The authors have studied 67 biopsy specimens of the levator muscle, obtained from the external levator resection for ptosis of 50 patients. Atrophy marking as 3+ and complete absence of the levator muscle fiber were predominating in the specimens of severe congenital ptosis or ptosis with poor levator funtion. The degree of levator muscle atrophy seemed to be related with levator function. Fibrosis and fatty infiltration of the levator muscle and Muller's muscle were examined frequently in the specimens with severe atrophy of muscle fibers. On histochemical detection of muscle fibers using ATPase stain, lightly stained Type I fibers of the levator muscle were larger in amount than darkly stained Type II fibers and atrophy of the two fibers was similar in degree. Muller's muscle fibers were evenly stained with positive ATPase reaction but slightly lighter than Type II fibers.
Adenosine Triphosphatases ; Atrophy ; Biopsy ; Fibrosis ; Humans ; Muscular Atrophy

Proptosis of the left eye had developed in a 3-year old girl for 6 months duration. Computed tomogram studies showed a large mass in the retrobulbar space. A frozen section confirmed the presence of meningioma. To the author's knowledge, the patient was the youngest reported patient who has the primary orbital meningioma. We performed en bloc excision of the optic nerve and the tumor mass without enucleation. The patient showed no evidence of the anterior segment necrosis or increased intraocular pressure postoperatively. She had satisfactory cosmetic appearance without recurrence of the tmnor after 8 month.
Child, Preschool ; Exophthalmos ; Female ; Frozen Sections ; Humans ; Intraocular Pressure ; Meningioma* ; Necrosis ; Optic Nerve* ; Orbit ; Recurrence

We analysed 234 eyes of 184 patients with various types of glaucoma which had undergone trabeculectomy during the period of Sep. 1985 through Mar. 1988. The follow-up period was at least 3 month. The intraocular pressure was controlled by trabeculectomy alone in 187 of 234 eyes(79.9%), and additional 28(12.0%) eyes were controlled by trabeculectomy and medication. Average pressure lowering after trabeculectomy was 20.6mmHg. A successful trabeculectomy was achieved in 37 of 38 eyes with primary open angle glaucoma(97.4%), in 30 of 31 eyes with acute angle closure glaluoma(96.8%), in 96 of 99 eyes with chronic angle closure glaucoma(96.9%) and 27 of 31 eyes with secondary glaucoma(87.1%).
Follow-Up Studies ; Glaucoma ; Humans ; Intraocular Pressure ; Trabeculectomy*

We performed the combined trabeculectomy and extracapsular cataract extraction on 8 eyes of 8 patients with coexisting glaucoma and cataract during the period of April 1986 through March 1987. The mean postoperative intraocular pressure was reduced by approximately 46%, from 27.2 + 3.9mmHg preoperatively to 14.6 + 3.1mmHg postoperatively. 7 of the 8 eyes required no medication, but one needed topical medication for adequate control of the intraocular pressure, postoperatively. Visual acuity improved in 7 of the 8 eyes, but remained unchanged in one eye. Postoperative complications were few. We concluded that the combined trabeculectomy and extracapsular cataract extraction was safe and effective procedure.
Cataract Extraction* ; Cataract* ; Glaucoma ; Humans ; Intraocular Pressure ; Postoperative Complications ; Trabeculectomy* ; Visual Acuity

The reliability of emergency ultrasonographic(US) detection of hemoperitoneum and solid organ injury in blunt abdominal trauma was evaluated retrospectively. From October 1,1995 to August 31,1996,90 patients were included in the study. Ultra- sonographic findings showed a sensitivity, specificity, and accuracy of 97.6%, 97.9%, and 98.1%, respectively, in detecting intraabdominal fluid collection. We believe that US in an emergency center is a quick, safe screening method in the evaluation of blunt abdominal trauma. In our department, US has replaced diagnostic peritonaeal lavage(DPL) and computed tomography(CT) as the screening study of first choice.
Emergencies* ; Hemoperitoneum* ; Humans ; Mass Screening ; Retrospective Studies ; Sensitivity and Specificity ; Ultrasonography*

Hydrogen sulfide is a by-product of decayed organic material and is ubiquitously found as an ingredient of manufacturing reagents or as an undesirable by-product of the manufacturing or industrial processing. Hydrogen sulfide is a chemical asphyxiant and interferes with cytochrome oxidase and aerobic metabolism. It has thus been deemed an important cause of work-related sudden death. This gas is particularly insidious due to the unpredictability of its presence and concentration and its neurotoxicity at relatively low concentrations, causing olfactory nerve paralysis and loss of the warning odor. Here, we report two cases of comatose patients presenting after accidental exposure to hydrogen sulfide gas.
Coma ; Death, Sudden ; Electron Transport Complex IV ; Humans ; Hydrogen ; Hydrogen Sulfide ; Indicators and Reagents ; Occupations ; Odors ; Olfactory Nerve ; Paralysis ; Prognosis

PURPOSE: Overcrowding in urban emergency departments (EDs) while a decline in rural EDs due to mismatch of supply and demand of emergency medical resources are still issues to date. Therefore, this study analyzed the current characteristics and reality of bed utilization in the EDs of Korea. METHODS: Real-time availability of bed information was obtained from the emergency medical resource information system. The data were extracted for 4 weeks every 3 months, from April 2014 to January 2015. We analyzed the emergency department utilization (EDU) rate of emergency medical centers and hospitals based in 16 provinces in Korea. RESULTS: A total of 14,889,750 data were included. The total EDU rate was 20.0% (9.1-43.9%). The EDU rate was 66.7% (40.0-95.0%) for regional emergency medical centers (REMC), 33.3% (15.0-63.3%) for local emergency medical centers (LEMC), 11.1% (0.0-30.0%) for local emergency medical agencies (LEMA). The EDU rate was 71.4.0% (50.0.0-96.7.0%) for tertiary general hospitals (TGH), 20.0% (10.0-36.8%) for general hospitals (GH), and 10.0% (0-20.0%) for hospital & medical centers (HMC). The REMC EDU rate was high in Seoul and Jeonbuk, and low in Jeonnam and Gyeongbuk. The LEMC utilization rate was high in Daegu and Jeonbuk. The LEMA utilization rate was high in Daegu and Ulsan. Moreover, despite the same ED type, the EDU rate of high degree hospitals was higher. CONCLUSION: The EDU rate differed by region, emergency medical center, and hospital type. We should consider investing in appropriate personnel and emergency medical resources in places with suboptimal EDU rate.
Daegu ; Emergencies* ; Emergency Service, Hospital* ; Gyeongsangbuk-do ; Health Resources ; Hospitals, General ; Information Systems ; Jeollabuk-do ; Jeollanam-do ; Korea ; Seoul ; Ulsan

PURPOSE: The principle of prehospital transport is that the patient should be transported to the nearest hospital that is suitable for the severity of the illness. Therefore, out-of-jurisdiction transport is improper. The purpose of this study was to understand the present situation and evaluate the appropriateness of out-of-jurisdiction prehospital transport by the 119 rescue group. METHODS: Between January and December 2009 we enrolled patients who were transported to the Gwangju Regional Emergency Medical Center by the 119 rescue group, which belongs to Jeolla province. The appropriateness of out-of-jurisdiction transport was based on the transport chart and medical record of the 119 rescue group and categorized into three groups. RESULTS: The total number of patients transported was 440: 78 (17.7%) were appropriate; 329 (74.8%) were inappropriate; 33 (7.5%) patients were very inappropriate. Of the 440, 156 (35.5%) were emergency cases, 147 (33.4%) were sub-emergency cases, and 137 (31.1%) were non-emergency cases. Comparing these data with the triage by the 119 rescue group, the kappa value was 0.368 (p<0.001). The patients or their guardians selected the hospital to which the patient was be transported in 382 (86.8%) cases. The actual transport distance was 40.0 km (range: 26.0 to 50.0) and was significantly longer than the nearest distance to a local emergency center which was 10.0 km (4.0 to 18.0) (p<0.001). CONCLUSION: Inappropriate out-of-jurisdiction transporting of patients is done frequently. Therefore, guidelines for prehospital transportation according to the triage is necessary. Additionally, the medical director and emergency medicine information center could play a role in selecting a hospital. A fee or a fine of transporters who do not observe the guidelines might limit the proportion of inappropriate transport cases.
Ambulances ; Emergencies ; Emergency Medical Services ; Emergency Medicine ; Fees and Charges ; Humans ; Information Centers ; Medical Records ; Physician Executives ; Transportation ; Transportation of Patients ; Triage

PURPOSE: Consensus guidelines clearly define how cardiopulmonary resuscitation (CPR) is to be performed, but the parameters of CPR in actual practice are not routinely measured, nor is the quality known. We sought to investigate the actual quality of CPR performed by trained hospital staffs and to determine whether metronome guidance improved the quality of CPR. METHODS: A prospective study was performed on 26 out of hospital cardiac arrest patients who received CPR at an emergency department (ED). In the ED, resuscitation efforts were recorded by using a camcorder. Using the recorded data, we analyzed the parameters of CPR quality such as ventilation and chest compression rates. RESULTS: In the 26 cardiac arrests, the first nine cases constituted group I. The subsequent nine cases, after the rescuers had been re-trained to provide CPR according to the guideline, constituted group II. The final eight cases after the rescuers had been trained to use metronome guidance constituted group III. The average ventilation rate in group I was 30.7 ventilations/min. Although the average ventilation rate in group II was lower than that of group I, it was still higher than the recommended rate. After metronome guidance, the ventilation rate was significantly reduced and approached to the rate of the present guideline. The average chest compression rate in group I was higher than the rate recommended in the present guideline and was significantly reduced after metronome guidance. CONCLUSION: We strongly believe that further study should be performed to consider the survival benefit of good-quality CPR. Devices providing feedback to alert rescuers may be useful for improving the quality of CPR.
Cardiopulmonary Resuscitation* ; Consensus ; Emergency Service, Hospital ; Heart Arrest ; Humans ; Out-of-Hospital Cardiac Arrest ; Prospective Studies ; Resuscitation ; Thorax ; Ventilation

PURPOSE: Climacturia is involuntary loss of urine during orgasm. The mechanism of climacturia in men who undergo radical prostatectomy (RP) is not fully understood, while deficiency in bladder neck coaptation during orgasm may be the cause. We evaluated the prevalence and risk factors of climacturia after RP. MATERIALS AND METHODS: We retrospectively reviewed the medical records of prostate cancer patients who underwent RP from 2002 to 2013 and was able to have a vaginal intercourse postoperatively. RP was conducted using open or robot-assisted approach. We analysed the symptoms of climacturia, relationship between climacturia and several clinical factors. Also, we tried to find factors to predict the presence of climacturia. RESULTS: Total of 123 patients were analyzed in this study. The median age of the men was 65 year and postoperative follow-up period for the interview was 37 months. Of the total 123 patients, 29 (23.6%) complained of the climacturia. In climacturia group, robot-assisted RP (p=0.018), nerve-sparing (p=0.046) and penile rehabilitation (p=0.012) were significantly less frequent, and more pad were comsumed (p=0.001) compared to non-climacturia group. On multivariable analysis, post-prostatectomy incontinence (PPI) (OR 6.49, p=0.004) and penile rehabilitation (OR 0.22, p=0.036) were significant factors to predict the presence of climacturia. CONCLUSIONS: Climacturia occurs in more than 20% patients who were potent enough after RP in our study. PPI and penile rehabilitation were positive and negative factor to predict an occurrence of climacturia, respectively. Therefore, in addition to PPI and erectile dysfunction, patients must be informed of this complication before undergoing RP.
Erectile Dysfunction ; Follow-Up Studies ; Humans ; Male ; Medical Records ; Neck ; Orgasm ; Prevalence ; Prostatectomy* ; Prostatic Neoplasms ; Rehabilitation ; Retrospective Studies ; Risk Factors ; Urinary Bladder ; Urinary Incontinence