A spontaneous tension hemothorax due to the rupture of an intercostal artery aneurysm is a rare complication of type I neurofibromatosis. Until now, around 23 cases have been reported. The patient reported here presented with a spontaneous tension hemothorax. At the emergency department, we were faced with a rapidly aggravating hemodynamic compromise after chest tubing. An emergent thoracotomy revealed an actively bleeding huge intercostal artery aneurysm. We intended primarily to repair the bleeding aneurysm, but we failed with because of vascular fragility. Thus we present this case to share our terrible experience to other physicians.
Aneurysm* ; Arteries* ; Emergency Service, Hospital ; Hemodynamics ; Hemorrhage ; Hemothorax* ; Humans ; Neurofibromatoses* ; Rupture* ; Thoracotomy ; Thorax

PURPOSE: Pneumonia is a common complication of organophosphate poisoning and increases the incidence of respiratory failure and the duration of mechanical ventilator support. Therefore, we investigated the clinical characteristics of pneumonia as a complication of organophosphate insecticide poisoning and then determined the factors related to the development of pneumonia. METHODS: A retrospective study was performed on patients with organophosphate insecticide poisoning, who were treated at our hospital with medical records and chest radiograph of patients. From January 1, 2001, to July 31, 2004, eighty five patients were included in this study. RESULTS: 1) Thirty-two (71% of the patients developing pneumonia) patients developed pneumonia later than 48 hours from admission and twenty-five (55.6% of the patients developing pneumonia) patients developed pneumonia later than 48 hours after mechanical ventilatory support. 2) The mean onset of pneumonia resistant to initial empirical antibiotics was 4.8 days from admission, and that of susceptible pneumonia was 3.7 days from admission. 3) Patients with pneumonia as a complication needed larger doses of atropine and more 2-pralidoxime injections, as well as longer mechanical ventilatory support, ICU admission, and total hospital admission. CONCLUSION: Most Pneumonia in organophosphate poisoning patients were nosocomial pneumonia & ventilator-associated pneumonia. Thus, to reduce the incidence of pneumonia complication in organophosphate poisoning patients, Physicians must take measures, such as hand-washing and careful periodic drainage of tubing condensate, etc., to reduce the incidence of nosocomial pneumonia. In selecting empirical antibiotics for pneumonia complicating organophosphate poisoning patients, physicians should take regional prevalence of nosocomial pathogens into consideration. In late-onset ventilator-associated pneumonia, physicians must consider pneumonia caused by organisms resistant to commonly used empirical antibiotics.
Anti-Bacterial Agents ; Atropine ; Drainage ; Humans ; Incidence ; Medical Records ; Organophosphate Poisoning ; Pneumonia* ; Pneumonia, Aspiration* ; Pneumonia, Ventilator-Associated ; Poisoning* ; Prevalence ; Radiography, Thoracic ; Respiratory Insufficiency ; Retrospective Studies ; Ventilators, Mechanical

Hydatid disease is a parasitic infection caused by the Echinococcal species. Humans are intermediate hosts and become infected directly by contact with canines or indirectly by contact with food, water, and contaminated objects. This disease involves multiple organs, including liver, lung, heart, muscle, bone, kidney, and brain. Rupture of a hydatid cyst, which is the most common complication of this disease, can cause serious sequelae, including allergic reaction, secondary infection, biliary obstruction, and metastasis. The hydatid disease occurs principally in areas of cattle and sheep ranching. In Korea, this disease is rare, and only a few cases have been reported. We report a case of hydatid disease with anaphylactic shock and suggest that hydatid cyst complications must be kept in mind when dealing with patients who have a history associated with an endemic region.
Anaphylaxis ; Animals ; Brain ; Cattle ; Coinfection ; Echinococcosis ; Heart ; Humans ; Hypersensitivity ; Kidney ; Korea ; Liver ; Lung ; Neoplasm Metastasis ; Rupture ; Sheep ; Shock*

Dental infection which has been harmful to human for a long time occurs when the balance of three factors; host, environment and source of infection are broken and occurs especially when the balance of the resistance of the host and the toxin of bacteria are collapsed. Though dental-origin infection causes severe pain, it is commonly localized in gingiva, pulp and the surface of alveolar bone and as the decrease of its prevalence due to the development of antibiotics and the ease of treatment by a simple aids, there are no case that proper caution are made for the infection. Expecially in case of patient with infectious Hansen's disease(leprosy), as they have many other medical diseases, dental disease are mostly passed by. As oromaxillary infection can end up to death, though it is hard to treat a severly progressed myofascial space infection, general understanding about the reason, the pattern of spreading, treatment, prevention of it should be needed to make actual management in the situation of an doubtless developing of infection in patient treatment and situation of suspicious development of early myofascial space infection. Since last 5 years, 36% of the patients were hospitalized due to their dental infection and consistent advertising and treatment resulted in a gradual decrease of it.
Anti-Bacterial Agents ; Bacteria ; Gingiva ; Humans ; Prevalence ; Stomatognathic Diseases

Percutaneous vertebroplasty is a safe and effective procedure for the treatment of benign and malignant lesions of the spine, but has been associated with some known complications. Most complications are related to the percutaneous approach, but more severe complications related to the unwanted migration of acrylic cement can occur. We report an unusual case of a fatal pulmonary embolism caused by acrylic cement. Known factors related to cement leakage are incorrect needle position, the consistency of the cement, and the vascularity of the lesion. Emergency physicians should consider acute pulmonary embolism as a diagnosis when evaluating a patient who is suffering from dysnea or chest pain after an orthopedic procedure performed with cement.
Chest Pain ; Diagnosis ; Emergencies ; Humans ; Needles ; Orthopedic Procedures ; Pulmonary Embolism* ; Spine ; Vertebroplasty*

Background: The purpose of this study was to review the nationwide emergency care-related health policies during the coronavirus disease 2019 (COVID-19) pandemic disaster in Korea and to analyze the effects of the policies on the safety of patients who visit emergency departments (EDs) during this period. Methods: This study is a quasi-experiment study. The study population was patients who visited all 402 EDs in Korea between December 31, 2019 and May 13, 2020, using the National Emergency Department Information System (NEDIS) database. The study period was classified into 5 phases according to the level of national crisis warning of infectious disease and the implementation of emergency care-related health policies, and all study phases were 27 days. The primary outcome was in-hospital mortality, and the secondary outcome was length of stay (LOS) in the ED during the COVID-19 outbreak. Results: The number of ED visits during the study period was 2,636,341, and the in-hospital mortality rate was 1.4%. The number of ED visits decreased from 803,160 in phase 1 to 496,619 in phase 5 during the study period. For in-hospital mortality, the adjusted odds ratio (OR) (95% confidence interval) was 0.77 (0.74–0.79) in phase 5 compared to phase 3. Additionally, by subgroup, the ORs were 0.69 (0.57–0.83) for the patients with acute myocardial infarction and 0.76 (0.67–0.87) for severe trauma in phase 5 compared to phase 3. The ED LOS increased while the number of ED visits decreased as the COVID-19 pandemic progressed, and the ED LOS declined after policy implementation (beta coefficient: −5.3 [−6.5 to −4.2] minutes in phase 5 compared to phase 3). Conclusion Implementing appropriate emergency care policies in the COVID-19 pandemic would have contributed to improving the safety of all emergency patients and reducing inhospital mortality by preventing excessive deaths.

Background: The purpose of this study was to review the nationwide emergency care-related health policies during the coronavirus disease 2019 (COVID-19) pandemic disaster in Korea and to analyze the effects of the policies on the safety of patients who visit emergency departments (EDs) during this period. Methods: This study is a quasi-experiment study. The study population was patients who visited all 402 EDs in Korea between December 31, 2019 and May 13, 2020, using the National Emergency Department Information System (NEDIS) database. The study period was classified into 5 phases according to the level of national crisis warning of infectious disease and the implementation of emergency care-related health policies, and all study phases were 27 days. The primary outcome was in-hospital mortality, and the secondary outcome was length of stay (LOS) in the ED during the COVID-19 outbreak. Results: The number of ED visits during the study period was 2,636,341, and the in-hospital mortality rate was 1.4%. The number of ED visits decreased from 803,160 in phase 1 to 496,619 in phase 5 during the study period. For in-hospital mortality, the adjusted odds ratio (OR) (95% confidence interval) was 0.77 (0.74–0.79) in phase 5 compared to phase 3. Additionally, by subgroup, the ORs were 0.69 (0.57–0.83) for the patients with acute myocardial infarction and 0.76 (0.67–0.87) for severe trauma in phase 5 compared to phase 3. The ED LOS increased while the number of ED visits decreased as the COVID-19 pandemic progressed, and the ED LOS declined after policy implementation (beta coefficient: −5.3 [−6.5 to −4.2] minutes in phase 5 compared to phase 3). Conclusion Implementing appropriate emergency care policies in the COVID-19 pandemic would have contributed to improving the safety of all emergency patients and reducing inhospital mortality by preventing excessive deaths.

Prostate cancer is the most common type of male cancer worldwide. Although radical prostatectomy (RP) is advised for prostate cancer in patients with a life expectancy of more than 10 years by various guidelines, most elderly men still do not undergo the procedure regardless of increasing life expectancy. This study aimed to determine whether RP is suitable for patients with prostate cancer aged 75 years or older. A retrospective study of patients who underwent RP at 6 institutions between 2005 and 2012 was conducted. Patients were divided into 2 groups at the time of surgery: 65-69 years (younger group) and 75 years or older (older group). We compared clinical characteristics, pathological results, complication rates, and recurrence-free survival between the two groups. Compared with the younger group, the older group had significantly higher preoperative serum prostate-specific antigen level, pre- and postoperative Eastern Cooperative Oncology Group (ECOG) performance status grade, hypertension prevalence, and Gleason score at biopsy and RP. However, except urinary incontinence, there were no statistically significant differences in the peri- and post-operative complications. After median follow-up periods of 36 months (younger group) and 40 months (older group), the biochemical recurrence-free survival rates were not significantly different (P = 0.581). Although the urinary incontinence rate was higher in the older group, RP was a suitable option for selected Korean men aged 75 years or older with limited complication rates and excellent outcomes similar to those for patients aged 65-69 years.
Age Factors ; Aged ; Biopsy ; Disease-Free Survival ; Humans ; Hypertension/epidemiology ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Grading ; Prostate-Specific Antigen/blood ; Prostatectomy ; Prostatic Neoplasms/mortality/pathology/*surgery ; Republic of Korea ; Retrospective Studies

PURPOSE: Paraquat is widely used non-selective contact herbicide. In spite of efforts to improve the outcome in paraquat poisoning, the mortality rate still remains high. The purpose of this study is to assess the predictive factors of prognosis by investigating initial laboratory data on paraquat poisoning. METHODS: The author retrospectively analyzed the clinical features, laboratory data, and outcomes for 130 paraquatpoisoning patients treated from June 1997 to September 2003 at the emergency medical center of Chonnam National University Hospital. RESULTS: The results were as follows: 1) The mortalities were significantly older than the survivors (49.3 years vs 37.6 years, p<0.05). Among the total 130 cases, the survivors numbered 50, and the deceased numbered 80. The mean age of all 130 cases was 44.8+/-16.9 years. 2) The white blood cell count and the levels of serum AST and ALT in the deceased were significantly higher than they were in the survivors. The levels of arterial pH, PaCO 2, base excess, HCO3 -, and serum potassium in the survivors were significantly higher than they were in the deceased. 3) A multivariate Cox-Regression analysis revealed that sex, serum potassium, and arterial HCO3 - were associated with the mortality rate. CONCILUSION: The above data reveal that the ingested amount, the result of the urine sodium dithionite test, and the initial state of laboratory parameters, including the white blood cell count, ABGA (pH, PaCO2, HCO3 -, base excess), serum potassium, AST, and ALT, can be used to predict the outcome of paraquat poisoning.
Dithionite ; Emergencies ; Humans ; Hydrogen-Ion Concentration ; Jeollanam-do ; Leukocyte Count ; Mortality ; Paraquat* ; Poisoning* ; Potassium ; Prognosis* ; Retrospective Studies ; Survivors

PURPOSE: To evaluate the prevalence of bladder neck contracture (BNC) and its risk factors in patients undergoing radical prostatectomy in Korea. MATERIALS AND METHODS: We analyzed data from 488 patients with prostatic cancer who underwent radical prostatectomy performed by seven surgeons in seven hospitals, including 365 open radical prostatectomies (ORPs), 99 laparoscopic radical prostatectomies (LRPs), and 24 robot-assisted laparoscopic radical prostatectomies (RARPs). Patients with BNCs were compared with those without BNCs to identify the risk factors for BNC occurrence. RESULTS: Overall, BNCs occurred in 21 of 488 patients (4.3%): 17 patients (4.7%) who underwent ORP, 4 patients (4%) who underwent LRP, and no patients who underwent RARP. In the univariate analysis, men with BNCs had a longer length of time before drain removal (12 days vs. 6.8 days, p<0.001), which reflected urinary leakage through the vesicourethral anastomosis. In the multivariate analysis, the length of time before drain removal was the only predictor of BNC (odds ratio, 1.12; p=0.001). Intraoperative blood loss was higher in patients with BNC, but the difference was not statistically significant. CONCLUSIONS: The most significant factor related to BNC occurrence after radical prostatectomy in our study was the length of time before drain removal, which reflects urinary leakage from the vesicourethral anastomosis. The proper formation of a watertight anastomosis to decrease urinary leakage may help to reduce the occurrence of BNC.
Contracture ; Humans ; Male ; Multivariate Analysis ; Neck ; Prevalence ; Prostatectomy ; Prostatic Neoplasms ; Risk Factors ; Urinary Bladder ; Urinary Bladder Neck Obstruction