Early detection of skeletal disorders was very important role in establishing therapeutic modality and prevention of complications. Since Tc-99m-phosphates derivatives used in bone scan agent, remarkable improvement was noted in effectiveness, cost, radiation hazard to patient and image quality than previously used agents such as strontium or fluoride. Bone scan with Tc-99m-MDP was done in 155 cases for early diagnosis of skeletal disorders at Severance Hospital, College of Medicine, Yonsei University from August, 1980 to May, 1982 were analyzed both clinically and radiologically, and the following results were obtained. l. Among 19 cases of avascular necrosis, positive cases were 17 (89.5%) in bone scan and 6(31.6%) in X-ray. Positive pattern could be classified into 3 types and the radionuclide uptake in the femoral head was decreased in 3 cases which was negative in X-ray and duration of their symptoms was within 4 months. 2. Fifteen among 17 hip fractures or dislocations were positive in bone scan. In 12 (80.0%) among 15 cases, complications were revealed and positive cases in X-ray were 7(58.3%), which were all positive in bone scan. 3. In 20 bone scans for early diagnosis of acute osteomyelitis, positive in bone scan were 17 and 14 (82.4%) of 17 cases were finally diagnosed as acute osteomyelitis. Among 15 cases diagnosed as acute osteomyelitis, positive in X-ray were 8(53.3%) and sensitivity of acute osteomyelitis in bone scan was 93.3%. 4. In 25 cases of the suspected infection of the joint, 15 were positive in bone scan and among them, cases diagnosed as pyogenic arthritis were 12 (80.0%) and positive in X-ray were 2 (16.7%). Only one of 10 cases of transient synovitis of the hip joint was positive in bone scan. 5. In rheumatoid arthritis, 13 of 15 cases were positive in bone scan and 10 among them were revealed the diffuse uptake of the radionuclide in the joint. In degenerative arthritis, 7 of 8 cases were positive in bone scan and they were revealed the focal uptake of the radionuclide in the same site where the bone was changed in x-ray. 6. Among 28 cases showed spine fracture in X-ray after trauma, 15 (53.6%) were positive in bone scan. In spine fracture, it was difficult to differentiate fresh fracture from old fracture with bone scan. The positive duration of bone scen in fracture of weight bearing bone was longer than in spine fracture. Rib fracture which was not found in X-ray could be diagnosed with bone scan.
Arthritis ; Arthritis, Rheumatoid ; Clinical Study ; Cost-Benefit Analysis ; Diagnosis ; Dislocations ; Early Diagnosis ; Fluorides ; Head ; Hip Fractures ; Hip Joint ; Humans ; Joints ; Necrosis ; Osteoarthritis ; Osteomyelitis ; Rib Fractures ; Spine ; Strontium ; Synovitis ; Weight-Bearing

Heat stroke, a medical emergency, occurs when the body's thermal regulation is upset and unable to dissipate adequate amounts of heat with a rise in body temperature. It is characterized by hyperyrexia, with a core temperature of 40degrees C or more, hot dry skin, and central nervous system disturbance and usually results in rhabdomyolysis and multiorgan failure. Our case, a 43-year-old healthy male, was caused by a marathon, half course, on a sunny day in late summer. He suddenly fell down on the road and was delivered to a nearby hospital, where a seizure developed. He was transfered to our hospital and then displayed Central Nervous System disturbance, hot dry skin, acute liver failure, rhabdomyolysis, anuric acute renal failure, and disseminated intravasculular coagulopathy. He was treated with general supportive care and hemofiltration. Despite the aggressive management, he died of shock on the fifth day after admission.
Acute Kidney Injury ; Adult ; Body Temperature ; Central Nervous System ; Emergencies ; Heat Stroke* ; Hemofiltration ; Hot Temperature* ; Humans ; Liver Failure, Acute ; Male ; Rhabdomyolysis ; Seizures ; Shock ; Skin

BACKGROUND: Propofol and ketamine had been used for anesthesia induction and for total intravenous anesthesia. The nature of any hypnotic interactions occurring between propofol and ketamine are unknown. A comparison of maternal and neonatal effects among propofol-ketamine combination, ketamine and propofol were studied when used for anesthesia induction in Cesarean section. METHODS: Forty five patients in ASA class I or II scheduled for Cesarean section randomly assigned to either propofol 2 mg/kg (n=15), ketamine 1 mg/kg (n=15) or propofol 1 mg/kg - ketamine 0.5 mg/kg combination group (n=15) as an induction agent. Maternal systolic and diastolic blood pressure, heart rate, Apgar score and umbilical blood gas analysis were measured. RESULTS: Before intubation, systolic and diastolic pressure were decreased in propofol group but increased in ketamine and propofol-ketamine combination group. Heart rate were increased in all three groups. But there were no significant differences among three groups (p<0.05). After intubation, there were significant increase in systolic, diastolic pressure and heart rate in three groups but no significant differences among three groups (p<0.05). And there was no significant neonatal depression as assessed by Apgar scores and blood gas analyses. CONCLUSIONS: Propofol-ketamine combination was found to be similar to propofol or ketamine only in the effects on the mother and neonate. But propofol-ketamine gained more stable hemodynamic change than propofol or ketamine before intubation. Therefore propofol-ketamine appears to be a suitable alternatives to propofol or ketamine as an induction agent for anesthesia in Cesarean section.
Anesthesia ; Anesthesia, Intravenous ; Apgar Score ; Blood Gas Analysis ; Blood Pressure ; Cesarean Section* ; Depression ; Female ; Heart Rate ; Hemodynamics ; Humans ; Infant, Newborn ; Intubation ; Ketamine* ; Mothers ; Pregnancy ; Propofol*

A 25-year-old man had been intermittently treated with topical steroid ointment for his eczematous lesions on the scrotum. One year later, a few hard nontender nodules were found with surrounding thickened lichenified skin on the previous lesions. Histopathologic examination of the skin revealed moderate acanthosis of the epidermis and multiple scattered calcified materials in the upper demis and within the hair follicle. We present this case, being considered a dystrophic calcinosis cutis due to local injury.
Adult ; Calcinosis* ; Epidermis ; Hair Follicle ; Humans ; Lupus Erythematosus, Discoid* ; Scrotum ; Skin

Idiopathic orbital myositis, a subgroup of inflammatory orbital pseudotumor may occur with acute-onset periorbital pain, diplopia, and, in most cases, eyelid swelling. Proptosis, extraocular muscle motility restrictions, and response to oral prednisolone administration were characteristic. Although the CT appearance of orbital myositis is often helpful, the findings are not pathognomonic: correlation with history, clinical finding, and therapeutic response must be considered in making the diagnosis. The results of corticosteroid therapy on the orbital pseudotumor caused by orbital myositis were as follows: 1. The effect of corticosteroid was more effective in single extraocular muscle involvement than in that of a multiple extraocular muscle. 2. Early age of onset and early treatment after symptom increased the effectiveness of corticosteroid therapy.
Age of Onset ; Diagnosis ; Diplopia ; Exophthalmos ; Eyelids ; Orbit* ; Orbital Myositis* ; Orbital Pseudotumor* ; Prednisolone

No abstract available.
Animals ; Rats*

The femoral neck in children is dense and is small in diameter and its periosteum is thicker and stronger than that of an adult. Thus, fractures of the femoral neck in children, unlike the 60-year-old woman, are rare and usually require severe violence and this accounts for the high frequency of associated injuries. Since these fractures are rare and the femoral neck in children has many anatomic and physiologic differences, we have to consider some factors that work against treatment of these fractures. Twenty seven cases of fractures of the femoral neck in children which were treated at Severance Hospital, Yonsei University College of Mediicne from Jan. 1971 to Dec. 1980 were analyzed both clinically and radiologically and the following results were obtained. 1. Among the 27 patients, the ratio of boys and girls was 2:1 and the highest incidence was between the ages of 3 and 5 years. 2. The main course of fractures was traffic accidents, 14 cases (51.9%) and the other causes were falling from a height (37.0%) and a few cases of a slip and a fall. 3. According to the classification of Delbet and Colonna, the cervico-trochanteric fracture (40.8%) was the commonest type and 13 cases (48.1%) were displaced fractures. 4. Common associated injuries were pelvic bone fractures, skull fractures, cerebral concussion and soft tissue injuries. 5. Fifteen cases (55.6%) were treated by conservative treatment and ten cases (37.0%) by closed reduction & internal fixation. 6. 23 of the 27 cases were followed for from 6 months to 10 years, average 19 months. The results were analyzed according to Ratliffs assessment and 14 cases (60.9%) showed good results. 7. Total cases with complications were 14 (60.9%), the commonest complication being coxa vara (40.8%) and the other main complications being premature epiphyseal closure (39.1%) and avascular necrosis (30.1%). 8. Secondary treatment was done in 6 cases and correction osteotomy was done in 4 cases which had showed a poor result. 9. Finally, factors affecting results were type of fracture, degree of displacement, maintenance of reduction, interval between injury and treatment, complications and patients age. 10. The authors recommend closed reduction and internal fixation with some threaded pins for all type II and type III fractures.
Accidental Falls ; Accidents, Traffic ; Adult ; Brain Concussion ; Child ; Classification ; Clinical Study ; Coxa Vara ; Female ; Femur Neck ; Humans ; Incidence ; Middle Aged ; Necrosis ; Osteotomy ; Pelvic Bones ; Periosteum ; Skull Fractures ; Soft Tissue Injuries ; Violence

No abstract available in English.
Clinical Study ; Neck

No abstract available.
Drug Therapy* ; Gestational Trophoblastic Disease*

BACKGROUND: The purpose of this study was to analyze the endotracheal intubation cases performed in the emergency department. METHODS: We investigated retrospectively 326 cases of endotracheal intubation performed in the emergency department of a tertiary care center from April 1, 1998 to March 31, 1999. We focused on operators, medications used, its success rate and immediate complications, and the relationship between its success rate and medications. RESULTS: Of 326 consecutive intubations, 193 patients(59.2%) were done by emergency medicine residents or attending physician. While 320 patients(98.2%) were successfully intubated, 6 patients could not be intubated and 2 patients underwent tracheostomy. Of 50 cases of intubations(15.3%) attempted with paralyzing agents, 48 cases were done with succinylcholine and 46 cases underwent by emergency physicians. Intubations with neuromuscular paralysis resulted in high success rates at the first attempt. Of 55 immediate adverse events were encountered in 47 patients(desaturation=17, bronchial intubation=15, hypotension=8, bradycardia=4, cardiac arrest=2, others=5). CONCLUSION: At this institution, paralyzing agents were used infrequently, but almost all of them were used by emergency physicians.
Emergencies* ; Emergency Medicine ; Emergency Service, Hospital* ; Humans ; Intubation ; Intubation, Intratracheal* ; Paralysis ; Retrospective Studies ; Succinylcholine ; Tertiary Care Centers* ; Tertiary Healthcare* ; Tracheostomy