Venous thromboembolism associated with combined oral contraceptive use: a single-institution experience

Objective@#Combined oral contraceptives (COCs) are used for various reasons. However, venous thromboembolism (VTE), a significant side effect, can be fatal. This study reports the first case series in Korea involving patients with COC-associated VTE registered at a university hospital. @*Methods@#This study recruited 13 patients diagnosed with COC-associated VTE between June 2006 and May 2018. Risk factors, including age, body mass index, smoking habits, estrogen dosage, type of progestin, and duration of COC use, were evaluated. @*Results@#Among patients with VTE, 9 showed pulmonary embolism (PE) concomitant with deep vein thrombosis (DVT). However, the remaining patients showed DVT (1 patient), PE (1 patient), and cerebral venous thrombosis (2 patients). The median duration between the onset of symptoms and a hospital visit was 3 days, and it sometimes took as long as 32 days. Among the 10 patients with PE, 1 high-risk group and 2 intermediate-high risk groups were treated with tissue plasminogen activators before anticoagulants. There were no cases of recurrence among patients who continued to take anticoagulants for 3 months. @*Conclusion@#These findings emphasize that healthcare professionals who prescribe or dispense COCs to women must inform them of the risk of VTE, including the risk factors, differences in risk depending on the type of progestin present in the product, and pertinent signs and symptoms. Efforts should also be made to inform patients of VTE, even through information campaigns such as brochures. Most importantly, women should remain alert for signs and symptoms of VTE when using COCs.

Venous thromboembolism associated with combined oral contraceptive use: a single-institution experience

Objective@#Combined oral contraceptives (COCs) are used for various reasons. However, venous thromboembolism (VTE), a significant side effect, can be fatal. This study reports the first case series in Korea involving patients with COC-associated VTE registered at a university hospital. @*Methods@#This study recruited 13 patients diagnosed with COC-associated VTE between June 2006 and May 2018. Risk factors, including age, body mass index, smoking habits, estrogen dosage, type of progestin, and duration of COC use, were evaluated. @*Results@#Among patients with VTE, 9 showed pulmonary embolism (PE) concomitant with deep vein thrombosis (DVT). However, the remaining patients showed DVT (1 patient), PE (1 patient), and cerebral venous thrombosis (2 patients). The median duration between the onset of symptoms and a hospital visit was 3 days, and it sometimes took as long as 32 days. Among the 10 patients with PE, 1 high-risk group and 2 intermediate-high risk groups were treated with tissue plasminogen activators before anticoagulants. There were no cases of recurrence among patients who continued to take anticoagulants for 3 months. @*Conclusion@#These findings emphasize that healthcare professionals who prescribe or dispense COCs to women must inform them of the risk of VTE, including the risk factors, differences in risk depending on the type of progestin present in the product, and pertinent signs and symptoms. Efforts should also be made to inform patients of VTE, even through information campaigns such as brochures. Most importantly, women should remain alert for signs and symptoms of VTE when using COCs.

Does Switching Rescuers Every 2 Minutes Improve the Quality of Chest Compression Provided in Cardiopulmonary Resuscitation?

PURPOSE: Effective chest compressions may improve the return of spontaneous circulation and positive neurologic outcomes in cardiac arrest victims. Out of concern for rescuer fatigue, guidelines for cardiopulmonary resuscitation (CPR) recommend that the individual applying chest compressions should be switched every 2 minutes, but there is little evidence to support this recommendation. In this study, we investigated whether or not changing the individual who is applying chest compressions every 2 minutes during cardiopulmonary resuscitation is appropriate or not. METHODS: We recruited health personnel working at one university hospital on a volunteer basis. On a randomly assigned day, we compared the effectiveness of the use of multiple rescuers following the 2 minute guideline, versus single rescuer (rescuer-limited) in performance of CPR. The resulting data was collected by use of CPR recording technology, and chest compression quality variables including compression rate, compression depth, proportion of adequate compression depth, and proportion of incomplete recoil were recorded. RESULTS: There were statistically significant improvements in the rescuer-limited trial outcome including average compression depth (p=0.013), proportion of adequate compression depth (p=0.027), and difference in reported fatigue (0.007). CONCLUSION: In this study, we found that a rescuer-limited method is more effective than the multiple rescuer method in terms of subjective fatigue and chest compression quality metrics.

Comparisons of Fracture Types and Pelvic Angiographic Findings in Hemodynamically Unstable Pelvic Bone Fracture

PURPOSE: Hemorrhagic shock is the leading cause of death in patients with pelvic bone fractures. The majority of blood loss is due to injured pelvic arteries and retroperitoneal veins and to bleeding from the fracture site itself. Pelvic angiography and embolization of injured vessels is an effective way to control continuous bleeding. However, identifying the bleeding focus in hemodynamically unstable patients before diagnostic intervention is difficult. The purpose of this study was to determine the correlation between fracture patterns in hemodynamically unstable patients with pelvic fractures and later pelvic angiography findings. METHODS: We performed a retrospective study of 21 hemodynamically unstable patients with pelvic fractures admitted to our emergency department between April 2001 to April 2006. All 21 patients underwent pelvic angiography. Pelvic fractures were assessed according to the Tile's classification and the degree of injury was assessed using the Injury Severity Score (ISS) and Revised Trauma Score (RTS). The hemodynamic status of the patients was defined using vital signs, base excess, and blood lactate. Fracture patterns were compared with hemodynamic status and angiography findings. RESULTS: In the 5year study period, 21 hemodynamically unstable pelvic bone fracture patients were admitted; ten were men (47.6%), and 11 were women (52.4%). The mean age was 41.1 years (range: +/-20.1). Of the 21 embolization was performed in 6 patient (28.6%): 1 patient of the 5 unstable pelvic bone fracture patients (20%), and 5 patients of 16 the stable pelvic bone fracture patients (31.3%). There were no significant differences between the RTS (p=0.587) and embolization rate (p=0.774) for either the stable patients or the unstable patients. Patients with arterial injury on angiography had a lower RTS compared with patients without arterial injury but there was no significant difference in ISS between the two groups. The angiographic injured sites were five internal femoral arteries and one external femoral artery. CONCLUSION: The findings in this study suggest that the pelvic fracture pattern in hemodynamically unstable patients with pelvic fractures does not correlate with pelvic angiography findings.

The Characteristics of Spinal Injury in Skiing and Snowboarding Injuries

PURPOSE: Few studies have been done for spinal injuries after skiing and snowboarding accidents. Assuming that the riding patterns of skiing and snowboarding were different, we analyzed the differences between the mechanisms, diagnoses and levels of spinal injuries caused by them. The purpose of this study was to gain a better understanding of spinal hazards associated with skiing and snowboarding in order to educate skiers and snowboarders. METHODS: We conducted a prospective study of 96 patients who had sustained spinal injuries as a result of skiing and snowboarding accidents from January 2003 to March 2006. We used a questionnaire, radiological studies, history taking, and physical examinations. We analyzed the mechanism of injury, the level of spinal injury, the severity of spinal injury, and the Abbreviated Injury Scale scores (AIS score). We used the t-test and the chi-square test. RESULTS: The skiing and the snowboarding injury group included in 96 patients. The skiing injury group included 30 patients (31.2%), and the snowboarding injury group included the remaining 66 patients (69.8%). The primary mechanism of injury in skiing was collisions and in snowboarding was slip downs (p=0.508). The primary level of spinal injury in skiing and snowboarding was at the L-spine level (p=0.547). The most common athlete ability of the injured person was at the intermediate level (p=0.954). The injured were most commonly at the beginner or the intermediate level (p=0.302). The primary diagnosis of spinal injury in skiing and snowboarding was back spain (p=0.686). The AIS scores did not differed between the two groups (p=0.986). CONCLUSION: The most common spinal injury after skiing and snowboarding accidents was back sprain. There was no difference in the severity of spinal injury between skiing and snowboarding accidents.

Relation between Serum S100beta and Severity and Prognosis in Traumatic Brain Injury

PURPOSE: S100beta, a marker of traumatic brain injury (TBI), has been increasingly focused upon during recent years. S100beta, is easily measured not only in cerebrospinal fluid (CSF) but also in serum. After TBI, serum S100beta, has been found to be increased at an early stage. The purpose of this study was to evaluate the clinical correlations between serum S100beta, and neurologic outcome, and severity in traumatic brain injury. METHODS: From August 2006 to October 2006, we made a protocol and studied prospectively 42 patients who visited the emergency room with TBI. Venous blood samples for S100beta, protein were taken within six hours after TBI and vital signs, as well as the Glasgow Coma Scale (GCS), were recorded. The final diagnosis and the severity were evaluated using the Abbreviated Injury Score (AIS), and the prognosis of the patients was evaluated using the Glasgow Outcome Score (GOS). RESULTS: Thirty-eight patients showed a favorable prognosis (discharge, recovery, transfer), and four showed an unfavorable prognosis. Serum S100beta, was higher in patients with an unfavorable prognosis than in patients with a favorable prognosis, and a significant difference existed between the two groups (0.74+/-50 microgram/L vs 7.62+/-6.53 microgram/L P=0.002). A negative correlation existed between serum S100beta, and the Revised Traumatic Score (R2=-0.34, P=0.03), and a positive correlation existed between serum S100beta, and the Injury Severity Score (R2=0.33, P=0.03). Furthermore, the correlations between serum S100beta, and the initial GCS and the GCS 24 hours after admission to the ER were negative (R2=-0.62, P<0.001; R2=-0.47, P=0.005). Regarding the GOS, the mean serum concentration of S100beta. was 7.62 beta partial differential/L (SD=+/-6.53) in the expired patients, 1.15 microgram/L in the mildly disable patient, and 0.727 microgram/L (SD=+/-0.73) in the recovered patients. These differences are statistically significant (p<0.001). CONCLUSION: In traumatic brain injury, a higher level of serum concentration of S100beta, has a poor prognosis for neurologic outcome.