BACKGROUND: High risks of fire alway exist for buildings in urban areas, especially those in downtown. Crowds, as well as more complex and larger structures, may cause more victims in the event of fire; therefore, emergency medical service plans must be established for such disastrous events. METHODS: On the evening of October 30, 1999, a fire broke out in downtown, Dong-Incheon Live-Hof restaurant; 56 people were killed and 76 were injured. Most of them were teenagers. We retrospectively reviewed the medical records of the victims. RESULTS: 1) Among the 56 dead, 54 died from smoke inhalation, one from extensive burns, and one from sepsis during treatment. 2) Among the 76 injured, 70 patients suffered from smoke inhalation, 53 from burns, and 9 from several types of trauma (sprains, contusions, lacerations, abrasions, fractures, etc.). 3) Later complications were laryngeal edema, pulmonary edema, scar contracture, and hypoxic brain damage, and so forth. 4) Post traumatic stress syndrome was unexpectedly more prevalent in mildly to moderately injured survivors and witnesses than in seriously injured survivors. CONCLUSION: Many complications exist after a fire. Some may be resolved in time, but others may result in permanent sequelae. Early rescue, early triage, and early management during transport by emergency medical service (EMS) personnel can result in fewer complications and a lower mortality rate. Therefore, we propose the establishment of plans to be followed during various major disasters.
Adolescent ; Burns ; Cicatrix ; Contracture ; Contusions ; Disasters ; Emergency Medical Services ; Fires* ; Humans ; Hypoxia, Brain ; Inhalation ; Lacerations ; Laryngeal Edema ; Medical Records ; Mortality ; Pulmonary Edema ; Restaurants* ; Retrospective Studies ; Sepsis ; Smoke ; Survivors ; Triage

BACKGROUND: Recently, the colour change plaster (NeuroCheck(R)) has been introduced, which measures sweat production on the basis of a colour change from blue to pink. This new test was useful to detect of diabetic peripheral neuropathy. The aim of this study was to evaluate the usefulness of the colour change plaster (NeuroCheck(R)) for the diagnosis of cardiac autonomic neuropathy in type 2 diabetic patients. METHODS: This study include 35 type 2 diabetic patients (10 male, 25 female) with a mean age of 55+/-14.9 years and a mean diabetes duration of 11.8+/-8.8 years. Cardiac autonomic neuropathy was diagnosed by means of Ewing's method. Peripheral autonomic neuropathy (Sudomotor function abnormality) was assessed by means of time (more than 600 seconds) until complete colour change in the indicator test. RESULTS: Peripheral autonomic neuropathy was diagnosed in 23 patients (65.7%). Time until starting colour change of plaster in normal and abnormal sudomotor patients were 38.3+/-33.7 sec and 367.1+/-470.3 sec (p<0.05). Time until completing colour change of plaster in normal and abnormal sudomotor patients were 372.5+/-198.8 sec and 1677.4+/-711.9 sec (p<0.05). The autonomic score of two groups were 2.4+/-2.3, 4.6+/-2.2 (p<0.05). Sudomotor abnormal group was older than normal (59.2+/-11.7 yrs, vs 47+/-17.4 yrs). Presence of retinopathy was related with sudomotor abnormality. Peripheral autonomic neuropathy was related with parasympathetic cardiac autonomic neuropathy. Sudomotor function abnormality was related with definite cardiac autonomic neuropathy, but it was not related with early cardiac autonomic neuropathy. The sensitivity, specificity, positive predictive value and negative predictive value of colour change plaster in the diagnosis of definitive cardiovascular autonomic neuropathy was 86.7%, 62.5%, 68.4% and 83.3%, respectively. CONCLUSIONS: The colour change plaster (NeuroCheck(R)) is not useful for the early diagnosis of cardiac autonomic neuropathy in type 2 diabetic neuropathy, but it may be possible for the screening test of definite cardiac autonomic neuropathy.
Diabetic Neuropathies ; Diagnosis* ; Early Diagnosis ; Humans ; Male ; Mass Screening ; Peripheral Nervous System Diseases ; Sensitivity and Specificity ; Sweat

PURPOSE: Most malignant peritoneal or pleural effusions caused by advanced malignancy are unresponsive to systemic chemotherapy except for chemotherapy sensitive tumors, and they are equally ineffective to regional therapy or radiotherapy. Thus, for the purpose of palliating the symptoms related to malignant effusion and to reduce fluid reaccumulations, we evaluated the therapeutic feasibility and efficacy of intracavitary ' Ho-CHICO (chito- san complex) instillation for intractable malignant effusions. MATERIALS AND METHODS: Thirty one patients with cytologically or pathologically proven malignant effusions underwent intracavitary 166Ho-CHICO therapy from May 1996 to March 1998 at Ajou University Hospital. The subjective and objective responses were evaluated 4 weeks after the treatment, including the changes of symptoms, weight, abdominal girth, doses of diuretics, frequencies and amounts of repeat aspirations for fluid reaccumulations, and imaging studies of chest radiograph and ultrasounds. RESULTS: The response rates treated with Ho-CHICO were 50% in patients with peritoneal effusion and 46% in patients with pleural effusion (overall 49%). The response rates between 166Ho-CHICO doses of 50-80 mCi and 90-100 mCi were similar (50% vs 47%). Response rate of 70% was noted in patients with even distribution of radioisotope on the post-therapy scan, but, the response rate was lower in cases with focal (44%) and uneven (29%) distribution pattern. There was no difference in response by the effusion sites. All patients tolerated intracavitary 166Ho-CHICO instillation well, although the majority of patients experienced Grade I/II side effects such as pain, fever, weakness and dyspnea. But, no serious complications of Grade lII or IV degree were observed with 166Ho-CHICO therapy. CONCLUSION: Intracavitary 166Ho-CHICO instillation was clinically efficacious in controlling malignant effusions without a significant toxicity seen with conventional sclerotic therapy. The therapeutic modality appeared to offer similar benefits obtained with the conventional intracavitary therapy.
Ascitic Fluid ; Aspirations (Psychology) ; Chitosan* ; Diuretics ; Drug Therapy ; Dyspnea ; Fever ; Holmium* ; Humans ; Pleural Effusion* ; Radiography, Thoracic ; Radiotherapy ; Ultrasonography

Diphenylhydantoin (DPH) is one of the most widely used anticonvulsants for treatment and prevention of seizures. However it is frequently associated with drug-induced leukopenia. Hypersensitivity reactions to phenytoin are well recognized and can be severe. Phenytoin is associated with serious hematologic side effects such as agranulocytosis, thrombocytopenia, red cell aplasia and hemolytic anemia, either through humoral or cell-mediated immunemechanism. We describe a 57-year-old male patient who developed a severe granulocytopenia while taking phenytoin for 66 days in the total amount of 21.6 gram. Bone marrow examination showed isolated depletion of myeloid elements. After 10 days of phenytoin withdrawal and G-CSF treatment, the patient recovered from granulocytic suppression. Using in vitro culture, marrow suppression associated with phenytoin therapy was felt to be non-immune mediated marrow suppression.
Agranulocytosis ; Anemia, Hemolytic ; Anticonvulsants ; Bone Marrow Examination ; Bone Marrow* ; Granulocyte Colony-Stimulating Factor ; Humans ; Hypersensitivity ; Leukopenia ; Male ; Middle Aged ; Phenytoin* ; Seizures ; Thrombocytopenia