Normal Thickness Ranges for the Adult Korean Epiglottis Using Ultrasonography

PURPOSE: The purpose of this study was to assess the reliability of ultrasonography to image the epiglottis and to determine a thickness range based on healthy Korean adults. METHODS: Anterior neck images were obtained in 100 healthy Koreans (52 males and 48 females) using ultrasonography. Sonographically, the epiglottis appeared as a curvilinear, hypoechoic structure with an echogenic preepiglottic space. 20 of 100 subjects, each patient underwent two ultrasound measurements by the same examiner to assess for intra-examiner reliability, followed by two additional measurements performed by a second examiner to assess for inter-examiner reliability. RESULTS: Intraclass correlation coefficient revealed excellent reliability (intra-examiner 0.901, inter-examiner 0.887). The average Korean epiglottis thickness was measured to be 2.31+/-0.22 mm (range: 1.88 mm to 2.84 mm), with greater thickness noted in men (2.41+/-0.21 mm) when compared to women (2.21+/-0.18 mm) (p <0.001). There was significant correlation between epiglottis thickness and body surface area (r=0.533), weight (0.517), height (0.437) and body mass index (0.372). Average examination time was recoded to be 17.84+/-13.09 seconds. CONCLUSION: Bedside ultrasonography is rapid, safe, easy to perform and can accurately evaluate the epiglottis as seen in our study. Because of excellent reliability, it is possible to establish diagnostic criteria.

Diagnosis of Congestive Heart Failure in Acute Dyspneic Patients with N-terminal Probrain Natriuretic Peptide (NT-proBNP)

PURPOSE: Misdiagnosis of congestive heart failure (CHF) is common in the emergency care setting uses clinical diagnostic tests. The utility of N-terminal probrain natriuretic peptide (NT-(pro)BNP) testing in the emergency department for differentiating between the causes of acute dyspnea and optimal cut-off points for its use are not well established. METHODS: One-hundred-nine consecutive patients with acute dyspnea, who visited our emergency medical center from December 2005 to February 2006, were prospectively recruited. Patients with acute coronary syndrome and chronic renal failure were excluded from study enrollment. The diagnosis of CHF was based on echocardiographic evidence of systolic or diastolic dysfunction. The diagnostic accuracy of NT-(pro)BNP was assessed by receiver operating characteristic curve analysis. RESULTS: The mean age was 69+/-15 years, and 41% of the patients were men. The diagnosis made in the emergency setting was incorrect in 29% of cases. The median NT(pro)BNP level among 45 patients (41%) who had acute CHF was 7739 versus 982 pg/ml for those 64 patients (59%) who did not have acute CHF(p<0.001). The area under the receiver operating characteristic curve was 0.88 (95% CI of 0.83-0.95). At a cutoff of 700pg/ml, NT-(pro)BNP had a sensitivity of 91%, a specificity of 70%, and an overall accuracy of 79% for acute CHF(p<0.001). An NT-(pro)BNP level <400pg/ml was optimal for ruling out acute CHF, which was a negative predictive value of 97%. Increased NT-(pro)BNP was the strongest independent predictor of acute CHF (odds ratio 21, 95% CI 6.1-70.0, p<0.001). CONCLUSION : NT-(pro)BNP appears to be useful as an aid in the diagnosis of CHF in acute dyspnea patients to the emergency department, however, an understanding of the cut-off points is helpful in accurate diagnosis of congestive heart failure.

Diagnosis of Congestive Heart Failure in Acute Dyspneic Patients with N-terminal Probrain Natriuretic Peptide (NT-proBNP)

PURPOSE: Misdiagnosis of congestive heart failure (CHF) is common in the emergency care setting uses clinical diagnostic tests. The utility of N-terminal probrain natriuretic peptide (NT-(pro)BNP) testing in the emergency department for differentiating between the causes of acute dyspnea and optimal cut-off points for its use are not well established. METHODS: One-hundred-nine consecutive patients with acute dyspnea, who visited our emergency medical center from December 2005 to February 2006, were prospectively recruited. Patients with acute coronary syndrome and chronic renal failure were excluded from study enrollment. The diagnosis of CHF was based on echocardiographic evidence of systolic or diastolic dysfunction. The diagnostic accuracy of NT-(pro)BNP was assessed by receiver operating characteristic curve analysis. RESULTS: The mean age was 69+/-15 years, and 41% of the patients were men. The diagnosis made in the emergency setting was incorrect in 29% of cases. The median NT(pro)BNP level among 45 patients (41%) who had acute CHF was 7739 versus 982 pg/ml for those 64 patients (59%) who did not have acute CHF(p<0.001). The area under the receiver operating characteristic curve was 0.88 (95% CI of 0.83-0.95). At a cutoff of 700pg/ml, NT-(pro)BNP had a sensitivity of 91%, a specificity of 70%, and an overall accuracy of 79% for acute CHF(p<0.001). An NT-(pro)BNP level <400pg/ml was optimal for ruling out acute CHF, which was a negative predictive value of 97%. Increased NT-(pro)BNP was the strongest independent predictor of acute CHF (odds ratio 21, 95% CI 6.1-70.0, p<0.001). CONCLUSION : NT-(pro)BNP appears to be useful as an aid in the diagnosis of CHF in acute dyspnea patients to the emergency department, however, an understanding of the cut-off points is helpful in accurate diagnosis of congestive heart failure.

A Retrospective Review of Patients Who Ingested Liquid Household Bleach Containing Sodium Hypochlorite

PURPOSE: Bleaching agents containing sodium hypochlorite are widely used at home to bleach laundry and to disinfect hard surfaces. A retrospective study, with a literature review, was conducted to focus attention on the clinical outcome after accidental or intentional ingestion of sodium hypochlorite. METHODS: The medical records of 67 patients presented to the Inha University emergency department for sodium hypochlorite ingestion between June 1996 and July 2003 were retrospectively examined. RESULTS: The Mean volume of the bleach in the 56 patients who ingested the bleach in a suicide attempt was significantly larger than that of the 11 patients with accidental ingestion (P=0.001). Nausea and vomiting was present in 79% of the patients. The volume of ingestion in patients with vomiting was significantly larger than that in patients without vomiting (P=0.001). Patients with epigastric pain ingested larger volumes of bleach compared to patients without the pain (P=0.01). Endoscopic examinations were performed in seven patient, and normal findings were seen in three patients. Grade 1 caustic injury was observed in two patients, and Grade 2 injuries in the rest. CONCLUSION: The solution of the sodium hypochlorite may cause mild symptoms and seems to be safe after ingestion. However, careful evaluation with endoscopy and hospital admission should be considered if there are symptoms or signs suggesting caustic injury of the esophagus and/or stomach or if the ingested volume is large.

Significance of Magnetic Resonance Imaging and Electroencephalography in Evaluating Children Visiting the Emergency Department with First Afebrile Seizures

PURPOSE: The purpose of our study is to evaluate the initial diagnostic value of magnetic resonance imaging (MRI) and electroencephalogrphy (EEG) in children who visit the emergency department (ED) with first afebrile seizure attacks. METHODS: We reviewed the medical records of children who visited the emergency department of Inha University Hospital with first afebrile seizure attacks and who underwent the diagnostic procedures of MRI & EEG during their visits. The study duration was for the 72 months from January 1997 to December 2002. One year after the study, we followed up the patients by using a telephone survey and by reviewing their medical records. RESULTS: The records of 46 patients, 23 boys and 23 girls, were reviewed. Generalized tonic clonic seizures appeared in 37 (80%) of the children and focal seizures in 9 (20%) of the children. Twenty nine (63%) of the children had two or more seizures during a single episode. There were 8 (17%) cases in which the seizures lasted for over 30 minutes. MRI abnormalities were found in only a small portion (9 cases, 20%) of the patients, but all of the MRI abnormalities were significant. The MRI abnormalities were as follows: brain atrophy (n=2), leptomeningeal enhancement (n=2), aneurysm (n=1), arachnoid cyst (n=1), ventriculomegaly (n=1), demyelinating disease (n=1), and hypoxic damage (n=1). Abnormal EEG findings were found in 15 (33%) of the children: Eleven showed partial seizures and 4 showed cerebral dysfunctions. CONCLUSION: Even though abnormal MRI & EEG findings were revealed in only a small portion of the patients, all of the revealed abnormal findings were very serious and were associated with significant problems. In conclusion, we suggest that initial MRI & EEG evaluations are valuable diagnostic procedures for children who visit the emergency department with first attacks of afebrile seizures.

Evaluation of Fingerstick Blood Glucose in Hypotensive Patients

PURPOSE: Due to its rapidity and easy accessibility, the fingerstick blood glucometer has been used in almost all hospitals and private clinics, and even by patients themselves. We also have used it even in shock patient care, but shock shows global tissue hypoperfusion, especially in peripheral tissue. The changes of peripheral circulation have an influence on the results for fingerstick glucose. To evaluate the accuracy of the glucometer for patients with poor peripheral perfusion, we designed this study. METHODS: A prospective, nonrandomized comparison group study was done. A hypotensive group and a normotensive group were compared. We obtained three data from each patient: venous blood glucose level (clinicopathologic laboratory), venous blood glucose level (by glucometer) and fingerstick glucose level (by glucometer). RESULTS: We saw a significant difference between the fingerstick glucometer results and the laboratory glucose levels in hypotensive patients: 131.67+/-55.33 mg/dl vs. 1 4 7 . 2 3+/-62.06 mg/dl (paired t-test, p0.05). There was no significant difference between the results of venous glucometer and laboratory test in either group: 142.37+/-61.27 mg/dl vs. 147.23+/-62.06 mg/dl (paired t-test, p>0.05) and 102.98+/-17.02 mg/dl vs. 105.60+/-21.95 mg/dl (paired t-test, p>0.05). Although some statistical differences existed between the results, all of the error rates were in an acceptable range (within 15%, accepted by American Diabetes Association consensus). CONCLUSION: These results suggest that the blood glucose level of the glucometer with venous blood is more accurate than that with peripheral blood in patients with poor peripheral circulation.

Primary Pulmonary Artery Angiosarcoma

A primary sarcoma of the pulmonary artery is a rare disease. The symptoms of the disease are nonspecific, so it is very difficult to get an exact diagnosis in an emegency situation. A 48-year-old man was admitted to our emergency center with the history of syncope. The patient had no symptoms of a chest problem. During the diagnostic work up, we found an increased density in the left upper lung field on the chest PA, which was the only diagnostic clue to the patient 's illness. A chest CT, a chest MRI, and other studies were done to diagnose the undelying cause of syncope. We found a large intraluminal mass in the pulmonary artery and anterior mediastinal lymph node enlargement. A firm tumor, which arose from the main pulmonary artery and caused a near total obstruction of the left main pulmonary artery, was found during operation, and a partial resection of the tumor mass was done. Histologic and immunohistochemical staining revealed the tumor to be poorly differentiated spindle cell sarcoma. We report the case of a pulmonary artery sarcoma patient, along with a brief review of related literature.