OBJECTIVE: Sixteen cases of blunt diaphragmatic injury were clinically reviewed during 10 years from Oct.1987 to Jun.1996 at the Kangdong sacred heart hospital. The age and sex distribution were ranged from 3 to 67-old-years. The most common age range was between third decades to fifth decades in 10 cases(62.50%) and occurred predominantly in male, the sex ratio was 4.3 : 1.(M:F 4.3:1) The modes of blunt diaphragmatic injury were due to motor vehicle accidents(MVA), motor cycle accidents(MCA), fall down(FD) and others. Most common injuries were responsible for MVA. MVA were pedestrian traffic accidents 5 cases (41.7%), driver 4 cases(33.3%) passenger 3 cases(25.0%). In the blunt diaphragmatic injury sites, the left-sided diaphragmatic injury had predominant[left-sided cases 10(62.50%), right-sided cases 6(37.50%)]. Cost common symptoms and signs were chest pain or chest discomfort(81.25%) and dyspnea(68.75%), abdominal tenderness(50.00%), decreased bowel sound and breath sound(50.00%) and others. All of 16 cases in blunt diaphragmatic injury were associated with other injuries. The associated injuries were hemopneumothorax 14(87.50%), hemoperitoneum 7(43.759o), liver injury 7(43.75%), orthopedics fracture 14(87.50%), head injury 5(31.25%) and others. The diagnostic methods were used with simple x-ray, ultrasonogram and computed tomogram. The preoperative diagnosis of blunt diaphragmatic injury were suggested in 10 cases(62.509o) and others were confirmed during operation. The thirteen cases of all of sixteen cases were performed emergency operation within eight hours. The herniated intraabdominal organs through ruptured diaphragm were presented in 10cases(62.5%) [stomach 7 cases(43.75%), spleen 6 cases(37.50%), colon 3 cases(18.75%), liver 3 cases(18.75%), small bowel and omentum 2 cases(12.50%), respectively]. The mean size of blunt diaphragmatic injury were 7.7cm, right-sided mean size were 9cm, left-sided mean size were 6.9cm. The most common site of blunt diaphragm- atic injury were presented in anteromedial site 7 cases(43.75%). Simple chest x-ray revealed abnormal finding [hemothorax 10cases(62.50%), pneumothorax 4cases(25.00%), herniated organ into thorax8 cases(50.00%), diaphragm elevation 3 cases(18.75%) and others]. The postoperative complication were associated in 10 cases(62.50%) out of 16 cases. Common complications were pleural effusion 6 cases(37.50%) and atelectasis 3 cases(18.75%). Injury severity score(ISS) value of 16 cases in the blunt trauma ranged from 10 to 59. It was presented with mean value of ISS(35.5),mean value of ISS survivors(35) and nonsurvivors(55.5). Revised trauma score(RTS) value ranged also from 4 to 12. There were revealed with mean value of RTS(9.7),mean value of RTS survivors(10) and nonsurvivors(6.5). All of the blunt traumatic injury, mortality rate was related to the values of ISS and RTS.
Accidents, Traffic ; Chest Pain ; Colon ; Craniocerebral Trauma ; Diagnosis ; Diaphragm ; Emergencies ; Heart ; Hemoperitoneum ; Hemopneumothorax ; Humans ; Liver ; Male ; Mortality ; Motor Vehicles ; Omentum ; Orthopedics ; Pleural Effusion ; Pneumothorax ; Postoperative Complications ; Pulmonary Atelectasis ; Sex Distribution ; Sex Ratio ; Spleen ; Thorax ; Ultrasonography

Intussusception is a condition of invagination of the proximal segment of bowel into the more distal receiving bowel. Intussusception is one of the common pediatric and surgical emergencies of infancy and childhood in Korea. Intussusception is the most common cause of acquired intestinal obstruction in infancy and childhood, and it needs emergency treatment. 1) On the age and sex distribution, the age under 15 month was the most common(70.6%), and the peak incidence was 3-12 months of age(60.1%). In sex distribution, male to female ratio was 1.25:1. 2) The seasonal distribution was summer(27.4%), spring, autumn and winter in order of frequency. 3) As to the etiology of Intussusception treated by surgery, idiopathic was the most common(75%). 4) The cardinal symptoms and signs were vomiting(72.5%), bloody or bloody mucoid stool(57.5%), abdominal pain(49.7%), abdominal distention(20.9%), abdominal mass(19.6%) and others in order of frequency. 5) On the hematologic finding, 60.8% revealed leukocytosis above 10,000/mm3. 6) As to the duration from the onset of the symptom to admission, 84.2% was within 24 hours, 9.8% was from 24 hours to 48 hours, and 5% was over 48 hours. 7) The common anatomical types were ileocolic(73.2%), and ileocecal(17.0%). 8) The success rate of air reduction was 84.3%. 9) In the method of operation, manual reduction was performed in 91.7% and intestinal resection in 8.3%. 10) The recurrence rate after air reduction was 12.4% and after operative manual reduction was 8.3%.
Emergencies* ; Emergency Service, Hospital* ; Emergency Treatment ; Female ; Humans ; Incidence ; Intestinal Obstruction ; Intussusception* ; Korea ; Leukocytosis ; Male ; Recurrence ; Seasons ; Sex Distribution

No abstract available.
Adult* ; Arteries* ; Humans

Twenty seven cases(1.7%) of traumatic intracerebral hematoma among in-patients of head injury had been operated in the Department of Neurosurgery, Chonnam University Hospital from June, 1973 to May, 1978. We attempted to analyse these cases clinically and discussed with the review of the literature. The results were summarized as follows: In the age and sex distribution, the common incidence of age was between third and fifth decade and 25 cases were male and 2 female. 2) The most common cause of trauma was traffic accident(13 cases:48.2%) and others were pedestrian(7 cases:25.9%), fall(5 cases:18.5%) and direct blow(2 cases:7.4%). 3) 3 types of the course of consciousness from accident to admission were unconscious to lucid to unconscious(13 cases), unconscious throughout(13 cases) and lucid throughout(1 case). There were no relationship between the course of consciousness and the site of the lesion. 4) The site of impact of the original blow on the head were almost the lateral blows(23 cases), while axial ones were only 4 cases(include one unknown case). The intracerebral hematoma tended to be caused more often by contre-coup injuries(21 cases) rather than by coup one(6 cases). 5) There were 14 hematomas in the temporal lobe(51.9%), 11 in the frontal lobe(40.7%) and 2 in the fronto-temporal lobe(7.4%). Among the 27 cases, only 6 cases were simple intracerebral hematomas, 16 cases were associated with subdural hematomas and 5 cases with epidural hematomas. 6) On the neurological findings, anisocoria was noted in 22 cases(81.5%), hemiparesis in 21 cases(78.0%), aphasia in 5 cases(15.0%) and decerebrate rigidity in 7 cases(26.0%). 7) Cerebral angiography disclosed specific findings due to the location and pathogenesis of hematoma;The angiographic evidence of intracerebral hematoma in the frontal lobe was quite same with the tumor in this site. The intracerebral hematoma in the temporal lobe showed displacement of middle cerebral artery with or without shifting of anterior cerebral artery to opposite side. 8) In all of cases, the osteoplastic craniotomy had been performed and the hematoma contents were evacuated through the puncture or the cortical incision. The mortality rate was 29.6%.
Anisocoria ; Anterior Cerebral Artery ; Aphasia ; Cerebral Angiography ; Consciousness ; Craniocerebral Trauma ; Craniotomy ; Decerebrate State ; Female ; Frontal Lobe ; Head ; Hematoma* ; Hematoma, Subdural ; Humans ; Incidence ; Jeollanam-do ; Male ; Middle Cerebral Artery ; Mortality ; Neurosurgery ; Paresis ; Punctures ; Sex Distribution ; Temporal Lobe

Effects of a M1 receptor antagonist, pirenzepine, a M2 receptor antagonist, AF-DX116, and a nicotinic receptor antagonist, mecamylamine on the pressor responses to preganglionic sympathetic nerve stimulation(PNS) and McN-A-343 and DMPP in spinal(pithed) rabbits were investigated in order to elucidate a functional role of M1, M2 and nicotinic receptors in ganglionic transmission. Pirenzepine and AF-DX116 selectively inhibited the McN-A-343-induced pressor reponse in chlorisondamine-treated rabbit and the BCh-induced bradycardia, respectively. Electrical stimulations of preganglionic sympathetic outflow at T8 level produced increases in blood pressure. Pirenzepine(3 microgram/kg) significantly inhibited the PNS-induced pressor response and the degree of inhibition was not changed by increasing the doses to 100 microgram/kg. AF-DX116(100 microgram/kg) had no effect on the PNS-induced pressor response. Mecamylamine inhibited the PNS-induced pressor response in a dose-dependent manner. The inhibitory action of mecamylamine was significantly augmented by combined-treatment with pirenzepine(30 microgram/kg) but AF-DX116(100 microgram/kg) did not affect the inhibitory action of mecamylamine. McN-A-343 and DMPP elicited pressor response in the spinal rabbit. Pirenzepine and AF-DX116 dose-dependently inhibited the McN-A-343-induced pressor response but they did not affect DMPP-induced pressor response. Mecamylamine inhibited both pressor responses induced by Mc-N-343- and DMPP. These results suggest that not only nicotinic receptors but also M1 receptors play a facilitatory role in ganglionic transmission but M2 receptors do not contribute the transmission in spinal(pithed) rabbits.
(4-(m-Chlorophenylcarbamoyloxy)-2-butynyl)trimethylammonium Chloride ; Blood Pressure ; Bradycardia ; Dimethylphenylpiperazinium Iodide ; Electric Stimulation ; Ganglia, Sympathetic* ; Ganglion Cysts ; Mecamylamine ; Pirenzepine ; Rabbits ; Receptors, Nicotinic*

No abstract available.

BACKGROUND: Left ventricular hypertrophy(LVH) is one of the complications of hypertension and has been known as an independent risk factor of cardiovascular complications. Recently, it has been reported that hypertensive patients with LVH had the most advanced extracardiac target-organ damage compared with other groups. Previous reports have shown that mean plasma atrial natriuretic peptide(ANP) and brain natriuretic peptide(BNP) levels in hypertensive patients are higher than in normotensive subjects. Therefore, in this study, we investigated the relationships between the plasma ANP and BNP levels and the degree of LVH in hypertensive patients and in normotensive subjects and also investigated the clinical significance of measurement of plasma ANP and BNP levels. METHODS: In all study subjects, left ventricle mass index(LVMI) and left ventricle geometry were measured by M-mode echocardiography. Measurements were made by the recommendations of the American Society of Echocardiography. Plasma ANP and BNP levels were measured by radioimmunoassay method. RESULTS: 1) 57% of the hypertensive patients had eccentric hypertrophy and 6% had concentric hypertrophy. 2) LV mass and LVMI of normotensive subjects and hypertensive patients were 169+/-53 g, 229+/-64 g and 99+/-27.3 g/m2, 142+/-37.7 g/m2, respectively(P<0.05). 3) There were statistically significant correlations between blood pressure and LVMI in all subjects(r=.43, P<0.05). 4) Plasma ANP levels were significantly increased in hypertensive patients than normotensive subjects (28.2+/-14.3 pg/mL and 42.8+/-26 pg/mL, respectively; P<0.05). 5) Plasma BNP levels were significantly increased in hypertensive patients than normotensive subjects (18.4+/-5.4 pg/mL and 36.5+/-26 pg/mL; respectively, P<0.05). 6) Plasma BNP levels were significantly increased in 63% of the hypertensive patients with LVH(P<0.05). 7) There were statistically significant correlations between blood pressure and plasma ANP and BNP levels(ANP:r=.39, p<0.05, BNP:r=.31, P<0.05). CONCLUSIONS: Plasma ANP and BNP levels were increased in the hypertensive patients but only plasma BNP levels were significantly increased in the hypertensive patients with LVH. Measurement of plasma BNP levels may be useful for early detection of LVH, an independent risk factor of cardiovascular complications. Therefore intensive blood pressure control in these patients may reduce cardiovascular morbidity and mortality.
Atrial Natriuretic Factor ; Blood Pressure ; Brain* ; Echocardiography ; Heart Ventricles ; Humans ; Hypertension* ; Hypertrophy ; Hypertrophy, Left Ventricular ; Mortality ; Natriuretic Peptides* ; Plasma* ; Radioimmunoassay ; Risk Factors

We present two cases of traumatic aneurysms developing during aneurysmal surgery. The aneurysms were clipped without difficulty in both anterior communicating aneurysmal cases. To prevent the vasospasm, bypervolemic theraphy was begun and hypertension was induced postoperatively. The postoperative rebleeding occured within two weeks after initial aneurymal clipping in both cases. New aneursms developed near the clipped anterior communicating aneruysms ; A1 in one case, A2 in the other case. Minor arterial injury was considered to be the main cause of theses new aneurysmal formation and the hemodynamic stress induced by hypertension and hypervolemic therapy might contribute to the development of new aneurysms.
Aneurysm* ; Hemodynamics ; Hypertension

We present two cases of traumatic aneurysms developing during aneurysmal surgery. The aneurysms were clipped without difficulty in both anterior communicating aneurysmal cases. To prevent the vasospasm, bypervolemic theraphy was begun and hypertension was induced postoperatively. The postoperative rebleeding occured within two weeks after initial aneurymal clipping in both cases. New aneursms developed near the clipped anterior communicating aneruysms ; A1 in one case, A2 in the other case. Minor arterial injury was considered to be the main cause of theses new aneurysmal formation and the hemodynamic stress induced by hypertension and hypervolemic therapy might contribute to the development of new aneurysms.
Aneurysm* ; Hemodynamics ; Hypertension

Phytolaccae had been used as a pharmaceutical drug or food But nowadays, due to its toxicity, Phytolaccae is rarely used and cases of patients poisoned with it are seldom reported. The case presented here was of 43 year-old male who after ingesting extract of Phytolacca esculenta suffered from abdominal pain, diarrhea, nausea, vomiting, tachycardia, hypotension, pruritus, paresthesia, oliguria and azotemia. Kidney biopsy revealed tubular necrosis and some protein casts in tubular lumens. These findings suggested that acute renal failure was mainly caused by nephrotoxicity of Phytolacca extracts. Through continuous arteriovenous hemofiltration and two times of hemodialysis, he was completely recovered from acute renal failure. Other symptoms also disappeared by symptomatic management, but paresthesia of both lower extremities still remained. So we reported this case with a brief review of literature.
Abdominal Pain ; Acute Kidney Injury* ; Adult ; Azotemia ; Biopsy ; Diarrhea ; Hemofiltration ; Humans ; Hypotension ; Kidney ; Lower Extremity ; Male ; Nausea ; Necrosis ; Oliguria ; Paresthesia ; Phytolacca* ; Poisoning* ; Pruritus ; Renal Dialysis ; Tachycardia ; Vomiting