Search for Structural Cardiac Abnormalities Following Sudden Cardiac Arrest Using Post-mortem Echocardiography in the Emergency Department: A Preliminary Study

PURPOSE: Sudden cardiac arrest (SCA) accounts for approximately 15% of all-cause mortality in the US and 50% of all cardiovascular mortalities in developed countries; 10% of cases have an underlying structural cardiac abnormality. An echocardiography has widely been used to evaluate cardiac abnormality, but it needs to be performed by emergency physicians available in the emergency department immediately after death, rather than by cardiologists. We aimed to determine whether post-mortem echocardiography (PME) performed in the emergency department may reveal such abnormalities. METHODS: We evaluated the reliability and validity of PME performed by emergency physicians in the emergency department. Measurement by a cardiologist was used as reference. RESULTS: Two emergency physicians performed PME on 3 out of the 4 included patients who died after unsuccessful cardiopulmonary resuscitation. PME was started within 10 minutes of death, and it took 10 minutes to complete. Parasternal views in either supine or left decubitus position were most helpful. The adequacy of the image was rated good to fair, and that of measurements was acceptable to borderline. Regarding the chamber size and left ventricular wall thickness, intraclass correlation coefficients for reliability and validity were 0.97 (n=15) and 0.95 (n=35), respectively (p<0.001). Evaluation of presence/absence of left ventricular wall thinning, valve calcification, and pericardial effusion was incomplete (3/7-5/7), precluding further analysis. CONCLUSION: Emergency physicians could perform reliable and valid PME to assess the chamber size and left ventricular wall thickness. A large prospective study with collaboration between emergency physicians and cardiologists would reveal the feasibility and usefulness of PME in diagnosing structural causes of sudden cardiac arrest.

Prevalence of Undiagnosed Diabetes in Patient with Random Serum Glucose Over 200 mg/dL in an Emergency Department in Korea: Preliminary Study

PURPOSE: The aim of this study was to determine the prevalence of diabetes in patients with random serum glucose over 200 mg/dL in an emergency department. METHODS: A retrospective descriptive pilot study was conducted using chart review of patients who have visited the ED at Kangdong Sacred Heart Hospital. Between April and October 2014, patients aged 18 years and older with random serum glucose level higher than 200 mg/dL and having no prior diabetes mellitus (DM) were enrolled. Regardless of the patient's chief complaint, a history of current symptoms related to diabetes of patients was obtained and additional serum HbA1c was measured. The follow-up test was recommended on endocrinology OPD or the inpatient ward. Patients' medical records regarding diagnosis of DM were reviewed. RESULTS: A total of 296 patients with random serum glucose level estimated above 200 mg/dL without previous DM history were enrolled in this study, however only 82 patients were eligible. Among them, 34 patients (41.4%) were newly diagnosed as DM; 38 patients had current presumptive symptoms of diabetes while 44 patients had none of those symptoms. Twenty three patients (60.5%) with presumptive diabetes symptoms were diagnosed as diabetes while another 15 patients (39.5%) were not. Eleven (25.0%) patients without symptoms of diabetes were diagnosed as diabetes while 33 patients (75.0%) were not. The difference between two groups was significant. (p=0.001) CONCLUSION: The prevalence of undiagnosed DM patients in patients with random serum glucose level over 200 mg/dL in the emergency department was considerably high. Therefore emergency physicians should pay attention to opportunistic hyperglycemia and active diabetes screening.

The Usefulness of a Scoring System as a Predictor of Acute Coronary Syndrome in Chest Pain with an Unclear Diagnosis in the Emergency Department

PURPOSE: The aim of this study was to investigate the usefulness of several risk scoring systems, such as TIMI, GRACE, HEART, and PERSUIT as predictors for acute coronary syndrome (ACS) in chest pain with an unclear diagnosis. METHODS: This study was conducted as a retrospective and observational study. Enrolled patients were classified into two groups depending on the cause of chest pain: ACS group (CG; N=80) and non-ACS group (NCG; N=42). Clinical variables, including age, gender, past history, characteristics of chest pain, final diagnosis, and risk score were analyzed according to each group. Risk scoring systems for prediction of acute coronary syndrome were compared using receiver operating characteristic curve (ROC) analysis and area under the curve (AUC). RESULTS: Significant differences in age (p<0.001), diabetes mellitus (p=0.049), prior ischemic heart disease (p<0.001), continuous chest pain (p=0.035), and severe chest pain (p=0.001) were observed between the two groups. Results of ROC analysis for each scoring system for prediction of ACS were as follows: HEART (AUC; 0.878, 95% Confidence Interval, CI; 0.806~0.930, cut-off value; 4 points, sensitivity; 90.48%, specificity; 71.25%), TIMI (AUC; 0.839, 95% CI; 0.762~0.899, cut-off value; 1 point, sensitivity 83.33%, specificity 77.50%), PERSUIT (AUC; 0.748, 95% CI; 0.661~0.822, cut-off value; 11 points, sensitivity 61.90%, specificity 77.50%), and GRACE (AUC; 0.698, 95% CI, 0.608~0.778, cut off value 102 points, sensitivity 83.33, specificity 53.75%). CONCLUSION: In comparative analysis of each scoring system, the HEART scoring system was found to be a strong predictor of ACS in chest pain with an unclear diagnosis, followed by the TIMI, PURSUIT, and GRACE scoring systems.

The Efficacy of Discharge Instructions Provided by a Tablet Personal Computer for Aiding the Comprehension and Satisfaction of Patients with Ureteral Stones

PURPOSE: This study was conducted in order to evaluate the possibility of improving the comprehension and satisfaction of patients discharged after receiving discharge instructions using a tablet personal computer (tablet PC), compared with conventional discharge instructions. METHODS: A randomized, prospective, consecutive, exploratory study was conducted on patients with ureteral stones in an emergency department (ED). The patients' objective comprehension, satisfaction, and subjective comprehension regarding their discharge instructions were compared with regard to discharge instruction (traditional verbal method, N=53 versus tablet PC method, N=53). RESULTS: No statistically significant differences in age, gender, or level of education were observed between the two groups. The mean number of correct answers regarding ureteral stones on the questionnaire was 2.35+/-1.02 in the conventional group (CG) and 3.37+/-0.9 in the tablet PC group (TG) (p0.05). The subjective comprehension score was 7.42 in the CG and 7.8 in the TG (p>0.05). CONCLUSION: Objective comprehension of ureteral stones showed improvement in the group with discharge instructions provided by the tablet PC. However, satisfaction and subjective comprehension did not show improvement.

A Case of a Calcitonin-Secreting Pancreatic Endocrine Tumor in a Pateint with Multiple Endocrine Neoplasia Type 1 / 대한내과학회지

Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant hereditary disorder characterized by the combined occurrence of tumors of the parathyroid gland, exocrine pancreas, and anterior pituitary gland. Calcitonin-secreting pancreatic endocrine tumors are rare, and calcitonin-secreting pancreatic endocrine tumors with MEN1 have not been reported in Korea. A 46-year-old woman was admitted for a right breast cancer operation. Abnormal blood chemistry findings were hypercalcemia and elevated calcitonin. The patient was diagnosed with a calcitonin-secreting pancreatic endocrine tumor, left thyroid papillary carcinoma, right breast invasive ductal carcinoma, a thymic carcinoid tumor, left adrenal adenoma, uterine myoma, and adenomyosis by computed tomography scan, and with pituitary macroadenoma by brain magnetic resonance imaging. We present this case with a review of the literature, because it is the first reported calcitonin-secreting pancreatic endocrine tumor with MEN 1 in Korea.

Effect of Intensity of Unconditional Stimulus on Reconsolidation of Contextual Fear Memory

Memory reconsolidation is ubiquitous across species and various memory tasks. It is a dynamic process in which memory is modified and/or updated. In experimental conditions, memory reconsolidation is usually characterized by the fact that the consolidated memory is disrupted by a combination of memory reactivation and inhibition of protein synthesis. However, under some experimental conditions, the reactivated memory is not disrupted by inhibition of protein synthesis. This so called "boundary condition" of reconsolidation may be related to memory strength. In Pavlovian fear conditioning, the intensity of unconditional stimulus (US) determines the strength of the fear memory. In this study, we examined the effect of the intensity of US on the reconsolidation of contextual fear memory. Strong contextual fear memory, which is conditioned with strong US, is not disrupted by inhibition of protein synthesis after its reactivation; however, a weak fear memory is often disrupted. This suggests that a US of strong intensity can inhibit reconsolidation of contextual fear memory.

A Case of Essential Thrombocythemia Presenting as Esophageal Varix Bleeding and Multiple Thrombosis / 영남의대학술지

Essential thrombocythemia (ET), a subcategory of chronic myeloproliferative disorder, is characterized by absolute thrombocytosis due to excessive clonal proliferation of platelets, hyperaggregability of platelets, and increased incidence of thrombosis and hemorrhage. We consider a diagnosis of ET when an unexplained and persistent thrombocytosis is observed. It is difficult to consider ET first when we meet a patient with esophageal varix bleeding or unusual multiple thromboses like mesenteric vein, splenic vein, and portal vein. This article reports a patient who presented initially with esophageal varix bleeding and unusual multiple thromboses, thereafter, she was diagnosed with ET after testing positive for the Janus Tyrosine Kinase 2 (JAK2) V617F mutation. In conclusion, in patients with varix bleeding and unusual multiple thromboses, myeloproliferative disorders like essential thrombocythemia should be considered as a potential cause and testing for the JAK2 mutation is warranted.

Cyclosporine in Relapsed Subcutaneous Panniculitis-like T-Cell Lymphoma after Autologous Hematopoietic Stem Cell Transplantation / Journal of the Korean Cancer Association, 대한암학회지

Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare T-cell lymphoma characterized by involvement of the subcutaneous tissue of neoplastic T lymphocytes. SPTCL with hemophagocytic syndrome (HPS) is associated with an aggressive clinical course and treatment of SPTCL with HPS is not well established. Cyclophosphamide, doxorubicin, vincristine, prednisolone (CHOP) therapy is not successful in most patients suffering from SPTCL with HPS. The role of high dose chemotherapy followed by hematopoietic stem cell transplantation (HSCT) remains controversial. We report a case of relapsed SPTCL after CHOP chemotherapy and salvage chemotherapy followed by autologous HSCT, which had rapid improvement within weeks after cyclosporine and prednisolone. Immunosuppressive therapy may be an important and successful treatment option in SPTCL patients, even though they may have clinically aggressive disease.

Osseointegration with Ceramic Coated Implant / 대한척추외과학회지

PURPOSE: This study was designed to clarify the osseointegration of the titanium screw coated with CMP, in regard to the time schedule, through the characteristic of early osseointegration. MATERIALS AND METHODS: Mechanical, radiological and histomophometric measurements were performed in 28 rabbit tibial proximal metaphyseal cortical bone screws 6, 12, 26 and 52 weeks after surgery for the in vivo comparison of the osseointegration of titanium screws (3.75 mm diameter, 5 mm length) with different surface treatments: CMP coating group, with the sol-gel method (experimental group) and uncoated group (control group). RESULTS: 1. Radiology: There were no differences between the two groups without a radiolucent line or in regard to the time schedule. 2. Histology: There were no differences between the two groups without a fibrous tissue intervening surface or in regard to the time schedule. 3. Torque test: The test results for the CMP coated group were 1.5 times higher than those for the uncoated group, which was statistically meaningful, but there was no difference in regard to the time schedule. CONCLUSION: CMP coating is an option to increase the osseointegration of the titanium screw.