A Clinical Analysis of Ectopic Pregnancy in an Emergency Room

The incidence of ectopic pregnancy is apparently increasing in recent years. In order to gain greater insight into the diagnosis and management of ectopic pregnancies, this study was undertaken on 100 patients with ectopic pregnancy(admitted via ER) who were operated and confirmed by histopathological study at the department of Obstetrics and Gynecology of Hallym University(Kangdong Sacred Heart Hospital) from January, 1996 to June, 1997. The results were as follows; 1. The hospital incidence of ectopic pregnancy was 1 in 11.6 deliveries(168/1954). 2. The most frequent age group was in 25-34 years of ages(58%). 3. Nullipara was 32 cases(32%) and number of cases who had 1, 2 and 3 deliveries were 35(35%), 31(31%) and 2(2%) respectively. 4. The most frequent number of pregnancy was second times(24%) and 65% of cases have been experienced artificial abortion. 5. In the past history, of possible predisposing factors, 65% had at least one abortion, 17% ectopic pregnancy, 17% cesarean section and 13% had previous laparoscopic tubal sterilization, but 19% showed no special distinct. 6. The main clinical symptoms are 96% in lower abdominal pain, 95% in amenorrhea and 65% in vaginal spotting and bleeding. 7. The most frequent interval between LMP and onset of symptoms was 6-8 weeks(49%). 8. Urine hcG test was positive in 94.9% and culdocentesis was positive in 94.3%. 9. In initial hemoglobin level, more than 11.0g% was 55%, however less than 10.0g% was 20%. 10. In initial systolic blood pressure at hospital, most of them were under normal condition, however 30% were under 90mmHg. 11. The amount of intraabdominal hemorrhage under 500cc was 42%(highest rate), 25% under 500cc-1000cc(second rate) and 6 cases overed 200cc. 12. The site of ectopic pregnancy was 88% in fallopian tube, 9% in uterine conus, 2% in intraabdomen and 1% in cervix. 13. The most common surgical procedure was ipsilateral salpingectomy(82%), of which 22 cases were operated by laparoscopy. 14. There was no fatal case in 100 ectopic pregnancy.

A Clinical Review of Intussusception of Infancy and Childhood in Emergency Department

Intussusception is a condition of invagination of the proximal segment of bowel into the more distal receiving bowel. Intussusception is one of the common pediatric and surgical emergencies of infancy and childhood in Korea. Intussusception is the most common cause of acquired intestinal obstruction in infancy and childhood, and it needs emergency treatment. 1) On the age and sex distribution, the age under 15 month was the most common(70.6%), and the peak incidence was 3-12 months of age(60.1%). In sex distribution, male to female ratio was 1.25:1. 2) The seasonal distribution was summer(27.4%), spring, autumn and winter in order of frequency. 3) As to the etiology of Intussusception treated by surgery, idiopathic was the most common(75%). 4) The cardinal symptoms and signs were vomiting(72.5%), bloody or bloody mucoid stool(57.5%), abdominal pain(49.7%), abdominal distention(20.9%), abdominal mass(19.6%) and others in order of frequency. 5) On the hematologic finding, 60.8% revealed leukocytosis above 10,000/mm3. 6) As to the duration from the onset of the symptom to admission, 84.2% was within 24 hours, 9.8% was from 24 hours to 48 hours, and 5% was over 48 hours. 7) The common anatomical types were ileocolic(73.2%), and ileocecal(17.0%). 8) The success rate of air reduction was 84.3%. 9) In the method of operation, manual reduction was performed in 91.7% and intestinal resection in 8.3%. 10) The recurrence rate after air reduction was 12.4% and after operative manual reduction was 8.3%.

Clinical review and evaluation of the blunt traumatic diaphragmatic injury

OBJECTIVE: Sixteen cases of blunt diaphragmatic injury were clinically reviewed during 10 years from Oct.1987 to Jun.1996 at the Kangdong sacred heart hospital. The age and sex distribution were ranged from 3 to 67-old-years. The most common age range was between third decades to fifth decades in 10 cases(62.50%) and occurred predominantly in male, the sex ratio was 4.3 : 1.(M:F 4.3:1) The modes of blunt diaphragmatic injury were due to motor vehicle accidents(MVA), motor cycle accidents(MCA), fall down(FD) and others. Most common injuries were responsible for MVA. MVA were pedestrian traffic accidents 5 cases (41.7%), driver 4 cases(33.3%) passenger 3 cases(25.0%). In the blunt diaphragmatic injury sites, the left-sided diaphragmatic injury had predominant[left-sided cases 10(62.50%), right-sided cases 6(37.50%)]. Cost common symptoms and signs were chest pain or chest discomfort(81.25%) and dyspnea(68.75%), abdominal tenderness(50.00%), decreased bowel sound and breath sound(50.00%) and others. All of 16 cases in blunt diaphragmatic injury were associated with other injuries. The associated injuries were hemopneumothorax 14(87.50%), hemoperitoneum 7(43.759o), liver injury 7(43.75%), orthopedics fracture 14(87.50%), head injury 5(31.25%) and others. The diagnostic methods were used with simple x-ray, ultrasonogram and computed tomogram. The preoperative diagnosis of blunt diaphragmatic injury were suggested in 10 cases(62.509o) and others were confirmed during operation. The thirteen cases of all of sixteen cases were performed emergency operation within eight hours. The herniated intraabdominal organs through ruptured diaphragm were presented in 10cases(62.5%) [stomach 7 cases(43.75%), spleen 6 cases(37.50%), colon 3 cases(18.75%), liver 3 cases(18.75%), small bowel and omentum 2 cases(12.50%), respectively]. The mean size of blunt diaphragmatic injury were 7.7cm, right-sided mean size were 9cm, left-sided mean size were 6.9cm. The most common site of blunt diaphragm- atic injury were presented in anteromedial site 7 cases(43.75%). Simple chest x-ray revealed abnormal finding [hemothorax 10cases(62.50%), pneumothorax 4cases(25.00%), herniated organ into thorax8 cases(50.00%), diaphragm elevation 3 cases(18.75%) and others]. The postoperative complication were associated in 10 cases(62.50%) out of 16 cases. Common complications were pleural effusion 6 cases(37.50%) and atelectasis 3 cases(18.75%). Injury severity score(ISS) value of 16 cases in the blunt trauma ranged from 10 to 59. It was presented with mean value of ISS(35.5),mean value of ISS survivors(35) and nonsurvivors(55.5). Revised trauma score(RTS) value ranged also from 4 to 12. There were revealed with mean value of RTS(9.7),mean value of RTS survivors(10) and nonsurvivors(6.5). All of the blunt traumatic injury, mortality rate was related to the values of ISS and RTS.

Prognostic Values of Symptom-Limited Exercise Test Early after Acute Myocardial Infarction

BACKGROUND: Uncomplicated myocardial infarction is often the harbinger of future cardiac events such as unstable angina, recurrent myocardial infarction or death. The prognostic utility of exercise test(pre-discharge low level exercise test) in patients recovering from acute myocardial infarction(AMI) has been documented by many studies. However there are few data of the safety and value of a symptom-limited exercise test early after AMI. We performed this study to assess the safety of test and the prevalence of abnormal response to symptom-limited exercise test and to determine the ability to predict future cardiac events. METHODS: The study group comprised 91 patients(male ; 73, Anterior infarction ; 43, Q-wave infarction ; 68, Thrombolysis ; 58, Age ; 57+/- years) with uncomplicated AMI. Symptom-limited exercise tests were performed before discharge(8.7+/-0.5 days after infarction) using modified Bruce protocol. Exercise test was considered positive if there was new > or =1mm horizontal or downsloping ST segment depression at 0.08sec after J point compared with baseline. The patients were followed for the development of new cardiac events. RESULTS: 1) The mean duration of exercise test was 14.2 min(range 4.3 - 21.5)and the mean workload(Metabolic Equivalents : METs) was 6.0 METs(range 2.1 - 17.0). There were no complications during exercise test and post-recovery phase. 2) There were positive test in 31 patients(34%), ST segment elevation in 10(11%), and inadequate blood pressure(BP) response in 10 patients(11%). 3) During the follow-up period(1-50 months, mean 12.5 months), 9 patients experienced post-myocardial infarction angina and revascularization therapy, respectively, and 1 patient had cardiac death and recurrent myocardial infarction, respectively. 4) The patients with cardiac events had a significantly higher degree in stenosis of infarct-related artery(90+/-3 vs 78+/-3, p<0.05) and lower systolic BP on peak exercise(136+/-7 vs 156+/-4, p<0.05). 5) The positive exercise test was associated with cardiac events in the follow-up period but ST-segment elevation, inadequate BP response, the use of thrombolytic agents, and non-Q wave infarction did not predict future cardiac events. CONCLUSIONS: The symptom-limited exercise tests early after acute myocardial infarction appear to be safe and will identify more patients with inducible myocardial ischemia relatively. The posive test can predict cardiac events and the prognosis of patients of this group can be improved with aggressive management and careful follow-up.