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

PURPOSE: Every country has a unique emergency medical system (EMS), as well as a medical service system. In Korea, relationship or cooperation between layperson, firehouse rescue and hospital is weak, and lack of involvement of emergency doctor in prehospital emergency medical system is one of the main cause of the phenomenon. There is possibility of improving prehospital EMS by the role of Emergency Medical Information Center (EMIC). Thus, the authors made a through investigation to improve the role of EMIC. METHODS: Questions concerning the following were sent to firehouse EMTs: 1) general matters related to communication, possibility of management after hospital arrival, rescue activities, etc., 2) educational matters about classification of severity, etc., and 3) matters about recognition and utilization of the EMIC. RESULTS AND CONCLUSION: An index guide for emergent management at the very spot where the accident took place is needed and should be published. Also, the EMIC must store more accurate information on emergency medical institutes, allowing firehouse rescue and hospitals to be more closely connected with each other by way of the EMIC.
Academies and Institutes ; Classification ; Emergencies ; Information Centers* ; Korea

OBJECTIVE: Measurement of intracranial pressure(ICP) is important in patients at risk of raised ICP. To evaluate the usefulness of measuring epidural pressure measurements for the estimation of intracranial pressure, we studied the relationship between epidural pressure and ventricular pressure. PATIENTS AND METHODS: From Nov. '97 to Jul. '98, 10 patients of extraventricular drainage(Group A) and 12 patients of decompressive craniectomy(Group B) are included in this study. Simultaneous recording of intracranial pressure (ICP) from an air-pouch epidural pressure monitoring system and a ventricular catheter was compared. RESULTS: The epidural pressure group(Group A) showed marked high epidural pressure(32.6+/-13.4mmHg) compared with those of intraventricular pressure, but in decompressive craniectomy group(Group B) shows nearly the same values(2.1+/-6.9mmHg). CONCLUSIONS: On the basis of the available comparison between these two methods of measuring intracranial pressure, in the light of the data we had established and the importance of ICP monitoring in neurosurgical critical care, intradural monitoring technique appears to be our measuring method of choice.
Catheters ; Critical Care ; Decompressive Craniectomy ; Humans ; Intracranial Pressure ; Ventricular Pressure*

No abstract available.
Diagnosis* ; Hemangioma* ; Tomography, Emission-Computed, Single-Photon*

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: Overcrowding of emergency departments remains an unsolved international issue and has led to not a few unfavorable consequences. For a solution of this, appropriate patient triage and selection of appropriate hospitals to which to be transported will be essential. METHODS: The authors performed a prospective analysis of 690 patients transported via emergency transport services to the Emergency Department of Pusan National University Hospital between May 1, 2000 and June 30, 2000. RESULTS: Five hundred five cases (73.2%) were considered as appropriate transport, but 185 (26.8%) were not. In 300 cases (43.5%), the hospitals to which the patients were transported had been decided by the patient's family members, in 283 cases (41.0%) by medical professionals, in 70 cases (10.1%) by EMS personnels, and in 37 cases (5.4%) by the patients themselves. In the selection of the hospital to be transported to, patients and family members took the patient's medical condition into consideration less seriously than the other groups, but they had the greatest influence on the decision. CONCLUSION: The patients and their family members turned out to be unsuitable for the selection of the hospital to be transported to, but they actually had the greatest influence on the selection. The EMS personnels had limited influence on the selection, and they were lacking in ability to select appropriate hospital with the consideration of the patient's condition. For now there's no active regional ambulance destination policy or decision scheme. For the optimization of emergency transport activity, every effort should be made to enhance the role and ability of EMS personnels in patient triage and selection of transported hospital and to develope well-functioning ambulance destination policies as soon as possible.
Ambulances ; Busan* ; Emergencies* ; Emergency Service, Hospital ; Humans ; Prospective Studies* ; Triage

Approximately 1% of all the meningiomas arise from the extradural space. Intradiploic meningiomas constitutes only a very small percentage of this figure. Because of its rarity, it is often confused preoperatively with primary bone tumors of the skull. The intradiploic meningioma of the orbital wall may be considered as a subgroup of intradiploic ectopic meningioma. The following is our report of a recently observed case of intradiploic meningioma of the orbital wall without intracranial or intraorbital involvement. The preoperative tentative diagnosis was osteoma of the orbital wall. Nomenclature and histogenesis of this type of meningioma are discussed.
Diagnosis ; Meningioma* ; Orbit* ; Osteoma* ; Skull

Approximately 1% of all the meningiomas arise from the extradural space. Intradiploic meningiomas constitutes only a very small percentage of this figure. Because of its rarity, it is often confused preoperatively with primary bone tumors of the skull. The intradiploic meningioma of the orbital wall may be considered as a subgroup of intradiploic ectopic meningioma. The following is our report of a recently observed case of intradiploic meningioma of the orbital wall without intracranial or intraorbital involvement. The preoperative tentative diagnosis was osteoma of the orbital wall. Nomenclature and histogenesis of this type of meningioma are discussed.
Diagnosis ; Meningioma* ; Orbit* ; Osteoma* ; Skull