Omental infarction: case series and review of the literature.

BACKGROUND: Omental infarction is a rare disease entity that can cause acute or subacute abdominal pain. In the past, it was thought that omental infarction mainly occurred on the right side because it was detected when surgery was performed on patients who complained of abdominal pain on the right side. OBJECTIVE: We present this case to demonstrate that omental infarction can occur at any site, including the epigastric area and the lower abdomen, and even on the left side where the greater omentum is located. CASE REPORT: Four patients with omental infarction presented to the Emergency Department with various clinical symptoms. All of them were diagnosed by computed tomography scan. Omental infarction occurred on the right side in 2 patients, at the epigastric area in 1 patient, and on the left side in 1 patient. Three were improved with supportive care. Laparoscopy was performed in 1 patient because his abdominal pain persisted despite conservative treatment. CONCLUSION: Omental infarction should be included in the differential diagnosis list of acute abdominal pain because it can occur at any site. In addition, because this disease runs a self-limited course, conservative care is recommended. Thus, unnecessary operations can be avoided in cases where omental infarction is diagnosed by imaging studies.

Elevated serum S100B levels in acute spinal fracture without head injury.

BACKGROUND: S100B is a biomarker that reflects injury to the central nervous system. As the spine is an integral part of the spinal cord, a study was undertaken to investigate whether serum S100B levels are associated with acute spinal fracture without head injury. METHODS: The study population consisted of 32 consecutive patients aged > or = 18 years in whom the emergency physicians suspected spinal fractures. All the patients underwent CT scans to establish the diagnosis of spinal fracture. MRI was then performed on all the patients to determine the presence of spinal cord injury. RESULTS: Serum S100B levels were higher in the spinal fracture group than in the non-spinal fracture group, and 19 of the 20 patients in the spinal fracture group (95%) had an S100B level >0.12 microg/l, whereas all 12 of the non-spinal fracture group had an S100B level < or = 0.12 microg/l. The S100B level in patients with epidural encroachment of the spinal cord was significantly higher (0.22-4.58 microg/l; mean 2.45 microg/l; 95% CI 0.95 to 3.94) than in those without epidural encroachment (0.114-2.87 microg/l; mean 0.80 microg/l; 95% CI 0.24 to 1.37) (p=0.037). Plain radiography revealed no definite abnormal findings in half of the patients with spinal fracture. CONCLUSIONS: Serum S100B levels are raised in all patients with acute spinal fracture without head injury. Spinal fracture may therefore be one of the extracerebral sources of S100B. Serum S100B levels may be an effective tool for excluding subtle spinal fractures with no clear radiographic findings.

Kidney rupture after extracorporeal shockwave lithotripsy: report of a case.

BACKGROUND: Complications of extracorporeal shockwave lithotripsy (ESWL) occur in a small number of patients, although serious injury is rare. OBJECTIVE: To report the serious complication of kidney rupture during ESWL. CASE REPORT: A 65-year-old man was transferred to the Emergency Department (ED) with right flank pain. He had undergone ESWL for the right renal stone at a regional hospital 2 days earlier. Flank pain developed immediately after ESWL and was not spontaneously relieved. Computed tomography scan performed at the regional hospital showed an extensive right perinephric hematoma. When the patient arrived at the ED, his vital signs were unstable but were stabilized with fluid resuscitation and transfusion. Conservative care with no nephrectomy was chosen because there was no evidence of active bleeding on Doppler ultrasound examination. He was uneventfully discharged on the 31st hospital day without further complications. CONCLUSION: Although it is rare, patients may present with kidney rupture or hypotension after ESWL.

Effects of audio tone guidance on performance of CPR in simulated cardiac arrest with an advanced airway.

THE AIM OF THE STUDY: Despite the emphasis of cardiopulmonary resuscitation (CPR) quality, the performance of on-site CPR is reported to be frequently unsuccessful. In order to improve CPR quality, various feedback systems have been developed, but they have not yet been widely used on site due to low economic efficiency. The present study was attempted to determine whether CPR quality can be improved using audio tone guidance. THE METHODS: A total of 80 seniors at our medical school and college of nursing participated in the study. After they were trained in CPR according to the 2005 guidelines, they performed CPR using a cardiac arrest model with an advanced airway. The participants were organized into 40 groups. After they took Test 1 without any feedback for 2 min, they were randomly assigned to the feedback and control groups and took Test 2 for 2 min. In the feedback group, a low-pitched sound was delivered every 0.6 s for the guidance of chest compression and a high-pitched sound was simultaneously delivered every 10 deliveries of a low-pitched sound for the guidance of ventilation at 6s intervals. THE RESULTS: In the feedback group the mean compression rate significantly improved in accuracy from 111.5+/-13.7/min to 100.1+/-3.2/min (P<0.01), and ventilation counts significantly improved in accuracy from 7.4+/-1.8/min to 9.9+/-0.3/min (P<0.01). However, the mean compression depth significantly decreased from 39.3+/-9.5 mm to 35.8+/-8.2 mm (P<0.01). THE CONCLUSION: Audio tone guidance ensures better chest compression rate and ventilation rate but this does not necessarily result in a better CPR quality.