Objective: High-quality intensive care, including targeted temperature management (TTM) for patients with postcardiac arrest syndrome, is a key element for improving outcomes after out-of-hospital cardiac arrest (OHCA). We aimed to assess the status of postcardiac arrest syndrome care, including TTM and 6-month survival with neurologically favorable outcomes, after adult OHCA patients were treated with TTM, using data from the Korean Hypothermia Network prospective registry. Methods: We used the Korean Hypothermia Network prospective registry, a web-based multicenter registry that includes data from 22 participating hospitals throughout the Republic of Korea. Adult comatose OHCA survivors treated with TTM between October 2015 and December 2018 were included. The primary outcome was neurological outcome at 6 months. Results: Of the 1,354 registered OHCA survivors treated with TTM, 550 (40.6%) survived 6 months, and 413 (30.5%) had good neurological outcomes. We identified 839 (62.0%) patients with preClinsumed cardiac etiology. A total of 937 (69.2%) collapses were witnessed, shockable rhythms were demonstrated in 482 (35.6%) patients, and 421 (31.1%) patients arrived at the emergency department with prehospital return of spontaneous circulation. The most common target temperature was 33°C, and the most common target duration was 24 hours. Conclusion The survival and good neurologic outcome rates of this prospective registry show great improvements compared with those of an earlier registry. While the optimal target temperature and duration are still unknown, the most common target temperature was 33°C, and the most common target duration was 24 hours.

OBJECTIVE: The purpose of this study was to test the hypothesis that an increase in the neutrophil-to-lymphocyte ratio (NLR) increases the risk of in-hospital density in patients aged 65 and older, who are hospitalized in intensive care through the emergency rooms. METHODS: A retrospective medical record study was conducted on elderly patients who were admitted to intensive care units via the emergency room. The exclusion criteria were data loss, intensive care unit reentry, cerebrovascular accidents, hematologic disease, and trauma cases. RESULTS: The study included 526 patients; the mean age was 79, and 261 (49.6%) were male. The in-hospital mortality was 18.4% (97 patients). The initial NLR was higher in the non-survivor group than the survivor group, but the difference was not statistically significant (9.82±11.02 vs. 11.48±6.11, P=0.080). In multivariate logistic analysis, the initial NLR had no statistical significance, and the odd ratio was increased from one day later. Comparing the receiver operating characteristic curve of the NLR and Acute Physiology and Chronic Health Evaluation II (APACHE II) and Simplified Acute Physiology Score II (SAPS II) scores, the NLR showed an increase in the area of under curve (AUC) value over time as well as the highest AUC with the SAPS II scores. CONCLUSION In elderly adults, early NLR was found to have weak power to predict in-hospital mortality. Over time, the NLR values more than two days after intensive care unit admission may be useful in predicting the in-hospital mortality for older patients. This may be due to the delay in the immune response and the complex medical history.

PURPOSE: There is increasing interest in intra-abdominal pressure (IAP) and intra-abdominal hypertension (IAH) in critically ill patients. This study investigated the effects and outcomes of elevated IAP in a trauma intensive care unit (ICU) population. METHODS: Eleven consecutive critically ill patients admitted to the trauma ICU at Pusan National University Hospital Regional Trauma Center were included in this study. IAP was measured every 8–12 hours (intermittently) for 72 hours. IAP was registered as mean and maximal values per day throughout the study period. IAH was defined as IAP ≥12 mmHg. Abdominal compartment syndrome was defined as IAP ≥20 mmHg plus ≥1 new organ failure. The main outcome measure was in-hospital mortality. RESULTS: According to maximal and mean IAP values, 10 (90.9%) of the patients developed IAH during the study period. The Sequential Organ Failure Assessment (SOFA) score was significantly higher in patients with IAP ≥20 mmHg than in those with IAP <20 mmHg (16 vs. 5, p=0.049). The hospital mortality rate was 27.3%. Patients with a maximum IAP ≥20 mmHg exhibited significantly higher hospital mortality rates (p=0.006). Non-survivors had higher maximum and mean IAP values. CONCLUSIONS Our results suggest that an elevated IAP may be associated with a poor prognosis in critically ill trauma patients.

PURPOSE: The purpose of this study was to compare with general characteristics affecting ambulatory recovery at one-year after the fixation of intertrochanteric fracture with proximal femoral nail (PFN) of elderly patients over the age of 65 years. MATERIALS AND METHODS: Between September 2008 and September 2015, 152 patients were diagnosed with femoral intertrochanteric fracture in Dong-Eui Medical Center. Of these patients, 75 were available in this retrospective study. Multivariate linear regression analysis, using a stepwise selection method, were performed to identify the prognostic factors affecting one-year postoperative recovery of ambulatory status, such as pre-injury ambulatory status, gender, age, fracture type, associated underlying disease, American Society of Anesthesiologists (ASA) grade, dementia, and complication. RESULTS: A decrease in the one-year postoperative ambulatory status was 68% and pre-injury ambulatory status was regained in 32% of patients. The pre-injury ambulatory status was the most important determinant of one-year postoperative recovery of ambulatory status. The ASA grade and complication were also predictors of recovery of ambulatory status. CONCLUSION: Pre-injury ambulatory status, ASA grade and complication were prognostic factors associated with one-year postoperative recovery of ambulatory status after fixating the intertrochanteric fracture using PFN in elderly patients over the age of 65 years.
Aged* ; Dementia ; Humans ; Linear Models ; Methods ; Retrospective Studies

Calcific tendinitis of the shoulder joint is common disease causing acute pain, mainly involving the supraspinatus or infraspinatus muscle, and less frequently the teres minor or subscapularis muscle. This study reports on the satisfactory arthroscopic removal of calcium deposits as well as infraspinatus and supraspinatus muscle repair without relapse via minimal incision using suture anchors. This was a case of atypically extensive calcific tendinitis involving the infraspinatus muscle, with a bursal side partial rupture of the supraspinatus muscle in a 61-year-old female whose chief complaint was chronic pain of the right shoulder exacerbated by limited movement.
Acute Pain ; Calcium ; Chronic Pain ; Female ; Humans ; Middle Aged ; Recurrence ; Rupture ; Shoulder Joint ; Shoulder* ; Suture Anchors ; Tendinopathy*

BACKGROUND: Facial flushing response to drinking is observed in East Asians with deficient activity of the variant aldehyde dehydrogenase 2 genotype. This study examined the role of flushing response in the relationship between alcohol consumption and dyslipidemia. METHODS: This cross-sectional study included 1,443 Korean men, including 261 non-drinkers, 470 flushers and 712 non-flushers. Based on a questionnaire, weekly alcohol consumption was assessed and categorized into 4 groups. Dyslipidemia was defined by the National Cholesterol Education Program-Adult Treatment Panel III criteria. After adjusting for confounding factors, we evaluated the relationship between weekly alcoholic drinks and dyslipidemia in flushers and non-flushers by comparing with non-drinkers, using a multi-variable logistic regression analysis. RESULTS: Non-flushers had a significant relationship between hypertriglyceridemia and alcohol consumption in two groups (4-8 drinks: adjusted odds ratio [aOR] 1.937, 95% confidence interval [CI] 1.029-3.644; ≥16 drinks: aOR 2.118, 95% CI 1.272-3.527) in contrast to flushers, who showed no significant relationship between hypertriglyceridemia and alcohol consumption. Non-flushers had a significant relationship to low serum high density lipoprotein (HDL) cholesterol levels in four groups (<4 drinks: aOR 0.428, 95% CI 0.277-0.662; 4-8 drinks: aOR 0.409, 95% CI 0.216-0.774; 8-16 drinks: aOR 0.285, 95% CI 0.152-0.536; ≥16 drinks: aOR 0.343, 95% CI 0.207-0.568), and flushers had a significant relationship in two groups (8-16 drinks: aOR 0.234, 95% CI 0.102-0.536; ≥16 drinks: aOR 0.342, 95% CI 0.166-0.705). CONCLUSIONS: Our results suggest that drinking alcohol increases the risk of hypertriglyceridemia in non-flushers and the risk of low HDL cholesterol flushers.
Alcohol Drinking* ; Alcoholics ; Aldehyde Dehydrogenase ; Asian Continental Ancestry Group ; Cholesterol ; Cholesterol, HDL ; Cross-Sectional Studies ; Drinking ; Dyslipidemias* ; Education ; Flushing* ; Genotype ; Humans ; Hypertriglyceridemia ; Lipoproteins ; Logistic Models ; Male* ; Odds Ratio ; Triglycerides

PURPOSE: Rapid activation of the cardiac catheterization laboratory (CCL) is fundamental in the treatment of ST-segment elevation myocardial infarction (STEMI), and it is recommended that emergency department physicians activate CCL as soon as possible, however false positive activation is a major concern. The aim of this study is to assess the relationship between false positive activation and clinical factors available at the time of diagnosis. METHODS: All subjects with CCL activation by an emergency physician between August 2009 and May 2012 were included in this study. False-positive CCL activation was defined as absence of a clear culprit lesion on coronary angiography or by assessment of electrocardiographic and biomarker data in the absence of angiography. RESULTS: Of 222 STEMI activations by emergency physicians, 55 (25%) were false-positive STEMI. Coronary spasm, cardiomyopathy, known CAD, and heart failure were the most common diagnoses among false-positive STEMI. A history of cardiomyopathy (adjusted odds ratio, 13.393; 95% CI, 2.550-70.334; p=0.002), systolic blood pressure<100 mmHg at presentation (adjusted odds ratio, 2.817; 95% CI, 1.129-7.026; p=0.026), no chest pain on admission (adjusted odds ratio, 2.460; 95% CI, 1.162-5.209; p=0.019), and prior coronary disease (adjusted odds ratio, 3.966; 95% CI, 1.828-8.606; p<0.001) independently increased the odds of false-positive STEMI activations. CONCLUSION: False-positive CCL activations were relatively common according to the definition in this study. Various patient-level characteristics were significantly associated with false-positive CCL activation.
Angiography ; Cardiac Catheterization ; Cardiac Catheters ; Cardiomyopathies ; Chest Pain ; Coronary Angiography ; Coronary Disease ; Diagnosis ; Diagnosis, Differential ; Electrocardiography ; Emergencies* ; Emergency Service, Hospital ; Heart Failure ; Myocardial Infarction* ; Odds Ratio ; Predictive Value of Tests ; Spasm

Avulsion injuries of the anterior inferior iliac spine, which is the origin of the rectus femoris muscle, are sometimes reported in children and adolescents, but acute avulsion injuries with complete rupture of the rectus femoris are very rare in adults. We treated a case of avulsion fracture of the anterior inferior iliac spine with suture anchors in an adult and achieved a favorable outcome. Thus, we report the case with a review of literature.
Adolescent ; Adult ; Child ; Humans ; Quadriceps Muscle* ; Rupture ; Spine ; Suture Anchors* ; Sutures*

We report a case of retiform hemangioendothelioma (RH) located in the infratemporal fossa and buccal area in a 13-year-old Korean boy. The tumor originated from the sphenoid bone of the infratemporal fossa area and spread into the cavernous sinus, orbital apex, and retro-nasal area with bone destruction of the pterygoid process. Tumor resection was conducted via Le Fort I osteotomy and partial maxillectomy to approach the infratemporal fossa and retro-nasal area. The diagnosis of RH was confirmed after surgery. In the presented patient, surgical excision was incomplete, and close follow-up was performed. There was no evidence of expansion or metastasis of the residual tumor in the 8 years after surgery. In cases of residual RH with low likelihood of expansion and metastasis, even though RH is an intermediate malignancy, close follow-up can be the appropriate treatment choice over additional aggressive therapy. To date, 29 papers and 48 RH cases have been reported, including this case. This case is the second reported RH case presenting as primary bone tumor and the first case originating in the oromaxillofacial area.
Adolescent ; Cavernous Sinus ; Diagnosis ; Follow-Up Studies ; Hemangioendothelioma* ; Humans ; Male ; Neoplasm Metastasis ; Neoplasm, Residual ; Orbit ; Osteotomy ; Osteotomy, Le Fort ; Sphenoid Bone

PURPOSE: The purpose of this study was to compare the general characteristics that affect the prognosis and evaluate the influence of stroke on one-year postoperative mortality and recovery of ambulatory status in elderly patients over 65 years old with femoral intertrochanteric fracture. MATERIALS AND METHODS: This study included 80 patients who were followed-up for one year after proximal femoral nailing for femur intertrochanteric fracture between January 2008 and December 2013. We analyzed the relationship among the one-year postoperative mortality, recovery of ambulatory status and the associated factors (age, gender, associated underlying disease, American Society of Anesthesiologists [ASA] grade, comminution of the fracture, dementia). RESULTS: The one-year postoperative mortality rate in all patients and patients with stroke was 28.8% and 42.9%, respectively. The one-year postoperative mortality rate was significantly higher in patients with stroke, high ASA grade, and unstable fracture. Decrease of the one-year postoperative ambulatory status was 50.9% in all patients and was significantly associated with grade III or IV ASA rating. No significant relationships were observed between the one-year postoperative recovery of ambulatory status and stroke. CONCLUSION: Stroke, ASA grade, and unstable fracture were prognostic factors associated with one-year postoperative mortality following intertrochanteric fracture. ASA rating was the only prognostic factor affecting one-year postoperative recovery of ambulatory status.
Aged ; Femur ; Hip Fractures* ; Humans ; Mortality ; Prognosis* ; Stroke*