Rupture of Ureter due to Ureter Stone

The spontaneous rupture of the ureter is a rare condition. Two cases are reported with a spontaneous rupture caused by ureteral calculi. The diagnosis was suspected by delayed post-CT KUB and confirmed by ureteroscopy. On the basis of the clinical evolution the authors discuss the diagnosis and pathogenesis of the observed ureteral rupture. Rupture of ureter must be considered as differential diagnosis of acute flank pain, especially when there is change of pain character or severity.

The Etiology and the Efficacy of Diagnostic Tools for Adult Patients Presenting with New-onset Seizure in an Emergency Department

PURPOSE: This study was conducted to evaluate the etiology and the efficacy of diagnostic tools such as physical examination, laboratory studies, cranial computed tomography (CT) scans, and electroencephalograms (EEGs) in adult patients presenting with new-onset seizure in an emergency department. METHODS: This is a retrospective study of a 4-year period during which 67 patients were admitted to an emergeny department complaining of new-onset seizure. Among them, 61 patients were eligible for inclusion in this study, and we reviewed their medical records, laboratory data, CT scans and EEG findings. RESULTS: The etiologies of new-onset seizure were 1) unknown, 2) alcohol withdrawal, 3) ischemic stroke, and 4) central nervous system infection. An abnormal CT lesion was diagnosed in 27.5% of the patients with normal neurological examinations. An abnormal CT lesion was diagnosed in 30% of the patients whose EEG results had a focal-wave pattern. But, No statistical significance could be attached to the relationship between the CT lesion and EEG results (p>0.05). CONCLUSIONS: The principal etiologies of new-onset seizure were 1) unknown, 2) alcohol withdrawl, 3) ischemic stroke. A CT scan should be performed in all patients with newonset seizure. A focal-wave pattern in the EEG may consider a necessity for brain imaging.

A Convenient Method of Adenosine Administration for Paroxysmal Supraventricular Tachycardia

PURPOSE: The purpose of this study was to observe the success rate, the average of total admininstration doses and the complications associated with a convenient method of adenosine administration for paroxysmal supraventricular tachycardia (PSVT). METHODS: A non-blind, randomized, prospective study was conducted during the 30 months from January 1999 to June 2001. We enrolled 65 cases during this period. The number of cases in the standard method group was 35, and that in the mixed method group was 30. In the standard method group, 6 mg of adenosine was administered intravenously; therefore, 15~20 ml of normal saline was immediately flushed. This method is usually used and recommended. In the mixed method group, 6 mg of adenosine had been previously mixed with 15 ml of normal saline was administered intravenously without any additional manipulation. We evaluated the success rate, the average successful doses, and the complications of each group. RESULTS: The success rate was 80% in the standard method group and 85.7 % in the mixed method group, but this difference was not statistically significant (Chi square test, p=0.39). The average of total admininstration doses were 10.3+/-6.3 mg in the standard method group and 11.0+/-6.5 mg in the mixed method group, but this difference is not statistically significant (student t-test, p=0.07). There was no remarkable complication in the mixed method group. CONCLUSION: The mixed method was effective and more convenient than the standard method. A further, larger study is required.

Antiphospholipid Syndrome Causing a Cerebral Infarction

Antiphospholipid syndrome (APS) is a thrombophilic disorder characterized by recurrent abortion, thrombocytopenia, and prolonged activated partial thromboplastin time (aPTT) in which venous or arterial thrombosis, or both, may occur in patients with antiphospholipid antibodies. Antiphospholipid antibodies have been associated with a variety of neurological disorders, many of which, but not all are manifestations of cerebral or ocular ischemia. Recently, we experienced one case of a cerebral infarct due to APS in a 24-year-old female. She visited the emergency department and presented with dizziness and vomiting. After admission, we conducted a physical examination, blood tests, and brain computed tomography. Her blood tests revealed prolonged aPTT and thrombocytopenia, and brain computed tomography showed a right cerebellar and pons infarct. We treated her with anticoagulants. She was discharged with nearly a full recovery on the seventh hospital day.