Cervical spine fracture can occur in patients with ankylosing spondylitis (AS) by even a minor trauma, which can lead to serious results. We report on the case of a 52-year-old male patient suffering from AS, who was admitted to our hospital with cardiac arrest due to fracture of the upper cervical spine without other organ injuries. A computed tomographic scan showed a cervical 2-3 level fracture and posterior dislocation of the upper cervical column. The patient was admitted to ICU, but died in hospital on day 3.
Cervical Vertebrae ; Dislocations ; Female ; Heart Arrest ; Humans ; Male ; Middle Aged ; Motor Vehicles* ; Spinal Fractures ; Spine* ; Spondylitis, Ankylosing* ; Whiplash Injuries

PURPOSE: The aim of this pilot study was to determine the relationship between the beta-fibrinogen G/A-455 single nucleotide polymorphism and the risk of ischemic stroke in Korea because there are racial differences in polymorphisms and Koreans have never been studied before. METHODS: From March to September 2003, we compared 80(male : female=1.2 : 0.8) patients who were diagnosed with ischemic stroke at Kyung Hee university hospital emergency center had been to 150 control subjects. The genotypes of the beta-fibrinogen G/A-455 polymorphism were confirmed by using the polymerase chain reaction (PCR) followed by HaeIII restriction enzyme digestion. RESULTS: The results showed that the patient group had a much higher rate of heterozygotism (GA or AG). A statistical analysis of the genotype frequency showed chi2 to be 6.24, indicating a significant difference between the patient and the control groups (p=0.044). For the allele frequency, the odds ratio was 1.88(95% CI 1.16-3.04), indicating a significant difference between the two groups, and also allele frequency in ischemic stroke patient with or without hyperfibrinogenemia, male sex and smoking history showed odds ratio to be 2.38(95% CI 1.26~4.49), 1.78(95% CI 1.01~3.14)and 1.94(95% CI 1.12~3.35) indicating significant difference. CONCLUSION: The high rate of polymorphisms of the AA genotype of beta-fibrinogen G/A-455 in ischemic stroke patients in our study leads us to the belief of the possibility that beta-fibrinogen G/A-455 polymorphisms in males with a smoking history and hyperfibrinogenemia, if found in advance, could lead to an improved prognosis and reduced clinical expenses by allowing early diagnosis and preventive management.
Digestion ; Early Diagnosis ; Emergencies ; Gene Frequency ; Genetics ; Genotype ; Humans ; Korea ; Male ; Odds Ratio ; Pilot Projects* ; Polymerase Chain Reaction ; Polymorphism, Single Nucleotide ; Prognosis ; Smoke ; Smoking ; Stroke*

Intracranial calcification is known to be a physiologic phenomenon and is often seen in brain CTs of patients visiting the emergency department. The pattern of a calcified lesion may be related to the pathologic condition, and calcified lesion itself may cause neurologic symptoms. The causes of pathologic intracranial calcification are infection, brain tumor, vascular disorder, endocrinologic disorders, and genetic disorder associated with calcium metabolic defects. The most common sites of intracranial calcification are the basal ganglia, subcortical tissue of the cerebrum, the thalamus, the choroid plexus, and the dentate nucleus of the cerebellum. The diagnosis of pathologic calcification can be done by using brain CT or MRI, and pathologic calcification should be differentiated from other causes of calcification by using laboratory data. We report and discuss a case of extensive intracranial calcification with idiopathic hypoparathyroidism.
Basal Ganglia ; Brain ; Brain Neoplasms ; Calcinosis ; Calcium ; Cerebellar Nuclei ; Cerebellum ; Cerebrum ; Choroid Plexus ; Diagnosis ; Emergency Service, Hospital ; Humans ; Hypoparathyroidism* ; Magnetic Resonance Imaging ; Neurologic Manifestations ; Thalamus

BACKGROUND: Doxylamine is an over-the-counter drug that is popular in the treatment of insomnia. Doxylamine is relatively safe but can cause rhabdomyolysis. The aim of this study was to evaluate whether the incidence of rhabomyolysis increased in elderly patients (age> or =65 years) with doxylamine overdose. METHODS: This study included 108 patients admitted to an Emergency Department after doxylamine overdose between January 1, 2000, and March 31, 2013. Age, sex, time ingested before admission, amount of drug ingested, gastric lavage, tachycardia, vomiting, hematuria, blood urea nitrogen, blood creatinine, urine pH, and alcohol ingestion were investigated for the risk factors of rhabdomyolysis. RESULTS: Forty-three patients (47.6%) developed rhabdomyolysis. Of 16 elderly patients, 11 developed rhabdomyolysis. Of the 92 patients <65 years-of-age, 34 developed rhabdomyolysis. Advanced age, alcohol ingestion, and increased blood creatinine level were significantly associated with the development of rhabdomyolysis. CONCLUSION: In elderly patients with doxylamine overdose, the incidence rate of rhabdomyolysis may be increased. A high index of suspicion and evaluation of rhabdomyolysis is warranted in elderly patients with doxylamine overdose.
Aged* ; Blood Urea Nitrogen ; Creatinine ; Doxylamine* ; Eating ; Emergencies ; Gastric Lavage ; Hematuria ; Humans ; Hydrogen-Ion Concentration ; Incidence* ; Rhabdomyolysis* ; Risk Factors ; Sleep Initiation and Maintenance Disorders ; Tachycardia ; Vomiting

PURPOSE: Case-control and cohort studies have reported inconsistent findings for the association between gender and mortality from a traumatic brain injury. We investigated the effect and association of gender on moderate to severe traumatic brain injury using meta-analysis. METHODS: We searched electronic health care databases including MEDLINE (Pubmed), the Cochrane Library, CINAHL, and Koreamed (January 2001 to December 2009) in August 2010. The keywords searched included traumatic brain injury or traumatic head injury, gender, and mortality. Two independent investigators selected and reviewed articles according to predefined inclusion and exclusion criteria. The quality of selected articles was evaluated by applying the Newcastle Ottawa scale. Data were abstracted by predetermined criteria. Odds ratios were calculated and combined using fixed and random effect models. RESULTS: Of 130 articles, four case-control studies and three cohort studies were included in the final analysis. In total, 89,335 patients were included(26,287 females and 63,048 males). Compared with the mortality of male patients, the combined odds ratio for the mortality of female patients was 1.074(95% confidence interval [CI], 1.027~1.124) in a fixed effect model, and 1.319(95% CI, 1.104~1.576) in a random effects model, respectively. The heterogeneity of all participants was severe, so the results were discarded and a subgroup analysis was conducted. The total number of participants was divided into premenopausal and postmenopausal groups by the menopausal age defined in each article. The pooled odds ratio of the premenopausal group was 1.014(95% CI, 0.949~1.083) in the fixed effect model and that of the postmenopausal group was 1.237(95% CI, 0.895~1.712) in the random effects model. The pooled estimate of the random effect model was adopted because of the severe heterogeneity of the postmenopausal group. CONCLUSION: We found no distinct effect of gender on moderate to severe traumatic brain injury. Large-scaled prospective studies based on female hormone levels are needed.
Brain ; Brain Injuries ; Case-Control Studies ; Cohort Studies ; Craniocerebral Trauma ; Delivery of Health Care ; Electronics ; Electrons ; Female ; Humans ; Male ; Odds Ratio ; Population Characteristics ; Research Personnel

Mitral regurgitation originating from mitral valve leaflet perforation secondary to blunt chest trauma is a rare condition. The mechanisms related with valvular injury are rapid acceleration- deceleration movements of the thorax, compression of the heart between the sternum and vertebrae during early systole or late diastole, and abrupt increase of the intrathoracic pressure followed by cardiac rupture. Transesophageal echocardiography (TEE) is a recommended diagnostic tool and is superior to transthoracic echocardiography (TTE) for diagnosing valvular lesions. Valvular injury causing sudden and severe mitral regurgitation will lead to congestive heart failure and death without operative correction. A high index of suspicion with appropriate diagnostic methods will provide a diagnosis and allow the possibility of operative correction. We report the case of a 45-year-old man with delayed presentation of traumatic mitral valve perforation and review previous reports of blunt traumatic mitral valve injury.
Deceleration ; Diagnosis ; Diastole ; Echocardiography ; Echocardiography, Transesophageal ; Heart ; Heart Failure ; Heart Rupture ; Humans ; Middle Aged ; Mitral Valve Insufficiency ; Mitral Valve* ; Spine ; Sternum ; Systole ; Thorax*

PURPOSE: Doxylamine is commonly used for relief of insomnia; in addition, it is also a drug that is freguently used for intoxication in Korea. This drug is relatively safe; however, it is known to occasionally induce rhabdomyolysis. We have seen many cases of alcohol ingestion in doxylamine intoxications; however, few previous studies have documented the effects of alcohol on rhabdomyolysis. Therefore, the purpose of this study is to determine the effect of alcohol on rhabdomyolysis in doxylamine intoxicated patients. METHODS: This study was conducted on 91 patients admitted to an emergency department after doxylamine intoxication during the period from January 2001 to March 2012. Using the protocol developed beforehand, the amount of drug ingestion, past history, laboratory results, and whether or not alcohol was ingested were recorded. Rhabdomyolysis was defined as serum creatine kinase (CK) over 1,000 U/L. The SPSS package with logistic regression, t-test, and Fisher's test was used for analysis of data. RESULTS: Alcohol ingestion was detected in 52% of the study patients. The presence of hematuria and alcohol ingestion showed a significant association with development of rhabdomyolysis. CONCLUSION: Doxylamine intoxicated patients with alcohol ingestion may have a high rate of incidence of rhabdomyolysis. Therefore, doxylamine intoxicated patients who drink alcohol at the same time should be aware of rhabdomyolysis.
Creatine Kinase ; Doxylamine ; Eating ; Emergencies ; Hematuria ; Humans ; Incidence ; Korea ; Logistic Models ; Rhabdomyolysis

The purpose of this study was to investigate the effects of immediate non-functional loading by analyzing histomorphology around the implant tissues in dogs. Five eight- to nine-month-old full-grown dogs weighing around 12 kg were used in the study. Group I (control group) comprised those in which delayed loading was applied to the right side of the mandible, and Group II (experimental group) consisted of dogs in which immediate loading was performed on the left side of the mandible. Resorbable blast media (RBM)-treated double-threaded US III implants measuring 3.5 mm in diameter and 11 mm long were used in the study. Each animal received four implants in each group, for a total of 40 implants. Cemented type abutments were used after implantation. An 8-week period was allowed for bone healing and an abutment was placed after exposing the periosteum for loading. An implant sample was obtained from bone blocks taken when the dogs were killed at 16 weeks after loading. A Mann-Whitney U-test was performed to evaluate statistical significance. Student's t-test was used for the histological evaluation. The bone formation ratio in Groups 1 and 2 was 88.23 and 86.41%, respectively. No significant difference in new bone formation was observed in the two groups. As no significant difference was seen in new bone formation between the delayed and immediate loading groups, early loading might be possible after implant placement.
Animals ; Dogs ; Mandible ; Osteogenesis ; Periosteum

Thirty-six sinus grafts were performed in 34 patients with an alveolar crest bone height in the posterior maxilla of 3 to 5 mm before grafting. The sinuses were grafted using Bio-Oss alone or mixed with fibrin glue. Group 1 was the control group and included 25 patients who received a xenograft mixed in saline. Group 2 comprised 9 patients who received a xenograft and fibrin glue. The study was further subdivided at the time of 9 months. This histologic study evaluated by hematoxylin-eosin (H & E) and histomorphometric analysis whether fibrin glue in combination with Bio-Oss enhances bone regeneration in sinus floor elevation in humans. The new bone formation was better in Group 2 than in Group 1, but the difference was not significant. The absorption of the graft material was faster in Group 2 than in Group 1, in the short term, but better in Group 1 over the long term, although the difference was not significant. Lamellar bone was formed earlier in Group 1 compared to Group 2, but the difference was not significant. Overall, the surgery site stabilized earlier with new bone formation in Group 2 than in Group 1, but the difference was not significant. Combining a fibrin sealant and Bio-Oss could lead to improved scaffolds for bone tissue engineering based on the synergistic effects of the biomaterials. Therefore, Bio-Oss or Bio-Oss plus Tisseel may be used depending on the situation.
Absorption ; Biocompatible Materials ; Bone and Bones ; Bone Regeneration ; Fibrin ; Fibrin Tissue Adhesive ; Floors and Floorcoverings ; Humans ; Maxilla ; Minerals ; Osteogenesis ; Transplantation, Heterologous ; Transplants

OBJECTIVE: This study examined the incidence of workplace violence (WPV) in an emergency department (ED), and its influence on ED workers' mental health. METHODS: A cross-sectional, anonymous survey was conducted on ED workers employed in a local emergency medical center during August 2018. The survey respondents' data on the demographic characteristics, WPV episode, Korean-translated Brief Encounter Psychosocial Instrument (BEPSI-K), stress questionnaire for Korean National Health and Nutrition Examination Survey (KNHANES), and Patient Health Questionnaire-9 (PHQ-9) were obtained. The results of the stress (BEPSI-K, KNHANES) and depression (PHQ-9) score were compared with the WPV experience of ED workers. RESULTS: A total of 104 of 120 ED workers (86.7%) were exposed to WPV. ED workers that experienced physical violence within the past year had higher KNHANES, BEPSI-K, and PHQ-9 than the workers, who did not experience such violence (P≤0.001). In addition, this survey demonstrated that a physical violence episode within the past year was associated with above moderate depression (P≤0.001; odds ratio, 19.597). CONCLUSION: Recent physical violence can cause psychiatric disorders in ED workers, such as depression or stress disorder. Therefore, policies are needed to prevent WPV in ED and support ED workers who have experienced WPV.
Anonyms and Pseudonyms ; Depression ; Emergencies ; Emergency Service, Hospital ; Humans ; Incidence ; Mental Health ; Nutrition Surveys ; Odds Ratio ; Physical Abuse ; Violence ; Workplace Violence