Blunt chest trauma to the heart may produce instantaneous death or, more frequently, congestive heart failure due to myocardial injury or disruption of intracardiac structures. Cardiac injury following by blunt chest trauma is often unsuspected and can range from cardiac contusion to chamber rupture, or to valvular dysfunction. The rate of occurrence of acute traumatic valvular insufficiency is extremely rare. Especially, the tricuspid valve is very rarely injured. Although clinical diagnosis of acute traumatic valvular insufficiency can be difficult to make for trauma patients with multiple injuries, echocardiography can establish diagnosis quickly and accurately. This report describes a patient who developed tricuspid regurgitation and acute heart failure following by an MCV.
Contusions ; Diagnosis ; Echocardiography ; Heart ; Heart Failure ; Humans ; Multiple Trauma ; Rupture ; Thorax* ; Tricuspid Valve ; Tricuspid Valve Insufficiency*

Tetanus is a rare disease in the developed countries, including Korea, as a result of nearly universal active immunization. Because many physicians have little experience with its diagnosis and management, misdiagnosis and therapeutic delay may result in catastrophic consequences. We report one case of generalized tetanus. A previously healthy 35-year-old man was admitted to the emergency department because of stiffness on jaw and neck. board-like abdomen, extended and rigid both legs, chest tightness, and dyspnea. Seven days before admission, he was injured on the right thing at work. In the emergency department, he was given 5,000 units of human tetanus immunoglobulin intramuscularly, as well as diazepam 2 mg/hr intravenously. On the second hospital day, tracheostomy was performed. Ten days later, his condition was improved. Twenty eight days after admission, he was discharged without any complication.
Abdomen ; Adult ; Developed Countries ; Diagnosis ; Diagnostic Errors ; Diazepam ; Dyspnea ; Emergency Service, Hospital ; Humans ; Immunoglobulins ; Jaw ; Korea ; Leg ; Neck ; Rare Diseases ; Tetanus* ; Thorax ; Tracheostomy ; Vaccination

No abstract available.
Emergencies* ; Emergency Service, Hospital* ; Emergency Treatment* ; Humans

No abstract available.
Female ; Ovary* ; Teratoma*

Although thrombolytic therapy is one of the most effective therapeutic option for acute ischemic stroke, hemorrhagic complication still remains major concern about its application. A patient with hemoperitoneum, who previously underwent thrombolytic therapy(intraarterial urokinase infusion, IAUK) for acute ischemic stroke was treated successfully with emergency transarterial embolization for rupture of hepatocellular carcinoma. We present a rare case of rupture of hepatocellular carcinoma after intraarterial urokinase infusion for acute ischemic stroke with brief review of the literature.
Carcinoma, Hepatocellular ; Emergencies ; Hemoperitoneum* ; Humans ; Rupture ; Stroke* ; Thrombolytic Therapy ; Urokinase-Type Plasminogen Activator*

Pneumocephalus is defined as "the presence of air or gas within the cranial cavity." Intracranial air may represent an incidental finding of no clinical significance or more aggressive, life-threatening disease. It is usually associated with head trauma and surgery, tumor, brain abscess, postradiation necrosis, or diagnostic procedures. In the absence of head trauma or surgery, meningitis due to gas-forming organisms is an extremely rare cause of pneumocephalus. We report an unusual case of a localized spontaneous pneumocephalus caused by pneumococcal meningitis in the absence of head trauma, surgery, and brain abscess.
Abscess ; Brain Abscess ; Brain Neoplasms ; Craniocerebral Trauma ; Incidental Findings ; Meningitis ; Meningitis, Pneumococcal* ; Necrosis ; Pneumocephalus* ; Streptococcus pneumoniae

PURPOSE: Fever is the single most common problem in children visiting the emergency department. Fever is treated with a variety of methods, including the recommended combination of tepid massage, and antipyretics. We compared the effects of antipyretics and tepid massage for the management of febrile children. METHODS: We conducted a prospective, randomized, controlled study to assess 49 children who visited to the ED, Kyung Hee Medical Center, with complaints of fever. Ages ranged from 3 to 60 months. Patients were grouped into one of the following three treatment groups: 1) acetaminophen only, 2) tepid massage only, and 3) acetaminophen and tepid massage. We measured body temperature at 0 and 30 minutes after management. RESULTS: The mean temperature at 30 minutes had decreased by initial temperature 0.58degrees C, 0.48degrees C, and 0.90degrees C for groups 1), 2), and 3), respectively. Although body temperature for group 3) decreased to a greater degree than it did in the other groups, the differences were not statistically significant. CONCLUSION: Although tepid massage have been recommended for managing fever, their effect is still uncertain, so they are not recommended, especially in the cases of crowded emergency rooms.
Acetaminophen ; Antipyretics* ; Body Temperature ; Child ; Emergencies* ; Emergency Service, Hospital* ; Fever* ; Humans ; Massage* ; Prospective Studies

Most currently available statins are associated with an increase with risk of myositis, including rhabdomyolysis. Myopathy is believed to be caused by interference in the cytochrome P450 3A4 enzyme system, which results in a marked increase in reductase activity. Cerivastatin, a new synthetic HMG-CoA reductase inhibitor, is a safe, well-tolerated effective drug for the treatment of patients with dyslipidemia. The drug is metabolized by the cytochrome P450 3A4 and cytochrome P450 2C8 hepatic isoenzymes. Because of this dual metabolic pathway, it has been suggested that cerivastatin is less subject to drug-todrug interactions. We describe a 60-year-old woman with rhabdomyolysis and localized myositis, after she had taken cerivastatin(lipobay, 0.3 mg/day) and gemfibrozil(lopid, 500 mg/day) for 1month.
Cytochrome P-450 Enzyme System ; Dyslipidemias ; Female ; Gemfibrozil ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Isoenzymes ; Metabolic Networks and Pathways ; Middle Aged ; Muscular Diseases ; Myositis ; Oxidoreductases ; Rhabdomyolysis*

Superior gluteal artery rupture without pelvic fracture is extremely rare, but the rupture of this vessel is a well-known complication of pelvic fractures. This vessel appears to be at risk at the time of pelvic fracture because of its vulnerable anatomical position in the sacrosciatic notch. The rupture of this vessel causes profound hypotension and compartment syndrome of the gluteal or thigh region. Embolization is the most effective treatment. We report an unusual case of a superior gluteal artery rupture without pelvic fracture in blunt trauma.
Arteries* ; Compartment Syndromes ; Hypotension ; Hypovolemia* ; Rupture* ; Shock* ; Thigh

PURPOSE: In many other countries, based on research, recombinant tissue plasminogen activator (r-tPA) has been approved for the treatment of acute ischemic strokes. However, in Korea, little research has been done till now, in spite of using r-tPA widely. We sought to assess the feasibility and the efficacy of treatment and to evaluate the prognosis and complications at the violation of using r-tPA. Our study was compared with other previous studies. METHODS: A retrospective review is presented of 25 the cases of patients with acute ischemic stroke treated with rtPA according to the National Institutes of Neurological Disorders and Strokes (NINDS) protocol. We classified the groups by protocol violation (time, blood pressure, and computed tomography). We then analyzed neurologic outcomes by using the National Institutes of Health Strokes Scale (NIHSS) and complications based on whether or not intracerebral hemorrhage (ICH) had occurred. RESULTS: Of the 25 patients (mean age: 57 males: 19), 6 had time violation (onset time > 180 min), 4 had blood-pressure violation (systolic BP > 185 mmHg), 5 had CT violation (low density at initial CT). The NIHSS score improved in 64% of all patients after 24 hours. However, improvement was lower in the case of deviation present than it was in the case of deviation absent (time, blood pressure, and CT, respectively, 20%, 50%, and 40%; p-value respectively 0.0274, 0.8350, and 0.4125). ICH occurred in 6 cases, but in cases of deviation present, ICH occurred at a greater frequency. CONCLUSION: Our safety and feasibility of outcome compared favorably with NINDS and other previous studies. In addition, we confirmed that the presence of protocol deviation was associated a poor outcome.
Academies and Institutes ; Blood Pressure ; Cerebral Hemorrhage ; Humans ; Korea ; Male ; National Institute of Neurological Disorders and Stroke ; National Institutes of Health (U.S.) ; Nervous System Diseases ; Prognosis* ; Retrospective Studies ; Stroke* ; Thrombolytic Therapy ; Tissue Plasminogen Activator