Situs inversus totalis with dextrocardia is a rare congenital anomaly and its incidence is approximately 1: 6,000-35,000 in general population. Such patients usually have structurally normal hearts and are expected to have normal life span. Coronary angioplasty in such patients have previously been reported, but reported cases in literature are scanty. This report describes our experience of successful percutaneous transluminal coronary angioplasty with stent in acute myocardial infarction patient with situs inversus totalis and dextrocardia who exhibited total occlusion of the mid left anterior descending coronary artery.
Angioplasty ; Angioplasty, Balloon, Coronary* ; Coronary Vessels ; Dextrocardia ; Heart ; Humans ; Incidence ; Myocardial Infarction* ; Situs Inversus* ; Stents*

BACKGROUND: This research is to determine the chief complaints and related features of elderly patients who are presented to emergency department with medical problems. METHODS: Medical records of patients, 65 years or above, who visited Uijeongbu Hospital Emergency Center between January 1, 2012 and June 30, 2012 were reviewed retrospectively. Age, gender, mode of transportation to the hospital, chief complaints, and diagnosis were among the subjects analyzed. RESULTS: Elderly patients with medical problems, 3,468 visited the emergency department, constituting 12.66% from 27,396 patients in total during the research period. Patients aged 70 to 74 were 28.45%, composing the most among the age groups. Ambulance was the mode of transportation used by 43.06% of the patients and 42.96% of them stayed overnight, while 11.13% stayed in the intensive care units. The most frequent chief complaints were abdominal pain (16.81%), dyspnea (13.96%), and fever (11.16%). The most common diagnosis for patients with abdominal pain was gastritis (20.75%), chronic heart failure (26.03%) for dyspnea, and pneumonia (28.96%) for fever. The main diagnoses of in-patients according to the order of frequency were cerebral vascular accident (16.38%), pneumonia (12.48%), and chronic heart failure (6.04%). CONCLUSION: The number of elderly patients who stayed overnight and stayed in the intensive care units have increased comparing to younger patients. The top 10 most frequent chief complaints accounted for 78.92% by medical elderly patients. The results of this research could be used for the development of geriatric emergency medicine training programs and critical pathway for interns and residents.
Abdominal Pain ; Aged ; Ambulances ; Critical Pathways ; Dyspnea ; Emergencies ; Emergency Medicine ; Fever ; Gastritis ; Heart Failure ; Humans ; Intensive Care Units ; Medical Records ; Pneumonia ; Retrospective Studies ; Transportation

Serum C-reactive protein(sCRP) is an acute-phase reactant that exhibiting negative correlation with serum albumin concentration. It was reported that sCRP is an independent predictor of survival in both hemodialysis and peritoneal dialysis patients, and an acute phase inflammation could be preceded by protein catabolism, hypoalbuminemia, anorexia and even atherosclerotic cardiovascular disease. We have evaluated serum biochemical parameters including albumin and prealbumin, Kt/Vurea, nPCR, SGA score, anthropometric parameters and diet history in 30 ESRD patients maintained on chronic hemodialysis subdivided by sCRP concentration. Upon comparing the two subgroups[high CRP group(sCRP >or= 0.4mg/dL), n=15 vs. normal CRP group (sCRP<0.4mg/dL), n=15], high CRP group showed significantly lower levels of hemoglobin(9.3+/- 0.7 vs. 9.8+/-0.6g/L, p<0.05), hematocrit(28.3+/-2.3 vs 29.8+/-1.696, p<0.05), creatinine(9.6+/-3.1 vs. 12.2+/-2.5mg/dL, p<0.05), prealbumin(20.9+/-5.0 vs. 25.8+/-6.4mg/dL, p< 0.05), SGA score(5.0+/-1.2 vs. 5.9+/-0.7, p<0.05), and percent of patients who have higher nPCR than protein intake(85.7 vs. 28.6%, p<0.05). Ferritin was significantly higher in high CRP group(503.1+/-205.7 vs. 323.3+/-186.6, p<0.05). There were no differences in age, sex, duration of hemodialysis, prevalence of diabetic nephropathy and cardiovascular disease, Kt/Vurea, nPCR, residual renal function, amount of protein intake and other nutritional parameters. In conclusion, there was higher probability of malnutrition, anemia and protein catabolism in hemo-dialysis patients with elevated sCRP concentration.
Anemia ; Anorexia ; C-Reactive Protein* ; Cardiovascular Diseases ; Diabetic Nephropathies ; Diet ; Ferritins ; Humans ; Hypoalbuminemia ; Inflammation ; Kidney Failure, Chronic ; Malnutrition ; Metabolism ; Nutritional Status* ; Peritoneal Dialysis ; Prealbumin ; Prevalence ; Renal Dialysis* ; Serum Albumin

No abstract available.
Estrogens* ; Stomach Neoplasms*

Pericardial defect is a rare congenital cardiac disorder. Most patients were asymptomatic but some patients with partial pericardial defect occasionally complain acute symptoms such as angina, syncope, rarely sudden cardiac death. So, differential diagnosis with other ischemic or structural heart disease is crucial in the management of such patients. But there is no consistently successful diagnostic method. In the past, artificial diagnostic pneumothorax was used to document the absence of pericardium. However, it is not easily accepted due to excess morbidity and failure rate. Recently, echocardiography and more often, computed tomography, magnetic resonance imaging are used to confirm the diagnosis. We experienced a 52 years old male patient with atypical chest pain, who was diagnosed as complete left pericardial defect with computed tomography.
Chest Pain ; Death, Sudden, Cardiac ; Diagnosis ; Diagnosis, Differential ; Echocardiography ; Heart Diseases ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pericardium ; Pneumothorax ; Syncope

BACKGROUND/AIMS: The aim of the present study was to evaluate the relationship between thyroid hormone levels and infarct severity in patients with ST-elevation myocardial infarction (STEMI). METHODS: We retrospectively reviewed thyroid hormone levels, infarct severity, and the extent of transmurality in 40 STEMI patients evaluated via contrast-enhanced cardiac magnetic resonance imaging. RESULTS: The high triiodothyronine (T3) group (> or = 68.3 ng/dL) exhibited a significantly higher extent of transmural involvement (late transmural enhancement > 75% after administration of gadolinium contrast agent) than did the low T3 group (60% vs. 15%; p = 0.003). However, no significant difference was evident between the high- and low-thyroid-stimulating hormone/free thyroxine (FT4) groups. When the T3 cutoff level was set to 68.3 ng/dL using a receiver operating characteristic curve, the sensitivity was 80% and the specificity 68% in terms of differentiating between those with and without transmural involvement. Upon logistic regression analysis, high T3 level was an independent predictor of transmural involvement after adjustment for the presence of diabetes mellitus (DM) and the use of glycoprotein IIb/IIIa inhibitors (odds ratio, 40.62; 95% confidence interval, 3.29 to 502; p = 0.004). CONCLUSIONS: The T3 level predicted transmural involvement that was independent of glycoprotein IIb/IIIa inhibitor use and DM positivity.
Aged ; Area Under Curve ; Biological Markers/blood ; Chi-Square Distribution ; Contrast Media/diagnostic use ; Coronary Angiography ; Female ; Humans ; Logistic Models ; Magnetic Resonance Imaging, Cine ; Male ; Middle Aged ; Multivariate Analysis ; Myocardial Infarction/blood/*diagnosis/pathology/radiography ; Myocardium/*pathology ; Odds Ratio ; Predictive Value of Tests ; ROC Curve ; Retrospective Studies ; Severity of Illness Index ; Thyroxine/blood ; Triiodothyronine/*blood

Hemobilia is a disease caused by injury or conditions that cause the abnormal communication between intrahepatic blood vessels and biliary tract, resulting in leakage of blood into the biliary tract. In the past, trauma had been the most common cause of hemobilia. However, with the increasing invasive procedures in the hepatobiliary tract, iatrogenic origin has become the major cause of hemobilia. Also, non-traumatic etiologies of hemobilia include vascular malformation such as aneurysm, gallstone, inflammation, biliary tumor, hepatocellular carcinoma and coagulopathy. Among these non-traumatic etiologies, choledocholithiasis is a rare cause of hemobilia. The authors have experienced two cases of hemobilia caused by choledocholithiasis, which was diagnosed by abdominal ultrasonography, abdominal CT and duodenoscopy. Both patients were treated by the endoscopic sphincterotomy and stone removal with basket.
Aneurysm ; Biliary Tract ; Blood Vessels ; Carcinoma, Hepatocellular ; Choledocholithiasis ; Common Bile Duct* ; Duodenoscopy ; Gallstones ; Hemobilia* ; Humans ; Inflammation ; Sphincterotomy, Endoscopic ; Tomography, X-Ray Computed ; Ultrasonography ; Vascular Malformations

Duodenal diverticulum usually originates in the second portion of the duodenum and occasionally causes duodenal obstruction, hemorrhage, perforation and diverticulitis. A bleeding from Dieulafoy's lesion in a duodenal diverticulum is rare. It is not easily dignosed and treated by forward viewing endoscopy. Recently, a case was reported describing the hemorrhage from the Dieulafoy's lesion in a duodenal diverticulum which was treated by hemoclip with forward viewing endoscopy. Hemoclip application is considered to be the most appropriate endoscopic treatment, because sclerotherapy, electrocoagulation or band ligation for Dieulafoy's lesion in the duodenal diverticulum may increase risk of duodenal perforation. We report a case of duodenal perforation due to hemoclip application for the treatment of Dieulafoy's lesion in a duodenal diverticulum.
Diverticulitis ; Diverticulum* ; Duodenal Obstruction ; Duodenum ; Electrocoagulation ; Endoscopy ; Hemorrhage ; Ligation ; Sclerotherapy

Coronary artery injury after thoracic injury is very rare, but can result in serious acute myocardial infarction (MI). It can be easily mistaken for chest wall pain or cardiac contusion if relying solely on a history and physical examination. We herein report a rare case of a 60-year-old female patient who presented with inferior wall ST-segment elevation MI due to right coronary artery dissection following blunt chest trauma after a traffic accident. Successful primary percutaneous coronary intervention was performed without complications.
Accidents, Traffic ; Contusions ; Coronary Vessels ; Female ; Humans ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Physical Examination ; Thoracic Injuries ; Thoracic Wall ; Thorax

PURPOSE: Scoring systems such as the Modified Alvarado Score (MAS), Eskelinen score (ES), Lintula score (LS), nd Ohmann score (OS) can be helpful in the early diagnosis of acute appendicitis (AA). We analyze and compare the diagnostic value of each scoring system and investigate the optimal cut off point. METHODS: A total of 62 adult patients admitted for suspicion of acute appendicitis in a tertiary hospital emergency department were analyzed prospectively. Each scoring system was calculated at admission and compared to the final diagnosis. Receiver operating characteristic (ROC) curves were used to determine the appropriate cutoff scores of scoring systems. The sensitivity and specificity, and area under the ROC curve were calculated. RESULTS: The area under curve of the Ohmann score was higher than those of the other scoring systems (OS: 0.79, MAS: 0.73, ES: 0.65, LS: 0.67). In pairwise comparison of the ROC curve of two scoring systems, OS was found to have significantly higher predictive power than ES and LS. However, no difference was observed between MAS and OS. CONCLUSION: No single score may be used alone to dictate or decline surgery. However, the scoring system may provide helpful information for primary or emergency physicians to determine whether the patient should undergo surgical consultation may provide helpful information for use by primary or emergency physicians in determination of whether the patient should undergo surgical consultation.
Adult ; Appendicitis ; Area Under Curve ; Early Diagnosis ; Emergencies ; Humans ; Prospective Studies ; ROC Curve ; Sensitivity and Specificity ; Tertiary Care Centers