Clinical observation was made on 131 cases of the unstable spine injury treated at the Orthopedic Surgery Department of Busan National University Hospital during the period from January 1974 to December 1981. The results obtained were as follows: 1. More than two-thirds of patients were between the age of 20 and 40, and the proportion of males to females showed a ratio of 5.9 to 1. The most common cause of injury was falling at an industrial area, rating 64.1% of all cases. 2. Fracture level was observed 31.3% in the first lumbar level, 24.4% in the twelfth thoracic vertebra, and 67.9% between the twelfth thoracic vertebra and the second lumbar vertebra. 3. Mechanisms of injury were 44.3% by pure flexion, 26.7% by flexion and rotation, 15.3% by direct shearing force, and 13.7% by vertical compression. 4. The fracture with lower extremity paralysis was due to the rotational fracture dislocation, which comprised 66% of all. 5. Kyphosis increased to the average of 10.6 degree in the case of decompressive laminectomy and of 3.4 degree in the case of spinal fusion. 6. The anatomical alignment and a definite stability could be obtained by the use of Harringtons rod in the cases of the unstable thoracolumbar fracture and fracture-dislocation. In 3 cases of all, we could get satisfactory results 1 month after the day injury occured. 7. In case of complete paralysis of lower extremity, it was found only 9.4% showed partial recovery, neurologically, and 61.9% of the patients with incomplete paralysis were also partly recovered. 8. The most common complication was urinary tract infection, which comprised 83% of the cases. With the use of intermittent urinary catheterization, the voiding reflex recovered within 4 months in most cases.
Accidental Falls ; Busan ; Dislocations ; Female ; Humans ; Kyphosis ; Laminectomy ; Lower Extremity ; Male ; Orthopedics ; Paralysis ; Reflex ; Spinal Fusion ; Spine ; Urinary Catheterization ; Urinary Catheters ; Urinary Tract Infections

The instability of the degenerative spondylolisthetic lumbar spine was clinically evaluated by patients symptoms and serial radiograms. With X-ray films of patients lumbar spine, the lumbosacral angle, the sacral angle, the vertebral height difference between anterior and posterior surface of the 5th lumbar vertebra and the level of intercristal line were analysed. And the results of treatment were analysed too. The Results were as follows: 1) In degenerative spondylolisthetic L3 and L4 spines, facets were arranged in sagittal plane and sacrum was vertically arranged, but in L5 facets were coronally arranged and sacrum and in horizontal plane. 2) The lumbosacral angle was 149.9 and the average difference between anterior and posterior height of L5 vertebral body was 3mm. These results revealed that sacrum was more vertical and the 5th vertebral body was more rectangular, so lumbar lordosis was decreased as a whole. 3) The intercristal line was passed at IA or L4–5 interspace in 72.1% of cases(normal:95.8%), so L4 vertebra was placed in higher level. 4) In group A posterolateral fusion was done in 2 cases. Among group B and C, operation was done in 9 cases;4 cases with laminectomy and 5 cases with laminectomy and posterolateral fusion. Two years after surgery, slipping and instability were far advanced in 2 laminectomized cases for whom posterolateral fusion was followed later. 5) Unstable group of degenerative spondylolisthesis with severe neurological symptoms and claudication must be treated by decompressive laminectomy and posterolateral fusion, especially in patients under 60 years of age. 6) Young woman having flattened lumbar curve without slipping, narrowed disc space of L4–5, high-seated L4 and vertical sacrum is thought to be in prespondylolisthetic stage of degenerative origin; therefore, intensive back muscle exercise to prevent the slipping should be performed and periodic X-ray examinations should be followed up to detect the progress of the disease.
Animals ; Back Muscles ; Female ; Humans ; Laminectomy ; Lordosis ; Sacrum ; Spine ; Spondylolisthesis ; X-Ray Film

Retroperitoneal fibrosis sometimes causes urological problem involving the ureter, but the mechanism is uncertain. An aortic aneurysm, including an iliac artery aneurysm, is thought to be one of the mechanisms of retroperitoneal fibrosis. However, cases caused by an isolated iliac artery aneurysm are very rare, and symptoms tend to be non-specific; therefore, no definitive treatment has been established. Herein, we report our recent experience of a patient with a left common iliac artery aneurysm involving the ureter, who underwent successful surgical therapy.
Aneurysm* ; Aortic Aneurysm ; Constriction, Pathologic* ; Humans ; Iliac Artery* ; Retroperitoneal Fibrosis* ; Ureter*

Malignant histiocytosis is a rare, usually fatal malignant neoplasm of reticuloendothelial systems. The disease is associated with fever, malaise, weight loss, hepatosplenomegaly, lymphadenopathy, pancytopenia, jaundice, and purpura. A 44-year-old female patient is described who had multiple, purple crusted nodules and plaques in the skin. In the laboratory study, pancytopenia was noted on the peripheral blood. In addition many atypical histiocytes were seen on the bone marrow aspiration. A lesional biopsy showed nodular infiltrations of atypical histiocytes in the dermis and some erythrophagocytosis was seen. Immunohistochemically, the histiocytes were weakly stained for lysozyme and α-l-antichymotrypsin, but were unstained for S-100 protein, cytokeratin, CEA(carcinoembryonic antigen), pan T/B marker CD30(ki-1), UCHL-1 LCA(leukocyte common antigen), and α-l-antitrypsin.
Adult ; Biopsy ; Bone Marrow ; Dermis ; Female ; Fever ; Histiocytes ; Histiocytic Sarcoma* ; Humans ; Jaundice ; Keratins ; Lymphatic Diseases ; Mononuclear Phagocyte System ; Muramidase ; Pancytopenia ; Purpura ; S100 Proteins ; Skin ; Weight Loss

No abstract available.
Hepatitis B Vaccines* ; Hepatitis B* ; Hepatitis* ; Hot Temperature* ; Humans ; Intellectual Disability*

STUDY OBJECT: To date, the study of critical illness in the emergency department has been limited. The purpose of this study was to determine the length of stay and procedures performed on critical care patient in ED, and to be help to establish Emergency physicians' education program. METHOD: We reviewed patient's medical record, who visited ED, Korea Univ. Hospital from Jan. 1996 to Jun. 1996 and admitted to ICU. We analyzed data to age, sex, clinical diagnosis, length of stay, and critical procedures in ED. RESULTS: The 12,721 patients visited ED during the study period, the 441 of 12,721 (3.50%) patients admitted to ICU. 56 patients were excluded whose medical re cords were incomplete. The study populations consisted of 165 women and 220 men. The mean age were 52 year old (median,58 year old). The mean length of stays were 606.1 (1445.9 minutes (median, 180 minutes)). One hundred sixty one of these patients (41.8 %) received one or more critical procedures. The medical critical patients were 252 cases, and surgical critical patients were 133 cases. The mean length of stay of medical critical patients was 738.8 (1748.9 minutes (median, 177.5 minutes)) in medical department,44.0% of them received critical procedures in ED. The surgical critical patients averaged 354.9 (410.7 minutes (median, 190 minutes)) and 37.6% received critical procedures. CONCLUSION: Critical ill patients stay in the ED with a substantial amount of time, before addition to the ICU. Critical ill patients who have hemodynamiccal unstable conditions, compromised cardiopulmonary functions, and neurologic deficities, were managed in ED frequently. Typical critical care procedures are commonly performed by emergency physicians. Therefore, it is important for emergency physician to prepare to critical ill patients.
Critical Care* ; Critical Illness ; Diagnosis ; Education ; Emergencies* ; Emergency Service, Hospital* ; Female ; Humans ; Korea ; Length of Stay ; Male ; Medical Records ; Middle Aged

No abstract available.
Hepatitis B Vaccines* ; Hepatitis B* ; Hepatitis* ; Hot Temperature* ; Humans ; Intellectual Disability*

BACKGROUND: Domestic violence once considered an infrequently occurring event existing only in deviant relationships, it has been more recently recognized as a widely distributed phenomenon resulting from multiple cultural, social, psycological factors. According to declining world economics, family violence rises with a simultaneous curtailment of agencies available to assist battered persons and there is increasing pressure on emergency departments to serve those who might otherwise have sought help from public agency. In Korea, we don't have any clinical data about domestic violence, and authors analysed clinical pictures of domestic violence victims who came to the emergency department of Korean University medical center. METHOD: We reviewed the victims of the domestic violence retrospectively, who visited in ED, Korean Univ. Hospital from Jan. 1996 to the Dec. 1996. We Analysed data to Age, sex, Injury severity score, location of injury, mechanism, perpetrator. RESULTS: During the study period, total 134 domestic violence victims were identified. The young, females were predominantly victimized. And married women were more commonly violated. (about 70%). ISS was relatively mild (2.491), face and head were mainly injured by punching and objects throwing. The Prevalence of domestic violence victims almost presented at Emergency department between 6:00/P.M. and 8:00 A.M.. CONCLUSION: Emergency physicians suspect domestic violence victims who injured at face and head by punching or hitted would. In these patients, we need more detail history and physical exam. And in case of repeated domestic violence, refer to neuropychatry dept and social workers with perpetratrs, and need mere concerte social programs for domestic violence.
Academic Medical Centers ; Domestic Violence* ; Emergencies* ; Emergency Service, Hospital* ; Female ; Head ; Humans ; Injury Severity Score ; Korea ; Prevalence ; Retrospective Studies ; Social Workers

As the productive activities have vastly increased following industrialization and urbanization in the modem society, the resulting high mobility of people and goods have caused a sharp increase in the accidents in the work places as well as traffic accidents. In particular, deaths caused by injuries are generally concentrated in the economically active young peoples, producing incalculable losses to the society and nation as a whole. Advanced nations with superior medical care systems have succeeded in reducing incidents of such deaths by operating trauma centers. Especially noteworthy is the case of the United States where such specialized trauma centers have greatly contributed to reducing deaths from injuries in the non-urban areas with less access to medical facilities. At present Korea has no medical centers specializing in injuries. In large cities, the injuries are being treated tertiary medical facilities while in the provinces they are referred to small and medium-sized hospitals that constitute secondary medical facilities. Currently in Korea the Trauma patients are treated at general hospitals that consist of 726 secondary medical facilities and 40 tertiary medical centers nationwide. The secondary medical facilities which tend to take most responsibility for the treatment of trauma are generally deficient in medical staff and facilities (including operating and intensive care facilities). Despite such deficiency and limitations, no regulations exist regarding treatment or transportation of trauma patients. This article reports the outcome of a comparative analysis of the results of trauma treatments among different types of medical facilities based on objective data in the hope that such study would facilitate a comparison with the treatment systems of advanced countries and thereby contribute to a precise formulation of problems that must be addressed in this area.
Accidents, Traffic ; Hope ; Hospitals, General ; Humans ; Critical Care ; Korea ; Medical Staff ; Modems ; Social Control, Formal ; Transportation ; Trauma Centers ; United States ; Urbanization ; Workplace ; Industrial Development

BACKGROUND: It has been documented that certain prognostic factors may affect the outcomes of the old aged victims by trauma. Considering that trauma is the sixth most common cause of death in people over the age of 65 years and there is a rapid growth of elderly population, it is paramount to understand the prognostic factors when dealing with geriatric trauma patients. Hypothesis and Goals : It can be hypothesized that the prognostic factors should be determined independently between populations being consisted of different races, countries, socio-economic states, cultures, or so on. Thus, study was designed to evaluate the factors affecting the outcomes of elderly Korean trauma patients. METHODS: One hundred forty six patients aged over 65 years were retrospectively reviewed, who visited the Emergency Canter of Korea University from January, 1997 to June, 1998. Of 146 patients, 7 were excluded due to discharge against advice or transfer to the other hospitals. Parameters analysed were age, sex, mechanism of injuries, body region injured, Injury Severity Score (ISS), previous medical illness, hospital morbidity, duration of hospital stay, and cost. Each patient was classified into improved or not-improved groups depending on the outcomes, and young-old or old-old group depending on the age. The factors affecting the hospital stay in improved patients were analyzed in the parameters of previous medical illness, hospital morbidity, multiple injuries, ISS, and age. All statistical tests were conducted with two-tailed levels of 0.05. RESULTS: Of 139 patients, the mean age was 74+/-7.1 years, mean ISS 9.3+/-7.26, mean hospital stay 27+/-27.1 days. Most commonly injured body region was the extremities due to fall from a level surface. Rate of previous illness showed 0.94 medical diseases per person and were aggravated after trauma in 39 patients (60.9%). Hospital morbidity rate was 0.46 incidents per person. There were no differences in age and duration of hospital stay between the improved and the not-improved group. Substantial differences were noted in affected body region, incidence of previous illness, and hospital morbidity between the groups (p=NS). Not-improved group had higher ISS (p<0.05). ISS, previous illness and hospital morbidity affected the duration of hospital stay in the improved group. Hospital stay was 40+/-25.1 days in patients with ISS over 6 while 6+/-8.6 days in those with ISS 5 (p<0.05). Hospital stay in the improved was 26+/-26.9 days while 31+/- 24.8 days in the improved old-old group (P=NS). Hospital stay in the young-old minor trauma (ISS5) patients with previous illness and hospital morbidity was 26+/-10.1 days while 4+/-7.3 days in those without previous illness and hospital morbidity (p<0.05). CONCLUSION: Previous medical illness and hospital morbidity, not age, are predictive of outcomes of geriatric trauma patients with respect to hospital stay. As most of the hospital morbidity was a trauma-induced aggravation of previous medical illness and hospital morbidity contributing poor outcomes can be potentially avoidable, routine aggressive care far the geriatric trauma patients with previous medical illnesses is needed.
Aged ; Body Regions ; Cause of Death ; Continental Population Groups ; Emergencies ; Extremities ; Humans ; Incidence ; Injury Severity Score ; Korea ; Length of Stay ; Multiple Trauma ; Retrospective Studies