Prognostic Factors for the Hyperosmolar Nonketotic State

BACKGROUND: A hyperosmolar nonketotic state has been known to have a high mortality, and even now, despite this high mortality, only a few studies of this disease have been performed. We studied the prognostic factors for the hyperosmolar nonketotic state. METHODS: We retrospectively studied the cases of 40 patients who were in a hypersomolar nonketotic state when admitted to Sanggye Paik Hospital during the 6-year period from 1995 through 2000. We divided the hyperosmolar nonketotic patients into two groups, the complete recovery group and the incomplete recovery group, and compared the clinical features, the laboratory findings, and the precipitating factors between two groups. RESULTS: 1) A total of 40 patients were studied: 24 in the complete recovery group and 16 patients in the incomplete recovery group. The mortality rate was 32.5%. 2) No significant statistical difference existed among the clinical features of the two groups, except for the sex(p<0.01). 3) Among the laboratory findings of both groups, analysis revealed that the effective osmolarity was significantly higher among those in the incomplete recovery group(p<0.01). Serum sodium concentration was also significantly higher among those in the incomplete recovery group(p<0.01). Serum creatinine was also significantly higher among those in the incomplete recovery group(p<0.05). Serum bicarbonate concentration, on the other hand, was significantly lower among those in that group(p<0.05). 4) Infection was identified as the most common precipitating factor(62.5%). Among the precipitating factors of the two groups, there were significant statistical difference in pneumonia, UTI, and inappropriate glucose control. 5) A significant statistical difference existed among the initial level of onsciousness of both groups(p<0.05). 6) The only significant independent factor responsible for prognosis of nonketotic hyperosmolar state patients was the sex. CONCLUSION: The sex was only significant independent prognostic factor of nonketotic hyperosmolar state patients.

Clinical Evaluation of Facial Laceration Patients Who Visited Tertiary Emergency Medical Center

BACKGROUND: Facial laceration is a common clinical problem in the emergency room that is frequently associated with other craniofacial injuries. It elicits an emotional response from the patient because of the underlying concern of permanent scar and secondary facial disfigurement, so they demand prompt and adequate treatment. The aim of this study is to analyze the incidence, etiology, depth, and site of facial lacerations to provide basic data for further understanding. METHOD: This study reviewed 1,043 facial-laceration patients treated in the emergency room at Pusan Paik Hospital between March 1999 and February 2000. This retrospective study was done by reviewing and analyzing the sex and age distributions, the monthly and daily distributions, the causes of injury, the types of injury, the sites of injury, the lengths of the lacerations, and associated injuries. RESULTS: The sex ratio of men to wemen was 2.4:1, and the 0~10 age group was at the top of the age distribution. The number of patients was the highest on sundays and during March. About 9.2% of the patients visited the emergency room between 10:00 P.M. and 11:00 P.M. Falls(38.1%) were the most common cause of facial laceration, and deep laceration(51.8%) was the most common type of facial laceration. The most common laceration site was the forehead, followed by the chin and the nose. The most common associated craniofacial injury was facial bone fracture(39%). Facial-lacerations were sutured by plastic surgeons(80%), emergency physicians(10%), and oromaxillofacial surgeons(10%). We found statistical significance in the types and lengths of lacerations between men and wemen, among age groups(p<0.05). CONCLUSION: Facial laceration is one of the most common craniofacial injuries in the emergency room. By now, most lacerations have been repaired by plastic surgeons. But, the causes of lacerations are diverse and many patients are admitted due to the associated injuries. Therefore, emergency physicians should participate more aggressively in the care of facial-laceration patients to improve the outcome of the patients.

Factors Influencing the Survival of the Patients with Prehospital Cardiac Arrest

BACKGROUND AND OBJECT: The survival rate of the patients with prehospital cardiac arrest in Korea is lower than that in other developed countries. The main cause of this low survival rate is that prehospital emergency medical service systems are not yet well established in Korea. This study was undertaken to obtain a fundamental data for the development of prehospital emergency medical service systems. MATERIALS AND METHOD: We retrospectively analized 104 patients with prehospital cardiac arrest on whom cardiopulmonary resuscitation (CPR) had been attempted in Sanggye Paik Hospital from January 1998 through December 1999. RESULTS: As to the CPR results, 43 patients (41.3%) showed no return of spontaneous circulation (ROSC), 22 patients (21.2%) died within 24 hours, 28 Patients (26.9%) survived over 24 hours but eventually died during admission, and 11 patient (10.6%) survived and were discharged. The mean time of the arrest-to-CPR interval was 19.69.0 min. Patients with ROSC and patients who had survived over 24 hours had shorter the arrest-to-CPR interval than patients without ROSC and patients who died within 24 hours, respectively (p<0.01, p<0.01). The cutting point of the arrest-to-CPR interval for ROSC was 21.3 minutes. CONCLUSION: The arrest-to-CPR interval is important to improve the survival rate of the patients with prehospital cardiac arrest. And CPR should be attempted aggresively in prehospital cardiac arrests when the arrest-to-CPR interval is within 21.3 minutes, considering the possibility of ROSC.

Perforated Appendicitis in a patient with Situs Inversus totalis: a case report

Appendicitis is one of the most common disease in emergency department(ED), but produces perplexing diagnostic problems. A complete understanding of the anatomy, pathophysiology, and presenting signs and symptoms of appendicitis, combined with thorough history and physical examination, will be the most important factors in allowing emergency physician to make the correct diagnosis of appendicitis. Situs inversus totalis is a rare congenital anomaly occurring in every 10,000 to 50,000 people. Its etiology is obscure but apparently dose not influence normal health or life expectancy. We present a case of perforates appendicitis with situs inversus totalis in a 24-year-old woman whose chief complaint was pain on the left lower quadrant of the abdomen. Chest and abdominal X-ray showed situs inversus totalis, but these typical findings of situs inversus totalis were missed before performing abdominal ultrasonography in ED. We must carefully consider whether congenital anomaly is or not by physical examination and X-ray finding. For patients whose diagnosis is less clear, additional diagnostic tool, for instance ultrasonography is recommended in ED.

A Case of Menetrier's Disease / 대한소화기내시경학회지

Menetrier's disease is a rare, characterized by the presence of large rugal folds involving part or all of the stomach. Patients with hypertrophic gastropathy often have distressing abdominal symptoms, weight loss, and edema due to gastric protem loss. A 64 year old male patient was admitted with the chief complaint of epigastric discomfort. Endoscopic, radiologic and histologic examination, revealed characteristic findings of Menetrier's disease. A case of Menetrier's disease is reported with a brief review of literature.