presentation is very important to emergency management, so this study was designed to investigate the clinical characteristics and the outcomes of patients with electrical injury. METHODS: A review of 75 cases of electrical injuries admitted to our hospital via the emergency department over a 4 year period from 1996 to 1999 was conducted. RESULTS: There were 49 patients with high-voltage injuries and 19 patients with low-voltage injuries. All but 4 patients were males, with a mean age of 29.5 years. The most common type of injury was 14.5% TBSA in the high-voltage group and 2.5% in the low-voltage group. Forty-nine(72.1%) of the injuries were work related. The number of patient with compartment syndrome was 19, and fasciotomies were performed in all but one patient. Myoglobinuria was noted in 22 patients, but no patient developed acute renal failure due to myoglobinuria. In the high-voltage group, 10 limb amputations were performed. Complication were observed in 12 patients. The most common complication was neurological injury. The average length of hospital stay was 50.7 days in the high-voltage group and 13.8 days in the low-voltage group. The overall mortality rate was 4.3%. CONCLUSION: Prevention of electrical injuries is very important. Education and compliance with safety measures, as well as basic knowledge and precaution in dealing with electricity, are essential to avoid these injuries.
Acute Kidney Injury ; Amputation ; Burns* ; Compartment Syndromes ; Compliance ; Education ; Electricity ; Emergencies ; Emergency Service, Hospital ; Extremities ; Humans ; Length of Stay ; Male ; Mortality ; Myoglobinuria

BACKGROUND: Incidence of traumatic hip dislocation have ween increased with development of transportation. Traumatic hip dislocation demands early recognition as an emergency and prompt reduction. So we designed this study to determine what kinds of factors affect the prognosis of the patient. METHODS: Eighty five patients who admitted emergency department of our hospital with the traumatic hip dislocation were enrolled in this study. Cause of injury, type of dislocation, method of reduction, the time from dislocation to reduction, age, gender and associated patellar injury were evaluated by retrospective chart reviews. RESULTS: Average age of excellent and good group(E&G) is 28+/-17.8 and fair and poor group(F&P) is 39+/-18.6, so the older the age the more poor prognosis(P<0.05). The time to take reduction of E&G group is 18+/-8.2 hours and F&P group is 25+/-12.6 hours, so the faster the better prognosis(P<0.05). We classify the type of hip dislocation by Thompson and Epstein method, type I to type V. The prognosis of type I is better than type V(P<0.05). Fifty five case were associated with patellar injury and they had poor prognosis than the other cases that were not associated with knee joint injury. CONCLUSION: In traumatic dislocated hip patients, the prognosis was poor in old age, delay in reduction, higher type of dislocation and associated with knee joint injury.
Dislocations ; Emergencies ; Emergency Service, Hospital ; Hip Dislocation* ; Hip* ; Humans ; Incidence ; Knee Joint ; Prognosis* ; Retrospective Studies ; Transportation

To investigate the osmolality of commercially supplied drugs used in anesthesia, the authors measured the osmolality of a total of 62 drugs with osmometer using the principle of freezing point depression. The osmolality range of drugs observed was 0-12,478 mOsm/kg water. The drugs of osmolality between 240 and 340 mOsm/kg water were 21(34%). Hypertonic drugs(<240 mOsm/kg water) were 18(29%) indicating two-thirds of the drugs were hypo-or hypertonic. Therefore, it is recommended that extreme hypo-or hypertonic drugs should be administered cautiously especially when they are administered rapidly and massively in order to prevent hemolysis or cell shrinkage.
Anesthesia* ; Depression ; Freezing ; Hemolysis ; Osmolar Concentration* ; Water

PURPOSE: The purpose of this study was to determine whether ultrasonography assisted internal jugular central venous catheterization by single operator or two-operator could improve the success rate and decrease the number of complications compared to the traditional landmark technique. METHODS: This study was a prospective, randomized, clinical trial conducted from July 2008 to February 2009 in an urban Korean teaching hospital. Patients requiring central venous access were randomized to 1 of the 3 insertion techniques (single-operator technique, two-operator technique, traditional landmark technique). The primary outcome measure was cannulation success. Additional outcome measures included number of attempts, access times, and complications. RESULTS:One hundred fourteen patients were enrolled. Thirty four of 37(91.9%) internal jugular vein catheters were successfully inserted by single-operator technique, 34 of 39(87.2%) by two-operator technique and 22 of 38(57.9%) by landmark technique. First attempt cannulation was successful in 28 of 34(82.4%) using single-operator technique, 26 of 34(76.9%) using two-operator technique and 9 of 22(40.9%) using landmark technique. The median start to venipuncture time was 138 seconds by single-operator technique, 170 seconds by two-operator technique and 329 seconds by landmark technique. There were 19 complications in the study, 15 in the landmark group, 2 in the singleoperator group, and 2 in the two-operator group. CONCLUSION: Real-time ultrasonography assisted internal jugular vein catheterization has an higher success rate, is less time consuming, and has a lower complication rate. The single-operator technique appears to be equivalent to the two-operator technique in success rate and procedure time.
Catheterization ; Catheterization, Central Venous ; Catheters ; Central Venous Catheters ; Emergencies ; Hospitals, Teaching ; Humans ; Jugular Veins ; Outcome Assessment (Health Care) ; Phlebotomy ; Prospective Studies ; Veins

BACKGROUND: The survival benefit of combination chemotherapy comparing supportive care to patients with advanced non-small cell lung cancer, especially stage IV non-small cell lung cancer patients with metastatic disease, is controversial. The main goal of this study was to evaluate the difference in survival between patients treated with chemotherapy and those who were not and to identify prognostic factors in the patients with stage IV non-small cell lung cancer. METHODS: From January 1989 to December 1994, total 67 patients including 20 patients treated with combination chemotherapy and 47 patients treated with only supportive care in stage IV non-small cell lung cancer patients with metastatic disease were enrolled in this study. Combination chemotherapy consisted of etoposide 120mg/m2 iv for 3 days and cis-platin iv day 1 every 4 weeks. The treatment groups were retrospectively analyzed by age, sex, histologic cell type, weight loss, serum LDH level, ECOG performance status and major organ metastasis. RESULTS: The significant prognostic factors influencing survival on this study were ECOG performance status and histologic subtype. Overall response rate by combination chemo-therapy was 30%(complete response 0%, partial response 30%). Median survival of overall patients was 13.6 weeks and median survival of chemotherapy group, 20 weeks, was significantly longer than that of supportive care group, 11.7 week(p<0.01). Median survival of responder in patients receiving chemotherapy, 45.5 weeks, was significantly longer than that of non-responder, 17.3 weeks(p<0.05). 1 year-survival rate of chemotherapy group and supportive care group was 15% and 8%, respectively. Nausea or vomiting, alopecia and anemia were seen in nearly most cases after this combination chemotherapy. Toxicities above grade 3 included neutropenia, anemia, thrombocytopenia, infection, fever, nausea, vomiting and alopecia. But this combination chemotherapy was relatively well tolerated except one treatment-related death from sepsis associated with severe granulocytopenia. CONCLUSION: These results suggest that systemic chemotherapy might be helpful to the stage IV non-small cell lung cancer patients with good performance status and large scale randomized prospective trials should be performed.
Agranulocytosis ; Alopecia ; Anemia ; Carcinoma, Non-Small-Cell Lung* ; Drug Therapy ; Drug Therapy, Combination* ; Etoposide ; Fever ; Humans ; Nausea ; Neoplasm Metastasis ; Neutropenia ; Retrospective Studies ; Sepsis ; Thrombocytopenia ; Vomiting ; Weight Loss

OBJECTIVE: Systemic lupus erythematceus(SLE) is an autoimmune disease and manifests with a variety of clinical and immunologic features in the multisystem SLE occurs worldwide in all ethnic groups but the prevalence and clinical man'ifestations of SLE may differ depending on ethnic groups and age. METHODS: We retrospectively analyzed the clinical and laboratory features of 167 patients with SLE at the Yeungnam University Hospital, Kyungpook National University Hospital and Keimyung University Hospital between January 1984 to February 1993. RESULTS: 1) The male to female ratio was 1:19.8 and the mean age was 28.1. Seventy six patients(42. 1%) were diagnosed to have SLE in the third decade. 2) The prevalence of positive ARA criteria for SLE revealed that antinuclear antibody (ANA) was 96.4%, cutaneous disorder 73.6%, hematologic disorder 72.5%, immunologic disorder 71.3%, arthralgia or arthritis 70.1%, renal disorder 55.7%, serositis 40.7%, oral ulcer 28.7% photosensitivity 25.7% and neuropsychiatric disorder 19.7%. 3) The malar rash was the most common manifestation in mucocutaneous disorder, arthralgia or arthritis in musculoskeletal disorder, proteinuria in renal disorder, pericarditis and pleuritis in cardiopulmonary disorder, psychosis in neuropsychiatric disorder, anemia in hematologic disorder, and hypocomplementemia in immunologic disorder. 4) Renal biopsy was performed in 65 cases among which the most common histologic type was diffuse proliferative glomerulonephritis(53.9%). CONCLUSION: These data suggested that clinical manifestations of SLE in Korean patients revealed similar to those of Western(Caucasian+Black) except that photosensitivity, serositis, neuropsychiatric disorders were less frequent in Korean.
Anemia ; Antibodies, Antinuclear ; Arthralgia ; Arthritis ; Autoimmune Diseases ; Biopsy ; Ethnic Groups ; Exanthema ; Female ; Gyeongsangbuk-do ; Humans ; Lupus Erythematosus, Systemic* ; Male ; Oral Ulcer ; Pericarditis ; Pleurisy ; Prevalence ; Proteinuria ; Psychotic Disorders ; Retrospective Studies ; Serositis

Foreign bodies that migrate outside the esophagus into the mediastinum or soft tissues usually cause respiratory symptoms. Also, esophageal foreign body granulomas that cause tracheal stenosis, lobar atelectasis, and bronchoesophageal fistulas are reported as complications. Foreign bodies can become lodged above esophageal strictures, and chronically-embedded esophageal foreign bodies can induce stricture formation, although these are less common. This is rare case report that the trachea was directly compressed due to impacted esophagus by foreign body.
Constriction, Pathologic ; Dyspnea ; Esophagus ; Fistula ; Foreign Bodies ; Granuloma, Foreign-Body ; Mediastinum ; Pulmonary Atelectasis ; Trachea ; Tracheal Stenosis

PURPOSE: The purpose of this study was to determine whether continuous capnography monitoring detects adverse respiratory and airway events earlier than pulse oximetry and the clinical exam can during intramuscular ketamine for procedural sedation in children. METHODS: This study was a prospective observational study conducted from April 2009 to March 2010 in an urban Korean teaching hospital. Pediatric patients who needed procedural sedation for primary closure were enrolled. After patients received intramuscular ketamine, they were monitored using clinical ventilation assessment, pulse oximetry and capnography. Adverse respiratory and airway events were recorded RESULTS: A total of 91 patients were enrolled. Of the 91 patients, 16 (17%) had adverse respiratory events; 5 had hypoxia. Capnography was 100% sensitive for predicting hypoxia and apnea. CONCLUSION: When intramuscular ketamine is administered for procedural sedation in children, capnography allows early detection of adverse respiratory events.
Anoxia ; Apnea ; Capnography ; Child ; Conscious Sedation ; Hospitals, Teaching ; Humans ; Ketamine ; Oximetry ; Prospective Studies ; Ventilation

PURPOSE: To assess the rates of infectious complications before and after the change of prophylactic antibiotic regimens in prostate needle biopsy. MATERIALS AND METHODS: The records of 5,577 patients who underwent prostate needle biopsy at Asan Medical Center between August 2005 and July 2012 were retrospectively reviewed. Group 1 (n=1,743) included patients treated between 2005 and 2009 with fluoroquinolone for 3 days, group 2 (n=2,723) included those treated between 2009 and 2012 with ceftriaxone once before the biopsy and fluoroquinolone before biopsy and continue therapy for 3 days, and group 3 (n=1,111) received the same treatment for more than 7 days after the biopsy. Univariable and multivariable logistic regression models addressed risk factors associated with infectious complication after prostate needle biopsy. RESULTS: Infectious complication after prostate needle biopsy developed in 18 (group 1), seven (group 2), and two patients (group 3) (p=0.001). In group 1, seven patients with infectious complication had positive blood cultures and harbored fluoroquinolone-resistant Escherichia coli, four had ceftriaxone susceptible isolates, and three had extended spectrum beta-lactamase-positive E. coli. Two patients in group 1 required intensive care because of septic shock. In multivariable analysis, the patients with combination of fluoroquinolone and ceftriaxone had significantly lower infectious complication rate than the fluoroquinolon alone (p=0.003). CONCLUSIONS: Antibiotic prophylaxis with ceftriaxone and fluoroquinolone before prostate needle biopsy decreased the risk of potentially serious infectious complications.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Antibiotic Prophylaxis/*methods ; Biopsy, Needle/adverse effects/methods ; Ceftriaxone/*therapeutic use ; Cross Infection/epidemiology/etiology/*prevention & control ; Drug Evaluation/methods ; Drug Resistance, Bacterial ; Drug Therapy, Combination ; Escherichia coli/drug effects ; Escherichia coli Infections/epidemiology/prevention & control ; Fluoroquinolones/*therapeutic use ; Humans ; Incidence ; Male ; Middle Aged ; Prostatic Neoplasms/*pathology ; Republic of Korea/epidemiology ; Retrospective Studies ; Ultrasonography, Interventional ; Young Adult