Characteristics and Risk Factors of Bicycle Injury

PURPOSE: The bicycle is a clean and future-oriented means of transportation and bicycle usage is growing. The bicycle has been in the spotlight lately with Europe and North America as the center. The purpose of this study was to establish proper prevention strategies for bicycle injuries. METHODS: In this retrospective study, we analysed 148 bicycle-related injury patients who visited our hospital between Feb 1, 2008 and Jan 31, 2009. Information such as age, gender, injury severity score, injury time, injury place, and other characteristics were collected. Data were analysed using SPSS 12.0K. RESULTS: Among the enrollees, 80.4% were male. Patients over 65 years of age accounted for only 18.2% of the group, but average injury severity score (ISS) of this group was the highest. Injuries occurred frequently between 16:00 and 22:00 in the evening, while the severity was higher between 00:00 and 08:00 in the morning. Most of the injuries developed on the roads, which included local roads, national highways, and alleyways. Injuries on the roads were more severe than those that occurred in other places. CONCLUSION: There have been suggestions for using bicycles safely. Legislation on bicycle helmet use already exists. Also, protective apparatus such as knee pads, wrist guards, and protection vests are recommended for use. Construction of more bike trails will be necessary. Above all, bicycle riders' safety consciousness is the most important part.

Initial Imaging Modality in Patients with Acute Ischemic Stroke

PURPOSE: Though their clinical effectiveness of intra-arterial thrombolytic treatment has been proven, there is still some controversy in the choice of baseline imaging study for selecting particular hyper acute stroke patients who would benefit from thrombolysis from among patients with hyper acute stroke. In spite of their excellent resolution MR images has limitations for use in a baseline study because of their cost. The purpose of this study was to assess which baseline study, CT image or diffusion-weighted image, was more beneficial in evaluating hyper acute stroke patients who might particularly benefit from intra-arterial thrombolysis of the middle cerebral artery occlusion. METHODS: We divided the patients into two groups: those for whom CT was used for the initial imaging modality and those for whom MRI was used. We compared in-hospital time delay and the disadvantage of time consumed in evaluating of patients between the two groups. Baseline and 24-hour follow-up CT or MR scans of patients treated with intra-arterial thrombolysis were retrospectively scored by using the Alberta Stroke Program Early CT Score (ASPECTS). RESULTS: The analysis included 64 patients with angiographically confirmed middle cerebral artery occlusion. Although there was significant time delay in obtaining a MR diffusion weighted image (130.20+/-71.63 min) compared to a CT scan (73.64+/-28.99 min) (p<0.001), there were no significant clinical loss scored by using National Institutes of Health Stroke Scale (NIHSS) (p=0.676) and no significant difference in the prognosis estimated by using the modified Rankin scale (p= 0.162). Diffusion weighted images showed significantly higher ASPECT score (p=0.028) in the good prognosis group, and the ROC curve revealed the diffusion weighted images to be better indication for intra-arterial thrombolysis. CONCLUSION: According to our results, MR diffusion weighted images were more useful than CT scans for predicting the outcome of intra-arterial thrombolytic treatment. Our results suggest MR diffusion weighted images can replace CT scans for baseline imaging studies for hyperacute stroke patients.

Clinical Analysis of Resuscitation in Victims of Out-of-Hospital Cardiac Arrest

PURPOSE: The purpose of this research is to estimate the overall survival rate and to understand the factors influencing hospital discharge when cardiopulmonary resuscitaion is attempted on out-of-hospital cardiac arrest victims. METHODS: From March 2000 to February 2001, we studied prospectively 71 consecutive victims with out-of-hospital cardiac arrest. We used the same record based on the "Utstein Style". RESULTS: Fifty-three of the 71 patients were transported by 119 ambulance; the remainder were transported by non-119 ambulance. An initial rhythm of pulseless electrical activity(PEA) was present in 66.2% of the patients, ventricular fibrillation(VF)/ventricular tachycardia in 22.5%, and asystole in 11.3%. Fifty-five of the 71 (77.5%) were cardiac arrest cases witnessed by a layman. The number of cardiac etiologies was 24 (33.8%), non-cardiac etiologies 36 (50.7%), and unknown causes 11 (15.5%). There were no statistical differences in return of spontaneous circulation (ROSC) and survival rate related to the causes of cardiac arrest, initial EKG rhythm, and method of transportation. Of the 71 patients, 29 patients (40.2%) experienced ROSC; seven patients survived. CONCLUSION: With the increase in cardiovascular disease and traffic accidents, the number of out-of-hospital cardiac arrests has risen accordingly. However, the survival rate has not changed much compared to the past. Major factors contributing to the unchanged survival rate are lack of bystander CPR, defibrillation in the prehospital stage, inappropriate CPR by EMT, early pronouncement of death, and unskilled CPR by the physician, and improvement in these areas are necessary in order to bring about a change .

A Clinical Review of Intussusception of Infancy and Childhood in Emergency Department

Intussusception is a condition of invagination of the proximal segment of bowel into the more distal receiving bowel. Intussusception is one of the common pediatric and surgical emergencies of infancy and childhood in Korea. Intussusception is the most common cause of acquired intestinal obstruction in infancy and childhood, and it needs emergency treatment. 1) On the age and sex distribution, the age under 15 month was the most common(70.6%), and the peak incidence was 3-12 months of age(60.1%). In sex distribution, male to female ratio was 1.25:1. 2) The seasonal distribution was summer(27.4%), spring, autumn and winter in order of frequency. 3) As to the etiology of Intussusception treated by surgery, idiopathic was the most common(75%). 4) The cardinal symptoms and signs were vomiting(72.5%), bloody or bloody mucoid stool(57.5%), abdominal pain(49.7%), abdominal distention(20.9%), abdominal mass(19.6%) and others in order of frequency. 5) On the hematologic finding, 60.8% revealed leukocytosis above 10,000/mm3. 6) As to the duration from the onset of the symptom to admission, 84.2% was within 24 hours, 9.8% was from 24 hours to 48 hours, and 5% was over 48 hours. 7) The common anatomical types were ileocolic(73.2%), and ileocecal(17.0%). 8) The success rate of air reduction was 84.3%. 9) In the method of operation, manual reduction was performed in 91.7% and intestinal resection in 8.3%. 10) The recurrence rate after air reduction was 12.4% and after operative manual reduction was 8.3%.