Stable Expression of Bovine Integrin Beta-6 Increases Susceptibility of Goat Kidney Cell Line to Foot-and-mouth Disease Virus

The integrins αvβ1, αvβ3, αvβ6, and αvβ8 are known to be the natural receptors of foot-and-mouth disease virus (FMDV). Among them, integrin αvβ6 is considered a major receptor for FMDV. We performed protein expression of full-length bovine integrins αv, β3, and β6 and confirmed the high efficiency of bovine αvβ6 as the FMDV receptor in FMDV non-permissive SW 480 cells. Next, we established the black goat kidney (BGK) cell line, stably expressing bovine integrin β6 (BGK-β6-4). We observed that BGK-β6-4 cells had significantly enhanced sensitivity to FMDV compared with that of BGK cells (P<0.05). In addition, BGK-β6-4 cells had equal or higher sensitivity to several serotypes of FMDV compared with that of other FMDV permissive cell lines, such as BHK-21 and IBRS-2. In conclusion, we established a promising novel goat cell line, BGK-β6-4, which can be used to isolate or culture FMDV. Furthermore, the BGK-β6-4 cell line may serve as a promising tool for studying integrin αvβ6 receptor functions.

The Effect of Topical Cyclosporine 0.05% on Tear Osmolarity for Dry Eye Syndrome

PURPOSE: To evaluate the effect of topical cyclosporine 0.05% (Restasis; Allergan, Irving, CA, USA) on tear osmolarity in patients with dry eye disease. METHODS: The present study was a single-center, randomized, prospective, and longitudinal trial. Patients who had been using artificial tears to treat dry eye disease were prescribed cyclosporine 0.05% and evaluated using tear osmolarity, tear break-up time, ocular surface staining score, Schirmer test, and the Ocular Surface Disease Index for symptomatic improvement. Clinical measurements of commonly used objective tests were performed at baseline and after 1, 3, and 6 months. RESULTS: At the end of the study, patients demonstrated statistically significant improvement in tear break-up time (6.26 +/- 1.26 sec at 3 months vs. 4.41 +/- 1.63 sec at baseline, p = 0.022) and OSDI (34.98 +/- 20.19 at 3 months vs. 45.02 +/- 22.38 at baseline, p = 0.032) only at 3 months. Other measures such as Schirmer test, ocular surface grade, and tear osmolarity also showed improvement. However, the differences were not significant. CONCLUSIONS: Over a 6-month period, topical cyclosporine 0.05% showed beneficial effects on symptoms and other commonly used signs of dry eye disease for 3 months; however, the tear osmolarity values were not significantly improved.

Clinical Outcomes of Foldable Iris-Fixed Phakic Intraocular Lens and Change in Corneal Endothelial Cell Density

PURPOSE: To evaluate the efficacy, safety, stability and complications of the foldable iris-fixated phakic intraocular lens (Artiflex(R), Ophtec BV, Groningen, Netherlands) implantation for the correction of myopia with astigmatism. METHODS: The present study included 40 eyes of 20 patients who underwent Artiflex lens implantation, and 20 eyes of 10 patients who underwent Toric Artiflex lens implantation and were followed up for 1 year. We retrospectively examined visual acuity, refraction, any changes in astigmatism, efficacy, safety and corneal endothelial cell density. A correlation coefficient analysis of the factors that affected the changes was performed. RESULTS: The mean preoperative refractive spherical equivalent was -9.18 +/- 2.27 D and reached -0.45 +/- 0.45 D at 1 year after surgery. Postoperatively, 99.9% of the eyes showed improved visual acuity of more than 0.8. In patients with Toric Artiflex lens implantation, the preoperative mean astigmatism was -2.67 +/- 0.87 D, and at 1 year postoperatively -0.76 +/- 0.40 D, showing a statistically significant decrease (p < 0.001). The preoperative mean endothelial cell density was 2,850 +/- 230 cells/mm2 and decreased 1.3% on the final follow-up (2,812 +/- 261 cells/mm2) but without statistical significance (p = 0.456). Statistically significant correlation was not observed between endothelial cell loss and anterior chamber depth (r2 = -0.146, p = 0.267). CONCLUSIONS: Implantation of the iris-fixed intraocular lenses, Artiflex and Toric Artiflex, was safe and effective for correcting high myopia and astigmatism.

Clinical Outcomes of Foldable Iris-Fixed Phakic Intraocular Lens and Change in Corneal Endothelial Cell Density

PURPOSE: To evaluate the efficacy, safety, stability and complications of the foldable iris-fixated phakic intraocular lens (Artiflex(R), Ophtec BV, Groningen, Netherlands) implantation for the correction of myopia with astigmatism. METHODS: The present study included 40 eyes of 20 patients who underwent Artiflex lens implantation, and 20 eyes of 10 patients who underwent Toric Artiflex lens implantation and were followed up for 1 year. We retrospectively examined visual acuity, refraction, any changes in astigmatism, efficacy, safety and corneal endothelial cell density. A correlation coefficient analysis of the factors that affected the changes was performed. RESULTS: The mean preoperative refractive spherical equivalent was -9.18 +/- 2.27 D and reached -0.45 +/- 0.45 D at 1 year after surgery. Postoperatively, 99.9% of the eyes showed improved visual acuity of more than 0.8. In patients with Toric Artiflex lens implantation, the preoperative mean astigmatism was -2.67 +/- 0.87 D, and at 1 year postoperatively -0.76 +/- 0.40 D, showing a statistically significant decrease (p < 0.001). The preoperative mean endothelial cell density was 2,850 +/- 230 cells/mm2 and decreased 1.3% on the final follow-up (2,812 +/- 261 cells/mm2) but without statistical significance (p = 0.456). Statistically significant correlation was not observed between endothelial cell loss and anterior chamber depth (r2 = -0.146, p = 0.267). CONCLUSIONS: Implantation of the iris-fixed intraocular lenses, Artiflex and Toric Artiflex, was safe and effective for correcting high myopia and astigmatism.

Comparison of Clinical Results between Transepithelial Photorefractive Keratectomy and Brush Photorefractive Keratectomy

PURPOSE: To compare the results of transepithelial photorefractive keratectomy (trans PRK) and brush-assisted photorefractive keratectomy (brush PRK) for the treatment of myopia. METHODS: A total of 146 eyes from 78 patients who received brush PRK or trans PRK with the Schwind Amaris laser platform were included in the present study. Uncorrected distance visual acuity (UDVA) and manifest refraction spherical equivalent (MRSE) at postoperative 1 week, 1, 3, 6, and 12 months were compared between the 2 groups as well as epithelial healing time. RESULTS: The mean time to complete epithelial healing was 3.27 +/- 0.75 days in the trans PRK group and 3.67 +/- 0.93 days in the brush PRK group (P < 0.05). At 1 week after surgery, UDVA recovered more rapidly after trans PRK than brush PRK (brush PRK: 0.13 +/- 0.12 log MAR units, trans PRK: 0.09 +/- 0.08 log MAR units, P < 0.05), however, UDVA was not significantly different at 1, 3, 6, and, 12 months postoperatively between the 2 groups. CONCLUSIONS: Re-epithelialization and visual recovery were faster in the trans PRK group while visual outcome and postoperative complications were equivalent to the brush PRK group.

Comparison of Intraocular Pressure Measured by Non-Contact Tonometer, Rebound Tonometer, Tono-Pen, and Goldmann Applanation Tonometer

PURPOSE: To compare the level of accuracy of intraocular pressure (IOP) measurements attained by non-contact tonometer (NCT), rebound tonometer (RT) Icare(R), and Tono-Pen (TONO-PEN AVIA(R)), using Goldmann Applanation tonometer (GAT) as a reference value and to explore their clinical usefulness. METHODS: In a prospective study of 71 normal eyes, IOP was measured with NCT, RT, Tono-Pen and GAT. The IOP values of were then compared between the eyes. RESULTS: RT showed statistically most significant agreement with the GAT [ICC 0.811, 95%CI 0.712-0.878]. In analysis of Bland-Altman plots, NCT showed the smallest mean bias (+0.2 mm Hg) and widest CI (95%CI; +/-5.05 mm Hg), RT showed relatively small mean bias (-0.7 mm Hg) and narrowest CI (95%CI; +/-3.75 mm Hg). CONCLUSIONS: There was a significant agreement between the RT and the GAT measurements. We expect RT to be considered as a reliable alternative when IOP measurement with GAT is not feasible.

Inflammatory Cytokine and Osmolarity Changes in the Tears of Dry Eye Patients Treated with Topical 1% Methylprednisolone

PURPOSE: To evaluate changes in clinical outcomes, inflammatory cytokine levels, and tear osmolarity in the tears of patients with moderate to severe dry eye syndrome before and after the application of topical 1% methylprednisolone. MATERIALS AND METHODS: Thirty-two patients with moderate to severe dry eye unresponsive to previous aqueous enhancement therapy were enrolled. Five patients were lost to follow up, and twenty-seven patients were eligible for analysis. Patients were instructed to apply topical 1% methylprednisolone four times per day, as well as to continue applying their current therapy of preservative-free 0.1% sodium hyaluronate four times per day. Corneal and conjunctival staining scores, tear film breakup time (TFBUT), Schirmer test, and tear osmolarity were assessed at baseline, 4 weeks, and 8 weeks. Tear samples were collected at every visit for cytokine analysis. RESULTS: Corneal and conjunctival staining scores and TFBUT showed significant improvement at 4 (p<0.001, <0.001, <0.001 respectively) and 8 (p<0.001, <0.001, <0.001 respectively) weeks. Tear osmolarity decreased significantly at 8 weeks (p=0.008). Interleukin (IL)-1beta, IL-8, and monocyte chemoattractant protein-1 were significantly decreased at 8 weeks compared with those at baseline (p=0.041, 0.001, 0.008 respectively). CONCLUSION: Short-term treatment with topical 1% methylprednisolone not only improved clinical outcomes, but also decreased tear osmolarity and cytokine levels. By measuring the changes in cytokine levels and tear osmolarity, we could objectively evaluate the anti-inflammatory effects of topical methylprednisolone applied in the treatment of patients with moderate to severe dry eye syndrome.

Long-Term Quality of Life after Myopic Laser Refractive Surgery

PURPOSE: To investigate long-term satisfaction and quality of life after myopic laser refractive surgery. METHODS: This study included 231 myopic patients who underwent laser refractive surgery (LASIK, LASEK or PRK) at least five years prior, between 2002 and 2005, at 5 hospitals. Using a telephone survey, patients were asked to subjectively answer 26 questions regarding satisfaction, quality of life changes, and visual symptoms. RESULTS: The mean patient satisfaction score was 8.12 (scale of 1 to 10). Improvement in quality of life was reported by 91% of the subjects. Intention to have surgery again was reported by 87.9% of the subjects and intention to recommend refractive surgery to a friend or family was reported by 80.5% of the subjects. The most common discomfort symptoms after myopic laser refractive surgery were dry eye symptoms (57.1%), followed by night vision disturbances (54.3%). CONCLUSIONS: Long-term satisfaction and quality of life were shown to be positive in patients treated with myopic refractive surgery.

Preemptive Analgesic Effect of Topical NSAIDS in Postoperative Pain Relief after LASEK

PURPOSE: To assess the preemptive analgesic effect of topical NSAIDs (0.5% ketorolac tromethamine, Acular) as postoperative pain relief in patients undergoing LASEK. METHODS: A prospective, randomized, placebo-controlled, paired eye study was performed. Patients undergoing LASEK were randomized to receive 0.5% ketorolac in one eye and 0.3% ofloxacin (placebo) in the contralateral eye at 30 minutes, 20 minutes, or ten minutes prior to LASEK. Pain was assessed using a visual analog scale of 0 to 10 in each eye 6, 12, 24, 36, 48 and 72 hours after surgery. Patients were also asked to assess the levels of glare, tearing and irritation using a visual analog scale from 0 to 10. RESULTS: A total of 62 eyes from 31 patients were enrolled in the present study. The mean postoperative pain score in the NSAID group was significantly lower than that in the placebo group at postoperative hours 6 (2.35 versus 4.97), 12 (2.52 versus 5.16), and 24 (3.84 versus 4.94) (p 0.05). Patients reported significantly less tearing and irritation in the NSAID-administered eye compared to those in the placebo eye after LASEK (p < 0.05). CONCLUSIONS: Preemptive administration of topical NSAIDs before LASEK was effective in reducing acute postoperative pain. Preemptive analgesia with topical NSAIDs may be a valuable treatment option for controlling postoperative pain following ocular surgery.

The Effects of Mild Hypothermia on the Expression of the Apoptosis-related Proteins following Transient Global Ischemia in Gerbil Hippocampus / 대한구급학회지

BACKGROUND: The neuroprotective mechanisms of hypothermia remain unclear. Recently, attenuation of apoptosis by hypothermia has been suggested as one of the responsible mechanisms. The aim of this study is to investigate the effects of post-ischemic hypothermia on apoptotic neuronal death as well as expression of some apoptosis-related proteins in a gerbil transient global ischemia model. METHODS: Following 5 minutes of ischemia, normothermia (NT, 37+/-0.5degrees C) or mild hypothermia (HT, 33+/-0.5degrees C) was immediately induced and maintained for 3 hours. The hippocampal CA1 neurons were examined on day 2, 3, 4, and 7 after ischemia for the survived neuronal densities, DNA nick end labeling and immunohistochemical expressions of Bcl-2, Bax, and caspase 3 in each group. Additionally, DNA gel electrophoresis and western blot analysis for each protein in hippocampus were performed. RESULTS: The neuronal death in CA1 area on day 3, 4, and 7 was significantly reduced in HT group compared to NT group. The number of TUNEL positive cells in HT group was also significantly reduced than NT group on day 3, 4, and 7. DNA laddering of hippocampus on day 4 and 7 also reduced in HT group. Expressions of Bax on days 2, 3 and activated caspase 3 on days 3, 4 were reduced in HT group. Western blots also disclosed a decrease in the intensity of the Bax on day 2 and 3 in HT group compared to NT group. CONCLUSIONS: These results suggest that mild post-ischemic hypothermia attenuates the apoptotic neuronal death through the inhibition of the intrinsic pathway of caspase activation following transient global ischemia and these effects may be related to a reduction of pro-apoptotic events.

Effects of Humoral Factors Released from Ischemic-preconditioned Hearts on Survival of Pancreatic Cells Exposed to Hypoxia: An In vitro Study Using Neonatal Pigs

PURPOSE: Brief myocardial ischemia evokes a cardioprotective response, referred to as "Ischemic Preconditioning", that limits injury caused by a subsequent prolonged ischemic insult. The myocardial ischemic preconditioning effect can be induced by ischemia of "distant" cardiac and noncardiac tissue, implicating the involvement of an as-yet unidentified humoral trigger. The purpose of this study was to prove the protective effect of a preconditioning ischemic trigger (PIT) obtained from coronary effluent to isolated pancreatic cells under hypoxic condition in neonatal pigs. METHODS: Isolated hearts were preconditioned 5 times with 5-min ischemia following 10-min reperfusion. Coronary effluent was collected during reperfusion, filtered by using a Sep-Pak C-18 catridge, and lyophilized after dissolving it with acetonitrile. Isolated pancreatic cells were divided into a PIT-treatment group and a control group, and each group was further divided into time-dependent and dose-dependent groups. Time-dependent groups were incubated under a hypoxic condition for durations of 1, 2, 3, and 4 hrs, and dose-dependent groups were treated with 3 different doses of PIT that had undergone hypoxic incubation for 4 hrs. Viability of the pancreatic cells after the hypoxic incubation period was evaluated by using a confocal microscope. RESULTS: In the control group, the average viability of pancreatic cells after 4 hrs of hypoxia was 60.48 +/- 1.24%, and in the PIT-treated group, the value was 71.88 +/- 1.33%, the difference in the viability between the PIT-treated group and the control group after 4 hrs of hypoxia was statistically significant. In the dose-dependent groups, the viability of pancreatic cells was significantly larger in the groups treated with original PIT and 1/10 PIT than in the control group. CONCLUSION: These data suggest that in the In-vitro pig model, PIT obtained from heart evoked ischemic tolerance to isolated pancreatic cells.

Incidence and Significance of Negative Hematuria in Patients with Urolithiasis Visiting the Emergency Room with Flank Pain

PURPOSE: This research was conducted to determine the incidence of negative hematuria in patients with urolithiasis in Korea and the significance during evaluation of a patient' s complaining of flank pain. METHODS: We evaluated 363 consecutive patients who were suspected of having urolithiasis and who underwent intravenous urography (IVU). All patients underwent urinalysis and a urine dipstick test (UDT). We evaluated the sensitivity, the specificity, the positive predictive value and the negative predictive value of UDT, urinalysis and a combination of these two tests, and we compared the rates of incidence of negative hematuria. In addition, we estimated the relation between the RBC count and the severity of the ureteral obstruction. RESULTS: The IVU was positive in 206 of the 363 patients. The incidence of negative hematuria for urinalysis, UDT, and the combination were 9.2%, 8.7% and 6.3%, respectively. Thirteen patients (3.6%) had another disease. There was no correlation between the degree of ureteral obstruction and the incidence of negative hematuria (p= 0.713). Also, no correlation was established between the degree of ureteral obstruction and RBC count (p=0.742). CONCLUSIONS: In patients with urolithiasis, the incidences of negative hematuria for urinalysis, UDT and a combination of the two tests were 9.2%, 8.7% and 6.3%, respectively. The presence or absence of hematuria in patients with acute renal colic should not determine whether a more definitive study is performed.

Clinical Study of Thyrotoxic Periodic Paralysis in the Emergency Department

PURPOSE: Thyrotoxic periodic paralysis (TPP) is not an uncommon disorder in patient with acute muscle weakness in the emergency department. However, many patients with TPP are misdiagnosed, leading to improper treatment. So, we analyze the clinical characteristics of TPP to make diagnosis and treatment properly. METHODS: The medical records of the patients confirmed as TPP by using thyroid function test from January 1998 to December 2002 were reviewed retrospectively. RESULTS: TPP occurs predominantly in males, especially young males, during dawn or morning. It's predisposing factors were heavy meals, physical exertion and alcohol drinking. Most patients were hypokalemic and in a normal acid-base state. Systolic hypertension and tachycardia were common in TPP because of the hyperadrenergic state. When hyperthyroidism was conversed to normal thyroid state, paralysis did not occur. CONCLUSION: There were several clinical clues to the diagnosis of TPP. Rapid and accurate diagnosis of TPP is important, so emergency physicians must know its clinical characteristics.

Death from Ingestion of beta-fluoroethyl Acetate Rodenticide

The highly toxic sodium monofluoroacetate (SMFA) was banned as a rodenticide in this country in the 1980s. The fluoroacetate metabolite, fluorocitric acid blocks cellular metabolism by inhibiting the Klebs cycle, producing widespread clinical effects including respiratory, neurologic, cardiologic, and fluid-electrolyte abnormalities. We report the case of intentional ingestion of a derivative product, beta-fluoroethyl acetate. A 79-yr-old female was brought to the emergency room without any problem. At 2hours post ingestion, she had a generalized tonic-clonic seizure and then, was unresponsive to painful stimuli. At 6hours post ingestion, she died from refractory ventricular fibrillation. We report this patient to increase awareness of beta-fluoroethylacetate toxicity.

Discriminant Analysis on Acute Renal Failure from Rhabdomyolysis after Drug Intoxication

PURPOSE: Acute renal failure is one of the most serious complications of rhabdomyolysis after drug intoxication and may increase morbidity and mortality. The aim of this study was to determine the predictive factors of acute renal failure (ARF) associated with drug intoxication. METHODS: We reviewed retrospectively the medical records of patients admitted for drug intoxication from January 2001 to April 2003 at our emergency department. Patients with drug intoxication whose plasma levels of creatinine phosphokinase were higher than 1,000 IU were included in this study. We identified 61 patients. The entire population is divided into those with initial serum creatinine concentrations less than 2.0 mg/dL (non-azotemic) and those with initial serum creatinine greater than 2.0 mg/dL (azotemic). The initially non-azotemic group is subdivided into patients who developed acute renal failure (RFD) and those who didn't (NRF) after admission. We evaluated them with respect to the ingested drug, age and sex, time from ingestion to visit, past history, vital signs, laboratory data and blood gas analysis. RESULTS: Five patients (9.4%) developed ARF in nonazotemic group. Discriminant analysis revealed that early predictors for ARF were BUN, calcium, ALT, LDH, arterial blood pH and oxygen saturation. The result was R = 0.13[BUN]+11.9[pH]+0.14[oxygen saturation]-0.66[calcium ] + 0.01 [ALT]-0.01[LDH]-88.4. Therefore R value < 0 was predictive of ARF with an accuracy of 96.2%. CONCILUSION: We could identify early predictive risk factors. These factors may help provide future strategies.

Cerebral Venous Sinus Thrombosis: A Case Report

Thrombosis of venous channels in the brain is not a common cause of cerebral infarction relative to arterial disease but is an important consideration because of its variable clinical features and potential morbidity. It is very often unrecognized at initial presentation. The diagnostic modality is brain imaging with magnetic resonance venography. An empty-delta sign appears on a contrast CT scan as enhancement of the collateral vein in the superior sagittal sinus wall surrounding a nonenhanced thrombus in the sinus. However, the sign is frequently absent. Heparin should be considered in the management of cerebral venous sinus thrombosis (CVST). We report a case of CVST in a 59-year-old woman that presented initially as a headache and was diagnosed after several visits to clinics.

Flumazenil Use in the Emergency Department: Benefit or Risk

PURPOSE: Flumazenil is frequently administered to poisoned and benzodiazepine-induced sedated patients. However, seizure, resedation, dysrhythmia, and death may occur in patients who awaken following flumazenil administration. Thus, this study investigated the benefit and the risk of the clinical use of flumazenil in emergency situations because the taking of an accurate history was often impossible METHODS: We included 177 patients given flumazenil in the emergency department. They were divided into four groups: Group I (n=51) was poisoned patients who were treated with flumazenil as an antidote, Group II (n=14) was patients in comas of unknown origin who were treated with flumazenil as a universal antidote, Group III (n=69) was patients who were treated with flumazenil for reversal from conscious, procedural sedation, and Group IV (n=43) was patients who were treated with flumazenil for recovery from unexpected oversedation. The benefits of flumazenil were analyzed based on a decreased need for procedures such as endotracheal intubation and mechanical ventilation. Then, the risks were evaluated based on the incidence of serious complications during flumazenil administration. RESULTS: In group I, removals of ventilators and endotracheal intubation were possible in 7/12 and 6/13 cases. However, more serious complications occurred in group I than in the other groups. In group II, a no-awakening response to flumazenil occurred in 71.4% of the patients. Group III had the lowest risk ratio among the groups. In group IV, removals of ventilator and endotracheal intubation were possible in 18/26 and 10/27 cases. However, in 16/43 (37.2%) cases, risk factors for seizures existed; thus, the use of flumazenil was considered inappropriate. CONCLUSION: Flumazenil may be safer and more effective for reversal action; but its clinical utility as an antidote in the emergency department is questionable.

Prediction of Poor Outcome in Comatose Survivors after Cardiopulmonary Resuscitation with Somatosensory Evoked Potentials and Proton Magnetic Resonance Spectroscopy

PURPOSE: The study was conducted to examine the usefulness of somatosensory evoked potentials (SEP) and proton magnetic resonance spectroscopy (1H-MRS) in predicting poor outcomes for comatose survivors after cardiopulmonary resuscitation. METHODS: We investigated 36 patients who were comatose after cardiac arrest. Among them, 35 had short latency SEP, and 27 had 1H-MRS. Both tests were performed in 26 patients. To estimate the cerebral outcome, we used the cerebral performance category (CPC) to classify the outcomes for our patients as good (CPC 1-2) or poor (CPC 3-5). RESULTS: Of the 36 patients, 11(31%) presented with good outcomes (CPC 1-2). A bilaterally absent N20 peak (n=35) predicted poor outcomes with a sensitivity of 54.2% and a specificity of 100%. A lactate-positive resonance (n=27) predicted poor outcomes with a sensitivity of 78.9% and a specificity of 100%. Using a combination of a bilaterally absent N20 peak and a lactate-positive resonance (n=26) predicted poor outcomes with a sensitivity of 94.4% and a specificity of 100%. CONCLUSION: The combination of a bilaterally absent N20 peak and a lactate-positive resonance is better than either alone in predicting poor outcomes in patients who are comatose after cardiac arrest.

Disaster Planning in the Emergency Department by Using an Analysis of Injuries Related to Assembly and Demonstration

PURPOSE: This study is to enable emergency centers to adequately cope with a vast number of demonstration-related injured patients by using an interventional study. With this analysis, emergency centers can hopefully prepare with adequate manpower, equipment and resources. METHODS: We reviewed the medical records of 117 patients with injuries related assembly and demonstration who visited the Emergency Medical Center of St. Mary's Hospital from Aug 13, 1999, to Jan 31, 2004 (pre-intervention state). These patients were analyzed according to sex, age, the severity of injury, the presence of a laceration, the injury mechanism, the final diagnosis, and the areas of the injury. Using these data, we established a disaster plan, then, we applied that plan to 59 patients who visited the Emergency Medical Center during Feb 2004 (post-interventional preliminary study). RESULTS: The common areas of the injury were the face (35.1%), the head (33.1%), and the extremities (25.4%) during the pre-intervention state. The number of patients with lacerations was 61 (52.1%). According to this, we established our own external hospital disaster plan. During the preliminary post-interventional study, the plan reduced the length of hospital stay, the delayed time to radiology, and the not-sutured rate (p<0.05). CONCLUSION: When patients injured during violent demonstrations are expected, local emergency care hospitals need to prepare manpower, resources, and supplies for facial and head lacerations and apply their disaster plan.

Emergency Ultrasonography for the Detection of a Pneumothorax in Blunt Thoracic Trauma Patients

PURPOSE: This study was conducted to determine the accuracy of ultrasonography (US) in the detection of a traumatic pneumothorax. METHODS: We prospectively evaluated thoracic US for the detection of a pneumothorax in blunt thoracic trauma patients. The presence of "lung sliding"and "comet tail" artifacts were determined in patients by using ultrasound before radiologic verification of a pneumothorax by residents and attending physicians of the emergency department who had been instructed in thoracic ultrasound. Finally, the diagnosis of a pneumothorax was confirmed by using chest computed tomography (CT). RESULTS: Forty nine patients were enrolled in this study. Twenty-five of the 49 patients had a pneumothorax at chest CT, and for 24 patients, the pneumothoraces had been detected at thoracic US and for 13 patients, they were seen at supine chest radiography. The sensitivity and the specificity of US were 96% and 92%, relatively the positive predictive value was 92%, and the negative predictive value was 96%. The sign of disappearance of "lung sliding" had a sensitivity and negative predictive value of 100% and a specificity of 88% for the diagnosis of a pneumothorax. The absence sign of a "comet tail"artifact had a specificity and positive predictive value of 100%, and a sensitivity of 95% for the diagnosis of a pneumothorax. CONCLUSION: In this study, US was more sensitive than supine chest AP view in the detection of a traumatic pneumothorax. Thoracic US is a reliable method for the detection of a pneumothorax and should be added to the currently performed FAST examination in trauma cases.