OBJECTIVE: We analyzed the main causes leading to a poor outcome (severe disability, a vegetative state and death) following surgical treatment for ruptured intracerbral aneurysms. METHODS: Between January 1994 and December 2007, we maintained a retrospective database of 339 patients who underwent surgical clipping. The various causes we investigated were the technical problems during operation, the initial SAH or ICH, vasospasm, hydrocephalus and the post-operative medical complications. The clinical outcome was assessed according to the Glasgow Coma Scale (GOS). RESULTS: There were 263 cases of good outcomes (77.6%) and 76 cases of poor outcomes (22.4%). The three main causes of a poor outcome were 1) preoperative causes such as the direct insult of the initial SAH and ICH in 21 cases (27.6%), 2) intra-operative causes such as the technical problems during dissection and clipping of the aneurysm neck in 29 cases (38.2%) and 3) postoperative causes such as clinical vasospasm in 16 cases (21.1%). The mean follow-up period was 17.6 months (range : 2 months to 9 years). CONCLUSION: A meticulous neck dissection and complete obliteration of the aneurysm preserving parent arteries and perforators are the most effective and prime methods that surgeons can employ to reduce the rate of poor outcomes when performing ruptured aneurysm surgery.
Aneurysm ; Aneurysm, Ruptured ; Arteries ; Follow-Up Studies ; Glasgow Coma Scale ; Humans ; Hydrocephalus ; Intracranial Aneurysm ; Microsurgery ; Neck ; Neck Dissection ; Parents ; Persistent Vegetative State ; Retrospective Studies ; Surgical Instruments

There is growing evidence of the association between inflammation and stress-related disorders including depression. The positive correlation between the increased levels of inflammatory cytokines observed in patients with other diseases and the byproduct of the depressive symptoms may be caused by chronic stress. Increased neuroinflammatory responses are capable of activating microglia and astrocytes, which leads to release pro-inflammatory cytokines. Moreover, elevated levels of inflammatory cytokines such as tumor necrosis factor-alpha, interleukin (IL)-1, and IL-6 are causally related to various aspects of depression such as the behavioral symptomatology. Eventually, these elevated cytokines aggravate and propagate neuroinflammation, impairing brain functions. Thus, activated astrocytes and microglia may be potential mediators in neuroinflammatory processes contributing to the development of depression.

Tracheal stenosis is a difficult disease entity to manage. Laser ablation is one effective treatment for treacheal stenosis and can be utilized if tracheal reconstructive surgery is impossible. Potassium titanyl phosphate laser, transmitted via flexible quartz fiber, can be precisely manipulated through flexible bronchoscope under local anesthesia. We treated 7 patients with tracheal and broncheal lesion under local anesthesia with KTP laser from January 1995 to July 1996. The patients included three males and four females. The age of patients ranged from 22 to 66 years with a mean of 43.7 years. The etiology of tracheal stenosis in patients was stenosis after tracheostomy(3 cases), prolong inturbation in cases of sepsis(1 cases), and the recurrence of lung cancer within endobronchial lesion(2 cases). In the cases of tracheal stenosis treated with laser ablation, there were 2 cases of recurrence of stenosis at the anastomosis site after the operation, 3 cases of stenosis at tracheostomy site, and 2 cases of local recurrence of lung cancer. The site of the tracheal stenosis was the balloon site of the tracheostomy tube(3-4cm inferior to the tracheostomy site, 2-3cm superior to the carina) and the anastomosis site that were narrowed to less than 5mm(4 cases). For the stenosis lesion in the endobronchial area, there were 2 patients with a lesion at the anterior wall, 1 patient with a lesion at the posterior wall, 2 patients with circumferential stenosis. Laser ablation time was 25.4+/-5.9min and used energy was 1768+/-365J. We have used KTP laser via flexible bronchoscope without major complications. Adjuvant radiation therapy may prevent fibroblast proliferation which leads to restenosis. In three patients of restenosis after laser ablation, adjuvant irradiation started within 4 hours after laser ablation, and the radiation doses were 1500cGy given in five fraction. In patients with adjuvant radiation therapy, stenosis has not recurred.
Anesthesia, Local ; Bronchoscopes ; Constriction, Pathologic ; Female ; Fibroblasts ; Humans ; Laser Therapy ; Lasers, Solid-State ; Lung Neoplasms ; Male ; Potassium* ; Quartz ; Radiotherapy, Adjuvant ; Recurrence ; Tracheal Stenosis* ; Tracheostomy

OBJECTIVE: The safety and effectiveness of Guglielmi Detachable Coil(GDC) embolization for cerebral aneurysm has been well documented. However, domestically there are few reports. The purpose of this study is to analyze procedural complications that occurred during endovascular coilling performed for cerebral aneurysms retrospectively. METHODS: From January 1996 to December 2003, a total of 453 patients (484 aneurysms) who had undergone GDC embolization for cerebral aneurysm were selected. The aneurysms were classified according to rupture history, location, dome and neck size. Procedural complications such as aneurysmal rupture, thrombosis and occlusion of patent vessels due to coil escape were noted. RESULTS: Procedural complications occurred 49 cases (10.1%). Among these, there were 27 of procedure-related aneurysmal rupture (5.6%), 14 of thrombosis (2.9%), 8 of occlusion of patent vessels due to coil escape (1.7%). Death or severe neurological deficit were seen in 18 cases of procedure-related rupture, 9 cases of thrombosis and 4 cases of coil escape. Procedure-related mortality and morbidity rates for endovascular coiling were calculated to be 2.9% and 3.6% respectively. CONCLUSION: The potential complications associated with shape, size and relationship to parent vessels of each specific cerebral aneurysm must be considered carefully before treatment. In order to reduce complications, proper equipment, knowledge on the hemodynamics and vascular anatomy, and operator's expertise are desired.
Aneurysm* ; Hemodynamics ; Humans ; Intracranial Aneurysm ; Mortality ; Neck ; Parents ; Retrospective Studies ; Rupture ; Thrombosis ; United Nations

Three strains, YP416 T , YP421 T, and Y422, were isolated from soil samples in Pocheon City, Gyeonggi province, South Korea. The strains belong to two novel yeast species in the genus Mrakia. Molecular phylogenetic analysis showed that the strain YP416 T was closely related to Mrakia niccombsii. Still, it differed by 9 nucleotide substitutions with no gap (1.51%) in the D1/D2 domain of the LSU rRNA gene and 14 nucleotide substitutions with 7 gaps (2.36%) in the ITS region. The strain YP421 T differed from the type strain of the most closely related species, Mrakia aquatica, by 5 nucleotide substitutions with no gap (0.81%) in the D1/D2 domain of the LSU rRNA gene and 9 nucleotide substitutions with one gap (1.43%) in the ITS region. The names Mrakia terrae sp. nov. and Mrakia soli sp. nov. are proposed, with type strains YP416 T (KCTC 27886 T ) and YP421 T (KCTC 27890 T ), respectively. MycoBank numbers of the strains YP416 T and YP421 T are MB 836844 and MB 836847, respectively.

The coexpression of cortical and medullary features in a single adrenal cortical cell has been recognized, leading to terms such as cortico-medullary cells. Here, we reported a case of adrenocortical adenoma consisting of cortico-medullary cells that clinically mimicked pheochromocytoma. A 52-year-old woman was admitted to our hospital complaining of an 8-month history of paroxysmal palpitation with refractory hypertension. A 24-hour urine study revealed increased norepinephrine and metanephrine levels. Computed tomography of the abdomen revealed a 1.0x0.9-cm mass in the left adrenal gland. The patient subsequently underwent unilateral laparoscopic adrenalectomy for a presumptive pheochromocytoma. Light microscopic findings of the left adrenal mass indicated an adrenocortical adenoma, but electron microscopy identified lipid vacuoles and smooth endoplasmic reticulum, along with dense core neurosecretory granules, so-called cortico-medullary cells. This is the first report of the detection of cortico-medullary cells in adrenocortical adenoma presenting as pheochromocytoma in Korea.
Abdomen ; Adrenal Glands ; Adrenalectomy ; Adrenocortical Adenoma ; Endoplasmic Reticulum, Smooth ; Female ; Humans ; Hypertension ; Light ; Metanephrine ; Microscopy, Electron ; Middle Aged ; Norepinephrine ; Pheochromocytoma ; Vacuoles

PURPOSE: Purpose: We compared the outcomes of training between the use of voice-advisory manikin (VAM) and instructor-led (IL) courses with respect to the acquisition of initial cardio-pulmonary resuscitation (CPR) skills, as defined by the 2010 resuscitation guidelines. METHODS: This study was a randomized, controlled, blinded, parallel-group trial. We recruited 82 first-year emergency medical technician students and randomly distributed them into two groups: the IL group (n=41) and the VAM group (n=37). In the IL group, participants were trained in “single-rescuer, adult CPR” in accordance with the American Heart Association's Basic Life Support course for healthcare providers. In the VAM group, all subjects received a 20-minute lesson about CPR. After the lesson, each student trained individually with the VAM for 1 hour, receiving real-time feedback. After the training, all subjects were evaluated as they performed basic CPR (30 compressions, 2 ventilations) for 4 minutes. RESULTS: The proportion of participants with a mean compression depth ≥50 mm was 34.1% in the IL group and 27.0% in the VAM group, and the proportion with a mean compression depth ≥40 mm had increased significantly in both groups compared with ≥50 mm (IL group, 82.9%; VAM group, 86.5%). However, no significant differences were detected between the two groups in this regard. The proportion of ventilations of the appropriate volume was relatively low in both groups (IL group, 26.4%; VAM group, 12.5%; p=0.396). CONCLUSION: Both methods the IL training using a practice-while-watching video and the VAM training facilitated initial CPR skill acquisition, especially in terms of correct chest compression.
Adult ; Cardiopulmonary Resuscitation* ; Emergency Medical Technicians ; Health Personnel ; Heart ; Humans ; Manikins* ; Resuscitation ; Thorax ; Ventilation ; Voice*

PURPOSE: In most areas of the world, transfers between emergency centers are performed through direct communication between physicians of transferring and receiving hospitals. The emergency medical information center "1339" (or 1339, for short), which had mediated inter-hospital transfers for about 10 years, was recently discontinued. This study aimed to survey the stance of physicians at transferring and receiving hospitals on the importance of 1339 functions. METHODS: In May 2012, before the discontinuation of 1339 as a mediator, a questionnaire was distributed to emergency-related physicians at several hospitals on the level of emergency care in Busan. RESULTS: There were 202 answers. Physicians of high level emergency centers had a higher tendency to transfer patients without pre-contact for transfer (p=0.019). The physicians at each level of care thought that direct communication between physicians was more accurate (69.9%), but mediation through 1339 was more convenient (53.6%). Mediation through 1339 was the most frequent resource used for pre-contact of inter-hospital transfers (58.1%). CONCLUSION: Physicians at each level of care tended to find pre-contact between physicians more accurate for inter-hospital transfers; however, they also thought mediation through 1339 was more convenient and it was the most frequently used resource for pre-contact of inter-hospital transfers.
Community Networks ; Emergencies ; Emergency Medical Services ; Hospital Information Systems ; Humans ; Information Centers ; Negotiating ; Surveys and Questionnaires

PURPOSE: This study was conducted to evaluate the correlations among pulmonary contusion severity, trauma score and cardiac troponin I (cTnI) level. METHODS: We prospectively evaluated patients with multiple injuries who had been admitted to the emergency department (ED) from July 2007 to July 2008. We first measured the total creatinine kinase (CK), the MB fraction of CK (CK-MB), TnI, and myoglobin within 2 hours after the injury. We then checked the electrocardiogram, x-ray, and computed tomography (CT) results. Finally, we assessed the injuries as variables and then compared the results for patients with elevated TnI levels (group A) and patients whose TnI levels fell within the normal range (group B). RESULTS: Eighty-six of the 92 patients admitted to the ED were enrolled. The pulmonary contusion score (PCS) was well correlated with PaO2/FiO2. TnI levels were correlated with PCS. When TnI levels were above 0.86 ng/ml, the mortality was estimated with 100% sensitivity and 86.1% specificity. CONCLUSION: Pulmonary contusion severity is correlated with TnI level. When the PCS is high and the cTnI level is elevated in multiple-injury patients, we recommend continuous cardiac monitoring and further evaluation.
Contusions ; Creatinine ; Electrocardiography ; Emergencies ; Humans ; Injury Severity Score ; Multiple Trauma ; Myoglobin ; Phosphotransferases ; Prospective Studies ; Reference Values ; Troponin I

PURPOSE: Near-infrared spectroscopy (NIRS) can noninvasively assess changes in tissue oxygen saturation (StO₂). The primary concern of the current study is to determine whether StO₂ can be used as a surrogate for global oxygenation parameters such as central venous oxygen saturation (ScvO₂), lactic acid, and base deficit (BD) in patients presenting to the emergency department (ED). METHODS: This was a prospective, observational study in patients requiring central venous catheter placement, admitted to the ED with complaints classified as infectious and non-infectious etiology. The NIRS sensor (15 mm probe) was applied on the thenar eminence for at least 3 minutes and ScvO₂, arterial lactic acid, and BD were measured during insertion of a central venous catheter. Data were analyzed using a simple correlation and Bland-Altman plot. RESULTS: A total of 120 patients were enrolled in the study and further classified as an infection (n=39) and a noninfection (n=81) group. Lactic acid BD showed significant correlation with StO₂ in total and in non-infection patients but the degree of correlation was weak and these correlations were not observed in infection patients. Approximately 94% of the difference between StO₂ and ScvO₂ was placed within limit of agreement but there was a risk that StO₂ may overestimate ScvO₂ when ScvO₂ becomes lower. When patients were assigned to two groups according to laboratory results (lactic acid 4.0 mmol/L; BD > 3.0 mmol/L; ScvO₂> 65% or 75%), no significant difference in StO₂ was observed between the two groups. CONCLUSION: In ED patients suspected of having systemic hypoperfusion, StO₂ showed a weak correlation with lactic acid and BD in non-infection patients and no correlation in infection patients. In addition, as ScvO₂ decreased, the difference between StO₂ and ScvO₂ showed a tendency to increase, and StO₂ was much higher than ScvO₂ at low ScvO₂ level. Therefore, before using StO₂ as surrogate for ScvO₂, lactic acid and BD in critically ill patients presenting to the ED, further investigation should be conducted to overcome the limitations of NIRS addressed in this study.
Central Venous Catheters ; Clinical Study* ; Critical Illness ; Emergencies* ; Emergency Service, Hospital ; Humans ; Lactic Acid ; Microcirculation ; Observational Study ; Oxygen* ; Prospective Studies ; Spectroscopy, Near-Infrared