PURPOSE: Airway management and ventilation at the pre-hospital stage are essential and very critical to patient welfare. In Korea, however, methods other than the use of a bag valve mask are hardly used at the pre-hospital stage by emergency medical technicians (EMTs). This study survey the current state of airway management and respiratory first aid at the pre-hospital stage. METHODS: A questionnaire survey of 356 EMTs was conducted by distributing questionnaires directly to first-class EMTs who participated in clinical training at emergency centers or by sending questionnaires and receiving answers by E-mail. The questionnaire solicited information concerning general characteristics of EMTs, monthly frequency of pre-hospital airway management of patients and the will of EMTs. Subjects were divided into two groups according to governmental subdivision or presence of training within 1-year. RESULTS: Concerning airway management and ventilation at the pre-hospital stage, the use of methods other than nasal prong and simple mask was very rare. As to the reasons, the respondents mentioned the shortage of manpower and lack of knowledge/experience. There was no significant difference in the ratio of pre-hospital airway management between urban and suburban/rural settings. Training within 1-year was not related to increased enforcement of airway management. CONCLUSION: In Korea, pre-hospital airway management is not well implemented by EMTs. Causes are deficiency of rescuer, less actual patient treatment experience and deficiency of knowledge/experience. Education and work experience can influence pre-hospital airway management. But, most pre-hospital airway management is unaffected by education and work experience.
Airway Management ; Surveys and Questionnaires ; Electronic Mail ; Emergencies ; Emergency Medical Technicians ; First Aid ; Humans ; Korea ; Masks ; Ventilation

Transverse myelitis (TM) extending from midbrain to the entire spinal cord accompanied by internuclear ophthalmoplegia is extremely rare but cause serious central nervous system complications in patients with systemic lupus erythematosus. We report a case of a 28-yr-old woman with TM extending from the midbrain to the conus medullaris longitudinally and internuclear ophthalmoplegia associated with systemic lupus erythematosus. Her neurological symptoms had an abrupt catastrophic onset and rapidly progressed to respiratory failure within 24 hr. Bilateral internuclear ophthalmoplegia was also followed by TM. Brain MR images showed definite brainstem lesions, which were deeply associated with internuclear ophthalmoplegia, and diffuse signal changes in the whole spinal cord, medulla, pons and midbrain. Clinical improvement of her ophthalmoplegia and of neurological dysfunction of the upper extremities was noted after prompt and aggressive treatment with intravenous pulsed methylprednisolone and cyclophosphamide. However, the neurological dysfunction of the lower limbs and bladder and colon paralysis were almost unchanged until six months passed.
Adult ; Cyclophosphamide/therapeutic use ; Female ; Humans ; Lupus Erythematosus, Systemic/*complications ; Magnetic Resonance Imaging ; Myelitis, Transverse/diagnosis/drug therapy/*etiology ; Ocular Motility Disorders/diagnosis/drug therapy/*etiology ; Prednisolone/therapeutic use

OBJECTIVE: The cordocentesis is regarded as an useful procedure for the prenatal evaluation of fetal disease, but it's complications are fetal loss, umbilical cord bleeding, umbilical cord hematoma, fetal bradycardia, fetomaternal hemorrhage, abruptio placentae, and chorioamnionitis due to it's invasiveness. The fetal bradycardia following cordocentesis is transient and self-limited in most cases, and the prevalence rate of fetal bradycardia following cordocentesis was reported to be between 1.5 and 13 per cent. The purpose of this study was to evaluate the association of fetal heart rate pattern following cordocentesis with adverse pregnancy outcome. METHODS: We investigated retrospectively the fetal heart rate following cordocentesis, the Apgar score of neonate, the birth weight of neonate, gestational age at delivery, preterm delivery, intrauterine growth retardation, stillbirth, and chromosome analysis in 64 codocenteses between 1 February 2000 and 28 February 2001. Normal fetal heart rate was defined as 100 up to 170 bpm, fetal bradycardia as less than 100 bpm lasting one more minute, and fetal tachycardia as more than 170 bpm lasting one more minute. RESULTS: 1. Fetal heart rate pattern following the cordocentesis was normal in 53 cases (82.8%), bradycardia in 6 cases (9.4%) and tachycardia in 5 cases (7.8%). 2. The pregnancy outcome was well-being fetus at birth in 51 cases, terminated pregnancy in 5 cases, intrauterine growth restricted fetus in 5 cases, preterm birth in 1 case and intrauterine death in 2 cases. 3. Mean Apgar-1minute/-5minute scores in neonates were 8.4 +/- 0.2/9.3 +/- 0.2 in the normal fetal heart rate group, 6.8 +/- 1.7/7.6 +/- 1.9 in fetal bradycardia group and 8.4 +/- 0.2/9.4 +/- 0.2 in fetal tachycardia group, that showed no statistically significant difference between groups. 4. The gestational weeks at birth/birth weight were 38.9 +/- 0.4 weeks/3193 +/- 90 g in normal fetal heart rate group, 36.8 +/- 3.2 weeks/2733 +/- 340 g in bradycardia group and 40.0 +/- 0.2/3465 +/- 21 g in tachycardia group, that showed no statistically significant difference between groups. 5. The number of puncture at the same time of cordocentesis was one in 45 cases, two in 15 cases and three in 4 cases. 6. There was no difference in fetal heart rate pattern following cordocentesis between 60 cases of normal and 4 cases of abnormal cardiovascular findings sonographycally. 7. The karyotyping was normal in 60 cases and abnormal in 4 cases, each of which was 46,XY,inv(9),46,X,i(Xq)/45,X,47,XY,+mar, and 46,XX,t(7;15)(q10;q10) respectively. CONCLUSION: Fetal bradycardia or tachycardia following cordocentesis was not associated with adverse pregnancy outcomes.
Abruptio Placentae ; Apgar Score ; Birth Weight ; Bradycardia ; Chorioamnionitis ; Cordocentesis* ; Female ; Fetal Diseases ; Fetal Growth Retardation ; Fetal Heart* ; Fetomaternal Transfusion ; Fetus ; Gestational Age ; Heart Rate, Fetal* ; Hematoma ; Hemorrhage ; Humans ; Infant, Newborn ; Karyotyping ; Parturition ; Pregnancy ; Pregnancy Outcome* ; Pregnancy* ; Premature Birth ; Prevalence ; Punctures ; Retrospective Studies ; Stillbirth ; Tachycardia ; Umbilical Cord

We described a 65-year-old female of 45,X/46,XX Turner's syndrome associated with patent ductus arteriosus who was admitted due to exertional dyspnea and palpitation. This patient had not spontaneous mensturation and had a short stature without webbed neck and a sexual infantilism. Chromosomal aberrations cause primarily structural defects of cardiovascular system, and a variety of structural aberrations involving the X chromosome can cause partial or complete Turner's syndrome. In Turner's syndrome, bicuspid aortic valve or coarctation of aorta is frequently combined, also aortic root dilatation, partial anomalous venous drainage, hypoplastic left heart, ventricular septal defect, atrial septal defect has been reported. However, this patient had not abnormality in aortic valve and whole aorta. Patent ductus arteriosus in 45,X/46,XX Turner's syndrome have not been reported in Korea. We report this case with a brief review of the literature.
Aged ; Aorta ; Aortic Coarctation ; Aortic Valve ; Bicuspid ; Cardiovascular System ; Chromosome Aberrations ; Dilatation ; Drainage ; Ductus Arteriosus, Patent* ; Dyspnea ; Female ; Heart ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Humans ; Korea ; Neck ; Sexual Infantilism ; Turner Syndrome ; X Chromosome

Gastric lipoma is rare submucosal tumor, accounting for less than 3% of all be- nign gastric tumor. Most are usually asymptomatic, but on occasion, they may present with abdominal pain, obstruction, dyspepsia, intussuception and gastrointestinal bleeding. Surgical resection is definitive diagnostic and therapeutic procedure. Surgical removal of gastric lipoma should be considered in the following situations: 1) the lesion is large, 2) the lesion is difficult to differentiate from malignant tumor, 3) the patient is symptomatic or has recurrent bleeding or obstruction. We report a case of gastric lipoma with bleeding in a 67-year-old male. Gastroscopy showed active gastric ulcer with fresh blood clot. Although medical conservative treatment was done, bleeding was continued. We referred patient to general surgical department for open surgical procedure and subtotal gastrectomy was performed. Histopathological examination of surgical gastric segment showed 5 5.5 cm sized ulcerated mass. Microscopic finding of cross section showed uniform and mature adipose cell, finding consistent with lipoma. We confirmed it submucosal gastric lipoma with ulcer bleeding.
Abdominal Pain ; Adipocytes ; Aged ; Dyspepsia ; Gastrectomy ; Gastroscopy ; Hemorrhage* ; Humans ; Lipoma* ; Male ; Stomach ; Stomach Ulcer ; Ulcer

In this experiment, pregnant Sprague-Dawley rats were treated with 100mg/kg of alltrans retinoic acid at 10th day of gestation. Pregnant rats were sacrificed at gestation day 14, 15, 16 and 18. Fetuses were delivered, and palatal processes were dissected. The specimens were prepared with fibronectin immunohistochemical stain, and mesenchymal changes were observed with electron microscope. The results were as follows. 1. In the findings fo fibronectin immunohistochemial stain, a part of the mesenchyme of the palatine process of the control group showed weak positive reaction at 14th gestation day, and the reactivity increased progressively by each day. In retinoic acid treated group, the positive reaction was trace at 14th day of gestation, and the reactivity increased progressively, but it was weaker than that of the control group. 2. Examination under transmission electron microscopy revealed well-developed rough endoplasmic reticulum, Goigi apparatus, mitochondrias which were found at the palatine process of the control group. In the retinoic acid treated group, at 16th and 18th day of gestation, the mesenchymal cells of the elevated palatine process had fragmented, sacculated rough endoplasmic reticulums, their mitochondrias were swollen and dissolved, In all cases with retinoic acid treated group, mitotic cells at various stages were more frequently found than in control group. In conclusion, the retinoic acid induces alterations of the intracytoplasmic organells. This finding suggests that retinoic acid is ditectly cytotoxic to mesenchymal cells. Positive fibronectin reaction was demonstrated before palatal elevation at th 15th day of gestation. Therefore, it could be postulated that mesenchymal cells synthesize and release the fibronectin. In the retinoic acid treated group, fibronectin showed positive reaction before and after palatal elevation, and it suggests that fibronectin would be involved in palatal elevation.
Animals ; Endoplasmic Reticulum, Rough ; Fetus ; Fibronectins ; Mesoderm* ; Microscopy, Electron, Transmission ; Mitochondria ; Pregnancy ; Rats* ; Rats, Sprague-Dawley ; Tretinoin*

BACKGROUND: Cathepsin D, an aspartic lysosomal proteinase, is believed to be involved in local invasion and metastasis of tumor cells by its proteolytic activity and has been described to be associated with tumor progression and prognosis in some human malignancies including breast cancer. But, its prognostic value for human lung cancer remains to be determined. The purpose of this study is to determine clinicopathological and prognostic significance of cathepsin D expression in non-small cell lung cancer. METHOD: Using a polyclonal antibody, immunohistochemical analysis of cathepsin D was performed on paraffin embedded sections of tumors obtained surgically from 54 patients with non-small cell lung cancer (37 squamous cell carcinoma, 14 adenocarcinoma, 2 large cell carcinoma, and 1 undifferentiated carcinoma). RESULTS: Eighteen patients (33.3%) showed positive immunoreactivities of cathepsin D in tumor cells. No significant correlation of cathepsin D expression in tumor cells was found in p-stage (surgical-pathologic stage), tumor size, tumor factor, nodal involvement, and differentiation. Of 54 patients, 29 (53.7%) patients showed moderate to massive cathepsin D-positive stromal cells within the tumor tissues, while the rest (46.3%) showed few cathepsin D-positive stromal cells within the tumor tissues. Cathepsin D expression n stromal cells was significantly associated with p-stage in non-small cell lung cancer (p=0.031). No significant correlation of the degree of cathepsin D-positive stromal cells was found in tumor size, T-factor, nodal involvement, differentiation. Cathepsin D expression status in tumor cells and stromal cells was not significantly associated with prognosis expressed by survival rate. The results of multivariate analyses of variables possibly associated with progonosis showed that nodal involvement was the only independent prognostic factor in all patients. CONCLUSION: Cathepsin D expression in stromal cells was significantly associated with p-stage in non-small cell lung cancer. However, it was not related to other clinicopathologic features and prognosis, and Cathepsin D expression in tumor was not related to p-stage and prognosis.
Adenocarcinoma ; Breast Neoplasms ; Carcinoma, Large Cell ; Carcinoma, Non-Small-Cell Lung* ; Carcinoma, Squamous Cell ; Cathepsin D* ; Cathepsins* ; Humans ; Lung Neoplasms ; Multivariate Analysis ; Neoplasm Metastasis ; Paraffin ; Prognosis* ; Stromal Cells ; Survival Rate

Cutaneous metastases from gastric carcinoma are uncommon. The frequency of metastses to the skin from gastric carcinoma have ranged from 0.3% to 0.4%. Carcinoma en cuirasse, first described by Velpeau in 1838, is marked sclerodermatous change and characterized by a difffuse morphea-like induration of the skin and represents a rare manifestations of breast carcinoma metastatic to the chest wall. It is vary rarely seen in lung, stomach, kidney and other metastasizing malignancies. We report a case of carcinoma en cuirase and nodular carcinoma from gastric carcinoma in a 36-year-old male who complained chiefly of multiple cutaneous nodules. He had mixed lesions of an erythematous morphea-like induration on the neck and multiple erythematous nodules on the chest and abdomen. Gastroscopy finding showed a Borrmann type IV advanced gastric carcinoma. Histopathologic examination of skin and stomach showed atypical cells with pleomorpic, hyperchromatic nuclei and scanty, eosinophilic cytoplasm, which are consistent with poorly differentiated adenocarcinoma. Immunohistochemical stainings showed positive reaction for cytokeratin. He died three months after the appearance of cutaneous lesions.
Abdomen ; Adenocarcinoma ; Adult ; Breast Neoplasms ; Cytoplasm ; Eosinophils ; Gastroscopy ; Humans ; Keratins ; Kidney ; Lung ; Male ; Neck ; Neoplasm Metastasis ; Skin ; Stomach ; Thoracic Wall ; Thorax

Simple renal cyst is the most common space- occupying lesion of kidney in adults. However, there were a few systematic Korean reports for the prevalence of simple renal cysts. Our purpose was to estimate the prevalence of simple renal cysts using ultrasonography, and to determine the relations to age and hypertension. The subjects were 504 volunteers (aged over 29 years) of the persons who were enrolled a health check-up program of Naju Hospital, Naju, Korea. Number of male in 504 persons was 334 (66.3%) and female 170 (33.7%). Mean age was 55 years (range; 30-86). The results were as follows: 1) One or more renal cysts were found in 50 individuals of 504 persons aged over 29 years (9.9%). In 331 persons aged over 49 years, the prevalence of simple renal cysts was 12.1%. The prevalence was significantly increased with age (P<0.001), but the difference between male (9.6%) and female (10.6%) was insignificant. 2) Mean value of cyst diameter was 23mm (5-69 mm) and was not correlated with age. However, the cyst diameter was significantly higher in female than in male, 32.4mm vs 18.0mm (P<0.001). Total number of cysts per person tended to increase with age (P<0.001). 3) The correlation between prevalence of simple renal cysts and blood pressure was statistically insignificant. However, the prevalence of hypertension in persons with cysts was higher than in persons with no cyst (27.9% vs 15.3%, P<0.05). Cyst diameter was not correlated with blood pressure. 4)Urinalysis in persons with cysts, showed microscopic hematuria in 47.4% and proteinuria in 26.3 %, however, grade of microscopic hematuria and proteinuria were not correlated with cyst diameter. The concentrations of blood urea nitrogen, serum creatinine, hemoglobin and hematocrit were not affected by presence or absence of simple renal cysts. By comparison with the recent foreign reports, the prevalence of simple renal cysts in Korean was similar to those in foreigners. Our study ascertained that simple renal cysts are age-dependent and total number of cysts per person also increases with age. In most of persons with simple renal cysts, the renal function is not affected and the related symptoms are trivial. However, we suggested that simple renal cysts may cause hypertension. To elucidate the correlation between simple renal cyst and hypertension, further studies are needed.
Adult ; Blood Pressure ; Blood Urea Nitrogen ; Creatinine ; Emigrants and Immigrants ; Female ; Hematocrit ; Hematuria ; Humans ; Hypertension* ; Jeollanam-do ; Kidney ; Korea ; Male ; Prevalence* ; Proteinuria ; Ultrasonography* ; Volunteers

OBJECTIVE: The positive rates of hepatitis B virus (HBV) markers differ according to age, sex, race, locality, sexual behavior, socioeconomic conditions, immunologic and genetic factors. It is a well-known fact that Korea is one of the endemic areas of HBV infection in the world. Past many reports have presented that the positive rates of HBsAg and anti-HBs in Korea were about 6~14% and 30~62%, respectively. However there were a few epidemiological surveys of rural communities on the positive rates of HBV markers. The present study undertook to determine the positive rates of HBsAg and anti-HBs in Hwasun county, a rural area of Korea. METHODS: We performed Population-based cross- sectional study by random cluster sampling of registered residents in Hwasun county. Out of the 2,920 subjects (4.1%) scheduled for the survey, 1,913 residents underwent the actual examination. We tested HBsAg and anti- HBs by reversed passive hemagglutination (RPHA) and passive hemagglutination (PHA), respectively. RESULTS: The positive rates of HBsAg and anti-HBs in all subjects were 5.6% and 20.8%, respectively, and those were 5.4% and 20.4% in 168 pregnant women, respectively. The positive rate of HBsAg was significantly higher in male (8.2%) than in female (4.0%) (p< 0.01). The positive rate of anti-HBs was 21.4% in female, but it was not significanly higher than in male (19.6%). There were no significant differences according to age groups in the positive rates of HBsAg and anti-HBs. CONCLUSION: There are no significant changes in the positive rates of HBsAg and anti-HBs between the present study for Hwasun county and past many reports in Korea. Although the rate of hepatitis B vaccination increased significantly, it was not effective because that the vaccinated total numbers in the rural area of Korea were probably small. So it is very important to undertake a nationwide program of hepatitis B immunization and to educate the residents in rural areas of Korea.
Continental Population Groups ; Female ; Hemagglutination ; Hepatitis B ; Hepatitis B Surface Antigens* ; Hepatitis B virus ; Humans ; Immunization ; Korea* ; Male ; Pregnant Women ; Rural Population ; Sexual Behavior ; Vaccination