The Mirizzi syndrome is a rare benign cause of obstructive jaundice. It is particularly interesting to surgeons because the surgery has to be carefully planned to avoid unnecessary damage to the common bile duct. Furthermore, it gives a differential diagnosis dilemma for surgeons as well as radiologist because there are no diagnostic procedures or clinical features that have a perfect access. As a result, the Mirizzi syndrome often has been mistaken for gallbladder cancer and cholangiocarcinoma. We experienced of a 76-year-old male patient, whose clinical symptoms were jaundice, epigastric pain and fever with chill and misdiagnosed as a cholangiocarcinoma with liver metastasis.
Aged ; Bile Duct Diseases ; Cholangiocarcinoma* ; Cholelithiasis ; Cholestasis ; Common Bile Duct ; Cystic Duct ; Diagnosis, Differential ; Fever ; Gallbladder Neoplasms ; Humans ; Jaundice ; Jaundice, Obstructive ; Liver ; Male ; Mirizzi Syndrome* ; Neoplasm Metastasis

PURPOSE: This study was performed for investigation of epidemiology, clinical characteristics, and serial value of cardiac troponin level of patients who had myocardial injury due to Carbon monoxide poisoning. METHODS: This study reviewed 98 cases of Carbon monoxide poisoning patients who visited Emergency Department from January 1, 2008 to October 31, 2013. We categorized them by two groups, one with elevation of cardiac troponin level and the other with normal level. We had comparison between two groups data using statistical analysis. RESULTS: Among 98 patients of Carbon monoxide poisoning who were admitted to hospital, 10 patients were excluded. 88 patients who were included to our study, 70 patients with normal value of Troponin, and 18 patients with elevated troponin level. Of all patients, Carbon monoxide inhalation due to suicided trial patients has more higher proportion in elevated troponin level group compared with normal group (40 (57.1%) vs 15 (83.3%), P=0.041). Furthermore, corrected QT interval, length of hospital stay, number of ICU admission, also were showed higher value in elevated troponin level group. CONCLUSION: Carbon monoxide induced myocardial injury is associated with subside trial, prolongation of correted QT interval, length of hospital stay, and number of ICU admission.
Carbon Monoxide Poisoning ; Carbon Monoxide* ; Emergency Service, Hospital ; Epidemiology ; Humans ; Inhalation ; Length of Stay ; Reference Values ; Troponin ; Troponin I

PURPOSE: The majority of electrical injuries coming to emergency department are low voltage injuries cases. Therefore this study was designed to investigate the clinical characteristics and the treatment outcomes of patients with low voltage electrical injury in one emergency center. METHODS: We, retrospectively, reviewed the medical records of the patients who visited emergency department between July, 2007 and May, 2012. We noted demographics, entrance and exit point of burn injuries, associated injuries and symptoms, electrocardiograms, laboratory results, results of treatment, and so on. RESULTS: There are 103 patients enrolled. Sixty-eight (66%) patients were men with a mean age of 24 years. Pediatric patients (< or =15) were 41 (40.0%). The right upper extremity was the most common entry point, and exit point was unclear in almost cases. There were no lethal complications, except 1 case. The case with lethal complication was 57 year old man who survived from out-of hospital cardiac arrest. He was injured by 220 V electric current during 2 minutes and total arrest time was 20 minutes. He was applied with mild therapeutic hypothermia and later, discharged with favorable neurologic outcome (Cerebral Performance Categories scale 2). Overall rate of discharge, admission and transfer were 67.0%, 28.2% and 4.9%, respectively. Among the discharged patients, no patient re-visited to emergency department with severe complication. After admission, all patients discharged without severe complication. CONCLUSION: There were neither unexpected complications nor delayed complication in our study. Therefore, ED physicians might consider discharge if patients had only minor complications that can manage out-patients follow up at the initial evaluation.
Arrhythmias, Cardiac ; Burns ; Demography ; Electric Injuries ; Electrocardiography ; Emergencies ; Follow-Up Studies ; Heart Arrest ; Humans ; Hypothermia ; Male ; Medical Records ; Outpatients ; Retrospective Studies ; Upper Extremity

PURPOSE: According to the 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, unconscious adult patients with ROSC after out-of-hospital cardiac arrest should be cooled to between 32degrees C and 34degrees C for 12 to 24 hours. Two recent randomized controlled trials that included comatose survivors of cardiac arrest have documented that therapeutic hypothermia improved the neurological recovery. (ED note: Newer cooling devices have recently been introduced, such as endovascular...?)We have introduced newer devices, such as endovascular cooling devices, so we compared endovascular cooling with the previously used surface cooling Methods. METHODS: This is a cohort study of patients with ROSC (>24hours) after cardiac arrest and who were admitted to the intensive care unit in a tertiary hospital over a twentyeight month period from September 2006 to December 2008 and they had received therapeutic hypothermia. The patients'baseline characteristics, the mortality, the neurologic outcomes, the side effects during therapeutic hypothermia and other factors were evaluated according to the cooling methods. RESULTS: Seventy-five patients were included over a 28 month period. Surface cooling methods were used in 37 patients, and endovascular cooling methods were used in 38 patients. There were no significant differences of the mortality and the neurologic outcome according to the cooling methods (p=0.973, 0.937). The time from collapse to reaching therapeutic hypothermia was 587.14+/-384.18 minutes for surface cooling and 496.24+/-213.83 minutes for endovascular cooling (p=0.105). The rewarming time was 451.09+/-229.93 minutes and 802.38+/-209.09 minutes for each cooling method, respectively, and the difference was statistically significant (p=0.002). There were no significant differences of the side effects during therapeutic hypothermia between the surface and endovascular cooling methods. CONCLUSION: Endovascular cooling methods are useful to maintain the target temperature within a narrower range and these methods have the advantage of automatic feedback control of the temperature and controlled rewarming. There were no significant differences in mortality, the neurologic outcome and other side effects between the surface and endovascular cooling methods during therapeutic hypothermia after cardiac arrest.
Adult ; American Heart Association ; Brain ; Cardiopulmonary Resuscitation ; Cohort Studies ; Coma ; Emergencies ; Heart Arrest ; Humans ; Hypothermia ; Imidazoles ; Intensive Care Units ; Nitro Compounds ; Out-of-Hospital Cardiac Arrest ; Rewarming ; Survivors ; Tertiary Care Centers ; Unconscious (Psychology)

PURPOSE: This study compared the value of ultrasonography(US) in the diagnosis of sternal fractures with those of conventional radiography and bone scan. MATERIAL AND METHOD: From March 2000 to March 2001, in Gil Medical Center, Gachon Medical College, 44 patients(22 women and 22 men, mean age 46 years, range 5~81 years) complained of tenderness in the sternal area. The cases histories of these patients with clinically suspected sternal fracture due to blunt trauma were prospectively studied. At the time of admission, conventional radiography(sternal view) was done. At one day after admission, sternal ultrasonography was obtained, and after 4~5 days, a bone scan was done. Sternal ultrasonographic findings, conventional radiographic findings, and bone-scan findings were compared. In addition, a 12-lead ECG was done. When it was necessary, cardiac enzyme was checked and echocardiography was performed. RESULT: In 21 of 44 patients(48%), a sternal fracture was found by sternal US. Only 9 of 21 patients (43%) were diagnosed as having a sternal fracture by using conventional radiography. 23 of 44 patients (52%) have negative findings on sternal US; they also had negative findings on conventional radiography. Except for 7 unchecked patients, 13 of 21 patients(62%) were diagnosed as having a sternal fracture by bone scan, and among the 23 patients who had negative findings on sternal US, the 19 patients checked with a bone scan also had negative findings. CONCLUSION: Sternal US can find sternal fractures that are difficult to find on conventional radiography. Compared with bone scan, sternal US takes a shorter time and sternal US is not difficult. Additionally, combined lesions with sternal fractures(peristernal hematoma, soft tissue swelling) and costal cartilage fractures are diagnosed more easily when using sternal US.
Diagnosis ; Echocardiography ; Electrocardiography ; Female ; Fractures, Cartilage ; Hematoma ; Humans ; Male ; Prospective Studies ; Radiography ; Ultrasonography*