Suicide attempts presenting to the emergency department before and during the COVID-19 pandemic: a comparative study

Objective@#To compare and analyze the differences in the sociodemographic and clinical characteristics of suicide attempters who visited an emergency department (ED) before and during the coronavirus disease (COVID-19) pandemic. @*Methods@#This single center, retrospective study was conducted by reviewing the medical records of patients in the “self-injury/suicide” category of the National Emergency Department Information System who visited an ED between January 2019 and December 2020. We obtained information on baseline characteristics, suicide attempt, and disposition. Data were analyzed using the chi-squared test. @*Results@#A total of 456 patients were included. The number of patients visiting the ED for suicide attempts increased by 18.2% (from 209 to 247 cases) during the COVID-19 pandemic, and the ratio of suicide attempters to the total number of ED visits increased by 48.8% (from 0.43% to 0.64%, P<0.001). There were significant differences in methods of suicide attempt, endotracheal intubation, ED disposition, and the presence of mental illness. Drug overdose (42.1% vs. 53.4%) and gas inhalation (5.7% vs. 8.5%) increased, and hanging decreased (6.0% vs. 2.0%) during the pandemic. Endotracheal intubation (13.9% vs. 5.7%) and intensive care unit admission (29.7% vs. 14.6%) decreased. More patients with the history of mental illness visited during the pandemic (54.0% vs. 70.1%). @*Conclusion@#Since the COVID-19 pandemic began, suicide attempts have increased in this single ED although the lethality of those attempts is low.

Surgical Treatment of Chronic Lateral Ankle Instability: Repair versus Reconstruction / 대한족부족관절학회지

Surgical treatment to restore stability in the ankle and hindfoot and prevent further degenerative changes may be necessary in cases in which conservative treatment has failed. Anatomical direct repair using native ligament remnants with or without reinforcement of the inferior retinaculum is the so-called gold standard operative strategy for the treatment of lateral ankle instability. Non-anatomical lateral ligament reconstruction typically involves the use of the adjacent peroneus brevis tendon and applies only those with poor-quality ligaments. On the other hand, anatomic reconstruction and anatomic repair provide better functional outcomes after the surgical treatment of chronic ankle instability patients compared to a non-anatomic reconstruction. Anatomical reconstruction using an autograft or allograft applies to patients with insufficient ligament remnants to fashion direct repair, failed previous lateral ankle repair, high body mass index, or generalized ligamentous laxity. These procedures can provide good-to-excellent short-term outcomes. Arthroscopic ligament repair is becoming increasingly popular because it is minimally invasive. Good-to-excellent clinical outcomes have been reported after short and long-term follow-up, despite the relatively large number of complications, including nerve damage, reported following the procedure. Therefore, further investigation will be needed before widespread adoption is advocated.

Beef from the United States: Is It Safe?

No abstract available.

Clinical Usefulness of T wave Inversion in Lead aVL of ECG on Acute Coronary Syndrome Patients

PURPOSE: The aim of the study is to evaluate the clinical usefulness of a TWI in the lead aVL of 12-lead ECG for predicting the left ascending artery (LAD) lesion, high risk, and 30-days mortality in patients with acute coronary syndrome (ACS). METHODS: A total of 275 patients who underwent coronary angiography under the diagnosis of ACS were analyzed retrospectively from Jan 2012 to December 2013. RESULTS: A total of 355 patients underwent coronary angiography. Of these, 275 patients (77.5%) were diagnosed with ACS. Of these, 187 patients (68.0%) had a left LAD lesion. Of these, 111 patients (59.3%) had a mid-LAD lesion. Of these, only 23 patients (22.5%) showed a TWI in the aVL lead. However, regarding the prediction of the high risk group, if there is a TWI in the aVL, when compared with patients without a TWI in the aVL, the high risk rate is four times higher in the univariable logistic regression analysis and 2.687 times higher in the multivariable logistic regression analysis. CONCLUSION: A TWI in the lead aVL of ECG of patients with chest pain in the ER was closely associated with high risk of ACS patients.

Study of a Modified Two-person Cardiopulmonary Resuscitation Method to Provide Effective Ventilation: Analysis Based on a Rescuer's Training Proficiency

PURPOSE: The purpose of this study is to compare the modified two-person cardiopulmonary resuscitation method (MM) (the first resuscitator performs chest compressions and squeezes the bag of bag-valve-mask (BVM) during pauses of compression, and the second resuscitator uses two hands to provide an open airway) using the conventional two-person cardiopulmonary resuscitation method (CM). METHODS: This simulation study used a manikin and a cross-over execution design and included 102 participants. After practice of CM and MM, participants were randomly assigned a partner. Each pair of participants performed the 2-CPR for five cycles using both methods alternately at random. All data were recorded in a personal computer and analyzed. RESULTS: Data from 510 cycles each of the CM and MM were analyzed. The MM generated a higher mean tidal volume (TV) (791.2 ml versus 563.8 ml, P<0.001) and more frequent visible chest ventilation (92.1% versus 64.7%, P<0.001). For the inexpert resuscitator group (50; 49%), the MM generated more frequent visible chest ventilation (88.6% versus 34.0%, P<0.001) and ventilation with an adequate TV (43.6% versus 32.0%, P<0.001). No significant difference in compression rate, depth, hand position, and release, and minimal difference of hands off time (0.5s) were observed between the two methods. CONCLUSION: The CM could not easily provide sufficient visible chest rise and might be a poor ventilation option for inexpert BVM resuscitators. The MM can be useful as an alternative method and preferable to the CM for inexpert BVM resuscitators.

Retnal Toxicty of Intravitreal Tissue Plasminogen Activator with C3F8 Injection in Rabbit Eyes

PURPOSE: To determine the concentration at which a mixed injection of tissue plasminogen activator (tPA) and C3F8 gas is toxic, we studied the histopathological changes in the rabbit retina. METHODS: Only tPA was injected into the right vitreous cavities of 18 normal pigmented rabbits at doses of 25 micro gram/0.1mL, 50 micro gram/0.1mL, and 100 micro gram/0.1mL, 6 rabbits per dosage. In the same rabbits, tPA and C3F8 (0.2cc) were simultaneously injected into the left vitreous cavities at doses of 25 micro gram/0.1mL, 50 micro gram/0.1mL, and 100 micro gram/0.1mL. All of the eyes were examined by slit lamp biomicroscopy and indirect ophthalmoscopy at 5, 10, and 15 days after the injection, and then they were enucleated for histopathological evaluation. RESULTS: Retinal pigmentary alterations were centered around the injection site 3 days postoperatively in the eyes receiving doses of 50 micro gram/0.1mL or greater. On light microscopy(LM), the involved areas showed vacuolization in the photoreceptor elements and the inner nuclear layer(INL) at a dose of 25 micro gram/0.1mL at postoperative 5 days and the vacuolar changes disappeared at postoperative 15 days. But at doses of 50 micro gram/0.1mL or greater, loss, contracture, and vacuolization of the photoreceptor outer segment (POS) and vacuolization of INL were noted at postoperative 15 days. On LM, at a dose of 25 micro gram/0.1mL, the involved areas showed vacuolization in POS and mitochondrial swelling of the photoreceptor inner segment (PIS) at postoperative 5 days. The mitochondrial swelling of PIS disappeared at postoperative 15 days. However, at doses of 50 micro gram/0.1mL or greater, loss and contracture of POS and mitochondrial swelling of PIS were noted at postoperative 15 days. The retinal damage from simultaneous injection of tPA and C3F8 at doses of 25, and 50 micro gram/0.1mL was equal to or less than that of only tPA injection, whereas at a doses of 100 micro gram/0.1mL the damage was greater. CONCLUSIONS: At doses of 50 micro gram/0.1mL or greater, irreVersible retinal toxicity was noted histopathologically in rabbit eyes. At doses of 25, and 50 micro gram/0.1mL, the degree of retianl damage did not seem to be affected by whether C3F8 was injected concomitantly or not.

The Usefulness of 3D-Surface Rendering of the MRI in Surgical Treatment of Patients with Intractable Neocortical Epilepsy

BACKGROUND: This study is designed to indicate the role of 3D-surface rendering of the MRI in defining and resect-ing the epileptogenic zone. METHODS: 25 healthy volunteers and 55 patients were studied. Conventional MRI and 3D-surface rendering were performed. Sulcal and gyral patterns were assesed by a neuroradiologist and a neurologist with-out the clinical informations. Chronic video-EEG monitoring with surface and subdural grid electrodes, and PET were done. Resection was performed based on data of the EEG recordings and 3D-surface rendering. RESULTS: Conventional MRI identified structural abnormality ("MRI-identifiable lesion") in 20 patients. 20 of 35 patients without structural abnormality in conventional MRI revealed abnormal sulcal and gyral patterns in 3D-surface rendering of MRI ("3D-identifiable lesion"). Subdural grid EEGs recorded focal or diffuse ictal EEG onset from the region of "3D-identifiable lesion". Histopathologic findings revealed cortical dysplasia in 48 and neocortical gliosis in seven. Overall surgical out-come, at the average follow up period of 32.5 months, showed class I in 63.6%, class II in 25.5%, and class III in 10.9%. Among 20 patients with "MRI-identifiable lesion", 80% were in class I and 20% were in class II. Among 35 patients without "MRI-identifiable lesion", 54.3% were in class I, 28.6% were class II, and 17.1% were in class III. 80% of 20 patients with "3D-identifiable lesion" showed class I and 20% of 15 patients without "3D-identifiable lesion" showed class I. CONCLUSIONS: Identification of "MRI-identifiable lesion" or "3D-identifiable lesion" was of value in defining the epileptogenic zone. Resection of "MRI-identifiable lesion" or "3D-identifiable lesion", which were epilep-togenic in EEGs, promised a good surgical outcome.

Comparison of Diode-Pumped, Frequency-Doubled Neodymium: YAG Laser and Blue-Green Argon Laser Iridotomy

PURPOSE: The solid-state, continuous-wave, frequency-doubled neodymium:yttrium-aluminum-garnet (Nd:YAG) laser pumped by diode laser has several advantages, including air cooling, higher electrical to optical efficiency ratios, and portability. The authors evaluated the use of the frequency-doubled Nd:YAG laser for peripheral iridotomy and compared with the argon blue-green laser. METHODS: Laser peripheral iridotomy was performed on 64 eyes of 47 patients with acute or chronic primary angle-closure glaucoma and narrow angles capable of closure. Thirty-one eyes of 25 patients were treated with frequency-doubled Nd:YAG laser and 33 eyes of 22 patients were treated with argon laser. Postoperative intraocular pressure, visual acuity, preoperative and postoperative medication, number of laser spots, and failure of patency were compared. RESULTS: Postlaser 1hr intraocular pressure elevation greater than 10 mmHg 1hr was seen in one (3.2%) of frequency-doubled Nd:YAG laser treated eyes and six (17.6%) of argon laser-treated eyes (p=0.055). The failure of patency was seen less often in frequency-doubled Nd:YAG laser than in argon laser (9.7% vs 27.3%, p=0.081). The number of laser spots was greater in frequency-doubled Nd:YAG laser than in argon laser (p=0.069). Preoperative, postoperative 1hr, 1day, 1mon, 3mons intraocular pressure, visual acuity, preoperative and postoperative antiglaucomatous medication, number of laser spots, and failure of patency were similar in the two groups. CONCLUSIONS: The above results suggest that the frequency-doubled Nd:YAG laser was at least as effective and appears to be as safe as the argon laser. However, laser iridotomy with frequency-doubled Nd:YAG laser may be more difficult than the argon laser.

Management of Exposed Porous Orbital Implant with Autogenous Dermis Graft

PURPOSE: This study was to evaluate the effectiveness of autogenous dermis graft in managing the exposed porous orbital implants. METHOD: Nine cases with exposed orbital implants(hydroxyapatite or Medpor(R)) were included in this study: six cases with hydroxyapatite and the remaining three cases with Medpor(R). Each of the cases was repaired with autogenous dermis graft. RESULTS: The mean follow-up was 13.3 months. Of nine cases, seven implants remained covered at the last visit. During the follow-up period, three of them received a second dermis patch graft surgery for re-exposure. The final success rate was 77.7%. CONCLUSION: These results suggested that autogenous dermis graft served as an excellent material for repair of the exposed porous orbital implants.

Results of Microsurgical Anterolateral Tunnel Approach for Cervical Disc Herniation

OBJECTIVE: The authors report the microsurgical anterolateral tunnel approach for the treatment of the cervical disc diseases and its postoperative surgical results. METHODS: All surgical procedures followed the method of classical microsurgical anterior discectomy. Small tunnel(7-8mm) was made on the disc space reaching to the posterior longitudinal ligament. The disc materials and bony spurs were removed through this tunnel. Thirty-one patients of cervical disc herniation(24 cases with pure disc herniation, 7 cases with combined cervical spondylosis) were evaluated on the symptoms, conformation in plain X-ray, C-T, and MRI. The follow up time was over 2 years . RESULTS: Postoperatively the result(following the out come scale) was excellent and good in Twenty-nine patients. One with fair result showed remnant disc particle and spur and another one is combined with cord contusion. One patient with lesion in C 3-4 space and two cervicothoracic junction showed excellent result. Two patients with osteoporosis also showed good results. Cervical spine curvature and disc space height were not changed on the plain X-ray and MRI in all patients. Twenty-nine patients were discharged within 3 days after surgery without any postoperative complications. CONCLUSIONS: The microsurgical anterolateral tunnel approach could be indicated for the treatment of patients with cervical disc diseases and with difficulty in achieving interbody fusion(the higher cervical level and cervicothoracic junction, osteoporosis etc.).

Inhibitory Effect of Antibody to alphavbeta5 in Corneal Angiogenesis

PURPOSE: This study investigated the importance of alphavbeta5 function during vascular endothelial growth factor (VEGF) induced corneal angiogenesis by examining the effects of antibody to alphavbeta5 that blocks alphav 5-mediated cell adhesion to vitronectin. METHODS: A hydrogel disk containing 500 ng of VEGF was implanted into the superior corneal stroma of each of sixteen New Zealand white rabbit eyes. Each eye also received a second hydrogel disk placed adjacent to the first, randomized to contain either 40 g of antibody to alphavbeta5 (n=8) or phosphate-buffered saline (PBS)(n=8). Both disks were positioned 1.2 mm apart from the superior limbus. Eyes were examined daily under a stereomicroscope by two observers and assigned an angiogenesis score based on number and length of new blood vessels. RESULTS: On days 3 through 7 postimplantation, angiogenesis scores were significantly lower in eyes treated with antibody to alphavbeta5 (averaged score=16.33) as compared to eyes treated with PBS (averaged score=26.52)(P<0.05, Wilcoxon signed rank test). CONCLUSIONS: In a rabbit corneal micropocket assay, antibody to alphavbeta5 inhibits corneal angiogenesis induced by VEGF. Substances that target the integrin alphavbeta5 subunit may have therapeutic potential in disorders characterized by ocular neovascularization.

Repair of Telecanthus with Titanium Miniplate in Blepharophimosis Syndrome

Telecanthus in congenital blepharophimosis has traditionally been repaired with conventional methods such as medial canthal tendon tucking and transnasal wiring.We report 2 cases of patients with telecanthus who underwent repair with titanium miniplate. After the anterior limb of medial canthal tendon was dissected, its insertion site was drilled and a titanium miniplate was fixed with screws.The dissected medial canthal tendon was fixed with 4-0 mersilene to a miniplate hole.After the surgery, we obtained a mean decrease of 11 mmin intermedial canthal distance and no complications except scar in incision site. We believe that this procedure has advantages such as short operation time, precise placement of the medial canthal tendon.For these reasons, it seems to be an excellent alternative to transnasal wiring, but considers this operation because of scar in incision site.

Surgical Outcome and Intraoperative Electrophysiological Monitoring in Selective Posterior Rhizotomy

Selective posterior rhizotomy(SPR) has been known to reduce the spasticity as well as to improve the quality of life in patients with intractable spasticity. Twenty patients underwent SPR under intraoperative electrophysiological monitoring (IOM). Fifty-two percent of sacrolumbar rootlet were cut after electrical stimulation. Eighteen patients(90%) with spastic type of cerebral palsy showed marked reduction of spasticity and functional improvement without any complication. The patients who did not respond to SPR had mixed types of spasticity. IOM facilitate the selection of pathological rootlets regardless of anaesthetic level, intensity of electrical stimulation, and individual variability of responses. It is concluded that careful selection of surgical candidates and of pathological rootlets under IOM are important to reduce the spasticity, thereby to obtain a better outcome.

Postural Reduction in Compression Fracture of Spines

121 patients with cervical(45 patients), thoracolumbar(76 patients) compression or mild burst fractures from January 1984 to December 1994 were studied:98 patients were treated postural reduction with hyperextension posture and 23 patients were with postural reduction and surgical methods. We compared the initial and post-reduction compression height ratio, wedge angle and kyphosis angle of compression fractures. The results were not only expansion of a compressed vertebral body but also successful fusion. The neurological recovery status according to Frankel classification was also improved after postural reduction. Most of the compression fractures or stable burst fractures of the cervical, thoracolumbar spines can be restored by the postural reduction.

The Effect of Astigmatic Control after Cataract Extraction with Temporal Incision

A group of 25 preoperative against-the-rule(AR) eyes had undergone phacoemulsification and posterior chamber lens implantation, 15 of them prepared with lateral(temporal) scleral pocket incision and 10 with superior scleral incision. Temporal incision group showed early AR astigmatism increment by about 1 diopter(D), which decayed slowly over the next 2 months. Superior incision group showed early with-the-rule (WR) astigmatism by about 2.5D, which shifted toward AR astigmatism at postoperative 10 day and the AR astigmatism increased substantially by the next 2 months. The early postoperative complications were hyphema(2 eyes, 13.3%) and corneal edema(1 eye, 6.7%) in the temporal incision group, which cleared spontaneously within 1 week pctoperative. There were no hyphema and corneal edema in the superior incision group. In summary, the temporal incision effectively achived rapid post-operative astigmatic recovery with strong axial stability in a manner that surgically induced astigmatism favorably reduces pre-existing AR astigmatism.

Two Cases of Iridoschisis

Iridoschisis is a very rare condition occurining in either sex, usually bilaterally. Glaucoma occurs in approximately 50% of the cases, and other ocular defects may be present in iridoschisis. It is considered as a degenerative process related to senescene. We experienced two cases of typical iridoschisis and report the cases with a review of the literature because iridoschisis is not reported yet in our country.

Consecutive Cyclic Esotropia Developing after Strabismus Surgery for Intermittent Exotropia

Cyclic esotropia is a very rare and specific entity. Cyclic esotropia is sometimes developed in a patient following strabismus surgery for intermittent exotropia. The term of 'consecutive cyclic esotropia' was suggested for this clinical entity. Three cases of consecutive cyclic esotropia have been reported in U.S.A., Canada and Japan, and only one case has been reported in Korea. We experienced two cases of consecutive cyclic esotropia which developed 10 months and 1 year after strabismus surgery for intermittent exotropia at our hospital. The patients underwent bimedial rectus recessions and results are uniformly good, with straight eyes and fusion. The cyclic pattern does not recur. We report these patients with a review of the literature.

Isolated Lateral Ventricle after V-P Shunt

Isolated lateral ventricle after ventriculoperitoneal shunt for hydrocephalus can occur by obstruction of foramen of Monro. Two cases of isolated lateral ventricles after ventriculoperitoneal shunt are reported. Patients showed neurological deterioration and brain CT scan revealed unilateral dilatation of lateral ventricle after ventriculoperitoneal shunt. They were successfully managed by another shunt system into dilated lateral ventricle.

Intramedullary Spinal Hemangioblastoma Associated with Syringomyelia

Intrameduallary spinal hemangioblastoma is frequently associated with syringomyelia. It grows slowly and can be removed totally. Syringomyelia can be subcided by total removal of tumor and opening of syringomyelia. Two cases of intramedullary spinal hemangioblastomas associated with syringomyelia are reported. Intramedullary tumor and syrinx was easily diagnosed by magnetic resonance imaging(MRI). They are successfully managed by total removal of tumor and opening of syrinx. Patients showed improved neurological status after operations.