We evaluated the ability of a simple scoring system for prediction of outcome soon after subarachnoid hemorrhage(SAH). The scoring system was calculated on the basis of the distribution of blood seen on the CT scan and patients' neurological grade on admission. Two points each were scored for interhemispheric, intraventricular, basal and intracerebral hemorrhage. We excluded hemorrhage in the Sylvian cistern from the calculation of the scoring system. Patients in neurological grade 1-3 scored -1, grade 4 scored 0, grades 5 & 6 scored +5. The CT score and grade score were summated to give the overall score. Patients were placed in 3 risk groups, low risk group in score of -1, medium risk group in score of 0-2, and high risk group in score above 3. The scoring system was applied prospectively to 134 patients who were admitted to our hospital from January 1995 to December 1996. The overall mortality rate was 32.1% within 3 months after onset of SAH. There was a close relationship between the patients' scores and their outcomes. Over 90% of low risk patients experienced a full and good recovery from the SAH compared to 30% of high risk patients. Less than 5% of low risk patients were died, whereas 56% of high risk group died. Thus a low risk patient has a better outcome than a high risk patient(p<0.001). The classification into risk groups has predictive value independent of angiographic finding, hypertension and vasospasm.
Cerebral Hemorrhage ; Classification ; Hemorrhage ; Humans ; Hypertension ; Mortality ; Prospective Studies ; Tomography, X-Ray Computed

No abstract available.
Facial Bones*

No abstract available.
Facial Bones*

No abstract available.
Aspergillosis ; Maxillary Sinus

PURPOSE: To evaluate the performance of Automated Corneal Shaper(R)(ACS) METHODS: we analysed the changes in intraocular pressure, axial length and corneal thickness and its influence on corneal flap following keratectomy by ACS in 20 porcine eyes. RESULTS: Corneal flap was made by ACS with plate 160, and its size and thickness were measured. With the suction ring application, intraocular pressure rised from 17.0 +/-1.96 mmHg to 62.0 +/-11.8 mmHg (p=0.001), while corneal thickness and axial length were decreased from 1090 +/-75.1 micro meter to 1074 +/-73.7 micro meter(p=0.001) and from 19.94 +/-0.89 to 19.72 +/-0.73 mm (p=0.028) respectively. Thickness of corneal flap was 122 +/-23.9 micro meter and its diameter was 8.3 +/-0.15 mm in average. CONCLUSION: special attention is required during LASIK (laser in situ keratomileusis) with Automated Corneal Shaper(R) in order to prevent intraocular damage by abrupt rise in intraocular pressure and change of eyeball contour.
Intraocular Pressure* ; Keratomileusis, Laser In Situ ; Suction

An aneurysmal bone cyst (ABC) can occur in many parts of the human body, but a primary ABC of the talus is extremely rare. ABCs are benign, but aggressively growing tumors that usually occur in the first two decades of life. Patients mainly complain of pain, limited movement of the involved joint or a palpable mass. Pain may worsen suddenly because of pathological fractures. If not treated properly, ABC has a risk of local recurrence, followed by the destruction of the joint and a significant functional deficit. While the complete removal of the bone tumor is essential, it is also important to treat the resultant bone defect after removal. The talus has an important part to play in weight-bearing. Therefore, an appropriate bone graft is required for large bone defects that occur after an ABC removal from the talus. We report a primary ABC of the talus in a 28-year-old male that was treated by curettage and a bone pillar pattern graft of autologous tricortical iliac crest bone. The patient had an excellent functional outcome with early weight-bearing, and there was no recurrence at 16 months of follow-up.

PURPOSE: Comparing the results of traffic accident deaths between ours and a previous study, we assessed the improvement in the emergency medical service system and the traumatic care system. METHODS: Three hundred twenty-one traumatic accident deaths occurring in Chunan and the nearby region between 1999 and 2000 were reviewed; data were obtained from paramedic trip reports, medical records, and radiological findings. RESULTS: One hundred fifty-eight (49%) deaths occurred in the prehospital setting. The remaining 163 (51%) patients were transported to the hospital. Of these, 89 (55%) died in the first 48 hours (acute), 26 (16%) within three to seven days (early) and 48 (29%) after seven days (late). Central nervous system injuries were the most frequent cause of death (57%), followed by exsanguination (25%) and organ failure (8%). Two distinct peaks of time were found on analysis: 50% of the patients died within the first 60 minutes, and 9% of the patients died at three to seven days after injury. The overall preventable death rate was 24%. CONCLUSION: Access to the prehospital emergency medical system was improved, and there was greater proportion of late deaths due to brain injury. We found the distribution to be a bimodal distribution.
Accidents, Traffic ; Allied Health Personnel ; Brain Injuries ; Cause of Death ; Central Nervous System ; Chungcheongnam-do ; Emergencies ; Emergency Medical Services ; Epidemiology* ; Exsanguination ; Humans ; Medical Records ; Mortality

PURPOSE: We report our experience using flexible ureteroscopy in diagnosing and treating upper urinary tract diseases. MATERIALS AND METHODS: Fifty six patients (male 35; female 21) who underwent flexible ureteroscopy for diagnostic purposes (n=24) or treatment (n=32) of upper urinary tract diseases from January 2000 to November 2001 were enrolled in this study. The primary indications for the ureteroscopy included stones (32), filling defects (10), stricture (8) and hematuria (6). A 7.5Fr flexible ureteroscope was used for observation and either an electrohydraulic lithotriptor (EHL) or Ho: YAG laser were used to remove the stones. RESULTS: The ureteroscopic procedures were performed under local (n=46) or general anesthesia (n=10). As a diagnostic procedure (n=24), clear underlying causes were found in 19 patients. As therapeutic purposes, the flexible ureteroscopic procedures were applied to 32 patients with urolithiasis (renal calyx, 14; renal pelvis, 6; proximal ureter, 7; and middle ureter, 5). Among them, an advancement in flexible ureteroscopy was possible in 24 patients. Of these, the stones in 20 (83%) had completely fragmented by the EHL or Ho: YAG laser lithotriptor without further treatment. In 4 patients (17%) who had residual stones, the adjuvant procedures including extracorporeal shock wave lithotripsy or a subsequent endoscopic procedure were performed for successful fragmentation. CONCLUSIONS: The flexible ureteroscopic procedure is one of the more effective and minimally traumatic diagnostic and therapeutic modalities for upper urinary tract diseases.
Anesthesia, General ; Constriction, Pathologic ; Female ; Hematuria ; Humans ; Kidney Pelvis ; Lasers, Solid-State ; Lithotripsy ; Shock ; Ureter ; Ureteroscopes ; Ureteroscopy ; Urinary Tract* ; Urolithiasis ; Urologic Diseases*

Spontaneous rupture of the kidney is rare. It usually occurs secondary to various kinds of underlying disease such as infection, hydronephrosis, calculous disease, benign or malignant tumor, renal artery aneurysm and arteriosclerosis. In most instances, it is an acute abdominal process which requires early diagnosis and immediate surgical exploration. We report a case of spontaneous rupture of the kidney secondary to renal cell carcinoma in a 44 year-old female.
Adult ; Aneurysm ; Arteriosclerosis ; Carcinoma, Renal Cell* ; Early Diagnosis ; Female ; Humans ; Hydronephrosis ; Kidney* ; Renal Artery ; Rupture, Spontaneous*

A 3rd degree burn on the heel including the Achilles tendon is vulnerable and requires active treatment to improve the functional outcomes. Previously, there have been a few treatments on severe burns, such as amputation, debridement or simple skin graft. The cooperative technique of an anterior lateral thigh flap with Achilles tendon reconstruction can be an innovative procedure that preserves the major arteries. The authors review a case and report the clinical outcome.
Achilles Tendon* ; Amputation ; Arteries ; Burns* ; Debridement ; Free Tissue Flaps* ; Heel* ; Reconstructive Surgical Procedures ; Skin ; Surgical Flaps ; Thigh* ; Transplants