Nipple reconstruction methods include various techniques, such as the local flap technique, free nipple grafting, and filler injection. The local flap technique can provide less donor site morbidity than a free nipple graft, but leaves an additional scar near the nipple. We present a novel method for reconstruction of the nipple using a flap located on one side of the nipple. The flap has a teardrop shape consisting of a circle and two wings folded to one side. The two wings form a pillar and cap, and the de-epithelialized tip of one wing fills the internal dead space of the new nipple. We applied this nipple reconstruction technique in the case of a 61-year-old patient who had a vertical scar due to inverted-T reduction mammoplasty. The patient had lost her nipple in previous breastconserving surgery. The immediate postoperative nipple projection was 10 mm. At the 7-month follow-up visit, the nipple projection was 7.5 mm. The teardrop flap is an innovative technique that leaves no additional scar by using the scar already present on one side of the nipple.

Lightning injury can cause systemic deterioration, including neurologic deficits. We present a case of lightning injury with reversible neurologic deficits in a 49-year-old man. Clinical manifestations of neurologic deficits due to lightning injury vary from lightheadedness to paralysis. In order to achieve a favorable outcome, immediate respiratory support and careful neurologic examinations are key elements during initial resuscitation. If secondary injuries due to any type of trauma following lightning were suspected, emergency physicians should make a decision regarding use of advanced diagnostic and therapeutic modalities.
Dizziness ; Emergencies ; Humans ; Lightning Injuries* ; Lightning* ; Middle Aged ; Neurologic Examination ; Neurologic Manifestations* ; Paralysis ; Resuscitation

PURPOSE: Electrocardiographic findings such as Tp-Te interval, Tp-Te dispersion, and Tp-Te/QT ratio could be used to predict dysrhythmic events regarding any kind of toxic materials. We investigated the prevalence of cardiac toxicity related to acute carbon monoxide (CO) poisoning and the characteristics of electrocardiographic changes corresponding to the severity of intoxication. METHODS: This retrospective observational study was conducted with 113 patients of acute CO poisoning from May, 2013 to July, 2014. Myocardial injury (MI) was determined based on an elevation of serum troponin T within the first 24 hours of the ED visit. The study population was classified according to Acute Neuropsychiatric Status (ANS) scoring: a mild intoxication group (ANS scores 0 and 1) and a severe intoxication group (ANS scores 2 and 3). RESULTS: Prevalence of MI was higher in the severe intoxication group of acute CO poisoning (p<0.001). QTc was significantly prolonged in the MI group (p=0.007). However, no differences in other electrocardiographic parameters were observed between MI group and non-MI group. CONCLUSION: Myocardial injury was combined more frequently with a severe intoxication group of acute CO poisoning compared to a mild intoxication group. A specific feature of eletrocardiogram in myocardial injury with acute CO poisoning was a QTc prolongation.
Carbon Monoxide Poisoning* ; Carbon Monoxide* ; Carbon* ; Electrocardiography* ; Humans ; Observational Study ; Poisoning ; Prevalence ; Retrospective Studies ; Troponin T

OBJECTIVE: Regionalization is one of the principal subjects for the advancement of rural emergency medical service systems in South Korea. This study shows the characteristics of interhospital transfer and status of the incidence of three major emergency disorders (acute myocardial infarction [AMI], acute stroke, and severe trauma) in one local province. METHODS: A retrospective study was conducted for patients with three major emergency disorders who visited emergency medical facilities in one local province from January 2013 to December 2015, on the basis of the National Emergency Department Information System (NEDIS) data. RESULTS: The incidence of three major emergency disorders had increased annually. Patients with each of these disorders tended to choose distinguishing methods of visiting emergency medical facilities. AMI patients tended to visited emergency medical facilities using private cars or on foot, while severe trauma patients usually visited by 119 ambulance, and acute stroke patients used 119 ambulance and private car in similar amounts. Overall, 65% of AMI patients were treated in intraregional medical facilities, but about 70% of acute stoke and severe trauma patients were transferred outside of the region. CONCLUSION: Because each of these disorders has an individual characteristic, it is difficult to expect a solution for the problems associated with emergency disorders just by assuring the availability of medical resources. Based on regionalization, a policy to provide the optimal treatment for those emergency disorders should be developed by planning public medical service systems based on the individual characteristics of emergency disorders, the standardized transfer plans of emergency patients and the assurance for mobilization and sharing of confined medical resources.
Ambulances ; Chungcheongnam-do* ; Emergencies* ; Emergency Medical Services ; Emergency Service, Hospital* ; Foot ; Humans ; Incidence ; Information Systems ; Korea ; Myocardial Infarction ; Patient Transfer ; Retrospective Studies ; Stroke

Objective: This study analyzed the impact of the coronavirus disease 2019 (COVID-19) pandemic on emergency care utilization in Chungnam Province by examining the status of emergency care utilization during this period. Methods: This study retrospectively analyzed 154,946 patients who visited emergency medical institutions in Chungnam Province for a major emergency between January 2015 and December 2021, using the National Emergency Department Information System data. Results: The incidence of the The three major emergency diseases are acute myocardial infarction (AMI), acute stroke, severe trauma decreased. Primary visits to the regional and local emergency medical centers increased, except for local emergency medical institutions. The utilization rate of the 119 ambulance service in 2020 decreased significantly for AMI compared to the previous year and was the lowest among the three major emergency diseases. Air transportation by helicopter decreased during the COVID-19 pandemic. The rate of emergency room arrivals within the golden hour decreased during the COVID-19 pandemic. The transfer and retransfer rates also decreased for all three major emergency diseases. Despite the decreased number of patients during the pandemic, the ratio of primary visits to the local emergency medical centers for the three major emergency diseases increased, and the lengths of stay in the emergency room increased. Conclusion The COVID-19 pandemic significantly impacted the occurrence, transportation, and therapeutic response to the three major emergency diseases in Chungnam Province. The vulnerability of patients with AMI in the pre-pandemic era was further exacerbated during the pandemic.

PURPOSE: An accurate, objective scoring system to assess the severity of community-acquired pneumonia (CAP) could be helpful to physicians in predicting patient mortality and improving decisions regarding hospitalization. However reports on the severity scoring system for prediction of mortality in patients with CAP in Korea are rare. The aim of this study was to propose a new modified severity scoring system based on a previously validated A-DROP for CAP and to compare it with pneumonia severity index (PSI), CURB- 65 and A-DROP. METHODS: The medical records of 364 patients admitted with CAP via ED from January 2013 through August 2014 were reviewed retrospectively. The demographic data, comorbidities, laboratories, PSI class, CURB-65 score, and A-DROP score were reviewed. The authors investigated a modification factor by comparing the survivors with the nonsurvivors. RESULTS: The study subjects were composed of 264 men and 100 women, with a mean age of 66.2+/-15.2 years. The overall 30-day mortality was 9.6%. The areas under the receiver operating characteristic (ROC) curves for prediction of 30-day mortality in patients with CAP were 0.803 (95% confidence interval (CI): 0.739-0.868), 0.734 (95% CI: 0.652-0.816) and 0.747 (95% CI: 0.662-0.833) for PSI, CURB-65 and A-DROP respectively. The new DROP-70 scoring system which includes age> or =70 years is a simple modified version of the A-DROP. The area under the ROC curves of DROP-70 was 0.774 (95% CI: 0.698-0.850). CONCLUSION: A new severity scoring system, DROP-70, could be a useful index for predicting 30-day mortality in patients with community-acquired pneumonia.
Comorbidity ; Female ; Hospitalization ; Humans ; Korea ; Male ; Medical Records ; Mortality ; Pneumonia* ; Prognosis* ; Retrospective Studies ; ROC Curve ; Survivors

Background: Subdermal shaving is a surgical procedure for the treatment of axillary osmidrosis. In this procedure, a direct axillary incision is made, and the apocrine glands are removed. Insufficient subcutaneous tissue removal during subdermal shaving can lead to recurrence due to the presence of remaining apocrine glands, while excessive removal can injure the subdermal plexus and cause skin necrosis. We measured the depth of the apocrine glands from the basement membrane of the epidermis to develop a quantitative method of determining the thickness of the skin flap to be removed. Methods: A chart review of patients who underwent subcutaneous shaving to treat osmidrosis between 2012 and 2019 was performed. Axillary subcutaneous tissues were harvested from five randomly chosen patients with osmidrosis before and after surgery. The apocrine gland depth was then measured via immunofluorescence (IF) staining of the collected tissues. A questionnaire was administered to 10 of the patients to investigate postoperative outcomes. Results: Of the 47 total patients, six (12.8%) experienced recurrence, seven (14.9%) had complications, four (8.5%) had skin necrosis, two (4.3%) had hematomas, and one (2.1%) had an infection. One patient underwent reoperation due to hematoma. IF staining revealed the mean distance from the basal layer of the epidermis to the apocrine glands to be 1.4312±0.8064 mm. On the questionnaire, the mean patient rating of axillary odor was 8.6 pre-surgery and 4.4 post-surgery. Conclusions During subdermal shaving, the subcutaneous tissue must be preserved up to 14.312±8.064 mm from the epidermal basement membrane to remove the apocrine glands while preserving the subdermal plexus.

PURPOSE: Acute traumatic subdural hematoma (SDH) increases after severe traumatic brain injury (TBI) and leads to high mortality. The time to operation is a correctable prognostic factor in TBI, but the timing of hematoma evacuation still remains controversial. We assessed the correlation between operative timing and mortality in traumatic acute SDH. METHODS: We conducted a retrospective study over an 8-year period in 163 surgical patients with acute traumatic SDH. Information was obtained about demographic, clinical, and radiological findings, surgical management, and mortality at discharge. RESULTS: Overall, 85 patients (52.1%) died, and 47 patients (28.8%) showed good recovery. The patients who underwent earlier surgery were more likely to have severe head injury. The time to operation in patients that died was shorter than patients with good recovery. The mean time for evacuation [Ed-Is this the same as time to surgery, or is this specifically when the hematoma was removed? Please clarify.] was 351.7+/-220.5 minutes in patients who died and 395.5+/-363.3 minutes in patients with good recovery. Patients undergoing surgery within 4 hours of injury had a mortality rate of 54.4% versus 50.9% receiving surgery after 4 hours. But the risk ratio for time spent to surgery increased until 240 minutes and then decreased. Logistic regression on patients with 240 minutes until surgery showed that the probability of death increased with time to surgery. CONCLUSION: Patients who undergo surgery within 180 minutes after injury have a lower probability of death than those with delayed surgery.
Brain Injuries ; Craniocerebral Trauma ; Hematoma ; Hematoma, Subdural ; Hematoma, Subdural, Acute ; Humans ; Logistic Models ; Odds Ratio ; Retrospective Studies

Central venous catheterization can have many complications. A pneumothorax, hemothorax, hemomediastinum, air embolism, cardiac tamponade, and major vascular laceration are complications that can be induced by internal jugular venous catheterization. A patient with Marfan syndrome had a soft connective tissue and variable characteristic major vascular anomaly. We report a case of an acute lethal extrapleural hematoma in a 14-year old female with Marfan syndrome resulting from a laceration of the subclavian artery during internal jugular venous catheterization.
Adolescent ; Cardiac Tamponade ; Catheterization* ; Catheterization, Central Venous ; Catheters* ; Central Venous Catheters ; Connective Tissue ; Embolism, Air ; Female ; Hematoma* ; Hemothorax ; Humans ; Lacerations* ; Marfan Syndrome ; Pneumothorax ; Subclavian Artery*

Central venous catheterization can have many complications. A pneumothorax, hemothorax, hemomediastinum, air embolism, cardiac tamponade, and major vascular laceration are complications that can be induced by internal jugular venous catheterization. A patient with Marfan syndrome had a soft connective tissue and variable characteristic major vascular anomaly. We report a case of an acute lethal extrapleural hematoma in a 14-year old female with Marfan syndrome resulting from a laceration of the subclavian artery during internal jugular venous catheterization.
Adolescent ; Cardiac Tamponade ; Catheterization* ; Catheterization, Central Venous ; Catheters* ; Central Venous Catheters ; Connective Tissue ; Embolism, Air ; Female ; Hematoma* ; Hemothorax ; Humans ; Lacerations* ; Marfan Syndrome ; Pneumothorax ; Subclavian Artery*