Recurrent hemoptysis in a 26-year-old woman with a ground-glass opacity lesion of the lung / 영남의대학술지

Hemoptysis is a major reason for emergency department (ED) visits. Catamenial hemoptysis (CH), a rare condition of thoracic endometriosis, can cause recurrent hemoptysis but is difficult to diagnose in the ED due to the scarcity of cases and nonspecific clinical findings. We report a case of a 26-year-old woman who presented to the ED with recurrent hemoptysis since 2 years without a definite cause. Her vital signs and blood test findings were unremarkable. Chest computed tomography (CT) did not show any specific lesions other than a non-specific ground-glass opacity pattern in her right lung. She was on day 4 of her menstrual cycle and her hemoptysis frequently occurred during menstruation. Although there was no histological confirmation, based on her history of hemoptysis during menstruation and no other cause of the hemoptysis, the patient was tentatively diagnosed with CH and was administered gonadotropin-releasing hormone. She had no recurrence of hemoptysis for 3 months. While CH is difficult to diagnose in the ED, the patient’s recurrent hemoptysis related to menstruation was a clue to the presence of CH. Therefore, physicians should determine the relationship between hemoptysis and menstruation for women of childbearing age presenting with repeated hemoptysis without a definite cause.

Scorecard for early recognition of patients at high risk of delirium in emergency department

OBJECTIVE: This study was conducted to evaluate scorecards for early recognition of high-risk patients of delirium in the emergency department (ED). METHODS: Data from 399 consecutive patients aged 65 years or older between January 1, 2015 and December 31, 2015 were retrospectively analyzed. Delirium was identified by reviewing medical records and was confirmed by a psychiatrist. The study population was divided into a training and validation group. Predisposing factors were evaluated and validated by multivariate logistic regression analysis and a calibration plot, after which a scorecard was constructed using these factors and applying points to double odds to each regression coefficient. RESULTS: Dementia, transfer from a long-term care facility, acute acid-base imbalance, moderate pain, and stroke were independent predisposing factors for delirium in ED, with assigned scores in the scorecard of 3, 2, 2, 2, and 2, respectively. The total score of the scorecard for delirious patients was significantly higher than that for non-delirious patients in both the training and validation groups. The coefficient of determination (R²) of the calibration plot was 0.74 and 0.68 in the training and validation group, respectively. In the receiver operation characteristic curve, the cut-off point of the scorecard for delirium was 2.5 and the sensitivity, specificity, and accuracy were 75.0%, 87.8%, and 86.7% in training group, while they were 76.9%, 85.1%, and 84.2% in the validation group, respectively. CONCLUSION: The scorecard was a useful screening tool for early recognition of patients with a high-risk of developing delirium in the ED.

Splenic artery aneurysm with the double-rupture phenomenon

Splenic artery aneurysm is the third most common type of intra-abdominal aneurysm, with a prevalence rate of 0.01% to 10.4% in the general population. Splenic artery aneurysm is usually asymptomatic and is typically detected by chance and does not require surgical management; however, if rupture occurs, although rare, the patient's situation can become critical. We report our experience with a man who presented with left flank and left shoulder pain. His symptoms were caused by multiple hematomas confined to the spleen, but 2 days after admission, he developed delayed hemoperitoneum and required surgical management. We believe that his condition was due to delayed intraperitoneal bleeding called the double-rupture phenomenon; emergency physicians must consider this phenomenon when taking care of splenic artery aneurysm patients.

Recurrent Paecilomyces Keratitis in a Patient with Jones Tube after Conjunctivodacryocystorhinostomy

No abstract available.

A Case of Unknown Cause of Subcutaneous Emphysema Presented by Generalized Edema

Subcutaneous emphysema and pneumomediastinum are commonly derived from trauma or injury of respiratory or gastrointestinal tracts, but occasionally the origin of air was not determined at evaluation. We report on a case of severe subcutaneous emphysema detected using simple X-ray films in the emergency department, which extended to almost all of the bodies, with a review of the literature.

Intravitreal Aflibercept for Neovascular Age-Related Macular Degeneration Resistant to Bevacizumab and Ranibizumab

PURPOSE: To evaluate outcomes of intravitreal aflibercept in cases resistant to bevacizumab and ranibizumab in neovascular age-related macular degeneration. METHODS: Twenty patients with neovascular age-related macular generation who were resistant to treatment with bevacizumab and ranibizumab were evaluated. After switching to aflibercept the best corrected visual acuity (BCVA) and central retinal thickness (CRT) were compared at baseline and at 1 month after injection. Additionally, changes in the intraretinal fluid, subretinal fluid and pigment epithelial detachment were evaluated. RESULTS: The mean BCVA was 0.83 +/- 0.56 log MAR and the mean CRT was 294.20 +/- 12.99 microm before aflibercept treatment. After switching to aflibercept the mean BCVA was 0.86 +/- 0.61 log MAR with no statistical difference (p = 0.406) and the mean CRT was decreased to 232.45 +/- 12.05 microm (p = 0.011). After 1 month of aflibercept injections, a reduction of intraretinal fluid in 4 eyes (80%), reduction of subretinal fluid in 11 eyes (78.6%) and reduction of pigment epithelial detachment in 5 eyes (50%) were observed. Increases in fluid or new lesions were not observed. CONCLUSIONS: Aflibercept injection appears beneficial in patients with neovascular age-related macular generation who are resistant to bavacizumab and ranibizumab treatment.

Nephropathy related to computed tomography in emergency department patients with serum creatinine <1.5 mg/dL / 영남의대학술지

BACKGROUND: Contrast-induced nephropathy (CIN) can cause serious adverse effects. To reduce the occurrence of CIN related computed tomography (CT) in emergency patients, we assessed the respective roles of serum creatinine (SCr) alone and estimated glomerular filtration rate (eGFR) as an early predictor for CIN related CT. METHODS: For patients with SCr <1.5 mg/dL who underwent CT in emergency department (ED) between September 2012 and October 2013, we assessed the prevalence of CIN and its adverse effects. The Modification of Diet in Renal Disease Study (MDRD) and Cockcroft-Gault (CG) formula was used for the calculation of eGFR. Practical calculation was performed by electronic medical record (EMR) system for MDRD and internet calculating service for CG. And we investigated the prevalence of CIN in eGFR <60 mL/min/1.73 m2 before CT. RESULTS: A total of 1,555 patients were enrolled. The prevalence of CIN after CT was 4.6% and it showed correlation with renal deterioration, increased in-hospital mortality, and prolonged hospitalization. Despite baseline SCr <1.5 mg/dL, among enrolled patients, 11.3% as MDRD equation and 29.5% as CG formula were <60 mL/min/1.73 m2 and in this condition, the prevalence of CIN was significantly high (odds ratio was 2.87 [1.64-5.02] as MDRD equation and 2.03 [1.26-3.29] as CG formula). CONCLUSION: Just SCr <1.5mg/dL was not appropriate to recognize preexisting renal insufficiency, but eGFR using MDRD equation was useful in predicting the risk of CIN related CT in ED. Using EMR, calculation of eGFR can be easier and more convenient.

Immunohistochemical profile of basic fibroblast growth factor(bFGF) in Growing Rat T-M joint

This sutdy was designed to localize the distribution of basic fibroblast growth factor(bFGF) in the developing rat condylar region and to elucidate the associated function of bFGF in the condyle development. The condyles of temporomandibular joint of Sprague-Dawley rats (27g of weight) were used. The tissues were examined with electron microscope and immunohistochemical method. The results were as follows: 1. The developing condylar region are divided in to 5 zones apparently: proliferative, maturation, hypertrophic, calcifying, and ossification zones. 2. The cells in the proliferative zone are condensed and have under-developed cell organells in the cytoplasm. This zone shows a strong immunoreactivity of bFGF. 3. The cells in the maturation zone are typical chondroblasts showing well-developed cell organells and round nucleus. The cartilaginous matrix does not show the immunoreactivity of bFGF, while the chondroblasts show the immunoreactivity. 4. The cells in the hypertrophic zone show hypertrophic change having the degenerated cell organelles and small nucleus. There are no immunoreactivity of bFGF in this zone except the nucleus and endoplasmic region showing mild immunoreactivity. 5, The cells in the calcifying zone show hypertrophic change and cell organelles are disappeared. The cells are surrounded by the calcified cartilaginous matrix. There are no immunoreactivity of bFGF in this zone except the endoplasmic region showing mild immunoreactivity. 6. In the zone of bone formation, chondroblasts are disappeared. Newly differentiated osteoblasts secreting osteoid around the calcified cartilaginous matrix. The bone marrow shows the immunoreactivity of bFGF, while the bone matrix does not show the immunoreactivity of bFGF.

Mucoepidermoid Carcinoma of The Mouth Floor

Case report of traumatic orbital apex syndrome and superior orbital fissure syndrome

No abstract available.