A Preliminary Study of Gender Difference on Clinical Presentation of Acute Ischemic Stroke: A Single Center Study

PURPOSE: To attain improvement in prognosis of patients suffering acute ischemic strokes (AIS), it is crucial to diagnose these swiftly and accurately. It is generally believed that female patients have a less favorable outcome, but there has not yet been sufficient data to confirm this opinion. The authors herein conducted a study to determine whether the symptoms of AIS differ between males and females. METHODS: A retrospective study was conducted on 322 consecutive patients who were diagnosed with AIS on the basis of MRI findings during the last two years. Demographic findings and clinical features were collected from emergency room records in order to evaluate gender differences. RESULTS: There were 148 female patients (45.8% of total) in our study, and the average age of affection for females was significantly higher than males. Our data did not achieve statistical significance; however, we observed the following tendencies: the time from symptom onset to admission was delayed in female group; both traditional and nontraditional symptoms were more prevalent in the male group; and atypical symptoms were observed in the female group. CONCLUSION: No gender difference was observed in the incidence of acute ischemic stroke. However, the proportion of atypical symptoms was relatively higher in female patients. Factors resulting in delay clinical attention and contributing to the observed discrepancy between genders in AIS diagnosis should be validated and investigated further.

Follow up Study about Health-Related Quality of Life in Injury Patients

PURPOSE: The purpose of this study is to assess healthrelated quality of life (HRQOL), to compare HRQOL of 3 months after injury with 10 days after injury, and to offer the result of this study to basic data of HRQOL in Korean patients with injury. METHODS: Between November 1, 2003, and March 2, 2004, 100 eligible injury patients who had visited emergency center were enrolled in the study. HRQOL was measured by Korean EuroQol 5 dimensions (KEQ-5D), and assessed in 10 days and 3 months after injury. The severity of injury was measured by Injury Severity Score (ISS). RESULTS: Of the 100 subjects, 54 (54%) were men and 46 (46%) were women, with mean (+/-SD) age of 43.7 (+/-15.2) and mean ISS (+/-SD) of 4.45 (+/-4.38). The KEQ-5D utility index and 5 subdimensional scores of 3 months after injury were significantly higher than those of 10 days after injury. The KEQ-5D utility indexes of 3 months after injury of each group by the ISS, age, sex, educational status and marrital status had significant higher than those of 10 days after injury. CONCLUSION: In this study, we observed that HRLOQ in patients with 3 months after injury was higher than those with 10 days after injury. However, to define the more definite feature of HRLOQ in patients with injury, the study with more and large epidemiologic controlled injury group and detailed variable adjustment should be done.

Health-related Quality of Life in Patients with Injury in the Emergency Department

PURPOSE: The purpose of this study is to assess healthrelated quality of life (HRQOL) in patients with injury in the Emergency department, to compare that HRQOLs with normal control group, and to offer the results of this study as basic data on the HRQOL in Korean patients with injury, in the Emergency department. METHODS: Between November 1, 2003, and March 2, 2004, 266 eligible injury patients who had visited our emergency center were enrolled in the study. The HRQOL was measured by using the Korean Short Form Health Survey-36 (KSF-36)and the Korean EuroQol 5 dimensions (KEQ-5D). The HRQOL was assessed at 10 days after injury. The severity of injury was measured by using the Injury Severity Score (ISS). RESULTS: Of the 266 subjects, 164 (61.7%) were men and 102 (38.3%) were women, with a mean (+/-SD) age of 42.8 (+/-15.2) and mean ISS (+/-SD) of 4.54 (+/-3.98). The KSF- 36 and KEQ-5D scores in patients with injury were significantly lower than those in the normal control group. The HRQOL scores of each group by cause of injury had significant differences in the KSF-36 MCS and the KEQ-5D utility index, but they had no significant differences in the KSF-36 PCS. Women were more likely to have poor HRQOLs than men, but no statistical significance was found. Patients with non-intentional injury and hospitalized were more likely to have poor HRQOLs than patients with intentional injury and discharged, but the statistical significance varied with the measurement tool. CONCLUSION: In this study, we observed that the HRLOQs in patients with injury were lower than those in healthy subjects. However, if more definite feature of HRLOQ in patients with injury are to be defined, a study with a large epidemiologic controlled injury group and with detailed adjustments of the variable is needed.

Correlation between Health-related Quality of Life Score and Injury Severity Score in Patients with Injury in Emergency Department

PURPOSE: The purpose of this study is to show the correlation between Health-related quality of life (HRQOL) score and injury severity score (ISS) in patients with injury in emergency department. METHODS: Between November 1, 2003, and March 2, 2004, 234 eligible injury patients who had visited our emergency center were enrolled in the study. HRQOL was assessed in 10 days after injury by Korean Short Form Health Survey- 36(KSF-36), Korean EuroQol 5 dimensions (KEQ-5D), and Korean Human Utility Index-3(KHUI-3). The severity of injury was measured by using the ISS. RESULTS: Of the 234 subjects, 149(63.7%) were men and 85(36.3%) were women, with mean(+/-SD) age of 46.1(+/-15.3) and mean ISS(+/-SD) of 4.54(+/-3.98). The KEQ-5D and KHUI-3 scores adjusted by ISS in patients with medical operation or hospitalization were significantly lower than those in patients without medical operation or hospitalization. All HRQOL scores except KSF-36 physical component summary (PCS) and general health (GH) score were significantly lower in patients group with high ISS than in patients group with low ISS. KEQ-5D and KHUI-3 had significant negative correlation with ISS (r=-0.58,-0.52). But there were no significant correlation between KSF-36 score and ISS. CONCLUSION: In this study, we observed that KEQ-5D and KHUI-3 scores in patients with injury were significantly correlated with ISS. However, to define the more definite feature of HRQOL in patients with injury, the study with more and large epidemiologic controlled injury group and detailed variable adjustment should be done.

A case of Posterior Reversible Encephalopathy Syndrome Presenting as Generalized Seizure after Delivery

Posterior reversible encephalopathy syndrome (PRES) is typically characterized by headache, altered mental functioning, seizure, and visual loss associated with imaging findings of bilateral subcortical and cortical edema with a predominantly posterior distribution. The usual causes of PRES are hypertensive encephalopathy, preeclampsia, eclampsia, cyclosporine A neurotoxicity and uremic encephalopathy. Early recognition of PRES is important because the treatment of PRES can be relatively contraindicated in some conditions, such as cerebral ischemia. We describe a 28-year-old woman who presented with a seizure 11 days after delivery. The diagnosis of PRES was made later. To make an early diagnosis of PRES, the emergency physician should include PRES in the differential diagnosis and consider an MRI with diffusion-weighted imaging in patients presenting with seizure, altered mental status, headache, and visual loss, especially patients with a hypertensive crisis, an organ transplantation, or a history of recent delivery.

Catecholamine-induced Myocarditis in Pheochromocytoma

Pheochromocytomas are rare tumors that originate in chromaffin tissue and produce distant variant effects, such as EKG abnormality, myocarditis, cardiomyopathy, and acute coronary syndrome, by secretion of catecholamines. Such variant effects of pheochromocytoma tend to lead the emergency physician to a wrong diagnosis. We describe the case of a 29-year-old female with pheochromocytoma who was diagnosed at the ER as having myocarditis with acute renal failure. The diagnosis of pheochromocytoma was made later. To avoid misdiagnosis, we should include pheochromocytoma in the differential diagnosis. We should also use additional imaging tests, such as bed-side abdominal ultrasonography or abdominal CT, at the ER on relatively young patients presenting with hypertensive crisis, acute renal failure, and features, such as ischemic EKG changes, which are suggestive of acute coronary syndrome or myocarditis.

The Accuracy of Noncontrast Helical Computerized Tomography Versus Intravenous Pyelography in Patients with Suspected Acute Urolithiasis in the Emergency Department

PURPOSE: This study was performed to compare the accuracy of noncontrast helical computerized tomography (NHCT) with that of intravenous pyelography (IVP) in the evaluation of urolithiasis in the emergency room (ER). METHODS: Between November 2003 and February 2004, a total of 47 consecutive patients presenting to the emergency department with acute flank pain were evaluated with NHCT followed by IVP. The mean of the time interval between NHCT and IVP was less than 5 minutes. All 47 sets of evaluations were later assessed randomly by an independent consulting radiologist for the presence, size, and location of a stone, ureteral dilatation, and secondary signs of ureteral obstruction. RESULTS: Forty-three of the 47 patients were diagnosed with urolithiasis. In 39 of the 43 patients diagnosed with ureteral calculi, the NHCT made the diagnosis. IVP made the diagnosis in 26 of the 43 patients. NHCT had a 90.7% sensitivity, 100% specificity, and 68% accuracy. Compared with IVP, using the McNemar test, NHCT was significantly better able to predict the presence of urolithiasis (p<0.001). CONCLUSIONS: Unnenhanced helical CT is superior to IVP in the demonstration of ureteral calculi in patients with suspected acute urolithiasis in the ER.