No abstract available.

In order to compare the efficacies of some surgical procedures for correction of congenital muscular tortiollis, we evaluate 36 patients who had been treated either by unipolar release (19 patients) or bipolar release (17 patients) of the sternocleidomastoid (SCM) muscle at Seoul National University Children Hospital from August 1985 to June 1993. The average follow up period was 4.1 years (range, 1 year to 7 years and 8 months). The average ages at the time of operation was 3.4 years (range, 11 months to 7 years and 1 month) in the unipolar group and 9.7 years(range, 4 years and 5 months to 16 years and 11 months) in the bipolar group. Postoperatively, flexion and extension range of motion of the neck was not limited of limited less than 10 degrees, if present, in all cases. In rotation motion, 89.4% of the unipolar group and 94.1% of the bipolar group showed no limitation or limitation of less than 10 degrees when compared to the normal side postoperatively. In lateral bending, however, 21.1% of the unipolar group and 21.5% of the bipolar group showed limitation of more than 10 degrees when compared to the normal side postoperatively. Facial asymmetry, which was present in 89.4% of the unipolar group and all cases of bipolar group preoperatively, disappeared in 73.7% of the unipolar group and 23.5% of the bipolar group and improved in 94.1% of the unipolar group and 64.7% of the bipolar group. The over-all functional and cosmetic results were assessed according to the modified Ling's criteria. In function results, 14 patients(73.3%) had excellent or good results in unipolar group and 12 patients(70.6%) in bipolar group. In cosmetic results, 15 patients(78.9%) had excellent or good results in unipolar group and 11 patients(64.7%) in bipolar group. Recurrence rate was higher in the unipolar group (15.8%) than in the bipolar group (5.8%). In conclusion, limitation of lateral bending was more resistant to the treatment than the limitation of rotation. Bipolar release of SCM muscle would be recommendable even in young children in terms of recurecce.
Child ; Facial Asymmetry ; Follow-Up Studies ; Humans ; Neck ; Range of Motion, Articular ; Recurrence ; Seoul ; Torticollis

BACKGROUND: We designed this study to determine whether trauma history and initial assessment anticipate the injury severity of the free-fall patient. METHODS: Two hundred patients who admitted emergency department of Severance hospital because of the fall from a height were enrolled in this study. The height of fall, the body orientation, and the characteristics of impacted material, and the Injury Severity Score(ISS) were evaluated by retrospective chart reviews. And regression equations were determined for predicting ISS on the basis of clinical parameters using multiple regression analysis. RESULTS: According to the characteristics of impacted material, the ISS was higher in the hard surface(13.7+/-9.5) than the sort surface(10.5+/-8.8)(p<0.05). There were correlations between height of fall and ISS(p<0.01, r=0.5). To the body orientation, the ISS was higher in the head-to-feet orientation(18.211.7) than the feet-to-head(10.9+/- 7.0) or other position(8.5+/-5.8)(p<0.01). The regression equations were as follows, ISS=2 +0.082xage(year)-1.54x(Glasgow Coma Scale)-3x(feet-to-head orientation)+0.65x height of fall(m)+2.7 x (hand surface)(p<0.01, R2=0.53). CONCLUSION: This study suggest that the injury severity of patient with free fall are significancy related to the height of fall, the characteristics of impacted material and the body orientation.
Coma ; Emergency Service, Hospital ; Humans ; Retrospective Studies

The results of a retrospective study on 197 cases of malignant skin tumors, which were operated from July 1991 to June 1996 were presented. 1. Primary malignant skin tumors in our series included basal cell carcinoma (42%), squamous cell carcinoma (39%), melanoma (7%). Eighty five percentage of them were developed after 5th decade. There was a slight male preponderance (male to female ratio; 1.2:1). 2. seventy five percentage of malignant skin tumors were occurred in the head and neck. However 34% of squamous cell carcinoma occurred in the extremities. 3. Overall recurrence rate was 7.1% and overall metastasis rate was 7.6%. Seven cases (8.5%) of basal cell carcinoma were recurred without metastasis and seven cases (53.8%) of melanoma were meatastasized without recurrence. 4. Overall recurrence occurred at average 27 months after primary resection and 79% of them occurred in the head and neck. Among 14 recurred tumors, one recurred secondarily and three were metastasized elsewhere. 5.Two thirds of metastasis occurred within one year of resection. Mortality rate in the patients with metastasis was 40%. Metastases involved multiple organs and involved lymph nodes most frequently. 6.Fifteen patients with metastasis were treated with surgery alone (2 cases), surgery and adjuvant therapy (3 cases), radiation and/or chemolherapy without surgery (6 cases), and no therapy(4 cases).
Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Extremities ; Female ; Head ; Humans ; Lymph Nodes ; Male ; Melanoma ; Mortality ; Neck ; Neoplasm Metastasis* ; Recurrence ; Retrospective Studies* ; Skin*

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

No abstract available.

Polycystic ovary syndrome is characterized by symptoms of oligomenorrhea, amenorrhea, infertility, hirsutism and obesity. It is known that the women with such diseases would have higher risks to coronary heart diseases, hypertension, DM and endometrial cancer later on, Known risk factors of endometrial cancer are nullipara, late menopause, obesity, DM, unopposed estrogen, tamoxifen treatment, and atypical endometrial hyperplasia ect. 75% of endometrial cancer occurs in age over 50 and 4% of endometrial cancer occurs in age under 40. Particulary endometrial cancer concurrent polycystic ovary syndrome occurs usually in people under age 40 and is commonly well differentiated cell type and is related to good prognosis. We experienced a case of endometrial cancer with polycystic ovary syndrome, who was early dignosed, presented with infertility and got an operation in our hospital, and report this case with a brief review of literature.
Amenorrhea ; Coronary Disease ; Endometrial Hyperplasia ; Endometrial Neoplasms* ; Estrogens ; Female ; Hirsutism ; Humans ; Hypertension ; Infertility ; Menopause ; Obesity ; Oligomenorrhea ; Polycystic Ovary Syndrome* ; Prognosis ; Risk Factors ; Tamoxifen

BACKGROUND: Clinical trials have shown that b-adrenergic blocking drugs are effective and well tolerated in patients with mild to moderate congestive heart failure. Carvedilol is a mild b1-selective adrenergic blocking agent with vasodilating properties due to a blocker and antioxidant and anti-proliferative properties. This study assessed the efficacy and safety of carvedilol in patients with moderate to severe congestive heart failure caused by idiopathic dilated cardiomyopathy. METHODS: We enrolled 27 patients with moderate to severe congestive heart failure with a left ventricular ejection fraction of 35% by MUGA scan. Each patient was randomly assigned to either control (n-9) or carvedilol (n-18, target dose 25 mg bid) for 6 months while background therapy with digoxin, diuretics, and ACE inhibitor remained constant. RESULTS: Compared to the control group, patients in the carvedilol group showed significant increase of left ventricular ejection fraction (p<0.05). In addition, patients in the carvedilol group had a tendency to show a decrease in left ventricular end-diastolic dimension and heart rate. Also, the carvedilol group had a greater frequency of symptomatic improvement than the control group. There was neither serious side effects nor hospitalization. CONCLUSION: These finding indicate that carvedilol produces important clinical benefits in patients with moderate to severe heart failure treated with digoxin, diuretics, and ACE inhibitor without serious side effects.
Cardiomyopathy, Dilated ; Digoxin ; Diuretics ; Heart Failure* ; Heart Rate ; Hospitalization ; Humans ; Stroke Volume

Malignant eccrine spiradenoma is very rare neoplasm of cutaneous adnexal origin, arising from previously benign eccrine spiradenoma. We present an additional case of malignant eccrine spiradenoma in abdomen of 56-year-old female patient. The mass was stable for 25 years and recently increased in size and became strikingly painful and tender. The excised mass showed typical findings of eccrine spiradenoma 8 its malignancy. There was no evidence of local invasion & distant metastasis. We resected the tumor mass with 3 cm safty margin and have followed up the patient.
Abdomen ; Female ; Humans ; Middle Aged ; Neoplasm Metastasis

BACKGROUND: Doxylamine, an antihistamine with sleep inducing property, is the most commonly intoxicated drug in the urban ED. This drug is relatively safe but is known to induce rhabdomyolysis in rare occasion. The purpose of this study is to determine the incidence of rhabdomyolysis after doxylamine overdose and prognostic factors that contributes to this complication. METHOD: This study was conducted from 26 patients admitted to our hospital after doxylamine intoxication during the period from April 1999 to June 1999. Using the protocol made beforehand, the amount ingested, past history, laboratory results were recorded. Rhabdomyolysis was defined as serum myoglobin over 300 ng/mL or serum creatine phosphokinase(CK) over 1,000 IU/L. Data were analyzed using SPSS program with t-test, Fisher's exact test and discriminant analysis. RESULTS: The rhabdomyolysis was diagnosed in 57.7% of patients. The amount ingested per body weight, prehospital vomiting and low arterial pCO2 predicted occurrence of rhabdomyolysis. The sensitivity of serum CK and myoglobin were 67% and 80% respectively and specificity was 100% for both. The diagnosis was possible for CK after an average of 14hr 20min time after ingestion and 8hr 12min for myoglobin. CONCLUSION: Rhabdomyolysis is a common complication of doxylamine intoxication and if the amount ingested was more than 1 tablet(25mg) per body weight, the incidence of rhabdomyolysis was higher. So, CK measurement after 14 hour postingestion and myoglobin after 8 hour is recommended to decide whether rhabdomyolysis occur.
Body Weight ; Creatine ; Diagnosis ; Doxylamine* ; Eating ; Humans ; Incidence* ; Myoglobin ; Rhabdomyolysis* ; Sensitivity and Specificity ; Vomiting