BACKGROUND: Increased frequency of comminuted clavicle mid-shaft fractures and importance of functional satisfaction through early joint exercise has resulted in higher emphasis on surgical treatments. This study aimed to evaluate the clinical radiological results of treatment of clavicle mid-shaft fractures by open reduction and internal fixation using a plate with a small incision. METHODS: The subjects of this study were 80 clavicle mid-shaft fracture cases treated with internal fixation using a plate from October 2010 to July 2014. Clavicle mid-shaft fractures were internally fixated using anatomical plates or locking compression plates. Achievement of bone union, union period, and clavicle length shortening were evaluated radiologically, and clinical assessment was done by using Constant and University of California at Los Angeles (UCLA) scores. RESULTS: All 80 cases were confirmed to have achieved bone union through radiographs with an average union period of 10.9 weeks (range: 7–18 weeks). The average clavicle length of shortening in the affected side was 1.8 mm (range: 0–17 mm). The average UCLA score and Constant score were 33.6 (range: 25–35) and 92.5 (range: 65–100), respectively. Regarding complications, four cases reported skin irritation by metal plates, and one case reported a screw insertion site fracture due to minor trauma history. CONCLUSIONS: We were able to induce successful bone union and obtain clinically satisfactory results in displaced mid-shaft fractures of the clavicle without major complications such as nonunion through treatment of internal fixation using a plate.
California ; Clavicle* ; Joints ; Skin

OBJECTIVE: To evaluate the relationship between serum gonadotropin level and parameters related to insulin resistance in Korean women with polycystic ovary syndrome (PCOS). METHODS: This retrospective study included 138 women aged 18 to 35 years who were newly diagnosed with PCOS according to the Rotterdam consensus. Participants were divided into three groups based on the serum luteinizing hormone to follicle-stimulating hormone (LH/FSH) ratio in the early follicular phase: group 1 (LH/FSH <1), group 2 (1.0≤ LH/FSH >2.0), and group 3 (LH/FSH ≥2.0). The correlations between the LH/FSH ratio and various metabolic parameters were evaluated using Pearson correlation coefficients. RESULTS: Patients with higher LH/FSH ratios showed higher total antral follicle counts and higher total ovarian volume. In the comparison of anthropometric and biochemical parameters among the three groups, the waist to hip ratio was the only parameter that differed significantly among the groups (P=0.003). Correlation analysis revealed no significant correlations between serum LH/FSH ratios and biochemical parameters related to insulin resistance. However, after adjustments for age and body mass index, a significant correlation between total cholesterol level and serum LH/FSH ratio was observed (r=0.221, P=0.018). CONCLUSION: Most parameters related to insulin resistance, with the exception of total cholesterol level, are unrelated to the inappropriate pattern of serum gonadotropin secretion in Korean women with PCOS.
Body Mass Index ; Cholesterol ; Consensus ; Female ; Follicle Stimulating Hormone ; Follicular Phase ; Gonadotropins* ; Humans ; Insulin Resistance ; Insulin* ; Luteinizing Hormone ; Polycystic Ovary Syndrome* ; Retrospective Studies ; Waist-Hip Ratio

Contraceptives, Oral, Combined ; Female ; Humans ; Polycystic Ovary Syndrome ; Retrospective Studies ; Ultrasonography

Purpose: This study sought to compare the characteristics of patients with pathogen-positive and negative cultures, and to investigate factors predicting pathogen-positive culture results in patients of acute poisoning with suspected aspiration. Methods: Consecutive patients with acute poisoning admitted to an intensive care unit between January 2016 and December 2018 were retrospectively studied. Respiratory specimens were collected from the enrolled patients at the time of the suspected aspiration. We compared the characteristics of patients with pathogen-positive and negative culture results and analyzed the causative pathogens. Results: Among the 526 patients, 325 showed no clinical features that could be attributed to aspiration, and 201 patients had clinical features suggestive of aspiration. Of these, 113 patients had pathogen-positive culture, 61 were negative, and the specimens of 27 patients contained poor-quality sputum. In univariate analysis, patients with a positive culture showed a longer time to culture from ingestion (p=0.01), faster heart rate (p=0.01), and higher partial pressure of arterial oxygen to the fraction of inspired oxygen (PaO2/FiO2) (p=0.02) than patients with negative culture. Multivariate analysis demonstrated that PaO2/FiO2 (adjusted odd ratio, 1.005; 95% confidence interval [CI], 1.002-1.008; p=0.005) was a significant risk factor for pathogen-positive culture. The area under the receiver operating characteristic curve of PaO2/FiO2 was 0.591 (95% CI, 0.510-0.669, p=0.05). Gram-negative pathogens (GNPs) were predominant and at least one GNP was observed in 84 (73.3%) patients among those with pathogen positive culture. Conclusion We failed to find any clinical factors associated with positive culture results. Antibiotics that cover GNPs could be considered when deciding the initial antibiotic regimen at the time of suspected aspiration.

No abstract available.
Bacteremia* ; Female ; Humans ; Pregnant Women*

Objective: Many trauma centers use their own criteria for major trauma patients, and these criteria are organized according to physiological causes and their related mechanisms. Mechanism related criteria have high sensitivity but low specificity. We confirmed 20 feet as a single factor for trauma team activation criteria. Methods: This study was retrospectively conducted in the Pusan National University Hospital trauma center, which is a level 1 trauma center in Busan. Patients were grouped as group 1, a fall from less than 20 feet; and group 2, a fall from more than 20 feet. We compare the two groups of prognostic factors using logistic regression analysis. Results: The relationship between the height of the fall and the patient’s prognosis showed a positive relationship on the logistic regression analysis. Yet the cut-off value of a 20 foot height showed poor predictive power for the patient’s prognosis. Conclusion In conclusion, as trauma team activation criteria, a 20 foot height seems to be a reasonable aspect of patients’ clinical prognosis between above 20 feet and below 20 feet. Yet it seems to be controversial as a cut-off value. Thus, more studies will be needed to identify a specific height for trauma team activation.

Objective: Previous studies focused primarily on drivers or front-seat passengers in motor vehicle accidents. Recent research has shown improvements in front-seat occupant protection. This study examined the risk factors contributing to severe injury in rear-seat occupants. Methods: This study was conducted retrospectively. The variables related to the crash data were acquired from the Emergency Department-based Injury In-depth Surveillance registry and electronic medical record of the authors’hospital between 2019 and 2020. Multivariate logistic regression analysis was used to identify the risk factors contributing to severe injury in rear-seat occupant. Results: One hundred and forty rear-seat occupants were analyzed. The occupants were categorized by the abbreviated injury scale into severe (n=39; 27.9%) and non-severe injury (n=101; 72.1%). The collision with a large-size vehicle (odds ratio [OR], 4.278; 95% confidence interval [CI], 1.617-18.000; P=0.015) and fixed objects (OR, 3.459; 95% CI, 1.347-8.883; P=0.049) was independently associated severe injury. Seatbelt use was also an independent risk factor of severe injury (OR, 2.649; 95% CI, 1.178-5.940; P=0.018). Common severe injuries encountered in rear seats were chest (12.1%), spine (9.3%), and abdomen (5.7%). Conclusion In contrast to the fact that seat belt use reduces the severity of injuries, seatbelt use was associated with severe injury in this study. Further research will be needed to assess the effects of seatbelt use. In addition, awareness should be raised about the relationship between the accident mechanism, seatbelt use, and the commonly injured body region.

PURPOSE: Despite significant concern on elevating the rate of return of spontaneous circulation (ROSC) of prehospital cardiac arrest patients, the rate in Korea is still low compared to other advanced countries. The purpose of this study is to investigate prehospital factors that can influence the use of an automated external defibrillator (AED). METHODS: We retrospectively analyzed 94 non-cardiogenic prehospital cardiac arrest patients who arrived at one hospital from June 20, 2010 to August 10, 2012. RESULTS: AED was attached to 37(39.4%) patients. Age (p=0.024), witnessed arrest (p=0.023), rate of AED attachment (p<0.001), and time interval call to emergency medical service (EMS) arrival at a scene (p=0.004) influenced the detection of ventricular tachycardia (VT) or ventricular fibrillation (VF). Bystander cardiopulmonary resuscitation (CPR) was performed in 6.4% of total patients. We assumed that assessment of patients' status, including age and underlying disease, might influence the decision of AED attachment. CONCLUSION: In cardiac arrest patients, early CPR and rapid defibrillation should be performed. Results of our study showed a low bystander CPR rate and low AED attachment rate. Further investigations should be conducted in order to find determine the factors that affect decisions of EMS personnel regarding attachment of AED.
Cardiopulmonary Resuscitation ; Defibrillators* ; Emergency Medical Services ; Heart Arrest* ; Humans ; Korea ; Retrospective Studies ; Tachycardia, Ventricular ; Ventricular Fibrillation

PURPOSE: Despite significant concern on elevating the rate of return of spontaneous circulation (ROSC) of prehospital cardiac arrest patients, the rate in Korea is still low compared to other advanced countries. The purpose of this study is to investigate prehospital factors that can influence the use of an automated external defibrillator (AED). METHODS: We retrospectively analyzed 94 non-cardiogenic prehospital cardiac arrest patients who arrived at one hospital from June 20, 2010 to August 10, 2012. RESULTS: AED was attached to 37(39.4%) patients. Age (p=0.024), witnessed arrest (p=0.023), rate of AED attachment (p<0.001), and time interval call to emergency medical service (EMS) arrival at a scene (p=0.004) influenced the detection of ventricular tachycardia (VT) or ventricular fibrillation (VF). Bystander cardiopulmonary resuscitation (CPR) was performed in 6.4% of total patients. We assumed that assessment of patients' status, including age and underlying disease, might influence the decision of AED attachment. CONCLUSION: In cardiac arrest patients, early CPR and rapid defibrillation should be performed. Results of our study showed a low bystander CPR rate and low AED attachment rate. Further investigations should be conducted in order to find determine the factors that affect decisions of EMS personnel regarding attachment of AED.
Cardiopulmonary Resuscitation ; Defibrillators* ; Emergency Medical Services ; Heart Arrest* ; Humans ; Korea ; Retrospective Studies ; Tachycardia, Ventricular ; Ventricular Fibrillation

PURPOSE: The Ministry of Health and Welfare recently designated 35 major trauma-specified centers (MTSC). The purpose of this study is to determine changes in patient flow and designated hospitals, and to describe the role of the emergency medical information center (EMIC) in a regional trauma care system. METHODS: Data of trauma patient inter-facility transfer arrangement by one EMIC were reviewed for 2 months before and after the designation of MTSC. The data included success or failure rates of the arrangement, time used for arrangement, and inquiring and accepting facility. RESULTS: At pre- and post-designation study period, there were 540 and 433 trauma patient inter-facility transfers arranged by EMIC, respectively. The median time used for arrangement decreased from 9.3 to 7.7 minutes (P = 0.007). Arrangement failure rate was 3.5% and 2.5%, respectively, with no significant interval change (P = 0.377). The percentage of inquiring MTSC decreased from 49.1 to 36.9% (P < 0.001). The percentage of accepting MTSC increased from 20.2 to 37.4% (P < 0.001). CONCLUSION: With the designation of MTSC, EMIC could arrange inter-facility transfers more quickly. The hospitals wanted more trauma patients after the designation. There would be a concentration of trauma patients to MTSCs in our region. Further studies are needed for scientific evidence on patient outcome.
Emergencies ; Emergency Service, Hospital ; Humans ; Information Centers ; Information Services ; Referral and Consultation ; Trauma Centers