PURPOSE: To attain improvement in prognosis of patients suffering acute ischemic strokes (AIS), it is crucial to diagnose these swiftly and accurately. It is generally believed that female patients have a less favorable outcome, but there has not yet been sufficient data to confirm this opinion. The authors herein conducted a study to determine whether the symptoms of AIS differ between males and females. METHODS: A retrospective study was conducted on 322 consecutive patients who were diagnosed with AIS on the basis of MRI findings during the last two years. Demographic findings and clinical features were collected from emergency room records in order to evaluate gender differences. RESULTS: There were 148 female patients (45.8% of total) in our study, and the average age of affection for females was significantly higher than males. Our data did not achieve statistical significance; however, we observed the following tendencies: the time from symptom onset to admission was delayed in female group; both traditional and nontraditional symptoms were more prevalent in the male group; and atypical symptoms were observed in the female group. CONCLUSION: No gender difference was observed in the incidence of acute ischemic stroke. However, the proportion of atypical symptoms was relatively higher in female patients. Factors resulting in delay clinical attention and contributing to the observed discrepancy between genders in AIS diagnosis should be validated and investigated further.
Diagnosis ; Emergency Service, Hospital ; Female ; Humans ; Incidence ; Magnetic Resonance Imaging ; Male ; Prognosis ; Retrospective Studies ; Stroke*

Pheochromocytomas are rare tumors that originate in chromaffin tissue and produce distant variant effects, such as EKG abnormality, myocarditis, cardiomyopathy, and acute coronary syndrome, by secretion of catecholamines. Such variant effects of pheochromocytoma tend to lead the emergency physician to a wrong diagnosis. We describe the case of a 29-year-old female with pheochromocytoma who was diagnosed at the ER as having myocarditis with acute renal failure. The diagnosis of pheochromocytoma was made later. To avoid misdiagnosis, we should include pheochromocytoma in the differential diagnosis. We should also use additional imaging tests, such as bed-side abdominal ultrasonography or abdominal CT, at the ER on relatively young patients presenting with hypertensive crisis, acute renal failure, and features, such as ischemic EKG changes, which are suggestive of acute coronary syndrome or myocarditis.
Acute Coronary Syndrome ; Acute Kidney Injury ; Adult ; Cardiomyopathies ; Catecholamines ; Diagnosis ; Diagnosis, Differential ; Diagnostic Errors ; Electrocardiography ; Emergencies ; Female ; Humans ; Myocarditis* ; Pheochromocytoma* ; Tomography, X-Ray Computed ; Ultrasonography

Posterior reversible encephalopathy syndrome (PRES) is typically characterized by headache, altered mental functioning, seizure, and visual loss associated with imaging findings of bilateral subcortical and cortical edema with a predominantly posterior distribution. The usual causes of PRES are hypertensive encephalopathy, preeclampsia, eclampsia, cyclosporine A neurotoxicity and uremic encephalopathy. Early recognition of PRES is important because the treatment of PRES can be relatively contraindicated in some conditions, such as cerebral ischemia. We describe a 28-year-old woman who presented with a seizure 11 days after delivery. The diagnosis of PRES was made later. To make an early diagnosis of PRES, the emergency physician should include PRES in the differential diagnosis and consider an MRI with diffusion-weighted imaging in patients presenting with seizure, altered mental status, headache, and visual loss, especially patients with a hypertensive crisis, an organ transplantation, or a history of recent delivery.
Adult ; Brain Ischemia ; Cyclosporine ; Diagnosis ; Diagnosis, Differential ; Early Diagnosis ; Eclampsia ; Edema ; Emergencies ; Female ; Headache ; Humans ; Hypertensive Encephalopathy ; Magnetic Resonance Imaging ; Organ Transplantation ; Posterior Leukoencephalopathy Syndrome* ; Pre-Eclampsia ; Pregnancy ; Seizures* ; Transplants

Prominent ear means congenital ear anomaly which has the obtuse conchoscapal angle caused by underdeveloped antihelix and has the larger concha shape than normal. It can be corrected by non-surgical method such as molding process with splint when ear cartilage keep flexibility right after birth and by surgical method with manipulating the ear cartilage directly. To correct prominent ear, we used simple and effective technique consisted of (1)anterior cartilage surface scoring and (2)two horizontal mattress suture without skin excision because we have the opinion that the most important deformity in prominent ear is lesser projection of antihelical fold. From March 1998 to February 2003 this method was applied to 12 patients. During the follow-up period no particular side effects were detected and we had an excellent aesthetic result.
Cartilage ; Congenital Abnormalities ; Ear Cartilage ; Ear* ; Follow-Up Studies ; Fungi ; Humans ; Parturition ; Pliability ; Skin ; Splints ; Sutures

The chest wall plays a role to protect vital organs in the trunk such as heart and lung, and to facilitate a semi-rigid structure for breathing. When a defect occurs in a chest wall for such reasons as trauma, tumor, infection, inflammation, post-radiation necrosis, congenital anomaly, and so forth, not only anatomical, but also functional aspects should be considered in reconstruction process. It is, generally speaking, difficult to reconstruct a chest wall defect, since these patients tend to be old aged and have underlying disease with chronic and heavily contaminated wounds which had experienced irradiation or operation. In chest wall reconstruction, the authors utilized muscle flaps in trunk to secure a semi-rigid structure, because muscle flaps in trunk are easily accessible, and have reliable blood vessels. We have conducted 42 cases of chest wall reconstruction between Feb, 1996 and Jan, 2003. Except one case, we succeeded in gaining satisfactory results in functional and anatomical aspects. Based on these experiences, we would like to clarify the principles of chest wall reconstruction as below, helping to choose a proper method in the operations. The principles are appropriate debridement, skeletal reconstruction when indicated, coverage of soft tissue with muscle flap and removal of dead spaces.
Blood Vessels ; Debridement ; Heart ; Humans ; Inflammation ; Lung ; Necrosis ; Respiration ; Thoracic Wall* ; Thorax* ; Wounds and Injuries

Cortical Blindness is loss of vision due to injury of geniculocalcarine visual tract, usually caused by cerebrovascular disease. Cardiac arrest leads to global brain hypoxia or to more focal neurologic deficits. Cortical blindness is one form of these focal neurologic deficits. The severity of visual disturbance in cortical blindness is variable, so the diagnosis can be made later unless emergency physicians are familiar with it. We report a case of transient cortical blindness following hypoxic episode caused by coronary vasospasm.
Blindness, Cortical* ; Cardiopulmonary Resuscitation* ; Coronary Vasospasm ; Diagnosis ; Emergencies ; Heart Arrest ; Hypoxia, Brain ; Neurologic Manifestations

Endoscopic surgery is popular in the neurosurgical field. The purpose of this study was to determine the role of endoscopy in obstructive hydrocephalus. From 1989 to 1999, we performed 81 endoscopic third ventriculostomies and 10 septostomies. Seventy-one of 81 operations were performed with endoscopic third ventriculostomy alone and 10 patients had endoscopic third ventriculostomy and ventriculoperitoneal shunt simultaneously. Age distribution varied from 2 months to 62 years of age. Our selection criteria included aqueductal stenosis (39 patients) and obstructive hydrocephalus due to tumor or cyst (42 patients). The most common candidate for endoscopic septostomy was atresia of the foramen of Monro (4 patients). Endoscopic septostomy was also performed to simplify shunting in patient; with multiseptated ventricle due to shunt infection, germinoma, thalamic tumor, craniopharyngioma, cyst and brain abscess. Sixty-five of 71 patients who were treated with endoscopic third ventriculostomy alone showed successful results (91.5%). However, 6 patients had unsatisfactory results and they needed a ventriculoperitoneal shunt. With no mortality, transient surgical complications were observed in 7 patients: 2 transient diabetes insipidus from electrical injury to the pituitary stalk, 1 epidural hematoma from sudden drainage of CSF, 1 delayed intraventricular hemorrhage. 2 obstruction of fenestration site and 1 transient memory disturbance from injury to the fornix. Endoscopic septostomy was useful in simplifying shunting in all cases with complicated hydrocephalus. Endoscopic surgery is straightforward and effective in appropriately selected cases with obstructive by drocephalus.
Adolescence ; Adult ; Child ; Endoscopy* ; Human ; Hydrocephalus/surgery* ; Infant ; Male ; Septum of Brain/surgery* ; Ventriculostomy*

Coarctation of aorta is a rare cause of secondary hypertension, and premature death will occur if no appropriate treatment is given. The only effective treatment was surgery before 1980, but restenosis was frequent. Several works on percutaneous transluminal angioplasty of the disease were reported. In patients with previously operated recoarctation, there is no doubt that balloon angioplasty is now the first choice of the therapy because of the surgical risks of reoperation. Nevertheless, there has still been some controversy regarding the application of this therapy to native coarctation, because of the potential risk of aortic disruption and the high incidence of restenosis. There have been some clinical reports of successful stent implantation for coarctation without major complications since 1991. We report on our experience with balloon-expandable stent implantation for native coarctation of the aorta in a 23-year-old man with congenital mitral stenosis. Aortogram showed a coarcted aortic segment of 3 mm in diameter and 25 mm long just distal to the left subclavian artery. The peak systolic pressure gradient across the coarctation before stent implantation was 100 mmHg. Stent implantation was performed with 14 X 40 mm balloon with Palmaz P308 stent. The peak systolic pressure gradient decreased to zero and the diameter of the coarctation of aorta increased to 14 mm after stent implantation immediately. The patient tolerated well and no significant complications were encountered during the procedure.
Angioplasty ; Angioplasty, Balloon ; Aortic Coarctation* ; Blood Pressure ; Humans ; Hypertension ; Incidence ; Mitral Valve Stenosis* ; Mortality, Premature ; Reoperation ; Stents* ; Subclavian Artery ; Young Adult

Coarctation of aorta is a rare cause of secondary hypertension, and premature death will occur if no appropriate treatment is given. The only effective treatment was surgery before 1980, but restenosis was frequent. Several works on percutaneous transluminal angioplasty of the disease were reported. In patients with previously operated recoarctation, there is no doubt that balloon angioplasty is now the first choice of the therapy because of the surgical risks of reoperation. Nevertheless, there has still been some controversy regarding the application of this therapy to native coarctation, because of the potential risk of aortic disruption and the high incidence of restenosis. There have been some clinical reports of successful stent implantation for coarctation without major complications since 1991. We report on our experience with balloon-expandable stent implantation for native coarctation of the aorta in a 23-year-old man with congenital mitral stenosis. Aortogram showed a coarcted aortic segment of 3 mm in diameter and 25 mm long just distal to the left subclavian artery. The peak systolic pressure gradient across the coarctation before stent implantation was 100 mmHg. Stent implantation was performed with 14 X 40 mm balloon with Palmaz P308 stent. The peak systolic pressure gradient decreased to zero and the diameter of the coarctation of aorta increased to 14 mm after stent implantation immediately. The patient tolerated well and no significant complications were encountered during the procedure.
Angioplasty ; Angioplasty, Balloon ; Aortic Coarctation* ; Blood Pressure ; Humans ; Hypertension ; Incidence ; Mitral Valve Stenosis* ; Mortality, Premature ; Reoperation ; Stents* ; Subclavian Artery ; Young Adult

With the exception of Meckel's diverticulum, a small bowel diverticulum is an acquired disease due to high pressure in the small bowel lumen. The causes of the increase in the pressure of the lumen are usually a motility disorder of the small bowel, a luminal obstruction due to a tumor mass, or adhesion of the bowel loop. The prevalence of small bowel diverticulum increases with age, but the clinical manifestations are asymptomatic or nonspecific, such as vague abdominal pain, nausea, vomiting, indigestion, constipation, and diarrhea. Therefore, the disease is relatively difficult to diagnose until complications, such as perforation, obstruction, intussusception, or hemorrhage, develop. Because of its rarity, Physicians usually neglect to rule out small bowel diverticulitis. As the proportion of the elderly increases, the rate of small bowel diverticulitis will increase. If complications from small bowel diverticulitis develop in the elderly, mortality and morbidity may increase. To detect small bowel diverticulitis before complications develop, emergency physicians need to be aware of small bowel diverticulitis in elderly patients with abdominal pain of uncertain cause and need to evaluate it with multiple diagnostic tools. We report a case of perforation of a small bowel diverticulum due to intestinal obstruction caused by primary Non-Hodgkin's lymphoma of the terminal ileum.
Abdominal Pain ; Aged ; Constipation ; Diarrhea ; Diverticulitis ; Diverticulum* ; Dyspepsia ; Emergencies ; Hemorrhage ; Humans ; Ileum* ; Intestinal Obstruction ; Intestine, Small ; Intussusception ; Lymphoma, Non-Hodgkin* ; Meckel Diverticulum ; Mortality ; Nausea ; Phenobarbital ; Prevalence ; Vomiting