The precise mechanism involved in DIC and delayed traumatic subarachnoid hemorrhage (DT-SAH) remains unclear in multiple-trauma patients. Hereby, we describe a polytraumatized patient with DIC who died due to DT-SAH. A 75-year-old female patient was admitted to our Emergency Department complaining of abdominal pain and drowsiness after a pedestrian accident. Her initial brain computerized tomography (CT) finding was negative for intracranial injury. However, her abdominal CT scan revealed a collection of retroperitoneal hematomas from internal iliac artery bleeding after a compressive pelvic fracture. This event eventually resulted in shock and DIC. An immediate angiographic embolization of the bleeding artery was performed along with transfusion and anti-thrombin III. Her vital signs were stabilized without neurological change. Fourteen hours after admission, she suddenly became comatose, and her follow-up brain CT scan revealed a dense DT-SAH along the basal cisterns with acute hydrocephalus. This event rapidly prompted brain CT angiography and digital subtraction angiography, which both confirmed the absence of any cerebrovascular abnormality. Despite emergency extraventricular drainage to reverse the hydrocephalus, the patient died three days after the trauma. This paper presents an unusual case of DT-SAH in a polytraumatized patient with DIC.
Abdominal Pain ; Aged ; Angiography ; Angiography, Digital Subtraction ; Arteries ; Brain ; Coma ; Dacarbazine ; Disseminated Intravascular Coagulation* ; Drainage ; Emergencies ; Emergency Service, Hospital ; Female ; Follow-Up Studies ; Hematoma ; Hemorrhage ; Humans ; Hydrocephalus ; Iliac Artery ; Multiple Trauma ; Shock ; Sleep Stages ; Subarachnoid Hemorrhage, Traumatic* ; Tomography, X-Ray Computed ; Vital Signs

OBJECTIVE: The aim of this preliminary collaborative study was to assess the clinical characteristics, management, and outcome of epidural hematoma (EDH) based on the data collected and registered in the Korean Trauma Data Bank System (KTDBS). METHODS: Of 2,698 patients registered in the KTDBS between September 2010 and March 2014, 285 patients with EDH were analyzed. Twenty-three trauma centers participated in the study voluntarily to collect data. We subcategorized the patients into two groups with good and poor outcomes. Various clinical characteristics and the time intervals with regard to treatment course were investigated to determine the relationship between these parameters and the functional outcome. RESULTS: Of multiple parameters for this analysis, older age (p=0.0003), higher degree of brain injury (p<0.0001), cases of surgical EDH (p<0.0001), time interval from trauma to hospital before 6 hours, and the decreasing pattern of Glasgow Coma Scale (GCS) between and initial and final GCS were strongly associated with poor outcome. Use of prophylactic anticonvulsant did not affect the functional outcome. There was an interesting difference in the use of mannitol in treating EDH between the urban and rural regions (p<0.0001). CONCLUSION: This is the first multi-center analysis of etiology of injury, pre-hospital care, treatment, and functional outcome of EDH in Korea. The degree of brain injury and the GCS difference were notable factors that were significant in determining the functional outcome of EDH.
Brain Injuries ; Glasgow Coma Scale ; Hematoma* ; Hematoma, Epidural, Cranial ; Humans ; Korea* ; Mannitol ; Republic of Korea ; Trauma Centers

Coronary artery ectasia (CAE) is a rare condition defined as the dilatation of coronary artery to at least 1.5 times larger than the normal adjacent coronary artery. Clinical manifestations of CAE vary, ranging from asymptomatic to ST-segment elevation myocardial infarction (STEMI). Because of its rarity and clinical diversity, the best treatment strategy and prognosis for CAE remain unclear. We describe a case of STEMI caused by intracoronary thrombus formation within an ectatic area in a patient with liver cirrhosis (LC). The patient was successfully managed by thrombus aspiration only, without balloon angioplasty or stent implantation, and maintained by dual antiplatelet therapy with aspirin and ticagrelor, a potent new P2Y12 inhibitor.
Angioplasty, Balloon ; Aspirin ; Coronary Vessels* ; Dilatation ; Dilatation, Pathologic ; Humans ; Liver Cirrhosis* ; Liver* ; Myocardial Infarction* ; Platelet Aggregation Inhibitors ; Prognosis ; Stents ; Thrombosis*

Antigen distributions of rotavirus and adenovirus were detected by enzyme immuno assay (EIA) in patients with acute gastroenteritis in Seoul from 2008 to 2012. Tested feces sample numbers from patients were 9,597. Antigen distributions of rotavirus and adenovirus were 13.9%, and 2.1%, respectively. The patterns of each viral pathogen may give potentially effective data for epidemiological studies.
Adenoviridae* ; Feces ; Gastroenteritis* ; Humans ; Rotavirus* ; Seoul*

Coronary artery ectasia (CAE) is a rare condition defined as the dilatation of coronary artery to at least 1.5 times larger than the normal adjacent coronary artery. Clinical manifestations of CAE vary, ranging from asymptomatic to ST-segment elevation myocardial infarction (STEMI). Because of its rarity and clinical diversity, the best treatment strategy and prognosis for CAE remain unclear. We describe a case of STEMI caused by intracoronary thrombus formation within an ectatic area in a patient with liver cirrhosis (LC). The patient was successfully managed by thrombus aspiration only, without balloon angioplasty or stent implantation, and maintained by dual antiplatelet therapy with aspirin and ticagrelor, a potent new P2Y12 inhibitor.
Angioplasty, Balloon ; Aspirin ; Coronary Vessels ; Dilatation ; Dilatation, Pathologic ; Humans ; Liver Cirrhosis ; Liver ; Myocardial Infarction ; Platelet Aggregation Inhibitors ; Prognosis ; Stents ; Thrombosis

PURPOSE: Simple decompression of the ulnar nerve has outcomes similar to anterior transposition for cubital tunnel syndrome; however, there is no consensus on the proper technique for patients with an unstable ulnar nerve. We hypothesized that 1) simple decompression or anterior ulnar nerve transposition, depending on nerve stability, would be effective for cubital tunnel syndrome and that 2) there would be determining factors of the clinical outcome at two years. MATERIALS AND METHODS: Forty-one patients with cubital tunnel syndrome underwent simple decompression (n=30) or anterior transposition (n=11) according to an assessment of intra-operative ulnar nerve stability. Clinical outcome was assessed using grip and pinch strength, two-point discrimination, the mean of the disabilities of arm, shoulder, and hand (DASH) survey, and the modified Bishop Scale. RESULTS: Preoperatively, two patients were rated as mild, another 20 as moderate, and the remaining 19 as severe according to the Dellon Scale. At 2 years after operation, mean grip/pinch strength increased significantly from 19.4/3.2 kg to 31.1/4.1 kg, respectively. Two-point discrimination improved from 6.0 mm to 3.2 mm. The DASH score improved from 31.0 to 14.5. All but one patient scored good or excellent according to the modified Bishop Scale. Correlations were found between the DASH score at two years and age, pre-operative grip strength, and two-point discrimination. CONCLUSION: An ulnar nerve stability-based approach to surgery selection for cubital tunnel syndrome was effective based on 2-year follow-up data. Older age, worse preoperative grip strength, and worse two-point discrimination were associated with worse outcomes at 2 years.
Adult ; Cubital Tunnel Syndrome/*diagnosis/physiopathology/*surgery ; Decompression, Surgical/*methods ; Female ; Follow-Up Studies ; Hand/surgery ; Hand Strength ; Humans ; Male ; Middle Aged ; Neurosurgical Procedures/*methods ; Prospective Studies ; Recovery of Function ; Surveys and Questionnaires ; Treatment Outcome ; Ulnar Nerve/physiopathology/*surgery ; Young Adult

Owing to the rapid development of intervention techniques and devices, endovascular coil embolization of cerebral arteries has become standardized. It is particularly preferred when a patient presents with an unruptured intracranial aneurysm of the posterior communicating artery (PcomA). However, the risk of thrombogenic complications of the coil migration may also result in a large cerebral infarction. When coil migration occurs during embolization, a procedure for removal of the embolic coil should be performed immediately. We experienced a clinically rare case of migration of a framing coil to the distal middle cerebral artery aneurysm during endovascular embolization of an unruptured PcomA aneurysm. The migrated coil was barely retrieved using snare techniques.
Aneurysm ; Arteries ; Cerebral Arteries ; Cerebral Infarction ; Embolization, Therapeutic ; Humans ; Intracranial Aneurysm ; SNARE Proteins

BACKGROUND: Treatment of diabetic foot infection remains difficult, due partly to defective neutrophil functions. Granulocyte-colony stimulating factor (G-CSF) increases neutrophil counts in peripheral blood and enhances neutrophil functions in healthy peoples and patients with hematologic diseases. We performed this study to evaluate neutrophil functions in diabetic patients with foot infections and the effect of rhG-CSF on neutrophil functions in vitro. METHODS: Twelve patients with diabetic foot infections and 12 normal volunteers were enrolled. Venous blood was collected in heparin-containing tubes, and neutrophils were isolated immediately. The isolated neutrophils were incubated with rhG-CSF (50 ng/mL) for 20 minutes. Assays of superoxide anion production of neutrophils were based on the reduction of ferricytochrome C. Assays of phagocytosis by neutrophils were done using Staphylococcus aureus and the weighted phagocytic index (WPI) was calculated by counting the number of phagocytosing neutrophils on the slides. RESULTS: Superoxide anion production of neutrophils in diabetic patients was 4.7 (unit: nmol/2105cells/30min), which was significantly lower than that of controls (7.6) (P<0.05). rhG-CSF increased the superoxide anion production of neutrophils to 9.8 in diabetic patients and to 15.6 in the controls (P<0.05). WPI in diabetic patients was 0.77, which was not significantly different from that of the controls (0.69). WPI was increased significantly by rhG-CSF in diabetic patients (0.88) and in controls (0.79). CONCLUSION: rhG-CSF enhanced neutrophil functions in vitro, which were evaluated by superoxide anion production and phagocytosis in diabetic patients with foot infections. These results suggest that rhG-CSF can be useful in the treatment of diabetic foot infections.
Cytochromes c ; Diabetic Foot ; Foot* ; Granulocyte Colony-Stimulating Factor ; Healthy Volunteers ; Hematologic Diseases ; Humans* ; Neutrophils* ; Phagocytosis ; Staphylococcus aureus ; Superoxides

The prevalence of human astroviruses was tested in patients with acute gastroenteritis by using conventional duplex reverse transcription (RT)-PCR and electrophoresis. Diarrheal fecal samples were collected from 9,597 patients at local hospitals in Seoul. The prevalence of astroviruses was 1.0% (94/9,597 patients; mostly infants), and that of sapoviruses was 0.1% (14/9,597 patients). Age- and gender-wise analyses were carried out on 29 astrovirus-positive patients having complete information on file regarding their age, gender, and other particulars. The results were higher in patients of ages 0 to 14 yr, and 69.0% of the astrovirus-positive patients were females, of which 69.2% were infants (0 to 12 months), and 61.5% were 1-4 yr old. Notably, in the case of 5 to 78-yr-old acute gastroenteritis patients, 100% were females.
Acute Disease ; Adolescent ; Adult ; Age Factors ; Aged ; Astroviridae Infections/complications/*epidemiology/virology ; Child ; Child, Preschool ; DNA, Viral/analysis ; Feces/virology ; Female ; Gastroenteritis/complications/*diagnosis ; Humans ; Infant ; Male ; Mamastrovirus/genetics/*isolation & purification ; Middle Aged ; Prevalence ; Reverse Transcriptase Polymerase Chain Reaction ; Sapovirus/genetics/isolation & purification ; Sex Factors ; Young Adult

BACKGROUND: Viruses that cause acute respiratory infection include adenovirus (ADV), respiratory syncytial virus A and B (RSV(A), RSV(B)), influenza virus A and B (FluA, FluB), parainfluenza virus 1, 2 and 3 (PIV1, PIV2, PIV3), human metapneumovirus (hMPV), human coronavirus (hCoV), human rhinovirus (hRV), and enterovirus, among others. METHODS: Viral incidence was evaluated in acute respiratory patients in Seoul, Korea from 2010 to 2012. A total of 2,544 oropharyngeal swab specimens were tested by real-time polymerase chain reaction (PCR) methods. RNA viruses (hRV, PIV, RSV, hCoV, and hMPV) and DNA viruses (ADV and bocavirus) were detected using the one-step reverse transcriptase PCR (RT-PCR) premix kit (SolGent, Korea) from January 2010 to June 2011, and using the real-time PCR kit (Kogenebiotech, Korea) from July 2011 to December 2012. RESULTS: Thirty-two percent (813/2,544) of specimens were positive; 31.9% (294/923) in 2010, 31.4% (232/738) in 2011, and 32.5% (287/883) in 2012. The most frequently isolated virus was hRV (40.7%, 331/813), followed by ADV (23.9%, 194/813), RSV (14.1%, 115/813), PIV (12.3%, 100/813), and hCoV (8.7%, 71/813). PIV1 was the most commonly isolated PIV, followed by PIV3 and PIV2, respectively. hCo OC43 was the most commonly isolated hCoV, followed by hCoV NL63 and hCoV 229E, respectively. CONCLUSION: Information on respiratory viruses circulating in Seoul, Korea over the last three years will be helpful in the management of acute respiratory infections, and for larger-scale epidemiological studies.