Silicone fluid is a biomaterial widely used in modern cosmetic procedures because there are few side effects, considerable chemical stability and predictable physical properties. However, many local and systemic adverse reactions have reported. In particular some serious pulmonary complications have been reported such as pulmonary thromboembolism, acute respiratory distress syndrome with some cases leading to mortality. Most of the serious complicated cases were induced by an illegal silicone fluid injection. We experienced two cases of acute respiratory distress syndrome with pulmonary hemorrhage induced by an illegal silicone fluid injection. The patients were 41 & 51 year old women, who complained of dyspnea. The chest X-ray and HRCT scan findings showed a bilateral ground glass attenuation on the bilateral dependent portion of the upper and middle lung zone. The patients clinical symptoms and the radiologic and other laboratory findings were compatible with acute respiratory distress syndrome induced by the silicon fluid injection. Here we report two cases of acute respiratory distress syndrome with pulmonary hemorrhage induced by an illegal silicone injection with a review of the relevant literature.
Dyspnea ; Female ; Glass ; Hemorrhage* ; Humans ; Lung ; Mortality ; Perineum* ; Pulmonary Embolism ; Respiratory Distress Syndrome, Adult* ; Silicon* ; Silicones* ; Thorax

BACKGROUND: High monitors are patients who require information on anesthesia and surgery and generally carry out active searches. These patients will benefit from more information related to surgery preoperatively whereas low monitors will benefit from less detailed information. This study examined whether or not patients' desire for information related to anesthesia and surgery differ according to their coping style classified by the Amsterdam Preoperative Anxiety and Information Scale (APAIS). METHODS: 465 patients were asked to fill out the questionnaires in APAIS, State-Trait anxiety inventory (STAI) and also to mark their perception on a 10 cm line in a visual analog scale (VAS). The APAIS with the other subjective measurements of anxiety were evaluated according to their gender, ASA class, past history of surgery and degree of education. Thirteen questionnaires were evaluated according to their coping styles. RESULTS: High monitors wanted to know all 13 questions compared with low monitors, whereas low monitors preferred not to know (P < 0.05). The APAIS has a significant relationship with the VAS and STAI (P < 0.05). Women, patients with no prior history of surgery, and patients with ASA 2 were significantly more anxious than men, patients with a prior experience of surgery and ASA 1 patients, respectively (P < 0.05). The VAS and APAIS were in good agreement in defining patients as anxious and there were significant correlations between the two instruments (P < 0.05). CONCLUSIONS: The APAIS can be used as an efficient tool for identifying patients who are particularly anxious or require information.
Anesthesia* ; Anxiety* ; Education ; Female ; Humans ; Male ; Visual Analog Scale

Emergency physicians often have to treat patients suffering from testicular pain. Testicular torsion is a critical disease which can, in the worst situation, require orchiectomy. Testicular torsion is more common among neonates and adolescents than adults, and there are very few adults reported to have testicular torsion. There are several cases of testicular torsion among adults aged 20 to 40. However, there have been almost no reports of patients with testicular torsion over the age of 50. Patients over the age of 50 have a greater possibility of a delayed diagnosis. Therefore, they also have a greater possibility of requiring an orchiectomy. In our case, 57-year-old male patient complained of testicular pain that developed during his sleep after golf practice. After exploratory surgery, he was diagnosed as having testicular torsion. In conclusion, emergency physicians should consider the possibility of testicular torsion when older adults complain of testicular pain. Also, patients who suffer from intermittent testicular pain show higher rates of developing testicular torsion.
Adolescent ; Adult ; Aged ; Delayed Diagnosis ; Emergencies ; Golf ; Humans ; Infant, Newborn ; Male ; Middle Aged ; Orchiectomy ; Scrotum ; Spermatic Cord Torsion ; Stress, Psychological

PURPOSE: This study was designed to evaluate the effect of emergency department (ED) overcrowding on the outcome of patient care. METHODS: A retrospective review of medical records was obtained from Order Communicating System in the adult ED at a tertiary care teaching hospital from September 1, 2001 to November 30, 2001. For the overcrowding index, the length of stay in the ED and the time from registration to order were calculated. The outcome was defined as the result of care done in the ED or during hospitalization. The overcrowding effect on the outcome was tested by using a multivariate logistic regression analysis. Compared with the survival group, the odds ratio (OR) and 95% confidence interval (95% CI) of the death group was calculated with adjustments for gender, age, arrival time in the ED, arrival day of the week, clinical department, operation, hospitalization in the intensive care unit, and injury or disease. RESULTS: The number of total cases was 5,852. Of these, 3,046 was males and 2,806 females. Of these, the number of mortality cases in the ED was 106. A total of 2,025 patients were hospitalized. Of all the hospitalization cases, 161 died on the ward in spite of management. The length of stay in the ED, and adjusted OR were significantly increased in the total death cases and in the death cases on the ward compared to those of the survival cases. For time, from registration to order above 10 minute, compared to those below 10 minute, the adjusted OR for death in the ED was significantly increased. CONCLUSION: The overcrowding indices, such as the length of stay or the time from registration to order, were related with the outcome, that is, total death and death in the ED or on the ward.
Adult ; Emergencies* ; Emergency Service, Hospital* ; Female ; Hospitalization ; Hospitals, Teaching ; Humans ; Intensive Care Units ; Length of Stay ; Logistic Models ; Male ; Medical Records ; Mortality ; Odds Ratio ; Patient Care* ; Pilot Projects* ; Retrospective Studies ; Tertiary Healthcare

PURPOSE: There is a continuing debate about whether small bowel obstruction (SBO) is best managed operatively or nonoperatively. There is also no definite criteria for physician to decide to operate patient with SBO. This retrospective study was designed to determine the factors influencing the treatment modality of SBO. METHODS: A clinical analysis was applied to 95 patients with SBO who were admitted to the emergency department of Seoul National University Hospital from January, 2000 to December, 2001. The patients were divided into the operative and non-operative treatment groups according to the treatment modality. We compared parameters such as age, sex, the etiology of SBO, the history of previous SBO, the history of previous operation due to SBO, time period from onset of symptoms to admission, and symptoms and signs between two groups. RESULTS: Among 95 cases, the operative management was performed in 21 cases and the non-operative treatment in 74 cases. There was no significant difference in the distribution of age and sex between two groups. The most common etiology of SBO was adhesion due to previous operation. In the operative treatment group, 12 (57.1%) cases had the history of previous operation because of SBO, which showed a significant difference compared to the non-operative treatment group (p<0.001). The major symptoms and signs were abdominal pain, vomiting, abdominal tenderness, hyperperistalsis, leukocytosis, tachycardia, rebound tenderness and fever. Of these symptoms and signs, rebound tenderness was only more common in the operative group than in the non-operative group (p<0.001). CONCLUSION: At the time of admission to the emergency department, the rebound tenderness in patients with SBO is an important factor to consider the early operative intervention.
Abdominal Pain ; Emergency Service, Hospital ; Fever ; Humans ; Leukocytosis ; Retrospective Studies ; Risk Factors* ; Seoul ; Tachycardia ; Vomiting

Fluconazole is a fungistatic agent that is used for treating systemic and superficial fungal infections like onychomycosis and tinea pedis. Various adverse effects of fluconazole have been reported regardless of the total dosage and the duration of treatment. We consider the number of patients who visit the emergency room with nonspecific symptoms that are related to antifungal agents are not inconsiderable. In this case, 44-year-old male patient experienced mental change during taking fluconazole to treat tinea pedis. The understanding of the side effects and the drug interactions with antifungal agents like fluconazole can help to treat patients with nonspecific symptoms that are related to antifungal agents.
Adult ; Antifungal Agents ; Consciousness ; Drug Interactions ; Emergencies ; Fluconazole ; Humans ; Hyperammonemia ; Male ; Onychomycosis ; Tinea ; Tinea Pedis

Amniotic fluid embolism continues to be a life-threatening. It is an unexpected and rare complication of pregnancy often presenting with sudden maternal cardiovascular collapse, disseminated intravascular coagulation (DIC), and maternal death. In the past, the diagnosis of amniotic fluid embolism was made when a woman presented with one of those clinical hallmarks and at autopsy fetal squamous and amniotic fluid cells were found within the maternal pulmonary arteries. However, several studies have demonstrated that squamous cells, trophoblasts, and other debris of fetal origin may commonly be found in the central circulation of women with conditions other than amniotic fluid embolism. Thus, this finding is neither sensitive nor specific. We present a case that was diagnosed clinically as amniotic fluid embolism by characteristic signs and symptoms during the labor, resulting in maternal death.
Amniotic Fluid* ; Autopsy ; Dacarbazine ; Diagnosis ; Disseminated Intravascular Coagulation ; Embolism, Amniotic Fluid* ; Female ; Humans ; Maternal Death ; Pregnancy ; Pulmonary Artery ; Trophoblasts

Rupture of the colon caused by high pressure compressed air is a rare, unique and traumatic intra-abdominal injury. As the use of compressed air in industrial work has increased, so has the risk of associated pneumatic injuries from its improper use. Recently we experienced a case of pneumatic rupture of the sigmoid colon accompanied by tension pneumoperitoneum, which caused respiratory distress. The patient's respiration was very rapid with the rate of 44 breaths per minute. On arterial blood gas analysis, pH was 7.40, pO2 68 mmHg, pCO2 44 mmHg, and SaO2 90%. Chest X-ray film showed marked pneumoperitoneum and an elevated diaphragm. The respiratory distress was severe and required immediate relief by emergency decompression peritoneocentesis before surgical intervention consisting of the serosal tear repair, colonic rupture colostomy and abdominal cavity irrigation. A follow up operation 2 months later for colostomy repair completed the patient's recovery.
Adult ; Case Report ; Colonic Diseases/etiology* ; Human ; Male ; Pneumoperitoneum/complications* ; Pressure ; Rupture, Spontaneous

The present study was performed to evaluate the effect of citric acid on the change of implant surface microstructure according to application time. Implants with pure titanium machined surface, and HA coated surface were utilized. Pure titanium machined surface and HA coated surface were rubbed with pH 1 citric acid for 30s., 45s., 60s., 90s., and 120s. respectively. Then, the specimens were processed for scanning electron microscopic observation. The following results were obtained. 1. The specimens showed a few shallow grooves and ridges in pure titanium machined surface implants. The roughness of surfaces conditioned with pH 1 citric acid was slightly increased. 2. In HA-coated surfaces, round particles were deposited irregularly. The specimens were not significant differences within 45s. But, began to be changed from 60s. The roughness of surfaces was lessened and the surface dissolution was increased relative to the application time. In conclusion, pure titanium machined surface implants and HA coated surface implants can be treated with pH 1 citric acid for peri-implantitis treatment if the detoxification of these surfaces could be evaluated.
Citric Acid* ; Hydrogen-Ion Concentration ; Peri-Implantitis ; Titanium

BACKGROUND AND OBJECTIVES: The aim of this study is to evaluate the clinical outcomes of two surgical techniques-modified Bondy technique and canal wall up mastoidectomy with tympanoplasty type I and scutumplasty (CWUM/T1)-to remove attic cholesteatoma while preserving ossicular chain intact. SUBJECTS AND METHOD: A retrospective study was performed on 23 surgical cases for the attic cholesteatoma with postoperative audiometry data of more than six months after surgery. The patients' postoperative clinical features and audiometric results were compared between the two surgical groups. RESULTS: Out of 23 patients, CWUM/T1 was performed in 13 cases and modified Bondy technique was used in 10 cases. There were no significant differences for the preoperative and postoperative audiograms between the two groups. But air-bone gap increased significantly after CWUM/T1 while it decreased after modified Bondy technique. Three cases with postoperative problems were seen after CWUM/T1 (recurrent cholesteatoma, pars tensa adhesion, recurrent otitis media with effusion). Two cases with postoperative problems were found after modified Bondy technique (mild attic retraction, pars tensa retraction). CONCLUSION: Both surgical techniques seem to be adequate to treat attic cholesteatoma while preserving intact ossicular chain. Given good postoperative hearing results and stability of open cavity against recidivism, the modified Bondy technique seems to be a good choice for the attic cholesteatoma with intact ossicular chain when mastoid is not highly pneumatized.
Audiometry ; Cholesteatoma* ; Hearing ; Humans ; Mastoid ; Methods ; Otitis Media ; Otologic Surgical Procedures ; Retrospective Studies ; Tympanoplasty*