A retrospective review was performed of 297 patients admitted to Chung Ang Gil Hospital between June 1995 and December 1996 with a diagnosis of blunt chest trauma. Of these patients, 34% suffered either immediate or delayed complications. Immediate complications included hemothorax in 58.8%, pneumothorax in 26.5%, and pulmonary contusion in 20.5%. Delayed complications occurred in 9.1% of patients overall; these included pulmonary contusion in 12.7%, pneumonia in 9.8%, pulmonary embolism in 2%, poeumothorax in 2%, and hemothorax in 2%. The mean age of the patients were 43 years. 210 patients(70.7%) were under age 50 and 87(29.3%) were 50 years of age or older. Male to female ratio was 1.9:1. Mean Initial Revised Trauma Score (RTS) and the Injury Severity Score (ISS) were 7.10+/-0.94 and 14+/-8.69, respectively. There were associated injuries in 225(75.8%) patients. Overall mortality rate was 7.1% and the mortality rate was significantly greater in patients with a RTS<6, ISS>or=16, associated injuries, advanced age(50 years of age or older), and pulmonary complications. Pulmonary complications were significantly greater in patients with a RTS<6, ISS>or=16, and an associated injuries.
Contusions ; Diagnosis ; Female ; Hemothorax ; Humans ; Injury Severity Score ; Male ; Mortality* ; Pneumonia ; Pneumothorax ; Pulmonary Embolism ; Retrospective Studies ; Thorax*

Many patients whose chief complaint is headache caused by accident such as traffic accident, falling, or assaults visit to emergency center. Majority of these patients has mild or moderate symptoms, and there is no need to treat surgically. However, the fact that head injury can cause SIADH(syndrome of inappropriate secretion of antidiuretic hormone) is likely to be overseen. Acute hyponatremia might have been associated with death or permanent brain damage. Hyponatremia is best handled by early recognition and correction of a downward trend in the serum sodium. Unfortunately, this is often difficult in the head-injured patient, where hyponatremia may occur fairly rapidly and is confused by symptoms of head injury. when moderate to severe hyponatremia occurs, it is important to determine its etiology and expeditiously initiate corrective action. There has not been any reported case of the occurrence of symptomatic SIADH after mild head injury in Korea yet. The authors report the experience of three cases of symptomatic SIADH after mild head injury with review of the literatures.
Accidents, Traffic ; Brain ; Craniocerebral Trauma* ; Emergencies ; Head* ; Headache ; Humans ; Hyponatremia* ; Inappropriate ADH Syndrome ; Korea ; Sodium

SNP given by intravenous drip has been used to control hypertensive crisis since 1929. Its rapid action makes it suitable for controlled hypotension during general anesthesia. Experience of its use in three cases is described, which undergoing surgery for A-com aneurysm. The results are as follows: 1) The fall in MAP produced by the SNP was directly proportional to the doses of the infusion. (P<0. 01). 2) Increased doses of the SNP caused further rise in pulse rate, but not occurred tachycardia. (P<0.05). 3) The CVP by the SNP decreased consistantly. (P<0.05). 4) When SNP 4ug/kg/min was administered, 2 cases of respiratory acidoses and one case of mild metabolic acidosis were noticed. 5) No CN toxicity was seen, and recovery to normal level of blood pressure was noticed.
Acidosis ; Acidosis, Respiratory ; Anesthesia* ; Anesthesia, General ; Aneurysm ; Blood Pressure ; Heart Rate ; Hypotension, Controlled* ; Infusions, Intravenous ; Nitroprusside* ; Sodium* ; Tachycardia

Objectives : A diverse range of adverse effects has been linked to the application of antidepressants for the treatment of depressive disorder. Recently, evidence has been emerging of the adverse metabolic effects of antidepressants. This study investigated the effects of antidepressants on plasma glucose and other factors in the fat and muscle tissue relating to metabolism. METHODS : Long-Evans-Tokushima-Ostuka (LETO) rats were used to evaluate the effects of different antidepressants. Amitriptyline, fluoxetine, and mirtazapine were administered to each of three subgroups for 4 weeks, between 11 and 15 weeks old, while a fourth subgroup was administered no antidepressant during the same period. Changes of weight and daily intake were monitored. Tissues and blood were collected at 15 weeks. RESULTS : The fluoxetine subgroup showed lower weight gain and lower food efficacy ratio than did the other subgroups. Blood glucose and other circulating factors showed no significant differences among groups, except for the leptin levels of the fluoxetine subgroup. However, the amitriptyline and mirtazapine subgroups showed similar patterns in the response of mRNA expression of peroxisome proliferator-activated receptors gamma cofactor-1 and uncoupling protein-1, 2, 3. CONCLUSION : These results could indicate possible differences in metabolic response based on the kind of antidepressant used.
Amitriptyline ; Animals ; Antidepressive Agents ; Blood Glucose ; Depressive Disorder ; Energy Metabolism ; Fluoxetine ; Glucose ; Leptin ; Mianserin ; Muscles ; Peroxisome Proliferator-Activated Receptors ; Plasma ; Rats ; RNA, Messenger ; Weight Gain

There are many surgical alternatives to medical therapy for trigeminal neuralgia. Among open procedures, Jannetta's procedure for microvascular decompression have widest favor. But there is no justification for exposing patients to such dangers when there are effective and safe alternatives such as percutaneous procedures. Of the percutaneous procedures, the most widely used are thermocoagulation, glycerolization, and microcompression of the gasserian ganglion. Percutaneous microcompression of the gasserian ganglion was introduced by Mullan in 1978 and its description was published in 1983. In the 1950's and 1960's deliberate compression of the gasserian ganglion was performed through an open operation. Mullan carried out this precedure using an inflatable balloon under brief anesthesia. 15 procedures were performed under brief general anesthesia in order to ensure maximum comfort for the patient in the operating room. The instruments consisted of a 14 gauge blunt tip needle, a 4F Fogarty catheter and a tuberculin syringe. The compression was maintained usually for 1 to 1.5 minutes. 14 out of 15 patients were relieved from their pain without serious complications.
Anesthesia ; Anesthesia, General ; Catheters ; Electrocoagulation ; Glycerol ; Humans ; Microvascular Decompression Surgery ; Needles ; Operating Rooms ; Syringes ; Trigeminal Ganglion ; Trigeminal Neuralgia* ; Tuberculin

BACKGROUND: Puffer fish can be the source of lethal flood poisoning in humans. Tetrodotoxin(TTX) poisonings are not infrequency seen in Korea, but there are few clinical reports. So we reviewed the patients of TTX poisoning and analyzed the clinical characteristics of patients. METHODS: A retrospective study was performed of 40 patients who visited Chung Ang Gil Hospital from Jan. 1, 1995 to May. 31, 1998 with a diagnosis of TTX poisoning by a review of patients' medical records and telephone inquiries, The diagnosis of TTX poisoning was made by causal links between consumption of puffer fish and the development of typical symptoms of tetrodotoxication. The clinical severity of the patients in this study was classified according to the classification of Fukuda. RESULTS: Mean age of the patients was 40 years. The highest incidence was in the 4th decade in 21 patients(52.5%). The ratio of male to female was 3.44:1, Seasonal distribution excluding cases in 1998 was 12 patients in spring, 6 in summer, 5 in autumn and 12 in winter. The mean interval between consumption and symptom onset was 137 minutes. Common initial symptoms were circumoral numbness(32 patients) and paresthesia of extremities(24 patients). Various symptoms were developed after ingestion of puffer flesh such as neuromuscular(39 patients), cardiovascular/pulmonary (23 patients) and gastrointestinal (16 patients) system. Mean recovery time from the onset of symptom was 22.00 hours. All were treated with symptomatic and supportive measures and recovered completely without sequelae. In 2 cases ventilatory supports were applied for 18.5 hours and 31.5 hours respectively.
Classification ; Diagnosis ; Eating ; Female ; Humans ; Incidence ; Korea ; Male ; Medical Records ; Paresthesia ; Poisoning* ; Retrospective Studies ; Seasons ; Telephone ; Tetraodontiformes*

PURPOSE: MOPP/ABV hybrid regimen incorporates MOPP and ABVD into a single regimen on the tenets of the Goldie-Coldman hypothesis. This study was performed to determine the efficacy of COPP/ABV hybrid regimen, in which cyclophosphamide was substituted for mechlorethamine, in patients with advanced Hodgkin's disease. MATERIALS AND METHODS: Patients with advanced Hodgkin's disease were treated with cyclophosphamide(600 mg/m2 iv, Dl), vincristine(1.4 mg/m2 iv, D1), procarbazine(100 mg/m2/d po, D1-7), prednisolone(40 mg/m2/d po D1-14), doxorubicin(35 mg/m2 iv, D8), bleomycin(10 mg/m2 iv, D8) and vinblastine(6 mg/m2 iv, D8). The treatment was repeated every 4 weeks. RESULTS: Between Aug. 1989 and Aug. 1996, 28 patients were enrolled. The median age was 33 years. Twenty one(75%) were previously untreated, newly diagnosed patients and 7(25%) were those who had relapsed after previous radiotherapy(RT). The common histologic types were nodular sclerosis(46%) and mixed cellularity(36%). Twenty three (82%) patients achieved complete remission(CR), three(11%) with the assistance of involved-field RT. Only one patient was primary treatment failure. The median follow-up duration was 56 months. Of the 23 patients achieving CR, three(13%) relapsed. Five-year relapse-free survival was 84.4%. Eight patients died. Five-year overall survival rate was 66.6% and 5-year failure-free survival rate was 66.3%. The survival rate of those who had relapsed after previous RT was significantly lower than that of newly diagnosed patients(P=0.03). The hematologic toxicities were common, but nonhernatologic toxicities were uncommon. Five patients died of treatment-related pneumonia or sepsis. Among them, four were those who had relapsed after previous RT. CONCLUSION: COPP/ABV hybrid regimen could cure significant proportion of patients with advanced Hodgkin's disease but the treatment-related mortality was high, especially in those who had relapsed after previous RT. Another regimen should be considered for those who received previous RT.
Cyclophosphamide ; Drug Therapy* ; Follow-Up Studies ; Hodgkin Disease* ; Humans ; Mechlorethamine ; Mortality ; Pneumonia ; Radiotherapy ; Sepsis ; Survival Rate ; Treatment Failure

Pheochromocytomas are rare catecholamine-secreting neuroendocrine tumors arising from chromaffin cells in the adrenal medulla. Typical classic triad are consisted of headaches, palpitations, and profuse diaphoresis. But some patients with pheochromocytomas have other cardiovascular manifestations such as left ventricular hypertrophy, congestive heart failure, and cardiac arrhythmia. Rarely, pheochromocytomas manifest as acute myocardial infarction leading to delayed diagnosis and treatment. We experienced one case of pheochromocytoma initially manifesting as acute myocardial infarction which showed normal coronary artery on coronary angiography. Pheochromocytoma should be suspected and evaluated in patients with acute myocardial infarction whose coronary angiography shows normal coronary without definite thrombosis.
Adrenal Medulla ; Arrhythmias, Cardiac ; Chromaffin Cells ; Coronary Angiography ; Coronary Vessels ; Delayed Diagnosis ; Headache ; Heart Failure ; Humans ; Hypertrophy, Left Ventricular ; Myocardial Infarction* ; Neuroendocrine Tumors ; Pheochromocytoma* ; Thrombosis

PURPOSE: The purpose of this study is to compare the results of using a locking compression plate and an unlocked plate for treating proximal humeral fractures. MATERIALS AND METHODS: This study was based on 20 patients who underwent plate fixation for proximal humeral fractures out of the 87 patients with proximal humeral fractures and who were admitted from 2003 to 2007 in our hospital. Of the 20 patients, 10 were treated with a locking compression plate and the other 10 were treated with an unlocked plate. Each group was evaluated according to the humeral neck shaft angle, the period until bony union, the complications and the Constant score. The humeral neck shaft angle was based on plain x-rays taken immediately after the operation and at 6 months postoperatively. The Constant score was evaluated on the last visit to our clinic. RESULTS: There was no significant statistical difference between the two groups in terms of the neck shaft angle, the period until bony union and the Constant score. Yet, there were three cases of screw migration in the unlocked plate group. CONCLUSION: There was no significant difference between the two groups in terms of the neck shaft angle, the period until bony union and the Constant score. The locking compression plate is considered to achieve more effective fixation for proximal humerus fractures because there were less complications such as screw migration.
Humans ; Humerus ; Neck ; Shoulder Fractures

Vasoactive pharmacotherapy is now being widely used as practical and reliable method for the treatment of the patients with erectile dysfunction. But the individual vasoactive agent has limitations in its clinical success and potential for side effects. So, the synergistic effect and low drug volume of each vasoactive drug in polypharmacotherapy of erectile dysfunction have made it possible to reduce both systemic and local complications with excellent success rate. A total of 223 patients with erectile dysfunction underwent a trial of intracavernous self injection therapy with Trimix(the mixture of papaverine, phentolamine and prostaglandin E1). Major underlying diseases were DM(115patients, 51.6%), hypertension(11 patients, 4.9%), spinal injury(three patients, 1.3%) and prior pelvic surgery(three patients, 1.3%). The volume of drug used ranged between 0.04 and 0.6ml(average:0.19ml). After a mean followup of 7.6 months(3-15 months), 141 patients(63.2%) left in the home injection program and among them, 125 patients(88.6%) had very high satisfaction. The drop-out rate was 36.8%(82 of 223) with most of the cases during early home phase. The causes of drop-out were the fear of needle or injection, inadequate response to injection, loss of interest and complications. Priapism(six patients, 3.8%), pain(six patients, 3.8%) and granuloma on injection site(one patient, 0.6%) were noticeable complications, but coporal fibrosis and systemic side effect were not noticed. In conclusion, Trimix intracavernosal injection therapy is minimally invasive, simple, relatively safe and, most of all, very effective method for the treatment of the patients with erectile dysfunctions.
Drug Therapy ; Erectile Dysfunction* ; Fibrosis ; Follow-Up Studies ; Granuloma ; Humans ; Male ; Needles ; Papaverine ; Phentolamine