BACKGROUND: Although diagnostic peritoneal lavage (DPL) is a well-established, reliably objective method of diagnosis of intraperitoneal injury, it is too sensitive to be used as a absolute indicator for emergency laparotomy. Recently, Otomo et al, have devised a new DPL criteria specifically designed and modified the classics criteria to aid in diagnosis of intestinal injury. So the author studied the difference of diagnostic sensitivity, specificity, and accuracy between the new and classic criteria for intestinal injury. METHODS: The author reviewed retrospectively one hundred fifteen patients underwent DPL from January 1993 to August 1999. The author adopted the classic criteria positive for intestinal injury when the lavage fluid was white blood cell(WBC) > or = 500/mm3 and newly developed supplementary criteria positive when RBC > or = 100,000/mm3, the positive-negative borderline was adjusted to WBC > or = RBC/150, and when RBC <100,000/mm3, to WBC > or = 500/mm3. And analyzed the difference of sensitivity, specificity, and accuracy each other. RESULTS: Among 115 patients, the sensitivity, specificity, and accuracy for intestinal injury were 96.4%, 87.4%, and 89.6% for the new criteria, and 100%, 42.5%, and 56.5% for the classic criteria. After exclusion of 10 patients in whom-DPL was performed within 3 hours or after 18 hours from the time of injury, the sensitivity, specificity and accuracy for intestinal injury were 96.4%, 97.4%, and 97.1% for the new criteria, and 100%, 46.8%, and 61% for the classic criteria. When analyzed the time interval from injury to DPL in the new criteria, 105 patients that DPL was performed between 3 to 18 hours had 2 false-positive, while 115 patients regardless of DPL time 11 false-positive. CONCLUSIONS : The author concluded that the new criteria of DPL effluent performed between 3 to 18 hours from abdominal blunt trauma would be more specific and accurate indicator of intestinal perforation than the classic criteria. And this new criteria will be used as a reliable indicator for emergency laparotomy for that patients.
Diagnosis ; Emergencies ; Humans ; Intestinal Perforation ; Laparotomy ; Peritoneal Lavage* ; Retrospective Studies ; Sensitivity and Specificity ; Therapeutic Irrigation

Objective: This study aimed to analyze the clinical characteristics of patients with acute glufosinate ammonium (GLA) poisoning and investigate the indicators associated with the severity of neurotoxicity in GLA-poisoned patients. Methods: We retrospectively collected the data of patients who were admitted due to GLA poisoning from 2018 to 2022, to gather the factors that could influence neurologic outcomes. These outcomes were estimated based on the Glasgow Coma Scale (GCS) scores at admission, the worst GCS score during impaired consciousness, the GCS score at discharge, and the presence and duration of seizures. Results: Among the 67 GLA-poisoned patients, the average GCS score at admission was 13.8±2.6 points, the worst GCS score recorded was 11.2±3.5 points, and the GCS score at discharge was 13.7±2.9 points. The factors significantly influencing the GCS score at the initial admission included respiration rate, saturation, white blood cell count, and pH (P=0.037, P=0.005, P=0.021, and P=0.001, respectively). Factors affecting the worst GCS score included age, diastolic blood pressure, platelet count, blood urea nitrogen (BUN), and pH (P=0.001, P=0.016, P=0.015, P=0.002, and P<0.001, respectively). The GCS score at discharge exhibited significant correlations with age, BUN, and pH (P<0.001, P<0.001, and P=0.011, respectively). The average age of the patients who experienced seizures after GLA poisoning was significantly higher at 75.1±12.9 years compared to that of patients without seizures (mean age, 65.0±15.2 years; P=0.006). Additionally, the average bicarbonate level was lower in patients with seizures, measuring 19.0±4.7 mmol/L, when compared with that of patients without seizures (average, 21.4±4.3 mmol/L; P=0.045). Conclusion The elderly, metabolic acidosis, and elevated BUN could serve as good indicators for adverse neurological outcomes in GLA-poisoned patients.

Objective: This study aimed to clarify the relationship between several viral infections and clinical features of febrile seizures. The clinical expression pattern was determined according to the virus. Methods: Data were collected on patients who visited the emergency room with febrile seizures from March 2016 to February 2019. The clinical characteristics of seizures and the clinical differences between each respiratory viral infection were analyzed. The severity of febrile seizures was measured by checking complex febrile seizures and electroencephalogram abnormalities. Results: Of the 227 febrile convulsions, 138 (60.8%) were men, and 89 (39.2%) were women. Sixty-five patients (28.6%) had a family history of febrile seizure, 68 (30.0%) had complex seizures, and 13 (7.1%) had electroencephalogram (EEG) abnormalities. Of the 13 respiratory viruses examined, rhinoviruses were detected more significantly in 63 patients (32.4%), but there was no significant difference when comparing the rate of febrile seizure among patients with fever. There were no significant differences in the clinical features, such as body temperature, duration, and complex seizure. In addition, each virus showed a similar incidence of EEG abnormalities. Conclusion No significant difference in the clinical features and objective examination according to the virus were observed, and the tendency of developing febrile seizures is similar.

Objective: This study aimed to clarify the relationship between several viral infections and clinical features of febrile seizures. The clinical expression pattern was determined according to the virus. Methods: Data were collected on patients who visited the emergency room with febrile seizures from March 2016 to February 2019. The clinical characteristics of seizures and the clinical differences between each respiratory viral infection were analyzed. The severity of febrile seizures was measured by checking complex febrile seizures and electroencephalogram abnormalities. Results: Of the 227 febrile convulsions, 138 (60.8%) were men, and 89 (39.2%) were women. Sixty-five patients (28.6%) had a family history of febrile seizure, 68 (30.0%) had complex seizures, and 13 (7.1%) had electroencephalogram (EEG) abnormalities. Of the 13 respiratory viruses examined, rhinoviruses were detected more significantly in 63 patients (32.4%), but there was no significant difference when comparing the rate of febrile seizure among patients with fever. There were no significant differences in the clinical features, such as body temperature, duration, and complex seizure. In addition, each virus showed a similar incidence of EEG abnormalities. Conclusion No significant difference in the clinical features and objective examination according to the virus were observed, and the tendency of developing febrile seizures is similar.

The study was the clinical analysis of 509 patients with pure ocular injuries who visited to Chonnam University Hospital Emergency center from July 1, 1996 to June 30, 1997 retrospectively. Clinical data survey including sex and age distribution, causes of trauma, injury site, ocular disease, and surgical intervention was done. Most of ocular injury patients were male. 3rd and 4th decade who were socially active were nearly 50%. Direct and indirect injury from foreign body was the most common cause of ocular injuries followed by fist blow, traffic accident, falling down, and sport injury. Cornea was the most common ocular injury site (209 patients, 41.1%). The incidence of the traumatic ocular disease showed corneal erosion (117 patients, 22.9%) and then eyeball perforation, traumatic hyphema etc. by frequency of order. Eyeball perforation was the most common ocular injury which needed a emergency surgical intervention. As a results, emergency physicians have to pay attention to the cornea in case of any type of ocular injuries and eyeball perforation which caused by direct and indirect injury from foreign body.
Accidents, Traffic ; Age Distribution ; Cornea ; Emergencies ; Foreign Bodies ; Humans ; Hyphema ; Incidence ; Jeollanam-do ; Male ; Retrospective Studies ; Sports

Schwannomas are benign tumors derived from the Schwann cells of the nerve sheath. These are rare tumors that can be found in any part of the body although fewer than 4% of these tumors involve the nasal cavity and paranasal sinuses. Here, we present three cases of sinonasal schwannoma. The tumor masses were removed by endoscopic excision under general anesthesia. Pathological examination of the excised specimens confirmed schwannoma and the tumor cells were immunoreactive for S-100 protein. The patients are doing well with no evidence of recurrence.
Anesthesia, General ; Humans ; Nasal Cavity ; Neurilemmoma ; Nose ; Paranasal Sinuses ; Recurrence ; S100 Proteins ; Schwann Cells

Estimation of an individual's age has received considerable attention in forensic science. Several methods have been described, and abundant results have been obtained and evaluated. Among the numerous methods for dental age prediction in adults, the progressive diminution of the coronal pulp cavity and dental attrition have been primarily used. Although the reliability of age estimation methods using teeth has been demonstrated, correlation between methods has not been reported. Therefore, the aim of this study was to evaluate concurrence between Drusini's methods. We reanalyzed the age of 107 patients (64 male, 43 female) using Drusini's method. The ages had been previously estimated as ranging from 24 to 69 years using Takei's method. Our results revealed a strong correlation between the two methods (r=0.762) and suggest both methods to be suitable for application in Korean individuals younger than 50 years old. A previous study has shown Takei's and Drusini's methods to be reliable for forensic purposes. The strong correlation between the two methods in the present study suggests that it would be reasonable to use the most appropriate method for age estimation dependent on oral state.
Adult* ; Age Determination by Teeth ; Forensic Dentistry ; Forensic Sciences ; Humans ; Korea ; Male ; Matched-Pair Analysis ; Tooth ; Tooth Attrition

Pyogenic granuloma is a overzealous proliferation of a vascular type connective tissue as a result of some minor trauma and is a well circumscribed elevated, pedunculated or sessile benign inflammatory lesion of skin and mucous membrane. The clinical features of pyogenic granuloma are indicative but not specific and nearly all cases of pyogenic granulomas are superficial in nature, and there is little if any mention in the literature of these lesions producing alveolar bone even jaw bone loss. This case is somewhat unique in that the lesion was an obvious histologic pyogenic granuloma; however, it appeared to invade the mandibular bone which resulted in the loss of the adjacent teeth. A 12-year-old boy came to Seoul National University Dental Hospital with chief complaints of left facial swelling. The features obtained were as follows ; Plain radiograms showed a large well-circumscribed radiolucent lesion on left mandibular ramus area, which made severe expansion of lingual cortex and displacement of lower left 3rd molar tooth germ. Computed tomograms showed large soft tissue mass involving left masticator space with destruction of left mandibular ramus. Histologically, sections revealed loose edematous stroma with intense infiltration of inflammatory cells and proliferation of vascular channels. Also, there were focal areas of extensive capillary proliferation, bone destruction and peripheral new bone formation.
Capillaries ; Child ; Connective Tissue ; Granuloma, Pyogenic* ; Humans ; Jaw ; Male ; Mandible ; Molar ; Mucous Membrane ; Osteogenesis ; Seoul ; Skin ; Tooth ; Tooth Germ

BACKGROUND/AIMS: Proton pump inhibitor (PPI) and two types of antimicrobial agents, amoxicillin, and clarithromycin have been widely used for the eradication of Helicobacter pylori. However, antibiotic resistant strains has rapidly increased and has emerged as an important factor for eraducation failure. MATERIALS AND METHODS: Patients diagnosed with chronic gastritis, peptic ulcer disease or gastric epithelial neoplasm was examined by H. pylori PCR for mutation at 23S rRNA. Positive H. pylori PCR without 23S rRNA mutation was eradicated by standard triple therapy. Patients with 23S rRNA mutation was eradicated by standard triple therapy or concomittent therapy with amoxicillin, PPI, clarithromycin and metronidazol or quadruple therapy with bismuth, PPI, tetracycline and metronidazol. We evaluated the predictors of eradication failure with regards to 23S rRNA mutation and initial eradication regimen. RESULTS: Nine hundred sixty-one patients were studied. H. pylori PCR was positive in 35.0% of the patients and 23S rRNA mutatation was found in 22.2% of the patients. The eradication rate of H. pylori for the A2143G point mutated group with standard triple therapy was 28.5% and significantly lower than 93.1% of the wild type group and 100% of the concomitant therapy group, 66.6% of one week quadruple group and 100% of two week quadruple group (P<0.005). CONCLUSIONS: When 23S rRNA point mutation was positive, the standard triple therapy was not effective and the eradication rates was only 22.2%. Alternative regimens should be considered when 23S rRNA point mutation is detected, especially when A2143G point mutation is detected because A2143G point mutation is highly related to eradication failure.
Amoxicillin ; Anti-Infective Agents ; Bismuth ; Clarithromycin ; Daegu ; Gastritis ; Helicobacter pylori* ; Humans ; Neoplasms, Glandular and Epithelial ; Peptic Ulcer ; Point Mutation ; Polymerase Chain Reaction ; Proton Pumps ; RNA* ; Tetracycline

PURPOSE: Verrucous carcinoma is a rare, low-grade and well-differentiated squamous cell carcinoma, representing as a warty tumor. Estimation of the incidence for cutaneous lesions is not available because they are rare. We describe a case of verrucous carcinoma, a rare type, complication of a chronic pressure ulcer of duration more than 15 years. METHODS: A 17-year-old boy presented with a large lesion involving the sacral area, which had been neglected for about 15 years. He had a history of surgical extirpation 2 years ago, but not cured. Examination revealed a cauliflower-like mass arising from an irregularly oval-shaped tumor which was 6.0x4.5cm in size with signs of infection and ulcer. The lesion involved the sacrococcygeal area, spreading to both medial gluteal regions. The perianal skin did not appear to be directly affected. RESULTS: A preoperative punch biopsy revealed a extremely well differentiated verrucous carcinoma. There were positive results in immunohistochemistry in the items of p53, p63, Ki-67. An 'en-bloc' excision of the tumor with the clinically normal surrounding tissue was carried out. Reconstruction was achieved by local regional flap. Histopathological findings of the excised area fully confirmed the preoperative biopsy report. It remained free of recurrence for a period of about 8 months. CONCLUSION: We believe that in patients with buttock involvement, regardless of the extent of such tumors, surgical therapy should be considered as the first-choice of treatment as reconstruction can be performed without excessive impairment for the patient.
Adolescent ; Biopsy ; Buttocks ; Carcinoma, Squamous Cell ; Carcinoma, Verrucous* ; Humans ; Immunohistochemistry ; Incidence ; Male ; Pressure Ulcer* ; Recurrence ; Skin ; Ulcer