No abstract available.
Fistula*

No abstract available.
Ductus Arteriosus, Patent*

Although intramedullary nailing is mostly used in the management of fractures in the long bone shaft, plate fixation is still alternative option in periprosthetic or metaphyseal fractures. For the rigid fixation during plating, sometimes we need wiring. Many surgeons experience slippage of wire resulting in loss of rigid fixation because plate and wire is so slippery and the diameter of bone is changing by level especially in the metaphyseal area. Wiring plate(CHO plate) was designed to prevent slippage. This plate has transverse holes for wires between screw holes on traditionally used dynamic compression plate. Sixteen fractures of long bone shaft were fixed with wiring plate and 11 cases which were followed up for more than one year were evaluated. There were periprosthetic fractures(4 cases), spiral or butterfly fractures(4 cases) and fractures of poor bone quality(two cases of malignancy and one case of osteoporosis). Nine cases were successfully reduced and the healed without loss of fixation. In two cases, delayed union and nonunion were observed due to wire breakage with plate loosening. Preliminarily, wiring plate fixation can be used for the periprosthetic fracture and one of alternative option in butterfly or spiral fracture and fracture in osteoporotic bone or pathologic fracture.
Butterflies ; Fracture Fixation, Intramedullary ; Fractures, Spontaneous ; Periprosthetic Fractures

PURPOSE: The purpose of this study was to determine whether ultrasonography assisted internal jugular central venous catheterization by single operator or two-operator could improve the success rate and decrease the number of complications compared to the traditional landmark technique. METHODS: This study was a prospective, randomized, clinical trial conducted from July 2008 to February 2009 in an urban Korean teaching hospital. Patients requiring central venous access were randomized to 1 of the 3 insertion techniques (single-operator technique, two-operator technique, traditional landmark technique). The primary outcome measure was cannulation success. Additional outcome measures included number of attempts, access times, and complications. RESULTS:One hundred fourteen patients were enrolled. Thirty four of 37(91.9%) internal jugular vein catheters were successfully inserted by single-operator technique, 34 of 39(87.2%) by two-operator technique and 22 of 38(57.9%) by landmark technique. First attempt cannulation was successful in 28 of 34(82.4%) using single-operator technique, 26 of 34(76.9%) using two-operator technique and 9 of 22(40.9%) using landmark technique. The median start to venipuncture time was 138 seconds by single-operator technique, 170 seconds by two-operator technique and 329 seconds by landmark technique. There were 19 complications in the study, 15 in the landmark group, 2 in the singleoperator group, and 2 in the two-operator group. CONCLUSION: Real-time ultrasonography assisted internal jugular vein catheterization has an higher success rate, is less time consuming, and has a lower complication rate. The single-operator technique appears to be equivalent to the two-operator technique in success rate and procedure time.
Catheterization ; Catheterization, Central Venous ; Catheters ; Central Venous Catheters ; Emergencies ; Hospitals, Teaching ; Humans ; Jugular Veins ; Outcome Assessment (Health Care) ; Phlebotomy ; Prospective Studies ; Veins

PURPOSE: The purpose of this study was to compare the rate of bloodstream infections associated with use of central venous catheters (CVCs) by an emergency department (ED) versus an intensive care unit (ICU). METHODS: Using the hospital administrative and billing database, we identified patients who received CVCs between January 1, 2006, and December 31, 2009 in the ED and ICU at an academic, urban hospital with an annual census of 55,000. We performed a structured, explicit chart review to determine durations of catheterization and rates of bloodstream infections. RESULTS: We screened 4,088 charts and identified 1,480 patients with CVCs that were administered in the ED, (total of 12,888 catheter-days with 47 bloodstream infections), and 982 patients with CVCs that were administered in the ICU (13,326 catheter-days with 52 bloodstream infections). The rate of bloodstream infections associated with CVCs placed in the ED was 3.65 per 1,000 catheter-days (95% confidence interval 2.68 to 4.85), and the rate of bloodstream infections in the ICU was 3.75 per 1,000 catheter-days (95% confidence interval 2.91 to 5.12). The median duration of catheterization was 6.0 days in the ED, and 10.0 days in the ICU. Among the infected CVCs, the median duration of catheterization was 12.0 days in the ED, and 14.0 days in the ICU. Of 1480 total CVCs administered in the ED, 897 were placed in the subclavian veins (61%), 554 in the internal jugular (37%), and 29 were placed in femoral veins (2%). Of the total 982 CVCs administered in the ICU, 779 were placed in the subclavian veins (79%), 158 in the internal jugular veins (16%), and 45 in femoral veins (4.3%). CONCLUSION: The rate of bloodstream infections in the ED is comparable to those in the ICU. The duration of catheterization was found to be a more important factor than the CVC insertion location.
Catheter-Related Infections ; Catheterization ; Catheterization, Central Venous ; Catheters ; Censuses ; Central Venous Catheters ; Emergencies ; Femoral Vein ; Hospitals, Urban ; Humans ; Critical Care ; Intensive Care Units ; Jugular Veins ; Subclavian Vein

Foreign bodies that migrate outside the esophagus into the mediastinum or soft tissues usually cause respiratory symptoms. Also, esophageal foreign body granulomas that cause tracheal stenosis, lobar atelectasis, and bronchoesophageal fistulas are reported as complications. Foreign bodies can become lodged above esophageal strictures, and chronically-embedded esophageal foreign bodies can induce stricture formation, although these are less common. This is rare case report that the trachea was directly compressed due to impacted esophagus by foreign body.
Constriction, Pathologic ; Dyspnea ; Esophagus ; Fistula ; Foreign Bodies ; Granuloma, Foreign-Body ; Mediastinum ; Pulmonary Atelectasis ; Trachea ; Tracheal Stenosis

PURPOSE: To study tissue adhesive effectiveness in with laceration at various body sites. METHODS: From January 2007 to December 2009, we collected the data of laceration patients treated using tissue adhesive in the emergency department of a university hospital. Data concerning treatment satisfaction were collected twice and analyzed. RESULTS: Of the 8665 patients with laceration, 196 (mean age 23 years, 106 males) were treated using tissue adhesive. Many of the 196 patients were <15-years-of-age. Involved body sites mainly comprised head/neck, followed by the upper extremities. The procedure was the most rapid of all treatments. CONCLUSION: Emergency physicians can reliably use tissue adhesive treatment for various lacerations in the emergency setting.
Emergencies ; Humans ; Lacerations ; Tissue Adhesives ; Upper Extremity

PURPOSE: For evaluation of drug intoxication patients, the MMPI is a widely used neuropsychiatric tool to investigate patients' personalities. METHODS: We administered a questionnaire and the MMPI to patients who came to our ER between 1 March 2007 and March 1 2008. Patient characteristics, past neuropsychiatric history, and were investigated. RESULTS: We enrolled 43 patients, X females and Y males. Anti-psychotics were the drugs that were most frequently consumed (by 42% of subjects) and economic status was the most frequent cause of overdose. Pathologic psychosis was the most frequent disorder in their medical history. The MMPI indicated that depression type (D) was 64 and 36 patients were increased over the nomal level. 16 patients of 18 patients with depression history were increased in the type D (p=0.000) and assessment was analytically increased (k=0.854). CONCLUSION: MMPI of drug intoxication patients may be useful during early neuropsychiatric examinations, and may be a useful tool for making treatment decisions.
Depression ; Female ; Humans ; Male ; Minnesota ; MMPI ; Porphyrins ; Psychotic Disorders ; Surveys and Questionnaires

Symptomatic bradycardia might be regarded as a serious emergency disease and it requires prompt emergency treatments. The American Heart Association has recommended transcutaneous pacing as a gold standard of treatment and also atropine, epinephrine or dopamine as the first line drugs. We report here on a case of symptomatic bradycardia that was treated with norepinephrine and the patient was not treated with pacing, atropine and dopamine.
American Heart Association ; Atropine ; Bradycardia ; Dopamine ; Emergencies ; Emergency Service, Hospital ; Emergency Treatment ; Epinephrine ; Humans ; Norepinephrine

Cardiac tamponade is a potentially acute, life threatening emergency that can cause death if it is not promptly diagnosed and treated. Cardiac tamponade is a comparatively uncommon presentation to the emergency department and it is usually associated with penetrating trauma. We report here on a case of cardiac tamponade due to suture material that was used for colectomy ten years previously. A 17-year-old male was admitted to an emergency department with a complaint of loss of consciousness and convulsion. He also complained of chest pain, dyspnea and hypotension. After a while, he displayed cyanosis and his jugular veins were distended. The emergency echocardiogram showed a large amount of pericardial effusion with features of tamponade. Pericardiocentesis was immediately performed. Although 800 cc of fresh blood was drained from the pericardial cavity, his bleeding wouldn't stop. So, the patient was moved immediately to the operation room, and pericardiectomy and median sternotomy were performed. The surgeon found that the foreign suture material had penetrated the pericardium and he successfully removed it. The removed foreign body was a bundle of thread. The patient was discharged without any complications after 9 days.
Adolescent ; Cardiac Tamponade ; Chest Pain ; Colectomy ; Cyanosis ; Dyspnea ; Emergencies ; Foreign Bodies ; Hemorrhage ; Humans ; Hypotension ; Jugular Veins ; Male ; Pericardial Effusion ; Pericardiectomy ; Pericardium ; Seizures ; Sternotomy ; Sutures ; Unconsciousness