Changes in peak inspiratory flow rate and peak airway pressure with endotracheal tube size during chest compression / 世界急诊医学杂志（英文）

@#BACKGROUND: Adequate airway management plays an important role in high-quality cardiopulmonary resuscitation (CPR). Airway management is usually performed using an endotracheal tube (ETT) during CPR. However, no study has assessed the effect of ETT size on the flow rate and airway pressure during CPR. METHODS: We measured changes in peak inspiratory flow rate (PIFR), peak airway pressure (Ppeak), and mean airway pressure (Pmean) according to changes in ETT size (internal diameter 6.0, 7.0, and 8.0 mm) and with or without CPR. A tidal volume of 500 mL was supplied at a rate of 10 times per minute using a mechanical ventilator. Chest compressions were maintained at a constant compression depth and speed using a mechanical chest compression device (LUCAS2, mode: active continuous, chest compression rate: 102±2/minute, chest compression depth 2–2.5 inches). RESULTS: The median of several respiratory physiological parameters during CPR was significantly different according to the diameter of each ETT (6.0 vs. 8.0 mm): PIFR (32.1 L/min [30.5–35.3] vs. 28.9 L/min [27.5–30.8], P<0.001), Ppeak (48.84 cmH2O [27.46–52.11] vs. 27.45 cmH2O [22.53–52.57], P<0.001), and Pmean (18.34 cmH2O [14.61–21.66] vs.13.66 cmH2O [8.41–19.24], P<0.001). CONCLUSION: The changes in PIFR, Ppeak, and Pmean were related to the internal diameter of ETT, and these values tended to decrease with an increase in ETT size. Higher airway pressures were measured in the CPR group than in the no CPR group.

Is it possible to reduce intra-hospital transport time for computed tomography evaluation in critically ill cases using the Easy Tube Arrange Device?

OBJECTIVE: Patients are often transported within the hospital, especially in cases of critical illness for which computed tomography (CT) is performed. Since increased transport time increases the risks of complications, reducing transport time is important for patient safety. This study aimed to evaluate the ability of our newly invented device, the Easy Tube Arrange Device (ETAD), to reduce transport time for CT evaluation in cases of critical illness. METHODS: This prospective randomized control study included 60 volunteers. Each participant arranged five or six intravenous fluid lines, monitoring lines (noninvasive blood pressure, electrocardiography, central venous pressure, arterial catheter), and therapeutic equipment (O2 supply device, Foley catheter) on a Resusci Anne mannequin. We measured transport time for the CT evaluation by using conventional and ETAD method. RESULTS: The median transport time for CT evaluation was 488.50 seconds (95% confidence interval [CI], 462.75 to 514.75) and, 503.50 seconds (95% CI, 489.50 to 526.75) with 5 and 6 fluid lines using the conventional method and 364.50 seconds (95% CI, 335.00 to 388.75), and 363.50 seconds (95% CI, 331.75 to 377.75) with ETAD (all P < 0.001). The time differences were 131.50 (95% CI, 89.25 to 174.50) and 148.00 (95% CI, 116.00 to 177.75) (all P < 0.001). CONCLUSION: The transport time for CT evaluation was reduced using the ETAD, which would be expected to reduce the complications that may occur during transport in cases of critical illness.

Physicochemical characterization of porcine bone-derived grafting material and comparison with bovine xenografts for dental applications

PURPOSE: The physicochemical properties of a xenograft are very important because they strongly influence the bone regeneration capabilities of the graft material. Even though porcine xenografts have many advantages, only a few porcine xenografts are commercially available, and most of their physicochemical characteristics have yet to be reported. Thus, in this work we aimed to investigate the physicochemical characteristics of a porcine bone grafting material and compare them with those of 2 commercially available bovine xenografts to assess the potential of xenogenic porcine bone graft materials for dental applications. METHODS: We used various characterization techniques, such as scanning electron microscopy, the Brunauer-Emmett-Teller adsorption method, atomic force microscopy, Fourier-transform infrared spectroscopy, X-ray diffraction, and others, to compare the physicochemical properties of xenografts of different origins. RESULTS: The porcine bone grafting material had relatively high porosity (78.4%) and a large average specific surface area (SSA; 69.9 m²/g), with high surface roughness (10-point average roughness, 4.47 µm) and sub-100-nm hydroxyapatite crystals on the surface. Moreover, this material presented a significant fraction of sub-100-nm pores, with negligible amounts of residual organic substances. Apart from some minor differences, the overall characteristics of the porcine bone grafting material were very similar to those of one of the bovine bone grafting material. However, many of these morphostructural properties were significantly different from the other bovine bone grafting material, which exhibited relatively smooth surface morphology with a porosity of 62.0% and an average SSA of 0.5 m²/g. CONCLUSIONS: Considering that both bovine bone grafting materials have been successfully used in oral surgery applications in the last few decades, this work shows that the porcine-derived grafting material possesses most of the key physiochemical characteristics required for its application as a highly efficient xenograft material for bone replacement.

Is the Modified AIMS65 Score Suitable for Distinguishing the Low Risk Group and the High Risk Group for Patients with Upper Gastrointestinal Bleeding?

PURPOSE: The goal of this study was to increase the performance of the AIMS65 score in the prediction of outcomes in upper gastrointestinal bleeding by modifying the AIMS65 score. METHODS: Data were collected retrospectively between January 2015 and June 2015. A total of 212 adult patients, who visited the emergency department with an upper gastrointestinal hemorrhage during this period were included for analysis. High risk patients were defined as follows: those who needed an endoscopic or surgical hemostasis, suffered rebleeding, hospitalized in an intensive care unit, and those who were deceased within 30 days or required a blood transfusion. The seven parameters of the modified AIMS65 score were as follows: Albumin levels, international normalized ratio (prothrombin time), altered mental status, systolic blood pressure, age>65 years, hemoglobin levels, and heart rate. RESULTS: The high-risk group was comprised of 163 patients, while the low risk group was comprised of 49 patients. The areas under the curve for AIMS65 and modified AIMS65 scores were 0.727 (95% confidence interval, 0.662-0.786) and 0.847 (95% confidence interval, 0.791-0.892), respectively, which were significantly different (p<0.001). The AIMS65 score had a sensitivity of 53.0% and a specificity of 78.5% at a score of 0. The modified AIMS65 score had a sensitivity of 22.4% and a specificity of 99.3% at a score of 0. For the modified AIMS65 score of 3 or lower, the sensitivity was 97.9% with a specificity of 21.4%. CONCLUSION: The modified AIMS65 score was effective in distinguishing between the low-risk group and the high-risk group among patients with upper gastrointestinal bleeding.

Direction of the J-Tip of the Guidewire to Decrease the Malposition Rate of an Internal Jugular Vein Catheter / 대한구급학회지

BACKGROUND: We hypothesized that the direction of the J-tip of the guidewire during insertion into the internal jugular vein (IJV) might determine its ultimate location. METHODS: In this study, 300 patients between the ages of 18 and 99 years who required central venous catheterization via IJV in the emergency department enrolled for randomization. IVJ catheterization was successful in 285 of 300 patients. An independent operator randomly prefixed the direction of the J-tip of the guidewire to one of three directions. Based on the direction of the J-tip, patients were allocated into three groups: the J-tip medial-directed group (Group A), the lateral-directed group (Group B), or the downward-directed group (Group C). Postoperative chest radiography was performed on all patients in order to visualize the location of the catheter tip. A catheter is considered malpositioned if it is not located in the superior vena cava or right atrium. RESULTS: Of the total malpositioned catheter tips (8 of 285; 2.8%), the majority (5 of 8; 62.5%) entered the contralateral subclavian vein, 2 (25.0%) were complicated by looping, and 1 (12.5%) entered the ipsilateral subclavian vein. According to the direction of the J-tip of the guidewire, the incidence of malpositioning of the catheter tip was 4 of 92 in Group A (4.3%), 4 of 96 in Group B (4.2%), and there were no malpositions in Group C. There were no significant differences among the three groups (p = 0.114). CONCLUSIONS: The direction of the J-tip of the guidewire had no statistically significant effect on incidence of malpositioned tips.

Direction of the J-Tip of the Guidewire to Decrease the Malposition Rate of an Internal Jugular Vein Catheter / 대한중환자의학회지

BACKGROUND: We hypothesized that the direction of the J-tip of the guidewire during insertion into the internal jugular vein (IJV) might determine its ultimate location. METHODS: In this study, 300 patients between the ages of 18 and 99 years who required central venous catheterization via IJV in the emergency department enrolled for randomization. IVJ catheterization was successful in 285 of 300 patients. An independent operator randomly prefixed the direction of the J-tip of the guidewire to one of three directions. Based on the direction of the J-tip, patients were allocated into three groups: the J-tip medial-directed group (Group A), the lateral-directed group (Group B), or the downward-directed group (Group C). Postoperative chest radiography was performed on all patients in order to visualize the location of the catheter tip. A catheter is considered malpositioned if it is not located in the superior vena cava or right atrium. RESULTS: Of the total malpositioned catheter tips (8 of 285; 2.8%), the majority (5 of 8; 62.5%) entered the contralateral subclavian vein, 2 (25.0%) were complicated by looping, and 1 (12.5%) entered the ipsilateral subclavian vein. According to the direction of the J-tip of the guidewire, the incidence of malpositioning of the catheter tip was 4 of 92 in Group A (4.3%), 4 of 96 in Group B (4.2%), and there were no malpositions in Group C. There were no significant differences among the three groups (p = 0.114). CONCLUSIONS: The direction of the J-tip of the guidewire had no statistically significant effect on incidence of malpositioned tips.

Could One-Hand Compression for a Small Child Cause Intra-abdominal Injuries?

PURPOSE: We examined the question of whether one-hand chest compression for a small child could compress intraabdominal organs. METHODS: We retrospectively examined medical charts and multidirectional computed tomography (MDCT) images obtained from children aged 1 to 18 years who presented to the hospital from March 2002 to March 2012. We measured the length of the sternum (Stotal) and the length of the lower half of the sternum (Stotal/2~X). We also measured the distance from the diaphragm to the midpoint of the sternum (Stotal/2~D) and half the width of an adult hand (Wtotal/2). Finally, we counted the number of instances at each age in which Stotal/2~X and Stotal/2~D were less than Wtotal/2. RESULTS: This study included records and MDCT images for 301 children with a mean age of 12.05+/-5.59 years. We also enrolled 47 adult rescuers (25 men, 53.2%) with a mean age of 23.20+/-2.13 years. The mean Wtotal/2 was 4.62+/-0.46 cm. All 1-year-old children had Stotal/2~X and Stotal/2~D less than Wtotal/2. Among children aged 2 years, six (60.0%) had Stotal/2~X and Stotal/2~D less than Wtotal/2. Among children aged 3 years, four (26.7%) had Stotal/2~X and Stotal/2~D less than Wtotal/2, and among those aged 4 years, two (13.3%) had Stotal/2~X and Stotal/2~D less than Wtotal/2. However, Stotal/2~X and Stotal/2~D were greater than Wtotal/2 in children aged 5 years or more. CONCLUSION: Our measurements indicate that one-hand chest compression for a small child could cause intraabdominal organ injury.

Comparison of Compression Adjusted Ventilation to Conventional Ventilation: For Adequate Ventilation Rate During Cardiopulmonary Resuscitation

PURPOSE: The objective of this study is to determine whether application of ventilation in line with compression rate in performance of CPR for cardiac arrest patients was helpful in maintaining an adequate ventilation rate. METHODS: Volunteers who received education on the revised 2010 CPR guidelines were randomly assigned to either a conventional ventilation (CV) group or a compression-adjusted ventilation (CAV) group. During performance of CPR, compression rate and ventilation rate were measured every minute, and the participants' roles were changed every two minutes; CPR was performed for a total of eight minutes. RESULTS: A total of 57 volunteers participated in this study. No statistically significant difference was observed between the compression rate of the CV group and that of the CAV group. However, regarding adequacy of the ventilation rate, greater improvement was observed in the CAV group, compared with the CV group (adequate ventilation: 86.2% vs. 46.4%, p<0.001). In addition, the median value of the ventilation rate was 8.4/min (IQR: 7.7-9.6) in the CV group and 9.5/min (IQR: 9.0-10.0) in the CAV group (p=0.003). CONCLUSION: When no other valid approach is available, use of the CAV method is conducive to maintenance of an adequate ventilation rate.

Successful Treatment of Alopecia Areata with Topical Calcipotriol

Alopecia areata (AA) is an inflammatory hair loss of unknown etiology. AA is chronic and relapsing, and no effective cure or preventive treatment has been established. Vitamin D was recently reported to be important in cutaneous immune modulation as well as calcium regulation and bone metabolism. It is well known that areata is common clinical finding in patients with vitamin D deficiency, vitamin D-resistant rickets, or vitamin D receptor (VDR) mutation. The biological actions of vitamin D3 derivatives include regulation of epidermal cell proliferation and differentiation and modulation of cytokine production. These effects might explain the efficacy of vitamin D3 derivatives for treating AA. In this study, we report a 7-year-old boy with reduced VDR expression in AA, recovery of whom was observed by topical application of calcipotriol, a strong vitamin D analog.

Nail Change after Chemotherapy: Simultaneous Development of Beau's Lines and Mees' Lines

No abstract available.

Could a Growth Spurt Cause Linear Focal Elastosis Like Striae Distensae?

Linear focal elastosis (LFE) is characterized by several asymptomatic, yellow, palpable, irregularly indurated, striae-like lines extending horizontally across the middle and lower back. A focal increase in elastic fibers is a hallmark of the disease as seen from biopsy specimens. The pathogenesis of LFE is unclear, as is the association between LFE and striae distensae (SD). However, the prevailing opinion is that LFE represents an excessive regenerative process of elastic fibers and is analogous to keloidal repair of SD. Although the timing of onset of LFE and SD was not synchronous in our patient, the triggering factor was the same, which was the growth spurt. This case is supporting the putative association between LFE and SD.

The Safety of Bolus Infusion Through Intraosseous Access Using the EZ-IO in Terms of Extraosseous Flow

PURPOSE: We evaluated the safety of bolus infusion through intraosseous access using the EZ-IO in adults in terms of extraosseous flow. METHODS: We conducted a prospective study of adults (over age 18) in whom intraosseous access through the tibia was performed by emergency physicians or residents from June 2010 to June 2011. We used ultrasonography to confirm extraosseous flow during infusion of 80 mL normal saline with a 4 mL/s flow rate through intraosseous access, immediately after confirmation of intraosseous needle insertion using conventional methods. Finally, we recorded any complications that occurred immediately in the area of intraosseous access. RESULTS: Of 30 patients enrolled in the study, 22(73.3%) were male and eight (26.7%) were female. The mean age of study participants was 62.78+/-15.68 years; mean cortical thickness of participants' tibias was 0.27+/-0.03 cm. The mean time required for performance of the intraosseous access procedure was 16.00+/-4.65 s; success rate on the first attempt, 100.0%. No immediate complications, including swelling or extraosseous flow at the area of intraosseous access, were observed. CONCLUSION: In this study, bolus infusion though intraosseous access using the EZ-IO in adults in emergency departments was a safe option in terms of extraosseous flow.

Clinical Predictors of Cervical Abscess in Adult Emergency Department Patients Presenting a Sore Throat

PURPOSE: To evaluate clinical predictors of cervical abscess in adult patients who present a sore throat. METHODS: We prospectively studied adult patients (18 years of age or older) who presented with a sore throat at one of three hospitals (Chungnam national university hospital, Chungbuk national university hospital, and Konyang university hospital) from June 2010 to June 2011. The enrolled patients received a neck computed tomography scan, and their clinical manifestations were investigated. We evaluated several clinical variables in order to predict the existence of cervical abscess by use of multiple logistic regression analysis, and assessed the ability of the results of these variables to accurately diagnose cervical abscess using a receiver operating characteristic curve. RESULTS: A total of 109 patients were enrolled in this study. We identified two clinical variables (swelling and voice change) useful in predicting the existence of cervical abscess, and the AUC acquired by adding the scores of the two clinical factors was 0.89 (p<0.01). The sensitivity and specificity of these clinical factors to predict cervical abscess were 0.96 and 0.69 when the cut off value was determined to be 2. CONCLUSION: Two clinical factors (swelling and voice change) were useful in predicting the appearance of cervical abscesses. Consideration should be made for the need for incision and drainage of a cervical abscess if a patient presents swelling, or swelling and voice change.

Clinical Predictors of Cervical Abscess in Adult Emergency Department Patients Presenting a Sore Throat

PURPOSE: To evaluate clinical predictors of cervical abscess in adult patients who present a sore throat. METHODS: We prospectively studied adult patients (18 years of age or older) who presented with a sore throat at one of three hospitals (Chungnam national university hospital, Chungbuk national university hospital, and Konyang university hospital) from June 2010 to June 2011. The enrolled patients received a neck computed tomography scan, and their clinical manifestations were investigated. We evaluated several clinical variables in order to predict the existence of cervical abscess by use of multiple logistic regression analysis, and assessed the ability of the results of these variables to accurately diagnose cervical abscess using a receiver operating characteristic curve. RESULTS: A total of 109 patients were enrolled in this study. We identified two clinical variables (swelling and voice change) useful in predicting the existence of cervical abscess, and the AUC acquired by adding the scores of the two clinical factors was 0.89 (p<0.01). The sensitivity and specificity of these clinical factors to predict cervical abscess were 0.96 and 0.69 when the cut off value was determined to be 2. CONCLUSION: Two clinical factors (swelling and voice change) were useful in predicting the appearance of cervical abscesses. Consideration should be made for the need for incision and drainage of a cervical abscess if a patient presents swelling, or swelling and voice change.

Distribution of Malassezia Species on the Scalp in Korean Seborrheic Dermatitis Patients

BACKGROUND: Malassezia species play an important role in the pathogenesis of seborrheic dermatitis. In particular, M. restricta and M. globosa are considered to be the predominant organisms in seborrheic dermatitis of Western countries. However, species distribution of Malassezia in seborrheic dermatitis has not been clearly determined yet in Asia. OBJECTIVE: To identify the distribution of Malassezia species on the scalp of seborrheic dermatitis patients in Korea using 26S rDNA PCR-RFLP analysis. METHODS: A total of 40 seborrheic dermatitis patients and 100 normal healthy volunteers were included in this study. For the identification of Malassezia species, the scalp scales of the subjects were analyzed by 26S rDNA PCR-RFLP analysis. RESULTS: The most commonly identified Malassezia species were M. restricta in the seborrheic dermatitis patients, and M. globosa in the normal controls. In the seborrheic dermatitis group, M. restricta was identified in 47.5%, M. globosa in 27.5%, M. furfur in 7.5%, and M. sympodialis in 2.5% of patients. In the healthy control group, M. globosa was identified in 32.0%, M. restricta in 25.0%, M. furfur in 8.0%, M. obtusa in 6.0%, M. slooffiae in 6.0%, and M. sympodialis in 4.0% of subjects. CONCLUSION: M. restricta is considered to be the most important Malassezia species in Korean seborrheic dermatitis patients.

A Clinical and Histologic Study of Pityriasis Rosea during the Last 5-Year Period / 대한피부과학회지

BACKGROUND: Pityriasis rosea is an acute inflammatory dermatosis with an unproven etiology. The typical clinical feature consists of an initial, single herald patch followed by the development of smaller, disseminated, papulosquamous and ovoid macules. OBJECTIVE: The aim of this study was to evaluate the clinical manifestations of pityriasis rosea. METHODS: We examined a total of 101 patients with pityriasis rosea who visited the Department of Dermatology in Chung-Ang University Medical Center from March of 2005 to February of 2010. RESULTS: There were 1.53 times more women (61 patients) than men (40 patients) among the study subjects. The age of onset varied from 4 years to 71 years with a mean age of 28.7 years and 60% of the cases were 20 years to 39 years old. The percentage of seasonal variation was 34% in winter, 24% in summer, 22% in spring and 21% in autumn. A herald patch was found in 43% and the main predilection sites were the trunk and the thigh. Secondary eruptions could be classified into the macular type (67%), papular type (30%), urticarial type (2%) and purpuric type (1%). They appeared on the back, the chest, the abdomen, the upper arms, the thighs, the neck, the forearm, the lower legs, the face, the hands and the feet. The histopathological findings of all the types of lesions were focal parakeratosis, intraepidermal vesicles and papillary dermal edema. As compared to the macular type, hyperkeratosis, parakeratosis and exocytosis of lymphocytes were less commonly observed in the papular type. CONCLUSION: Most of the study results were compatible with those of other previous studies. However, the number of patients with papular type pityriasis rosea was currently increasing.

A Clinical and Histologic Study of Pityriasis Rosea during the Last 5-Year Period / 대한피부과학회지

BACKGROUND: Pityriasis rosea is an acute inflammatory dermatosis with an unproven etiology. The typical clinical feature consists of an initial, single herald patch followed by the development of smaller, disseminated, papulosquamous and ovoid macules. OBJECTIVE: The aim of this study was to evaluate the clinical manifestations of pityriasis rosea. METHODS: We examined a total of 101 patients with pityriasis rosea who visited the Department of Dermatology in Chung-Ang University Medical Center from March of 2005 to February of 2010. RESULTS: There were 1.53 times more women (61 patients) than men (40 patients) among the study subjects. The age of onset varied from 4 years to 71 years with a mean age of 28.7 years and 60% of the cases were 20 years to 39 years old. The percentage of seasonal variation was 34% in winter, 24% in summer, 22% in spring and 21% in autumn. A herald patch was found in 43% and the main predilection sites were the trunk and the thigh. Secondary eruptions could be classified into the macular type (67%), papular type (30%), urticarial type (2%) and purpuric type (1%). They appeared on the back, the chest, the abdomen, the upper arms, the thighs, the neck, the forearm, the lower legs, the face, the hands and the feet. The histopathological findings of all the types of lesions were focal parakeratosis, intraepidermal vesicles and papillary dermal edema. As compared to the macular type, hyperkeratosis, parakeratosis and exocytosis of lymphocytes were less commonly observed in the papular type. CONCLUSION: Most of the study results were compatible with those of other previous studies. However, the number of patients with papular type pityriasis rosea was currently increasing.

Primary Cutaneous Mucinous Carcinoma on the Abdomen / 대한피부과학회지

Primary cutaneous mucinous carcinoma is a rare epithelial neoplasm that arises from the deepest portion of the eccrine duct. It most commonly occurs on the scalp and face with a preference for on the eyelids. The histopathologic characteristics are large mucinous pools with fibrous septae and clusters of tumor cells. We report here on a case of mucinous carcinoma that developed on the abdomen of a 47-year-old woman.

Primary Cutaneous Mucinous Carcinoma on the Abdomen / 대한피부과학회지

Primary cutaneous mucinous carcinoma is a rare epithelial neoplasm that arises from the deepest portion of the eccrine duct. It most commonly occurs on the scalp and face with a preference for on the eyelids. The histopathologic characteristics are large mucinous pools with fibrous septae and clusters of tumor cells. We report here on a case of mucinous carcinoma that developed on the abdomen of a 47-year-old woman.

Sorafenib (Nexavar(R), BAY 43-9006)-induced Hand-foot Skin Reaction with Facial Erythema

Sorafenib (Nexavar(R), BAY 43-9006) is a novel, orally administered multi-kinase inhibitor that has recently been approved for the treatment of metastatic renal cell carcinoma. It is also used to delay disease progression in patients with advanced solid organ malignancies and metastatic melanoma. Sorafenib is associated with a relatively high incidence of dermatologic adverse events. The commonly occurring dermatologic adverse events associated with sorafenib include hand-foot skin reaction, facial erythema, splinter subungual hemorrhages, alopecia, pruritus and xerosis. We report here on a case of a 50-year-old man who was diagnosed with metastatic hepatocellular carcinoma. He developed both facial erythema and hand-foot skin reaction after the administration of sorafenib.