BACKGROUND: The aim of this study was to compare the efficacy of ketorolac, paracetamol, and paracetamol plus morphine on pain relief after thyroidectomy. METHODS: Eighty patients were randomly allocated to one of the 4 groups: normal saline (group C), ketorolac 30 mg (group K), paracetamol 1 g (group P), and paracetamol 700 mg plus morphine 3 mg (group PM). Each regimen was administered intravenously (IV) 30 min. before the end of surgery. If pain was not relieved, patients received an IV bolus of pethidine hydrochloride 25 mg. Pain intensity using a visual analogue scale (VAS) was recorded at 0.5, 1, 2, 4, and 6 hr after the end of surgery. RESULTS: VAS at 0.5 and 1 hr after the end of surgery were significantly lower in group K, group P, and group PM than in group C (P < 0.05). The number of patients receiving pethidine hydrochloride at 0.5 and 1 hr after the end of surgery was significantly lower in group K, group P, and group PM than in group C (P < 0.05). There was no significant difference among the groups in the incidences of adverse events associated with study medications and patient satisfaction (P > 0.05). CONCLUSIONS: Paracetamol 1 g IV possesses a similar analgesic efficacy to ketorolac 30 mg IV after thyroidectomy. Paracetamol may represent an alternative to ketorolac for pain prevention after mildly to moderately painful surgery in situations where the use of NSAIDs is unsuitable.
Acetaminophen ; Analgesics ; Anti-Inflammatory Agents, Non-Steroidal ; Humans ; Incidence ; Ketorolac ; Meperidine ; Morphine ; Patient Satisfaction ; Thyroidectomy

PURPOSE: Lymphoproliferative lesions of the ocular adnexa were analyzed to examine the final outcome, recurrence and extraorbital spread. METHODS: The biopsies and clinical follow up data for 55 patients (68 eyes) with ocular adnexal lymphoproliferative lesions were reviewed retrospectively and analyzed according to the WHO classification. RESULTS: The ocular-adnexal lymphoproliferative lesions were located as follows: orbit in 49 eyes, conjunctiva in 18 eyes, eyelid in 1 eye. The three main subtypes of lymphoma according to the WHO classification were extranodal marginal zone B-cell lymphoma of mucosa- associated lymphoid tissue (MALT-lymphoma) (62 eyes), diffuse large B-cell lymphoma (2 eyes), and benign lymphoid hyperplasia (4 eyes). Remission was achieved at 60eyes. Recurrence was occurred in 7eyes (orbit: 4, conjunctiva: 3) of MALT-lymphoma cases. Location of lymphoma at presentation was not a predictor for recurrence (conjunctiva 16.7%, orbit 8.2%; p>0.05), but bilaterality at presentation was predictive values for recurrence by a statistically significant difference(bilateral 23.1%, unilateral 4.8%; p=0.045). CONCLUSIONS: Most common ocular adnexal lymphoma in Korea was MALT- lymphoma (91.2%). Bilaterality has a predictive values on recurrence, and extraorbital spread was found only in orbital MALT-lymphoma. It is suggested that orbital MALT- lymphoma should be treated with excisional biopsy and subsequent low dose radiotherapy and followed up indefinity.
Biopsy ; Classification ; Conjunctiva ; Eyelids ; Follow-Up Studies ; Humans ; Hyperplasia ; Korea ; Lymphoid Tissue ; Lymphoma ; Lymphoma, B-Cell ; Lymphoma, B-Cell, Marginal Zone ; Orbit ; Prognosis* ; Radiotherapy ; Recurrence ; Retrospective Studies

The authors reviewed 2,420 pediatric age group patients in the emergency room in Inchon Christian Hospital during 2 years period from Jul. 1974 to Jun. 1976. The results were obtained as follow. 1. Among the patients visting the emergency room, the patients under the 15 years of age were 21.9% of total emergency patients. 2. The male to female ratio was 1.6 :1.3. The patients under the 3years of age among the pediatric age group were occupied 43.7%. 4. Monthly distribution of patients showed high incidence in Jun., aug. and Sep. 5. Most frequent disease was respiratory diseases (26.6%), followed by accident (22.1%), gastrointestinal disease (13.6%) and neurologic disease(11.2%). 6. In the reapiratory diseases, the most frequent disease was URI (57.9%), followed by pneumonia (18.9%) and bronchitis (8.6%), In the accidents, the most frequent disease was traffic accident (28.3%), followed by trauma (24.9%) and burn (15.9%). In the gastroentestinal diseases, the most frequent diseas was diarrhea (47.9%), followed by gastrointerits (26.2%)and dysentery (10.1%). In the neurologic diseases, the most frequent diseas was febrile convulsion (32.3%), followed by tbc. Meningitis (21.3%) and epilepsy (19.5%). In the neonatal diseases, the most frequent disease was aspiration pneumonia (23.1%) and epilepay (19.5%). In the neonatal diseases, the most frequent disease was aspiration pneumonia (23.1%), followed by dehydration fever (17.1%) and prematurity (14.5%). In the poisonings, the most frequent factor was CO gas (37.7%), followed by food poisoning (21.9%)and insecticide (9.6%). In the infectious diseases, the most frequent disease was measles (34.3%), followed by pulmonary tbc. (16.2%) and mumps (12.1%). 7. Most popular time of visiting the emergency room was betwiin 8 : 00 pm to 12 : 00pm, at which time about 33.9% of patients were seen. 8. Admission rate through emergency room was 28.5% of total admitted patients.
Accidents, Traffic ; Bronchitis ; Burns ; Communicable Diseases ; Dehydration ; Diarrhea ; Dysentery ; Emergencies* ; Emergency Service, Hospital* ; Epilepsy ; Female ; Fever ; Foodborne Diseases ; Gastrointestinal Diseases ; Humans ; Incheon ; Incidence ; Male ; Measles ; Meningitis ; Mumps ; Pneumonia ; Pneumonia, Aspiration ; Poisoning ; Seizures, Febrile ; Statistics as Topic*

The mesenteric lipoma is rare in chilcren. A 2 years and 8 months old female child was admitted to department of Pediatrics in Inchon Christian Hospital on the 17 th Dec., 1974, because of abdominal distention and dyspnea. Operation revealed a soft yellowish mass, measuring 25x23x19cm. In size and 4,000gm. In weight. The pathologic diagnosis confirmed lipoma of the mesentery. The patient was discharged without any complications on the 8 th postoperative day. A brief review of literatures was made.
Child ; Diagnosis ; Dyspnea ; Female ; Humans ; Incheon ; Infant ; Lipoma* ; Mesentery ; Pediatrics

BACKGROUND: OSCE was conducted to measure the immediate outcome of ICM. The measurement focused on basic clinical skills. METHODS: The subject of study was 115 third year medical students who took ICM course. The examination consisted of ten 5-minute stations with nine cases that represented commonly encountered problems in primary care. OSCE stations were duplicated into two sites. Therefore, same OSCE was performed six times in each sites. We evaluated the reliability of OSCE scores and compared the mean scores according to the examination sites and time sequences. Also, we got feedback from all participants by questionnaires. RESULTS: Mean of total OSCE score was 52.1. Cronbach alpha of total station was 0.559. For blood pressure check, lung physical examination, and neck mass physical examination station, there was a significant difference in mean scores as the time sequences(p<0.05). Both students and examiners evaluated the OSCE positively, and felt that OSCE was meaningful experience to prepare clinical skills. CONCLUSION: We can confirm that OSCE is a reasonable evaluation tool for ICM. However, further trials to develop the more reliable and valid examinations will be warranted.
Blood Pressure ; Clinical Competence ; Clinical Medicine* ; Humans ; Lung ; Neck ; Physical Examination ; Primary Health Care ; Students, Medical ; Surveys and Questionnaires

BACKGROUND: One of major weakness in medical education in Korea is clinical skills has not been uniformly well taught during undergraduate period. To reinforce the basic clinical skill education, we developed introduction to clinical medicine(ICM) course In this study, we described the ICM course development process and the experience. METHODS: We performed comprehensive literature review related to ICM and doctoring curriculum. ICM/OSCE sub-commitee members discussed several time to develop the course. To assess the level of accomplishment of this course, we got feedback from 115 third year medical students by questionnaires. RESULTS: ICM was composed of 9 topics which covers the basic clinical skills. For each topic, three hours per week was allocated, one hour for didactic session and the other 2 hours for practical exercise. Standardized patients were used to teach interview skill. Most of students revealed history taking, abdominal examination, musculo-skeletal system, and interview skill session were valuable learning experience. However, for Gynecology and Pediatric session which were taught by mainly lectures, students evaluated them negatively. INTERPRETATION: This year, we focused on teaching basic clinical skills at ICM. However, our ultimate goal is to develop the ICM course which can allow the students to learn both the art and the science of Medicine.
Clinical Competence* ; Clinical Medicine* ; Curriculum ; Education ; Education, Medical ; Gynecology ; Humans ; Korea ; Learning ; Lectures ; Students, Medical ; Surveys and Questionnaires

PURPOSE: To investigate the results of graded decompression of orbital fat and walls in Graves' orbitopathy (GO) considering the degree of proptosis reduction at surgery and preoperative computed tomography (CT) findings. METHODS: This is a retrospective interventional case series. Graded orbital fat and wall decompression was performed in 90 orbits of 55 patients. In patients with enlarged extraocular muscles and minimal orbital fat proliferation in preoperative CT scans, one- or two-wall decompression of posterior orbit was performed with minimal fat excision. In other cases, the maximal amount of fat tissue was removed from the post-septal area to the apex. If the proptosis was not satisfactorily symmetrically reduced at surgery, one- or two-wall decompression was performed successively. Symmetric reduction of proptosis was consistently confirmed intraoperatively to assure that a desired amount of exophthalmos reduction was achieved. RESULTS: Four types of decompression were performed: fat only (group 1), fat and one-wall (group 2), fat and two-wall (group 3), and two-wall and minimal fat decompression (group 4). The mean preoperative Hertel value (20.6 +/- 2.8 mm) was reduced significantly at six months postoperatively (16.1 +/- 2.3 mm). Proptosis significantly decreased with a mean of 4.3 +/- 1.7 mm, and the reduction was greatest (5.1 +/- 2.1 mm) in group 3. In group 1, a significant correlation between Hertel change and the volume of resected orbital fat was found (r = 0.479). Diplopia was newly developed or aggravated postoperatively in eight patients, and six of these patients were in group 3. With the exception of one patient, visual acuity improved to nearly normal postoperatively in all patients with optic neuropathy. CONCLUSIONS: Graded orbital decompression of orbital fat and bony walls, as assessed by the degree of proptosis reduction during surgery, was effective and predictable with minimal complications in GO patients with vision-threatening or cosmetically disfiguring proptosis.
Adipose Tissue/*surgery ; Adult ; Aged ; Decompression, Surgical/*methods ; Female ; Follow-Up Studies ; Graves Ophthalmopathy/diagnosis/*surgery ; Humans ; Male ; Middle Aged ; Orbit/*surgery ; Retrospective Studies ; Tomography, X-Ray Computed ; Treatment Outcome ; Young Adult

PURPOSE: To investigate the results of graded decompression of orbital fat and walls in Graves' orbitopathy (GO) considering the degree of proptosis reduction at surgery and preoperative computed tomography (CT) findings. METHODS: This is a retrospective interventional case series. Graded orbital fat and wall decompression was performed in 90 orbits of 55 patients. In patients with enlarged extraocular muscles and minimal orbital fat proliferation in preoperative CT scans, one- or two-wall decompression of posterior orbit was performed with minimal fat excision. In other cases, the maximal amount of fat tissue was removed from the post-septal area to the apex. If the proptosis was not satisfactorily symmetrically reduced at surgery, one- or two-wall decompression was performed successively. Symmetric reduction of proptosis was consistently confirmed intraoperatively to assure that a desired amount of exophthalmos reduction was achieved. RESULTS: Four types of decompression were performed: fat only (group 1), fat and one-wall (group 2), fat and two-wall (group 3), and two-wall and minimal fat decompression (group 4). The mean preoperative Hertel value (20.6 +/- 2.8 mm) was reduced significantly at six months postoperatively (16.1 +/- 2.3 mm). Proptosis significantly decreased with a mean of 4.3 +/- 1.7 mm, and the reduction was greatest (5.1 +/- 2.1 mm) in group 3. In group 1, a significant correlation between Hertel change and the volume of resected orbital fat was found (r = 0.479). Diplopia was newly developed or aggravated postoperatively in eight patients, and six of these patients were in group 3. With the exception of one patient, visual acuity improved to nearly normal postoperatively in all patients with optic neuropathy. CONCLUSIONS: Graded orbital decompression of orbital fat and bony walls, as assessed by the degree of proptosis reduction during surgery, was effective and predictable with minimal complications in GO patients with vision-threatening or cosmetically disfiguring proptosis.
Adipose Tissue/*surgery ; Adult ; Aged ; Decompression, Surgical/*methods ; Female ; Follow-Up Studies ; Graves Ophthalmopathy/diagnosis/*surgery ; Humans ; Male ; Middle Aged ; Orbit/*surgery ; Retrospective Studies ; Tomography, X-Ray Computed ; Treatment Outcome ; Young Adult

PURPOSE: To investigate the effects of placement of the absorbable packing material Nasopore at the anastomosis site of newly formed mucosal flaps on postoperative re-bleeding, discomfort, and on the success rate of dacryocystorhinostomy (DCR). METHODS: A review of the medical records of patients with primary acquired nasolacrimal duct obstruction that underwent external or endonasal DCR by a single surgeon was performed. The degree of re-bleeding, discomfort, and postoperative results, including anatomical success, functional success and postoperative nasal findings such as granulation, synechiae, and membrane formation were compared in patients whose anastomosis site was packed with either Nasopore or Merocel, a non-absorbable packing material. RESULTS: A total of 77 patients (101 eyes) were included. Of the 101 eyes, 30 were packed with Nasopore, while 71 were packed with Merocel. The Nasopore group showed significantly better results than the Merocel group in the degree of re-bleeding and the level of patient discomfort (p = 0.000, 0.039, respectively; Pearson's chi-square test), whereas there were no statistically significant differences between the two groups in postoperative anatomical and functional success (p > 0.05). CONCLUSIONS: Nasopore significantly reduced postoperative nasal re-bleeding and patient discomfort during the early post-surgical period, but failed to show an effect on the postoperative anatomical and functional success of DCR.
Adult ; Aged ; Dacryocystorhinostomy/*methods ; Epistaxis/prevention & control ; Female ; Formaldehyde/therapeutic use ; Hemostatics/therapeutic use ; Humans ; Lacrimal Duct Obstruction/*surgery ; Male ; Middle Aged ; Nasolacrimal Duct/*surgery ; Polyurethanes/*therapeutic use ; Polyvinyl Alcohol/therapeutic use ; Postoperative Complications/*prevention & control ; Young Adult

PURPOSE: To investigate the effects of placement of the absorbable packing material Nasopore at the anastomosis site of newly formed mucosal flaps on postoperative re-bleeding, discomfort, and on the success rate of dacryocystorhinostomy (DCR). METHODS: A review of the medical records of patients with primary acquired nasolacrimal duct obstruction that underwent external or endonasal DCR by a single surgeon was performed. The degree of re-bleeding, discomfort, and postoperative results, including anatomical success, functional success and postoperative nasal findings such as granulation, synechiae, and membrane formation were compared in patients whose anastomosis site was packed with either Nasopore or Merocel, a non-absorbable packing material. RESULTS: A total of 77 patients (101 eyes) were included. Of the 101 eyes, 30 were packed with Nasopore, while 71 were packed with Merocel. The Nasopore group showed significantly better results than the Merocel group in the degree of re-bleeding and the level of patient discomfort (p = 0.000, 0.039, respectively; Pearson's chi-square test), whereas there were no statistically significant differences between the two groups in postoperative anatomical and functional success (p > 0.05). CONCLUSIONS: Nasopore significantly reduced postoperative nasal re-bleeding and patient discomfort during the early post-surgical period, but failed to show an effect on the postoperative anatomical and functional success of DCR.
Adult ; Aged ; Dacryocystorhinostomy/*methods ; Epistaxis/prevention & control ; Female ; Formaldehyde/therapeutic use ; Hemostatics/therapeutic use ; Humans ; Lacrimal Duct Obstruction/*surgery ; Male ; Middle Aged ; Nasolacrimal Duct/*surgery ; Polyurethanes/*therapeutic use ; Polyvinyl Alcohol/therapeutic use ; Postoperative Complications/*prevention & control ; Young Adult