BACKGROUND: Cardiac injuries are the most commonly overlooked injuries in patients who die from trauma. Patients who survive blunt cardiac rupture or penetrating injuries are rare and the incidence is not well defined. Many patients require urgent or emergency operations and operative mortality is very high. MATERIAL AND METHOD: A retrospective review of 26 patients with cardiac injuries due to thoracic trauma undergoing emergency thoracotomy from January 1997 to December 2005. RESULT: There were 17 male and 9 female patients, with a mean age of 45.3+/-16.2 (range: 17~80). Thirteen patients (50%) were injured in motor vehicle accidents, and five patients (19%) in motorcycle accidents. Six patients (23%) were injured by knives, and two patients (8%) were injured by falling. Anatomic injuries included right atrium (12 [46%]), left atrium (1 [4%]), right ventricle (5 [19%]), left ventricle (5 [19%]), and cardiac chambers (2 [7%]). Diagnosis was made by computer tomography in 12 patients and sonography in 14 patients. The average times from admission to operating room was 89.2+/-86.7 min (range: 10~335). The average time for diagnosis was 51.3+/-13.6 min (range: 5~280). The mean Revised Trauma Score (RTS) was 6.7+/-0.8, and the Glasgow Coma Scale (GCS), was 12.8+/-2.8. The overall mortality rate was 12% (3 out of 26 patients). CONCLUSION: The mortality rate from cardiac injury is very high. The survival rate can be increased only by a high index of suspicion, aggressive expeditious diagnostic evaluation, and prompt appropriate surgical management.
Diagnosis ; Emergencies ; Female ; Glasgow Coma Scale ; Heart Atria ; Heart Injuries ; Heart Rupture ; Heart Ventricles ; Humans ; Incidence ; Male ; Mortality ; Motor Vehicles ; Motorcycles ; Operating Rooms ; Retrospective Studies ; Survival Rate ; Thoracotomy

OBJECTIVES: This study aimed to compare the psychosocial characteristics among patients with functional gastrointestinal disorder (FGID), adults with functional gastrointestinal symptoms, and normal control group and investigate factors related to quality of life (QoL) of FGID patients. METHODS: 65 patients diagnosed with FGID were selected. 79 adults were selected as normal control group based on the Rome III diagnostic criteria, and 88 adults who showed functional gastrointestinal symptoms were selected as “FGID positive group”. Demographic factors were investigated. Psychosocial factors were evaluated using the Korean-Beck Depression Inventory-II, Korean-Beck Anxiety Inventory, Korean-Childhood Trauma Questionnaire, Multi-dimensional Scale of Perceived Social Support, Connor-Davidson Resilience Scale and WHO Quality of Life Assessment Instrument Brief Form. A one-way ANOVA was used to compare differences among groups. Pearson correlation test was used to analyze correlations between QoL and psychosocial factors in patients with FGID. RESULTS: There were group differences in the education level. Depression (F=29.012, p<0.001), anxiety (F=27.954, p<0.001) and Childhood trauma (F=7.748, p<0.001) were significantly higher in FGID patient group than in both FGID-positive and normal control group. Social support (F=5,123, p<0.001), Resilience (F=9.623, p<0.001) and QoL (F=35.991, p<0.001) were significantly lower in the FGID patient group than in others. QoL of FGID patients showed a positive correlation with resilience (r=0.475, p<0.01), and showed a negative correlation with depression (r=−0.641, p<0.01), anxiety (r=−0.641, p<0.01), and childhood trauma (r=−0.278, p<0.05). CONCLUSIONS: FGID patients have distinctive psychosocial factors compared to the both FGID-positive and normal control group. Therefore, the active interventions for psychosocial factors are required in the treatment of patients with FGID.
Adult ; Anxiety ; Demography ; Depression ; Education ; Gastrointestinal Diseases ; Humans ; Psychology ; Quality of Life

Untreated hyperthyroidism and high-dose thyroid hormone are associated with osteoporosis, and increased bone mineral density (BMD) has been demonstrated in postmenopausal females with hypoparathyroidism. Studies on the effect of suppressive levothyroxine (LT4) therapy on BMD and bone metabolism after total thyroidectomy in patients with differentiated thyroid carcinoma have presented conflicting results, and few studies in relation to the status of hypoparathyroidism have been studied. One hundred postmenopausal women and 24 premenopausal women on LT4 suppression therapy were included in this study. BMD of lumbar spine and femur and bone turnover markers were measured at the baseline and during the follow-up period up to 18 months using dual energy X-ray absorptiometry. Biochemical marker of bone resorption was measured by urine deoxypyridinoline and bone formation by serum osteocalcin. The age ranged from 36 to 64 years old. Thyroid stimulating hormone (TSH) was suppressed during the study. The results showed that BMD of femur and lumbar spine were not significantly changed in both pre- and postmenopausal women except femur neck in postmenopausal women without hypoparathyroidism. Patients with hypoparathyroidism had higher BMD gain than those without hypoparathyroidism in total hip (1.25 vs. -1.18%, P=0.015). Biochemical markers of bone turnover, serum osteocalcin, and urine deoxypyridinoline did not show significant change. In conclusion, patients with well differentiated thyroid carcinoma are not at a great risk of bone loss after LT4 suppressive therapy. The state of hypoparathyroidism is associated with increased BMD, particularly in postmenopausal women.
Absorptiometry, Photon ; Biomarkers* ; Bone Density* ; Bone Resorption ; Female ; Femur ; Femur Neck ; Follow-Up Studies ; Hip ; Humans ; Hyperthyroidism ; Hypoparathyroidism ; Metabolism ; Osteocalcin ; Osteogenesis ; Osteoporosis ; Postmenopause ; Spine ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy ; Thyrotropin ; Thyroxine*

The pleural and lesser omental effusion were commonly seen on acute or chronic recurrent pancreatitis complication. But pericardial effusion is rare complication of recurrent pancreatitis and may result to tamponade. We report a case with literature on alcoholic acute recurrent pancreatitis complicated by development of pericardial and pleural effusion, which resolved after catheter drainage.
Alcoholics ; Catheters ; Drainage ; Humans ; Pancreatitis* ; Pericardial Effusion* ; Pleural Effusion

Background: Even though there were developments in various treatment techniques for acute limb ischemia, this disease is both life threatening and limb threatening. We investigated early and mid-term results of operation for acute limb ischemia with symptoms, the combined diseases, location of occlusion, complication in our patients. Meterial and Method: A retrospective review was conducted in 54 patients (43 men, 11 women, mean age 67.2 years) presenting with acute limb ischemia due to arterial thrombosis or embolism between Jan. 1996 and Dec. 2003, initially underwent thromboembolectomy. Result: In 33 patients (61.1%) the timeinterval from the onset of symptom to admission was within 24 hours. Causes of acute limb ischemia were embolic occlusion (27.8%), native arterial thrombosis (66.7%), and bypass graft thrombosis (5.6%). The distribution of arterial occlusion location was at 8 aortoiliac (14.8%) and 43 distal to femoral (79.6%) and brachial (5.6%). Clinical categories were grade I in 64.8%, IIa in 24.1%, IIb in 7.4%, and III in 3.7%. All the patients were received embolectomy. Underlying diseases were heart disease (72.2%), hypertension (33.3%), cerebrovascular accident (16.7%) and diabetes (18.5%). History of smoking was noted in 96.3% of the cases. Mortality rate was 5.6% and overall amputation rate was 9.3% (5/54). The 1-year limb salvage rate was 93.62%. Postoperative complications were 1 wound infection, 1 GI bleeding, 3 acute renal failure, and 1 compartment syndromes. The functional outcomes of the salvaged limb according to the recommended scale for gauging changes in clinical status, revised version in 1997 were +3 in 68.5%, +2 in 9.3%, +1 in 7.4%, -1 in 5.6%, -2 in 3.7%, and -3 in 5.6%. Conclusion: This study revealed 5.6% mortality and the amputation rate was 9.3%. We have retrospectively shown good results from early diagnosis & early operation. To improve outcome, early diagnosis and understand the underlying diseases, prompt treatment and operation would be appreciated.
Acute Kidney Injury ; Amputation ; Compartment Syndromes ; Early Diagnosis ; Embolectomy ; Embolism ; Extremities* ; Female ; Heart Diseases ; Hemorrhage ; Humans ; Hypertension ; Ischemia* ; Limb Salvage ; Male ; Mortality ; Postoperative Complications ; Retrospective Studies ; Smoke ; Smoking ; Stroke ; Thromboembolism ; Thrombosis ; Transplants ; Vascular Diseases ; Wound Infection

Most submucosal tumors of the stomach are of mesenchymal origin. Gastric schwannoma, which is a subset of mesenchymal tumors, is a rare tumor taking origin from Schwann's cells. A 61-year-old woman whose endoscopy showed a well circumscribed submucosal mass measuring 2.5 cm on the midbody of the stomach. Endosonographically, the tumor was well circumscribed, low echoic submucosal mass with cystic lesion in the 4th layer of the gastric wall. The patient underwent wedge resection. Microscopically, the cells were made up of irregular fasciculating bundles of spindle cells featured with benign nuclear atypia and peripheral lymphoid cell cuffing, involving muscularis propria. Immunohistochemical staining showed positivity for S-100 protein and the neuron-specific enolase, but were negative to CD 34, desmin and smooth muscle actin. From these findings, this tumor was diagnosed as a schwannoma.
Actins ; Desmin ; Endoscopy ; Female ; Humans ; Lymphocytes ; Middle Aged ; Muscle, Smooth ; Neurilemmoma* ; Phosphopyruvate Hydratase ; S100 Proteins ; Stomach

BACKGROUND: Spontaneous pneumomediastinum is an uncommon, benign, self-limited disorders that usually occurs in young adults without any apparent precipitating factors or disease. The purpose of this study was to review our experience in dealing with this entity and describe a reasonable course of assessment and management. MATERIAL AND METHOD: A retrospective case series was conducted to identify adults patients with SPM who were diagnosed and treated in a single institution between 2001 and 2005. RESULT: Fifteen patients were identified who included 14 men and 1 women with a mean age of 26 years. Presenting symptoms were chest pain in 12 patients (80%), dyspnea in 5 patients (33%), and throat discomfort in 4 patients (26%). Two cases were associated with use of inhalational drugs and 3 cases were associated with exercise. The predisposing factors were asthma, excessive exercise, and vomiting in spontaneous pneumomediastinum. The physical findings were subcutaneous emphysema in 10 patients (77%). Chest radiography and computerized tomography were the diagnostic methods in all cases with CT scan revealing six cases with associated pulmonary abnormalities. Esophagogram and flexible bronchoscopy were selectively used. Fifteen patients (100%) were admitted to the hospital. Their mean hospital stay was 3 days. All patients were conservatively treated. In a follow-up of 3 years no complications or recurrences were observed. CONCLUSION: Most simple spontaneous pneumomediastinum cases were benign diseases and most of them (77%) had shown typical chest pain, dyspnea and subcutaneous emphysema. Inhalational drug use was not a major cause of SPM; however, increased use of bronchoinhalers was a suspicious cause of SPM.
Adult ; Asthma ; Bronchoscopy ; Causality ; Chest Pain ; Dyspnea ; Female ; Follow-Up Studies ; Humans ; Length of Stay ; Male ; Mediastinal Emphysema* ; Mediastinum ; Pharynx ; Precipitating Factors ; Radiography ; Recurrence ; Retrospective Studies ; Subcutaneous Emphysema ; Thorax ; Tomography, X-Ray Computed ; Vomiting ; Young Adult

BACKGROUND: Perforation of esophagus is relatively uncommon. but it is associated with high morbidity and mortality. Treatment and outcome are largely determined by the time of presentation. We performed a retrospective review of patients with esophageal perforation to assess the outcome of current management techniques. MATERIAL AND METHOD: A retrospective chart review was performed on all patients treated for perforation of esophagus from March 1990 to March 2005. There were 28 patients (22 men and 6 women: mean age 51 years, range 17 to 82 years) The causes of the perforations were as follows: foreign body retention (9 patients), trauma (7 patients), spontaneous rupture (7 patients), and iatrogenic (5 pati-ients). 18 patients were presented within 24 hours and 10 patients were presented after 24 hours. Esophageal repair was performed in 21 (75%) of them, 4 patients were treated with esophagectomy, 3 patients were treated with feeding gastrostomy and drainage. RESULT: Hospital mortality was 18% and iatrogenic was increase the mortality rate (p <0.05). Site of perforation, time from perforation, and treatment method had no influence on mortality. Postoprative leaks occurred in 4 patients after primary repair and were treated conservatively. CONCLUSION: Esophageal perforation remains a devastating event which is difficult to diagnose and manage. Primary repair can be performed in most patients with esophageal perforation regardless of time to presentation with a low mortality. Accurate diagnosis and early treatment are essential to the successful managenent of patients.
Diagnosis ; Drainage ; Esophageal Perforation* ; Esophagectomy ; Esophagus ; Female ; Foreign Bodies ; Gastrostomy ; Hospital Mortality ; Humans ; Male ; Mortality ; Retrospective Studies ; Rupture, Spontaneous

BACKGROUND/AIMS: Albis(R) is a newly developed drug comprised of ranitidine, bismuth and sucralfate. The aim of the study was to demonstrate the efficacy and safety superiority of Albis(R) compared to Stillen(R) for treating erosive gastritis. METHODS: This study was a randomized, double-blind, multi-center trial. The primary endpoint was 2 weeks of treatment. RESULTS: Of the 229 patients in the intention-to-treat (ITT) population, 87 from the Albis(R), and 96 from the Stillen(R) group were included in the per protocol (PP) analysis. The endoscopic improvement rate was not different between the Albis(R)(R) group and the control in both the PP (42.5%, 39.6%) and ITT (35.3%, 34.5%) populations. The endoscopic cure of erosion was also not different in the Albis(R) group than that in the control group in both the PP (32.3%, 31.3%) and ITT (27.6%, 27.4%) populations. The endoscopic improvement rate for hemorrhage, edema, and erythema were also not different between the two groups in both the PP and ITT populations. No statistically significant differences were observed for adverse events between the two groups. CONCLUSIONS: Half of the approved dose of Albis(R) for peptic ulcers was superior to Stillen(R). A low dosage of Albis(R) is more cost efficient and safe than that of Stillen(R).
Bismuth ; Edema ; Erythema ; Hemorrhage ; Humans ; Peptic Ulcer ; Ranitidine ; Sucralfate

Background/Aims: Functional dyspepsia is a disease involving a range of upper gastrointestinal symptoms derived from various pathophysiologies. Tablets containing a combination of rabeprazole and controlled-release (CR) mosapride were recently developed.To investigate a more effective treatment, this trial evaluated the efficacy and safety of UIC201609/UIC201610 as a preliminary study. Methods: A multicenter, double-blind, randomized study was performed on 30 subjects. UIC201609/UIC201610 (combination of rabeprazole and CR mosapride) was the case group, and the two control groups were rabeprazole 10 mg once a day and mosapride 15 mg CR tablet once a day. As a primary efficacy endpoint of the study, the changes in the total score of eight items of the Nepean Dyspepsia Index-Korean version were analyzed at 2 weeks and 4 weeks. The outcomes regarding safety were collected. Results: The total symptom score of Nepean Dyspepsia Index-Korean decreased in the rabeprazole single group (29.4±17.1), mosapride CR single group (33.4±15.6), and UIC201609/UIC201610 group (33.4±11.8) at 4 weeks without significant differences. On the other hand, the UIC201609/UIC201610 combination group showed more score reduction of pain in the upper abdomen, burning in the upper abdomen compared to each control group, but it did not reach statistical significance. No difference was found in safety analysis. Conclusions UIC201609/UIC201610 once daily showed some improvement in epigastric pain and dyspepsia in patients with functional dyspepsia, but there was no significance. Further study based on the advanced clinical trial design will be needed to confirm the efficacy of UIC201609/UIC201610 combination therapy in the future.