BACKGROUND: Multi-organ failure from sepsis is very lethal disease entity, which is suspected to be caused by activated inflammatory cells. Inflammatory cells activated by endotoxins generate oxidants and cytokines such as TNF-alpha and IL-6, which in turn stimulate macrophages and neutrophils. Augmented inflammation makes an organ-injury deteriorate into an organ-failure, which may progress to multi-organ failure. This study is designed to evaluate the therapeutic effects of vitamin-C, a scavenger of oxidants, in sepsis. METHODS: Male Sprague-Dawley rats were divided into 3 groups : a control group, a group injected intrapetoneally with LPS(lipopolysaccharide), and a group injected intraperitoneally with LPS and vitamin-C. Each eight rats were sacrified 24 hours and 48 hours after injection, and samples of the blood, the liver and the lung were obtained. Biochemical assays of TNF-alpha level in the blood and malondialdehyde(MDA) level, catalase activity and nitric oxide synthase(NOS) activity in the liver and the lung tissues were performed. RESULTS: Serum TNF-alpha level, tissue lipid peroxidation and tissue i-NOS activity were dramatically increased, and tissue catalase activity was exhausted rapidly in sepsis. High dose vitamin-C administration decreased serum TNF-alpha level, tissue lipid peroxidation and tissue i-NOS induction, and protected against catalase exhaustion. CONCLUSION: high dose vitamin-C therapy was proved to have definite antioxidant effect in septic condition.
Animals ; Antioxidants ; Catalase ; Cytokines ; Endotoxins ; Humans ; Inflammation ; Interleukin-6 ; Lipid Peroxidation ; Liver ; Lung ; Macrophages ; Male ; Models, Animal* ; Neutrophils ; Nitric Oxide ; Oxidants ; Rats* ; Rats, Sprague-Dawley ; Sepsis* ; Tumor Necrosis Factor-alpha

Many patients whose chief complaint is headache caused by accident such as traffic accident, falling, or assaults visit to emergency center. Majority of these patients has mild or moderate symptoms, and there is no need to treat surgically. However, the fact that head injury can cause SIADH(syndrome of inappropriate secretion of antidiuretic hormone) is likely to be overseen. Acute hyponatremia might have been associated with death or permanent brain damage. Hyponatremia is best handled by early recognition and correction of a downward trend in the serum sodium. Unfortunately, this is often difficult in the head-injured patient, where hyponatremia may occur fairly rapidly and is confused by symptoms of head injury. when moderate to severe hyponatremia occurs, it is important to determine its etiology and expeditiously initiate corrective action. There has not been any reported case of the occurrence of symptomatic SIADH after mild head injury in Korea yet. The authors report the experience of three cases of symptomatic SIADH after mild head injury with review of the literatures.
Accidents, Traffic ; Brain ; Craniocerebral Trauma* ; Emergencies ; Head* ; Headache ; Humans ; Hyponatremia* ; Inappropriate ADH Syndrome ; Korea ; Sodium

PURPOSE: A vast array of injuries result from high voltage electrical damage. The compartment syndrome of forearm prone to have high risk of major amputations, especially in arc burn. Early decompressing fasciotomy has been recommended for the prevention of limb amputations. There are controversies about the effect of fasciotomy. We tried to Pressure Cuff Recording (PCR) wave forms of Plethysmography for the monitoring early signs of vascular compromises in decision of early selective fasciotomy. We investigated the role of PCR wave forms to reduce major amputation rate. METHODS: We reviewed 875 burned limb of 520 electric current damage victims (fasciotomy or amputation were performed, PCR wave forms evaluated) during the last 14 years (from Jan. 1, 1996 to Jun. 30, 2009). We analysed the differences of amputation rates by the currency, input/output, burn types, effects of PGE1 adminstration, fasciotomy time, converting of PCR wave forms. RESULTS: There was no major amputations among low tension victims (minor amputation rate; 0.3%). The minor and major amputation rate were 19.5% and 27.0 in high tension injury. The flash burns rarely made the amputations, but arc burns had 12.1% of minor and 41.2% of major amputations. The direct contact burns had 24.7% of minor and 21.3% of major amputations. Most of the victims had their hand as input and foot as output. The minor and major amputation rate were 26.2% and 10.9% in none-fasciotomy, 8.8% and 48.0% in within 8 hours, 10.0% and 52.9% in 8-24 hours, 9.3% and 63.0% in over 24 hours fasciotomy group. Final normal type (N type) of PCR result had only 3.1% of minor amputations and 3.1% of major amputations. Final obstructive type (O type) had 37.6% of minor amputations, 60.8% of major amputations. Initial stenotic type (S type) of converted to N type had 6.6% amputation, but to O type had 98.7% amputation. CONCLUSION: The early selective fasciotomy are essential to reduce major amputations in high tension injuries, especially in arc burns. The PCR wave form converting to obstructive type could be helpful to predict the possible amputation. The PCR wave form is a good tool to monitor early signs of vascular compromise around fasciotomy. It plays as the index of immediate fasciotomy decision.
Alprostadil ; Amputation ; Burns ; Burns, Electric ; Compartment Syndromes ; Extremities ; Foot ; Forearm ; Hand ; Organothiophosphorus Compounds ; Plethysmography ; Polymerase Chain Reaction

Degenerative lumbar spondylolisthesis requires fusion of the involved segments and decompression laminectomy because it is mechanically unstahle and usually associated with stenosis of the spinal canal. Transabdominal retroperitoneal approach through small longitudinal pararectal skin incision provides easy and safe access to L3-4 and L4-5 disc spaces with less bleeding. We thought that anterior interbody fusion enable us to restore the disc space and to reduce partially the listhesis with less hleeding and less harvest of graft hone compared to posterolateral fusion, and also without the risk of neural or dural damage which could he occurred in posterior lumbar interbody fusion 4.15.16.17). Thus, authors performed the same-day anterior and posterior spinal surgery (APSS) in 28 patients (30 disc spaces) from 1992 to 1996 and analyzed the clinical and radiological results. The most common site of involvement was L4-5 level (82.1%). The mean follow-up period was 2 years and 2 months (from l2 months to 4 years). Fusion was ohtained at 29 disc spaces (96.7%) within 24 weeks (average, I 6 weeks). The anterior displacement was corrected up to the average of 65.4% (5.8mm) postoperatively and the average of 60.7% (5.2mm) correction remained at last follow-up. The intervertebral disc space was restored up to the average of 96.9% (7.5mm) postoperatively and the average of 86.0% (6.2mm) restoration remained at last follow-up. Twenty-five out of 28 patients (89.2%) showed excellent or good clinical results hy the criteria of Kim, et al6). In conclusion, the same-day procedure of successive anterior interbody fusion, decompression laminectomy and posterior pedicular instrumentation for the degenerative lumbar spondylolisthesis associated with spinal stenosis was thought to be a good method of treatment.
Constriction, Pathologic ; Decompression ; Follow-Up Studies ; Hemorrhage ; Humans ; Intervertebral Disc ; Laminectomy ; Skin ; Spinal Canal ; Spinal Stenosis ; Spondylolisthesis* ; Transplants

Objective: Lipoprotein(a) (Lp[a]) and the atherogenic index of plasma (AIP) have been reported as predictive markers of coronary artery calcium (CAC). However, previous studies demonstrated that the cardiovascular risk associations with Lp(a) are attenuated in patients with low-density lipoprotein cholesterol (LDL-C) levels ≤135 mg/dL. However, few articles have identified the risk factors of CAC in patients without high LDL-C. Therefore, we performed this study to investigate the association of Lp(a) and AIP with CAC in patients with LDL-C levels ≤135 mg/dL. Methods: This study included 625 lipid-lowering agent naive patients with LDL-C levels ≤135 mg/dL who underwent coronary computed tomographic angiography. We performed multivariate logistic regression analysis to evaluate the risk factors for a coronary artery calcium score (CACS) >0, CACS ≥400, and CAC ≥90th percentile. Results: The mean age of the patients was 55.0±7.9 years and their mean LDL-C level was 94.7 ±23.3 mg/dL. Multivariate regression analysis showed that age, male sex, diabetes, hypertension, Lp(a), and AIP were independent predictors of CAS>0. Age, male sex, and diabetes were independent predictors of CACS≥400. Diabetes, hypertension, and AIP were independent predictors of CAC ≥90th percentile (all p<0.05). Unlike Lp(a), higher AIP tertiles were associated with significantly higher CAC percentiles and greater proportions of patients with CACS ≥400 and CAC ≥90th percentile. Conclusion In patients without high LDL-C, AIP could be a more reliable predictor of CAC than Lp(a).

PURPOSE: Plasma lactate and base deficit has been used as a marker to determine the status of tissue perfusion in trauma and clinically ill patients and also to predict the outcome of these patients. This study was performed to investigate the effect of plasma lactate and base deficit in predicting burn patients outcome. METHODS: A retrospective review was performed on 102 patients from January 2012 to December 2013 who were admitted as severe burn patients to our burn care unit. Plasma lactate and base deficit were measured upon admission to the hospital and SIRS score, hospital day, ABSI and TBSA were collected after admission. RESULTS: 102 patients were enrolled. Initial base deficit, hospital day, burn surface area and ABSI score showed statistical differences between low SIRS group and high SIRS group. The SIRS score, hospital day and ABSI score showed statistical differences between high base deficit group and low base deficit group (P<0.05). But there were no statistical differences in plasma lactate between two groups (P>0.05). CONCLUSION: In this study, initial base deficit but not plasma lactate, was predictor of morbidity following burn injury.
Burns* ; Humans ; Lactic Acid* ; Perfusion ; Plasma* ; Retrospective Studies

PURPOSE: Plasma neutrophil gelatinase-associated lipocalin (NGAL) is a biomarker that shows correlation with the severity of acute infection and acute kidney injury (AKI). This study was conducted in order to determine the predictive value of NGAL in the emergency department for predicting the severity of acute pyelonephritis. METHODS: A retrospective study was conducted between October 2012 and May 2013. A total of 46 patients diagnosed with acute pyelonephritis were enrolled in this study. Plasma NGAL was measured upon admission to the hospital and clinical and laboratory data, CT were collected. Based on these data, we classified our patients according to two groups (high NGAL group: NGAL > or =400 ng/mL vs low NGAL group: NGAL <400 ng/mL) and we evaluated the correlation between clinical data, laboratory data, and CT. RESULTS: Among the 46 patients, there were 45 female patients and the mean age was 59.0+/-20.4 years. Statistically significant differences in CT grades, hospital stay, SIRS, and shock were observed between the NGAL groups. The area under the ROC curve for CT severity by NGAL was 0.890(95% CI, 0.796-0.985), which was better than CRP and MDRD GFR. NGAL levels showed correlation with CRP (r=0.508; p<0.001) and MDRD GFR (r=-0.766, p<0.001). CONCLUSION: NGAL is a useful specific biomarker predicting severity of acute pyelonephritis.
Acute Kidney Injury ; Biomarkers ; Emergency Service, Hospital ; Female ; Humans ; Length of Stay ; Lipocalins* ; Neutrophils* ; Plasma* ; Pyelonephritis* ; Retrospective Studies ; ROC Curve ; Shock

BACKGROUND: Varix bleeding in children is infrequent but it is potentially fatal. It has characteristics different from adult age varix bleeding. But there was little clinical data about it. The purposes of this study is to detect its characteristics of varix bleeding in pediatric patients, and to help an emergency physician make a decision about the management. METHODS: We reviewed medical records of 32 patients who visit Seoul National University Hospital Pediatric Emergency center from Jan. 1, 1995 to Dec. 31, 1996. RESULTS: 1) The peak age was between 1 and 5 years of age, and the ration of males to females was 1: 1. 2) As a underlying cause, intrahepatic disease were more common than extrahepatic diseases(87.1%:12.9%). 3) 10 patients(31.3%) had URI symptoms as a precipitating factor. 4) Varix bleeding has a circardian rhythm, and occured more often during the night. 5) In Child Classification for the hepatic reserve fuction, Child C was the most common(75%). 6) Endoscopic eliminations were performed in 14 patients(43.8%). 7) According to shock classification. the ration of conservative to vasopressin treatment in class I and class II were 13(40.6%)/10(31.3%) and 6(18.8%)/3(9.4%), respectively. 8) Fever was the most common complication(43.8%), and the mortality rate was 3.1%. CONCLUSION: We suggest that the only conservative management can show a good result far pediatric varix bleeding compared to other treatment modalities.
Adult ; Child ; Classification ; Emergencies* ; Esophageal and Gastric Varices* ; Female ; Fever ; Hemorrhage* ; Humans ; Male ; Medical Records ; Mortality ; Precipitating Factors ; Seoul ; Shock ; Varicose Veins ; Vasopressins

BACKGROUND: Inflammatory mediators, including oxidants, play a important role in the systemic response to burn injury and cause a sepsis and subsequent multiple organ failure by lipid peroxidation of cell. It has been known that vitamin C has potent antioxidant effect and inhibits the lipid peroxidation. This study was designed to evaluate the inhibitory effect of vitamin C about lipid peroxidation in the early stage of bum injury. METHODS: 15 rats with second degree bum on 30-35% of body surface were divided into three groups. Only normal saline was injected into intraperitonial space on the control group , and vitamin C of 50 mg/kg of body weight was added on the low dose group (LDG), and vitamin C of 500 mg/kg of body weight on the high dose group (HDG). After 24 hours of bum damage, biochemical levels of malondialdehyde (MDA), superoxide dismutase (SOD) and catalase were measured in lung and liver tissue. The statistical methods used were Kruskal-Wallis test and Mann-Whitney test. RESULTS: MDA levels of LDG and HDG were significantly low compared to that of the control group (p<0.01). On the catalase activity, there was no significant difference when comparing the control group with LDG (p=0.015), but significant difference with HDG (p<0.01). There was no significant differences between three groups on the activities of SOD (p>0.01), except comparing the control group with HDG in lung tissue (p<0.01). CONCLUSION: Vitamin C therapy in the early stage of bun decreased the level of MDA and increased the catalase activity. It means that vitamin C inhibits the lipid peroxidation and has antioxidant effect. But vitamin C revealed the only partial effect on the SOD activity.
Animals ; Antioxidants* ; Ascorbic Acid* ; Body Weight ; Burns* ; Catalase ; Lipid Peroxidation ; Liver ; Lung ; Malondialdehyde ; Multiple Organ Failure ; Oxidants ; Rats* ; Sepsis ; Superoxide Dismutase ; Vitamins*

Acute massive pulmonary embolism after intracerebral hemorrhage (ICH) is rare but associated with a high mortality rate. A 44-year-old man presented with acute pulmonary embolism on 38th day after onset of ICH. We tried off-pump pulmonary embolectomy with CPB on stand-by. But, hemodynamic deterioration occurred when right pulmonary artery was clamped after removal of some clots, therefore CPB was rapidly instituted under normothermic beating heart with full heparinization. On pump beating, heart pulmonary embolectomy was performed successfully without adverse events. On postoperative 2nd day, the patient was started on anticoagulation therapy and recovered favorably without any neurologic sequelaes.
Adult ; Cerebral Hemorrhage ; Embolectomy ; Heart ; Hemodynamics ; Heparin ; Humans ; Pulmonary Artery ; Pulmonary Embolism