Stress cardiomyopathy (SCMP) is a reversible heart disease, commonly accompanied by emotional or physical stress. Early clinical features are similar to those of acute myocardial infarction, such as acute chest symptoms, ST-segment elevation on electrocardiography, and cardiac biomarkers elevation. However, there is usually no evidence of significant coronary obstruction on a coronary angiogram. Moreover, ventricular dysfunction with regional wall motion abnormalities does not correlate with a single vascular territory. The typical type of SCMP is apical wall motion abnormality with an apical ballooning pattern, and various types of SCMP have recently been reported. Generally, cardiac dysfunction or abnormal wall motion is improved within several weeks, and the prognosis of SCMP is generally good. Thus, the mainstay of the treatment is largely conservative. However, there are some serious complications during the acute phase. In particular, cardiac rupture is a rare but serious structural complication associated with high mortality. In this manner, SCMP could potentially be life threatening during the acute phase, despite it generally being a benign disease in most cases. Early recognition of this complication, appropriate medical therapy, and surgical intervention are required to improve recovery and survival. Here, I report a case of an 83-year-old female patient with SCMP complicated by ventricular septal rupture.
Aged, 80 and over ; Biomarkers ; Cardiomyopathies ; Electrocardiography ; Female ; Heart Diseases ; Heart Rupture ; Humans ; Mortality ; Myocardial Infarction ; Prognosis ; Takotsubo Cardiomyopathy* ; Thorax ; Ventricular Dysfunction ; Ventricular Septal Rupture*

May-Thurner syndrome, also known as iliac vein compression syndrome, is an anatomically variable condition that is characterized by left common iliac vein compression by the right common iliac artery and the lumbar vertebra. This chronic and pulsatile venous compression by the right common iliac artery can cause local intimal injury, inflammation, scarring, and fibrosis, leading to venous outflow obstruction and increased intraluminal pressure. This can cause several complications, such as venous insufficiency, venous claudication, deep vein thrombosis, and very rarely extraperitoneal hematoma due to spontaneous iliac vein rupture. In particular, in middle aged women, hormonal imbalance coupled with these mechanical and inflammatory factors can cause further weakening of the venous wall integrity and develop spontaneous and potentially lethal venous rupture. This paper reports an extremely rare case of a 58-year-old woman with May-Thurner syndrome with acute and extensive deep vein thrombosis of the left lower extremity and a spontaneous extraperitoneal hematoma caused by utero-ovarian vein rupture.
Abdominal Cavity ; Cicatrix ; Female ; Fibrosis ; Hematoma* ; Humans ; Iliac Artery ; Iliac Vein ; Inflammation ; Lower Extremity ; May-Thurner Syndrome* ; Middle Aged ; Rupture* ; Spine ; Vascular System Injuries ; Veins* ; Venous Insufficiency ; Venous Thrombosis*

PURPOSE: The aim of this study was to determine the relationship between the injury severity and pain intensity according to age in patients with extremity injuries. METHODS: Adult patients with an extremity injury who visited the emergency department (ED) from June 1, 2016 to November 31, 2016 were analyzed retrospectively. The major injury was defined as structural damage below the muscle layer, such as muscle, ligament, and bone. Minor injury group and major injury group were separated according to this definition. The relationship of age and pain score assessed with the numerical rating scale (NRS) with the injury severity was analyzed. RESULTS: Of a total of 1,441 patients, the number of patients with a minor and major injury was 854 (59.3%) and 587 (40.7%), respectively. The proportion of patients aged 65 and older was 6.1% and 25.7% in the minor and major injury group, respectively. Age and NRS scale showed significantly positive associations with the injury severity (p < 0.001). In all NRS scores, the overall proportion of major injuries in the older age group was higher than that in the younger age group. Regardless of the younger ( < 65 years) or older (≥65 years) age group, the NRS score was positively related to the injury severity (young age group [odds ratio, 3.944]; older age group [odds ratio, 5.754]). CONCLUSION: The pain intensity is positively related to the severity of injury regardless of age. The pain intensity is the important factor of a patient assessment and treatment in the emergency department.
Adult ; Emergency Service, Hospital ; Extremities* ; Humans ; Ligaments ; Pain Measurement ; Retrospective Studies ; Trauma Severity Indices

Objective: This study evaluated the usefulness of cystatin C as a prognostic predictor in heart failure patients admitted to the emergency department. Methods: This study was conducted retrospectively on patients with heart failure admitted to the emergency department between January and December 2018. Patients newly and previously diagnosed with heart failure underwent both N-terminal prohormone of brain natriuretic peptide and cystatin C tests. To assess the patients’ prognosis, a poor prognosis was defined as the occurrence of one or more of the following events: intubation, admission to an intensive care unit, coronary angiography, continuous renal replacement therapy, extracorporeal membrane oxygenation, cardiopulmonary resuscitation, and death. The patients were divided into two groups based on the occurrence of these events; the characteristics between the groups with and without events were compared. Results: Seventy-four patients were included in the study analysis: 35 and 39 in the group without and with events, respectively. The number of patients with a history of diabetes, hypertension, troponin T, and cystatin C levels were significantly higher in the group with events than in the group without events (P=0.028, P=0.041, P<0.001, and P=0.002, respectively). Multiple logistic regression analyses showed that cystatin C is a significant prognostic predictor of events. Conclusion An increased cystatin C level has been shown to clinically predict a poor prognosis of heart failure patients admitted to emergency departments.

OBJECTIVE: The systemic inflammatory response syndrome (SIRS) criteria used in the triage scale have been implemented incompletely without laboratory data, such as the white blood cell (WBC) count, so the validity of SIRS as a triage tool has been uncertain. This study assessed the validity of the Korean Triage and Acuity Scale (KTAS) in applying SIRS with or without a WBC count. METHODS: The KTAS level was simulated by the number of SIRS criteria. This new KTAS level that did not apply the WBC count was defined as the partial-simulated KTAS (PS-KTAS), and the KTAS level including the WBC count was called the total-simulated KTAS (TS-KTAS). The authors used the intensive care unit (ICU), overall admission rate, and use of emergent interventions as the primary outcomes. RESULTS: A total of 1,077 patients with a suspected infection were triaged using the SIRS in KTAS. Multivariable logistic regression analysis showed that the odds ratio for overall admission was greater with a higher KTAS level than with KTAS level 4 in both the PS-KTAS and TS-KTAS. All areas under the curve of the PS- and TS-KTAS for ICU admission and emergent intervention rate both showed very low discriminant powers. CONCLUSION: Compared to TS-KTAS, PS-KTAS showed a similar or partially better relationship between the KTAS level and the use of critical medical resource. Future research is recommended to improve the matching between the SIRS scoring and each KTAS level to better classify the patient severity status and develop or discover new infection assessment tools that can be applied to KTAS.
Humans ; Intensive Care Units ; Leukocyte Count ; Leukocytes ; Logistic Models ; Odds Ratio ; Systemic Inflammatory Response Syndrome ; Triage

Objective: The Korean Triage and Acuity Scale (KTAS) is a triage tool for patients in the emergency department (ED). This study aimed to evaluate the ability of the KTAS to predict poor outcomes in South Korean ED patients with a suspected infection. We also compared the effectiveness of KTAS with that of the National Early Warning Score (NEWS) and Modified Early Warning Score (MEWS) in predicting poor outcomes. Methods: We conducted a single-center retrospective study that included adult patients with a suspected infection who were admitted to the ED between January 2019 and December 2019. Patients who received a prescription for antibiotics and associated culture tests in the ED were considered to have an infection. Poor outcomes were evaluated by in-hospital mortality, general ward admission, and intensive care unit (ICU) admission. A receiver operating characteristics (ROC) curve analysis was performed to evaluate and compare KTAS, NEWS, and MEWS. Results: Of the 4,127 patients in the study, in-hospital mortality was reported in 154 (3.7%) patients. The median KTAS was lower in the non-survivors than in the survivors (2.51 vs. 3.35). Multivariate logistic regression analysis showed that the KTAS was associated with in-hospital mortality, ward admission, and ICU admission. The area under the ROC curve (AUROC) values for predicting in-hospital mortality associated with the KTAS, NEWS, and MEWS were 0.776 (95% confidence interval, 0.747-0.803), 0.829 (0.759-0.811) and 0.739 (0.694-0.786), respectively. Conclusion Our results showed that the KTAS was associated with in-hospital mortality, ward admissions, and ICU admissions among ED patients with a suspected infection. Thus, KTAS may be reliable in predicting a poor outcome in ED patients with a suspected infection.

Objective: Rapid determination of acute coronary syndrome (ACS) in the emergency department (ED) is very important for patients presenting with ischemic symptoms. The aim of this study was to determine the predictive value of HEART score for ACS and significant coronary artery stenosis (SCS). Methods: We retrospectively analyzed data of patients who visited the ED with chest discomfort and were admitted to the cardiology department. Enrolled patients were classified into ACS and non-ACS groups according to their discharge diagnosis. Patients who underwent imaging were further divided into SCS and non-SCS groups according to study results. We compared age, sex, vital signs, risk factors, electrocardiogram, troponin, and HEART score for each group. For ACS and SCS predictive performance, the test characteristics of HEART score was calculated using sensitivity, specificity, predictive value, likelihood ratio, and receiver operating characteristic (ROC) curve analysis. Results: Of 207 patients, 112 had ACS. Among enrolled patients, 155 underwent imaging workup, of whom 67 had SCS. HEART score ≤3 had 93% sensitivity for ACS and 97% for SCS. HEART score ≥7 had 82% specificity for ACS and 83% for SCS. HEART score area under ROC curve for ACS was 0.706 (95% confidence interval, 0.627–0.776) and 0.737 (95% confidence interval, 0.660–0.804) for SCS. Conclusion HEART score was a fair predictor of ACS and SCS in ED patients who presented with chest symptoms and were admitted to the cardiology department. The predictive power of HEART score was better for SCS than for ACS.

PURPOSE: This study was conducted in order to identify the clinical characteristics of fish bone impaction among children in three tertiary hospitals and to investigate the usefulness of plain radiographs. METHODS: Children with suspected fish bone impaction in their aerodigestive tract were enrolled in this study. Data on patient's sex and age, characteristics of the allegedly ingested fish bone, utilization rate and result of neck radiographs, and removal procedures were collected retrospectively from three university-affiliated hospitals. RESULTS: A total of 270 children, from Seoul National University College of Medicine (n=113), Seoul National University Bundang Hospital (n=114), and Seoul National University Boramae Hospital (n=43) were enrolled consecutively. A total of 162 patients (60.0%) were male; the mean age of subjects was 6.9+/-4.1 years. The most commonly suspected source of fish bones was mackerel (n=58, 21.5%), followed by yellow corbina (n=57, 21.1%), and cutlass fish (n=22, 8.2%). Results of initial oropharyngeal inspections by emergency physicians (EP) were negative in 213 patients (78.9%). Among these patients, 173(64.1%) underwent simple neck radiography (radiograph group) and 40(14.8%) patients did not (non-radiograph group). In the radiograph group, no fish bone (0.0%) was observed on plain radiographs. Additional throat examinations were consulted to otolaryngologists (OL), and fish bones were detected in 62(35.8%) and 15(37.5%) patients, from the radiograph group and non-radio group, respectively. Among oropharyngeal inspections performed by EP or OL (130 patients), the most common impacted site of fish bones was the paratonsillar area (n=92, 71.5%). CONCLUSION: Mackerel and corbina are common sources of fish bone impaction in Korean children. Due to poor visualization and no additional information for use in management, the usefulness of plain radiographs is questionable.
Child ; Emergencies ; Gastrointestinal Tract ; Humans ; Neck ; Perciformes ; Pharynx ; Retrospective Studies ; Tertiary Care Centers

Resuscitative endovascular balloon occlusion of the aorta (REBOA) was developed for controlling intra-abdominal arterial bleeding before definitive bleeding control, and is commonly used in patients with ruptured abdominal aortic aneurysms. Although there is limited evidence for other uses of REBOA, we used REBOA in a patient with massive gastrointestinal bleeding. A 53-year-old man with hematochezia was admitted to our emergency department with an initial systolic blood pressure (SBP) of 83 mmHg. His SBP decreased to 40 mmHg in 10 minutes despite rapid fluid infusion. We decided to resuscitate the patient with REBOA in the emergency department and then move him to an intervention room after stabilization. After aortic occlusion, SBP abruptly increased from 57 to 108 mmHg, and the patient could be transferred to an intervention room. The patient was admitted to intensive care, but died of massive rebleeding 24 hours after admission to the emergency department.
Aorta* ; Aortic Aneurysm, Abdominal ; Balloon Occlusion* ; Blood Pressure ; Critical Care ; Emergency Service, Hospital ; Gastrointestinal Hemorrhage ; Hemorrhage* ; Humans ; Intestines ; Middle Aged ; Resuscitation ; Shock

Most known osteoporosis medicines are effective for bone resorption, and so there is an increasing demand for medicines that stimulate bone formation. Watercress (N. officinale R. Br.) is widely used as a salad green and herbal remedy. This study analyzed a watercress extract using ultra-performance liquid chromatography/mass spectrometry, and identified a rutin as one of its major constituents. Osteogenic-related assays were used to compare the effects of watercress containing rutin (WCR) and rutin alone on the proliferation and differentiation of human osteoblast-like MG-63 cells. The reported data are expressed as percentages relative to the control value (medium alone; assigned as 100%). WCR increased cell proliferation to 125.0+/-4.0% (mean+/-SD), as assessed using a cell viability assay, and increased the activity of alkaline phosphatase, an early differentiation marker, to 222.3+/-33.8%. In addition, WCR increased the expression of collagen type I, another early differentiation marker, to 149.2+/-2.8%, and increased the degree of mineralization, a marker of the late process of differentiation, to 122.9+/-3.9%. Rutin alone also increased the activity of ALP (to 154.4+/-12.2%), the expression of collagen type I (to 126.6+/-6.2%), and the degree of mineralization (to 112.3+/-5.0%). Daidzein, which is reported to stimulate bone formation, was used as a positive control; the effects of WCR on proliferation and differentiation were significantly greater than those of daidzein. These results indicate that WCR and rutin can both induce bone formation via the differentiation of MG-63 cells. This is the first study demonstrating the effectiveness of either WCR or rutin as an osteoblast stimulant.
Alkaline Phosphatase ; Bone Resorption ; Cell Proliferation ; Cell Survival ; Collagen Type I ; Humans ; Osteoblasts ; Osteogenesis ; Osteoporosis ; Rutin* ; Spectrum Analysis