A Clinical Study of Acute Appendicitis in Schizophrenia Patients Presenting at an Emergency Center

PURPOSE: To investigate the clinical characteristics and Alvarado scores of schizophrenia with patients acute appendicitis presenting at the emergency department. METHODS: We retrospectively reviewed medical records and identified schizophrenia patients who were diagnosed with acute appendicitis between January 2000 to December 2009 and who presented at the emergency department in 6 University hospitals. Comparisons were made with non-schizophrenic patients with acute appendicitis. Data collected included the patient's age, sex, clinical features, time interval between onset of symptoms and visiting the hospital, Alvarado score, disease complications, and diagnostic imaging modality. RESULTS: We identified 27 schizophrenia patients with acute appendicitis. Mean age was 34.5+/-8.3; 51.9% were women. The median time from onset of symptoms to visiting the emergency department was 3.8+/-1.4 days in the schizophrenic group and 2.3+/-2.1 in the normal control group. The mean Alvarado scores were 5.4+/-1.5 for the schizophrenic group and 6.5+/-2.1 for controls. Perforation of the appendix and formation of abscesses was higher in schizophrenic patients with appendicitis. CONCLUSION: These findings suggest that acute appendicitis is diagnosed late and with difficulty in schizophrenic patients and these patients may be the most vulnerable to failure to obtain timely surgical care. Early and careful access is recommended in suspected cases of appendicitis in schizophrenia patients.

Analysis of cardiovascular change of an Aconitum-containing Chinese Remedy

PURPOSE: The roots of Aconitum plants (e.g.,A carmichaelii, A napellus) have been believed to possess antiinflammatory, analgesic, and cardiotonic effects and have been used in traditional Chinese medicine mainly for the treatment of musculoskeletal disorders. Because of low safety margin, it is not uncommon to visit emergency departments to have variable amounts of highly toxic diterpene alkaloids (e.g., aconitine) contained in their systems. Typical manifestations of aconitine posioning are neurological, cardiovascular, and gastrointestinal problems. The known cardiovascular manifestations are several types of arrhythmia and hypotension. The author experienced a cases of transient ventricular ischemic change in an EKG and elevation in cardiac enzymes. This study aimed to evaluate cardiac ischemia associated with aconitine poisonining. METHODS: The author analyzed 13 patients with aconitine poisoning, who visited the Emergency Department of Chonnam National University Hospital from 1995 to 2001. Variables included in data analysis were age, sex, clinical features, cardiac enzyme levels, and EKG changes. RESULTS: Aconitine had been taken for a variety of medical problems, including arthralgia, neuralgia, and some gastrointestinal complaints. All patients suffered from neurological (tingling of the mouth and skin, followed by numbness and weakness in the extremities), cardiovascular (palpitation, dizzness), and gastrointestinal (nausea, vomiting) manifestations. Most patients had a variety of cardiac rhythm disturbances. Two patients exhibited transient cardiac ischemia, including cardiac enzyme elevation and ischemic changes on their an EKGs. CONCLUSION: Two patients (15.4%) among 13 patients showed transient cardiac ischemia, including cardiac enzyme elevation and ischemic changes on their EKGs. It is important to observe the possibility of myocardial toxicity of aconitum and to evaluate the mechanism of cardiac toxicity through clinical and experimental study

A Case of Locked-in Syndrome with Hypoglycemia

Locked in syndrome (LIS) is a state of tetraplegia and lower cranial nerve palsies in which vertical eye movement and blinking are the only means of communication, but consciousness is preserved. LIS is most frequently a sequelae of a basilar artery thrombosis lesion and may be caused by trauma, hemorrhage, a tumor, infection, etc., which results in a ventral pontine lesion or bilateral midbrain lesion. Early diagnosis and treatment must be a priority because the recovery of patients with locked in syndrome caused by a basilar artery occlusion is exceptional, with a 65~75% mortality. Although an improved clinical outcome can be achieved in patients with a basilar artery occlusion by early recanalization after the use of thrombolytic therapy or angioplasty, early diagnosis and treatment of this state is difficult, for the neurologic deficits develope gradually. The diagnosis of LIS in patients who present with hypoxia, metabolic disorder, endocrine disorder, central nerve system disorder, acute alcohol intoxication, acute drug intoxication, etc may be missed. At the emergency department, closer attention and frequent neurologic examinations must be given to patients who complain of altered mental state. We report a case of LIS which was misdiagnosised as hypoglycemic encephalopathy and review the literature.