Torsades de pointes is characterized by paroxysms of ventricular tachycardia at rates typically greater than 200 beats/min in which QRS morphology shows alternating polarity in an undulating pattern so that the complexes appear to be twisting about the beseline;this arrhythmia is virtually always associated with prolongation of the QT interval. Its importance lies not in its unusual structure but in the potentially fatal outcome if conventional treatment is administred. Torsades de pointes was diagnosed in 4 patients;the first with hypokalemia, the second with congenital QT prolongation syndrome, the third with amiodarone, the fourth with organophosphorous and hypokalemia. Treatment of these patients consisted of potassium supply, isoproterenol, lidocaine, phenobarbital, tenormin, phenytoin, cardioversion, atropine. Three patients improved successfully, but one patient died, as a direct result of the ensuing ventricular fibrillation and cardiac arrest on one hour after admission.
Amiodarone ; Arrhythmias, Cardiac ; Atenolol ; Atropine ; Electric Countershock ; Fatal Outcome ; Heart Arrest ; Humans ; Hypokalemia ; Isoproterenol ; Lidocaine ; Phenobarbital ; Phenytoin ; Potassium ; Tachycardia, Ventricular ; Torsades de Pointes* ; Ventricular Fibrillation

No abstract available.
Acetabulum* ; Arthroplasty, Replacement, Hip*

Chronic fatigue of the respiratory muscles has contributed to the decreased ventilatory capacity and reduced excercise tolerance of individuals with COPD, especially in kyphoscoliosis. Nasal mask BiPAP has been shown to be useful for the patient with nocturnal muscle fatigue and COPD. A 35-year-old man with severe kyphoscoliosis was admitted to ICU due to acute respiratory failure. He had been diagnosed of COPD and had been intubated with mechanical ventilatory support for 7 times. This time he was intubated with ventilatory support, too, in ICU and readmitted to the ICU for severe hypoxemia and hypercarbia from general ward. Thereafter he refused the intubation. Nasal mask BiPAP ventilatory support system was applied and IPAP, EPAP level being adjusted to the 12, 4 cmH2O under monitoring vital signs and arterial blood gas analysis. His condition was improved and discharged home with support of nasal mask BiPAP system after 33 day-stay in the ICU.
Adult ; Anoxia ; Blood Gas Analysis ; Fatigue ; Humans ; Intubation ; Masks* ; Muscle Fatigue ; Patients' Rooms ; Pulmonary Disease, Chronic Obstructive* ; Respiratory Insufficiency ; Respiratory Muscles ; Vital Signs

OBJECTIVE: The purpose of this study is to investigate the clinical characteristics of cerebral venous thrombosis (CVT) in a single center in Korea. METHODS: A total of 36 patients were diagnosed with CVT from August 2005 to May 2013. The patient data regarding age, sex, disease stage, pathogenesis, location, laboratory findings, radiological findings, and treatment modalities were retrospectively collected. The results were compared with those of previous studies in other countries. RESULTS: The patient group comprised 21 men and 15 women with a mean age of 46.9 years (ranging from three months to 77 years). The most common cause was a prothrombotic condition (8 patients, 22.2%). Within the patient group, 13 patients (36.1%) had a hemorrhagic infarction, whereas 23 (63.9%) had a venous infarction without hemorrhage. By location, the incidence of hemorrhagic infarction was the highest in the group with a transverse and/or sigmoid sinus thrombosis (n=9); however, the proportion of hemorrhagic infarction was higher in the cortical venous thrombosis group (75%) and the deep venous thrombosis group (100%). By pathogenesis, the incidence of hemorrhagic infarction was the highest in the prothrombotic group (n=6), which was statistically significant (p=0.016). CONCLUSION: According to this study, CVT was more prevalent in men, and the peak age group comprised patients in the sixth decade. The most common cause was a prothrombotic condition. This finding was comparable with reports from Europe or America, in which CVT was more common in younger women. Hemorrhagic infarction was more common in the prothrombotic group (p=0.016) than in the non-prothrombotic group in this study.
Americas ; Colon, Sigmoid ; Europe ; Female ; Hemorrhage ; Humans ; Incidence ; Infarction ; Korea ; Male ; Retrospective Studies ; Sinus Thrombosis, Intracranial ; Venous Thrombosis*

OBJECTIVE: To propose grading of intracerebral hemorrhage (ICH) in ruptured middle cerebral artery (MCA) aneurysms, which helps to predict the prognosis more accurately. METHODS: From August 2005 to December 2010, 27 cases of emergent hematoma evacuation and aneurysm clipping for MCA aneurysms were done in the author's clinic. Three variables were considered in grading the ICH, which were 1) hematoma volume, 2) diffuse subarachnoid hemorrhage (SAH) that extends to the contralateral sylvian cistern, and 3) the presence of midline shifting from computed tomography findings. For hematoma volume of greater than 25 mL, we assigned 2 points whereas 1 point for less than 25 cc. We also assigned 1 point for the presence of diffuse SAH whereas 0 point for the absence of it. Then, 1 point was assigned for midline shifting of greater than 5 mm whereas 0 point for less than 5 mm. RESULTS: According to the grading system, the numbers of patients from grade 1 to 4 were 4, 6, 8 and 9 respectively and 5, 7, 8, 4 and 3 patients belonged to Glasgow Outcome Scale (GOS) 5 to 1 respectively. It was found that the patients with higher GOS had lower ICH grade which were confirmed to be statistically significant (p<0.01). Preoperative Hunt and Hess grade and absence of midline shifting were the factors to predict favorable outcome. CONCLUSION: The ICH grading system composed of above three variables was helpful in predicting the patient's outcome more accurately.
Aneurysm ; Cerebral Hemorrhage ; Glasgow Outcome Scale ; Hematoma ; Humans ; Intracranial Aneurysm ; Middle Cerebral Artery ; Prognosis ; Subarachnoid Hemorrhage

PURPOSE: Acute appendicitis is one of the most common diseases requiring surgical treatment. Delayed diagnosis, which causes complications like perforation of the appendix, abscess formation, or misdiagnosis, leads to unnecessary surgery. Many scoring systems have been suggested for the diagnosis of acute appendicitis. This study aims to evaluate the clinical value of previous scoring systems. METHODS: This study was conducted with a total of 270 patients who had visited the National Police Hospital (NPH) Emergency Room for acute abdominal symptoms from January to June 2008. The Alvarado and the Ohmann scores were applied retrospectively based on the patients' records. We found 3 criteria which were relatively objective and clinically meaningful; then, we designed a new 10 points scoring system. RESULTS: The sensitivity and the specificity of the Alvarado scoring system were 83.23% and 64.42%, respectively, whereas those of the Ohmann scoring system were 74.85% and 66.35%, respectively. The sensitivity and the specificity of the NPH scoring system were found to be 78.4% and 68.9%, respectively. The Ohmann scoring system showed a little lower sensitivity, and the NPH scoring system showed a little higher specificity, but the differences were not statistically significant. CONCLUSION: Our study indicates that the scoring systems considered are not useful diagnostic methods for primary screening and diagnosis of acute appendicitis.
Abscess ; Appendicitis ; Appendix ; Delayed Diagnosis ; Diagnostic Errors ; Emergencies ; Humans ; Mass Screening ; Police ; Retrospective Studies ; Sensitivity and Specificity ; Unnecessary Procedures

PURPOSE: The study evaluated elastography, a technique that allows differentiation between pathological and normal tissue by determination of tissue hardness. METHODS: From March 2009 to April 2010, 25 consecutive patients with thyroid nodules who were referred for surgical treatment were examined in this prospective study. Thirty nodules in these patients were examined by conventional ultrasound, ultrasound elastography, and fine needle aspiration cytology. Lesions were scored (1~3) according to hardness based on the Ueno classification system. The final diagnosis was based on histopathologic results. RESULTS: Of the 30 thyroid nodules, four were classified as benign and 26 were malignant. Two of the nodules with an elastography score of 1 were benign and 17 nodules whose elastography score was 3 were malignant. Two benign nodules and nine malignant nodules had an elastography score of 2. Applying an elastography score exceeding 2 as a indicator for malignancy determined that the sensitivity and specificity of the ultrasound elastography was 100.0% and 50.0%, respectively, the positive and negativepredictive values were 92.9% and 100.0%, respectively, and the accuracy of the technique was 93.3%. CONCLUSION: Ultrasound elastography may be a useful adjunct to ultrasonography in the identification of indeterminate thyroid nodules for which tissue diagnosis is required.
Biopsy, Fine-Needle ; Classification ; Diagnosis ; Diagnosis, Differential* ; Elasticity Imaging Techniques* ; Hardness ; Humans ; Prospective Studies ; Sensitivity and Specificity ; Thyroid Gland* ; Thyroid Nodule* ; Ultrasonography*

No abstract available.
Radionuclide Imaging*

OBJECTIVE: Postoperative subgaleal cerebrospinal fluid (CSF) collection is considered as one of the common minor surgical complication which can lead to prolonged hospitalization. We introduce "galeal tack-up suture" to prevent postoperative subgaleal CSF collection. METHODS: Galeal tack-up suture consists of various surgical techniques which aim to fix galea to cranium in order to prevent CSF pooling in subgaleal space. A total of 87 patients who underwent craniotomy were divided into two groups while closing the wound : group A with galeal tack-up suture and group B with routine wound closure without galeal tack-up suture. The patients were observed for postoperative subgaleal CSF collection. RESULTS: Among 87 cranitomy cases, galeal tack-up suture was performed in 32 cases and routine wound closure was done in 55 cases. Postoperative subgaleal CSF collection occurred in 13 cases (15%) in which 12 cases occurred in group B patients and 1 case occurred in group A patients (p=0.026). CONCLUSION: Galeal tack-up suture is an easy and effective technique in wound closure to prevent postoperative CSF collection.
Cerebrospinal Fluid Rhinorrhea ; Cerebrospinal Fluid* ; Craniotomy ; Hospitalization ; Humans ; Scalp ; Skull ; Sutures* ; Wounds and Injuries

PURPOSE: The aim of this study was to compare three methods of hernioplasty: high ligation (HL), tissue repair (TR), and tension free (TF) and to determine the usefulness of high ligation for repair of indirect inguinal hernia in young adults. METHODS: One hundred thirty two patients who were under the age of 25 and who underwent repair of their inguinal hernia between January 2001 and December 2005 were reviewed retrospectively by using their inpatient and outpatient records and phone calls. Sixty seven, 23 and 42 patients underwent HL, TR and TF, respectively. The clinical features that were analyzed included location, type, signs and symptoms, operation method, complications and recurrence. RESULTS: The operation times were (mean+/-SD) 46.2+/-19.1, 56.0+/-11.5, and 61.8+/-14.9 minutes for HL, TR and TF, respectively. For the post-operative complications, there was 1 case of wound infection (1.5%) and 1 case of scrotal hematoma (1.5%) for HL; 1 case of wound infection (4.4%) and 1 case of scrotal swelling (4.4%) for TR; 3 cases of wound infection (7.0%), 2 cases of scrotal swelling (4.7%), 1 cases of intermittent pain (2.3%) and 1 case of scrotal hematoma (2.3%) for TF. Two patients in the HL group had recurrences, but there was no recurrence in the TR and TF groups. CONCLUSION: High ligation hernioplasty in young adults showed a shorter operation time, but there were no differences in the rate of complications between the methods. In the case of recurrence, it can be corrected by performing tissue repair or tension free hernioplasty because the normal anatomy may be preserved even after operation. Therefore, high ligation hernioplasty proved to be a useful method for repair of indirect inguinal hernia in young adults. In contrast, for the recurred or older age patients, tissue repair or tension free hernioplasty may be a more useful method.
Hematoma ; Hernia, Inguinal* ; Herniorrhaphy ; Humans ; Inpatients ; Ligation* ; Outpatients ; Recurrence ; Retrospective Studies ; Wound Infection ; Young Adult*