An analysis of HIV patients visiting hospitals in Korea by complete enumeration:based on the Health Insurance Review and Assessment Service database

Objective@#This study investigated the hospital use patterns of patients with human immunodeficiency virus (HIV) infections in Korea. The prevalence of HIV infections in Korea is very low and there is no data on the type of medical treatment HIV patients receive. We therefore decided to perform a complete enumeration of the utilization of medical facilities by HIV patients using a nationwide claims database. @*Methods@#The nationwide Health Medical Insurance Review and Assessment (HIRA) service claims database was used to identify and include all new patients with HIV infections from 2013 to 2018. The current inpatient, outpatient, and emergency service use of these patients were investigated. The number of invasive procedures, interventions, and operations performed on these patients, and their death rate, was also investigated. @*Results@#The number of patients visiting outpatient departments increased by 44% from 2013 to 2018. The most frequently visited department was internal medicine, followed by emergency medicine. Dental procedures followed intravenous line insertions as the most common procedures undertaken by patients with HIV. @*Conclusion@#The results of this study show the status of hospital visits by patients with HIV infections in Korea and provide the basic data upon which policy decisions can be based.

Association between the emergency department length of stay and severity-standardized survival among severe emergency patients

Objective@#The length of stay in the emergency department (ED) is a major contributor to ED overcrowding, which in turn negatively affects the quality of emergency care. Several efforts have been made to reduce the ED length of stay (ED-LOS), including a mandatory target to limit ED-LOS within certain parameters. However, the association between ED-LOS and treatment results is yet to be clarified. The authors investigated the influence of ED-LOS on patient survival by comparing severity-adjusted survival. @*Methods@#This study was a retrospective analysis of data registered in 2018 in the National Emergency Department Information System (NEDIS). Cases registered by the regional and local emergency centers were included for analysis. The standardized W scores (Ws) based on the Emergency Department Initial Evaluation Score were used to assess treatment outcomes represented by severity-standardized survival, and the correlation between the Ws and the ED-LOS was analyzed. @*Results@#A total of 2,281,526 cases were included for analysis. The overall mortality comprised 52,284 cases (2.3%) and the median ED-LOS was 165 minutes (interquartile range, 96-301). Although a longer ED-LOS was associated with poorer outcomes overall, the association was not apparent when an analysis of cases eligible for ED-LOS evaluation in the national evaluation program was carried out. Moreover, in the analysis of severe cases with a predicted survival probability of less than 0.9, an ED-LOS shorter than 6 hours was associated with significantly poorer severity-adjusted survival. @*Conclusion@#The study revealed that the current ED-LOS criteria used in the national evaluation program were not associated with better survival.

A Study on the Disaster Medical Response during the Mauna Ocean Resort Gymnasium Collapse

PURPOSE: To investigate and document a disaster medical response during the collapse of the Gyeongju Mauna Ocean Resort gymnasium, which occurred on February 17, 2014. METHODS: The official records of each institution were verified to select the study population. All the medical records and emergency medical service records were reviewed by an emergency physician. Personal or telephonic interviews were conducted without a separate questionnaire if the institutions or agencies crucial to disaster response did not have official records or if information from different institutions was inconsistent. RESULTS: One hundred fifty-five accident victims, who were treated at 12 hospitals mostly for minor wounds, were included in this study. The collapse killed 10 people. Although the news of the collapse was disseminated in 4 minutes, it took at lease 69 minutes for a dispatch of 4 disaster medical assistance teams to take action; 4.5% of patients were treated on-site, 56.7% were transferred to 2 nearest hospitals, and 42.6% were transferred to hospitals with poor preparation to handle disaster victims. CONCLUSION: In the collapse of the Gyeongju Mauna Ocean Resort gymnasium, the initial triage and distribution of patients were inefficient, with delayed arrival of medical assistance teams. These problems had also been noted in prior mass casualty incidents. Government agencies are implementing improvements, and this study could aid the implementation process.

Early Predictors of Critical Cases for the Patients Who Visited Emergency Department due to Gas Inhalation: Early Predictors of Severity in Gas Inhalation

PURPOSE: To define early predictors of critical cases involving patients who visited the emergency department (ED) due to gas inhalation, with the goal of identifying patients who require intensive monitoring and treatment. METHODS: The retrospective study was carried out for patients who visited the ED at Ulsan University Hospital due to gas inhalation from March 2014 to February 2016. General demographics, mechanism of accident, critical symptoms, vital signs, blood lab test results, severity, and clinical manifestation were investigated. Patients were divided into a critical group and non-critical group, and predictors of critical cases were investigated by comparing both groups. RESULTS: Of the 180 patients, 26 patients were in the critical group. In this group, more patients displayed altered mentality and cardiac arrest (both p<0.001). The critical group also showed significantly higher fractions for low-blood pressure (systolic blood pressure<90 mmHg; p<0.001), number of critical symptoms (p<0.001), transport by emergency medical services (p=0.003), and consultation involving other departments (p<0.001). Patients in the critical group showed higher Korean Triage and Acuity Scale (KTAS) level (p<0.001), lactate value (p=0.001), and carboxy-hemoglobin value (p=0.017) as well as older age (p=0.001), lower pH (p=0.001), and HCO₃⁻ value (p<0.001). Multiple regression analysis revealed that predictors of critical cases were older age and higher KTAS level (both p<0.001). CONCLUSION: Patients admitted to the ED for treatment of gas inhalation, who were older and had a higher KTAS level, require intensive monitoring and treatment.

A study on the disaster medical response during the Mauna Ocean Resort gymnasium collapse

OBJECTIVE: To investigate and document the disaster medical response during the Gyeongju Mauna Ocean Resort gymnasium collapse on February 17, 2014. METHODS: Official records of each institution were verified to select the study population. All the medical records and emergency medical service run sheets were reviewed by an emergency physician. Personal or telephonic interviews were conducted, without a separate questionnaire, if the institutions or agencies crucial to disaster response did not have official records or if information from different institutions was inconsistent. RESULTS: One hundred fifty-five accident victims treated at 12 hospitals, mostly for minor wounds, were included in this study. The collapse killed 10 people. Although the news of collapse was disseminated in 4 minutes, dispatch of 4 disaster medical assistance teams took at least 69 minutes to take the decision of dispatch. Four point five percent were treated at the accident site, 56.7% were transferred to 2 hospitals that were nearest to the collapse site, and 42.6% were transferred to hospitals that were poorly prepared to handle disaster victims. CONCLUSION: In the Gyeongju Mauna Ocean Resort gymnasium collapse, the initial triage and distribution of patients was inefficient and medical assistance arrived late. These problems had also been noted in prior mass casualty incidents.

Clinical Characteristics of Unstable Pelvic Bone Fractures Associated with Intra-abdominal Solid Organ Injury

PURPOSE: This study analyzed the characteristics of unstable pelvic bone fractures associated with intraabdominal solid organ injury. METHODS: Medical records were retrospectively collected from January 2000 to December 2010 for patients with unstable pelvic bone fractures. Unstable pelvic bone fracture was defined as lateral compression types II and III, antero-posterior compression types II and III, vertical shear and combined type by young classification. Subjects were divided into two groups, with (injured group) and without (non-injured group) intra-abdominal solid organ injury, to evaluate whether the characteristics of the fractured depended on the presence of associated solid organ injury. Data included demographics, mechanism of injury, initial hemodynamic status, laboratory results, revised trauma score (RTS), abbreviated injury scale (AIS), injury severity score (ISS), amount of transfusion, admission to the intensive care unit (ICU), and mortality. RESULTS: The subjects were 217 patients with a mean age of 44 years and included 134 male patients(61.8%). The injured group included 38 patients(16.9%). Traffic accidents were the most common mechanism of injury, and lateral compression was the most common type of fracture in all groups. The initial blood pressure was lower in the injured group, and the ISS was greater. The arterial pH was lower in the injured group, and shock within 24 hours after arrival at the emergency department was more frequent in the injured group. The amount of the transfused packed red blood cells within 24 hours was higher in the injured group than the non-injured group. Invasive treatment, including surgery and angiographic embolization, was more common in the injured group, and the stay in the ICU was longer in the injured group. CONCLUSION: A need exists to decide on a diagnostic and therapeutic plan regarding the possibility of intraabdominal solid organ injury for hemodynamically unstable patients with unstable pelvic bone fractures and multiple associated injuries.

Extensive Enteritis with Rapid Onset of Massive Ascites as the Initial Presentation of Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is a multisystemic autoimmune disorder with protean manifestations. However, compared with articular, cutaneous, or renal involvement, gastrointestinal symptoms are far less common and are particularly unusual for the initial presentation of SLE. Gastrointestinal manifestations range from mild nonspecific symptoms to serious life-threatening complications, such as mesenteric vasculitis, intestinal pseudoobstruction, acute pancreatitis, and protein-losing enteropathy. Therefore, in order to improve the prognosis, early diagnosis and timely treatment are important. We describe a 45-year-old female patient who presented with extensive enteritis and peritonitis as the initial manifestation of SLE. Symptoms at presentation included severe abdominal pain and rapid development of massive ascites. After administration of high-dose corticosteroid therapy, her symptoms showed prompt improvement.

Hemopericardium Following Acupuncture

Acupuncture-related hemopericardium is a rare but potentially fatal complication. We describe a hemopericardium that occurred shortly after acupuncture in a 55-year-old woman. A chest CT scan and echocardiography revealed a hemopericardium, and pericardiocentesis was then immediately and successfully performed. Subsequently, her clinical course improved. This case increases the attention of emergency physicians for acupuncture-related complications, especially hemopericardium, and the necessity of rapid diagnosis and management.

Hemopericardium Following Acupuncture

Acupuncture-related hemopericardium is a rare but potentially fatal complication. We describe a hemopericardium that occurred shortly after acupuncture in a 55-year-old woman. A chest CT scan and echocardiography revealed a hemopericardium, and pericardiocentesis was then immediately and successfully performed. Subsequently, her clinical course improved. This case increases the attention of emergency physicians for acupuncture-related complications, especially hemopericardium, and the necessity of rapid diagnosis and management.

Clinical Characteristics of Intraperitoneal and Retroperitoneal Solid Organ Injuries after Trauma

PURPOSE: The aim of this study was to analyze the characteristics and prognosis of intraperitoneal and retroperitoneal solid organ injuries after trauma. METHODS: We analyzed computed tomography (CT) data for 232 patients who had injury to solid abdominal organs between January 2002 and June 2009. The patients who had solid organ injury on CT were categorized into intraperitoneal, retroperitoneal and intra/retroperitoneal injury groups. Medical records were reviewed retrospectively, and data regarding the sex and age of patients, mechanism of injury, initial hemodynamic status, Revised Trauma Score (RTS), Abbreviated Injury Scale (AIS), Injury Severity Score (ISS), amount of transfusion, admission rate to intensive care unit (ICU), and mortality were collected and analyzed. Injury severity of solid organs was classified according to the American Association for the Surgery of Trauma (AAST) grading system. RESULTS: The intraperitoneal injury group had 131 patients, the retroperitoneal injury group 49 patients, and the intra/retroperitoneal injury group 52 patients. The intra/retroperitoneal injury group exhibited low blood pressure, a large number of packed red blood cells that were transfused, and high ISS and abdominal AIS. They tended to stay longer in the ICU and showed a higher mortality. Conservative management was the most common therapeutic modality for all 3 groups. CONCLUSION: The intra/retroperitoneal injury group showed higher fall for the mecahnism of injury, a lower initial blood pressure and a larger number of packed red blood cells that were transfused compared with the other groups. Therefore, physicians should rapidly identify those with a poor prognosis at initial presentation and make a decision quickly when they are caring for intra/retroperitoneal injury patients.

Characteristics of Stable Pelvic Bone Fractures with Intra-abdominal Solid Organ Injury

PURPOSE: This study analyzed the characteristics of stable pelvic bone fractures with intra-abdominal solid organ injury. METHODS: Medical records were retrospectively reviewed from January 2000 to December 2009 of patients with stable pelvic bone fractures. A stable pelvic bone fracture according to Young's classification is defined as a lateral compression type I and antero-posterior compression type I. Subjects were divided into two groups, one with (injured group) and one without (non-injured group) intra-abdominal solid organ injury, to evaluate the dependences of the characteristics on the presence of an intra-abdominal solid organ injury. Data including demographics, mechanism of injury, initial hemodynamic status, laboratory results, Revised Trauma Score (RTS), Abbreviated Injury Scale (AIS), Injury Severity Score (ISS), amount of transfusion, admission to intensive care unit (ICU), and mortality were analyzed. RESULTS: The subjects were 128 patients with a mean age of 42 years old, of whom were 67 male patients (52.3%). The injured group had 21 patients(16.4%), and the most frequent injured solid organ was the liver. Traffic accident was the most common mechanism of injury and lateral compression was the most common type of fracture in all groups. Initial systolic blood pressure was lower in the injured group, and the ISS was greater in the injured group. Arterial pH was lower in the injured group, and shock within 24 hours after arrival at the emergency department was more frequent in the injured group. Transfused packed red blood cells within 24 hours were 8 patients(38.1%) in the injured group and 11 patients(10.3%) in the non-injured group. Conservative treatment was the most common therapeutic modality in all groups. Stay in the ICU was longer in the injured group, and three mortalities occurred. CONCLUSION: There is a need to decide on a diagnostic and therapeutic plan regarding the possibility of intra-abdominal solid organ injury for hemodynamically unstable patients with stable pelvic bone fractures and for patients with stable pelvic bone fractures along with multiple associated injuries.

Predictors of Anaphylactic Shock in Patients with Anaphylaxis after Exposure to Bee Venom

PURPOSE: The purpose of this study is to analyze the clinical characteristics of anaphylaxis and anaphylactic shock caused by bee venom. METHODS: We retrospectively collected the data of the patients who experienced anaphylaxis caused by natural bee sting or acupuncture using bee venom from January 1999 to December 2008. Seventy subjects were divided into the shock and non-shock groups. The clinical characteristics, sources of bee venom, treatments and outcomes were compared between the two groups. RESULTS: The mean age of the subjects was 45.5 +/- 16.3 years old and the number of males was 44 (62.9%). There were 25 patients in the shock group and 45 in the non-shock group. The age was older (P=0.001) and females (P=0.003) were more frequent in the shock group. Transportation to the hospital via ambulance was more frequent in the shock group (p<0.001). No difference was found in species of bee between the two groups. The cephalic area, including the face, was the most common area of bee venom in both groups. Anaphylaxis caused by bee sting commonly occurred between July and October. Cutaneous and respiratory symptoms were the most frequent symptoms related to anaphylaxis. Cardiovascular and neurologic symptoms were more frequent in the shock group. The amount of intravenously administered fluid and subcutaneous injection of epinephrine were much more in the shock group than that in the non-shock group. CONCLUSION: Older age was the factors related to anaphylactic shock caused by bee venom. Further validation is needed to evaluate the gender factor associated with shock.

Multiple Intraabdominal Solid Organ Injuries after Blunt Trauma

PURPOSE: This study evaluated the characteristics and the prognosis of multiple intraabdominal solid organ injuries, including those to the liver, spleen, and kidney, after blunt trauma. METHODS: From January 2001 to March 2009, 39 patients with multiple intraabdominal solid organ injuries, which had been confirmed by contrast-enhanced computed tomography after blunt trauma, were included in this retrospective study. The injury severity score (ISS), abbreviated injury scale (AIS), revised trauma score (RTS), American Association for the Surgery of Trauma (AAST) injury grade of solid organs, initial hemodynamic status, blood gas analysis, blood transfusion, and the mortality were the main outcome measurements. RESULTS: Injured groups were classified into liver/kidney (n=17), liver/spleen (n=4), spleen/kidney (n=13), and liver/kidney/spleen (n=5) groups. Patients were older in the liver/kidney group than in the liver/kidney/spleen group (43 vs 18 years, p=0.023). The initial systolic blood pressures tended to be lower in the liver/kidney group than in the other groups (84 vs 105, 112, and 114 mmHg, p=0.087). The amounts of 24-hour packed RBC transfusion were 32 units in the liver/kidney group and 4 units in the liver/kidney/spleen group, but the difference was not statistically significant. Differences were found in neither the RTS, ISS, and AIS for head, chest, abdominal, and pelvic injuries nor the AAST injury grade for solid organ, but injuries to the chest were more severe in the liver/spleen group than in the spleen/kidney group (AIS 4.0 vs 2.8, p=0.028). Conservative treatment was the most frequent applied treatment in all groups. There were 6 mortalities : 3 due to hypovolemia, 2 to sepsis, and 1 to brain injury. Mortalities occurred only in the liver/kidney group. CONCLUSION: Patients who had intraabdominal solid organ injuries of the liver and the kidney simultaneously, tended to be transfused more at an early time after trauma, to have lower initial systolic blood pressures, and to have a higher mortality.

Comparison of Intraperitoneal and Retroperitoneal/Pelvic Contrast Extravasation: The Characteristics and Prognosis of the Each Patient Group with Arterial Embolization according to the Abdominal Computed Tomography Scanning after Blunt Trauma

PURPOSE: This study compared the characteristics of and the prognosis for intraperitoneal and retroperitoneal/pelvic contrast extravasation, which had been confirmed by enhanced abdominal CT scan, after blunt trauma in patients who had undergone angiographic embolization. METHODS: From January 2001 to March 2009, data were retrospectively collected regarding patients who had undergone contrast extravasation (CE) on CT scanning and arterial embolization after blunt trauma. The study patient group was divided into the intraperitoneal and the retroperitoneal/pelvic groups according to the area of contrast extravasation. We reviewed the initial demographic data, the location of injury, the solid organ injury, the embolized vessel, and the clinical outcome. RESULTS: The mean age of the study subjects was 40.2+/-2.6 years old, and there were 24 male patients. The intraperitoneal group included 10 patients, and retroperitoneal/pelvic group was comprised of 17 patients. The amount of transfusion from presentation to intervention and during the first 24 hours was greater in the retroperitoneal/pelvic group than in the intraperitoneal group. The intraperitoneal group showed a higher frequency and severity of liver injury than the retroperitoneal/pelvic group. Angiography revealed that the hepatic artery (n=4) was the most frequently embolized vessel in the intraperitoneal group, while the internal iliac artery (n=6), followed by the renal artery (n=4), internal pudendal artery (n=3), and the gluteal artery (n=2), were the most frequently injured vessels in the retroperitoneal/pelvic group. CONCLUSION: In patients with intra-abdominal contrast extravasation found on CT scanning and arterial embolization after blunt trauma, the need for transfusion was less in the intra-abdominal group than in the retroperitoneal/pelvic group. Liver injury was also more frequent and severe in the intraperitoneal group than in the retroperitoneal/pelvic group.

Drug-Induced Anaphylactic Shock at the Emergency Department

PURPOSE: This study was conducted to investigate the characteristics of drug induced anaphylaxis and anaphylactic shock in patients who were admitted to the emergency department. METHODS: We retrospectively collected the data on patients with drug induced anaphylaxis and who were admitted to the emergency department from January 2001 to June 2009. The study group was divided into the non-shock and shock groups according to whether the systolic blood pressure more than 90 mmHg. The initial demographic data, the causes of drug-induced anaphylaxis, the clinical manifestations, the treatment and the prognosis were reviewed for 72 patients. RESULTS: The mean age of the study subjects was 47.9+/-14.2 years old and there were 40 male patients and 32 female patients. There were 26 patients in the non-shock group and 46 in the shock group. The mean age was older in the shock group than in the non-shock group (51.5+/-15.1 vs 42.5+/-10.6, p-0.002). A history of drug allergy was more common in the shock group, but no difference was found for the comorbid chronic diseases between the two groups. Radio-contrast media was the most common cause, followed non-steroidal anti inflammatory drugs and antibiotics, but there is no difference in the causes between the two groups. The symptoms of cyanosis, syncope, sweating and dizziness were more frequently manifested in the shock group. The administration of intravenous fluid and injection of subcutaneous epinephrine at the emergency department were more frequent in the shock group than in the non-shock group. CONCLUSION: For the patients who were admitted to the emergency department with drug induced anaphylaxis, the mean age was older and the symptoms of cyanosis, syncope, sweating, dizziness were more frequent in the anaphylactic shock patients than in the non-shock group. More treatments were given at the emergency department to the anaphylactic shock patients.

Retention of CPR Skills by Nursing Students Received Training in AHA BLS Course for Healthcare Providers

PURPOSE: After initial cardiopulmonary resuscitation (CPR) training, CPR performance declines substantially over time. We undertook this study to evaluate the retention of CPR skills by nursing students who received training in the American Heart Association (AHA) basic life support (BLS) course for healthcare providers. METHODS: Third-year nursing students at Ulsan College received training in an 8-hour AHA BLS course. The sequence of CPR actions follows those of the AHA 2005 guidelines. Six months later, skill retention was tested in some of the students without previous notice. Performance in fifteen discrete skills was tested in a scenario format. Resuscitation skills were measured using skill-reporting manikin connected to a PC using Ambu(R) MegaCode Simulation Software and Philips'AED Trainer-2(R). Each of the tests was recorded in video-tapes and the results were analysed by two emergency physicians. RESULTS: Sixty participants were trained and 22 of them were chosen for testing after 6 months. Although not statistically significant, assessing responsiveness (n=17, 77.3%), correct hand placements for compressions (n=17, 77.3%), delivering adequate compression (n=15, 68.2%), turning on the AED (n=18, 81.8%), and placing pads correctly (n=17, 77.3%) tended to be better than the performance of the other discrete skills. The chest compression rate and depth were 105.6+/-26.4/min and 45.5+/-11.3mm, respectively. These two skills were performed correctly 59.1% and 59.1% in all the participants, respectively. CONCLUSION: This study confirmed the generally poor 6- month retention of CPR skills and demonstrated the need for reeducation in nursing students. Further studies are needed to identify the appropriate re-training interval for different occupations.

Comparison of Presentation in Acute Myocardial Infarction by Gender / 성인간호학회지

PURPOSE: This study was to explore gender differences on presenting patients with acute myocardial infarction in the emergency department. METHODS: The survey was done with 143 emergency medical charts presented to the emergency department and diagnosed with acute myocardial infarction between January 2005 and December 2006. The collected data were analyzed with frequency, chi-square, and t-test. RESULTS: Significant gender differences were apparent in age, route to the emergency department, elapsed time from onset of symptoms to arrival, and initial heart rate. Women were significantly more likely to report hypertension, diabetes, and congestive heart failure than men, but men were significantly more likely to report smoking. Chest pain was the most common initial symptom in both men and women. Women were significantly more likely to report dyspnea and nausea/vomiting than men. CONCLUSION: Although similarities exist in the associated symptoms of acute myocardial infarction, women might experience different symptoms, compared to men. These findings have implication that patients and health care providers should consider gender difference in presenting symptoms.

Analysis of Medical Records and Development of Chest Pain Care Record in the Emergency Department / 성인간호학회지

PURPOSE: The purposes of this study were to investigate medical records and to develop care records for management of patients with chest pain in the emergency department. METHOD: Retrospective review of the 42 medical chart of patients presented to the emergency department with chest pain were used. The collected data were analyzed with a frequency of items in the medical records. RESULTS: In a frequency analysis of recorded items for doctors' chest pain assessment during history taking, the history/risk factors was the highest rank. The following ranks were 'commenced with when/ timing, extra symptoms, place, nature, stay/ radiate, alleviate/aggravate, intensity' in sequence. In a frequency of recorded items in nurse's progress notes according to nursing actions, the 'checking/monitoring' was the highest rank. The following ranks were 'performing, administering/injecting, referring/ arranging, testing, preparing/catheterizing, teaching/informing' in sequence. Chest pain care records for the emergency department was designed, based upon data analysis and literature review. CONCLUSION: The designed records can be a rapid and effective approach tool for assessment and recording of patients with chest pain. Further research is necessary for evaluating the designed chest pain care records.

Cytotoxic Effect of 6-OHDA on the Dopaminergic Neurons and Astrocytes in the Dorsal Raphe Nucleus of the Rat / 대한해부학회지

This study was designed to clarify the cytotoxic effects of 6-hydroxydopamine (6-OHDA) on the dopaminergic neurons and astrocytes in the dorsal raphe nucleus (DRN), and to investigate neurodegenerative changes by immuno-histochemistry. Adult male rats (Sprague-Dawley strain) weighing from 250 to 350 g were used as experimental animals. 6-OHDA (100 micrometer dissolved in 0.1% ascorbic acid) was injected into the lateral ventricle of the rat brain with the Hamilton syringe. The control rats were treated with the similar volume of 0.1 % ascorbic acid. The rats were sacrificed at the 3rd, 5th, 10th and 20th day, respectively, after the injection of 6-OHDA. The cytotoxicity of 6-OHDA resulted in severe neurodegeneration of the dopaminergic neurons in the DRN. In the 3rd day, the dopaminergic fibers were dilated. In the 5th and 10th days, the dopaminergic fibers were depleted, and dopaminergic cell bodies were shrunken. In the 20th day, the dopaminergic cell bodies were almost completely disappeared. Astroglial reactions induced by 6-OHDA were also observed in the DRN. In the 5th day, astrocytes were significantly increased as compared with that of the control value. The value were reached at its maximum by the 20th day. Based on the present results, it suggests that 6-OHDA may act as a specific neurotoxin to dopaminergic neurons in the DRN, and induce severe neurodegenerative changes. Also, it suggests that the astroglial reaction in the DRN is gradually activated during the neurodegerative changes.

Cardiac Functions and Hemodynamic Values Related to Prognosis of The Septic Shock Patients in the Emergency Department

BACKGROUND: Septic shock is characterized by an abnormal vascular tone that has been related to various factors. Myocardial depression can also occur in septic shock. Various experimental studies have indicated that the myocardial depression could be present early in the course of septic shock. This study aimed to assess hemodynamic characteristics according to outcome of septic shock in emergency department. METHOD: The study population comprised 20 patients admitted to our emergency department for septic shock. All patients with septic shock(prolonged hypotension, signs of tissue hypoperfusion, signs of sepsis, suspected source of infection, or documented bacteremia) had conventional serial hemodynamic evaluations in emergency department to identify early hemodynamic variables that predicted outcome. All patients were monitored with a pulmonary artery catheter and an arterial catheter. Hemodynamic measurements and oxygen profile were obtained. RESULTS: There were 9(53%) survivors and 8(47%) nonsurvivors. There were no significant differences in systolic pressure, pulse rate, mean pulmonary artery pressure, pulmonary capillary wedge pressure, systemic vascular resistance index, and pulmonary vascular resistance index between survivors and nonsurvivors at initial hemodynamic value. However, significant differences were found in cardiac index(4.3+/-0.5 vs. 2.74+/-0.7 L/min/m2), stroke volume index(44+/-10 vs. 23+/-5 ml/beat/m2), left ventricular stroke work index(39+/-11 vs. 15+/-6 gm m/m2), and right ventricular stroke work index(8.1+/-3.0 vs. 5.2+/-2.9 gm m/m2) between survivors and nonsurvivors at initial hemodynamic value. CONCLUSION: Survivors had better myocardial function than nonsurvivors during the early phase of septic shock. This results suggest that myocardial depression during septic shock develops in the early course of septic shock, which is associated with outcome.