No abstract available.

No abstract available.
Brain Stem* ; Glioma*

Pneumomediastinum is a relatively uncommon, infrequently reported entity, In the evaluation of these entity, it is important to exclude pathological causes, including Boerhaave's syndrome which carries a high mortality. Spontaneous pneumomediastinum is related to excessive intraalveolar pressure leading to rupture of perivascular alveoli in the setting of a Valsalva maneuver without communication to gut material. So, it has a benign self-limited course and rarely requires medical intervention. On the contrary, secondary pneumomediastinum caused by instrumental, traumatic, and spontaneous perforation of esophagus. Although the prognosis have been improved since the advent of broad-spectrum antibiotics and nutritional support, pneumomediastinum due to esophageal perforation still has a high morbidity and mortality. The most important prognostic factor is the time interval between perforation and initiation of therapy, and an awareness and a high clinical suspicion is critical in the early diagnosis and treatment. Recently, we have experienced 2 cases of pneumomediastinum, one case was spontaneous pneumomediastinum and the other may be caused by instrumental esophageal perforation. We report the clinical course of the patients with a current literature review.
Anti-Bacterial Agents ; Early Diagnosis ; Esophageal Perforation ; Esophagus ; Fibrinogen ; Humans ; Mediastinal Emphysema* ; Mortality ; Nutritional Support ; Prognosis ; Rupture ; Valsalva Maneuver

BACKGROUND: Ketamine use in emergency room has been increased. It has rapid onset of action and appropriate duration of action. It does not need endotracheal intubation and produces potent analgesia, sedation, and amnesia. The object of this study is to determine the safety and the degree of physician's satisfaction in relation to ketamine use. MATERIALS AND METHODS: This is a prospective study using protocol. Pediatric trauma patients who need sedation were given IM ketamine(4mg/kg) and atropine(0.01mg/kg) in a same syringe. Monitoring of patients was done by EM residents and complications of ketamine use were recorded. Physician's satisfaction was also recorded after the procedure. RESULTS: Intramuscular ketamine was administered 54 times, mainly for laceration repair. Physicians completed protocol for 51 of treated children. The median time for onset of sedation was 6.5+/-2.4 min, and duration of action was 32.4+/-10.8 min. Hypersalivation occurred in 9.8%(n=5); random movement 3.9%(n=2), emesis during procedure(n=1), emesis at home(n=1), and transient oxygen desaturation(n=1). All were quickly identified and treated without specific airway management and sequelae. Of 84% of physicians was satisfied with ketamine use for pediatric sedation. CONCLUSION: Intramuscular ketamine can be administered safely and satisfactorily in emergency room to facilitate pediatric procedures in conjunction with a defined protocol and appropriate monitoring.
Airway Management ; Amnesia ; Analgesia ; Child ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Intubation, Intratracheal ; Ketamine* ; Lacerations ; Oxygen ; Prospective Studies ; Sialorrhea ; Syringes ; Vomiting

OBJECTIVE: As an electronic health record system is implementing in Korean health care sectors, concerns about key functionalities of electronic health record systems are increasing. The purpose of this study was to identify core functions and set the priority in electronic health record systems under the Korean contexts in order to assure and improve the quality of the systems. METHODS: A survey was conducted using questionnaire developed by the study team based on literature review. The subjects were medical record administrators working at medical record department in general hospitals. RESULTS: The response rate was 59.8%(55/92). The functions which more than ninety percent of subjects responded as necessary right now and/or in near future related to 'drug alert', 'clinical guideline', 'chronic disease management', 'automated real-time surveillance', 'coded data', 'result reporting', 'de-identifying data', 'disease registry', and 'provider-provider communication and connectivity'. CONCLUSION: The results showed the high prioritized functions were decision support and health information/data management.
Electronic Health Records* ; Health Care Sector ; Hospitals, General* ; Humans ; Medical Record Administrators ; Medical Records ; Needs Assessment* ; Surveys and Questionnaires

No abstract available.
Resuscitation* ; Shock, Hemorrhagic*

The plantaris muscle (PM) has a small fusiform muscle belly and a long slender tendon sandwiched between the soleus (SM) and gastrocnemius muscle (GM). During routine dissection for research, an additional PM in the popliteal region of a 75-year-old Korean female was discovered. Two distinct PMs were present, the superior PM (sPM) and inferior PM (iPM). While the sPM originates from the lower lateral supracondylar ridge and the knee capsule, the iPM originates from the femoral condyle and sPM tendon splitting into two parts at the distal belly. The lateral side of the iPM tendon travels between GM and SM and ends at the calcaneal tendon. sPM and the medial side of the iPM tendon run along with the sPM tendon and inserts at the fascia at the inner surface of proximal 1/3 of the medial head of GM. This case report introduces a new variation of the PM that should be taken into consideration.

Paget's disease is a disorder of middle or older aged persons in which abnormal osteoclastic and osteoblastic activity spontaneously occurs within the affected portion of any particular bone or bones. This causes a gradual gross structural alteration through continuous remodeling. The occurance of Pagets disease is extremely rare in China, Japan, Middle East, and Africa. We have experienced one case of Paget's disease of bone affecting the spine and femur, which is reported in this paper with brief review of literature.
Africa ; China ; Femur ; Humans ; Incidence ; Japan ; Middle East ; Osteitis Deformans ; Osteoblasts ; Osteoclasts ; Spine

In 1868 Charcot described the joint in tabes dorsalis, which since then has been designated as Charcot neuroarthrophathy. It is characterized by painless swelling and abnormal mobility of the affected joint. Arthrophthy of the type described by Charcot has been associated with various other conditions, such as diabetes mellitus, syringomyelia, injury to nerve root, congenital indifference of pain, leprosy, and intra articular use of steroid, etc. Authors present a case of Charcot spine due to tabes dorsalis.
Diabetes Mellitus ; Joints ; Leprosy ; Spine ; Syringomyelia ; Tabes Dorsalis

The head injuried patient with skeletal trauma is a challege to the orthopedic surgeon. The orthopedist initially may face the difficult management of fracture and dislocation in the patient associated with head injury. The management of the injuries to the head takes precedence over extremity injuries initially, but the orthopedist must be managed aggresively with assumption that full neurologic recovery will occur. This report analysed the treatment and results in 85 cases fracture and dislocation with head injury among the 59 patients at the Chungnam National University Hospital during the period ranging from March, 1980 to March, 1983. End result obtained are as follows: 1. The sex ratio between the male and female was 3.9: 1 and the prevalent age distribution was from 21 to 30 years of age. 2. The motorcycle accident was most common cause of the trauma and the next most frequent one was the automobile accident. 3. Type of head injury were contusion or concussion, intracranial hemorrhage, linear skull fracture, depressed skull fracture and open skull fracture. 4. Better result were obtained by operative treatment in femur fracture, especially spastic group. 5. The incidence of delayed diagnosis was 8 cases and the delay in diagnosis ranged from 15 to 95 days with an average of 38 days. 6. We, consulting with neurosurgeon, must assume that full neurologic recovery will take place and so open reduction and internal fixation should be carried out as quickly as possible.
Age Distribution ; Automobiles ; Chungcheongnam-do ; Clinical Study ; Contusions ; Craniocerebral Trauma ; Delayed Diagnosis ; Diagnosis ; Dislocations ; Extremities ; Female ; Femur ; Head ; Humans ; Incidence ; Intracranial Hemorrhages ; Male ; Motorcycles ; Muscle Spasticity ; Neurosurgeons ; Orthopedics ; Sex Ratio ; Skull Fracture, Depressed ; Skull Fractures