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

No abstract available.
Ifosfamide*

A retrospective study was done on secondary intraocular lens implantation in 19 children(22 eyes)who were not satisfied with aphakic glasses and were not tolerant with contact lenses.In all cases,postoperative visual acuity improved or remained at the preoperative level.In 10 cases,postoperative visual acuity was better than 20/40. After at least 12 months of follow-up,average difference of refractive power between the two eyes in the same patient is 0.79 diopter. Early postoperative complications related to secondary intraocular lens implantation were vitreous hemorrhage(1 eye)and IOL decentration. Vitreous hemorrhage was resorbed in three weeks.In case of IOL decentration,we repositioned the IOL.Late complcations during the follow-up period included development of dense capsular opacification in four eyes.They are all treated by Nd:YAG capsulotomy. After capsulotomy there were some improvement in visual acuity. From these results,secondary intraocular lens implantation appears to be a safe, effective method for correction of aphakic children who are not satisfied with aphakic glasses and/or intolerant of use of contact lenses.
Aphakia* ; Child ; Contact Lenses ; Eyeglasses ; Follow-Up Studies ; Glass ; Humans ; Lens Implantation, Intraocular* ; Lenses, Intraocular* ; Postoperative Complications ; Retrospective Studies ; Visual Acuity ; Vitreous Hemorrhage

BACKGROUND: Mannitol is widely used in neurosurgical patients and may induce an increase in serum potassium concentration according to doses and administration rates with unknown mechanism. The treatment of hyperkalemia is aimed at eliminating the causes and includes calcium, sodium bicarbonate, glucose with insulin, loop diuretics and hyperventilation. This study was undertaken to observe the effects of hyperventilation on the serum potassium concentration following infusion of mannitol (2.0 gm/kg). METHODS: We studied 30 patients who were operated brain aneurysm clipping surgery and were divided into 3 groups (n=10). In control group, mild hypocapnia was maintained (PaCO2, 32 2 mmHg) before and after mannitol infusion. In group I, moderate hypocapnia was maintained (PaCO2, 27 2 mmHg) before and after mannitol infusion. In group II, mild hypocapnia (PaCO2, 32 2 mmHg) was maintained before 30 minutes of mannitol infusion and moderate hypocapnia (PaCO2, 27 2 mHg) after mannitol infusion. We started infusion of 20% mannitol with a dosage of 2.0 gm/kg, 15~20 min after cranium was opened. RESULTS: The changes of serum potassium were as follows (Mean SD mEq/l) (just before and 15min, 30min, 60min after mannitol infusion): 3.79 0.48, 4.66 0.60, 4.44 0.48, 4.13 0.40 (Control group), 3.62 0.18, 3.63 0.42, 4.14 0.51, 3.95 0.33 (Group I), 3.76 0.20, 3.91 0.15, 4.11 0.30, 4.04 0.23 (Group II). After 15 minutes of mannitol infusion, the serum potassium levels of group I and II were lower than that of control group (p<0.05) and there was no significant difference between group I and II. CONCLUSIONS: These results suggest that hyperventilation may blunt the increase in serum potassium concentration following rapid infusion of high dose mannitol.
Calcium ; Glucose ; Humans ; Hyperkalemia ; Hyperventilation* ; Hypocapnia ; Insulin ; Intracranial Aneurysm ; Mannitol* ; Potassium* ; Skull ; Sodium Bicarbonate ; Sodium Potassium Chloride Symporter Inhibitors

The changes of arterial carbon dioxide partial pressure considerably influence cerebral blood flow and different anesthetic agents have different effects on cerebrovascular physiology. However the importance of these differences in neuroanesthetic practice are unclear. Transcranial Doppler ultrasonography allows the noninvasive direct measurements of cerebral blood flow velocity and direction in the basal brain arteries. The authors performed transcranial Doppler ultrasonography to measure the blood flow velocity of middle cerebral artery in 12 patients who were anesthetized with 10 mcg/kg of fentanyl and 66 % nitrous oxide in oxygen(fentanyl group) and 12 patients with 1.0 vo1% isoflurane and 66 % nitrous oxide in oxygen(isoflurane group) during normocapnia(P(ET)CO(2)=38 mmHg) and hypocapnia(P(ET)CO(2)=28 mmHg)state. The carbon dioxide reactivity was expressed as the changes in mean blood flow velocity per unit changes in endtidal carbon dioxide partial pressure(P(ET)CO(2)). Mean blood flow velocity of middle cerebral artery decreased from 46.6+/-8.9 cm/s to 30.0+/-5.3 cm/s in the fentanyl group and 42.7+/-5.6 cm/s to 32.5+/-4.6 cm/s in the isoflurane group as the P(ET)CO(2) decreased from 38 mmHg to 28 mmHg. There was a significant difference between the CO2 reactivity of fentanyl group(1.7+/-0.7 cm/s/mmHg) and isoflurane group(1,0+/-0,2 cm/s/mmHg) (p<0.05). It is concluded that hyperventilation is more likely to affect cerebral blood flow during fentanyl-nitrous oxide anesthesia than during isoflurane-nitrous oxide anesthesia.
Anesthesia ; Anesthetics ; Arteries ; Blood Flow Velocity ; Brain ; Carbon Dioxide ; Fentanyl* ; Humans ; Hyperventilation ; Isoflurane* ; Middle Cerebral Artery ; Nitrous Oxide ; Partial Pressure ; Physiology ; Ultrasonography, Doppler, Transcranial

No abstract available.
Interleukin-4* ; Interleukins* ; Receptors, Interleukin-4* ; Rheumatic Diseases*

Prader-Willi syndrome is a well known multi-systemic disorder featuring hypothalamic dysfunction and hypotonia with underlying chromosomal anomaly. High morbidity, early mortality due to complications as diabetes mellitus, hypertension, athero-sclerosis, and cardio-respiratory failure have been reported from poorly tolerated obesity and combined metabolic disorders. We experienced a 20-year- old girl with Prader-Willi syndrome diagnosed at the age of 7. She underwent massive, uncontrolled weight gain despite constant multi-drug therapy including human recombinant growth hormone, orlistat, sibutramine and combined behavioral managements. Her body weight reached 104 kg and she developed dyslipidemia, fatty liver, hypertension, diabetes mellitus and episodes of sleep apnea. She showed no significant response to the supportive treatment because of characteristic involvement in CNS especially hypothalamus and psycho-behavioral disorders. As Bariatric surgery was the most effective and curative method in treatment of severe morbid obesity, Roux-en-Y gastric bypass was performed. After the operation, she showed substantial weight loss and consequent improvements in obesity related complications. She could stop all medications concerning for obesity. We report a case of bariatric surgery on a girl with Prader-Willi syndrome and combined severe morbid obesity who underwent bariatric surgery which resulted in marked weight loss and improvements in associated complications.
Bariatric Surgery* ; Body Weight ; Diabetes Mellitus ; Dyslipidemias ; Fatty Liver ; Female ; Gastric Bypass ; Growth Hormone ; Humans ; Hypertension ; Hypothalamus ; Mortality ; Muscle Hypotonia ; Obesity ; Obesity, Morbid* ; Prader-Willi Syndrome* ; Sleep Apnea Syndromes ; Weight Gain ; Weight Loss

PURPOSE: The purpose of this study was to explore the differential effects of multi-dimensional perfectionism on academic achievement, depression, engagement, and burnout in medical students. Also, the mediating effects of engagement on perfectionism and academic achievement, as well as the effects of burnout on perfectionism and depression, were examined. METHODS: Two hundred eight medical students participated, and 167 students completed questionnaires, including the Frost Multi-dimensional Perfectionism Scale (FMPS), Hewitt & Flett Multi-dimensional Perfectionism Scale (HFMPS), Beck Depression Inventory (BDI), Schaufeli Engagement Scale (SES), and Malslach Burnout Inventory-General Survey (MBI-GS). Academic achievement was measured as the grade point average (GPA) of the previous semester. Data were analyzed by correlation analyses, independent t-tests, and Structural Equation Model (SEM) for path analysis. RESULTS: Adaptive perfectionism (personal standard, self-oriented perfectionism) was associated with GPA (r=0.164, p<0.05; r=0.173, p<0.05) and engagement (r=0.394, p<0.01; r=0.449, p<0.01), and maladaptive perfectionism (parental criticism, concern over mistakes, socially prescribed perfectionism) was associated with depression (r=0.208, p<0.01; r=0.254, p<0.01; r=0.234, p<0.01) and burnout (r=0.218, p<0.01; r=0.236, p<0.01; r=0.280, p<0.01). Engagement had mediating effects on adaptive perfectionism and GPA, and burnout had mediating effects on maladaptive perfectionism and depression. Students who experienced academic failure had lower engagement than those who did not. CONCLUSION: This study demonstrates that academic achievement and emotional difficulties such as depression are determined by adaptive and maladaptive perfectionism, respectively, in medical students.
Achievement ; Adaptation, Psychological ; Burnout, Professional ; Depression ; Humans ; Negotiating ; Students, Medical ; Surveys and Questionnaires

No abstract available.

BACKGROUND: The addition of epinephrine to local anesthetics has been known to prolong the duration of neural blokade and to increase the intensity of analgesia, but underlying mechanisms are unclear. This study was designed to investigate electrophysiologically the analgesic effects of epinephrine and its interaction with tetracaine. METHODS: Whole cell patch clamp recordings were made from acutely dissociated neurons from adult rat dorsal root ganglion (DRG). Using voltage clamp method, we compared the IC50 values of tetracaine for Na+ and Ca2+ channel suppression in the absence and presence of a fixed dose of epinephrine. Action potentials evoked by current pulses were also investigated to evaluate the effect of tetracaine and epinephrine on the excitability of DRG neurons. RESULTS: Clinical doses of epinephrine did not alter the dose-response curves of tetracaine for peak Na+ and Ca2+ channel current, but the amplitude of action potential spikes was reduced and firing rates evoked by sustained current pulse increased. The addition of epinephrine did not affect the changes of action potential parameters caused by tetracaine alone. CONCLUSIONS: The ability of epinephrine to increase the intensity of analgesia induced by tetracaine seems more likely due to an analgesic action at the level of spinal cord rather than a direct analgesic action at a level of primary sensory neurons. Local vasoconstriction and stimulation of descending inhibitory system via alpha-adrenergic pathway may play a role.
Action Potentials ; Adult ; Analgesia ; Anesthetics, Local ; Animals ; Diagnosis-Related Groups ; Epinephrine* ; Fires ; Ganglia, Spinal* ; Humans ; Inhibitory Concentration 50 ; Neurons ; Rats ; Sensory Receptor Cells ; Spinal Cord ; Spinal Nerve Roots* ; Tetracaine* ; Vasoconstriction