Simple Removal Method of Esophageal Blunt Foreign Bodies

PURPOSE: Patients with esophageal foreign bodies are difficult to treat in an emergency room. Conventional endoscopic and fluoroscopy guide Foley's catheter removal methods are time consuming, expensive, and often not even possible in an emergency room. To resolve this difficulty, Thus I sought an alternative simple method using Foley's catheter without fluoroscopy. METHODS: I reviewed retrospectively patients with esophageal blunt foreign bodies. The subjects consisted of 40 patients who had been treated with a Foley's catheter without fluoroscopy from May 2000 to December 2002 at the emergency room. RESULTS: Of all 40 cases, 27 patients had foreign bodies lodged in the first esophageal constrictor; 10 patients in the second; and 3 patients in the third. The success rate was 40/40 (100%). In 36 patients, the foreign bodies were removed at the first try. In the remaining 4 patients, they were removed at the second try. Side effects were crying (36 cases), vomiting (18 cases), slightly bloody vomitus (12 cases), sore throat (12 cases), slightly nasal bleeding (6 cases). No serious complications were observed. The average time of removal was 38 minutes. The quickest removal was done in 10 minutes; the longest in 58 minutes. CONCLUSIONS: The simple Foley's catheter removal method is a safe, cost-effective and time-saving method, and does not require the use of endoscopy or fluoroscopy. Moreover, minimal training is required to perform the procedure. Compared to conventional methods, the technique is equally effective and avoids the risk of general anesthesia. The possibility of an esophageal coin foreign body developing into a serious complication may be time-dependent (how fast a patient is treated) rather than the modality-dependent.

Clinical Characteristics and Effects of Pain Trigger Point Injection on Myo-fascial Pain Syndrome Patients Visiting the Emergency Room

PURPOSE: Myofascial pain syndrome (MPS) is thought to be, the least understood and most frequently misdiagnosed disease. With appropriate diagnosis, pain trigger point injection has been proven its effectiveness, so I investigated the usefulness of pain trigger point injection for the treatment of MPS. METHODS: Twelve patients with clinical MPS were evaluated. Pain trigger points were identified by using the positive jump response to the operator's finger pressure. After the pain trigger points had been identified, 2 ml of lidocaine (Travel's technique) were injected. RESULTS: Of the total of 12 patients investigated, include self-diagnosis, 6 (50%) were misdiagnosed mainly as neurosis. These 12 patients had 33 pain trigger points. The pain trigger points were distributed mainly in the chest, 8 patients (66%), and 25 points (76%). As to the duration of pain, in 10 patients, the pain dramatically disappeared within 5 minutes. In the remaining two patients improved symptoms were noted within 20 minutes after injection. CONCLUSIONS: The proper diagnosis of MPS, which is frequently misdiagnosed as neurosis, or some other physiologic and psychologic diseases was the first step and the mainstay in the treatment of MPS. This study suggests that in the diagnosis of MPS, the most practically useful method in the emergency room is to confirm the positive jump response, including tout band and referred pain, by using finger pressure. Pain trigger point injection therapy was dramatically effective, so hopefully it will be available allow clinicians as a possible treatment to better care for patients suffering from MPS.

A Study of Patients with Suicidal Attempt

This study was designed to investigate clinical characteristics and outcome of patient with suicidal attempt. A retrospective analysis by chart review of 130 cases of patients with suicidal attempt who visited emergency department of Dankook University Hospital from January 1998 to December 1998. The results were as follows; 1. The ratio of patients with suicidal attempt to total patients who visited emergency department was 0.7%. The highest suicidal attempt rates were among aged 20-39. The gender ratio is similar. 2. Suicidal attempt were more common in summer, July, Friday, evening. 3. The most common place of suicidal attempt was home. 4. Drug ingestion was the most common method of suicidal attempt. Drug used for suicidal attempt were agricultural drug including organic phosphorus and carbamate, and therapeutic drug. 5. Common motives of suicidal attempt were marriage conflict, family conflict. 6. The intensity of will to die was more strong in old aged male. 7. Suicidal attempt associated with alcohol drinking was 39.2%. 8. Common symptoms or signs of intoxication were neurological and gastrointestinal.