No abstract available.
Gastroschisis* ; Hernia, Umbilical*

No abstract available.
Abdominal Wall* ; Muscles*

No abstract available.
Primary Myelofibrosis*

Tularemia is a zoonosis caused by Francisella tularensis. It is primarily a disease of wild animals. Human infection is incidental and usually results from interaction with biting or blood-sucking insects, wild or domestic animals, or the environment. An increasing number of cases have been reported in several countries. However, in Korea it has not been reported until now. A 40-year old male patient visited our department on Jan 13, 1997, complaining of multiple swollen lymph-nodes on his axillae and reddish swollen left upper arm which contained an abscess at its central portion for about ten days. On Dec 25, 1996, he found a dead wild rabbit on a nearby mountainside, ate it after cooking it by himself with his hands injured. His abscess was drained and microbiologic examination was done. However no microorganism was isolated. His lymph nodes were surgically removed from both axillae, and we investigated them microbiologically and pathologically. On microbiologic examination, small aerobic gram negative coccobacilli were grown on a chocolate agar plate in an aerobic condition with 5% CO2 at 37 degrees centigrade. On H & E staining, the lymph node showed chronic granulomatous inflammation. We sent the microorganism and lymph nodes to the Centers for Disease Control and Prevention in the United States of America for the definitive diagnosis. Finally the microorganism was identified as F. tularensis by culture morphology, biological tests and immunohistochemical staining. We report the first case of F. tularensis in Korea.
Abscess ; Adult ; Agar ; Americas ; Animals ; Animals, Domestic ; Animals, Wild ; Arm ; Axilla ; Cacao ; Centers for Disease Control and Prevention (U.S.) ; Cooking ; Diagnosis ; Francisella tularensis ; Hand ; Humans ; Inflammation ; Insects ; Korea ; Lymph Nodes ; Male ; Tularemia* ; United States

Although percutaneous abscess drainage has become and accepted alternative from of therapy for selected patients with abscess, it is well known that there are several factors in the failure of adequate drainage such as pre-and post- procedural management, technique itself, various features of abscess, and selection and application of catheters. Among these factors, we made an experiment about drain efficacy of commonly used various catheters with different viscosities of water-glycerin solution under the two different pressure gradients. The experimental values of flow rate were lower than than the calculated values. An efficacy of experimental value was 4-14%. Because the inner diameter of fittings and stopcocks was usually smaller than the inner diameter of catheters, these factors also affected the drain efficacy. Finally, we though that it will be very helpful to the treatment of patients as well as to study about the catheter drainage, if the drain efficacy of individual catheters has been notified.
Abscess ; Catheters* ; Drainage ; Humans ; Viscosity

BACKGROUND: Despite improvement of mortality in acute myocardial infarcrtion, high mortality rate associated with cardiogenic shock remains essentially unchanged. We have reviewed our result of coronary intervention in 15 patients and found relative survival advantage. METHODS: Between Sep. 1992 and Aug. 1995, 15 consecutive patients(M. 10, F. 5) with cardiogenic shock in acute myocardial infarction were treated with coronary intervention using ballon PTCA. IABP was inserted in all patients prior to PTCA. RESULTS: 1) Most commonly found infarct related artery was left anterior descending artery(11) followed by right coronary artery(3) and left main coronary artery(1). 2) Successful reperfusion rate was 86.7%(13/15), and in-hospital mortality rate was 26.7%(4/15). 3) In-hospital mortality was higher in elderly patients compared with less than 70yaer old patients(0%(0/11)vs. 75.0%(3/4)(P < 0.05). 4) Mortality rate was lower in single vessel disease than multivessel disease(11.1%(1/9) vs. 50%(3/6) p<0.05). CONCLUSION: Although this study is uncontrolled, the date suggest that urgent coronary intervention for improving coronary perfusion may reduce mortality of acute myocardial infarction complicated by cardiogenic shock, particularly with single vessel disease and young age group.
Aged ; Arteries ; Hospital Mortality ; Humans ; Mortality ; Myocardial Infarction* ; Perfusion ; Reperfusion ; Shock, Cardiogenic*

The effects of intraventricular alpha2-adrenoceptor agonist and antagonist, clonidine and rauwolscine, on changes of blood pressure induced by the rise of intracranial pressure were investigated in urethane-anesthetized rabbits. 2) The rise of ICP, induced by the infusion of saline into a balloon placed in the epidural space, was comparatively slow in the beginning of the infusion but became sharp as the infusion proceeded. Corresponding with the gradual increase of ICP, there was a slight decrease in BP. An abrupt rise of BP was observed when ICP showed a sharp increase. 3) Intraventricular rauwolscine 5(microgram) by itself did not affect BP. In these rauwolscine-treated rabbits the increase of both ICP and BP by the infusion was similar to that of the control animals. 4) The pretreatment with rauwolscine 50(microgram) did hardly affect BP, but this made the increase of ICP and BP by the infusion different from that of the control animals. The slight hypotensive response in the beginning of the infusion did not appear and the pressor response to the raised ICP was markedly facilitated. The volume of saline inused into the infusing balloon to cause the same increase of ICP as in the control animals was much smaller than in the control ones, and the magnitude of the maximal increase of BP was much greater. 5) The pretreatment with 500 microgram of intraventricular rauwolscine produced an increase of BP. In these animals the increase of both ICP and BP by the infusion seemed to be slightly facilitated than in the control animals. 6) Intraventricular clonidine 30(microgram) markedly decreased BP. In these clonidine-treated animals the slight hypotensive response in the beginning was more distinct than in the control animals, and the pressor response was hardly seen. 7) The hypotensive response to intraventricular clonidine 30(microgram) was weakened in the animals pretreated with intraventricular rauwolscine 500(microgram). In these animals the increase of both ICP and BP by the infusion appeared as in the control animals. 8) The above results suggest that the pressor response to the raised ICP in rabbits was inhibited under the condition of stimulation of central alpha2-adrenoceptors and facilitated under the condition of blockade of the receptors. It seems that the rise of blood pressure takes place when the activity of alpha2-adrenoceptors is impared by the increased pressure of the balloon placed in the epidural space.
Animals ; Blood Pressure ; Clonidine ; Epidural Space ; Intracranial Pressure* ; Rabbits* ; Yohimbine

A retrospective study was conducted to evaluate the clinical outcomes of midtrimester emergency cervical cerclage in patients with painless cervical dilatation with/without prolapsed amniotic sac, including cases of no previous history of cervical incompetence. 10 patients including 1 twin pregnancy were teviewed for study, All had received emergency cervical cerclage with Macdonald operation or Shirodka operation at 18 to 31 weeksgestation. The procedures were carried out without serious complication except for one patient who had received re-operation 3 days after Macdonald operation because of re-protrusion of amniotic sae. The mean procedure to delivery internal was 8.9+/-5.3 (range 1 to 17) weeks. The mean gestational age at delivery was 32.4+/-5.6 (range 22 to 39+6) weeks for the entire group, 36.1+/-2.6 (range 32+4 to 39+6) weeks for the 6 who achived viability, and 27.6+/-5.0 (range 22 to 29+4) weeks for the 3 who died during the neonatal period. 1 died during gestation and was delivered at 33+6 weeksgestation. The mean birthweight was 2181.6+/-971.6 (range 498 to 3500)g for the entire group, and 2712.9+/- 571.5 (range 1860 to 3500)g for the 7 infants who lived until after neonatal period. The total survival rate for 11 babies was 64%. This study demonstrates that midtrimester emergency cervical cerclage for the patients who have dilated cervix with/without prolapsed amniotic sac is valuable method to try in the cases predicted they would lost the baby with conservative treatment only.
Cerclage, Cervical* ; Cervix Uteri* ; Dilatation* ; Emergencies* ; Female ; Gestational Age ; Humans ; Infant ; Labor Stage, First ; Pregnancy ; Pregnancy Trimester, Second ; Pregnancy, Twin ; Retrospective Studies ; Survival Rate

Barrett's esophagus is a premalignant condition of esophageal adenocarcinoma. Inducible nitric oxide synthase (iNOS) is induced by cytokines and can generate locally high concentrations of nitric oxide (NO), whose metabolites can mediate genotoxicity and influence multistage carcinogenesis by causing DNA damage. Therefore, we evaluated the immunolocalization and expression of iNOS in surgically induced rat Barrett's esophagus. Esophagoduodenal anastomosis was performed in rats for inducing reflux of duodenal contents. Rats were killed at postoperative 10, 20, 30 and 40 weeks. We examined histologic changes and iNOS expression in esophagus by immunohistochemistry and reverse transcription-poly-merase chain reaction. Eighty six percent of experimental rats showed Barrett's esophagus above esophagoduodenal junction. iNOS immunoreactivity was clearly observed in the epithelial cells of Barrett's esophagus, predominantly at the apical surface of epithelial cells. Cytoplasmic staining was also seen only in atypical Barrett's esophagus. iNOS mRNA was detected only in the lower esophagus of experimental group. In conclusion, this study suggests that iNOS has some roles on Barrett's esophagus formation.
Anastomosis, Surgical ; Animals ; Barrett Esophagus/*enzymology/*surgery ; Cytoplasm/metabolism ; DNA Damage ; Disease Models, Animal ; Duodenum/*enzymology/surgery ; Esophagus/metabolism ; Immunohistochemistry ; Male ; Models, Anatomic ; Neoplasms, Experimental/pathology ; Nitric Oxide/metabolism ; Nitric-Oxide Synthase/*biosynthesis ; RNA/metabolism ; RNA, Messenger/metabolism ; Rats ; Rats, Sprague-Dawley ; Research Support, Non-U.S. Gov't ; Reverse Transcriptase Polymerase Chain Reaction ; Time Factors

PURPOSE: For the differential diagnosis of acute abdomen, abdominal computed tomography (CT) is commonly performed in the emergency department (ED). Rapid and accurate interpretation after CT is essential; however, final interpretation of the images by a board-certified radiologist for 24 hours a day is nearly impossible. Therefore, a preliminary interpretation is mainly made by emergency physicians in the ED, which may result in some discrepancy with the interpretations of board-certified radiologists. This study was conducted to determine the discrepancy rate of emergency medicine (EM) residents' preliminary interpretation and any reduction in discrepancy through feedback imaging education programs by attending radiologists. METHODS: This was a before-and-after study, including 540 cases of abdominal CT scans performed in the ED between November 1, 2014 and April 30, 2015. Residents first documented their preliminary interpretation of 300 cases for 3 months. Board-certified radiologists then provided feedback image education to EM residents for these cases for 1 month. After feedback education, preliminary interpretations of 240 cases were documented for 2 months. Discrepancy rates before and after feedback education were then analyzed. RESULTS: Total and major discrepancy rates before feedback image education were 28% and 11.7%, respectively, which declined to 14.6% and 4.6%, respectively, after feedback image education (p<0.05). CONCLUSION: Feedback image education was effective in reducing the discrepancy rate of the interpretation of abdominal CT scans by EM residents.
Abdomen, Acute ; Diagnosis, Differential ; Education* ; Emergencies* ; Emergency Medicine* ; Emergency Service, Hospital ; Tomography, X-Ray Computed*