Hernias through the broad ligament are rare with a reported incidence of only 4-7% of cases of internal hernias. Here, we report on a rare case of incarcerated internal hernia through a spontaneous defect in the broad ligament which was repaired using a laparoscopic technique. A 41-year-old female was admitted with colic abdominal pain. Laparoscopic exploration was performed for the diagnosis of intestinal obstruction. Laparoscopic examination confirmed an approximately 10-cm-long ileal loop herniated in the anterior to posterior direction through a left broad ligament defect. A large defect in the broad ligament was closed by an intracorporeal continuous running suture. The patient was highly satisfied with the cosmetic result. In conclusion, laparoscopy could be particularly helpful during pelvic surgery, which usually requires large skin incisions to ensure a good field of view. This approach was cosmetically effective, decreased the postoperative complications, and promoted early recovery to usual activity.
Abdominal Pain ; Adult ; Broad Ligament* ; Colic ; Diagnosis ; Female ; Hernia* ; Humans ; Incidence ; Intestinal Obstruction ; Laparoscopy* ; Postoperative Complications ; Running ; Skin ; Sutures

A recent widespread concept is that ultrasound-guided central venous catheter insertion is a mandatory method. Some techniques have been introduced for ultrasound-guided central venous catheterization. Among them, short-axis lateral in-plane technique is considered to be the most useful technique for internal jugular vein access. Therefore, we used this technique for the insertion of a large-bore cuffed tunneled dual-lumen catheter for hemodialysis. Additionally, a lesser number of catheter angulations may lead to good flow rates and catheter function; we recommend that skin puncture site in the neck at the posterior triangle is better than the Sedillot's triangle. Using this approach, we can reduce the possible complications of pinching and kinking of the catheter.
Catheterization, Central Venous ; Catheters* ; Central Venous Catheters ; Jugular Veins* ; Neck ; Punctures ; Renal Dialysis* ; Skin ; Ultrasonography

OBJECTIVE: A tablet device has several medical applications because it's portability. Most importantly, its powerful graphics and touch-based features have several benefits in the surgical field, especially for generating three-dimensional (3D) images based on patients' computed tomography (CT) scans. METHODS: In this study, 3D objects were manipulated by an operator on an iPad during several laparoscopic surgeries of intra-abdominal organs. Before surgery, 3D structures, such as vessels, soft tissues, and bones, were reconstructed by the surgeon using the patients' CT scans on the patients' bed-side personal computer. RESULTS: In this study, 3D image-guided surgeries were performed using an iPad in five patients. The benefits of this technique were recorded and analyzed in detail by the surgeon. CONCLUSION: Although in a pilot phase with unresolved issues, direct intra-operative handling of a patient-tailored 3D model developed using a tablet device could be useful compared with conventional two-dimensional imaging.
Humans ; Laparoscopy ; Microcomputers ; Surgery, Computer-Assisted* ; Tomography, X-Ray Computed

The primary site for a hemodialysis catheter insertion is the right internal jugular vein (IJV) followed by the left IJV and subclavian vein. In cases when veins of the upper extremities are exhausted, femoral veins are an alternative insertion location. Femoral catheter insertions should only be used for short periods because of the increased risk of infection. There is a percutaneous technique to recanalize occluded central veins for hemodialysis catheter insertion. We experienced success with a cut-down method for permcath through a completely occluded IJV. We, therefore, find surgical recanalization to be better than percutaneous method in terms of cost and safety.
Catheters ; Femoral Vein ; Humans ; Jugular Veins ; Methods ; Renal Dialysis ; Subclavian Vein ; Upper Extremity ; Veins

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Background: According to the recent coronavirus disease 2019 (COVID-19) pandemic experience, many emergency departments experience difficulties in responding to emerging infectious diseases and this has led to a public health crisis. Our emergency department (ED) is designed to respond to mass outbreaks of infection. Three major preparations were taken to respond to infectious disease; first, to improve the emergency department facilities;second, to created programs to respond to each phase of an epidemic of COVID-19; lastly, to implemented education and training to promote the safety of medical staff. We would like to share the actual responses and statistics of patients visiting emergency department during COVID-19 periods of pandemic. Materials and Methods: This research was conducted through a retrospective chart analysis provided by a public medical center with 502 beds since the first report of a COVID-19 confirmed case on January 19, 2020 to June 15, 2020 in Seoul, the capital of Korea. Our emergency department was designed based on Korean Regional Emergency Center Facility Standards, and modified throughout each phases of COVID-19 outbreak. Patients suspected to be infectious are screened in the triage, separating them from general patients, and then receive isolation treatment in isolated wards. Results: A total of 4,352 patients visited the ED. 3,202 screenings were conducted with 5 confirmed cases. Another 1,150 patients were treated with general emergent symptoms.There were no problems such as closure of the emergency department or isolation of medical staff while managing COVID-19 confirmed patients. Conclusion Improving emergency department facilities, create an operational program to respond to each phase of COVID-19 outbreak and implement educational programs enabled large number of screening tests and hospitalization for COVID-19 suspected patients while maintaining general medical services. Research in emergency department designs and operational programs should increase to combine research data with better ideas to respond not only during regular periods but also during periods of pandemic.

Background: According to the recent coronavirus disease 2019 (COVID-19) pandemic experience, many emergency departments experience difficulties in responding to emerging infectious diseases and this has led to a public health crisis. Our emergency department (ED) is designed to respond to mass outbreaks of infection. Three major preparations were taken to respond to infectious disease; first, to improve the emergency department facilities;second, to created programs to respond to each phase of an epidemic of COVID-19; lastly, to implemented education and training to promote the safety of medical staff. We would like to share the actual responses and statistics of patients visiting emergency department during COVID-19 periods of pandemic. Materials and Methods: This research was conducted through a retrospective chart analysis provided by a public medical center with 502 beds since the first report of a COVID-19 confirmed case on January 19, 2020 to June 15, 2020 in Seoul, the capital of Korea. Our emergency department was designed based on Korean Regional Emergency Center Facility Standards, and modified throughout each phases of COVID-19 outbreak. Patients suspected to be infectious are screened in the triage, separating them from general patients, and then receive isolation treatment in isolated wards. Results: A total of 4,352 patients visited the ED. 3,202 screenings were conducted with 5 confirmed cases. Another 1,150 patients were treated with general emergent symptoms.There were no problems such as closure of the emergency department or isolation of medical staff while managing COVID-19 confirmed patients. Conclusion Improving emergency department facilities, create an operational program to respond to each phase of COVID-19 outbreak and implement educational programs enabled large number of screening tests and hospitalization for COVID-19 suspected patients while maintaining general medical services. Research in emergency department designs and operational programs should increase to combine research data with better ideas to respond not only during regular periods but also during periods of pandemic.

PURPOSE: This study aims to review the appropriateness of the issued death certificates and autopsy reports and to evaluate the improvement points of these documents in accordance with the guidelines of the Korean Medical Association and the National Statistical Office. Moreover, this study also examines why the guideline is necessary for the credibility of these documents. METHODS: The death certificates and autopsy reports written by a training hospital were analyzed for a 12-month period, between December 2014 and November 2015. The reference to analysis was the “guidelines to medical certificate 2015” written by the Korean Medical Association, “World Health Organization (WHO) death certificate principle”, and “guideline leaflet,” as provided by the National Statistical Office. Two researchers analyzed the documents that were against the guidelines, and suggested improvement points. The analyzed variables were age, sex, issued date, direct cause of death, manner of death, location of death, and types of accident. The primary goal was to see the rate of issued documents written correctly according to the guidelines and to suggest possible improvement points. The secondary goal was to analyze the reason for accordance and discordance between researchers. RESULTS: There were a total of 603 death certificates and autopsy reports issued during the research period; 562 (93.2%) and 41 (6.8%) cases, respectively. As for the manner of death, 521 cases were “death from disease,” 64 were “external causes,” and 18 were “others or unknown” (86.4%, 10.6%, and 3.0%, respectively). As for the issued department, internal medicine and emergency medicine issued 301 (49.9%) and 126 (20.9%) documents, respectively. Of these, 139 (23.1%) cases were regarded to be in accordance with the guidelines, while 304 (50.4%) were considered to be discordant cases. Among the discordant cases, there were 177 (29.4%) cases that were the mode of death directly written to cause of death. As for the records of “period of occurrence to death” were recorded only 70 (11.7%) cases (including “unknown” 65 cases) and the others were blank. The Kappa number of analysis regarding the evaluation correspondence of the two researchers was 0.44 (95% confidence interval, 0.38 to 0.51). CONCLUSION: The most frequent error was ‘the condition of death to direct cause of death’ with the ratio of 29.4%. This may have been because the rate of concordance between the researchers based on the guidelines was not high enough. There is a need to provide specific guidelines for each case, and also promote and educate regarding significant errors.
Autopsy ; Cause of Death ; Death Certificates* ; Emergency Medicine ; Internal Medicine ; Medical Errors ; Observational Study*

PURPOSE: Abdominal computed tomography (CT) is a widely recognized method to diagnose patients with acute abdominal pain in the emergency departments (EDs). We aimed to investigate the current state and interpretations of abdominal CT performed in the ED of a tertiary university hospital. METHODS: This was a retrospective study based on an abdominal CT database and medical records of patients over 15 years of age, who had visited our ED between January 1 and December 31, 2013. The data collected included CT types, final interpretations, characteristics of the patients, and location of pain at the time of CT. RESULTS: A total of 1,978 abdominal CTs were performed among 1,923 patients during the research period. The most frequent organs involved in the major diagnosis were those in the urinary system, followed by the appendix, liver, large intestine, and gallbladder. The most frequently interpreted diagnoses in these organs were in the order of urinary stone, appendicitis, liver cirrhosis, infectious colitis, and acute cholecystitis. The most frequent location of pain was the right lower quadrant (429 cases, 21.7%), and the most frequently performed CT types were contrast-enhanced abdominal and pelvic CT (1,260 cases, 63.7%). CONCLUSION: Various interpretations were derived based on the abdominal CTs, ranging from critical to mild diseases and from common to rare diseases. Based on this study, we have developed a preliminary interpretation checklist for abdominal CTs.
Abdominal Pain ; Appendicitis ; Appendix ; Checklist* ; Cholecystitis, Acute ; Colitis ; Diagnosis ; Emergencies* ; Emergency Service, Hospital* ; Gallbladder ; Humans ; Intestine, Large ; Liver ; Liver Cirrhosis ; Medical Records ; Methods ; Rare Diseases ; Retrospective Studies ; Tomography, X-Ray Computed ; Urinary Calculi

Objective: The Surviving Sepsis Campaign (SSC) guidelines have been associated with reduced mortality in sepsis patients. On the other hand, previous studies were performed using the Sepsis-2 definitions and past guidelines. This study assessed the association between compliance with the 2016 SSC guidelines and the outcomes of patients with sepsis and septic shock in accordance with the latest Sepsis-3 definitions. Methods: Three hundred and fifteen patients with sepsis and septic shock were enrolled in this study. The patients were stratified according to their compliance with the SSC guidelines bundle. The characteristics and outcomes of the compliance and non-compliance groups were compared. In the overall patients, the risk factors for all-cause mortality were assessed using Cox proportional hazards models. Results: Among the patients, 172 and 143 patients were in the compliance group and non-compliance group, respectively. The baseline characteristics and disease severity were similar in the two groups. The all-cause mortality rates were 27.3% and 38.5% in the compliance group and non-compliance group, respectively (P=0.035). The all-cause mortality was significantly lower in the compliance group than in the non-compliance group (log-rank test, P=0.025). The risk factors for the all-cause mortality were age (adjusted hazard ratio [aHR], 1.025; 95% confidence interval [CI], 1.008-1.042; P=0.004), septic shock (aHR, 3.14; 95% CI, 1.98-4.98; P<0.001), and lactate levels (aHR, 1.08; 95% CI, 1.03-1.14; P=0.002). The overall compliance with the guidelines protected against all-cause mortality (aHR, 0.66; 95% CI, 0.45-0.98; P=0.040). Conclusion Compliance with the SSC guidelines bundle was associated with a lower all-cause mortality among patients with sepsis and septic shock