Purpose: This study evaluated the causes and risk factors for revision surgery after anterior cervical discectomy and fusion (ACDF) for lower cervical degenerative diseases and verified the factors that can reduce the possibility of revision surgery. Materials and Methods: Six hundred and sixty-one patients who underwent ACDF by one of two board-certified orthopedic spine surgeons for lower cervical degenerative diseases between 2004 and 2021 were enrolled in this study. The patients were divided into two groups based on whether or not they had undergone revision surgery. The statistical significance was analyzed for the age, sex, height, weight, body mass index, status of diabetes mellitus, symptoms at presentation (radiculopathy, myelopathy, and myelo-radiculopathy), number of fusion level, graft type, and smoking status of patients in each group to assess the risk factors for revision surgery. For statistical analysis, a Fisher’s exact test, t-test, and chi-square analysis were conducted according to variables. Results: Fifty-two out of 661 (7.9%) patients underwent revision surgery. The revision surgery took place at an average of 66.3 months after ACDF. The reason for revision surgery was adjacent segment disease (ASD) in 28 (53.8%), pseudoarthrosis in 10 (19.2%), hardwarerelated problems in 4 (7.7%), both ASD and pseudoarthrosis in 3 (5.8%), infection in 3 (5.8%) and other segmental disease in 4 (7.7%) of those patients. The need for revision surgery was unaffected by age, sex, height, weight, body mass index, status of diabetes mellitus, symptoms at presentation, and graft type (p>0.05). The statistical significance of revision surgery was confirmed in patients with multisegment fusion level (≥3 levels, p=0.048) and smoking patients (p<0.001). Conclusion Multi-segment fusion should be avoided, and smoking should be ceased during the perioperative period to reduce the risk of revision surgery when considering ACDF for degenerative cervical spine diseases.

Objective: This study analyzed the characteristics of people who attempted suicide that resulted in deaths as compared to that of the suicide survivors. Methods: This study included 799 suicide attempts that occurred from March 1, 2015, to March 31, 2019 at the emergency department of the university hospital in a city of around 300,000 people. Suicide attempts were classified into the survivor and death groups, and the characteristics of each group were compared. The suicide deaths due to re-attempts were also analyzed. Results: There were more males than females in the death groups. There was a high proportion of people aged 50 or older in the death groups. Hanging, carbon monoxide poisoning, and jumping from great heights were the most commonly used methods of suicide in the death groups. In the selected death group, psychiatric symptom, physical illness, and economic problem among the suicidal causes and depressive disorder among the psychiatric diagnoses were factors that increase the risk of suicide death. Sixty-three point four percent of the survival groups and 52.5% of the selected deaths had not received psychiatric care. On the analysis of suicide deaths due to re-attempts, the average number of suicide attempts was 2.45±0.9. The time from the first suicide attempt to the last suicide attempt was 13.8±10.4 months. Conclusion If it is necessary to make a treatment decision for a suicide attempt in a limited time, such as the case of treating a suicide attempter who visits an emergency department, it is necessary to consider the characteristic factors of the death attempts of suicidal people.

Objective: This study examined the characteristics of the patients taking poison intentionally at the pre-hospital stage to prevent it at the community level. Methods: We retrospectively reviewed the data that had been reported to fire stations from January 2017 to December 2018. This data included sex, age, occupation, the season of the year, time, place, methods, alcohol ingestion, transferred to the hospital or not, and we examined how taking poison had an effect on the suicide success rate. Results: The subjects were a total of 1,356 patients who had been reported to fire stations due to intentionally taking poison. Forty-five point five percent of them were male, and 54.5% were female. The most common method of intentional taking poison was sedatives (58.3%), followed by pesticides (24.6%), antidepressants (19.0%), and other methods (12.6%). The home place was preferred more than any other places. The suicide success rate was 2.1% in males and 1.4% in females. For the age groups, those patients 40-64 years old tried taking poison much more than the other age groups. In the aspect of the season of the year, summer was the highest season for taking poison, at 30.3%. The daytime was more preferred than the night time. Conclusion In this study, we analyzed the characteristics of the pre-hospital intentional poisoning cases according to gender, age, occupation, season of the year, time, and between the transferred and the untransferred groups. Efforts should be made in cooperation with the community to prevent suicide attempts by intentionally taking poison.

Percutaneous needle aspiration biopsy is a relatively simple and safe procedure for the diagnosis of lung and mediastinal lesions. Systemic air embolism during and after percutaneous needle aspiration biopsy of the lung is very rare; however, it is still a complication that can cause fatal outcomes, such as cerebral infarction and myocardial infarction. Here, we report a 72-year-old woman who suffered a change in consciousness immediately after receiving a percutaneous needle aspiration biopsy for the pathologic examination of pulmonary nodules found during a routine health medical examination. She had left side weakness and ST segment elevation on an electrocardiogram. After a high concentration of oxygen, she recovered from neurological symptoms and electrocardiographic abnormalities. The authors report a case of air embolism occurring simultaneously in the brain and coronary arteries after percutaneous needle aspiration biopsy.
Aged ; Biopsy ; Biopsy, Needle* ; Brain ; Cerebral Infarction ; Consciousness ; Coronary Vessels ; Diagnosis ; Electrocardiography ; Embolism ; Embolism, Air* ; Fatal Outcome ; Female ; Humans ; Intracranial Embolism ; Lung* ; Myocardial Infarction ; Needles* ; Oxygen

An aortoesophageal fistula is one of the very few causes of upper gastrointestinal bleeding but can be fatal if the diagnosis is delayed. This usually occurs secondary to esophageal or aortic surgery. A primary aortoesophageal fistula is rare and less likely to be suspected. Here, we present a case of a primary aortoesophageal fistula that presented as massive upper gastrointestinal bleeding. An 81-year-old man with a history of aortic aneurysm had syncope and bright color hematemesis. The aortoesophageal fistula was not diagnosed early enough and the patient died. Therefore, emergency physicians should consider aortoesophageal fistula as a potential cause when encountering upper gastrointestinal bleeding.
Aged, 80 and over ; Aortic Aneurysm ; Diagnosis ; Emergencies ; Esophageal Fistula ; Fistula* ; Gastrointestinal Hemorrhage ; Hematemesis ; Hemorrhage* ; Humans ; Syncope

Objectives To study the clinical results of Liuwei Dihuang Wan plus jinkui Shenqi Wan treating small renal calculus (diameter< 1.0cm) which are not suitable for surgical operation. Methods 200 eases were randomly recruited into a control group and a treatrnent group, with 100 cases in each group. 100 cases in the treatment group was further enrolled into team A (having the syndrome of kidney Yin deficiency) and team B (having the syndrome of kidney yang deficiency), with 50 eases in each team. Team A and team B was treated with Liuwei Dihuang Wan and Jinkui Shenqi Wan respectively. The control group was treated with drugs that removing urinary calculus. Results The cure rate and the effective rate in team A was 60% and 86% respectively; and 62% and 88% respectively in team B. The total cure rate and effective rate of the treatment was 61% and 87% respectively. On the other hand, the cure and effectively rate of the control group was 7% and 35% respectively. The difference between the two groups were significant (P<0.01). Conclusion Liuwei Dihuang Wan plus jinkui Shenqi Wan has good effect in treating small renal calculus.

OBJECTIVES: The aim of this study was to evaluate the reliability and validity of the Korean Version of the Diagnostic Interview Schedule for Children Version IV(DISC-IV), a highly structured diagnostic interview used to assess more than 30 psychiatric disorders in children and adolescents. METHODS: A total of 91 study subjects, including 67 subjects who visited the child and adolescent psychiatry outpatient clinic at our institution and 24 community-based subjects, were assessed using the Korean Version of the DISCIV. Clinical diagnosis was used as a gold standard for the examination of the validity of the DISC-IV. Forty-four of the study subjects were randomly selected for test-retest reliability measurement. RESULTS: The validity of the Korean Version of the DISC-IV showed kappa values ranging from 0.25 to 0.40 in the clinical sample and 0.65 to 1.00 in the community sample. The sensitivities varied according to the diagnostic categories, but the specificities were excellent for all diagnostic entities. CONCLUSION: The Korean Version of the DISC-IV showed good reliability and validity in Korean children and adolescents. The Korean Version of the DISC-IV might be a useful tool for assessing psychiatric disorders in children and adolescents.
Adolescent ; Adolescent Psychiatry ; Ambulatory Care Facilities ; Appointments and Schedules* ; Child* ; Diagnosis ; Humans ; Reproducibility of Results*

PURPOSE: The purpose of this study was to assess the reliability of ultrasonography to image the epiglottis and to determine a thickness range based on healthy Korean adults. METHODS: Anterior neck images were obtained in 100 healthy Koreans (52 males and 48 females) using ultrasonography. Sonographically, the epiglottis appeared as a curvilinear, hypoechoic structure with an echogenic preepiglottic space. 20 of 100 subjects, each patient underwent two ultrasound measurements by the same examiner to assess for intra-examiner reliability, followed by two additional measurements performed by a second examiner to assess for inter-examiner reliability. RESULTS: Intraclass correlation coefficient revealed excellent reliability (intra-examiner 0.901, inter-examiner 0.887). The average Korean epiglottis thickness was measured to be 2.31+/-0.22 mm (range: 1.88 mm to 2.84 mm), with greater thickness noted in men (2.41+/-0.21 mm) when compared to women (2.21+/-0.18 mm) (p <0.001). There was significant correlation between epiglottis thickness and body surface area (r=0.533), weight (0.517), height (0.437) and body mass index (0.372). Average examination time was recoded to be 17.84+/-13.09 seconds. CONCLUSION: Bedside ultrasonography is rapid, safe, easy to perform and can accurately evaluate the epiglottis as seen in our study. Because of excellent reliability, it is possible to establish diagnostic criteria.
Adult* ; Body Mass Index ; Body Surface Area ; Epiglottis* ; Female ; Humans ; Male ; Neck ; Ultrasonography*