A typical synovial osteochondromstosis within the both knee joints occured in a 29-year-old man. The patient complained of palpable masses in the both knee joints showed multiple round, oval, amorphous calcified loose bodies. Arthrotomy of the left knee joint, removal of loose bodies and total synovectomy were performed. The microscopic findings of loose body revesled a degenerated cartilage cap and showed ares of cacification, ossification and fibroadipose tissue in the central part of the body. The mocroscopic findings of synovium revesled a cartilagenous metaplasis of the fibro vascular tassue and showed no evidence of calcification or ossification. The cartilagenous tissue was relatively matured form.
Adult ; Cartilage ; Chondromatosis, Synovial ; Humans ; Knee Joint ; Knee ; Synovial Membrane

Epidural hematoma with Brown-Sequard syndrome caused by an epidural injection is a rarely found condition in the emergency department (ED). We report an unusual case of Brown-Sequard syndrome in a 55-year-old man who presented at the ED with right-sided weakness and contralateral loss of pain and temperature sensation after a cervical epidural injection for shoulder pain. Cervicla spine magnetic resonance imaging showed an epidural hematoma from C4 to C6. After admission, his right hemiparesis and contralateral sensory loss improved within eight days, and surgical decompression was not required. Diagnosing spinal lesions in the ED is challenging, especially in patients with acute neurological signs requiring immediate evaluation for stroke. In this case, definite hemiparesis and some contralateral sensory loss were noted. Therefore, a potential spinal lesion was suspected rather than a stroke. This case emphasized the importance of conducting a focused neurological examination after history taking.

PURPOSE: The aim of this study was to compare the difference in acute stroke management between urban and rural areas, to investigate the factors affecting these differences, and to acquire basic information for establishing an efficient regional hub and spoke system for stroke patients. METHODS: This retrospective study was based on adult patients diagnosed with acute ischemic stroke from January 2012 to December 2012 at a regional cerebrovascular center. The term "acute" was defined as 24 hours from symptom recognized. The term "urban" was defined as the region within the boundary of a metropolitan area. The distance from the symptom onset location to the stroke center was calculated using a global positioning system. RESULTS: The rate of arriving at a stroke center within 3 hours after stroke recognition for acute ischemic stroke patients was much higher in urban areas compared to rural areas (27.5 vs. 19.2%, respectively; p-value=0.011). In stroke cases in rural areas, the distance from symptom onset location to a stroke center was determined as statistically significant through multivariate logistic regression analysis (Odds ratio (OR), 0.982; 95% Confidence interval (CI) 0.969-0.995). In contrast, the use of a public ambulance (OR, 4.258; 95% CI 2.233-8.118) and inter-hospital transfer (OR, 0.416; 95% CI 0.216-0.800) were the main prehospital delay factors in urban areas. CONCLUSION: For stroke cases in urban areas, it was important to directly visit a stroke center without transfer using a public ambulance. For rural areas, a new hub hospital and policies are necessary for reducing prehospital delay.
Adult ; Ambulances ; Emergency Medical Services ; Geographic Information Systems ; Humans ; Logistic Models ; Retrospective Studies ; Stroke*

PURPOSE: After cataracts, eye injuries are the second leading cause of visual impairment worldwide. But most eye injuries are preventable simply by wearing appropriate eye protection. In this study we evaluate factors leading to eye injury in a sample of emergency department (ED) patients. METHODS: This study was conducted with 424 isolated eye injury patients who visited our ED from January to December of 2008. The following data were reviewed; date of visit, characteristics of subjects, existing use of eyewear, relationship of injury to work, causative activity, location where the injury occurred, type of injury, disposition at ED discharge, length of hospital stay, and the existence of sequelae. Severe eye injuries were classified based on the type of injury, disposition at ED, remaining visual loss, and sequelae. RESULTS: Among the total 424 isolated eye injury patients, 411 cases were analyzed. Eye injuries occurred most frequently at home (22.6%), in a factory workplace (21.2%), or an outdoor agricultural workplace (18.2%). The incidence of eye injuries peaked in the fifth decade of life. Among the 306 (74.5%) cases that were workplace unrelated, the main causative activities were assault (18.0%), injury associated with play (14.1%), sports (11.1%), and lawn mowing (9.2%). CONCLUSION: The most common location where the eye injury occurred was at home. Eye injuries prevention in the workplace is well promoted, but in fact, eye injuries were more common at home and during non-occupational activities. We suggest that public education programs which highlight non-occupational eye injury risk and prevention measures should be instituted to reduce preventable eye injuries.
Cataract ; Emergencies ; Eye ; Eye Injuries ; Humans ; Incidence ; Length of Stay ; Risk Factors ; Sports ; Vision Disorders

OBJECTIVE: Performing high quality cardiopulmonary resuscitation (CPR) is important for improving the survival rate with a good neurological outcome and fewer complications. The retention of accurate CPR knowledge is essential for providing high quality CPR. This study examined the effects of chest compression only CPR training on the retention of correct CPR knowledge. METHODS: In December 2016, an interview survey to target the study population was conducted by trained interviewers, using a structured questionnaire. The respondents' general characteristics, status of CPR education, and knowledge and willingness regarding CPR were investigated. Pearson's chi-square tests and multivariate logistic regression analyses were used to determine which education-related factors affected the correct skill knowledge of performing CPR. RESULTS: Among the respondents, there are 80 persons (17.4%) who answered correctly in the questions regarding the skills of performing CPR. The respondents who had a willingness to perform CPR to family and strangers were 90.2% and 44.9% respectively. Through multivariable analysis, the factors related to correct skill knowledge in performing CPR in the didactic with practice group were people who had undergone CPR training within 2 years (odds ratio [OR], 2.293; 95% confidence interval [CI], 1.311–4.009), and person who had undergone chest compression only CPR training (OR, 2.044; 95% CI, 1.033–4.042). CONCLUSION: Chest compression only type of CPR training and the experience of CPR education within 2 years were associated with accurate skill knowledge of performing CPR.
Cardiopulmonary Resuscitation* ; Education ; Humans ; Logistic Models ; Out-of-Hospital Cardiac Arrest ; Surveys and Questionnaires ; Survival Rate ; Thorax*

BACKGROUND: Many histone deacetylase (HDAC) inhibitors are well recognized as potential anti-cancer drugs. Inhibition of HDACs induces temporal transcription or epigenetic control, thus regulating many different biological responses. Here, we investigated the osteogenic effect of the HDAC inhibitor suberoylanilide hydroxamic acid (SAHA; vorinostat). METHODS: The effects of SAHA on osteoblast differentiation were examined in the 6XOSE-Luc reporter assay for determination of runt-related transcription factor 2 (Runx2) activity and alkaline phosphatase (ALP) activity and in an immunoprecipitation assay to determine the Runx2 acetylation state. The osteogenic activity of SAHA in vivo was studied in and receptor activator of nuclear factor-kappa B ligand (RANKL)-induced osteoporotic mouse model. RESULTS: SAHA increased the transcriptional activity of Runx2 in a dose-dependent manner in the 6XOSE-Luc reporter assay. SAHA by itself was unable to induce ALP activity; however, SAHA enhanced ALP activity induced by bone morphogenetic protein-2 (BMP-2). The degree of acetylation of Runx2 was increased with SAHA treatment, which suggests that the increase in Runx2 transcriptional activity might be dependent on stabilization by acetylation. Also, SAHA successfully reversed soluble RANKL-induced osteoporotic bone loss. CONCLUSIONS: Our study shows an intriguing osteogenic potential of SAHA in a BMP-2-dependent manner and suggests that SAHA could be used at lower doses along with BMP-2 to treat osteoporosis.
Acetylation ; Alkaline Phosphatase ; Animals ; Bone Morphogenetic Protein 2 ; Epigenomics ; Histone Deacetylase Inhibitors ; Histone Deacetylases ; Hydroxamic Acids* ; Immunoprecipitation ; Mice ; Osteoblasts ; Osteogenesis ; Osteoporosis ; RANK Ligand ; Transcription Factors

Background: Acanthosis nigricans is characterized by a velvety thickening of the epidermis accompanied by different degrees of hyperpigmentation, and known to be linked to obesity and insulin resistance. Objective: We aimed to analyze obesity-related factors in acanthosis nigricans patients and to evaluate the correlations between acanthosis nigricans and various factors. Methods: From January 2004 to February 2015, 27 acanthosis nigricans patients participated in this study. Blood samples were collected from a control group of seven overweight people and from the seven acanthosis nigricans patients, and they were analyzed for different obesity-related factors. Skin samples were collected from the 23 acanthosis nigricans patients and from 11 patients with epidermal nevi, and immunohistochemistry was performed to detect the presence of adiponectin receptor 1, adiponectin receptor 2, and the leptin receptor. Results: The median serum leptin level in the acanthosis nigricans patients (13 ng/mL) was significantly higher than that in the overweight control individuals (8.9 ng/mL) (p=0.021). The acanthosis nigricans patients had significantly higher levels of insulin-like growth factor-1 in their serum samples (p=0.017). The immunohistochemical analysis determined that the skin from the acanthosis nigricans patients stained significantly more intensely for the leptin receptor compared with that seen in the skin from the patients with epidermal nevi (p=0.002). Conclusion In conclusion, this study’s findings suggest that the levels of leptin and insulin-like growth factor-1 in the serum, and the expression of the leptin receptor in the skin are elevated with acanthosis nigricans.

PURPOSE: To present and evaluate a system of high-frequency oscillatory ventilator (HFOV) during intra-/inter-hospital neonate transport. METHODS: The system includes a charged HFOV (SOPHIE, Fritz Stephan GmbH, Dusseldorf, Germany), an incubator, and E-oxygen/air-cylinders with connections to the HFOV. The test lung was evaluated at the high and medium ventilator settings used for infants to determine the operating time of HFOV. The time required to exhaust the gas supply was checked, and the HFOV was operated until the low-battery alarm sounded to determine the operating time of the batteries. RESULTS: The batteries provided electrical power for at least 60 mins, and the oxygen and air-cylinders lasted at least 20 mins. The system has been used frequently for the intra-hospital transport, from delivery rooms to ICU and from ICU for surgery. The system has been used twice for the inter-hospital transport of infants with bronchopulmonary dysplasia and pulmonary hypertension to another hospital 45 km away (one hour distance). In one case, the ambulance's electrical power supply failed, causing the system failure during the last 5 mins of transport. However, with the complete check and simulation of the system and the ambulance bulk oxygen/electric supply, the second patient was transported successfully in stable condition. CONCLUSION: The system was useful for intra-/inter-hospital transport of the neonates on HFOV. For the transport time of 60 mins, fully charged HFOV, 2 E-oxygen-cylinders, and 3 E-air-cylinders seemed to be sufficient. H-oxygen-cylinder and ambulance electrical power supply should also be provided for safe and efficient transport between hospitals.
Ambulances ; Bronchopulmonary Dysplasia ; Delivery Rooms ; Electric Power Supplies ; Electricity ; Equipment Design ; High-Frequency Ventilation ; Humans ; Hypertension, Pulmonary ; Incubators ; Infant ; Infant, Newborn ; Lung ; Oxygen ; Ventilators, Mechanical

BACKGROUND: The prevalence and prognostic value of overt disseminated intravascular coagulation (DIC) in patients with septic shock presenting to emergency departments (EDs) is poorly understood, particularly following the release of a new definition of septic shock. The purpose of this study was to investigate the prevalence and prognostic value of DIC in septic shock. METHODS: We performed retrospective review of 391 consecutive patients with septic shock admitting to the ED of tertiary care, university-affiliated hospital during a 16-month. Septic shock was defined as fluid-unresponsive hypotension requiring vasopressor to maintain a mean arterial pressure of 65 mmHg or greater, and serum lactate level ≥ 2 mmol/L. Overt DIC was defined as an International Society on Thrombosis and Hemostasis (ISTH) score ≥ 5 points. The primary endpoint was 28-day mortality. RESULTS: Of 391 patients with septic shock, 290 were included in the present study. The mean age was 65.6 years, the 28-day mortality rate was 26.9%, and the prevalence of overt DIC was 17.6% (n = 51) according to the ISTH score. The median DIC score was higher in non-survivors than in survivors (5.0 vs. 2.0, p = 0.001). Significant higher risk of mortality was observed in overt DIC patients compared to those without (28.2% vs. 13.7%, p = 0.005). Multivariable logistic regression analysis identified DIC to be independently associated with 28-day mortality (odds ratio, 2.689 [95% confidence interval, 1.390-5.201]). CONCLUSIONS: Using the ISTH criteria of DIC, overt DIC in septic shock was found to be common among patients admitting to the ED and to be associated with higher mortality when it is accompanied with septic shock. Efforts are required to identify presence of overt DIC during the initial treatment of septic shock in patients presenting the the ED.
Arterial Pressure ; Consensus* ; Dacarbazine ; Disseminated Intravascular Coagulation* ; Emergencies* ; Emergency Service, Hospital* ; Hemostasis ; Humans ; Hypotension ; Lactic Acid ; Logistic Models ; Mortality ; Prevalence* ; Retrospective Studies ; Shock, Septic* ; Survivors ; Tertiary Healthcare ; Thrombosis

PURPOSE: Children with esophagitis express a variety of nonspecific symptoms and signs depending on their age, and diagnosis is limited because gastrointestinal endoscopy (GFS) and biopsy are difficult to perform. The aim of this study was to examine the prevalence of esophagitis in children with upper abdominal pain, to determine the necessity of esophageal biopsy, and to evaluate the associated risk factors. METHODS: We reviewed 266 pediatric patients with upper abdominal pain who underwent history-taking, physical examination, and GFS with esophageal and gastric biopsies between January 2006 and December 2007. Esophagitis was confirmed on biopsy. We analyzed the risk factors for histologic esophagitis and the necessity of esophageal biopsy. RESULTS: The prevalence of esophagitis was 19.9% (53/266 patients). The sensitivity and specificity of endoscopic diagnosis were 41.5% and 77%. Of 53 patients with histologic esophagitis, reflux esophagitis was seen in 50 patients, eosinophilic esophagitis was seen in 2 patients, and esophageal candidiasis was seen in 1 patient. Vomiting was a significant factor in patients under 8 yr of age (p<0.05). H. pylori infection was documented in 41.5% of patients with histologic esophagitis, compared with 58.5% of patients not infected with H. pylori (p<0.05). The possibility of histologic esophagitis was higher in patients with H. pylori infection (OR 2.5, 95% CI 1.2544 to 4.8286) and in those who visited in the spring (OR 2.5, 95% CI 1.2544 to 4.8286). CONCLUSION: We believe esophageal tissue biopsy should be performed in pediatric patients with upper gastrointestinal symptoms who are undergoing GFS and stomach tissue biopsy, especially preschoolers and H. pylori-infected children in the spring.
Abdominal Pain ; Biopsy ; Candidiasis ; Child ; Endoscopy, Gastrointestinal ; Eosinophilic Esophagitis ; Esophagitis ; Esophagitis, Peptic ; Humans ; Physical Examination ; Prevalence ; Risk Factors ; Sensitivity and Specificity ; Stomach ; Vomiting