BACKGROUND: The pediatric CPR is rather uncommon practice than adult CPR in emergency room. Therefore, few interest and studies were focused in pediatric CPR. The object of this study is to make an analysis about pediatric CPR performed within hospital setting. METHOD: From January 1. 1990 to December 31. 1996, a total of 59 patients, less than 15-year-old, who received cardiopulmonary resuscitation were subject of this study. The study was done retrospective chart analysis for sex, age, weight, the place of cardiac arrest, initial EKG rhythms, endotracheal tube size, the causes of arrest, CPR time, ROSC, the amount and types of CPR drugs used during resuscitation. Wilcoxon rank sum test and chi2 test were used to compare the dose of drugs during CPR in each group. RESULTS: There were no statistical difference between ROSC and non-ROSC group in place of arrest, initial EKG rhythms, CPR time, dosage of CPR drugs. CONCLUSION: The uniform reporting guideline of pediatric advanced life support should be used for future pediatric CPR study, such as Utstein style guideline in pediatric CPR.
Adolescent ; Adult ; Cardiopulmonary Resuscitation* ; Electrocardiography ; Emergency Service, Hospital ; Heart Arrest ; Humans ; Resuscitation ; Retrospective Studies

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

BACKGROUND: Abdominal pain is one of the most common complaints in the emergency department and the evaluation presents an extraordinary challenge to the emergency physician's skill. C-reactive protein, an acute phase protein which is increased in the presence of inflammation in various clinical conditions, has been proven useful in assessing disease severity, in monitoring the development of complications, and in evaluating the response to specific treatments. So we tried to determine whether CRP offers an advantage over other clinical or laboratory variables for decision-making in the management of acute abdominal pain in the emergency department. METHOD: Patients who came to a University Hospital ED with acute abdominal pain, between september 1, 1998 and November 30, 1998, were included in this study, Data collection included age, sex, duration of symptom, location of pain, and laboratory dta(white blood cell count, portion of neutrophils, ESR, CRP, amylase). RESULT: This study included 85 patients, 34 of whom were men. The mean age was 36.9+/-19.1 years. CRP might be useful to detect the serious condition, sensitivity 81%, but more useful to differentiate normal condition from serious condition in acute abdominal pain patients, specificity 83%. CONCLUSION: CRP is an useful indicator of decision-making to abdominal patients in the emergency department. Hospitalization or operation is very unlikely when CRP value is normal.
Abdominal Pain* ; Acute-Phase Proteins ; Blood Cell Count ; C-Reactive Protein* ; Data Collection ; Emergencies ; Emergency Service, Hospital ; Hospitalization ; Hospitals ; Humans ; Inflammation ; Male ; Neutrophils ; Sensitivity and Specificity

Mutation of p53 gene is one of t.he commonest genetic changes in the development of human cancer including ovary. We intvestigated the diagnostic usefulness of the demonstration of p53 gene immunoreactivity in ovarian cancers, because immunochemical demonstration of p53 immunoreactivity is inexpensive, easily controlled and can be applied in routine pathology laboratories. p53 immunoreactivity was not identified in any patients in whom there was no morphological evidence of neoplasia. ln contrast, in contrast, in 46% of patients of ovarian cancer, p53 immunoreactivity was identified. Overexpression of gene correlated with advanced stage but did not corre1ate with grade, cell type and tumor size.
Female ; Genes, p53* ; Humans ; Immunohistochemistry ; Ovarian Neoplasms* ; Ovary ; Pathology

OBJECTIVE: Spontaneous intracerebral hemorrhage (ICH) and ischemic stroke share common vascular risk factors such as aging and hypertension. Previous studies suggested that the rate of recurrent ICH and ischemic stroke might be similar after ICH. Presence of cerebral arterial stenosis is a potential risk factor for future ischemic stroke. This study investigated the prevalence and factors associated with cerebral arterial stenosis in Korean patients with spontaneous ICH. METHODS: A total of 167 patients with spontaneous ICH were enrolled. Intracranial arterial stenosis (ICAS) and extracranial arterial stenosis (ECAS) were assessed by computed tomography angiography. Presence of ICAS was defined if patients had arterial stenosis in at least one intracranial artery. ECAS was assessed in the extracranial carotid artery. More than 50% luminal stenosis was defined as presence of stenosis. Prevalence and factors associated with presence of ICAS and cerebral arterial stenosis (presence of ICAS and/or ECAS) were investigated by multivariable logistic regression analysis. RESULTS: Thirty-two (19.2%) patients had ICAS, 7.2% had ECAS, and 39 (23.4%) patients had any cerebral arterial stenosis. Frequency of ICAS and ECAS did not differ among ganglionic ICH, lobar ICH, and brainstem ICH. Age was higher in patients with ICAS (67.6±11.8 vs. 58.9±13.6 years p=0.004) and cerebral arterial stenosis (67.9±11.6 vs. 59.3±13.5 years, p<0.001) compared to those without stenosis. Patients with ICAS were older, more frequently had diabetes, had a higher serum glucose level, and had a lower hemoglobin level than those without ICAS. Patients with cerebral arterial stenosis were older, had diabetes and lower hemoglobin level, which was consistent with findings in patients with ICAS. However, patients with cerebral arterial stenosis showed higher prevalence of hypertension and decreased kidney function compared to those without cerebral arterial stenosis. Multivariable logistic regression analyses showed that aging and presence of diabetes independently predicted the presence of ICAS, and aging, diabetes, and hypertension were independently associated with presence of cerebral arterial stenosis. CONCLUSION: 19.2% of patients with spontaneous ICH had ICAS, but the prevalence of ECAS was relatively lower (7.2%) compared with ICAS. Aging and diabetes were independent factors for the presence of ICAS, whereas aging, hypertension, and diabetes were factors for the cerebral arterial stenosis.
Aging ; Angiography ; Arteries ; Blood Glucose ; Brain Stem ; Carotid Arteries ; Cerebral Hemorrhage* ; Constriction, Pathologic* ; Ganglion Cysts ; Humans ; Hypertension ; Kidney ; Logistic Models ; Phenobarbital ; Prevalence ; Risk Factors ; Stroke

No abstract available.
Female ; Headache ; Humans ; Middle Aged

Purpose: This study aims to verify the preoperative factor that can affect the footprint coverage during arthroscopic rotator cuff repair in full-thickness medium-size cuff tear and the change of footprint coverage on magnetic resonance imaging (MRI) at postoperative 6 months. Methods: A total of 30 medium-size full-thickness rotator cuff tears were analyzed. They were classified into complete footprint coverage group (CC, n=19) and incomplete footprint coverage group (IC, n=11) by arthroscopic findings and immediate postoperative MRI findings. MRI was performed before the operation, 1 day after the operation, and 6 months after the operation. Preoperative MRI evaluated the size of the anteroposterior tear width (cm), length of retraction (cm), fatty infiltration, and muscle atrophy. Postoperatively, footprint coverage, fatty degeneration, and muscle atrophy were evaluated. We compared healing and change of fatty degeneration between two groups. Results: The healing rate was significantly increased in the CC group (complete/partial healing, 10/9) compared to the IC group (complete/partial healing, 6/5) (p＜ 0.001). Six of 11 partial coverages (54.5%) were even improved to complete coverage at postoperative 6-month follow-up. However, the difference in footprint coverage did not affect the change of fatty degeneration at postoperative 6 months. Any change of fatty degeneration (FD) and initial FD of rotator cuff tendons were not correlated with healing (p＜ 0.05). Conclusion The footprint coverage can be changed in postoperative 6 months in MRI and anteroposterior tear size, retraction, fat degeneration, and muscle atrophy do not affect footprint coverage in medium-sized full-thickness rotator cuff tears.

PURPOSE: To evaluate the clinical results of double tension band wiring for communited olecranon fractures involving proximal 1/3. MATERIALS AND METHODS: We reviewed 9 cases of communited olecranon fractures involving proximal 1/3 treated with double tension band wiring followed for minimum 10 months. There were 2 cases of olecranon fractures involving only proximal 1/3, 6 cases of olecranon fractures involving from proximal 1/3 to middle 1/3 and 1 case of olecranon fractures involving from proximal 1/3 to distal 1/3. We analyzed the bone union time, radiologic results for gap, reduction loss, pin migration, pain, range of motion, complications and functional outcomes at last follow up. RESULTS: All patients had solid bone union without additional surgery and average union time was 10.3 weeks. Anatomical reduction could be obtained in 8 of 9 cases but there was 1 mm step off in one case. 36 pins were used to fix the fractures, 1 pin of 18 distal pins and 2 pins of 18 proximal pins were migrated to backward but there was no reduction loss. Only 1 distal pin needed early removal due to skin irritation. Average range of motion ranged from flexion contracture 3.3 degrees to further flexion 137.8 degrees. On functional analysis, we got 8 cases of good result, 1 case of fair result and there was no poor result. CONCLUSION: Double tension band wiring for comminuted olecranon fracture involving proximal 1/3 was concluded to give a firm fixation of the fracture site as bone union could be acquired without serious pin problems.
Contracture ; Humans ; Olecranon Process ; Range of Motion, Articular ; Skin

BACKGROUND: The emergency physician(EP)'s interpretation of the electrocardiogram(ECG) is important in determining the disposition of patients evaluated in an emergency department(ED) for chest pain o other cardiac complaints. This particularly important in life-threatening ECG findings. When the cardiologist's final interpretation was defined as the correct one, the concordance compared with the EP was reported to be 50-60%, while the missed diagnosis of acute myocardial infarction(AMI) was reported as 0.6-8.0%, which could be deleterious to the patient. METHOD AND MATERIAL : One hundred and twenty eight ECGs were interpreted by two residents from each year residency. ED records of the study patients were reviewed, and the EP's and cardiologist's ECG interpretations were compared. The ECGs were classified by severity according to the following system: class I, normal or minor abnormalities only; class II, abnormalities with potential to alter case management; and class III, potentially life-threatening abnormalities. RESULTS: The overall concordance between EP's and cardiologist's ECG interpretations was 59.3% and the concordance comparing each year residency showed no statistical significant difference (p value less than 0.05). The underdiagnosed rate was 48.4%, 32.0%, 23.4%, 22.7% for first, second, third and fourth year residency respectively, and 2.3%, 5.5%, 10.9%, 5.5% respectively for the overdiagnosed rate. CONCLUSION: Although the overall concordance showed a relatively high result in our study, the concordance of class III ECG resulted a much lower rate. Therefore, additional studies are needed to identify variables that contribute to ED ECG misinterpretation and to develop methods to resolve these difficulties. Assessment of department ECG misinterpretation would be useful in focusing on resident and staff education.
Case Management ; Chest Pain ; Diagnosis ; Education ; Electrocardiography* ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Internship and Residency

BACKGROUND AND PURPOSE: We investigated subsequent vascular events in patients with transient ischemic attack (TIA) and determined the predictors of such events among vascular risk factors including large-artery disease, TIA-symptom duration, and acute ischemic lesions on diffusion-weighted imaging (DWI). METHODS: We identified 98 consecutive patients with TIA who visited a tertiary university hospital and underwent DWI and brain magnetic resonance angiography within 48 hours of symptom onset. We reviewed the medical records to assess the clinical characteristics of TIA, demographics, and the subsequent vascular events including acute ischemic stroke, TIA, and myocardial infarction. RESULTS: Large-artery disease was detected in 55 patients (56%). Ten patients (10%) experienced TIA symptoms for longer than 1 hour, and acute infarctions on DWI were identified in 30 patients (31%). During the mean follow-up period of 19 months, seven patients (7%) had an acute ischemic stroke and 20 patients (20%) had TIA. Retinal artery occlusion in two patients, spinal cord infarction in one patient, and peripheral vascular claudication in one patient were also recorded. Cox proportional-hazards multivariate analysis revealed that large-artery disease was an independent predictor of subsequent cerebral ischemia (hazard ratio [HR], 2.8; 95% confidence interval [CI], 1.1-7.1; p=0.02) and subsequent vascular events (HR, 2.9; 95% CI, 1.2-6.7; p=0.01). CONCLUSIONS: In patients with TIA, large-artery disease is an independent predictor of subsequent vascular events. Acute infarction on DWI and a symptom duration of more than 1 hour are not significantly correlated with a higher risk of subsequent vascular events. These findings suggest that the underlying vascular status is more important than symptom duration or acute ischemic lesion on DWI.
Brain ; Brain Ischemia ; Constriction, Pathologic* ; Demography ; Follow-Up Studies ; Humans ; Infarction ; Ischemic Attack, Transient* ; Magnetic Resonance Angiography ; Medical Records ; Multivariate Analysis ; Myocardial Infarction ; Prognosis ; Retinal Artery Occlusion ; Risk Factors ; Spinal Cord ; Stroke