The Value of Delayed KUB and Abdominoplevic CT in the Diagnosis of Bladder Rupture

PURPOSE: Retrograde cystography is the method of choice for the diagnosis of bladder rupture, but recently usage of abdominopelvic CTs has increased at emergency rooms (ERs). METHODS: We reviewed the medical records and radiographs of 36 patients with bladder rupture. Of these, twenty seven patients underwent abdominopelvic CT, delayed kidney-ureter-bladder, and retrograde cystography. Delayed KUB was done about 30 minutes after the abdominopelvic CT. RESULTS: Of the 36 patients with bladder ruptures, 25 had intraperitoneal bladder ruptures, and 9 had extraperitoneal ruptures. One patient had a bladder contusion, and the last patient had combined bladder rupture with intraperitoneal and extraperitoneal ruptures. The abdominopelvic CTs for the bladder rupture patients showed ascites with low density, bladder-wall thickening, perivesical fluid, and irregular bladder contour. In the 24 patients who underwent delayed KUB, spillage of dye was noted intraperitoneal or extraperitoneal cavity. CONCLUSION: If abdominopelvic CT shows ascites with low density, bladder-wall thickening, perivesical fluid, and/or an irregular bladder contour, then a delayed KUB would be a useful method for diagnosing the bladder rupture.

Analysis of Injuries Following the Crash of Chinese Passenger Flight B767-200 During Its Approach to Kimhae Airport

PURPOSE: These days, airline traffic is so developed that the globe has become much smaller and interest in fear of passenger-flight crashes is increasing. Using the opportunity offered by the Kimhae airline disaster, the author studied the relation of the injury mechanism & the seat-position to the injury severity in order to provide helpful information for use in other situations. METHODS: The author performed a retrospective analysis and compared survivors (37 persons) with deaths (129 persons) in the crash of Chinese passenger-flight B767-200 approaching Kimhae airport on April 15, 2002. RESULTS: Most of the survivors were seated in the rear of the airplane while most of those who died were in the front. Thus, a definite correlation exists between seat position in the aircraft and the injury severity. The deceleration force generated during a flight crash is sufficient to induce fatal injury. CONCLUSION: Most flight crashes are due to CFIT (controlled flight into terrain) accidents which are caused by the pilot being insensible to safety. This time, it was also the case. The author wishes it not to be the case next time.

The Value of (99m) Tc-MIBI-Heart SPECT in Myocardial Contusion

PURPOSE: This study analyzed the value of (99m)Tc - M I B I SPECT(Single Photon Emission Com-puted Tomography) in the diagnosis of myocardial contusion after blunt chest trauma . METHODS: We evaluated 24 patients with cardiac contusions after blunt chest trauma who were diagnosed by clinical symptoms, chest x-ray, electrocardiogram(ECG), and Creatine phospho-kinase(CPK). (99m)Tc-MIBI SPECT was performed within 48 hours along with the above tests prospectively. RESULTS: 1. Among the 24 patients, 14 patients were finally diagnosed as having a myocardial contusion by means of ECG, echocardiography, (99m)Tc-MIBI SPECT, and cardiac enzyme. 2. The sensitivity, specificity and accuracy of (99m)Tc - MIBI SPECT were 46.7%, 66.7%, and 54.2%, respectively. The same results for initial ECG were 46.6%, 88.9%, and 62.5%. 3. For those who had positive findings in (99m)Tc - MIBI SPECT, average hospital stay was 14.5 days and abnormal electrocardiogram was found in 90.0%. However, for those who had negative findings, average hospital stay was 11.2 days and abnormal electrocardiogram was found in 35.7%. CONCLUSION: (99m)Tc-MIBI SPECT is not a definite modality in diagnosing myocardial contusion, but can be useful in diagnosing and determining the need for hospitalization after cardiac contusion.

The Value of (99m) Tc-MIBI-Heart SPECT in Myocardial Contusion

PURPOSE: This study analyzed the value of (99m)Tc - M I B I SPECT(Single Photon Emission Com-puted Tomography) in the diagnosis of myocardial contusion after blunt chest trauma . METHODS: We evaluated 24 patients with cardiac contusions after blunt chest trauma who were diagnosed by clinical symptoms, chest x-ray, electrocardiogram(ECG), and Creatine phospho-kinase(CPK). (99m)Tc-MIBI SPECT was performed within 48 hours along with the above tests prospectively. RESULTS: 1. Among the 24 patients, 14 patients were finally diagnosed as having a myocardial contusion by means of ECG, echocardiography, (99m)Tc-MIBI SPECT, and cardiac enzyme. 2. The sensitivity, specificity and accuracy of (99m)Tc - MIBI SPECT were 46.7%, 66.7%, and 54.2%, respectively. The same results for initial ECG were 46.6%, 88.9%, and 62.5%. 3. For those who had positive findings in (99m)Tc - MIBI SPECT, average hospital stay was 14.5 days and abnormal electrocardiogram was found in 90.0%. However, for those who had negative findings, average hospital stay was 11.2 days and abnormal electrocardiogram was found in 35.7%. CONCLUSION: (99m)Tc-MIBI SPECT is not a definite modality in diagnosing myocardial contusion, but can be useful in diagnosing and determining the need for hospitalization after cardiac contusion.

Clinical Analysis of Surgical Results and Preoperative Management of Acute Aortic Dissection / 대한흉부외과학회지

BACKGROUND: Acute aortic dissection associated with high mortality rate has an extremely poor prognosis if early diagnosis and treatment are not received. Recently, with advanced computed tomography and echocardiography, diagnostic rate is higher and early operation is possible. Therefore preoperative medical therapy at ER(emergency room) lowered the mortality rate. This study was done to analyze the results with preoperative management at ER and operations, retrospectively. MATERIAL AND METHOD: A series of 42 patients treated surgically for acute aortic dissections from 1991 to 2001 were included in this study. There were 18 males and 24 females. Mean age was 51.1 years. The admission course through emergency and outpatient department(OPD) was 34 and 8 respectively. RESULT: 26 patients underwent ascending aorta replacement-7 combined aortic valve replacements, 7 patients underwent descending aorta replacements and 9 patients received Bentall's operation. At emergency department, 20 patients received antihypertensive drugs and beta-receptor blockers and 6 patients died. 22 patients did not receive antihypertensive and beta-receptor block drugs and 10 patients died. There were 16(38%) overall deaths. CONCLUSION: Early diagnosis at ER or OPD is essential for acute aortic dissection, and it is important to select the most appropriate noninvasive interventions as possible. Therefore, preoperative drug therapy at ER is suggested according the patient conditions.

Injuries and Their Complications after Urban Area Fires: The Dong-Incheon Live-Hof Restaurant Fire

BACKGROUND: High risks of fire alway exist for buildings in urban areas, especially those in downtown. Crowds, as well as more complex and larger structures, may cause more victims in the event of fire; therefore, emergency medical service plans must be established for such disastrous events. METHODS: On the evening of October 30, 1999, a fire broke out in downtown, Dong-Incheon Live-Hof restaurant; 56 people were killed and 76 were injured. Most of them were teenagers. We retrospectively reviewed the medical records of the victims. RESULTS: 1) Among the 56 dead, 54 died from smoke inhalation, one from extensive burns, and one from sepsis during treatment. 2) Among the 76 injured, 70 patients suffered from smoke inhalation, 53 from burns, and 9 from several types of trauma (sprains, contusions, lacerations, abrasions, fractures, etc.). 3) Later complications were laryngeal edema, pulmonary edema, scar contracture, and hypoxic brain damage, and so forth. 4) Post traumatic stress syndrome was unexpectedly more prevalent in mildly to moderately injured survivors and witnesses than in seriously injured survivors. CONCLUSION: Many complications exist after a fire. Some may be resolved in time, but others may result in permanent sequelae. Early rescue, early triage, and early management during transport by emergency medical service (EMS) personnel can result in fewer complications and a lower mortality rate. Therefore, we propose the establishment of plans to be followed during various major disasters.

Three Cases Of Symptomatic Hyponatremia After Mild Head Trauma

Many patients whose chief complaint is headache caused by accident such as traffic accident, falling, or assaults visit to emergency center. Majority of these patients has mild or moderate symptoms, and there is no need to treat surgically. However, the fact that head injury can cause SIADH(syndrome of inappropriate secretion of antidiuretic hormone) is likely to be overseen. Acute hyponatremia might have been associated with death or permanent brain damage. Hyponatremia is best handled by early recognition and correction of a downward trend in the serum sodium. Unfortunately, this is often difficult in the head-injured patient, where hyponatremia may occur fairly rapidly and is confused by symptoms of head injury. when moderate to severe hyponatremia occurs, it is important to determine its etiology and expeditiously initiate corrective action. There has not been any reported case of the occurrence of symptomatic SIADH after mild head injury in Korea yet. The authors report the experience of three cases of symptomatic SIADH after mild head injury with review of the literatures.