ABSTRACT
PURPOSE: Unstable pelvic fracture with bleeding can be fatal, with a mortality rate of up to 40%. Therefore, early detection and treatment are important in unstable pelvic trauma. We investigated the early predictive factors for possible embolization in patients with hemodynamically unstable pelvic trauma.METHODS: From January 2011 to December 2013, 46 patients with shock arrived at a single hospital within 24 hours after injury. Of them, 44 patients underwent CT scan after initial resuscitation, except for 2 who were dead on arrival. Nine patients with other organ injuries were excluded. Seventeen patients underwent embolization. A single radiologist measured the width (longest length in axial view) and length (longest length in coronal view) of pelvic hematoma on CT scans. Demographic, clinical, and radiological data were reviewed retrospectively.RESULTS: Among 35 patients with hemodynamically unstable pelvic fracture, 22 (62.9%) were men. Width (P = 0.002) and length (P = 0.006) of hematoma on CT scans were significantly different between the embolization and nonembolization groups. The predictors of embolization were width of pelvic hematoma (odds ratio [OR], 1.07; P = 0.028) and female sex (OR, 10.83; P = 0.031). The cutoff value was 3.35 cm. More embolization was performed (OR, 12.00; P = 0.003) and higher mortality was observed in patients with hematoma width >3.35 cm (OR, 4.96; P = 0.048).CONCLUSION: Patients with hemodynamically unstable pelvic trauma have a high mortality rate. CT is useful for the initial identification of the need for embolization among these patients. The width of pelvic hematoma can predict possible embolization in patients with unstable pelvic trauma.
Subject(s)
Female , Humans , Male , Embolization, Therapeutic , Fractures, Bone , Hematoma , Hemorrhage , Mortality , Resuscitation , Retrospective Studies , Shock , Tomography, X-Ray ComputedABSTRACT
PURPOSE: To determine whether primary snoring could be distinguished from obstructive sleep apnea syndrome (OSAS) by clinical evaluation and symptom scores. METHODS: 56 snoring and 20 asymptomatic subjects were recruited and polysomnography was used to confirm that there were 39 OSAS, 17 primary snoring, and 20 control subjects. We evaluated the size of the childrens adenoids and tonsils. Parents completed sleep disordered breathing scale (SDBS) and obstructive sleep apnea 18 (OSA-18) questionnaires for use as symptom scores, as well as an attention deficit hyperactivity disorder rating scale-IV (ADHD RS-IV). RESULTS: There were no differences between primary snoring and OSAS in terms of tonsil and adenoid size, SDBS (9.4+/-4.6 vs 10.8+/-4.5), and OSA-18 score (61.1+/-25.1 vs 71.2+/-8.4). The patients with OSAS (15.8+/-7.9) and PS (22.2+/-9.4) had a higher ADHD RS-IV score than the control subjects (2.9+/-3.3). There was no difference in the ADHD RS-IV scores of patients with primary snoring and OSAS. CONCLUSION: We confirmed that clinical evaluation could not distinguish OSAS and primary snoring. In addition, our study suggests that primary snoring as well as OSAS is associated with attention deficit hyperactivity disorder.
Subject(s)
Child , Humans , Adenoids , Attention Deficit Disorder with Hyperactivity , Discrimination, Psychological , Palatine Tonsil , Parents , Polysomnography , Surveys and Questionnaires , Sleep Apnea Syndromes , Sleep Apnea, Obstructive , SnoringABSTRACT
Kawaski disease is the leading cause of acquired heart disease in children in many parts of the world. Atypical Kawasaki disease does not meet the diagnostic criteria of Kawasaki disease. Incomplete presentations make early diagnosis and timely treatment difficult. Delays in diagnosis and treatment are associated with an increased risk of coronary artery aneurysm. Thus, echocardiography should be considered in febrile infants of uncertain etiology. Clinical practitioners should have a high index of suspicion to diagnose and initiate prompt treatment to reduce the comorbidity of coronary arterial disease in patients with atypical Kawasaki disease. A 9-month-old girl had daily high spiking fever for 9 days and showed erythematous change on BCG vaccination site only. Echocardiography was performed and disclosed saccular aneurysm of left coronary artery and diffuse right coronary artery dilatation. She was treated with intravenous immunoglobulin and aspirin. After 6 months, a follow-up echocardiogram revealed decreased size of coronary arteries. In such cases, careful evaluation of clinical findings with erythematous change on BCG vaccination site are needed.
Subject(s)
Child , Female , Humans , Infant , Aneurysm , Aspirin , BCG Vaccine , Comorbidity , Coronary Vessels , Diagnosis , Dilatation , Early Diagnosis , Echocardiography , Fever , Follow-Up Studies , Heart Diseases , Immunoglobulins , Mucocutaneous Lymph Node Syndrome , Mycobacterium bovis , VaccinationABSTRACT
Male infertility, due to pituitary or hypothalamic disease, which results in a deficiency of luteinizing hormone, follicle-stimulating hormone, or both, is less common than that due to primary testicular damage, but should be eminently treatable by replacement of either or both of these hormones. Exogenous gonadotropin, or pulsatile gonadotropin-releasing, hormone is now commonly used to treat male infertility due to hypogonadotropic hypogonadism. Here, we report on a male patient with an acquired hypogonadotropic hypogonadism, which developed after puberty, who underwent successful treatment with human chorionic gonadotropin (hCG) and human menopausal gonadotropin (hMG).