Blunt thorax trauma may produce a variety of cardiac lesions, which may occur alone or in combination. Nonpenetrating perforation of interventricular septum with chordae rupture of tricuspid valve is a infrequent pathologic event. A 40-years-old worker was transfered to hospital with increasing symptoms of right heart failure following a blunt compressing chest trauma with a huge overolling cement pipe(Wt.680kg) 6 weeks ago. The immediately diagnosed serial rib fracture of the left thorax cage and dislocation of the left acromoclavicular joint were treat conservatively. A conventional transthoracic color Doppler and two dimensional echocardiogram detected traumatic ventricular septal defect with bilatral shunt and tricuspid regurgitation. An additional transesophageal color echocardiopraphic demonstrated the ruptured chordae tendineae of the tricuspid septal leafet, which prolapsed deeply into the right atrium. The conventional color Doppler echocardiopraphy enhances the ability to detect the presence of a ventricular septal perforation and valve dysfunction in a patient with cardiac contusion. The transesophageal echocardiopraphy is a useful semiinvasive tool for the detailed morphological evaluation of atrioventricular valves and their substructure.
Chordae Tendineae ; Contusions ; Dislocations ; Echocardiography* ; Heart Atria ; Heart Failure ; Heart Septal Defects, Ventricular ; Humans ; Joints ; Rib Fractures ; Rupture* ; Thorax* ; Tricuspid Valve ; Tricuspid Valve Insufficiency ; Ventricular Septal Rupture*

In evaluating the early state of shock patients and their response to treatment, generally vital signs or additional hemodynamic values were used. Vital signs are easily obtained and repetitious values or continous monitoring is possible, whereas it cannot evaluate the patient's status properly nor is it a good prognostic factor. Meanwhile, additional hemodynamic values are obtained from pulmonary artery catheterization. But this procedure is difficult to proceed in the emergency room. Since central venous oxygen saturation has the advantage of being easily obtained and acts as a good prognostic factor for shock patients, we intended to prove its efficacy. From 1997 May to October, 50 patients admitted to Yonsei University Young Dong Severance Hospital in shock state, with systolic blood pressure below 90mmHg, were evaluated. Central venous catheter was inserted to obtain central venous oxygen saturation, serum lactate, base excess value, and its' initial value compared with the prognosis. The central venous oxygen saturation and base excess were low, while serum lactate value was high in the nonsurvival group. And in ROC(relative operating characteristic) curve, the AUC(area under curve) of central venous oxygen saturation was larger than the others. In comparing the MOF(multi-organ failure) group with the non-MOF group, the MOF group had a lower central venous oxygen saturation and base excess, and a higher serum lactate level, whereas in ROC curve, the AUC of base excess was larger than the others. Therefore, in estimating the prognosis of shock patients, the early central venous oxygen saturation proved to be a good prognostic factor.
Area Under Curve ; Blood Pressure ; Catheterization, Swan-Ganz ; Central Venous Catheters ; Emergency Service, Hospital ; Hemodynamics ; Humans ; Lactic Acid ; Oxygen* ; Prognosis ; ROC Curve ; Shock* ; Vital Signs

BACKGROUND: This study is aimed to analyze the results of aeromedical consultation of ROKAF for recent 10 years. METHODS: We reviewed the records of all ROKAF rated personnel who developed a medical problem requiring aeromedical consultation during the period from 1991 to 2000. RESULTS: We collected 263 cases. The most frequent clinical categories were ENT and musculoskeletal problems. In the group of fighter pilots, 30 cases were classified into permanent grounding. Chronic hepatitis and Herniated disc were the main causes. In the group of undergraduate pilots, aerotitis media by high altitude flight and airsickness by high performance flight, were the main causes. CONCLUSION: According to this study, we need to reinforce the supervision about the revealed major causes.
Altitude ; Hepatitis, Chronic ; Intervertebral Disc Displacement ; Motion Sickness ; Organization and Administration

A 63 year old male suffered from a acute huge inferolateral and posterior myocardial infarction with vertricular septal perforation(1x1.5cm). Cardiogenic shock and ventricular tachycardia occured on the 3rd day in hospital. After cardiopulmonary resuscitation the deteriorated condition of the patient was improved by intraaortic balloon counterpulsation(IABP). The invasive diagnostic procedure(LV angiography and coronary angiogram) was carried out under the employment of IABP and artificial ventrilation. The patients has recovered from the operation(coronary artery bypass graft and VSD patch op) and myocardial infarction. Because of recurrent aspiration pneumonia the patient was nourished per gastrostomy. He died 3 month later due to upper gastrointestinal bleeding.
Angiography ; Arteries ; Cardiopulmonary Resuscitation ; Counterpulsation* ; Employment ; Gastrostomy ; Hemorrhage ; Humans ; Inferior Wall Myocardial Infarction* ; Male ; Middle Aged ; Myocardial Infarction ; Pneumonia, Aspiration ; Shock, Cardiogenic* ; Tachycardia, Ventricular ; Transplants ; Ventricular Septal Rupture*

Takayasu,s arteritis is a systemic disease characterized by occlusion of aorta and its major branches because of a panaortitis with thickening of the adventitia. Coronary artery narrowing is due to extension of inflammations that occur in aorta. Angina pectoris may be the first symptom of the disease if the coronary arteries are the initial site of severe arterial narrowing. We present a case of bilateral coronary ostial stenosis where Takayasu,s arteritis was pathologically proved as an etiology. The patient was taken coronary ostial angioplasty with good result.
Adventitia ; Angina Pectoris ; Angioplasty ; Aorta ; Arteritis ; Constriction, Pathologic* ; Coronary Vessels ; Humans ; Inflammation ; Takayasu Arteritis*

Arterial cannulation for constant monitoring of arterial pressure and blood gase analyses has become commonplace in the care of the critically ill patients. The radial artery is often regarded as causing a negligible complication risk because of extensive collateral arterial flow in the hand. One of other alternative sites for arterial cannulation is femoral artery. Femoral artery cannulation has a high degree of success in very small, critically ill children. It should be considered an acceptable alternative to small-vessel cannulation when the latter is not technically achievable, or in the unstable patient where rapid establishment of reliable artery access is necessary. Arterial cannulation may cause many complications: arterial catheters can directly injure the vessels, resulting in thrombosis, occlusion, distal embolization or ischemia. Local insertion site complications, such as hematoma, hemorrhage, and infection may occur. Arterial catheter may also be a source of systemic sepsis. We report an unusual case of unintentional release of a catheter fragment into the external iliac artery in a 7-month (7.8 kg) male patient with tetralogy of Fallot, which was inadvertently inserted during right femoral artery cannulation. The catheter fragment was successfully retrieved with the Amplatz Goose Neck microsnare under fluoroscopy without any problems.
Arterial Pressure ; Arteries ; Catheterization* ; Catheters* ; Child ; Critical Illness ; Femoral Artery* ; Fluoroscopy ; Hand ; Hematoma ; Hemorrhage ; Humans ; Iliac Artery* ; Ischemia ; Male ; Neck ; Radial Artery ; Sepsis ; Tetralogy of Fallot ; Thrombosis

BACKGROUND AND OBJECTIVES: Being probably of embryonal in origin, the nasolabial cyst is relatively rare and is thought to arise either from the epithelial remnants entrapped along the lines of fusion during the development of face or from the remnants of the developing nasolacrimal duct. The purpose of this study was to examine the clinical and radiological features of nasolabial cyst in order to provide basis for its correct diagnosis and treatment. MATERIAL AND METHODS: The nine cases of nasolabial cyst which were treated in Masan Samsung Hospital from January in 1991 to April in 1997 were the used as subjects. These cases were examined according to age and sex distribution and their clinical features, radiologic and histologic findings, treatment and prognosis, were studied. RESULTS: In our study of nine cases of nasolabial cyst, more females than males were observed, and with respect to age, individuals in their Fortise were more frequently noted. Also, swelling of nasolabial fold were the most frequently observed among symptom and signs. Computerized tomography shows well-circumscribed cystic mass lateral to pyriform aperture. Seven cases underwent operation. Six cases were excised by intraoral sublabial approach, one case which forms fistula to skin was removed by transcutaneous approach. CONCLUSION: Nasolabial cyst is benign harmatomatous cyst of face. This lesion is often unrecognized or confused with other intranasal mass, other fissural and odontogenic cysts, midface infection, or swelling in the nasolabial area. Therefore careful clinical and radiologic evaluation should be considered in the differential diagnosis.
Diagnosis ; Diagnosis, Differential ; Female ; Fistula ; Humans ; Male ; Nasolabial Fold ; Nasolacrimal Duct ; Odontogenic Cysts ; Prognosis ; Sex Distribution ; Skin

We experienced a rare case of a 6-year-old boy who was suspected of having lipid transfer protein (LTP) syndrome; the patient was diagnosed with LTP syndrome using the ImmunoCAP/ImmunoCAP Immuno Solid-phase Allergen Chip (ISAC) test. LTP syndrome affects patients who are already sensitized to pollens with signs and symptoms of allergic rhinitis with or without bronchial asthma.Its severity is closely associated with the geographical location as well as the level, nature, and duration of the allergen exposure in a susceptible individual with or without cofactors, such as exercise, alcohol, chemicals, or nonsteroidal anti-inflammatory drug. Patients with LTP syndrome may present with diverse manifestations ranging from local symptoms, such as mild contact urticaria, oral allergy syndrome, or gastrointestinal problems, to anaphylaxis and even anaphylactic shock. Our case highlights the usefulness of the ImmunoCAP/ImmunoCAP ISAC test in establishing a diagnosis of LTP syndrome.

No abstract available.
Coronary Vessels* ; Electrocardiography* ; Spasm*

No abstract available.
Aneurysm* ; Hydrocephalus* ; Hypothalamus* ; Subarachnoid Hemorrhage*