An epidemiological investigation of 878 workers(male 812, female 66) who suffered from low back injury(LBI) in some workplace of Pusan city from January 1 to December 31 in 1992 was carried out to obtain the various informations of the prevention and management in the occupational low back pain(LBP). The results were summarized as follows: 1. The mean age of LBP workers was 39.3±10.4(18-67) in male 48.5±12.6(21-69) in female workers. And the most common age groups were the 4th decade in male and the 6th decade in female workers. 2. In the frequency distribution of LBI according to the kind of industry, manufacturing industry was most frequent, and industry of construction, transport-storage-communication were the next in order. Among manufacturing industry, LBI of metallic products and machinery was the most frequent. 3. The occupational frequency of LBP was technical worker, monotonous worker, driver of automobile, driver of heavy equipment and office worker in order. 4. The cumulative percentage of LBI was 6.9% at the first day of employment and 90.8% until 10 years after employment. 5. The mean working duration from employment to onset of injury was 1081 days(about 2.9 years) and the working duration according to occupation was the shortest in driver of heavy equipment(502 days) and longest in office worker(1982 days). 6. The careless handling of object was the most common cause of LBI, and fall down, slip down, collision and traffic accidents were the next in order. 7. The most common cause of LBI according to occupation was traffic accident in driver of automobile, fall down in driver of heavy equipment and careless handling of object in office worker respectively. 8. The case of localized LBI were 517(58.9%) and the cases of LBI combined with other injuries, such as head, neck, trunk, arm or leg, were 361(41.1%) 9. Lumbar sprain was the most frequent diagnosis of LBI, and Herniated Nucleus Pulposus(HNP) and lumbar fracture were the next in order. 10. In multiple injuries, LBI combined with multiple body injury was the most frequent, and the next was LBI combined with arm and leg, with trunk, with head and with neck in order. 11. LBI combined with multiple body injury was the main injury in fall down, slip down and traffic accident, and lumbar sprain was the main injury in careless handling of object.
Accidents, Traffic ; Arm ; Automobiles ; Back Injuries ; Busan ; Diagnosis ; Employment ; Epidemiologic Studies ; Female ; Head ; Humans ; Leg ; Male ; Multiple Trauma ; Neck ; Occupations ; Spine ; Sprains and Strains

Ankle fractures in children often involve the physis. They are of particular importance because partial or entire growth arrest can occur and result in significant complications. We followed thirty-four ankle fracture involving distal physis of tibia and fibula for more than 1 year and analyzed them using the modified Salter-Harris classification, the Dias-Tachdjian classification and the type of fracture (closed or open), Complications occurred in eight cases (23.5%) – two of twenty-six closed fractures (7.7%) and six of eight open fractures (75%). The complications were more significant in open fractures. Angular deformity (5 cases), limb-length discrepancy (4 cases), incongruity of the joint surface (2 cases), fibular overgrowth (2 cases) and synostosis (1 case) occurred alond or combined. In three cases of them we performed surgical management (bone bridge resection or/and supramalleolar corrective osteotomy) and had satisfactory results. This study suggests that the incidence of complications is difficult to anticipate, but is correlated with severity of initial injuries of growth plate and soft tissue, and is much higher in open fracture. After physeal injury, children should be followed until skeletal maturity and the severe deformities can be prevented by early detection and correction of growth plate disturbance.
Ankle Fractures ; Ankle ; Child ; Classification ; Congenital Abnormalities ; Fibula ; Fractures, Closed ; Fractures, Open ; Growth Plate ; Humans ; Incidence ; Joints ; Synostosis ; Tibia

Pericardial defect is a rare congenital cardiac disorder. Most patients were asymptomatic but some patients with partial pericardial defect occasionally complain acute symptoms such as angina, syncope, rarely sudden cardiac death. So, differential diagnosis with other ischemic or structural heart disease is crucial in the management of such patients. But there is no consistently successful diagnostic method. In the past, artificial diagnostic pneumothorax was used to document the absence of pericardium. However, it is not easily accepted due to excess morbidity and failure rate. Recently, echocardiography and more often, computed tomography, magnetic resonance imaging are used to confirm the diagnosis. We experienced a 52 years old male patient with atypical chest pain, who was diagnosed as complete left pericardial defect with computed tomography.
Chest Pain ; Death, Sudden, Cardiac ; Diagnosis ; Diagnosis, Differential ; Echocardiography ; Heart Diseases ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pericardium ; Pneumothorax ; Syncope

PURPOSE: To evaluate the precipitating factors of amputation as initial treatment in diabetic foot patients. MATERIALS AND METHODS: Between March, 1994 and February 2003, 41 cases (37 patients) diabetic foot patients who had diabetic ulcer, pyogenic inflammation and gangrene and followed up over 1 year were collected. Among them, We evaluate the precipitating factors of amputation for average 39.6months (12-118months). RESULTS: Among many factors, Wagner classification, pulse volume recording of toes, Ankle-Brachial Index and Albumin level are statistically significant in amputation patients. CONCLUSION: In determining the amputation of diabetic foot as initial treatment, the trauma history, circulation of foot and serum albumin level are important precipitating factors. So the education about preventing even minor trauma and maintaining good nutrition state decrease the amputation rate in diabetic foot patients.
Amputation* ; Ankle Brachial Index ; Classification ; Diabetic Foot* ; Education ; Foot ; Gangrene ; Humans ; Inflammation ; Precipitating Factors* ; Serum Albumin ; Toes ; Ulcer

PURPOSE: To evaluate the precipitating factors of amputation as initial treatment in diabetic foot patients. MATERIALS AND METHODS: Between March, 1994 and February 2003, 41 cases (37 patients) diabetic foot patients who had diabetic ulcer, pyogenic inflammation and gangrene and followed up over 1 year were collected. Among them, We evaluate the precipitating factors of amputation for average 39.6months (12-118months). RESULTS: Among many factors, Wagner classification, pulse volume recording of toes, Ankle-Brachial Index and Albumin level are statistically significant in amputation patients. CONCLUSION: In determining the amputation of diabetic foot as initial treatment, the trauma history, circulation of foot and serum albumin level are important precipitating factors. So the education about preventing even minor trauma and maintaining good nutrition state decrease the amputation rate in diabetic foot patients.
Amputation* ; Ankle Brachial Index ; Classification ; Diabetic Foot* ; Education ; Foot ; Gangrene ; Humans ; Inflammation ; Precipitating Factors* ; Serum Albumin ; Toes ; Ulcer

PURPOSE: Therapeutic hypothermia (TH) has been a standard treatment for ventricular fibrillation (VF) cardiac arrest survivors to improve neurological outcomes. However, there is a lack of evidence that TH has a neuroprotective effect to asphyxial cardiac arrest, which is one of the most prevalent causes of sudden death besides VF cardiac arrest. We studied whether TH improves the neurological outcomes after resuscitation from asphyxial cardiac arrest. METHODS: We included asphyxial cardiac arrest survivors from January 2002 to December 2010. Clinical and neurological outcome data of 24 consecutive patients undergoing TH were compared with 18 patients who did not undergo TH (11 historical controls and seven refusal of TH by patient's next-of-kin). Neurological outcome was assessed at discharge according to the Cerebral Performance Category scale. The incidence of complications after asphyxial cardiac arrest was compared between the two groups. RESULTS: Baseline characteristics except arterial pH after recovery of spontaneous circulation were not different between the TH group and the non-hypothermic group. Good neurological outcome was similar between the TH group and the non-hypothermic group (8.3% vs 0.0%, p=0.498). The TH group included 18 hypokalemic patients, while non-hypothermic group included eight hypokalemic patients (p=0.044). The rate of other complication did not differ significantly between the two groups. CONCLUSION: Therapeutic hypothermia was not associated with good neurological outcome in asphyxial cardiac arrest survivors and was not associated significantly with the incidence of complications after asphyxial cardiac arrest. However, the findings are not conclusive because of a lack of patients, lack of randomization, and uncertainty of appropriateness of therapeutic hypothermia method to asphyxial cardiac arrest.
Asphyxia ; Coma ; Death, Sudden ; Disulfiram ; Heart Arrest ; Humans ; Hydrogen-Ion Concentration ; Hypothermia ; Hypothermia, Induced ; Incidence ; Neuroprotective Agents ; Random Allocation ; Resuscitation ; Survivors ; Uncertainty ; Ventricular Fibrillation

To eveluate the risk factors which are related to recurrence of ischemic stroke, we selected subjects who were admitted to YNUH due to recurrent stroke and compared their risk factors with non-recurred group- who suffered from single ischemic stroke. In the subjects, 55 of them are men and 22 were women and in the non-recurred groups, 84 of them were men and 40 were women, Subject's age ranged from 29 to 86 years(Mean 62. 5years), and non-recurred group's age ranged from 27 to 90 years(Mean 60.7years), Peak incidence of ischemic stroke is in the 7th decade in both groups. Age and sex are not statistically significant for recurrence of ischemic stroke. The patient's history of diabetes mellitus, myocardial infarction, atrial fibrillation, transient attack and type or site of ischemic stroke had no significant effect statistically on the recurrent ischemic stroke. However, when the patient had previous history of hypertension or systolic blood pressure more than 160mmHg and diastolic more than 95mmHg, there was substantial difference (P<0.05) between the two group in the recurrence of ischemic stroke. According to the above results, hypertension is most likely significang risk factor of the recurrence of ischemic stroke within 2yeats after initial one. Therefore, adequate treatment of the hypertension is impertant for the prevention of ischemic stroke. Further study is required for searching other risk factors.
Atrial Fibrillation ; Blood Pressure ; Diabetes Mellitus ; Female ; Humans ; Hypertension ; Incidence ; Male ; Myocardial Infarction ; Recurrence ; Risk Factors* ; Stroke*

This study was undertaken to prove that the selectively infiltrated parts of nucleus pulposus with indigo carmine was degenerated parts of nucleus pulposus. This study was done, between August and October 2002, in 5 patients, who received endoscopic discectomy, due to intervertebral disc herniation. Discogram was done with mixture of indigo carmine and radioactive dye. Blue discolored part was removed through endoscope, and small undiscolored part was removed together for the control. The two parts were stained with hematoxylin and eosin and compared under the microscope. Undiscolored part was normal nucleus pulposus, composed of chondrocytes with a matrix of type II collagen and proteoglycan, mainly aggrecan. However, in discolored part, slits with destruction of collagen fiber array and ingrowth of vessel and nerve were observed. Using indigo carmine in endoscopic discectomy gives us selective removal of degenerated disc.
Chondrocytes/metabolism/pathology ; Collagen Type II/metabolism ; Comparative Study ; Diskectomy/*methods ; Endoscopy ; Humans ; Indigotindisulfonate Sodium/*diagnostic use ; Intervertebral Disk/metabolism/pathology/*surgery ; Intervertebral Disk Displacement/diagnosis/*surgery ; Proteoglycans/metabolism ; Sensitivity and Specificity

PURPOSE: The principle of prehospital transport is that the patient should be transported to the nearest hospital that is suitable for the severity of the illness. Therefore, out-of-jurisdiction transport is improper. The purpose of this study was to understand the present situation and evaluate the appropriateness of out-of-jurisdiction prehospital transport by the 119 rescue group. METHODS: Between January and December 2009 we enrolled patients who were transported to the Gwangju Regional Emergency Medical Center by the 119 rescue group, which belongs to Jeolla province. The appropriateness of out-of-jurisdiction transport was based on the transport chart and medical record of the 119 rescue group and categorized into three groups. RESULTS: The total number of patients transported was 440: 78 (17.7%) were appropriate; 329 (74.8%) were inappropriate; 33 (7.5%) patients were very inappropriate. Of the 440, 156 (35.5%) were emergency cases, 147 (33.4%) were sub-emergency cases, and 137 (31.1%) were non-emergency cases. Comparing these data with the triage by the 119 rescue group, the kappa value was 0.368 (p<0.001). The patients or their guardians selected the hospital to which the patient was be transported in 382 (86.8%) cases. The actual transport distance was 40.0 km (range: 26.0 to 50.0) and was significantly longer than the nearest distance to a local emergency center which was 10.0 km (4.0 to 18.0) (p<0.001). CONCLUSION: Inappropriate out-of-jurisdiction transporting of patients is done frequently. Therefore, guidelines for prehospital transportation according to the triage is necessary. Additionally, the medical director and emergency medicine information center could play a role in selecting a hospital. A fee or a fine of transporters who do not observe the guidelines might limit the proportion of inappropriate transport cases.
Ambulances ; Emergencies ; Emergency Medical Services ; Emergency Medicine ; Fees and Charges ; Humans ; Information Centers ; Medical Records ; Physician Executives ; Transportation ; Transportation of Patients ; Triage

Purpose: We aimed to analyze changes in suprascapular nerve (SSN) position within the suprascapular notch during in vivo shoulder abduction. Materials and Methods: Three-dimensional models of the shoulder complex were constructed based on magnetic resonance imaging of the brachial plexus (BP-MR) in a patient diagnosed with SSN dysfunction but normal scapular movement. Using BP-MR in neutral position and computed tomography data on shoulder abduction, shoulder abduction was simulated as the transition between two positions of the shoulder complex with overlapping of a neutral and abducted scapula. SSN movement during abduction was evaluated using the finite element method. Contact stress on the SSN was measured in the presence and absence of the transverse scapular ligament (TSL). Results: In the neutral position, the SSN ran almost parallel to the front of the TSL until entering the suprascapular notch and slightly contacted the anterior-inferior border of the TSL. As shoulder abduction progressed, contact stress decreased due to gradual loss of contact with the TSL. In the TSL-free scapula, there was no contact stress on the SSN in the neutral position. Towards the end of shoulder abduction, contact stress increased again as the SSN began to contact the base of the suprascapular notch in both TSL conditions. Conclusion We identified changes in the position of the SSN path within the suprascapular notch during shoulder abduction. The SSN starts in contact with the TSL and moves toward the base of the suprascapular notch with secondary contact. These findings may provide rationale for TSL release in SSN entrapment.