PURPOSE: The spontaneous extensor pollicis longus (EPL) tendon rupture is a well-documented complication of non-displaced or minimally displaced distal radius fracture. Authors analyzed the radiographs of patients treated for closed EPL rupture after distal radius fracture. MATERIALS AND METHODS: Twenty-eight patients (21 females, 7 males; average age of 58 years) with tendon transfer for spontaneous rupture of EPL after distal radius fracture were included. Wrist radiographs were taken at the first visit with EPL rupture. On the lateral view, posterior cortical displacement, distance from highest point in Lister's tubercle to fracture line, and height of the Lister's tubercle were measured. The distance from the lunate facet to the fracture line was measured on anteroposterior view. Radiologic change at the time of EPL rupture around the Lister's tubercle was evaluated by comparing it with the contra lateral wrist radiograph. Radial beak fracture pattern was also identified. RESULTS: The interval between the injury and the spontaneous EPL rupture varied from 2 to 20 weeks, with an average of 6.7 weeks. There were 25 cases of non-displacement, 3 cases of mean 2.0 mm cortical displacement. The average distance from the lunate facet to the fracture line was 9.1 mm (3-12.1 mm), from the highest point in Lister's tubercle to the fracture line was 3.0 mm toward proximal radius (1.7-4.9 mm). The average height of the Lister's tubercle was 3.4 mm in the injured wrist and 3.1 mm in the opposite wrist. Radial beak fracture pattern was shown at 11 cases. CONCLUSION: All cases presented no or minimal displaced fracture, and the fracture line was in the vicinity of the Lister's tubercle. Those kinds of fractures can highlight the possibility of spontaneous EPL rupture, depites its rarity.
Animals ; Beak ; Female ; Humans ; Male ; Radius Fractures* ; Radius* ; Rupture* ; Rupture, Spontaneous ; Tendon Transfer ; Tendons ; Wrist

PURPOSE: The purpose of this study was to investigate current statistics relating to foreigners who visit a Korean emergency department (ED). METHODS: Subjects included in this study were 125,263 patients who visited one Korean ED from January 1, 2008 to December 31, 2010. We divided subjects into two groups, natives (Koreans) and foreigners (non-Koreans). We compared the two groups according to their age, sex, chief medical complaints, department to which they were referred, their final diagnosis, results of treatment applied, ED residence time, mortality rate, total billed cost of treatment, balance of any unpaid bills and method of visiting the ED. RESULTS: Of the total patients included in the study, 119,864 (95.7%) were natives and 5,399 (4.3%) were foreigners. In natives, the majority were 0 to 10 years old (35.1%), while foreigners were mostly 41 to 50 (22.8%) years old. The most common symptom in both natives and foreigners was fever. The most common diagnosis for foreigners was head, face, and neck injury (13.8%). The main referred departments for foreigners were internal medicine (20.1%), pediatric medicine (16.9%), and orthopedics (14.3%). The admission rate for foreigners (13.0%), was lower than that of natives (17.3%). The mortality rate for foreigners (0.5%) was higher than that of natives (0.3%). The ED residence time for foreigners was higher than that of natives. The total billed cost of treatment and balance of unpaid money by foreigners was higher than that of natives. For foreigners, the proportion of medical fees paid from personal accounts and industrial medical insurance were higher than those of natives. CONCLUSION: Medical insurance and policy for the management of foreigners who visit the ED must be improved.
Emergencies ; Emergency Medical Services ; Emigrants and Immigrants ; Fees and Charges ; Fees, Medical ; Fever ; Head ; Humans ; Insurance ; Internal Medicine ; Korea ; Neck Injuries ; Orthopedics ; Population Groups

Spontaneous renal rupture is a rare, but important, clinical problem that heralds a variety of kidney abnormalities. Tumors are the most common cause, followed by vascular disease, infection, nephritis and blood dyscrasia. In some cases, no underlying abnormality of the kidney can be found. The patients usually present with an acute onset of flank pain, a tender mass, and common symptoms and signs of shock. In most cases rapid surgical intervention is necessary and nephrectomy remains the treatment of choice in cases of a ruptured tumor. A 47 year-old female, who had been in good health previously, was hospitalized because of a sudden onset of left flank pain for one day. There was no history of trauma. Physical examination revealed marked tenderness and guarding over the left flank abdomen. A perirenal hematoma on the left side was seen with abdominal sonography. Computerized tomography demonstrated a large perirenal hematoma and a kidney rupture caudally. Selective renal angiography demonstrated an active bleeding over the lower pole, so a coil embolization and nephrectomy were performed. The histological examination of the kidney revealed no underlying abnormality. We report a case of idiopathic spontaneous renal rupture, along with a literature review.
Abdomen ; Angiography ; Embolization, Therapeutic ; Female ; Flank Pain ; Hematoma ; Hemorrhage ; Humans ; Kidney ; Middle Aged ; Nephrectomy ; Nephritis ; Physical Examination ; Rupture* ; Shock ; Vascular Diseases

Coccidioidomycosis is a rare systemic fungal infection in Korea. However, the incidence of coccidioidomycosis has recently begun to increase due to the increasing incidence of people traveling overseas to endemic areas. In previously reported cases of coccidioidomycosis in Korea, the radiographic findings usually showed a solitary pulmonary nodule, pleural effusion, cavitation, and hilar lymphadenopathy, but no miliary nodules. We report a case of disseminated coccidioidomycosis with miliary nodules in an immunocompetent patient. A 32 year old male, who had traveled in Corona, New Mexico, USA, was admitted for an evaluation of persistent cough with fever. Chest radiography revealed initially diffuse multiple small nodules that appeared to be miliary tuberculosis. However, a subsequent evaluation revealed that he had disseminated coccidioidomycosis.
Adult ; Coccidioidomycosis* ; Cough ; Fever ; Fungi ; Humans ; Incidence ; Korea ; Lymphatic Diseases ; Male ; New Mexico ; Pleural Effusion ; Radiography ; Solitary Pulmonary Nodule ; Thorax ; Tuberculosis, Miliary

Coccidioidomycosis is a rare systemic fungal infection in Korea. However, the incidence of coccidioidomycosis has recently begun to increase due to the increasing incidence of people traveling overseas to endemic areas. In previously reported cases of coccidioidomycosis in Korea, the radiographic findings usually showed a solitary pulmonary nodule, pleural effusion, cavitation, and hilar lymphadenopathy, but no miliary nodules. We report a case of disseminated coccidioidomycosis with miliary nodules in an immunocompetent patient. A 32 year old male, who had traveled in Corona, New Mexico, USA, was admitted for an evaluation of persistent cough with fever. Chest radiography revealed initially diffuse multiple small nodules that appeared to be miliary tuberculosis. However, a subsequent evaluation revealed that he had disseminated coccidioidomycosis.
Adult ; Coccidioidomycosis* ; Cough ; Fever ; Fungi ; Humans ; Incidence ; Korea ; Lymphatic Diseases ; Male ; New Mexico ; Pleural Effusion ; Radiography ; Solitary Pulmonary Nodule ; Thorax ; Tuberculosis, Miliary

PURPOSE: This study was conducted in order to determine the current status of duty hours of emergency resident physicians in Korea. METHODS: The training committee of the Korean Society of Emergency Medicine surveyed using a questionnaire on resident training status, which contained the total number of duty hours during four weeks of July (first to 28th day) according to the grades of the resident physician. The proportions of both irregular working hours and independent working hours without supervision of a board certified physician were also evaluated. RESULTS: Responses from 80 hospitals out of 97 training hospitals were analyzed. The average number of duty hours of emergency resident physicians was 63.7+/-10.7 hours/week. The proportion of hospitals for which the average number of duty hours exceeded 80 hours/week was 16.1%. Irregular working hours consisted of 63.9%. Residents in 15(18.7%) hospitals worked 3.7~73.5% of their duty hours without supervision of a board certified physician. The higher grade resident had fewer working hours (p<0.001). No statistical difference was observed in the rate of both irregular work and unsupervised work according to the grade. CONCLUSION: Results of this study showed that nine(11.3%) hospitals had average duty hours above 80 hours/week. In Korea, training hospitals should prepare to minimize the impact of duty hour restriction in the near future, as well as to improve training quality.
Cross-Sectional Studies* ; Emergencies* ; Emergency Medicine ; Emergency Service, Hospital ; Korea ; Organization and Administration ; Surveys and Questionnaires

PURPOSE: The purpose of this study was to provide direction to improvement of advanced cardiovascular life support (ACLS) training in Korea. METHODS: We conducted a retrospective analysis of the questionnaire written by 55 instructors of the 31 institutions registered in the Korean Association of Cardiopulmonary Resuscitation (KACPR) from 2009 and 2010. The contents of the questionnaire consisted of an evaluation of the ACLS curriculum, modification of the ACLS curriculum, problems of ACLS training, and other open-ended answers. RESULTS: In this questionnaire, the result for assessment of the lecture on acute coronary syndrome was intermediate, that answer was given by the majority, 40.0%. The result for assessment of the lecture on stroke was intermediate, that answer was given by the majority, 40.0%. In addition, the result for the necessity of the lecture on acute coronary syndrome was intermediate, 25.5%, which was the most common response. The result for the necessity of the lecture on stroke was intermediate, 27.3%, which was the most common response. In the ACLS curriculum, 14.5% of respondents responded that simulation curriculum should be strengthened; 20.0% of participants responded that training on equipment and medical technique should be enhanced. CONCLUSION: Lecture without practice should be avoided and simulation-oriented education should be strengthened in the ACLS course.
Acute Coronary Syndrome ; Advanced Cardiac Life Support ; Cardiopulmonary Resuscitation ; Curriculum ; Surveys and Questionnaires ; Korea ; Retrospective Studies ; Stroke

Despite the great socioeconomic burden of stroke, there have been few reports of stroke statistics in Korea. In this scenario, the Epidemiologic Research Council of the Korean Stroke Society launched the “Stroke Statistics in Korea” project, aimed at writing a contemporary, comprehensive, and representative report on stroke epidemiology in Korea. This report contains general statistics of stroke, prevalence of behavioral and vascular risk factors, stroke characteristics, pre-hospital system of care, hospital management, quality of stroke care, and outcomes. In this report, we analyzed the most up-to-date and nationally representative databases, rather than performing a systematic review of existing evidence. In summary, one in 40 adults are patients with stroke and 232 subjects per 100,000 experience a stroke event every year. Among the 100 patients with stroke in 2014, 76 had ischemic stroke, 15 had intracerebral hemorrhage, and nine had subarachnoid hemorrhage. Stroke mortality is gradually declining, but it remains as high as 30 deaths per 100,000 individuals, with regional disparities. As for stroke risk factors, the prevalence of smoking is decreasing in men but not in women, and the prevalence of alcohol drinking is increasing in women but not in men. Population-attributable risk factors vary with age. Smoking plays a role in young-aged individuals, hypertension and diabetes in middle-aged individuals, and atrial fibrillation in the elderly. About four out of 10 hospitalized patients with stroke are visiting an emergency room within 3 hours of symptom onset, and only half use an ambulance. Regarding acute management, the proportion of patients with ischemic stroke receiving intravenous thrombolysis and endovascular treatment was 10.7% and 3.6%, respectively. Decompressive surgery was performed in 1.4% of patients with ischemic stroke and in 28.1% of those with intracerebral hemorrhage. The cumulative incidence of bleeding and fracture at 1 year after stroke was 8.9% and 4.7%, respectively. The direct costs of stroke were about ₩1.68 trillion (KRW), of which ₩1.11 trillion were for ischemic stroke and ₩540 billion for hemorrhagic stroke. The great burden of stroke in Korea can be reduced through more concentrated efforts to control major attributable risk factors for age and sex, reorganize emergency medical service systems to give patients with stroke more opportunities for reperfusion therapy, disseminate stroke unit care, and reduce regional disparities. We hope that this report can contribute to achieving these tasks.
Adult ; Aged ; Alcohol Drinking ; Ambulances ; Atrial Fibrillation ; Cerebral Hemorrhage ; Emergency Medical Services ; Emergency Service, Hospital ; Epidemiology ; Female ; Hemorrhage ; Hope ; Humans ; Hypertension ; Incidence ; Korea ; Male ; Mortality ; Prevalence ; Reperfusion ; Risk Factors ; Smoke ; Smoking ; Stroke ; Subarachnoid Hemorrhage ; Writing