Spontaneous subarachnoid hemorrhage(SAH) is a cause of high mortality and morbidity in the emergency department. Rebleeding has been well investigated, and it is now recognized that early operation can prevent rebleeding. However, ultra-early rebleeding, which may occur prior to early operation(within 24 hours after admission), worsens the clinical outcome of patients with SAH. To determine the risk factors of ultra-early rebleeding in patients with spontaneous SAH before early operation, we analyzed the cases of 383 patients admitted within 24 hours after their last attack of SAH between 1994 to 1996. In this analysis, diagnosis of rebleeding before admission was defined only if the patients experienced a definite clinical deterioration once more after an attack suggesting SAH. After admission patients who observed a sudden neurological deterioration were subject to repeat CT scanning and rebleeding was diagnosed only when new hemorrhage was observed on the CT scan in comparison with the previous scan. 45 cases(11.7%) of 383 patients had ultra-early rebleeding. The incidence of ultra-early rebleeding significantly increased in the patients who admitted hospital within 2 hours after attack. The incidence of ultra-early rebleeding also increased in the old-age group(70 years or more), patients with high systolic blood pressure, those who underwent angiography within 6 hours of the last SAH, and patients who had poor neurological condition.
Angiography ; Blood Pressure ; Diagnosis ; Emergency Service, Hospital ; Hemorrhage* ; Humans ; Incidence ; Mortality ; Risk Factors* ; Tomography, X-Ray Computed

BACKGROUND: Although diagnostic peritoneal lavage (DPL) is a well-established, reliably objective method of diagnosis of intraperitoneal injury, it is too sensitive to be used as a absolute indicator for emergency laparotomy. Recently, Otomo et al, have devised a new DPL criteria specifically designed and modified the classics criteria to aid in diagnosis of intestinal injury. So the author studied the difference of diagnostic sensitivity, specificity, and accuracy between the new and classic criteria for intestinal injury. METHODS: The author reviewed retrospectively one hundred fifteen patients underwent DPL from January 1993 to August 1999. The author adopted the classic criteria positive for intestinal injury when the lavage fluid was white blood cell(WBC) > or = 500/mm3 and newly developed supplementary criteria positive when RBC > or = 100,000/mm3, the positive-negative borderline was adjusted to WBC > or = RBC/150, and when RBC <100,000/mm3, to WBC > or = 500/mm3. And analyzed the difference of sensitivity, specificity, and accuracy each other. RESULTS: Among 115 patients, the sensitivity, specificity, and accuracy for intestinal injury were 96.4%, 87.4%, and 89.6% for the new criteria, and 100%, 42.5%, and 56.5% for the classic criteria. After exclusion of 10 patients in whom-DPL was performed within 3 hours or after 18 hours from the time of injury, the sensitivity, specificity and accuracy for intestinal injury were 96.4%, 97.4%, and 97.1% for the new criteria, and 100%, 46.8%, and 61% for the classic criteria. When analyzed the time interval from injury to DPL in the new criteria, 105 patients that DPL was performed between 3 to 18 hours had 2 false-positive, while 115 patients regardless of DPL time 11 false-positive. CONCLUSIONS : The author concluded that the new criteria of DPL effluent performed between 3 to 18 hours from abdominal blunt trauma would be more specific and accurate indicator of intestinal perforation than the classic criteria. And this new criteria will be used as a reliable indicator for emergency laparotomy for that patients.
Diagnosis ; Emergencies ; Humans ; Intestinal Perforation ; Laparotomy ; Peritoneal Lavage* ; Retrospective Studies ; Sensitivity and Specificity ; Therapeutic Irrigation

BACKGROUND: Headache is a common symptom. It has not proved useful methods that the physician evaluated the alert patient who had headache. It needs the presence of predictors of intracranial pathology(ICP) which serves as influential factors in the indication of evaluation and hospitalization of patients. METHOD: So, in order to identify such factors, patient records were retrospectively analysed. 168 patients with the chief complaint of headache presented to the Emergency Department of Chonnam University Hospital during the period from January 1, 1995 to December 31, 1997. All were in an alert mental state and had no evidence of trauma and intoxication. RESULTS: 14 cases(8.3% revealed ICP. 41 cases(24.4% revealed systemic disease. The remainder of cases were divided among unclassified headaches(61 cases, 36.3%, tension headaches(30 cases, 17.9%, and migraine(22 cases, 13.1%. Comparison of ICP-positive and ICP-positive cases revealed that ICP-Positive Patients could be categorized by the following findings: (1) Presence of the focal sign through neurological examination, (2) age greater than 55 years, (3) presence of associated symptoms, (4) acute headache. These four manifestations were proven to be statistically significant as predictors of ICP. CONCLUSION: Although the positive predictive value of the above criteria is not perfect for the prediction of ICP, they are worthy of clinical consideration in alert patients presenting with headache.
Emergencies* ; Emergency Service, Hospital* ; Headache* ; Hospitalization* ; Humans ; Jeollanam-do ; Neurologic Examination ; Retrospective Studies

No Abstract Available.
Central Serous Chorioretinopathy* ; Retina* ; Retinal Detachment* ; Retinaldehyde*

Various kinds of multifocal intraocular lenses(IOLs) have been developed for the improvement of near and far visual acuity after cataract operation. This prospective study was performed to compare a function of AMO ARRAY multifocal IOL(Array group) with conventional monofocal IOL(Mono group). Each type of IOL was implanted into 25 eyes and uncorrected visual acuity(UCVA) and best corrected visual acuity(BCVA) at near, intermediate and far distance were evaluated before and 2 months after operation in both groups. Contrast sensitivity, photophobia and glare were also evaluated as subjective symptoms in both groups. Mean UCVA at distant and near distance before operation was 0.23+/-0.15 and 0.25+/-0.20 in mono group, and 0.13+/-0.11 and 0.14+/-0.11 in Array group. Mean UCVA/BCVA at distant and near distance 2 month after operation was improved to 0.79+/-0.28/0.87+/-0.27 and 0.34+/-0.15/0.82+/-0.26 in mono group and 0.83+/-0.19/0.86+/-0.19 and 0.50+/-0.15/0.79+/-0.15 in Array group. The difference of UCVA at near distance was statistically significant(P<0.05), while that of BCVA at near and far distance was not statistically significant between two groups(P<0.05). Array group had less contrast sensitivity at all spatial frequencies(1.5, 3, 6, 12, 18 cycles/degree) and more glare than the mono group after operation. AMO ARRAY multifocal IOL induces a good result of visual rehabilitation in both near and far distance, but it may cause more glare and less contrast sensitivity than the monofocal IOL.
Cataract ; Contrast Sensitivity ; Glare ; Lenses, Intraocular* ; Photophobia ; Prospective Studies ; Rehabilitation ; Visual Acuity

BACKGROUND: ST segment elevation in patient with chest pain was seen in acute myocardial infarction and in numerous other non-infarction syndrome. The causes of non-infarction syndrome were left ventricular hypertrophy, BER(benign early repolarization), and left bundle branch block in cardiac origin and were hyperkalemia and hyperventilation syndrome in metabolic origin and were others. Furthermore, the differentiation of electrocardiogram between acute myocardial infarction and non-infarction syndrome was very difficult. So, we compared and analysed characteristics of ST segment elevation of acute myocardial infarction and non-infarction syndrome that suggested the clue of early diagnosis of coronary artery disease. METHOD AND MATERIALS: We retrospectively reviewed the electrocardiogram of 961 patients with chest pain who visited the emergency center from January 1999 to December 1999. Acute myocardial infarction was diagnosed by clinical finding, electrocardiogram, cardiac enzyme, echocardiogram, and myocardial spect. Left ventricular hypertrophy, BER, and left bundle branch block in cardiac origin of non-infarction syndrome were diagnosed by electrocardiographic criteria suggested by William J. Brady. Acute myocarditis, acute pericarditis, and hyperventilation syndrome were diagnosed by clinical finding. RESULTS: Among 961 patients with chest pain, 236(24.6%) patients manifested ST segment elevation who were diagnosed acute myocardial infarction in 162(68.6%) patients and non-infarction syndrome in 74(31.4%) patients. The causes of non-infarction syndrome in 74 patients were left ventricular hypertrophy(32:13.6%), BER(28:11.9%), left bundle branch block(11:4.7%), and others(3:1.3%). Three others were acute myocarditis, acute pericarditis, and hyperventilation syndrome. Electrocardiographic characteristics of ST segment elevation of non-infarction syndrome manifested almost same finding compared to William J. Brady' criteria. CONCLUSION: ST segment elevation in patient with chest with chest pain visited emergency department was seen in acute myocardial infarction(68.6%) and the other non-infarction syndromes(31.4%). Significant number of patients were not associated with acute myocardial infarction. Therefore, we must completely understand characteristics of ST segment elevation in acute myocardial infarction and the other non-infarction syndromes to diagnose fatal early coronary artery disease and to avoid unnecessary thrombolytic therapy.
Bundle-Branch Block ; Chest Pain* ; Coronary Artery Disease ; Early Diagnosis ; Electrocardiography ; Emergencies ; Emergency Service, Hospital ; Humans ; Hyperkalemia ; Hypertrophy, Left Ventricular ; Hyperventilation ; Myocardial Infarction* ; Myocarditis ; Pericarditis ; Retrospective Studies ; Thorax* ; Thrombolytic Therapy ; Tomography, Emission-Computed, Single-Photon

A standardized approch to serious head injury employing immediate CT scanning and aggressive medical and surgical therapy has improved outcomes in cases of intracranial lesions. Unfortunately, there is less agreement on how patients with mild head injury should be handled when first seen in an emergency department setting. The ideal policy in mild head injury would be diagnosis or rule-out intracranial lesions as quickly as possible. We reviewed the records of 126 mild head injury patients admitted during 6-month period to the Chonnam University Hospital to identify a group of mild head injury patients having lesions on brain CT scanning and to investigate the risk factors affecting abnormal lesions on brain CT scanning. All patients had alert mental status without neurological deficit and signs of skull fracture. Routine brain CT scans were obtained on all patients. Fifteen patients(12%) had 17 lesions on brain CT scans. Three patients needed surgery for their intracranial lesions. The initial Glasgow Coma Scale(GCS) was 15 in 107 patients and 14 in 19 patients. The incidence of abnormal brain CT lesions for each GCS was 9% in 15 and 26% in 14. The common symptoms of patients who had abnormal brain CT lesions was headache in 7(47%) cases, loss of consciousness in 7(47%) cases, amnesia in 4(27%) cases, dizziness in 4(27%) cases, vomiting in 3(20%) cases, and lethargy in 3(20%) cases. These data suggest that early brain CT scanning is necessary in alert patients who have GCS in 14, headache loss of consciousness, amnesia, dizziness, vomiting, or lethargy following mild head injury.
Amnesia ; Brain* ; Coma ; Craniocerebral Trauma* ; Diagnosis ; Dizziness ; Emergency Service, Hospital ; Head* ; Headache ; Humans ; Incidence ; Jeollanam-do ; Lethargy ; Risk Factors ; Skull Fractures ; Tomography, X-Ray Computed* ; Unconsciousness ; Vomiting

No abstract available.
Genitalia* ; Humans ; Male*

BACKGROUND: To investigate how many rookie pitchers suffered from injuries while playing in the amateur league without guidelines for prevention of excessive pitching, we analyzed their amateur pitching patterns based on the pitch count, use of breaking balls, and pitches during winter camp. METHODS: Forty-one rookie pitchers who graduated from high school or university in 2013 and joined professional baseball teams. Participants were interviewed by a trainer using our questionnaire. Injury inclusion criteria were 1) history of shoulder surgery, 2) history of elbow surgery, 3) shoulder pain requiring treatment, and 4) elbow pain requiring treatment. RESULTS: Mean number of pitches per game and warm-up pitches for practice was 84.5 pitches (range, 15 to 130 pitches) and 16.4 pitches (range, 2 to 210 pitches), respectively. Mean number of pitches during the last year was 906.9 (range, 80 to 2,000). Mean number of maximal pitches was 127 pitches (range, 50 to 210 pitches). Fourteen pitchers had pitched over 150 pitches. Twenty-seven pitchers (65.9%) had pitched in spite of enduring pain. During winter training (mean 1.8 months), mean number of pitches per day was 162.5 pitches, and 20 pitchers (48.8%) had practiced pitching excessively despite the cold weather. Twenty-six rookies (63.4%) had shoulder pain or history of shoulder surgery, and 31 pitchers (75.6%) had elbow pain or history of elbow surgery. Only four participants (9.8%) did not have pain and history of surgery. CONCLUSIONS: For young baseball pitchers, guidelines for prevention of excessive pitching and for regulating the winter training program may be needed.
Baseball* ; Education ; Elbow* ; Humans ; Shoulder Pain ; Shoulder* ; Weather

Since the reservior of leptospires organism is consisted of a broad spectrum of animals, the best method of prevention is vaccination. The clinical trial of leptospires vaccine conducted on human volunteer for its immunogenicity and safety. Summarized results are as follows: 1. The Oral temperature among vaccinated group ranged from 36.7 +/- 0.34 degrees C, while in placebo injected group it ranged from 36.4 +/- 0.46 degrees C to 36.7 +/- 0.53 degrees C. There wan no association between vaccination and fever (p<0.05). 2. Mild local reactions revealed in vacciness were swelling (50-75%), Redness(75-90%), and induration(25-40%). Placebo injected group revealed only redness in 12.5% in the 1st injection and 37.5% in the second injection. The duration local reactions on injection site for both vaccinees and placebo groups disappeared within 48 hours. 3. Generalized Symptoms complained by the vaccinees were myalgia (25%), back pain(15%), headache(15%), pruritus(15%), and abdominal pain(10%), whereas placebo group complained of headache(25%), myalgia(12.5%), back pain(12.5%), pain in eyes(12.5%), abdominal pain(12.5%) prutitus(12.5%) and nausea(12.5%). 4. The serological test(MAT) of vaccinees showed geometric mean antibody titer as follows: a. L. icterohemorrhagiae lai, 1 week after 1st vaccination: 22.45, 1 week after 2nd vaccination: 111.23, 3 week after 2nd vaccination: 266.64, b. L. canicola canicola, 1 week after 1st vaccination: 24.62, 1 week after 2nd vaccination: 123.92, 3 week after 2nd vaccination: 276.55, c. L. icterohemorrhagiae copenhageni, 1 week after 1st vaccination: 28.28, 1 week after 2nd vaccination: 128.55, 3 week after 2nd vaccinaton: 247.88, Whereas all of the placebo injected group, showed below 1 : 20 titers. The sero-conversion rate of vaccinees were 100 percent.
Animals ; Fever ; Healthy Volunteers ; Myalgia ; Vaccination