PURPOSE: To compare the results of laser epithelial keratomileusis (LASEK) and epi-laser in situ keratomileusis (Epi-LASIK) for the treatment of moderate to high myopia. METHODS: In this study, 50 patients with a manifest refraction of moderate to high myopia were assigned to two groups: 50 eyes of 25 patients treated with LASEK and 50 eyes of 25 patients treated with epi-LASIK. Uncorrected visual acuity (UCVA), manifest refraction, corneal haze, and postoperative pain were reviewed in LASEK and epi-LASIK treated eyes at 3 months after the operation. RESULTS: At one week after surgery, UCVA was recovered more rapidly after epi-LASIK than LASEK (LASEK: 0.61+/-0.23, Epi-LASIK: 0.79+/-0.11, p<0.05), but UCVA at both 1 and 3 months showed no significant difference between the LASEK and epi-LASIK groups. However, epi-LASIK-treated eyes had lower postoperative pain scores and lower corneal haze scores (1 month; p=0.01) than those of LASEK-treated eyes. CONCLUSIONS: Epi-LASIK showed a more rapid visual recovery than LASEK at 1 week after surgery for the correction of myopia. Epi-LASIK-treated eyes also had less postoperative pain and an earlier reduction of postoperative corneal haze. These results suggest epi-LASIK could be a viable alternative procedure for the correction of moderate to high myopia.
Humans ; Keratectomy, Subepithelial, Laser-Assisted ; Myopia* ; Pain, Postoperative ; Visual Acuity

PURPOSE: Chlorine gas is a common irritant that usually causes mild respiratory symptoms. One severe symptom, RADS (Reactive Airway Dysfunction Syndrome), is not well known to physicians. We analyzed the clinical features of chlorine gas exposure. METHODS: We prospectively collected 25 cases of chlorine gas exposure near our emergency center on January 10th, 2007, and analyzed demographic data, event-to-ER interval, symptoms, and laboratory results based on medical records. RESULTS: Only 2 patients out of 25 were admitted because of severe symptoms, the rest were discharged without complications. Sixty percent of them visited the ER within 12 h of exposure. The most common symptoms were chest discomfort (60%), headache (40%), nausea (40%), throat irritation (26%), and cough (32%). Two out of eight dyspnea cases showed abnormal pulmonary function, but only one case was diagnosed as RADS. CONCLUSION: Most symptoms after chlorine gas exposure can be treated conservatively. However, patients with chlorine exposure should be followed up long term for delayed complications.
Chlorine ; Cough ; Dyspnea ; Emergencies ; Environmental Exposure ; Follow-Up Studies ; Headache ; Humans ; Hypersensitivity ; Nausea ; Pharynx ; Prospective Studies ; Thorax

PURPOSE: To compare high-order aberrations in the pseudophakia with different types of intraocular lenses (IOLs), as well as with normal phakic eyes. METHODS: This single-center prospective study comprised 80 cataract patients who underwent cataract surgery and 20 phakic eyes. Twenty eyes received an AF-1(R) VA-60BB; 20 eyes, a Corneal(R) ACR6D SE; 20 eyes, a Sensar(R) AR40e; and 20 eyes, a ClariFlex(R). One month after cataract surgery, the eye aberration was measured using a Hartmann-Shack type aberrometer. The same test was performed for 20 normal phakic eyes. The individual Zernike polynomials, the root mean square (RMS) values of the third and fourth order aberration, and the total RMS among the groups were compared. RESULTS: The individual Zernike coefficient (Z3(-1), Z3(3), Z4(-4), Z4(0), Z4(4)) showed a significant difference in the IOL-implanted groups compared with the normal phakic eyes. There were statistically significant differences in the RMS values of the third and fourth order aberration, and total among each group. CONCLUSIONS: There was a statistically significant increase in aberration in patients with high refractive index IOL and a statistically significant decrease in patients with silicone IOL, compared to the normal phakic eyes.
Cataract ; Humans ; Lenses, Intraocular* ; Prospective Studies ; Pseudophakia* ; Refractometry ; Silicones

Myxedema coma is the extreme form of untreated hypothyroidism. In reality, few patients present comatose with severe myxedema. We describe a patient with myxedema coma which was initially misdiagnosed as a brain stem infarct. She presented to the hospital with alteration of the mental status, generalized edema, hypothermia, hypoventilation, and hypotension. Initially her brain stem reflexes were absent. After respiratory and circulatory support, her neurologic status was not improved soon. The diagnosis of myxedema coma was often missed or delayed due to various clinical findings and concomitant medical condition and precipitating factors. It is more difficult to diagnose when a patient has no medical history of hypothyroidism. A high index of clinical suspicion can make a timely diagnosis and initiate appropriate treatment. We report this case to alert clinicians considering diagnosis of myxedema coma in patients with severe decompensated metabolic state including mental change.
Aged ; Brain Stem Infarctions/diagnosis/radiography ; Diagnosis, Differential ; Diagnostic Errors ; Echocardiography ; Female ; Humans ; Hypothyroidism/complications/drug therapy ; Myxedema/*diagnosis/etiology/radiography ; Republic of Korea ; Thyroxine/therapeutic use ; Tomography, X-Ray Computed

A 47-year-old woman ingested about 12 mg of colchicine with suicidal intent. Colchicine, a highly poisonous alkaloid, is a commonly used treatment for gout, Bechet's disease, and familial Mediterranean fever. Despite the knowledge of its side effects, the risk of a significant overdose is under-appreciated. She suffered from acute multisystem toxicity, including gastrointestinal disorders, bone marrow suppression, alopecia, and probable pancreatitis, but she ultimately recovered with supportive therapy. We report a case of acute colchicine toxicity from a single overdose with a review of the literature.
Alopecia ; Bone Marrow ; Colchicine ; Familial Mediterranean Fever ; Female ; Gastroenteritis ; Gout ; Humans ; Middle Aged ; Pancreatitis

PURPOSE: Electrical shock is not always followed by a perfusing rhythm, and multiple shock failure (MSF) is common during CPR. We sought to investigate its risk factors and prognostic implications. METHODS: Adult OHCA patients with emergency department (ED) ACLS attempts were identified from a tertiary hospital OHCA registry extending from 2008 to 2012. Shock failure was defined as any electrical shock attempt not followed by a pulse-generating rhythm. Patients were assigned to one of three groups based on the number of shock failures: 1) MSF: ≥3 electrical shock failures before the first ROSC or CPR termination (if there was no ROSC), 2) early shock success (ESS): pulse-generating rhythm achieved within 3 electrical shock attempts and 3) others: all remaining patients. Baseline characteristics, initial laboratory measurements, and outcomes were compared. RESULTS: A total of 590 patients were included. There was no significant difference in baseline characteristics between the MSF group (n=49) and the early shock success group (n=50) except in its higher proportion of presumed cardiac aetiology. The MSF group showed less severe metabolic acidosis and coagulopathy on ED arrival and better renal function and higher haematocrit and serum albumin levels compared with the ESS group. MSF was associated with less sustained ROSC, but was also associated with more survival discharge and better long-term neurologic outcomes after sustained ROSC. CONCLUSION: MSF may indicate heart-specific problems rather than severe metabolic derangements. Better long-term outcomes can be expected once sustained ROSC is achieved, therefore, this phenomenon warrants more focused research.
Acidosis ; Adult ; Cardiopulmonary Resuscitation ; Emergency Service, Hospital ; Heart Arrest ; Humans ; Resuscitation* ; Risk Factors* ; Serum Albumin ; Shock* ; Tertiary Care Centers ; Ventricular Fibrillation

PURPOSE: Inappropriate cuff inflations cause many complications. A conventional pilot balloon palpation technique is insufficient to detect high cuff pressures, but is still preferred. Hence, we conducted this study to identify effectiveness, preference and ease of use of a new estimation technique named "passive release technique" for endotracheal tube cuff inflation. METHODS: Twenty-nine nurses inflated cuffs by a pilot balloon palpation technique in manikins inserted with a 7.5 mm endotracheal tube. Then, being educated about passive release techniques, they inflated cuffs using such a passive release technique. Intracuff pressures and air volumes were measured by manometers and syringes. Preference and ease of use between the two methods were scored using a 10-point Likert scale. RESULTS: For the pilot balloon palpation technique, only 4 nurses (13.8%) inflated cuffs within the normal range of pressures (normal: 15 to 30 mb) with an average of 39.3+/-34.0 cmH2O. For the passive release technique, 19 nurses (65.5%) inflated cuffs within the normal range of pressures with an average of 24.2+/-9.3 cmH2O (McNemar's test, p<0.01). In the pilot balloon palpation technique, inflated air volumes of 7.8+/-2.0 ml were not significantly different from inflated air volumes 8.5+/-1.2 ml (p=0.07) for the passive release technique. But the difference was found to be statistically significant in a variance ratio test (F-test) (p<0.01). In view of preference and ease of use between the two methods, mean values were not statistically different, 7.3+/-2.0 vs. 7.0+/-2.0 and 7.0+/-2.3 vs. 7.3+/-2.4, respectively. CONCLUSION: When direct intracuff measurement is not available, a passive release technique using a syringe is an effective and easy method to achieve cuff inflation.
Inflation, Economic ; Intubation ; Manikins ; Palpation ; Reference Values ; Statistics as Topic ; Syringes

Powered by compressed air, a nail gun is an essential alternative tool to a hammer on any construction site. This useful machine launches nails at high speed, automatically embedding them in a piece of wood in only a fraction of a second. In spite of its convenience, life-threatening and fatal nail gun injuries can occur when a nail gun is misused, such as in a suicide attempt, or when the operator has insufficient training because combustion nail guns are capable of firing projectiles at velocities higher than 150 m per second. Although injuries by nail guns are rarely reported, there have been reports of nail gun injuries to the head and the trachea in Korea. In the emergency room, the authors experienced a patient injured by an accidental shooting of a nail gun while working in construction. In that accident, a nail penetrated the patient's cervical vertebra through the left cheek. This report is aimed at studying medical treatment for patients with penetrating injuries caused by nail guns.
Cheek ; Compressed Air ; Emergencies ; Firearms ; Fires ; Head ; Humans ; Korea ; Nails ; Neck ; Neck Injuries ; Spine ; Suicide ; Trachea ; Wood

PURPOSE: As emergency ultrasound (EUS) can improve the management of emergency department patients, education in EUS has become an essential part of emergency medicine resident training. This study examined the efficacy of pediatric EUS education for resident physicians 6 months after training. METHODS: A survey was conducted on emergency medicine resident physicians who participated in the Pediatric Emergency Ultrasound Course in November 2014, which is a training program of pediatric EUS generated by Korean Society of Pediatric Emergency Medicine and Society of Emergency and Critical Care Imaging. The instructor checked the list to evaluate attendee after the course. After the course, resident physicians have been encouraged to use EUS at the patient's bedside, and the same list was checked 6 months after the course. At the same time, a survey of the number of experience of EUS during the 6 months was performed. RESULTS: Ten emergency resident physicians of Seoul National University of Hospital participated in the course and all attendees were re-evaluated 6 months after the course. The mean initial score immediately after the course and that at the 6 months follow-up was 28.6±3.13 and 20.8±3.79, respectively (p < 0.05). No significant relationship was observed between the difference score and the EUS experience number, including the observations of the other physician's EUS (p=0.603) and hands-on by themselves (p=0.771). CONCLUSION: Although a EUS education program could improve the resident physician's ability, the effect decreased with time. Hence, the resident physician's EUS ability cannot be maintained via simple emergency department duty. Therefore, the education program should be repeated regularly.
Critical Care ; Education* ; Emergencies* ; Emergency Medicine* ; Emergency Service, Hospital ; Follow-Up Studies ; Humans ; Seoul ; Ultrasonography*