Anatomical feasibility of fenestrated stent graft to treat complex abdominal aortic aneurysms from a Korean single institute database

Purpose@#This study aims to investigate the feasibility of Zenith Fenestrated AAA Endovascular Graft (Z-FEN, Cook Medical) from a single Korean institution database by evaluating the vascular anatomy of Korean abdominal aortic aneurysm (AAA) patients with hostile aortic neck. @*Methods@#This is a retrospective study on patients with AAA who underwent endovascular aortic repair (EVAR) and open surgery repair between January 2012 and December 2021 (n = 211). The anatomic characteristics of the aortic neck were evaluated using 3-dimensional reconstructed computed tomographic scans. For the juxtarenal AAA patients (n = 39), feasibility of fenestrated stent graft was evaluated under the protocol of fenestrated EVAR. For those who were not suitable for the application of Z-FEN, the reasons for unsuitability were analyzed. @*Results@#Among 211 AAA patients, 108 patients (51.2%) had complex aortic neck, and 39 (18.5%) had insufficient aortic neck length (<15 mm) for conventional EVAR. Of the 39 patients with juxtarenal AAAs, 13 (33.3%) were determined feasible for Z-FEN. Twenty-six patients (66.7%) were noncandidate for Z-FEN due to severe neck angulation, short aortic neck length, inadequate iliac artery anatomy, large aortic neck diameter, and severe calcification and thrombosis. Proximal aortic neck length of the non-feasible group was significantly shorter than that of the feasible group (P = 0.002). @*Conclusion@#Z-FEN was applicable to 33.3% of the juxtarenal AAA patients. As recent studies confirm, the effectiveness and safety of fenestrated EVAR, Z-FEN can be an option for AAA patients with short aortic neck.

Case management of suicide attempters seen in emergency rooms: result and factors affecting consent to follow-up

OBJECTIVE: The purpose of this study was to identify the factors that influence the consent of case management for suicide prevention. METHODS: This study included 232 suicide attempters from September 1, 2015 to August 31, 2016 at the Emergency Medical Center of Soonchunhyang University Bucheon Hospital, Korea. A retrospective chart analysis was performed using a chi-square test or Fisher exact test, as well as univariate and multivariate logistic regression analysis (R ver. 3.3.3). RESULTS: The positive factors affecting case management consent were direct face-to-face counseling with a case manager, patient's age, suicide attempt without alcohol, first suicide attempt, and no psychiatric history. In addition, suicide attempters who underwent follow-up case management were more likely to participate in outpatient mental health care. Through the case manager, continuous emotional support and encouragement were provided to the suicide attempt, which proved to be effective. CONCLUSION: This study emphasizes the importance of case management for suicide attempters visiting the emergency medical center and suggests that the cooperation of national and regional systems should be expanded to increase the case participation rate.

Analysis of the Factors that Affect Emergency Department Length of Stay in Patients with Orbital Wall Fracture

PURPOSE: The aim of this study un to determine factors that affect Emergency department (ED) Length of Stay (LOS) in patients with orbital wall fracture. METHODS: We retrospectively analyzed orbital fracture patients who visited our ED from January 1, 2012 to December 31, 2013. Patients'data, including sex, age, mechanism of injury, site of fracture, associated injury, physical finding, CT finding, and intra-ocular injuries were recorded. LOS was divided into three phases (Pre-consultation time, Consultation waiting time, Consultation time). We performed analysis to determine the factors associated with LOS. We also performed analysis to determine the factors associated with severe intraocular injury (SIOS). RESULTS: A total of 154 patients (160 eyes) were included. Orbital fractures were more frequent in males. The most common cause of orbital fracture was violence. LOS was 290.0 (IQR 200.0~465.0) min, pre-consultation time was 36.0 (IQR 22.0~61.0) min, consultation waiting time was 64.0 (IQR 34.0~128.0) min, and consultation time was 152.0 (IQR 87.0~245.0) min. Violence, alcohol consumption, consultation with plastic surgeon, and consultation with ophthalmologist showed association with prolonged LOS (p<0.001, p<0.001, p=0.04, p<0.001). Violence and alcohol consumption affected consultation waiting time (p<0.001, p<0.001) and consultation time (p=0.04, p<0.001). Consultation with a plastic surgeon and consultation with an ophthalmologist affected consultation time (p=0.03, p<0.001). Patients with symptoms including blindness, blurred vision, and visual field defect showed significant association with SIOS (Odd ratio=14.08). CONCLUSION: Violence, alcohol consumption, and consultations with specialists showed significant association with LOS.

Analysis of Placement of the Chest Compression Site with Measuring the Sternal Length of Young Korean Adult

PURPOSE: The aim of this study was to identify an adequate chest compression site with measurement of the sternal length of young Korean adults. METHODS: We measured the distance from the suprasternal notch to the lower end of the sternum by palpation and width of heel above the carpal bone end 1 cm (H1), 2 cm (H2) in young Korean adults. We also measured weight, height, and BMI of participants. We then compared correlation of each collected variant to sternal length and heel length. RESULTS: A total of 200 young adults (100 men, 100 women) were enrolled. In measurement of the mean sternal length (SL), no difference was observed between men (19.9 cm) and women (19.6 cm) (p<0.05). However, height, weight, and BMI showed positive correlation with SL (R2 value, BMI=6.7, height=9.2, weight=10.4). After participants were divided into four groups based on gender and mean height, we calculated mean H2 and SL/2 of each group. The mean H2 and SL/2 of the group composed of men above mean height was 8.5 cm and 10.2 cm. The same value for the group of men below mean height was 8.5 cm and 9.7 cm. The mean H2 and SL/2 of the group composed of women above mean height was 7.5 cm and 10.1 cm. The same values for the group of women below mean height were 7.3 cm and 9.6 cm. The mean SL/2 was always higher than the mean H2 in different height groups. CONCLUSION: Compression just above the lower end of the sternum by heel on the hand is appropriate in men. In contrast, when performing chest compression in women, chest compression at the level of the sternum away from the width of the index finger of the sternal end is recommended.