Spontaneously Regressed Bilateral Scapulothoracic Bursitis / 대한정형외과학회잡지

Scapulothoracic bursitis causes snapping scapular syndrome, which is characterized by shoulder pain accompanying bony crepitation during shoulder motion, or as an isolated entity causing shoulder discomfort. The pathogenesis of scapulothoracic bursa formation is thought to be related to chronic repetitive mechanical stress on the periscapular tissue, usually from the result of a bone abnormality (a protrusion of the scapula or rib cage). Scapulothracic bursitis is treated with conservative management and the result can be successful. Accurate diagnosis is important because surgery is not necessary except for cases with pain, excessive friction, or dysfunction. We report a patient with rapidly developed bilateral scapulothoracic bursitis without pain and snapping, which can be confused with a soft tissue sarcoma. In this case, conservative management was used to treat the patient.

The Retraining Effect and Retention of CPR Skill in Medical Students

PURPOSE: This paper compares the CPR (cardiopulmonary resuscitation) skills of medical students with conventional training with those students without any previous training. We tried to evaluate if previous had any impact on CPR skills retention. METHODS: Incoming 1st year medical students were provided conventional CPR instruction. At 18-23 months, we randomly retrained the subjects. Then we tested CPR performance skill at 26 months. Out of 151 subjects who received their first CPR instruction, 135 were available for testing at 26 months. Retraining group and control group was 55 and 80 respectively. RESULTS: Overall performance was superior in the retrained group. The median score for retrained group and control group was 18(17-19) and 15(10-16).(p<0.001) For the retrained group, the percentage of adequate rescue breathing, reassessment, responsiveness assessment and compression were 100%, 98.2%, 96.4%, 92.7% respectively. For the control group, the percentage of adequate rescue breathing, adequate breathing, responsiveness assessment and compression were 91.2%, 73.8%, 68.8%, 60.0%. CONCLUSION: The CPR skills seems to be retained for 8 months. Without any retraining the CPR skills could not be retained after 26 months. Therefore, retraining of CPR is a necessity, but more study is required in oder to find out the interval of retraining.

Diagnosis and Treatment of Patients With Acute Neurologic Symptoms Using a Coordinated Response Protocol

PURPOSE: Patient delays in seeking treatment of stroke and Emergency Department delays are major factors in preventing the use of thrombolytic therapy for stroke. For the achievement of rapid diagnosis and treatment in the emergency center, a unified and systematic confrontation of symptoms and good team cooperation are essential. METHODS: Various departments involved in the management of acute stroke in the ED conferred to discuss ways to minimize door-to-CT and door-to-drug times in the ED. This team formulated the BEST (Brain salvage through Emergent Stroke Therapy) protocol to optimize the treatment of acute stroke patients. Our study employed the BEST protocol for four month during the period from October, 2004 to February, 2005. Inclusion criteria for the protocol were admission to our Hospital's ED with an acute neurologic symptoms and an onset time of less than 12 hours. RESULTS: Ninety-six patients, including fifty-eight men were enrolled in the study. Reasons for acute neurologic changes were ischemic stroke (66 patients), hemorrhagic stroke (22 patients), and metabolic causes (8 patients). Of the 66 ischemic stroke patients, 11 received tissue plasminogen activator (tPA) and 2 were administered Intraarterial Urokinase (IAUK). Door-to-CT times before and after initiation of the BEST protocol were 47+/-19 minutes and 26+/-12 minutes, respectively (p-value=0.024). And door-to-drug times before and after the BEST protocol were 96+/-16 minutes and 67+/-28 minutes, respectively (pvalue=0.035). CONCLUSION: Assembly of a specific "stroke team"and implementation of a well-designed protocol allows the most efficient evaluation and treatment of patients with acute stroke, thus minimizing both door-to-CT and door-to-drug times.