The Clinical Usefulness of Halo Sign on CT Image of Trauma Patients

PURPOSE: This research was performed to determine which clinical signs and symptoms of brain injury are sensitive indicators of skull fracture (SF) and intracranial injury (ICI) in head injured children. METHODS: We conducted a prospective study of minor head trauma in children younger than 2 years of age for a 1-year period. Skull radiographs, brain computed tomography (CT), and data forms, including mechanism of injury, symptoms, physical findings, and hospital course, were completed for each child. RESULTS: Of 137 study subjects, 17 (12.4%) had SF/ICI. Falls were the most common mechanism of injury, and heights of fall above 1 meter were associated with incidence of SF/ICI (p<0.05). Scalp abnormalities were not associated with incidence of SF/ICI. As for clinical symptoms, lethargy and a grouping of features (irritability & vomiting) were associated with incidence of SF/ICI (p<0.05). The incidence of seizure, loss of consciousness, vomiting, irritability, and scalp abnormality did not differ significantly between those with normal radiologic findings and those with SF/ICI. Among asymptomatic patients, 11 (14.5%) patients had SF/ICI, and among patients with normal scalp findings, 9 (12.7%) patients had SF/ICI. CONCLUSION: Clinical signs and symptoms, except for lethargy and a grouping of features (irritability & vomiting), were not sensitive predictors of SF/ICI. Nevertheless, SF/ICI occurred among normal children. In such a case, a liberal policy of CT scanning is warranted.

Comparison of Hypotensive with Non-hypotensive Group in Severe Trauma Patients

PURPOSE: There have been many reports that point to the increasing death and emergency operation rate in traumatic hemorrhagic shock patients. The purpose of this study was to discover the clinical difference between the hypotensive traumatic patients and the non-hypotensive traumatic patients that had been managed in intensive care unit (ICU). METHODS: We retrospectively reviewed the medical records of 122 patients admitted to ICU for trauma from January 2001 to December 2002. We compared the hypotensive (systolic blood pressure (SBP) < 90 mmHg) group with the non-hypotensive group about age, diastolic blood pressure, initial hemoglobin, Injury Severity Score (ISS), Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), transfusion volume at emergency department, blood pH, blood base deficit, duration of admission, ICU stay, death rate, transfusion volume and others. RESULTS: There was no difference between two groups in age, causes of injury, situation whether or not the patient was directly transported from the scene and ISS. But there were differences between two groups in initial hemoglobins, GCS, RTS, blood pH, blood base deficit, duration of admission, ICU stay, and death rate. It was documented that the ICU stay correlated with systolic blood pressure, diastolic blood pressure, initial hemoglobin, blood base deficit, ISS, GCS, and RTS but not correlated with transfusion volume in emergency department. CONCLUSION: Systolic blood pressure is not the sensitive parameter of blood loss. Various kinds of indices of hypotensive group are more severe than non-hypotensive group. If traumatic patients are hypotensive blood pressure on arrival at emergency department, we should be careful of the state of these patients.

Use of Malaria Antibody Test Kit and Clinical Features in Malaria Patients

PURPOSE: Distinguishing malaria from severe infection among febrile patients in emergency room is difficult, so we tried to analyze the clinical manifestations of malaria and the results of using devices as a quick way to detect malaria among febrile patients visiting an emergency medical center (EMC). METHODS: We retrospectively reviewed the clinical records of patients visiting a local EMC from January 2001 to December 2004 and confirmed as having vivax malaria by using a peripheral blood smear and Malaria antibody test (Immunochromatographic assay). RESULTS: All of the 108 included patients were infected with Plasmodium vivax and suffered from high fever, but tertian fever was seen in only 41 patients (37.9%). Various symptoms included headache, myalgia, abdominal pain, and so on. Laboratory findings noted thrombocytopenia, anemia, elevated alanin aminotransferase, and coagulopathies. Malaria antibody test was used in all cases for early diagnosis in the EMC. Compared with the peripheral blood smear, malaria antibody test identified 103 cases as positive, and five cases as negative. The diagnostic sensitivity of the malaria antibody test is 95.3%. CONCLUSION: Since south Korea is a malaria endemic area, for patients visiting an emergency room with a high fever, accompanied by thrombocytopenia and anemia, malaria must be included in the differential diagnosis whether the fever is tertian or not. The Malaria antibody test can be done by even an unskilful person, so it is a very helpful screening test and an early detection tool for malaria.

Dunbar's syndrome (Celiac Artery Compression Syndrome): A Case Report

Celiac artery compression syndrome is a rare disorder and characterized by postprandial intestinal angina caused by insufficient blood supply to the gastrointestinal organs in symptomatic patients. Celiac artery compression syndrome occurs when the median arcuate ligament of the diaphragm causes extrinsic compression of the celiac trunk. It is characterized by the clinical triad, epigastric pain, weight loss and postprandial emesis. The pathophysiologic origin of these symptoms is not clearly understood. Theories involving either a neurogenic or vascular origin for the clinical features associated with celiac artery compression syndrome have been proposed, but objective evidence to support these theories is lacking. We report a case of a 35-year-old man who presented with a two-week history of postprandial abdominal pain, nausea, some emesis, and weight loss.

Spontaneous Splenic Rupture Secondary to a Metastatic Gastric Carcinoma

Pathologic splenic rupture is an uncommon finding associated with a long list of pathologic conditions, including infectious diseases, hematologic diseases, metabolic disorders, drug therapy, primary and secondary benign or malignant splenic tumors, acute or chronic pancreatitis, collagen disorders pregnancy, and others. In this report, we present a case study of a pathologic splenic rupture caused by metastasis from a previously undiagnosed gastric carcinoma.

The Efficacy of Early Computed Tomography in the Diagnosis and Treatment of Bowel Obstruction

PURPOSE: The purpose of this research is to evaluate the efficacy of early computed tomography in the diagnosis and treatment of bowel obstruction. METHODS: The medical records of 108 patients who underwent CT for clinically suspected bowel obstruction were reviewed retrospectively. We compared the emergency department (ED) stay time, the rate of emergent operation, and the days of hospital treatment between two groups. Group 1 have underwent CT within 3 hours, group 2 have done after 3 hours from arrival. RESULTS: After the abdominal CT, Mean ED stay time was shortened significantly. The mean ED stay time was 8.1 hours in Group 1 (n=58), and 18.0 hours in Group 2 (n=50). But We failed to reveal that the early CT is beneficial to emergent operation and total hospital time for bowel obstruction. CONCLUSION: In patients suspected bowel obstruction, Early CT is helpful for diagnosis, treatment and can shorten the ED stay time.

Diagnostic Value of the Triage(R) Cardiac System for Acute Myocardial Infarction: Comparison with Established Devices

PURPOSE: The purpose of this study is to evaluate the diagnostic value of the Triage(R) Cardiac System (Biosite, USA) for quantitative detection of acute myocardial infarction. METHODS: During a three-month period, we prospectively studied the cases of patients who visited the emergency department (ED) with suspicious acute ischemic chest pain. With the exclusion of patients with stable angina (according to ACC/AHA guideline) and non-cardiogenic chest pain, a total of 20 patients were studied. We evaluated the sensitivity and the specificity of the Triage(R) Cardiac System, and we compared the results with those from an established device (Elecsys(R) 1010, Boehringer Mannheim, Germany) by using a Pearson correlation and the student t-test. RESULTS: The mean operating time of the Triage(R) Cardiac System was faster than that of the established device (16 +/- 1.2 min vs 30+/-0.6 min). The sensitivity and the specificity were same for the two devices. The sensitivity and the specificity of CK-MB were 63.6% and 88.9% respectively, and those of cardiac troponin were 54.5% and 100%. In the evaluation of patients who arrived at the ED after 4 hours of symptom onset, the sensitivity and the specificity were high. The Pearson correlation of CK-MB between the two devices was significant (r=0.970, p<0.01). The CK-MB values of acute myocardial infarction were significantly different with unstable angina (Triage(R) Cardiac System: t = 2.857 p = 0.017; Elecsys(R) 1010: t = 2.804 p = 0.018). CONCLUSION: The Triage(R) Cardiac System is a good diagnostic device for acute myocardial infarction, and its fast reporting of the result and its ease to use in the ED are superior to those of the established device.