PURPOSE: To report a case of recurrent uveitis associated with autoimmune liver disease. CASE SUMMARY: A 50-year-old female with severe fatigue and arthritis visited the ophthalmology department due to decreased visual acuity and discomfort in her right eye for ten days. She had intermittent injection and blurred vision in both eyes for 30 years. Slit lamp examination of her right eye showed keratic precipitates, pigment deposits on the anterior capsule of the lens and anterior chamber cells; fundus examination was normal without any sign of chorioretinitis. Inflammatory reaction was improved after steroid and cycloplegic eye drop treatment. Two months later, her left eye developed anterior uveitis. Inflammation was well controlled with steroid and cycloplegic eye drop treatment. To evaluate the cause of uveitis and associated systemic disease, serological testing was performed, and abnormal elevation of liver enzymes was detected. The patient was referred to the Gastroenterology Department and diagnosed with autoimmune liver disease. Oral ursodeoxycholic acid was prescribed. Liver function profile improved to normal range, and the patient is currently under routine follow-up with no sign of recurrent uveitis. CONCLUSIONS: When a patient with recurrent uveitis presents symptoms such as nausea, fatigue, abdominal pain, jaundice or abnormal liver profile, association with autoimmune liver disease should be considered.
Abdominal Pain ; Anterior Capsule of the Lens ; Anterior Chamber ; Arthritis ; Chorioretinitis ; Fatigue ; Female ; Follow-Up Studies ; Gastroenterology ; Hepatitis, Autoimmune ; Humans ; Inflammation ; Jaundice ; Liver ; Liver Diseases* ; Middle Aged ; Nausea ; Ophthalmology ; Reference Values ; Serologic Tests ; Ursodeoxycholic Acid ; Uveitis* ; Uveitis, Anterior ; Visual Acuity

PURPOSE: To clinically determine the proportion of people with a fixed dissociating eye in patients with dissociated vertical deviation (DVD). METHODS: Medical records of 86 patients diagnosed with DVD in our department of ophthalmology from 2001 to November 2011 were retrospectively analyzed. RESULTS: Of the 71 patients, 25 (35.21%) showed a higher degree of dissociation in the fixating eye, 26 (36.62%) had higher dissociation in the non-fixating eye; 20 of 25 patients with a higher level of dissociation in the fixating eye and 22 of 26 patients with a higher level of dissociation in the non-fixating eye received surgical correction for DVD, such as superior rectus muscle recession or inferior oblique muscle anterior transposition. CONCLUSIONS: In DVD, the proportion of patients showing a higher level of dissociation in the fixating eye was significant. Patients with DVD require thorough evaluation; measurement of the level of dissociation and determination of the fixating eye is beneficial for management and surgical intervention.
Humans ; Medical Records ; Ophthalmology ; Retrospective Studies

PURPOSE: To evaluate the effects of psychosocial stress on intraocular pressure and lacrimal secretion. METHODS: Twenty normal adult volunteers (40 eyes) who had no history of systemic or ocular disease such as dry eye syndrome or glaucoma were recruited from clinical research participants. Heart rate, intraocular pressure and lacrimal secretion were measured after the Trier Social Stress Test (TSST) which induces psychosocial stress. The same measurements were taken 1 week later and the recorded measurements were considered as the control group. RESULTS: Heart rate was elevated significantly after the TSST, indicating psychosocial stress was induced by the TSST. Compared to stress resolution status, intraocular pressure and lacrimal secretion were increased after the TSST (p = 0.027, p = 0.011). Elevation of intraocular pressure and lacrimal secretion was statistically significant in males (p = 0.031, p = 0.007), but not significant in females (p = 0.336, p = 0.554). CONCLUSIONS: Psychosocial stress can increase intraocular pressure and lacrimal secretion.
Adult ; Dry Eye Syndromes ; Exercise Test ; Female ; Glaucoma ; Heart Rate ; Humans ; Intraocular Pressure ; Male

PURPOSE: To define the clinical characteristics of acute vertical strabismus in adults strabismus without known ocular and cranial external factors. METHODS: We performed a retrospective study of 72 adult patients who developed acute vertical strabismus without known ocular and cranial external factors such as trauma or operation and were followed up for at least 6 months. RESULTS: Undetermined cause (n = 41, 57%) was the most common etiology of acute vertical strabismus, followed by fourth cranial nerve palsy (n = 15, 20.8%), myasthenia gravis (n = 7, 9.7%), third cranial nerve palsy (n = 6, 8.3%), brain tumor (n = 2, 2.7%), and carotid-cavernous fistula (n = 1, 1.3%). The average vertical deviation at primary position was 7.2 prism diopter at initial visit. Thirty-eight (62.3%) patients recovered to orthophoria and 13 (21.3%) patients showed decreased level of diplopia. The average recovery period was 2.9 months. Ten cases remained as strabismus and 5 underwent surgery upon patient's request. CONCLUSIONS: Unknown cause was the most common diagonosis of adult acute vertical strabismus without known ocular and cranial external factors. In the present study, 62.3% of patients recovered to orthophoria and 83.6% recovered without surgical procedures.
Adult* ; Brain Neoplasms ; Diplopia ; Fistula ; General Surgery ; Humans ; Myasthenia Gravis ; Oculomotor Nerve ; Paralysis ; Retrospective Studies ; Strabismus* ; Trochlear Nerve Diseases ; Wounds and Injuries

BACKGROUND: This study was investigated risk factors of abdominal aortic aneurysm that correlation with an aortic diameter and necessity of ultrasonographic screening program through ultrasonographic examination of the aorta, additionally investigated prevalence of abdominal aortic aneurysm. METHODS: We conducted a prospective study of an aorta-proximal part, middle part, distal part with using abdominal ultrasography with 246 subjects more than 65 years old who visited the emergency department of chuncheon sacred hospital without symptoms during the period March 2004-February 2005. Also, examined risk factors (age, sex, smoking, hypertension, vascular disease) and did comparative analysis of relation between an aortic diameter and risk factors. RESULTS: The abdominal aortic diameter of them was 2.08+/-0.37cm in proximal part, 1.78+/-0.31cm in middle part, 1.55+/-0.31cm in distal part. The difference between male and female group was regarded(proximal part 2.20+/-0.35cm vs 1.99+/-0.36cm, the middle part 1.88+/-0.30cm vs 1.69+/-0.31cm, distal part 1.66+/-0.30cm vs 1.48+/-0.29cm). The difference of diameter in distal part was regarded in comparison of young old man and old old man (1.58+/-0.31cm vs 1.91+/-0.27cm). The difference of middle and distal aortic diameter between a smoking and non-smoking group was regarded (1.88+/-0.31cm vs 1.74+/-0.31cm, 1.62+/-0.32cm vs 1.53+/-0.30cm). The difference of distal aortic diameter between a hypertensive and non-hypertensive group(1.58+/-0.36cm vs 1.54+/-0.28cm) and between the groups which had a vascular disease or not(1.78+/-0.36cm vs 1.54+/-0.30cm) was regarded. There was no abdominal aortic aneurysm among them. CONCLUSION: The diameter of distal part increased with more ages, in male, smoker, and person with hypertension and vascular disease. In this study, abdominal aortic aneurysm wasn't found.
Aged ; Aorta ; Aortic Aneurysm, Abdominal ; Emergencies* ; Emergency Service, Hospital ; Female ; Gangwon-do ; Geriatrics ; Humans ; Hypertension ; Male ; Mass Screening ; Prevalence ; Prospective Studies ; Risk Factors ; Smoke ; Smoking ; Ultrasonography ; Vascular Diseases

OBJECTIVE: The aim of this study was to identify the latent class, according to the risk factors, of the patients hospitalized due to intentional self-harm by lethal means. METHODS: The risk factors were derived by categorizing the intentional self-harming measures by lethal (hanging, pesticide poisoning, jumping, and drowning) and non-lethal (drug poisoning and stab) measures and comparing the demographics, diseased state, and suicide-related characteristics. Latent class analysis was performed to identify the type of intentional self-harm. RESULTS: Male (sex), elderly (age), rural (residing location), and comorbid diseases were found to be the risk factors for fatal injuries. For this, four latent classes were modeled. Factors, such as the age group between 20 to 40 years, women, and family conflict were included in the first class. The second class included the age group between 30 to 50 years, men, and financial problems. The third class covered the age group between 60 to 70 years and comorbidity. The fourth class contained the age group of 10 to 50 years, women, and mental problems. The rate of suicide and choice of fatal suicide was ranked in the order of 3 (62.7%, 21.5%), 2 (59.8%, 13.9%), 4 (36.8%, 5.7%), and 1 (29.5%, 5.9%). CONCLUSION: A lethal mean access control policy needs to be established for the high-risk group of self-harm. Moreover, establishing an emergency room-community link prevention policy could help reduce the re-suicide attempt among suffering patients.
Aged ; Cluster Analysis ; Comorbidity ; Demography ; Emergencies ; Family Conflict ; Female ; Humans ; Inpatients ; Male ; Methods ; Poisoning ; Risk Factors ; Self-Injurious Behavior ; Suicide

PURPOSE: We undertook this study to evaluate the pertinence of yearly CPR training for three years in hospital. METHODS: We evaluated 106 participants (79 registered nurses, 17 assistant nurses, 10 medical technicians who were not emergency medical technicians). We performed the education once a year for three years. We used color slides and videos for the lecture. We used a CPR training manikin for training in the CPR skills. For the evaluation, we used a list involving 10 items about understanding the CPR scheme and the CPR training program. We divided the 106 participants based on frequency of training, occupation and career. RESULTS: The mean number of points for understanding the CPR scheme was 17.5 points out of 28. The mean number of points for check for breathing, rescue breathing, pulse check, and chest compression were 2.5, 2.3, 1.7, and 1.7, respectively out of 4 points. In CPR skills, appropriate rescue breathing was 37+/-31%, and appropriate chest compression was 62+/-39%. There were no significant statistical differences based on frequency of CPR training or career. There were significant statistical differences based on occupation. CONCLUSION: Our yearly CPR training in the hospital was not pertinent in improving the ability to perform CPR. Different CPR training methods are needed for different occupation. We think that further study are needed to develope effective CPR training methods and to identify the appropriate re-training interval.
Cardiopulmonary Resuscitation* ; Education ; Emergencies ; Manikins ; Nursing* ; Occupations ; Respiration ; Thorax

As snowboarding has become one of the most popular winter sports, lots of young people enjoy it and they have become the center of this winter sports. However, this increased number of snowboarding lovers results in raising the number of injuries. In the case of severe chest injury caused by snowboarding can be a source of a serious injury such as cardiac tamponade. The development of cardiac tamponade is an acute, life-threatening emergency. To test a cardiac tamponade, a patient with chest trauma should be diagnosed from the information given by a physical examination and simple chest radiography. If the heart is doubted to be wounded, an emergency echocardiography has to be executed. An emergency treatment for the cardiac tamponade patient is to normal saline infusion quickly to augment the capacity of a blood vessel. Extremely, surgeries such as pericardiocentesis or pericardiotomy can be applied to ease the pressure inside the heart. Some patients with chest blunt trauma while snowboarding developed cardiac tamponade and they were successfully recovered through pericardiocentesis. This precedent is reported here with the consideration of the references.
Blood Vessels ; Cardiac Tamponade* ; Echocardiography ; Emergencies ; Emergency Treatment ; Heart ; Humans ; Pericardiectomy ; Pericardiocentesis ; Physical Examination ; Radiography ; Skiing* ; Sports ; Thoracic Injuries ; Thorax* ; Wounds and Injuries

PURPOSE: Emergency department visits for acute allergic reactions are common. However, relatively little is known about the characteristics of patients who visit the emergency department for such reactions. We undertook this study to evaluate the frequency, the cause, the severity, the treatment and the prognosis of patients admitted for allergic reactions to a college hospital in a city. METHODS: We studied 724 patients visiting two emergency departments of college hospitals during the years 2002-2003. Clinical symptoms involved pruritus, dyspnea, hoarseness, nausea, vomiting, abdominal pain, diarrhea, dizziness, and seizure. Physical examinations involved vital signs, urticaria, rash, local edema, angioedema, rhinitis/conjunctivitis, wheezing, stridor, cyanosis, and laryngeal edema. We divided the causative agents into drugs, insects, foods, and others. We classified the treatments of the allergic reaction as antihistamines, corticosteroids, epinephrine, oxygen, and hydration. We divided patients into mild, moderate, and severe acute hypersensitivity groups. RESULTS: In order of frequency, clinical symptoms were pruritus (88.1%), urticaria (72.4%), rash (68.9%), local edema (11.7%), etc. The causative agents were foods (53.0%), unknown origin (29.1%), insects (11.0%), and drugs (6.8%). Antihistamine, corticosteroid, epinephrine were injected in 93.4%, 89.1%, 2.3% of the patients, respectively. The mild, moderate, and severe groups were 87%, 9.8%, and 3.2% of the patients, respectively. CONCLUSION: For patients with allergic symptoms visiting to the university-affiliated teaching hospitals in a small city, foods were the major causative agent, but drugs and insects provoked more severe allergic reactions.
Abdominal Pain ; Adrenal Cortex Hormones ; Anaphylaxis ; Angioedema ; Cyanosis ; Diarrhea ; Dizziness ; Dyspnea ; Edema ; Emergencies* ; Emergency Service, Hospital* ; Epinephrine ; Exanthema ; Histamine Antagonists ; Hoarseness ; Hospitals, Teaching ; Humans ; Hypersensitivity* ; Insects ; Laryngeal Edema ; Nausea ; Oxygen ; Physical Examination ; Prognosis ; Pruritus ; Respiratory Sounds ; Seizures ; Urticaria ; Vital Signs ; Vomiting

PURPOSE: An appropriate emergency medical support system is required at sites of large-scale congregations because different kinds of emergencies may be encountered. My colleagues and I initiated this project to present the information required for the process of devising an onsite plan for large crowds. The basic structure is based on an analysis of patients who were injured while attending large scale street-cheering demonstrations in Seoul during the period of the 2002 World Cup. METHOD: The analysis concentrated on the period from May 31, 2002, to June 30, 2002, during the 2002 Korean-Japan World Cup. Seven soccer games involving the Korean team and 8.91 million people from 116 places were considered. The following report was generated from the supporting schedules and the activity reports of emergency rescue crews from fire departments. It is largely based on rescue activity journals and transportation records. RESULT: There were 796 patients among the in 8.91 million people. Male patients were 383 (42.8%) and female 413 (51.2%). Patients in their 20's were 267, and that was the largest age group. In Korean game against Germany, 183 patients were treated, and that was the largest among the seven games involving Korean's team. There was one patient in every 10,000 people on average. Sicknesses were not that serious, and most of them were headaches, stomachaches and exhaustion. CONCLUSION: The frequency and pattern of generation of patients were affected by the scale of the cheering crowd, the sex and age composition of the crowd, and the weather. In planning future medical support for similar events, the structure of the plan should be based on the site and the size of the crowd, after which the plan can be finalized by considering details such as the importance of the game and the weather.
Appointments and Schedules ; Disaster Planning ; Emergencies ; Female ; Fires ; Germany ; Headache ; Humans ; Male ; Seoul* ; Soccer ; Transportation ; Weather