Preventive effect of biodegradable stents on biliary stricture and fibrosis after biliary anastomosis in a porcine model

Purpose@#The current drain tubes for preventing surgically biliary anastomotic stricture are not naturally and easily removed. If a drain tube using biodegradable material is easily available and the degradation time of the tube is well controlled, surgical anastomotic stricture and fibrosis could be prevented. The aim of this animal study was to evaluate the preventive effect of novel biodegradable stents (BS) on biliary stricture and fibrosis after duct-to-duct (DD) biliary anastomosis. @*Methods@#Ten mini-pigs were allocated to the control group (n = 5) and or the stent group (n = 5). The common bile duct was exposed through surgical laparotomy and then resected transversely. In the stent group, a 4-mm or 6-mm polydioxanone/ magnesium sheath-core BS was inserted according to the width of the bile duct, followed by DD biliary anastomosis. In the control group, DD biliary anastomosis was performed without BS insertion. @*Results@#In the stent group, stents were observed without deformity for up to 4 weeks in all animals. Eight weeks later, histopathologic examination revealed that the common bile duct of the anastomosis site was relatively narrower in circumference in the control group compared to the stent group. The degree of fibrosis in the control group was more marked than in the stent group (3.84 mm vs. 0.68 mm, respectively; P < 0.05). @*Conclusion@#Our study showed that novel BS maintained their original shape and radial force for an adequate time and then disappeared without adverse events. The BS could prevent postoperative complications and strictures after DD biliary anastomosis.

Transcultural Adaptation and Validation of the Family Satisfaction in the Intensive Care Unit Questionnaire in a Korean Sample / 대한중환자의학회지

BACKGROUND: A number of questionnaires designed for analyzing family members' inconvenience and demands in intensive care unit (ICU) care have been developed and validated in North America. The family satisfaction in the intensive care Unit-24 (FS-ICU-24) questionnaire is one of the most widely used of these instruments. This study aimed to translate the FS-ICU-24 questionnaire into Korean and validate the Korean version of the questionnaire. METHODS: The study was conducted in the medical, surgical, and emergency ICUs at three tertiary hospitals. Relatives of all patients hospitalized for at least 48 hours were enrolled for this study participants. The validation process included the measurement of construct validity, internal consistency, and interrater reliability. The questionnaire consists of 24 items divided between two subscales: satisfaction with care (14 items) and satisfaction with decision making (10 items). RESULTS: In total, 200 family members of 176 patients from three hospitals completed the FS-ICU-24 questionnaire. Construct validity for the questionnaire was superior to that observed for a visual analog scale (Spearman's r = 0.84, p < 0.001). Cronbach's αs were 0.83 and 0.80 for the satisfaction with care and satisfaction with decision making subscales, respectively. The mean (± standard deviation) total FS-ICU-24 score was 75.44 ± 17.70, and participants were most satisfied with consideration of their needs (82.13 ± 21.03) and least satisfied with the atmosphere in the ICU waiting room (35.38 ± 34.84). CONCLUSIONS: The Korean version of the FS-ICU-24 questionnaire demonstrated good validity and could be a useful instrument with which to measure family members' satisfaction about ICU care.

Transcultural Adaptation and Validation of the Family Satisfaction in the Intensive Care Unit Questionnaire in a Korean Sample / 대한구급학회지

BACKGROUND: A number of questionnaires designed for analyzing family members' inconvenience and demands in intensive care unit (ICU) care have been developed and validated in North America. The family satisfaction in the intensive care Unit-24 (FS-ICU-24) questionnaire is one of the most widely used of these instruments. This study aimed to translate the FS-ICU-24 questionnaire into Korean and validate the Korean version of the questionnaire. METHODS: The study was conducted in the medical, surgical, and emergency ICUs at three tertiary hospitals. Relatives of all patients hospitalized for at least 48 hours were enrolled for this study participants. The validation process included the measurement of construct validity, internal consistency, and interrater reliability. The questionnaire consists of 24 items divided between two subscales: satisfaction with care (14 items) and satisfaction with decision making (10 items). RESULTS: In total, 200 family members of 176 patients from three hospitals completed the FS-ICU-24 questionnaire. Construct validity for the questionnaire was superior to that observed for a visual analog scale (Spearman's r = 0.84, p < 0.001). Cronbach's αs were 0.83 and 0.80 for the satisfaction with care and satisfaction with decision making subscales, respectively. The mean (± standard deviation) total FS-ICU-24 score was 75.44 ± 17.70, and participants were most satisfied with consideration of their needs (82.13 ± 21.03) and least satisfied with the atmosphere in the ICU waiting room (35.38 ± 34.84). CONCLUSIONS: The Korean version of the FS-ICU-24 questionnaire demonstrated good validity and could be a useful instrument with which to measure family members' satisfaction about ICU care.

Delays in Reperfusion of Patients with ST Elevation Myocardial Infarction: According to Mode of Transportation and Arrival Time

PURPOSE: The aim of this study was to evaluate the time delays in reperfusion of patients with ST elevation myocardial infarction (STEMI) according to the mode of transportation and patient arrival time. METHODS: An observational study of patients with STEMI treated with primary percutaneous coronary intervention (PCI) was performed from January 2004 to May 2009. The patients were classified into several subgroups according to the transportation method (self-transportation, EMS, and transfer) and patient arrival time (regular hours: weekdays, 7 AM~6 PM, off-hours: weekdays, 6 PM~7 AM, weekend and holiday). The symptom-to-door time (STDT), door-to-balloon time (DTBT), and the timeline to reperfusion were compared in each group. RESULTS: The median STDTs, DTBTs and the percent of the timeline to reperfusion (DTBT < or =90 min) differed significantly according to the transportation mode (p<0.001, respectively). Especially, the transfer group had longer median STDT (200 min, IQR 120~330), shorter median DTBT (80 min, IQR 66~102) and a significantly higher rate of achieving a timely DTBT (64.8%), compared to the other groups (self-transport and EMS use). Compared to the regular hour group, the offhour group had a shorter STDT (129 min vs. 180 min, p=0.016) and longer DTBT (99 min vs. 81 min, p<0.001). The percent of patients achieving a timely DTBT was much lower during off-hours (41.1% vs. 61.5%, p<0.001). CONCLUSION: The results of this study showed that the transfer group and regular hour group had a significantly shorter median DTBT, and the timeline for reperfusion was longer in the transfer group compared to the regular hour group in this study.

Short-term Outcomes of the Combination of Vasopressin and Epinephrine versus Epinephrine Alone for Out-of-hospital Cardiac Arrest: A Prospective Observational Study

PURPOSE: A recent study demonstrated that the effects of vasopressin were superior to epinephrine in patients with asystole. According to the Korean national registry of out-ofhospital cardiac arrest (OHCA), more than 2/3 of paients had asystole. This study was performed to evaluate whether the combined administration of vasopressin and epinephrine in the emergency department (ED) for patients with OHCA would increase survival and survival discharge. METHODS: From October 2007 to June 2008, we changed the cardiopulmonary resuscitation (CPR) protocol in adult, non-traumatic OHCA in that 40 U of vasopressin was to be administered as soon as possible followed by epinephrine (VSP group). Data about cardiac arrest were collected using the Utstein templates. Data from January to September 2007, when vasopressin had not been used, were also collected for comparative analysis (EPN group). These two groups were compared in terms of rate of survival and survival discharge. RESULTS: There were 59 and 62 patients in the EPN group and the VSP group, respectively. There were no significant differences in the baseline characteristics including age, cardiac rhythm of asystole, witnessed arrest, and bystander CPR. Survival was similar between the EPN group and VSP group (46% vs 57%, p=0.240) as was survival discharge (20% vs 15%, p=0.398, respectively). CONCLUSION: The combination therapy of vasopressin and epinephrine during CPR for OHCA does not show any survival advantage over epinephrine alone.

The Effect of Hypothermia on the Gene Expression of Inducible NOS and NF-kappaB in the Lung in Hemorrhagic Shock in Rats

PURPOSE: In previous studies, therapeutic hypothermia (HT) in hemorrhagic shock (HS) had beneficial effects on the hemodynamic and metabolic parameters, and on the survival. The mechanism is uncertain. We hypothesized that the suppression of inducible nitric oxide synthase (iNOS) and NF-kappaB could be associated with the beneficial effects of therapeutic HT in HS. METHODS: Sixteen male Sprague-Dawley rats were randomized to normothermia (36~37degrees C, NT group) or moderate hypothermia (27~30degrees C, HT group). They underwent volumecontrolled (2 ml/100 g weight) HS (90 minutes) and partial resuscitation with shed blood (1 ml/100 g). RESULTS: In the HS and post-resuscitation phase, the mean arterial pressures were higher in the HT group than in the NT group and PaO2 was higher in the HT group than in the NT group. The lactate level was lower in the HT group than in the NT group (1.1+/-1.1 nmol/L vs 6.4+/-5.0 nmol/L, p=0.021). Serum concentrations of IL-1 beta and IL-6 and activated p65 NF-kappaB levels in the lung tissue were higher in NT group than in the HT group (p<0.05). Lung malondialdehyde contents and the expression of iNOS mRNA were significantly decreased in the HT group compared to the NT group (63.8+/-6.2 nmol/g vs 44.6+/-4.5 nmol/g, p<0.001; 1313.0+/-924.4 vs 9088.4+/-3984.0 arbitrary units, p<0.001, respectively). CONCLUSION: These data suggest that in HS, therapeutic HT inhibits lipid peroxidation, activation of NF-kappaB, and gene expression of iNOS in the lung. These factors might be the mechanism of the beneficial effects of HT in HS.

Is the Six-hour Fasting before Abdominal Computed Tomography Necessary to Prevent Gastrointestinal Adverse Events in Patients with Abdominal Pain?

PURPOSE: We tried to determine whether six-hour fasting before abdominal computed tomography (CT) scan is necessary to prevent aspiration of gastric contents in patients with acute abdominal pain. METHODS: Adult patients with acute abdominal pain who were checked abdominal CT were enrolled. Exclusion criteria were age 7 days), renal impairment and hypersensitivity to contrast media. We compared Group-I ( or =6-hour fasting). We collected the demographic and clinical data on the causes of abdominal pain, pain duration, presence of nausea and vomiting, and use of medications before and after abdominal CT. In order to estimate the volume of gastric contents, we measured the area on the CT image which showed the largest volume of gastric contents. RESULTS: Among the 122 patients, Group-I consisted of 38 patients(31.1%) and Group-II included 84(68.9%). The demographic makeups of the two groups were similar, except for gender proportion (more males in Group-I). Group-I showed significantly greater gastric contents compared than Group-II(46.8+/-32.1 vs. 33.7+/-28.3, p=0.024). A slightly negative correlation (r=-0.2313; 95% CI=-0.3929 to -0.0559) was observed between the fasting time and the volume of gastric contents. However, the frequencies of the nausea [13/38 (34.2%) vs. 26/84 (31%), p=0.721] and vomiting [6/38 (15.8%) vs. 18/84 (21.4%), p=0.468] showed no difference between two groups. There were no aspiration events in either groups. CONCLUSION: Six hours of fasting before abdominal CT may not be required to prevent aspiration of gastric contents in patients with acute abdominal pain.

Etomidate Should be Used Carefully for Emergent Endotracheal Intubation in Patients with Septic Shock

Etomidate and midazolam are the most popular drugs among the induction agents for emergent endotracheal intubation. The purpose of this study was to compare the incidence of adrenal insufficiency and mortality between the septic shock patients who received etomidate (ETM group) and those who received midazolam (MDZ group). Between November 2004 and September 2006, 65 patients were analyzed in this study. The hospital mortality rate was 36% in the ETM group (n=25) and 50% in the MDZ group (n=40), which was not statistically significant (p=0.269). The incidence of relative adrenal insufficiency was significantly higher in the ETM group than in the MDZ group (84% and 48%, respectively; p=0.003). On multivariate analysis, the use of etomidate was the only significant factor affecting the incidence of relative adrenal insufficiency (odds radio, 5.59; 95% confidence interval, 1.61- 19.4). In conclusion, we think that physicians who treat patients with septic shock should be aware that etomidate can cause adrenal insufficiency, and should start corticosteroids if etomidate is administered.

Are We Using the Appropriate dose of Sedatives during RSI? : Retrospective Observational Study in Two Emergency Centers

PURPOSE: The use of rapid sequence intubation (RSI) by emergency physicians in emergency departments is increasing. Our aim was to evaluate the current practice of RSI, focusing particularly on the appropriateness of sedative dose. METHODS: We retrospectively investigated RSI cases in two urban emergency centers occurring between June 2005 and May 2006. We calculated the sedative dose used per patients' weight and divided into a low dose group (less than the minimum recommended dose) and a full dose group. We investigated the differences between these two groups, including hemodynamic changes, success rates and complication rates. RESULTS: Of 745 cases of endotracheal intubation performed, 211 cases were defined as RSI cases. The mean sedative dose was 0.29 mg/kg (+/-0.08 SD) for etomidate and 0.08 mg/kg (+/-0.03 SD) for midazolam. Sedatives were underdosed in 56.3% of etomidate cases and 82.1% of midazolam cases, for a mean underdose rate of 63.6%. Drops in SBP (systolic blood pressure) were significantly different between the etomidate and midazolam groups (-14.4 mmHg vs -22.43 mmHg, p=0.04), but there was no significant difference in SBP between low dose and full dose groups. The overall complication rate was 17.1%, was again with no significant difference between full dose and low dose groups. CONCLUSION: Overall, sedatives were underdosed in 63.6% of cases with midazolam more frequently underdosed than etomidate. However, the underdosing of sedatives was not significantly correlated with the first pass rate or the complication rate.

Is Oral N-acetylcysteine Effective on the Prevention of Radiocontrast induced Nephropathy in Patients with Acute Renal Failure?

PURPOSE: N-acetylcysteine (NAC) has been known to have protective effects on the prevention of radiocontrast induced nephropathy (RCIN) in chronic renal failure (CRF). We investigated the effects of NAC in acute renal failure (ARF). METHODS: From January to June 2006, we retrospectively enrolled patients with ARF who were checked with contrast computed tomography (CT) at an emergency department. We divided patients into the NAC group and the control group. We compared baseline demographic characteristics, underlying diseases, infused fluid volume, blood urea nitrogen (BUN), and serum creatinine (Cr) level before and after CT scan. ARF was defined as serum Cr>1.5. mg/dL. RCIN was defined as an increase in serum Cr level of at least 0.5 mg/dL or 25% 48 hours after CT. RESULTS: Of a total 106 cases, 23 patients were the NAC group and 83 were the control group. There were no significant differences in baseline findings including underlying disease, cause of ARF and serum Cr level. The volume of infused fluid before and after CT were not different between the two groups (before; p=0.183 after; p=0.149). After CT scan, BUN and serum Cr level were decreased without statistical significance in both groups (NAC vs control group: BUN; 21.0+/-12.9 vs 20.5+/-14.2 p=0.863 Cr; 1.3+/-0.5 vs 1.4+/-0.5 p=0.451). RCIN developed in total 3 cases, 2 cases in the NAC group and 1 in the control group (p=0.524) and one of the NAC group performed hemodialysis. CONCLUSION: In case of patients with ARF, there was no protective effect of NAC on RCIN.

Usefulness of Clinical Treatment Protocol on the Acute Pyelonephritis for Diabetic and Elderly Female Patients

PURPOSE: To know the feasibility of ED observation unit treatment for acute pyelonephritis (APN) in women with diabetes or older age. METHODS: From January 2006 to February 2007, we enrolled adult women APN patients with diabetes or older age (65 years old or more) prospectively, and managed them with predetermined written protocol including intravenous ciprofloxacin, anti-pyretics, anti-emetics, and hydration. After 6 hour observation, we evaluated the patients to be admitted or not according to the protocol (the after group). From May 2003 to December 2005, data of ED visited APN patients were collected retrospectively for comparison (the before group). We compared the admission rates, re-visits to ED, and ultimate admission rates in older or diabetic patients in the before- and after-protocol group. RESULTS: 55 and 39 diabetic cases were enrolled respectively in the before- and after group respectively. The initial admission rate in diabetic patients was significantly lower in the after group (31.6% vs 76.4% p<0.001) and the revisit rate was not significantly different (p=0.586). In older patients, 95 and 57 cases were enrolled respectively. The initial admission rate was significantly lower in after group (69.5% vs 42.1%) and the revisit rate was not statistically different (p=0.452). CONCLUSION: For diabetic and older women patients with APN, ED observation unit treatment protocol can be applied safely and shows significant decrease in admission rate.

Experience of a Korean Disaster Medical Assistance Team in Sri Lanka after the South Asia Tsunami

On 26 December 2004, a huge tsunami struck the coasts of South Asian countries and it resulted in 29,729 deaths and 16,665 injuries in Sri Lanka. This study characterizes the epidemiology, clinical data and time course of the medical problems seen by a Korean disaster medical assistance team (DMAT) during its deployment in Sri Lanka, from 2 to 8 January 2005. The team consisting of 20 surgical and medical personnel began to provide care 7 days after tsunami in the southern part of Sri Lanka, the Matara and Hambantota districts. During this period, a total of 2,807 patients visited our field clinics with 3,186 chief complaints. Using the triage and refer system, we performed 3,231 clinical examinations and made 3,259 diagnoses. The majority of victims had medical problems (82.4%) rather than injuries (17.6%), and most conditions (92.1%) were mild enough to be discharged after simple management. There were also substantial needs of surgical managements even in the second week following the tsunami. Our study also suggests that effective triage system, self-sufficient preparedness, and close collaboration with local authorities may be the critical points for the foreign DMAT activity.

Clinical Presentations, Diagnosis, and Treatments of a Psoas Abscess

PURPOSE: A psoas abscess is a rare, but life-threatening disease. We report 11 cases of a psoas abscess in adults and discuss its clinical presentations, diagnosis, and treatments. METHODS: Retrospective analysis of patients who presented to the emergency department with a psoas abscess from Jan. 2000 to Aug. 2004 was conducted. RESULTS: Of the 11 patients with a psoas abscess, 9 (81.8%) had a secondary psoas abscess. The most common causes of the secondary psoas abscess were various invasive procedures, such as acupuncture, a nerve block, etc. The main clinical presentations were fever (72.7%) and back pain (45.5%). The mean time to presentation was 12.0+/-10.6 days. All patients had leukocytosis and elevated CRP. Computed tomography (81.8%) and magnetic resonance imaging (18.2%) were performed for the diagnosis. The mean diagnostic lag time (from admission to the treatment) was 7.8+/-7.5 days. All patients received intravenous antibiotics. Four patients (36.4%) underwent surgical drainage, and three patients (27.3%) underwent percutaneous drainage. Two patients (18.2%) were treated with simple aspiration, and another two (18.2%) received no procedure. Six patients (54.5%) had complications. Three (27.3%) had a recurrent abscess, and two (18.2%) had a epidural abscess. In one patient, femoral neuropathy developed. The time from clinical presentation to diagnosis in the complication associated group was longer than it was in complication non-associated group (27.5+/-19.6 vs 10.6+/-3.2 days, p=0.03). CONCLUSION: A psoas abscess is difficult to diagnose because of vague clinical symptoms and can have serious complications if the diagnosis is missed or delayed.

The Role of MRI in Spinal Cord Injury Without Radiographic Abnormality

PURPOSE: Spinal cord injury without radiographic abnormality (SCIWORA) usually has been documented in pediatric patients. We report 8 cases of SCIWORA in adult and evaluate the diagnostic and prognostic value of MRI in SCIWORA. METHODS: We retrospectively studied adult patients who presented to the emergency room of a tertiary army hospital with SCIWORA, from Jan. 2001 to Dec. 2002. We reviewed the patient 's medical records, plain films, CT and MRI findings. RESULTS: There were 8 patients of SCIWORA during 2 years. Major mechanisms of injuries were sports-related injury (62.5%) and fall (25%). They presented with central cord syndrome (62.5%), Brown-Sequard syndrome (12.5%), monoparesis (12.5%), and sensory symptom only (12.5%). All patients were checked with MRI and five patients (62.5%) showed abnormal MRI findings including spinal cord hemorrhage, edema, and disc herniation. All patients received megadose methylprednisolone therapy, and three underwent operations. Patients, who had been recovering at the time of admission to our ER, had normal MRI findings, and all patients with normal MRI findings had full neurological recovery within 3 days. Only two patients had neurological sequelae, and their MRI findings were spinal cord hemorrhage and herniated disc with cord compression, respectively. CONCLUSION: SCIWORA in adults, even though rare, exists, and MR imaging findings determine treatment plan and neurological outcome of patients.

Descriptive Study of Prognostic Factors of Exertional Heat Stroke in Military Personnel

PURPOSE: This study was designed to evaluate the characteristics of exertional heat stroke between the non-survival and the survival groups. METHODS: From January 1996 to December 2002, patients with exertional heat stroke who came to the emergency department of a military hospital were enrolled. Data on individual factors, atmospheric conditions, pre-hospital management, initial vital signs, laboratory findings, presence of seizure attack, and performance of intubation were reviewed retrospectively and compared between the nonsurvival and the survival groups. RESULTS: During the study period, 22 patients were diagnosed as suffering from exertional heat stroke and 5 patients died. Most of the episodes occurred during the summer days with high ambient temperature (mean 30.6+/-3.0 degrees C) and humidity (mean 75.6+/-7.7%), and 13 patients were unacclimatized recruits. The non-survival group showed a lower initial systolic blood pressure, platelet count, arterial pH, and HCO3 - level, and a higher serum creatinine, ALT, and amylase level than did the survival group (p<0.05). However there were no significant differences in individual factors, atmospheric conditions, pre-hospital management, initial pulse rate, temperature, white blood cell count, hemoglobin count, and the sodium, potassium, BUN and AST levels between the two groups. CONCLUSION: Initial systolic blood pressure, platelet count, and arterial pH, as well as HCO3 -, serum creatinine, ALT, and amylase levels seem to be important factors for the prognosis of exertional heat stroke.

Clinical Analysis of Octreotide in Varix Bleeding

PURPOSE: This study was conducted to confirm the effects of octreotide in patients with variceal bleeding. METHODS: We performed a retrospective analysis of 26 patients with variceal bleeding, who visited the Emergency Center of Seoul National University Hospital from January 1st to June 31st, 1996, the control group, and a prospective analysis of 28 patients with variceal bleeding, who visited the Emergency Center of Seoul National University Hospital from March 1st to August 31st, 1999, for the octreotideinfused group. The octreotide-infused group recieved a continuous infusion of octreotide, 25 microgram/hr, for 5 days after an initial bolus of 50 microgram. When active bleeding continued over 1 hour, over 5 pints of packed-RBC were needed for transfusion within 24 hours, or when the systolic blood pressure was under 90 mmHg, a ballon tamponade with Sengstaken-Blackemore tube was used. T-test and X2 test were used for statistical analysis(p<0.05). RESULTS: Forty-one patients were male(octreotide-infused group 22, control group 19) and 13 were female(octreotide-infused group 6, control group 7). The mean age was 55 years(octreotide-infused group 56 years, control group 52 years). There were no significant differences in vital signs, hemoglobin/hematocrit levels, and Child-Pugh's classifications between the octreotide-infused group and the control group initially. There was a significant difference in the rates of early bleeding control within 24 hours(p<0.05), but there were no significant differences in the rates of rebleeding, mortality within 1 week, and use of a balloon tamponade. CONCLUSION: Variceal bleeding is a serious complication of liver cirrhosis and has a high mortality rate. Octreotide is an effective vasoactive agent for control of early bleeding. Thus, octreotide should be used first before endoscopic definitive therapies, to stabilize the vital signs of patients and to secure a field for endoscopic procedures.

Clinical Analysis of Phalloides Syndrome

BACKGROUND: To review the important features and treatment modalities of phalloides syndrome. METHOD: We performed a retrospective analysis of 16 patients with phalloides syndrome who visited the Emergency Center of Seoul National University ospital, Uijongbu St. Mary 's Hospital, Gachon Medical College Hospital, and Kyungpook National University Hospital from July 1st to August 31st, 1998. Mann-Whitney U test was used for statistical analysis(p < 0.05). RESULTS: 9 were male and 7 were female. The mean age was 54 years(men 46 years, women 65 years). Fourteen cases(88%) occurred in Kyungpook area. All cases of phalloides syndrome RESULT:ed from mistaking toxic mushrooms for edible mushrooms. The doses of ingestion of mushroom were not available because the patient could not remember the exact amounts. The identification of mushrooms in 4 cases was confirmed by mycologist, 6 cases by mushroom photoatlas, and remained 6 cases were not confirmed. The initial symptoms of mushroom poisoning were abdominal pain, nausea, and watery diarrhea. The time intervals from the ingestion of mushroom to the onset of symptom were from 6 to 13 hours(mean 11.3 +/-2.68 hours). The laboratory data showed the increased GOT and GPT, prolonged prothrombin time, elevated serum creatinine level, and decreased platelet count. The initial management of phalloides mushroom poisoning was done conservatively, but the early specific treatments such as gastrointestinal decontamination, administration of activated charcoal, IV penicillin or silymarin were not perfomed in all cases. The mortality rate was 18.8%. There were significant differences in total bilirubin, prothrombin time, platelet count, and serum creatinine between survival and non-survival group(p<0.05). CONCLUSION: It is important to know the morphological differences between edible and toxic mushroom for prevention of phalloides syndrome. If the patient with acute gastroenteritis has a history of mushroom ingestion, the emergency physician should suspect phalloides syndrome and start early proper treatment. For the identification of mushroom, it is desirable to contact a mycologist.

Problems in Completing a Death Certificate

BACKGROUND: This study was conducted to analyze the current problems in completing death certificates and to identify the correct method for completing death certificates. METHODS: We reviewed 262 death certificates in three hospitals from March 1 to April 30, 2000, and 119 death certificates in one hospital from March 1 to 31, 2000. We identified major and minor errors and analyzed and compared them retrospectively. RESULTS: A total of 381 death certificates were reviewed: 59 in Seoul National University Hospital, 101 in Ewha Woman's University Hospital, and 102 in Gachon Medical College Hospital, which has no education program for completing death certificates in postgraduate training, and 119 in Samsung Medical Center which has an education program for completing death certificates. 358 certificates(94.0%) had at least one error. There were only 23 death certificates(6.0%) without an error. In 182 cases(47.8%), there was one major error. In 321 death certificates(84.3%), there were more than two errors. A comparison of Samsung Medical Center with the other hospitals showed that the number of total errors was statistically different(p=0.001). CONCLUSION: There were few death certificates without an error in this study. In a hospital which has postgraduate training in completing death certificates, there are fewer errors than in other hospitals which have no training course. Emergency physicians actually certify many deaths, so they must know the correct method of completing death certificates for statistics on morbidity and mortality.