BACKGROUND: Emergency Medical Technicians can do emergency care only under the control of the physicians. Emergency medical services system(EMSS) in Korea is now extended from the level of basic life support(BLS) to advanced life support(ALS). Unfortunately we don't have any official medical control system yet. We and regional EMSS, 119 rescue team(BLS), have had monthly joint meeting to validate and improve the prehospital care since August, 1998. METHODS: From August, 1998 to February, 1999, 1,708 patients were transported to Ewha Mokdong Hospital by regional 119 rescue team. Eight hundred and six(47.2%) run record were collected and analyzed. The appropriateness of the prehospital care were evaluated based on the comparison of assessment data and treatment data in each run record. The run record were divided into 5 groups; 1) necessary-adequate, 2) necessary-inadequate, 3) necessary-undo, 4) unnecessary-done, and 5) unnecessary-undo. 1) and 5) were judged as acceptable, and 2), 3), and 4) as unacceptable. RESULTS: Among 806 transported patients, 60.8% required one or more emergency care. 21.0% of required care were not provided, and 20.7% of provided care were not adequate. 78.8% of unprovided and 75.9% of inadequate care were 'airway and oxygen supply'. Overall unacceptable rate was decreased from 31.7% to 17.0% during first 5 months, but it rose up again to 24.7% after 2 months. Cardiopulmonary resuscitation(CPR) was performed in 29 prehospital cardiac arrest victims and admitted to ICU in 5 cases. CPR was not provided in 8 necessary situations, and unnecessary CPR was done in 3 cases. CONCLUSION: EMSS in Korea also need a kind of medical control system, even for BLS level. Major portion of the quality assurance program could be 'airway and oxygen supply', but attention should be focused in cardiac arrest victims and CPR. Record keeping and reliance of run record data are now pending problems. Fire department should develop a formal medical control system and the referring hospital should have an organization for maintaining the quality of prehospital care.
Cardiopulmonary Resuscitation ; Emergency Medical Services* ; Emergency Medical Technicians ; Fires ; Heart Arrest ; Humans ; Joints ; Korea ; Oxygen ; Retrospective Studies*

This report deals with a 49-year-old male farmer who had a pathological fraeture. of the right femoral shaft due to metastatic carcinoma from the middle lobe of the right lung. The lesion of the femur was resected en-bloc and bone stabilization of the fractured bone was obtained by an intramedullary Kiintscher nail plus cement fixation. Two weeks later, a right middle and lower lobectomy was done. Microscopic examination of both specimens from right femur and lung revealed poorly differentiated squamous cell carcinoma. The postoperative course was satisfactory with no recurrence for period of 26 months.
Carcinoma, Squamous Cell ; Farmers ; Femur ; Humans ; Lung ; Male ; Methylmethacrylate ; Middle Aged ; Neoplasm Metastasis ; Recurrence

BACKGROUND: We investigated the effectiveness of fibular strut allograft augmentation of proximal humerus fractures to prevent varus deformity in patients over the age of 65 years with insufficient medial support. METHODS: We analyzed the clinical and radiological outcomes of locking plate fixation with adjunct fibular strut allograft augmentation in 21 patients with proximal humeral fractures. The inclusion criteria were age (65-year-old or older); presence of severe medial comminution; inadequate medial support; and those who could participate in at least a one year follow-up. The average age was 76.4 years. We analyzed each patient's Constant score, our indicator of clinical outcome. As radiological parameters, we analyzed time-to-bone union; restoration of the medial hinge; difference between the immediately postoperative and the last follow-up humeral neck-shaft angles;; and anatomical reduction status, which was assessed using the Paavolainen method. RESULTS: A successful bone union was achieved in all patients at an average of 11.4 weeks. We found that the average Constant score was 74.2, showing a satisfactory outcome. The average difference in the humeral neck-shaft angles between the immediately postoperative time-point and at the final follow-up was 3.09°. According to the Paavolainen method, the anatomical reduction was rated excellent. The medial hinge was restored in 14 of 21 patients. Although we did not find evidence for osteonecrosis, we found that a single patient had a postoperative complication of screw cut-out. CONCLUSIONS: Fibular strut allografting as an adjunct treatment of proximal humeral fractures may reduce varus deformity in patients with severe medial comminution.
Allografts ; Congenital Abnormalities* ; Follow-Up Studies ; Humans ; Humerus* ; Methods ; Osteonecrosis ; Postoperative Complications ; Shoulder Fractures ; Transplantation, Homologous

The Dichloromethane(methylene chloride) is a highly volatile liquid used as a solvent, extraction medium, and paint remover. The most significant route of intoxication to dichloromethane is generally inhalation at work site or home, but ingestion is rare. The main toxicological harvard insults from in vivo conversion of dichloromethane to carbon monoxide. We present a case of dichloromethane intoxication following ingestion. A 71 years old male patient ingested 60-70cc of dichloromethane was brought to emergency department after stomach washout via nasogastric tube at other hospital. On arrival at emergency department(approximately 19 hours after ingestion), he was stuporous with a blood pressure 140/90mmHg, heart rate of 92 beats/min, dyspneic, respiratory rate of 24/min and body temperature 36.8 degrees C. His Pupils were isocoric, miotic, and sluggishly reactive. There were mucosal bums and significant secretion in oral cavity. On auscultation, breathing sound was coarse without role on both lung field. The COHb levels were 6.3%at 32 hours after ingestion and normalized to 0.6%at 44 hours after ingestion. Patient was transfered to intensive care unit and supportive care was started with 100% oxygen. On ingestion 4th day, chest X-ray showed pulmonary edema and acute respiratory distress syndrome developed. Patient regained the consciousness on the 11th day. On the 30th day, respiratory function improved and the ventilator was removed. Alveolitis and mild pulmonary fibrosis developed and mild dyspnea was continued. On the 36th day, gastroscopic examinations showed ulceration of esophagus and stomach. On the 76th day, patient was discharged after pulmonary rehabilitation.
Aged ; Auscultation ; Blood Pressure ; Body Temperature ; Carbon Monoxide ; Consciousness ; Dyspnea ; Eating* ; Emergencies ; Emergency Service, Hospital ; Esophagus ; Heart Rate ; Humans ; Inhalation ; Intensive Care Units ; Lung ; Male ; Methylene Chloride* ; Mouth ; Oxygen ; Paint ; Pulmonary Edema ; Pulmonary Fibrosis ; Pupil ; Rehabilitation ; Respiratory Distress Syndrome, Adult ; Respiratory Rate ; Respiratory Sounds ; Stomach ; Stupor ; Thorax ; Ulcer ; Ventilators, Mechanical ; Workplace

We experienced a case of pedunculated left atrial primary fibrosarcoma, which obstructed the mitral orifice and produced symptoms and manifestations of mitral stenosis clinically. There was no evidence of metastasis to adjacent tissue or distant organs. It was treated by open heart surgery.
Fibrosarcoma* ; Heart Atria* ; Mitral Valve Stenosis ; Neoplasm Metastasis ; Thoracic Surgery

We observed the motion of left ventricular posterior wall aortic root posterior wall in 20 normal persons and 20 patients with left ventricular hypertrophy during the period from March 1985 to Agust 1985. The results were as followings; 1) The percentage of rapid filling time to one cycle of heart beat obtained from the ventriculat posterior wall motion was significantly prolonged in patients with left ventricular hypertrophy(24.1+/-5.44%) than in normal persons(13.5+/-3.69%)(p<0.05) and that of slow filling time was significantly shortend in patients with left ventricular hypertrophy(27.4+/-6.10%) than in normal persons(38.7+/-9.06%)(P<0.005). 2) The rapid filling slop obtained from left ventricular postrior wall motion was significantly reduced in patients with left ventricular hypertrophy(44.0+/-12.45mm/sec)than in normal persons(91.7+/-53.16mm/sec)(P>0.005) but the slow were not signigficantly different between the two groups. 3) The left artial emptying index calculated from the aortic root posterior wall motion was significantly lower in patients with left ventricular hypertrophy(0.6+/-0.18) than in normal persons(1.1+/-0.26)(P<0.005).
Echocardiography* ; Heart ; Humans ; Hypertrophy, Left Ventricular*

No abstract available.
Ankle*

3 cases of giant cell tumor in the distal femur or upper tibia were treated by curettage and acrylic cement packing between October 1978 and May 1981. All were females. The postoperative courses were satisfactory with no recurrence or malignant change for periods of 16 months to 30 months. In one case, acrylic cement reinforced with tantalum wire was used because it is superior to acrylic cement alone in mechanical properties. The adventages of this method are: 1. The cautery effect of setting cement. 2. Avoidence of the need for large quantities of cancellous bone 3. The possibility of incorporating a prosthesis if the lesion is extensive. 4. Rapid mobilization. 5. Ease of early diagnosis of recurrence.
Cautery ; Cementation ; Curettage ; Early Diagnosis ; Female ; Femur ; Giant Cell Tumors ; Giant Cells ; Humans ; Methods ; Prostheses and Implants ; Recurrence ; Tantalum ; Tibia

A total 48 cases of myelography using Metrizamide were performed between August 1981 and July 1983 at the department of Orthopedic Surgery, Kwangju Christian Hospital. Of these cases, H.N.P was 26, tuberculous spondylitis 16, spondylolisthesis 4, and multiple sclero-sis 2 cases. The advantages of this study were as folows: 1. Complications were minimal in most of the cases except a slight headache. 2. Large amount of infusion was possible. 3. Rootlet was clearly seen. 4. Removal of dye was not necessary. 5. It gave a good contrast for the radiologic study.
Gwangju ; Headache ; Metrizamide ; Myelography ; Orthopedics ; Spondylitis ; Spondylolisthesis ; Water

Congenital fibrous bands may be found at the gluteus maximus, the gluteus medius,thequadriceqs,the triceps and the deltoideus muscles. Congenital fibrous bands of both gluteus maximus muscles are rare and cause extension contracture of the hip joints. We experienced a case of congenital fibrous bands of both gluteus maximus muscles associated with severe limited flexion of both hips. Almost full flexion of both hips was obtained by excision of the congenital fibrous bands.
Contracture ; Hip Joint ; Hip ; Muscles