BACKGROUND: This study was designed to describe the current tends of emergency tracheal intubation and predict difficult airway intubations in emergency department (ED) at a teaching hospital in Korea. METHODS: All patients who was taken endotracheal incubation in ED during a 1-year period (Mar 1997 through Feb 1998) were included in the study population. Medical records of the patients were retrospectively reviewed. Among them, 56 patients were prospectively evaluated parameters to predict difficult airway intubations. RESULTS: During the study period, a total of 413 patients(1.5%) required endotracheal intubation. Except far 2 cases, all patients intubated orotracheally, and 298(72%) patients were intubated by emergency medicine resident. Pharmacologic adjuncts were used in 200(48%) patients, the neuromuscular blocking agent(NMBA) was used in 16(3.8%) Commonly used drugs were thiopental and vecuronium. The difficult incubation was not associated with presence of denture, length and circumference of neck, and mental status. The visibility of vocal cord on laryngoscopy significantly correlated to the difficult airway. CONCLUSION: At this institution, the majority of ED incubation were performed by emergency physicians and NMBA was not routinely used. The visibility of vocal cord during the direct laryngoscopy could be a predictor of difficult incubation in ED.
Dentures ; Emergencies* ; Emergency Medicine ; Emergency Service, Hospital ; Hospitals, Teaching ; Humans ; Intubation* ; Intubation, Intratracheal ; Korea ; Laryngoscopy ; Medical Records ; Neck ; Neuromuscular Blockade ; Prospective Studies ; Retrospective Studies ; Thiopental ; Vecuronium Bromide ; Vocal Cords

PURPOSE: The aim of this study was to evaluate the utility of contrast-enhanced MRI with first-pass and delayed images in prediction of myocardial viability after acute myocardial infarction. MATERIALS AND METHODS: Ten patients (M:F=:4, mean age =6 5 years) with acute myocardial infarction underwent first-pass image after bolus injection of gadolinium (one image/sec for 120sec)and delayed image (7 2 minutes later). According to 60 segments on midventricular level, the assessment of MRI were concerned about location of lesion, depth of lesion, enhancement on first-pass image and enhancement pattern on delayed image. MRI findings were compared with wall motion on resting echocardiography and stress or follow-up echocardiography. RESULTS: 1) MRI findings were classified into 4 types: normal enhancement on first-pass and delayed images (type 1), normal enhancement on first-pass image and nontransmural hyperenhancement on delayed image (type 2), non-transmural enhancing defect on first-pass image and transmural enhancement with endocardial non-enhancing defect on delayed image (type 3), and transmural enhancing defect on first-pass image and transmural hyperenhancement on delayed image (type 4).2) Type 2 suggested viable myocardium and type 3 had high porbability of viability. Type was compatible with non-viable myocardium. CONCLUSION: Enhancing defect on first-pass image and involving thickness on both the first-pass image and delayed image in contrast enhanced MRI may predict myocardial viability.
Echocardiography ; Follow-Up Studies ; Gadolinium ; Humans ; Magnetic Resonance Imaging* ; Myocardial Infarction* ; Myocardium

PURPOSE: The purpose of this study was to investigate the pattern of cerebral response to motor tasks in patients with schizophrenia compared with normal subjects using functional MRI. MATERIALS AND METHODS: Nine right handed-schizophrenic patients and six right-handed normal subjects were included. We used right hand movement as task. Series of 120 consecutive echo-planar images per section were acquired during three cycles of task and rest activations. Lateralization index of cortical response was measured and compared between patients and normal subjects. RESULTS: Right hand motor task was associated with greater activation in left sensorimotor cortex than the right in normal subjects. Schizophrenia patients showed relatively decreased activation in left cortex and increased activation in right cortex compared with normal subjects. In one patient, reversed lateralization was noted. CONCLUSION: Normal hemispheric asymmetry of cortical response to motor task was found in different pattern in schizophrenia. Our result is consistent with functional disturbance of motor circuitry in this disorder. Functional MRI will play an important role in diagnosis and research of this disorder.
Brain ; Diagnosis ; Hand ; Humans ; Magnetic Resonance Imaging* ; Schizophrenia*

We experienced a case of Takayasus arteritis with eclampsia in a 43-year-old woman. The patient had angiographically definite Takayasus arteritis with the involvement of right common and internal carotid arteries. On MR images performed at clinical manifestations of eclampsia, unilateral involvement of T2 high signal intensities were demonstrated in right cerebral hemisphere. We report this case with a literature review.
Adult ; Carotid Artery, Internal ; Cerebrum ; Eclampsia* ; Female ; Humans ; Magnetic Resonance Imaging ; Pregnancy* ; Takayasu Arteritis*

Warthin's tumor is a benign lesion of the salivary and principally-parotid gland. An extraparotid location is rare. We report a case of Warthin 's tumor which was located in the neck, far from the parotid gland.
Head and Neck Neoplasms ; Neck* ; Parotid Gland

BACKGROUND: When patients return to the emergency department shortly after being seen, it is generally assumed that their initial evaluation or treatment was inadequate. But in other aspects many short term revisits may be unnecessary in the aspect of emergency care because it is known that substantial numbers of patients use emergency department for nonemergency problems. So we analysed the tendency and the cause of short term revisit patients, determined the rates and the associated demographic, clinical, disease variables as a tool of quality assurance. METHODS: We carried out a chart review of patients seen in the emergency department, who revisited within 72 hours, of Young Dong Severance Hospital retrospectively between January 1, 1998 and September 30, 1999 (period 2), and compared with result between April 1, 1990 and March 31, 1991 (period 1) respectively. RESULTS: In the period 1, the total revisits patients were 204/21,025(0.97%), in that period scheduled revisits were 15.2%, the unscheduled were 84.8%, and the frequent revisits (more than 3 times) were 6.4%. In the period 2, the total revisit patients were 4,722/72,802 (6.49%), in that period scheduled revisits were 86.3%, the unscheduled were 13.7%, and the frequent revisits were 24.8%. The most common cause of revisit during the period 2 is a drug addictor (31.2%) that frequently used the emergency room for seeking drug. CONCLUSIONS : The scheduled revisit patients for dressing, medication, re-evaluation were increased enormously, so the medical care of these patients might be a part of job that performed in emergency department. And if the health care system could support the adequate nursing care facility, the portion of avoidable revisits of emergency department can be decreased. We also found that the emergency department is an important points for the early identification and referral for the treatment of patients who revisited emergency room for seeking drug, and the analysis of physician related factor in revisits patients may be used as a tool of quality assurance in the emergency department.
Bandages ; Delivery of Health Care ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital* ; Humans ; Nursing Care ; Referral and Consultation ; Retrospective Studies

PURPOSE: We wanted to evaluate the levels of effect and safety of high-intensity focused ultrasound ablation (HIFU) for treating patients with advanced pancreatic cancer. MATERIALS AND METHODS: Nineteen sessions of HIFU, with the patients under general anesthesia, were performed in 18 patients with advanced pancreatic cancer. The change of the gray-scale of the target lesion was analyzed during HIFU, and MRI was performed before and after HIFU. We assessed the extent of coagulative necrosis, the change of pain and the complications after HIFU. The change of tumor size and the survival of patients were also evaluated. RESULTS: The average size of tumor was 4 cm in diameter. Eighty nine percent of the target tumors showed increased echogenicity. On MRI, necrosis of the entire target tumor occurred in 79% of the patients. After treatment, effective pain relief was noted in 89% of the patients. There were no major complications. No size increase of the treated tumor was noted during 24 weeks of follow-up for 10 patients. Six patients among 12 patients who were available for follow-up are still alive and they are receiving chemotherapy. Six patients expired due to other disease or progression of metastasis. CONCLUSION: HIFU is a safe method without any major complications, and it is effective for inducing tumor necrosis and achieving pain control for patients with advanced pancreatic cancer.
Anesthesia, General ; Drug Therapy ; Follow-Up Studies ; High-Intensity Focused Ultrasound Ablation ; Humans ; Magnetic Resonance Imaging ; Necrosis ; Neoplasm Metastasis ; Pancreatic Neoplasms* ; Radiation Oncology ; Ultrasonography*

Bell's palsy is manifested by unilateral facial paralysis, but its cause is not clearly elucidated yet. Though the relationship between Bell's palsy and diabetes mellitus (DM) has been well established in adults, the relationship is not obvious in children and adolescents. Here, we report a case of adolescent Bell's palsy accompanied by DM. In this case, steroids were used for the treatment of Bell's palsy, and the blood glucose level in the patients was well controlled by metformin alone without additional use of insulin. We suggest that the presence of diabetes should be determined by blood test in the childhood and adolescent patients with facial paralysis, especially who are obese. As the use of steroids, however, is associated with the elevated blood glucose levels, it should be used with caution.
Adolescent ; Adult ; Bell Palsy ; Blood Glucose ; Child ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Facial Paralysis ; Hematologic Tests ; Humans ; Insulin ; Metformin ; Steroids

The first edition of Korean Clinical Practice Guidelines for Stroke, which was published in 2009, reflected evidence published prior to June 2007. Since then, many clinical trials and well-designed observational studies provided new evidence that may be pertinent to clinical practice. Accordingly, investigators of the Clinical Research Center for Stroke have timely updated the guidelines. This article summarizes the recent evidence and updated guidelines regarding the use of aspirin for primary stroke prevention, the management of asymptomatic carotid stenosis, the use of antithrombotics in atrial fibrillation for stroke prevention, the diagnosis and management of unruptured aneurysm, intravenous and intra-arterial thrombolysis in acute ischemic stroke, antiplatelet therapy for secondary stroke prevention in patients with non-cardioembolic stroke or transient ischemic attack, and the management of symptomatic carotid stenosis for secondary stroke prevention.
Aneurysm ; Aspirin ; Atrial Fibrillation ; Carotid Stenosis ; Humans ; Ischemic Attack, Transient ; Research Personnel ; Stroke

BACKGROUND/AIMS: Several simple tests for hepatic fibrosis employ indirect markers. However, the efficacy of using direct and indirect serum markers to predict significant fibrosis in clinical practice is inconclusive. We analyzed the efficacy of a previously reported indirect marker of hepatic fibrosis - the aspartate aminotransferase to platelet ratio index (APRI) - in patients with nonalcoholic chronic liver diseases (CLDs). METHODS: A total of 134 patients who underwent a percutaneous liver biopsy with a final diagnosis of chronic hepatitis B (n=93), chronic hepatitis C (n=18), or nonalcoholic fatty liver disease (n=23) were enrolled. A single-blinded pathologist staged fibrosis from F0 to F4 according to the METAVIR system, with significant hepatic fibrosis defined as a METAVIR fibrosis score of > or =2. RESULTS: The mean area under the receiver operating characteristic curve (AUROC) of APRI for predicting significant fibrosis in nonalcoholic CLDs was 0.84 [95% confidence interval (CI), 0.78-0.91]. APRI yielded the highest mean AUROC in the patients with chronic hepatitis B (0.85; 95% CI, 0.771-0.926). The positive predictive value of APRI > or =1.5 for predicting significant fibrosis was 89%. The negative predictive value of APRI <0.5 for excluding significant fibrosis was 80%. CONCLUSIONS: APRI might be a simple and noninvasive index for predicting significant fibrosis in nonalcoholic CLDs.
Aspartate Aminotransferases ; Biopsy ; Blood Platelets ; Diagnosis ; Fatty Liver ; Fibrosis* ; Hepatitis B ; Hepatitis B, Chronic ; Hepatitis C, Chronic ; Humans ; Liver Diseases* ; Liver* ; ROC Curve ; Biomarkers