Subclavian artery occlusion after blunt trauma is an extremely rare injury. This has been attributed to its wellprotected location deep in the scalene triangle, bounded by the first rib and clavicle. A case of post-traumatic occlusion of the subclavian artery with clavicle fracture was reported by Sodhi et al in 2006 and in Korea was reported by Han et al in 2001. We believe that is the first report of post-traumatic occlusion of the subclavian artery without clavicle and first rib fracture in Korea.
Clavicle ; Korea ; Rib Fractures ; Ribs ; Subclavian Artery ; Wounds, Nonpenetrating

Gastric volvulus is a rare disease; only 700 cases have been reported since Berti first described autopsy findings of a patient in 1866. Its symptoms are non-specific and therefore it is difficult to diagnose it early. Acute gastric volvulus has a poor prognosis because it may cause shock and strangulation. Perforation or gastric hemorrhage can also result from ischemia when diagnosis is delayed. Therefore, it requires rapid diagnosis and an emergency operation. Wandering spleen is a rare condition characterized by the absence or underdevelopment of one or all of the ligaments that hold the spleen in its normal position in the abdomen. Wandering spleen and gastric volvulus have a common cause lack of intraperitoneal visceral ligaments. The authors now report a case of wandering spleen accompanying gastric voluvulus, which resulted in wandering spleen and perforation.
Abdomen ; Autopsy ; Emergencies ; Hemorrhage ; Humans ; Ischemia ; Ligaments ; Prognosis ; Shock ; Spleen ; Stomach Volvulus ; Wandering Spleen

Esophageal hiatal hernia occurs when a portion of the stomach prolapses through the esophageal hiatus into the thoracic cavity. The most common symptoms are epigastric or substernal pain, nausea, vomiting and dyspepsia, but most people with hiatal hernia are asymptomatic or have nonspecific symptoms. Hiatal hernia is usually discovered as an incidental finding on upper gastrointestinal studies or gastroscopy. We now report a case of type II paraesophageal hiatal hernia with gastric perforation. It is important to consider panperitonitis caused by perforation of a herniated stomach when the patient with hiatal hernia has acute abdominal pain.
Abdominal Pain ; Dyspepsia ; Gastroscopy ; Hernia, Hiatal ; Humans ; Incidental Findings ; Intestinal Perforation ; Nausea ; Peritonitis ; Prolapse ; Stomach ; Thoracic Cavity ; Vomiting

Ischemic colitis is the most common type of ischemic gastrointestinal disease. It is a medical condition in which inflammation and injury of the large intestine results from inadequate blood supply. Ischemic colitis mainly occurs in elderly patients and encompasses a wide clinical spectrum. A case of ischemic colitis after snake bite with DIC was first reported by Iwakiri et al in 1995; another case, in Korea, was reported by Kim et al in 2008. Here we report a case in Korea of ischemic colitis after snake bite without DIC.
Aged ; Colitis, Ischemic ; Dacarbazine ; Disseminated Intravascular Coagulation ; Gastrointestinal Diseases ; Humans ; Inflammation ; Intestine, Large ; Korea ; Snake Bites ; Snakes

Pulmonary decompression sickness (DCS) is a relatively uncommon form of type II DCS, with a frequency of only 2.4% as averaged from several studies. The deposition of venous gas emboli in the pulmonary arterial circulation produces progressive dyspnea, cough, chest pain and the physical findings of increased central venous pressure and pulmonary arterial pressure, and right-sided strain on an electrocardiogram. We recently experienced a case of pulmonary DCS presenting as interstitial pulmonary edema combined with low central venous pressure. In this case, air bubbles that were trapped in the most nondependent part of the femoral vein were discovered incidentally, on abdominal computed tomography scan, which may mean that the buoyancy of gas bubbles was sufficient to counteract the venous blood flow propelling such bubbles in the direction of blood flow. In addition, we discuss the current availability of recompression facilities in South Korea since some difficulties are anticipated in treating an unstable patient with a monoplace hyperbaric chamber, which is typically the only available type of hyperbaric chamber in South Korea.
Arterial Pressure ; Central Venous Pressure ; Chest Pain ; Cough ; Decompression ; Decompression Sickness ; Diving ; Dyspnea ; Electrocardiography ; Embolism, Air ; Femoral Vein ; Humans ; Hyperbaric Oxygenation ; Pulmonary Edema ; Republic of Korea ; Sprains and Strains

PURPOSE: Cardiac dysfunction may be present in patients with hepatic cirrhosis. This study was performed to evaluate the plasma concentration of pro Brain Natriuretic Peptide (pro-BNP), a marker of severity of hepatic cirrhosis and cardiac dysfunction. METHODS:We retrospectively analyzed the medical records of 85 patients who had been diagnosed with hepatic cirrhosis and admitted through the emergency department. Circulating levels of pro-BNP, Child-Pugh class and Sequential Organ Failure Assessment (SOFA) score were determined. RESULTS: Plasma pro-BNP levels were significantly increased in cirrhotic patients with ascites or heart failure (p=0.000, p=0.000, respectively) but not in patients with encephalopathy or gastrointestinal bleeding (p=0.396, p=0.059, respectively). Circulating pro-BNP levels were closely correlated with SOFA scores (r=0.331, p=0.002) and correlated with Modified Child-Pugh classification scores (r=0.273, p=0.033). The SOFA score is an easily applied tool with good prognostic abilities, but pro-BNP and Child-Pugh class can also be used to enhance clinical judgment of prognosis. CONCLUSION: Increased pro-BNP levels are likely related to the severity of disease in hepatic cirrhosis. Advanced cirrhosis is associated with advanced cardiac dysfunction and pro-BNP has prognostic value for cirrhosis.
Ascites ; Emergencies ; Fibrosis ; Heart Failure ; Hemorrhage ; Humans ; Judgment ; Liver Cirrhosis ; Medical Records ; Natriuretic Peptide, Brain ; Plasma ; Prognosis ; Retrospective Studies

PURPOSE: We evaluated the utility of ultrasound-assisted lumbar puncture (UALP) in aged patients who visited our emergency center. METHODS:This was a prospective, randomized, controlled study. From July to December 2007 we enrolled patients who were at least 60 years of age . Patients were divided into a group that had lumbar puncture (LP) using landmark palpation (group A) and a UALP group (group B). We did between-group comparisons for the number of attempts, procedure time, the number of LP failures, and whether traumatic LP was done. For all hypotheses, a significance level of 0.05 was used. Variables are reported as percentages and mean +/-standard deviation. RESULTS: We enrolled sixty aged patients: 30 in group A and 30 in group B. There were 5 cases of LP failure in group A and none in group B (p<0.05). There were 6 cases of traumatic lumbar puncture in group A, and one case in group B (p=0.05). The number of attempts was 3.3+/-2.4 in group A and 1.5+/-0.8 in group B (p<0.05). It took 10.6+/-7.7 minutes to finish each LP in group A compared to 5.3+/-4.2 minutes in group B (p<0.05). CONCLUSION: The use of ultrasound-assisted lumbar puncture significantly reduces the number of failures, the number of attempts, and the procedure time in aged patients.
Aged ; Emergencies ; Humans ; Palpation ; Prospective Studies ; Spinal Puncture

PURPOSE: The aim of this study was to investigate the ability of thoracic computed tomography (CT) to predict esophageal stricture formation and risk factors associated with the development of stricture induced by ingestion of caustic materials. METHODS:This was a study of 41 patients who had visited an emergency care center following ingestion of caustic substances sometime between January 1998 and August 2008. A retrospective analysis of medical records was performed. Findings for the esophageal lesion were classified according to changes in the esophageal wall and the infiltration of peri-esophageal soft tissue. Also, clinical, laboratory, and endoscopic data from these patients were reviewed. The correlation between the degree of esophageal damage seen on CT scans and esophageal constriction seen on esophagography were then evaluated. RESULTS: A total of 41 cases of caustic ingestion were identified (age range, 20~82 years). The most common caustic agent ingested was acid (70%). The most frequent cause for ingestion was attempted suicide (70%); the other cases (30%) were accidental ingestion. The findings on thoracic CT in the 41 patients were as follows: first-degree esophageal injury in 4 (9.8%), second-degree in 8 (19.5%), third-degree in 17 (41.6%), fourth-degree in 12 (29.3%). Fourteen patients (34.1%) developed caustic esophageal stricture. The closer the degree of esophageal damage was to grade IV, the more prevalent the esophageal constriction became. This correlation was statistically significant (p<0.001). Of the 41 patients, 26 underwent endoscopy at an early stage after they visited an emergency care center. An analysis of the correlation between the degree of esophageal damage seen on endoscopy and that seen on CT scans was performed. This revealed a significant correlation (p=0.002, r=0.585). CONCLUSION: Thoracic CT grading suggesting periesophageal soft tissue infiltration and fluid collection (grade III to IV) rather than only edema (grade I) may be associated with stricture formation. Early CT grading is safe and useful for predicting the development of stricture induced by caustic ingestion.
Caustics ; Constriction ; Constriction, Pathologic ; Eating ; Edema ; Emergency Medical Services ; Endoscopy ; Esophageal Stenosis ; Humans ; Medical Records ; Retrospective Studies ; Risk Factors ; Suicide, Attempted ; Thorax

PURPOSE: The purpose of this study was to evaluate the cumulative incidence rate (CIR) of unintentional injuries and to describe the pattern of unintentional injuries among preschool children in Korea. METHODS:We retrospectively reviewed the records of the National Health Insurance Agency for the year 2006. Data for people with unintentional injuries (ICD code: S00~T98) were collected, and stratified random samples were selected according to age, sex and severity of injury. A questionnaire including the location, mechanism and results of the injuries was developed. The risks, location and mechanism of injuries were analyzed. RESULTS: The CIR of unintentional injuries among preschool children during the 1 year period studied was 25,991 per 100,000, and the CIR of severe injuries was 355. More injuries occurred in males, in rural areas, and in low income (medical aid) families. Most injuries occurred at home or near the home, and did so by slipping, falling and being struck. CONCLUSION: The incidence and characteristics of unintentional injuries among preschool children in Korea are affected by gender, location and income level. Establishing strategies directed towards vulnerable subgroups should contribute to a program designed to effectively prevent childhood injuries.
Child ; Child, Preschool ; Humans ; Incidence ; Korea ; Male ; National Health Programs ; Surveys and Questionnaires ; Retrospective Studies

PURPOSE: Pelvic fracture is one of the more serious skeletal injuries, resulting in substantial mortality. The large amount of kinetic energy necessary to fracture the bony pelvis often leads to concomitant thoraco-abdominal injury. Pelvic fracture and combined injuries need effective initial resuscitation. However, it is hard to predict mortality due to the complexity of multiple injuries. Therefore, the purpose of this study was to identify factors predicting mortality in patients with pelvic fracture and concomitant thoraco-abdominal injury. METHODS:A retrospective study was performed on 174 cases of pelvic fracture who visited the Emergency Department between January 2003 and June 2008. Data were collected regarding demographic characteristics, mechanism of injury, injury severity score (ISS), Abbreviated Injury Score (AIS), Simplified Acute Physiologic Score II (SAPS II), transfusion requirements, fluid requirements, the findings on angiography, hemoglobin level, platelet count, prothrombin time (PT), fibrinogen, albumin, base deficit, lactate, anti-thrombin III, length of ICU stay, and total hospitalization days. Pelvic fracture categories were derived by adapting the Young-Burgess classification. RESULTS: One hundred forty patients survived (Group I); 34 died (Group II). Blood pressure, pulse rate, hemoglobin, albumin, lactate, base deficit, PT, fibrinogen and Antithrombin III were significantly different between two groups. Transfusion, fluid requirements, ISS and SAPS II were significantly higher in group II. Extravasation on the CT was more frequent found in group II. The ISS 1.194 (95% CI, 1.076~1.325) and SAPS II 1.162 (95% CI,1.042~1.296) were independent significant predictors of mortality. CONCLUSION: Predictors of mortality in pelvic fracture patients should be available during the first attempt at resuscitation. The ISS and SAPS II were the most important predictors in defining mortality.
Angiography ; Antithrombin III ; Blood Pressure ; Emergencies ; Fibrinogen ; Heart Rate ; Hemoglobins ; Hospitalization ; Humans ; Injury Severity Score ; Lactic Acid ; Multiple Trauma ; Pelvic Bones ; Pelvis ; Platelet Count ; Prognosis ; Prothrombin Time ; Resuscitation ; Retrospective Studies