Asynchronous Bilateral Renal Infarction with Atrial Fibrillation Korea

Acute renal infarction is an uncommon disease which is often delayed or missed due to its rarity and unspecific clinical presentations. Most patients have an underlying disease or embolic event that can be detected easily by history and physical examination. The frequently noted symptoms include flank, abdominal, and back pain, as well as nausea. The pain is usually acute, severe, and sharp in nature without radiation. The most sensitive laboratory test is lactate dehydrogenase. Angiography, renal scintigraphy, IVP (intravenous pyelography), sonography and, CT (computed tomography) can be used in diagnosing renal infarction. However, CT is more preferred for the diagnosis of renal infarction because it has the advantages of easy accessability and noninvasiveness. Once diagnosed, conservative treatment with intra-arterial infusion of thrombolytics or heparin appears to be the most favorable modality. We report a 82-year-old male with asynchronous bilateral renal infarctions associated with atrial fibrillation and coronary artery disease. His clinical status improved during admission without any events.

A Child with an Acute Abdomen due to a Ruptured Hepatoblastoma

A hepatoblastoma is the most common liver tumor in children between 6 months to 3 years of age. It is a rare malignancy of the liver with an incidence of 0.7 to 1 case per 1 million children under 15 years of age in Western countries. Males are more affected. Patients usually have normal liver function test, but have high serum levels of alpha-fetoprotein (AFP), which is a sensitive diagnostic marker. They usually present with abdominal distension or an asymptomatic abdominal mass. Rarely, patients with a hepatoblastoma show an acute abdominal emergency which is not typical for the disease process. The management of a ruptured hepatocellular carcinoma provides guidance for diagnosis and treatment of a hepatoblastoma because the incidence of hepatoblastoma is low. We report a child who presented abdominal pain and distension with the diagnosis of a ruptured hepatoblastoma.

The Clinical Analysis on the Altered Mental Status in the ED

PURPOSE: Altered mental status (AMS) is a collective phrase that describes an undifferentiated assortment of disorders of mentation including impaired cognition, attention, awareness, and level of consciousness. Although AMS is a common chief complaint and a frequent issue in the emergency department (ED), the clinical surveys of AMS have not been conducted in Korea. We analyzed the AMS patients on the clinical basis. METHODS: From march 2002 to may 2002, we had enrolled prospectively 256 adult patients who visited the ED of Sanggye Paik Hospital because of AMS. The patients accompanied by AMS clinically were included, excluding patients caused by trauma, cerebrovascular accident with alert mentality. The clinical records were reviewed to analyze the clinical features of AMS, 9 months after discharge from ED. RESULTS: AMS was found in 256 patients which comprised the 2.2% of the ED patients during the test period, and 112 patients were admitted. The most commonly encountered mental status was drowsiness(36.3%), and the overall mortality rate 10.2%. The AMS was caused by neurogenic, metabolic, alcohol-related, psychogenic disorders in frequency accounting for most of AMS etiologies. CONCLUSION: This survey shows that the incidence of AMS is 2.2%, old age increases the rate of admission, and the common etiologies are neurogenic, metabolic, alcohol-related disorders. It seems prudent to approach the patients with AMS on the basis of etiologies and age.