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Background and purpose Previous studies have identified that the reverse shock index multiplied by the Glasgow Coma Scale score (rSIG) is a good predictor of mortality in trauma patients. However, it is unknown if rSIG has utility as a predictor for massive transfusion (MT) in trauma patients. The present study evaluated the ability of rSIG to predict MT in trauma patients. Methods This was a retrospective, observational study performed at a level 1 trauma center. Consecutive patients who presented to the trauma center emergency department between January 2016 and December 2018 were included. The predictive ability of rSIG for MT was assessed as our primary outcome measure. Our secondary outcome measures were the predictive ability of rSIG for coagulopathy, in-hospital mortality, and 24-h mortality. We compared the prognostic performance of rSIG with the shock index, age shock index, and quick Sequential Organ Failure Assessment. Results In total, 1627 patients were included and 117 (7.2%) patients received MT. rSIG showed the highest area under the receiver operating characteristic (AUROC) curve (0.842; 95% confidence interval [CI], 0.806–-0.878) for predicting MT. rSIG also showed the highest AUROC for predicting coagulopathy (0.769; 95% CI, 0.728–0.809), in-hospital mortality (AUROC 0.812; 95% CI, 0.772–0.852), and 24-h mortality (AUROC 0.826; 95% CI, 0.789–0.864). The sensitivity of rSIG for MT was 0.79, and the specificity of rSIG for MT was 0.77. All tools had a high negative predictive value and low positive predictive value. Conclusion rSIG is a useful, rapid, and accurate predictor for MT, coagulopathy, in-hospital mortality, and 24- h mortality in trauma patients.

Cryogenic hydrogen adsorption using molecular sieve beds is considered to be one of the main candidate processes for recovery of produced tritium from purge gas in breeding blankets and it has been chosen for separating hydrogen isotopes in Tritium Extraction System (TES) of Korean Helium Cooled Ceramic Reflector (HCCR) Test Blanket System (TBS). Various adsorbents and their performance have been studied for the cryogenic adsorption using small-scale experiments. However, large-scale experiments comparable to TBS-relevant scale are required to have sufficient confidence for component design and performance prediction of Cryogenic Molecular Sieve Bed (CMSB) for the TBS and beyond. To properly evaluate hydrogen adsorption performance of a large size CMSB, a series of experiments have been performed using PGLoop facility which is constructed and operated in the National Fusion Research Institute. The experimental conditions were set to include breeding-blankets-relevant parameters. As such, the effects of swamping ratio, total pressure, and flow rates on the performances of CMSB were studied in the range of hydrogen partial pressures from 100 to 700 Pa. While a slight reduction in hydrogen adsorption performance is observed in comparison to the small isotherm experiments, which can be attributed to scale-up effects, it shows that the experimental results agree reasonably well with existing literature data.

Korea has own programs toward DEMO and fusion reactors that will require further improved DEMO blanket and energy utilization systems. Primary goals of DEMO blanket development in Korea are to develop and verify the integrated blanket design tools; to develop blanket materials, cooling and tritium fuel cycle technologies; and to develop and evaluate fabrication and joining technologies. The concept of helium-cooled ceramic reflector (HCCR) blanket is adopted to be tested in ITER as Test Blanket Module (TBM). Currently, the design and R&D activities are mainly performed through the ITER TBM program in Korea. It is expected to demonstrate the major objectives of the breeding blanket: extraction of heat from burning plasma, tritium self-sufficiency and its integrity within the whole systems considering safety features. Although TBM program will provide very essential data and experience, there will be a considerable technical gap from DEMO blanket. This paper presents the technical gap in the main technical categories of the breeding blanket based on the experience of the development of HCCR TBM and breeding blanket. It is found that still about 60–70% of the DEMO blanket technology can be achieved through the HCCR TBM depending on the technology maturity level, and some ways to DEMO blanket from HCCR TBM are proposed.

Introduction: Chlorfenapyr is a pyrrole-based pro-insecticide. The main activity of this agent is the inhibition of adenosine triphosphate synthesis, and it is used in agriculture to control several insects and mites resistant to carbamate, organophosphate and pyrethroid insecticide. The World Health Organization classifies this agent as a class II toxin (moderately hazardous). Case presentation: All previously reported cases of chlorfenapyr poisoning in humans occurred following oral ingestion except one case involving exposure to chlorfenapyr vapour. Discussion: In this report, we describe a case of chlorfenapyr intoxication after skin exposure in a 49-year-old patient who died 5 days after exposure. Conclusion: This case demonstrates that similar to oral ingestion, dermal absorption of chlorfenapyr may also be fatal.

Development of the Helium Cooled Ceramic Reflector (HCCR) breeding blanket is underway according to the development strategy of core technology for K-DEMO under the fusion energy development roadmap in Korea. The main goals are to validate integrated design tools and to develop core technologies in the field of materials, manufacturing and joining technologies, helium cooling and tritium technologies, system integration, and safety technologies. A unique graphite reflector concept was adopted to save cost by reducing the amount of beryllium neutron multiplier. The main functions and design concepts of the HCCR breeding blanket are to be verified in ITER through the HCCR Test Blanket Module (TBM) program. Not only breeder modules are to be tested in ITER but also the technologies of cooling, coolant purification, tritium extraction, etc. are to be tested or proved in ITER before employed in DEMO. This paper introduces the current updates of the design and R&D activities of the HCCR TBM systems in the preliminary design stage.

Chemical compatibility between reduced activation ferritic-martensitic steel, ARAA, and lithium meta-titanate breeder was investigated under operating conditions; high temperature and helium purge gas including a low concentration of hydrogen. ARAA specimens were embedded inside lithium meta-titanate powder and compacted under a load of 200 MPa to form disk-shaped samples. The samples were heated at 550 °C for up to 1000 h in helium with up to 1% hydrogen atmosphere to simulate a fusion breeding blanket environment. The surface of the ARAA specimen was chemically reacted with the lithium meta-titanate breeder to form an oxide layer. The thickness of the oxide layer increased as the heating time increased. The hydrogen in the purge gas made the oxide layer thinner due to the reaction with oxygen in the oxide layer. The growth phenomena of the oxide layer were evaluated.

Objectives Despite the low diagnostic yield of echocardiogra0, it is often used in the evaluation of syncope. This study determined whether patients without abnormalities in the initial evaluation benefit from transthoracic echocardiogram (TTE) and the clinical factors predicting an abnormal TTE. Methods This study enrolled 241 patients presenting to the emergency department with syncope. The TTE results were analyzed based on risk factors suggesting cardiogenic syncope in the initial evaluation. Results Of the 115 patients with at least one risk factor, 97 underwent TTE and 27 (27.8%) had TTE abnormalities. In comparison, of the 126 patients without risk factors, 47 underwent TTE and only 1 (2.1%) had TTE abnormalities. Significantly different factors between patients with normal and abnormal TTE findings were entered in a multiple logistic regression analysis, which yielded age [adjusted odds ratio (aOR), 1.09; 95% CI, 1.02–1.15; p =0.006], an abnormal electrocardiogram (ECG) (aOR, 7.44; 95% CI, 1.77–31.26; p =0.010), and a brain natriuretic peptide (BNP) level of >100pg/mL (aOR, 2.64; 95% CI, 1.21–5.73; p =0.011) as independent predictors of TTE abnormalities. The cutoff value of age predicting an abnormal TTE was 59.0years (area under the curve, 0.777; p Conclusion A patient who is older than 59years or has an abnormal ECG or an elevated BNP level may benefit from TTE. Otherwise, TTE should be deferred in patients with no risk factors in the initial evaluation.

Purpose We aimed to examine the utility of the Poison Severity Score (PSS) and Sequential Organ Failure Assessment (SOFA) score as early prognostic predictors of short-term outcomes in patients with carbon monoxide (CO) poisoning. We hypothesized that both the PSS and the SOFA score would be useful prognostic tools. Methods This was retrospective observational study of patients with CO poisoning who presented to the emergency department and were admitted for more than 24 hours. We calculated PSS, the initial SOFA score, a second (2nd) SOFA score, and a 24-hour delta SOFA score. The primary outcome was reported as the cerebral performance category (CPC) scale score at discharge. We classified those with CPC 1–2 as the good outcome group and those with CPC 3–5 as the poor outcome group. Results This study included 192 patients: 174 (90.6%) belonged to the good outcome group, whereas 18 (9.4%) belonged to the poor outcome group. The PSS (1.00 [0.00, 1.00] vs 3.00 [3.00, 3.00], p < 0.001), initial SOFA (1.00 [0.00, 2.00] vs 4.00 [3.25, 6.00], p < 0.001), 2nd SOFA score (0.00 [0.00, 1.00] vs 4.00 [3.00, 7.00], p < 0.001), and 24-hour delta SOFA score (-1.00 [-1.00, 0.00] vs 0.00 [-1.00, 1.00], p = 0.047) of the good outcome group were significantly higher than those of the poor outcome group. The areas under the receiver operating characteristic curve for PSS and the initial SOFA and 2nd SOFA scores were 0.977 (95% confidence interval [CI] 0.944–0.993), 0.945 (95% CI 0.903–0.973), and 0.978 (95% CI 0.947–0.994), respectively. Conclusion The PSS, initial SOFA score, and 2nd SOFA score predict acute poor outcome accurately in patients with CO poisoning.

A helium cooling system (HCS) circulates helium coolant to remove heat from a tritium breeding blanket in a fusion reactor. A small amount of tritium can permeate into the HCS from the blanket, and it should be removed as per safety requirements in the system. A coolant purification system (CPS) is connected to the HCS, and one percent of the helium flow is bypassed into the CPS from the HCS for purification of the coolant. An ambient molecular sieve bed (AMSB) will play a role in capturing the tritiated water, Q2O. In order to develop and confirm the AMSB design and its function, a test facility is constructed especially for the experimental validation of the adsorption characteristics under a very low concentration of vapor. An experiment will be conducted under a helium flow. However, before the main helium test, air tests are performed at room temperature and 0.33 MPa. The facility can be divided into two parts, one part containing a device generating a small amount of moisture and the other containing the test section including the AMSB. The vapor generator can continuously supply vapor of 1 to hundreds of ppm to the dry gas. Various AMSBs can be installed in the test section. The adsorption performance and saturation characteristics according to the diameter, length, and flow rate are compared. The experiment was conducted on two columns of different lengths. Specifically, when the performance validation test with the 64 mm AMSB was conducted over a period of more than 10 days, it showed very stable adsorption performance. The length of the AMSB estimated in the experiment was several times shorter than that obtained through a correlation equation. If these results are reflected in the design, the design can be more compact or the operation cycle can be increased. These experiments can contribute to the development of AMSB designs.

Objective We compared training using a voice advisory manikin (VAM) with an instructor-led (IL) course in terms of acquisition of initial cardiopulmonary resuscitation (CPR) skills, as defined by the 2010 resuscitation guidelines. Methods This study was a randomized, controlled, blinded, parallel-group trial. We recruited 82 first-year emergency medical technician students and distributed them randomly into two groups: the IL group (n=41) and the VAM group (n=37). In the IL-group, participants were trained in "single-rescuer, adult CPR" according to the American Heart Association's Basic Life Support course for healthcare providers. In the VAM group, all subjects received a 20-minute lesson about CPR. After the lesson, each student trained individually with the VAM for 1 hour, receiving real-time feedback. After the training, all subjects were evaluated as they performed basic CPR (30 compressions, 2 ventilations) for 4 minutes. Results The proportion of participants with a mean compression depth ≥50 mm was 34.1% in the IL group and 27.0% in the VAM group, and the proportion with a mean compression depth ≥40 mm had increased significantly in both groups compared with ≥50 mm (IL group, 82.9%; VAM group, 86.5%). However, no significant differences were detected between the groups in this regard. The proportion of ventilations of the appropriate volume was relatively low in both groups (IL group, 26.4%; VAM group, 12.5%; P=0.396). Conclusion Both methods, the IL training using a practice-while-watching video and the VAM training, facilitated initial CPR skill acquisition, especially in terms of correct chest compression.

Inflammatory pseudotumor of the liver is a benign disease which is histologically characterized by plasma cell infiltration and reactive fibrotic inflammation. Differentiating this disease from malignant tumor is not easy. The authors report a case of inflammatory pseudotumor mimicked as intrahepatic cholangiocarcinoma. A 74-year-old man visited the emergency department complaining of jaundice and myalgia which have lasted for 1 to 2 weeks. After computed tomography (CT) scan and magnetic resonance imaging of the liver, he was initially diagnosed with intrahepatic cholangiocarcinoma, but was ultimately found to be inflammatory pseudotumor after pathologic examination of the liver tissue. His symptoms improved after a course of antibiotic therapy and conservative treatment, and the lesion disappeared on follow-up CT scan. Korean J Pancreas Biliary Tract 2016;21(3):180-184

In the design of a fusion reactor, a helium cooling system (HCS) is used to extract heat from the blanket. To reduce the permeated tritium to HCS, coolant purification system (CPS) has been developed and experimental loop has been constructed. In the present paper, the main components of the CPS loop such as oxide bed and absorption bed were introduced focusing with design, fabrication and their performance calculation. Since the molecular size of tritium is too small to be captured, it is oxidized to Q2O using a copper oxide bed. Then, the adsorption bed using molecular sieve captures Q2O through physical adsorption. For the design of CPS, correlation of previous studies and general properties of molecular sieve were used. Since the concentration of Q2 in this system is estimated as 0.4 Pa, which is very low compared to the helium pressure of 8 MPa, the used correlations for design and saturation characteristics of the absorption bed under low partial pressure of Q2O should be validated. In the present study, component test was prepared to verify the designed absorption bed, which can simulate the helium flow condition with low concentration of Q2. The test was performed under various conditions such as temperature, pressure, concentration of Q2 and velocity. The results will be used for CPS loop design.

Predisposing factors for venous thrombosis can be identified in the majority of patients with established venous thromboembolism (VTE). However, an obvious precipitant may not be identified during the initial evaluation of such patients. In the present case, a 47-year-old female presented to the emergency department of our hospital after ingesting multiple drugs. She had no VTE-related risk factors or previous episodes, nor any family history of VTE. After admission to the intensive care unit sudden hypoxemia developed, and during the evaluation cerebral, renal, and splenic infarctions with pulmonary embolisms were diagnosed. However, the sources of the emboli could not be identified by transthoracic echocardiography or computed tomography angiography. Protein C deficiency was identified several days later. We recommend that hypercoagulable states be taken into consideration, especially when unexplained thromboembolic events develop in multiple or unusual venous sites.

Background: Cardiac enzymes such as creatine kinase-MB, troponin I, and brain natriuretic peptide (BNP) are thought to be useful prognostic factors in patients with acute ischemic stroke. This study investigated the efficacy of cardiac biomarkers as prognostic factors. Methods: We reviewed patients with acute ischemic stroke whose cardiac biomarkers had been measured and who were admitted to our hospital between January 2012 and December 2013. The cardiac biomarkers were measured within 24 hours after admission to the emergency room. We evaluated the clinical characteristics and compared the outcomes of the patients based on their cardiac biomarkers. Results: The following cardiac biomarkers were measured in 219 patients with acute ischemic stroke: creatine kinase-MB (n=218), troponin I (n=219), and BNP (n=143). Statistically significant differences were observed in older age (68.77±12.42 vs. 74.59±6.68, p

Korea plans to test a Helium Cooled Ceramic Reflector (HCCR) Test Blanket Module (TBM) in ITER. The HCCR TBM adopts a four sub-module concept considering the fabricability and the transfer of irradiated TBM for post irradiation examination. Each sub-module has seven-layer breeding zone, including three neutron multiplier layers packed with beryllium pebbles, three lithium ceramic pebble bed packed tritium breeder layers, and a reflector layer packed with graphite pebbles. Based on this configuration, neutronic and electromagnetic calculations were performed and their results were applied for the conceptual design of HCCR TBM that considers manufacturing feasibility. Also, a design and safety analysis of HCCR Test Blanket System (TBS) was performed using integrated design tools modifying nuclear system codes for helium coolant and tritium behavior evaluation. The Advanced Reduced Activation Alloy (ARAA) is being developed as a structural material. A total of 73 candidate ARAA alloys were designed and their out-of-pile performance was evaluated. The graphite pebbles as the neutron reflector were fabricated by using mechanical machining and grounding method with the surface coated with SiC. The hydrogen permeation characteristics of structural materials were evaluated using the Hydrogen PERmeation (HYPER) facility. The recent design and R&D progress on these areas are addressed in this paper.

Korea plans to install and test Helium Cooled Ceramic Reflector (HCCR) Test Blanket Module (TBM) in the ITER, because the HCCR blanket concept is one of options of the DEMO blanket. Currently, many design and R&D activities have been performed to develop the Korean HCCR TBM. An integrated design tool for a fusion breeder blanket has been developed based on nuclear technologies including a safety analysis for obtaining a license for testing in the ITER. A half-scale sub-module mockup of the first wall with the manifold was fabricated, and the manufacturability and thermo-hydraulic performances were evaluated. High heat load and helium cooling test facilities have been constructed. Next, the recent status of TBM material development in Korea was introduced including Reduced Activation Ferritic Martensitic (RAFM) steel, lithium ceramic pebbles and silicon carbide (SiC) coated graphite pebbles. Several fabrication methods of RAFM steel, lithium ceramic pebbles, and silicon carbide coating on graphite pebbles were investigated. Recent design and R&D progress on these areas are introduced here.

Objective To assess whether ultrasonographic examination compared to chest radiography (CXR) is effective for evaluating complications after central venous catheterization. Methods We performed a prospective observational study. Immediately after central venous catheter insertion, we asked the radiologic department to perform a portable CXR scan. A junior and senior medical resident each performed ultrasonographic evaluation of the position of the catheter tip and complications such as pneumothorax and pleural effusion (hemothorax). We estimated the time required for ultrasound (US) and CXR. Results Compared to CXR, US could equivalently identify the catheter tip in the internal jugular or subclavian veins (P=1.000). Compared with CXR, US examinations conducted by junior residents could equivalently evaluate pneumothorax (P=1.000), while US examinations conducted by senior residents could also equivalently evaluate pneumothorax (P=0.557) and pleural effusion (P=0.337). The required time for US was shorter than that for CXR (Pl0.001). Conclusion Compared to CXR, US could equivalently and more quickly identify complications such as pneumothorax or pleural effusion.

This study is to know the factors that may affect cartilage repair after autologous chondrocyte implantation (ACI) for the treatment of an osteochondral lesion of the talus (OLT) as seen through a second look arthroscopy. A total of 38 patients who had ACI treatment for OLT underwent a second look arthroscopy 1 year after the ACI operation. A modified magnetic resonance observation of cartilage repair tissue (MOCART) scoring system was used to assess the outcome of the repaired cartilage. Influencing factors were sex, accompanied procedure, location, site, depth, pre-operative AOFAS score, size and age. Factors that may affect cartilage repair after ACI treatment for OLT were evaluated. Of the different factors assessed, sex (P=0.75), accompanied procedure (P=0.50), depth (P=0.08), location (P=0.54), site (P=0.50) and pre-operative AOFAS score (P=0.42) were found not to affect cartilage repair after ACI treatment for OLT. The size of the lesion (P=0.0021) and patient's age (P=0.01) were the influential factors. As a result, factors affecting repaired cartilage formation after ACI of OLT were found through the second look arthroscopy. It was determined that not all of the factors affecting the clinical outcome after ACI for the repair of an OLT affected cartilage repair after ACI.

Background: Two-dimensional (2D) speckle imaging has shown that it could evaluate not only regional but also global strain (ɛ) and strain rate (SR) of the left and right ventricles. There are no data for global ɛ/SR imaging for left atrial (LA) function evaluation. Methods: A total of 54 subjects (37 men; mean age, 44 ± 10 years) with normal treadmill exercise stress echocardiography and no coronary risk factors were enrolled. Global longitudinal LA ɛ/SR data obtained by 2D speckle imaging with automated software (EchoPAC, GE Medical) were compared with LA volumetric parameters. Results: LA ɛ/SR imaging was acceptable in all patients. Bland-Altman analysis for these parameters showed no evidence of any systematic difference regarding inter- and intraobserver variabilities. Global longitudinal LA strain during systole and peak systolic global longitudinal LA SR were correlated with LA total emptying fraction (EF) (r = 0.399, P = 0.004; r = 0.366, P = 0.008). Global longitudinal LA strain during early diastole and peak early diastolic global longitudinal LA SR were correlated significantly with LA passive EF (r = 0.476, P < 0.001; r = 0.507, P < 0.001). Global longitudinal LA strain during late diastole and peak late diastolic global longitudinal LA SR were not correlated with LA active EF (r = 0.198, P = 0.163; r = 0.265, P = 0.060). Conclusions: Global longitudinal LA ɛ/SR parameters determined by 2D speckle tracking echocardiography are feasible and reproducible indices for the evaluation of LA function. (ECHOCARDIOGRAPHY, Volume 26, November 2009)

The objective of this study is to develop and test an integrated conceptual model of the Internet acceptance. Based on the two dominant theoretical paradigms - the theory of reasoned action (TRA) and the technology acceptance model (TAM) - we propose a model of the Internet acceptance to investigate the relationship between external variables such as individual differences, task characteristics and management support, and individual acceptance of the Internet. The model is tested using data gathered from 374 end users of the Internet in Korean firms and data analysis is conducted using a structural equation modeling with LISREL. Significant relationships are found between experience and usefulness, between experience and ease of use, and between ease of use and usefulness. Organizational support is found to influence usefulness, ease of use and subjective norm. We also observe that actual usage is not influenced by subjective norm, but significantly influenced by experience, usefulness and ease of use. This result implies that individual acceptance of the Internet is significantly related to external factors such as experience, task characteristics and organizational characteristics rather than beliefs.

Current guideline recommends that immediate coronary angiography (CAG) should be considered in all postcardiac arrest patients in whom acute coronary syndrome is suspected. In the setting of out-of-hospital cardiac arrest (OHCA), obtaining clinical data such as chest discomfort and medical diseases associated with acute coronary syndrome can be difficult. Therefore, emergency physicians depend on electrocardiographic findings after return of spontaneous circulation (ROSC) when they have to decide whether emergency CAG should be performed. In clinical practice, the usefulness of emergency CAG evaluation of OHCA patients without ST-segment elevation myocardial infarction is debatable. We describe 2 OHCA patients who did not exhibit ST-segment elevation after ROSC and received underwent emergency CAG.

We report a case of multicentric, biatrial cardiac myxoma in a 29-year-old female who complained of exertional dyspnea, abdominal distension and peripheral edema. Any other associated skin lesions, breast mass or endocrine disorder presenting complex form were' not seen on her. Also, there was no contributory medical history, hypertension and diabetes mellitus. By using transthoracic echocardiography, we identified a biatrial myxoma attached to the interatrial septum. During surgical excision, we found a large right atrial myxoma with extension through the fossa ovalis into the left atrium and small myxoma attached to the right atrial free wall. After successful resection of interatrial septum and free wall, atrial septal defect was created during the resection and safely repaired by bovine pericardial patch.

Two-dimensional (2D) speckle imaging has shown that it could evaluate not only regional but also global strain (epsilon) and strain rate (SR) of the left and right ventricles. There are no data for global epsilon/SR imaging for left atrial (LA) function evaluation.A total of 54 subjects (37 men; mean age, 44 +/- 10 years) with normal treadmill exercise stress echocardiography and no coronary risk factors were enrolled. Global longitudinal LA epsilon/SR data obtained by 2D speckle imaging with automated software (EchoPAC, GE Medical) were compared with LA volumetric parameters.LA epsilon/SR imaging was acceptable in all patients. Bland-Altman analysis for these parameters showed no evidence of any systematic difference regarding inter- and intraobserver variabilities. Global longitudinal LA strain during systole and peak systolic global longitudinal LA SR were correlated with LA total emptying fraction (EF) (r = 0.399, P = 0.004; r = 0.366, P = 0.008). Global longitudinal LA strain during early diastole and peak early diastolic global longitudinal LA SR were correlated significantly with LA passive EF (r = 0.476, P0.001; r = 0.507, P0.001). Global longitudinal LA strain during late diastole and peak late diastolic global longitudinal LA SR were not correlated with LA active EF (r = 0.198, P = 0.163; r = 0.265, P = 0.060).Global longitudinal LA epsilon/SR parameters determined by 2D speckle tracking echocardiography are feasible and reproducible indices for the evaluation of LA function.

Objectives: The objective of the present study was to investigate whether the combined use of transcricothyroid membrane ultrasonography and ultrasonographic evaluation for pleural sliding is useful for verifying endotracheal intubation in the ED. Methods: We performed a prospective clinical trial in the ED from January to July 2008. All patients enrolled in the present study had been admitted to the ED owing to severe airway problems. A linear probe was placed horizontally over the cricothyroid membrane (dynamic phase) during the intubation process. Endotracheal intubation was confirmed by ultrasonographic lung sliding. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated. Results: Thirty patients (17 men, 13 women; mean age 59.6 ± 16.7 [SD] years) were enrolled in the study. Of the 30, 7 had a history of trauma. Four trauma patients were diagnosed with haemopneumothorax. The ratio of initial oesophageal-to-endotracheal intubation was 3:27. Sensitivity, specificity, PPV and NPV for endotracheal intubation were 96.3%, 100%, 100% and 75%, respectively. After verification by ultrasonographic lung sliding, sensitivity, specificity, PPV and NPV were each 100%. Conclusions: The combination of transcricothyroid membrane ultrasonography and ultrasonographic lung-sliding evaluation could be useful in confirming endotracheal intubation in the ED.

Esophageal squamous cell papillomatosis is a rare disorder that is usually found incidentally on an upper gastrointestinal endoscopy examination or autopsy. A 70-year-old woman presented with a two-month history of dysphagia and abdominal discomfort. A chest CT scan showed diffuse marked thickening of the esophageal wall along the entire length and multiple small enhancing polypoid projections in the distal esophagus. Diffuse circumferential FDG uptake in the entire esophagus was seen on [18F] FDG PET/CT. Squamous papillomatosis was diagnosed by an endoscopic biopsy. We report a case of extensive esophageal papillomatosis with imaging features on CT and [18F] FDG PET/CT, with a review of the clinical literature.

Introduction Apical hypertrophic cardiomyopathy is a variant of hypertrophic cardiomyopathy (HCM) characterized by a spade-shape configuration on echocardiographic examination. It often accompanies a quite normal or even larger coronary arteriogram. Therefore acute myocardial infarction with significant atherosclerosis is rarely reported in patients with apical HCM or hypertrophic cardiomyopathy. Also there was no report of apical HCM combined with acute myocardial infarction and multiple coronary thrombosis. We report a rare case of typical apical HCM, who developed acute myocardial infarction due to multiple coronary thrombosis.

Subcutaneous panniculitis-like T-cell lymphoma (SCPTCL) is a rare subtype of peripheral T-cell lymphoma. This case report is of a 24-years-old man presented with subcutaneous nodules on his lower abdomen and buttocks. An abdominal CT revealed multiple nodules and increased streaky densities in the subcutaneous fat layer of the abdominal wall and buttocks. In addition, multiple focal FDG uptake lesions of the subcutaneous fat layer were detected from a 18FFDG PET/CT and the histologic diagnosis determination was SCPTCL. We report here one case of SCPTCL, determined by the CT and 18FFDG PET/CT imaging features and a review of the relevant literature.

Background:Primary stenting as a direct reperfusion procedure after acute myocardial infarction might reduce recurrent myocardial infarction and target vessel revascularization. However, result of long or multiple stenting in the long or tandem lesions were not known. Method:From Jan. 1996 to Dec. 1998, patients with acute myocardial infarction including cardiogenic shock were undergone primary stenting using long or multiple stent. The clinical end points were death, recurrent infarction, subsequent bypass surgery, or repeat angioplasty of the in-farct-related vessel. The results were compared with age, sex, lesion, and risk matched standard stenting group. Result:Baseline characteristics were similar for the 20 patients who underwent standard length stenting and the 13 patients who underwent long or multiple stenting. Stent diameter was similar in two group (3.4±0.3 mm vs. 3.5±0.4 mm, p=0.65), but total stent length was longer in long or multiple stenting group (15.5±1.8 mm vs. 40.18.4 mm, p=0.01). Average numbers of stent using in multiple stenting were 1.5±0.7. Stenting in the in-farct-related artery was successful in all patients randomized to stent treatment. At 6 months, the incidence of the primary end point was 25% (5/20) in the standard stent group and 31% (4/13) in the long or multiple stent group (p=0.5). Conclusion:Outcomes of long or multiple stenting including mortality, recurrent myocardial infarction and target vessel revascularization was similar to standard stenting. Long or multiple stenting after acute myocardial infarction may possible procedure in some selective cases having long or tandem lesion. (Korean Circulation J 1999;29(12):1341-1349)

Background:Although the superior reperfusion and improved clinical outcome following angioplasty for acute myocardial infarction (AMI) have been well known, 10 to 15% of reinfarction and recurrent ischemia in hospital are main limitation of primary percutaneous transluminal coronary angioplasty (PTCA). This study was undertaken to examine the safety and feasibility of stent-supported primary angioplasty in acute myocardial infarction. Methods:Between July 1995 and Jun. 1997, 32 patients underwent direct or rescue PTCA, including patients with cardiogenicc shock. After PTCA, stentingwas attempted in patient with dissection or having more than 30% of residual stenosis. Result:In patient with direct PTCA, angiographic success rate was obtained in 91%(30/32). Stenting was attempted in 15 of 30 patients. These patients had suboptimal results (8 patients), nonocclusive dissection (3 patients) and acute occlusion (2 patient). Thrombolysis in myocardial infarction (TIMI) grade 3 flow was restored in 28 patients (93%). In one patient no-reflow phenomena was observed following stent insertion. Despite intra-aortic balloon pumping, there was one death during the hopitalization due to cardiogenic shock following PTCA. Subacute stent thrombosis developed in two patients. 27 patients (90%) were event-free and clinically improved through out the follow up period (11.5±5.2 month). Quantitative angiography showed excellent angiographic result after stenting compared with balloon PTCA (2.4±0.6 mm vs. 3.4±0.3 mm p