Meckel's diverticulum is the most common malformation of gastrointestinal tract. Symptoms of Meckel's diverticulum usually arise within 2 years of life. The most common presentations include hemorrhage, perforation, diverticulitis and intestinal obstruction. Perforation of the Meckel's diverticulum in a neonate is uncommon but life threatening condition. We describe the first case of perforation of Meckel's diverticulum in a 1-day-old neonate who presented with abdominal distension without hemorrhage.
Diverticulitis ; Gastrointestinal Tract ; Hemorrhage ; Humans ; Infant, Newborn* ; Intestinal Obstruction ; Meckel Diverticulum*

PURPOSE: Daegu, Korea was severely affected by pandemic and post-pandemic H1N1 infection during August 2009 to March 2012. The aim of this study was to analyze various clinical characteristics of patients who visited the emergency department with H1N1 infection during the first three years, and to compare the results for each year. We then performed an evaluation of the differences. METHODS: The medical records of patients who visited our emergency department and conformed to H1N1 virus infection by conventional rRT-PCR during the pandemic wave from August 2009 to March 2010(wave 1) and post-pandemic waves from August 2010 to March 2011(wave 2) and from August 2011 to March 2012(wave 3) were reviewed. A total of 986 patients (wave 1; 840, wave 2; 144, wave 3; 2) were included in this study. We analyzed the clinical characteristics, proportions of pneumonia, admission rate, relationships with underlying medical conditions, and requirement for mechanical ventilation of the infected patients, and then performed a statistical evaluation of the differences between wave 1 and wave 2 that was severely affected. RESULTS: During wave 1,840 patients, during wave 2, 144 patients, and during wave 3, two patients were diagnosed as novel influenza. Age 18-39 showed a significantly higher rate(78.7%) in the wave 1 patients group. Main clinical symptoms were cough and febrile sense in both waves. Patients with underlying medical conditions in wave 2(97 cases, 67.4%) showed a higher rate than those of wave 1(101 cases, 12.0%). Chronic obstructive pulmonary disorder was the most closely related underlying disorder in wave 2(18.8%). Patients requiring admission(37.5%) and ventilatory care(6.9%) due to severe pneumonic symptoms showed a significantly higher rate in wave 2. Only two young patients were diagnosed as novel influenza. Both complained of mild fever and cough, which recovered spontaneously. CONCLUSION: Most cases of influenza A (H1N1) infection were uncomplicated, characterized by influenza-like symptoms and spontaneous recovery. The number of patients showed a marked decreased year by year, however, the severity of clinical presentations increased in wave 2. Young adults who did not have cross-reactive antibodies to novel influenza A (H1N1) from previous infection or immunization were dominant in wave 1. Older patients with underlying medical conditions were more likely to admitted and present fatal progress in wave 1 and wave 2. Because influenza viruses are unpredictable, continued national preparedness, flexible response, and careful monitoring are essential.
Antibodies ; Cough ; Emergencies* ; Emergency Service, Hospital* ; Daegu ; Epidemiology ; Fever ; Humans ; Immunization ; Influenza A Virus, H1N1 Subtype ; Influenza, Human* ; Korea ; Medical Records ; Observational Study* ; Orthomyxoviridae ; Pandemics* ; Pneumonia ; Respiration, Artificial ; Young Adult

PURPOSE: Daegu, Korea was severely affected by pandemic and post-pandemic H1N1 infection during August 2009 to March 2012. The aim of this study was to analyze various clinical characteristics of patients who visited the emergency department with H1N1 infection during the first three years, and to compare the results for each year. We then performed an evaluation of the differences. METHODS: The medical records of patients who visited our emergency department and conformed to H1N1 virus infection by conventional rRT-PCR during the pandemic wave from August 2009 to March 2010(wave 1) and post-pandemic waves from August 2010 to March 2011(wave 2) and from August 2011 to March 2012(wave 3) were reviewed. A total of 986 patients (wave 1; 840, wave 2; 144, wave 3; 2) were included in this study. We analyzed the clinical characteristics, proportions of pneumonia, admission rate, relationships with underlying medical conditions, and requirement for mechanical ventilation of the infected patients, and then performed a statistical evaluation of the differences between wave 1 and wave 2 that was severely affected. RESULTS: During wave 1,840 patients, during wave 2, 144 patients, and during wave 3, two patients were diagnosed as novel influenza. Age 18-39 showed a significantly higher rate(78.7%) in the wave 1 patients group. Main clinical symptoms were cough and febrile sense in both waves. Patients with underlying medical conditions in wave 2(97 cases, 67.4%) showed a higher rate than those of wave 1(101 cases, 12.0%). Chronic obstructive pulmonary disorder was the most closely related underlying disorder in wave 2(18.8%). Patients requiring admission(37.5%) and ventilatory care(6.9%) due to severe pneumonic symptoms showed a significantly higher rate in wave 2. Only two young patients were diagnosed as novel influenza. Both complained of mild fever and cough, which recovered spontaneously. CONCLUSION: Most cases of influenza A (H1N1) infection were uncomplicated, characterized by influenza-like symptoms and spontaneous recovery. The number of patients showed a marked decreased year by year, however, the severity of clinical presentations increased in wave 2. Young adults who did not have cross-reactive antibodies to novel influenza A (H1N1) from previous infection or immunization were dominant in wave 1. Older patients with underlying medical conditions were more likely to admitted and present fatal progress in wave 1 and wave 2. Because influenza viruses are unpredictable, continued national preparedness, flexible response, and careful monitoring are essential.
Antibodies ; Cough ; Emergencies* ; Emergency Service, Hospital* ; Daegu ; Epidemiology ; Fever ; Humans ; Immunization ; Influenza A Virus, H1N1 Subtype ; Influenza, Human* ; Korea ; Medical Records ; Observational Study* ; Orthomyxoviridae ; Pandemics* ; Pneumonia ; Respiration, Artificial ; Young Adult

Leiomyosarcoma of the duodenum is an uncommon tumor and have not specific symptoms and signs, almost all cases of tumor were diagnosed in operating room. This tumor is generally firm, relatively well encapsulated, lobulated and often soft if they undergo hemorrhagic necrosis. Most authors emphasized the relative number of mitosis as the most reliable findings of leiomyosarcoma. Recently, we experienced a case of leiomyosarcoma of duodenum which was confirmed by operative and pathological diagnosis.
Diagnosis ; Duodenum* ; Leiomyosarcoma* ; Mitosis ; Necrosis ; Operating Rooms

PURPOSE: Acute otitis media(AOM) has variable clinical symptoms and is diagnosed with injection, bulging, and decreased mobility of tympanic membrane. There are many misdiagnoses because children who are suspected of having acute otitis media are uncooperative during diagnosis with an otoscope. An inaccurate diagnosis of acute otitis media when using an otoscope results in wasted of medical resourses and increased tolerance to antibiotics. Therefore, this study was conducted to evaluate the usefulness of a video otoscope as a tool of diagnosis of acute otitis media. METHODS: Among 416 patients who visited Pundang Jesaeng Hospital Emergency Medical Center with a complaint of otalgia from 1 October 2002 to 30 September 2003, we studied 51 patients who were followed up at the otorhinolaryngology depatment. Emergency Medicine residents recorded the findings for tympanic membrane by using an otoscope and by using a video otoscope. we used kappastatistics to carry out a prospective study in which the accuracy of diagnosis of AOM was analyzed by comparison with the confirmed diagnosis by an otolaryngologic specialist. RESULTS: In this study, the number of males was 24 (47%) and that of females was 27 (53%). Of the 51 Patients, 22 (43%) presented with rhinorrhea, 15 (29%) with cough, 11 (22%) with sputum, 10 (20%) with fever, 8 (16%) with a sore throat, 7 (14%) with otorrhea, 4 (8%) with hearing difficulty, 3 (6%) with irritability, 3 (6%) with tinnitus, 3 (6%) with vomiting and 2 (4%) with dizziness. A comparison of the diagnostic accuracy of AOM between otolaryngologic specialist and residents in emergency department, when was undertaken by using kappa statistics, and a diagnostic agreement of 65% (kappa=0.28) for the otoscope, and 76 %( kappa=0.45) for the video otoscope. The diagnostic sensitivity of acute otitis media by video otoscope was 75%, and specificity was 82%. CONCLUSION: When the tympanic membrane of the patient suspected of a having AOM is examined in an emergency medical center, video otoscopy should be a useful diagnostic tool for AOM owing to its high diagnostic accuracy.
Anti-Bacterial Agents ; Child ; Cough ; Diagnosis* ; Diagnostic Errors ; Dizziness ; Earache ; Emergencies ; Emergency Medicine ; Emergency Service, Hospital ; Female ; Fever ; Hearing ; Humans ; Male ; Otitis Media* ; Otitis* ; Otolaryngology ; Otoscopes* ; Otoscopy ; Pharyngitis ; Prospective Studies ; Sensitivity and Specificity ; Specialization ; Sputum ; Tinnitus ; Tympanic Membrane ; Vomiting

Concurrent cerebral and coronary artery embolization is a theoretically possible, but extremely rare complication of an atrial myxoma. We present a paitent with a left atrial mass (a probable myxoma) who presented with concurrent cerebral and myocardial infarctions due to emboli of tumor origin. An 84-year-old woman presented with an acute cerebral infarction of the middle cerebral artery territory. Several hours after admission, she complained of chest pain consistent with a myocardial infarction. Transthoracic and transesophageal echocardiographic studies revealed the presence of a large, mobile, heteroechoic mass with a few daughter nodules in the left atrium, compatible with a myxoma. Coronary angiography disclosed subtotal occlusion of the ramus intermedius branch and visible tumor vascularization adjacent to the right coronary artery. With medical treatment, including anticoagulation, the patient was stabilized and had an uneventful clinical course for the ensuing 6 months since discharge.
Aged, 80 and over ; Cerebral Infarction ; Chest Pain ; Coronary Angiography ; Coronary Vessels ; Female ; Heart Atria ; Humans ; Middle Cerebral Artery ; Myocardial Infarction ; Myxoma ; Nuclear Family

PURPOSE: This study was performed to determine whether the anion gap, the base excess, the lactate, and the strong ion gap obtained in the emergency department correlate with the prognosis and whether the strong ion gap is the most useful marker compared to the prognostic ability of the anion gap, the base excess, and the lactate. METHODS: We reviewed the records of 106 patients admitted to the intensive care unit via the emergency department. We measured the anion gap, the base excess, and the lactate and we calculated strong anion gap by using a formula. We divided the patients into survivors and nonsurvivors and compared the prognostic abilities of the four variables by using the Student's t-test and receiver operator characteristic curves. RESULTS: The mean age of the patients was 67+/-14, and the numbers of males and females were similar (58 males vs 48 females). The number of survivors was 92 (86.7%), and that of nonsurvivors was 14 (3.2%). The anion gap ( 24.8+/-8.8 vs. 16.4+/-4.8 mmol/L, p value=0.000), the base excess (-11.9+/-8.7 vs. -3.49+/-6.5 mmol/L, p value = 0.001), the lactate (9.1+/-7.7 vs. 4.5+/-3.1 mmol/L, p value = 0.011 ) and the strong ion gap (16.6+/-3.6 vs. 10.9+/-3.7, p value=0.000) of the nonsurvivors were higher. All of the four varibles were associated with the prognosis, but among them, the strong ion gap discriminated most strongly with an area under the receiver operator characteristic curve of 0.866 (95% confidence interval, 0.787 to 0.92). CONCLUSION: The initial emergency-department acid-base variables, the anion gap, the base excess, the lactate and the strong ion gap have prognostic abilities, but the strong ion gap is the variable that most strongly predicts of mortality.
Acid-Base Equilibrium ; Critical Illness* ; Emergencies* ; Emergency Service, Hospital* ; Female ; Humans ; Intensive Care Units ; Lactic Acid ; Male ; Mortality ; Prognosis ; Survivors

PURPOSE: This study was conducted to confirm the effects of octreotide in patients with variceal bleeding. METHODS: We performed a retrospective analysis of 26 patients with variceal bleeding, who visited the Emergency Center of Seoul National University Hospital from January 1st to June 31st, 1996, the control group, and a prospective analysis of 28 patients with variceal bleeding, who visited the Emergency Center of Seoul National University Hospital from March 1st to August 31st, 1999, for the octreotideinfused group. The octreotide-infused group recieved a continuous infusion of octreotide, 25 microgram/hr, for 5 days after an initial bolus of 50 microgram. When active bleeding continued over 1 hour, over 5 pints of packed-RBC were needed for transfusion within 24 hours, or when the systolic blood pressure was under 90 mmHg, a ballon tamponade with Sengstaken-Blackemore tube was used. T-test and X2 test were used for statistical analysis(p<0.05). RESULTS: Forty-one patients were male(octreotide-infused group 22, control group 19) and 13 were female(octreotide-infused group 6, control group 7). The mean age was 55 years(octreotide-infused group 56 years, control group 52 years). There were no significant differences in vital signs, hemoglobin/hematocrit levels, and Child-Pugh's classifications between the octreotide-infused group and the control group initially. There was a significant difference in the rates of early bleeding control within 24 hours(p<0.05), but there were no significant differences in the rates of rebleeding, mortality within 1 week, and use of a balloon tamponade. CONCLUSION: Variceal bleeding is a serious complication of liver cirrhosis and has a high mortality rate. Octreotide is an effective vasoactive agent for control of early bleeding. Thus, octreotide should be used first before endoscopic definitive therapies, to stabilize the vital signs of patients and to secure a field for endoscopic procedures.
Balloon Occlusion ; Blood Pressure ; Classification ; Emergencies ; Esophageal and Gastric Varices ; Hemorrhage* ; Humans ; Liver Cirrhosis ; Mortality ; Octreotide* ; Prospective Studies ; Retrospective Studies ; Seoul ; Varicose Veins* ; Vital Signs

Syphilitic myelitis is a rare manifestation of neurosyphilis, whose magnetic resonance imaging findings are not well documented. The authors report on a case of a 48-year-old male who presented with acute onset of paraplegia and voiding difficulty and was diagnosed as having syphilitic myelitis. Among tests performed for the diagnosis, serum Venereal Disease Research Laboratory (VDRL) and fluorescent treponemal antibody absorbed (FTA-ABS) tests showed a positive result. Analysis of cerebrospinal fluid (CSF) showed a normal white blood cell count, increased protein, reactive VDRL, and FTA-ABS tests. Magnetic resonance imaging (MRI) of cervical and thoracic spines showed diffuse intramedullary T2-hyperintense signal intensity without T1-weighted gadolinium enhancement. The syphilitic myelitis was resolved after institution of intravenous high dose penicillin G therapy for two weeks. Additional follow-up CSF analysis performed three months after treatment showed decreased protein and negative VDRL. MRI taken nine months later appeared normal and VDRL in CSF was still negative. This case study reports on the first Korean case of acute transverse myelitis caused by syphilis.
Fluorescent Treponemal Antibody-Absorption Test ; Follow-Up Studies ; Gadolinium ; Humans ; Leukocyte Count ; Magnetic Resonance Imaging ; Male ; Myelitis ; Myelitis, Transverse ; Neurosyphilis ; Paraplegia ; Penicillin G ; Sexually Transmitted Diseases ; Spine ; Syphilis

Recent study showed that peripheral inflammation induced an increased expression of brain-derived neurotrophic factor (BDNF) mRNA which was mediated by nerve growth factor in the dorsal root ganglion (DRG). Therefore, it is conceivable that peripheral inflammation may induce an increase in BDNF synthesis in DRG and consequently enhance the level of BDNF in the spinal cord and that gene expression of trkB mRNA may be altered. In the present study, we evaluated changes in BDNF-immunoreactivity and trkB mRNA in the DRG and spinal cord by means of immunohis-tochemistry and RT-PCR, respectively, following peripheral tissue inflammation produced by intraplantar injection of Freund's adjuvant into rat paws. In addition, coexistence of BDNF and preprotachykinin (PTT) mRNAs, BDNF and CGRP mRNAs or BDNF and trkB mRNAs in the DRG following inflammation was observed by means of in situ hybridization. The results obtained were as follows; 1. Inflammation induced a significant increase of the number of BDNF-immunoreactive (IR) neurons in the ipsilateral DRGs. The increase was observed 1 and 3 days after injection of adjuvant, and the levels had returned to normal by 7 days. In the spinal cord, inflammation also induced an elevation in the expression of BDNF-IR terminals in the medial superficial layers of the ipsilateral dorsal horn and in lamina V 1 and 3 days after injection. 2. There was significant increase of truncated trkB (t-trkB) mRNA in the ipsilateral DRG 3 days following inflammation. Changes in the expression of trkB mRNA in the DRG or trkB and t-trkB mRNAs in the spinal cord were not observed. 3. Many neurons showed increased coexistence of BDNF and PTT mRNAs or BDNF and CGRP mRNAs in the DRG following inflammation. 4. Few neurons showed coexistence of BDNF and trkB mRNAs in the DRG following inflammation. The results suggest a paracrine function for BDNF within the DRG in addition to an important role related with nociception following peripheral inflammation.
Animals ; Brain-Derived Neurotrophic Factor* ; Diagnosis-Related Groups ; Freund's Adjuvant ; Ganglia, Spinal* ; Gene Expression ; Horns ; In Situ Hybridization ; Inflammation* ; Nerve Growth Factor ; Neurons ; Nociception ; Rats* ; RNA, Messenger ; Spinal Cord* ; Spinal Nerve Roots*