A 29-year-old man was referred to the emergency department with a complaint of abdominal pain and dizziness. He had experienced two previous syncopal episodes. His family history revealed that his mother and his two uncles had received permanent pacemaker implantation. His initial heart rate was 49 beats per minute. The electrocardiography (ECG) showed atrial flutter and right bundle branch block (RBBB) with left anterior fascicular block (LAFB). On admission, 24-hour Holter showed ventricular pause up to 16 seconds during syncope. Radio frequency catheter ablation (RFCA) of atrial flutter was performed. The ECG revealed bifascicular block (RBBB and LAFB) and first-degree atrioventricular block. He received a permanent pacemaker implantation. His brother's and his sister's ECGs also showed trifascicular block and the pedigree showed autosomal dominant inheritance. This patient was diagnosed with a progressive familial heart block (PFHB) type I. This would be the first report of a PFHB type I case documented in Korea.
Abdominal Pain ; Adult ; Atrial Flutter ; Atrioventricular Block ; Bundle-Branch Block ; Catheter Ablation ; Dizziness ; Electrocardiography ; Emergencies ; Heart ; Heart Block ; Heart Rate ; Humans ; Korea ; Mothers ; Pedigree ; Syncope ; Wills

BACKGROUND AND PURPOSE: There is little information available about the effects of Emergency Medical Service (EMS) hospital notification on transfer and intrahospital processing times in cases of acute ischemic stroke. METHODS: This study retrospectively investigated the real transfer and imaging processing times for cases of suspected acute stroke (AS) with EMS notification of a requirement for intravenous (IV) tissue-type plasminogen activator (t-PA) and for cases without notification. Also we compared the intra-hospital processing times for receiving t-PA between patients with and without EMS prehospital notification. RESULTS: Between December 2008 and August 2009, the EMS transported 102 patients with suspected AS to our stroke center. During the same period, 33 patients received IV t-PA without prehospital notification from the EMS. The mean real transfer time after the EMS call was 56.0+/-32.0 min. Patients with a transfer distance of more than 40 km could not be transported to our center within 60 min. Among the 102 patients, 55 were transferred via the EMS to our emergency room for IV t-PA. The positive predictive value for stroke (90.9% vs. 68.1%, p=0.005) was much higher and the real transfer time was much faster in patients with an EMS t-PA call (47.7+/-23.1 min, p=0.004) than in those without one (56.3+/-32.4 min). The door-to-imaging time (17.8+/-11.0 min vs. 26.9+/-11.5 min, p=0.01) and door-to-needle time (29.7+/-9.6 min vs. 42.1+/-18.1 min, p=0.01) were significantly shorter in the 18 patients for whom there was prehospital notification and who ultimately received t-PA than in those for whom there was no prehospital notification. CONCLUSIONS: Our results indicate that prehospital notification could enable the rapid dispatch of AS patients needing IV t-PA to a stroke centre. In addition, it could reduce intrahospital delays, particularly, imaging processing times.
Emergencies ; Emergency Medical Services ; Humans ; Retrospective Studies ; Stroke ; Tissue Plasminogen Activator

PURPOSE: A rapid, portable, and noninvasive means of detecting increased intracranial pressure (IICP) is required when conventional imaging methods are unavailable. The purpose of this study is to show the predictive value of IICP using ultrasonographic measurement of pulsatility index (PI), through the common carotid artery. METHODS: We performed a prospective study of emergency department patients who have hemorrhage finding on brain conputed tomography (hemorrhage group) and normal group for 9 months prospectively. Hemorrhage group was divided into IICP group and non IICP group by brain CT findings. The PI was calculated using systolic flow velocity and diastolic flow velocity acquired from common carotid ultrasonography. For each patient, brain computed tomography (CT) was also evaluated for signs of IICP. RESULTS: 140 patients were enrolled; 70 patients were normal group and hemorrhage group included 70 patients; 38 had IICP (IICP group) and 32 had no signs of IICP on CT (non IICP group). Mean PI of normal group was 1.46+/- 0.30, non IICP group was 1.40+/-0.31 and mean PI value of IICP group was 2.39+/-0.78. Cutoff value was 1.69, sensitivity was 81.6% and specificity was 81.4%. CONCLUSION: The PI from common carotid artery is a simple, fast, and noninvasive procedure. The PI is a potentially useful tool the assessment of and themonitoring of patients suspected of having IICP.
Brain ; Carotid Artery, Common ; Emergencies ; Hemorrhage ; Humans ; Intracranial Pressure ; Prospective Studies ; Sensitivity and Specificity

Polymyositis is one form of inflammatory myopathy. In some patients, this disease does not entirely respond to conventional initial therapy with glucocorticoid, methotrexate and azathioprine. Multiple options exist for treating these patients, but only intravenous immune globulin has been subjected to a randomized clinical trial. We report here on a case of polymyositis that did not respond to multiple drug therapy, but it did respond to tacrolimus. After treatment with tacrolimus, the patient's disease has been well controlled for many years.
Azathioprine ; Humans ; Immunoglobulins, Intravenous ; Methotrexate ; Myositis ; Polymyositis ; Tacrolimus

PURPOSE: Biochemical markers can help predict neurological outcome in post-resuscitation patients. This prospective study evaluated the prognostic value of serum S100B protein and neuron-specific enolase (NSE) time courses in predicting unfavorable neurological outcomes. METHODS: We serially measured serum S100B protein and NSE levels 12 times during the 96 h after the return of spontaneous circulation (ROSC) in 40 patients. Neurological outcome was assessed at 6 months after cardiac arrest. Patients were divided into good (CPC 1 to 2) and poor (CPC 3 to 5) neurological outcome groups and assessed for cerebral performance category scores. We compared the two groups at each serum value and calculated cut-off values. RESULTS: Serum S100B protein levels over the study period, except at 4 hours, and NSE levels from 14 hours after ROSC were significantly higher in the poor neurological outcome group (n=32) than the good neurological outcome group (n=8). The most predictive serum S100B protein and NSE times were at 14 hours (cut off value=0.16 microgram/L, sensitivity 81.8%, specificity 100%, AUC=0.938) and 54 hours (cut off value=19.21 microgram/L, sensitivity 86.4%, specificity 100%, AUC=0.932). CONCLUSION: Serum S100B protein and NSE levels are early and useful markers for assessing neurological outcome after successful resuscitation from cardiac arrest.
Biomarkers ; Emergencies ; Heart Arrest ; Humans ; Nerve Growth Factors ; Phosphopyruvate Hydratase ; Prognosis ; Prospective Studies ; Resuscitation ; S100 Proteins ; Sensitivity and Specificity ; Sepsis ; Shock, Septic ; Triage

Spontaneous intraperitoneal hemorrhage from uterine leiomyomas is rarely encountered. The cause of hemorrhage is mainly trauma and torsion of myoma. Massive intraperitoneal hemorrhage from spontaneous rupture of a superficial uterine vein overlying a subserous myoma is extremely rare. A 48-year-old woman complained general weakness, lower abdominal discomfort and lower back pain. On admission to the hospital, hypovolemic shock, severe anemia and ascites were noticed. Ultrasonography and CT scan showed huge pelvic mass and much amount of fluid in the pelvic cavity. During emergent laparotomy, 3,500 mL of blood were drained from the abdominal cavity and a ruptured superficial vein was noted, located on the serosal surface of a fundal myoma. We report one case of massive intraperitoneal hemorrhage and hypovolemic shock due to spontaneous rupture of a superficial uterine vein overlying a subserous myoma.
Abdominal Cavity ; Anemia ; Ascites ; Female ; Hemoperitoneum ; Hemorrhage ; Humans ; Laparotomy ; Leiomyoma ; Low Back Pain ; Middle Aged ; Myoma ; Rupture ; Rupture, Spontaneous ; Shock ; Veins

PURPOSE: In cases of locally advanced non-small cell lung cancer (NSCLC), concurrent chemoradiotherapy (CCRT) is the leading therapeutic modality. However, much controversy exists about the chemotherapeutic regimens and radiation methods. MATERIALS AND METHODS: During concurrent chemoradiotherapy, three or four cycles of gemcitabine (500 mg/m2) and cisplatin (30 mg/m2) were administered every two weeks while 50.4 Gy of irradiation was administered in 28 fractions (once/day, 5 treatment days/week) to the tumor site, mediastinum, and the involved lymph node region. In addition, a booster irradiation dose of 18 Gy in 10 fractions was administered to the primary tumor site unless the disease progressed. Two or three cycles of consolidation chemotherapy were performed with gemcitabine (1,200 mg/m2, 1st and 8th day) and cisplatin (60 mg/m2) every three weeks. RESULTS: A total of 29 patients were evaluable for modality response. Response and treatment toxicities were assessed after concurrent chemoradiotherapy and consolidation chemotherapy, respectively. One patient (4%) achieved a complete response; whereas 20 patients (69%) achieved a partial response after concurrent chemoradiotherapy. Following the consolidation chemotherapy, three patients (10.3%) achieved complete responses and 21 patients (72.4%) achieved partial responses. The median follow-up period was 20 months (range 3m39 months) and the median survival time was 16 months (95% CI; 2.4m39.2 months). The survival rates in one, two, and three years after the completion of treatment were 62.7%, 43.9%, and 20%, respectively. Complications associated to this treatment modality included grade 3 or 4 esophagitis, which occurred in 15 patients (51.7%). In addition, an incidence of 24% for grade 3 and 14% for grade 4 neutropenia. Lastly, grade 2 radiation pneumonitis occurred in 6 patients (22%). CONCLUSION: The response rate and survival time of concurrent chemoradiotherapy with biweekly gemcitabine (500 mg/m2) and cisplatin (30 mg/m2) were encouraging in patients with locally advanced NSCLC. However, treatment related toxicities were significant, indicating that further modification of therapy seems to be warranted.
Incidence ; Chemoradiotherapy ; Lung Neoplasms

PURPOSE: Pneumonia is one of the most common infections in children who visit emergency Department(ED), but standard clinical guidelines for children with pneumonia in Korea have not been studied. This study was performed to collect and evaluate a data-base of children with pneumonia for establishing clinical guidelines in ED. METHODS: This study reviewed 304 children who were diagnosed and treated for pneumonia in the ED at one tertiary hospital between January 2003 and December 2003 retrospectively by reviewing the charts and analyzing the clinical characteristics, laboratory findings, and radiologic findings between an admission group and a discharge group. RESULTS: The 2 year-5 year age group was the top of age distribution and the peak incidence of monthly distribution was December. Two hundred forty seven(81.3 percent) children were hospitalized(admission group), and the mean length of hospitalization was 7.24+/-3.24 days. The most common indications of admission were fever, tachypnea and an age of less than three months. There was statistical differences in the outpatient department follow-up between the two groups(85.8 percent in admission group vs 35.1 percent in discharge group). CONCLUSION: More prospective studies are needed to establish clinical standard guidelines for children with pneumonia. This will be helpful in ED management and will aid the prevention of pneumonia.
Age Distribution ; Child* ; Emergencies* ; Emergency Service, Hospital* ; Fever ; Follow-Up Studies ; Hospitalization ; Humans ; Incidence ; Korea ; Outpatients ; Pneumonia* ; Retrospective Studies ; Tachypnea ; Tertiary Care Centers

Penetrating facial wounds are uncommon and are usually life threatening because of the possibility of brain damage. There are three possible pathways for penetrating the cranium through the orbit: via the orbital roof, via the superior orbital fissure, or between the optic canal and lateral wall of the orbit. Brain injuries resulting from the penetrating wounds show extensive parenchymal damage, hemorrhage, and brain edema. Transorbital penetrating wounds can lead to diverse lesions of the optical apparatus, including the eye globe, the optical nerve, and the chiasm. Moreover, intracerebral structures may be hurt, and bleeding and infection may occur. Early diagnosis and prompt debridement are the fundamental factors affecting the outcome of a penetrating facial wound. An 87-year-old man was admitted to the emergency department with a grinder impacted into the medial aspect of the right eye. On presentation, the man was fully conscious with a Glasgow Coma Scale score of 15 and complained of a visual disturbance of the right eye. Computed tomography demonstrated a right orbital medial and inferior wall fracture, a frontal bone fracture, and a contusional hemorrhage in frontal lobe of the brain. A craniotomy with hematoma removal and repair of the orbital floor was done. He showed no neurological deficits except right visual loss. This appears to be the first report of a man with a penetrating facial wound caused by a grinder, who presented with a potentially disastrous craniocerebral injury that did not lead to any serious neurological seguelae.
Aged, 80 and over ; Brain ; Brain Edema ; Brain Injuries ; Contusions ; Craniocerebral Trauma ; Craniotomy ; Debridement ; Early Diagnosis ; Emergency Service, Hospital ; Frontal Bone ; Frontal Lobe ; Glasgow Coma Scale ; Hematoma ; Hemorrhage ; Humans ; Orbit ; Skull ; Wounds and Injuries* ; Wounds, Penetrating

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*