BACKGROUND: The aim of this study was to examine the efficacies of somatosensory evoked potential (SEP) and diffusion-weighted magnetic resonance imaging (DWI) in predicting the clinical prognosis of comatose patients following cardiac arrest. METHODS: Forty-one patients resuscitated from out-of hospital cardiac arrest (OHCA) were retrospectively studied. After return of spontaneous circulation (ROSC), SEP was conducted between one and three days after resuscitation, and DWI was conducted within five days of resuscitation. SEP was classified into three grades: normal, delayed conduction or unilateral loss of the N20 peak, and bilateral loss of the N20 peak. Bilateral loss of the N20 peak was considered a predictor of poor prognosis. For DWI, diffuse signal intensity (SI) abnormality in the cerebral cortex or abnormality in other brain areas in addition to the bilateral cerebral cortex was taken as a predictor of poor prognosis. For patient clinical prognosis, the Glasgow-Pittsburgh Cerebral Performance Category (CPC) was used to evaluate neurological results at the time of discharge. Resulting CPC scores of 1 and 2 were considered as a favorable prognosis, and scores of 3, 4, and 5 were considered as a poor prognosis. Sensitivity, specificity, positive predictive value, and negative predictive value for the prediction of poor prognosis were analyzed for each test individually and for the combination of the two tests. RESULTS: Among the 41 subject patients, 31 underwent SEP, 30 underwent DWI, and 20 underwent both tests. The prognosis predictor of SEP (bilateral loss of the N20 peak) predicted poor prognosis with 56.5% sensitivity, 100% specificity, 100% positive predictive value, and 44.4% negative predictive value. The prognosis predictor of DWI (diffuse SI abnormality in the cerebral cortex or abnormality in other brain areas in addition to the bilateral cerebral cortex) predicted poor prognosis with 85% sensitivity, 100% specificity, 100% predictive value, and 76.9% predictive value. For patients who underwent both tests, the sensitivity and negative predictive value for the prediction of poor prognosis increased to 92.3% and 87.5%, respectively, and the specificity and positive predictive value were maintained at 100%. CONCLUSIONS: The accuracy of poor prognosis prediction for patients in prolonged comas after resuscitation is enhanced by combining the results of SEP and DWI along with the individual results of each test.
Brain ; Cerebral Cortex ; Coma* ; Dinucleoside Phosphates ; Evoked Potentials, Somatosensory* ; Heart Arrest* ; Humans ; Magnetic Resonance Imaging* ; Prognosis* ; Resuscitation ; Retrospective Studies ; Sensitivity and Specificity

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

Transdermal drug delivery is applicable to only a few drugs because the stratum corneum is an excellent barrier to percutaneous absorption. Iontophoresis is a non-invasive technique which increases the drug deliveries into the skin through an electric current. In iontophoretic systems, the movement of ionized drugs is facilitated by electrical energy according to the basic electrical principles of "like charges repel each other and opposite charges attract". Iontophoresis has been explored for many dermatological applications with considerably successful reports. This article reviews the principles and advantages/limitations of iontophoresis, the factors affecting iontophoresis and its applications in various dermatological conditions.
Fees and Charges ; Iontophoresis ; Skin ; Skin Absorption

PURPOSE: The symptoms of dizziness are common in the emergency department, accounting for 1~2% of all emergency department visits. Central vertigo, especially stroke is a leading concern when these symptoms occur in isolated condition. However, no method is available to discriminate isolated central vertigo from peripheral vertigo. The objectives of the present study were to evaluate the clinical usefulness of the simple prediction method of central vertigo among patients presenting with the symptoms of dizziness in the emergency department. METHODS: A three-year retrospective study with symptoms of dizziness was performed in a university teaching hospital between 1st January 2005 and 31st December 2007. Multivariate logistic regression analysis of all clinical parameters was performed for a model comprising 10 variables to form a St. Mary's dizziness prediction score. RESULTS: A total of 1058 patients were enrolled. Among central vertigo patients, 70 were ischemic stroke, 8 vertebrobasilar insufficiency, 3 hemorrhagic stroke and 1 had a brain tumor. The odds ratio of the predictor variables were (1) 2.13 for men, (2) 7.18 for disequilibrium, (3) 3.49 for headache, (4) 7.17 for falling tendency, (5) 2.96 for risk factor score 1, and (6) 8.71 for risk factor score 2. Each of these variables was assigned a score 1 or 2 to obtain a total of 8. The risk of central vertigo was 2.64%, 25.60%, and 84.21% for the low, intermediate, and high risk groups, respectively. CONCLUSION: St. Mary's dizziness prediction score is a simple and relatively reliable tool for accessing the symptoms of dizziness and diagnosing isolated central vertigo in the emergency department.
Accounting ; Brain Neoplasms ; Diagnosis, Differential ; Dizziness ; Emergencies ; Headache ; Hospitals, Teaching ; Humans ; Logistic Models ; Male ; Odds Ratio ; Retrospective Studies ; Risk Factors ; Stroke ; Vertebrobasilar Insufficiency ; Vertigo

PURPOSE: Pneumonia is a serious and relatively common complication among submersion victims without out-of-hospital cardiac arrest (OHCA). The purpose of this study was to investigate the risk factors of pneumonia among adult submersion victims without OHCA. METHODS: All adult submersion victims without OHCA who visited our hospital between 2004 and 2013 were included. This study was conducted retrospectively, with collection of data by review of medical records. Among total submersion victims (310 patients), 191 patients did not suffer OHCA. We investigated the characteristics of the patients and classified them according to two groups based on the presence of pneumonia. We then compared clinical variables between the two groups. RESULTS: A total of 191 adult submersion patients without OHCA; 157 patients did not have pneumonia during their hospital stay; 34 patients had pneumonia. In respective analysis, alert mentality, pH and core temperature showed correlation with pneumonia. However, in logistic regression analysis with these 3 variables, only pH was a risk factor of pneumonia. All patients with pneumonia except one were discharged with full recovery. CONCLUSION: The risk of pneumonia among adult submersion victims without OHCA is higher when the lower pH is checked. Further studies are needed in order to evaluate the other risk factors of pneumonia for early prediction and proper management.
Adult* ; Heart Arrest ; Humans ; Hydrogen-Ion Concentration ; Immersion* ; Length of Stay ; Logistic Models ; Medical Records ; Out-of-Hospital Cardiac Arrest* ; Pneumonia* ; Respiratory Distress Syndrome, Adult ; Retrospective Studies ; Risk Factors

We experienced a case of thoracic aortic aneurysm combined with coronary artery disease. A 68-year-old man complained of anginal pain in the left anterior chest and nonspecific pain in the posterior chest. The aneurysm was extending from left subclavian artery to the diaphragm and sign of impending rupture was noted in the chest CT. Coronary angiograms revealed significant obstruction of left circumflex coronary artery(>95%) and left anterior descending artery(>50%). Exposure was obtained through the left posterolateral thoracotomy incision in the 4th intercostal space and then partial femoro-femoral cardio- pulmonary bypass was established. After aortic cross clamping, the aneurysmal sac was opened and repaired with interposition of 26 mm Hemashield graft. Under the beating heart with femoro-femoral cardiopulmonary bypass, aorto-left circumflex coronary bypass with autogenous saphenous vein used as conduit was performed. Postoperatively multiple cerebral infarction ensued due to intraoperative hypovolemic shock and hypoxic brain damage during cardiopulmonary bypass. Currently, the patient's mental status is drowsy and in an improving state.
Aged ; Aneurysm ; Aneurysm, Dissecting ; Aortic Aneurysm, Thoracic* ; Cardiopulmonary Bypass ; Cerebral Infarction ; Constriction ; Coronary Artery Bypass ; Coronary Artery Disease* ; Coronary Vessels* ; Diaphragm ; Heart ; Humans ; Hypoxia, Brain ; Rupture ; Saphenous Vein ; Shock ; Subclavian Artery ; Thoracotomy ; Thorax ; Tomography, X-Ray Computed ; Transplants

Pulmonary aspergilloma is potentially a life threatening disease resulting from the colonization of lung cavities by Aspergillus fumigatus. A case is reported: a 43-year-old man with symtomatic cavitary aspergilloma presenting with severe productive coughing, hemoptysis, occasional fever, and chilling. On preoperative plain chest radiograph and CT scan, we could find a rounded irregular opacity in a large pulmonary cavity. He received 2 separate operations for therapeutic need. At the first opertion, we performed cavernostomy and thoracoplasty because of severe pleural adhesions, tearing of cavity wall, and high risk of respiratory insufficiency. At the second operation, we performed myoplasty and omentoplasty for closure of remaining air space and complete wrapping of the BPF site. All symptoms of dyspnea and hemoptysis have since resolved. We believed that in the high risk patients who have severe respiratory symptoms, such as in aspergilloma and open cavity with a risk of respiratory insufficiency, cavernostomy followed by myoplasty or omentoplasty should be recommended.
Adult ; Aspergillus fumigatus ; Colon ; Cough ; Dyspnea ; Fever ; Hemoptysis ; Humans ; Lung ; Pulmonary Aspergillosis ; Radiography, Thoracic ; Respiratory Insufficiency ; Surgical Flaps ; Thoracoplasty ; Tomography, X-Ray Computed

A 50-year-old male patient was admitted due to right ventricular and aortic foreign bodies with ascending aortic pseudoaneurysm. The patient had a history of Kirschner wire fixation of right sternoclavicular joint 3 months ago. Under cardiopulmonary bypass, two K-wires were removed and injured pulmonary valve leaflet and aortic wall were repaired successfully. The postoperative course was uneventful and the patient was discharged on the 14th postoperative day.
Aneurysm, False ; Cardiopulmonary Bypass ; Foreign Bodies* ; Humans ; Male ; Middle Aged ; Pulmonary Valve ; Sternoclavicular Joint

PURPOSE: The purpose of this study is to investigate the clinical characteristics of patients admitted to emergency rooms with ocular chemical injuries, the substances responsible for such injuries, in order to improve their prevention and treatment. METHODS: The subjects of this study were 73 patients admitted to the hospital with ocular chemical injuries from January 1, 2009 to December 31, 2010. The subjects were divided into groups based on the PSS (poisoning severity score) grade of their injuries, where grades 0 and 1 were classified as the low group (low PSS) and grades 2 and 3 were classified as the high group (high PSS). There were 28 subjects in the low PSS group (38.3%) and 45 subjects in the high PSS group (61.6%). The results were retrospectively reviewed by examining the medical records of the patients. RESULTS: Upon their arrival to the hospital, the most common symptoms were red eye (50.7%), pain (39.7%), and eye irritation (39.7%). Red eyes were more frequently observed from 27 persons (60%) in the high PSS group (p=0.04). The most common causative substances were chemicals and adhesives/glues for both groups (21 cases each). Among the 15 patients exposed to acids or alkalis, 13 patients belonged to the high PSS group. Only two patients visited the hospital after having washed their eyes. CONCLUSION: Worse damage was observed from work-related exposure (including alkali or acid exposure), causing red eye and ocular chemical injuries. Onsite first aid was lacking.
Alkalies ; Burns, Chemical ; Emergency Service, Hospital ; Eye Injuries* ; First Aid ; Humans ; Medical Records ; Occupational Exposure ; Poisoning ; Retrospective Studies ; Therapeutic Irrigation

The anomaly which the right pulmonary artery originates from the ascending aorta is a rare and usually fatal form of congenital heart disease. This lesion is often associated with a patent ductus arteriosus. Death frequently occurs in early infancy. Anomalous origin of the right pulmonary artery is much more common than anomalous origin of the left pulmonary artery. The anomalous right pulmonary artery usually arise from the posterior aspect of the ascending aorta close to the aortic valve. We report a 1 month-old infant with right pulmonary artery arising from the ascending aorta, which was corrected successfully by direct anastomosis to the main pulmonary artery.
Aorta* ; Aortic Valve ; Ductus Arteriosus, Patent ; Heart Defects, Congenital ; Humans ; Infant ; Infant, Newborn ; Pulmonary Artery*