Spontaneous subarachnoid hemorrhage(SAH) is a cause of high mortality and morbidity in the emergency department. Rebleeding has been well investigated, and it is now recognized that early operation can prevent rebleeding. However, ultra-early rebleeding, which may occur prior to early operation(within 24 hours after admission), worsens the clinical outcome of patients with SAH. To determine the risk factors of ultra-early rebleeding in patients with spontaneous SAH before early operation, we analyzed the cases of 383 patients admitted within 24 hours after their last attack of SAH between 1994 to 1996. In this analysis, diagnosis of rebleeding before admission was defined only if the patients experienced a definite clinical deterioration once more after an attack suggesting SAH. After admission patients who observed a sudden neurological deterioration were subject to repeat CT scanning and rebleeding was diagnosed only when new hemorrhage was observed on the CT scan in comparison with the previous scan. 45 cases(11.7%) of 383 patients had ultra-early rebleeding. The incidence of ultra-early rebleeding significantly increased in the patients who admitted hospital within 2 hours after attack. The incidence of ultra-early rebleeding also increased in the old-age group(70 years or more), patients with high systolic blood pressure, those who underwent angiography within 6 hours of the last SAH, and patients who had poor neurological condition.
Angiography ; Blood Pressure ; Diagnosis ; Emergency Service, Hospital ; Hemorrhage* ; Humans ; Incidence ; Mortality ; Risk Factors* ; Tomography, X-Ray Computed

In hepatocellular carcinoma distant metastasis after curative surgical resection without intrahepatic metastasis is very rare. A 55-year old man presented with a huge pelvic bone mass. Eight years ago he underwent posterior hepatic segmentectomy following diagnosis of hepatocelluar carcinoma. He has received regular check-ups with abdominal ultrasonography and serum alpha-fetoprotein. On admission an MRI on the pelvic area showed an 18x10 cm sized lobulated mass invading the pelvic bone and acetabulum. Microscopic examination revealed that the tumor was a well differentiated hepatocellular carcinoma. There was no evidence of intrahepatic recurrence. He was treated with transarterial chemoembolization, external radiotherapy (total 3750 cGy), and systemic chemotherapy using 5-fluorouracil.
Acetabulum ; alpha-Fetoproteins ; Carcinoma, Hepatocellular ; Diagnosis ; Drug Therapy ; Fluorouracil ; Humans ; Magnetic Resonance Imaging ; Mastectomy, Segmental ; Middle Aged ; Neoplasm Metastasis* ; Pelvic Bones* ; Radiotherapy ; Recurrence* ; Ultrasonography

It is very important to prevent hemolytic transfusion reaction. We experienced 1 case of transfusion in liver transplantation patient with multiple unexpected antibodies. On crossmatching for 20 pRBC (packed red blood cells), weak reactions were observed in room temperature, but strong reactions were observed in 37 , and AHG (antihuman globulin) phase. The patient had unexpected antibodies of anti-C, anti-Jka, anti-Dia. The probabilitis of compatible blood of anti-C, anti-Jka, anti-Dia in Koreans had been reported to be 14.2%, 32.8%, and 90%, respectively. We received 217 units of C antigen-negative pRBCs prepared by typing of 2679 type B pRBCs from Central, Eastern and Southern Blood Center of the Korean Red Cross. From the 217 units, 60 units of pRBCs compatible with patient's serum in AHG phase were prepared in our laboratory. The hemolytic tranfusion reaction can be successfully prevented by aid of Blood Center of Korean Red Cross and it should be emphasized that performing crossmatching including AHG phase is very important.
Antibodies* ; Blood Group Incompatibility ; Humans ; Liver Transplantation ; Liver* ; Red Cross ; Transplantation*

Transesophageal echocardiography is a useful device to evaluate the posterior structure of heart with an advantage of enabling clearer images, as compared to transthoracic echocardiography. With intraoperative transesophageal echocardiography, we can reconfirm pre-diagnosed lesions, determine the success of the operation, and in particular, diagnose new lesions that are undetected in pre-operative evaluation. In the present case, undiagnosed patent ductus arteriosus was found on intraoperative transesophageal echocardiography during cardiopulmonary bypass. Subsequently, the patent ductus arteriosus was ligated successfully. With transesophageal echocardiography, we can diagnose the structural and functional abnormality of heart unidentified in the pre-operative evaluation. Also, transesophageal echocardiography can play the role of a rescuer to solve the problems that occur during cardiopulmonary bypass.
Cardiopulmonary Bypass* ; Ductus Arteriosus, Patent* ; Echocardiography ; Echocardiography, Transesophageal* ; Heart ; Humans

PURPOSE: The National Emergency Medical Center has been running a project for the storage and delivery of antidotes for acute poisoning patients of the Department of Health and Welfare, Korea. This study analyzed the results of this project over the past two years. METHODS: The requests received by the National Emergency Medical Center and the data on the delivery process were analyzed. RESULTS: This study analyzed a total of 121 patients with acute poisoning, who were requested to receive an antidote reserved at 20 key hospitals in 2015–2017, and whose age was 52.3±23.5 years; old; 54 were women. Intentional poisoning were 58.7%, and the home was the most common place of exposure (66.9%). The toxic substances were chemicals (32.2%), pesticides (27.3%), medicines (24.8%), and snake venom (4.1%). The patient's poison severity score was 2.4±0.7 (median 3) indicating moderate-to-severe toxicity. Antidote administration was the cases treated in key hospitals 67.8% (82/121), in which transferred patients accounted for 57.3% (47/82). After receiving an antidote request from a hospital other than the key hospitals, the median was 75.5 minutes (range 10 to 242 minutes) until the antidote reached the patient, and an average of 81.5 minutes was required. The results of emergency care were intensive care unit (70.3%), general wards (13.2%), death (10.7%), and discharge from emergency department (5.0%). CONCLUSION: This study showed that the characteristics of acute poisoning patients treated with an antidote were different from previous reports of poisoned patients in the emergency department, and basic data on the time required for delivery from key hospitals was different.
Antidotes* ; Drug Overdose ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital* ; Female ; Humans ; Intensive Care Units ; Korea* ; Patients' Rooms ; Pesticides ; Poisoning* ; Running ; Snake Venoms

Background/Aims: Although proton pump inhibitors (PPIs) remain a mainstay for the suppression of gastric acid secretion, long-term PPI use is associated with side effects. However, the genotoxicity associated with long-term PPI use is unclear. Materials and Methods: This prospective observational pilot study enrolled patients who had been on PPIs for >1 year and healthy controls from July 2015 to August 2016. The subjects completed self-report questionnaires pertaining to their drug and medical history, and only those with no medical history and a ≥2-year wash-out period (for drugs other than PPIs) were included. We collected peripheral-blood lymphocytes from long-term PPI users and healthy controls and analyzed the genotoxicity by using the cytokinesis-block micronucleus cytome assay; we also determined the fasting serum levels of pyridoxine, folate, cobalamin, and homocysteine. Results: Ten long-term PPI users and 40 healthy control subjects were enrolled. The median serum pyridoxine, folate, cobalamin, and homocysteine levels were not significantly different between the groups. The median frequencies of micronuclei (MNi), nucleoplasmic bridges (NPBs), and nuclear buds (Nbuds) per 1,000 binucleated cells, in long-term PPI users and healthy controls, were 30.3 and 16.3 (P<0.005), 2.5 and 1.8 (P<0.005), and 9.3 and 5.0 (P<0.005), respectively. Even after adjustment for confounding factors, the OR of the MNi, NPBs, and Nbuds for long-term PPI users compared with healthy control subjects were 14.1 (P<0.001), 2.0 (P=0.001), and 1.3 (P=0.3), respectively. Conclusions Long-term PPI use was significantly associated with an increased risk of genotoxicity after adjustment for age, sex, body mass index, medical history, drug history, and the serum levels of vitamins.

BACKGROUND AND OBJECTIVES: The influence of anterior inferior cerebellar artery (AICA) loop on sudden sensorineural hearing loss (SSHL) remains controversial. The objective of this study was to evaluate the correlation between the anatomical type of AICA loop and SSHL. SUBJECTS AND METHOD: We reviewed the medical records of 69 ears from 60 patients with SSHL between January 2005 and April 2008, retrospectively. AICA loops were classified according to the Chavda classification method by magnetic resonance imaging. According to the extension depth of the loop in the internal auditory canal, it was classified as type I, II and III. The loop was classified as S (small diameter) and L (large diameter) by comparing the thickness of the loop with adjacent facial nerves. RESULTS: The predominant type of AICA loop was type I (68.1%) and type S (78.3%). There was no significant correlation between the pretreatment hearing level, extension depth and diameter. There was also no significant correlation between the rate of hearing recovery by Siegel's criteria and diameter. However, there was significant correlation between the rate of hearing recovery by Siegel's criteria and the types of the extension depth (p< 0.05). The ears with type II and III of AICA loop presented higher rates of hearing recovery by Siegel's criteria than those with type I. CONCLUSION: This study suggests that the type II and III of AICA loop may be considered a good prognostic factor in SSHL.
Arteries ; Ear ; Facial Nerve ; Hearing ; Hearing Loss, Sensorineural ; Humans ; Magnetic Resonance Imaging ; Medical Records ; Retrospective Studies

Primary cholangiocarcinoma is a rare bile duct epithelial neoplasm that can present with atypical clinical manifestations, complicating its diagnosis. A 62-year-old male showed symptoms suggestive of a complicated hepatic cyst that was later identified as intrahepatic cholangiocarcinoma. The patient presented with abdominal discomfort without fever. Imaging revealed a large cystic lesion in the liver. Despite the initial treatment for a presumed abscess, a biopsy confirmed cholangiocarcinoma. This case highlights the diagnostic challenge of distinguishing between benign complicated hepatic cysts and malignancies, particularly when typical markers of infection are absent. Early biopsy and vigilant assessments are crucial in such presentations to avoid a delayed diagnosis and initiate appropriate treatment.

Hepatic tuberculosis, typically associated with miliary tuberculosis, can occasionally present as localized liver lesions. This case report describes a 77-year-old male presenting with persistent abdominal pain and fever, following an endoscopic retrograde cholangiopancreatography for bile duct sludge removal. Subsequent computed tomography revealed focal liver lesions. Despite initial treatment with antibiotics for a suspected inflammatory liver abscess, his condition did not improve. A liver biopsy was performed, revealing caseous granulomas, and the tuberculosis polymerase chain reaction result was positive. The patient was diagnosed with primary hepatic tuberculosis, which later disseminated. Oral anti-tuberculosis therapy was initiated and is currently being closely monitored. This case emphasizes the importance of considering hepatic tuberculosis in the differential diagnosis of liver lesions, particularly in cases involving cholestatic liver function tests, and persistent symptoms unresponsive to conventional antibiotics.

Primary cholangiocarcinoma is a rare bile duct epithelial neoplasm that can present with atypical clinical manifestations, complicating its diagnosis. A 62-year-old male showed symptoms suggestive of a complicated hepatic cyst that was later identified as intrahepatic cholangiocarcinoma. The patient presented with abdominal discomfort without fever. Imaging revealed a large cystic lesion in the liver. Despite the initial treatment for a presumed abscess, a biopsy confirmed cholangiocarcinoma. This case highlights the diagnostic challenge of distinguishing between benign complicated hepatic cysts and malignancies, particularly when typical markers of infection are absent. Early biopsy and vigilant assessments are crucial in such presentations to avoid a delayed diagnosis and initiate appropriate treatment.