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

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: 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

We report two cases of proliferating trichilemmal cyst in a 61-ear-old woman and a 44-year-old woman who had a solitary tumor, on the left temporal area of the scalp and right flank, respectively. Histologically, the tumors were localized in the dermis and corisised of multilobulated cysts. The cyst walls were composed of liquamous epithelium showing trichilemmhl keratinization. Some of the cells had clear cytoplasm and were positive on PAS staining. Individiial cell keratinization, mild nuclear atypia were also found in the cyst walls. For the treatment, surgical excision was performed with sufficiert margin.
Adult ; Cytoplasm ; Dermis ; Epithelium ; Female ; Humans ; Scalp

Meralgia paresthetica is a syndrome consisting of numbness, pain, tingling, burning and/or a variety of other paresthesias on the distribution of the lateral femoral cutaneous nerve (LFCN) of the thigh. We report a case of meralgia paresthetica in a 41-year-old woman who complained of the symptoms of pain, burning sensation, and dysesthesia which occurred whilst standing up without any other constitutional symptoms. The authors suspect that frequent. and persistent squatting may play a role in the development of the present symptoms.
Adult ; Burns ; Female ; Humans ; Hypesthesia ; Paresthesia ; Sensation ; Thigh

BACKGROUND: The efficiency of lipid extraction by different kinds of solvents from stratum corneum may vary. OBJECTIVE: To assess the efficiency of lipid extraction by several solvents from the stratum corneum, the total lipids weights were measured by an electronic microbalance, and lipids compositions of a stratum corneum were analyzed by thin layer chromatography(TLC) after pretreatment of several solvents, respectively. METHODS: Stratum corneums separated fro circumcised prepuce were pretreated with acetone, petroleum ether, or distillecl water for 10 minutes. Lipids of stratum corneum were extracted with methanol chlorofonn-H,O mixture(4: 2: 1.6, v/v, Bligh Dyer solvent). Lipids weights were weighed, and the ratio of lipid weight and wet weight of stratum corneum were measured. TLC was performed and lipids compositions were quantitated by photodensitometer. Lipids extraction in viva was performed on both forearms. After two times stripping with sellotape, lipids were extrected with the solvents using cup method. These were dried and lipids weights were weighed. RESULTS: The efficiency of lipid extraction from the stratum corneum of circumcised prepuce were acetone, petroleum e1 her, and distilled water in decreasing order. All groups were similar in the compositions of the stratum corneum lipids except for those of cholesterol esters and sphingolipids. The efficiency of lipid extraction from in vivo skin were ranked in order from petroleurn ether, acetone, down to distilled water. The efficiency of lipid extraction of petroleum ether and acetone were higher than that of distilled water. CONCLUSION: The efficiency of lipid extraction is influenced by the kinds of solvents as well as the materials and the methods of extraction.
Acetone ; Cholesterol Esters ; Ether ; Forearm ; Methanol ; Petroleum ; Skin ; Solvents* ; Sphingolipids ; Water ; Weights and Measures

PURPOSE: To identify the necessity of more reasonable diagnostic criteria and the possibility of early prediction of coronary involvement in the higher risk group, we investigated and compared clinical and laboratory findings in the acute phase and coronary involvements in those younger (n=17) and older(n=53) than one year of age in Kawasaki disease(KD). METHODS: Retrospective chart reviews were performed on 70 patients with KD who were admitted to the Chung-Ang University Hospital from April 1997 to May 2001. RESULTS: Male were significantly higher in the younger age group(M : F ratio 3.3 : 1 vs. 1.0 : 1, P=0.004). Fever durations before intravenous immunoglobulin(IVIG) and echocardiography were significantly shorter in the younger group(4.6+/-1.3 vs. 6.2+/-2.5, P=0.004 vs. 0.01, respectively). Cases meeting typical diagnostic criteria were significantly less in the younger group(P=0.006). In the laboratory findings, serum albumin, BUN and K+ levels in the acute febrile phase were significantly higher in the younger group(P=0.002, 0.006, <0.001, respectively) and incidences of coronary artery dilatation in the acute phase were significantly higher in the younger group(P=0.01). CONCLUSION: Although less met the typical diagnostic criteria of KD, infants younger than one year of age are more susceptible to coronary artery change in the acute febrile phase. Therefore, KD should be entertained as a diagnostic possibility in young infants with prolonged fever without distinct fever focus, and echocardiography should be considered as part of the evaluation of these patients, and then early diagnosis and prompt IVIG should be conducted.
Coronary Vessels ; Dilatation ; Early Diagnosis ; Echocardiography ; Fever ; Humans ; Immunoglobulins, Intravenous ; Incidence ; Infant ; Male ; Mucocutaneous Lymph Node Syndrome* ; Retrospective Studies ; Serum Albumin

PURPOSE: It is proposed that endothelial cell dysfunction, a central pathogenic feature of preeclampsia is caused by circulating unknown factors produced by placenta in the blood of women with preeclampsia. In this study we investigated the effect of such factors in the serum from preeclamptic mother or her neonatal umbilical vein on the activity of sICAM-1 and apoptosis in cultured human umbilical venous endothelial cells. METHOD: Quantitive determinations of sICAM-1 and apoptosis were detected from isolated and cultured HUVEC supernatants which were incubated with serum samples for 48hours. The serum samples were collected from preeclamptic mother and her neonatal cord blood in pairs according to gestational age and were compaired to nonpreeclamptic control groups. RESULTS: sICAM-1 level was significantly higher in the maternal groups compared to corresponding cord groups (P<0.001). The preterm maternal group showed higher level than term maternal group (P<0.001). The preeclamptic preterm mother groups showed elevated level compared to other mother groups and the existence of preterm delivery affects sICAM-1 level more importantly than the existence of preeclampsia. In TUNEL stain preeclamptic preterm mother group showed increased number of apoptotic nuclei compared to other groups. The neonatal cord group of preterm preeclampsia showed no apoptotic body on cultured HUVEC. CONCLUSIONS: Unknown circulating factors in preeclamptic preterm mother activate expression of sICAM-1 and apoptosis in cultured human umbilical venous endothelial cells. But the fetal circulation may not be affected by the factor (s) that lead to disturbed endothelial cell function in women with preterm preeclampsia.
Apoptosis* ; Endothelial Cells* ; Female ; Fetal Blood* ; Gestational Age ; Humans* ; In Situ Nick-End Labeling ; Mothers ; Placenta ; Pre-Eclampsia* ; Umbilical Veins

PURPOSE: It is difficult to predict volume responsiveness in hemodynamically unstable patients with spontaneous breathing activity. Our objective was to test whether the respiratory variations in pulse oximetry plethysmography (POP) waveform amplitude could predict fluid responsiveness to fluid resuscitation (FR) in spontaneously breathing adult shock patients. METHODS: We investigated 21 patients presenting with shock in the Emergency Room. We assessed hemodynamic status and calculated the respiratory variations in POP waveform amplitude before and after FR. Heart rate, blood pressures (MAP, SBP), maximal POP (POPmax), minimal POP (POPmin) and deltaPOP, defined as deltaPOP = (POPmax - POPmin) / ([POPmax + POPmin] / 2) were recorded. We measured hemodynamic parameters by doppler ultrasound, USCOM(R). RESULTS: Comparisons of hemodynamic parameters between before and after FR showed no significant difference in heart rate, but POP showed significant differences in changes in SBP, MAP, cardiac index, stroke volume index and respiratory variations. In response group(> or =15% in delta CI), the change in cardiac index, stroke volume index, and the respiratory variation in the POP were not significantly different. CONCLUSION: In spontaneously breathing patients with shock, we suggest that delta POP is not a reliable parameter in the prediction of fluid responsiveness.
Adult ; Emergencies ; Heart Rate ; Hemodynamics ; Humans ; Oximetry ; Plethysmography ; Respiration ; Resuscitation ; Shock ; Stroke Volume

BACKGROUND AND OBJECTIVES: Cilostazol is an anti-platelet and arterial vasodilating drug that inhibits phosphodiesterase type III, an enzyme that breaks down cyclic AMP in platelets, vascular smooth muscle cells, cardiac myocytes and adipocytes. Several animal and human studies have shown that cilostazol has the potential to reduce restenosis after coronary angioplasty, but the precise mechanism by which the inhibition of vascular smooth muscle cell growth occurs from an increase in cyclic AMP is not yet clear. MATERIALS AND METHODS: We investigated the effects of cilostazol on cell proliferation and expression of iNOS and p21 by western blotting with the cultured aortic vascular smooth muscle cells stimulated with platelet-derived growth factor BB. RESULTS: In comparison to the control, treatment with cilostazol significantly inhibited (p<0.05) the increase in cell number. Inducible nitric oxide synthase (iNOS) and p21 expression increased with cilostazol treatment, and these effects of cilostazol were eliminated by simultaneous incubation with the NOS inhibitor, L-NAME. These results indicate that cilostazol increases p21 expression at least partially through an iNOS-dependent pathway in cultured vascular smooth muscle cells stimulated with PDGF-BB. CONCLUSION: These findings suggest that cilostazol has a direct inhibitory effect on abnormal proliferation of vascular smooth muscle cells accompanied by the induction of iNOS-dependent p21 expression, and cilostazol may have potential to prevent restenosis after percutaneous coronary intervention by this mechanism.
Adipocytes ; Angioplasty ; Animals ; Blotting, Western ; Cell Count ; Cell Proliferation ; Cyclic AMP ; Humans ; Muscle, Smooth, Vascular* ; Myocytes, Cardiac ; NG-Nitroarginine Methyl Ester ; Nitric Oxide Synthase ; Nitric Oxide Synthase Type II ; Percutaneous Coronary Intervention ; Platelet-Derived Growth Factor