Femoral head and neck fractures during the course of avascular necrosis are rare with only few reports in the English literature. Moreover, there are very few reports on an analysis of the patterns of these fractures. Four cases of femoral head fracture caused by minor trauma, which were quite different from the crescent fractures during the course of avascular necrosis were analyzed in regard to the underlying disease, causes, sites, types, directions, pattern of fractures and the injury mechanism of the fractures. The results are reported with special regard to the pattern of the stress fracture of the femoral head and neck during the course of avascular necrosis.
Fractures, Stress ; Head* ; Neck* ; Necrosis*

PURPOSE: To report a rare case of primary mucinous adenocarcinoma arising from a sweat gland in the eyelid. CASE SUMMARY: A 68-year-old male presented to our hospital with a painless, superficial nodular lesion over the skin of the right lateral canthus that had slowly grown over the past two years. The patient had a history of surgical excision for three nodular lesions at the same site 5 years ago, and an excisional biopsy was mucinous adenocarcinoma with a positive margin. A systemic evaluation, including whole-body Positron Emission Tomography scan (PET), chest computerized tomography, gastrointestinal endoscopy, and colonoscopy, revealed no other abnormal lesions. Therefore, the eyelid lesion was considered a primary mucinous adenocarcinoma of the skin. CONCLUSIONS: Primary mucinous adenocarcinoma of the eyelid can rarely metastasize. Therefore, a systemic examination is warranted to discriminate primary and metastatic adenocarcinoma and also to monitor the long-term follow-up for the evaluation of local recurrence.
Adenocarcinoma ; Adenocarcinoma, Mucinous ; Aged ; Biopsy ; Colonoscopy ; Endoscopy, Gastrointestinal ; Eyelids ; Humans ; Male ; Mucins ; Organothiophosphorus Compounds ; Positron-Emission Tomography ; Recurrence ; Skin ; Sweat Glands ; Thorax

Carcinoid tumor of stomach continue to interest clinician because of the rarity and difficulty in diagnosis clioically with infrequent classical carcinoid syndrome. Recently, we experienced a case of gastric carcinoid with hemetemesis and melena. We feel that this case is an instructive example of the fascinating variety of entities which can result in massive upper gastrointestinal bleeding. So we present this case with s review of relevant literatures.
Carcinoid Tumor* ; Diagnosis ; Hemorrhage* ; Melena ; Stomach

OBJECTIVESThe mechanism of the adverse health effects of ambient particulate matter on humans has not been well-investigated despite many epidemiologic association studies. Measurement of personal exposure to particulate pollutants and relevant biological effect markers are necessary in order to investigate the mechanism of adverse health effects, particularly in fragile populations considered to be more susceptible to the effects of pollutants.

METHODSWe measured personal exposure to PM(2.5) and examined oxidative stress using urinary malondialdehyde three times in 51 preschoolers and 38 elderly subjects. A linear mixed-effects model was used to estimate PM(2.5) effects on urinary MDA levels.

RESULTSAverage personal exposure of the children and elderly to PM(2.5) was 80.5 +/- 29.9 and 20.7 +/- 12.7 mug/m(3), respectively. Mean urinary MDA level in the children and the elderly was 3.6 +/- 1.9 and 4.0 +/- 1.6 mumol/g creatinine. For elderly subjects the PM(2.5) level was significantly associated with urinary MDA after adjusting for age, sex, BMI, passive smoking, day-care facility site, alcohol consumption, cigarette smoking, and medical history (heart disease, hypertension and bronchial asthma). However, there was no significant relationship for children.

CONCLUSIONSThe elderly were more susceptible than young children to oxidative stress as a result of ambient exposure to PM(2.5). Identification of oxidative stress induced by PM(2.5) explains the mechanism of adverse health effects such as cardiovascular or respiratory diseases, particularly in the elderly.

PURPOSE: The clinical factors that help to determine the management in the emergency department for acute poisoning are the type of toxic material and the amount, the cause of poisoning, and the toxidrome. Especially, when one cannot obtain much information about the type of toxic material and the amount from history taking, the most important factor in deciding whether a patient should be hospitalized or discharged is the toxidrome. The Poisoning Severity Score is a standardized system for scoring clinical signs and symptoms due to poisoning. This study was conducted to see if the Poisoning Severity Score on arrival at the emergency department might be used as a prognostic factor and, to see if there are any other factors that might be used to deciding on treatment plans and whether to hospitalize or discharge a patient. METHODS: Retrospective chart reviews of poisoned patients who had visited the Emergency Department of Ansan Hospital of Korea University were used in this study. Age, sex, the time taken to arrive at the emergency department after poisoning, the type of toxic material and the cause of poisoning, the mean arterial pressure, the pulse pressure, the respiratory rate, the body temperature, the initial Poisoning Severity Score, the AST, the serum creatinine level, the anion gap, and the base excess were checked. Also, the use of activated charcoal, gastric lavage, antidotes, hemodialysis/hemoperfusion, and mechanical ventilation, as well as the final Poisoning Severity Score and the clinical progress were checked. RESULTS: In cases of high initial poisoning, the final Poisoning Severity Score was, with statistical significance, much higher than it was in cases of low initial poisoning. Also, in cases of high final Poisoning Severity Scores, the mechanical ventilation rate and the death rate were higher than they were in cases of low final Poisoning Severity Scores, and this difference was statistically significant. In cases of high final Poisoning Severity Scores, mean age was older, and the intentional poisoning rate, the hemodialysis/ hemoperfusion rate, the base excess, and the initial Poisoning Severity Score were higher than in cases of low final Poisoning Severity Score. CONCLUSIONS: We have concluded that the initial Poisoning Severity Score can be a useful factor for giving a prognosis and for deciding on hospitalization and on a therapeutic plan. Also, we have concluded that multiple variables, such as the patient's age, the type of toxic material, the cause of poisoning, and the base excess are significant factors that can complement the initial Poisoning Severity Score in deciding on a hospitalization and therapeutic plan. Consequently, early evaluation of the type of toxic material and the cause of poisoning from history taking and early measurement of the initial Poisoning Severity Score and the variables mentioned above are of utmost importance in formulating a prognosis and deciding on the need for hospitalization.
Acid-Base Equilibrium ; Antidotes ; Arterial Pressure ; Blood Pressure ; Body Temperature ; Charcoal ; Complement System Proteins ; Creatinine ; Emergency Service, Hospital ; Gastric Lavage ; Gyeonggi-do ; Hemoperfusion ; Hospitalization ; Humans ; Korea ; Mortality ; Poisoning* ; Prognosis ; Respiration, Artificial ; Respiratory Rate ; Retrospective Studies

PURPOSE: Although the majority of children's forearm diaphyseal fractures may be treated conservatively with closed reduction and cast immobilization, unstable or irreducible fractures are usually treated by surgical management. Authors performed percutaneous pin leverage reduction technique for irreducible displaced diaphyseal fractures. The aim of this study is to determine the efficacy of pin leverage technique in pediatric forearm diaphyseal fractures MATERIALS AND METHODS: In this retrospective study, we reviewed 22 cases of forearm diaphyseal fractures reduced by percutaneous pin leverage technique between 1997 and 2002. We analyzed radiographs, operation time, hospital stay and immobilization period, range of motion, postoperative complications and functional results by Thomas. RESULTS: Average length of follow up was 28 months with mean age of 10.5 years. All fractures in this series healed less than 2 degrees of diaphyseal angulation. Average operation time including anesthesia was 42 minutes and hospital stay was 4.6 days. Time to union was 49.6 days in average and range of motion and functional results were satisfactory in all cases except one case of congenital radioulnar synostosis. There was one case of superficial pin track infection as complication. CONCLUSION: In operative treatment of children's diaphyseal fractures of forearm bones, percutaneous pin leverage reduction technique is a good alternative method prior to open reduction in case of difficult closed reduction.
Anesthesia ; Child ; Follow-Up Studies ; Forearm* ; Humans ; Immobilization ; Length of Stay ; Postoperative Complications ; Range of Motion, Articular ; Retrospective Studies ; Synostosis

PURPOSE: To examine the clinical utility of lactic acidosis as a predictor of in-hospital mortality and as an early therapeutic marker in severe sepsis and septic shock patients. METHODS: We conducted a prospective observational study. Patients visiting the emergency department from January 2005 to October 2006 who were suspected to have severe sepsis and septic shock were candidates for enrollment. Therapies in the emergency department consisted of early goal-directed resuscitation and employed central venous access, antibiotics, fluid resuscitation, mechanical ventilation, vasoactive agent, and inotropes as required. We measured hemodynamic variables, arterial blood gases, and serum lactate at presentation (0 hours) and at four hours. The SAPS II at emergency department and SOFA score at 0 hours, 4 hours, 24 hours, 48 hours and 72 hours were recorded. RESULTS: A total of 102 patients were enrolled during the study period. Data were presented as mean+/-SD. Thirtyfour patients died in the hospital, eighteen patients of them within 72 hours after admission. Septic shock was encountered in 44 patients. Non-survivors had significantly lower pH, higher serum lactate level, higher SAPS II scores, lower mean arterial blood pressure, higher heart rates, and lower PaO2/FiO2 values at 0 and 4 hours than did survivors. During the first four hours, persistent lactic acidosis and high SAPS II scores were independently associated with mortality. Although most patients achieved the therapeutic goals, excepting central venous oxygen saturation in nonsurvivors, patients with persistent lactic acidosis at 0 and 4 hours had significantly high in-hospital mortality and early overall mortality than other patients (80.0%, p=0.000, 65.0%, p=0.000, respectively). Patients recovering from lactic acidosis at 4 hours showed lower in-hospital mortality and early overall mortality than patients with persistent lactic acidosis (50.0% vs. 80.0%, p=0.070, 14.3% vs. 65.0%, p=0.004). CONCLUSION: Persistent lactic acidosis was found to be an independent variable for predicting mortality and morbidity. Persistent lactic acidosis may be used as a prognostic and treatment indicator during the resuscitation of patients with severe sepsis and septic shock in an emergency department.
Acidosis ; Acidosis, Lactic* ; Anti-Bacterial Agents ; Arterial Pressure ; Emergency Service, Hospital ; Gases ; Heart Rate ; Hemodynamics ; Hospital Mortality ; Humans ; Hydrogen-Ion Concentration ; Lactic Acid ; Mortality ; Observational Study ; Oxygen ; Prospective Studies ; Respiration, Artificial ; Resuscitation ; Sepsis* ; Shock, Septic* ; Survivors

Cutaneous angiosarcoma is a rare, aggressive vascular malignancy with a grave prognosis. It usually arises in the scalp or face as a locally-advanced patch, plaque or tumor at presentation and most often affects males and the elderly. Histopathologically, well-differentiated angiosarcomas are composed of well- or ill-formed vascular channels, often lined by flattened atypical endothelial cells and are distinguished from benign counterparts by their so-called "collagen dissection pattern" and anastomosing architecture. Varied differentiation may be observed even in the same tumor. Epithelioid angiosarcoma is a rare variant of poorly-differentiated angiosarcoma. The patients were seven cases of angiosarcomas including an epithelioid variant. They were six males and one female with an age range between 65~84 years (avg. 74 years). Lesions resembled seborrheic dermatitis, erysipelas or "spreading bruise" that varied from blue to red in color and from papule to mass in size. They revealed satellite lesions far from the main lesion in some cases. Skin biopsies were performed for all patients and histopathologic features were compatible with angiosarcoma and epithelioid angiosarcoma. We herein report seven angiosarcomas of diverse clinical features because their early detection and precise differential diagnosis should be mandatory for effective management.
Aged ; Biopsy ; Dermatitis, Seborrheic ; Diagnosis, Differential ; Endothelial Cells ; Erysipelas ; Female ; Hemangiosarcoma* ; Humans ; Male ; Prognosis ; Scalp* ; Skin

Biliary drainage can improve the quality of life in a patient with obstructive jaundice caused by malignancy. Biliary metal stent insertion is a very useful method because it drains the bile physiologically and patients have little discomfort with the procedure. It has a few complications such as restenosis, liver perforation, bowel perforation, fistula formation and stent dislocation. Perforation and fistula formation are caused by pressure due to the self expanding characteristics of the metal stent. We report here on a case of duodenobiliary fistula that was caused by a biliary metal stent in a patient suffering with hepatocellula carcinoma, and we also include a review of the relevant literature.
Bile ; Carcinoma, Hepatocellular ; Dislocations ; Drainage ; Fistula ; Humans ; Jaundice, Obstructive ; Liver ; Quality of Life ; Stents ; Stress, Psychological

PURPOSE: Extracorporeal life support has been used as an extension of conventional cardiopulmonary resuscitation (CPR). However, the appropriate indications for extracorporeal CPR (ECPR) including the duration of CPR are unknown. We analyzed the cases of patients who received ECPR in our institute to find indicators for ECPR. METHODS: Patients who received ECPR in the emergency department of Korea University Ansan hospital from April 2006 to March 2007 were candidates for enrolment. Inclusion criteria were 1) a witnessed sudden cardiac arrest with correctable cause, 2) age <75 years, 3) cardiac arrest unresponsive to standard CPR, 4) absence of serious underlying disease such as advanced cancer, 5) impending arrest state due to respiratory failure or cardiogenic shock. Cardiac arrest related to trauma was excluded from the study. Tracked outcomes were hospital survival, improvement of Glasgow Coma Scale-motor respones, and return of spontaneous circulation. We analyzed the cause of arrest, arrest rhythm, time of administration of extracorporeal life support, and laboratory values. RESULTS: A total of seven patients received ECPR during one year. All patients achieved spontaneous circulation after ECPR and four patients showed improvement of GCS-motor response. Two patients were discharged alive. Their GCS and CPC were 15 points and 1 point, respectively. Intervention to correct underlying cause of arrest during ECPR, rapid start of ECPR during chest compression, and recovery of mean arterial pressure, heart rate, and urine output during ECPR all correlated with good outcomes. CONCLUSION: ECPR as a method of extended CPR improved the survival of cardiac arrest patients unresponsive to standard CPR.
Arterial Pressure ; Cardiopulmonary Resuscitation* ; Coma ; Death, Sudden, Cardiac ; Emergency Service, Hospital ; Gyeonggi-do ; Heart Arrest* ; Heart Rate ; Humans ; Korea ; Respiratory Insufficiency ; Shock, Cardiogenic ; Thorax