BACKGROUND: Hemorrhage itself has been shown to produce abnormalities in immunity, particularly depression of the lymphocyte function. In order to better examine the amount of hemorrhage required to suppress the lymphocyte function, we determined the effect of graded fixed-volume hemorrhage on splenocyte proliferation and the lymphocyte subpopulation. METHODS: Male Sprague-Dawley rats(weight, 350~400g) were anesthetized, subjected to hemorrhages of 7.5ml/kg, 15ml/kg, and 22.5ml/kg by percutaneous cardiac puncture with 26G needles. After 1, 2, 4, and 7 days, animals were killed to obtain the blood and spleen. The splenocyte proliferative capacity was measured by using the tritiated thymidine incorporation technique, and the peripheral lymphocyte subpopulation was determined using flow cytometry with the following monoclonal antibodies: T cell(CD3+), T helper cell(CD4+), T cytotoxic cell(CD8+), and B cell(CD45RA+). RESULTS: Hemorrhage of 7.5ml/kg did not induce depression of splenocyte proliferation. However, for hemorrhage greater than 15ml/kg, the splenocyte proliferative capacity was significantly depressed at 2 days after hemorrhage and recovered at 4 days. Hemorrhage induced no changes in the relative percentage of lymphocyte subpopulations and in the number of each cell in peripheral blood. CONCLUSION: This study suggests that cellular immunity is depressed at 48 hrs after a hemorrhage greater than 15ml/kg without any change in the peripheral lymphocyte subpopulation.
Animals ; Antibodies, Monoclonal ; Depression ; Flow Cytometry ; Hemorrhage* ; Humans ; Immunity, Cellular ; Lymphocyte Subsets ; Lymphocytes* ; Male ; Needles ; Punctures ; Rats* ; Rats, Sprague-Dawley ; Spleen ; Thymidine

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

Medicolegal autopsy is a vital tool for obtaining reliable injury mortality data. This study statistically analyzed data obtained from medicolegal autopsies performed in Korea in 2013. The aim of this study was to analyze various aspects of the 4,861 deaths that were categorized as unusual in Korea in 2013. A total of 4,861 deaths were analyzed by gender, age, manner of death, and cause of death. Of the 4,861 deaths, 3,542 (73.3%) were of men and 1,302 (26.7%) were of women. With respect to the manner of death, 54.4% were recorded as unnatural deaths, 38.8% were natural deaths, and 6.9% had unknown causes. Of the 2,642 unnatural deaths, 45.0% were determined to be accidental deaths, 26.3% suicidal, 16.9% homicidal, and 11.8% undetermined. Of the total number of unnatural deaths, 42.1% were trauma-related deaths, for which falling down accounted for 33.8%. Asphyxiation accounted for 16.0% of unnatural deaths, and of these, the predominant cause was hanging (58.8%). In addition, 14.4% of deaths were due to drowning, 12.9% poisoning, 11.0% thermal injuries, 1.8% complications arising from medical procedures, and 0.8% electrocution, starvation, or neglect. Among the 1,886 natural deaths, heart diseases accounted for 52.0% and vascular diseases accounted for 16.9%. Of the 196 deaths among children under the age of 10 years, 41.8% were recorded as unnatural deaths, 45.1% were natural deaths, and 1.5% had unknown causes.
Autopsy* ; Cause of Death ; Child ; Data Interpretation, Statistical ; Drowning ; Female ; Heart Diseases ; Humans ; Korea ; Male ; Mortality ; Poisoning ; Starvation ; Vascular Diseases

BACKGROUND: Doxylamine, an antihistamine with sleep inducing property, is the most commonly intoxicated drug in the urban ED. This drug is relatively safe but is known to induce rhabdomyolysis in rare occasion. The purpose of this study is to determine the incidence of rhabdomyolysis after doxylamine overdose and prognostic factors that contributes to this complication. METHOD: This study was conducted from 26 patients admitted to our hospital after doxylamine intoxication during the period from April 1999 to June 1999. Using the protocol made beforehand, the amount ingested, past history, laboratory results were recorded. Rhabdomyolysis was defined as serum myoglobin over 300 ng/mL or serum creatine phosphokinase(CK) over 1,000 IU/L. Data were analyzed using SPSS program with t-test, Fisher's exact test and discriminant analysis. RESULTS: The rhabdomyolysis was diagnosed in 57.7% of patients. The amount ingested per body weight, prehospital vomiting and low arterial pCO2 predicted occurrence of rhabdomyolysis. The sensitivity of serum CK and myoglobin were 67% and 80% respectively and specificity was 100% for both. The diagnosis was possible for CK after an average of 14hr 20min time after ingestion and 8hr 12min for myoglobin. CONCLUSION: Rhabdomyolysis is a common complication of doxylamine intoxication and if the amount ingested was more than 1 tablet(25mg) per body weight, the incidence of rhabdomyolysis was higher. So, CK measurement after 14 hour postingestion and myoglobin after 8 hour is recommended to decide whether rhabdomyolysis occur.
Body Weight ; Creatine ; Diagnosis ; Doxylamine* ; Eating ; Humans ; Incidence* ; Myoglobin ; Rhabdomyolysis* ; Sensitivity and Specificity ; Vomiting

Choriocarcinoma is a relatively rare malignancy of which characteristic is rapid metastasis to the other organs. It is related to the previous gestation or originated from the teratoma. Choriocarcinoma is mostly originated from the intrauterine chorionic villi, but it is rarely originated from the utreine cervix, fallopian tube, ovary, vagina and pelvic cavity. Primary choriocarcinoma of the fallopian tube is exceedingly rare and it is originated from ectopic tubal pregnancy, tubal migration from the intrauterine pregnancy or intratubal teratoma. 9 Symptoms and signs of the choriocarcinoma originated from the ectopic pregnancy are abdominal pain, vaginal bleeding, palpable adnexal mass, positive pregnancy test and amenorrhea. Thus it is difficult to distinguish choriocarcinoma from ectopic pregnancy on the basis of symptoms before the microscopic diagnosis presented.20 Effective treatment of choriocarcinoma is chemotherapy. Additional operation is possible. B-HCG is a useful measure for the follow up. We experienced a 36-year-old multigravida Korean woman who was diagnosed as the rupture of ectopic pregnancy after left salpingectomy in our hospital and then confirmed primary choriocarcinoma of the fallopian tube without metastasis on microscopic finding. Postoperative chemotherapy was performed with methotrexate. The follow up of disease is still on going at two month intervals and she has remained healthy, We report this case with review of literatures.
Abdominal Pain ; Adult ; Amenorrhea ; Cervix Uteri ; Choriocarcinoma* ; Chorionic Villi ; Diagnosis ; Drug Therapy ; Fallopian Tubes* ; Female ; Follow-Up Studies ; Humans ; Methotrexate ; Neoplasm Metastasis ; Ovary ; Pregnancy ; Pregnancy Tests ; Pregnancy, Ectopic ; Pregnancy, Tubal ; Rupture ; Salpingectomy ; Teratoma ; Uterine Hemorrhage ; Vagina

BACKGROUND: When patients return to the emergency department shortly after being seen, it is generally assumed that their initial evaluation or treatment was inadequate. But in other aspects many short term revisits may be unnecessary in the aspect of emergency care because it is known that substantial numbers of patients use emergency department for nonemergency problems. So we analysed the tendency and the cause of short term revisit patients, determined the rates and the associated demographic, clinical, disease variables as a tool of quality assurance. METHODS: We carried out a chart review of patients seen in the emergency department, who revisited within 72 hours, of Young Dong Severance Hospital retrospectively between January 1, 1998 and September 30, 1999 (period 2), and compared with result between April 1, 1990 and March 31, 1991 (period 1) respectively. RESULTS: In the period 1, the total revisits patients were 204/21,025(0.97%), in that period scheduled revisits were 15.2%, the unscheduled were 84.8%, and the frequent revisits (more than 3 times) were 6.4%. In the period 2, the total revisit patients were 4,722/72,802 (6.49%), in that period scheduled revisits were 86.3%, the unscheduled were 13.7%, and the frequent revisits were 24.8%. The most common cause of revisit during the period 2 is a drug addictor (31.2%) that frequently used the emergency room for seeking drug. CONCLUSIONS : The scheduled revisit patients for dressing, medication, re-evaluation were increased enormously, so the medical care of these patients might be a part of job that performed in emergency department. And if the health care system could support the adequate nursing care facility, the portion of avoidable revisits of emergency department can be decreased. We also found that the emergency department is an important points for the early identification and referral for the treatment of patients who revisited emergency room for seeking drug, and the analysis of physician related factor in revisits patients may be used as a tool of quality assurance in the emergency department.
Bandages ; Delivery of Health Care ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital* ; Humans ; Nursing Care ; Referral and Consultation ; Retrospective Studies

Osteoma is the most common benign tumor of the paranasal sinuses and the frontal sinus is the most frequently involved site. Osteomas are slow growing osteoblastic lesions commonly seen in the outer table of the calvarium, the mandible, the frontal and ethmoid sinus, and occasionally in tubular bones. They are usually detected during the second to fifth decades of life, and reported ratio of male to female is 1.5:1 to 2:1. The symptoms of osteomas are usually developed as gradual growth. They are headaches, facial pain, proptosis, decreased visual acuity, chemosis, diplopia, epiphora, nonpulsating exophthalmus, and transient blindness. Posterior intracranial extension of a frontoethmoid osteoma may lead to brain abscess, intracranial mucocele, tension pneumocephalus. We experienced a 60-year-old male patient who came to the emergency room with acute and severe left periorbital swelling, red eye, and epiphora lasted for 10 days. In a plain radiographs and computerized tomographic scans, a 2.5 x 2.5 x 3.0 cm well marginated mass impressed by osteoma in frontoethmoidal sinus was detected. After the symptoms subsided by conservative treatment, total excision was made by bicoronal approach. Authors reported a frontoethmoidal osteoma presenting periorbital cellulitis without orbital mucocele, which is very rare symptom.
Blindness ; Brain Abscess ; Cellulitis* ; Diplopia ; Emergency Service, Hospital ; Ethmoid Sinus ; Exophthalmos ; Facial Pain ; Female ; Frontal Sinus* ; Headache ; Humans ; Lacrimal Apparatus Diseases ; Male ; Mandible ; Middle Aged ; Mucocele ; Orbit ; Osteoblasts ; Osteoma* ; Paranasal Sinuses ; Pneumocephalus ; Skull ; Visual Acuity

PURPOSE: The 2018 PyeongChang Winter Olympic Games involved 2925 elite athletes, and providing proper health care services for these elite athletes was a critical priority. We established an emergency department (ED) in the Pyeongchang Mountain Polyclinic during the Olympics, which served staff and athletes from many countries. This experience, as well as a description of illnesses and injuries encountered during the games, may provide useful information for planning medical care at similar events in the future. MATERIALS AND METHODS: The polyclinic ED operated from January 25 to February 27, 2018. All cases were enrolled in this study, and their data were analyzed by date and category. In addition, the number of injuries by body part, number of illnesses by organ system, and illness symptoms and causes were analyzed. RESULTS: In total, 288 patients were encountered in the ED. These included 113 injuries and 175 illnesses. We consulted with 153 staff members and 75 athletes, and reported that the fingers were the most commonly injured body part, followed by the knee. The respiratory system was the most commonly involved organ system, and the most common cause of illness was infection. Thirty-eight influenza tests were performed, among which the results of seven were positive. We performed 17 norovirus tests, among which the results of four were positive. CONCLUSION: Our analysis of our ED experience will aid arrangements for medical services in future Winter Games. Additionally, given our new experience, we will now be able to provide better medical services for future winter sports events.
Athletes ; Delivery of Health Care ; Emergencies ; Emergency Service, Hospital ; Fingers ; Humans ; Influenza, Human ; Knee ; Norovirus ; Respiratory System ; Sports

BACKGROUND: Thoracic sympathectomy for hyperhidrosis has been recognized as an effective treatment using thoracoscopic devices and operative techniques, but the satisfaction has decreased due to a compensatory hyperhidrosis. Therefore, the postoperative results and compensatory hyperhidrosis were analyzed. We also measured the temperature differences in the hand and foot during the preoperative and postoperative periods and measured the blood flow of upper and lower extremities. MATERIAL AND METHOD: From December 1995 to July 1998, total of 47 patients with hyperhidrosis underwent sympathectomy via VATS at the Department of Thoracic and Cardiovascular Surgery, Kangnam St. Mary's Hospital. The patients were evaluated for preoperative and postoperative temperature changes on the finger and toe, and preoperative and postoperative blood flows were measured by the Doppler examination on the digital artery, radial artery and dorsalis pedis artery. RESULT: There were no operative deaths but some complications existed: 7 pneumothorax, 3 recurrence and 1 Honor syndrome. Ninety-five percent of the patients also had compensatory sweating especially in the trunk. There were 5 patients who regretted recurring the operation because of the compensatory sweating. Sweating decreased in 46% of the sole hyperhidrosis patients. The temperature difference between preoperation and postoperation was 1degree C on the right hand side and 1.9degree C on the left hand side(p<0.05). There was no significant temperature difference on the sole. Blood flow increased significantly in the palm, but no difference in the sole. CONCLUSION: In conclusion, thoracic sympathectomy for hyperhidrosis is a safe and effective treatment but satisfaction has been decreased by the compensatory sweating; therefore, it is important to thoroughly explain the compensatory sweating prior to surgery. Improvement of the plantar hyperhidrosis is not due to a physiological change, but to a psychological stability.
Arteries ; Fingers ; Foot ; Hand ; Humans ; Hyperhidrosis* ; Lower Extremity* ; Pneumothorax ; Postoperative Period ; Radial Artery ; Recurrence ; Regional Blood Flow ; Sweat* ; Sweating* ; Sympathectomy ; Thoracic Surgery, Video-Assisted ; Toes

Although arteriovenous malformation (AVM) of the uterus is a very rare cause of menometrorrhagia or postmenopausal vaginal bleeding, it is notable to think in the assessment of a woman with abnormal uterine bleeding because correct diagnosis can yield proper therapy to be designed and avoid hysterectomy in women who want to continue their reproductive capacity. AVM may be congenital or acquired. In times past, the diagnosis is usually made after hysterectomy, but currently it may be made before treatment by ultrasound, pelvic angiography, or magnetic resonance imaging. We have experienced one case of AVM of uterus, which is diagnosed after hysterectomy.
Angiography ; Arteriovenous Malformations* ; Diagnosis ; Female ; Humans ; Hysterectomy ; Magnetic Resonance Imaging ; Ultrasonography ; Uterine Hemorrhage ; Uterus*