The globus symptom is a condition in which a patient, often middle aged women, complains of a lump andchocking sensation in the throat, Functional disturbance of the cricopharyngeal muscle, rendering it incapable ofrelaxing during swallowing, has long been recognized as a cause of globus symptom and dysphagia. We wanted to findout how often and to what extent distrubed relaxation of the cricopharyngeal muscle can be seen in patients withglobus symptom with routine examination and video esophagogram. The results were as follows: 1. Male : femaleratio was 1:2.4. 2. Globus symptom was most frequent in the age group between 30-39 of female. 3. Organic lesionswere seen in 43.6%(24 Pts) of globus patients. 4. Cricopharyngeal muscle was visualized in 29.1%(16Pts), esophageal diverticulum in 3.6%(2 Pts) and degenerative spondylosis in 3.6%(2 Pts). 5. Incidence of visualizationof cricopharyngeal muscle were higher in male group (50%) than female one (20.5%). 6. Cricopharyngeal muscle wasmost frequently visualized on early swallowing phase(12/16 Pts).
Deglutition ; Deglutition Disorders ; Diverticulum, Esophageal ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Pharynx ; Relaxation ; Sensation ; Spondylosis

The anterior middle fossa is the most common location of benign intracranial arachnoid cysts. In the adult, headache, temporal bulging, and mild proptosis are the usual presenting complaints, although seizures and contralateral weakness have been described. Bitemporal hemianopsia associated with this lesion has not been noted previously. Herein we describe the patient with bitemporal hemianopsia associated with sylvian fissure arachnoid cyst. Cystoperitoneal shunt was beneficial. The etiology, histology, and suggested therapy of other patient with arachnooid cyst are also discussed.
Adult ; Arachnoid Cysts ; Arachnoid* ; Exophthalmos ; Headache ; Hemianopsia* ; Humans ; Seizures

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

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

Author performed this experiment to define the most important factor preventing the intimal thickening. An endothelium of abdominal aorta in the rat was denuded by two different wires having same caliver. The degree of injury was limited to the endothelial cells in one, and extended to the internal elastic lamina in another. The results showed that at 72 hours, in the case of superficial injury, the entire injury site was covered by new regenerating cells, but in the case of disruption of the internal elastic lamina, the migrating smooth muscle cell completely reached into the intima and resulted in intemal thickening. Similar findings persisted to 1 week later. Above results suggest the most important factor preventing the intimal thickening in endothelial injury is the depth of the injury which limited within the endothelial cells without extending into the internal elastic lamina and medial smooth muscle cells.
Rats ; Animals

No abstract available.
Carcinoma, Squamous Cell* ; Tuberculosis, Laryngeal*

We report a case of pneumonia in 36 year-old male patient who presented acute respiratory failure and associated radiologic findings of bilateral ground-glass opacity with focal cystic changes, showing rapidly aggravating course and was diagnosed as concomitant Pneumocystis carinii and Cytomegalovirus pneumonia accompanied by acquired immunodeficiency syndrome through antemortem open lung biopsy.
Acquired Immunodeficiency Syndrome ; Biopsy ; Cytomegalovirus ; Humans ; Lung ; Male ; Pneumocystis carinii ; Pneumonia ; Respiratory Insufficiency*

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

Biliary endoprosthesis could provide permanent internal biliary drainage inpatient with obstructive jaundicewith advantages of absence of troublesome external catheter and no loss of fluid, bile and electrolytes overexternal drainage. Incidence of sepsis and cholangitis may be lowered. Endoprosthesis was performed in 18 patientsof obstructive jaundice from January, 1985 to december, 1985 at Department of Radilogy, Kyungpook NationalUniversity Hospital. The results are as follows: 1. The cases of obstructive jaundice included bile duct cancer in11, stomach ca. metastasis in 3, ca. of ampulla of Vater in 1, ca. of head of pancresas in 1, CBD cancer withpostop. recurrenced in 1, and impacted CBD stone in 1 case. 2. The levels of obstruction were at the trifurcationin 8, CHD in 5, proximal CBD in 3, and distal CBD in 2 cases. 3. Decline of serum bilirubin level was noted in 15cases with the most rapid decline wihtin 1 week after the procedure. 4. The complication occurred in 5 cases. Thethree cases were recovered spontaneously, but one died of bile peritonitis, another experienced obstrution ofendoprosthesis. 5. The endoprosthesis is benificial intreatment of obstructive jaundice for which surgery is notindicated, and saving expensive abdominal surgery and less advantageous percutaneous external drainage, henceenhancing life quality.
Ampulla of Vater ; Bile ; Bile Duct Neoplasms ; Bilirubin ; Catheters ; Cholangitis ; Drainage ; Electrolytes ; Gyeongsangbuk-do ; Head ; Humans ; Incidence ; Inpatients ; Jaundice, Obstructive ; Neoplasm Metastasis ; Peritonitis ; Quality of Life ; Sepsis ; Stomach

OBJECTIVE: To evaluate the effect of agonistic and antagonistic isometric contraction on the motor evoked potentials (MEP). METHOD: The MEP responses of right flexor carpi radialis (FCR) and extensor carpi radialis (ECR) muscles were simultaneously recorded during constant isometric flexion and extension of wrist. The intensities of isometric flexion and extension were 30%, 50%, and 100% of maximal voluntary contraction, which were achieved by isokinetic dynamometer. Background electromyographic activities in surface and needle electrodes were used for selective contraction. RESULTS: In agonistic muscles, the amplitudes of MEP responses were significantly increased according to the intensity of isometric contraction. In antagonistic muscles, the amplitudes of MEP responses in ECR were significantly increased with increasing intensity of isometric flexion. The amplitudes of MEP responses in FCR were increased with increasing intensity of isometric extension in spite of suppression in H-reflex of FCR during isometric extension. CONCLUSION: In antagonistic muscles, facilitation of MEP response in ECR and FCR during isometric contraction was occurred as in the agonistic isometric contraction.
Electrodes ; Evoked Potentials, Motor* ; Forearm* ; H-Reflex ; Isometric Contraction* ; Muscles ; Needles ; Transcranial Magnetic Stimulation ; Wrist