No abstract available.
Bony Callus*

No abstract available.
Fingers* ; Nasal Bone*

An accurate and relatively simple method for estimating the amount of acute blood loss is essential in the hemorrhagic shock patients. Conventional physiologic parameters, blood pressure, pulse rate and CVP, could not serve for evaluation of the adequate oxygen transport in the tissue. Pulmonary artery catheter is a best tool for evaluating the cardiopulmonary function and the oxygen transport system, and mixed venous oxygen saturation(SvO2) monitoring have made a great advances for early detection of cardiovascular dysfunction and the changes in peripheral tissue oxygenation. But pulmonary artery catheterization is complicated procedure in emergency setting. Although the central venous oxygen saturation(ScvO2) cannot completely replace the SvO2 value, it has a close relation with SvO2 change in variable clinical situations. We testify the usefulness of ScvO2 monitoring in 24 patients of the hemorrhagic shock. Initial resuscitation was performed with ATLS standard and continuous ScvO2 was monitored. Systolic blood pressure and pulse rate were recorded for one hour from initial resuscitation in each 15 minutes. Nineteen patient was traumatic hemorrhagic shock and five was non traumatic. Twelve of 19 patients was blunt trauma, and remains were stab in injury mechanism. Mortality rate was 29.2%. Initial ScvO2 of nonsurvivor was 43.6%, and 51.3% in survivor groups(p>0.05). In the group of stab wound and non-traumatic hemorrhage, the ScvO2 was gradually increase by time. But ScvO2 in survivors of blunt trauma was increased first 30 minutes and decrease afterthen. Continuous monitoring of ScvO2 may by partly useful in resuscitation for hemorrhagic shock. It is more valuable in the blunt trauma than in the penetrating injury or non-traumatic hemorrhage.
Blood Pressure ; Catheterization, Swan-Ganz ; Catheters ; Emergencies ; Heart Rate ; Hemorrhage ; Humans ; Mortality ; Oxygen* ; Pulmonary Artery ; Resuscitation ; Shock, Hemorrhagic* ; Survivors ; Wounds, Stab

No abstract available.
Scalp* ; Superficial Back Muscles*

No abstract available.
Hand*

Trichorhinophalangeal syndrome (TRPS) was first described in 1966 by Giedion. It is a rare genetic disease and divided into two groups : TRPS type I and TRPS type II. TRPS type I is an autosomal dominant inherited disorder, defined by three characteristic findings : first, sparsely distributed brittle and slow-growing scalp hair, second, a bulbous pear-shaped nose with an elongated philtrum, third brachydactyla with angular deformities. The characteristic radiological features of the hands include cone shaped epiphysis of the proximal interphalangeal joints. Most TRPS type II is sporadic and shows multiple exosteosis, mental retardation and microcephaly in addition to the three chracteristic findings of TRPS type I . A 20-year-old female visited our department for the evaluation of her sparse, slow-growing scalp hair. She also had a bulbous pearshaped nose, ulnar deviated fingers and shortened both hallux. Some relatives of patients show similar symptoms of scalp hair. A Radiologic aly, histopathologic aly and chromosomal study were done, and we established the diagnosis, TRPS type I.
Congenital Abnormalities ; Diagnosis ; Epiphyses ; Female ; Fingers ; Hair ; Hallux ; Hand ; Humans ; Intellectual Disability ; Joints ; Lip ; Microcephaly ; Nose ; Scalp ; Young Adult

Medial orbital wall fracture was described by Converse and Smith in the first time in 1957. These fractures which comprise more than 30% of all the orbital wall fracture are may easily be overlooked in routine orbital radiology. Accordingly, examination with orbital CT is essential for accurate diagnosis and appropriate treatment. These type of fracture are followed frequently by post-oprative complication such as diplopia and enophthalmos because it is very difficult to approach to orbital medial was in these operations. The mechanism of the orbital wall fractures are abruptly increased hydraulic pressure by sudden impact on orbital rim or soft tissue of orbital region. So patients who show the signs of subcutaneous emphysema, edema on the orbital region or diplopia need to get through examination with orbital CT for accurate diagnosis and immediate reconstruction of the fractured orbital wall. Conventional approaches in the operations of the orbital medial wall fractures are that with bicoronal incision, subciliary incision, transconjunctival incision and infra-orbital rim incision. But, approach with bicoronary incision, needs broader dissection and longer time for operation. Operations with transconjunctival incision and that with subciliary incision have difficulty to approach to fractured sites. Operations with other conventional methods may be also followed by scar problem. The authors performed reduction and reconstruction of the fractured orbital medial wall fractures successfully without any complications and difficulties by intra-eyebrow approach with which they made incision of 2 - 2.5 cm on mid-area of eyebrow to expose fractured medial wall with good operative field.
Cicatrix ; Diagnosis ; Diplopia ; Edema ; Enophthalmos ; Eyebrows ; Humans ; Orbit* ; Subcutaneous Emphysema

No abstract available.
Cough* ; Humans ; Hydrogen-Ion Concentration*

Medical records of very low birth weight infants weighing less than 1500 grams at birth were reviewed and analyzed. One hundred and forty three infants who were admitted to neonatal intensive care unit of Presbyterian Medical Center, including those who were born and transferred from other hospitals, from January 1987 to December 1991 were examined and the following results were obtained; 1) The incidence of very low birth weight infant was 1.21% 2) The most common maternal risk factor was premature labor and the next was toxemia. 3) The most common disease of very low birth weight infant was neonatal hyperbilirubinemia and the next was septicemia. 4) Twenty five infants (38.5%) of intensive care group and 67 infants (85.9%) of Not-ventilated group survived with overall survival rate of 64.6%. 5) The heavier birth weight and longer intrauterine period were factors offering better chance for survival. 6) Among 43 (30%) infants expired, 7 (16.3%) died within 24 hours after birth, 12 (27.9%) died in second or third day, 4 (9.3%) died between fourth and seventh day, and 20 (46.5%) died between eighth.and twenty eighth day.
Birth Weight ; Female ; Humans ; Hyperbilirubinemia, Neonatal ; Incidence ; Infant* ; Infant, Newborn ; Infant, Very Low Birth Weight* ; Critical Care ; Intensive Care, Neonatal ; Medical Records ; Obstetric Labor, Premature ; Parturition ; Pregnancy ; Protestantism ; Risk Factors ; Sepsis ; Survival Rate ; Toxemia

Tetanus is a rare disease in the developed countries, including Korea, as a result of nearly universal active immunization. Because many physicians have little experience with its diagnosis and management, misdiagnosis and therapeutic delay may result in catastrophic consequences. We report one case of generalized tetanus. A previously healthy 35-year-old man was admitted to the emergency department because of stiffness on jaw and neck. board-like abdomen, extended and rigid both legs, chest tightness, and dyspnea. Seven days before admission, he was injured on the right thing at work. In the emergency department, he was given 5,000 units of human tetanus immunoglobulin intramuscularly, as well as diazepam 2 mg/hr intravenously. On the second hospital day, tracheostomy was performed. Ten days later, his condition was improved. Twenty eight days after admission, he was discharged without any complication.
Abdomen ; Adult ; Developed Countries ; Diagnosis ; Diagnostic Errors ; Diazepam ; Dyspnea ; Emergency Service, Hospital ; Humans ; Immunoglobulins ; Jaw ; Korea ; Leg ; Neck ; Rare Diseases ; Tetanus* ; Thorax ; Tracheostomy ; Vaccination