BACKGROUND: Ketamine use in emergency room has been increased. It has rapid onset of action and appropriate duration of action. It does not need endotracheal intubation and produces potent analgesia, sedation, and amnesia. The object of this study is to determine the safety and the degree of physician's satisfaction in relation to ketamine use. MATERIALS AND METHODS: This is a prospective study using protocol. Pediatric trauma patients who need sedation were given IM ketamine(4mg/kg) and atropine(0.01mg/kg) in a same syringe. Monitoring of patients was done by EM residents and complications of ketamine use were recorded. Physician's satisfaction was also recorded after the procedure. RESULTS: Intramuscular ketamine was administered 54 times, mainly for laceration repair. Physicians completed protocol for 51 of treated children. The median time for onset of sedation was 6.5+/-2.4 min, and duration of action was 32.4+/-10.8 min. Hypersalivation occurred in 9.8%(n=5); random movement 3.9%(n=2), emesis during procedure(n=1), emesis at home(n=1), and transient oxygen desaturation(n=1). All were quickly identified and treated without specific airway management and sequelae. Of 84% of physicians was satisfied with ketamine use for pediatric sedation. CONCLUSION: Intramuscular ketamine can be administered safely and satisfactorily in emergency room to facilitate pediatric procedures in conjunction with a defined protocol and appropriate monitoring.
Airway Management ; Amnesia ; Analgesia ; Child ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Intubation, Intratracheal ; Ketamine* ; Lacerations ; Oxygen ; Prospective Studies ; Sialorrhea ; Syringes ; Vomiting

BACKGROUND: Although enriched broth cultures have been recommended as an adjuvant to the direct plating of tissue and body fluid specimens, the cost-effectiveness of broth cultures has been questioned in regard with the clinical significance of "broth only isolates(BOI)". The purpose of this study was to investigate the usefulness of thioglycollate broth(THIO) cultures. METHODS: We reviewed retrospectively results in the culture specimens of body fluids, tissue biopsies, and puses received during the month of July 1997. All specimens were inoculated into THIO in addition to agar plates. We reviewed the medical records of culture-positive patients to determine the clinical significance and relevance of their isolates. Clinically significant isolates were defined as those for which an appropriate antimicrobial therapy was done except one judged as contaminants by clinicians and clinically relevant isolates as the clinically significant one isolated first. RESULT: Of 2,008 specimens, 512(25.4%) from 365 patients grow 561 isolates 464 plate isolates and 97 BOI. Two hundred eighty nine(62.3%) of the 464 isolates from plate cultures were clinically significant, compared to only 12(12.4%) of 97 BOI (P<0.05). Only four (4.1%) BOI were clinically relevant, including one Pseudomonas aerugiosa from ascites. one Klebsiella pneumoniae and two Staphylococcus aureus from tissue specimens. CONCLUSION: A routine use of enriched broth culture rarely recover clinically relevant isolates. Considering the laboratory and medical costs of the recovery of contaminants and clinically irrelevant isolates, the enrichment broth cultures should be used more selectively.
Agar ; Ascites ; Biopsy ; Body Fluids ; Humans ; Klebsiella pneumoniae ; Medical Records ; Pseudomonas ; Retrospective Studies ; Staphylococcus aureus

As regard to the treatment modality and its prognosis following the treatment, there are some differences between the thoracolumbar compression fracture and bursting fracture. If bursting fracture is accompanied by nerve injury, especially if the fracture fragment is compressing the spinal cord, it is reported that decompression with early surgical intervention would achieve a much better prognosis. Therefore, the authors tried to suggest an overall statistics on the patient's age, mechanism of injury and injured site and to compare the sensitivity of tools used in diagnosing bursting fracture radiologically, as well as the sensitivity of posterior vertebral body angle, which is used in diagnosing subtle bursting fracture. Three hundred forty three patients admitted to emergency center of Yongdong Severance Hospital with a thoracolumbar fracture from 1992. Jan. to 1994. Dec. Of the 343 patients, minor fracture and those with insufficient X-ray films and clinical notes were excluded from the study. The study was done with 199 patients in retrospective method. All the 199 patients had plain X-ray and computed tomography taken. the results were as follows 1. The male to female ratio was 114 to 85 with average age being 47.1 years old(14-93 years old). 2. The mechanisms of injury were falling down, traffic accident, slipped down, sprain and confusional injury in the order written. 3. There were 67 cases of compression fracture and 132 cases of bursting fracture. 157 cases had I level injury in the order of Ll, T12, and L2, 33 cases had 2 level injury, and 8 cases were injured in 3 level of the spine. 4. Of the factors determining the radiological diagnosis of bursting fracture, the disruption of posterior cortical line had the highest sensitivity. 5. Of the 45 cases of 1 level injured subtle bursting fracture, those with posterior vertebral body angle of more than 100 degree radiographically had a sensitivity of 82%. Of the thoracolumbar fractured patient admitted to the emergency room, searching for disruption of posterior cortical line in plain film helped in diagnosing bursting fracture, and calculating the posterior vertebral body angle helped in determining whether further computed topography was needed in subtle bursting fracture.
Accidents, Traffic ; Decompression ; Diagnosis ; Emergencies ; Emergency Service, Hospital ; Female ; Fractures, Compression ; Humans ; Male ; Prognosis ; Retrospective Studies ; Spinal Cord ; Spine ; Sprains and Strains ; X-Ray Film

No abstract available.
Sotos Syndrome*

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

PURPOSE: We compared the clinical and urodynamic findings of patients suffering with lower urinary tract symptoms(LUTS)/benign prostatic hyperplasia(BPH) and who underwent transurethral resection of the prostate, and we tried to determine the effect of urodynamical obstruction and the bladder function on the result of this operation. MATERIALS AND METHODS: 101 patients with LUTS/BPH were categorized in four groups based on the findings of the preoperative urodynamic study: 15(14.8%) patients without bladder outlet obstruction[(BOO(-)], 50 (49.5%), patients with BOO[(BOO(+)], 12 patients(11.8%) with BOO and with detrusor underactivity(BOO+DU), and 24 patients(23.7%) with BOO and with detrusor overactivity(BOO+DO). The outcomes and satisfaction were analyzed by the changes of the International Prostate Symptom Score(IPSS) and the quality of life(QoL) index before and after transurethral resection of the prostate(TURP), respectively. RESULTS: The Qmax was significantly high and residual urine was significantly low in group BOO(-). The PdetQmax was significantly high in group BOO(+) and also in the BOO+DO group. In group BOO(-), the decrease of the total IPSS was smaller than that noted in the other groups. There were significant decreases of the IPSS after TURP in groups BOO (+), BOO+DU and BOO+DO each voiding and storage subscore were decreased,but in group BOO+DO, the improvement was not as much as that in the other groups. The QoL was improved significantly in group BOO compared to the other groups. CONCLUSIONS: Performing urodynamics preoperatively helps to predict the degree of symptom relief, and a higherbaseline BOO positively predicts the postoperative improvement of the IPSS and the QoL. The outcome of the BOO+DU group was satisfactory, but storage symptoms still existed for the BOO+DO group.
Humans ; Prostate* ; Prostatic Hyperplasia* ; Transurethral Resection of Prostate ; Urinary Bladder Neck Obstruction ; Urinary Bladder* ; Urinary Tract* ; Urodynamics*

We propose the various Telemedicine applications on the DooRae (Distributed Object Oriented Multimedia Application Crafting Environment for Collaboration) framework(or platform). DooRae-Telemedicine supports the application development of the collaborative multimedia environment connected with the network(LAN, MAN, WAN) in the CBM(Computer based Multimedia) based. Also, it is not restrict on space between a doctor(s) and a patient(s) into cyberspace made by network. The kinds of Telemedicine in this paper have different distinction, and the development of these application system is possible on DooRae environment. DooRae-Telemedicine has a interaction, various communication type, a question and an answer, multi-session, application sharing and whiteboard which resembles chalkboard. Also, various supplementary functions such as video conference and voice conference for DooRae-telemedicine are what makes face-to-face medicine effective. Also it supports real or non-real type. The operating system developed on windows 95 and windows NT This research has been done creating multimedia-based telemedicine system for home PCs in network environment. Most of telemedicine used hardware and exclusive line of high cost as CATV broadcasting technique. But DooRae-telemedicine will contribute to change the Home-PC for better use of collaborations among doctor and patients through various modes o interactions in cyberspace.
Cooperative Behavior ; Humans ; Multimedia* ; Telemedicine* ; Voice

No abstract available.
Granuloma, Lethal Midline*

This study was conducted to fine out the preventive effects of chitosan and chitosan oligomer on the disorders of hepatic functions and lipid metabolism induced by 2, 3, 7, 8-tetrachlorodibenzo-p-dioxin (TCDD), using adult male rats (SD) for four weeks. Rats were fed chitosan (4%) or chitosan oligomer (4%) diets respectively before 3weeks of TCDD treatment (50 ug/kg BW) by intraperitoneal injection and then continually supplied these diets for one week until being sacrificed. The elevation of serum total and LDL cholesterol levels induced by TCDD treatment was significantly reduced in the rats fed chitosan diets. The increment of liver triglyceride levels caused by TCDD treatment was tended to suppress in all rats fed chitosan and chitosan oligomer diets. Fecal total lipid and cholesterol excretion were high levels in the rats fed chitosan diets. The hepatic cytosolic catalase activities significantly decreased by TCDD treatment appeared recovering trend by chitosan diets. In hepatic microsomal cytochrome p-450, NADPH cytochrome p-450 reductase, ethoxycoumarin-o-deethylase (ECOD) and benzphetamin N-demethylase (BPND), chitosan than chitosan oligomer diets apparently decreased the increasing levels by TCDD treatment. In histochemical observation, the fat droplets and apoptosis of hepatocytes by TCDD treatment were markedly alleviated by chitosan and chitosan oligomer diets. These results indicate that chitosan, more than chitosan oligomer can exert preventive effects on some disorders of hepatic functions and lipids accumulation by TCDD.
Adult ; Animals ; Apoptosis ; Catalase ; Chitosan* ; Cholesterol ; Cholesterol, LDL ; Cytochrome P-450 Enzyme System ; Cytosol ; Diet ; Hepatocytes ; Humans ; Injections, Intraperitoneal ; Lipid Metabolism* ; Liver ; Male ; NADPH-Ferrihemoprotein Reductase ; Rats* ; Tetrachlorodibenzodioxin* ; Triglycerides

No abstract available.
Renal Insufficiency*