No abstract available.

Acral fibrokeratoma, more often called acquired digital fibrokeratoma, is a firm hyperkeratotic horn-like projection of skin surrounded by a slightly elevated epidermial collarette. Most frequently they appear on the finger of adult man. Authors report two cases, one developed on the palm and the other on the ankle. Because of the rarity of these lesions and their even more unusual location, these case were deemed worthy of report.
Adult ; Ankle ; Fingers ; Humans ; Skin

BACKGROUND: Infectious complications commonly occur in the survivors of out-of-hospital cardiac arrest. The aim of our study was to describe the incidence, associated factors and outcome of infectious complications of the survivors of out-of-hospital cardiac arrest. METHODS: We conducted a retrospective analysis of 75 patients who survived out-of-hospital cardiac arrest. We collected the data on the demographics, the modes of cardiac arrest, the duration of CPR, the dose of epinephrine, the use of hypothermia, new infections, the duration of mechanical ventilation, the length of stay in the intensive care unit (ICU), recovery of consciousness and the mortality. RESULTS: New infections developed in 46.7% of the patients. Asystole was the most common rhythm (70.7%). The most common infectious complication was pneumonia (40.0%) urinary tract infection developed in 10 cases, vascular catheter local infection developed in 6 cases, primary blood stream infection developed in 3 cases, wound infection developed in 2 cases and pseudomembranous colitis developed in 1 case. The most common pathogens of pneumonia were Pseudomonas aeruginosa and Staphylococcus aureus. Blood cultures were obtained in 36 patients during the first 24 hr and the pathogen was isolated in three. The patients with infection had a longer duration of mechanical ventilation and a longer stay in the ICU (p < 0.001, p = 0.001). CONCLUSIONS: Infectious complications are common in survivors of out-of-hospital cardiac arrest and these infections are associated with a longer duration of mechanical ventilation and a longer stay in the ICU. The most common infectious complication was pneumonia and the pathogens of pneumonia were Pseudomonas aeruginosa and Staphylococcus aureus.
Cardiopulmonary Resuscitation ; Consciousness ; Demography ; Enterocolitis, Pseudomembranous ; Epinephrine ; Heart Arrest ; Humans ; Hypothermia ; Incidence ; Intensive Care Units ; Length of Stay ; Out-of-Hospital Cardiac Arrest ; Pneumonia ; Pseudomonas aeruginosa ; Respiration, Artificial ; Retrospective Studies ; Rivers ; Staphylococcus ; Staphylococcus aureus ; Survivors ; Urinary Tract Infections ; Vascular Access Devices ; Wound Infection

BACKGROUND: Vancomycin-resistant enterococci (VRE) infections have become a major healthcare-associated pathogen problem worldwide. Nosocomial VRE infections could be effectively controlled by screening patients at high risk of harboring VRE and thereby lowering the influx of VRE into healthcare centers. In this study, we evaluated factors associated with VRE colonization in patients transferred to emergency departments, to detect patients at risk for VRE carriage. METHODS: This study was conducted in the emergency department of a medical college-affiliated hospital in Korea. Every patient transferred to the emergency department and admitted to the hospital from January to December 2016 was screened for VRE using rectal cultures. In this cross-sectional study, the dependent variable was VRE colonization and the independent variables were demographic and clinical factors of the patients and factors related to the transferring hospital. Patients were divided into two groups, VRE and non-VRE, and previously collected patient data were analyzed. Then we performed logistic regression analyses of characteristics that differed significantly between groups. RESULTS: Out of 650 patients, 106 (16.3%) had positive VRE culture results. Significant variables in the logistic analysis were transfer from geriatric long-term care hospital (adjusted odds ration [aOR]: 8.017; 95% confidence interval [CI]: 1.378–46.651), hospital days (4–7 days; aOR: 7.246; 95% CI: 3.229–16.261), duration of antimicrobial exposure (1–3 days; aOR: 1.976; 95% CI: 1.137–3.436), and age (aOR: 1.025; 95% CI: 1.007–1.043). CONCLUSION: VRE colonization in patients transferred to the emergency department is associated primarily with factors related to the transferred hospitals rather than demographic and clinical characteristics.
Bacterial Infections ; Colon* ; Cross-Sectional Studies ; Delivery of Health Care ; Emergencies* ; Emergency Service, Hospital* ; Enterococcus* ; Humans ; Infection Control ; Korea* ; Logistic Models ; Long-Term Care ; Mass Screening ; Vancomycin Resistance ; Vancomycin-Resistant Enterococci

PURPOSE: This study was conducted to determine the predictive value of the C-reactive protein (CRP) and kidney computed tomography (CT) in the emergency department (ED) for predicting the severity of acute pyelonephritis. METHODS: One hundred thirty-nine patients who were diagnosed with acute pyelonephritis between January 2007 and June 2008 were enrolled in this study. The patient underwent a kidney CT in the ED and the CT findings were classified as normal, a focal wedge-shaped lesion, a multi-focal wedge-shaped lesion, a mass-effect lesion, and abscess formation. The symptoms, vital signs, past history, initial laboratory findings, serum CRP in the ED, and the length of the hospital stay based on the kidney CT grade in the ED were compared. RESULTS: Among the 139 patients, 138 were females and the mean age was 48.5+/-17.7 years. We classified the CT grades as follows: grade 1, normal (n=20); grade 2, focal wedge-shaped lesion (n=25); grade 3, multi-focal wedgeshaped lesion (n=45); grade 4, mass-effect lesion (n=42); and grade 5, abscess formation (n=7). Statistically significant differences in leukocyte count, neutrophil ratio, ESR, CRP, and length of hospital stay existed between the CT grades. Patients were classified into two groups based on the CT grade (the mild group [grades 1 and 2], and the severe group [grades 3~5]). The leukocyte count, neutrophil ratio, ESR, CRP, maximal body temperature, duration of fever, duration of pyuria >3 days, and length of hospital stay were greater in the severe group. Based on the results of multivariate logistic regression analysis, the CRP level was shown to be an independent predictor that affected the severe group. The area under the ROC curve for CRP was 0.775 (95% CI, 0.695~0.854). CONCLUSION: The CRP level in the ED was an independent predictor that affected the severe group. Thus, the initial CRP level with the kidney CT grade may be used as a prognostic indicator of acute pyelonephritis in the ED.
Abscess ; Body Temperature ; C-Reactive Protein ; Emergencies ; Female ; Fever ; Humans ; Kidney ; Length of Stay ; Leukocyte Count ; Logistic Models ; Neutrophils ; Pyelonephritis ; Pyuria ; ROC Curve ; Tomography, Spiral Computed ; Vital Signs

PURPOSE: This study was conducted to see the effect of alcohol ingestion on clinical features of acute drug intoxicated patients. METHODS: We prospectively investigated drug intoxicated patients who visited the emergency department 6 hours after acute poisoning from January 2004 to December 2007. Patients were classified into two groups according to serum alcohol levels: an alcohol group (serum alcohol level>10 mg/dl) and a non-alcohol group. The type of toxic material, age, sex, duration of time to arrive to the emergency department (ED) after poisoning, mean arterial pressure, respiratory rate, base excess level, AST level, serum creatinine level, cause of poisoning, suicide attempt, past psychiatric history, discharge against medical advice rate, and admission rate were checked. The initial and final Poisoning Severity Score (PSS), the Glasgow coma scale, the length of stay in the intensive care unit (ICU), the usage of a mechanical ventilator, and death rate were also checked. RESULTS: The study enrolled 222 intoxicated patients of which 75 fell into the non-alcohol group and 147 into the alcohol group. Alcohol ingestion of acute poisoning in males was higher than in females. The AST level and discharge against medical advice rates in the alcohol group were higher than the non-alcohol group. The base excess level, length of stay in ICU, past psychiatric history rate, and admission rates in the non-alcohol group were higher than the alcohol group. The PSS were not correlated with alcohol consumption between the two groups. CONCLUSION: Alcohol ingestion is not associated with PSS. However, alcohol ingestion is commonly found in acute drug intoxicated patients. The discharge against medical advice rate in the alcohol group was higher than the non-alcohol group.
Alcohol Drinking ; Arterial Pressure ; Creatinine ; Eating ; Emergencies ; Female ; Glasgow Coma Scale ; Humans ; Intensive Care Units ; Length of Stay ; Male ; Prospective Studies ; Respiratory Rate ; Severity of Illness Index ; Suicide ; Ventilators, Mechanical

PURPOSE: This study was conducted to predict poor outcomes in coma patients resuscitated from cardiac arrest due to submersion. METHODS: We retrospectively investigated 27 submersion victims who were comatose for more than 6 hours after cardiac arrest. Vegetative state and death (GOS 1-2) were classified as poor outcomes whereas all other outcomes (GOS 3-5) were classified as good outcomes. Demographic, clinical, laboratory, radiologic, eletrophysiologic, and treatment variables were evaluated for their usefulness in predicting outcome. RESULTS: Of the 27 patients, 9 (33%) presented with good outcomes. Among the many variables, a GCS score of 3-5 in the first 24 hours, absence of pupillary reactions in the first 24 hours or on day 3, motor response to pain flexion or less (M1 - 3) or no motor response to pain (M1) in the first 24 hours or on day 3, bilateral absence of N20 on SEP showed significant differences between the two outcome groups (p<0.05). Prognostic factors with 100% specificity for prediction of poor outcome included absence of pupillary reactions in the first 24 hours or on day 3, no motor response to pain (M1) on day 3, and bilateral absence of N20 on SEP. CONCLUSION: The factors including chest radiography, body temperature, and laboratory findings which were associated with submersion showed no significant differences between the good and the poor outcome groups. Absence of pupillary reactions in the first 24 hours or on day 3, no motor response to pain (M1) on day 3, and bilateral absence of N20 on SEP helped predict poor outcome in submersion patients resuscitated from cardiac arrest.
Body Temperature ; Coma* ; Heart Arrest* ; Humans ; Immersion* ; Outcome Assessment (Health Care) ; Persistent Vegetative State ; Radiography ; Retrospective Studies ; Sensitivity and Specificity ; Thorax

PURPOSE: Scoring systems such as the Modified Alvarado Score (MAS), Eskelinen score (ES), Lintula score (LS), nd Ohmann score (OS) can be helpful in the early diagnosis of acute appendicitis (AA). We analyze and compare the diagnostic value of each scoring system and investigate the optimal cut off point. METHODS: A total of 62 adult patients admitted for suspicion of acute appendicitis in a tertiary hospital emergency department were analyzed prospectively. Each scoring system was calculated at admission and compared to the final diagnosis. Receiver operating characteristic (ROC) curves were used to determine the appropriate cutoff scores of scoring systems. The sensitivity and specificity, and area under the ROC curve were calculated. RESULTS: The area under curve of the Ohmann score was higher than those of the other scoring systems (OS: 0.79, MAS: 0.73, ES: 0.65, LS: 0.67). In pairwise comparison of the ROC curve of two scoring systems, OS was found to have significantly higher predictive power than ES and LS. However, no difference was observed between MAS and OS. CONCLUSION: No single score may be used alone to dictate or decline surgery. However, the scoring system may provide helpful information for primary or emergency physicians to determine whether the patient should undergo surgical consultation may provide helpful information for use by primary or emergency physicians in determination of whether the patient should undergo surgical consultation.
Adult ; Appendicitis ; Area Under Curve ; Early Diagnosis ; Emergencies ; Humans ; Prospective Studies ; ROC Curve ; Sensitivity and Specificity ; Tertiary Care Centers

Acute pancreatitis due to organophosphate intoxication is a known risk, but acute parotitis due to organophosphate intoxication is rare. We describe the case of a 74-year-old man who had acute organophosphate intoxication-induced ipsilateral parotitis. He developed ipsilateral parotid gland swelling and elevated serum amylase on the second day of the poisoning. However, serum lipase did not elevate and amylase isoenzyme predominated over S-type. Thus, we suggest that acute parotitis can develop due to organophosphate intoxication, and that this possibility should be checked by serial serum amylase, serum lipase, and amylase isoenzyme testing.
Aged ; Amylases ; Humans ; Lipase ; Pancreatitis ; Parotid Gland ; Parotitis

PURPOSE: To evaluate the prognostic value of multimodal evoked potentials in predicting both awakening and failure to awake from coma due to cardiac arrest. METHODS: Multimodal evoked potentials composed of somatosensory evoked potentials (SEPs), visual evoked potentials (VEPs) and brainstem auditory evoked potentials (BAEPs) were recorded for 46 patients with anoxicischemic encephalopathy who had coma duration>24 h. Patients with trauma, stroke, malignancy, or age<14 y were excluded. Outcomes were categorized as awakening (GOS 3-5) vs. vegetative state or death (GOS 1-2). RESULTS: Forty-one percent of patients regained consciousness, and 59% died or remained vegetative. Bilaterally absent SEP N20 peaks predicted non-awakening with a sensitivity of 52% and a specificity of 100%. Unilaterally or bilaterally absent BAEP III-V predicted non-awakening with a sensitivity of 12% and a specificity of 100%. Using bilaterally absent SEP N20 peaks, unilaterally or bilaterally absent BAEP III-V, or both of the above predicted non-awakening with a sensitivity of 56% and a specificity of 100%. Bilaterally present SEP N20 peaks predicted awakening with a sensitivity of 100% and a specificity of 63%. However, the combination of bilateral presence of SEP N20 and VEP P100 in predicting awakening increased the specificity to 74%, reaching a sensitivity of 89%, a PPV of 71% and a NPV of 91%. CONCLUSION: Non-awakening in postanoxic coma can be reliably predicted with SEPs and BAEPs. Bilaterally preserved SEPs and VEPs predicted awakening with an accuracy of 80% at 1~4 days after cardiopulmonary resuscitation.
Coma ; Consciousness ; Evoked Potentials ; Evoked Potentials, Auditory, Brain Stem ; Evoked Potentials, Somatosensory ; Evoked Potentials, Visual ; Heart Arrest ; Humans ; Persistent Vegetative State ; Prognosis ; Sensitivity and Specificity ; Stroke ; Survivors