BACKGROUND/AIMS: Recent reports have suggested that precolonoscopy bowel preparation is easier to tolerate if a small volume solution is used. The aim of this study was to compare oral sodium phosphate with polyethylene glycol solution in terms of the quality of colon cleansing, ease of preparation, and gastrointestinal intolerance. METHODS: Sixty one patients were prospectively randomized to receive either a standard 4-liter polyethylene glycol solution or a 90 ml oral sodium phosphate preparation. Before and after bowel preparation all patients were weighted, and serum electrolytes were measured. Patients were asked to record the effects of the preparation and to give it a "discomfort rating" on a scale from 1 to 5. Surgeons were blinded to the preparation used and rated the quality of bowel cleansing on a scale of 1 to 5. RESULTS: The smaller volume of oral sodium phosphate was not associated with any clinically significant problem,caused no increase in the incidence of side effects, was preferred by patients, and was effective in colonic cleansing. The incidence of sleep disturbance, abdominal pain, nausea, vomiting, anal discomfort, chest pain, chilling and dizziness associated with oral sodium phosphate was similar to that with polyethylene glycol lavage. Abdominal distension was more common with polyethylene glycol lavage and statistical difference was seen(P<0.01). There were no clinically significant changes in any biochemical parameters and vital signs caused by precolonoscopic preparation except asymptomatic hyperphosphatemia in the sodium phosphate group that was not statistically different. The decreased body weight was seen with Colonlyte(R) that was statistically different(P<0.01). CONCLUSION: The overall quality of bowel preparation with oral sodium phosphate was similar to that with polyethylene glycol lavage. Patients tolerated preparation with oral sodium phosphate to be somewhat easier than polyethylene glycol lavage. Therefore, we conclude that the use of oral sodium phosphate as a precolonoscopy bowel preparation is clinically useful.
Abdominal Pain ; Body Weight ; Chest Pain ; Colon ; Dizziness ; Electrolytes ; Humans ; Hyperphosphatemia ; Incidence ; Nausea ; Polyethylene Glycols ; Prospective Studies ; Sodium ; Therapeutic Irrigation ; Vital Signs ; Vomiting

PURPOSE: Jumping off a bridge is one method of suicide. In a recent report, out of the 37 patients with cardiac arrest after drowning, 5 (36%) patients suffered severe traumatic injuries. The objective of this study was to report these injuries, without cardiac arrest, in patients after jumping off a bridge with the purpose of suicide. METHODS: We retrospectively reviewed the charts of all patients admitted to the emergency department in a tertiary care hospital after drowning in the Han River between 1997 and 2012. We analyzed the results of imaging studies. Each injury was described as one of the six body regions, similar to the method of the Injury Severity Score. RESULTS: A total of 469 patients were admitted to the emergency department from drowning. Sixty-six patients had jumped off a bridge with the purpose of suicide. Forty patients experienced cardiac arrest. In cardiac arrest patients, 25 patients (62.5%) underwent radiologic examinations. Only 2 patients (5.0%) received damage on the cervical spine and face. All non-cardiac arrest patients underwent imaging studies. Nine patients (34.6%) showed evidence of injuries. Most injuries occurred in the chest; four patients suffered the following injuries: rib fracture, pneumothorax, pneumomedistinum, and thoracic spine fracture. One patient had abdominal damage, an intra-abdominal hematoma. Last one patient suffered an injury to the chest and abdomen. CONCLUSION: In drowning patients with the purpose of suicide, variable damage could not be ruled out. It is especially not confined to a specific area, and damage to various parts of the body should be considered.
Abdomen ; Body Regions ; Drowning ; Emergency Service, Hospital ; Heart Arrest ; Hematoma ; Humans ; Injury Severity Score ; Methods ; Multiple Trauma ; Pneumothorax ; Retrospective Studies ; Rib Fractures ; Rivers ; Spine ; Suicide* ; Tertiary Healthcare ; Thorax

PURPOSE: Diabetes is underdiagnosed. Higher-risk populations, such as emergency department (ED) patients, may provide an opportunity for identification of undiagnosed diabetes. Prior studies have indicated that hemoglobin A1c (HbA1c) is effective in the screening detection of diabetes. The objective of this study was to evaluate the correlation between random plasma glucose and HbA1c in Korean ED patients with unknown diabetes status and to determine the value of ED glucose level as a screening tool for diabetes. METHODS: This was a prospective nonconsecutive case series of adults aged > or =18-years-of-age presenting to the ED with acute illness that involved acquisition of a a plasma glucose sample for clinical management. From June 1-June 30, 2009, consenting patients with no prior history of diabetes underwent additional testing for HbA1c level. ED glucose results were stratified based on outpatient American Diabetes Association Fasting Plasma Glucose classifications. Two HbA1c cut-off points (6.1% and 6.5%) were selected as the optimum cut-offs for identifying diabetes based on International Expert Committee. RESULTS: There were 423 patients enrolled. The ED glucose levels were correlated with the HbA1c levels (r=0.488, p<0.001). There were few patients (n=10) with a glucose level > or =200 mg/dL, but most (90%) had an elevated HbA1c level. CONCLUSION: Based on the frequencies of elevated HbA1c levels among patients with elevated ED glucose values, a clinically relevant portion of hyperglycemic patients may have undiagnosed diabetes. ED patients with hyperglycemia may warrant referral for confirmatory diabetes testing.
Adult ; Aged ; Diabetes Mellitus ; Emergencies ; Fasting ; Glucose ; Hemoglobin A ; Hemoglobins ; Humans ; Hyperglycemia ; Korea ; Mass Screening ; Outpatients ; Plasma ; Prospective Studies ; Referral and Consultation

PURPOSE: Diabetes is underdiagnosed. Higher-risk populations, such as emergency department (ED) patients, may provide an opportunity for identification of undiagnosed diabetes. Prior studies have indicated that hemoglobin A1c (HbA1c) is effective in the screening detection of diabetes. The objective of this study was to evaluate the correlation between random plasma glucose and HbA1c in Korean ED patients with unknown diabetes status and to determine the value of ED glucose level as a screening tool for diabetes. METHODS: This was a prospective nonconsecutive case series of adults aged > or =18-years-of-age presenting to the ED with acute illness that involved acquisition of a a plasma glucose sample for clinical management. From June 1-June 30, 2009, consenting patients with no prior history of diabetes underwent additional testing for HbA1c level. ED glucose results were stratified based on outpatient American Diabetes Association Fasting Plasma Glucose classifications. Two HbA1c cut-off points (6.1% and 6.5%) were selected as the optimum cut-offs for identifying diabetes based on International Expert Committee. RESULTS: There were 423 patients enrolled. The ED glucose levels were correlated with the HbA1c levels (r=0.488, p<0.001). There were few patients (n=10) with a glucose level > or =200 mg/dL, but most (90%) had an elevated HbA1c level. CONCLUSION: Based on the frequencies of elevated HbA1c levels among patients with elevated ED glucose values, a clinically relevant portion of hyperglycemic patients may have undiagnosed diabetes. ED patients with hyperglycemia may warrant referral for confirmatory diabetes testing.
Adult ; Aged ; Diabetes Mellitus ; Emergencies ; Fasting ; Glucose ; Hemoglobin A ; Hemoglobins ; Humans ; Hyperglycemia ; Korea ; Mass Screening ; Outpatients ; Plasma ; Prospective Studies ; Referral and Consultation

The in vitro antifungal susceptibility of 636 Candida bloodstream isolates collected from 15 tertiary hospitals in Korea was determined using the Vitek-2 yeast susceptibility system (bioMerieux, France). Overall susceptibility rates were 98.1%, 95.9%, 99.1%, and 97.3% for amphotericin B, fluconazole, voriconazole, and flucytosine, respectively. The results show that the rates of resistance to 4 antifungal drugs remain low among Candida bloodstream isolates in Korea.

PURPOSE: Due to an increased interest in health, there have been many types of marathon races for athletes and the general population. Marathon is an extremely difficult sport, therefore, many running injuries can occur. In this study, we aimed at characterization of injuries and clinical courses resulting from marathon induced heat stroke. Based on our findings, we provide suggestions for proper management of patients with marathon induced heat stroke. METHODS: We performed a retrospective study of 24 patients who visited the emergency department (ED) at Yeouido St. Mary's hospital between January 2000 and August 2011 with symptoms of heat stroke resulting from participation in a marathon race. We reviewed the medical records, which showed clinical presentation and laboratory findings. RESULTS: Of the 24 patients, 20(83.3%) were men. Their average age was 38.1+/-8.4 years old and their average initial rectal temperature was 39.9+/-1.3degrees C. Seventeen (70.8%) patients came to the ED complaining of syncope and seven(29.2%) came because of mental change. In follow-up laboratory tests, ten patients showed an increased level of serum Creatine phosphokinase (CPK) to over 1,000 IU/L, six showed serum Aspartate aminotransferase (AST)/Alanine aminotransferase (ALT) to over 300 IU/L, four showed serum creatinine to over 2.0 mg/dL, and two showed an increase in serum troponin-I and MB fraction of creatine kinase. Results of initial laboratory tests showed normal AST/ALT levels, however, they started to rise between 12 to 24 hours, and reached the highest record after 2~3 days of hospitalization. CONCLUSION: Marathon induced heat stroke can cause various complications, such as rhabdomyolysis, acute hepatic injury, acute renal failure, and metabolic acidosis. Therefore, we recommend follow-up and observation for patients with marathon induced heat stroke.
Acidosis ; Acute Kidney Injury ; Aspartate Aminotransferases ; Athletes ; Continental Population Groups ; Creatine Kinase ; Creatinine ; Emergencies ; Follow-Up Studies ; Heat Stroke ; Hot Temperature ; Humans ; Male ; Medical Records ; Porphyrins ; Retrospective Studies ; Rhabdomyolysis ; Running ; Sports ; Syncope ; Troponin I

PURPOSE: Our aim was to determine the efficacy of hematuria testing in suspected urinary stone disease using contrast enhanced multidetector computed tomography (MDCT) as the reference standard. METHODS: Records of all patients who presented to the emergency department with suspicion of urinary stone that undergone MDCT during a 2-year period were reviewed. The sensitivity, specificity, positive predictive value, and negative predictive value of the positive hematuria on the urinalysis for renal colic were calculated. The rates of incidence of negative hematuria were obtained. In addition, significant alternative CT findings requiring immediate or deferred treatment were classified. RESULTS: A total of 492 enhanced MDCTs were performed. Urinary stone had been identified in 414(84.1%) of the 492 patients, and 78 patients had a negative stone, including 33 (6.7%) with clinically significant alternative diagnoses in the latter group. Microscopic urinalysis had a sensitivity, specificity, positive predictive value, and negative predictive value of 89.4%, 41.1, 88.9%, and 42.1%, respectively. The combination of microscopic urinalysis and Urine Dipstick test (UDT) yielded a sensitivity, specificity, positive predictive value, and negative predictive value of 96.9%, 28.2%, 87.5%, 62.9%, respectively. The incidence of negative hematuria for microscopic urinalysis, UDT, and the combination were 10.6%, 4.4%, 3.1%, respectively. CONCLUSION: The presence or absence of blood on urinalysis alone cannot be used to reliably determine which patients actually have urinary stone. Therefore, patients presenting with an episode of clinically suspected urinary stone should undergo CT scanning because it enhances diagnostic certainty by identifying alternative significant diagnoses not suspected on clinical grounds alone.
Emergencies ; Hematuria ; Humans ; Incidence ; Multidetector Computed Tomography ; Renal Colic ; Sensitivity and Specificity ; Urinalysis ; Urinary Calculi ; Urolithiasis

To develop a live vaccine candidate using an attenuated strain of Salmonella Typhimurium (ST), biochemical properties, plasmid profile, PFGE patterns and pathogenic analysis of the ST isolate were carried out after sequential passage of the ST isolate in porcine neutrophils. By the passage, the ability of the neutrophil-adapted isolate to utilize d-xylose was lost, while the ability of the strain to ferment trehalose was delayed after 2 or more days of the culture. Also, changes including deletion of the gene fragments were observed in PFGE analysis of the neutrophil-adapted isolates. Two plasmids, 105kb and 50kb, were cured in the strain passaged over 15 times in porcine neutrophils. The 50% of lethal dose (LD50) of the parent strain was changed from 1 x 10(5) LD50 to 6 x 10(6) LD50 by the passage in intraperitoneal injection of the strains into mice. These results suggested that bacterial genotypic and phenotypic responses might be globally altered depending on the inside environment of neutrophils.
Animals ; Humans ; Injections, Intraperitoneal ; Lethal Dose 50 ; Mice ; Neutrophils ; Parents ; Plasmids ; Salmonella ; Salmonella typhimurium ; Sprains and Strains ; Trehalose ; Xylose

The scarring process of burns can be accompanied by pain and/or paresthetic sensation which may persist after completion of scar formation. Once the wound is healed, it is possible that paresthetic and/or painful sensations persist as a result of abnormalities in the newly regenerated nerve endings or because of deficient reinnervation of the scarred tissue, that may give rise to abnormal inputs. Existence of glutamate receptors in peripheral nerves innervating normal and inflamed skin has been well addressed. Therefore we tried ketamine in postburn neuropathic pain expecting the antagonistic effect as a NMDA antagonist. We experienced two postburn pain patients who were successfully managed without any significant sign of side effects by an intralesional injection of ketamine and bupivacaine.
Bupivacaine ; Burns ; Cicatrix ; Humans ; Injections, Intralesional* ; Ketamine* ; N-Methylaspartate ; Nerve Endings ; Neuralgia* ; Peripheral Nerves ; Receptors, Glutamate ; Sensation ; Skin ; Wounds and Injuries

BACKGROUND: At present, the clinical breakpoints (CBPs) of both fluconazole and voriconazole are available only for 3 common Candida species in the Clinical and Laboratory Standards Institute (CLSI) and the European Committee on Antimicrobial Susceptibility Testing (EUCAST) methods. Epidemiological cutoff values (ECVs) were recently applied to both methods to detect the emergence of acquired resistance (i.e., non-wild-type isolates) among 5 common Candida species. METHODS: We performed a nationwide study to determine the fluconazole and voriconazole susceptibility of Candida bloodstream isolates (BSIs) using both the CLSI and EUCAST methods. A total of 423 BSIs of 5 Candida species were collected from 8 hospitals. The azole susceptibilities were assessed on the basis of the species-specific CBPs and ECVs. RESULTS: Of the 341 BSIs of 3 common Candida species (i.e., C. albicans, C. tropicalis, and C. parapsilosis), 0.3% and 0.9%, 0.0% and 1.5% of isolates were categorized as fluconazole and voriconazole resistant according to the CLSI and EUCAST CBPs, respectively. Of 423 total BSIs, 1.4% and 2.6% had fluconazole minimum inhibitory concentrations (MICs) exceeding the ECVs according to the CLSI and EUCAST, respectively; 1.0% and 2.1% had voriconazole MICs exceeding the ECVs according to the CLSI and EUCAST, respectively. Categorical agreement between the methods using ECVs was 98.3% for fluconazole and 98.3% for voriconazole. CONCLUSIONS: The EUCAST and CLSI methods using ECVs provide highly concordant results. Moreover, non-wild-type isolates with possibly acquired azole resistance were rare among the BSIs of 5 common Candida species in Korea.
Antifungal Agents/*pharmacology ; Candida/*drug effects/isolation & purification ; Candidiasis/epidemiology/microbiology ; Drug Resistance, Fungal/drug effects ; Fluconazole/*pharmacology ; Humans ; Microbial Sensitivity Tests ; Pyrimidines/*pharmacology ; Republic of Korea ; Triazoles/*pharmacology