We encountered a rare condition of rice body in subacromial and subdeltoid spaces in a patient with unremarkable medical history. Although it is uncommon, there have been continued reports on its formation in certain type of infective and inflammatory arthritis. However, except for a traumatic event, evaluation yielded no known and conceivable cause for his chronic inflammatory bursitis. Relatively typical findings for rice body on magnetic resonance imaging have been described, and in our case the imaging prompted us to schedule early removal, which is generally accepted as the management of choice to prevent further progression of symptoms. The symptoms of the shoulder showed significant improvement, and a close follow-up schedule has been recommended for observation of recurrence and development of any foreseeable underlying cause.
Appointments and Schedules ; Arthritis ; Bursitis ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Recurrence ; Shoulder ; Shoulder Joint

Central venous catheterization is common in the emergency department for monitoring of CVP (central venous pressure), fluid administration, and drug infusions. However, the insertion of a central venous catheter is a technically challenging procedure with known risks and complications. A 94-year-old woman was transferred to an emergency department due to difficulties in removing the guidewire during central catheter insertion through the right subclavian vein. A focused bedside ultrasound showed that the guidewire was improperly positioned in the right internal jugular vein. Upon computed tomographic evaluation, the guidewire perforated the right subclavian vein, looped in the mediastinum, reentered the right internal jugular vein toward the right jugular foramen, and was removed by surgery. In conclusion, as catheter and guidewire entrapment are well-known potential complications of central venous catheterization, when resistance is encountered at any stage of central venous catheterization (especially when removing the entrapped catheter or guidewire) the procedure should be stopped and evaluated with imaging assistance. Clinicians should be aware of more complicated sequelae caused by blunt removal of an entrapped catheter and guidewire, despite its low probability.
Catheterization ; Catheterization, Central Venous* ; Catheters ; Central Venous Catheters* ; Emergencies ; Female ; Humans ; Jugular Veins ; Mediastinum ; Patient Harm ; Subclavian Vein ; Ultrasonography

This study aimed to analyze infant, maternal, perinatal, and fetal mortality statistics in the Republic of Korea (Korea), 2014. It was based on the open-access data available from the Statistics Korea website (http://kostat.go.kr/portal/eng/index.action). Recent trends in these vital statistics were also examined. The results of this study constitute a descriptive presentation and analysis of the national data. The number of infant deaths was 1,305 out of 435,435 live births in 2014, and the infant mortality rate was 3.0. The number of maternal deaths was 48. The maternal mortality ratio per 100,000 live births was 11.0. The maternal mortality ratio per 100,000 women of child-bearing age (15 to 49 years old) was 0.37. The number of perinatal deaths was 1,365, and the perinatal mortality rate was 3.1. The number of fetal deaths was 5,317. The fetal mortality rate was 12.1. The trends in those vital statistics in recent years were consistent except for a few findings, including a decrease in the maternal mortality ratio of pregnant women 40 years old and older and a change in the proportions of the causes of infant death, with a decrease in mortality due to neonatal respiratory distress and an increase in mortality due to bacterial sepsis. Although these vital statistics were generally consistent, some aspects varied by year. Pregnant women less than 20 years old should be monitored more intensively for their babies' health. Our findings can serve as basic data supporting the establishment of health policies by the Korean government.
Cause of Death ; Female ; Fetal Death ; Fetal Mortality ; Health Policy ; Humans ; Infant Death ; Infant Mortality ; Infant* ; Korea ; Live Birth ; Maternal Death ; Maternal Mortality ; Mortality ; Perinatal Death ; Perinatal Mortality* ; Pregnant Women ; Republic of Korea* ; Sepsis ; Vital Statistics

PURPOSE: Emergency physicians usually perform ultrasound exams for patients with multiple injuries. Extended focused assessment with sonography for trauma (eFAST) can reveal injuries from chest to the abdomen immediately. However, in Korea, the curriculums of medical schools do not currently include eFAST. We have devised a study to assess the feasibility of the eFAST exam in medical school students. METHODS: This study was conducted in students in their fifth year out of six years of medical school, over 11 weeks. Four Emergency Medicine specialists trained the students over 4 hours, tested the students, and conducted a questionnaire. RESULTS: Average age of students was 25.9+/-2.6 years, and 24 were male and 20 were female. Mean success rate of 17 components on the eFAST exam was 95.9% (94.6%-97.4%). The success rate of transverse view of aorta, transverse view of bladder, lung sliding sign, and sea-shore sign of both anterior chest walls was 100%, scanning the spleen and attaching the probe to a body surface were 75%, 86.3%. Total time consumption was 449.0+/-22.2 seconds. The questionnaires showed that the eFAST exam for the splenorenal recess, spleen, and left upper quadrant lung was difficult. CONCLUSION: We found that medical students in Korea could perform the eFAST exam by themselves after 4 hours education. In the future, these findings can be helpful in development of an eFAST education program for medical students.
Abdomen ; Aorta ; Curriculum ; Education ; Emergencies ; Emergency Medicine ; Female ; Humans ; Korea ; Lung ; Male ; Multiple Trauma ; Surveys and Questionnaires ; Schools, Medical* ; Specialization ; Spleen ; Students, Medical ; Thorax ; Ultrasonography ; Urinary Bladder

BACKGROUND: I-gel is a recently developed supraglottic airway device with many advantages. Like laryngeal mask airway (LMA), I-gel is an easier and quicker intubation alternative to endotracheal intubation in certain situations. In this study, we assessed the ease of I-gel insertion and compared the clinical performance of anesthetsiology residents (group R) experienced in endotracheal intubation versus that of interns (group I) with little intubation experience. METHODS: This prospective and randomized study included 60 patients. The ease of insertion, number of I-gel insertion attempts, presence of air leakage, and postoperative complications such as bleeding, dental trauma, hoarseness, and sore throat were evaluated in each group. RESULTS: Insertion was successful on the initial attempt in 29 of 30 cases in group R. In group I, 24 initial insertions were successful. The mean insertion times were 12.5 +/- 4.8 and 27.9 +/- 12.5 seconds for group R and group I, respectively (P < 0.001). No significant differences were observed between the two groups regarding postintubational air leakage. Regarding complications, two cases of bleeding, one case of dental trauma, and two cases of sore throat were recorded. No significant differences were observed between the two groups for any of the complications examined. CONCLUSIONS: I-gel is a suitable alternative insertion device that enables rapid and easy intubation by physicians who are experienced with endotracheal intubation. Moreover, this device also enables efficient and safe insertion during emergent situations for novice clinicians, even those who have little experience in intubation.
Airway Management ; Anesthesiology* ; Hemorrhage ; Hoarseness ; Humans ; Intubation ; Intubation, Intratracheal ; Laryngeal Masks ; Pharyngitis ; Postoperative Complications ; Prospective Studies

Wilson's disease is a rare genetic disorder that has abnormal copper metabolism. Although the disease's main problems are found in liver and brain, some studies revealed manifestation of various musculoskeletal problems in the patients. In this report, we encountered a young patient who had fracture in the forearm bone. Initially, exception to a previous history of fracture from a motorcycle accident, the patient did not have any medical or drug use history, and laboratory work-ups were insignificant. However, with suspicion on his bone's integrity, bone densitometry was recommended and revealed osteopenic change. To disclose a cause for the change, questions were made to recall any particular history or event, and his complaint of recent vision loss led to ophthalmologic consultation where under slit-lamp test found Kayser-Fleischer ring. Further laboratory work-up found low levels of serum copper and ceruloplasmin and high copper level in 24-hr urine sample that led to the diagnosis of Wilson's disease. Although Wilson's disease has been frequently noticed with considerable musculoskeletal manifestation, it rarity makes the diagnosis illusive to a physician. Hence, despite of its rarity, it is imperative to remember the disease's bony manifestation, and it should be suspected in young patients with demineralized bone when the reason for brittle bone cannot be answered with other better known conditions.
Brain ; Ceruloplasmin ; Copper ; Densitometry ; Diagnosis* ; Forearm ; Hepatolenticular Degeneration* ; Humans ; Liver ; Male ; Metabolism ; Motorcycles

OBJECTIVE: The efficacy of two-drug combination treatment may be schedule-dependent. We investigated a simulated in-vitro interaction between taxol and doxorubicin in a Cervical cancer cell line HeLa and the role of peroxiredoxin in cytotoxicity. METHODS: Two contradicting schedules of two drugs (taxol followed by doxorubicin or vice versa) were compared each other in terms of cytotoxicity in parental HeLa cell line and the peroxiredoxin (prx)-overexpressing variant. Cytotoxic activity was determined by MTT assay. Cell cycle pertubation was evaluated by flow cytometric analysis. Protein levels were determined by western blot. RESULTS: The sequential treatment of taxol followed by doxorubicin (T-- Appointments and Schedules ; Blotting, Western ; Cell Cycle ; Cell Line ; Cell Line, Tumor* ; Cyclin D1 ; Doxorubicin ; HeLa Cells ; Humans ; Paclitaxel ; Parents ; Peroxiredoxins* ; Uterine Cervical Neoplasms

PURPOSE: Extracorporeal shock wave lithotripsy (ESWL) is a first-line treatment for pediatric urinary stone disease. We aimed to determine the factors affecting the outcome of ESWL for unilateral urinary stones in children. MATERIALS AND METHODS: A total of 81 pediatric patients aged 0 to 16 years with urinary stones treated by ESWL from January 1995 through May 2012 were retrospectively reviewed. All patients were required to have unilateral urinary stone disease. Children who underwent other surgical procedures before ESWL were excluded. Outcomes evaluated after ESWL were the stone-free rate at 3 months after ESWL, success within a single session, and success within three sessions. Factors affecting the success within three sessions were also analyzed. RESULTS: The final analysis was for 42 boys and 22 girls (mean age, 9.2+/-5.2 years). Of these 64 patients, 58 (90.6%) were treated by ESWL without other surgical procedures and 54 (84.4%) were successfully treated within three ESWL sessions. In the multivariate analysis, multiplicity (odds ratio [OR], 0.080; 95% confidence interval [CI], 0.012 to 0.534; p=0.009) and large stone size (>10 mm; OR, 0.112; 95% CI, 0.018 to 0.707; p=0.020) were significant factors that decreased the success rate within three ESWL sessions. CONCLUSIONS: Most of the pediatric urinary stone patients in our study (90.6%) were successfully treated by ESWL alone without additional procedures. If a child has a large urinary stone (>10 mm) or multiplicity, clinicians should consider that several ESWL sessions might be needed for successful stone fragmentation.
Aged ; Child ; Humans ; Lithotripsy ; Multivariate Analysis ; Pediatrics ; Retrospective Studies ; Shock ; Treatment Outcome ; Urinary Calculi

As a minor blood antigen, the Duffy blood group has 5 antigens which are Fya, Fyb, Fy3, Fy4 and Fy5. When the Duffy group is implicated in delayed transfusion reactions, one expects to find anti-Fya rather than Fyb. We experienced a case of delayed hemolytic transfusion reaction caused by anti-Fyb antibody. A 69 year-old woman was referred having had hematuria, fever, chill and jaundice 9 days after transfusion. The hemoglobin was 9.5mg/dl, reticulocyte count 1.4%, liver function test showed total bilirubin 10.8mg/dL, LDH 5,225IU/L, alkaline phosphatase 26IU/L. Indirect antiglobulin test was positive, while the direct one was negative. A delayed hemolytic transfusion reaction was suspected as patient's serum was reacted with panel cells for the antibody identification test and the anti-Fyb was finally identified. The patient recovered without specific treatment. There were no severe complication and sequele.It appears to be the first reported case of hemolytic transfusion reaction caused by anti-Fyb in Korea.
Aged ; Alkaline Phosphatase ; Bilirubin ; Blood Group Incompatibility ; Coombs Test ; Female ; Fever ; Hematuria ; Humans ; Jaundice ; Korea ; Liver Function Tests ; Reticulocyte Count

We encountered a rare condition of rice body in subacromial and subdeltoid spaces in a patient with unremarkable medical history. Although it is uncommon, there have been continued reports on its formation in certain type of infective and inflammatory arthritis. However, except for a traumatic event, evaluation yielded no known and conceivable cause for his chronic inflammatory bursitis. Relatively typical findings for rice body on magnetic resonance imaging have been described, and in our case the imaging prompted us to schedule early removal, which is generally accepted as the management of choice to prevent further progression of symptoms. The symptoms of the shoulder showed significant improvement, and a close follow-up schedule has been recommended for observation of recurrence and development of any foreseeable underlying cause.
Appointments and Schedules ; Arthritis ; Bursitis ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Recurrence ; Shoulder ; Shoulder Joint