Mumps-induced Opsoclonus-Myoclonus Syndrome: A Case Report

Opsoclonus-myoclonus syndrome (OMS) is a rare neurologic disorder characterized by progressive opsoclonus (irregular, rapid, horizontal and vertical eye movements), myoclonus, cerebellar dysfunction and severe hypotonia. Here we present the case of a 19-year-old man with OMS induced by mumps virus infection. Emergency physicians should know about the typical presentation of OMS and make a proper response.

MDCT Findings of Biliary Ascariasis: a Case Report

Ascaris lumbricoides is one of the most common parasitic infestations of the gastrointestinal tract worldwide. The migration of Ascaris lumbricoides into the biliary tree is an uncommon but well-known complication of intestinal ascariasis and often results in biliary colic. A case of acute common bile duct obstruction caused by a roundworm in a 37-year-old woman, a North Korean defector, is reported. Ultrasonography showed no specific abnormal findings except acute cholecystitis and an intrahepatic biliary stone. However, the MDCT clearly demonstrated a linear filling defect in the common bile duct that led to the correct diagnosis. Biliary ascariasis should be considered in the differential diagnosis of upper abdominal pain of patients in populations at risk.

Does Extended Emergency Department Length of Stay (EDLOS) Affect Mortality in Patients with Traumatic Intraperitoneal Hemorrhage needing Emergency Laparotomy?

PURPOSE: Outcome for critically ill patients often depends on time-sensitive critical care interventions. Thus we examined the effects of time on the mortality and the factors affecting emergency department length-of-stay (EDLOS) in hypotensive patients needing laparotomy in an emergency department. METHODS: ED records were reviewed for documentation of factors that might be associated with prolonged EDLOS, such as computed tomography, the number of standard radiographs, overcrowding, special procedures, and consultations. EDLOS was considered to consist of the time from arrival in the ED to departure from the ED. To assess the effect of multiple simultaneous factors a Cox proportional hazard model was created and a risk ratio (RR) was used to assess the effect of time on mortality. Risk ratio for death was equal to the percentage of patients with tested attributes among patients who died divided by the percent with those attributes among survivors. RESULTS: One-hundred sixteen patients met the inclusion criteria. Average time to the ED was 199.7+/-100.0 minutes. Using a Cox proportional hazards model, the independent predictors of prolonged EDLOS were determined to be additional CT for other areas outside of the abdomen, the number of standard radiographs, whether the patients had a weekend visit, and overcrowding. The risk ratio for time spent in the ED before laparotomy increased up to a time of 120 minutes, then significantly decreased below all earlier values on patients with hypotension and unreponsive to fluid therapy. The risk ratio increased after 240 minutes in patients with hypotension and responsive to fluid therapy. CONCLUSION: The probability of death showed a relationship to the EDLOS for patients who were in the EDLOS for 120 minutes or less in hypotensive abdominal injury patients needing laparotomy in the emergency department.

Effects of Emergency Department Length of Stay on Prognosis for Critically Ill Patients Undergoing Traumatic Emergency Surgery

PURPOSE: Prolonged stay in the emergency department (ED) have been associated with high mortality, but this association remains controversial. We examined the relationship between emergency department length of stay (EDLOS) and the mortality in critically ill patients undergoing traumatic emergency surgery. METHODS: A retrospective cohort study was conducted at an academic medical center with 257 critically ill patients undergoing traumatic emergency surgery from 2003 to 2004. Patients were classified into two groups those spending less than 4 hours in the emergency department and those spending over 4 hours. The groups were compared for hospital-mortality, and the data were entered into multinominal logistic regression, ROC curve, and life table using 12.0 version of SSPS. RESULTS: The overall mortality rate was 16.0%. Average length of stay was 220.1+/-138.5 minutes and 191.3+/-112.9 minutes in the survivors and non-survivor groups, respectively (p=0.212). Hospital-mortality and cumulative survival rate were similar in the group spending less than 4 hours to those in the group spending over 4 hours. The mortality was mainly related to the severity of the patients' condition (SAPS II). CONCLUSION: EDLOS did not affect hospital mortality, and EDLOS of more than 4 hours was not associated with worse prognosis.

Clinical Study of Hospital Mortality in Patients Visiting the Emergency Room at Nighttime in a City of Korea

PURPOSE: Attention has been focused recently on the impact of sleep deprivation, in-house staff, and overwork on patient outcome. The objective of this study was to determine whether any associations existed between the timing of a patient visit to an emergency setting and hospital mortality. METHOD: We analyzed retrospectively a series of consecutive visits to the emergency room of our hospital in 2003. Patients were divided according to the times of their visits to emergency room daytime (from 8:00 am to 6:00 pm) and nighttime (all others). We further divided nighttime visits into early nighttime (from 6:00 pm to 1:00 am) and late nighttime (from 1:00 am to 8:00 am) visits. The odds of death within 48 hours after visit for patients in the nighttime group were analyzed by using a multivariate logistic regression. The independent variable was visit to the emergency room during nighttime. RESULT: The patients visiting at night had a lower mortality (0.9% vs 1.6%, p=0.000), with an odd ratio for death within 48 hours, adjusted for severity of illness, of 1.265 (95% CI, 0.955-1.674). Severity of illness was the main contributor to the increased mortality rates of patients in the nighttime group. There was no significant difference in mortality rates between the early and the late nighttime subgroups. CONCLUSION: Nighttime visits to the emergency room are not associated with a higher mortality than daytime visits.

Apoptosis in Respiratory Epithelial Cells: Triggering by Paraquat and Modulation by L-ascorbic acid

PURPOSE: Apoptosis is a programmed cell death that is a selective process of physiological cell deletion. This study was undertaken to evaluate a paraquat-triggered apoptosis and the ability of ascorbic acid to modulate the process in the A549 cell line, a well-characterized cellular model of human lung alveolar cells. METHODS: A 549 cells were incubated with different concentrations of paraquat for up to 24 hour, followed by 24, 48, and 72 hours of recovery in paraquat-free medium. To test the abilities of antioxidants as modulators of paraquatinduced apoptosis, we pre-treated the cells for 4 hours with 250 micrometer L-ascorbic acid (vitamin C) before exposure to paraquat, and we incubated cells with paraquat in the presence of 250 micrometer L-ascorbic acid. Apoptosis was assayed by staining the cells with FITC-annexin V, and the cells were analyzed by using flow cytometry. RESULTS: Paraquat was inducer of apoptosis. A549 cells incubated with paraquat for up to 24 hour showed no apoptotic features, but the following incubation in a paraquat-free medium resulted in a time-dependent appearance of apoptosis. The ascorbic acid proved effective in reducing paraquat-induced apoptosis. CONCLUSION: We propose an experimental model for investigating the steps and mechanism of paraquat-induced apoptosis in alveolar cells

Survey of Emergency Department Violence

PURPOSE: Violence in the Emergency Department is a common concern but it is an ill-defined and underreported problem because no organization or administrative guidelines exist to adequately address it. The aim of this effort was to gather demographic information on the persons responsible for the violence and on the causes of the violence, so we would have basic data for the prevention of such violence. METHODS: The answers of Emergency Department doctors and nurses working in tertiary, university hospitals in South Korea to questions on a prospective questionaires during the period from December 2002 through February 2003 were analyzed. The survey used 10 questions to elicit demographic information on the persons responsible for the violence, the degree of violence, the severity of the patient' s disease and the reason for the violence. RESULTS: Two hundred twenty-five (225) cases of violence in the emergency department were reported from 6 tertiary hospitals during the 2-month duration. Total respondents to the questionaires were 225 (6 staffs, 131 nurses, and 88 residents). Verbal insults and threats were the most common form of violence. Almost all of the violence was due to the male gender, and 74.5% of violence was done by patient's guardians. More than half of those responsible for the violence were in an alcohol-drunken state. The causes of violence were long waiting time and poor patient-practitioner relationship and were not related with the severity of disease. CONCLUSION: If violence in the emergency department is to be managed and/or prevented, more administrative and financial efforts, a regular format for documentation of incidents, regular preventive education, and further study, if possible, with the Korean Society of Emergency Medicine are necessary.

Development and Prognosis of Non-Q Myocardial Infarction

PURPOSE: In the prethrombolytic era, patients with non-Q myocardial infarction (non-MI) exhibited a lower short-term mortality, but were at higher risk for inhospital and long-term reinfarction, leading to a higher long-term mortality rate than for patients with Q MI. The objective of this study was to determine whether the incidence of non-Q MI among and the prognosis for patients with ST-segment elevation and thrombolytic therapy were different from those among patients who did not have thrombolytic therapy. METHODS: A retrospective chart review was done for 222 patients of acute myocardial infarction with ST-segment elevation The analysis compared the rate of transformation of ST-elevation to Q MI and non-Q MI and the clinical outcome (30-day mortality, reinfarction, recurrent angina, left ventricular (LV) dysfunction, and new congestive heart failure (CHF)) of patients who subsequently developed a Q or non-Q MI postthrombolysis to those for the controls. RESULTS: The rate of non-Q MI was not significantly higher among patients receiving thrombolysis than among the control (31% vs 25%, p>0.1). Among patients receiving thrombolysis, the 30-day mortality (2.6% vs 0%), the inhospital reinfarction (10.3% vs 11.5%), and recurrent angina (20.6% vs 14.5%) were not significantly lower for those who developed a non-Q MI compared with either those who developed a Q MI or the control patients who developed non-Q MI, but left ventricular dysfunction (35.9% vs 55.2%) and new congestive heart failure (0 vs 10.3%) were significantly lower compared with those who developed Q MI. CONCLUSION: Patients receiving thrombolysis do not necessarily develop a non-Q MI and do not have a better prognosis than those who either develop a postthrombolysis Q MI or a non-Q MI after no thrombolysis.

Effect of Fibrinolytic Therapy in Reperfusion of the Coronary Artery on the Prognosis in Acute Myocardial Infarction

PURPOSE: The most significant advance in treatment of acute myocardial infarction is reperfusion therapy with fibrinolytics and percutaneous coronary intervention (PCI). The aim of this study was to assess the efficacy of reperfusion and the clinical outcomes of patients with acute myocardial infarction (AMI) who underwent fibrinolytic therapy. METHODS: A retrospective chart review was done for 226 patients with acute myocardial infarction who met the criteria for fibrinolytic therapy. We compared the thrombolysisin-myocardia-infarction (TIMI) flow in angiography of the infarct-related artery and the clinical outcomes between patients with and without fibrinolytic therapy. Also we analyzed the effects of fibrinolytics in various treatment modalities. The clinical outcomes included the 30-day mortality, repeat AMI/unstable angina, and coronary artery bypass graft (CABG). RESULTS: Angiography after fibrinolytic therapy revealed TIMI grades 0/1, 2, or 3 flow in 15.1%, 21.4%, and 63.5% of vessels, respectively, but in patients without fibrinolytic therapy those percent were 35.0%, 26.0%, and 39.0%, respectively. A significantly increased mortality was seen in patients with lower TIMI grade flow (11.1%, 0%, and 0.8% with TIMI grade 0/1, 2 and 3, respectively, p =0.001). The 30-day mortality were significantly lower in patients with fibrinolytic therapy than in patients without fibrinolytic therapy, particularly in patients with TIMI grade 0-2 flow. There was no significant difference in the 30-day mortality and the clinical outcomes among patients with fibrinolytic therapy, emergency PCI, and delayed PCI. CONCLUSION: Fibrinolytic therapy improved the TIMI flow in angiography and reduced the 30-day mortality.

Diagnostic Value of Cardiac STATus(TM) for Diagnosing Acute Cardiac Ischemia in Patients with Acute Chest Pain in an Emergency Settings

PURPOSE: The purpose of this study was to investigate the usefulness of a qualitative bedside test for detection of cardiac troponin I (Cardiac STATus(TM)) in evaluating patients with acute chest pain in emergency settings. MATERIAL AND METHODS: In 147 patients who had chest pain without ST-segment elevation on their electrocardiograms, we evaluated the sensitivity and the specificity of the new, rapid, bedside troponin I assay for acute myocardial infarction (AMI) and acute cardiac ischemia (ACI). Patients whose samples were taken at least 4 hours after the onset of pain were selected. RESULTS: Cardiac STATus(TM) was positive in 28 patients (19.0%). Among 31 patients with AMI, Cardiac troponin I was positive in 19 (61.3%) patients. Among 95 patients with ACI, Cardiac STATusT M was positive in 24 patients (25.3%). The results were false positive in 12/31 patients (38.7%) for AMI and in 71/119 patients (59.7%) for ACI. The negative predictive value of the Cardiac STATus(TM) was 90.5% for AMI and 65.0% for ACI. During the 30 days of follow-up, there were 4 deaths and 12 cases of non-fatal AMI. Cardiac troponin I proved to be independent predictor of cardiac events. CONCLUSION: In contrast to its excellent specificity (0.92), the sensitivity (0.61) of the Cardiac STATus(TM) assay was poor. Thus, we conclude that this test is not highly sensitive for early detection of myocardial-cell injury. Negative test results were associated with low risk, but did not allow safe discharge of patients with chest pain from the emergency setting. Positive results of Cardiac STATus(TM) were associated with unfavorable outcomes.

Risk assessment of Rebleeding and Mortality after Acute Upper Gastrointestinal Bleeding through Clinical Manifestations

PURPOSE: Upper gastrointestinal bleeding (UGIB) is an urgent medical condition that emergency medicine doctors commonly encounter in the emergency room (ER). Initial management and triage of UGIB patients depend on nonendoscopic findings, so we sought risk factors for UGIB patients by using only the initial clinical data and the patient's condition in the ER. METHODS: By reviewing the data of 302 patients with the impression of UGIB between January of 1998 and December of 2000, the authors attempted to predict risk factors related to rebleeding, mortality, and need for surgical treatment. Based on blood analysis, physical exam, and history taking performed at the ER, the authors conducted a retrospective study in order to determine factors which influence rebleeding and overall mortality. RESULTS: From the blood pressure, pulse rate, and blood analysis taken at the time of admission, the levels of hemoglobin and hematocrits were shown to be related to rebleeding (p<0.05). If there was on-going bleeding, the relative risk of rebleeding was 2.314 times (p=0.023), and if the hemoglobin value was under 8 gm/dL, relative risk of rebleeding was 6.809 times (p=0.000). The factors which influenced the overall mortality rate were the blood pressure measured at the time of admission (p=0.001), the presence of on-going bleeding and rebleeding (p=0.000), and the level of hemoglobin, hematocrits and creatinine (p=0.001). A logistic regression analysis showed that when there was on-going bleeding, the relative risk of the mortality was 10.4 times (p=0.000) and when there was a high creatinine level, it was 7.8 times (p=0.001) CONCLUSION: When a patient with UGIB reports to the ER and shows unstable vital signs, a low hemoglobin level, and evidence of on-going bleeding, one should perform gastroendoscopy as soon as possible, and a need exists for aggressive treatment, even after admission.

Educational Effect on Prehospital Personnel for Prehospital Stroke Management

PURPOSE: If optimal neurologic recovery of stroke patients is to be achieved, thrombolysis and intervention must be initiated within hours from the onset of stroke symptoms. The prehospital personnel play a vital role in prehospital stroke management, including rapid recognition of stroke and rapid transport of the victim to the treating facility. The fact is, however, education and assessment of prehospital personnel's knowledge and practice in recognizing stroke are lacking. In this study, we assessed the prehospital personnel's knowledge of stroke; then, we performed an analysis to determine if that knowledge proved to have an impact on stroke management. METHODS: The study was conducted from March to August 2001 at 9 fire stations in Seoul and other regional areas, and included 164 prehospital personnel. In order to conduct a before-and-after comparative study, we first investigated the prehospital personnel's current knowledge of stroke; then, we administered our own educational training which was taught by an emergency physician. RESULTS: One hundred sixty-four prehospital personnel participated in the educational training program. Most of them (63.4%) were educated at the National Fire Academy. The most frequently listed stroke risk factor was hypertension (98.2%). The most frequently listed stroke symptom and sign was abnormal speech (91.5%). The level of knowledge about the prehospital stroke scale was very low (facial palsy: 10.8%, arm drift: 7.9%, dysarthria: 17.7%). Before the education, their knowledge about the definition of stroke, its risk factors, symptoms and signs, the goal of prehospital management, and the therapeutic window for thrombolysis was not satisfactory. However, there was a significant improvement after the education(p<0.001). The extent of knowledge about stroke varied with the characteristics of the prehospital personnel. The prehospital personnel's knowledge was relatively higher if they were EMP-P certified; from the Department of Emergency Medical Service; worked in Seoul; had been educated for stroke; or had been less than 2 years on the job. CONCLUSION: Presently, the prehospital personnel 's knowledge about prehospital stroke management has proven to be insufficient. However, there was a significant improvement in stroke knowledge after education by an emergency physician

A Case of Severe Bradyarrhythmia after Ingestion of Rhododendron Brachycarpum

Rhododendron brachycarpum has been known as a panacea in Korean folk medicine, and is used to treat various diseases including hypertension. Excessive ingestion can cause intoxication by grayanotoxin. We experienced a 59 year-old man suffering of grayanotoxin intoxication following excessive ingestion of Rhododendron brachycarpum. The patient presented dizziness, weakness, and chest discomfort with cold sweats. Electrocardiography showed marked sinus bradycardia with atrio-ventricular dissociation. With intravenous saline and atropine, the patient recovered. This case calls attention to the potential cardiotoxicity of Korean folk medicine Rhododendron brachycarpum.

Decision Making by CT Grading in Blunt Hepatic Injury Patient

BACKGROUND: Because of increased number of traffic and industrial accidents, the incidence of blunt abdominal injury patients has increased. Recently, abdominal computed tomographic(CT) scans have been widely used in emergency departments for initial diagnostic workups on patients with blunt hepatic injuries. The purpose of this study is to analyze the correlation between abdominal CT scans and the clinical outcomes and to recommend a direction for the management of blunt hepatic injury. METHODS: A retrospective review was conducted of 66 patients with blunt hepatic injuries who underwent abdominal CT scans and were treated at the Department of Emergency Medicine of Dankook University Hospital during the period from January 1998 to December 2000. Statistical analysis was performed using the chi-square(x2) test, Spearman correlation test, Cochran-Mantel-Haenszel chi-square(x2) test and Fisher's exact test; a value of p<0.05 was considered significant. RESULTS: Based on CT scans, we graded the liver injuries by using the system of the Organ Injury Scaling Committee of American Association for the Surgery of Trauma. Grade II injuries(28 cases, 42.4%) were the most common in this study. Most patients with injuries above grade III were managed surgically, and CT grades correlated well with operative treatment and initial fluid resuscitation. Initial shock status correlated with the CT grade, but did not correlate with operative management. For nonoperative management, as the CT grade increased, the amount of blood transfusion also increased. Increasing liver enzyme did not correlate with CT grade. The mortality rate was 9.1%, and the most common cause of death were hypovolemic shock due to massive bleeding. CONCLUSION: Non-operative management is the first choice of treatment in low grade blunt hepatic injury(CT grade I, II, and III). For cases above grade IV hepatic injury, the key points of operative management were the hepatic injury itself and it's complication.

Stool Cultures and Antibiotic Therapy in Cases of Acute Diarrhea

BACKGROUND: Most episodes of acute diarrhea are self-limiting. Most patients require neither a stool culture nor antibiotic therapy. This study was designed to investigate the predictors of a stool-culture positivity and indicators for antibiotic therapy in acute infectious diarrheal patients. METHODS: Medical records of 139 adult cases were retrospectively reviewed during the 12 months between January 1999 and December 1999. We used the Chisquare-test to analyze the data for statistical significance. RESULTS: Fecal leukocytes were examined in 104 cases; 30 tested positive (28.8%). Eighty-five stool cultures were taken, and 24 yielded enteric pathogens, such as Salmonella, Shigella, V. Cholera and V. Parahaemolyticus. Cultures from patients treated between August and October, with fever above 37.6degrees C, or with symptoms of abdominal pain had higher yields(44.2% vs 11.9%, p=0.001, correlation coefficient=0.359; 36.8% vs 10.7%, p=0.012, correlation coefficient=0.273;, 38.1% vs 18.6%, p=0.046, correlation coefficient=0.216 ; respectively) and when combined with fecal leukocytes had a sensitivity of 100% and a specificity of 90.1-95.1%. CONCLUSION: The primary variables (season, fever, and abdominal pain) were excellent predictors of stool culture positivity and indicators for antibiotic therapy, especially when combined with fecal leukocytes

A Study of Patients with Suicidal Attempt

This study was designed to investigate clinical characteristics and outcome of patient with suicidal attempt. A retrospective analysis by chart review of 130 cases of patients with suicidal attempt who visited emergency department of Dankook University Hospital from January 1998 to December 1998. The results were as follows; 1. The ratio of patients with suicidal attempt to total patients who visited emergency department was 0.7%. The highest suicidal attempt rates were among aged 20-39. The gender ratio is similar. 2. Suicidal attempt were more common in summer, July, Friday, evening. 3. The most common place of suicidal attempt was home. 4. Drug ingestion was the most common method of suicidal attempt. Drug used for suicidal attempt were agricultural drug including organic phosphorus and carbamate, and therapeutic drug. 5. Common motives of suicidal attempt were marriage conflict, family conflict. 6. The intensity of will to die was more strong in old aged male. 7. Suicidal attempt associated with alcohol drinking was 39.2%. 8. Common symptoms or signs of intoxication were neurological and gastrointestinal.

The Study on the Chief Complaints and Completion of Referral Sheets of Patients Transferred to ER

We studied the contents of referral sheets of the patients transferred to DMC Emergency Center from Jan 1, 1999 to Jan 31, 1999. The study far the completion and chief complaints in the referral sheets shows the followings. 1. Examining the referral sheets status of disease, name and age record of 5 major items grade 0.92, the highest point, examining item and laboratorial record grade 0.72, dignosis record grades 0.38, and patients condition and diagnosis opinion record grade 0.10. 2, Name and age item had high completion score in referral sheets from local clinic and hospital for secondary referral level. For address item, however, local clinic scored 0.63 and hospital for secondary referral level scored 0.28, which showed statistically significant difference(P<0.001). 3. In the aspect of severity, name and age record leveled 0.94 to the non emergency patient, 0.92 to the emergency patient, 0.91 urgent patient, showed and no statistic significant difference. 4. The major 10 symptoms of the complaints were these the pain of abdomen and pelvis(25.2%), somnolence and stupor, coma(13.6%), headache(10.9%), and open wound of head(4.0%), ranked 10th common symptom level.

The Investigation of Epidemiological and Clinical, Laboratory Characteristics of Acute Febrile Illness of Autumn-Winter Type in Rural Communities of Korea

BACKGROUND: Tsutsugamushi disease, Leptospirosis, and Hemorrhagic fever with renal syndrome(HFRS) are an acute febrile illness of autumn-winter type which are characterized by fever, headache, myalgia in acute stage. We reported the clinical and laboratory characteristics of 49 cases under investigation far febrile illness in rural communities of Korea in order to differentiate the diagnosis among Tsutsugamushi disease, Leptospirosis, and HFRS. METHODS: This study was done retrospectively by investigation of patient's age, occupation, symptom, laboratory findings and chest X-ray findings of Tsutsugamushi disease, Leptospirosis, and HFRS. All patients was seen in our hospital between September and November in 1997 and 1998 consecutive year. RESULTS: The most characteristic symptoms and signs of Tsutsugamushi disease were eschar(90.1%), and skin rash(70%). The epidemiological and laboratory characteristics of Tsutsugamushi disease were age 40 or more, farmer(90.1%), s-GOT(serum glutamic oxaloacetic transaminase) and s-GPT(serum glutamic pyruvic transaminase) elevation. The most characteristic symptoms and signs of Leptospirosis were sputum and cough(75%). The epidemiological and laboratory characteristics of Leptospirosis were all farmers(100%), hyperbilirubinemia(1.67 mg/dl). The most characteristic symptoms and signs of HFRS were gastrointestinal disturbance(100%), flank pain(66.7%). The epidemiological and laboratory characteristics of HFRS were leukocytosis, thrombocytopenia, azotemia, proteinuria (91.6%), and hematuria (83.3%). CONCLUSION: As the clinical feature, presence of eschar and skin rash were suggestive of Tsutsugamushi disease. As the clinical feature, presence of cough and sputum and laboratory finding such as elevation of bilirubin level were suggestive of Leptospirosis. As the clinical feature, presence of gastrointestinal disturbance, flank pain and laboratory finding of thrombocytopenia, and renal dysfunction were suggestive of HFRS.

Clinical Analysis of Delayed Intracranial Hemorrhage in Head Injury

Experinece in the management of 74 patients with delayed traumatic intracranial hemorrhage(DTICH) of 474 head injury from January 1996 to December 1996 is poresented with emphasis on the incidence, occurring time, risk factors and outcome. The incidence of DTICH was 15.6% of all hospitalized head-injury patients. After an injury, every patient had an immediate computerized tomography(CT) scan to diagnose intracranial pathology and then CT follow-up was carried out according to intial CT finding and reurological deficit. The lesion was almost occurred in patients with initial abnormal CT finding(85.1%). 82.4% of DTICH were noted within 72 hours after injury. The delayed epidural hematoma and intracerebral hemorrhage were almost noted in first 72 hours(>90%), but the delayed subdural hemorrhage was found after a time interval varying from 6 hours to 10 days. So we strongly recommend CT follow-up in 4-8hour, 24-72hour, and then 7th day after head injury, especially in patients with initial abnormal CT findings. The risk factor of the delayed lesion was not hypotension, hypoxia, and consciousness level, but age of patients and the initial CT finding. The development of DTICH was not heralded by neurological deterioration. The prognosis of DTICH was not worse than non-DTICH. The patient with delayed subdural hemorrhage was better than the patient with non-delayed lesion(including hemorrhage and normal CT finding).

Bone Mineral Density in Patients with Osteoporotic Compression Fractures

Osteoporosis is the most common generalized skeletal disease, which lays a significant socioeconomic burden to Korea. The early diagnosis and treatment of osteoporosis are of the great interest to minimize the economic co nsequence. We have studied vertebral BMD and bone scan of 30 patients with osteoporotic compression fractures. The purpose of this study was to investigate the effect of osteoporotic compression fracture on bone mineral density(BMD). We have measured the vertebral heights, vertebral bone mineral density, and bone scan counts of vertebral bodies on osteoporotic patients. Vertebral BMD was measured from T12 to L4 using dual photon absorptiometry. Anterior(Ha), middle(Hm), and posterior(Hp) height of vertebrae were measured from T12 to L4, and the spinal deformity indices(Ha/Hp, Hm/Hp, and Hp/Hi ratios) were calculated. The bone scan counts were measured from T12 to L4, and bone scan ratios were calculated. The BMD of fractured vertebrae was significantly higher than that of non-fractured vertebrae The spinal deformity indices were not correlated to the BMD of fractured vertebrae. The bone scan ratio was correlated to the BMD of fractured vertebrae. This study suggests that the increased BMD observed in fractured vertebrae is related to metabolic effect of compression fractures rather than mechanical effect.