No abstract available.
Animals ; Hypersensitivity* ; Lymphocytes* ; Mice*

Thoracic outlet syndrome is a collective term embracing previously described syndromes such as scalenus anticus, cervical rib, costoclavicular, hyperabduction and shoulder girdle compression syndromes. Its symptoms and signs are due to bony and soft tissue compression of the neurovascular bundle at the thoracic outlet. It is the purpose of this paper to evaluate the results of experience in treating the patient with thoracie outlet syndrome by surgical means. In this study, 3 cases: cervical rib (1 case), excessive callus formation after clavicular fracture (1 case), and hyperabduction syndrome with combined scalenus anticus syndrome (1 case), which had developed thoracic outlet syndrome were treated at Severance Hospital and gratifying results were obtained.
Bony Callus ; Cervical Rib ; Humans ; Shoulder ; Thoracic Outlet Syndrome

BACKGROUND: Hyperkalemia is a common and potentially life-threatening metabolic disorder. The electrocardiogram(ECG) is known to be a relatively sensitive diagnostic tool hyperkalemia. However many exceptions, in which patients showed normal ECG findings even though hyperkalemic, have been reported. The purpose of this study was to determine the extent of correlation between the ECG findings and hyperkalemia and to determine when the ECG has value for diagnosing hyperkalemia. METHODS: Patients who had been diagnosed as having hyperkalemia at two university hospitals during three years were enrolled in this study. We reviewed the medical records of the patients and evaluated the following 6 ECG abnormalities: tall T waves, narrow T waves, QRS widening, atrioventricular block, loss of P waves, and sine waves. We defined tall T waves and narrow T waves as 20 percentiles of heights and widths of the T waves from the 100 patients with normokalemia. RESULTS: During the study period, there were 100 hyperkalemic patients, and we analyzed 69 available electrocardiograms. Abnormal ECG findings were revealed in 67% of 69 patients. The higher the serum potassium level, the more abnormal ECG findings. The common ECG abnormalities were tall T waves and loss of P waves. The patients with normal ECGs even though hyperkalemic had relatively low potassium levels. And whether chronic renal disease was not correlated to the ECG abnormality. CONCLUSION: The electrocardiogram is a good diagnostic tool for hyperkalemia if it is used with accurate diagnostic criteria. Thus, hyperkalemia should be considered when the ECG shows tall T waves or loss of P waves.
Atrioventricular Block ; Electrocardiography* ; Hospitals, University ; Humans ; Hyperkalemia* ; Medical Records ; Potassium ; Renal Insufficiency, Chronic

No abstract available.

BACKGROUND: Do-Not-Resuscitate(DNR) order has been used without specific legislation commonly in hospitals of Korea. We designed this study to assess the current use of DNR order in the emergency department and to make a database for establishing a policy for DNR order, especially in ER. METHODS: We retrospectively reviewed medical records of 164 patients who expired in the emergency department of Severance hospital from Sep. 1996 to Aug. 1997. We evaluated age, sex, diagnosis, specific department involved, whether written orders were made and medical care after decision of DNR. The patients were divided into 2 groups : DNR vs CPR. To determine factors influencing DNR decision, we searched for presence of malignancy, irreversible shock, unconsciousness and chronic illness. The logistic regression analysis was used for statistical significance. RESULTS: We found that 102(62.2%) out of 164 expired patients had a DNR order. But only in 59% of cases, were written DNR order on the chart. Factors which had the most influence on decision of DNR were malignancy and age. The sex, chronic illness, irreversible shock, and unconsciousness were not significant factors. CONCLUSION: We found malignancy and old age as an important factor when DNR order had been made. But further evaluation of other factors may be necessary to establish definitely a policy for DNR order.
Cardiopulmonary Resuscitation ; Chronic Disease ; Diagnosis ; Emergency Service, Hospital ; Humans ; Korea ; Logistic Models ; Medical Records ; Retrospective Studies* ; Shock ; Unconsciousness

The authors performed occipito-cervical(C2-3) fusion in a case of atlanto-axial subluxation caused by congenital seperation of dens. At first posterior cervical fusion(C1-2-3) with rib graft was performed, but several days after the operation C1-2 subluxation developed again with cervical cord compression syndrome. In the second operation, the occiput was included in the fusion after removal of the posterior neural arch of atlas which resulted in good reduction and marked improvement in neurologic symptoms.
Neurologic Manifestations ; Ribs ; Transplants

PURPOSE: Although the use of intravenous gamma-globulin(IVGG) in Kawasaki disease(KD) is effective in reducing clinical symptoms and coronary artery complications, 20-30% of patients have persistent or recrudescent fever and ongoing clinical symptoms. In these patients, the additional infusion of IVGG is considered. The authors studied the characteristics of patients who received IVGG retreatment, and compared them with the patients who did not need IVGG retreatment, for determination of IVGG retreatment. METHODS: We reviewed the medical records of 117 KD patients who could be followed up at least six months. We studied the conventional laboratory findings, electrocardiogram(EKG), signal averaged ECG(SAECG) and echocardiogram. RESULTS: Twenty three patients had early cardiac complications during the six months of follow-up. Four patients had late cardiac complications after six months. The early cardiac complication rate was higher in the IVGG retreatment group than the single infusion group(P<0.0001). The late complication rate was also higher in the retreatment group(P<0.0001). The patients who received methyl-prednisolone(m-PD) pulse therapy had much higher rates of early and late cardiac complications than those who received a single IVGG infusion. Among the clinical data and laboratory findings, only CRP increased significantly in patients who have had the cardiac complications. The IVGG retreatment group had increased CRP than the single infusion group. CONCLUSION: The patients with increased initial CRP may have an increased incidence of complications and an increased possibility of IVGG retreatment. We thought that retreated KD patients might have inflammations severe enough to need high dose IVGG as shown by high CRP levels, and IVGG retreatment could not prevent coronary artery lesions sufficiently.
Coronary Vessels ; Fever ; Follow-Up Studies ; gamma-Globulins* ; Humans ; Incidence ; Inflammation ; Medical Records ; Mucocutaneous Lymph Node Syndrome* ; Retreatment*

Multiple level laminectomies are a destructive procedure complicating kyphosis, anterior subluxation and instability of the spine in children. The surgical procedure of multiple level osteoplastic laminotomies was proposed as an alternative by Raimondi et al in 1976. The goal is preservation of the normal architecture of the spine in patients who are still developing. We have experienced a case of multiple level laminotomies(T4-T11) for removal of epidural neuroblastoma in a 3-month old baby. The technical points of surgical procedure were discussed.
Child ; Humans ; Infant ; Kyphosis ; Laminectomy* ; Neuroblastoma ; Spinal Canal* ; Spine

We presented several cases of the exophthalmos due to the orbital tumors, with the review of the literatures. We performed modified Kronlein operation and anterior orbitotomy, appropriately for each cases to improve the visual acuity and at least to correct cosmetically the proptosed eye. It will be better to do one's best in order to search a possible way to save the eye ball by which the ophthalmologist can remove the orbital tumor even if the patient lost his vision.
Exophthalmos* ; Humans ; Orbit ; Visual Acuity

A giant aneurysmal cerebral arteriovenous malformation in the left parieto-occipital region is described in a 4 year old child, including resolution of the alternating hemiparesis and left ventricular hypertrophy of the heart following successful removal of the malformation by microsurgical technique. This arteriovenous malformation has a large aneurysmal sac, 6x5x4cm, in size with several feeders from branches of the left middle and posterior cerebral arteries and drains directly into the straight sinus. So we have proposed to call it "a giant aneurysmal cerebral arteriovenous malformation".
Aneurysm* ; Arteriovenous Malformations ; Child ; Child, Preschool ; Heart ; Humans ; Hypertrophy, Left Ventricular ; Intracranial Arteriovenous Malformations* ; Paresis ; Posterior Cerebral Artery