Patients with cardiac rupture due to blunt trauma have more than 50% mortality rate and most of them expire before they arrive at the hospital emergency room. Since patients typically present with cardiac tamponade, the diagnosis can be easily confirmed with physical examination, echocardiography, and chest CT scan. However, in our case of the massive hemothorax on right side without evidence of cardiac tamponade, the diagnosis for cardiac rupture does not seems to be easy. Therefore, we must assume the probability of cardiac rupture if we plan an explo-thoracotomy in a patients with massive right hemothorax without rib fracture. We describe two cases of cardiac rupture combined with pericardial laceration and right massive hemothorax by blunt chest trauma. The ruptured hearts of the patients were successfully closed using cardio-pulmonary bypass or cell saver system without detrimental sequelae.
Cardiac Tamponade ; Diagnosis ; Echocardiography ; Emergency Service, Hospital ; Heart ; Heart Rupture* ; Hemothorax* ; Humans ; Lacerations ; Mortality ; Physical Examination ; Rib Fractures ; Thorax* ; Tomography, X-Ray Computed

PURPOSE: We evaluated the clinical and radiological results of acetabular reconstructions using an acetabular roof reinforcement ring (ARR). MATERIALS AND METHODS: From May 1993 to November 1999, 18 hips revised with ARR were evaluated. The mean age at operation was 53 years. The average follow-up period was 51 months (24-94 months). Acetabular defects were classified based on the AAOS classification system. There was one case of type IIA defect, six cases of type IIB defect, ten cases of type III defect and one case of type IV defect. All were treated with morselized allografts and autografts, and three were reconstructed with additional structural autografts. RESULTS: The average Harris hip score improved from 54 preoperatively to 76 postoperatively, but five patients complained of intermittent hip pain. On the last follow-up radiographs, the bone grafts were united and remodeled in all cases, but only partial resorption was observed in two hips. We found evidence of osteolysis in four hips and observed cup migration in three hips. Three hips, in which Muller rings were used, were re-revised during the follow-up period. CONCLUSION: Acetabular reconstruction using ARR led to good clinical and radiological results, but a relative high rate of rerevision was shown in the cases fitted with the Muller ring. Appropriate ARR should be used depending on the extent of the acetabular defect.
Acetabulum* ; Allografts ; Arthroplasty* ; Autografts ; Classification ; Follow-Up Studies ; Hip ; Humans ; Osteolysis ; Transplants

BACKGROUND: Elevated levels of cortisol and growth hormone are critical counterregulatory responses to severe hypoglycemia. However, the proportion and clinical characteristics of patients with type 2 diabetes mellitus (DM) who fail to show appropriate cortisol and/or growth hormone secretion in response to severe hypoglycemia have not been investigated. METHODS: We measured plasma cortisol and growth hormone levels in type 2 DM patients with severe hypoglycemia who visited the emergency department between 2006 and 2015. RESULTS: Of 112 hypoglycemic patients, 23 (20.5%) had an impaired cortisol response (<18 µg/dL) and 82 patients (73.2%) had an impaired growth hormone response (<5 ng/mL). Nineteen patients (17.0%) had impaired responses to both cortisol and growth hormone. The patients with impaired responses of cortisol, growth hormone, and both hormones were significantly older and more likely to be female, and had higher admission rates, lower growth hormone levels, and lower adrenocorticotropic hormone levels than the patients with a normal hormonal response. Multivariate logistic regression analysis indicated that an impaired growth hormone response was significantly associated with advanced age, shorter DM duration, a higher admission rate, and a higher body mass index (BMI). An impaired cortisol response was significantly associated with growth hormone levels. Patients with an impaired growth hormone response had higher admission rates than patients with a normal response. CONCLUSION: A considerable number of type 2 DM patients had impaired cortisol and/or growth hormone responses to severe hypoglycemia. Advanced age, shorter DM duration, and higher BMI were independently associated with an abnormal growth hormone response.
Adrenocorticotropic Hormone ; Body Mass Index ; Diabetes Mellitus, Type 2 ; Emergency Service, Hospital ; Female ; Growth Hormone ; Humans ; Hydrocortisone ; Hypoglycemia ; Logistic Models ; Plasma

Background/Aims: We aimed to evaluate site-specific cancer risk in diabetic patients and to investigate causal and temporal relationships by analyzing organ-specific cancer risk according to the duration of diabetes. Methods: Using a database provided by the Korean National Health Insurance Service, we conducted a retrospective, population-based cohort study of adults aged ≥ 30 years from January 2005 to December 2013. To verify the possibility of detection bias or reverse causation, we compared hazard ratios (HRs) for each cancer according to the following duration of diabetes: less than 6 months, 6 months to 3 years, and more than 3 years. Results: The incidence of overall cancer per 1,000 person-years was higher in patients with diabetes than in those without diabetes (20.36 vs. 10.83). The overall cancer risk according to the duration of diabetes was the highest within the first 6 months after diagnosis (HR, 2.03; 95% confidence interval [CI], 1.99 to 2.07), and the HR decreased with the duration of diabetes, ranging from 1.19 (95% CI, 1.18 to 1.21) between 6 months and 3 years to 1.12 (95% CI, 1.11 to 1.13) after 3 years. Both overall cancer risk and HR remained significantly higher in patients with diabetes than in those without diabetes. The risk for prostate cancer was higher in men with diabetes than in those without diabetes (HR, 1.12; 95% CI, 1.10 to 1.14). In women, the risk for endometrial cancer was significantly higher in patients with diabetes than in those without diabetes throughout the duration of diabetes. Conclusions The risk for stomach, colorectum, liver, pancreas, and kidney cancer appeared to be higher in patients with diabetes than in those without diabetes regardless of the sex or duration of diabetes.

Postganglionic cholinergic dysautonomia is a rare disease characterized by impaired secretion of tears and saliva, generalized absence of sweating, lack of cardiac response to carotid massage and atony of the gastrointestinal tract and urinary bladder. Autonomic function tests show the preservation of sympathetic adrenergic functions in contrast to the generalized involvement of postganglionic parasympathetic and sympathetic cholinergic nerves. Recently, we experienced a patient with gut dysmotility in selective postganglionic cholinergic dysautonomia. She is now being treated with bethanechol and milk of magnesia and has experienced minimal symptom improvement.
Bethanechol ; Gastrointestinal Tract ; Humans ; Magnesium Oxide ; Massage ; Milk ; Primary Dysautonomias* ; Rare Diseases ; Saliva ; Sweat ; Sweating ; Tears ; Urinary Bladder