PURPOSE: We planned to determine the diagnostic capability of focused assessment with sonography for trauma (FAST) in cases of blunt abdominal injury (BAI). METHODS: A retrospective analysis of FAST sheets was performed from April 2002 to December 2004. During the study period, 135 BAI patients were evaluated with FAST at the Emergency Department of Bundang CHA Hospital. Of this group, twenty-eight patients were excluded, leaving 107 patients for analysis. Abdomen CT (computerized tomography) or exploratory laparotomy confirmed the presence of hemoperitoneum. At the secondary survey, patients underwent a three-view FAST examination (LogicQ; General Electric, Waukesha, USA) by an emergency physician, followed within 2 hours by an abdomen CT or exploratory laparotomy. The FAST examination was considered positive if it demonstrated evidence of free intra-abdominal fluid. RESULTS: There were 45 true-positive FAST examination, 57 true-negatives, 1 false-positive, and 4 false negatives (sensitivity 91.8%, specificity 98.3%, positive predictive value 97.8%, negative predictive value 93.4%). The area under the ROC curve was 0.951 for the FAST examination. CONCLUSION: FAST is a highly reliable method for screening patients suspected of having BAI for the presence or absence of hemoperitoneum.
Abdomen ; Abdominal Injuries ; Emergencies ; Emergency Service, Hospital ; Hemoperitoneum ; Humans ; Laparotomy ; Mass Screening ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Tomography, X-Ray Computed

PURPOSE: We planned to determine the diagnostic capability of focused assessment with sonography for trauma (FAST) in cases of blunt abdominal injury (BAI). METHODS: A retrospective analysis of FAST sheets was performed from April 2002 to December 2004. During the study period, 135 BAI patients were evaluated with FAST at the Emergency Department of Bundang CHA Hospital. Of this group, twenty-eight patients were excluded, leaving 107 patients for analysis. Abdomen CT (computerized tomography) or exploratory laparotomy confirmed the presence of hemoperitoneum. At the secondary survey, patients underwent a three-view FAST examination (LogicQ; General Electric, Waukesha, USA) by an emergency physician, followed within 2 hours by an abdomen CT or exploratory laparotomy. The FAST examination was considered positive if it demonstrated evidence of free intra-abdominal fluid. RESULTS: There were 45 true-positive FAST examination, 57 true-negatives, 1 false-positive, and 4 false negatives (sensitivity 91.8%, specificity 98.3%, positive predictive value 97.8%, negative predictive value 93.4%). The area under the ROC curve was 0.951 for the FAST examination. CONCLUSION: FAST is a highly reliable method for screening patients suspected of having BAI for the presence or absence of hemoperitoneum.
Abdomen ; Abdominal Injuries ; Emergencies ; Emergency Service, Hospital ; Hemoperitoneum ; Humans ; Laparotomy ; Mass Screening ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Tomography, X-Ray Computed

The amniotic band syndrome is a collection of fetal malformations caused by fibrous bands that appear to entangle or entrap various parts of fetus in utero, leading to deformation, malformation, or disruption involving the limbs, craniofacial region and trunk. The incidence of this syndrome is relatively rare. This syndrome often shows irreversible serious outcome. So, early diagnosis of amniotic band syndrome is important. Ultrasonography enables us to detect the amniotic band syndrome prenatally. In the second and third trimester of the pregnancy, it is relatively easy to detect major anomalies of amniotic band syndrome by its characteristic features, including amputation and/or constriction of the extremities, facial clefts, asymmetric encephaloceles and gastroschisis. Five cases of amniotic band syndrome which have been diagnosed prenatally by ultrasonography are discussed. The diagnosis was based on sonographic visualization of amniotic band and associated fetal deformation, malformations or disruption known to characterize the amniotic band syndrome.
Amniotic Band Syndrome* ; Amputation ; Constriction ; Diagnosis* ; Early Diagnosis ; Encephalocele ; Extremities ; Female ; Fetus ; Gastroschisis ; Humans ; Incidence ; Infant, Newborn ; Pregnancy ; Pregnancy Trimester, Third ; Ultrasonography*

In capacitive heating device, which considered efficient for deep heating, parallel arrangement of the electrodes is a serious limiting factor in heating for eccentrically located lesions because it causes overheating of the exposed ipsilateral skin surface, the heating pattern is also frequently inappropriate, arid the arrangement tends to be unstable due to the patient's gravity. Therefore we attempted an angular arrangement of the electordes to achieve more homogenous and efficient heating for such lesions. In phantom study, both the thermal profile and thermogram established the heating pattern in this unusual angular arrangement of the electrodes at 60degree, 90degree and 120degree angles, respectively. An angular arrangement was also clinically applied to 3 patients. The patients' tolerance was good without significant complication and the thermal distribution was satisfactory. In conclusion, this unusual arrangement of electrodes appears to be promising in the clinical application to the eccentrically located lesions.
Electrodes* ; Gravitation ; Heating* ; Hot Temperature* ; Humans ; Skin

The aims of the study were to evaluate the effect of epinephrine-containing local anesthetics on pulpal blood flow (PBF) and to investigate its effect on cavity preparation-induced PBF change. PBF was recorded using a laser Doppler flowmeter (Perimed Co., Sweden) from canines of nine cats under general anesthesia before and after injection of local anesthetics and after cavity preparation. 2% lidocaine hydrochloride with 1 : 100,000 epinephrine was administered by local infiltration given apical to the mandibular canine at the vestibular area and the same volume of isotonic saline was injected on the contralateral tooth as a control. A round carbide bur was operated at slow speed with isotonic saline flushing to grind spherical cavities with increasing depth through the enamel and into the dentin on both teeth. The obtained data was analyzed with paired t-test. Cavity preparation caused significant increase of PBF (n = 9, p < 0.05). Local infiltration of lidocaine with epinephrine resulted in decreases of PBF (n = 9, p < 0.05), whereas there was no significant change of PBF with the physiologic saline as a control. Cavity preparation on tooth anesthetized with lidocaine with epinephrine caused significantly less increase of PBF than in control tooth (p < 0.05). Therefore, the result of the present study demonstrates that local infiltration of 2% lidocaine with 1 : 100,000 epinephrine effectively reduces PBF increase caused by cavity preparation.
Anesthesia, General ; Anesthesia, Local* ; Anesthetics, Local ; Animals ; Cats ; Dental Enamel ; Dentin ; Epinephrine ; Flowmeters ; Flushing ; Lidocaine ; Neurogenic Inflammation ; Tooth*

PURPOSE: To understand the MR findings of extraabdominal desmold tumors by correlation with histopathologic findings. MATERIALS AND METHODS: MR images of histologically proved 12 patients with extraabdominal desmold tumor were retrospectively reviewed. Three types of MR features were defined; type I had signal changes on T1 and T2 weighted images and relatively homogeneous nature, type II had homogeneously low signal intensities on T1 and T2 weighted images and type III was a mixed form of type I and type II. Signal intensity, enhancement pattern and margin of the lesions were analyzed on MR images. Pathologic features were analyzed by three aspects, which were cellularity, amount of collagen and vascularity, and were correlated with MR images. RESULTS: The signal intensities of type I desmolds were intermediate on T1 weighted image and higher on T2 weighted image with localized margin and gadolinium enhancement. Pathologically this type showed predominant cellularity and vascularity. The signal intensities of type II desmold were homogenous low signal intensities on both T1 and T2 weighted images without enhancement. Pathologically this type showed predominant collagen components and hypovascularity. Type III desmolds were mixed form of type I and type II on MR images as well as on pathologic features. Type I and type II desmold tumors had localized margins, however type III had both localized and infiltrative margins. CONCLUSION: The MR findings of extraabdominal desmold tumors would reflect the pathologic background of the tumor.
Collagen ; Gadolinium ; Humans ; Retrospective Studies

In order to assess the effects of radiofrequency-induced local hyperthermia on the normal liver, histopathologic findings and biochemical changes after localized hyperthemia in canine liver were studied. Hyperthermia was externally administered using the Thermotron RF-8 (Yamamoto Vinyter Co., Japan; Capacitive type heating machine) with parallel opposed electrodes. Thirteen dogs were used and allocated into one control group (N=3) and two treatment groups according to the treatment temperature. GroupI(N=5) was heated with 42.5+/-0.5degree C for 30 minutes, and GroupII(N=5) was heated with 45+/-0.5degree C for 15-30 minutes. Samples of liver tissue were obtained through a needle biopsy immediately afterhyperthermia and 7, 14 and 28 days after treatment and examined for SGOT, SGPT and alkaline phosphatase. Although SGOT and SGPT were elevated after hyperthermia in both groups (three of five in each group), there was no liver cell necrosis or hyperthermia related mortality in GroupI. A hydropic swelling of hepatocytes was prominent histologic finding. Hyperthermia with 45degree C for 30 minutes was fatal and showed extensive liver cell necrosis. In conclusion, liver damage day heat of 42.5+/-0.5degree C for 30 minutes is reversible, and liver damage by heat of 45+/-0.5degree C for 30 minutes can be fatal or irreversible. However, these results cannot be applied directly to human trial. Therefore, in order to apply hyperthermic treatment on human liver tumor safely, close observation of temperature with proper thermometry is mandatory. Hyperthermic treatment should be confined to the tumor area while sparing a normal liver as much as possible.
Alanine Transaminase ; Alkaline Phosphatase ; Animals ; Aspartate Aminotransferases ; Biopsy, Needle ; Dogs ; Electrodes ; Fever ; Heating ; Hepatocytes ; Hot Temperature ; Humans ; Hyperthermia, Induced* ; Japan ; Liver* ; Mortality ; Necrosis ; Thermometry

The purpose of this study was to investigate the influence of NK1 receptor antagonists on the pulpal blood flow (PBF) when applied iontophoretically through the dentinal cavity of the teeth in order to understand whether iontophoretically applied NK1 receptor antagonists can control the pulpal inflammation. Eleven cats were anesthetized with alpha-chloralose and urethane, and substance P (SP) was administered to the dental pulp through the catheterized lingual artery in doses that caused PBF change without the influence of systemic blood pressure. NK1 receptor antagonists were applied iontophoretically to the prepared dentinal cavity of ipsilateral canine teeth of the drug administration, and PBF was monitored. Data were analyzed statistically with paired t-test. PBF increase after iontophoretic application of the NK1 receptor antagonists followed by the intra-arterial administration of SP was significantly less than PBF increase after iontophoretic application of the 0.9% saline followed by the intra-arterial administration of SP as a control (p < 0.05). Iontophoretic application of the NK1 receptor antagonists (0.2~3.4 mM) following the intra-arterial administration of SP resulted in less increase of PBF than the iontophoretic application of the 0.9% saline following the intra-arterial administration of SP as a control (p < 0.05). Therefore, the results of the present study provide evidences that the iontophoretic application is an effective method to deliver drugs to the dental pulp, and that iontophoretically applied NK1 receptor antagonists block SP-induced vasodilation effectively. The above results show the possibility that the iontophoretical application of NK1 receptor antagonists can control the neurogenic inflammation in the dental pulp.
Animals ; Arteries ; Blood Pressure ; Catheters ; Cats* ; Chloralose ; Cuspid ; Dental Pulp ; Dentin ; Inflammation ; Iontophoresis ; Neurogenic Inflammation ; Substance P ; Tooth ; Urethane ; Vasodilation

No abstract available.
Acalculous Cholecystitis* ; Churg-Strauss Syndrome* ; Colitis, Ischemic* ; Ulcer*

PURPOSE: This study was performed to determine whether the anion gap, the base excess, the lactate, and the strong ion gap obtained in the emergency department correlate with the prognosis and whether the strong ion gap is the most useful marker compared to the prognostic ability of the anion gap, the base excess, and the lactate. METHODS: We reviewed the records of 106 patients admitted to the intensive care unit via the emergency department. We measured the anion gap, the base excess, and the lactate and we calculated strong anion gap by using a formula. We divided the patients into survivors and nonsurvivors and compared the prognostic abilities of the four variables by using the Student's t-test and receiver operator characteristic curves. RESULTS: The mean age of the patients was 67+/-14, and the numbers of males and females were similar (58 males vs 48 females). The number of survivors was 92 (86.7%), and that of nonsurvivors was 14 (3.2%). The anion gap ( 24.8+/-8.8 vs. 16.4+/-4.8 mmol/L, p value=0.000), the base excess (-11.9+/-8.7 vs. -3.49+/-6.5 mmol/L, p value = 0.001), the lactate (9.1+/-7.7 vs. 4.5+/-3.1 mmol/L, p value = 0.011 ) and the strong ion gap (16.6+/-3.6 vs. 10.9+/-3.7, p value=0.000) of the nonsurvivors were higher. All of the four varibles were associated with the prognosis, but among them, the strong ion gap discriminated most strongly with an area under the receiver operator characteristic curve of 0.866 (95% confidence interval, 0.787 to 0.92). CONCLUSION: The initial emergency-department acid-base variables, the anion gap, the base excess, the lactate and the strong ion gap have prognostic abilities, but the strong ion gap is the variable that most strongly predicts of mortality.
Acid-Base Equilibrium ; Critical Illness* ; Emergencies* ; Emergency Service, Hospital* ; Female ; Humans ; Intensive Care Units ; Lactic Acid ; Male ; Mortality ; Prognosis ; Survivors