A Case of Facial Palsy Developed after Vestibular Neuritis Involving Superior Vestibular Nerve / 대한평형의학회지

Vestibular neuritis is generally thought to be caused by a viral or postviral inflammatory disorder of vestibular structures. But there is no definite evidence to explain this pathophysiological mechanism until now. We experienced an unusual case of 34-year-old man who presented with facial paralysis several days after vertigo of a whirling nature. We report a case of facial palsy developed in succession of ipsilateral vestibular neuritis involving superior vestibular nerve which may infer the viral pathophysiology for the vestibular neuritis with a brief literature review.

The Influence of the Sick House Syndrome on Nasal Mucosa and Nasal Symptoms / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Concerns about the quality of indoor air have increased recently. However, there has not been any significant research conducted concerning the patterns of histologic and organic changes induced in humans by indoor air pollution. The aim of the study is to investigate the organic changes of nasal mucosa and nasal symptoms due to exposed concentrations of indoor air pollution. SUBJECTS AND METHOD: We studied fourteen people from four families, all of whom had plans to move into new apartments. We measured the quantities of indoor air pollution before their move, one week after moving in, and then one month after the move. Other clinical tests such as an acoustic rhinometry, olfactory tests and nasal smears were performed. RESULTS: Mean concentrations of Total Volatile Organic Chemicals (TVOCs) and aldehydes showed an increase after moving into the new apartments. Post-move acoustic rhinometry, Connecticut Chemosensory Clinical Research Center (CCCRC) test and endoscopic findings showed a decrease in nasal function and patency. Additionally, in nasal smears, eosinophils with bilobulated nuclei were observed, and eosinophil count showed a pattern of increase. CONCLUSION: High concentrations of indoor air pollutants could induce organic changes of the nasal cavities and cause the recession of olfactory function. Due to indoor air pollutants, hypersensitivity of nasal mucosa was induced, and histological changes of nasal mucosa as well as hematological changes were observed. These indicate that indoor air pollution impinges on the nasal mucosa and cause nasal symptoms.

Analysis of Predictive Factors for Children with Abdominal Pain in Emergency Departments

PURPOSE: Abdominal pain is one of most common complaints in children who visit emergency department (ED), but sometimes it is very difficult in differential diagnosis between medical and surgical disease. This study was performed to collect and analysis of diagnositic scores of children with abdominal pain who could not definitely diagnosed as medical or surgical disease in ED. METHODS: This study reviewed 201 children who were visited for abdominal pain in ED at a tertiary hospital from January 2005 to June 2005. We reviewed the medical records and analysed clinical characteristics, laboratory findings, and radiologic findings retrospectively. We analyzed the diagnostic scores between medical and surgical disease group. RESULTS: The number of medical disease are 125 patients, and the number of surgical disease are 76 patients. Significant predictable factors for surgical diseases are right quadrant pain, vomiting, tenderness, rebound tenderness, leukocytosis and diagnostic score. The mean diagnostic score of medical diseases is 4.55+/-4.10 (mean+/-SD) and the mean score of surgical diseases is 16.22+/-3.48(mean +/-SD). CONCLUSION: For the diagnosis of children with abdominal pain which is uncertain either medical or surgical disease in ED, the diagnostic scores, careful observation and physical examination repeatedly are helpful for correct diagnosis and prompt treatment.

Use of Malaria Antibody Test Kit and Clinical Features in Malaria Patients

PURPOSE: Distinguishing malaria from severe infection among febrile patients in emergency room is difficult, so we tried to analyze the clinical manifestations of malaria and the results of using devices as a quick way to detect malaria among febrile patients visiting an emergency medical center (EMC). METHODS: We retrospectively reviewed the clinical records of patients visiting a local EMC from January 2001 to December 2004 and confirmed as having vivax malaria by using a peripheral blood smear and Malaria antibody test (Immunochromatographic assay). RESULTS: All of the 108 included patients were infected with Plasmodium vivax and suffered from high fever, but tertian fever was seen in only 41 patients (37.9%). Various symptoms included headache, myalgia, abdominal pain, and so on. Laboratory findings noted thrombocytopenia, anemia, elevated alanin aminotransferase, and coagulopathies. Malaria antibody test was used in all cases for early diagnosis in the EMC. Compared with the peripheral blood smear, malaria antibody test identified 103 cases as positive, and five cases as negative. The diagnostic sensitivity of the malaria antibody test is 95.3%. CONCLUSION: Since south Korea is a malaria endemic area, for patients visiting an emergency room with a high fever, accompanied by thrombocytopenia and anemia, malaria must be included in the differential diagnosis whether the fever is tertian or not. The Malaria antibody test can be done by even an unskilful person, so it is a very helpful screening test and an early detection tool for malaria.

Increased Intracranial Pressure Detected by Emergency Ultrasonography of the Optic Nerve Sheath Diameter

PURPOSE: A rapid, portable, and noninvasive means of detecting increased intracranial pressure (IICP) is desirable when conventional imaging methods are unavailable. The purpose of this study was to show that ultrasonographic measurement of the optic nerve sheath diameter (ONSD) can accurately predict the presence of IICP. METHODS: We performed a prospective study of emergency department patients suspected of having IICP due to possible focal intracranial pathology. The ONSD was measured 3 mm behind the globe using a linear probe on the closed eyelids of supine patients. For each patient, the mean of the two ONSD measurements was calculated, and the brain computed tomography (CT) was evaluated for signs of IICP. RESULTS: One hundred patients were enrolled; 31 had CT results consistent with IICP, and their mean ONSD was 6.30 mm; the mean ONSD of patients who didn't show signs of IICP on CT was 4.50 mm. The sensitivity and the specificity for the ONSD, when compared with CT results, were 100% and 98.6%, respectively. CONCLUSIONS: The evaluation of the ONSD is a simple noninvasive procedure, and is a potentially useful tool in assessing and monitoring patients suspected of having IICP.

A Case of Splenic Artery Aneurysm Rupture

Splenic artery aneurysms are an uncommon form of vascular disease that carry the risk of rupture and fatal hemorrhage. Precise cause of splenic artery aneurysms are not be established, the most common pathologic finding is defect of the media. Splenic artery aneurysms occur in patient with multiple pregnancies, portal hypertension, splenomegaly, after orthotopic liver transplantation and fibrodysplasia. Most patients who are diagnosised with splenic artery aneurysm are asymptomatic. Arteriography is a confirmed diagnostic method for detecting splenic artery aneurysms and searching the location of aneurysms. Operative treatment and therapeutic catheter embolization have been used for treatment of splenic artery aneurysms.

The Efficacy of CT Scan and the Optimal Treatment for Traumatic Occult Pneumothorax

PURPOSE: An unrecognized pneumothorax detected on chest and abdomen CT scan after chest blunt trauma is associated with the prognosis for the patient. We assessed the efficacy of chest CT scan and the optimal treatment for traumatic occult pneumothorax patients. METHODS: The charts and the chest radiographic data of all trauma patients diagnosed with traumatic occult pneumothorax from January 2000 through December 2003 at Ilsan Paik hospital were retrospectively reviewed. Data recorded included age, gender, injury mechanism, associated injuries, length of stay, revised trauma score (RTS), injury severity score (ISS), the type of pneumothorax, the course during the hospital, and whether the use of mechanical ventilation and general anesthesia. RESULTS: A total of 67 patients with traumatic occult pneumothorax were admitted over a 48-month period via the emergency department. Of the 67 patients, 39 patients (58.2%) had closed thoracostomy. The mean RTS was 11.21+/-1.45, and the mean ISS was 20.46 +/-12.52 in closed thoracostomy patients. In other 28 patients, the mean RTS was 11.64+/-1.12, and the mean ISS was 19.64 +/-11.25. In the closed thoracostomy groups, 10 patients (14.9%) needed mechanical ventilation or general anesthesia. In the other group, 3 patients needed it. CONCLUSION: CT scanning provided important information for finding traumatic occult pneumothorax. If anterolateral type pneumothorax is present, or highly positive mechanical ventilation is needed, the patients must be treated with closed thoracostomy. However when the occult pneumothorax has minimal size or general anesthesia is needed, patients can be safely observed and should be treated with a selective approach.

A Clinical Analysis of Abdominal Stab Injuries for Five Years

PURPOSE: The prognosis of a patient in the management of abdominal stab wound depends on the time of emergency exploration and on how much negative exploration rates can be decreased. We will examine the indication and the treatment plan of emergency exploration by the clinical evaluation of the patients in this hospital. METHODS: Charts of all patients with abdominal stab wound were reviewed that they admitted at the emergency room for 5 years between January 1st, 1998 and December 31th, 2002 and the indication of an emergency abdominal exploration was analysed on four-category bases. RESULTS: 1) In 39 cases of Group which emergency exploration, negative exploration rate was 30.8%. 2) Operated patients were not observed intraabdominal organ injury in 1 of 13 cases (7.7%) which were hemodynamic unstable, 3 of 28 (10.7%) which were peritoneal irritation sign, 3 of 9 (33.3%) which were evisceration of bowel or omentum, 2 of 15 (13.3%) which were organ injury or hemoperitoneum on abdominal CT finding basis. 3) The complication and mortality rate in our study was 11.6%, 2.3%. CONCLUSION: There is no doubt about the operation of emergency abdominal exploration for hemodynamic instability or generalized peritonitis. But the evisceration of bowel or omentum, by itself, should not be judged to be an indication. And it is considered that in the case of hemodynamic stable patient, to decrease negative exploration rates, the decision of an abdominal exploration by an abdominal CT finding is valuable enough if it has a clear basis.

Transection of the Internal Jugular Vein by a Neck Stab Injury : A case report

Injuries to the internal jugular vein rarely occur in Korea. However, neck veins are damaged more frequently than any other structure by neck stab injuries, and jugular venous injuries are caused almost exclusively by penetrating neck trauma. Vascular injury is the leading cause of death from trauma. Bleeding from injury to jugular veins is a main contributing factor of mortality as a result of penetrating neck trauma. When we meet a patient of neck stab injury, we must do a careful physical examination and some selective special diagnostic studies. Patients with penetrating neck injuries who are taken directly to the operating room are those with severe external hemorrhage and expanding hematoma and those who are hemodynamically unstable despite of resuscitation. A 22-year-old woman received a stab injury to the neck. On the neck CT scan, the patient was revealed to have a pseudoaneurysm caused by transection of the internal jugular vein. The patient recovered well from the injury as a result of a selective operation, an end-to-end anastomosis. We report that case of a penetrating neck injury resulting in transection of the internal jugular vein and give a review of other reported cases.

A Case of a Traumatic Vertebro-Jugular Arteriovenous Fistula

The vertebral artery is infrequently injured because it lies deep in the neck, surrounded for the most part by bony foramina. Vertebral artery injuries are caused by penetrating traumas, blunt traumas and iatrogenic injuries. Sequela of vertebral artery injury include arteriovenous (AV) fistulae, and pseudoaneurysms may appear months after injury. Angiography is currently the gold standard for evaluating vascular injuries, such as vertebral artery injuries, and can be therapeutic. A vertebral artery fistula can also be treated by operative ligation. We experienced a rare case of a vertebro-jugular AV fistula secondary to a cervical stab wound. In this case, the patient was successfully treated by coil embolization and glue injection during angiography, which was confirmed by a postangiograpy operation.