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Objective@#Severe acute cholecystitis is an infectious disease that requires immediate gallbladder drainage. Although percutaneous transhepatic gallbladder drainage (PTGBD) is the most common method of gallbladder drainage, the optimal timing remains unclear. @*Methods@#This study is a retrospective analysis of patients diagnosed with severe acute cholecystitis who underwent PTGBD between July 2018 to June 2021. This study investigated the effect of time from emergency department arrival to PTGBD (tPTGBD) on patient prognosis. @*Results@#Totally, 48 patients were included in this study. Based on the cutoff value calculated using the Youden index, the group with tPTGBD of <5.93 hours had a shorter hospital stay (10 vs. 13.5 days, P=0.021), lower portion of progression (27:5 [15.6%] vs. 7:9 [56.3%], P=0.004), even they had a higher initial SOFA score (6 vs. 4.6, P=0.049). However, no statistical difference was obtained for the length of ICU stay between both groups (1 vs. 2, P=0.617). @*Conclusion@#Executing PTGBD to severe acute cholecystitis patients within 5.93 hours after presenting at the emergency department is associated with reduced progression and hospital stay.
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Purpose@#As coronavirus disease 2019 pandemic has been prolonged, it became crucial to analyze the long-term impact of the pandemic on emergency department (ED) utilization for efficient use of emergency medicine resources. @*Methods@#We reviewed the data of children (≤ 18 years) who visited the ED in Daejeon, Korea, from February 2019 through January 2021. This period was dichotomized by February 2020 into the reference and pandemic periods. The latter period was further divided into the early (February-August 2020) and late pandemic periods. Between the reference and pandemic periods, and between the early and late pandemic periods, we respectively compared proportions of children in all patients (including adults), age groups, high acuity (the Korean Triage and Acuity Scale 1-2), diagnostic codes, visits via ambulances, ED length of stay, and ED disposition. @*Results@#Compared to the reference and early pandemic periods, the pandemic and late pandemic periods respectively showed changes as follows: proportion of children in all patients (from 29.8% to 19.0% and from 19.8% to 18.1%; all Ps < 0.001), children younger than 5 years (from 56.7% to 49.9% and from 52.1% to 47.4%; all Ps < 0.001), high acuity (from 12.0% to 7.8% [P < 0.001] and from 8.8% to 6.7% [P = 0.004]), “Injury, poisoning and certain other consequences of external causes (S00-T98; from 30.0% to 49.0% and from 48.3% to 49.8%),” and “Diseases of the respiratory system (J00-J99; from 29.6% to 10.3% and from 12.8% to 7.5%).” Increases in the visits via ambulances, ED length of stay, children undergoing intensive care unit hospitalization or death were noted only in comparison between the reference and pandemic periods. @*Conclusion@#A long-term impact of the pandemic on ED use may be a decrease in the proportion of young or ill children.
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Purpose@#The main purpose of this meta-analysis was to identify the degree of effect size and variables for the impact of manual physical therapy on the improvement in the range of motion of frozen shoulder patients. @*Methods@#This study collected 8 studies published between 1st January 2010 and 31st December 2020. The analysis of the results verified 49 effect size data and the random effect model was chosen. @*Results@#First, the full case showed the largest mean effect size of 2.485 (p 0.737). The number of intervention periods showed 4 weeks 20 or more effect size of 2.782 (p > 0.294). Finally, the ‘Trim and Fill’ result confirmed that the calibration effect size was 1.471 (p < 0.001). @*Conclusion@#This study verified that manual physical therapy had a substantial effect on the improvement of the range of motion of patients with frozen shoulders and that the effects were dependent on the methods of outcomes.
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Purpose@#The purpose of this study was to investigate the effects of the fascia distortion model (FDM), one of the fascia treatments, on unstable ankle subjects. This was done through the chronic ankle instability tool (CAIT) questionnaire on maximum isometric muscle strength, proprioception, dynamic balance, and maximum angle. @*Methods@#An experiment was conducted using the chronic ankle instability tool questionnaire on males and females in their twenties who suffered from ankle instability. Before the experiment, maximum isometric strength, proprioceptive, dynamic balance, and maximum angle were measured. The fascia distortion model was applied and then measurements were taken again to compare and analyze the changes. Analysis was carried out using the paired t-test. @*Results@#After applying the fascia distortion model, maximum isometric strength, proprioceptive, dynamic balance, and maximum angle significantly improved (p < 0.05). @*Conclusion@#This study found that the fascia distortion model method was effective in improving maximum isometric strength, proprioceptive, dynamic balance, and maximum angle. The results suggest that the fascia distortion model method is a new intervention that could be used for subjects with chronic ankle instability.
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Angiolipoma is a benign fatty neoplasm that has components of proliferating blood vessels. These types of lesions commonly occur in the subcutaneous tissue of the limbs and trunk. Angiolipoma in the gastrointestinal tract is extremely rare, and the final diagnosis generally depends on histological examination of the excised biopsy. In most previously reported cases, the lesions were diagnosed and treated with surgical management. In this study, we report a case of gastric angiolipoma of approximately 4 cm in size that was diagnosed and treated with endoscopic submucosal dissection.
ABSTRACT
Angiolipoma is a benign fatty neoplasm that has components of proliferating blood vessels. These types of lesions commonly occur in the subcutaneous tissue of the limbs and trunk. Angiolipoma in the gastrointestinal tract is extremely rare, and the final diagnosis generally depends on histological examination of the excised biopsy. In most previously reported cases, the lesions were diagnosed and treated with surgical management. In this study, we report a case of gastric angiolipoma of approximately 4 cm in size that was diagnosed and treated with endoscopic submucosal dissection.
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Thiopurine-based drugs such as azathioprine and 6-MP are among the most common immunosuppressants used to treat inflammatory bowel disease, autoimmune hepatitis, various autoimmune diseases, and patients undergoing organ transplantation. The drugs are associated with various complications, of which one of the most serious is hepatotoxicity that may trigger non-cirrhotic portal hypertension. We report a case with this side-effect in a patient taking azathioprine to treat Crohn’s disease.
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Purpose@#The primary purposes of this study were to identify the degree of the effect size and the variables related to it on the effects of physical therapy on myofascial pain syndrome. @*Methods@#This study collected 15 studies published between 2008.01.01 and 2019.12.31. The Analysis results confirmed 57 effect size data. The random-effect model was chosen because of the heterogeneity of the data. @*Results@#First, the full case showed the largest mean effect size of 2.03 (p<0.001). Second, the size of the effect, according to the hands-on intervention, was 2.74 (p<0.003). Third, the VAS showed an effect size of 2.30 (p<0.001). Fourth, the intervention period showed a 1- to 15-day effect size of 2.94 (p<0.001). The number of interventions showed a 6 to 10 effect size of 2.84 (p<0.006). The number of participants showed a 10 or less effect size of 2.66 (p<0.001). Finally, the ‘Trim and Fill’ result confirmed that the calibration effect size was 0.93 (p<0.001). @*Conclusion@#Physical therapy had a great effect on myofascial pain syndrome in the neck and shoulders, and that the effect differed according to the methods of the intervention and the methods of evaluation.
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Purpose@#The primary purposes of this study were to identify the degree of the effect size and the variables related to it on the effects of physical therapy on myofascial pain syndrome. @*Methods@#This study collected 15 studies published between 2008.01.01 and 2019.12.31. The Analysis results confirmed 57 effect size data. The random-effect model was chosen because of the heterogeneity of the data. @*Results@#First, the full case showed the largest mean effect size of 2.03 (p<0.001). Second, the size of the effect, according to the hands-on intervention, was 2.74 (p<0.003). Third, the VAS showed an effect size of 2.30 (p<0.001). Fourth, the intervention period showed a 1- to 15-day effect size of 2.94 (p<0.001). The number of interventions showed a 6 to 10 effect size of 2.84 (p<0.006). The number of participants showed a 10 or less effect size of 2.66 (p<0.001). Finally, the ‘Trim and Fill’ result confirmed that the calibration effect size was 0.93 (p<0.001). @*Conclusion@#Physical therapy had a great effect on myofascial pain syndrome in the neck and shoulders, and that the effect differed according to the methods of the intervention and the methods of evaluation.
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Arteriovenous malformation (AVM) of the pancreas is exceedingly rare, although it may be increasingly diagnosed due to the widespread use of cross-sectional imaging of the abdomen; even rarer is its association with pancreatitis. A 45-year-old male was admitted to our hospital with symptom of epigastric pain. Dynamic contrast imaging scans of the abdomen showed a focal acute pancreatitis and pancreatic AVM. The angiography findings were compatible with pancreatic AVM. The cause of abdominal pain was diagnosed by acute pancreatitis caused by pancreatic AVM, and, for definitive treatment of symptomatic pancreatic AVM, distal pancreatectomy with splenectomy was performed. The histological results confirmed the presence of irregular dilated tortuous arteries and veins, and a retention cyst with epithelial cell lining. We experienced a rare case of a 45-year-old-Korean male who had acute pancreatitis associated with pancreatic AVM. Pancreatic AVM is extremely rare; even rarer is its association with pancreatitis.
Subject(s)
Humans , Male , Middle Aged , Abdomen , Abdominal Pain , Angiography , Arteries , Arteriovenous Malformations , Epithelial Cells , Pancreas , Pancreatectomy , Pancreatitis , Splenectomy , VeinsABSTRACT
This study was performed to identify the impact of awareness and educational experiences on cardiopulmonary resuscitation in the ability to execute of cardiopulmonary resuscitation among Korean adults. This study used original data of 2014 Community Health Data Survey. 228,712 participants in this survey were resident in South Korea who is aged 19 or older on July 2014. Participants in this survey were sampled an average of 900 residents(target error ± 3 percent) per community health center of Korea. Data were analyzed by using R 3.1.3 employing chi-squared test, fisher's exact analysis, and logistic regression analysis. Ability to execute CPR was significantly higher in males(3.34 time), higher the education level (1.61 times), the white color occupation (1.14 times), the higher the income level (1.07 times), the higher the education level (0.91 times), non-hypertensive patients (1.12 times), non-diabetic patients (1.16 times), non-dyslipidemic patients (0.86 times), non-stroke patients (0.30 times), CPR education experience group (3.25 times), CPR experience group with manikin-based training (4.30 times), higher subjective health status (1.08 times, 1.16 times) respectively. This study identified that awareness, educational experience, and mannequin-based learning experience of CPR impacted on the ability to execute CPR. Responding to education-related factors could contribute to reducing the rate of out-of-hospital acute cardiac arrest by improving the ability to execute CPR of the general public.
Subject(s)
Adult , Humans , Cardiopulmonary Resuscitation , Community Health Centers , Diagnostic Self Evaluation , Education , Heart Arrest , Korea , Learning , Logistic Models , OccupationsABSTRACT
Anomalous union of the pancreaticobiliary duct (AUPBD) is a rare congenital anomaly, defined as the pancreaticobiliary ductal union located outside of the duodenal wall, usually forming a markedly long common channel. This anomaly is associated with congenital choledochal cyst, carcinoma of the biliary tract and pancreatitis, and is more commonly seen in Asian than in Western countries. AUPBD is frequently accompanied by biliary dilatation, but some patients with AUPBD have no biliary dilatation. The causal relationship between AUPBD and biliary dilatation associated with this anomaly has not been fully established. Here, we report a case of type IIIc2 AUPBD without biliary duct dilatation that was treated by drainage of major papilla.
Subject(s)
Humans , Asian People , Bile Ducts , Biliary Tract , Choledochal Cyst , Dilatation , Drainage , Pancreatic Ducts , PancreatitisABSTRACT
BACKGROUND/AIMS: Colonoscopy can detect precancerous lesions, which can subsequently be removed and reduce incidences of and mortality from colorectal cancer (CRC). However, recently published data have highlighted a significant rate of CRC in patients who previously underwent colonoscopy. Among many reasons, incomplete resection has been considered as a significant contributor. However, to date, there have only been a few studies regarding incompletely resected polyps, especially advanced colorectal adenoma (ACA). Hence, we aimed to evaluate the prognosis of incompletely resected ACA. METHODS: We retrospectively reviewed the medical records of patients with ACA who had underwent endoscopic treatment with incomplete resection. The primary outcomes were (1) the incomplete resection rate of ACA, as determined by a histopathologic examination and (2) the recurrence rate of incompletely resected ACA. We also investigated the probable contributing factors that may have led to a relapse of incompletely resected ACA. RESULTS: A total of 7,105 patients had their colorectal polyps resected by endoscopic treatment, and 2,233 of these were considered as ACA. Of these, 354 polyps (15.8%) were resected incompletely, and only 163 patients were followed-up. Of those followed-up, 31 patients (19.0%) experienced local recurrence. The risk factors for recurrence after incomplete resection were evaluated; age, morphology of adenoma, and use of rescue therapy, such as argon plasma coagulation, were found to be associated with adenoma recurrence. CONCLUSIONS: Incompletely resected ACA in older patients or in patients with sessile-type adenomas should be monitored strictly, and if incomplete resection is suspected, rescue therapy must be considered.
Subject(s)
Humans , Adenoma , Argon Plasma Coagulation , Colonic Polyps , Colonoscopy , Colorectal Neoplasms , Incidence , Medical Records , Mortality , Polyps , Prognosis , Recurrence , Retrospective Studies , Risk FactorsABSTRACT
Gangliocytic paraganglioma is an uncommon tumor of digestive system that is usually found in the second portion of duodenum. It is generally considered benign tumor, although few reports of local recurrences and regional lymph node metastases have been made. Gangliocytic paraganglioma is characterized by its histologic pattern including ganglion cells, spindle cells and epithelioid cells. Heterotopic pancreas, also known as ectopic pancreas, is a pancreatic tissue appeared outside of its normal location lacking anatomic or vascular connection with the pancreas. In duodenum, it is a relatively unusual lesion that may be found incidentally during surgery or endoscopy. We present a case of 39-year-old woman with gangliocytic paraganglioma combined with heterotopic pancreas in the ampulla of Vater successfully treated by endoscopic resection.
Subject(s)
Adult , Female , Humans , Ampulla of Vater , Digestive System , Duodenum , Endoscopy , Epithelioid Cells , Ganglion Cysts , Lymph Nodes , Neoplasm Metastasis , Pancreas , Paraganglioma , RecurrenceABSTRACT
Gangliocytic paraganglioma is an uncommon tumor of digestive system that is usually found in the second portion of duodenum. It is generally considered benign tumor, although few reports of local recurrences and regional lymph node metastases have been made. Gangliocytic paraganglioma is characterized by its histologic pattern including ganglion cells, spindle cells and epithelioid cells. Heterotopic pancreas, also known as ectopic pancreas, is a pancreatic tissue appeared outside of its normal location lacking anatomic or vascular connection with the pancreas. In duodenum, it is a relatively unusual lesion that may be found incidentally during surgery or endoscopy. We present a case of 39-year-old woman with gangliocytic paraganglioma combined with heterotopic pancreas in the ampulla of Vater successfully treated by endoscopic resection.
Subject(s)
Adult , Female , Humans , Ampulla of Vater , Digestive System , Duodenum , Endoscopy , Epithelioid Cells , Ganglion Cysts , Lymph Nodes , Neoplasm Metastasis , Pancreas , Paraganglioma , RecurrenceABSTRACT
PURPOSE: Use of emergency rooms (ERs) has increased considerably in Korea. This increase has caused over-crowding and has increased the burden on ER services, created a lack of continuous service provided by ERs, and raised costs. The objective of this study was to examine the characteristics of ER use for urgent and non-urgent cases in 2009-2011. METHODS: In this multivariate analysis, we included data collected from the 2009-2011 Korea Medical Expenditure Panel Survey to assess independent factors associated with ER use in non-urgent settings. We consecutively included patients > or =19 years who had completed the survey until 2011. RESULTS: Among the 10,428 respondents, 19.1% of patients had used ERs. Patients who had used EDs were less likely to have attended graduate school (high school: odds ratio [OR], 0.78 [0.63-0.98]; university: OR, 0.69 [0.54-0.89]) or have chronic disease (OR: 0.68 [0.60-0.78]). In addition, patients who did not have a usual source of care (OR, 0.78 [0.70-0.87]) or those who did not have private insurance (OR, 0.86 [0.74-0.99]) were less likely to use ERs. In the 1,994 cases of ER use, however, the any factors were not affected in the non-urgent ER use group. CONCLUSION: The number of patients who used ERs has increased, and there were no significant differences in ER use between non-urgent and urgent patients. ERs may have been used for non-urgent cases owing to other reasons. Further studies on the reasons for non-urgent ER use and development of urgent patient criteria are required.
Subject(s)
Adult , Humans , Chronic Disease , Surveys and Questionnaires , Emergency Medical Services , Emergency Service, Hospital , Health Care Surveys , Health Expenditures , Insurance , Korea , Multivariate Analysis , Odds RatioABSTRACT
PURPOSE: A stylet aids intubation as a glottis by changing and maintaining the bending inside the endotracheal tube and is used as an auxiliary device in intubation. The aim of this experimental study is to evaluate resistance differences among endotracheal tube sizes and the usefulness of lubricant for stylet removal. METHODS: Depending on endotracheal tube size and lubricant use status, the subjects were divided into the control (n=10, each 7 tube sizes), lidocaine gel (n=70), and saline groups (n=70). Using a tensile strength meter, the work and the peak withdrawal force consumed for retracting a stylet were measured. RESULTS: When the work dependent on the endotracheal tube size and stylet coating was compared, significantly less work was consumed for 6.0-, 6.5-, 7.0-, 8.0-, 8.5 mm stylet group coated with lidocaine gel (p=0.029, p=0.002, p=0.001, p=0.001, p<0.001, p<0.001) or 6.0-, 6.5-, 8.0-, 8.5 mm stylets coated with saline compared to the control group (p=0.002, p<0.001, p<0.001, and p<0.001). In comparison of the peak withdrawal force dependent on the endotracheal tube size and stylet coating, significantly less peak withdrawal force was consumed for the 6.0- or 8.0- mm stylet group coated with lidocaine gel (p=0.004, p<0.001) or 6.0-, 6.5-, 7.5-, or 8.0 mm stylets coated with saline compared to the control group (p=0.025, p=0.001, p=0.008, and p=0.001). CONCLUSION: We found that the effectiveness of lubricant resulted in various sized tubes. Less work was consumed for five tube sizes (6.0-, 6.5-, 7.0-, 8.0-, 8.5 mm) in lidocaine gel groups and four tube sizes (6.0-, 6.5-, 8.0-, 8.5 mm) in saline groups. Less peak withdrawal force was consumed for two tube sizes (6.0-, 8.0 mm) in lidocaine gel groups and four tube sizes (6.0-, 6.5-, 7.5-, 8.0 mm) in saline groups.
Subject(s)
Device Removal , Friction , Glottis , Intubation , Intubation, Intratracheal , Lidocaine , Lubricants , Tensile StrengthABSTRACT
BACKGROUND: We postulate that a delay in the implementation of hepatic arterial embolization for traumatic liver injury patients will negatively affect patient prognosis. Our work also seeks to identify factors related to the mortality rate among traumatic liver injury patients. METHODS: From January 2008 to April 2014, patients who had been admitted to the emergency room, were subsequently diagnosed with traumatic liver injury, and later underwent hepatic arterial embolization were included in this retrospective study. RESULTS: Of the 149 patients that underwent hepatic arterial embolization, 86 had the procedure due to traumatic liver injury. Excluding the 3 patients that were admitted to the hospital before procedure, the remaining 83 patients were used as subjects for the study. The average time between emergency room arrival and incidence of procedure was 164 min for the survival group and 132 min for the non-survival group; this was not statistically significant (p = 0.170). The average time to intervention was 182 min for the hemodynamically stable group, and 149 min for the hemodynamically unstable group, the latter having a significantly shorter wait time (p = 0.047). Of the factors related to the mortality rate, the odds ratio of the Glasgow Coma Score (GCS) was 18.48 (p < 0.001), and that of albumin level was 0.368 (p = 0.006). CONCLUSIONS: In analyzing the correlation between mortality rate and the time from patient admission to arrival for hepatic arterial embolization, there was no statistical significance observed. Of the factors related to the mortality rate, GCS and albumin level may be used as prognostic factors in traumatic liver injury.
Subject(s)
Humans , Coma , Embolization, Therapeutic , Emergency Service, Hospital , Incidence , Liver , Mortality , Odds Ratio , Patient Admission , Prognosis , Retrospective Studies , Time FactorsABSTRACT
BACKGROUND: We postulate that a delay in the implementation of hepatic arterial embolization for traumatic liver injury patients will negatively affect patient prognosis. Our work also seeks to identify factors related to the mortality rate among traumatic liver injury patients. METHODS: From January 2008 to April 2014, patients who had been admitted to the emergency room, were subsequently diagnosed with traumatic liver injury, and later underwent hepatic arterial embolization were included in this retrospective study. RESULTS: Of the 149 patients that underwent hepatic arterial embolization, 86 had the procedure due to traumatic liver injury. Excluding the 3 patients that were admitted to the hospital before procedure, the remaining 83 patients were used as subjects for the study. The average time between emergency room arrival and incidence of procedure was 164 min for the survival group and 132 min for the non-survival group; this was not statistically significant (p = 0.170). The average time to intervention was 182 min for the hemodynamically stable group, and 149 min for the hemodynamically unstable group, the latter having a significantly shorter wait time (p = 0.047). Of the factors related to the mortality rate, the odds ratio of the Glasgow Coma Score (GCS) was 18.48 (p < 0.001), and that of albumin level was 0.368 (p = 0.006). CONCLUSIONS: In analyzing the correlation between mortality rate and the time from patient admission to arrival for hepatic arterial embolization, there was no statistical significance observed. Of the factors related to the mortality rate, GCS and albumin level may be used as prognostic factors in traumatic liver injury.