The author's affiliation should be corrected. We apologize for any inconvenience that may have caused.

BACKGROUND: The aim of this study was to investigate the relationships between left ventricular ejection fraction (LVEF) and mortality and neurologic outcomes with post-cardiac arrest syndrome (PCAS) after out-of-hospital cardiac arrest (OHCA). METHODS: Patients with PCAS after OHCA admitted to the intensive care unit between January 2014 and December 2015 were analyzed retrospectively. RESULTS: total of 104 patients were enrolled in this study. The mean age was 54.4 ± 15.3 years, and 75 of the patients were male (72.1%). Arrest with a cardiac origin was found in 55 (52.9%). LVEF < 45%, 45-55%, and > 55% was measured in 39 (37.5%), 18 (17.3%), and 47 (45.2%) of patients, respectively. In multivariate analysis, severe LV dysfunction (LVEF < 45%) was significantly related to 7-day mortality (odds ratio 3.02, 95% Confidence Interval 1.01-9.0, p-value 0.047). CONCLUSIONS: In this study, moderate to severe LVEF within 48 hours after return of spontaneous circulation was significantly related to 7-day short-term mortality in patients with PCAS after OHCA. Clinicians should actively treat myocardial dysfunction, and further studies are needed.
Echocardiography ; Humans ; Intensive Care Units ; Male ; Mortality* ; Multivariate Analysis ; Out-of-Hospital Cardiac Arrest* ; Passive Cutaneous Anaphylaxis ; Retrospective Studies ; Stroke Volume*

Rapunzel syndrome is caused by gastric trichobezoar with extended tail and small bowel obstruction. Patients with gastric trichobezoar can be asymptomatic until the bezoar increases in size. We report a case of a girl who visited the emergency department with abdominal pain. She was finally diagnosed with Rapunzel syndrome that causes multiple small bowel intussusceptions associated with trichophagia. Surgery was needed to reduce the multiple intussusceptions, and to remove the large trichobezoar. This case highlights to consider the possibility of Rapunzel syndrome when diagnosing the main cause of intussusceptions.
Abdominal Pain ; Bezoars ; Emergency Service, Hospital ; Female ; Humans ; Intestinal Obstruction ; Intussusception ; Pica ; Tail ; Trichotillomania

Inflammatory myositis is a heterogeneous group of rare diseases characterized by inflammation of the skeletal muscle. The association between cancer and inflammatory myositis is well established, with most cancer-associated myopathies diagnosed within 2 years of initial diagnosis. However, despite this strong association, inflammatory myositis as a paraneoplastic syndrome of urethral cancer has not been reported in Korea. Furthermore, compartment syndrome in the context of inflammatory myositis is extremely rare. A 69 year-old woman presented with paresthesia and painful swelling of the right lower extremity 2 months after diagnosis with urethral cancer, which was treated by chemoradiotherapy. Painful numbness was particularly severe when extending the knee, leading to a preliminary diagnosis of myositis with compartment syndrome, which was confirmed by magnetic resonance imaging. After fascia resection, the patient was treated with high dose steroid and immunoglobulin therapy. Here, we report a case of compartment syndrome followed by inflammatory myositis in a patient with urethral cancer.
Chemoradiotherapy ; Compartment Syndromes* ; Diagnosis ; Fascia ; Female ; Humans ; Hypesthesia ; Immunization, Passive ; Inflammation ; Knee ; Korea ; Lower Extremity ; Magnetic Resonance Imaging ; Muscle, Skeletal ; Muscular Diseases ; Myositis* ; Paraneoplastic Syndromes ; Paresthesia ; Rare Diseases ; Urethral Neoplasms*

BACKGROUND: The aim of this study was to investigate the relationships between left ventricular ejection fraction (LVEF) and mortality and neurologic outcomes with post-cardiac arrest syndrome (PCAS) after out-of-hospital cardiac arrest (OHCA). METHODS: Patients with PCAS after OHCA admitted to the intensive care unit between January 2014 and December 2015 were analyzed retrospectively. RESULTS: total of 104 patients were enrolled in this study. The mean age was 54.4 ± 15.3 years, and 75 of the patients were male (72.1%). Arrest with a cardiac origin was found in 55 (52.9%). LVEF < 45%, 45-55%, and > 55% was measured in 39 (37.5%), 18 (17.3%), and 47 (45.2%) of patients, respectively. In multivariate analysis, severe LV dysfunction (LVEF < 45%) was significantly related to 7-day mortality (odds ratio 3.02, 95% Confidence Interval 1.01-9.0, p-value 0.047). CONCLUSIONS: In this study, moderate to severe LVEF within 48 hours after return of spontaneous circulation was significantly related to 7-day short-term mortality in patients with PCAS after OHCA. Clinicians should actively treat myocardial dysfunction, and further studies are needed.
Echocardiography ; Humans ; Intensive Care Units ; Male ; Mortality ; Multivariate Analysis ; Out-of-Hospital Cardiac Arrest ; Passive Cutaneous Anaphylaxis ; Retrospective Studies ; Stroke Volume

The author's affiliation should be corrected. We apologize for any inconvenience that may have caused.

OBJECTIVE: The aim of this study was to evaluate the clinical characteristics of heat stroke in a bath facility and investigate predictive factors of multiple major complications in heat stroke patients. METHODS: This was a retrospective study on heat stroke patients who visited an urban emergency center from January 2010 to March 2018. We compared clinical characteristics, complication, and outcomes of heat stroke patients in bath and non-bath facilities. Multivariate logistic regression analysis were performed to identify independent predictors of multiple major complications in heat stroke patients. RESULTS: A total of 67 heat stroke patients with heat stroke were enrolled, of which 42 (62.6%) were in a bath facility and 25 (37.3%) were in a non-bath facility. Patients with heat stroke in the bath facility were characterized by old age, past medical history of hypertension and diabetes mellitus, and high incidence of hypotension compared with those in the non-bath facility but also low incidence of acute renal failure, seizure, and multiple major complications. In the multivariate analysis, predictive factors of multiple major complications in heat stroke patients were non-bath facility (odds ratio [OR], 5.4; 95% confidence interval [CI], 1.2–29.9), Glasgow Coma Scale (GCS)≤8 (OR, 8.2; 95% CI, 1.3–49.4), and mean arterial pressure (MAP), body temperature above 40.5℃ (OR, 8.1; 95% CI, 1.1–58.8) < 60 mmHg (OR, 14.8; 95% CI, 1.8–122.9). CONCLUSION: Heat stroke in the bath facility resulted in less major complications, and high body temperature, GCS ≤8, and MAP < 60 mmHg were independent predictive factors of multiple major complications in heat stroke patients.
Acute Kidney Injury ; Arterial Pressure ; Baths* ; Body Temperature ; Diabetes Mellitus ; Emergencies ; Glasgow Coma Scale ; Heat Stroke* ; Hot Temperature* ; Humans ; Hypertension ; Hypotension ; Incidence ; Logistic Models ; Multivariate Analysis ; Retrospective Studies ; Seizures

PURPOSE: We conducted this study in order to evaluate the question of whether a simple voice prompt, "push hard and fast", could improve the quality of chest compression performed by lay people. METHODS: Non-medical college students with no experience of cardiopulmonary resuscitation (CPR) education participated in this study. They were randomly divided into two groups-metronome prompt automated external defibrillator (AED) (M) group and metronome with intermittent "push hard and fast" voice prompt AED (V) group and performed two cycles of chest compression-only CPR. "Push hard and fast" voice was prompted every 10 seconds. The rate of metronome was fixed to 100/min in two groups. We measured compression depth, compression rate, and total compression frequency using ResusciAnne(R)SkillReporter(TM) (Laerdal, Korea). RESULTS: A total of 208 volunteers were enrolled. There were 120 (57.7%) females, and mean age was 21+/-2 years old. The compression depth was deeper in the V group (40.0+/-12 mm) than in the M group (35.9+/-13 mm) (p=0.02). The mean rate of chest compression was faster in the V group (98+/-20 cpm) than in the M group (88+/-31 cpm) (p=0.07) (*cpm: compressions per minute). Total frequency of chest compression during 2-cycle CPR was also higher in the V group (392+/-80) than in the M group (341+/-117) (p<0.001). CONCLUSION: A simple voice prompt, "push hard and fast", can improve the quality of chest compression performed by untrained lay people.
Cardiopulmonary Resuscitation ; Defibrillators ; Education ; Female ; Humans ; Thorax* ; Voice* ; Volunteers

BACKGROUND: von Willebrand disease (VWD) is one of the most common inherited bleeding disorders. However, the number of patients who register to the Korea Hemophilia Foundation (KHF) is much lower than the expected prevalence rate and only few hospitals perform tests for diagnosis autonomously. Thus, we surveyed practical realities of VWD in Yeungnam region. METHODS: Patients with VWD (N=267) who were diagnosed at eleven university hospitals from March 1995 to March 2018 were enrolled in this study. We evaluated the medical records from each hospital retrospectively. RESULTS: Two hundred and twenty-eight children and 39 adults met the diagnostic criteria for VWD. Seventy-eight (57.4%) patients had the blood type O. Fifty-eight patients were definite type 1 (21.7%), 151 were possible type 1 (56.6%), and the others were type 2. Abnormal laboratory findings were the most common factor for the diagnosis in children. VWF mutations were detected in 17 patients. Patients with a family history showed age of diagnosis of 9 y, which is higher than in those with no family history (6 yr), and also showed a higher rate of significant bleeding (32.1% vs. 14.2%). VWF:RCo and VWF:Ag tests were performed in-hospital at only 1 of 11 hospitals. Twelve of 267 patients were enrolled at the KHF (4.5%). CONCLUSION: A high rate of out-sourcing studies may result in inaccurate diagnosis. The registration rate to the KHF is still lower than the prevalence rate. A comprehensive nationwide registration system is necessary in order to identify the actual prevalence rate and promote the diagnosis of VWD in Korea.
Adult ; Child ; Diagnosis ; Hemophilia A ; Hemorrhage ; Hospitals, University ; Humans ; Korea ; Medical Records ; Prevalence ; Retrospective Studies ; von Willebrand Diseases

Purpose: Acute promyelocytic leukemia (APL) is a rare disease in children and there are some different characteristics between children and adult. We aimed to evaluate incidence, clinical characteristics and treatment outcomes of pediatric APL in Korea. Materials and Methods: Seventy-nine pediatric APL patients diagnosed from January 2009 to December 2016 in 16 tertiary medical centers in Korea were reviewed retrospectively. Results: Of 801 acute myeloid leukemia children, 79 (9.9%) were diagnosed with APL. The median age at diagnosis was 10.6 years (range, 1.3 to 18.0). Male and female ratio was 1:0.93. Thirty patients (38.0%) had white blood cell (WBC) count greater than 10×109/L at diagnosis. All patients received induction therapy consisting of all-trans retinoic acid and chemotherapy. Five patients (6.6%) died during induction chemotherapy and 66 patients (86.8%) achieved complete remission (CR) after induction chemotherapy. The causes of death were three intracranial hemorrhage, one cerebral infarction, and one sepsis. Five patients (7.1%) suffered a relapse during or after maintenance chemotherapy. The estimated 4-year event-free survival and overall survival (OS) rates were 82.1%±4.4%, 89.7%±5.1%, respectively. The 4-year OS was significantly higher in patients with initial WBC < 10×109/L than in those with initial WBC ≥ 10×109/L (p=0.020). Conclusion This study showed that the CR rates and survival outcomes in Korean pediatric APL patients were relatively good. The initial WBC count was the most important prognostic factor and most causes of death were related to serious bleeding in the early stage of treatment.