BACKGROUND: Methemoglobinemia(MetHb) induced by dapsone overdose is not uncommon in Korea, especially in rural area. For treatment of dapsone-induced methemoglobinemia, methylene blue(MB) and activated charcoal(AC) should be used. To date, no reports have compared the amount of MB used between MB alone with MB & AC combined group(MB+AC). And also between moderate (MetHb<35%) and severe (MetHb>35%) intoxicated group defined by initial MetHb level. Authors hypothesized that less amount of MB can be used if MB and AC was used together and larger amount of MB is necessary to reduce MetHb level to asymptomatic level in severely intoxicated group. METHODS: From Jan 1990 to Dec 1996, a total of 54 patients who received treatment for dapsone intoxication were subject of study, The study was done retrospective chart analysis for initial MetHb level, total amount of MB and AC. Wilcoxon rank sum test and Chi-sqiare test was used to compare the total dosage of MB used for each group. Linear regression analysis was used between initial MetHb and the total amount of MB. Results were considered statistically significant when p<0.05. RESULTS: For MB alone and MB+AC group, the differences in total amount of MB used were statistically significant with mean dosage of 7.14+/-1.1mg/kg and 4.28+/-0.7mg/kg, respectively. And total amount of MB used between moderate and severe intoxicated group, the differences were statistically significant with mean dosage of 5.16+/-1.1mg/kg vs. 10.98+/-1.9mg/kg, respectively. There was significant correlation between initial MetHb level (X) and the amount of methylene blue (Y), Y=0.3X-2.42 (r2=0.41, p=0.0001) in MB alone, Y=0.186X-1.95(r2=0.21, p=0.034) in MB+AC respectively. CONCLUSION: For methemoglobinemia induced by dapsone, total amount of MB can be reduced especially in severe Intoxicated group if AC use was combined in treatment modality. There was significant correlationship between initial MetHb level and total amount of MB used.
Charcoal* ; Dapsone* ; Humans ; Korea ; Linear Models ; Methemoglobinemia ; Methylene Blue* ; Retrospective Studies

BACKGROUND: Unexpected deaths of the patients at ED are surprising to the medical staffs as well as the families. It may also increase the possibilities of medico-legal problems. This study was conducted to review the unexpected death in ED and find the predictive factors leading patients to unexpected death. METHODS: A retrospective study with reviewing available medical records of 183 patients who were expired at ED of Shinchon Severance Hospital from Mar. 1997 to Feb. 1998 and 103 patients of Youngdong Severance Hospital from Mar. 1996 to Feb. 1998 was done. Analyses were 4one on 30 variables of physical findings, laboratory results, procedures and therapies. We used univariate analysis, such as t-test and x2-test and multiple logistic regression analysis. RESULTS: Of the total 286 deaths in ED, 153 cases were enrolled in this analysis. The number of unexpected deaths were 76. Age, mental status, fraction of neutrophil count, BUN level, whether endotracheal incubation was done, use of inotropics were the factors with statistical ,significance on the univariate analysis, but only comatose mentality, endotracheal incubated case, and use of the inotropics were significant on logistic regression analysis. The longer the ED length of stay, the higher the rate of mortality and unexpected death. CONCLUSION: This result suggest that medical attention is needed on the patients with comatose decreased mental stylus, endotracheally intubated case and needing inotropic agents to prevent unexpected deaths. Shortening the ED length of stay may also be a factor for decrease the unexpected death rate.
Coma ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Length of Stay ; Logistic Models ; Medical Records ; Medical Staff ; Mortality ; Neutrophils ; Retrospective Studies

Even though various kinds of diagnostic and therapeutic measures have been used for the detection and cure of the acute osteomyelitis, this disease is difficult to be eradicated in many clinical cases. However it is rather easy to treat once this disease can be detected in early stage. So far radiological examination and many kinds of maneuvers including blood culture, clinical laboratory, xeroradiography, computed tomography have been performed for the early detection of this disease but invalid in the most cases. Recently some authors reported that the bone scanning was useful for the early detection of acute osteomyelitis, but this method also had difficulty in differential diagnosis and uncertaninty of its activity. This study aims to try to find methods of early detection of acute osteomyelitis. Experimental osteomyelitis was developed by the inoculation of Staphylococcus aureus to proximal tibias of 39 young rabbits already sclerosed by solution of sodium morrhuate. By comparing the clinical, radiological, bacteriological and laboratory findings in sequence from 2 days to 7 weeks after inoculation, the following results were obtained. 1. The incidence of experimental osteomyelitis after inoculation of staphylococcus aureus SNUH-S-188 in suspension of 1×10(7) colony forming units was 84%, 74%, and 79% in radiological, blood culture and pathologic examination respectively. 2. The leucocytosis was noticed only in early stage and slight degree of anemia was found during the 1st and 2nd weeks after inoculation. The sedimentation rate was increased only in early acute stage and same was eosinophil count. The leucocyte alkaline phosphatase(LAP) and platelet count. showed no significant abnormal changes. 3. Lymphocyte and eosinophil turned over from normal and eosinophil was predominant in experimental osteomyelitis. 4. Serum calcium, phosphorus, total protein and albumin showed significant decrease in all stages and was conversely paralle1 to changes in groin temperature. The level of BUN was normal indicating normal kidney function in experimental osteomyelitis. 5. Even though the enzymes of which showed no significant changes enrolled alkaline phosphatase and serumgluiamicoxalic-transaminase(S-GOT), but some increa.e was attained to 27% and 44% respectively. 6. It is important and significant to find continuous increase of lactic dehydrogenase (LDH) and creatine phosphokinase (CPK) since 48 hours after inoculation and author, think these will be the reliable and sensitive indices in early detection of the development of osteomyelitis and efficacy of therapeutic measures.
Alkaline Phosphatase ; Anemia ; Calcium ; Creatine Kinase ; Diagnosis, Differential ; Eosinophils ; Groin ; Incidence ; Kidney ; Lymphocytes ; Methods ; Osteomyelitis ; Oxidoreductases ; Phosphorus ; Platelet Count ; Rabbits ; Sodium Morrhuate ; Staphylococcus aureus ; Staphylococcus ; Stem Cells ; Tibia ; Xeroradiography

BACKGROUND: We designed this study to determine whether trauma history and initial assessment anticipate the injury severity of the free-fall patient. METHODS: Two hundred patients who admitted emergency department of Severance hospital because of the fall from a height were enrolled in this study. The height of fall, the body orientation, and the characteristics of impacted material, and the Injury Severity Score(ISS) were evaluated by retrospective chart reviews. And regression equations were determined for predicting ISS on the basis of clinical parameters using multiple regression analysis. RESULTS: According to the characteristics of impacted material, the ISS was higher in the hard surface(13.7+/-9.5) than the sort surface(10.5+/-8.8)(p<0.05). There were correlations between height of fall and ISS(p<0.01, r=0.5). To the body orientation, the ISS was higher in the head-to-feet orientation(18.211.7) than the feet-to-head(10.9+/- 7.0) or other position(8.5+/-5.8)(p<0.01). The regression equations were as follows, ISS=2 +0.082xage(year)-1.54x(Glasgow Coma Scale)-3x(feet-to-head orientation)+0.65x height of fall(m)+2.7 x (hand surface)(p<0.01, R2=0.53). CONCLUSION: This study suggest that the injury severity of patient with free fall are significancy related to the height of fall, the characteristics of impacted material and the body orientation.
Coma ; Emergency Service, Hospital ; Humans ; Retrospective Studies

PURPOSE: Nasal cytology for eosinophils has been reported to be very useful for the diagnosis of allergic rhinitis. The purpose of this study is to describe the relationship of the appearance of nasal eosinophils with the levels of total eosinophil counts, total IgE, and house dust mite specific IgE in child patients with symptoms of rhinitis. METHODS: Two hundred seventy eight children with symptoms of rhinitis less than 16 years of age were recruited and evaluated for the following variables: total eosinophil counts, total IgE concentrations, house dust mite specific IgE concentrations, and nasal cytology for eosinophils. RESULTS: The rate of appearance of nasal eosinophils graded as positive rose as the children's age increased. The levels of total eosinophil counts, total IgE concentrations and house dust mite-specific IgE concentrations were significantly higher in children with nasal eosinophils graded as positive than those with less than 5 percent of nasal eosinophils. The rates of appearance of nasal eosinophils graded as positive below and above 250/microL of total eosinophil counts, 250 kUa/L of total IgE concentrations, and 2 kUa/L of house dust mite (D. pteronyssinus or D. farinae) specific IgE concentrations were 16 and 41 percent, 27 and 56 percent, and 13 and 68 percent, respectively CONCLUSION: The levels of total eosinophil counts, total IgE concentrations, and house dust mite specific IgE concentrations correlate significantly with the recovery of nasal eosinophils in children with symptoms of rhinitis.
Child* ; Diagnosis ; Dust* ; Eosinophils* ; Humans ; Immunoglobulin E* ; Pyroglyphidae* ; Rhinitis*

BACKGROUND: This study was conducted to verify the hypothesis that the suppression of lipid peroxidation with the antioxidant, U-74389G, could improve the survivability of paraquat intoxicated rats. METHODS: First, we obtained the 24-h mortality by using several paraquat dosages and calculated the 24-h LD50 in 24 male Wistar rats(250~350g). To examine the effect of U-74389G, we divided the rats in 4 groups: a control group and U-74389G only group, a paraquat only group, and a paraquat plus U-74389G group(n=10 each). Paraquat, 35mg/kg, was injected intraperitoneally at 0 h. U-74389G, 10mg/kg, was administered intraperitoneally at 0, 12 h or at 1, 12 h in the respective groups. The rats were observed for 24 hours. At 24 h, plasma and lung, liver, and kidney tissues were obtained after sacrificing the surviving rats to determine the degree of lipid peroxidation by using a thiobarbituric acid reactive substances(TBARS) quantitative analysis. RESULTS: The 24-h LD50 of paraquat was calculated as 40mg/kg in our rats. The 24-h mortality was as follows: control group and U-74389G group 0%, paraquat group 30%, and paraquat plus U-74389G group 10%. The TBARS analysis showed no differences between the U-74389G and the control groups. The paraquat group showed significantly increased TBARS levels in the serum and in the kidney and lung tissue compared to the control group(p<0.05). With U-74389G, the increased TBARS levels were significantly decreased in the plasma, kidney, and lung tissues compared to the paraquat group(p<0.05). However, in the liver tissue, there were no significant differences among the groups. CONCLUSION: A 21-aminosteroid antioxidant, U-74389G, improved the survivablity of paraquat-intoxicated rats through the suppression of lipid peroxidation. Our result suggests the possibility of clinical application of this drug as an antidote for paraquat poisoning.
Animals ; Humans ; Kidney ; Lethal Dose 50 ; Lipid Peroxidation ; Liver ; Lung ; Male ; Mortality ; Paraquat ; Plasma ; Poisoning ; Rats* ; Thiobarbituric Acid Reactive Substances

BACKGROUND: When patients return to the emergency department shortly after being seen, it is generally assumed that their initial evaluation or treatment was inadequate. But in other aspects many short term revisits may be unnecessary in the aspect of emergency care because it is known that substantial numbers of patients use emergency department for nonemergency problems. So we analysed the tendency and the cause of short term revisit patients, determined the rates and the associated demographic, clinical, disease variables as a tool of quality assurance. METHODS: We carried out a chart review of patients seen in the emergency department, who revisited within 72 hours, of Young Dong Severance Hospital retrospectively between January 1, 1998 and September 30, 1999 (period 2), and compared with result between April 1, 1990 and March 31, 1991 (period 1) respectively. RESULTS: In the period 1, the total revisits patients were 204/21,025(0.97%), in that period scheduled revisits were 15.2%, the unscheduled were 84.8%, and the frequent revisits (more than 3 times) were 6.4%. In the period 2, the total revisit patients were 4,722/72,802 (6.49%), in that period scheduled revisits were 86.3%, the unscheduled were 13.7%, and the frequent revisits were 24.8%. The most common cause of revisit during the period 2 is a drug addictor (31.2%) that frequently used the emergency room for seeking drug. CONCLUSIONS : The scheduled revisit patients for dressing, medication, re-evaluation were increased enormously, so the medical care of these patients might be a part of job that performed in emergency department. And if the health care system could support the adequate nursing care facility, the portion of avoidable revisits of emergency department can be decreased. We also found that the emergency department is an important points for the early identification and referral for the treatment of patients who revisited emergency room for seeking drug, and the analysis of physician related factor in revisits patients may be used as a tool of quality assurance in the emergency department.
Bandages ; Delivery of Health Care ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital* ; Humans ; Nursing Care ; Referral and Consultation ; Retrospective Studies

BACKGROUND: The emergency physician(EP)'s interpretation of the electrocardiogram(ECG) is important in determining the disposition of patients evaluated in an emergency department(ED) for chest pain o other cardiac complaints. This particularly important in life-threatening ECG findings. When the cardiologist's final interpretation was defined as the correct one, the concordance compared with the EP was reported to be 50-60%, while the missed diagnosis of acute myocardial infarction(AMI) was reported as 0.6-8.0%, which could be deleterious to the patient. METHOD AND MATERIAL : One hundred and twenty eight ECGs were interpreted by two residents from each year residency. ED records of the study patients were reviewed, and the EP's and cardiologist's ECG interpretations were compared. The ECGs were classified by severity according to the following system: class I, normal or minor abnormalities only; class II, abnormalities with potential to alter case management; and class III, potentially life-threatening abnormalities. RESULTS: The overall concordance between EP's and cardiologist's ECG interpretations was 59.3% and the concordance comparing each year residency showed no statistical significant difference (p value less than 0.05). The underdiagnosed rate was 48.4%, 32.0%, 23.4%, 22.7% for first, second, third and fourth year residency respectively, and 2.3%, 5.5%, 10.9%, 5.5% respectively for the overdiagnosed rate. CONCLUSION: Although the overall concordance showed a relatively high result in our study, the concordance of class III ECG resulted a much lower rate. Therefore, additional studies are needed to identify variables that contribute to ED ECG misinterpretation and to develop methods to resolve these difficulties. Assessment of department ECG misinterpretation would be useful in focusing on resident and staff education.
Case Management ; Chest Pain ; Diagnosis ; Education ; Electrocardiography* ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Internship and Residency

The mechanism of chronic pain is very complicated. Memory, pain, and opioid dependence appear to share common mechanism, including synaptic plasticity, and anatomical structures. A 48-yr-old woman with severe pain caused by bone metastasis of breast cancer received epidural block. After local anesthetics were injected, she had a seizure and then went into cardiac arrest. Following cardiopulmonary resuscitation, her cardiac rhythm returned to normal, but her memory had disappeared. Also, her excruciating pain and opioid dependence had disappeared. This complication, although uncommon, gives us a lot to think about a role of memory for chronic pain and opioid dependence.
Amnesia/*diagnosis ; Anesthesia, Local/adverse effects ; Bone Neoplasms/drug therapy/radiotherapy/secondary ; Breast Neoplasms/drug therapy/pathology/radiotherapy ; *Cardiopulmonary Resuscitation ; Electroencephalography ; Female ; Heart Arrest/etiology ; Humans ; Magnetic Resonance Imaging ; Mepivacaine/adverse effects ; Middle Aged ; *Pain Management ; Seizures/etiology ; Tomography, X-Ray Computed

PURPOSE: The aim of this study was to evaluate the recurrence rates of a giant cell tumor of the bone an determine what, if any, patient factors, tumor characteristics and surgical treatments correlate with the incidence of a local recurrence. MATERIALS AND METHODS: The records of fifty two cases who were diagnosed with a giant cell tumor of the bone between March 1992 and March 2001 and were could be followed up for at least 2 years were analysed retrospectively. This study reviewed the clinical characters, and the treatment method, recurrence, complication, the result of the follow-up. A Fisher' exact test was carried out to analyse the statistics. RESULTS: Sixteen patients (31%)had a local recurrence. The average time to recurrence was 17 months. All but case one recurred within 2 years after receiving surgical treatment. There was no significant differences in the recurrence rates based on the following variables: gender, tumor location, Campanacci grade, the presence of a pathologic fracture, primary versus recurrent tumor at presentation, resection margin, the use of a bone graft, internal fixation or polymethylmethacrylate. CONCLUSION: The clinical characters and methods of treatment were not correlated with a local recurrence. Most recurrences of a giant cell tumor can be expected within the first two to three years. Therefore the patient needs to be followed up in that period and longer for the a late recurrence and pulmonary metastasis.
Follow-Up Studies ; Fractures, Spontaneous ; Giant Cell Tumors* ; Giant Cells* ; Humans ; Incidence ; Neoplasm Metastasis ; Polymethyl Methacrylate ; Recurrence* ; Retrospective Studies ; Transplants