Case of Pheochromocytoma Presenting as a Seizure in the Emergency Department

Pheochromocytomas are catecholamine-producing tumors that originate from chromaffin cells of adrenal medulla. Typical symptoms are paroxysmal hypertension, headache, hyperhidrosis, and hypermetabolism. But, the clinical presentation is sometimes quite variable. Atypical clinical presentations can complicate diagnosis. Seizure as a presenting symptom is very rare in pheochromocytoma. We report the case of a 58-year-old female transferred to our emergency department with seizure and transient stuporous mentality. Incidentally, we diagnosed pheochromocytoma by femoral artery computed tomography because of puncture complication in the femoral artery.

Case of Pheochromocytoma Presenting as a Seizure in the Emergency Department

Pheochromocytomas are catecholamine-producing tumors that originate from chromaffin cells of adrenal medulla. Typical symptoms are paroxysmal hypertension, headache, hyperhidrosis, and hypermetabolism. But, the clinical presentation is sometimes quite variable. Atypical clinical presentations can complicate diagnosis. Seizure as a presenting symptom is very rare in pheochromocytoma. We report the case of a 58-year-old female transferred to our emergency department with seizure and transient stuporous mentality. Incidentally, we diagnosed pheochromocytoma by femoral artery computed tomography because of puncture complication in the femoral artery.

Clinical Comparison of Acute Poisoning Victims Between Urban and Rural Areas

PURPOSE: The living standards vary between the urban and rural areas in Korea. This study aims to compare the characteristics of acute poisoning victims in urban and rural areas. METHODS: A retrospective study was conducted over a period of 2 years from 2008 to 2009. The study group included adults over 19 year old with acute poisoning and who were later were admitted to the local emergency medical center located in Daegu, Korea. The exclusion criteria were 1) the victims of adverse effects of therapeutic doses of drugs, 2) the victims with chronic exposure and 3) the victims who were missing data in their emergency medical records. We divided the victims into the adult group (19-64 years old) and the old group (over 65 years old). RESULTS: There were 569 acute poisoning victims during the study period, and they constituted 1.11% of the total ED visits (51,199). Four hundred seventy six patients were enrolled in this study. Out of the 359 acute poisoning victims, 252 victims were from urban areas and 107 victims were from rural areas. They showed statistical differences for gender, ED access, transport, toxins and the time to the ED. In the old group, 61 victims out of 117 were from urban areas and the remaining 56 victims were from rural areas. They showed statistical differences for gender, ED access, toxins and transport. CONCLUSION: Through the clinical comparison between the acute poisoning victims of urban and rural areas, we exposed the clinical differences between the urban and rural areas, and we concluded that prevention and education for acute poisoning should be generated differently between the two groups.

Effect of Keratectomy on Hydroxyapatite Exposure in Evisceration

The exposure rate of hydroxyapatite is higher in evisceration than in enucleation. This study is to compare the exposure rate of hydroxyapatite after evisceration with keratectomy and that without keratectomy. We reviewed 89medical records of the patients who had received eviscera- tion with hydroxyapatite implantation retrospectively. Of the 69 patients who had not received keratectomy during the eviceration, 9 patients (13%) had postoperative hydroxyapatite exposure. None of the 20 patients who had received keratectomy had exposure. In case of hydroxyapatite implantation after evisceration, keratectomy and 360 . circumferential sclerotomy will decrease the exposure rate of hydroxyapatite.

Short Term Effect of Xalatan in Normal Koreans

Xalatan(Prostaglandin F-2alpha analog) is intraocular pressure reducing agent which increases uveoscleral outflow. It has little systemic side effect, has little effect on pupillary diameter prescribed a few times a day. As a result, it is an antiglaucoma drug convenient for usage. We observed the effect of intraocular pressure and side effect to investigate the clinical effectiveness of Xalatan in normal Koreans. We instilled Xalatan single dose a day to 10 subjects (20 eyes). We measured intraocular pressure by Goldman applanation tonometer on the first, the third, the fifth, the seventh, and the fourteenth day after dropping of the drug. Decreases in the intraocular pressure are statistically significant (p-value<0.05) compared to the pressure previous to the instillation. To evaluate the side effect of Xalatan, we investigated pupillary diameter, pulse rate, blood pressure, the change of iris color and performed external eye examination. However it didn`t show any side effect except for conjunctival injection. Therefore we expect that Xalatan will have a great effect on glaucoma patients in Korea.

Digital Videographic Measurement of Cyclotorsional Angle in Normal Human Eye

The eyeball movement is classified into horizontal, vertical movement and cyclotorsion. The cyclotorsion has been known to be induced by two oblique and vertical rectus muscles. But there have been few precise methods for the measurement of cyclotorsion. So, we tried to find the precise method for the measurement of cyclotorsion with digital videographic method. Sixteen normal volunteers were included in this study, who had no eyeball movement disorders. For the measurement of cyclotorsion that followed by head tilt, the volunteers haed was tilted to fifteen, thirty, forty-five and sixty degree to the left and the partially compensated counter torsion was recorded with video camera. The movement was analyzed with digitally using IBM clone computer. The linear regression equation, between the head tilt and cyclotorsion was Y=2.019 X + 22.2280 (Y=head tilt, X=cyclotorsion) and coefficient of variation(%) was 0.88%. Therefore, our videographic method for the measurement of cyclotorsion was relatively precise and may be applied in the measurement of ocular torsion.