Hysterosalpingography and Hysteroscopy have been used for the detection of intraute-rine pathology such as polyps, submucous myomas, intrauterine adhesion and endometrial hyperplasia or cancer. Recently the ultrasound has also been utilized for the detection of uterine pathology. Therefore the purpose of this study was to evaluate the diagnostic efficacy of SonoHysterography in detection of intrauterine pathology compared with HSG and Hysteroscopy. 32 patients underwent Sono-Hysterography and Hysteroscopy for the evaluation of the uterine pathology from september 1995 to January 1996. Nine of 32 patients had infertility problem and HSG performed prior to Sono-Hysterography and Hysteroscopy. The results are as follows : 1. The patients' ages ranged from 20 to 50 years(median 37.9). 2. All 9 patients with infertility who had positive HSG findings in uterine cavity showed the intrauterine pathology in Sono-Hysterography as well as Hysteroscopy. The detail findings are as follows :septated uterus(n=2), intrauterine adhesion :IUA(n=3), endometrial polyp(n=3), and IUA combined endmetrial hyperplasia(n=1). 3. Twenty two of 23 patients with abnormal uterine bleeding showed the intrauterne pathology and one patient had negative finding in Sono-Hysterography. However, Hysteroscopy revealed positive intrauterine pathology in 22 patients who had abnormal uterine bleeding. One patients who had positive finding in Sono-Hysterograply showed negative by Hysterography. In contrast, one patient who had negative finding in Sono-Hysterography had positive uterine pathology with polyp in Hysteroscopy. The histologic pathology in all 23 patients reported endometrial polyp(n=12), placental polyp(n=2), submucous myoma(n=1), endometrial hyperplasia(n=5), endometrial cancer(n=1), normal endometrial finding(n=2). 4. Sono-Hysterography, therefore, has a sensitivity and positive predictive value of 96.6%, 93.5% respectively. Our study showed a positive Sono-Hysterography is very predictive of the intrauterine pathology. Sono-Hysterography is safe, quick and minimal invasive procedure. So it is an invaluable technique in the evaluation of uterine cavity.
Endometrial Hyperplasia ; Female ; Humans ; Hysterosalpingography ; Hysteroscopy* ; Infertility ; Myoma ; Pathology* ; Polyps ; Ultrasonography ; Uterine Hemorrhage

We report the case of 60-yr-old female in which therapeutic hypothermia (TH) was successfully induced maintaining the target temperature of 34degrees C for 12 hr despite a risk of hypothermia-induced coagulation abnormalities following an emergent coronary artery bypass grafting (CABG) due to failed percutaneous coronary intervention, who suffered a cardiac arrest. Emergent CABG may be a relative contraindication for TH in post-cardiac arrest patients because hypothermia may increase the risk of infection and bleeding. However, the possibility of an improved neurologic outcome outweighs the risk of bleeding, although major surgery may be a relative contraindication for TH.
Body Temperature ; Coma/complications ; *Coronary Artery Bypass ; Electrocardiography ; Female ; Heart Arrest/complications/*diagnosis/therapy ; Humans ; *Hypothermia, Induced ; Intensive Care Units ; Middle Aged ; Percutaneous Coronary Intervention ; Treatment Outcome

PURPOSE: Rapid multidisciplinary trauma care by trauma team is essential for severely injured patients. Different protocols for trauma team activation are used in each hospital. Correct trauma triage is needed to ensure appropriate use of medical resources. The aim of this study was to evaluate the performance of our modified protocol for trauma team activation. METHODS: This is an observational, retrospective cohort study. Injured patients with trauma team activation (TTA) or who had been admitted to a surgical intensive care unit were investigated from 1st March 2010 to 31st May 2012. The TTA protocol was analyzed with respect to sensitivity, positive predictive value (PPV), and overtriage (1-PPV). Undertriage (1-sensitivity) was defined as no TTA despite severe injury (Injury Severity Score (ISS) >15). RESULTS: A total of 229 patients were included. There were 201 patients with TTA and 28 patients without TTA. Of the 201 patients with TTA, 104 were identified as severely injured (ISS>15), yielding sensitivity of 79%, PPV of 51%, and overtriage of 49%. Undertriage was 21% (n=28) when considering all severely injured patients (n=132). Among 12 criteria of our TTA protocol, 'injury in two or more body regions' accounted for 85.6% of the overtriage. Of the patients with undertriage, 75% represented isolated head injury and 28.5% from interhospital transfer. CONCLUSION: The rate of overtriage of TTA protocol in our hospital is appropriate, but the rate of undertriage is relatively high. We believe, to decrease the overtriage of all and undertriage in patients with injury in an isolated specific body region, more research for evaluation of effects of protocol excluding the criteria of 'injury in two or more body regions' is needed.
Body Regions ; Cohort Studies ; Craniocerebral Trauma ; Emergency Service, Hospital* ; Humans ; Critical Care ; Retrospective Studies ; Triage

PURPOSE: Pneumonia is a serious and relatively common complication among submersion victims without out-of-hospital cardiac arrest (OHCA). The purpose of this study was to investigate the risk factors of pneumonia among adult submersion victims without OHCA. METHODS: All adult submersion victims without OHCA who visited our hospital between 2004 and 2013 were included. This study was conducted retrospectively, with collection of data by review of medical records. Among total submersion victims (310 patients), 191 patients did not suffer OHCA. We investigated the characteristics of the patients and classified them according to two groups based on the presence of pneumonia. We then compared clinical variables between the two groups. RESULTS: A total of 191 adult submersion patients without OHCA; 157 patients did not have pneumonia during their hospital stay; 34 patients had pneumonia. In respective analysis, alert mentality, pH and core temperature showed correlation with pneumonia. However, in logistic regression analysis with these 3 variables, only pH was a risk factor of pneumonia. All patients with pneumonia except one were discharged with full recovery. CONCLUSION: The risk of pneumonia among adult submersion victims without OHCA is higher when the lower pH is checked. Further studies are needed in order to evaluate the other risk factors of pneumonia for early prediction and proper management.
Adult* ; Heart Arrest ; Humans ; Hydrogen-Ion Concentration ; Immersion* ; Length of Stay ; Logistic Models ; Medical Records ; Out-of-Hospital Cardiac Arrest* ; Pneumonia* ; Respiratory Distress Syndrome, Adult ; Retrospective Studies ; Risk Factors

PURPOSE: Historically, acute respiratory failure is the most common cause of death in drowning patients. However, there are an increasing number of severe drowning cases where patients die of circulatory failure or cardiovascular collapse. The aim of this study was to analyze the causes of death in severe drowning patients and evaluate the data in terms of survival curves in order to propose a treatment plan for severe drowning patients in the future. METHODS: The subjects were 58 patients that visited St. Mary's Hospital from January 2000 to September 2006 who had drowned and required CPR and mechanical ventilation. Univariate analysis was performed to evaluate factors known to be predictive of severity. Survival analysis was done to determine the degrees of correlation with acute respiratory distress syndrome (ARDS) and refractory shock. RESULTS: Thirty-nine out of 58 severely drowning patients expired in all, with most deaths occurring in the early stages - 45% expired on the first day, 55% on the second day, and 60% on the third day. Cause of death analysis yielded the following results: the correlation coefficient for the existence of ARDS was 2.96 (p=0.086), which did not achieve statistical significance, but, the coefficient for refractory shock was 9.23 (p=0.002) and was statistically significant. CONCLUSION: Most severe drowning patients expired in the first three days after drowning, and refractory shock was a more significant contributor to patients death than ARDS. This result underscores the need for treatment protocols that includes active management of hemodynamic instability combined with mechanical ventilatory management in the initial stages of treatment.
Cardiopulmonary Resuscitation ; Cause of Death ; Clinical Protocols ; Drowning* ; Hemodynamics ; Humans ; Mortality ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult ; Respiratory Insufficiency ; Shock

Recently, percutaneous epidural neuroplasty has become widely used to treat radicular pain caused by spinal stenosis or a herniated intervertebral disc. A 19-year-old female patient suffering from left radicular pain caused by an L4-L5 intervertebral disc herniation underwent percutaneous epidural neuroplasty of the left L5 nerve root using a Racz catheter. After the procedure, the patient complained of acute motor weakness in the right lower leg, on the opposite site to where the neuroplasty was conducted. Emergency surgery was performed, and swelling of the right L5 nerve root was discovered. The patient recovered her motor and sensory functions immediately after the surgery. Theoretically, the injection of a large volume of fluid in a patient with severe spinal stenosis during epidural neuroplasty can increase the pressure on the opposite side of the epidural space, which may cause injury of the opposite nerve by barotrauma from a closed compartment. Practitioners should be aware of this potential complication.
Barotrauma ; Catheters ; Constriction, Pathologic ; Emergencies ; Epidural Space ; Female ; Hemiplegia ; Humans ; Intervertebral Disc ; Leg ; Lower Extremity* ; Sensation ; Spinal Stenosis ; Young Adult

In cases that penetrating keratoplasty do not help to improve vision, keratoprosthesis implantation is necessary. This study was performed to assess clinical and mechanical stability of Seoul type-keratoprosthesis[SKPro], bio-compatibility and effect of amniotic membrane transplantation on clinical and mechanical stability of SKPro. SKPro consists of an optic portion made of PMMA, a skirt of Gore-tex or polyurethane and a haptic of prolene. The skirt of SKPro was covered with recipient conjunctiva completely at postoperative 1 month and melting of covered conjunctiva and exposure of skirt developed at postoperative 2 months and progressed slowly to postoperative 6 months. But retroprosthetic membrane formation, extrusion of SKPro, posterior segment complication such as retinal detachment did not develop and transplanted SKPro showed relatively good clinical stability during 6 months. Pressure loading test showed relatively good mechanical stability under high pressure at postoperative 2 months. Histologic study showed moderate inflammatory reaction and abnormal pattern of collagen and extracellular matrix in lamellar pocket and anterior flap. There was no deposit of collagen in Gore-tex skirt. But histology of posterior flap of lamellar pocket was nearly normal. Group that was transplanted with amniotic membrane twice showed more better stability than once and without amniotic membrane transplantation on clinical and mechanical stability.
Amnion ; Collagen ; Conjunctiva ; Extracellular Matrix ; Freezing ; Keratoplasty, Penetrating ; Membranes ; Polymethyl Methacrylate ; Polypropylenes ; Polytetrafluoroethylene ; Polyurethanes ; Retinal Detachment ; Seoul*

In cases that penetrating keratoplasty do not help to improve vision, keratoprosthesis implantation is necessary. This study was performed to assess clinical and mechanical stability of Seoul type-keratoprosthesis[SKPro], bio-compatibility and effect of amniotic membrane transplantation on clinical and mechanical stability of SKPro. SKPro consists of an optic portion made of PMMA, a skirt of Gore-tex or polyurethane and a haptic of prolene. The skirt of SKPro was covered with recipient conjunctiva completely at postoperative 1 month and melting of covered conjunctiva and exposure of skirt developed at postoperative 2 months and progressed slowly to postoperative 6 months. But retroprosthetic membrane formation, extrusion of SKPro, posterior segment complication such as retinal detachment did not develop and transplanted SKPro showed relatively good clinical stability during 6 months. Pressure loading test showed relatively good mechanical stability under high pressure at postoperative 2 months. Histologic study showed moderate inflammatory reaction and abnormal pattern of collagen and extracellular matrix in lamellar pocket and anterior flap. There was no deposit of collagen in Gore-tex skirt. But histology of posterior flap of lamellar pocket was nearly normal. Group that was transplanted with amniotic membrane twice showed more better stability than once and without amniotic membrane transplantation on clinical and mechanical stability.
Amnion ; Collagen ; Conjunctiva ; Extracellular Matrix ; Freezing ; Keratoplasty, Penetrating ; Membranes ; Polymethyl Methacrylate ; Polypropylenes ; Polytetrafluoroethylene ; Polyurethanes ; Retinal Detachment ; Seoul*

PURPOSE: Jumping off a bridge is one method of suicide. In a recent report, out of the 37 patients with cardiac arrest after drowning, 5 (36%) patients suffered severe traumatic injuries. The objective of this study was to report these injuries, without cardiac arrest, in patients after jumping off a bridge with the purpose of suicide. METHODS: We retrospectively reviewed the charts of all patients admitted to the emergency department in a tertiary care hospital after drowning in the Han River between 1997 and 2012. We analyzed the results of imaging studies. Each injury was described as one of the six body regions, similar to the method of the Injury Severity Score. RESULTS: A total of 469 patients were admitted to the emergency department from drowning. Sixty-six patients had jumped off a bridge with the purpose of suicide. Forty patients experienced cardiac arrest. In cardiac arrest patients, 25 patients (62.5%) underwent radiologic examinations. Only 2 patients (5.0%) received damage on the cervical spine and face. All non-cardiac arrest patients underwent imaging studies. Nine patients (34.6%) showed evidence of injuries. Most injuries occurred in the chest; four patients suffered the following injuries: rib fracture, pneumothorax, pneumomedistinum, and thoracic spine fracture. One patient had abdominal damage, an intra-abdominal hematoma. Last one patient suffered an injury to the chest and abdomen. CONCLUSION: In drowning patients with the purpose of suicide, variable damage could not be ruled out. It is especially not confined to a specific area, and damage to various parts of the body should be considered.
Abdomen ; Body Regions ; Drowning ; Emergency Service, Hospital ; Heart Arrest ; Hematoma ; Humans ; Injury Severity Score ; Methods ; Multiple Trauma ; Pneumothorax ; Retrospective Studies ; Rib Fractures ; Rivers ; Spine ; Suicide* ; Tertiary Healthcare ; Thorax

PURPOSE: Occult injuries are diagnosed using computed tomography (CT), often with intravenous (IV) contrast CT, in major trauma patients. The contrast dye is known to be potentially nephrotoxic. Thus, we measured the incidence and risk factors for contrast-induced nephropathy (CIN) in major trauma patients. METHODS: A retrospective review was performed on 247 patients who were treated by the activated trauma team between June 2012 and July 2014. The exclusion criteria were underlying renal failure, no IV contrast CT administered, and no creatinine (Cr) follow-up within 72 hours. We examined age, gender, initial vital signs, the Glasgow Coma Scale (GCS), initial Cr levels, Cr level within 72 hours after admission, the IV contrast CT number, Injury Severity Score (ISS). CIN was defined as 25% relative or 0.5 mg/dL absolute increase in serum Cr within 72 hours of presentation. RESULTS: One hundred forty-three patients were included in this study. CIN manifested in 12 patients (8.4%). The injury severity was associated with CIN (ISS≥16, p=0.003; GCS≤8, p<0.001; death, p<0.001). Initial Cr levels, elderly patients, and initial hypotension were not statistically significant (p=0.065, 0.176, and 0.402, respectively). The number of IV contrast CTs administered was also not associated with the occurrence of CIN (p=0.331). CONCLUSION: We found an 8.4% incidence of CIN in multiple trauma patients exposed to IV contrast. The number of IV contrasts, age, initial systolic blood pressure, and initial Cr levels were not associated with CIN. Only injury severity was associated with CIN occurrence; therefore, physicians should pay more attention to severely-injured patients.
Aged ; Blood Pressure ; Creatinine ; Follow-Up Studies ; Glasgow Coma Scale ; Humans ; Hypotension ; Incidence ; Injury Severity Score ; Multiple Trauma ; Renal Insufficiency ; Retrospective Studies ; Risk Factors ; Vital Signs