Five hundred and thirty five cases of patients who were transferred to the Department of Emergency Medicine in Pusan University Hospital from Aug 1, 1997 to Aug 31, 1997 and from Oct 1, 1997 to Oct 31, 1997 were studied prospectively. The results were as follows: 1. Total 535 patients were transferred to the emergency department of PNUH(Pusan National University Hospital) for 2 months(average 8.2 a day). Male to female ratio was 1.58:1 and peak age group was 6th decade(17.0% of total). 2. In distribution about arrival time of transferred patients, 40.7% was from 08:00 to 16:00, 39.3% was from 16:00 to 24:00 and 20.0% was from 0:00 to 8:00. 3. Cases that were communicated with the emergency department of PNUH were 7.7%, cases that were communicated with other departments of PNUH were 10.1%, and 82.2% of total cases were transferred without any communication. 4. A 40.7% of patients was transferred by a hospital ambulance, 33.1% of patients used non-emergency vehicles such as taxis or buses, 25.3% of patients was transferred by an 119 or 129 rescue ambulance, and 0.9% was transferred by on foot or others. 5. Transferring hospital was divided into 3 groups: primary hospital, secondary hospital, and university hospital. The majority was secondary hospital(83.6%). 6. The cases that patients wanted to be treated in PNUH were the greatest in number as 55.5%, the cases transferred due to emergency surgery were 9.3%, the cases transferred without specialized department concerned were 28.6%, the cases transferred because of bed deficit were 1.7% and the cases transferred due to other cause were 4.9%. 7. Traumatic patients were 32.5%, and among them 9.9% was due to motor vehicle accident, among these 78.5% was mild patients. Non-traumatic patients were 67.5% and among them 74.2% was mild patients. 8. Among all transferred patients, 75.7% was admitted for general care, emergency operation, and ICU care. The percentage of discharge was 19.1%, the percentage of death was 2.4%, and the percentage of transfer to other hospital was 2.8%. Generally, because of bed deficit and of availability of operation room, patients were transferred to other hospital. 9. Among specialized departments, the proportion of the department of internal medicine, neurosurgery and pediatrics was 29.3%, 17.2% and 11.4% respectively. In conclusion, it is considered that proper patient transfer and effective medical service can be achieved through the well-organized EMSS, and cooperative interhospital communication.
Ambulances ; Busan* ; Emergencies* ; Emergency Medicine ; Emergency Service, Hospital ; Female ; Foot ; Humans ; Internal Medicine ; Male ; Motor Vehicles ; Neurosurgery ; Patient Transfer ; Pediatrics ; Prospective Studies

The results of a retrospective study on 197 cases of malignant skin tumors, which were operated from July 1991 to June 1996 were presented. 1. Primary malignant skin tumors in our series included basal cell carcinoma (42%), squamous cell carcinoma (39%), melanoma (7%). Eighty five percentage of them were developed after 5th decade. There was a slight male preponderance (male to female ratio; 1.2:1). 2. seventy five percentage of malignant skin tumors were occurred in the head and neck. However 34% of squamous cell carcinoma occurred in the extremities. 3. Overall recurrence rate was 7.1% and overall metastasis rate was 7.6%. Seven cases (8.5%) of basal cell carcinoma were recurred without metastasis and seven cases (53.8%) of melanoma were meatastasized without recurrence. 4. Overall recurrence occurred at average 27 months after primary resection and 79% of them occurred in the head and neck. Among 14 recurred tumors, one recurred secondarily and three were metastasized elsewhere. 5.Two thirds of metastasis occurred within one year of resection. Mortality rate in the patients with metastasis was 40%. Metastases involved multiple organs and involved lymph nodes most frequently. 6.Fifteen patients with metastasis were treated with surgery alone (2 cases), surgery and adjuvant therapy (3 cases), radiation and/or chemolherapy without surgery (6 cases), and no therapy(4 cases).
Carcinoma, Basal Cell ; Carcinoma, Squamous Cell ; Extremities ; Female ; Head ; Humans ; Lymph Nodes ; Male ; Melanoma ; Mortality ; Neck ; Neoplasm Metastasis* ; Recurrence ; Retrospective Studies* ; Skin*

BACKGROUND: The prehospital care system in the Pusan area is primitive in organization, and the emergency medical system of every hospital needs to be developed. A analysis of patients who were treated in emergency rooms and who died is necessary in order to establish an emergency medical service system which is appropriate for the community. METHOD: The authors reviewed the records of 117 patients who died in the emergency room of Pusan National University Hospital from January 1998 to December 1998. RESULTS: 1) Among the 117 patients, 68 patients were male (58.1%) and 49 patients were female (41.9%). The incidence of patients over the age of 70 was very high (33 cases, 28.2%). 2) Among the 117 patients, 99 patients died due to disease (84.6%), 16 due to trauma, and 2 due to intoxication. The most prevalent disease was cardiovascular disease. 3) Among the 117 patients, 63 patients arrived voluntarily (53.8%); the remainder were transferred from other hospitals. Forty-eight patients were transported by 119 ambulance (41.0%), and 41 patients were transported by hospital ambulance. 4) As for consciousness level, 52 patients (44.4%) were alert upon arrival at the emergency room, but 42 patients (35.9%) were unresponsive. 5) In 53 patients, the intervals between arrival at the emergency room and the onset of cardiac arrest were from 2 to 24 hours (45.3%). 6) Cardiac arrest was most frequent between 10:00 pm and 8:00 am. 7) Cardiopulmonary resuscitation was done in 74 patients (63.2%), and the mean duration was from 30 minutes to 1 hour. 8) Sixty-six patients were patients of internal medicine, and their mean stay time was 17 hours 27 minutes. CONCLUSION: These results suggest that systematic education in advanced cardiopulmonary resuscitation, expansion of emergency physicians, an increase in the number of intensive care units are required.
Ambulances ; Busan ; Cardiopulmonary Resuscitation ; Cardiovascular Diseases ; Consciousness ; Education ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital* ; Female ; Heart Arrest ; Humans ; Incidence ; Intensive Care Units ; Internal Medicine ; Male

PURPOSE: Fibrous dysplasia is related to the mutation of gene encoding the alpha-subunit of a signal-transducing G-protein and has variable clinical course. Operation can be performed to prevent functional disorder or structural deformity. After curettage, autologous bone graft were used to fill the defects after curettage. The aim of this study is to compare the result of autogenous cancellous bone grafting and allogenic bone grafting for fibrous dysplasia. MATERIALS AND METHODS: Among the patients who visit our hospital during the period of April, 1997 to October, 2013, we selected 34 patients who diagnosed fibrous dysplasia and visited our clinic over 1 year. There were 13 males and 21 females. Average age was 26.4 (range 2 to 57) years old. Autogenous bone graft (group I) in 5 cases, Non-autogenous bone graft (group II) in 30 cases. Iliac bone is used in all cases of autogenous bone graft. There were no significant difference in age, follow-up period, preoperational laboratory finding between two groups. Radiographic image was done to evaluate the recurrence of fibrous dysplasia or secondary degeneration. RESULTS: There were four cases in recurrence (group I: 1 case, group II: 3 cases, p=0.554). In all recurrent cases, reoperations were done using curettage and autogenous iliac bone graft. There was no re-recurrence after reoperation. One case of secondary aneurysmal bone cyst was confirmed (group II) and 1 cases of pathologic fractures had developed (group I: 0 case, group II: 1 cases, p=0.559). No malignant change occurred. CONCLUSION: There were no significant difference between autogenous bone graft group and non-autogenous bone graft group. Our result suggested that autogenous bone graft seems to be good method to treat fibrous dysplasia, in the case of small volume of tumor lesion or non-weight bearing portion.
Aneurysm ; Bone Cysts ; Bone Transplantation* ; Congenital Abnormalities ; Curettage ; Female ; Follow-Up Studies ; Fractures, Spontaneous ; GTP-Binding Proteins ; Humans ; Male ; Recurrence ; Reoperation ; Transplants

Corrected transposition of the great arteries is usually characterized by inverted ventricles and transposition of the great arteries. This combination without cardiac anormalies results in normal arterial oxigen content, hence the term corrected. Unfortunately, the condition rarely exists without other major cardiac anormalies. The authors report a case of situs inversus that was associated with corrected TGA, VSD, PS and ASD. The girl was admitted for evaluation of systolic ejection murmur on the both lower sternal border. Doppler echocardiography and cardiac angiography showed the diagnosis and so valvulotomy and closure operation of VSD and ASD was done.
Angiography ; Arteries ; Diagnosis ; Echocardiography, Doppler ; Female ; Humans ; Situs Inversus ; Systolic Murmurs

Paraneoplastic limbic encephalitis is commonly associated with small cell lung carcinoma. A 31-year-old female presented with amnesia and bizarre behavior for 1 month. Brain T2-weighted MRI showed high signal intensity in right medial temporal region. Abdominal CT revealed a mass in right lower abdomen, and subsequent excisional biopsy disclosed immature ovarian teratoma. Most symptoms improved after resection of the tumor. Our case demonstrates that immature ovarian teratoma also can be associated with paraneoplastic limbic encephalitis with good prognosis.
Abdomen ; Adult ; Amnesia ; Biopsy ; Brain ; Female ; Humans ; Limbic Encephalitis* ; Magnetic Resonance Imaging ; Prognosis ; Small Cell Lung Carcinoma ; Teratoma* ; Tomography, X-Ray Computed

BACKGROUND: Angioleiomyoma, a vascular leiomyoma, is a rare, benign smooth-muscle tumor that originates in the tunica media of vessels. It occurs anywhere in the body, most frequently in the lower extremities. METHODS: We reviewed the medical records of 16 patients who were treated for angioleiomyoma between 2000 and 2012. The clinical features of angioleiomyoma and the correlation between symptoms and pathological subtypes were investigated. RESULTS: There were 9 males and 6 females. Ages of the patients ranged from 21 to 61. Pain was the primary symptom in 44% of the patients. Tumors were smaller than 2.0 cm in all dimensions and were located in the face in 4 patients, whereas 5 lesions occurred in the upper extremities and the remaining 7 in the lower extremities. Three histologic subtypes were identified: solid, venous, and cavernous. The subtypes did not correlate with the clinical symptoms. CONCLUSIONS: Angioleiomyoma appears to be a rare tumor that occurs in the face and the extremities. The tumor usually occurs in middle age. A differential diagnosis of this tumor is difficult, but the tumor should be considered in the diagnosis of painful subcutaneous masses. Ultrasonography and magnetic resonance imaging can be helpful in the diagnosis of angioleiomyoma. These tumors can be successfully treated with simple excision, with a low recurrence rate.
Angiomyoma* ; Diagnosis ; Diagnosis, Differential ; Extremities ; Female ; Humans ; Leiomyoma ; Leiomyomatosis ; Lower Extremity ; Magnetic Resonance Imaging ; Male ; Medical Records ; Middle Aged ; Recurrence ; Tunica Media ; Ultrasonography ; Upper Extremity

Oriental hump nose is characterized by mild degree of the hump, broad dorsum, low nasal height and drooping tip. Therefore, conservative humpectomy followed by either tip-plasty or augmentation rhinoplasty yields more satisfactory results than classical Joseph's nasal hump reduction. However, the degree of the hump as well as the length of the nose can be affected by the height of the nasal root. That is, if the nasal root is too low, the hump nose may stand out and the nose will seem longer than the actual measurements. We think that it is important to consider the height of the nasal root in the course of the nasal hump reduction. During the last 2 year periods, we have classified twenty eight patients with hump nose into three groups, low(group A: 7 patients), moderate(group B: six patients) and high(group C: fifteen patients), based on the nasal root height. Each group went through different operative procedures according to their nasal root height and favorable results were obtained.
Humans ; Nose ; Rhinoplasty ; Surgical Procedures, Operative

This study was conducted to Identify the effects of diazepam on stress-induced c-fos expression In rat brain. The rats were divided into 4 groups according to injection agents [0.9% isotonic saline 1ml, diazepam(5 mg/kg)] and restraint stress, respectively. Saline or diazepam was injected into the peritoneum of rats 10 minutes before the restraint groups were restrained in a wire chamber. Fos-immunoreactive neurons were calculated in the hippocampal area CA2, dentate gyrus, amygdalohippocampal area, paraventricular nucleus, ventral lateral geniculate nucleus, supramammillary nucleus, temporal cortex area 3, occipital cortex area 2, piriform cortex, and cingulate cortex area 3. The results were as follows: 1) In the hippocampal formation including hippocampal area CA2 and dentate gyrus, Fos expression increased significantly in the saline-injected restraint animals than in any other groups. A two-way factorial ANOVA retreated a significant erects of stress and diazepam, and a significant stress by diazepam interaction. 2) In amygdalohippocampal area, Fos expression increased significantly in the saline-injected restraint animals than in diazepam-injected animals. A two-way factorial ANOVA revealed a significant effects of stress and diazepam, but no significant Interaction of stress and diazepam. 3) In paraventricular nucleus, Fos expression increased significantly in the saline-injected restraint animals than in saline-Injected animals and diazepam-injected animals. A two-way factorial ANOVA revealed a significant effects of stress, no significant effects of diazepam, and no significant Interaction of stress and diazepam. 4) In ventral lateral geniculate nucleus, Fos expression Increased significantly in the saline-injected restraint animals than in diazepam-Infected animals and diazepam-injected restraint animals. A two-way factorial ANOVA revealed a significant effects of diazepam, no significant effects of stress, and no significant interaction of stress and diazepam. 5) In supramammillary nucleus, temporal cortex area 3, occipital cortex area 2, piriform cortex, and cingulate cortex area 3, there was no significant difference of Fos expression in each group. A two-way factorial ANOVA revealed no significant effects of stress and diazepam, and no significant interaction of stress and diazepam. These results suggest that the hippocampal formation is involved in the response to the stress and the tension reduction effect of diazepam.
Animals ; Brain* ; Dentate Gyrus ; Diazepam* ; Gyrus Cinguli ; Hippocampus ; Neurons ; Paraventricular Hypothalamic Nucleus ; Peritoneum ; Rats*

We report our initial experience with laparoscopic radical cystectomy of an orthotopic neobladder. A 68 years old male patient with muscle invasive, organ confined, and transitional cell carcinoma of the bladder underwent operation. The operation specimen was extracted through the 5 cm sized, muscle splitting incision in the umbilical trocar site. The urinary diversion was achieved by ileal W-neobladder through a removal site of a specimen. The orthotopic neobladder was sutured to the urethra intracorporeally. Operation time and blood loss were 11 hours and 450 ml, respectively. The patient was discharged on the 14th postoperative day. Laparoscopic radical cystectomy, which involves the orthotopic neobladder creation, is feasible, although difficult and technically demanding. With growing experience, laparoscopic radical cystectomy can be an alternative to open technique.
Aged ; Carcinoma, Transitional Cell ; Cystectomy* ; Humans ; Laparoscopy ; Male ; Surgical Instruments ; Urethra ; Urinary Bladder ; Urinary Bladder Neoplasms ; Urinary Diversion