Typhlitis or neutropenic enterocolitis is a life-threatening, necrotizing process of the cecum whose incidence is increasing. Typhlitis presents as fever, abdominal pain, and diarrhea in neutropenic patients. As the incidence of typhlitis increases, emergency physicians must be aware of this rapidly progressive and potentially fatal disease. The definitive management of typhlitis is controversial. The most prudent course for the emergency physician is to initiate aggressive medical management early in the ED. We describe a 25-year-old man with severe neutropenia presented to the emergency department with fever, abdominal pain, diarrhea that began 2days earlier. Abdominal computerized tomography(CT) demonstrated diffuse concentric thickening of the cecal wall, intramural edema, inflammatory bowel changes but no free air and abscess formation. He was recovered by early diagnosis and aggressive medical therapy. We report a case of typhlitis with literature reviews.
Abdominal Pain ; Abscess ; Adult ; Cecum ; Diarrhea ; Early Diagnosis ; Edema ; Emergencies* ; Emergency Service, Hospital ; Enterocolitis, Neutropenic ; Fever ; Humans ; Incidence ; Neutropenia ; Typhlitis*

Isolated infernal iliac artery aneurysms and rupture are relatively infrequent, often difficult to detect and therefore rarely considered in the differential diagnosis for abdominal pain. The consequences can be grave, The incidence of isolated iliac artery aneurysm is 1~2% of that of abdominal aortic aneurysm(AAA). The natural history is of gradual enlargement, with rupture the most common clinical presentation. The signs and symptoms of such an aneurysm are influenced by its concealed location within the bony pelvis. Awareness of these special characteristics improves the chances of early diagnosis and proper surgical treatment before possible rupture. Here is a case of ruptured aneurysm of left internal iliad artery. A 73-year-old man was presented to our emergency center with severe abdominal pain and voiding difficulty Abdominal Computed Tomography(Cf) and angiography showed ruptured aneurysm of left infernal iliad artery. Emergency operation was successfully performed for the ruptured internal iliad artery aneurysm.
Abdominal Pain ; Aged ; Aneurysm* ; Aneurysm, Ruptured ; Angiography ; Arteries ; Diagnosis, Differential ; Early Diagnosis ; Emergencies ; Humans ; Iliac Artery* ; Incidence ; Natural History ; Pelvis ; Rupture ; Rupture, Spontaneous*

BACKGROUND: Combined spinal epidural anesthesia (CSE) often produces a more extensive spinal block than expected. This study was designed to evaluate the effects of CSE on subarachnoid block in patients undergoing lower extremity surgery. METHODS: Thirty-three patients who undergone lower extremity surgeries were randomly allocated to three groups of 11 patients each. Using needle through needle technique, all patients received a subarachnoid injection of hyperbaric 0.5% bupivacaine 1.6~2.0 ml through a 25G Whitacre spinal needle. Group 1 received no extradural injection for 25min, but group 2 and 3 received extradural saline 10 ml and bupivacaine 10 ml 5min after the subarachnoid injection, respectively. Levels of sensory and motor block were assessed at 4, 6, 8, 10, 15, 20, and 25 min after subarachnoid injection. RESULTS: The median values of maximum sensory block level were T7 in all groups. Levels of sensory blockade and the time to onset of maximum sensory blockade were similar among the three groups. There was no significant difference in the degree of motor block among three groups. CONCLUSIONS: This study suggests that extradural saline 10 ml or 0.5% bupivacaine 10 ml which injected 5min after subarachnoid injection does not significantly influence the level of subarachnoid block in lower extremity surgical patients. However, further study is required to declare the safety or optimal dose of extradural injection during CSE.
Anesthesia, Epidural* ; Bupivacaine ; Humans ; Injections, Epidural ; Lower Extremity* ; Needles

The laryngeal mask as an new form of airway has recently been described. This mask is introduced blindly into the hypopharynx to form a seal around the larynx, so permitting spontaneous or positive pressure ventilation without passing the larynx, therefore associated with much reduced incidence of laryngeal damage. But endotracheal intubation is associated with a significant rate of layngeal damage and subsequent vocal cord pathology. This study was designed to investigate the effects of postoperative sore throat related to insertion of laryngeal mask airway and to compare with these effects after endotracheal intubation. One hundred randomly selected female patients who had gynecological procedures under general anesthesia were surveyed to ascertain the incidence of sore throats. The results were as follows; l) The incidence of sore throat after endotracheal intubation with the Portex tube was 48% but 12% after insertion of laryngeal mask. 2) The average volume of air required to inflate the cuff of laryngeal mask sufficiently to form air-tight seal around larynx was 11.4+/-2.8ml and cuff pressure was 25.6+/-13.2cmH2O when the laryngeal mask 3 was used for Korean adult female.
Adult ; Anesthesia, General ; Female ; Humans ; Hypopharynx ; Incidence* ; Intubation, Intratracheal ; Laryngeal Masks* ; Larynx ; Masks ; Pathology ; Pharyngitis* ; Positive-Pressure Respiration ; Vocal Cords

The laryngeal mask as an new form of airway has recently been described. This mask is introduced blindly into the hypopharynx to form a seal around the larynx, so permitting spontaneous or positive pressure ventilation without passing the larynx, therefore associated with much reduced incidence of laryngeal damage. But endotracheal intubation is associated with a significant rate of layngeal damage and subsequent vocal cord pathology. This study was designed to investigate the effects of postoperative sore throat related to insertion of laryngeal mask airway and to compare with these effects after endotracheal intubation. One hundred randomly selected female patients who had gynecological procedures under general anesthesia were surveyed to ascertain the incidence of sore throats. The results were as follows; l) The incidence of sore throat after endotracheal intubation with the Portex tube was 48% but 12% after insertion of laryngeal mask. 2) The average volume of air required to inflate the cuff of laryngeal mask sufficiently to form air-tight seal around larynx was 11.4+/-2.8ml and cuff pressure was 25.6+/-13.2cmH2O when the laryngeal mask 3 was used for Korean adult female.
Adult ; Anesthesia, General ; Female ; Humans ; Hypopharynx ; Incidence* ; Intubation, Intratracheal ; Laryngeal Masks* ; Larynx ; Masks ; Pathology ; Pharyngitis* ; Positive-Pressure Respiration ; Vocal Cords

PURPOSE: Extracorporeal treatment has been used increasingly to treat patients with acute ethylene glycol poisoning. We analyzed all patients with acute poisoning of ethylene glycol during a recent 10-year period to provide clinical recommendations for adequate application of continuous renal replacement therapy for these patients. METHODS: A retrospective chart review study was conducted for patients whose final diagnosis were “toxic effects of glycols or other alcohols,” between October 2006 and September 2016. The basal characteristics of patients, suspected amount of ingestion, intention of poisoning, concomitant alcohol ingestion, mental state at admission, time from exposure to admission, chief complaint, length of hospital stay, method of treatments, laboratory results including acute kidney injury and urine oxalate crystal, as well as treatment results were examined. RESULTS: A total number of 14 patients were included in this study. Nine patients (64.3%) underwent continuous renal replacement therapy; 5 patients (35.7%) underwent ethanol mono-therapy. Between the antidote therapy group and the extracorporeal treatment group, there was a significant difference in the levels of plasma bicarbonate, chloride, anion gap, pH, and base excess in arterial blood gas analysis, as well as the calculated osmolar gap. One patient expired due to multi-organ failure, while the others recovered completely. CONCLUSION: Continuous renal replacement therapy was most frequently chosen as a treatment method in patients with acute ethylene glycol poisoning. Further research regarding indication of continuous renal replacement therapy and combing therapy with other treatment will be necessary to determine the best treatment method.
Acid-Base Equilibrium ; Acute Kidney Injury ; Animals ; Blood Gas Analysis ; Comb and Wattles ; Diagnosis ; Eating ; Ethanol ; Ethylene Glycol* ; Glycols ; Humans ; Hydrogen-Ion Concentration ; Intention ; Length of Stay ; Methods* ; Plasma ; Poisoning* ; Renal Replacement Therapy ; Retrospective Studies

PURPOSE: Several studies have suggested that many children have no symptoms before hospitalization with asthma exacerbations. The purpose of this study was to evaluate how many asymptomatic children were hospitalized for asthma exacerbation, and to analyze their prior symptoms. METHODS: Children over 3 years old, hospitalized for acute asthma exacerbation in the Pediatric Allergy and Respiratory Centers in the Kangnam St. Mary's Hospital from January 2003 to December 2006 were enrolled, and their medical records reviewed retrospectively. RESULTS: Among 142 identified patients (median age 5+/-2.5 yr), the group who developed asthmatic symptoms within four weeks before admission occupied about 18.5%. And the group who developed asthmatic symptoms in four weeks or acute exacerbation in six weeks before admission occupied about 23.2%. And group who had asthmatic symptoms in four weeks or acute exacerbation in six weeks or acute exacerbation one year before admission occupied about 31.6%. In September, the group who had no symptom before admission was larger than the group who had asthmatic symptom. The baseline characteristics of each group were not significantly different with respect to age, sex, past history or family history of allergic disease, UniCAP, total IgE and eosinophil count. CONCLUSION: Many children had no symptoms before admission for acute asthma exacerbation. Therefore, we suggest considering that a large number of patients with no previous symptoms are at great risk of acute exacerbation in September, when maintenance therapy is determined.
Asthma* ; Child* ; Child, Preschool ; Eosinophils ; Hospitalization ; Humans ; Hypersensitivity ; Immunoglobulin E ; Medical Records ; Respiratory Center ; Retrospective Studies

Background: This study aimed to explore the time interval distribution pattern between the Physicians Order for Life-Sustaining Treatment (POLST) form completion and death at a tertiary hospital in South Korea. It also examined the association between various independent parameters and POLST form completion timing. Methods: A total of 150 critically ill patients admitted to Korea University Guro Hospital between June 1, 2018 and December 31, 2018 who completed the POLST form were retrospectively analyzed and included in this study. Data were analyzed with descriptive statistics, and group comparisons were performed using the chi-square test for categorical variables. Fisher’s exact test was also used to compare cancer versus non-cancer groups. Results: More than half the decedents (54.7%) completed their POLST within 15 days of death and 73.4% within 30 days. The non-cancer group had the highest percentage of patients (77.8%) who died within 15 days of POLST form completion while the colorectal (39.1%) and other cancer (37.5%) groups had the lowest (P=0.336). Conclusion Our findings demonstrated a current need for more explicit guidance to assist physicians with initiating more timely, proactive end-of-life discussions.

Deep infection following thoracic aortic replacement is a serious and life threatening complication and successful treatment remains a challenge to surgeons. The infected prosthetic graft should be removed; however, this is not always possible. We report our case, whereby our patient was treated with debridement and omental flap, without removal of the original graft. A 40-year-old male patient underwent ascending aorta replacement due to Stanford type A aortic dissection. The patient complained of fever and chilling 15 days postoperatively and the chest computed tomography (CT) showed fluid collection around the ascending aorta graft. White blood cell count was 13,200 (neutrophil 81%), and blood culture showed no growth. The patient was diagnosed as having a prosthetic graft infection. The sternum was opened, and surrounding tissue was widely debrided. Irrigation with 1% povidone-iodine solution and soaking with 5% povidone-iodine solution was completed as opened sternum status for three days. The omental flap wrapped the graft and filled the sub sternal space, and the sternum was sealed after three days of irrigation. Rifodex was administered for 6 months, and Ciprobay for 9 months. Follow-up chest CT at 1 year postoperatively demonstrated no abnormal findings. Erythrocyte sedimentation rate and C-reactive protein at 22 months postoperatively showed normal ranges. Deep sub sternal infection following a thoracic aorta graft could be treated with an omental flap and conservative care without graft removal.
Adult ; Aneurysm ; Aorta ; Aorta, Thoracic ; Blood Sedimentation ; C-Reactive Protein ; Debridement ; Fever ; Follow-Up Studies ; Humans ; Leukocyte Count ; Male ; Povidone-Iodine ; Reference Values ; Sternum ; Thorax ; Transplants

Hepatocellular cell carcinoma (HCC) is one of the most common and malignant neoplasm in the world. Waldenstrom's macroglobulinemia (WM) is a rare B-lymphocyte neoplasia characterized by monoclonal production of IgM Igs and by a marrow containing a diffuse infiltrate of plasmocytoid lymphocytes. A 67-year-old man was admitted because of multiple site pain, especially right flank and posterior neck pain. Physical examination showed hepatomegaly. Laboratory findings were as follows; total protein 8.6 g/dL, albumin 3.1 g/dL with monoclomal protein(IgM-lamda). Hepatitis C virus(HCV) infection was detected by polymerase chain reaction(PCR). Computed tomography and celiac angiography disclosed HCC. Aspiration biopsy of the liver revealed HCC. Magnetic resonance imaging showed compression fracture and epidural mass in cervical spines. Bone marrow examination revealed normocellularity with an increase of lymphoplasmacytic series. He was diagnosed as having WM and HCC. HCC is frequently associated with other malignancies. As the site of the extrahepatic primary cancer, the stomach ranked first. WM is also known for its association with an increased incidence of a second neoplasm, most of which are less differentiated lymphomas. but an association with a non-lymphoreticular malignancy is quite rare. We report first case of synchronous HCC with bone metastasis and WM (IgM,lamdatype) in korean with chronic hepatitis C.
Aged ; Angiography ; B-Lymphocytes ; Biopsy, Needle ; Bone Marrow ; Bone Marrow Examination ; Carcinoma, Hepatocellular* ; Fractures, Compression ; Hepacivirus ; Hepatitis C ; Hepatitis C, Chronic* ; Hepatitis, Chronic* ; Hepatomegaly ; Humans ; Immunoglobulin M ; Incidence ; Liver ; Lymphocytes ; Lymphoma ; Magnetic Resonance Imaging ; Neck Pain ; Neoplasm Metastasis ; Neoplasms, Second Primary ; Physical Examination ; Spine ; Stomach ; Waldenstrom Macroglobulinemia*