Clinical Significance of Prolonged QTc Dispersion in Spontaneous Intracerebral Hemorrhage

PURPOSE: QTc dispersion is a quantitative measure of myocardial repolarization and is a new important prognostic factor for many diseases. We have analyzed the admission ECGs of 53 patients with spontaneous intracerebral hemorrhage (ICH) for QTc dispersion. This study was performed to investigate the value of QTc dispersion as a prognostic factor in ICH patients. METHODS: ECGs done within 24 hours from attack onset were analyzed for abnormalities and QTc. The QTc dispersion is the QT duration of the longest minus the shortest rate-corrected QT interval. We studied the differences in QTc dispersions on the initial ECGs in the ED between a favorable group and an unfavorable group. RESULTS: We found that patients had less chance for a good recovery if they had a lower Glasgow Coma Scale (GCS) score on admission, a larger volume hematoma, a prolonged QTc dispersion, or a longer maximal QTc interval of the 53 patients with ICH, 16 (30.2%) patients demonstrated ECG abnormalities. The QTc dispersion was extremely prolonged in both groups. The favorable group included patients with a mean QTc dispersion=70.6 ms, whereas the unfavorable group included patients with a QTc dispersion= 117.6 ms. CONCLUSION: A prolonged QTc dispersion and a lower GCS score were significant predictors of a poor prognosis for spontaneous ICH patients. An increased QTc dispersion on the initial ECG is an important prognostic factor for ICH patients. More attention should be given to the disposition and intensive care of such patients.

Clinical Analysis of CPR in Infants with Out-of-Hospital Cardiopulmonary Arrest

PURPOSE: Since 1960 pediatric advanced life support (PALS) has been studied and applied to clinical situations, ILCOR guidelines 2000 for CPR and ECC was achieved. Pediatric cardiopulmonary arrest differs from adult arrest in etiologies, mechanisms, and managements. This study was performed to identify the clinical manifestations and real picutre of CPR to recognize the need of standard CPR method that increases the survival in infants with out-of hospital arrest. METHODS: This study was planned by retrospectively reviewed the records of all children who arrived without spontaneous respiration and palpable pulse at the emergency room of the three Hospitals from January 1996 to July 2003. RESULTS: During that period, 45 infants presented with out of-hospital cardiopulmonary arrest. Overall, there was a return of vital signs in 15 of the 45 patients; 6 survived to discharge from hospital. 1. Out-of-hospital arrest in infants demonstrated that 60% were male, mean age was 133.4 days. Of these, 71.1% of the arrests occurred in the home with family members presents, those family members didn't perform basic CPR in only 1 case. 2. In any ROSC group, the interval between the arrest and arrival at the hospital was 14.4 minutes. In ROSC never achieved group, the interval was 32.0 minutes. 3. Two of the 15 patients with SIDS(13.3%) and four of the 13 patients with respiratory arrest(30.8%) survived to hospital discharge. CONCLUSION: Factors that predicted survival to discharged alive included a death caused by respiratory disease, a short interval between the arrest and arrival at the hospital, and a short duration of resuscitation efforts in the ER. We found that need of standard guideline and commonly applied CPR techniques.

Evaluation of Prognostic Factors in Acute Renal Failure at the Emergency Department

PURPOSE: This study intended to identify prognostic factors influencing recovery, progressing chronic renal failure (CRF) and mortality in acute renal failure (ARF) patients at the emergency department. METHODS: We retrospectively analyzed 104 patients with ARF and with serum creatinine (Cr) level above 2 mg/dL and glomerular filtration rate (GFR) 60 years, underlying disease, cause of ARF, urine volume, existence of oliguria, duration of oliguria, proteinuria, GFR, serum BUN, serum Cr, BUN/Cr ratio, arterial pH, PaO2, S a O2, serum Na+, serum K+, serum albumin, serum total bilirubin, serum osmolarity, serum AST, serum ALT, serum creatine kinase, and serum myoglobin were all significant factors discriminating between recovery patients and nonrecovery patients (progressing CRF, mortality). Based on a multivariate analysis, sex, existence of oliguria, duration of oliguria, GFR, BUN/Cr ratio, PaO2, serum K+, SaO2, serum bilirubin, and serum osmolarity were useful factors which might affected non-recovery. CONCLUSION: In ARF, the prognostic factors were serum K+, S a O2, duration of oliguria, and BUN/Cr ratio. The higher serum K+, the lower SaO2, the longer the duration of oliguria, and the lower the BUN/Cr ratio are for ARF patients at the emergency department, the more the intensive care emergency physician must perform.

A Case of Infective Endocarditis in which Cerebral Infarction and Hemorrhage developed together

Risk factors for infective endocarditis include injection drug abusers and patients with structural heart defects undergoing dental procedures. Infective endocarditis is clinically important because it is hard to diagnose it in its early stage owing to its various clinical manifestations, and because its morbidity and mortality increase when neurologic complications occur. This is a case of infective endocarditis in the course of treatment of which complicating cerebral hemorrhage and infarction progressed rapidly and prompted death.

A Case of an Aortic Arch Aneurysm in which a Fistula Formed Between the Pulmonary Parenchyma

Massive hemoptysis represents a major medical emergency that is associated with high mortality. The causes of hemoptysis are various and include pulmonary and cardiovascular disorders and trauma. The causes of pulmonary disorder are tuberculosis, bronchiectasis, abscess, malignancy, bronchitis, and fungal infection. The causes of cardiovascular disorder are mitral stenosis, pulmonary embolism, and congestive heart failure. A fistula between an aortic aneurysm and the pulmonary parenchyma is one of the causes of hemoptysis, but it is a rare. However, if undiagnosed, it is a uniformly fatal cause of massive hemoptysis. This is a case of bleeding from a fistula between an aortic arch aneurysm and a lung parenchyma in a patient with an aortic arch aneurysm who presented with massive hemoptysis. He had suffered intermittent hemoptysis since he was diagnosed with an aortic arch aneurysm three years before. A high clinical suspicion must be maintained when a history of intermittent hemoptysis is obtained in patients with an aortic aneurysm or prior aortic graft surgery.