As the productive activities have vastly increased following industrialization and urbanization in the modem society, the resulting high mobility of people and goods have caused a sharp increase in the accidents in the work places as well as traffic accidents. In particular, deaths caused by injuries are generally concentrated in the economically active young peoples, producing incalculable losses to the society and nation as a whole. Advanced nations with superior medical care systems have succeeded in reducing incidents of such deaths by operating trauma centers. Especially noteworthy is the case of the United States where such specialized trauma centers have greatly contributed to reducing deaths from injuries in the non-urban areas with less access to medical facilities. At present Korea has no medical centers specializing in injuries. In large cities, the injuries are being treated tertiary medical facilities while in the provinces they are referred to small and medium-sized hospitals that constitute secondary medical facilities. Currently in Korea the Trauma patients are treated at general hospitals that consist of 726 secondary medical facilities and 40 tertiary medical centers nationwide. The secondary medical facilities which tend to take most responsibility for the treatment of trauma are generally deficient in medical staff and facilities (including operating and intensive care facilities). Despite such deficiency and limitations, no regulations exist regarding treatment or transportation of trauma patients. This article reports the outcome of a comparative analysis of the results of trauma treatments among different types of medical facilities based on objective data in the hope that such study would facilitate a comparison with the treatment systems of advanced countries and thereby contribute to a precise formulation of problems that must be addressed in this area.
Accidents, Traffic ; Hope ; Hospitals, General ; Humans ; Critical Care ; Korea ; Medical Staff ; Modems ; Social Control, Formal ; Transportation ; Trauma Centers ; United States ; Urbanization ; Workplace ; Industrial Development

The aim of this study is to review the protective effect of a bicycle helmet on each facial location systematically. PubMed was searched for articles published before December 12, 2014. The data were summarized, and the odds ratio (OR) between the locations of facial injury was calculated. A statistical analysis was performed with Review Manager (The Nordic Cochrane Centre). Bicycle helmets protect the upper and middle face from serious facial injury but do not protect the lower face. Non-wearers had significantly increased risks of upper facial injury (OR, 2.07; P<0.001) and of middle facial injury (OR, 1.97; P<0.001) as compared to helmet users. In the case of lower facial injury, however, only a slightly increased risk (OR, 1.42; 95% confidence interval (CI), 0.67-3.00, P=0.36) was observed. The abovementioned results can be attributed to the fact that a helmet covers the head and forehead but cannot cover the lower face. However, helmets having a chin cap might decrease the risk of lower facial injury.
Bicycling ; Chin ; Facial Injuries* ; Forehead ; Head ; Head Protective Devices* ; Odds Ratio

Suprarenal IVC obstruction occurs rarely but has various causes. Because this obstruction proceed chronically and usually has collateral circulation, if there is no IVC or hepatic vein obstruction symptom such as Budd-Chiari syndrome, operation is usually needless. However, although symptom is not combined, if malignancy can not be ruled out and there is no proper and radiologically visible collateral, mass resection with IVC wall and bypass graft should be done. 58 year-old female patient visit the hospital for IVC mass that is occasionally discovered by routine abdominal ultrasonography examination. After abdominal CT scanning and IVC venography, IVC obstructive mass between renal vein and hepatic vein was found. Patient didn't show any abnormality in hematological examination such as coagulation and platelet counts. There was no IVC obstruction symptom such as lower limb swelling. Inferior hepatic vein was abnormally dilated and this was regarded as collateral vessel for IVC obstruction. Radiologically, primary leiomyosarcoma was not ruled out and so operation was decided. Suprarenal IVC was dissected and mass was exposed. And with the use of femoral vein and right atrium, temporally veno-veno bypass was performed. Mass including IVC wall was excised and upper end of divided IVC was sutured. Lower end of divided IVC was anastomosed with 16 mm Dacron graft and graft was anastomosed with right atrium by end-to-end methods (Cavoatrial shunt). Postoperative pathologic examination revealed the mass to be organized thrombi. After 2 weeks later, follow-up IVC venography was performed and good patency was found from IVC to right atrium through artificial bypass graft and patient was discharged without complications.
Budd-Chiari Syndrome ; Collateral Circulation ; Female ; Femoral Vein ; Follow-Up Studies ; Heart Atria ; Hepatic Veins ; Humans ; Leiomyosarcoma ; Lower Extremity ; Middle Aged ; Phlebography ; Platelet Count ; Polyethylene Terephthalates ; Renal Veins ; Thrombosis* ; Tomography, X-Ray Computed ; Transplants ; Ultrasonography

The piriformis syndrome is a condition allegedly attributable to compression of the sciatic nerve by the piriformis muscle. Recently, magnetic resonance neurography and electrophysiologic study have helped to diagnose piriformis syndrome. High dose radiotherapy could induce acute and delayed muscle damage. We had experienced piriformis syndrome with fatty atrophy of piriformis muscle after radiotherapy for recurrent cervical cancer.
Atrophy ; Magnetic Resonance Spectroscopy ; Muscles ; Piriformis Muscle Syndrome ; Sciatic Nerve ; Sciatic Neuropathy ; Uterine Cervical Neoplasms

The activation of neurotrophic signaling pathways following the upregulation of glial cell line-derived neurotrophic factor (GDNF), a member of the transforming growth factor-β family, has a potential neuroprotective effect in the adult brain. Herein, we report that hippocampal transduction of adeno-associated virus serotype 1 (AAV1) with a constitutively active form of ras homolog enriched in brain [Rheb(S16H)], which can stimulate the production of brain-derived neurotrophic factor (BDNF) in hippocampal neurons, induces the increases in expression of GDNF and GDNF family receptor α-1 (GFRα-1), in neurons and astrocytes in the hippocampus of rat brain in vivo . Moreover, upregulation of GDNF and GFRα-1 contributes to neuroprotection against thrombin-induced neurotoxicity in the hippocampus. These results suggest that AAV1-Rheb(S16H) transduction of hippocampal neurons, resulting in neurotrophic interactions between neurons and astrocytes, may be useful for neuroprotection in the adult hippocampus.

BACKGROUND: Self inflating resuscitators are widely used for the patients who need positive pressure ventilation during transport. During self inflating resuscitator ventilation, the FiO2 may decreases even with the use of the oxygen reservoir. Such phenomenon may increase the difficulty and risk of transport of the critically ill patients. Twin self inflating resuscitator was assembled by being modified from two conventional ones to achieve more stable FiO2. METHODS: The twin self inflating resuscitator and one conventional adult self inflating resuscitator were tested on a test lung. In the twin resuscitator, two adult self inflating resuscitators were connected serially without distal unidirectional valve plate. The resuscitators were compressed at variable tidal volumes, respiratory rates and oxygen flow rates, guided by the monitor. RESULTS: With conventional self inflating resuscitator ventilation, the FiO2 was maintained over 95% until minute ventilation of 7,500, 1,4000, 17,500 ml at respectively 5, 10, 15 L/min oxygen flow rate. With serial type, the FiO2 started to decrease with the minute ventilation over 12,500, 24,000, 28,000 ml at 5, 10, 15 L/min oxygen flow rate. CONCLUSIONS: By simple connection of two self inflating resuscitators, the FiO2 during self inflating resuscitator ventilation could be maintained during almost two times of minute ventilation compared to conventional ones.
Adult ; Critical Illness ; Humans ; Lung ; Oxygen ; Positive-Pressure Respiration ; Respiratory Rate ; Tidal Volume ; Ventilation*

OBJECTIVE: Neuromelanin loss of substantia nigra (SN) can be visualized as a T1 signal reduction on T1-weighted high-resolution imaging. We investigated whether volumetric analysis of T1 hyperintensity for SN could be used to differentiate between Parkinson's disease dementia (PDD), Alzheimer's disease (AD) and age-matched controls. MATERIALS AND METHODS: This retrospective study enrolled 10 patients with PDD, 18 patients with AD, and 13 age-matched healthy elderly controls. MR imaging was performed at 3 tesla. To measure the T1 hyperintense area of SN, we obtained an axial thin section high-resolution T1-weighted fast spin echo sequence. The volumes of interest for the T1 hyperintense SN were drawn onto heavily T1-weighted FSE sequences through midbrain level, using the MIPAV software. The measurement differences were tested using the Kruskal-Wallis test followed by a post hoc comparison. RESULTS: A comparison of the three groups showed significant differences in terms of volume of T1 hyperintensity (p < 0.001, Bonferroni corrected). The volume of T1 hyperintensity was significantly lower in PDD than in AD and normal controls (p < 0.005, Bonferroni corrected). However, the volume of T1 hyperintensity was not different between AD and normal controls (p = 0.136, Bonferroni corrected). CONCLUSION: The volumetric measurement of the T1 hyperintensity of SN can be an imaging marker for evaluating neuromelanin loss in neurodegenerative diseases and a differential in PDD and AD cases.
Aged ; Alzheimer Disease* ; Dementia* ; Humans ; Magnetic Resonance Imaging ; Mesencephalon ; Neurodegenerative Diseases ; Parkinson Disease* ; Parkinsonian Disorders ; Retrospective Studies ; Substantia Nigra*

Disseminated intravascular coagulation (DIC) is the result of a severe underlying disorder that initiates massive activation of the coagulation system. We report an unusual case of 79-year-old man who developed DIC after tooth extraction in abdominal aortic aneurysm. He was referred to our hospital because of persistent bleeding after tooth extraction. Physical examination indicated a pulsating mass in abdomen. Abdominal computerized tomography (CT) scan revealed 70 mm diameter aneurysm of the abdominal aorta, extending from the renal infrahilar level to the common iliac artery, and his coagulation profile showed the features of DIC by revealing thrombocytopenia, hypofibrinogenemia, and increased level of fibrinogen degradation product (FDP). After he had received blood component therapy including fresh frozen plasma and continuous intravenous heparin infusion (4,800 U/day), the bleeding diathesis and coagulopathy improved. He refused to have definitive surgery for the aneurysm.
Abdomen ; Aged ; Aneurysm ; Aorta, Abdominal ; Aortic Aneurysm ; Aortic Aneurysm, Abdominal* ; Dacarbazine ; Disease Susceptibility ; Disseminated Intravascular Coagulation* ; Fibrinogen ; Hemorrhage ; Heparin ; Humans ; Iliac Artery ; Physical Examination ; Plasma ; Thrombocytopenia ; Tooth Extraction* ; Tooth*

A 59-year-old Korean man complained of a painless scrotal hard nodule and weak urine stream. The ultrasound scan revealed a 2.2-cm sized round heteroechogenic nodule located in the extratesticular area. Microscopic hematuria was detected in routine laboratory examinations. On scrotal exploration, multiple spargana were incidentally found in the mass and along the left spermatic cord. On cystoscopy, a 10-mm sized mucosal elevation was found in the right side of the bladder dome. After transurethral resection of the covered mucosa, larval tapeworms were removed from inside of the nodule by forceps. Plerocercoids of Spirometra erinacei was confirmed morphologically and also by PCR-sequencing analysis from the extracted tissue of the urinary bladder. So far as the literature is concerned, this is the first worm (PCR)-proven case of sparganosis in the urinary bladder.
Animals ; Cystoscopy ; DNA, Helminth/chemistry/genetics ; Hematuria/diagnosis ; Humans ; Male ; Middle Aged ; Polymerase Chain Reaction ; Scrotum/*parasitology/*pathology/ultrasonography ; Sequence Analysis, DNA ; Sequence Homology, Nucleic Acid ; Sparganosis/*diagnosis/parasitology ; Spirometra/*isolation & purification ; Urinary Bladder Diseases/*parasitology/*pathology/surgery

INTRODUCTION: Mini-implant system is applicable to areas of narrow space and area requiring temporary loading support. The purpose of this study was to evaluate the clinical outcome of a mini-implant system as well as the application of mini-implant system in the dental clinical field. MATERIALS AND METHODS: The patients who had been operated from Jan 2007 to Dec 2007 in the four dental facility including Seoul National University Bundang Hospital were enrolled. To evaluate the factors associated with the clinical outcome, the patients were classified according to gender, age, area of surgery, type of implant, diameter and length of the implant, and the purpose of the mini-implant system application. RESULTS: From 147 implants, only three implants failed, one of them was for temporary loading. There were no serious surgical or prosthetic complications in this study. CONCLUSION: An analysis of the preliminary data revealed a satisfactory clinical outcome. However, more long-term evaluation of narrow ridge type as well as the patient's satisfaction on the use of a provisional type mini-implant system is needed.
Dental Facilities ; Humans ; Retrospective Studies