PURPOSE: We examined the question of whether one-hand chest compression for a small child could compress intraabdominal organs. METHODS: We retrospectively examined medical charts and multidirectional computed tomography (MDCT) images obtained from children aged 1 to 18 years who presented to the hospital from March 2002 to March 2012. We measured the length of the sternum (Stotal) and the length of the lower half of the sternum (Stotal/2~X). We also measured the distance from the diaphragm to the midpoint of the sternum (Stotal/2~D) and half the width of an adult hand (Wtotal/2). Finally, we counted the number of instances at each age in which Stotal/2~X and Stotal/2~D were less than Wtotal/2. RESULTS: This study included records and MDCT images for 301 children with a mean age of 12.05+/-5.59 years. We also enrolled 47 adult rescuers (25 men, 53.2%) with a mean age of 23.20+/-2.13 years. The mean Wtotal/2 was 4.62+/-0.46 cm. All 1-year-old children had Stotal/2~X and Stotal/2~D less than Wtotal/2. Among children aged 2 years, six (60.0%) had Stotal/2~X and Stotal/2~D less than Wtotal/2. Among children aged 3 years, four (26.7%) had Stotal/2~X and Stotal/2~D less than Wtotal/2, and among those aged 4 years, two (13.3%) had Stotal/2~X and Stotal/2~D less than Wtotal/2. However, Stotal/2~X and Stotal/2~D were greater than Wtotal/2 in children aged 5 years or more. CONCLUSION: Our measurements indicate that one-hand chest compression for a small child could cause intraabdominal organ injury.
Adult ; Cardiopulmonary Resuscitation ; Child* ; Diaphragm ; Hand ; Humans ; Male ; Retrospective Studies ; Sternum ; Thorax

OBJECTIVE: This study aimed to investigate factors associated with incomplete occlusion of a cerebral aneurysm detected by indocyanine green videonangiography (ICG-VA) following aneurysm clipping. METHODS: We performed surgery on 135 patients with 151 intracranial aneurysms over a 1-year period. Included was an aneurysm more than 3 mm in size, the dome of which was sufficiently exposed and clipped permanently with one clip. Following ICG-VA, aneurysms were divided into a delayed-filling group and a no-filling group. Retrospective comparisons of the clip force, blade length and width, neck and dome size of the aneurysm, diameter of the parent artery, presence of atherosclerosis in the aneurysm neck, and systolic blood pressure during ICG-VA were made between the two groups. RESULTS: Eight of 31 aneurysms in 29 patients showed delayed filling of contrast. The clip force in the delayed-filling group was lower than in the no-filling group and the atherosclerosis of the aneurysm neck differed between the two groups (P<0.05). Blade width in the delayed-filling group was also significantly lower than in the no-filling group (P<0.05). Following adjustment for atherosclerosis of the aneurysm neck, clip force and blade width in the delayed-filling group was even lower. Incomplete passage of the clip tip was observed in four aneurysms, weak clip force in three, and a slit between clip blades in one. After booster clipping or clip reposition, neither aneurysm regrowth nor recanalization was observed during 6 months of follow-up. CONCLUSION: Closing force, blade width, tip position, and remnant slit are important for incomplete occlusion of an aneurysm.
Aneurysm ; Arteries ; Atherosclerosis ; Blood Pressure ; Humans ; Indocyanine Green ; Intracranial Aneurysm ; Neck ; Parents ; Retrospective Studies

PURPOSE: To determine the accuracy of a simple radiologic images as a diagnostic tool for intra-articular fractures of the distal radius (IAF). METHODS: This study proceeded prospectively from April 2008 to December 2009. We let 25 ERs (emergency residents) interpret the radiologic images of 45 patients who had injuries of their wrists and presented to a hospital. We used surgical findings or multidetector computed tomography (MDCT) to confirm the final diagnosis of enrolled patients. Finally, we evaluated the sensitivity, specificity, and accuracy of simple radiologic images of IAF. We also compared test performance characteristics between the four grades of the ERs (1st, 2nd, 3rd, and 4th years) via Mann-Whitney and Kruskal-Wallis tests. We considered differences to be significant, if p<0.05 RESULTS: Of 45 patients, 40 (88.9%) had fractures of the distal radius; of the 40, 25 (62.5%) had IAF. There were no differences in sensitivity, specificity, or accuracy between the four grades of the ERs (p=0.86, 0.76, 0.49). The sensitivity of simple radiologic images for diagnosing IAF was 0.69; specificity was 0.77; accuracy was 0.72. CONCLUSION: In this study, we found that simple radiologic images as the primary diagnostic tool for intra-articular fractures of the distal radius were not completely adequate. Therefore, ERs should carefully consider using MDCT imaging to diagnose patients who suffer from wrist pain.
Emergencies ; Humans ; Intra-Articular Fractures ; Linear Energy Transfer ; Multidetector Computed Tomography ; Prospective Studies ; Radius ; Radius Fractures ; Sensitivity and Specificity ; Wrist

PURPOSE: We investigated the clinical characteristics and demographics of patients who suffered from hydrofluoric acid chemical injury and the mechanism of damage. METHODS: We retrospectively reviewed the medical records of patients who were exposed to hydrofluoric acid from March 2004 to March 2009 and who were seen at the emergency centers in two university teaching hospitals. RESULTS: Forty four patients out of 47 patients suffered from chemical burn, while the injuries of the remaining 3 could not be identified by the medical records. A total of 17 hydrofluoric acid chemical injury patients were enrolled during the study period, and their mean age was 29.6+/-7.0. All the patients were accidentally injured by contact with the material and none of them inhaled or ingested the material. Only 6 patients wore appropriate protective equipments and 5 underwent the water irrigation for more than 10 minutes. The most common exposure area was the hand and forearm (70.5%). Less than 1% of all of the patients had their total body surface (TBS) exposed to hydrofluoric acid (mean=0.35%). The mean time interval from calcium gluconate administration to pain relief was 33.6+/-8.8 hours. CONCLUSION: When exposed to hydrofluoric acid, it is important to wear protective equipment and undergo water irrigation for more than 10 minutes. Pain and skin damage were observed in all the patients. After treatment, we concluded that administration of calcium gluconate and pain killers was successful in relieving pain, and the prognosis was also positive for the admitted and followed up patients when less than 1% of the TBS was exposed.
Burns, Chemical ; Calcium Gluconate ; Demography ; Emergencies ; Forearm ; Gluconates ; Hand ; Hospitals, Teaching ; Humans ; Hydrofluoric Acid ; Medical Records ; Prognosis ; Retrospective Studies ; Skin ; Water

PURPOSE: We studied which structures were compressed in 1 rescuer cardiopulmonary resuscitation (CPR) in order to determine the optimal compression site on infants. METHODS: Charts and multidirectional computed tomography of infants who presented in the hospitals from March, 2004 to March, 2009 were reviewed retrospectively. We measured the length of the sternum (Stotal), the index finger` s mark (L1) and the two fingers` mark (L2) that were located on the sternum during one rescuer CPR simulation. We studied those structures located at the following points: the lower half of the sternum (Stotal/2), the sternum at the inter-nipple line (Xn), the point of maximal anterior-posterior heart diameter (Xm), and the lower margin of L1 and L2 from Stotal/2, Xn, Xm. RESULTS: Of 75 enrolled infants, Stotal was 5.68+/-2.00 cm; Xn was 2.11+/-1.47 cm; Xm was 1.43+/-1.18 cm; L1 was 1.25+/- 0.21 cm; L2 was 2.88=/-0.33 cm; the ratio of Xm to Stotal was 0.24+/-0.19. 16(21.3%) had ascending aorta, 31(41.3%) had aortic root, and 14(18.7%) had a left ventricular outflow tract in Stotal/2. 14(18.7%) had aortic root, 35(46.7%) had left ventricular outflow tract in Xn. All had left ventricle in the Xm. 12(16.0%) had liver in the lower margin of L1 from Xm. All had liver in the lower margin of L2 from Xm. CONCLUSION: We knew that we had compressed the aortic root, left ventricular outflow tract as we complied with the 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. However, the left ventricle was located at the lower quarter of the sternum.
American Heart Association ; Aorta ; Cardiopulmonary Resuscitation ; Emergencies ; Heart ; Heart Ventricles ; Humans ; Infant ; Liver ; Retrospective Studies ; Sternum

BACKGROUND AND OBJECTIVES: Currently, the drug-eluting stent (DES) has been widely used because of its excellent clinical outcome. We compared the utilization patterns and clinical outcomes between the DES and the bare metal stent (BMS) in the real world. SUBJECTS AND METHODS: We retrospectively reviewed the stent registry at the Catholic Medical Center between January 2002 and October 2004. There were 1120 patients treated with DES (n=1837) who were compared to 910 patients who received BMS implantation (n=1238). RESULTS: Patients with de novo lesions in the DES group more frequently had multivessel disease and received a greater number of stents than those in BMS group (p<0.001). The mean diameter of inserted stents was smaller in the DES group (p<0.001). The follow-up rate for clinical and angiographic evaluations at 6 months after stenting was 91% and 65% (n=592) in the BMS group and 90% and 74% (n=829) in the DES group, respectively. The rate of major adverse cardiac events (death, nonfatal myocardial infarction, or target vessel revascularization) at 6 months was 7.3% in the DES group and 17.5% in the BMS group (p<0.001). The rates of target vessel revascularization in the DES group and in the BMS group were 4.2% and 12.9%, respectively (p<0.001). CONCLUSION: The patients in the DES group had longer length, smaller diameter and higher number of placed stents, compared to the BMS group. The rates of revascularization and major adverse cardiac events in the DES group were lower than those in the BMS group.
Angioplasty ; Drug-Eluting Stents* ; Follow-Up Studies ; Humans ; Myocardial Infarction ; Prognosis* ; Retrospective Studies ; Stents*

OBJECTIVE: Various methods of treatment for idiopathic cervical dystonia have been tried in the past with unsatisfactory results. The authors report cases of five patients who underwent selective peripheral denervation for spasmodic torticollis. METHODS: Between July 2002 and December 2003, 5 patients underwent surgery at St. Mary's Hospital for spasmodic torticollis. Age of the patient at the onset of symptoms ranged from 29 to 56years (mean 43.75years). Selective peripheral denervation(SPD) was performed at 7 to 11months after the onset of symptoms (mean 8.75 months). A patient was considered to be the candidate for surgery if conservative methods were unsuccessful and symptoms persisted for longer than 7months. In addition, 2patients who refused treatment with botulinum toxin were also enrolled in this study. RESULTS: Although one patient underwent reoperation, all of the five patients' symptoms were improved after the operation. Clinically, patients with retrocollis showed better improvement than laterocollis patients. CONCLUSION: Although injection of botulinum toxin is the first-choice in treatment modality, when surgery is required, selective peripheral denervation provides good results with minimum side effects.
Botulinum Toxins ; Denervation* ; Humans ; Reoperation ; Torticollis*

OBJECT: The purpose of this study was to determine the prevalence of fungal infection and ulcer on the feet of diabetic patients and the existence of correlation between ulcer and fungal infection. METHODS: A total of 21, 693 outpatients diagnosed as diabetes mellitus at the department of endocrinology of 32 hospitals were examined. The diabetic patients with foot problems were consulted to the department of dermatology. Physical examination and KOH preparation were performed. RESULTS: 13, 271 patients had certain kinds of foot problem, accounting for 61.2% of 21, 693 diabetics examined. Of these, fungal foot disease were found in 10, 403 that constituted 78.4% (48.0% of the entire diabetic population). Tinea pedis was the diagnosis in 6, 496 (29.9%), onychomycosis in 7, 783 (35.9%), and coexistence was in 3, 883 (17.9%). Foot deformity was in 1, 346 (6.2% of diabetics; 10.1% of foot disease), non-palpable pulse in 1, 051 (4.8% ; 7.9%), and foot ulcer was in 425 (2.0% ; 3.2%), following in a descending order of frequency. Odds ratios for diabetic foot ulcer were 2.5 in patients with the foot deformity, 1.6 with fungal foot disease and 2.2 with non-palpable pulse. Conversely, Odds ratios for fungal foot disease were 2.5 with foot deformity, and 1.6 with foot ulcer. A total of 5, 486 patients paid a visit to the department of dermatology. Of these, 4, 519 patients were diagnosed with fungal infection through physical examination and KOH smear by dermatologists. The population comprised of 2, 272 males and 2, 247 females, showing similar prevalence between sexes. However, age did have positive correlation regarding prevalence of fungal foot disease. The number of diabetic patients with toenail problems was 3, 847 patients (70%) and onychomycosis was proven mycologically in 3, 276. Onychomycosis of distal subungal type was the most common clinical finding, most frequently involving the great toenails. Abnormal skin findings of the foot were seen in 3, 885(70.8%) and tinea pedis was found in 3, 209 (58.5%), most commonly involving the soles. CONCLUSION: This study showed that fungal infection might be regarded as a risk factor of foot ulcer. Treatment of fungal infection in diabetic patients might prevent diabetic foot disease such as ulcer and reduce the disability, morbidity and mortality in diabetic patients.
Dermatology ; Diabetes Mellitus ; Diabetic Foot ; Diagnosis ; Endocrinology ; Female ; Foot Deformities ; Foot Diseases ; Foot Ulcer ; Foot* ; Humans ; Male ; Mortality ; Nails ; Odds Ratio ; Onychomycosis ; Outpatients ; Physical Examination ; Prevalence* ; Risk Factors ; Skin ; Tinea Pedis ; Ulcer*

The prevalence of Behcet's disease is the highest in the East Asian and the Medi-terranean countries. Behcet's disease is also distributed in the Asian countries, but the nationwide survey has not been performed in Korea yet. The Korean Study Group for Behcet's Disease, founded in 1999, conducted a multicenter, retrospective survey on epidemiologic and clinical features of the patients with Behcet's disease from 20 hospitals around the nation from 1997 to 1999. Of 3,497 patients, 1,527 were classified into complete or incomplete type of Behcet's disease according to the revised Shimizu's classification. The sex ratio was 1:1.75 with the female predominance. Geographical distribution showed the highest frequency in Seoul (38.5%). Clinically, 98.8% had oral ulcers, 83.2% had genital ulcers, 84.3% had skin lesions and 50.9% had ocular lesions. As for the minor clinical manifestations, articular symptoms were the most frequent. The pathergy test showed positive in 15.4% of patients and revealed a higher positive rate in males (20.2%) than in females (12.7%). In conclusion, we performed the first multicenter study on Behcet's disease in Korea and revealed the female predominance, higher frequency of ocular lesions, and lower positivity of pathergy test in the patients.
Adolescence ; Adult ; Aged ; Behcet's Syndrome/complications/*epidemiology ; Child ; Child, Preschool ; Female ; Human ; Infant ; Korea/epidemiology ; Male ; Middle Age ; Prevalence ; Retrospective Studies ; Sex Distribution

BACKGROUND: Onychomycosis, especially toenail onychomycosis has become one of the common fungal infection and has historically been regarded as a cosmetic rather than medical problem by many patients, even by physicians. Recently, however, there are several reports that this is a refractory disease which may cause a deleterious effect on patients' quality of life (QOL). OBJECTIVE: The purpose of this study was to investigate the impact of toenail onychomycosis on QOL in Korea and to assess the changes of QOL after treatment. METHODS: Total 1004 patients with toenail onychomycosis which was confirmed by clinical findings and KOH preparation were enrolled at 47 dermatologic centers in Korea, and interviewed with standardized QOL questionnaire before and after systemic antifungal treatment. Responses to the questionnaire were scored by f-point scale (0~4) and averaged, and were analyzed for 5 dimensions of emotional impact, social impact, symptom and functional impact, patients' views concerning treatment, and relationship with doctor. RESULTS: 1. Before and after treatment, the most serious impact was emotional dimension showing 1.90 and 1.30 in average score (AS), and social (AS: 1.14 and 0.83) and symptom and functional impact (AS: 1.05 and 0.92) was also affected. 2. In female rather than male, statistically more significant impact on patients' QOL was observed in all dimensions. 3. After treatment, 3 of 5 dimensions were improved significantly - emotional dimension (AS: from 1.90 to 1.30), social dimension (AS: from 1.14 to 0.83), patients' view concerning treatment(AS: from 1.34 to 1.02) 4. The degree of patients' satisfaction at the therapeutic effect was very high - 62.4% (immediately after. treatment) and 65.8% (9 months after initiation of treatment) of patients answered excellent or good. CONCLUSION: This study confirms that toenail onychomycosis has significant Impact on the overall QOL of patients. Also the effect of antifungal therapy on patients' QOL were satisfactory. Therefore, both doctor and patient should pay more attention to the treatment of onychomycosis.
Female ; Humans ; Korea* ; Male ; Nails* ; Onychomycosis* ; Quality of Life* ; Social Change ; Surveys and Questionnaires