Subcapsular Hematoma of the Spleen from Chronic Pancreatitis: A Case Report

Since the pancreas and the spleen lie in close proximity, splenic complications during the course of pancreatitis are possible, but uncommon. No previously published report in Korean has described splenic subcapsular hematoma due to pancreatitis, and we now report one such case.

Prognostic Factors in Duodenal Ulcer Perforation

PURPOSE: There has been controversy over an adequate operative method for peptic ulcer perforation, but currently there is general agreement in the surgical literature that perforated duodenal ulcers in patients who constitute excessive surgical risk should be managed by the simplest possible procedure and in the absence of surgical risk, definitive operations are advocated. However, an accurate description of the degree of severity of concurrent medical disease and surgical risk factor is not available and the question as to whether the postoperative mortality is influenced by the magnitude of the procedure or determined only by the patient's risk remains unanswered. METHODS: This retrospective study reviewed the case histories of all patients who underwent operations for perforated duodenal ulcer at Gil Medical Center from January 1993 through 1998 and evaluates the influences of prognostic factors, APACHE II, SAPS, age, duration of peritonitis, concurrent major medical disease and ulcer size, and operative procedures on postoperative mortality in high risk and low risk groups. RESULTS: Large APACHE II score (> or =15) and SPSS (> or =10), delayed operation, large ulcer (> or =2 cm), age (> or =60), and major medical illness that severely compromised cardiorespiratory, hepatic, renal, and immunologic function were associated significantly with mortality in patients with a perforated peptic ulcer. CONCLUSION: Age, duration of peritonitis, major medical disease, APACHE II score, and ulcer size should be pre-sumed to be important prognostic factors. Although further study is necessary in a larger number of patients, it appears that operative procedures have no influence on postoperative mortality.

Evaluation of Pertinence in Prehospital Triage and Management by Paramedic's Reports

BACKGROUND: Recently, patients' demands for emergency medicine are increasing, and most of prehospital medical care, including basic life support, cardiopulmonary resuscitation and triage, are provided by paramedics or emergency medical technicians. Evaluation of the adequacy of prehospital management and triage has become important for improving the quality and the effectiveness of the emergency medical system. METHODS: The 202 patients who were transferred by ambulance with paramedics, nurses, or emergency medical technicians to the Emergency Department in Gil Medical Center from July 1, 1999, to September 31, 1999, were enrolled. This study was conducted prospectively by using the emergency physician's log and newly devised protocols recorded by paramedics or nurses. RESULTS: 1) Male to female ratio was 1:0.8, and the peak age of the patients were the 4th(18.8%) and 6th decade(15.3%). 2) Of the 202 patients, 84 patients were transferred for trauma and 118 for medical problems. The mean transfer time was 6+/-1.73 minutes. 3) The validities of prehospital triage and decisions using the trauma severity measure and the disease severity measure, were 33.3% in trauma patients and 57.6% in medical patients. 4) The results for the adequacy rate in prehospital management analyzed by using the rate of necessity of treatment, performance of treatment, and adequate treatment were as follows: oxygen supply, 38.1/41.6/93.8; wound dressing, 19.3/71.8/92.9; immobilization of the cervical spine, 15.8/56.3/92.9; application of a spinal board, 12.9/42.3/72.7; application of a splint, 9.9/50.0/60.0; manual maintenance of an airway, 9.9/55.0/63.6; and CPR, 4.5/66.7/0.5) Kind of ALS(Advanced Life Support) were not conducted(peripheral IV, EKG, intubation medical administration, defibrillation, pacing). The rates of necessity of treatment were as follows: peripheral IV, 40.6%; ECG monitoring, 23.3%; endotracheal intubation, 8.9%; medical administration, 8.9%; defibrillation, 3.5%; and pacing, 1.5%. CONCLUSION: The adequacy of prehospital triage and decisions using trauma and disease severity measures was relatively low. To improve the adequacy of BLS(Basic Life Support) and to increase the performance of ALS(Advanced Life Support), we must create challenges to develop new protocols and to supplement new equipment.

The Role of Fine Needle Aspiration Cytology of Salivary Gland Tumors

BACKGROUND: Controversy exists concerning the utility of fine needle aspiration cytology (FNAC) in diagnosing salivary masses. Thus, the goal of this study was to evaluate the efficacy of preoperative fine needle aspiration cytology compared with those of frozen section (FS) and final histopathologies in terms of sensitivity, specificity, accuracy and pitfalls. METHODS: A total of 66 aspirates were from the salivary gland, 50 (75.8%) from the parotid gland and 16 (24.2%) from the submandibular gland, from Jan. 1990 to Jul. 1998. The results from 49 of 66 aspirates were compared with the results from frozen-section pathology. RESULTS: The 66 cases included 59 cases of benign lesions (49 cases of pleomorphic adenomas, 4 cases of basal cell adenomas, 3 cases of Warthin's tumors, and 3 cases of other benign tumors) and 7 cases of malignant lesions (3 cases of mucoepidermoid carcinomas and 4 cases of other malignant tumors). The accuracy in distinguishing malignant from benign lesions was 89.4% for FNAC. The sensitivity, the specificity, and the type-specific accuracy of FNAC were 89.7%, 96.3%, and 70.0%, respectively. A comparison of the cytopathologic diagnosis and the FS diagnosis was made. The accuracy of the FS in distinguishing malignant lesions was 93.8%. The sensitivity, the specificity, and the type-specific accuracy of FS were 80.0%, 95.4%, and 87.7%, respectively. The salivary gland tumors mainly misdiagnosed in FNAC were basal-cell adenomas and Warthin's tumor in benign disease and mucoepidermoid carcinomas in malignant tumors. CONCLUSION: Though FNAC still has some problems and pitfalls, the comparative accuracies of FNAC and FS are similar. A review of the value of FS diagnosis in the surgical treatment of salivary gland lesions suggests that FS diagnosis alone should not determine the surgical management of salivary gland tumors. FNAC is a sensitive and specific diagnostic tool and is complementary to a frozen section biopsy of a salivary gland mass.