Hypertension is a risk factor for developing fatal aortic dissection. Aortic dissection occurs 2~3 times as often in men than in women between ages of 50~70 years old. Among other risk factors, aortic dissection occurs especially in women below the age of 40 years old in pregnancy-related cases. In pregnancy-related cases, aortic dissection occurs in the third trimester and in puerperium, as well as in multiparous women. The writers experienced an aortic dissection related pregnancy. The patient was 32 years old, diagnosis of dissection occurred in the postpartum period. Although, aortic dissection is a rare complication of pregnancy, the knowledge of this may assist the emergency physician save the lives of patients.
Adult ; Diagnosis ; Emergencies ; Female ; Humans ; Hypertension ; Male ; Postpartum Period ; Pregnancy ; Pregnancy Trimester, Third ; Risk Factors

PURPOSE: We designed a retrospective study to measure the accuracy of the ICD-10 (International Classification of Disease-10) code for trauma patients. We also analyzed the error of the ICISS (International Classification of Disease based Injury Severity Score) due to a missing or an incorrect ICD-10 code. METHODS: For the measuring the accuracy of the ICD-10 code for trauma patients in a tertiary teaching hospital's emergency department, two board certified emergency physician performed a retrospective chart review. The ICD-10 code was classified as a main code or a sub-code. The main code was defined as the code of the main department of treatment, and the sub-code was defined as a code other than the main code. We calculated and compared two ICISS for each patient one by using both the existing code and the other by using a corrected code. We compared the proportions of severe trauma (defined as an ICISS less than 0.9) between when the existing code and the corrected code was used respectively. RESULTS: We reviewed the records of 4287 trauma patients who had been treated from July 2008 to November 2008. The accuracy of the main code, the sub-code of emergency department, main-code, the subcode of hospitalized patients were 97.1%, 59.8%, 98.2% and 57.0%, respectively. Total accuracy of the main and sub-code of emergency department and of hospitalized patients were 91.4% and 58.6%. The number of severe trauma patients increased from 33 to 49 when the corrected code was used in emergency department and increased from 35 to 60 in hospitalized patients. CONCLUSION: The accuracy of the sub-code was lower than that of the main code. A missing or incorrect subcode could cause an error in the ICISS and in the number of patients with severe trauma.
Emergencies ; Humans ; International Classification of Diseases ; Retrospective Studies

PURPOSE: There are no reports on amusement-park-related injuries in Korea. Thus, the objective of this study was to describe traumatic injury patterns that occurring in an amusement park. METHODS: The medical records of an infirmary were retrospectively reviewed. From January 1, 2008, to December 31 2008, patients who were transferred to the nearest emergency departments of hospitals for the purpose of further test and treatment were enrolled. Demographics, injury types and involved parts of the body were analyzed. RESULTS: A total of 3,608 patients visited an infirmary for traumatic injury and about two-thirds had soft tissue injuries. Of those, 191 patients (5.3%) were transferred to the emergency department of a hospital. Of the patients who were transferred to a hospital, laceration and contusion were the responsible injuries for about half. Laceration was the most common injury in pediatric patients, and a sprain or a strain was the most common in adult patients. The most commonly injured parts of the body were the extremities in adult patients. However, in pediatric patients, injuries of the head, face and neck were similar to injuries of the extremities. CONCLUSION: Soft tissue injury was the most common amusement-park-related injury. Laceration was the most common reason to transfer a patient to a hospital. There were differences in injury type and injured part of the body between adult and pediatric patients.
Adult ; Contusions ; Demography ; Emergencies ; Extremities ; Head ; Humans ; Korea ; Lacerations ; Medical Records ; Neck ; Retrospective Studies ; Soft Tissue Injuries ; Sprains and Strains

PURPOSE: In spite of its high sensitivity, the D-dimer test has a limited role in diagnosis of pulmonary thromboembolism (PTE) due to its low specificity. This study was designed to evaluate the diagnostic accuracy of an index for PTE with addition of C-reactive protein (CRP) in patients showing increased D-dimer level. METHODS: We carried out a retrospective study in a tertiary emergency department and enrolled patients who did blood sampling for D-dimer and CRP at the same time among patients suspected of PTE between December 2000 and October 2008. PTE was confirmed by imaging studies, chest computed tomography and angiography. We analyzed D-dimer and CRP levels and correlated them with PTE. RESULTS: A total of 362 patients were enrolled; 67 had PTE. Areas under the curve (AUC) of the Receiver Operating Characteristic (ROC) curve of D-dimer for PTE were smaller than those for a relative increase in the ratio of D-dimer to CRP (RDDCRP). CONCLUSION: The diagnostic accuracy of D-dimer for PTE can be increased by normalizing D-dimer levels to CRP levels.
Angiography ; C-Reactive Protein ; Emergencies ; Fibrin Fibrinogen Degradation Products ; Humans ; Pulmonary Embolism ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Thorax

Primary intracranial hemangiopericytoma is rare and resemble meningioma on imaging study. It shows meningeal attachment, and is usually isointense with gray matter on T1-weighted MR image with heterogeneous enhancement and prominent vascular flow voids on T2-weighted image. Cystic type of hemangiopericytoma is very rare and only 3 cases have been reported in the literature which arised in the middle fossa, cerebellum, and occipital area. Ventricular hemangiopericytomas were reported in 9 cases, and all of them were solid type. Authors experienced a peculiar case of cystic hemangiopericytoma in the 3rd ventricle and report it with review of the literature.
Cerebellum ; Hemangiopericytoma* ; Meningioma ; Third Ventricle*

PURPOSE: The osmolar gap increases in proportion to the ethanol level. Some previous studies have shown that the correlation between the osmolar gap and the ethanol level is weak in trauma patient by using an indirect comparison with other patients. We conducted a direct comparison of the correlation of the osmolar gap to the ethanol level between trauma patients and non-trauma patients. We also analyzed the accuracy of the estimated ethanol level between the two groups. METHODS: The research candidates were adult patients who had visited the emergency department of our hospital from December 2003 to November 2008. By using a retrospective chart review, we classified them into three subgroups: non-trauma without shock, trauma without shock, and trauma with shock. In each group, we compared the correlation between the osmolar gap and the measured ethanol level, and we analyzed the accuracy of the estimated ethanol level by using Lin's concordance correlation coefficient. RESULTS: Four hundred forty-seven patients were enrolled in this study. For correlation of the osmolar gap and the measured ethanol level, Pearson's correlation coefficient was 0.916 in all patients, 0.939 in non-trauma without shock patients, 0.917 in trauma without shock patients, and 0.844 in trauma with shock patients. In the analysis of the accuracy of the estimated ethanol level by using Lin's concordance correlation coefficient, the accuracy in trauma with shock patients was lower than that in non-trauma without shock patients. CONCLUSION: We found that the correlation between the osmolar gap and the measured ethanol level in the patient group with trauma was lower than it was in the patient group without trauma. Moreover trauma patients with shock had a lower accuracy of the estimated ethanol level than non-trauma patients.
Adult ; Emergencies ; Ethanol ; Humans ; Osmolar Concentration ; Retrospective Studies ; Shock

PURPOSE: The separation of prescription and dispensation of drugs starting from July 2000 has led to a reduced exposure to drugs for the general population. Therefore, we hypothesize that the policy of separation the prescribing and the dispensing of drugs has decreased the actual incidence of drug intoxication from drug abuse. METHODS: Patients with acute intentional drug intoxication who were admitted to emergency centers in Seoul were retrospectively studied. The study period was subdivided into three: before, during, and after the launch of the policy of separation of prescription and dispensation, corresponding to the periods January to June, 2000; January to June 2001; and January to June 2002, respectively. RESULTS: Acute drug intoxication was associated with 0.2% of all prescriptions during the studied period. There was no significant difference in the types of intoxicating drugs whereas the most commonly abused drug was Doxylamine succinate. Prescribed medications accounted for 37.0%, 29.2%, and 32.3% of the acute drug intoxication cases in 2000, 2001, and 2002, respectively. There was no significant difference in the treatment outcomes between the three study groups although three patients died of paraquat intoxications in 2001. CONCLUSION: The launch of the policy of separation of prescription and dispension of drugs did not significantly reduce the rate of acute drug intoxication from drug abuse which questions the effectiveness of the policy in decreasing drug abuse. We suggest reassessment of sedatives, in particular, those prescribed medications, in order to decrease the incidence of acute intoxications.
Doxylamine ; Emergencies* ; Humans ; Hypnotics and Sedatives ; Incidence ; Paraquat ; Poisoning* ; Prescriptions* ; Retrospective Studies ; Seoul ; Substance-Related Disorders ; Succinic Acid

Thyroid antibodies are frequently observed in urticaria patients, but their roles in urticaria are not clearly elucidated. We investigated the role of serum specific IgE to thyroid peroxidase (TPO) in patients with aspirin intolerant acute urticaria (AIAU) and aspirin intolerant chronic urticaria (AICU). We recruited 59 AIAU and 96 AICU patients with 69 normal controls (NC). Serum specific IgE to TPO was measured by manual direct ELISA, and CD203c expressions on basophil with additions of TPO were measured to prove a direct role of TPO in effector cells. The prevalences of serum specific IgE to TPO were significantly higher in AIAU (15.2%) and AICU groups (7.5%) compared to NC (0%, P=0.018: P=0.013, respectively). Flow cytometry showed CD203c induction in a dose dependent manner with serial additions of TPO in some AIAU and AICU patients having high specific IgE to TPO. Our findings show that the prevalence of serum specific IgE to TPO was significantly higher in both AIAU and AICU patients than in NC. It is suggested that specific IgE to TPO play a pathogenic role in AIAU and AICU.
Adult ; Anti-Inflammatory Agents, Non-Steroidal/adverse effects ; Aspirin/*adverse effects ; Autoantibodies/immunology ; Basophils/drug effects/*immunology ; Humans ; Immunoglobulin E/blood/*immunology ; Iodide Peroxidase/blood/*immunology ; Urticaria/*chemically induced/*immunology/pathology

PURPOSE: This study was designed to investigate the time delay in the prehospital and inhospital course of acute ischemic stroke patients at an emergency department (ED). METHODS: We collected data from medical records retrospectively, including baseline characteristics, mode of arrival, arrival time, and neurological symptoms, from January 2006 to October 2008. Time data were also collected; from symptom onset to ED visit (prehospital delay), ED visit to brain imaging (imaging delay), and from ED visit to treatment (treatment delay). We designed multivariate Cox-regression models to predict factors influencing prehospital and ED time for ischemic stroke. RESULTS: In total, 946 ischemic stroke patients were enrolled. Diabetes mellitus was associated with a longer prehospital delay. Heart disease, hyperlipidemia, and use of an emergency medical service (EMS) were associated with a shorter prehospital delay. Female gender, night time visits, and abnormal speech were associated with a longer imaging delay. Hypertension, use of EMS, multiple symptoms, and prehospital delay within 3 hours were associated with a shorter delay. Abnormal speech was also a significant factor for a longer treatment delay. Tingling sense or numbness, multiple symptoms, and a prehospital delay within 3 hours were related to a shorter treatment delay. CONCLUSION: The time delay in the prehospital and ED course of acute ischemic stroke patients was associated with multiple factors including gender, comorbidities, use of EMS, arrival time, acute symptom onset within 3 hours, neurological symptoms, and multiple neurological symptoms.
Cerebral Infarction ; Comorbidity ; Diabetes Mellitus ; Emergencies ; Emergency Medical Services ; Female ; Heart Diseases ; Humans ; Hyperlipidemias ; Hypertension ; Hypesthesia ; Medical Records ; Neuroimaging ; Retrospective Studies ; Stroke

Dronedarone is a new antiarrhythmic drug for the treatment of nonpermanent atrial fibrillation. Compared with amiodarone, it is regarded as a safe medication due to its structural differences. In this report, we describe a 56-year-old man who developed photosensitivity due to dronedarone. He presented with itchy skin rashes for 1 week. Maculopapular exanthema was localized on the neck, both arms, and both hands, with sparing of the other parts of the body. Dronedarone was prescribed 4 weeks ago when atrial fibrillation occurred. After development of skin rashes, dronedarone was discontinued, and systemic steroid, antihistamine, and topical corticosteroid were administered for 1 week, with improvement in skin rashes. The photopatch test was performed with antiarrhythmic drugs, including dronedarone, amiodarone, and flecainide, 4 weeks after withdrawal of dronedarone. Positive reactions were recorded only to dronedarone at the site exposed to ultraviolet A. He was diagnosed with dronedarone-induced photosensitivity and advised to change the antiarrhythmic medication to others. There have been a few case reports on photosensitivity reactions due to dronedarone, which were diagnosed only by clinical suspicion. However, we suspected photosensitivity and proved it by the photopatch test. Photosensitivity should be considered in patients having skin rashes on the exposed area and taking antiarrhythmic medication, including dronedarone.
Amiodarone ; Anti-Arrhythmia Agents ; Arm ; Atrial Fibrillation ; Exanthema ; Flecainide ; Hand ; Humans ; Middle Aged ; Neck