A 3-year-old boy with Wilms' tumor had unusual severe hypertension, polydipsia, polyuria, and hypokalemia. Physical examination on admission was unremarkable except for the presence of a smooth, firm mass in the right abdomen. Computerized tomography showed a tumor occupying upper two thirds of the right kidney. Plasma renin activity and aldosterone concentration were markedly elevated, 37.7 mg/ml/hour (normal supine 0.15-2.33 mg/ml/hour) and 120.1 ng/dl (normal supine 1 to 16 ng/dl), respectively. His hypertension, varied from 150/90 mmHg as high as 240/180 mmHg, was not effectively controlled by antihyperensive drugs. Because of concern for the complications of hypertension, a right nephrectomy was performed on the sixth hospital day. At laparotomy, there was no evidence of mechanical compression of the renal artery by the tumor. The tumor, about 8 cm in diameter, was confined within the renal capsule without involvement of the renal blood vessels at the hilum. Histopathologically, it was characteristic Wilms' tumor of favorable histology. On electron microscopy, the tumor cells contained many electron dense secreting granules in the cytoplasm, suggesting that the tumor itself was the source of the renin and cause the clinical manifestations. Shortly after nephrectomy, signs and symptoms were relieved dramatically, and plasma renin activity and aldosterone concentration were also decreased to normal.
Abdomen ; Aldosterone ; Blood Vessels ; Child* ; Child, Preschool ; Cytoplasm ; Humans ; Hypertension* ; Hypokalemia* ; Kidney ; Laparotomy ; Male ; Microscopy, Electron ; Nephrectomy ; Physical Examination ; Plasma ; Polydipsia* ; Polyuria* ; Renal Artery ; Renin ; Wilms Tumor*

Paroxymal ventricular tachycardia occurs most frequently during the first several months following myocardial infarction, although the risk of arrhythmia development continues for many years. Underlying disease was coronary artery disease, dilated or hypertrophic cardiomyopathy, valvular heart disease, myocarditis, and idiopathic. Idiopathic ventricular tachycardia may be the most common type in Korea and usually originates from either right ventricular outflow tract or left ventricular septum. For the emergency treatment of sustained, hemodynamically stable ventricular tachycardia, antiarrhythmic drugs are the therapy of choice(choice of therapy). Mostly class I antiarrhythmic drugs, such as lidocaine, are preferred. In hemodynamically unstable ventricular tachycardia, electrical defibrillation should be applied, in case of recurrences, followed by pharmacological treatment with class I antiarrhythmic drugs or amiodarone. We report a case of paroxymal ventricular tachycardia improved due to(by) electrical defibrillation was done repeaedly in patient with cerebral infarction.
Amiodarone ; Anti-Arrhythmia Agents ; Arrhythmias, Cardiac ; Cardiomyopathy, Hypertrophic ; Cerebral Infarction ; Coronary Artery Disease ; Emergency Treatment ; Heart Valve Diseases ; Humans ; Infarction* ; Korea ; Lidocaine ; Myocardial Infarction ; Myocarditis ; Recurrence ; Tachycardia, Ventricular* ; Ventricular Septum

Purpose: This study aimed to report the results of femorofemoral bypass (FFB) using a great saphenous vein (GSV) graft as an alternative to polytetrafluoroethylene (PTFE) grafts. Materials and Methods: From January 2012 to December 2021, 168 patients who underwent FFB (PTFE, 143; GSV, 25) were included. The patients’ demographic features and surgical intervention results were retrospectively reviewed. Results: There were no intergroup differences in patients’ demographic features.In GSV vs. PTFE grafts, the superficial femoral artery provided statistically significant inflow and outflow (P<0.001 for both), and redo bypass was more common (P=0.021). The mean follow-up duration was 24.7±2.3 months. The primary patency rates at 3 and 5 years were 84% and 74% for PTFE grafts and 82% and 70% for GSV grafts, respectively. There was no significant intergroup difference in primary patency (P=0.661) or clinically driven target lesion revascularization (CD-TLR)-free survival (P=0.758). Clinical characteristics, disease details, and procedures were analyzed as risk factors for graft occlusion. Multivariate analysis revealed that none of the factors was associated with an increased risk of FFB graft occlusion. Conclusion FFB using PTFE or GSV grafts is a useful method with an approximately 70% 5-year primary patency rate. The GSV and PTFE grafts showed no difference in primary patency or CD-TLR–free survival during follow-up; however, FFB using GSV may be an option in selective situations.

The 2010 Emergency Physician (EP) Survey of the Korean Society of Emergency Medicine (KSEM) was the first comprehensive survey of its members on their working conditions, working environment, and compensation. The survey was conducted using a questionnaire on the web interface and e-mail from March to December of 2010. The subjects were currently active EPs working in an emergency department (ED). Additional e-mails, telephone calls, and visits were necessary in order to encourage the participation of members. Out of 841 members, 394 members completed the questionnaire. Excluding members who are currently not working in an ED, retired, opened a private practice as a primary physician, or unknown status, 635 (75.5%) EPs were working in 203 EDs out of a total of 465 EDs in Korea. There was a wide range of variations in ED employing EP. EP employing practices by the hospitals depended on the size and level of ED and the region of the country. ED employed 4.52+/-2.97 Eps, and 4.80+/-5.69 emergency residents, 4.21+/-3.05 interns, and 26.02+/-16.99 nurses. On average, EPs worked 17.51+/-5.84 days, and 7.87+/-3.17 night shifts in a month, 228.11+/-57.46 hours in a month. The average pay for the hour was 33,300 KRW. Satisfaction of the EPs with their compensation was below average. Important factors in selection of a workplace depended on night-shifts, time for the family, pay, and the relationship with other specialties. On a 10 point scale, satisfaction with their training was 6.38; the answer to selection of the same specialty was 5.53; satisfaction with the current emergency medical services (EMS) system was 3.85; emergency medicine in 10 years was 5.75. The adult APGAR score was 5.05. As in the survey, members of KSEM as a whole are working a large number of heavy duty hours, with insufficient pay. Most of them feel over burdened and unsatisfied with their current state. They also share a dim outlook on the future. In order to increase job satisfaction of EPs, there must be an improvement in the welfare and working conditions. This survey was conducted in order to obtain a clear view of the current status of EPs in Korea, and in hopes of contributing to improvement of the EP status. This survey will lay a cornerstone for development of an EMS system in Korea.
Adult ; Apgar Score ; Compensation and Redress ; Electronic Mail ; Emergencies* ; Emergency Medical Services ; Emergency Medicine ; Emergency Service, Hospital ; Hope ; Humans ; Job Satisfaction ; Korea ; Private Practice ; Surveys and Questionnaires ; Telephone

A 50-year-old woman who had chronic headache was admitted to the hospital. Stent-assisted coil embolization of the aneurysm in the right vertebral artery was performed. After the procedure, the patient experienced a transient memory impairment. A microembolic lesion in the right medial temporal lobe and cerebral hemisphere was observed on diffusion-weighted imaging. We report a case of transient global amnesia caused by microembolus in the medial temporal lobe after embolization of an aneurysm.
Amnesia, Transient Global* ; Aneurysm ; Cerebrum ; Embolization, Therapeutic* ; Female ; Headache Disorders ; Humans ; Intracranial Aneurysm* ; Memory ; Middle Aged ; Temporal Lobe ; Vertebral Artery

The major causes of small bowel obstruction are postoperative adhesion, hernia, intussusception and malignancies. However, in cases of uncommon causes of small bowel obstruction, surgeons are in a dilemma because the preoperative diagnosis and making a decision to operate are frequently difficult and delayed. Phytobezoars are unusual cause of small bowel obstruction. They are mostly due to ingestion of stringent immature fruits following gastric surgery. They are usually formed in stomach and do not migrate to the other intestinal tract, but can lead to the serious complication of acute small bowel obstruction. We are reporting a case of acute small bowel obstruction due to phytobezoar about 2x2x3 cm3 size in a 90 year old female.
Aged* ; Aged, 80 and over ; Bezoars ; Diagnosis ; Eating ; Female ; Fruit ; Hernia ; Humans ; Intestinal Obstruction* ; Intussusception ; Stomach

Localized fibrous tumor of the pleura is rare, slowly growing, benign tumor. Most of these tumors clinically behave asymptomatically, although tumor-associated hypoglycemia occurs in a few cases and lead to hypoglycemic coma. Laboratory investigations show elevation of IGF-II with a 2-3 times higher effect on the blood glucose level than insulin. Surgical resection of the tumor is recommended. We report on the case of a 81-year-old man, who complained of hypoglycemic episodes. Diagnostic evaluation showed a fibrous tumor of pleura attached to the right diaphragm.
Aged, 80 and over ; Blood Glucose ; Coma ; Diaphragm ; Humans ; Hypoglycemia* ; Insulin ; Insulin-Like Growth Factor II ; Pleura*

OBJECTIVES: Ciprofloxacin, one of the most widely used fluoroquinolone, has been used for some abdominal and genitourinary infections in emergency departments (EDs). This investigation was performed to identify the risk factors of inappropriate use of ciprofloxacin in the ED. METHODS: We retrospectively reviewed the medical records of patients who had visited the ED of Seoul National University Hospital from January 2002 to December 2002 and who had been prescribed ciprofloxacin as an initial empirical antibiotic. The appropriateness of ciprofloxacin use was judged according to existing institutional guidelines. RESULTS: Of the total 577 patients (219 males, mean age 53.0+/-17.1; 358 females, mean age 50.3+/-18.7), ciprofloxacin was used appropriately in 289 (50.1%). In the univariate analysis, gender, site of suspected infection, route of administration, and disposition were significantly different between the appropriate and the inappropriate use groups (p<0.005). In multivariate analysis, the adjusted odds ratio for related factors for inappropriate ciprofloxacin use was significantly higher in old age patients (>65 years old) than in younger patients (under 30 years old; OR=2.02, 95% CI=1.01-4.03), in patients having the GI tract infections than in patients having genitourinary tract infections (OR=14.28, 95% CI=8.76-23.29), in patients who were administered orally than intravenously (OR=2.45, 95% CI=2.08-5.71), and in patients who stayed in the ED than in those who were admitted (OR=4.29, 95% CI=1.98-9.34). CONCLUSION: Inappropriate use of ciprofloxacin in the ED is very common. If the emergence of ciprofloxacin resistance is to be avoided, education and efforts for judicious use of ciprofloxacin are warranted.
Adult ; Ciprofloxacin* ; Education ; Emergencies* ; Emergency Service, Hospital* ; Female ; Gastrointestinal Tract ; Humans ; Male ; Medical Records ; Multivariate Analysis ; Odds Ratio ; Retrospective Studies ; Risk Factors* ; Seoul

Metformin is a biguanide oral hypoglycemic agent commonly used in the treatment of diabetes mellitus. Metfofmin is excreated largely by the kidney and binds only negligibly to plasma proteins. Toxicity is usually seen when metformin is prescribed to patients with renal insufficiency. Lactic acidosis in diabetics on metformin therapy is rare but still associated with poor prognosis. For an early diagnosis, clinical symptoms of intoxication should be well known by physicians and patients. First-line therapy for correction of lactic acidosis and effective elimination of metformin is bicarbonate hemodialysis. We report a case of acute renal failure due to metformin-associated lactic acidosis in elderly type 2 diabetes mellitus patient and she was successfully treated by hemodialysis with bicarbonate buffer.
Acidosis, Lactic* ; Acute Kidney Injury* ; Aged* ; Blood Proteins ; Diabetes Mellitus ; Diabetes Mellitus, Type 2* ; Early Diagnosis ; Humans ; Kidney ; Metformin ; Prognosis ; Renal Dialysis ; Renal Insufficiency

Purpose: The correlation of initial anatomy of the aneurysm, aneurysmal remodeling and endoleaks is controversial. We performed a retrospective study to measure aneurysmal remodeling with time, and to assess the structural changes in the aneurysm neck after endovascular aneurysm repair (EVAR). Materials and Methods: From January 2013 to February 2018, 108 patients with abdominal aortic aneurysms (AAA) underwent EVAR. Follow-up computed tomography images were available for 90 patients. Anatomic variables, including the neck angle, neck length, maximal diameter, maximal area, and thrombus volume were measured. Temporal changes were measured preoperatively, immediate postoperatively (within 1 week after EVAR), and at 6 months, 1 year, and 2 years post-EVAR. Correlation between the variables according to the temporal changes and presence of type Ia endoleaks (T1aE) was analyzed. Results: The mean follow-up period was 10.63±20.34 months. Significant decreases in neck angle and length occurred immediately postoperative (P<0.001 and 0.036). Maximum diameter decreased at 6 months post-EVAR (P=0.003), but no significant changes in the maximal area occurred over time (P=0.142). Thrombus volume in the aneurysm sac increased immediately post-EVAR (P=0.008). There was no significant relationship between T1aE and neck changes in the group and time comparison (P=0.815 and 0.970). Conclusion Changes in neck angle, length and thrombus volume occurred immediately after EVAR, whereas a change in the maximum diameter of the AAA was noted 6 months after EVAR. Preoperative anatomic variables related with T1aE were not found.