Intraductal papillary mucinous neoplasm (IPMN) is a recently recognized clinicopathologic entity characterized by dilatation of pancreatic duct filled with copious mucin and papillary ductal epithelial proliferation ranging from simple hyperplasia to invasive carcinoma. The exact clinicopathologic identification of this tumor is important because of favorable prognosis contrast to that of conventional ductal adenocarcinoma. Herein we report a case of surgically resected typical IPMN. A 59-year-old man had a long history of diabetes mellitus with epigastric pain of 4 months duration. Ultrasonography and computed tomographic examination revealed cystic dilatations of main pancreatic duct in the head. The patient underwent total pancreatectomy. The gross appearance showed diffuse dilatation of main pancreatic duct associated with cystic dilatation of subbranches in the uncinate process. Histologic examination revealed diffuse papillary proliferations lined by mucinous epithelium with mild atypism within ectatic ducts. No invasive carcinoma was noted. Histochemically, the papillary epithelium contained mostly neutral and acid sialomucin.
Male ; Humans

PURPOSE: Ceftriaxone, a potent parenteral third-generation semisynthetic cephalosporin is widely used for the treatment of a variety of bacterial infections in both children and adult. Review of recent data indicates that ceftriaxone treatment has been associated with the development of reversible biliary pseudolithiasis and that is thought by many to be a benign process. Despite, several reports describe patients with ceftriaxone pseudolithiasis who required cholecystectomy for presumed acute cholecystitis. In this study we evaluated the incidence, risk factors, and prognosis of gallbladder pseudolithiasis after ceftriaxone treatment. METHODS: Between march, 1997 and January, 1998, any child admitted to the Children's hospital of National University of Seoul and prescribed ceftriaxone for probable or definite bacterial infection were eligible for the study. 21 of them had ultrasound examination on the 2~12 days later after the start of ceftriaxone treatment, 8 of whom documented gallbladder precipitates or pseudolithiasis during treatment by serial abdominal ultrasound. Repeat abdominal ultrasound was performed 10~80 days later after the end of ceftriaxone treatment. The children with underlying liver disease or decreased renal function were excluded in this study. RESULTS: 1) 21 children had ultrasound examinations of gallbladder during ceftriaxone treatment and 8 (38%) of them acquired pseudolithiasis. 2) The patients who developed gallbladder pseudolithiasis were significantly older (6.3+/-2.9 yr. vs 2.2+/-3.1 yr.)(p<0.05), and older than 24 months were probably the significant risk associated with this phenomenon (p<0.05). However, no significant differences in sex, type of infection, fasting, and ceftriaxone treatment regimen (dose, duration of therapy). 3) The abnormality found on gallbladder ultrasonography was a strikingly hyperechogenic material with post-acoustic shadowing in 5 patients without post-acoustic shadowing in 3 patients 4) Follow up of gallbladder ultrasound was performed in 6 patients after cessation of ceftriaxone treatment. Sonographic abnormalities completely resolved within 14 days post cessation of therapy in 2 patients; 30 days, 1 patient; 80 days, 3 patients. CONCLUSIONS: We suggest that routine abdominal ultrasound should be considered in all children who received high dose ceftriaxone in more than 24 months of age and developed hepatobiliary symptoms during or just after ceftriaxone treatment.
Adult ; Bacterial Infections ; Ceftriaxone* ; Child ; Cholecystectomy ; Cholecystitis, Acute ; Fasting ; Follow-Up Studies ; Gallbladder ; Humans ; Incidence ; Liver Diseases ; Prognosis ; Risk Factors ; Seoul ; Shadowing (Histology) ; Ultrasonography

PURPOSE: The purpose of this study is to evaluate the effectiveness and the adverse events of high dose insulin/euglycemia therapy in acute calcium channel blocker (CCB) poisoning. METHODS: We developed a systematic search strategy and applied it to 4 electronic reference databases. We searched medical journals as well as the bibliographies of relevant articles. All forms of literature relevant to human use of high dose insulin for acute CCB poisoning were included. The literature search was conducted by two investigators in August, 2015 with publication language restricted to English and Korean. Case reports were divided between CCB overdose alone and multi-drug overdose including CCB. The effect and adverse event of high dose insulin and clinical outcome of each case were analyzed. RESULTS: Among 55 searched studies, 20 studies were included. A prospective study, a retrospective study, a systematic review study, and 17 case reports were identified. Case reports consisted of 11 CCB alone and 12 multidrug overdose cases including CCB. Although most cases described significant clinical improvements, one of them showed no beneficial effect. Several adverse events including hypoglycemia and hypokalemia were reported. No significant sequalae from adverse events was reported. CONCLUSION: Although there were many case reports demonstrating successful use of high dose insulin for CCB poisoning, the effect cannot be estimated due to a possibility of publication bias. Therefore, high dose insulin/euglycemia therapy might be considered adjunctive therapy in cases of CCB intoxication refractory for standard therapy.
Calcium Channel Blockers ; Calcium Channels* ; Calcium* ; Humans ; Hypoglycemia ; Hypokalemia ; Insulin ; Poisoning ; Prospective Studies ; Publication Bias ; Publications ; Research Personnel ; Retrospective Studies

PURPOSE: Extracorporeal life support (ECLS) is a term used to describe a number of modalities including extracorporeal membrane oxygenation (ECMO) to support cardiac and/or pulmonary systems. The purpose of this study is to review the available evidence regarding the effect of ECLS in patients with acute poisoning. METHODS: Electronic literature searches with PubMed, Embase, Cochrane library, and KoreaMed were conducted for identification of relevant studies addressing ECLS in treatment of acute poisoning. The literature search was conducted by two investigators in March, 2016 with publication language restricted to English and Korean. The toxic substance, technique of ECLS, and final outcome of each case were analyzed. RESULTS: The final analysis included 64 articles including 55 case reports. There were no articles classified according to a high level of evidence such as randomized trial and prospective cohort study. ECLS treatment was used in the management of patients poisoned with 36 unique substances. Venovenous ECMO was performed in 4 cases. Among the reported cases, 10 patients died despite treatment with ECLS. CONCLUSION: Evidence supporting ECLS for patients with acute poisoning is inadequate. However, many case reports suggest that early consideration of ECLS in poisoned patients with refractory cardiac arrest or hemodynamic compromise refractory to standard therapies may be beneficial.
Cardiopulmonary Bypass ; Cohort Studies ; Extracorporeal Circulation ; Extracorporeal Membrane Oxygenation ; Heart Arrest ; Hemodynamics ; Humans ; Poisoning* ; Prospective Studies ; Publications ; Research Personnel

PURPOSE: Automated external defibrillators (AEDs) could not recommend shock for ventricular fibrillation in the presence of electromagnetic interference. The purpose of this study was to examine the effect of an induced electromagnetic field on performance of AED. METHODS: The intensity of magnetic waves from commercial electric mats was measured. Three AEDs were attached to the resuscitation manikin and the question of whether shock would be recommended for simulated electrocardiogram of VF or normal sinus rhythm was tested. The simulation was repeated 10 times under the influence of 0, 5, and 18 µT magnetic field or electric mat. Relevant literature studies on electromagnetic interference on AED were reviewed. RESULTS: The magnetic flux density from the electric mat was measured to 5.67-6.1 µT in warming phase, and 2.25-2.84 µT in maintenance phase. There was no false positive or false negative recommendation of shock under the influence of 0, 5, and 18 µT magnetic field or electric mat. However, one AED detected motion even in the stationary state. Among 11 studies from the literature search, five studies reported misinterpretation of AED. Minor errors including delayed analysis, motion artefact, and noise in speakers were reported from 6 studies. CONCLUSION: Although we could not reproduce false negative interpretation, AED made a mistake in confusing electromagnetic interference with motion artefact. Therefore, emergency providers should be cautious not to use AED close to household appliances or medical equipment inducing electromagnetic interference.
Artifacts ; Defibrillators* ; Electrocardiography ; Electromagnetic Fields ; Emergencies ; Family Characteristics ; Magnetic Fields ; Magnets* ; Manikins ; Noise ; Resuscitation ; Shock ; Ventricular Fibrillation

PURPOSE: The purpose of this study was to evaluate the usefulness of intravenous lipid emulsion as well as adverse events in acute poisoning patients. METHODS: Literature was accessed through PubMed, EMBASE, Cochrane library, Web of science, and KoreaMed. All forms of literatures relevant to human use of intravenous lipid emulsion for acute poisoning were included. Cases reports or letters without description of clinical outcomes for each case were excluded. The literature search was conducted by two investigators in March, 2015, with publication language restricted to English and Korean. The effect, onset time, and adverse event of lipid emulsion and final outcome of each case were analyzed. RESULTS: Eighty-one published articles were included, excluding articles whose title and abstract were not relevant to this study. No articles were classified as high level of evidence. Sixty-eight case reports were identified, consisting of 25 local anesthetics and 43 other drugs, such as tricyclic antidepressants and calcium channel blockers. Although most cases described significant clinical improvements, some of them showed no beneficial effect or worsening of clinical course. Several adverse events including hyperamylasemia and laboratory interference were reported. CONCLUSION: Although there were many case reports illustrating successful use of lipid for various drug poisonings, the effect cannot be estimated due to significant possibility of publication bias. Therefore, lipids might be considered in severe hemodynamic instability resulting from lipophilic drug poisoning, however further studies should follow to establish the use of lipid as the standard of care.
Anesthetics, Local ; Antidepressive Agents, Tricyclic ; Calcium Channel Blockers ; Drug Overdose ; Fat Emulsions, Intravenous ; Hemodynamics ; Humans ; Hyperamylasemia ; Lipid A ; Poisoning* ; Publication Bias ; Publications ; Research Personnel ; Standard of Care

OBJECTIVE: During the past 20 years, over 1,400 doctors have been certified as emergency physicians in Korea. The number of scientific publications in the field of emergency medicine has also increased. This study aims to evaluate the research productivity of academic emergency physicians in South Korea. METHODS: Articles published from 1996 to 2015 by authors affiliated with Korean emergency departments were retrieved using Pubmed, Embase, and Web of Science. Research productivity was analyzed quantitatively to ascertain the number of articles for publication type and year. The performance of these articles was also analyzed qualitatively using impact factor, citation number, and Hirsch index. Bibliometric analysis was performed by researching Web of Science, Scopus, and Google Scholar. RESULTS: A total of 858 articles with 293 Korean authors as the first or corresponding authors were published across 191 journals. The number of publications increased continuously. The most common publication type was original article (n=618), the most commonly studied research topic was resuscitation medicine (n=110), and the average impact factor of the original articles was 2.158. The highest h-index was 17 and, using Web of Science, the maximum number of citations was found to be 85. CONCLUSION: This study suggests that the research productivity of Korean authors in the emergency medicine field has progressed steadily during the last 10 years. However, qualitative indexes, such as the number of citations and h-index value, remain low.
Bibliometrics* ; Efficiency* ; Emergencies* ; Emergency Medicine* ; Emergency Service, Hospital ; Humans ; Journal Impact Factor ; Korea* ; Publications ; Research Personnel ; Resuscitation

Background and Objectives: Human CD34＋hematopoietic stem cells can reconstitute the human hematopoietic system when transplanted into immunocompromised mice after irradiation. Human leukapheresis peripheral blood (LPB)-and cord blood (CB)-derived CD34＋ cells have a similar capacity to reconstitute myeloid lineage cells in a humanized mice (hu-mice) model. However, potent stem cells, such as CB-CD34＋ cells, efficiently reconstitute the lymphoid system in vivo compared to LPB-CD34 ＋ cells. Modeling the human hematolymphoid system is vital for studying immune cell crosstalk in human xenografted mice, with CB-CD34＋ cells used as an optimized cell source because they are essential in reconstituting lymphoid lineage cells. Methods: and Results: In this study, we established hu-mice that combined human characteristics with long-term survival and investigated the efficiency of the engraftment of lymphoid lineage cells derived from LPB- and CB-CD34＋cells in the bone marrow, spleen, and LPB. We found an overall increase in the transcriptional activity of lymphoid lineage genes in CB-CD34＋ cells. Our results revealed that potent CB-CD34＋ cells displaying a general upregulation of the expression of genes involved in lymphopoiesis could contribute to the hematolymphoid system in the humanized mice model with longevity. Conclusions Our data suggest that humanized mouse model by usage of CB-CD34 ＋ cells displaying high expression of TFs for lymphoid lineage cells can contribute to study the immune response against lymphocytes.

Objective: This study verifies the practicality of the delta neutrophil index to lymphocyte ratio for the prognostic evaluation of sepsis patients. Methods: Records of 2,233 patients diagnosed with sepsis were reviewed; 1,042 patients were included in the final analysis. Receiver operating characteristic (ROC) curve studies were used to calculate the area under the curve (AUC) to determine the neutrophil-to-lymphocyte ratio (NLR) and the delta neutrophil-to-lymphocyte ratio (Delta-NLR). To adjust for skewed distributions, the NLR and Delta-NLR were analyzed after natural logarithm transformations. Multivariate logistic regression was applied to determine potential predictors for mortality. Results: To predict 30-day mortality, AUCs were performed using the values of days 0, 1, and 2 (0.604, P<0.0001; 0.648, P<0.0001; and 0.684, P<0.0001, respectively). The NLR results were 0.504 (P=0.8624), 0.553 (P=0.0191), and 0.598 (P<0.0001), respectively. The AUC increased significantly when the Delta-NLR at day 0 was combined with age, hemoglobin levels, and lactate levels. Further subgroup analysis was performed by dividing patients into an upper respiratory infection (URI) group, a gastrointestinal tract infection (GI) (including hepatobiliary infection) group, and a urinary tract infection (UTI) group. The predictive ability of the GI group was determined to be much higher than the other two groups. Conclusion Increase in the Delta-NLR of sepsis patients was found to be an independent predictor of mortality within 30 days.

Background and Objectives: Human CD34＋hematopoietic stem cells can reconstitute the human hematopoietic system when transplanted into immunocompromised mice after irradiation. Human leukapheresis peripheral blood (LPB)-and cord blood (CB)-derived CD34＋ cells have a similar capacity to reconstitute myeloid lineage cells in a humanized mice (hu-mice) model. However, potent stem cells, such as CB-CD34＋ cells, efficiently reconstitute the lymphoid system in vivo compared to LPB-CD34 ＋ cells. Modeling the human hematolymphoid system is vital for studying immune cell crosstalk in human xenografted mice, with CB-CD34＋ cells used as an optimized cell source because they are essential in reconstituting lymphoid lineage cells. Methods: and Results: In this study, we established hu-mice that combined human characteristics with long-term survival and investigated the efficiency of the engraftment of lymphoid lineage cells derived from LPB- and CB-CD34＋cells in the bone marrow, spleen, and LPB. We found an overall increase in the transcriptional activity of lymphoid lineage genes in CB-CD34＋ cells. Our results revealed that potent CB-CD34＋ cells displaying a general upregulation of the expression of genes involved in lymphopoiesis could contribute to the hematolymphoid system in the humanized mice model with longevity. Conclusions Our data suggest that humanized mouse model by usage of CB-CD34 ＋ cells displaying high expression of TFs for lymphoid lineage cells can contribute to study the immune response against lymphocytes.