BACKGROUND: Ketamine use in emergency room has been increased. It has rapid onset of action and appropriate duration of action. It does not need endotracheal intubation and produces potent analgesia, sedation, and amnesia. The object of this study is to determine the safety and the degree of physician's satisfaction in relation to ketamine use. MATERIALS AND METHODS: This is a prospective study using protocol. Pediatric trauma patients who need sedation were given IM ketamine(4mg/kg) and atropine(0.01mg/kg) in a same syringe. Monitoring of patients was done by EM residents and complications of ketamine use were recorded. Physician's satisfaction was also recorded after the procedure. RESULTS: Intramuscular ketamine was administered 54 times, mainly for laceration repair. Physicians completed protocol for 51 of treated children. The median time for onset of sedation was 6.5+/-2.4 min, and duration of action was 32.4+/-10.8 min. Hypersalivation occurred in 9.8%(n=5); random movement 3.9%(n=2), emesis during procedure(n=1), emesis at home(n=1), and transient oxygen desaturation(n=1). All were quickly identified and treated without specific airway management and sequelae. Of 84% of physicians was satisfied with ketamine use for pediatric sedation. CONCLUSION: Intramuscular ketamine can be administered safely and satisfactorily in emergency room to facilitate pediatric procedures in conjunction with a defined protocol and appropriate monitoring.
Airway Management ; Amnesia ; Analgesia ; Child ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Intubation, Intratracheal ; Ketamine* ; Lacerations ; Oxygen ; Prospective Studies ; Sialorrhea ; Syringes ; Vomiting

No abstract available.
Pre-Eclampsia* ; Proteinuria*

While renovating our traditional medical curriculum to integrated curricular system in 1996, we planned to introduce a course of problem-based learning (PBL) on tutorial basis after finishing 14 courses of the integrated medical curriculum for two years. One tutorial group was composed of one tutor and eight students, and 105 students of the second grade were divided into thirteen small tutorial groups. The period of PBL course was two weeks from December 1 to 14 in 1997. There were three interrelated steps for design of PBL course: course preparation, implementation, and evaluation which were conducted by PBL subcommittee consisted of nineteen teachers. Students were exposed to four clinical case modules, and they met in small tutorial room three times per week for two weeks. The PBL programme was evaluated by questionnaire survey method at the end of PBL course. We obtained satisfactory and positive results from reply of faculty and students. Since many teachers participated in planning, implementing, and evaluation of PBL, we could accumulate lots of knowledge and skills regarding the PBL, and it was a good opportunity to train expertise for PBL, test the feasibility changing to PBL curriculum. At this moment, our present integrated medical curriculum will be gradually converted to PBL system totally, and our experience will provide a good aid for other medical schools appling traditional medical curriculum to introduce PBL in their medical education.
Curriculum ; Surveys and Questionnaires ; Education, Medical ; Humans ; Problem-Based Learning* ; Schools, Medical

PURPOSE: The purpose of this study was to evaluate and compare the scintigraphic findings and diagnostic accuracy of double-phase Tc-99m sestamibi scan in primary and secondary hyperparathyroidism (HPT). MATERIALS AND METHODS: We retrospectively reviewed 16 cases of primary (18 lesions) and 11 cases of secondary HPT (44 lesions) who underwent Tc-99m-sestamibi scan before the surgical intervention. Scan was performed using LEM camera (Siemens, Germany) after the injection of 740MBq of Tc-99m sestamibi. Routine image consisted of baseline and 3-hour delayed images and each image was obtained using both parallel and pine hole collimator. The study population was 27 patients (male/female=5/22, age: 49.1+/-10.8). RESULTS: Eighteen lesions of primary HPT consisted of 13 adenomas and 5 hyperplasias, while all lesions of secondary HPT were hyperplasias. Among the case of primary HPT, we could detect all the lesions of 13 adenomas but only 2 lesions of 5 hyperplasias (40%) could be detected by double phase scintigraphy. Three cases of primary lesion showed decreased uptake in delayed images compared with baseline. The sensitivity, specificity, positive predictive value and accuracy of primary and secondary HPT were 58.8% (10/17), 83.3% (10/12), 83.3% (10/12), 75.9% (22/29), and 37.5% (15/40), 50% (2/4), 88.2% (15/17), 38.6% (17/44), respectively. Overall sensitivity, specificity, positive predictive value and accuracy were 43.9% (25/57), 75% (12/16), 86.2% (25/29), and 53.4% (39/73). There were no statistical difference between the weight of primary and secondary HPT lesion (p>0.05). CONCLUSION: Tc-99m sestamibi scan is fairly good modality to detect parathyroid lesion in patient with primary HPT before the surgical intervention. However, since some of cases may reveal decreased uptake in delayed image, a careful attention to the findings of baseline images may be helpful. Still the low accuracy of sestamibi scan in diagnosis of secondary HPT prohibits routine use of it for this disease.
Adenoma ; Diagnosis ; Humans ; Hyperparathyroidism, Primary ; Hyperparathyroidism, Secondary* ; Hyperplasia ; Parathyroid Glands ; Radionuclide Imaging* ; Retrospective Studies ; Sensitivity and Specificity

As regard to the treatment modality and its prognosis following the treatment, there are some differences between the thoracolumbar compression fracture and bursting fracture. If bursting fracture is accompanied by nerve injury, especially if the fracture fragment is compressing the spinal cord, it is reported that decompression with early surgical intervention would achieve a much better prognosis. Therefore, the authors tried to suggest an overall statistics on the patient's age, mechanism of injury and injured site and to compare the sensitivity of tools used in diagnosing bursting fracture radiologically, as well as the sensitivity of posterior vertebral body angle, which is used in diagnosing subtle bursting fracture. Three hundred forty three patients admitted to emergency center of Yongdong Severance Hospital with a thoracolumbar fracture from 1992. Jan. to 1994. Dec. Of the 343 patients, minor fracture and those with insufficient X-ray films and clinical notes were excluded from the study. The study was done with 199 patients in retrospective method. All the 199 patients had plain X-ray and computed tomography taken. the results were as follows 1. The male to female ratio was 114 to 85 with average age being 47.1 years old(14-93 years old). 2. The mechanisms of injury were falling down, traffic accident, slipped down, sprain and confusional injury in the order written. 3. There were 67 cases of compression fracture and 132 cases of bursting fracture. 157 cases had I level injury in the order of Ll, T12, and L2, 33 cases had 2 level injury, and 8 cases were injured in 3 level of the spine. 4. Of the factors determining the radiological diagnosis of bursting fracture, the disruption of posterior cortical line had the highest sensitivity. 5. Of the 45 cases of 1 level injured subtle bursting fracture, those with posterior vertebral body angle of more than 100 degree radiographically had a sensitivity of 82%. Of the thoracolumbar fractured patient admitted to the emergency room, searching for disruption of posterior cortical line in plain film helped in diagnosing bursting fracture, and calculating the posterior vertebral body angle helped in determining whether further computed topography was needed in subtle bursting fracture.
Accidents, Traffic ; Decompression ; Diagnosis ; Emergencies ; Emergency Service, Hospital ; Female ; Fractures, Compression ; Humans ; Male ; Prognosis ; Retrospective Studies ; Spinal Cord ; Spine ; Sprains and Strains ; X-Ray Film

STUDY DESIGN: Retrospective study. PURPOSE: This retrospective study aimed to determine the incidence of adjacent level new fractures in a sandwich constellation (one or two untreated vertebrae between two cemented vertebrae) compared with that in other constellations formed by two-level percutaneous vertebroplasty (PVP). It also aimed to investigate the potential factors contributing to adjacent new fractures in a sandwich constellation. OVERVIEW OF LITERATURE: There are few studies regarding the intervening intact vertebral body between two cemented vertebrae. Clinical data from previous studies investigation this sandwich situation, too, have been vague. METHODS: Clinical data were obtained from 132 patients who had two cemented vertebral bodies, irrespective of whether they had undergone one or two PVP sessions between January 2013 and June 2016 at a single institution. Cases with one or two intact vertebral levels between the two cemented vertebrae were classified into group 1 (n=47), and cases with two consecutive cemented bodies or more than three levels of intervening configurations were classified into group 2 (n=85). Demographic data and radiological parameters for new fractures after PVP were compared between the two groups, and the rates of subsequent adjacent fractures were investigated. RESULTS: The incidence of single-level sandwich constellations was quite uncommon (7.7%). The overall incidences of adjacent fracture were 29.8% (14/47) in group 1 and 14.1% (12/85) in group 2. This difference was statistically significant (p=0.03). Approximately 80% (11/14) of the adjacent new fractures in group 1 developed at an intervening level. The patient demographics and radiological parameters for subsequent fractures after PVP did not statistically correlate with the risk of adjacent new fractures in group 1. CONCLUSIONS: Because they were subjected to double-load shifts, sandwich constellations were prone to re-fractures after PVP. These vertebral configurations required more aggressive management for osteoporosis.
Demography ; Humans ; Incidence ; Osteoporosis ; Retrospective Studies ; Spine ; Vertebroplasty

BACKGROUND: Abdominal pain is one of the most common complaints in the emergency department and the evaluation presents an extraordinary challenge to the emergency physician's skill. C-reactive protein, an acute phase protein which is increased in the presence of inflammation in various clinical conditions, has been proven useful in assessing disease severity, in monitoring the development of complications, and in evaluating the response to specific treatments. So we tried to determine whether CRP offers an advantage over other clinical or laboratory variables for decision-making in the management of acute abdominal pain in the emergency department. METHOD: Patients who came to a University Hospital ED with acute abdominal pain, between september 1, 1998 and November 30, 1998, were included in this study, Data collection included age, sex, duration of symptom, location of pain, and laboratory dta(white blood cell count, portion of neutrophils, ESR, CRP, amylase). RESULT: This study included 85 patients, 34 of whom were men. The mean age was 36.9+/-19.1 years. CRP might be useful to detect the serious condition, sensitivity 81%, but more useful to differentiate normal condition from serious condition in acute abdominal pain patients, specificity 83%. CONCLUSION: CRP is an useful indicator of decision-making to abdominal patients in the emergency department. Hospitalization or operation is very unlikely when CRP value is normal.
Abdominal Pain* ; Acute-Phase Proteins ; Blood Cell Count ; C-Reactive Protein* ; Data Collection ; Emergencies ; Emergency Service, Hospital ; Hospitalization ; Hospitals ; Humans ; Inflammation ; Male ; Neutrophils ; Sensitivity and Specificity

OBJECTIVE: The presence of the various cytokines in human peritoneal fluid has been evaluated incompletely. Changes in cytokine lefels may be related to activation of peritoneal macrophage and T-lymphocyte, development of endometriosis, and infertility. This study assesses peritoneal fluid levels of interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10) and tumor necrosis factor-alpha (TNF-alpha) in infertile women with endometriosis and normal women without endometriosis. Design : Prospective and case-control study in university hospital. MATERIALS AND METHODS: Cytokine levels in peritoneal fluid obtained during laparotomy or laparoscopy from 21 patients in infertile patients in infertile patients with endometriosis and 24 controls undergoing laparotomy or laparoscopy with no evidence of pelvic endometriosis were determined by enzymelinked immunosorbent assay. RESULTS: The mean levels of interleukin-6 in infertile patients with endometriosis and controls were 72.7+/-23.7 pg/ml and 18.5+/-9.7 pg/ml respectively (p=0.02). Similarly, the mean levels of interleukin-8 in infertile patients with endometriosis was significantly higher than that of controls (445.0+/-89.6, vs 45.1+/-48.4, p=0.04). The mean concentration of interleukin-10 in infertile patients with endometriosis was significantly lower than that of controls (1.09+/-0.04 vs 2.19+/-0.03, p=0.03). The level of tumor necrosis factor-alpha was not significantly different between the two study groups. CONCLUSIONS: Increased IL-6 and IL-8 and decreased IL-10 levels in the peritoneal fluid may be related to pathogenesis in the endometriosis and infertility, suggesting that partially contribute to the disturbed immune regulation observed in infertili women with endometriosis.
Ascitic Fluid* ; Case-Control Studies ; Cytokines ; Endometriosis* ; Female ; Humans ; Infertility ; Interleukin-10 ; Interleukin-6 ; Interleukin-8 ; Laparoscopy ; Laparotomy ; Macrophages, Peritoneal ; Prospective Studies ; T-Lymphocytes ; Tumor Necrosis Factor-alpha

PURPOSE: To evaluate the radiographic results of patients with subtrochanteric femoral fracture using minimal incision and cephalomedullary nail technique. MATERIALS AND METHODS: This study was performed on 54 patients, 54 cases of hip, recruited among patients who underwent minimal incision and Cephalomedullary nail from September 2005 to August 2008 and were available for 1-year or longer follow up. The gender ratio was 37 males and 17 females, and the mean age at the time of surgery was 57.4 years (range; 16~81 years). According to injury mechanism, traffic accident was 29 cases, fall down form high height was 18 cases, slip down was 7 cases. In classification by Seinsheimer, type II was 23 cases (m/c), type III was 18 cases, type IV was 13 cases. Average follow up period was 14 months (12~18). Radiographic evaluation was performed for time taking union, mal-union and complication. RESULTS: 53 of the 54 cases united. 39 of 54 reductions were anatomic. 19 fractures had a monir varus deformity of proximal fragment (between 2degrees and 5degrees). There was no varus deformity of more than 5degrees. 1 case that had been treated with PFN had nail breakage without trauma. There were no other complications. CONCLUSION: Surgical treatment of subtrochanteric fractures with minimal incision and Cephalomedullary nail technique can reslut in excellent reduction without complications including inflammation & malunion. Careful attention to detail for using Lowman clamp is demanding to decrease soft tissue injury.
Accidents, Traffic ; Congenital Abnormalities ; Female ; Femoral Fractures ; Follow-Up Studies ; Hip ; Hip Fractures ; Humans ; Inflammation ; Male ; Nails ; Soft Tissue Injuries

No abstract available.
Diagnosis* ; Polycystic Kidney Diseases*