As most medical facilities in Korea have been concentrated in large cities, the need to improve emergency medical services in islands and mountainous areas has emerged. Consequently, the Ministry of Health and Welfare and local governments have introduced emergency medical helicopters (known as helicopter ambulances or air ambulances) with doctors in medically vulnerable areas. Having been introduced in two regions in 2011, air ambulances are operational in seven regions as of the end of 2019. The flight time is from sunrise to sunset, except in Gyeonggi province, which is open all day. Although the criteria for transport vary depending on whether an ambulance is available for operation, it is basically intended for emergency critical diseases, such as severe trauma, stroke, and acute myocardial infarction. From September 23, 2011 to December 31, 2018, a total of 10,367 transfer requests were received, which included 534 (5.2%) interruptions, 2,657 (25.6%) rejects, and 7,176 (69.2%) transfers. A total of 7,209 patients were transferred during this period, which included 1,693 (23.5%) patients of severe trauma, 1,149 (15.9%) patients of stroke, 802 (11.1%) patients of acute myocardial infarction, and 3,565 (49.5%) patients suffering from other emergency diseases. Some economic research on air ambulances in Korea has been reported to be cost-effective, but additional research should be performed. In the future, it is necessary to widen the area of operation of air ambulances and find alternative means of transporting patients during unfavorable conditions such as night or bad weather.

We conducted this cohort analytic study to determine whether women with unexplained elevations of maternal serum hCG at 15-18 weeks' gestation are at increased risk for pregnancy complications and adverse perinatal outcomes. The inclusion criteria were a singleton gestation, a confirmed gestational age, and an hCG level greater than 2.0 multiples of the median (MoM). The exclusion criteria were fetal anomalies, an abnormal karyotype, molar pregnancy, and an MSAFP level greater than 2.5 multiples of the median (MoM). A group of randomly selected women with hCG levels under 2.0 MoM served as controls. Patients with elevated levels of hCG had a significantly higher risk for PIH (17.9% versus 4.5%; P <.05) and preterm delivery (17.9% versus 3.5%; P<, 05) than control. But no significant differences were observed in the incidence of intrauterine growth restriction and low birth weight and in the newborn weight. We suggested that pregnancies with unexplained elevated hCG levels should be regarded as high-risk pregnancies. And these patients require careful monitoring with adequate obstetric management.
Abnormal Karyotype ; Chorionic Gonadotropin* ; Cohort Studies ; Female ; Gestational Age ; Humans* ; Hydatidiform Mole ; Incidence ; Infant, Low Birth Weight ; Infant, Newborn ; Pregnancy ; Pregnancy Complications ; Pregnancy Outcome* ; Pregnancy* ; Pregnancy, High-Risk

Acromioclavicular joint injuries are frequently seen with the recent increase of traffic and industrial accidents. The treatment of complete separation of the acromioclavicular joint has been, and is still, a subject of controversy. In view of a recent trend, anatomical reduction of acromioclavicular joint, and rigid internal fixation method is preferable, especially in type 3 injury. We operated on 16 cases of complete acromioclavicular separation by the technique of coracoclavicular wiring from March 1983 to Feb. 1987. The following results were obtained. 1. The functional results were excellent; 12 cases(75%), good; 3 cases(19a%), and fair ; 1 cases(6%). 2. The complications include wire reakage ; 1 case(6%), bony erosion ; 3 cases(19%) and subluxation, 1 case(6%). 3. The advantages of coracoclavicular wiring. 1) Avoids violation of acromioclavicular joint but does not restrict rotation of the clavicle. 2) The operation is simple to perform. 3) Postoperative immobilization is minimal. 4) Removal of the wire is easy under local anesthesia. 5) This method corresponds to the coracoclavicular ligment biomechanically. Therefore, coracoclavicular wiring is thought to be a good operative method in the treatment of complete acromioclavicular separation.
Accidents, Occupational ; Acromioclavicular Joint ; Anesthesia, Local ; Clavicle ; Immobilization ; Methods

No abstract available.
Extremities* ; Osteogenesis* ; Ultrasonography*

PURPOSE: Torus palatinus is a bony prominence at the middle of the hard palate. The size varies from barely discernible to very large, from flat to lobular. This oral exostosis is not a disease or a sign of disease, but if large, may be a problem. So, we present the clinical and histopathologic features and applied therapy and provide a comprehensive review of the rare case of the symptomatic exostoses. METHODS: A 37-year-old woman had slowly growing exophytic nodular mass of the bone that arises the midline suture of the hard palate. The patient was concerned about discomfort associated with movement of her tongue and about frequent irritation of the palatal mucosa during mastification of the hard food. The patient had a large, unilobulated torus palatinus. It extended from the area adjacent to the canine to a point beyond the junction with the soft palate. The mass was oblong in shape, measuring about 3cm long, 2cm wide, and 0.8cm in height. RESULTS: Before surgical intervention a CT was obtained for the sake of estimating the thickness of the bone between the exostoses and the maxillary antrum and floor of the nose. The surgical procedure was performed with the patient under general anesthesia. Removal of the exostosis was performed after midline mucoperiosteal incision with osteotome and diamond burr. Histologic finding revealed decalcified dense bony tissue, the presence of lacunae, and normal osteocytes. CONCLUSION: Surgical removal is recommended when one or more of the following condition exist: interference with the construction of prosthesis, interference with oral function, irritation or pathology of the overlying tissue, inability of the patient to maintain proper oral hygiene, and fear of malignancy or other psychologic trauma. We report a rare case of the torus arising in hard palate with symptoms.
Adult ; Anesthesia, General ; Diamond ; Exostoses ; Female ; Floors and Floorcoverings ; Humans ; Hyperostosis ; Maxillary Sinus ; Mucous Membrane ; Nose ; Oral Hygiene ; Osteocytes ; Palate ; Palate, Hard ; Palate, Soft ; Prostheses and Implants ; Sutures ; Tongue

Striae distensae are characterized by linear, smooth bands of atrophic-appearing skin. In histologic findings, the epidermis is thin and flattened. There is a decrease in the thickness of the dermis. Separation of collagen fibers and small, fragmented elastic fibers are seen in the dermis. Striae distensae develop as a result of disruption of the connective tissue framework. Main mechanism of edematous striae distensae is disintegration of collagen, followed by the pressure induced by generalized edema as the secondary mechanism. The patient is a 17-year-old boy who had generalized pitting edema and abdominal distension due to nephrotic syndrome. On the abdomen, he has presented with edematous striae and ulceration with exudate for 1 week. Edematous striae distensae are uncommon but can develop from the combined effects of glucocorticoid and generalized edema. We report a case of edematous striae distensae in nephrotic syndrome.
Abdomen ; Adolescent ; Collagen ; Connective Tissue ; Dermis ; Edema* ; Elastic Tissue ; Epidermis ; Exudates and Transudates ; Humans ; Male ; Nephrotic Syndrome* ; Skin ; Striae Distensae* ; Ulcer

PURPOSE: To report cases of transplanting a donor's 2 corneas to 5 patients suffering from several corneal diseases. CASE SUMMARY: Two corneas were donated from a 66-year-old donor, who suffered from brain damage due to asphyxia, one hour after being pronounced dead by doctors. Two penetrating keratoplasties and 3 partial lamellar keratoplasties were performed for patients with corneal opacity, corneal ulcer and corneal perforation. After the procedure all grafts were stable. CONCLUSIONS: Under the present circumstances of decreasing donations of corneas after death and the increasing demand for keratoplasty in Korea, the mutual cooperation among hospitals to treat more than one patient using one donated cornea is a method the authors believe can alleviate this situation.
Aged ; Asphyxia ; Brain ; Cornea ; Corneal Diseases ; Corneal Opacity ; Corneal Perforation ; Corneal Transplantation ; Corneal Ulcer ; Humans ; Keratoplasty, Penetrating ; Korea ; Stress, Psychological ; Tissue Donors ; Transplants

Dermatophytes usually do not invade beyond the epidermis. However mechanical breakage of the skin resulting from scratching or trauma and immunocompromised state may allow penetration of the fungi into reticular dermis. We report a patient with an unusual manifestation of Trichophyton rubrum infection. A 39-year-old male presented with 3.5x5 cm sized, erythematous, ulcerated lesion on the left heel for about 1 month. Histologic findings of the skin lesion showed granulomatous change and numerous hyphae in the dermis. Trichophyton rubrum was isolated on the fungus culture. The patient was treated with terbinafine (250 mg/day) for 10 weeks, resulting in the clearing of the skin lesion.
Adult ; Arthrodermataceae ; Dermis ; Epidermis ; Fungi ; Granuloma* ; Heel ; Humans ; Hyphae ; Male ; Skin ; Trichophyton* ; Ulcer

Dermatophytes usually do not invade beyond the epidermis. However mechanical breakage of the skin resulting from scratching or trauma and immunocompromised state may allow penetration of the fungi into reticular dermis. We report a patient with an unusual manifestation of Trichophyton rubrum infection. A 39-year-old male presented with 3.5x5 cm sized, erythematous, ulcerated lesion on the left heel for about 1 month. Histologic findings of the skin lesion showed granulomatous change and numerous hyphae in the dermis. Trichophyton rubrum was isolated on the fungus culture. The patient was treated with terbinafine (250 mg/day) for 10 weeks, resulting in the clearing of the skin lesion.
Adult ; Arthrodermataceae ; Dermis ; Epidermis ; Fungi ; Granuloma* ; Heel ; Humans ; Hyphae ; Male ; Skin ; Trichophyton* ; Ulcer

BACKGROUND: Pneumonia is the most common cause of death among patients with infectious disease in Korea. However, studies of pneumonia with septic shock in patients presenting to the emergency department are limited. The aim of this study was to investigate the prognostic factors associated with pneumonia with septic shock in patients presenting to the emergency department. METHODS: From January 2008 to September 2014, patients with pneumonia with septic shock admitted through the emergency department were retrospectively examined. RESULTS: Of the 561,845 patients who visited the emergency department, 398 were admitted for pneumonia with septic shock. The 28-day mortality rate in these patients was 36.4%. The independent prognostic factors were old age (>70 yrs) (odds ratio [OR], 2.42; 95%, confidence interval [CI], 1.35-4.32), Acute Physiology and Chronic Health Evaluation (APACHE) II score (OR, 1.04; 95% CI, 1.01-1.08), leukopenia (OR, 3.63; 95% CI, 1.48-8.94), prolonged PT-INR (OR, 2.53; 95% CI, 1.41-4.54), and hypoxemia (OR, 2.88; 95% CI, 1.30-6.38). CONCLUSIONS: A poor prognosis of patients with pneumonia is associated with old age (>70 yrs), increased APACHE II score, leukopenia, prolonged PT-INR, and hypoxemia.
Anoxia ; APACHE ; Cause of Death ; Communicable Diseases ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Korea ; Leukopenia ; Mortality ; Pneumonia* ; Prognosis ; Retrospective Studies ; Shock, Septic*