Prognostic Value and Optimal Sampling Time of S-100B Protein for Outcome Prediction in Cardiac Arrest Patients Treated with Therapeutic Hypothermia / 대한구급학회지

BACKGROUND: The aim of this study was to determine the prognostic value and optimal sampling time of serum S-100B protein for the prediction of poor neurological outcomes in post-cardiac arrest (CA) patients treated with therapeutic hypothermia (TH). METHODS: We prospectively measured serum S100 calcium binding protein beta subunit (S-100B protein) levels 12 times (0-96 hours) after the return of spontaneous circulation (ROSC). The patients were classified into two groups based on cerebral performance category (CPC): the good neurological outcome group (CPC 1-2 at 6 months) and the poor neurological outcome group (CPC 3-5). We compared serial changes and serum S-100B protein levels at each time point between the two groups and performed receiver operating characteristic curve analysis for the prediction of poor neurological outcomes. RESULTS: A total of 40 patients were enrolled in the study. S-100B protein levels peaked at ROSC (0 hour), decreased rapidly to 6 hours and maintained a similar level thereafter. Serum S-100B protein levels in the poor CPC group (n = 22) were significantly higher than in the good CPC group (n = 18) at all time points after ROSC except at 4 hours. The time points with highest area under curve were 24 (0.829) and 36 (0.837) hours. The cut-off value, the sensitivity (24/36 hours) and specificity (24/36 hours) for the prediction of poor CPC at 24 and 48 hours were 0.221/0.249 ug/L, 75/65% and 82.4/94.1%, respectively. CONCLUSIONS: Serum S-100B protein was an early and useful marker for the prediction of poor neurological outcomes in post-CA patients treated with TH and the optimal sampling times were 24 and 36 hours after ROSC.

Prognostic Value and Optimal Sampling Time of S-100B Protein for Outcome Prediction in Cardiac Arrest Patients Treated with Therapeutic Hypothermia / 대한중환자의학회지

BACKGROUND: The aim of this study was to determine the prognostic value and optimal sampling time of serum S-100B protein for the prediction of poor neurological outcomes in post-cardiac arrest (CA) patients treated with therapeutic hypothermia (TH). METHODS: We prospectively measured serum S100 calcium binding protein beta subunit (S-100B protein) levels 12 times (0-96 hours) after the return of spontaneous circulation (ROSC). The patients were classified into two groups based on cerebral performance category (CPC): the good neurological outcome group (CPC 1-2 at 6 months) and the poor neurological outcome group (CPC 3-5). We compared serial changes and serum S-100B protein levels at each time point between the two groups and performed receiver operating characteristic curve analysis for the prediction of poor neurological outcomes. RESULTS: A total of 40 patients were enrolled in the study. S-100B protein levels peaked at ROSC (0 hour), decreased rapidly to 6 hours and maintained a similar level thereafter. Serum S-100B protein levels in the poor CPC group (n = 22) were significantly higher than in the good CPC group (n = 18) at all time points after ROSC except at 4 hours. The time points with highest area under curve were 24 (0.829) and 36 (0.837) hours. The cut-off value, the sensitivity (24/36 hours) and specificity (24/36 hours) for the prediction of poor CPC at 24 and 48 hours were 0.221/0.249 ug/L, 75/65% and 82.4/94.1%, respectively. CONCLUSIONS: Serum S-100B protein was an early and useful marker for the prediction of poor neurological outcomes in post-CA patients treated with TH and the optimal sampling times were 24 and 36 hours after ROSC.

Analysis of Accident Mechanisms in Unhelmeted Motorcycle Accident Victims

PURPOSE: Due to their vulnerability and relatively high driving speed, motorcycles have been associated with a high risk of sustaining multiple severe injuries after traffic accidents. We sought to investigate sustained injuries and the association of accident mechanisms with injury severity for unhelmeted motorcycle accident victims. METHODS: This study was conducted as an observational retrospective study. Unhelmeted motorcycle accident victims who visited the study hospital from January 2010 to December 2011 were included. Data were obtained from medical records, ambulance run-sheets, and telephone interviews. Accident mechanisms were divided into collision with an obstacle, single vehicle accident, collision with another vehicle, collision by another vehicle, and falling accident from the viewpoint of energy. Glasgow coma scale (GCS), Revised trauma score (RTS), and Injury Severity Score (ISS) were analyzed for comparison of injury severity according to the accident mechanisms. RESULTS: Of 404 patients who visited the study hospital, 165 patients were included; 87.3%(144/165) were male, and 78.8%(130/165) were drivers. The incidence of motor cycle accident showed the highest in the teenager and in time during 18:00~24:00 o'clock. Lower extremity was the most common site of injury, followed by upper extremity, head, and face etc. Injury due to falling was the most severe injury mechanism, followed by collision with another vehicle, collision by another vehicle, and a single vehicle and an obstacle (p=0.013). CONCLUSION: Lower extremity injury was the most common injury site in unhelmeted motorcycle accidents, and motorcycle accidents by fall and collision with another vehicle should be considered as a severe mechanism of injury.

A Novel Method for Delivery of an Appropriate Rate of Ventilation During Cardiopulmonary Resuscitation with a Placement of Advanced airway: Setting a Compression Numbers to Ventilation Ratio

PURPOSE: Hyperventilation during cardiopulmonary resuscitation (CPR) is common and can be detrimental to survival. We designed a method for delivery of an appropriate rate of ventilation during CPR by setting a compression numbers to ventilation ratio. METHODS: We conducted a virtual simulation trial using 12 randomly sorted actual CPR video files. Participants provided ventilation using a self-inflating bag while watching one minute of CPR video clips utilizing pre-set compression to ventilation ratios of 10:1, 12:1, and 15:1, respectively. Ventilation rates per minute were manually calculated and analyzed. RESULTS: Eight medical doctors and eight emergency medical technician students were included. Among the three groups, significant different mean (S.D) ventilation rate per min (compression to ventilation ratio were 10:1, 12:1, and 15:1) was (9.9 (1.3) vs. 8.8 (1.0) vs. 7.2 (0.8), respectively; p<0.0001). Proportion of the number of appropriately delivered ventilations was 62.5%, 89.6%, and 38.0% for compression to ventilation ratios of 10:1, 12:1, and 15:1, respectively (p<0.0001). CONCLUSION: Compression to ventilation ratio of 12:1 resulted in a significantly appropriate ventilation rate, compared with the ratio of 10:1 or 15:1. Pre-set compression to ventilation ratio of 12:1 seems to be a novel method for delivery of an appropriate number of ventilations during CPR after establishment of an advanced airway.

Injury Data Comparison between National and Local Emergency Centers in Korea

PURPOSE: The incidence and severity of injuries differs between each region of Korea due to socioeconomic differences. The comparative analysis between national injury data and the evaluation of regional epidemiologic characteristics is useful in establishing an injury prevention strategy for a regional community. This study was conducted in order to provide basic data for the establishment of an injury prevention strategy by priority through comparison between national injury data collected by National Emergency Department Information System (NEDIS) and injury data from regional emergency centers located in small cities, in Korea. METHODS: The study subjects were the injury patients who visited a total of 117 regional, specialized and local emergency centers from April 2009 to March 2010, as well as those who visited Konkuk University Chungju Hospital during the same period. We collected national data from the Injury Surveillance Report published by Korea Centers for Disease Control and Prevention and compared these with study hospital data collected by our own injury registration system to include gender, ratio, age, and mechanism and severity of patient injury. RESULTS: Of 3,931,573 patients who visited 117 emergency centers and 23,671 patients who visited the study hospital during the study year, the number of injury patients was 786,006 (20.0%) versus 6,177 (26.1%), respectively. 485,521 (62.0%) of the nation-wide subjects versus 4,046 (65.5%) of the study hospital subjects were male, and 298,197 (38.0%) of the nation-wide subjects versus 2,128 (34.5%) of the study hospital subjects were female. The comparison by age of the injury subjects was as follows: below 9 years (22.4% versus 16.8%), twenties (14.5% versus 16.3%) and forties (14.5% versus 15.2%). In the comparison of injury mechanism, blunt injury was higher (20.4%) in nation-wide subjects followed by slip injury (20.0%) and transport accident (19.0%). Transport accidents produced the highest cause of injury (26.0%) in the study subjects followed by slip injury (20.1%) and bunt injury (16.1%). In the severity comparison, 641,344(81.6%) versus 4797(77.8%) were mild injury patients, 139,260(17.7%) versus 1299(21.1%) were severely injured, and 3114 (0.4%) versus 69(1.1%) were fatal injuries. The causes of severe injury nation-wide included intoxication (46.3%), falls (34.8%) and machine accidents (33.3%) versus machine (46.0%), asphyxia (44.4%), intoxication (39.3%) in the study hospital, and the causes of fatal injuries nation-wide were intoxication (5.2%), drowning (4.3%), and asphyxia (4.2%), versus drowning (11.1%), asphyxia (5.6%) and intoxication (4.9%) in the study hospital. CONCLUSION: Through the comparison between study hospital with national injury data, we found that the percentage of severe and fatally injured patients was higher in the nationally with transportation related accidents being highest in terms of mechanism. The construction of a regional injury data system with ongoing comparison with national injury data may be useful in the establishment of a regional injury intervention strategy by priority.

Three Cases of Traumatic Pulmonary Pseudocysts in Old Age

In old age, a traumatic pulmonary pseudocyst is an extremely rare condition that generally develops after blunt chest trauma. It is more common among pediatric and young adult patients. We report three elderly patients who presented with chest symptoms after blunt chest trauma and whose computed tomography showed post-traumatic pulmonary pseudocysts.

The Effect of Informational Handouts on Patient Satisfaction for Emergency Medical Service

PURPOSE: Although detailed explanations by medical staff increase patient satisfaction, there is often a lack of personnel to provide this service. Handouts detailing common general inquiries have the potential to provide similar information. This study was conducted to examine the effects of emergency room informational handouts on patient satisfaction. METHODS: From September 2009 to October 2009, handouts regarding emergency department (ED) facilities, the triage process, and symptom-based information were distributed on alternating weeks to patients in the ED waiting area. Questionnaires were distributed to all eligible patients and guardians at the time of admission and collected the next day. The questionnaire used a five-point Likert scale, and consisted of 15 detailed questions regarding satisfaction with the ED registration process, medical evaluation and treatment, and the ED environment. RESULTS: In total, 400 questionnaires were distributed and collected from 281(70.3% response rate). A total of 121 (43.1%) received the informational handout and 160 (56.9%) did not. Overall, 141(50.2%) males, 140(49.8%) females, 205(73.0%) patients, and 75(27.0%) guardians responded. Only two of the 15 detailed questions had statistically higher scores in the group that received the informational handout (p<0.05) (satisfaction with explanation given about emergency room facilities and satisfaction with instructions given by the nurse). For other questions, there was a non-statistically significant trend towards higher scores in the informational handout group. CONCLUSION: Informational handouts did not statistically improve patient satisfaction with ED care.

Surgical Treatment of Isolated Phlebectasia of the Forearm: A case report / 대한흉부외과학회지

Phlebectasia of the venous system of the upper limb is very rare and it does not have a well-defined etiology. Phlebectasia means isolated fusiform or saccular dilatation of the venous system and isolated phlebectasia of the forearm may present as a painless cosmetic deformity or it may cause pain, decreased range of movement, compression on adjacent structures, bleeding, thrombosis and consumptive coagulopathy. We report here on a case of isolated phlebectasia of the forearm and we briefly review the relevant literature.

Surgical Treatment of Primary True Aneurysm on the Dorsalis Pedis Vein: A case report / 대한흉부외과학회지

An aneurysm is a focal, localized dilatation of a blood vessel. This term is most commonly applied to dilatation of arteries. However, dilatation can occur in any part of the vascular system. Primary true aneurysm of the superficial venous system that contains all the vascular layers is known to be very rare. We report here on surgically treating a case of primary true aneurysm on the dorsalis pedis vein and we briefly review the related literature.

Clinical Usefulness of Chest Wall Ultrasonography for Detecting Fractures of Costal Cartilage due to Minor Blunt Chest Trauma / 대한흉부외과학회지

BACKGROUND: Rib fractures are the most common injuries that are caused by blunt chest trauma. However, fractures of the costal cartilage generally go unnoticed on chest X-rays unless they involve a calcified cartilage. For this reason, the sensitivity of conventional radiography for detecting rib fractures is low, and especially those involving the cartilaginous part of the rib. Thus, we have evaluated the usefulness of ultrasonography for detecting fractures of the costal cartilage that were overlooked on the conventional radiographs of patients who suffered minor blunt chest traumas. MATERIAL AND METHOD: A total of 45 patients who suffered minor blunt chest trauma and who had no evidence of rib fractures or other major fractures on conventional radiographs were admitted for ultrasonography between April 2008 and March 2009. There were 24 women and 21 men, and the mean age of the patients was 50.4+/-15.91 years (range: 17~76 years). They were examined for the detection of fractures of the costal cartilage by performing ultrasonography with a 7.5-MHz linear transducer. RESULT: A total of 30 patients (67%) had fractures of the costal cartilage, whereas 15 patients (33%) had no evidence of chondral rib fractures. The mean number of fracture sites of the fractured costal cartilage was 1.6+/-0.81 (range: 1~4 sites) in 30 patients. Periosteal hematoma was the most common finding associated with fractures of the costal cartilage (n=7, 17%), followed by sternum fracture (n=5, 12%). However, periosteal hematoma was noticed in 1 patient (2%) who was without fracture of the costal cartilage, and sternum fracture was noticed in 1 patient (2%) who was without fractures of the costal cartilage. CONCLUSION: The results of this study suggest that ultrasonography may be a useful imaging modality for detecting fractures of the costal cartilage that are overlooked on the conventional radiographs of patients who suffer minor blunt chest trauma.

Systemic Complications occurring after Korean Venomous Snake Bite, with focus on Hematologic and Neurologic Complications

PURPOSE: This study explored and evaluated the systemic complications resulting from the bite of Korean venomous snake, focussing on hematologic and neurologic features. METHODS: Medical records (demographic data, clinical measurements including laboratory results, severity score, and amount of antidote administration, and hospitalization course) of consecutive patients who presented with snakebites to two university teaching hospital during a 10-year period were retrospectively reviewed. Subgroup analysis was conducted for evaluations of anti-acetylcholine esterase administration in complicated victims. RESULTS: The 170 patients displayed occurrence rates of hematologic and neurologic complications of 12.9% and 20.6%, respectively. Among 22 patients with hematologic complications, isolated thrombocytopenia was evident in eight patients (36.4%), prothrombin time (PT)/activated partial thromboplastin time (aPTT) prolongation in 11 patients (50.0%), and both in three patients (13.6%). The mean time to recovery was 4.5+/-1.8 days for isolated thrombocytopenia, and 5.1+/-1.8 days for PT and aPTT prolongation. Hematologic complications could occur suddenly 1~4 days after hospitalization. Among 35 patients with neurologic complications, dizziness was evident in 16 patients (45.7%), and diplopia / blurred vision in 19 patients (54.3%). The mean time to recovery was 3.4+/-0.6 days in patients receiving anti-acetylcholine esterase and 6.9+/-1.8 days in those not receiving anti-acetylcholine esterase (p=0.00). CONCLUSION: Occurrence rates of hematologic and neurologic complications following venomous snake bite differed as compared to other studies conducted in Korea. Onset of hematologic complications can occur rapidly days after admittance. Anti-acetylcholine esterase administration may be effective in treating neurologic complications.

Analysis of Bone Mineral Density and Biochemical Markers in Hip Fractures Injured by Low-energy Trauma / 대한정형외과학회잡지

PURPOSE: This study was conducted to compare bone mineral density (BMD) and biochemical markers of bone metabolism of an osteoporotic hip fracture group with those of a control group. MATERIALS AND METHODS: The fracture group included 76 patients with hip fractures who were injured by low energy trauma from November, 1999 to August, 2003. The control group consisted of 83 patients recruited over the same period. There were 22 men and 54 women in the fracture group, with an average age of 67.2 years for men and 71.1 years for women. In the control group, there were 22 men and 61 women, of average age 67.9 years for men and 70.1 years for women. There were no siginificant differences in age, height, weight, or body mass index. We analyzed BMD by a dual energy X-ray absorptiometry (DEXA). Bone specific alkaline phosphatase (B-ALP) and osteocalcin were used as markers of bone formation and urine-deoxypyridinoline (DPD) as a maker of bone resorption. RESULTS: B-ALP showed a significant decrease in the fracture group (p<0.05). Also, average serum osteocalcin showed a significant decrease in the fracture group (p<0.05). There was no significant difference in urine-DPD between the two groups. The mean values of BMD in men and women were significantly decreased in the fracture group. CONCLUSION: The results of this study suggest that a decreased BMD contributes to hip fractures in elderly people and that B-ALP and serum osteocalcin rather than urine-DPD are reliable biochemical markers of bone metabolism in osteoporotic hip fractures.

Minimally Invasive Percutaneous Plate Stabilization of Proximal Tibial Fractures

PURPOSE: Despite of various treatment methods, proximal tibial fractures are common injuries that may be associated with poor outcomes and high rates of complications. To improve this, percutaneous plating technique was performed in the proximal tibial fractures. MATERIALS AND METHODS: Twenty-four proximal tibial fractures (AO 41A; 5, AO 41C; 12, AO 42; 7) were treated by percutaneous plating with either or both sides without bone graft. One was open fracture. RESULTS: All fractures were healed. The average time for fracture healing was 16.5 weeks (range, 8~24 weeks). Complications included a 1cm shortened case and two mal-alignments; a 6 degree valgus case and 5 degree varus case. There was one case of superficial infection, which healed after plate removal. But, there was no deep infection. Results were evaluated by modified Rasmussen score system, all patients had excellent or good result. CONCLUSION: Minimally invasive percutaneous plating technique can provide favorable results in the treatment of proximal tibial fractures.

Anger Experience and Expression in Patients with Schizophrenia / 신경정신의학

OBJECTIVES: The prejudice against the mentally deranged persons has an effect on the treatment of the mental illness and is one of the reasons why they have difficulties in social adaptation and rehabilitation. We intended to examine the characteristics and expression of the anger in schizophrenic patients to find how much anger they feel compared with general population. And we tried to find the basis on which the prejudice can be corrected. METHOD: 105 schizophrenic patients were selected according to DSM-IV. Control groups were 43 patients who were admitted to the department of internal medicine in university hospital and 65 healthy adults. The experiences and expressive patterns of anger were surveyed by State-Trait Anger Expression Inventory, Korean edition. And the characteristics of the anger in the schizophrenic patients were compared with those in controls and analyzed. RESULTS: Stateanger was significantly higher in the schizophrenic patients group than in healthy control group and trait-temperament was significantly lower in schizophrenic patients group than in other two control groups. Among the anger expression scales, anger-in and anger-control were significantly lower in schizophrenic patients group than in healthy control group. But trait-reaction and angerout showed no significant difference among three groups. And no significant difference was shown among the anger scales of three groups according to the presence of insight of the disorder. CONCLUSION: It is shown that schizophrenic patients have considerably much anger when compared to healthy control group and insufficient ability to suppress and control the anger. But it may be said that the expressions of anger in schizophrenic patients are not apparent. These results may be due to either the weakness of ego function, which is one of the symptoms of schizophrenia, or negative symptoms following chronicity of the disorder. Unex-pected aggressiveness or violence of them may be triggered by stimuli from the circumstances, if they are not in acute phase. And the misunderstanding of general public that schizophrenic patients are dangerous unconditionally should be corrected by the education. We can't develop the appropriate strategy to cope with the anger of the schizophrenic patients until we under-stand well the characteristics of anger in them.