The predictive factors for hospitalization of nonurgent patients visiting an emergency department in an urban area: a single center study

OBJECTIVE: Emergency department (ED) visits by nonurgent patients are controversial because they are considered one of the causes of ED overcrowding and an example of the improper use of medical resources. On the other hand, some non-urgent patients do require hospitalization. The purpose of this study was to compare hospitalized and discharged patients who were classified as nonurgent upon their initial ED visit and identify the predictive factors associated with hospitalization in nonurgent patients visiting an ED. METHODS: Among a nonurgent patient group visiting an urban university hospital ED in 2016, the hospitalized and discharged patients were compared. RESULTS: A total of 13,988 nonurgent patients were analyzed, of which 773 (5.5%) were hospitalized. The predictive factors related to hospitalization for nonurgent patients were as follows: male, age 65 years or older, ED visits during outpatient clinic availability, and in the evening, heart rate greater than 100 per minute, respiration rate greater than 20 per minute and body temperature over 38℃ CONCLUSION: Among nonurgent patients, there are patients who require hospitalization. If these predictive factors are considered in the initial ED triage, it should improve the safe treatment of nonurgent patients and improve the efficiency of the use of limited resources.

Formulation Characteristics of Three Kinds of Elravie(R) Fillers / 대한피부과학회지

BACKGROUND: Hyaluronic acid (HA) is a mucopolysaccharide that occurs naturally throughout the human body, where it attaches to collagen and elastin to form cartilage, and also helps maintain the strength and flexibility of the cartilage that cushions joints. A decline in HA synthesis may lead to a variety of symptoms, ranging from joint discomfort, to wrinkles. Cross-linked HA is a viscoelastic solid that resists in vivo degradation by hyaluronidase for much longer than endogenous HA, and which is also a key ingredient in various cosmetics. OBJECTIVE: To describe our experience with three kinds of Elravie(R) fillers. METHODS: We obtained images of filler shape using a folliscope. Scanning electron microscopy (SEM) was used to compare particle sizes. Hydrophilic filler is a hydroxyl, and for this reason, we mixed the filler with water. Next, PARKER ink was added to the mixture, and viscosity and elasticity were measured using a rheometer. RESULTS: Among the tested fillers, particle size was largest in the Restylane(R) SubQ. Elravie(R) ultra volume filler was greater in volume than Elravie(R) deep line, and Elravie(R) light fillers. We confirmed Elravie(R) fillers to be hydrophilic. Elravie(R) ultra volume filler was found to have the highest viscosity and elasticity, whilst Elravie(R) light filler had the lowest. CONCLUSION: All three kinds of Elravie(R) fillers were found to be suitable for human cosmetic use.

Effects of Carnitine on Peripheral Blood Mitochondrial DNA Copy Number and Liver Function in Non-Alcoholic Fatty Liver Disease / 대한소화기학회지

BACKGROUND/AIMS: Functional and anatomical abnormalities of mitochondria play an important role in developing steatohepatitis. Carnitine is essential for enhanced mitochondrial beta oxidation through the transfer of long-chain fatty acids into the mitochondria. We examined the impact of carnitine complex on liver function and peripheral blood mitochondria copy number in NAFLD patients. METHODS: Forty-five NAFLD patients were enrolled. Patients were categorized into the carnitine complex-administered group and control group. Before and 3 months after drug administration, a liver function test and peripheral blood mitochondrial DNA and 8-oxo-dG quantitive analysis were conducted. RESULTS: In carnitine treatment group, ALT, AST, and total bilirubin were reduced after medication. There was no difference in AST, ALT, and total bilirubin between before and after treatment in control group. In carnitine group, peripheral mitochondrial DNA copy number was significantly increased from 158.8+/-69.5 copy to 241.6+/-180.6 copy (p=0.025). While in control group the mitochondrial copy number was slightly reduced from 205.5+/-142.3 to 150.0+/-109.7. 8-oxo-dG level was also tended to decrease in carnitine group (p=0.23) and tended to increase in control group (p=0.07). CONCLUSIONS: In NAFLD, the carnitine improved liver profile and peripheral blood mitochondrial DNA copy number. This results suggest that carnitine activate the mitochondria, thereby contributing to the improvement of NAFLD.

Sigmoid Colon Diverticular Bleeding in a 75-year-old Woman / 대한소화기학회지

Most common cause of brisk hematochezia is diverticular bleeding in Western countries. It occurs in 15% of patients with diverticulosis and one-third of them appear to be massive. Most of diverticulosis in Western countries occur in the left colon but the right colon is more common in Korea. Especially, the reports of diverticular bleeding on left colon are rare in Korea. We report a case presenting with multiple diverticuli complicated by recurrent massive bleeding restricted to the left colon. 75-year-old female was admitted due to hematochezia and dizziness. On past history, two years and two weeks ago respectively, she was treated of diverticular bleeding with and without diverticulitis. Hemoglobin level was 9.8 g/dL. On Colonoscopy, numerous diverticuli were seen at sigmoid colon upto splenic flexure which showed fresh blood clots in the lumen. We diagnosed her as recurrent massive diverticular bleeding on the sigmoid colon. She received elective laparoscopic left hemicolectomy.

A Case of Orbital Medial Wall Fracture in a Pilot

Incidences of blowout fractures have increased due to rapid industrialization and rise in violent crimes. However, there have been few studies on the proper follow-up guidelines or protocol after reduction of the orbital wall for patients working in a high atmospheric pressure environment. We have experienced a pilot with an orbital medial wall fracture who underwent reduction through an endoscopic approach. The patient underwent the Valsalva maneuver and scan of paranasal sinuses 8 weeks after reduction. Emphysema did not occur in the orbit even after the Valsalva maneuver and he was able to return to his workplace without any complications. We report this case with a brief review of the literature.

The Effect of Intensive Therapy Using Nebulized Antibiotics after Endoscpic Sinus Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There are some difficulties and dilemmas in treating patients who show acute recurrent infection or persistent inflammation after sinus surgery. Recently, nebulized antibiotic therapy was recommended as another treatment option for these patients. Our study was to evaluate the effect of nebulized antibiotic therapy in these patients. SUBJECTS AND METHOD: We selected 38 adult patients who had received endoscopic surgery previously. They were patients of the refractory group who have showed persistent purulent rhinorrhea despite treatment for 2 months after sinus surgery and the acute exacerbation group who have showed repeated worsening of their symptoms more than 3 times for 6 months. Cultures were taken from all cases and proper oral antibiotics were used based on their culture results. Oral antibiotics were stopped during the nebulized antimicrobial therapy. Nebulized antibiotics therapy was performed 5 times a week for 4 weeks with cefmenoxime hydrochloride using ultrasonic nebulizer. The symptom score and endoscopic appearance were checked also before and 1, 2 and 3 months after the treatment. RESULTS: In 38 patients, 6 patients were excluded due to follow up loss or voluntary stop of treatment and 32 patients were available. S. aureus, P. aeruginosa and coagulase-negative Staphylococcus were most common organisms in all patients. The symptom score and endoscopic appearance after the treatment showed significant improvement. No complication was found in all cases. CONCLUSION: Nebulized antibiotic therapy might be considered as another therapeutic option for patients with refractory or acute exacerbation of chronic rhinosinusitis after endoscopic sinus surgery.

Efficacy of Rotating Chair Test And Caloric Test For The Diagnosis of Acute Unilateral Vestibular Neuritis

BACKGROUND AND OBJECTIVES: The acute unilateral vestibular neuritis is fairly a common disease and the precise diagnostic tool is needed for the selection of effective treatments. Therefore, we studied the clinical usefulness of the rotatory chair test and caloric test which have been commonly used in patient of acute unilateral vestibular neuritis. MATERIALS AND METHODS: One hundred and sixty four patients who were diagnosed with acute unilateral vestibular neuritis from August of 2004 to June of 2007 were included. Their medical records of the rotating chair test and caloric test were reviewed retrospectively to study the correlation of the two tests. RESULTS: Of 164 patients, 101 patients (61.6%) and 88 patients (53.7%) showed significant canal paresis (CP) and directional preponderance (DP) on the caloric tests that corresponded with the physical exam. 130 patients (79.3%) and 84 patients (51.2%) showed significant asymmetry and time constant (Tc) on the rotating chair test that corresponded with the predictive direction with spontaneous nystagmus. CONCLUSIONS: For acute unilateral vestibular neuritis patients, the asymmetry of the rotatory chair test showed the highest correlation with clinical findings. But physical exam should be preceded because neither rotator chair test nor caloric test yields a specific correlation with the physical exam. Especially, single test only may too many false negative results. For these tests can reduce false positive cases of the physical exam and raise the specificity of the diagnosis, the planning of proper treatments should be followed thereafter.

Canine model of ischemic stroke with permanent middle cerebral artery occlusion: clinical and histopathological findings

The aim of the present study was to assess the clinical and histopathological findings in a canine model of ischemic stroke. Cerebral ischemic stroke was induced by middle cerebral artery occlusion in four healthy beagle dogs using silicone plugs. They showed neurological signs of forebrain dysfunction such as reduced responsiveness, head turning, circling, postural reaction deficits, perceptual deficits, and hemianopsia. These signs gradually regressed within 4 weeks without therapy. On magnetic resonance imaging, T2 hyperintensity and T1 hypointensity were found in the cerebral cortex and basal ganglia. These lesions were well-defined and sharply demarcated from adjacent brain parenchyma with a homogenous appearance. No abnormalities of the cerebrospinal fluid were observed. At necropsy, atrophic and necrotic lesions were observed in the cerebral cortex. The cerebral cortex, basal ganglia, and thalamus were partially unstained with triphenyl-tetrazolium chloride. Histopathologically, typical features of infarction were identified in cortical and thalamic lesions. This study demonstrates that our canine model resembles the conditions of real stroke patients.

Tuberculous Cervical Lymphadenitis, Treatment and Outcome / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tuberculous cervical lymphadenitis is a clinically common cervical inflammatory disease. But there are controversies in the management in spite of high prevalence. The aim of this study was to investigate proper treatment modality, such as antituberculous chemotherapy and surgery. SUBJECTS AND METHOD: The study was based on a retrospective chart review in 65 patients with tuberculous cervical lymphadenitis who were treated between January 2001 and May 2005 at Gachon University Gil Medical Center, Incheon, Korea. We have studied clinical manifestations, characteristics of the neck masses, diagnostic approach, radiologic finding, treatment modality, treatment response, and prognosis. RESULTS: Females were more affected, by about three fold, than males and the prevalence rate was higher in younger patients ranging from 20 to 30. The diagnosis was made over 89% with the initial tests such as FNAB, AFB stain and tuberculous PCR. The successful treatment rate just with anti-tuberculous medication was 90.6%. Especially, in the patients with abscess formation, treatment was successful in 90% only with anti-tuberculous medication. Seventeen cases were treated with medication and surgical management. These patients underwent selective neck dissection or mass excision to remove the entire lesion and there were no recurrence. CONCLUSION: Tuberculous lymphadenitis can be managed well just with anti-tuberculous medication. But, if local symptoms get worse even though the patient is under medical treatment, early surgical treatment is needed. The important thing is to remove the entire lesion when the surgical treatment must be taken.

A Case of Recurrent Frontal Sinus Mucocele Complicated by Visual Disturbance and Treated by Endoscopic Marsupialization and Intrafrontal Stent Insertion

Paranasal sinus mucocele is a slowly expanding benign lesion which can occur as a result of obstruction in the sinus ostium or ostial tract. Frontal sinus mucocele differ from mucoceles of other sinuses in that the frontal outflow tract is usually narrower and less accessible. Since the introduction of endoscopic sinus surgical instrument and techniques, there has been an increasing trend towards the use of endoscopic transnasal technique for managing the paranasal sinus mucoceles. Some studies also recommend the use of intrafrontal stent to reduce the rate of restenosis of frontal sinus outflow tract. We experienced a case of recurrent frontal sinus mucocele complicated by visual disturbance and periorbital swelling. To treat this condition, an intranasal marsupialization was performed and an intrafrontal stent was applied. This paper reports the particulars of this case with a review of related literature.

Canine exocrine pancreatic insufficiency treated with porcine pancreatic extract

A 1. 8-year-old intact female Maltese dog was presented because of a history of chronic diarrhea, polyphagia, weight loss, and coprophagia. The patient was severely emaciated and evacuated very moist and four-smelling, yellow feces. Fecal stain with Sudan III revealed numerous lipid droplets. Result of fat absorption test showed aldigestion. A definite diagnosis was made based on trypsin-like immunoreactivity assay in serum which was low enough to be diagnosed as an exocrine pancreatic insufficiency. After pancreatic enzyme supplement with porcine pancreatin powder, the clinical signs were disappeared. This case report documents clinical manifestations, diagnostic tools, treatment and efficiency of oral pancreatic enzyme replacement therapy of exocrine pancreatic insufficiency in a Maltese dog.

A case of adrenal gland dependent hyperadrenocorticism with mitotane therapy in a Yorkshire terrier dog

Hyperadrenocorticism, a disorder characterized by excessive production of cortisol by the adrenal cortex, is wellrecognized in dogs. A 10-year-old, intact male, Yorkshire terrier dog was evaluated because of corneal ulceration and generalized alopecia. Diagnosis was made based on history taking, clinical signs, physical examination, and results of routine laboratory testing (complete blood count, serum biochemical analysis, and urinalysis). In addition, adrenocorticotropic hormone (ACTH) stimulation test and abdominal ultrasonography were also used to diagnose this case. The patient was diagnosed as adrenal gland neoplasia and medical therapy using the adrenocorticolytic agent, mitotane, was initiated. An ACTH stimulation test was performed after initial therapy. After successful induction was obtained, maintenance therapy with mitotane still continued.