Hepatorenal Syndrome / 대한소화기학회지

Hepatorenal syndrome (HRS) is a critical and potentially life-threatening complication of advanced liver disease, including cirrhosis.It is characterized by the development of renal dysfunction in the absence of underlying structural kidney pathology. The pathophysiology of HRS involves complex interactions between systemic and renal hemodynamics, neurohormonal imbalances, and the intricate role of vasoconstrictor substances. Understanding these mechanisms is crucial for the timely identification and management of HRS.The diagnosis of HRS is primarily clinical and relies on specific criteria that consider the exclusion of other causes of renal dysfunction.The management of HRS comprises two main approaches: vasoconstrictor therapy and albumin infusion, which aim to improve renal perfusion and mitigate the hyperdynamic circulation often seen in advanced liver disease. Additionally, strategies such as liver transplantation and renal replacement therapy are essential considerations based on individual patient characteristics and disease severity. This review article provides a comprehensive overview of hepatorenal syndrome, focusing on its pathophysiology, diagnostic criteria, and current management strategies.

Surgical Treatment for Diffuse Pigmented Villonodular Synovitis of the Ankle by A Combined Open and Arthroscopic Synovectomy: A Case Report / 대한족부족관절학회지

Pigmented villonodular synovitis (PVNS) is a rare proliferative disease involving the synovial membranes. Complete excision with a total synovectomy is important for diffuse type PVNS because of its high recurrence rate. In the ankle, complete excision of diffuse type PVNS is difficult due to the anatomical structure of the ankle joint. This paper reports the author's experience of surgical treatment with combined open and arthroscopic synovectomy. In this manner, it is expected that the complications of the open procedure and the recurrence rate of arthroscopic procedure can be reduced.

Widespread Lumbosacral Subdural Abscess after Bee Venom Therapy: A Case Report

OBJECTIVES@#We report a case of widespread lumbosacral subdural abscess in a patient who underwent bee venom therapy.SUMMARY OF LITERATURE REVIEW: Subdural abscess is rare, but has a poor prognosis. Therefore, prompt recognition and appropriate treatment are paramount.@*MATERIALS AND METHODS@#A 54-year-old woman was hospitalized due to severe back pain. Two days previously, she had undergone bee venom therapy. The patient then visited the emergency room because of severe back pain. However, a paraspinal infection was not detected on enhanced magnetic resonance imaging (MRI). Six days after admission, the patient showed signs of meningeal irritation and an emergency cerebrospinal fluid analysis showed typical findings of bacterial meningitis. Although adequate antibiotic treatment was administered, 20 days after admission, the patient's symptoms became aggravated. Pachymeningeal enhancement, myelomeningitis, and subdural abscess compressing the cauda equina were found on enhanced MRI. Thus, laminectomy between L3–L4 and L5–S1 was performed, as well as subdural abscess drainage. Antibiotic agents were applied for 6 weeks after the operation, and resolution of the subdural abscess was identified on follow-up MRI.@*RESULTS@#In this patient, lumbosacral subdural abscess occurred due to bee venom therapy. It was cured by adequate surgical and antibiotic treatment.@*CONCLUSIONS@#Bee venom therapy can cause subdural abscess of the spinal cord. Even if it is a rare case, this possibility is worth consideration in the Korean medical context.

Schwannoma Arising from the Plantar Digital Nerve of the 2nd Toe: A Case Report / 대한족부족관절학회지

A schwannoma is a benign tumor that originates from the peripheral nerve sheath. Schwannomas occur most commonly in the head and neck region involving the brachial plexus and the spinal nerves. The lower limbs are less commonly affected. This paper presents a case of a patient with a schwannoma showing atypical localization at the digital nerve of the foot causing neurological symptoms.

Widespread Lumbosacral Subdural Abscess after Bee Venom Therapy: A Case Report

STUDY DESIGN: Case report. OBJECTIVES: We report a case of widespread lumbosacral subdural abscess in a patient who underwent bee venom therapy. SUMMARY OF LITERATURE REVIEW: Subdural abscess is rare, but has a poor prognosis. Therefore, prompt recognition and appropriate treatment are paramount. MATERIALS AND METHODS: A 54-year-old woman was hospitalized due to severe back pain. Two days previously, she had undergone bee venom therapy. The patient then visited the emergency room because of severe back pain. However, a paraspinal infection was not detected on enhanced magnetic resonance imaging (MRI). Six days after admission, the patient showed signs of meningeal irritation and an emergency cerebrospinal fluid analysis showed typical findings of bacterial meningitis. Although adequate antibiotic treatment was administered, 20 days after admission, the patient's symptoms became aggravated. Pachymeningeal enhancement, myelomeningitis, and subdural abscess compressing the cauda equina were found on enhanced MRI. Thus, laminectomy between L3–L4 and L5–S1 was performed, as well as subdural abscess drainage. Antibiotic agents were applied for 6 weeks after the operation, and resolution of the subdural abscess was identified on follow-up MRI. RESULTS: In this patient, lumbosacral subdural abscess occurred due to bee venom therapy. It was cured by adequate surgical and antibiotic treatment. CONCLUSIONS: Bee venom therapy can cause subdural abscess of the spinal cord. Even if it is a rare case, this possibility is worth consideration in the Korean medical context.

Fracture and Dislocation of the Midtarsal Joint: A Case Report / 대한족부족관절학회지

The midtarsal joint is composed of the talonavicular and calcaneocuboid joints. It is also known as the Chopart joint. Midtarsal joint fracture and dislocation are relatively rare and frequently missed or misdiagnosed. A proper understanding about the anatomy of the midtarsal joint is an essential part in comprehending the mechanism of injury and rationale for treatment. Anatomical reduction of midtarsal joint with correction of the column in length and shape are important; however, it is technically challenging and may require open procedure. Herein, we described a case of initial open reduction and internal fixation for midtarsal joint fracture and dislocation with a brief literature review.

Semi-Circumferential Decompression: Microsurgical Total en-bloc Ligamentum Flavectomy to Treat Lumbar Spinal Stenosis with Grade I Degenerative Spondylolisthesis

BACKGROUND: To describe and assess clinical outcomes of the semi-circumferential decompression technique for microsurgical en-bloc total ligamentum flavectomy with preservation of the facet joint to treat the patients who have a lumbar spinal stenosis with degenerative spondylolisthesis. METHODS: We retrospectively analyzed the clinical and radiologic outcomes of 19 patients who have a spinal stenosis with Meyerding grade I degenerative spondylolisthesis. They were treated using the "semi-circumferential decompression" method. We evaluated improvements in back and radiating pain using a visual analogue scale (VAS) and the Oswestry Disability Index (ODI). We also evaluated occurrence of spinal instability on radiological exam using percentage slip and slip angle. RESULTS: The mean VAS score for back pain decreased significantly from 6.3 to 4.3, although some patients had residual back pain. The mean VAS for radiating pain decreased significantly from 8.3 to 2.5. The ODI score improved significantly from 25.3 preoperatively to 10.8 postoperatively. No significant change in percentage slip was observed (10% preoperatively vs. 12.2% at the last follow-up). The dynamic percentage slip (gap in percentage slip between flexion and extension X-ray exams) did not change significantly (5.2% vs. 5.8%). Slip angle and dynamic slip angle did not change (3.2° and 8.2° vs. 3.6° and 9.2°, respectively). CONCLUSIONS: The results suggested that semi-circumferential decompression is a clinically recommendable procedure that can improve pain. This procedure does not cause spinal instability when treating patients who have a spinal stenosis with degenerative spondylolisthesis.

Violence in Korean medical dramas

PURPOSE: Although violence occurs frequently in Korean television dramas, its description or definition is unusual. Many studies have shown that TV dramas have a powerful effect on society and the violence shown in medical dramas helps in comprehension of hospital violence occurring in real life. Therefore, this study will cover the types and levels of violence. METHODS: We selected five recent Korean medical dramas. These five dramas, which consisted of 94 episodes and were broadcast from 2007 to 2011, are analyzed. Violence is limited to the occurrence inside the hospital; violence that occurs outside of the hospital is excluded. Media violence is analyzed within PAT (perpetrator-action-target). In addition, the violence levels and violence relationships are analyzed. RESULTS: Among the types of violence, 88.5% is verbal abuse, 3.5% is physical threat, and 8.0% is physical violence. In comparison of the violence relationship, violence between a doctor and a doctor forms the highest rate of 72.6%. In the level of violence, 0 level of violence caused by verbal abuse is the highest (88.5%); however, 5 level of violence level, which is death, is not observed. There are 1475 minutes of violence scenes from 6243 minutes, which is 23.6% of total time. CONCLUSION: Frequency of violence in Korean medical dramas is higher than that of normal dramas. Considering the powerful influence of the mass media, the violence of medical dramas should be controlled. To resolve the problem, the role of advisory doctors seems important.

Femoral Neuropathy Secondary to Iliacus Hematoma: A Case Report / 대한고관절학회지

A 17-year-old male patient complained of acutely developed severe paresthesia, pain, and weakness of the right lower extremity. He fell to the ground during performance of hand-stand physical exercise. Despite administration of conservative treatment for two weeks in a private clinic, motor function of the hip flexor and knee extensor were measured as poor grade. EMG showed femoral nerve and lateral femoral cutaneous nerve injury. Findings on MRI and CT revealed a mass measuring 8x5x7 cm in the iliac fossa. After evacuation of the hematoma(400 cc), neurologic dysfunction and thigh circumference were fully recovered, compared with the contralateral side, after one and half year follow up. This condition rarely occurs in individuals without coagulopathy. We reported on a rare case of iliacus hematoma and femoral neuropathy treated by surgical decompression in a patient with no coagulopathy.

The Use of Vapocoolant Spray for the Treatment of Minor Trauma in the Hospital Emergency Department

PURPOSE: Vapocoolant spray is used as an agent to relieve localized pain due to sport injury or intravenous cannulation. The aim of this study was to determine the effectiveness of vapocoolant spray in the treatment of minor trauma in a hospital emergency department. METHODS: We carried out a prospective randomized controlled trial of alert patients with minor trauma who visited our emergency department. The total of 90 participants, all over 14 years old, were divided into 3 groups: a 'NSAIDs IM' group (n=30), 'Vapocoolant spray' group (n=30), and 'NSAIDs IM with Vapocoolant spray' group (n=30). Patients rated their pain and satisfaction of treatment using a 100-mm visual analogue scale (VAS). We assessed pain by VAS 4 times: first upon arrival, and then at 15, 30 and 60 minutes after treatment. We also assessed their treatment satisfaction utilizing VAS at the point of discharge. In addition, we calculated the time between subject arrival and initial treatment. RESULTS: Groups did not differ significantly in terms of age or sex distribution. The mean of the VAS score did not differ significantly among the groups upon their arrival (p=0.885) and were observed as follows: 'NSAIDs IM' group 44.80+/-12.70 mm, 'Vapocoolant spray' group 45.20+/-10.49 mm, and 'NSAIDs IM with Vapocoolant spray' group 46.17+/-9.54 mm. At 15, 30 and 60 min after treatment, the mean reduction in VAS score significantly differed between groups (p<0.05). At 15 min after treatment the results were as follows: 'NSAIDs IM' group 5.27+/-3.26 mm, 'Vapocoolant spray' group 15.17+/-7.17 mm, and 'NSAIDs IM with Vapocoolant spray'group 14.57+/-4.07 mm. At 30 min after treatment the results were: 'NSAIDs IM' group 13.57+/-7.86 mm, 'Vapocoolant spray' group 19.47+/-9.96 mm, and 'NSAIDs IM with Vapocoolant spray' group 21.20+/-6.52 mm. At 60 min after treatment the results were: 'NSAIDs IM' group 25.73+/-8.07 mm, 'Vapocoolant spray' group 20.90+/-9.88 mm, and 'NSAIDs IM with Vapocoolant spray' group 28.93+/-6.66 mm. Satisfaction of treatment and initial treatment time differed between groups (p<0.05). For satisfaction of treatment, the median of VAS significantly differed between the 'NSAIDs IM' group and the 'NSAIDs IM with Vapocoolant spray' group [46.50(41-52) mm vs. 57.00(51-62) mm, p<0.0167]. Initial treatment time significantly differed between the 'NSAIDs IM' group and the other groups [22.50(13-34) min vs. 10.00(7-20) min and 13.00(7-20) min, p<0.0167]. CONCLUSION: Vapocoolant spray is effective in reducing pain with minor trauma in the hospital emergency department. We can simultaneously improve the patient treatment satisfaction and reduce initial treatment time by using the vapocoolant spray.

The Use of Vapocoolant Spray for the Treatment of Minor Trauma in the Hospital Emergency Department

PURPOSE: Vapocoolant spray is used as an agent to relieve localized pain due to sport injury or intravenous cannulation. The aim of this study was to determine the effectiveness of vapocoolant spray in the treatment of minor trauma in a hospital emergency department. METHODS: We carried out a prospective randomized controlled trial of alert patients with minor trauma who visited our emergency department. The total of 90 participants, all over 14 years old, were divided into 3 groups: a 'NSAIDs IM' group (n=30), 'Vapocoolant spray' group (n=30), and 'NSAIDs IM with Vapocoolant spray' group (n=30). Patients rated their pain and satisfaction of treatment using a 100-mm visual analogue scale (VAS). We assessed pain by VAS 4 times: first upon arrival, and then at 15, 30 and 60 minutes after treatment. We also assessed their treatment satisfaction utilizing VAS at the point of discharge. In addition, we calculated the time between subject arrival and initial treatment. RESULTS: Groups did not differ significantly in terms of age or sex distribution. The mean of the VAS score did not differ significantly among the groups upon their arrival (p=0.885) and were observed as follows: 'NSAIDs IM' group 44.80+/-12.70 mm, 'Vapocoolant spray' group 45.20+/-10.49 mm, and 'NSAIDs IM with Vapocoolant spray' group 46.17+/-9.54 mm. At 15, 30 and 60 min after treatment, the mean reduction in VAS score significantly differed between groups (p<0.05). At 15 min after treatment the results were as follows: 'NSAIDs IM' group 5.27+/-3.26 mm, 'Vapocoolant spray' group 15.17+/-7.17 mm, and 'NSAIDs IM with Vapocoolant spray'group 14.57+/-4.07 mm. At 30 min after treatment the results were: 'NSAIDs IM' group 13.57+/-7.86 mm, 'Vapocoolant spray' group 19.47+/-9.96 mm, and 'NSAIDs IM with Vapocoolant spray' group 21.20+/-6.52 mm. At 60 min after treatment the results were: 'NSAIDs IM' group 25.73+/-8.07 mm, 'Vapocoolant spray' group 20.90+/-9.88 mm, and 'NSAIDs IM with Vapocoolant spray' group 28.93+/-6.66 mm. Satisfaction of treatment and initial treatment time differed between groups (p<0.05). For satisfaction of treatment, the median of VAS significantly differed between the 'NSAIDs IM' group and the 'NSAIDs IM with Vapocoolant spray' group [46.50(41-52) mm vs. 57.00(51-62) mm, p<0.0167]. Initial treatment time significantly differed between the 'NSAIDs IM' group and the other groups [22.50(13-34) min vs. 10.00(7-20) min and 13.00(7-20) min, p<0.0167]. CONCLUSION: Vapocoolant spray is effective in reducing pain with minor trauma in the hospital emergency department. We can simultaneously improve the patient treatment satisfaction and reduce initial treatment time by using the vapocoolant spray.

Comparison of central venous pressure and the inferior vena cava/aorta diameter index for evaluation of body fluid status

PURPOSE: Central venous pressure (CVP) is used almost universally to evaluate patient body fluid status. But historical and more recent data suggest that this approach may be flawed. In this study, we compared the accuracy of CVP versus the inferior vena cava/aorta diameter index (IVC/Ao index), a new approach to assessing body fluid status. METHODS: This study was carried out prospectively with subjects over 18 years of age who visited the emergency department between November 2010 and January 2011. A central venous catheter (CVC) was inserted into patients undergoing computed tomography (CT). IVC and aortic diameter were measured below the renal vein using the CT in axial view. To determine the exact CVP, we measured the distance from the tip of the CVC to the superior vena cava/right atrium (SVC/RA) junction in coronal and axial CT views, and placed the tip of a CVC at the SCV/RA junction. We analyzed the correlation between the CVP, IVC diameter and the IVC/Ao index. RESULTS: A total of 65 patients were enrolled in this study. The mean CVP was 9.25+/-5.99 mmH2O, IVC diameter was 1.456+/-0.568 cm and IVC/Ao index was 0.854+/-0.316. The correlation coefficient for CVP and IVC diameter was 0.625 (p<0.01) and for CVP and IVC/aorta index it was 0.711 (p<0.01). Coefficient of variations (CVs) of the IVC/Ao index was 0.76 at CVP 5 mmH2O and 0.14 at CVP 17 cmH2O. The correlation coefficient for CVP and IVC/Ao index in the group with a CVP result of less than 8 cmH2O was 0.330, and in the group with a CVP result greater than 8 cmH2O, it was 0.660 (p<0.01). CONCLUSION: The CVP results had a higher correlation to the IVC/aorta index than to the IVC diameter. The coefficient of variant (CV) tended to increase as CVP decreased. It is best not to use a single value of CVP or IVC/Ao index to evaluate the body fluid state, as some kind of dynamic parameter should be used.

Comparison of central venous pressure and the inferior vena cava/aorta diameter index for evaluation of body fluid status

PURPOSE: Central venous pressure (CVP) is used almost universally to evaluate patient body fluid status. But historical and more recent data suggest that this approach may be flawed. In this study, we compared the accuracy of CVP versus the inferior vena cava/aorta diameter index (IVC/Ao index), a new approach to assessing body fluid status. METHODS: This study was carried out prospectively with subjects over 18 years of age who visited the emergency department between November 2010 and January 2011. A central venous catheter (CVC) was inserted into patients undergoing computed tomography (CT). IVC and aortic diameter were measured below the renal vein using the CT in axial view. To determine the exact CVP, we measured the distance from the tip of the CVC to the superior vena cava/right atrium (SVC/RA) junction in coronal and axial CT views, and placed the tip of a CVC at the SCV/RA junction. We analyzed the correlation between the CVP, IVC diameter and the IVC/Ao index. RESULTS: A total of 65 patients were enrolled in this study. The mean CVP was 9.25+/-5.99 mmH2O, IVC diameter was 1.456+/-0.568 cm and IVC/Ao index was 0.854+/-0.316. The correlation coefficient for CVP and IVC diameter was 0.625 (p<0.01) and for CVP and IVC/aorta index it was 0.711 (p<0.01). Coefficient of variations (CVs) of the IVC/Ao index was 0.76 at CVP 5 mmH2O and 0.14 at CVP 17 cmH2O. The correlation coefficient for CVP and IVC/Ao index in the group with a CVP result of less than 8 cmH2O was 0.330, and in the group with a CVP result greater than 8 cmH2O, it was 0.660 (p<0.01). CONCLUSION: The CVP results had a higher correlation to the IVC/aorta index than to the IVC diameter. The coefficient of variant (CV) tended to increase as CVP decreased. It is best not to use a single value of CVP or IVC/Ao index to evaluate the body fluid state, as some kind of dynamic parameter should be used.

Spontaneous Rupture of the Extensor Pollicis Longus Tendon in a Tailor

A spontaneous rupture of the extensor pollicis longus (EPL) tendon is associated with rheumatoid arthritis, fractures of the wrist, systemic or local steroids and repetitive, and excessive abnormal motion of the wrist joint. The authors encountered a case of a spontaneous rupture of the EPL tendon. The patient had no predisposing factors including trauma or steroid injection. Although the patient had a positive rheumatoid factor, he did not demonstrate other clinical or radiological findings of rheumatoid arthritis. During surgery, the EPL tendon was found to be ruptured at the extensor retinaculum (third compartment). Reconstruction of the extensor tendon using the palmaris longus tendon was performed. At the 18-month follow-up, the patient showed satisfactory extension of the thumb and 40degrees extension and flexion at the wrist.

Utility of quantitative procalcitonin level and abbreviated MEDS scoring system as prognostic factors of sepsis patients in the emergency department

PURPOSE: Procalcitonin (PCT) is a newly introduced marker of systemic bacterial infection. The MEDS (Mortality in Emergency Department Sepsis) scoring system has proven to be the most useful and appropriate clinical prediction tool in cases of systemic bacterial infection in the emergency department. There have been no studies comparing the PCT assay with the abbreviated MEDS scoring system (without neutrophil bands). This study aimed to determine the efficacy of quantitative PCT assay and the abbreviated MEDS score in predicting the 28-day mortality and intensive care unit (ICU) admission in emergency department patients with systemic inflammatory response syndrome (SIRS). METHODS: This study was carried out prospectively on 212 patients >18-years-of-age with the criteria of SIRS who had visited to the emergency department. They were included if they had an emergency department diagnosis of sepsis, two or more SIRS criteria. We checked the initial PCT concentration and calculated abbreviated MEDS score. The primary outcome was 28-day mortality and ICU admission. We evaluated the predictive abilities of the initial PCT assay and abbreviated MEDS score. Receiver operating characteristic (ROC) curves were used to identify the value of PCT and abbreviated MEDS scoring system that maximized the sum sensitivity and specificity. RESULTS: Among the 212 patients included in this study, the mortality rate was 21%(45 of 212 patients) and the ICU admission rate was 33%(70 of 212 patients). Non-survivor group had a significantly higher PCT concentration (median, interquartile range (IQR), 12.23 ng/mL, 2.33-39.77 vs. 0.58 ng/mL, 0.10-3.60, p=0.05) and a higher abbreviated MEDS score (12.62+/-4.33 vs. 5.53+/-3.57, p<0.05) than the survival group. ICU admission patients had a significantly higher PCT concentration (median, IQR, 7.75 ng/mL, 1.43-36.85 vs. 0.55 ng/mL, 0.08-3.03 p<0.05) and a higher abbreviated MEDS score (10.90+/-4.60 vs. 5.13+/-3.48, p<0.05) than general ward admission patients. ROC analysis showed the discriminative power of the abbreviated MEDS score and PCT assay in predicting ICU admission and 28-day mortality. For ICU admission, areas of under the curves (AUC) of abbreviated MEDS score and PCT were 0.842 and 0.749, respectively (p<0.05). For PCT, AUC of abbreviated MEDS and PCT were 0.888 and 0.784, respectively (p<0.05). The optimal PCT threshold in predicting ICU admission was 1.22 ng/mL (odds ratio (OR), 6.92; 95% confidence interval (CI), 3.51-13.63; p<0.05) and 1.90 ng/mL in predicting 28-day mortality (OR, 11.90; 95% CI, 4.76-29.74). The optimal threshold of abbreviated MEDS score in predicting ICU admission was 8 (OR, 10.95; 95% CI, 5.47-21.90; p<0.05) and 9 in predicting 28 day mortality (OR, 19.03; 95% CI, 8.28-43.78; p<0.05). CONCLUSION: Both abbreviated MEDS scoring system and single plasma PCT assays can be used as a useful marker in rapidly and accurately predicting poor prognosis in emergency department patients with sepsis.

Utility of quantitative procalcitonin level and abbreviated MEDS scoring system as prognostic factors of sepsis patients in the emergency department

PURPOSE: Procalcitonin (PCT) is a newly introduced marker of systemic bacterial infection. The MEDS (Mortality in Emergency Department Sepsis) scoring system has proven to be the most useful and appropriate clinical prediction tool in cases of systemic bacterial infection in the emergency department. There have been no studies comparing the PCT assay with the abbreviated MEDS scoring system (without neutrophil bands). This study aimed to determine the efficacy of quantitative PCT assay and the abbreviated MEDS score in predicting the 28-day mortality and intensive care unit (ICU) admission in emergency department patients with systemic inflammatory response syndrome (SIRS). METHODS: This study was carried out prospectively on 212 patients >18-years-of-age with the criteria of SIRS who had visited to the emergency department. They were included if they had an emergency department diagnosis of sepsis, two or more SIRS criteria. We checked the initial PCT concentration and calculated abbreviated MEDS score. The primary outcome was 28-day mortality and ICU admission. We evaluated the predictive abilities of the initial PCT assay and abbreviated MEDS score. Receiver operating characteristic (ROC) curves were used to identify the value of PCT and abbreviated MEDS scoring system that maximized the sum sensitivity and specificity. RESULTS: Among the 212 patients included in this study, the mortality rate was 21%(45 of 212 patients) and the ICU admission rate was 33%(70 of 212 patients). Non-survivor group had a significantly higher PCT concentration (median, interquartile range (IQR), 12.23 ng/mL, 2.33-39.77 vs. 0.58 ng/mL, 0.10-3.60, p=0.05) and a higher abbreviated MEDS score (12.62+/-4.33 vs. 5.53+/-3.57, p<0.05) than the survival group. ICU admission patients had a significantly higher PCT concentration (median, IQR, 7.75 ng/mL, 1.43-36.85 vs. 0.55 ng/mL, 0.08-3.03 p<0.05) and a higher abbreviated MEDS score (10.90+/-4.60 vs. 5.13+/-3.48, p<0.05) than general ward admission patients. ROC analysis showed the discriminative power of the abbreviated MEDS score and PCT assay in predicting ICU admission and 28-day mortality. For ICU admission, areas of under the curves (AUC) of abbreviated MEDS score and PCT were 0.842 and 0.749, respectively (p<0.05). For PCT, AUC of abbreviated MEDS and PCT were 0.888 and 0.784, respectively (p<0.05). The optimal PCT threshold in predicting ICU admission was 1.22 ng/mL (odds ratio (OR), 6.92; 95% confidence interval (CI), 3.51-13.63; p<0.05) and 1.90 ng/mL in predicting 28-day mortality (OR, 11.90; 95% CI, 4.76-29.74). The optimal threshold of abbreviated MEDS score in predicting ICU admission was 8 (OR, 10.95; 95% CI, 5.47-21.90; p<0.05) and 9 in predicting 28 day mortality (OR, 19.03; 95% CI, 8.28-43.78; p<0.05). CONCLUSION: Both abbreviated MEDS scoring system and single plasma PCT assays can be used as a useful marker in rapidly and accurately predicting poor prognosis in emergency department patients with sepsis.

The Risk Factors of Delirium in Elderly Patients with Hip Fracture: A Prospective Study

PURPOSE: The purpose of this study was to report on the incidence and risk factors of perioperative delirium in elderly patients with hip fracture. MATERIALS AND METHODS: There were seventy four patients who were older than 65 years and who underwent an operation for hip fracture between April 2006 and February 2008. All the patients were tested with the Mini-Mental State Examination Korean version after admission and they were checked daily for the duration of their hospitalization. We diagnosed delirium by the Confused Assessment Method and we evaluated the risk factors for perioperative delirium. RESULTS: Delirium occurred in 21 patients (28.4%). The delirium group had a lower Mini-Mental State Examination Korean version score compared with that of the control group. The percentage of patients cared for in the intensive care unit (ICU) was significantly higher in the delirium group. There were statistically significant differences between the delirium group and the control group for the serum electrolytes, albumin and a past history of diabetes, stroke and CNS medications. CONCLUSION: Delirium is common in the elderly patients with hip fracture. Electrolyte disequilibrium and a low albumin level showed significant positive correlation between the delirium group and the control group. A history of stroke, diabetes and CNS medications are risk factors for delirium.

Two Cases of Phytolacca Americana Intoxication with Confusion and Abdominal Cramping

Phytolacca americana poisoning is a benign plant intoxication that causes gastrointestinal symptoms, including abdominal cramps, vomiting, diarrhea, and gastrointestinal bleeding. Other signs and symptoms include diaphoresis, salivation, visual disturbance, and seizures or mental changes. We report two cases of patients who experienced confusion and abdominal pain, vomiting, and hematemesis after oral ingestion of pokeweed. A 60-year-old female with confusion and a 67-year-old female with abdominal pain, vomiting, and diarrhea were admitted to the emergency department after pokeweed poisoning. After supportive treatment of hydration and gastrointestinal medication, the two patients showed full recovery within 24 h and were discharged from the hospital.

Spontaneous Spinal Epidural Hematoma after use of Anticoagulation Therapy / 대한척추외과학회지

Spontaneous epidural hematoma (SEH) is an uncommon cause of spinal cord compression. It tends to occur in patients at high risk for hemorrhage. Various medications are associated with SEH, including antiplatelet agents, anticoagulants, and thrombolytics. Because patients usually present with neurologic deficits, early diagnosis and proper management are required to achieve full recovery. The principal management is surgical evacuation of the SEH via laminectomy. We present a case of a 51-year-old woman on both oral aspirin and intravenous heparin who subsequently developed a SEH.