No abstract available.
Thromboangiitis Obliterans

Neonatal tension pneumothorax is life-threatening. A tension pneumothorax on the right side was detected on a newborn boy weighing 2,380 g, who was born at 35 weeks of gestation. Given the unavailability of an on-duty thoracic surgeon and appropriately sized chest tubes in the neonatal intensive care unit, an emergency physician performed closed thoracostomy using two 7-French latex catheters. Immediately after the re-expansion of the right lung, left tension pneumothorax was newly detected. Two more 7-French latex catheters were inserted, relieving the left lesion. We consider that the right pneumothorax occurred due to the mixture of spontaneous rupture of the subpleural blebs and barotrauma during the initial positive pressure ventilation, while the left lesion did due to the high-flow oscillatory ventilation. Despite the limited availability of devices in the present case, a favorable outcome was achieved by the use of alternative catheters, which were chosen by the emergency physician.

Although percutaneous abscess drainage has become and accepted alternative from of therapy for selected patients with abscess, it is well known that there are several factors in the failure of adequate drainage such as pre-and post- procedural management, technique itself, various features of abscess, and selection and application of catheters. Among these factors, we made an experiment about drain efficacy of commonly used various catheters with different viscosities of water-glycerin solution under the two different pressure gradients. The experimental values of flow rate were lower than than the calculated values. An efficacy of experimental value was 4-14%. Because the inner diameter of fittings and stopcocks was usually smaller than the inner diameter of catheters, these factors also affected the drain efficacy. Finally, we though that it will be very helpful to the treatment of patients as well as to study about the catheter drainage, if the drain efficacy of individual catheters has been notified.
Abscess ; Catheters* ; Drainage ; Humans ; Viscosity

Authors studied the regulatory mechanism of protein kinase C on the action of acetylcholine in rabbit carotid artery. The arterial rings were myographied isometrically in an isolated organ bath. In this study, acetylcholine relaxed phenylephrine-induced contraction of rabbit carotid artery in the presence of endothelium. In the pretreatment of methylene blue or nitro-L-arginine, the action of acetylchioline was reduced. Pretreatment of phorbol 12-myristate 13-acetate(PMA) attenuated the action of acetylcholine, but PMA did not attenuated it in the presence of staurosporine, suggesting that protein kinase C suppressed the action of acetylcholine. The potency of phorbol ester on the action of acetylcholine was PMA>phorbol 12, 13-dibutyrate(PDBu)>phorbol 12,13-diacetate(PDA), but the direct effect of phorbol on the contraction of arterial rings was PDBu>PMA>PDA. This implied that protein kinase C involved in the contraction of smooth muscle and the attenuation of the action of acetylcholine were different. PMA did not affect on A23187- and sodium nitroprusside-induced vasorelaxation. Acetylcholine increased tissue cGMP contents, which was reduced by PMA. These results suggest that in rabbit carotid artery protein kinase C reduce acetylcholine-stimuated endothelium derived relaxing factor(EDRF) release by affecting membrane receptor, and do not affect on the function of EDRF and cGMP production in the smooth muscle.
Acetylcholine* ; Baths ; Carotid Arteries* ; Endothelium ; Membranes ; Methylene Blue ; Muscle, Smooth ; Protein Kinase C ; Sodium ; Staurosporine ; Vasodilation

PURPOSE: This study provided a sample of self-reported turnover rates and their causes for emergency medicine physicians. METHODS: A questionnaire was distributed to 47 emergency physicians practicing in private clinics via post or e-mail. Self-reported demographic data, workload, causes of turnover, psychosocial and job related stress were collected. 27 emergency physicians participated in this study by completing and returning the questionnaire. RESULTS: Turnover rate for emergency physician was 14.3%. The mean age of the participants was 45.19+/-3.43, and 25 of the 27 participants were male. The length of time working in a private clinic was 7.14+/-4.02 years. Years since acquisition of emergency board certification was 3.38+/-2.97 years. Work hours per week were 52.70+/-8.99. Income satisfaction and personal well-being were higher than compared to their time practicing medicine as emergency physicians. The average scores for APGAR and psychosocial stress were 5.63+/-2.71 and 2.19+/-0.85, respectively. Reported causes of turnover in emergency clinical practice included negative impacts to quality of life, impact of aging, negative effects of shift work, negative "fishbowl" work environment, etc. CONCLUSION: The causes of turnover for emergency physicians include concerns regarding health impacts due to shift work, negative impact on quality of life, and concerns related to job security. In order to decrease emergency physician turnover rates, administrative considerations should be put in place to include a decrease in night shift hours per physician, and frequency for senior emergency physician is most important. Investigation into causes of turnover for physicians should not be limited to private clinic operations but should also include administration, research, teaching, and other duties.
Aging ; Certification ; Electronic Mail ; Emergencies ; Emergency Medicine ; Humans ; Hypogonadism ; Male ; Mitochondrial Diseases ; Ophthalmoplegia ; Quality of Life ; Surveys and Questionnaires

We correct the revised date of this article.

Authors analyzed the findings of findings of chest radiographs and high-resolution CT(HRCT) of chronic mercury vapor poisoning in 12 patients who were diagnosed by previous working history for mercury-thermometer and high level of mercury in blood and urine. The purpose of this paper is to introduce the HRCT findings of chronic mercury vapor poisoning. Duration of mercury exposure was ranged from 10 to 41 months(mean, 21.8 months). Estimated value of serum mercury was ranged from 3.6 to 8.7µg/dl(mean, 5.3 µg/dl: normal value is less than 0.5µg/dl). Estimated value of mercury in urine was ranged from 104 to 482µg/1(mean, 291.4µg/1: normal value is less than 20µg/1). Chest radiographs showed positive findings such as ground-glass opacities and peribronchial cuffings in only 2 out of 12 patients, but HRCT showed positive findings such as ground-glass opacities in 8 patients, peribronchial cuffings in 7 patients, centrilobular abnormalities in 5 patients, interface sign in 4 patients, interlobular septal thickening with intralobular lines in 2 patients and lobular consolidation in one patient. In conclusion, chest HRCT is superior to chest radiograph to show the pulmonary manifestation of chronic mercury vapor poisoning. In patients with chronic mercury vapor poisoning, HRCT findings of centrilobular distributed ground-glass opacities and peribronchial cuffinges are characteristic.
Humans ; Lung* ; Poisoning* ; Radiography, Thoracic ; Reference Values ; Thorax

A large tumor located at right temporoparietal lobe was found in 25-years-old female. The brain CT scan and MR imaging revealed a large multi-lobulated mass which was composed of solid and cystic portions involving right temporoparietal lobe. Preoperative routine laboratory check showed microcytic hypochromic anemia and monoclonal gammopathy with bate-gamma bridging. The mass was removed totally by operation and histologic diagnosis resulted in chordoid meningioma surrounded by massive polyclonal lymphoplasmacellular infiltrates. After the mass was removed, the blood picture of the patient normalized and the patient discharged with neurologically free stage. We report this case with relative literatures.
Anemia, Hypochromic ; Brain ; Diagnosis ; Female ; Humans ; Magnetic Resonance Imaging ; Meningioma* ; Paraproteinemias ; Tomography, X-Ray Computed

PURPOSE: Acute kidney injury (AKI) is a common, serious complication in rhabdomyolysis patients. Early recognition and adequate therapy in rhabdomyolysis-related AKI are essential to reducing mortality. However, existing biomarkers, such as plasma creatinine, have several limitations for early detection of AKI. Novel parameters have recently been studied for greater reliability in prediction and staging of AKI in critically ill patients in the emergency department. The aim of this study is to evaluate the role of certain parameters for early prediction and staging of AKI in adults with acute non-traumatic rhabdomyolysis. METHODS: Eighty eight patients with adult non-traumatic rhabdomyolysis, who were admitted to the emergency intensive care unit (ICU) from Dec 2013 to Nov 2014, were enrolled in this observational cohort study. AKI was defined according to the Acute Kidney Injury Network (AKIN) criteria. Diagnostic characteristics of initial laboratory parameters were analyzed using the area under the receiver operating characteristic (ROC) curve. RESULTS: Of the 88 patients, 60 patients (68.2%) developed AKI during the ICU stay. The ROC curve for plasma neutrophil gelatinase-associated lipocalin (NGAL) showed the highest sensitivity (81.7%) and specificity (78.6%) among initial parameters. In pairwise comparison, the areas under the curve (AUCs) for plasma NGAL and serum creatinine were 0.868 (95% confidence interval [CI]: 0.779-0.931) and 0.765 (95% CI: 0.662-0.849), respectively. A statistically significant difference was observed in both (p=0.047). Plasma NGAL levels increased significantly as the stage of AKI progressed, using AKIN criteria (p<0.001). CONCLUSION: Plasma NGAL can be a reliable parameter for early prediction and approximate staging of AKI in adult non-traumatic rhabdomyolysis in the emergency department.
Acute Kidney Injury* ; Adult ; Biomarkers ; Cohort Studies ; Creatinine ; Critical Illness ; Diagnosis ; Emergencies* ; Emergency Service, Hospital* ; Humans ; Intensive Care Units ; Lipocalins ; Mortality ; Neutrophils ; Plasma ; Rhabdomyolysis* ; ROC Curve ; Sensitivity and Specificity

Carbon monoxide (CO) poisoning has increased rapidly in South Korea and may cause a variety of clinical effects. The most common complications are neurologic and neuropsychological disturbances. However, in rare cases, CO poisoning may also be associated with acute kidney injury and non-traumatic rhabdomyolysis. Here, we report a case of acute kidney injury and rhabdomyolysis complicating CO poisoning. A 32-year-old woman was admitted to our emergency department with dyspnea and confused consciousness after exposure to CO during a suicide attempt involving charcoal briquettes. Laboratory findings revealed a carboxyhemoglobin (COHb) level of 44.8%, a blood urea nitrogen level of 20.5 mg/dL, a serum creatinine level of 1.4 mg/dL, and a creatine phosphokinase level of 8,688.3 IU/L. Acute kidney injury and rhabdomyolysis complicating CO poisoning were diagnosed. This case was managed with normobaric oxygen therapy and hydration. The patient recovered completely with respect to renal function and muscle enzyme level, and COHb level returned to 0%.
Acute Kidney Injury* ; Adult ; Blood Urea Nitrogen ; Carbon Monoxide Poisoning* ; Carbon Monoxide* ; Carbon* ; Carboxyhemoglobin ; Charcoal ; Consciousness ; Creatine Kinase ; Creatinine ; Dyspnea ; Emergency Service, Hospital ; Female ; Humans ; Korea ; Oxygen ; Poisoning ; Rhabdomyolysis* ; Suicide