BACKGROUND: Hyponatremia in the elderly, one of the most common disorders seen in the emergency room (ER), has been shown to have a poor prognosis if treated improperly. However, it often is a challenge to detect because of its varying symptoms. This study aimed to improve the diagnosis and management of severe hyponatremia in the ER by analyzing clinical characteristics and patterns according to patient age. METHODS: Of the patients who visited the ER at Asan Medical Center in Seoul from May 1 to October 2006, 151 patients whose blood sodium concentration was 120 mEq/L or lower were examined in terms of gender, age, history, major symptoms, history of diuretic uses, and blood tests. RESULTS: The study group included 91 males and 60 females. Of these, 81 (53.6%) were middle-aged and 70 (46.4%) were elderly. For underlying diseases, 58 (38.4%) had liver disease and 79 (52.3%) had cancer. In the elderly group, more patients (21, 30%) visited the ER with neurological disturbances than with gastrointestinal symptoms (13, 18.6%); and more elderly patients (14, 20%) presented with serious hyponatremia (blood sodium concentration 110 or lower) than middle-aged patients (6, 7.4%). CONCLUSION: In the elderly, many patients visiting the ER did not have any underlying disease but were suffering from more severe hyponatremia. The major symptoms observed included neurological disturbances such as impaired consciousness and generalized weakness. The elderly can easily develop serious hyponatremia with accompanying neurologic disturbances. The emergency physician, having a high level of suspicion, should make a quick diagnosis and manage these patients appropriately.
Aged ; Consciousness ; Emergencies ; Female ; Hematologic Tests ; Humans ; Hyponatremia ; Liver Diseases ; Male ; Prognosis ; Sodium ; Stress, Psychological

We performed a electrophoresis to determine the serum level of isoenzyme of creatine phosphokinase in 30 patients with head injuries. The present study was undertaken to examine whether the measurement of serum level of brain type isoenzyme(CPK-BB) and heart type isoenzyme(CPKMB) were valuable in evaluating the clinical status of head injuries. All patients were diagnosed by Glasgow coma scale score, CT scan and then we performed a serial blood sampling during the first 7days. Brain type creatine phosphokinase(CPK-BB) was detected in the serum in 4 of 30 patientts(13.3%) and heart type creatine phosphokinase(CPK-MB) was detected in the serum in 8 of 30 patients(26.7%). These findings were seen within 48 hours after head injuries. The higher level were associated with severe brain damage; hemorrhagic contusion, subdural hemorrhage, subarachnoid hemorrhage and pneumocephalus.
Brain ; Contusions ; Craniocerebral Trauma* ; Creatine Kinase* ; Creatine* ; Electrophoresis ; Glasgow Coma Scale ; Head* ; Heart ; Hematoma, Subdural ; Humans ; Isoenzymes* ; Pneumocephalus ; Subarachnoid Hemorrhage ; Tomography, X-Ray Computed

Background: Recent studies about completely displaced midshaft clavicle fractures have reported that their nonunion/malunion rates were significantly higher in conservatively treated patients compared to surgically treated patients. The purpose of this study was to evaluate the factors associated with treatment decisions for midshaft clavicle fractures and also the factors that affect patient satisfaction with their treatment choice. Methods: We retrospectively reviewed the records of 75 patients who had been diagnosed with a midshaft clavicle fracture and were treated conservatively at a single institution between March 1, 2013, and December 31, 2014. Their medical records were reviewed to investigate the severity of the initial vertical displacement. A telephone survey was carried out to identify the presence of any patient-perceived deformity and determine if the patient eventually underwent surgery and whether the patient would prefer surgery if the injury recurred. Results: Significantly more patients with vertical displacement ≥100% (9/28) eventually underwent surgery compared to patients with vertical displacement <100% (3/32; p=0.028). Patients with vertical displacement ≥100% (13/28) were significantly more likely to prefer surgery compared to patients with vertical displacement <100% (7/32, p=0.044). Among the conservatively treated patients, nine of 32 participants with a patient-perceived deformity and one of 16 without a patient-perceived deformity responded that they would prefer to receive surgery in same situation in the future (p=0.079). Conclusions Patients with a midshaft clavicle fracture with vertical displacement of ≥100% may eventually require surgical treatment. When conservative treatment is carried out, the long-term patient results may be unsatisfactory due to perceived residual deformities.

Background: Melatonin receptors are present in the human skin and retina. These receptors can be stimulated by light emitting diodes (LEDs) at specific wavelengths, thereby inducing cutaneous photorejuvenation. However, the underlying mechanism remains unclear. Objective: To evaluate the influence of LEDs at specific wavelengths on melatonin membrane receptor (MT1) and cutaneous photorejuvenation via the MT1 pathway in vitro. Methods: Normal human dermal fibroblasts (HDFs) were irradiated using LEDs at different wavelengths (410~940 nm) at a dose of 1 J/cm 2 . MT1 activity was evaluated after melatonin stimulation and LED irradiation. Thereafter, the expressions of collagen (COL) and matrix metalloproteinases (MMPs), with and without luzindole (MT1/2 receptor antagonist), were investigated via semi-quantitative reverse transcription polymerase chain reaction (PCR), real-time PCR, western blotting, and enzyme-linked immunosorbent assay. Results: In HDFs, the MT1 mRNA and protein levels increased significantly in response to melatonin (dose, 50 nM) (p<0.01) and LED irradiation at 595, 630, 850, and 940 nm (p<0.01). LED irradiation up-regulated COL type I and down-regulated MMP-1. Compared to LED irradiation without luzindole, LED irradiation with luzindole produced no significant increase in COL type I mRNA and protein levels (p<0.01). Conclusion We found that LED irradiation induces collagen synthesis and MMP-1 inhibition in HDFs via MT1 activation. Additionally, multiple LED wavelengths (595, 630, 850, and 940 nm) stimulated MT1 in HDFs, unlike in the eyes, where only blue light induced plasma melatonin suppression. This suggests the possibility of the melatoninergic pathway in photorejuvenation.

Background: Recent studies about completely displaced midshaft clavicle fractures have reported that their nonunion/malunion rates were significantly higher in conservatively treated patients compared to surgically treated patients. The purpose of this study was to evaluate the factors associated with treatment decisions for midshaft clavicle fractures and also the factors that affect patient satisfaction with their treatment choice. Methods: We retrospectively reviewed the records of 75 patients who had been diagnosed with a midshaft clavicle fracture and were treated conservatively at a single institution between March 1, 2013, and December 31, 2014. Their medical records were reviewed to investigate the severity of the initial vertical displacement. A telephone survey was carried out to identify the presence of any patient-perceived deformity and determine if the patient eventually underwent surgery and whether the patient would prefer surgery if the injury recurred. Results: Significantly more patients with vertical displacement ≥100% (9/28) eventually underwent surgery compared to patients with vertical displacement <100% (3/32; p=0.028). Patients with vertical displacement ≥100% (13/28) were significantly more likely to prefer surgery compared to patients with vertical displacement <100% (7/32, p=0.044). Among the conservatively treated patients, nine of 32 participants with a patient-perceived deformity and one of 16 without a patient-perceived deformity responded that they would prefer to receive surgery in same situation in the future (p=0.079). Conclusions Patients with a midshaft clavicle fracture with vertical displacement of ≥100% may eventually require surgical treatment. When conservative treatment is carried out, the long-term patient results may be unsatisfactory due to perceived residual deformities.

Endovascular stent grafting is regarded as a promising alternative approach to open surgical repair for treating various aortic diseases in high risk patients. We report here on a case of a 79-year-old female who underwent endovascular stent-graft insertion in the ascending aorta for treating a complicated ascending aortic rupture that occurred secondary to radiation necrosis during the treatment of recurrent breast cancer.
Aged ; Aorta ; Aortic Diseases ; Aortic Rupture ; Breast Neoplasms ; Female ; Humans ; Necrosis ; Stents ; Transplants

Purpose: The number of infrapopliteal runoff vessels seems to be one of the factors influencing arterial patency in patients who had undergone superficial femoral artery (SFA) angioplasty with stenting. However, the effectiveness of infrapopliteal runoff vessels in predicting patency during SFA angioplasty remains unclear. This study aimed to determine whether the number and quality of infrapopliteal runoff vessels affect the primary patency after SFA angioplasty with stenting in patients with claudication. Materials and Methods: This study reviewed a retrospective database of patients with claudication who underwent SFA angioplasty with stenting between March 2011 and December 2016. The preoperative computed tomography findings of all patients were reviewed to assess infrapopliteal runoff vessels. The Trans-Atlantic Inter-Society (TASC) II classification and modified Society for Vascular Surgery (SVS) runoff score were used for subsequent analysis. Kaplan–Meier survival curves were constructed, and Fisher’s exact and chi-square tests were used for data analysis. Results: A total of 153 limbs of 122 patients (88.2% male, mean age: 69.1 years) underwent SFA angioplasty with stenting. The overall primary patency rates of TASC II A/B and C/D cases were 77.1% and 31.2%, respectively, at 36 months (P<0.001). The primary patency rates at 36 months using the modified SVS runoff scoring system were 64.6% and 49.8% for the good-to-compromised (≤9 points) and poor (≥10 points) runoff groups, respectively (P=0.011). Conclusion The modified SVS runoff scoring system is effective in predicting primary patency after SFA angioplasty with stenting in patients treated for claudication.

Purpose: The number of infrapopliteal runoff vessels seems to be one of the factors influencing arterial patency in patients who had undergone superficial femoral artery (SFA) angioplasty with stenting. However, the effectiveness of infrapopliteal runoff vessels in predicting patency during SFA angioplasty remains unclear. This study aimed to determine whether the number and quality of infrapopliteal runoff vessels affect the primary patency after SFA angioplasty with stenting in patients with claudication. Materials and Methods: This study reviewed a retrospective database of patients with claudication who underwent SFA angioplasty with stenting between March 2011 and December 2016. The preoperative computed tomography findings of all patients were reviewed to assess infrapopliteal runoff vessels. The Trans-Atlantic Inter-Society (TASC) II classification and modified Society for Vascular Surgery (SVS) runoff score were used for subsequent analysis. Kaplan–Meier survival curves were constructed, and Fisher’s exact and chi-square tests were used for data analysis. Results: A total of 153 limbs of 122 patients (88.2% male, mean age: 69.1 years) underwent SFA angioplasty with stenting. The overall primary patency rates of TASC II A/B and C/D cases were 77.1% and 31.2%, respectively, at 36 months (P<0.001). The primary patency rates at 36 months using the modified SVS runoff scoring system were 64.6% and 49.8% for the good-to-compromised (≤9 points) and poor (≥10 points) runoff groups, respectively (P=0.011). Conclusion The modified SVS runoff scoring system is effective in predicting primary patency after SFA angioplasty with stenting in patients treated for claudication.

We have experienced five cases of atrial septal defect closure under complete port access using the da Vinci system. We used only six 8~12 mm ports without thoracotomy or sternotomy for operation.
Heart Septal Defects, Atrial ; Robotics ; Sternotomy ; Thoracotomy