BACKGROUND: To describe the fast experience of case-leased advanced cardiac life support(ACLC) course in Korea. METHODS: We have given case-based ACLC course to 13 nurses(6 emergency nurses, 4 coronary care unit muses, 3 professors) and 17 physicians(4 emergency physicians, 12 emergency residents, 1 intem). We performed the case-based ACLS course according to 1992 American Heart Association guidelines and recommendations for advanced cardiac life support by american ACLS instructors(1 pulmonologist, 4 critical care nurses). We performed final theoretical written test and 2 times written survey (immediate and 100th day after the course) about the course. RESULTS: On final written test, all practitioners answered at leasts 70% of the questions correctly. There was no significant difference between nurses and physicians(86.2+/-3.6 of physicians and 82.5+/-6.8 of nurses, p=0.06). 90%of participants considered that case-based advanced cardiac life support was acceptable. 100th day after the course, 93%of participants answered that ACLS course have been helpful on his/her job and also want retraining of ACLS course. 70%of participants considered that ideal ACLS training committee in Korea is the Korean Society of Emergency Medicine. CONCLUSION: Case-based ACLS course is a useful educational method far physicians and nurses in Korea. In the future, we should organize Korean resuscitation committee and then make guidelines for ACLS, and then continuously educate physicians and nurses.
Adult* ; Advanced Cardiac Life Support ; Alprostadil ; American Heart Association ; Coronary Care Units ; Critical Care ; Emergencies ; Emergency Medicine ; Humans ; Korea* ; Resuscitation

We reviewed surgical specimens from 11 patients with diffuse neurofibroma to define the specific clinicopathologic characteristics. Ten cases were cutaneous neurofibromas and one case was an uncommon gastrointestinal neurofibroma involving the rectum. The most frequent sites of involvement were the head and neck, especially the eyelids and the periorbital areas. They usually presented as a plaque-like elevation of the skin. They primarily occured in children and young adults and positive family histories of von Recklinghausen's neurofibromatosis were obtained in 45.4%. Pathologically, the involved skin & rectum were diffusely thickened by an infiltrative growing mass, showing proliferation of short fusiform cells in the uniform matrix of fine fibrillary collagen. The characteristic prominence of Wagner-Meissner bodies (45.4%) suggests they could be associated with pathogenesis of diffuse neurofibroma. On the basis of these findings, we could confirm diffuse neurofibroma to be a distinct form of neurofibroma.
Child ; Adult ; Male ; Female ; Humans

No abstract available.
Factor VIII* ; Hemophilia A* ; Humans

BACKGROUND: The improved technique for cardiopulmonary resuscitation(CPR) has resulted in the survival of many patient who experienced cardiac arrest. However, mortality in resuscitated patients is high, and the survival rate without brain damage is very low. Various neurological examination models, neuro-imaging techniques, electrophysiological procedures, and biochemical tests have been studied with respect to the detection of cerebral damage and outcome, but an early, reliable prediction of individual outcomes is still uncertain. METHODS: We studied twenty patient who had been in a coma for more than 24 hours after CPR, Somatosensory evoked potentials(SEP) were measured within the first three days after CPR. RESULTS: Of the twenty patients, seven patients(35%) had a good outcome, and thirteen patients(65%) had a bad outcome. Of the eleven patients with loss of the cortical evoked potential's N20 peak, all had a bad outcome. CONCLUSION: SEPs are of great benefit in prognostic evaluation after CPR.
Brain ; Cardiopulmonary Resuscitation* ; Coma* ; Evoked Potentials, Somatosensory* ; Heart Arrest ; Humans ; Mortality ; Neurologic Examination ; Survival Rate

Prediction of individual outcome after cardiopulmonary resuscitation is of major medical, ethical, and socioeconomic interest but uncertain. We experienced the case thats the patient got complete neurologic recovery after the 123th day firm cardiac arrest, who had been suspected to go with poor prognosis because she got the findings of Glasgow Coma Scale 4, severe diffuse encephalopathy on encephalogram and generalized tonic-clonic seizure at the 4th day. Recently, a 29 year-old women who sustained from respiratory arrest induced presumably by sedative and anticonvulsant therapy for control of seizure that happened during local lidocaine anesthesia far mamoplasty was transfered to our emergency medical center from local private plastic office. Arrest time was about 20 minutes. On hospital arrival, she had a pulseless bradyasystole and no respiration, but spontaneous circulation was restored at 10 minutes artier CPR started. We started cerebral oriented resuscitation including mild hypothermia(34degrees C), hemodilution, calcium channel blocker infusion. On hospital day 4, patient's glasgow coma scale(GCS) was 4. On hospital clay 7, Brain Magnetic Resonance Imaging(MRI) showed high signal intensity on T2WI, involving the bilateral basal ganglia. After contrast administraton, marked enhancement can be seen at the lesion site. Patient's glasgow coma scale(GCS) increased step by step to 5 on 8th day, 7 on 14th day, 10 on 15th day, 13 on 17th day, 15 on 20th day. 40 days later the patient was discharged with minor neurologic abnormality including hand tremor, dysphonia, amenorrhea and Mini Mental State Examination(MMSE) score(26). Long-term Follow up revealed that all neurologic functional abnormality inducting hand tremor, dysphonia, amenorrhea and MMSE score(26) is completely recovered on 123th day after episode of cardiopulmonary arrest.
Adult ; Amenorrhea ; Anesthesia ; Basal Ganglia ; Brain ; Calcium Channels ; Cardiopulmonary Resuscitation ; Coma ; Dysphonia ; Emergencies ; Female ; Follow-Up Studies ; Glasgow Coma Scale ; Hand ; Heart Arrest* ; Hemodilution ; Humans ; Hypoxia-Ischemia, Brain* ; Lidocaine ; Plastics ; Prognosis ; Respiration ; Resuscitation ; Seizures ; Tremor

BACKGROUND: The goal of successful resuscitation is not only to stop the process of ischemia as soon as possible but also to overcome the secondary injury process after resuscitation, which involves a complex interplay of mechanisms. Brain damage accompanying cardiac arrest and resuscitation is frequent and devastating. Cells die by one of two mechanisms: necrosis or delayed neuronal death. Delayed neuronal death may require protein synthesis. Neurons in the CA1 subfield of the hippocampus are selectively vulnerable to death after injury by ischemia and reperfusion. Death of these neurons occurs after an interval of 1 or 2 days. We assessed the effects of a protein synthesis inhibitor, cycloheximide(CHX), on hippocampal neuronal death of rats by using the ventricular fibrillation cardiac arrest(VFCA) model. METHODS: The effect of CHX(3mg/kg, s.c.) on hippocampal neuronal death was studied in two groups of 18 rats each, one group being subjected to a 2-min VFCA and the other to a 3-min VFCA. Each group was divided into three subgroups: control(group I,II) without subcutaneous injection of CHX, 'exp-12' of group I/II treated with CHX 12 hours after return of spontaneous circulation (ROSC), and 'exp-24' of group I/II treated with CHX 24 hours after ROSC. The coronal sections of the hippocampus levels were stained with hematoxylin-eosin after 72 hours of survival. The histologic damage score(HDS) was used to assign a score to the total number of damaged neurons counted in each of the hippocampal CA1 subfields. RESULTS: 1. There were not significan differences in heart rates, blood pressures, blood sugar, and blood gas in group I & II during the pre-arrest steady state or at 5 min and 30 min after ROSC. 2. In group I & II, the HDS, were significantly reduced in rats(I exp-12, 1.1+/-0.6; I exp-24, 1.3+/-0.5; II exp-12, 1.4+/-0.7; and II exp-24, 1.8+/-0.8) treated with CHX 12 hours or 24 hours after ROSC than control rats(I, 2.5+/-0.9, II, 2.9+/-0.8)(p<0.05). CONCLUSION: These results suggest that delayed hippocampal neuronal death from ischemic insult after ventricular fibrillation cardiac arrest followed by resuscitation can be prevented by a protein synthesis inhibitor, CHX. Further experimental studies of the action mechanism of protein synthesis inhibitors to delayed neuronal death and clinical applications are required.
Animals ; Blood Glucose ; Brain ; Heart Arrest* ; Heart Rate ; Hippocampus ; Injections, Subcutaneous ; Ischemia ; Necrosis ; Neurons* ; Protein Synthesis Inhibitors ; Rats* ; Reperfusion ; Resuscitation ; Ventricular Fibrillation*

Sinus venosus is a rare cardiac defect, which may lead to an interatrial shunt. Diagnosis on echocardiography may be difficult requiring an evaluation by a board-certified cardiologist. We report a case of a 41 year-old male who presented with recurrent episodes of hemiparesis (first left sided, second right sided). Surgical correction of sinus venosus led to resolution of his symptoms.
Heart Septal Defects, Atrial

The double eyelid operation is one of the most common cosmetic surgery performed in orientals, and there are numerous studies about surgical procedures of that. In the case of appropriate candidates, the non-incision technique makes excellent cosmetic results, with the advantages of shorter operating time, less morbidity, less pain, no scarring and easy revision of shape. But, usually the non-incision technique is recommended in the cases with thin upper eyelid, small amount of orbital fat, less redundant skin of upper eyelid and in whom a wide fold is not desired so on. Therefore, the disadvantages of this method are that it cannot be applied to all patients. The postoperative complications are disappearance or faded fold, formation of cyst or lumps, asymmetry etc. and the incidence of these complications is slightly higher than those of the incisional method. In this study, the double eyelid operation using the continuous buried suture method was performed in 210 patients for formation of double eyelid from Jan. 1993 to Dec. 1995. In conclusion very good results can be obtained by the continuous buried suture method even in the cases of puffy upper eyelid. This method can make a double eyelid shape in the fashion the patient wants and can be a new indication for correction of unilateral double eyelid. This method is safe, satisfactory and take shorter postoperative recovery time and it can reduce the incidence of postoperative complications.
Cicatrix ; Eyelids* ; Humans ; Incidence ; Orbit ; Postoperative Complications ; Skin ; Surgery, Plastic ; Sutures*

Arthroscopic repair of an isolated teres minor tendon tear without associated shoulder joint pathology has not been reported in the literature. We report on a case of isolated teres minor tendon tear after trauma. The patient complained of severe shoulder pain and progressive limited range of motion 4 months after the injury. Magnetic resonance imaging showed a full-thickness tear of the teres minor tendon at its musculotendinous junction and arthroscopic repair was performed. At 2 years follow-up, satisfactory clinical and radiological outcomes were observed with return to pre-injury level. Here, the authors report this case and provide a review of literature.
Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Pathology ; Range of Motion, Articular ; Shoulder Joint ; Shoulder Pain ; Tears* ; Tendons*

Androgen acts via the androgen receptor and can play a critical role in the development and growth of the prostate and the pathophysiology of prostatic diseases. Testosterone is the most abundant circulating androgen and is converted to dihydrotestosterone (DHT), a more potent androgen, by steroid 5alpha-reductase. There are two 5alpha-reductase isoenzymes, type 1 and type 2, in humans and animals. Type 2 5alpha-reductase predominates in the prostate. While deficiency of type 2 5alpha-reductase causes male pseudohermaphroditism, increased DHT has been implicated in benign prostatic hyperplasia and prostate cancer. The aim of this article is to highlight the significance of 5alpha-reductase in the development and growth of the prostate and pathogenesis of prostatic diseases.
46, XY Disorders of Sex Development ; Animals ; Dihydrotestosterone ; Growth and Development ; Humans ; Isoenzymes ; Prostate ; Prostatic Diseases ; Prostatic Hyperplasia ; Prostatic Neoplasms ; Receptors, Androgen ; Sexual Development ; Testosterone