Displaced intra-articular fractures of the calcaneus result in serious and prolonged disability. These injuries continue to pose a therapeutic challange and there remains a great deal of controversy regarding treatment, operative versus nonperative. The lateral approach for open reduction, popularized by Palmer, has been used by many authors, with high percentage of excellent results. We treated 21 displaced intra-articular fractures of the calvaneus in 18 patients by open reduction and internal fixation through the lateral approach from July 1990 to May 1992 and the patients have been followed from 12 to 36 months from the time of their injury. The clinical and radiographic analyses were as follows; 1. The most common cause of injury was falls from a height: 19 fractures in 16 patients(88.8%), Spine fracture was most commonly associated injury : 5 patients (27.8%). 2. Fracture was classified according to classification of Paley and Hall. Eight fractures were tongue type(no comminution 4, with comminution 4), 12 joint depression type(no comminution 8, with comminution 4), and a comminuted type. 3. The average bohler tuber-joint angle was
Accidental Falls ; Calcaneus ; Classification ; Congenital Abnormalities ; Depression ; Follow-Up Studies ; Foot ; Fractures, Comminuted ; Heel ; Humans ; Hypesthesia ; Intra-Articular Fractures ; Joints ; Osteomyelitis ; Spine ; Toes ; Tongue ; Transplants

Carbon monoxide (CO) poisoning is the most common cause of fatal poisoning in the United States and may be the most common worldwide cause of fatal poisoning. CO poisoning can affect the entire body and usually causes neurologic or cardiac injury. While not common, rhabdomyolysis, skeletal muscle necrosis, and renal failure can also occur. We report on a suicidal 22-year-old man who inhaled CO gas from a burning briquette. His case was complicated by compartment syndrome (CS). Finally, he had to undergo fasciotomy and removal of necrotic muscle. A CO poisoned patient who is unconscious cannot describe symptoms and moderate swelling or tenderness might be neglected. Though CS rarely appears in CO poisoning, delayed diagnosis may result in fatal consequences. Therefore, in the case of an unconscious patient, the entire body must be examined closely to identify early signs related to CS (tenderness, swelling, redness). If the diagnosis is uncertain after the clinical evaluation, the pressure within the compartment should be measured.
Burns ; Carbon Monoxide ; Carbon Monoxide Poisoning* ; Compartment Syndromes* ; Delayed Diagnosis ; Diagnosis ; Humans ; Muscle, Skeletal ; Necrosis ; Poisoning ; Renal Insufficiency ; Rhabdomyolysis ; United States ; Young Adult

Objective: In September 2018, the traffic law revision has enforced all passengers in cars to wear seatbelts. Our study aims to investigate the effects of this law revision on fellow passengers involved in car accidents by considering their seatbelt-wearing rate and severity score. Methods: This study is a retrospective observational study. Data were collected from the Emergency Department-based Injury in-depth Surveillance (for the years 2017 and 2019), Korea Disease Control and Prevention Agency. Candidates were patients who visited emergency rooms (ERs) of 23 hospitals from January to December in the years 2017 and 2019. Patients under the age of 15 years or without Excess Mortality Ratio-adjusted Injury Severity Score (EMR-ISS) data or having accidents on highways were excluded. Results: The total number of patients who visited ERs during the study periods was 91,506 and 14,806 in 2017 and 2019, respectively, and were included in our study. There were more fellow female passengers than male passengers during both the study periods: 5,559 in 2017 (67.9%) and 4,341 in 2019 (66.8%). Compared to 52.2% in 2017, the rate of wearing seatbelts increased to 54.5% in 2019. However, after adjusting for age, sex, use of ambulance, injury time, alcohol use, type of road, and counterpart, multivariate logistic regression revealed that compared to the 2017 group, the odds ratio of severe injuries in the 2019 group was 1.10 (95% confidence interval, 0.98-1.24). Conclusion Increased rate of wearing seatbelts after imposing the traffic law revision was not satisfactory. Therefore, it is necessary to tighten regulations on fellow passengers without seat belts and improve awareness through public relations.

PURPOSE: This study aimed to compare cerebral hemispheric volumes between pharmacologic treatment and supportive management of patent ductus arteriosus (PDA). METHODS: The study was conducted retrospectively. The subjects of period 1 group were very low birth weight infants whose PDA were treated with pharmacologic closure. Period 2 group were treated with supportive management. Regional brain volumes measured using magnetic resonance imaging were compared between the two groups. RESULTS: total of 12 infants were included. Their median gestational age was 27⁺⁶ (range: 24⁺¹–31⁺¹) weeks and birth weight was 1,065 g (range: 690–1,380). Between the two groups, there was no difference in Apgar score, incidence of bronchopulmonary dysplasia, necrotizing enterocolitis, and culture proven sepsis. The regional brain volumes such as gray matter (Period 1 group, 76,833 mm³ [55,759–100,388] vs. Period 2 group, 79,870 mm³ [59,957–113,018], P=0.59), white matter (82,993 mm³ [63,130–121,311] vs. 92,576 mm³ [77,200–104,506], P=0.18), cerebrospinal fluid (17,167 mm³ [9,279–22,760] vs. 14,348 mm³ [7,018–27,604], P=0.94), basal ganglia (2,065 mm³ [1,697–2,482] vs. 2,306 mm³ [2,065–3,009], P=0.18), and cerebellum (18,374 mm³ [14,843–24,657] vs. 18,096 mm³ [16,134–23,627], P=0.94) were not different between the two groups. CONCLUSION: Regional brain volumes were not different between pharmacological and conservative treatment in infants with PDA. Further wellcontrolled studies are required to evaluate the advantages or disadvantages of supportive management without pharmacologic treatment of PDA.
Apgar Score ; Basal Ganglia ; Birth Weight ; Brain* ; Bronchopulmonary Dysplasia ; Cerebellum ; Cerebrospinal Fluid ; Ductus Arteriosus, Patent* ; Enterocolitis, Necrotizing ; Gestational Age ; Gray Matter ; Humans ; Ibuprofen* ; Incidence ; Infant* ; Infant, Newborn ; Infant, Premature ; Infant, Very Low Birth Weight* ; Magnetic Resonance Imaging ; Pilot Projects* ; Retrospective Studies ; Sepsis ; White Matter

Angiofibroma is a rare disease that is diagnosed typically in adolescent male patients as a nonencapsulated, submucosal spreading tumor. Because these tumors are highly vascular, embolization and surgery remain as the two major therapeutic tools. For reducing the blood supply of the tumor and decreasing intraoperative bleeding, embolization has become an effective preoperative procedure. There are two embolization methods which are intravascular and intratumoral embolization. Recently, we experienced two cases of nasopharyngeal angiofibroma that were resected by endoscopic approach after intraoperative serial intratumoral embolization with good results. We report these with a review of literature.
Adolescent ; Angiofibroma* ; Endoscopy ; Hemorrhage ; Humans ; Male ; Preoperative Care ; Rare Diseases

Background: The prognostic consequences of transient hemodynamic deterioration due to cardiac displacement, which is most severe during left circumflex artery (LCX) grafting in off-pump coronary artery bypass surgery (OPCAB) are unknown. This study aimed to investigate the association between mixed venous oxygen saturation (SvO2) < 60% during LCX grafting and the occurrence of composite of morbidity endpoints. Methods: Data of patients who underwent elective OPCAB between January 2010 and December 2019 were reviewed. Logistic regression analysis was performed to detect risk factors for the composite of morbidity endpoints, defined as 30-day or in-hospital mortality, postoperative myocardial infarction, prolonged mechanical ventilation > 24 h, cerebrovascular accident, and acute kidney injury. Results: Among 1,071 patients, the composite of morbidity endpoints occurred in 303 (28%) patients. SvO2 < 60% during LCX grafting was significantly associated with the composite of morbidity (OR: 2.72, 95% CI [1.60, 4.61], P < 0.001) along with advanced age, chronic kidney disease, ratio of early mitral inflow velocity to mitral annular early diastolic velocity, and EuroSCORE II. Other major hemodynamic variables including the cardiac index were not associated with the outcome. Additional regression analysis revealed pre-operative anemia as a predictor of SvO2 < 60% during LCX grafting (OR: 2.09, 95% CI [1.33, 3.29], P = 0.001). Conclusions A decrease in SvO2 < 60%, albeit confined to the period of cardiac displacement, was associated with a 2.7-fold increased risk of detrimental outcomes after OPCAB, implying the prognostic importance of this transient deterioration in oxygen supply-demand balance.

No abstract available.
Leukemia* ; Sweet Syndrome*

OBJECTIVES: The objective of this study was to identify the possible role of stem cell and myeloperoxidase (MPO) in the metabolic activation of styrene, hydroquinone and trichloroethylene, by investigating the effects of stem cell from umbilical cord blood and MPO on the frequency of sister chromatid exchange (SCE) and micronuclei (MN) induction in cultured human peripheral lymphocytes exposed to these chemicals. METHODS: Isolated lymphocytes from whole blood were cultured for 72 hours. The cells were treated with 1.50 mM styrene, 50 microM hydroquinone and 1.50 mM trichloroethylene dissolved with acetone (30 microl in total volume) at 24 hours after the beginning of culture. Control group was treated with acetone only. Immediately after adding these chemicals, 1.3X1 06 cells/ml and 2.6X1 06 cells/ml stem cell or 1.0 and 2.0 unit MPO with H2O2 (for substrate) were added to the cultures. Slides were stained with Giemsa's solution, and acridine orange for sister chromatid exchange, and for micronucleus analysis, respectively. RESULTS: The results were as follows: 1) Myeloperoxidase and stem cell did not significantly affect the frequencies of SCE or MN in the control group. 2) The frequency of SCE or MN with exposure to styrene did not different from control in the absence of stem cell or MPO. Sister chromatid exchange induced by styrene was significantly increased by adding stem cell or MPO in dose-dependent relationship. The frequency of MN induced by styrene significantly increased in the presence of 2.0 unit MPO. 3) The frequency of SCE was significantly increased with exposure to hydroquinone than acetone treated control in the absence of stem cell or MPO. Sister chromatid exchange induction by hydroquinone significantly increased dose-dependently in the presence of stem cell or MPO. There was a tendency of increase of the MN frequency induced by hydroquinone in the presence of stem cell or MPO, but not significant. 4) It was found that trichloroethylene itself did not increase SCE or MN frequency. Frequency of SCE induced by trichloroethylene was significantly increased with adding stem cell (low and high) and 2.0 unit MPO. Even though stem cell or MPO increased the frequency of MN of lymphocyte exposed to trichloroethylene, the difference was not significant. CONCLUSIONS: Authors found that the frequencies of both sister chromatid exchange and micronucleus induced by styrene, hydroquinone, and trichloroethylene were increased significantly with the treatment of stem cell or myeloperoxidase. It was suggested that myeloperoxidase may therefore play an important role in the metabolic activation of styrene, hydroquinone, and trichloroethylene and myeloperoxidase probably be involved in the myelotoxicity of these chemicals.
Acetone ; Acridine Orange ; Biotransformation ; Fetal Blood ; Humans ; Lymphocytes* ; Peroxidase* ; Siblings* ; Sister Chromatid Exchange* ; Stem Cells* ; Styrene* ; Trichloroethylene*

PURPOSE: This study evaluated the efficacy and positive influences of a critical event monitoring system (CEMS), which is an automatic alerting system for patients with critical laboratory results. METHODS: We compared various patient data variables with hyperkalemia during the 1 year before and after CEMS, which was initiated in July 2007 (Before group: July 2006~June 2007, After group: July 2007~June 2008). RESULTS: A total of 2,417 patients had severe hyperkalemia (K+> or =6.5 mmol/L) during the period. Of the 2,417, 1680 were excluded, Leaving 389 patients to be enrolled in the 'before group' and 348 in the 'after group'. Baseline characteristics were similar between the two groups. Although the load of work for the medical staff increased during the period when CEMS was begun, the time interval from critical laboratory results to appropriate treatment decreased (72.68+/-94.03 vs. 70.07+/-92.28 minutes) as did the length of hospital stays (20.27+/-27.01 vs. 17.03+/-26.89 days). These decreases were not statistically significant. Decreases in time interval and hospital stay were more prominent for patients treated in the ICU and by emergency physicians during the day time. Mortality within 48 hours (19.5 vs. 19.5%) did not change after beginning CEMS. Mortality in the ICU (2.04 vs. 1.94%, p=0.046) decreased after beginning CEMS. CONCLUSION: Information technology strategies such as using CEMS may be an effective tool for improving the quality of medical care. But we must also consider other factors such as work load of the medical staff which also influence the quality of medical care.
Clinical Laboratory Information Systems ; Critical Care ; Emergencies ; Humans ; Hyperkalemia ; Length of Stay ; Medical Staff ; Quality of Health Care ; Sulfides

Purpose: The aim of this study was to analyze the age group characteristics and factors associated with the severe trauma in children who visited a regional trauma center. Methods: We reviewed children aged 18 years or younger who visited a regional trauma center, equivalent to level 1 trauma centers in the United States, in Incheon, Korea from July 2014 through December 2019. They were classified by the age groups: preschoolers (0-6 years), schoolers (7-12 years), and adolescents (13-18 years). Across the 3 age groups, event profiles, severity, and outcomes of injury were compared. Multivariable logistic regressions were used to identify factors associated with the severe trauma, defined as the Injury Severity Score of 16 or higher. Results: Among the total of 367 children, 74 (20.2%) were preschoolers, 73 (19.9%) were schoolers, and 220 (59.9%) were adolescents. The most common injury mechanisms in the preschoolers, schoolers, and adolescents were fall (40.5%), pedestrian collision (32.9%), and motorcycle accident (38.6%), respectively. The adolescents had the highest median Injury Severity Score (13 [6-23]; P < 0.001). In the multivariable analyses, the Glasgow Coma Scale of 3-8 (odds ratio [OR], 14.60; 95% confidence interval, 5.40-39.42) had the highest OR for severe trauma, followed by injury in the abdomen or pelvic contents (OR, 11.61; 95% confidence interval, 4.66-28.89). Conclusion In pediatric trauma, the mechanism and severity of injury may differ according to age groups, with the severe trauma associated with injuries to the head and torso. It is advisable to have age group-specific approaches and strategies for injury prevention.