Objective: : The indications for repeated brain computed tomography (CT) for delayed intracranial hemorrhage (DICH) remain inconclusive. This study aimed to identify the risk factors for DICH in patients with severe trauma. Methods: : Patients with blunt trauma, admitted to a level I trauma center between January 2018 and June 2020, were retrospectively reviewed. Patients who underwent repeat brain CT but had a normal initial brain CT were included. The patients were divided into the DICH and normal groups, and their general characteristics and outcomes were compared. Multi-logistic regression analysis was performed to identify the risk factors. Patients with DICH were also interviewed. Results: : Of 784 patients, 37 (4.7%) were included in the DICH group. The DICH group presented with more severe injury. In multi-logistic regression, age over 65 years (odds ratio [OR], 2.681; 95% confidence interval [CI], 1.250–5.753; p=0.011), lowest systolic blood pressure under 90 mmHg during resuscitation (OR, 2.678; 95% CI, 1.247–5.750; p=0.012), severe abdominal injury (OR, 2.667; 95% CI, 1.213–5.864; p=0.015) and cervical spine fracture (OR, 2.408; 95% CI, 1.084–5.351; p=0.031) were associated with DICH. Among the 37 patients with DICH, one patient underwent an invasive procedure, and no mortality was reported. Conclusion : The incidence of DICH may be higher in patients with severe trauma and repeat brain CT could be considered in selected high-risk cases, even when the initial scan is normal.

Sodium glucose cotransporter 2 (SGLT2) inhibitor has been recently reported of diabetic ketoacidosis due to accumulation of ketone bodies in patients with severe dehydration caused from such like diarrhea even though the patient had normal glucose level. This is a case of ketoacidosis in normal glucose level as production of ketone bodies is stimulated in liver with increased secretion of glucagon by stimulation of α cells in pancreas due to increase of lipolysis caused from reducing insulin and by SGLT2 inhibitor among patients who are under concurrent insulin and SGLT2 inhibitor. Thus, insulin dosage reduction requires caution in order to control blood glucose level on combined treatment of SGLT2 inhibitor in a patient who is administering insulin because the patient may be caused ketoacidosis in normal blood glucose level.
Blood Glucose ; Dehydration ; Diabetic Ketoacidosis* ; Diarrhea ; Glucagon ; Glucose* ; Humans ; Insulin* ; Ketone Bodies ; Ketosis ; Lipolysis ; Liver ; Pancreas ; Sodium*

PURPOSE: Laparoscopic colorectal procedures are widely used for benign disease but controversial for malignant disease. In early colorectal cancer, laparoscopic colectomy can be performed safely on the basis of oncologic principles. The purpose of this study is to evaluate the safety and effectiveness of laparoscopic-assisted colorectal resection for malignant polyps and benign disease. METHODS: Twenty five patients submitted to surgical treatment between Oct. 1996 to June 2000 were reviewed retrospectively. RESULTS: Malignant polyps comprized 7 cases whose resection margins were all positive for cancer cells after endoscopic polypectomy and benign diseases in 18 cases (benign polyp: 7, diverticular disease: 4, submucosal tumor: 4 etc.). The common sugical procedures were anterior or low anterior resection (7 cases) and segmental resection (6 cases). There was no conversion to an open surgery. In malignant polyps, pathologic results revealed early cancer with no lymph node metastasis. There was no operative mortality. Postoperative recovery was uneventful except 2 cases (9.0%) of complications, which were, prolonged ileus in one patient and subcutaneous emphysema in another patient. CONCLUSIONS: Laparoscopic-assisted resection can be recommended as a safe and effective procedure for treatment of colonic malignant polyps and benign disease.
Colectomy ; Colon ; Colorectal Neoplasms ; Humans ; Ileus ; Laparoscopy ; Lymph Nodes ; Mortality ; Neoplasm Metastasis ; Polyps* ; Retrospective Studies ; Subcutaneous Emphysema