We have investigated the effect of cholestasis on the hepatic thiosulfate sulfurtransferase (rhodanese) and UDP-glucuronosyltransferase (UDP-GT) activities in rats. Rhodanese activities in the liver cytosol, mitochondria and microsomal fractions as well as in the rat serum, and UDP-GT activity in the microsome have been investigated for a period of 42 days after common bile duct (CBD) ligation. The cytosolic rhodanese activity showed a significant decrease between the first through the 42nd day, and the mitochondrial activity showed a significant decrease between the 7th through the 42nd day after CBD ligation compared to the activities from the sham operated control, respectively. In the case of microsomal preparation, both rhodanese and UDP-GT also showed significant decrease in their activities after the ligation for the former enzyme between the 14th and the 42nd days, and for the latter enzyme between the third and 42nd days, respectively. On the other hand, the serum rhodanese activity increased markedly soon after the ligation, exhibiting the peak activity after 1 day of CBD ligation with about 4.6-fold increment. The activity subsequently decreased gradually reaching to the control level at the 42nd day post-ligation. Enzyme kinetic parameters of hepatic rhodanese and UDP-GT were analyzed using sodium thiosulfate and p-nitrophenol as substrates, respectively, with the preparations from the 28th day post-ligation. The results indicated that although the K-m values of these enzymes were about the same as the sham-operated control, the V-max values of the both enzymes decreased significantly. These results, therefore, suggest that the biosynthesis of rhodanese and UDP-GT have been reduced in response to cholestasis, and that the elevation of rhodanese activity in the serum is most likely due to leakage from the liver subsequent to CBD ligation.
Animals ; Cholestasis ; Common Bile Duct* ; Cytosol ; Hand ; Ligation* ; Liver* ; Microsomes ; Mitochondria ; Rats* ; Sodium ; Thiosulfate Sulfurtransferase*

PURPOSE: We wanted to evaluate the actual work patterns of residents and nurses and the effects of controlling visits by relatives on the mortality of patients and their length of stay and on the workload of the residents and nurses. METHODS: We investigated the actual workload of the residents who worked 12 hours shifts and nurses who worked 8 hours shifts in an emergency center for two weeks. We compared the mortality of the patients, the length of their stay and the work patterns between before we controlled visits by relatives and after we controlled visits by relatives. RESULTS: On the average, residents spent 407.01 minutes (56.5%) taking care of patients for a shift (720 min.) and nurses spent 305.29 minutes (63.6%) taking care of patients for a shift (480 min.). Although we controlled visits by relatives, we're unable to reduce the patient mortality and the length of their stay. Yet we were able to reduce the unnecessary repeated explanation-time, the resting time and the nurses and residents were able to better concentrate to explain to patients or their relatives. We were also able to increase the treatment time and description time, and especially for residents. Nurses spent 71.86 minutes (15.0%) to take a rest a shift, and residents spent 166.40 minutes (23.1%) resting a shift (p=0.01). CONCLUSION: To reduce unnecessary repeated explanation-time and the resting time and to allow nurses and residents to better concentrate when explaining to patients or their relatives, and also to increase the treatment and description time, controlling relatives in an emergency center is necessary.
Emergencies ; Humans ; Length of Stay

Delayed hemothorax after blunt torso injury is rare, but might be associated with significant morbidity and mortality. We present a case of delayed hemothorax bleeding from phrenic artery injury in a 24-year-old woman. The patient suffered from multiple rib fractures on the right side, a right hemopneumothorax, thoracic vertebral injury and a pelvic bone fracture after a fall from a fourth floor window. Delayed hemothorax associated with phrenic artery bleeding, caused by a stab injury from a fractured rib segment, was treated successfully by a minimally invasive thoracoscopic surgery. Here, we have shown that fracture of a lower rib or ribs might be accompanied by delayed massive hemothorax that can be rapidly identified and promptly managed by thoracoscopic means.
Accidental Falls ; Female ; Hemothorax/*complications/surgery ; Humans ; Rib Fractures/complications/*diagnosis ; Thoracic Arteries/diagnostic imaging ; Time Factors ; Young Adult

BACKGROUND: We hypothesized that the direction of the J-tip of the guidewire during insertion into the internal jugular vein (IJV) might determine its ultimate location. METHODS: In this study, 300 patients between the ages of 18 and 99 years who required central venous catheterization via IJV in the emergency department enrolled for randomization. IVJ catheterization was successful in 285 of 300 patients. An independent operator randomly prefixed the direction of the J-tip of the guidewire to one of three directions. Based on the direction of the J-tip, patients were allocated into three groups: the J-tip medial-directed group (Group A), the lateral-directed group (Group B), or the downward-directed group (Group C). Postoperative chest radiography was performed on all patients in order to visualize the location of the catheter tip. A catheter is considered malpositioned if it is not located in the superior vena cava or right atrium. RESULTS: Of the total malpositioned catheter tips (8 of 285; 2.8%), the majority (5 of 8; 62.5%) entered the contralateral subclavian vein, 2 (25.0%) were complicated by looping, and 1 (12.5%) entered the ipsilateral subclavian vein. According to the direction of the J-tip of the guidewire, the incidence of malpositioning of the catheter tip was 4 of 92 in Group A (4.3%), 4 of 96 in Group B (4.2%), and there were no malpositions in Group C. There were no significant differences among the three groups (p = 0.114). CONCLUSIONS: The direction of the J-tip of the guidewire had no statistically significant effect on incidence of malpositioned tips.
Catheterization ; Catheterization, Central Venous ; Catheters* ; Central Venous Catheters ; Emergency Service, Hospital ; Heart Atria ; Humans ; Incidence ; Jugular Veins* ; Radiography ; Random Allocation ; Subclavian Vein ; Thorax ; Vena Cava, Superior

PURPOSE: Many patients in South Korea are brought to hospitals by ambulance. As such, bacterial contamination within the ambulance and their critical or semi-critical equipment may be dangerous, especially for immunocompromised patients. No previous studies have examined the distribution patterns of pathogenic bacteria in ambulances or the bacterial contamination rate associated with riding in an ambulance in South Korea. The purpose of this study was to determine the distribution of pathogenic bacteria species in ambulances, and to investigate the bacterial contamination rate associated with ambulances and their equipment, in South Korea. METHODS: Thirty ambulances (17 from private facilities and 13 from regional emergency centers) were enlisted for this study. We took 955 swabs and isolated the resulting bacteria. We surveyed the intervals between cleaning and disinfecting of the ambulances and their equipment. We compared the distributional of the bacterial species, following Spaulding's classification, between critical equipment (CE), semi-critical equipment (SCE) and non-critical equipment (NCE) in the ambulances, using the chi-square test. RESULTS: The ambulances were cleaned and disinfected every 5 and 8 days, respectively. The equipment was cleaned and disinfected once every 22 and 30 days, respectively. Of the 955 swabs, 159 (16.6%) were found to be contaminated by bacteria. Fourteen pathogenic bacteria were isolated from the CE and SCE, but no methicillin-resistant or vancomycin-resistant bacteria were found. CONCLUSION: Approximately 16.6% of the ambulances and their equipment were contaminated by bacteria, and pathogenic bacteria were found on both CE and SCE. Consequently, in South Korea, we find a risk associated with the hazard presented by bacterial contamination in ambulance CE and SCE.
Ambulances ; Bacteria ; Emergencies ; Humans ; Immunocompromised Host ; Methicillin Resistance ; Republic of Korea

PURPOSE: Many patients in South Korea are brought to hospitals by ambulance. As such, bacterial contamination within the ambulance and their critical or semi-critical equipment may be dangerous, especially for immunocompromised patients. No previous studies have examined the distribution patterns of pathogenic bacteria in ambulances or the bacterial contamination rate associated with riding in an ambulance in South Korea. The purpose of this study was to determine the distribution of pathogenic bacteria species in ambulances, and to investigate the bacterial contamination rate associated with ambulances and their equipment, in South Korea. METHODS: Thirty ambulances (17 from private facilities and 13 from regional emergency centers) were enlisted for this study. We took 955 swabs and isolated the resulting bacteria. We surveyed the intervals between cleaning and disinfecting of the ambulances and their equipment. We compared the distributional of the bacterial species, following Spaulding's classification, between critical equipment (CE), semi-critical equipment (SCE) and non-critical equipment (NCE) in the ambulances, using the chi-square test. RESULTS: The ambulances were cleaned and disinfected every 5 and 8 days, respectively. The equipment was cleaned and disinfected once every 22 and 30 days, respectively. Of the 955 swabs, 159 (16.6%) were found to be contaminated by bacteria. Fourteen pathogenic bacteria were isolated from the CE and SCE, but no methicillin-resistant or vancomycin-resistant bacteria were found. CONCLUSION: Approximately 16.6% of the ambulances and their equipment were contaminated by bacteria, and pathogenic bacteria were found on both CE and SCE. Consequently, in South Korea, we find a risk associated with the hazard presented by bacterial contamination in ambulance CE and SCE.
Ambulances ; Bacteria ; Emergencies ; Humans ; Immunocompromised Host ; Methicillin Resistance ; Republic of Korea

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

Pulmonary barotrauma during ascent is a common complication in SCUBA diving. One of the most severe forms of pulmonary barotrauma is a cerebral arterial gas embolism(CAGE). It is reported to account for about 30% of diving related deaths. The early recognition of CAGE is very important for the emergency physician because prompt hyperbaric recompression therapy can improve the clinical course. Thus, the emergency physician should know the clinical manifestation of CAGE to apply several treatment modalities early. We report a case of cerebral arterial gas embolism presented with hemiparesis and blurred vision immediately after SCUBA diving at 13 meters.
Barotrauma ; Diving* ; Embolism, Air* ; Emergencies ; Paresis

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