No abstract available.

PURPOSE: Trauma is the 5th most common leading cause of death in Korea, but there has been no appropriate management system for patients until now. We analyzed the main causes of death in trauma patients by comparing the characteristics of those patients with the characteristics of patients who survived. We feel this analysis should have a positive effect on the development of an appropriate trauma management system in Korea. METHODS: We retrospectively reviewed trauma patients who had been admitted to the Department of General Surgery from February 2002 to February 2007. We compared several expected risk factors between the mortality and the survival group. Data on the transportation, arrival time at the emergency center, amount of transfusion, initial shock index, cause of death, and initial physical condition according to RTS (Revised trauma score), ISS (Injury severity score) and TRISS (Trauma and Injury Severity Score) were collected. Patients with ISS lower than 12 were excluded. RESULTS: Three hundred sixty-six(366) patients with multiple injuries were included. There were 40 patients in the mortality group and 326 patients in the survival group. The mean arrival time (minutes) to emergency center was longer in the mortality group (137.6 vs 93.6 p 0.04). The total amount of transfusion (ml) was larger in the mortality group (7139 vs 2470 p 0.01). The initial shock index was higher in the mortality group (1.45 vs 1.17 p<0.01). The RTS, ISS, and TRISS were not statistically different between the groups. In the multivariate analysis, mean arrival time and initial shock index were important factors for survival. CONCLUSION: If the mortality rate of trauma patients is to be reduced , the arrival time at the emergency center should be minimized. Improvement of the emergency medical transfer service system is very important for achieving that.
Cause of Death ; Emergencies ; Humans ; Korea ; Mortality ; Multiple Trauma ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Shock ; Transportation

BACKGROUND: Neuropathic pain can be induced by nerve injury or inflammation. An N-methyl-D-Aspartate (NMDA) antagonist (MK-801), and a sodium channel blocker (lidocaine) have been found to reduce mechanical allodynia. This study was conducted to determine whether intrathecal lidocaine or MK-801 had an antiallodynic effect on established mechanical allodynia in two well-characterized neuropathic pain rat models. METHODS: Male Sprague Dawley rats (n = 107) were anesthetized, and the left L5 and L6 spinal nerves were ligated (SNL group) or Freund complete adjuvant (FCA) was administrated to the same spinal nerves (FCA group) in order to cause neuropathic pain. A catheter was then implanted into the lumbar intrathecal space. After obtaining the baseline scores, time-effect curves of each drug were established for the antiallodynic effects of lidocaine (30g, 100g and 300g) and MK-801 (1g, 3g, 10g and 30g). The allodynic thresholds for the left hind paw withdrawal to von Frey hairs were assessed and converted to %MPE, and the ED50 value was then calculated using the %MPE. The antiallodynic effects of the two groups were then compared by analyzing the dose-response curves and the ED50 values. RESULTS: Both intrathecal lidocaine and MK-801 resulted in a dose dependent antiallodynic effect. ED50 values and the analysis of dose response curves showed that intrathecal lidocaine provided more effective antiallodynia in the SNL group, whereas intrathecal MK-801 resulted in a greater antiallodynic effect in the FCA group. CONCLUSIONS: In the SNL group, lidocaine had a better effect in reducing allodynic pain, whereas in the FCA group, MK-801 showed a greater antiallodynic effect.
Animals ; Catheters ; Dizocilpine Maleate* ; Hair ; Humans ; Hyperalgesia* ; Inflammation ; Lidocaine* ; Male ; Models, Animal* ; N-Methylaspartate ; Neuralgia* ; Rats* ; Rats, Sprague-Dawley ; Sodium Channels ; Spinal Nerves

PURPOSE: Abrupt abstinence from alcohol in cause of chronic alcohol addiction can trigger alcohol withdrawal syndrome. The authors studied the effect of post-operative alcohol withdrawal syndrome in patients who require intensive care due to trauma. METHODS: For the study group, we selected 70 patients who had undergone emergency surgery from May 2003 to March 2007 due to trauma and who had been treated with prophylactic thiamine. Data was collected retrospectively. We excluded those who extended their hospital stay for other than traumatic causes, those who died within 3 days of surgery after trauma, those who transferred to other institutions, and those who received a psychiatric diagnosis. Patient groups were determined by the existence or the non-existence of withdrawal syndrome. Age, sex, injury mechanism, mortality, complications, durations of hospital stay and intensive care, use of mechanical ventilator, and sedative use were investigated. A Chi-square test and The Mann-Whitney method were used for statistical analysis in this study. RESULTS: Twenty-four (24) patients from the 58 who had an ISS of 16 or more showed alcohol withdrawal syndrome, and men were shown to be affected with the syndrome significantly more than women. Although ISS was higher in the group with alcohol withdrawal syndrome, statistically, the difference was not significant (p<0.08). The total hospital stay in the patient group with alcohol withdrawal syndrome was on average 10 days longer. However, the difference was not significant (p<0.054). The duration of intensive care in the patient group with alcohol withdrawal syndrome was significantly longer (p<0.029). The patients with alcohol withdrawal syndrome showed no significant difference in the duration of mechanical ventilator use (p<0.783), or in the duration of sedative use (p<0.284). Respiratory distress, pneumonia, upper airway infection, sepsis, acute renal failure, and mortality in the alcohol withdrawal syndrome group were investigated, but no statistically significant difference were noted. CONCLUSION: We found that the duration of intensive care in chronic alcohol abusers was longer due to the development of alcohol withdrawal syndrome. We also discovered that, when the patients overcame the symptoms of alcohol withdrawal syndrome after intensive care, no difference was found in the frequency of developing complications, the morbidity, and the mortality. Therefore, we conclude that intensive care in trauma patients who are chronic alcohol abusers decreases the incidence of complications found in patients with postoperative alcohol withdrawal syndrome and does not adversely impact the prognoses for those patients.
Acute Kidney Injury ; Critical Care ; Emergencies ; Female ; Humans ; Incidence ; Injury Severity Score ; Length of Stay ; Male ; Mental Disorders ; Pneumonia ; Prognosis ; Retrospective Studies ; Sepsis ; Thiamine ; Ventilators, Mechanical

PURPOSE: The objectives of this study were to define the prognostic factors of papillary microcarcinoma of the thyroid (PMCT), to analyse their histopathologic and epidemiologic characteristics and to investigate the optimal therapeutic management. METHODS: Our series included 254 consecutive patents who were affected by PMCT and who were operated on by the same surgeon between 1985 and 2002 among a total of 3,100 patients who underwent thyroid surgery. All the surgical specimens were examined in the same Department of Pathology. The prognostic factors were evaluated by uniand multivariate statistical analyses. RESULTS: The histopathologic characteristics such as vascular extension, infiltration into the adjacent parenchyma, a larger primary tumor (size ≥5 mm) or tumor in the thyroid capsule were all indicative of a poor prognosis. For the patents with poor prognostic factors and who were treated by partial thyroidectomy alone, the prevalence of recurrent disease was higher than that for the patients who were with treated by total thyroidectomy and 131 iodine administration. CONCLUSION: According to the prognostic factors, different therapeutic modalities could be proposed to treat patients with pillary thyroid microcarcinoma. It is reasonable to perform total thyroidectomy and 131 iodine therapy for patients with PMCT and who have high risk factors.
Humans ; Iodine ; Pathology ; Prevalence ; Prognosis ; Risk Factors ; Thyroid Gland* ; Thyroidectomy

PURPOSE: Postoperative hypocalcemia is a common complication compared with the other complications following total thyroidectomy due to thyroid carcinoma. We evaluated the incidence of transient and permanent hypocalcemia and the preservation status of the parathyroid glands following total thyroidectomy due to thyroid carcinoma. METHODS: We analyzed a total of 145 cases of total thyroidectomy due to thyroid carcinoma. The preservation status of the prarathyroid glands after total thyroidectomy was classified as intact preservation or ischemic change, according to the number of intact preserved parathyroid glands in group 1 (more than 2), group 2 (1) or group 3 (0). RESULTS: Permanent hypocalcemia was not found in group 1. The rate of transient or permanent hypocalcemia was significantly lower in group 2 than that in group 3 (P< 0.05). CONCLUSION: The parathyroid glands should be preserved to minimize the occurrence of hypocalemia after performing total thyroidectomy. The number of intact preserved parathyroid glands can be a good indicator for predicting the occurrence of post-total thyroidectomy hypocalcemia.
Humans ; Hypocalcemia* ; Incidence ; Parathyroid Glands ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy*

PURPOSE: The frequency of diagnosis of each nodule category under the Bethesda classification was studied, and the differences in the results between cytopathologic and histopathologic analyses of same patients were assessed. Special attention was paid to the atypical cells of undetermined significance (ACUS), which is an intermediate category. The histopathology of ACUS specimens was confirmed to examine the clinical implication. METHODS: Patients (n=417) who underwent thyroid ultrasonography and fine needle aspiration of the thyroid since the application of Bethesda classification (November 2009 to August 2010) in this institution was enrolled in the study. RESULTS: According to the Bethesda criteria, of the 640 nodules there were 56 cases (8.8%) of ACUS, 14 cases (2.2%) of follicular neoplasm, 13 cases (2.0%) were suspicious for malignancy, and 37 cases (5.8%) were positive of malignancy. A total of 102 surgically-excised specimens were obtained, of which 40 specimens were previously categorized cytopathologically as ACUS. Of these 40 specimens, 16 cases (40%) were found to be malignant. CONCLUSION: A precise understanding of each diagnostic category seems to be necessary, which may help with treatment of patients with thyroid mass. This is especially true for ACUS, which was previously understood as an intermediate specimen, but which is actually a heterogeneous mix of benign specimen, benign specimen with various atypia, and malignancy. In case of ACUS, an extensive and accurate diagnostic approach utilizing various examination methods may be beneficial for the patient treatment.
Biopsy* ; Biopsy, Fine-Needle* ; Classification* ; Diagnosis ; Humans ; Thyroid Gland* ; Ultrasonography

Prostate cancer is the most frequently diagnosed cancer. Although prostate tumors respond to androgen ablation therapy at an early stage, they often acquire the potential of androgen-independent growth. Elevated transcriptional activity of androgen receptor (AR) and/or signal transducer and activator of transcription-3 (STAT3) contributes to the proliferation of prostate cancer cells. In the present study, we examined the effect of resveratrol, a phytoalexin present in grapes, on the reporter gene activity of AR and STAT3 in human prostate cancer (LNCaP-FGC) cells stimulated with interleukin-6 (IL-6) and/or dihydrotestosterone (DHT). Our study revealed that resveratrol suppressed the growth of LNCaP-FGC cells in a time- and concentration-dependent manner. Whereas the AR transcriptional activity was induced by treatment with either IL-6 or DHT, the STAT3 transcriptional activity was induced only by treatment with IL-6 but not with DHT. Resveratrol significantly attenuated IL-6-induced STAT3 transcriptional activity, and DHT- or IL-6-induced AR transcriptional activity. Treatment of cells with DHT plus IL-6 significantly increased the AR transcriptional activity as compared to DHT or IL-6 treatment alone and resveratrol markedly diminished DHT plus IL-6-induced AR transcriptional activity. Furthermore, the production of prostate-specific antigen (PSA) was decreased by resveratrol in the DHT-, IL-6- or DHT plus IL-6-treated LNCaP-FGC cells. Taken together, the inhibitory effects of resveratrol on IL-6- and/or DHT-induced AR transcriptional activity in LNCaP prostate cancer cells are partly mediated through the suppression of STAT3 reporter gene activity, suggesting that resveratrol may be a promising therapeutic choice for the treatment of prostate cancer.
Dihydrotestosterone ; Genes, Reporter ; Humans ; Interleukin-6 ; Prostate ; Prostate-Specific Antigen ; Prostatic Neoplasms* ; Receptors, Androgen ; Transducers ; Vitis

PURPOSE: The aim of this study was to evaluate and establish the indications of interventional artery embolization in patients with a traumatic liver, spleen and pelvis injury. METHODS: 91 patients with a traumatic liver, spleen and pelvis injury, who had been treated with interventional arterial embolization from April 1992 to April 2004, were included in this retrospective study. The abdominal pelvic injuries were classified according to the CT scan findings based on the injury scale of the American Association for the Surgery of Trauma. The mechanism of trauma, initial vital signs, initial hemoglobin, hospital length, transfusion amount, shock index and fluid resuscitation amount were surveyed. All the patients underwent angiography. If there was evidence of an active hemorrhage during angiography, interventional arterial embolization with Gelfoam or stainless coil was performed. RESULTS: Among the 91 patients with a traumatic liver, spleen and pelvis injury, 25 out of 30 patients treated by hepatic arterial embolization, 36 out of 42 patients by splenic artery embolization and 14 out of 19 patients by pelvic artery embolization showed successful outcomes that were supported by shock index improvement (P<0.05), less fluid resuscitation requirements (P<0.05) and less packed red blood cell (RBC) requirements (P<0.05). CONCLUSION: Interventional artery embolization is a preferable non-surgical management for patient with a traumatic liver, spleen and pelvis injury. These results suggests that the indications of interventional arterial embolization are a shock index <1, transfusion amount to maintain a Hg level of 10 g/dl <3 pint per day and fluid resuscitation amount <2,000 ml per 2 hours.
Angiography ; Arteries ; Erythrocytes ; Gelatin Sponge, Absorbable ; Hemorrhage ; Humans ; Liver ; Pelvis ; Resuscitation ; Retrospective Studies ; Shock ; Spleen ; Splenic Artery ; Tomography, X-Ray Computed ; Vital Signs

BACKGROUND: The objectives of this study were to assess propofol as sedative agents for colonoscopy in the safety and efficacy, compared with midazolam plus meperidine. METHODS: 120 patients undergoing colonoscopy in a prospective study were randomly assigned to one of three medication regimens. Patients in group A (n=42) received i.v. 25 mg of meperidine and 2.5 mg of midazolam. Patients in group B (n=41) received i.v. a median dose of 96.59 mg of propofol (range 40-180) and patients in group C (n=37) received i.v. 25 mg of meperidine and a median dose of 77.03 mg of propofol (range 40-150), administered by a nurse with endoscopist supervision. Endpoints were patient satisfaction, procedure and recovery times and complications. RESULTS: The mean time to sedation was much faster in 2 groups using propofol (group A: 152+/-105.9 sec, group B: 52.9+/-46.5 sec, group C: 56+/-63.7sec; p<0.001). The mean time to reach the cecum was not different among the 3 groups. There were total 3 episodes of oxygen desaturation to <90%, as one in each group, but the patients were spontaneously recovered with only increasing O2 concentration and arousal. Patients in group C expressed better overall mean satisfaction than patients in group A (p=0.049), but difference was not found between group A and group B. The amnestic effect was better in two groups using propofol than group A (p=0.017) The mean dose of propofol was lower in the patients who received propofol combined with low dose of meperidine than those with propofol only (77.03 mg vs 96.59 mg, p=0.009). CONCLUSION: Nurse-administered propofol sedation with endoscopist supervision is believed to be safe and useful for colonoscopy with careful monitoring.
Arousal ; Cecum ; Colonoscopy ; Conscious Sedation* ; Humans ; Meperidine ; Midazolam ; Organization and Administration ; Oxygen ; Patient Satisfaction ; Propofol* ; Prospective Studies*