The present study was performed to provide an anatomical basis of the coracoacromial (CA) arch and the articular surfaces of the scapula which can be applied to the diagnosis and treatment of some common shoulder problems. The standard dimensions and the range of variation of the CA arch, the acromial articular surface and the glenoid cavity were investigated in 114 dry scapulae obtained from 57 (male, 35 ; female, 22) Korean cadavers ranging in age from 18 to 97 years (average age of 67). The results were as follows : 1. The length (46.3mm), width(25.2mm), thickness (8.2mm) and height (4.5mm) of the acromion were measured. The length, width and thickness were significantly larger in the males. The slope of the acromion was 51.5°, and the slope of the scapular spine was 118.5°. 2. The height (13.5mm), slope of the root (138.4°) and the horizontal part (25.3°) of the coracoid process, and the angle between the root and the horizontal part (106.6°) were measured. There were no significant differences between sexes and sides in all morphometric values related to the coracoid process. 3. The length (67.6mm) and height (24.7mm) of the CA arch, the height of the CA ligament from the supraglenoid tubercle (13.1mm), and length of the CA ligament (27.6mm) were measured. Both the length and height of the CA arch and the length of the CA ligament were significantly larger in the males. The slope and anterior and posterior angles of the CA arch were 16.8°, 42.2°, and 34.7°, respectively. 4. The long (13.8mm) and short (8.0mm) diameters of the acromial articular surface were measured, and both diameters were significantly longer in the males. The acromial articular surface was 8.4mm away from the tip of the acromion and extended 1.4mm inferiorly below the inferior surface of the acromion. 5. The long (34.8mm) diameter, and superior (15.0mm), middle (19.5mm), and inferior (25.6mm) short diameters of the glenoid cavity were measured. The long and both superior and inferior short diameters were significantly longer in the males.
Acromion ; Cadaver ; Diagnosis ; Female ; Glenoid Cavity ; Humans ; Ligaments ; Male ; Scapula* ; Shoulder ; Spine

No abstract available.
Broad Ligament* ; Female ; Leiomyosarcoma*

BACKGROUND: This study was designed to describe the current tends of emergency tracheal intubation and predict difficult airway intubations in emergency department (ED) at a teaching hospital in Korea. METHODS: All patients who was taken endotracheal incubation in ED during a 1-year period (Mar 1997 through Feb 1998) were included in the study population. Medical records of the patients were retrospectively reviewed. Among them, 56 patients were prospectively evaluated parameters to predict difficult airway intubations. RESULTS: During the study period, a total of 413 patients(1.5%) required endotracheal intubation. Except far 2 cases, all patients intubated orotracheally, and 298(72%) patients were intubated by emergency medicine resident. Pharmacologic adjuncts were used in 200(48%) patients, the neuromuscular blocking agent(NMBA) was used in 16(3.8%) Commonly used drugs were thiopental and vecuronium. The difficult incubation was not associated with presence of denture, length and circumference of neck, and mental status. The visibility of vocal cord on laryngoscopy significantly correlated to the difficult airway. CONCLUSION: At this institution, the majority of ED incubation were performed by emergency physicians and NMBA was not routinely used. The visibility of vocal cord during the direct laryngoscopy could be a predictor of difficult incubation in ED.
Dentures ; Emergencies* ; Emergency Medicine ; Emergency Service, Hospital ; Hospitals, Teaching ; Humans ; Intubation* ; Intubation, Intratracheal ; Korea ; Laryngoscopy ; Medical Records ; Neck ; Neuromuscular Blockade ; Prospective Studies ; Retrospective Studies ; Thiopental ; Vecuronium Bromide ; Vocal Cords

Cerebrovascular accident remains the second most common cause of death in Korea, following combined cancer mortality. It is one of the most common causes of disability, and atherothromboembolic ischemic infarction accounts for nearly half of stroke in Korea. Carotid endarterectomy is proven to be effective in preventing stroke from internal carotid artery stenosis. The authors report the results of prospective study of 63 carotid endarterectomies, performed from September, 1995 to November, 1997 at our institution, to clarify the persisting diversity of opinions as to ideal preoperative diagnostic tests, anesthetic management, intraoperative monitoring techniques for cerebral protection, type of arterial repair, and postoperative evaluation for cerebral function. We confirmed that preoperative diagnostic tests of duplex scanning and magnetic resonance angiogram can replace the invasive conventional cerebral angiography, and observation of consciousness under regional anesthesia is the most reliable and safe method for carotid endarterectomy utilizing selective shunting, if needed.
Anesthesia, Conduction ; Carotid Stenosis ; Cause of Death ; Cerebral Angiography ; Consciousness ; Diagnostic Tests, Routine ; Endarterectomy, Carotid* ; Infarction ; Korea ; Monitoring, Intraoperative ; Mortality ; Prospective Studies* ; Stroke

BACKGROUND: Propofol and ketamine had been used for anesthesia induction and for total intravenous anesthesia. The nature of any hypnotic interactions occurring between propofol and ketamine are unknown. A comparison of maternal and neonatal effects among propofol-ketamine combination, ketamine and propofol were studied when used for anesthesia induction in Cesarean section. METHODS: Forty five patients in ASA class I or II scheduled for Cesarean section randomly assigned to either propofol 2 mg/kg (n=15), ketamine 1 mg/kg (n=15) or propofol 1 mg/kg - ketamine 0.5 mg/kg combination group (n=15) as an induction agent. Maternal systolic and diastolic blood pressure, heart rate, Apgar score and umbilical blood gas analysis were measured. RESULTS: Before intubation, systolic and diastolic pressure were decreased in propofol group but increased in ketamine and propofol-ketamine combination group. Heart rate were increased in all three groups. But there were no significant differences among three groups (p<0.05). After intubation, there were significant increase in systolic, diastolic pressure and heart rate in three groups but no significant differences among three groups (p<0.05). And there was no significant neonatal depression as assessed by Apgar scores and blood gas analyses. CONCLUSIONS: Propofol-ketamine combination was found to be similar to propofol or ketamine only in the effects on the mother and neonate. But propofol-ketamine gained more stable hemodynamic change than propofol or ketamine before intubation. Therefore propofol-ketamine appears to be a suitable alternatives to propofol or ketamine as an induction agent for anesthesia in Cesarean section.
Anesthesia ; Anesthesia, Intravenous ; Apgar Score ; Blood Gas Analysis ; Blood Pressure ; Cesarean Section* ; Depression ; Female ; Heart Rate ; Hemodynamics ; Humans ; Infant, Newborn ; Intubation ; Ketamine* ; Mothers ; Pregnancy ; Propofol*

Anaphylactic deaths are frequently observed at autopsies. Since death associated with medical practice has become social concern, the identification of anaphylactic shock is an important part of forensic medicine. However, autopsy findings of anaphylactic shock are usually non-specific; therefore, the diagnosis of anaphylactic shock must be inferred from collecting data on the past history of the deceased, circumstances of death, and negative autopsy findings. The analysis of serum mast cell tryptase level is a well-known, useful ancillary test for the diagnosis of anaphylactic shock, but is not widely used in daily practice in Korea. We recently encountered 2 autopsy cases of anaphylactic shock and confirmed that analysis of serum mast cell tryptase level was useful for the diagnosis of anaphylactic shock. In this report, we present these 2 autopsy cases of anaphylactic shock, with literature review of the usefulness and limitations of serum mast cell tryptase analysis.
Anaphylaxis ; Autopsy ; Forensic Medicine ; Korea ; Mast Cells ; Tryptases

BACKGROUND: Hyperkalemia is a common and potentially life-threatening metabolic disorder. The electrocardiogram(ECG) is known to be a relatively sensitive diagnostic tool hyperkalemia. However many exceptions, in which patients showed normal ECG findings even though hyperkalemic, have been reported. The purpose of this study was to determine the extent of correlation between the ECG findings and hyperkalemia and to determine when the ECG has value for diagnosing hyperkalemia. METHODS: Patients who had been diagnosed as having hyperkalemia at two university hospitals during three years were enrolled in this study. We reviewed the medical records of the patients and evaluated the following 6 ECG abnormalities: tall T waves, narrow T waves, QRS widening, atrioventricular block, loss of P waves, and sine waves. We defined tall T waves and narrow T waves as 20 percentiles of heights and widths of the T waves from the 100 patients with normokalemia. RESULTS: During the study period, there were 100 hyperkalemic patients, and we analyzed 69 available electrocardiograms. Abnormal ECG findings were revealed in 67% of 69 patients. The higher the serum potassium level, the more abnormal ECG findings. The common ECG abnormalities were tall T waves and loss of P waves. The patients with normal ECGs even though hyperkalemic had relatively low potassium levels. And whether chronic renal disease was not correlated to the ECG abnormality. CONCLUSION: The electrocardiogram is a good diagnostic tool for hyperkalemia if it is used with accurate diagnostic criteria. Thus, hyperkalemia should be considered when the ECG shows tall T waves or loss of P waves.
Atrioventricular Block ; Electrocardiography* ; Hospitals, University ; Humans ; Hyperkalemia* ; Medical Records ; Potassium ; Renal Insufficiency, Chronic

BACKGROUND: Methemoglobinemia(MetHb) induced by dapsone overdose is not uncommon in Korea, especially in rural area. For treatment of dapsone-induced methemoglobinemia, methylene blue(MB) and activated charcoal(AC) should be used. To date, no reports have compared the amount of MB used between MB alone with MB & AC combined group(MB+AC). And also between moderate (MetHb<35%) and severe (MetHb>35%) intoxicated group defined by initial MetHb level. Authors hypothesized that less amount of MB can be used if MB and AC was used together and larger amount of MB is necessary to reduce MetHb level to asymptomatic level in severely intoxicated group. METHODS: From Jan 1990 to Dec 1996, a total of 54 patients who received treatment for dapsone intoxication were subject of study, The study was done retrospective chart analysis for initial MetHb level, total amount of MB and AC. Wilcoxon rank sum test and Chi-sqiare test was used to compare the total dosage of MB used for each group. Linear regression analysis was used between initial MetHb and the total amount of MB. Results were considered statistically significant when p<0.05. RESULTS: For MB alone and MB+AC group, the differences in total amount of MB used were statistically significant with mean dosage of 7.14+/-1.1mg/kg and 4.28+/-0.7mg/kg, respectively. And total amount of MB used between moderate and severe intoxicated group, the differences were statistically significant with mean dosage of 5.16+/-1.1mg/kg vs. 10.98+/-1.9mg/kg, respectively. There was significant correlation between initial MetHb level (X) and the amount of methylene blue (Y), Y=0.3X-2.42 (r2=0.41, p=0.0001) in MB alone, Y=0.186X-1.95(r2=0.21, p=0.034) in MB+AC respectively. CONCLUSION: For methemoglobinemia induced by dapsone, total amount of MB can be reduced especially in severe Intoxicated group if AC use was combined in treatment modality. There was significant correlationship between initial MetHb level and total amount of MB used.
Charcoal* ; Dapsone* ; Humans ; Korea ; Linear Models ; Methemoglobinemia ; Methylene Blue* ; Retrospective Studies

The authors have presented a case of malignant melanoma (o.d.) originated from posterior part of the choroid which extended to the orbit. And two cases of basal cell carcinoma of the lids which were improved dramatically by the application of X'ray therapy. Neither recurrence nor complicated cataracta developed later.
Carcinoma, Basal Cell* ; Choroid* ; Cues* ; Melanoma* ; Orbit ; Recurrence

OBJECTIVES: The aim of this study was to examine the association of attention-deficit hyperactivity disorder (ADHD) in Korean populations with functional polymorphisms of six genes dopamine receptors (Ser311/Cys311 polymorphism, Taq1 A polymorphism, and Taq1 B polymorphism in DRD2, BalI polymorphism in DRD3, and promoter -521 C/T polymorphism and exon III 48 bp repeat polymorphism in DRD4) and one gene in dopamine transporter (DAT1). METHODS: Participants were 58 children with ADHD and 110 control children. The genotypes were determined by PCR. RESULTS: There was a statistically significant difference in genotype frequency of -521 C/T polymorphism within the promoter region of the DRD4 between two groups. Furthermore, in the male group, both genotype and allele frequencies showed statistically significant differences. CONCLUSION: Findings of the study indicate that -521 C/T polymorphism in promoter region of DRD4 appears to be a possible candidate gene for ADHD in Korean population.
Attention Deficit Disorder with Hyperactivity ; Child ; Dopamine ; Dopamine Plasma Membrane Transport Proteins ; Exons ; Gene Frequency ; Genotype ; Humans ; Male ; Promoter Regions, Genetic ; Receptors, Dopamine