BACKGROUND: We studied the incidence of trauma caused by alcohol related accidents, and the effects that has on the occurrence, the extent, and the outcome to the patient. METHODS: In our study we studied trauma patients excluding pediatric patients(15 years old and under) who came to the Emergency department of Korea University Medical School Anam Hospital from the 1st of january 1996 to 30th of June 1996, looked into their medical records, and studied the records in a retrospective manner. The trauma patients were divided into two groups, a) alcohol-related and b) alcohol-non-related. The two groups were then subdivided according to their sex, age, the time they came in, the anatomical part of the trauma, the mechanism of their injury, the extent of the injury, the length of their hospital stay, the length of their ED stay and were seperately compared and analysed. Statistically, ANOVA and logistic regression analysis using SAS were used in the study and then was assessed in Chi-square analysis methods. RESULTS: The total of the trauma patients, added up to 832 people, 577: male and 255: female. Among this sum, 16 trauma patients were alcohol related(male:127 & female 36). 115 people were in the age group of 21-40. Compared to the non-alcohol related trauma group, the alcohol-related group had more facial & scalp injuries and tended to come in the hours between 0-6 AM. The cause of the injuries were mossy by fast-fighting and suicide, compared to mostly accidental-slipping injuries in the non alcohol-related group. There were no difference in the degree of the injury(ISS) and the length of hospital stay between the two groups, whereas the length of the stay at the ED was longer alcohol-related trauma patients. CONCLUSION: Alcohol related trauma patients were mostly in their 20s and 30s, came to the hospital at a late time it the reason for their visit were mossy because of fist fighting. In the Emergency department, because prompt and correct diagnosis is quite difficult to make in this group, their ED stay tended to be longer. We can conclude that measuring the blood alcohol level of these patients, continuing the psychological therapy and educating people is needed.
Diagnosis ; Emergency Service, Hospital ; Female ; Humans ; Incidence ; Korea ; Length of Stay ; Logistic Models ; Male ; Medical Records ; Retrospective Studies ; Scalp ; Schools, Medical ; Suicide

Hantavirus pulmonary syndrome(HPS) is a systemic disease that is caused by a newly discorved and characterized virus of the Hantavirus genus, which is most frequently referred to as the sin nombre virus. The clinical syndrome resembles other hantavirus syndromes worldwide, except that it is characterized by a brief prodromal illness followed by rapidly progressive, noncardiogenic edema, and that it is more deadly than any previously recognized hantavirus infection. The clinical manifestations of HPS are characterized by four clinical phases prodrome, pulmonary edema and shock, diuresis, and convalescence. Mortality is greatest in the first 24 hours of the pulmonary edema and shock phase of the illness. These phases are strikingly similar to the clinical phases of Hemorrhagic fever with renal syndrome(HFRS) induced by Hantaan virus, except that HPS has not been associated with renal failure and Disseminated intravascular coagulation(DIC). We here report a case of hantavirus pulmonary syndrome developed in a 58 year-old man. He had a flu-like illness followed by the rapid onset of respiratory failure due to noncardiogenic pulmonary edema. HPS was diagnosed by clinical manifestations, identification of high titer antibody to Hantaan virus antigen and histologic finding of transbronchial lung biopsy (TBLB) specimen. The patient was treated with mechanical ventilation and initial corticosteroid pulse therapy resulting in successful outcome.
Biopsy ; Convalescence ; Diuresis ; Edema ; Fever ; Hantaan virus ; Hantavirus Infections ; Hantavirus Pulmonary Syndrome* ; Hantavirus* ; Humans ; Lung ; Middle Aged ; Mortality ; Pulmonary Edema ; Renal Insufficiency ; Respiration, Artificial ; Respiratory Insufficiency ; Shock ; Sin Nombre virus

PURPOSE: Trauma-induced suppression of cellular immune function likely contributes to sepsis, multiple organ dysfunction syndrome and death. T cell proliferation decreases after traumatic stress. The addition of prostaglandin E2 (PGE2), which depresses immune function after hemorrhage and trauma, to T-cells decreases T-cell proliferation; and hypertonic saline restores PGE2-induced T-cell suppression. Recently, it has become apparent that macrophage migration inhibitory factor (MIF) plays a central role in several immune responses, including T-cell proliferation. However, the role of MIF in mediating hypertonic saline (HTS) restoration of T cell dysfunction is unknown. Therefore, we hypothesize that T cell immune restoration by HTS occurs, at least in part, by a MIF-mediated mechanism. METHODS: Jurkat cells were cultured in Roswell Park Memorial Institute media, at a final concentration of 2.5 x 106 cell/mL. The effects of HTS on T-cell proliferation following PGE2-induced suppression were evaluated in Jurkat cells: HTS at 20 or 40 mmol/L above isotonicity was added. MIF levels were determined by enzyme-linked immunosorbent assay and western blot analysis. RESULTS: PGE2 caused a 15.0% inhibition of Jurkat cell proliferation, as compared to the control. MIF levels decreased in PGE2-suppressed cells, as compared to the control. MIF levels were higher in cells treated with HTS than PGE2-stimulated cells. CONCLUSION: The role of HTS in restoring Jurkat cells proliferation suppressed by PGE2, at least in part, should be mediated through a MIF pathway.
Blotting, Western ; Cell Proliferation ; Dinoprostone ; Enzyme-Linked Immunosorbent Assay ; Hemorrhage ; Humans ; Hypertonic Solutions ; Jurkat Cells ; Macrophage Migration-Inhibitory Factors ; Macrophages ; Multiple Organ Failure ; Negotiating ; Prostaglandins E ; Sepsis ; T-Lymphocytes

PURPOSE: Macrophage migration inhibitory factor (MIF) may serve as a general marker for systemic inflammation in septic and nonseptic acute critical illness. Additionally, our previous experiment has demonstrated that immunosuppressant Prostaglandin E2 (PGE2) lowered MIF levels and inhibited T-cells proliferation when compared to control levels. The addition of hypertonic saline (HTS) increased MIF production as compared with PGE2-stimulated T-cells in concordance with restore PGE2-suppressed T-cells proliferation. Generally, HTS has been well known for its anti-inflammatory effect so far. Therefore, the experiments were conducted to evaluate MIF after stimulating lipopolysaccharide (LPS) either in the presence or absence of HTS in monocyte, in response to early phase injury. METHODS: Human acute monocytic leukemic cell line (THP-1) cells were cultured in RPMI media, to a final concentration of 1 x 10(6) cells/mL. The effect of HTS on LPS-induced MIF was evaluated in monocyte with 1 microg/mL LPS. HTS at 10, 20 or 40 mmol/L above isotonicity was added. MIF concentrations of the supernatant were determined by enzyme-linked immunosorbent assay, and cell lysates were used for Western blots analysis to determine the MIF expression. RESULTS: MIF concentrations in the cell supernatant increased in LPS-induced cells compared to control cells. Also, levels of MIF protein expression were higher in LPS stimulating cells. However, the addition of HTS to LPS stimulated cell restored MIF concentrations and MIF expression. CONCLUSION: The role of HTS in maintaining physiological balance in human beings, at least in part, should be mediated through the MIF pathway.
Anti-Inflammatory Agents ; Blotting, Western ; Cell Line ; Critical Illness ; Dinoprostone ; Enzyme-Linked Immunosorbent Assay ; Humans ; Immunosuppression ; Inflammation ; Lipopolysaccharides ; Macrophage Migration-Inhibitory Factors ; Macrophages ; Monocytes ; Saline Solution, Hypertonic ; T-Lymphocytes

OBJECTIVE: In vitro studies have revealed that treatment of various human cancer cell lines with specific cyclooxygenase 2 (COX-2) inhibitors induces apoptotic cell death. The goal of this article is to investigate the benefits of combining COX-2 inhibitors with existing treatment modalities in the management of ovarian cancer. METHODS: In this study we sought to determine the effects of combining paclitaxel and the COX-2 inhibitor celecoxib on apoptosis of epithelial ovarian cancer (EOC) cells. SK-OV-3 cells were exposed to increasing concentrations of paclitaxel (10(-7) M, 10(-6) M and 10(-5) M) and celecoxib (10(-8) M, 10(-7) M, 10(-6) M, 10(-5) M and 10(-4) M) as well as a combination of both drugs. The activity of apoptosis was evaluated by the morphologic examination and the MTT assay. The pattern of apoptosis was also assessed by the caspase-3 activity and the fraction of cleaved PARP (poly ADP-ribose polymerase) protein. RESULTS: Single application of both drugs could significantly increase the rate of apoptosis after 24 hours of continuous exposure. But concomitant treatment of SK-OV-3 EOC cell line with paclitaxel and celecoxib resulted in marked impairment of paclitaxel-induced apoptosis. The pattern of apoptosis induced by paclitaxel on SK-OV-3 EOC cell line was caspase-3 independent. CONCLUSION: Combining COX-2 inhibitors and paclitaxel does not have an additive or synergistic tumoricidal effect. On the contrary, celecoxib treatment markedly inhibited the apoptotic effects of paclitaxel in SK-OV-3 EOC cell line.
Adenosine Diphosphate Ribose ; Apoptosis* ; Caspase 3 ; Cell Death ; Cell Line* ; Cyclooxygenase 2 ; Cyclooxygenase 2 Inhibitors ; Humans ; Ovarian Neoplasms* ; Paclitaxel ; Celecoxib

BACKGROUND: Predicting outcome after head trauma is of great interest for clinicians, especially in the early stage. It may provide a basis for therapeutic strategies and may be helpful to select different approaches. But, reliable outcome prediction from head trauma is still unresolved. The purpose of this study is to determine which clinical parameters can be used effectively after an event of head trauma. METHODS: In our study we studied head trauma patients who came to the Emergency department of Korea University Medical School Anam Hospital from the 1st of June 1998 to 31th of January 2000, looked into medical records, and studied the records in a retrospective manner. The head trauma patients were divied into two group, a) favourable outcome-related and b) unfavourable outcome-related. The two groups were then subdivided according to their sex, age, the mechanism of their injury, the time they came in, alcohol drinking, loss of consciousness, vomiting, pupil change, previous medical illness, associated injuries and were seperately compared and analyzed. And the factors affecting Glasgow Outcome Scale(GOS) were analyzed in the parameters of Injury Severity Score(ISS), Revised Trauma Score(RTS), Glasgow Coma Scale(GCS), motor score of GCS(mGCS), Marshall Computed Tomographic Classification(MCTC). Statistically, t-test and Mann-Whistney rank sum test using Jandelsigma were used in the study and then were assessed in Chi-square analysis methods. The statistical significance was determined at a level of p less than 0.05. RESULTS: The total of the head trauma patients, added up to 129 people, 99:males and 30:females. Among this sum, 99 patients showed a favourable outcome and 30 patients showed an unfavourable outcome at discharge. The causes of injury included: automobile accident in 42 cases; falls in 26; assaults in 6; and accidental-slipping injury etc in 55 cases. 12 patients had bilateral unreactive pupils on admission, 2 had unilateral reactive pupils, and 113 had bilateral reactive pupils. Compared to the favourable outcome-related head trauma group, the unfavourable outcome-relared head trauma group had more history of loss of consciousness, unreactive pupils and tended to have previous medical illness. There were no difference in alcohol related, vomiting and associated injuries between two groups(favourable outcome-related head trauma group: unfavourable outcome-related head trauma group). Substantial difference were observed in GCS, mGCS, ISS, RTS, MCTC between two groups. Patients with unfavourable outcome had a significantly higher ISS, lower RTS, lower mGCS. After MCTC, patients with mass lesion had unfavourable outcome than patients with diffuse injury. CONCLUSION: Age, history of loss of consciousness, previous medical illness and unreactive pupil change are predictives of outcomes of head trauma patients with respect to Glasgow outcome scale. The lower GCS, lower RTS, lower mGCS, higher ISS, mass lesion based on CT scan provide poorer prognostic outcome in patients with head trauma. Use of prognostic factors thorough complete history taking and physical examination would provide useful prognostic information and facilitate improved therapeutic decision-making in head-injuried patients.
Alcohol Drinking ; Automobiles ; Coma ; Craniocerebral Trauma* ; Emergency Service, Hospital ; Glasgow Outcome Scale ; Head* ; Humans ; Korea ; Medical Records ; Physical Examination ; Pupil ; Retrospective Studies ; Schools, Medical ; Tomography, X-Ray Computed ; Unconsciousness ; Vomiting

PURPOSE: A medical disaster assistance team from our hospital was sent to the Haiti earthquake for 7 days of medical support. METHODS: We analyzed the characteristics of patients who visited our field clinic at the scene during the subacute period after the disaster. RESULTS: We treated 120 patients over 4 days, including two patients during the preparatory period. Most patients had visited a clinic in the second half of the period. Internal medicine and pediatrics were associated with the chief complaints of most patients. Acute tonsillitis had the largest number of patients(24.6%), followed by skin infections (9.2%), contusions and sprains(8.4%), and gastric ulcers (8.4%). Most of the medications were for conservative management(68.3%). CONCLUSION: During the subacute period after the earthquake, most patients had secondary injuries, such as wound complications and complications from air and water pollution, rather than direct injuries from the earthquake. We recommend that more medical preparation than surgical preparation is required during subacute periods after an earthquake.
Contusions ; Disasters ; Earthquakes ; Haiti ; Humans ; Internal Medicine ; Medical Assistance ; Palatine Tonsil ; Pediatrics ; Skin ; Stomach Ulcer ; Tonsillitis ; Water Pollution

A premenarcheal 10-year-old girl visited our clinic due to a rapidly growing and painless mass of the right breast of three months duration. The breast mass was removed using a wide local excision. The pathological findings revealed the tumor was made up of a phyllodes tumor. A phyllodes tumor, also known as cystosarcoma phyllodes, is a rare fibroepithelial tumor of the breast, which accounts for 0.3 to 1.0 % of all breast neoplasms. They have a greater degree of stromal cellularity than fibroadenomas, with a characteristic leaf-like projection. These tumors can occur between the ages of 9 to 88 years, but are most common in the third and fourth decades of life; therefore, are uncommon in children. A phyllodes tumor in an adolescent patient was first studied by Amerson, in 1970, at which time he reviewed 355 cases from the American literature, and found a five percent incidence in subjects below 20 years old. Because only a few cases have been reported in the literature; here we report a case of a phyllodes tumor in a 10-year-old girl.
Adolescent ; Breast ; Breast Neoplasms ; Child* ; Female* ; Fibroadenoma ; Humans ; Incidence ; Phyllodes Tumor* ; Young Adult

We report a case of 51-year-old woman with pure unroofed coronary sinus without persistent left superior vena cava and other cardiac anomaly. She presented with dyspnea on exertion during several years. Her chest film showed prominent cardiomegaly and dilated hilar vessels. Cardiac rhythm was atrial fibrillation. Transthoracic echocardiography demonstrated the enlarged coronary sinus with defect toward left atrium on parasternal long axis view and significant flow from coronary sinus into right atrium on subxyphoid view, and its other findings were dilated right ventricle and right atrium, paradoxical septal motion, moderate tricuspid regurgitation and mild mitral regurgitation, which were mimicking of large secundum atrial septal defect. Radionuclide cardioangiography and cardiac catheterization showed the existence of significant shunt. There was no evidence of persistent left superior vena cava on chest CT. Closure of Coronary sinus opening was done. Thereafter her symptoms of congestive heart failure were much improved. We think that careful examination of 2-D echocardiography can be valuable tool for diagnosis of unroofed coronary sinus in adult patient.
Adult ; Atrial Fibrillation ; Axis, Cervical Vertebra ; Cardiac Catheterization ; Cardiac Catheters ; Cardiomegaly ; Coronary Sinus* ; Diagnosis ; Dyspnea ; Echocardiography ; Female ; Heart Atria ; Heart Failure ; Heart Septal Defects, Atrial ; Heart Ventricles ; Humans ; Middle Aged ; Mitral Valve Insufficiency ; Thorax ; Tomography, X-Ray Computed ; Tricuspid Valve Insufficiency ; Vena Cava, Superior*

BACKGROUND AND OBJECTIVES: Recent studies have demonstrated that lipoprotein (a) [Lp(a)] plays an important role in atherothrombogenesis and to be associated with an increased risk for cardiovascular disease. SUBJECTS AND METHODS: We evaluated the distribution of Lp (a) and its association with cardiovascular risk factors, by conducting a cross sectional survey of 14,516 apparently healthy Koreans. The study group consisted of 8,007 men and 6,509 women, aged 20 years and over. RESULTS: The mean, medium and 75th percentile Lp (a) levels were 20.1, 13.2 and 23.8 mg/dL, respectively. The distribution of Lp (a) was highly skewed toward a lower level. The Lp (a) level was positively associated with age (p<0.001) and low density lipoprotein (LDL)(p<0.001). The body mass index (BMI)(p=0.006), log (triglyceride)(p<0.001) and alcohol consumption more than 3 times per week (p<0.047) were inversely related to the Lp (a) level. However, no relationship was seen with smoking, gender, exercise, homeostatic model assessment-insulin resistance (HOMA-IR) and high sensitivity C reactive protein (hsCRP). CONCLUSION: The Lp (a) level was positively associated with age and low density lipoprotein (LDL). The body mass index (BMI) and log (triglyceride) were inversely related to the Lp (a) level. However, the association between Lp (a) and cardiovascular disease in the general Korean population should be confirmed via large scale prospective cohort studies.
Alcohol Drinking ; Body Mass Index ; C-Reactive Protein ; Cardiovascular Diseases ; Cohort Studies ; Cross-Sectional Studies ; Female ; Humans ; Lipoprotein(a)* ; Lipoproteins ; Male ; Risk Factors* ; Smoke ; Smoking