No abstract available.
Blood Group Incompatibility* ; Bromelains*

BACKGROUND: Septic shock is characterized by an abnormal vascular tone that has been related to various factors. Myocardial depression can also occur in septic shock. Various experimental studies have indicated that the myocardial depression could be present early in the course of septic shock. This study aimed to assess hemodynamic characteristics according to outcome of septic shock in emergency department. METHOD: The study population comprised 20 patients admitted to our emergency department for septic shock. All patients with septic shock(prolonged hypotension, signs of tissue hypoperfusion, signs of sepsis, suspected source of infection, or documented bacteremia) had conventional serial hemodynamic evaluations in emergency department to identify early hemodynamic variables that predicted outcome. All patients were monitored with a pulmonary artery catheter and an arterial catheter. Hemodynamic measurements and oxygen profile were obtained. RESULTS: There were 9(53%) survivors and 8(47%) nonsurvivors. There were no significant differences in systolic pressure, pulse rate, mean pulmonary artery pressure, pulmonary capillary wedge pressure, systemic vascular resistance index, and pulmonary vascular resistance index between survivors and nonsurvivors at initial hemodynamic value. However, significant differences were found in cardiac index(4.3+/-0.5 vs. 2.74+/-0.7 L/min/m2), stroke volume index(44+/-10 vs. 23+/-5 ml/beat/m2), left ventricular stroke work index(39+/-11 vs. 15+/-6 gm m/m2), and right ventricular stroke work index(8.1+/-3.0 vs. 5.2+/-2.9 gm m/m2) between survivors and nonsurvivors at initial hemodynamic value. CONCLUSION: Survivors had better myocardial function than nonsurvivors during the early phase of septic shock. This results suggest that myocardial depression during septic shock develops in the early course of septic shock, which is associated with outcome.
Blood Pressure ; Catheters ; Depression ; Emergencies* ; Emergency Service, Hospital* ; Heart Rate ; Hemodynamics* ; Humans ; Hypotension ; Oxygen ; Prognosis* ; Pulmonary Artery ; Pulmonary Wedge Pressure ; Sepsis ; Shock, Septic* ; Stroke ; Stroke Volume ; Survivors ; Vascular Resistance

BACKGROUND: Ski injuries depend on many factors which involve the skier's skill, the skiing environment, and skier's equipment. The purpose of this study was to determine the factors associated with fractures by skiing accident. SUBJECT: We evaluated 566 patients with ski injuries who visited to the emergency post located in the YongPyong Ski Resorts from Nov. 1996 to Feb. 1997. Among the patients,379 patients had no fracture(group I) and 187 patients had fracture(group II). RESULT: There was no differences in mean age and sex ratio between two groups. Fractures of the lower extremities were more common than the upper extremities. Slipping was the most common injury mechanism. arming-up was done in 40% of group I and in 17% of group II. The fracture injuries were more common in the skier with intermediate(45%) skill than the beginner(29%) and the ones with advanced skill(12%). The slope with intermediate difficulty was the most frequent site of fracture accidents. The fracture group tended to choose the slope beyond their skiing ability. CONCLUSION: Our results suggest that fracture during skiing can be prevented if skiers do warming-up prior to skiing and choose slope appropriate to their skiing skill.
Emergencies ; Health Resorts ; Humans ; Lower Extremity ; Sex Ratio ; Skiing ; Upper Extremity

Transcutaneous cardiac pacing(TCP) is a rapid, safe, noninvasive and easily utilized form of emergency cardiac pacing, with hemodynamically similar to transvenous cardiac pacing. This paper reports the result of transcutaneous pacing in a series of patients in emergency department.32 patients with bradyanhythmia were enrolled during the study period. TCP was successful in 29(91%) patients. No evidence of electrical capture was seen in two patients in asystole and a patient with ventricular escape rhythm. Mean capture threshold was 66 mA. Transvenous pacemaker was inserted in 18(56%) of the 32 patients during transcutaneous cardiac pacing. Twenty(61%) of the 32 patients survived and eventually discharged. Ten patients(31%) were died of uncorrectable underlying disease in spite of successful ECG capture and palpable pulse by TCP. In conclusion, TCP is a reliable, noninvasive method that offers the possibility to initiate pacing within seconds and can be used by any emergency medical staff. In our opinion, it should be considered as the first choice of emergency treatment of hemodynamically unstable bradyarrhythmia.
Bradycardia* ; Electrocardiography ; Emergencies* ; Emergency Service, Hospital* ; Emergency Treatment ; Heart Arrest ; Humans ; Medical Staff ; United Nations

PURPOSE: The objective of this retrospective study is to evaluate the practical feasibility and safety of applying hem-o-lok clips for the closure of the appendiceal stump in complicated appendicitis. METHODS: From January 2009 to April 2010, 267 patients who underwent laparoscopic appendectomies at the Pusan National University Yangsan Hospital were included in this study. Of these patients, 161 were diagnosed by computed tomography as having complicated acute appendicitis. In 107 patients, the appendiceal stump was closed with hem-o-lok clips, whereas in the remaining 160 patients, it was closed with endoloops. These two groups were compared for clinicopathologic data and procedural cost-effectiveness. RESULTS: No significant differences were found between the two groups in terms of age, sex, hospital stay, or blood loss. Furthermore, postoperative complications were similar and highly acceptable in both groups. However, operation times were significantly shorter and hospital cost was lower for the hem-o-lok group. CONCLUSION: The hem-o-lok clips has advantages such as simplicity of application, a shorter operation time, and lower hospital cost when used as a means of securing the base of the appendix in relation to the endoloop procedure.
Appendectomy ; Appendicitis ; Appendix ; Hospital Costs ; Humans ; Length of Stay ; Postoperative Complications ; Retrospective Studies

Mixed adenoneuroendocrine carcinoma (MANEC) is a rare disease that was first defined in the 2010 World Health Organization classification of endocrine tumors. We present the case of a 65-year-old man with an ulcerative depressed lesion measuring 3 cm in diameter and found in the lower gastric body. It was diagnosed as a MANEC, and we performed subtotal gastrectomy with D2 lymph node dissection. The patient is still alive, and no recurrence was observed at a 12-month follow-up. Most MANECs tend to have a poor prognosis. Curative resection, including an adequate lymph node dissection, should be considered, and intense follow-up is needed.
Aged ; Classification ; Follow-Up Studies ; Gastrectomy ; Humans ; Lymph Node Excision ; Prognosis ; Rare Diseases ; Recurrence ; Stomach Neoplasms ; Stomach* ; Ulcer ; World Health Organization

OBJECTIVE: This study compared three prominent midsagittal planes (MSPs) to identify the MSP that best approximates the true symmetrical MSP. METHODS: Forty-three patients (mean age, 23.0 ± 8.20 years) were grouped as follows: group 1 consisted of 10 patients with skeletal Class I and a menton (Me) deviation of < 2 mm; group 2, 11 patients with skeletal Class III and a Me deviation < 2 mm; group 3, nine patients with skeletal Class III and a Me deviation of 2 to less than 4 mm; and group 4, 13 patients with skeletal Class III and an Me deviation ≥ 4 mm. The candidate MSPs were established by three-dimensional (3D) cone beam computed tomography (CBCT) reorientation methods (RMs): (1) the MSP perpendicular to the Frankfort horizontal (FH) plane while passing through the crista galli and basion; (2) the MSP including the nasion, incisive foramen, and basion; (3) the MSP including the nasion, anterior nasal spine, and posterior nasal spine. The mean absolute distances (MADs) to the MSPs were calculated from the coordinates of 1,548 points on 129 CBCT images. The differences in the values of the 3D coordinates among RMs were compared. RESULTS: The MADs of the three RMs showed significant differences (p < 0.05). Most of the differences in values of the coordinates were not significant among RMs. CONCLUSIONS Although the differences in distance among the three MSPs were minor, the MSP perpendicular to the FH plane while passing through the crista galli and basion best approximated the true symmetrical MSP.

Purpose: The aim of this study was to analyze the effects of reduced fasting time on postoperative recovery in patients who underwent totally laparoscopic distal gastrectomy (TLDG). Methods: This retrospective study included 347 patients who underwent TLDG. Patients were divided into 2 groups:reduced fasting time group (n = 139) and conventional feeding group (n = 208). We compared the total hospital cost and recovery parameters, such as postoperative complications, mean hospital stay, day of first flatus, initiation of soft diet, and serum CRP levels, between the 2 groups. Results: The reduced fasting time group had a lower total hospital cost (P < 0.001) than the conventional feeding group.Regarding postoperative complications, there was no significant difference between the 2 groups (P = 0.085). Patients in the reduced fasting time group had a significantly shorter duration of mean hospital stay (P < 0.001), an earlier first flatus (P = 0.002), an earlier initiation of soft diet (P < 0.001), and lower level of serum CRP concentration (day of surgery, P = 0.036;postoperative days 2, 5, and 7, P = 0.01, 0.009, and 0.012, respectively) than patients in the conventional feeding group. Conclusion Reduced fasting time can enhance postoperative recovery in patients who undergo TLDG and may reduce medical costs.

We report a case of 65 years old man who was found on routine esophagogastroduodenoscopy to have gastric tumour. Histology revealed adenocarcinoma. Staging investigation with abdominal computed tomography (CT) confirmed gastric cancer of the antrum with lymph node enlargement at hepatoduodenal ligament. The patient underwent laparoscopic assisted distal gastrectomy with D2 lymphadenectomy. Pathology revealed intestinal type moderately differentiated tubular adenocarcinoma invading lamina propria (pT1a). Four positive lymph nodes out of 34 did not show metastatic adenocarcinoma but rather Squamous Cell Carcinoma (SCC) and were positive for p63 and CK5/6 on immunohistochemistary. Primary site of SCC was not found. He received adjuvant chemotherapy with TS-1 60 mg. After two years of follow-up he is asymptomatic and repeated EGD and abdominal CT Scan were normal. Herein, the authors report the case of early gastric cancer with synchronous metastatic SCC with unknown primary site.

PURPOSE: This study was to investigate the resuscitation outcomes and the clinical characteristics of geriatric nontraumatic out-of-hospital cardiac arrest by analyzing data from a single institution's registry. METHODS: We conducted a retrospective study of 804 patients who came to the emergency department with nontraumatic out-of-hospital cardiac arrest during the period 1991-2002. Only patients over 18 years of age were included. Clinical characteristics, variables associated with cardiac arrest, and data during resuscitation were obtained from our cardiac arrest database. Patients were divided into two age groups: less than 65 years of age (non-geriatric group, n=530), and over 65 years of age (geriatric group, n=274). RESULTS: The proportion of cardiac etiology was higher with the geriatric group than with the non-geriatric group (48% vs 39%, chi-square=0.013). A lower incidence of ventricular arrhythmia was observed in the geriatric group (8% vs 13%, chi-square= 0.037). The arrest time, the CPR time, the witnessed arrest, the epinephrine doses, and total defibrillation energy were not different between two groups. Spontaneous circulation was restored in 127 (46%) patients in the geriatric group and in 255 (48%) patients in the non-geriatric group (chi-square=0.382). The patients discharged alive numbered were 33 (6%) in the non-geriatric group and 10 (4%) in the geriatric group (chi-square=0.138). CONCLUSION: Cardiac etiology was predominant in geriatric cardiac arrest and a lower incidence of ventricular arrhythmia was observed. An older age (over 65 years) did not affect the resuscitation outcome.
Arrhythmias, Cardiac ; Cardiopulmonary Resuscitation ; Emergency Service, Hospital ; Epinephrine ; Heart Arrest* ; Humans ; Incidence ; Out-of-Hospital Cardiac Arrest ; Resuscitation* ; Retrospective Studies