PURPOSE: "Stress-induced cardiomyopathy"or "Takotsubo cardiomyopathy", which mimics acute myocardial infarction (AMI), has recently been reported, particularly in Japan. However, little is known about the characteristics of this syndrome. We retrospectively evaluated twenty-three cases of this novel syndrome. METHODS: We analyzed twenty-three patients(7 men and 16 women) who fulfilled the following inclusion criteria: 1) age >18 years old; 2) no previous cardiac disease, especially coronary artery disease; 3) acute onset of symptoms; 4) ST segment elevation or depression and/or T-wave inversion on ECG; 5) cardiac enzyme elevation; 6) regional wall motion abnormality in the echocardiogram or left ventriculogram; 7) no significant stenosis in the coronary angiogram. RESULTS: The most common stressful conditions that preceded the chest pain were: emotional stress (n=8, 34.8%), medical illness (n=7, 30.4%), accident (n=3, 13.1%), and recovery from surgery (n=3, 13.1%). The average initial creatinine kinase MB fraction and cardiac troponin I level were 32.2+/-51.7 ng/ml and 4.11+/-19.7 ng/ml, respectively. ECG changes [ST-segment elevation or depression (n=10, 43.5%) and T-wave inversion (n=19, 82.6%)] were usually found, whereas in contrast a Q wave was rarely found (n=3, 13.4%). The average left ventricular ejection fraction (LVEF) was decreased to 43.2+/-12.2% and regional wall motion abnormality [apex only (n=11, 47.8%), global (n=7, 30.4%)] was found on the initial echocardiograms. Upon follow-up echocardiograms, the average LVEF was improved to 60.6+/-5.8% and regional wall motion abnormality was normalized in all patients. CONCLUSION: Stress-induced cardiomyopathy, mimicking AMI, is triggered by psychologically and physically stressful events. This condition is characterized by a distinctive form of systolic dysfunction and favorable outcomes with medical therapy.
Cardiomyopathies* ; Chest Pain ; Constriction, Pathologic ; Coronary Artery Disease ; Creatinine ; Depression ; Electrocardiography ; Emergencies* ; Emergency Service, Hospital* ; Follow-Up Studies ; Heart Diseases ; Humans ; Japan ; Life Change Events ; Male ; Myocardial Infarction* ; Phosphotransferases ; Retrospective Studies* ; Stress, Psychological ; Stroke Volume ; Troponin I

PURPOSE: In spite of its high sensitivity, the D-dimer test has a limited role in diagnosis of pulmonary thromboembolism (PTE) due to its low specificity. This study was designed to evaluate the diagnostic accuracy of an index for PTE with addition of C-reactive protein (CRP) in patients showing increased D-dimer level. METHODS: We carried out a retrospective study in a tertiary emergency department and enrolled patients who did blood sampling for D-dimer and CRP at the same time among patients suspected of PTE between December 2000 and October 2008. PTE was confirmed by imaging studies, chest computed tomography and angiography. We analyzed D-dimer and CRP levels and correlated them with PTE. RESULTS: A total of 362 patients were enrolled; 67 had PTE. Areas under the curve (AUC) of the Receiver Operating Characteristic (ROC) curve of D-dimer for PTE were smaller than those for a relative increase in the ratio of D-dimer to CRP (RDDCRP). CONCLUSION: The diagnostic accuracy of D-dimer for PTE can be increased by normalizing D-dimer levels to CRP levels.
Angiography ; C-Reactive Protein ; Emergencies ; Fibrin Fibrinogen Degradation Products ; Humans ; Pulmonary Embolism ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Thorax

PURPOSE: Ethanol is the most common toxic substance encountered clinically and is becoming increasingly important in forensic medicine. Generally, pre-treatment with an alcohol disinfectant such as isopropyl alcohol for blood sampling could influence evaluations and affect legal evidence. This study was performed to determine whether isopropyl alcohol affects the serum ethanol level. METHODS: Volunteers were prohibited from drinking alcohol and taking medication for 48 hours prior to participating. Pregnant volunteers and volunteers with abnormal liver enzymes or abnormal kidney function were excluded. Enrolled subjects had their blood collected from each arm to measure the alcohol concentration, one side was disinfected with povidone iodine and the other with isopropyl alcohol. After waiting one hour, they ingested 20g of alcohol and waited. After one hour, the serum ethanol levels were measured using the same method as the first sampling. RESULTS: Ten volunteers enrolled for this study. Without the alcohol intake, all serum ethanol levels were in the nondetectable range(<3 mg/dL) for both samples with either isopropyl alcohol or povidone iodine. After drinking alcohol, the serum ethanol level varied among individuals; the mean value of the serum ethanol levels in the alcohol preparation group was 21.08+/-4.85 mg/dL, which was significantly greater than that of the povidone iodine preparation group (19.71+/-5.47 mg/dL) (p=0.006). However, the Bland-Altman analysis showed that the precision of both groups was 1.230 mg/dL, which was less than the measurement error of the equipment (3.48 mg/dL). Therefore, there was no significant difference between the two groups with regard to the measurement error. CONCLUSION: Before alcohol intake, there was no influence on the blood alcohol concentration from the alcohol disinfection, and the result was reliable. After alcohol intake, the possible influence of pre-treatment alcohol on the serum ethanol level was less than the measurement error of the equipment used.
2-Propanol ; Alcohol Drinking ; Arm ; Disinfection ; Drinking ; Ethanol ; Forensic Medicine ; Kidney ; Liver ; Povidone-Iodine

PURPOSE: This study was designed to investigate the time delay in the prehospital and inhospital course of acute ischemic stroke patients at an emergency department (ED). METHODS: We collected data from medical records retrospectively, including baseline characteristics, mode of arrival, arrival time, and neurological symptoms, from January 2006 to October 2008. Time data were also collected; from symptom onset to ED visit (prehospital delay), ED visit to brain imaging (imaging delay), and from ED visit to treatment (treatment delay). We designed multivariate Cox-regression models to predict factors influencing prehospital and ED time for ischemic stroke. RESULTS: In total, 946 ischemic stroke patients were enrolled. Diabetes mellitus was associated with a longer prehospital delay. Heart disease, hyperlipidemia, and use of an emergency medical service (EMS) were associated with a shorter prehospital delay. Female gender, night time visits, and abnormal speech were associated with a longer imaging delay. Hypertension, use of EMS, multiple symptoms, and prehospital delay within 3 hours were associated with a shorter delay. Abnormal speech was also a significant factor for a longer treatment delay. Tingling sense or numbness, multiple symptoms, and a prehospital delay within 3 hours were related to a shorter treatment delay. CONCLUSION: The time delay in the prehospital and ED course of acute ischemic stroke patients was associated with multiple factors including gender, comorbidities, use of EMS, arrival time, acute symptom onset within 3 hours, neurological symptoms, and multiple neurological symptoms.
Cerebral Infarction ; Comorbidity ; Diabetes Mellitus ; Emergencies ; Emergency Medical Services ; Female ; Heart Diseases ; Humans ; Hyperlipidemias ; Hypertension ; Hypesthesia ; Medical Records ; Neuroimaging ; Retrospective Studies ; Stroke

PURPOSE: In clinical situations requiring the use or the sputum Gram stain test, the adequacy of specimens is often compromised by improper sample generation by patients. We designed a study to evaluate the effect of good written instruction for sputum expectoration on the outcome of sample adequacy. METHODS: Data were collected from adult patients over age 15 at a tertiary teaching hospital emergency department who had the sputum Gram stain test from October 1 to October 31, 2006. Patients were given carefully written instruction cards for sputum expectoration, together with a bottle of mineral water to gargle before expectoration. Patients' data were compared to a group of patients who visited the same ED during the same month in 2005. RESULTS: The total numbers of sputum tests were 164 in 2006 and 151 in 2005. The number and percentage of adequate specimens increased from 62(44%) in the 2005 patient group to 114(69.5%) in the 2006 patient group (p=0.000). CONCLUSION: By the simple use of properly written instructions for expectoration and of mineral water for oral gargling before sputum expectoration, the adequacy of sputum specimens for testing can be significantly improved.
Adult ; Emergencies* ; Emergency Service, Hospital* ; Hospitals, Teaching ; Humans ; Mineral Waters ; Sputum*

PURPOSE: This study was performed to evaluate factors affecting the decision to operate in orbital fracture patients. METHODS: This study included 396 orbital fracture patients who visited an urban tertiary teaching hospital emergency room from January 1, 2002 to December 31, 2005. We reviewed medical records of the patients. Data collected included a patient's sex, age, mechanism of trauma, wall fractures, associated other facial bone fracture, visual disturbance and ocular motility disturbance. The Chi-square test, t-test were applied in order to evaluate the factors associated with the decision to operate in orbital fracture cases. Multinomial logistic regression was applied to those factors which achieved significance in Chi-square test. RESULTS: As seen in other studies, orbital fractures were frequent in young males ages 10 through 40. The most common cause of orbital fractures was violence (41.0%). In the Chi-square test, medial, lateral and inferior wall fractures; skull vault fracture; nasal septum fracture; diplopia; ocular motor dysfunction; and fractures involving more than two walls were found to be statistically significant in the decision to operate compared to other factors. Diplopia, lateral wall fracture, ocular motor dysfunction, skull vault fracture, and inferior wall fracture were confirmed by multinominal logistic regression analysis as positive predictors of a decision to operate in orbital fracture. CONCLUSION: Orbital wall fracture patient with diplopia, lateral or inferior wall fracture, ocular motor dysfunction, and skull vault fracture are likely to result in surgical intervention.
Diplopia ; Emergency Service, Hospital ; Facial Bones ; Forecasting ; Hospitals, Teaching ; Humans ; Logistic Models ; Male ; Medical Records ; Nasal Septum ; Orbit* ; Orbital Fractures* ; Patient Education as Topic ; Skull ; Violence

PURPOSE: We present a case of a patient who underwent corneal refractive surgery to improve their corrected visual acuity due to a complication of hyperopic laser-assisted in-situ keratomileusis (LASIK). CASE SUMMARY: The patient complained of decreased vision after hyperopic LASIK surgery 12 years prior. The corrected distance visual acuity (CDVA) was 20/200 in the right eye and 20/32 in the left, with manifested refractions of +1.25 +2.00 × 90 and -0.25 +2.00 × 80, respectively. The patient had a with-the-rule astigmatism. The values of corneal and total spherical aberration, which can be determined as coefficients of the Zernike polynomials, were respectively -1.027 µm and -0.773 µm in the right eye and -0.965 µm and -0.881 µm in the left eye. Slit lamp biomicroscopy revealed no remarkable findings. We performed surface ablation surgery to flatten the central cornea of the patient's right eye. At 12 months after surgery, the CDVA of the patient's right eye was 20/30 and the negative corneal spherical aberration was reduced. CONCLUSIONS: Corneal refractive surgery to reduce negative corneal spherical aberration by flattening the central cornea is one of possible treatment options for the reduced corrected distance visual acuity after hyperopic LASIK.
Astigmatism ; Cornea ; Humans ; Keratomileusis, Laser In Situ ; Patient Rights ; Refractive Surgical Procedures ; Slit Lamp ; Visual Acuity

STUDY DESIGN: A retrospective study OBJECTIVES: To compare the radiological and clinical outcomes of three surgical methods SUMMARY OF LITERATURE REVIEW: There were many proposed surgical treatments for lumbar degenerative kyphosis but the best treatment is still controversial. MATERIALS AND METHODS: Thirty three patients (all female) had undergone surgery. The mean age at surgery was 61.2. The average follow-up period was 34.7 months. The patients were divided into three groups. Group A included 7 cases with a correction by a posterior osteotomy, Group B included 15 with a posterior correction without an osteotomy, and Group C included 11 with combined anterior-posterior surgery. The radiographic measurements of lumbar lordosis, upper lumbar lordosis, lower lumbar lordosis, and pelvic tilt were performed before surgery, after surgery, and at the final follow-up visit. The loss of correction, complication rates and the clinical results were also compared. RESULTS: Postoperative correction of the lumbar and lower lumbar lordosis were significantly higher in group A and C than group B. The correction of upper lumbar lordosis was significantly higher in group A than group C. On the final follow-up, there was no significant difference in the loss of correction and clinical results between the three groups. The number of cases with complications in groups A, B and C was 4 (57%), 2 (13.3%) and 2 (18.2%), respectively. Two patients in group A required additional surgery. CONCLUSIONS: Groups A and C were more effective than posterior-only correction. There was no significant difference in the clinical results between the three groups but complication rate was higher in Group A than the other groups. Combined anterior and posterior surgery can be a safe and effective method for correction.
Animals ; Follow-Up Studies ; Humans ; Kyphosis ; Lordosis ; Osteotomy ; Retrospective Studies

OBJECTIVES: To evaluate the surgical indications and to compare the results of the anterior plate fixation and transpedicular fixation in cases of traumatic spondylolisthesis of the axis. MATERIALS AND METHODS: From 1987 to 2001, eighteen of 26 cases of traumatic spondylolisthesis of the axis were treated by anterior plate fixation and 8 of 26 by transpedicular screw fixation. Two of 8 cases received unilateral screw fixation and 6bilateral fixation. Two cases of the transpedicular screw fixation group were treated by additional posterior plate fixation. Oper-ativeindication was an unstable fracture, namely, with over 3.5 mm of anterior displacement, over 10 degrees of angulation, i.e., Levine types II, IIA, III, and IA. Postoperatively, Philadelphia orthosis or a soft collar was applied for 6 to 8 weeks. RESULTS: All cases achieved bone union. One case of neck pain, three cases of neck motion limitation and three cases of a kyphotic deformity exceeding 10degrees were observed in the posterior transpedicular screw fixation group. In terms of surgical complications, two cases of transient dysphagia were observed in the anterior plate fixation group and two cases of screw malposition in the transpedicular screw fixation group. The transpedicular screw fixation technique has some associated problems, such as a large operative wound scar, a large bleeding volume, and technical difficulty. CONCLUSION: Both the anterior plate fixation and transpedicular screw fixation methods are useful treatment methods for Levine type II, IIA and III hangman fracture for early bone union and early rehabilitation. The anterior plate fixation technique is easi-er and has fewer complications than posterior transpedicular screw fixation, therefore, the ranspedicular screw fixation method should be confined to the management of type IA fracture with rotational displacement.
Axis, Cervical Vertebra* ; Cicatrix ; Congenital Abnormalities ; Deglutition Disorders ; Hemorrhage ; Neck ; Neck Pain ; Orthotic Devices ; Rehabilitation ; Spondylolisthesis ; Wounds and Injuries

OBJECTIVE: We investigated the expression of chemokine receptors in human ovarian cancer to understand the role of chemokines in ovarian cancer development and metastasis. METHODS: Twenty-two cases of epithelial ovarian cancer were studied for expression of 13 chemokine receptors such as CXCR1-CXCR5 and CCR1-CCR8 by using semi- quantitative RT-PCR and immunohistochemistry. Moreover, we studied the relationship between the chemokine receptors expression and lymph nodes metastasis of ovarian cancers. RESULTS: As compared with normal ovarian tissues, ovarian cancer tissues showed higher mean expression levels of CCR1,3,4,5,7,8 and CXCR1,3,4. Of chemokine receptors, CCR7 revealed the significantly higher levels of expression in ovarian cancer tissues relative to normal tissues. In the cases of retroperitoneal lymph nodes metastasis, increased expression of CCR2,4 and CXCR 1,3,4 was observed although there was no statistical significance. CONCLUSION: These results suggest that there is a complex chemokine/chemokine receptor network in pathogenesis and the way of lymph node metastasis of ovarian cancer rather than a specific chemokine or chemokine receptor.
Chemokines ; Humans ; Immunohistochemistry ; Lymph Nodes ; Neoplasm Metastasis ; Ovarian Neoplasms* ; Receptors, Chemokine*