PURPOSE: To analyze the MR finding of skeletal malignant lymphoma. MATERIALS AND METHODS: The authors retrospectively reviewed the MR imaging findings(location, signal intensity and contrast enhancement of lesions, and patterns of bone marrow involvement) of 12 patients with malignant lymphoma presenting in bones and confirmed by incisional biopsy, blind bone marrow biopsy or fol-low-up MR imaging. RESULTS: Among the 15 lesions in 12 patients, the spine was the most commonly involved site(n=5), followed by the ilium(n=4), femur(n=3), sternum(n=2), and tibia(n=1). On T1-weighted images, lesions showed signal intensity close to muscle, while on T2-weighted images, involved bones showed variable signal intensity from muscle to water signal intensity. Patterns of bone marrow involvement were nodular(n=2), diffuse(n=5), or segmental(n=8). All cases of segmental bone marrow involvement also produced soft tissue mass. In two cases in which this occurred, cortical breakdown was not noted. CONCLUSION: On T1- and T2-weighted MR images, particularly the latter, bone marrow involvement of malignant lymphoma was observed, with variable signal intensity. Contrast enhanced images revealed distinct lesion. Patterns of bone marrow involvement varied.
Biopsy ; Bone Marrow ; Bone Neoplasms ; Humans ; Lymphoma* ; Magnetic Resonance Imaging* ; Retrospective Studies ; Spine ; Water

BACKGROUND: The most important acute complication of percutaneous transluminal coronary angioplasty (PTCA) is abrupt closure by dissection and thrombus, which account for the majority of deaths and emergency coronary artery bypass procedures associated with PTCA. We sought to determine the relationship between clinical, angiographic characteristics and abrupt thrombotic closure related to coronary intervention. METHODS: One hundred thirty two patients (61.6+/-8.0 year, 98 male) underwent PTCA or stenting under the diagnosis of acute myocardial infarction were analyzed at Chonnam University Hospital between Jan '97 and Jun '98. Patients were divided into two groups, one, 14 patients (Group A, 61.7+/-8.0 year, 9 male), who developed thrombotic occlusion, and the other, 118 patients (Group B, 61.5+/-8.0 year, 89 male) who did not develop abrupt closure related to the coronary intervention. RESULT: There were no significant differences in age, sex, risk factors, activated partial thromboplastin time, fibrinogen, erythrocyte sedimentation rate, C-reactive protein, location of lesion, branch involvement, lesion severity, AHA/ACC morphology between two groups. The incidence of intra-coronary thrombus was greater in Group A than in Group B (44% vs. 2%, p=0.025). Acute thrombotic occlusion related to the coronary interventions developed more frequently in the lesions within two days after the symptomatic onset (55% vs. 19%, p=0.035) and in the right coronary artery (RCA) lesions (55% vs. 24%, p=0.041). CONCLUSION: Predictors of abrupt thrombotic occlusion during coronary intervention in patients with acute myocardial infarction are intracoronary thrombus, earlier intervenion within 2 days after onset of aucte myocardial infarction and RCA lesion.
Angioplasty, Balloon, Coronary ; Blood Sedimentation ; C-Reactive Protein ; Coronary Artery Bypass ; Coronary Vessels ; Diagnosis ; Emergencies ; Fibrinogen ; Humans ; Incidence ; Jeollanam-do ; Myocardial Infarction* ; Partial Thromboplastin Time ; Risk Factors ; Stents ; Thrombosis

OBJECTIVE: Massive intracerebral hemorrhage (ICH) is devastating neurosurgical disease. Decompression surgery has been performed to manage the uncontrolled increased intracranial pressure and good clinical result has been reported. Authors analyze the ICP trend after the decompression surgery and report the clinical usefulness. METHODS: Thirty patients data with massive ICH were analyzed retrospectively. Surgical indication was constantly followed in these patient ; Glasgowcoma scale score less than 8, midline shift more than 6 mm on brain CT. In all patients ventricular puncture was done before the decompression and monitored the ventricular pressure changes during and after the surgery. RESULTS: In massive ICH patients, the ICP was maintained in physiological range if the hematoma was removed more than 80%. And when we tried additional therapies like hypothermia or coma therapies in another group, the ICP was elevated at the time of the additional therapy. CONCLUSION: From this study, if the ICH removed more than 80% and The ICP was not exceed 20 mmHg during the first post-operation day, the ICP hardly exceed 20 mmHg after than. Authors thought that decompression surgery is not an essential treatment for the massive ICH patient if their hematoma removed enough.
Brain ; Cerebral Hemorrhage ; Coma ; Decompression ; Decompressive Craniectomy ; Hematoma ; Humans ; Hypothermia ; Intracranial Pressure ; Punctures ; Retrospective Studies ; Ventricular Pressure

BACKGROUND: Pressure support ventilation(PSV) is a new form of mechanical ventilatory support that assists spontaneous inspiratory effort of an intubated patient with a clinician-selected amount of positive airway pressure. Low level pressure support during inspiration can overcome the resistive component of inspiratory work imposed by ah endotracheal tube. However the clinical efficacy of PSV as a weaning method has not been established yet. Object : The aim of study was to evaluate the efficacy of PSV when it is added to intermittent mandatory ventilation (IMV) in facilitating weaning process compared to IMV mode alone. METHOD: When the subject patients became clinically stable with their arterial blood gas analysis in acceptable range, they underwent weaning process either by IMV alone or by IMV plus PSV. The level of pressure support was held constant through the weaning period. For the patients who required mechanical ventilation for less than 72hr, 2h weaning trial was performed with IMV rate starting from 6/min. For the patients who required mechanical ventilation more than 72 hr, 7 hr weaning retrial was performed with IMV rate starting from 8/min. For the patients who failed three consecutive trials of weaning, retrial of weaning was attempted over 3 days with IMV rate starting from 8/min. Clinical characteristics, APACHE II score and nutritional status were compared. For all patients, heart rate, mean blood pressure and respiratory rate were mornitored for 48 hrs after weaning trial started. RESULTS: The total number of weaning trial was 37 in 23 patients(18 by IMV, 19 by IMV+PSV). Total ventilation time, APACHE II score and nutritional status were not statistically different between the two groups. The weaning success rate were not statistically different(38.3% by IMV, 42.1% by IMV+PSV) and the changes of mean blood pressure, heart rate, respiratory rate during first 48 hours were not different between the two groups. CONCLUSION: Low level PSV when added to IMV for weaning trial does not seem to improve the success rate of weaning from mechanical ventilation. PSV at 10cm H2O did not induce significant physiologic changes during weaning process.
APACHE ; Blood Gas Analysis ; Blood Pressure ; Heart Rate ; Humans ; Nutritional Status ; Respiration, Artificial ; Respiratory Rate ; Ventilation* ; Weaning*

PURPOSE: In most emergency departments (EDs), primary care is managed by medically inexperienced interns or general physicians. The resulting reduction in the quality of management and the long time necessary to manage patients leads to overcrowding of the ED. Thus, effective ED management, which can be achieved through primary care by doctors with licenses of emergency medicine, is required. METHODS: The author performed a retrospective analysis and compared 475 patients who visited our hospital from June 20, 2000, to June 26, 2000, which was during the doctors' strike period (SP) to 234 patients who visited our hospital from June 22, 1999, to June 28, 1999, during the nonstrike period (NSP). RESULTS: The total of 475 patients during the SP is significantly higher than the total of 234 patients during the NSP (p<0.01). The mean of 1.58, for the number of emergency laboratory test per patient during the SP was significantly lower than the mean of 2.21 during the NSP. As to emergency mangagement cases during the SP compared to the cases during the NSP, the number of simple management cases increased and the number of complex management cases decreased. As to the patients' lengths of stay (LOS) in ED, 79 patients (63.7%) during the SP were admitted within 3 hours, while 305 patients (86.9%) during the SP were discharged within 3 hours, so significance difference is present between the two groups (p< 0.05 ). CONCLUSION: This study demonstrates that replacing residents with staff physicians results in fewer laboratory tests ordered, fewer radiologic studies ordered, and shorter lengths of stay in the ED.
Emergencies* ; Emergency Medicine ; Emergency Service, Hospital* ; Humans ; Length of Stay ; Licensure ; Medical Staff* ; Primary Health Care ; Retrospective Studies ; Strikes, Employee

BACKGROUND: The past. studies on prediction formulas of pulmonary function parameters in healthy nonsmoking Korean adults have been performed in relatively small number of subjects and the reported results were restricted on a few parameters. Also there was no systematic investigation into the effect of smoking on pulmonary function parameters in smokers who have no respiratory symptoms. Therefore we attempted to establish prediction formulas of pulmonary function parameters and examined the effect of smoking on pulmonary function parameters. METHODS: We analyzed the result of parameters derived from the forced expiratory spirogram in 1,067 nonsmoking subjects from June in 1990 to December in 1991. They consisted of 306 males and 761 females and had neither respiratory symptoms nor history of respiratory disease. We derived prediction formulas by multiple linear regression method from their age, heights, and weights in each sex. To examine the effect of smoking on pulmonary function parameters, we classified 383 smoking men into three groups according to the past amount of smoking as follows : i.e. group of smokers who have smoked below 10 pack-years, 10-20 pack-years and above 20 pack-years. Regarding each group of past smoking as an independent dummy variable, we analyzed pulmonary function parameters including nonsmoking men as a baseline by multiple linear regression. We evaluated the smoking effect on pulmonary function parameters according to estimated p-value. RESULT: 1) Prediction formulas for pulmonary function parameters in each sex were derived. 2) The past smoking less than 10 pack-years does not give any effect on pulmonary function parameters. The past smoking of 10~20 pack-years showed significant negative correlation with FEV1/FVC and FEF 25~75%, and the smoking above 20 pack years showed negative correlation with FEV1 and FEV1/FVC. CONCLUSION: We have got prediction formulas of pulmonary function parameters which is driven from forced expiratory spirogram in nonsmoking Korean adults by multiple linear regression from age, heights and weights of subjects. The past smoking more than 10 pack-years showed negative correlation with some pulmonary function parameters of airflow obstruction.
Adult* ; Female ; Humans ; Linear Models ; Male ; Smoke* ; Smoking* ; Weights and Measures

CSF shunting procedures are widely employed in the treatment of hydrocephalus and other disturbances of the dynamics of CSF such as a rachnoid cyst and syrinx. The relative simplicity of this operation with respect to other neurosurgical procedures is matched by a high incidence of complications. Many kinds of shunt devices have been developed to reduce complications. Yet, this operation frequently requires surgical revision. Traditional shunts were primarily designed to manage hydrocephalus by regulating intracranial pressure. Those devices, in some circumstances, can cause to underdrain or overdrain CSF and may need a surgical revision to adjust the pressure Authors have treated 28 patients with the disturbaces of CSF dynamics using pressuread justable valve system (Codman-Medos p rogrammable Hakim valve system). Two patients had arachnoid cysts and the others had hydrocephalus with various etiologies. Subdural hygroma was developed in 5 patients and underdrainage was observed in 9 patients on CT scan. By adjusting the pressure, Authors achieved clinical improvements without a need for surgical revision. The optimum pressure was 97.4+17.4mmHO for the patients with hydrocephalus with various etiologies in adults. In conclusion, the incidence of shunt revision by using this shunt device for the treatment of hydrocephalus and arachnoid cysts was decreased.
Adult ; Arachnoid Cysts ; Humans ; Hydrocephalus ; Incidence ; Intracranial Pressure ; Lymphangioma, Cystic ; Neurosurgical Procedures ; Reoperation ; Subdural Effusion ; Tomography, X-Ray Computed ; Ventriculoperitoneal Shunt*

PURPOSE: These days, airline traffic is so developed that the globe has become much smaller and interest in fear of passenger-flight crashes is increasing. Using the opportunity offered by the Kimhae airline disaster, the author studied the relation of the injury mechanism & the seat-position to the injury severity in order to provide helpful information for use in other situations. METHODS: The author performed a retrospective analysis and compared survivors (37 persons) with deaths (129 persons) in the crash of Chinese passenger-flight B767-200 approaching Kimhae airport on April 15, 2002. RESULTS: Most of the survivors were seated in the rear of the airplane while most of those who died were in the front. Thus, a definite correlation exists between seat position in the aircraft and the injury severity. The deceleration force generated during a flight crash is sufficient to induce fatal injury. CONCLUSION: Most flight crashes are due to CFIT (controlled flight into terrain) accidents which are caused by the pilot being insensible to safety. This time, it was also the case. The author wishes it not to be the case next time.
Aircraft ; Airports* ; Asian Continental Ancestry Group* ; Deceleration ; Disasters ; Gyeongsangnam-do* ; Humans ; Retrospective Studies ; Survivors

The use of metallic plate and screws in the anterior cervical fusion has become generally acceptable and popular. Mainly, there are two different plating systems available. However, there has been few attempts to compare their clinical results with and without a plating system or between two different systems in a single series of clinical study. The authors reviewed 117 patients who underwent anterior cervical fusion during the period of January 1992 to September 1996. Simple fusion without a plating system was applied in 55 cases(group 1), a bicortical non-locked plate screw system in 25(group 2), and a monocortical locked plate screw system in 37(group 3). The average follow-up period was 13. 2 months. In group 1, twenty-two patients(40%) with fracture-dislocation or corpectomy required a rigid brace such as halo brace and Minerva cast for 3 months postope ratively and seven patients(13%) experienced graft complications, mainly graft extrusion. In group 2 and 3, the patients required only soft b races for 4 to 8 weeks and no patients experienced serious graft complications like ones in group 1 but, instead two patients with screw breakages, two back-outs and one non-union were observed. In comparison of the clinical complications such as hoarsness, there were no significant differences between the groups. In conclusion, the plating system in anterior cervical fusion appears to be safe despite the facts that mo re technical demands are required during surgery. It also provides better postoperative stability in the spine and permits earlier ambulation without a rigid brace. A monocortical locked plate screw system appears to have less hardware failures and better su rgical results than a bicortical non-locked plate screw system.
Allografts ; Braces ; Continental Population Groups ; Follow-Up Studies ; Humans ; Spine ; Transplants ; Walking

The functional derangement of skeletal muscles which may be attributed to chronic hypoxia has been accepted as a possible mechanism of exercise impairment in patients with chronic obstructive pulmonary disease (COPD). The metabolc changes in skeletal muscle in patients with COPD are characterized by impaired oxidative phosphorylation early activation of anaerobic glycolysis and excessive lactate and hydrogen ion production with exercise. But the cause of exercise limitation in patients with chronic lung disease without hypoxia has not been known. In order to evaluate the change in the skeletal muscle metabolism as a possible cause of the exercise limitation in chronic lung disease patients without hypoxia, we compared the muscular metabolic data of seven male patients which had been derived from noninvasive 31P magnetic resonance spectroscopy(MRS) with those of five age-matched normal male control persons. 31P MRS was studied during the sustained isometric contraction of the dominant forearm flexor muscles up to the exhaustion state and the recovery period. Maximal voluntatry contraction(MVC) force of the muscle was measured before the isometric exercise, and the 30% of MVC force was constantly loaded to each patient during the isometric exercise. There were no differences of intracellular pH (pHi) and inorganic phosphate/phosphocreatine (Pi/PCr) at baseline, exhaustion state and recovery period between two groups. But pHi during the exercise was lower in patients group than the control group (p<0.05). Pi/PCr during the exercise did not show significant difference between two groups. These results suggest that the exercise limitation in chronic lung disease patients without hypoxia also could be attributed to the abnormalities in the skeletal muscle metabolism.
Anoxia ; Exercise ; Forearm ; Glycolysis ; Humans ; Hydrogen-Ion Concentration ; Isometric Contraction ; Lactic Acid ; Lung Diseases ; Lung* ; Magnetic Resonance Spectroscopy* ; Male ; Metabolism* ; Muscle, Skeletal* ; Muscles ; Oxidative Phosphorylation ; Protons ; Pulmonary Disease, Chronic Obstructive