Laparoscopic Splenectomy in a Case of Stable Blunt Abdominal Trauma

Splenic rupture is a frequent surgical emergency in blunt abdominal trauma patients. There are several treatment options, including conservative treatment, a partial splenectomy, splenorrhaphy, and a splenectomy for splenic injury. Although reports on the safety and the efficacy of an elective laparoscopic splenectomy are abundant in the literature, a laparoscopic splenectomy for a ruptured spleen has only been reported in a few cases. We report a case of a laparoscopic splenectomy in the patient with Grade III traumatic splenic injury. To our knowledge, this is the first report in which a laparoscopic splenectomy was performed in Korea for the treatment of a traumatic splenic injury.

Effect of Issuing of Hospitalization Sheets by Emergency Department on Shortening Length of Stay

PURPOSE: The purpose of the study is to find whether there is any effect on shortening the length of stay of long term patients due to issuing of hospitalization sheets by emergency department. METHODS: For the investigation, 27,948 patients who resided in hospitals over 6 hours from 2006 to 2007 were chosen as the subjects. The main materials for the investigation were various time variables according to the medical records. For the verification of each factor, Student's t-test and Pearson' correlation coefficient were used. RESULTS: There was statistically significant difference in regard to length of stay (p<0.01). The departments related to internal medicine showed that they required longer times in every aspect compared to those of non-internal medicine. There were statistically significant differences (p<0.01) in regard to the time of patients' length of stay and the time of issuing sheets for hospitalization according to the numbers of related department. However, there was no meaningful difference in regard to the waiting time for hospitalization. CONCLUSION: In conclusion, in the cases of long term patients who stayed over 6 hours in 2007 when the random sheets for hospitalization were issued by emergency department, the length of stay was significantly reduced. It was found that the time was more increased in the departments of internal medicine than the departments of noninternal medicine and when the related sub departments increased.

Clinical Significance of Delayed re-evaluation in Initial Symptoms Following Snakebite Injury

PURPOSE: Antivenin is a standard therapy in snakebite victims. While the required antivenin dose can be easily estimated, based on the initial symptoms, this strategy may be unsuccessful if the initial symptoms progressively worsen. The purpose of this study was to identify the progression rate of the initial symptoms following snakebite and its associated factors. METHODS: The medical records of 44 patients treated for snakebite from give the actual dates of the study period were retrospectively examined. Thirty-two of these patients were enrolled. Demographic data, local wound grade and local effect score at initial presentation (G-0 and LES-0, respectively) and 12 hours after admission (G-12 and LES-12, respectively) were reviewed, along with laboratory data. RESULTS: The 32 patients had an average age of 54.0+/-14.5 years and were predominantly male (n=26) and presented mainly during summer. Compared to G-0 and LES-0, re-evaluated G-12 and LES-12 were significantly increased despite initial administration of proper antivenin dosage (p=0.001 and p=0.000, respectively). Total amounts of antivenin correlated with LES-12 (correlation co-efficiency 0.558, p<0.05). However, factors associated with symptom progression were not revealed. CONCLUSION: Initial snakebite symptoms might progressively worsen within hours despite acceptable initial antivenin therapy. Therefore, re-evaluation within several hours must be considered if when the initial snakebite symptoms are minimal or mild.

Practical Application of Semiquantitative Procalcitonin Test in Emergency Department

PURPOSE: Procalcitonin (PCT) is a good marker of infection but is still not routinely used. Here, we assessed the usefulness of a semi-quantitative procalcitonin test kit (PCT-Q(R)), a rapid and simple test for evaluating sepsis in the emergency department. METHODS: We recruited 80 patients who visited the emergency center and with systemic inflammatory response syndrome (SIRS). Patients were classified into 4 groups according to PCT levels using PCT-Q[Ed-Trademark signs only have to be given one time in a document]. Mortality rate, bacteremia, severity score, and severity of sepsis (SIRS/sepsis/severe sepsis/septic shock) were assessed with the criteria of the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference. We calculated a receiver operating characteristic curve (ROC curve), cut-off value, and the related diagnostic parameters of each cut-off value. RESULTS: Higher PCT levels were significantly associated with increased mortality, bacteremia, and severity scores. PCT levels could discriminate between sepsis and severe sepsis at a threshold of 2 ng/ml. CONCLUSION: PCT-Q is a prognostic marker of infectious disease, but low levels do not always indicate a good prognosis. PCT levels increase with aggravation of sepsis, especially at values greater than 2 ng/ml for severe sepsis.