No abstract available.
Acetazolamide* ; Aneurysm* ; Brain* ; Humans ; Perfusion* ; Subarachnoid Hemorrhage* ; Tomography, Emission-Computed, Single-Photon*

BACKGROUND: The goal of this study is to identify the factors that predict mortality in elderly trauma patients. METHOD: We reviewed retrospectively the medical record of 144 cases of geriatric trauma admitted to Kyungpook National University Hospital firm January 1998 to December 1998. We evaluated the general characteristics, mechanisms of injury, Revised Trauma Score(RTS), Injury Severity Score(ISS), Probability of survival(Ps) by TRISS(Trauma and Injury Severity Score) method, amount of blood transfused, preexisting disease, complications, length of stay, and mortality. RESULTS: 1. The mean age was 75.39+/-7.89 years old, and male to female ratio was 0.89 : 1. 2. The mechanisms of injury were primarily frills(56.3%) followed by bicycle or motorcycle(13.9%), and pedestrian injuries(13.2%) and motor vehicle accidents(6.9%). 3. The mean Glasgow Coma Scale(GCS), RTS and ISS ate 13.3+/-3.5, 7.2+/-1.4 and 14.2 +/-11.6 respectively. 4. The actual mortality rate was 18.1% (26/144). But by TRISS method, predicted mortality rate was 9.3%(12.5/144), excess mortality rate was 108% and Z score was 3.99 indicating that actual number of death exceed predicted number of death. 5. Between the survivors and nonsurvivors, the insults were significantly different as follows ; systolic blood pressure(141.9+/-28.3 vs. 116.8+/-48.7 mmHg), GCS(14.3+/-2.0 vs. 9.0 +/-5.1), RTS(7.8+/-0.7 vs 5.4+/-2.3), ISS(11.3+/-5.6 vs 27.2+/-20.2), Ps by TRISS(0.97+/-0.06 vs 0.65+/-0.37), preexisting diseases(50.8 vs 69.8%). CONCLUSION: Geriatric patients are more likely to die after trauma than other age groups. The cause of higher actual mortality rate compared to predicted mortality rate was considered as the higher incidence of delayed death due to sepsis or multiple organ failure. In order to reduce the mortality, even with relatively stable initial vile sign, invasive hemodynamic monitoring and intensive treatment are recommended and also, prevention and treatment of nosocomial infection are very important.
Aged ; Coma ; Cross Infection ; Female ; Gyeongsangbuk-do ; Hemodynamics ; Humans ; Incidence ; Length of Stay ; Male ; Medical Records ; Mortality* ; Motor Vehicles ; Multiple Organ Failure ; Preexisting Condition Coverage ; Retrospective Studies ; Sepsis ; Survivors

BACKGROUND: To determine if positive pressure pneumoperitoneum has adverse effects on autonomic nervous system function, we examined baroreflex sensitivity (BRS) during carbon dioxide pneumoperitoneum in patients undergoing laparoscopic surgery. METHODS: Twenty adult patients scheduled for laparoscopic gynecologic surgery were selected for the study. After general anesthesia was induced with sevoflurane, continuous electrocardiography and blood pressure were monitored. Spontaneous BRS was achieved using sequence method immediately before, and 5 minutes after, pneumoperitoneum. Heart rate variability (HRV) was also determined. RESULTS: After pneumoperitoneum, BRS decreased from 12.9 +/- 1.8 ms/mmHg to 8.1 +/- 1.1 ms/mmHg (P < 0.05), and the power of the high frequency band decreased from 237.8 ms2/Hz to 49.6 ms2/Hz (P < 0.05). CONCLUSIONS: Compared to recordings obtained before pneumoperitoneum, BRS was decreased during pneumoperitoneum. This may predispose patients undergoing laparoscopic surgery to hemodynamic instability in addition to pneumoperitoneum itself.
Adult ; Anesthesia, General ; Autonomic Nervous System ; Baroreflex ; Blood Pressure ; Carbon ; Carbon Dioxide ; Electrocardiography ; Female ; Gynecologic Surgical Procedures ; Heart Rate ; Hemodynamics ; Humans ; Laparoscopy ; Methyl Ethers ; Pneumoperitoneum

PURPOSE: Long-acting gonadotropin-releasing hormone agonists (GnRHa) are commonly used to treat central precocious puberty (CPP) in Korea. Although rare, there have been reports on the characteristic of adverse reactions of GnRHa in CPP among the Korean population. This study was intended to report on our clinical experience regarding significant adverse reactions to long-acting GnRHa in CPP and early onset puberty and to evaluate the prevalence rate of serious side effects. METHODS: This retrospective study included children with CPP and early onset puberty, who were administered monthly with long-acting GnRHa (leuprolide acetate, triptorelin acetate) at the outpatient clinic of Department of Pediatrics, at Inha University Hospital, between January 2011 and December 2013. We analyzed the clinical characteristics of patients who experienced significant adverse reactions and evaluated the prevalence rate. RESULTS: Six serious side effects (0.9%) were observed among total of 621 CPP and early onset puberty children with GnRHa therapy. The number of sterile abscess formation was four in three patients (4 events of 621). Anaphylaxis occurred in only one patient, and unilateral slipped capital femoral epiphysis (SCFE) in another one patient. Anaphylaxis occurred after the 6th administration of the monthly depot triptorelin acetate. Unilateral SCFE developed in GnRHa therapy. CONCLUSION: Sterile abscess formation occurred in 0.6% of CPP and early onset puberty patients from the administration of a monthly depot GnRHa therapy. The occurrences of anaphylaxis and SCFE are extremely rare, but can have serious implications on patients. Clinicians should be aware of these potential adverse effects related to GnRHa therapy in CPP.
Abscess ; Adolescent ; Ambulatory Care Facilities ; Anaphylaxis ; Child ; Drug-Related Side Effects and Adverse Reactions ; Gonadotropin-Releasing Hormone* ; Humans ; Korea ; Leuprolide ; Pediatrics ; Prevalence ; Puberty* ; Puberty, Precocious* ; Retrospective Studies ; Slipped Capital Femoral Epiphyses ; Triptorelin Pamoate

PURPOSE: The detection of axillary lymph-node micrometastases in breast-cancer patients by using the reverse transcriptase-polymerase chain reaction (RT-PCR) may provide a good guide for postoperative therapy. To evaluate effectiveness of RT-PCR for the detection of micrometastasis, we have compared the results of conventional, immunohistochemical (IHC) staining with those of RT-PCR. METHODS: We conducted RT-PCR amplifications of MUC1 and cytokeratin (CK) 19 on lymph nodes from 40 breast- cancer patients and conducted IHC staining for cytokeratin. The results of histological examination and cytokeratin IHC staining were compared with the RT-PCR results for the detection of lymph-node micrometastases. RESULTS: Nineteen of 40 cases (47.5%) were lymph-node positive and twenty-one cases (52.5%) were lymph-node negative. Using RT-PCR MUC1 and CK19 expressions were detected in all positive lymph nodes and in 4 (19.0%) and 5 (23.8%), in negative nodes, respectively. Not all positive nodes were stained by IHC (94.7%), and none of the negative lymph nodes were stained by IHC. Thus, IHC staining was ineffective in detecting micrometastases. CONCLUSION: Detection of MUC1 and CK19 by using RT- PCR can be a more accurate and useful method than IHC staining for the detection of axillary lymph-node micrometastases in breast cancer.
Breast Neoplasms* ; Breast* ; Humans ; Keratin-19* ; Keratins* ; Lymph Nodes* ; Neoplasm Micrometastasis* ; Polymerase Chain Reaction

BACKGROUND: Sometimes adequate pulmonary venous flow signal could not be obtained in transthoracic echocardiogram. It has been reported that contrast agent that has transpulmonary passage capability could be used in the enhancement of Doppler signal in the left side of the heart. We evaluated the Levovist(R)-enhanced pulmonary vein flow signals obtained by transthoracic echocardiogram and compared with those obtained by transesophageal echocardiogram. METHOD: Ten patients(male 8, female 10, mean age 46+/-11) with sinus rhythm who underwent transesophageal echocardiogram were enrolled. Spectral Doppler signal intensity(score; 0-5), systolic time velocity integral(Stvi), diastolic time velocity integral(Dtvi) of pulmonary vein flow before and after intravenous injection of the contrast were obtained and compared with those obtained by transesophageal echocardiogram. RESULTS: There was no serious side effect related to Levovist(R). Spectral Doppler signal intensity score of pulmonary vein flow with nonenhanced transthoracic echocardiogram was 2.1 / 5, and adequate Doppler signal could not be obtained in two patients. After contrast enhancement, Doppler signal intensity score rose up to 4.3 / 5 and adequate Doppler signal could be obtained in all patients. Time velocity integrals of systolic and diastolic pulmonary vein flow obtained by transthoracic echocardiogram correlated well with those obtained by transesophageal echocardiogram. CONCLUSION: Contrast enhancement of Doppler signal with the agent that has transpulmonary passage capability(Levovist(R)) is useful in the evaluation of pulmonary vein flow in patient whose transthoracic echocardiographic Doppler signal is inadequate.
Echocardiography ; Female ; Heart ; Humans ; Injections, Intravenous ; Pulmonary Veins*

To support the ovarian hormone hypothesis in the etiology of breast cancer, a hospital-based case-control study with community controls was conducted to evaluate the relationship of intervals among menstrual and reproductive events to the risk of breast cancer in Korea. The cases were 190 breast cancer patients, who had been histologically diagnosed at Seoul National University Hospital from Jan. 1, 1993 to Jun. 30, 1994. Included were cancer-free women, who had undertaken the Gynecological examination at the same hospital (n=190). Women recruited for a survey of diabetes prevalence in Yonchon County, adjacent to Seoul City, were taken as a community control group (n=190). Information on menstrual and reproductive factors with other life-styles was collected through a direct interview by the well-trained interviewers. The adjusted odds ratios and the 95% confidence intervals were based on the unconditional logistic regression model. Likelihood ratio test for trend was applied for the ordinal variables. Early age at menarche, late age at natural menopause, late age at first full term pregnancy, and fewer number of full term pregnancies are independently associated with the high risk of breast cancer in Korea. Moreover, the interval between the age at menarche and the age at natural menopause of community controls (29.9+/-6.15 years) was significantly shortened compared to breast cancer cases (34.9+/-4.42 years). Particularly noteworthy was that intervals between the age at menarche and the age at first full term pregnancy of both control groups (9.0+/-3.72 years for hospital controls; 7.2+/-4.04 years for community controls) were significantly shortened compared to breast cancer cases (11.0+/-4.51 years). These findings support the hypothesis that the longer exposure to ovarian hormones during the reproductive years, the higher the risk of breast cancer.
Adult ; Age Factors ; Aged ; Breast Neoplasms/*epidemiology ; Case-Control Studies ; Female ; Human ; Korea/epidemiology ; Menstruation/*physiology ; Middle Age ; Pregnancy ; Reproduction/*physiology ; Risk Factors

To support the ovarian hormone hypothesis in the etiology of breast cancer, a hospital-based case-control study with community controls was conducted to evaluate the relationship of intervals among menstrual and reproductive events to the risk of breast cancer in Korea. The cases were 190 breast cancer patients, who had been histologically diagnosed at Seoul National University Hospital from Jan. 1, 1993 to Jun. 30, 1994. Included were cancer-free women, who had undertaken the Gynecological examination at the same hospital (n=190). Women recruited for a survey of diabetes prevalence in Yonchon County, adjacent to Seoul City, were taken as a community control group (n=190). Information on menstrual and reproductive factors with other life-styles was collected through a direct interview by the well-trained interviewers. The adjusted odds ratios and the 95% confidence intervals were based on the unconditional logistic regression model. Likelihood ratio test for trend was applied for the ordinal variables. Early age at menarche, late age at natural menopause, late age at first full term pregnancy, and fewer number of full term pregnancies are independently associated with the high risk of breast cancer in Korea. Moreover, the interval between the age at menarche and the age at natural menopause of community controls (29.9+/-6.15 years) was significantly shortened compared to breast cancer cases (34.9+/-4.42 years). Particularly noteworthy was that intervals between the age at menarche and the age at first full term pregnancy of both control groups (9.0+/-3.72 years for hospital controls; 7.2+/-4.04 years for community controls) were significantly shortened compared to breast cancer cases (11.0+/-4.51 years). These findings support the hypothesis that the longer exposure to ovarian hormones during the reproductive years, the higher the risk of breast cancer.
Adult ; Age Factors ; Aged ; Breast Neoplasms/*epidemiology ; Case-Control Studies ; Female ; Human ; Korea/epidemiology ; Menstruation/*physiology ; Middle Age ; Pregnancy ; Reproduction/*physiology ; Risk Factors

PURPOSE: In children, dysphagia is a common cause of recurrent pneumonia and malnutrition and can be fatal. However, till now no studies were performed concerning the clinical investigation of dysphagia in Korea. METHODS: In this study we evaluated the clinical manifestations of dysphagia in children with an age range between 1 month and 12 years by reviewing the clinical records, and we classified the dysphagia by videofluoroesophagography. RESULTS: The etiologies of dysphagia demonstrated as follows; developmental delay in 7 patients, treacheoesophageal fistula in 2 patients, and ischemic encephalopathy, encephalitis, brain tumor, subepiglottic stenosis, bronchiolitis, and Williams syndrome in 1 patient, respectively. The presenting symptoms of dysphagia revealed as follows; choking in 7(46%) patients, nasal regurgitation in 2(13.3%) patients, hypersensitive gag reflex in 2(13.3%) patients and drooling, foreign body sensation, and feeding refusal in 1 patient, respectively. The complications of dysphagia were malnutrition in 12(80%) patients, which was followed by aspiration pneumonia in 8(53.3%) patients. On videofluoroesophagography, 5 patients showed oral phase dysphagia, Seven and two patients showed pharyngeal and esophageal phase dysphagia, respectively. Two patients presented normal deglutition on videofluoroesophagography. Total of 8 patients required gastrostomy because of recurrent aspiration and poor weight gain. In 7 patients, however, dysphagia improved with rehabilitation therapy only. CONCLUSION: Our data demonstrated that the complications of dysphagia in childhood were not uncommon, and suggested that diagnostic workup including videofluoroesophagography were helpful in classifying the feeding difficulties of these children. Gastrostomy and rehabilitation offered effective therapeutic possibilities.
Airway Obstruction ; Brain Ischemia ; Brain Neoplasms ; Bronchiolitis ; Child* ; Constriction, Pathologic ; Deglutition ; Deglutition Disorders* ; Disulfiram ; Encephalitis ; Fistula ; Foreign Bodies ; Gastrostomy ; Humans ; Korea ; Malnutrition ; Pneumonia ; Pneumonia, Aspiration ; Reflex ; Rehabilitation ; Sensation ; Sialorrhea ; Weight Gain ; Williams Syndrome

PURPOSE: In children, dysphagia is a common cause of recurrent pneumonia and malnutrition and can be fatal. However, till now no studies were performed concerning the clinical investigation of dysphagia in Korea. METHODS: In this study we evaluated the clinical manifestations of dysphagia in children with an age range between 1 month and 12 years by reviewing the clinical records, and we classified the dysphagia by videofluoroesophagography. RESULTS: The etiologies of dysphagia demonstrated as follows; developmental delay in 7 patients, treacheoesophageal fistula in 2 patients, and ischemic encephalopathy, encephalitis, brain tumor, subepiglottic stenosis, bronchiolitis, and Williams syndrome in 1 patient, respectively. The presenting symptoms of dysphagia revealed as follows; choking in 7(46%) patients, nasal regurgitation in 2(13.3%) patients, hypersensitive gag reflex in 2(13.3%) patients and drooling, foreign body sensation, and feeding refusal in 1 patient, respectively. The complications of dysphagia were malnutrition in 12(80%) patients, which was followed by aspiration pneumonia in 8(53.3%) patients. On videofluoroesophagography, 5 patients showed oral phase dysphagia, Seven and two patients showed pharyngeal and esophageal phase dysphagia, respectively. Two patients presented normal deglutition on videofluoroesophagography. Total of 8 patients required gastrostomy because of recurrent aspiration and poor weight gain. In 7 patients, however, dysphagia improved with rehabilitation therapy only. CONCLUSION: Our data demonstrated that the complications of dysphagia in childhood were not uncommon, and suggested that diagnostic workup including videofluoroesophagography were helpful in classifying the feeding difficulties of these children. Gastrostomy and rehabilitation offered effective therapeutic possibilities.
Airway Obstruction ; Brain Ischemia ; Brain Neoplasms ; Bronchiolitis ; Child* ; Constriction, Pathologic ; Deglutition ; Deglutition Disorders* ; Disulfiram ; Encephalitis ; Fistula ; Foreign Bodies ; Gastrostomy ; Humans ; Korea ; Malnutrition ; Pneumonia ; Pneumonia, Aspiration ; Reflex ; Rehabilitation ; Sensation ; Sialorrhea ; Weight Gain ; Williams Syndrome