PURPOSE: Controversy exists regarding whether pediatric blunt abdominal trauma patients with microscopic hematuria should undergo radiographic evaluation. Adult patients have indications such as shock and deceleration injury. This study was conducted to suggest indications for the use of CT to detect significant renal injury in pediatric blunt abdominal trauma patients with microscopic hematuria. METHODS: From January 2005 to December 2009, patients less than 18 years of age with blunt abdominal trauma and microscopic hematuria who had undergone CT were included in this retrospective study. We analyzed the correlation between microscopic hematuria, shock, deceleration injury, and American Association for the Surgery of Trauma (AAST) renal injury grade. Patients were divided into two groups: the insignificant renal injury group (AAST grade 1) and the significant renal injury group (AAST grades 2-5). We compared age, gender, mechanism of injury, degree of microscopic hematuria, evidence of shock, presence of deceleration injury, and associated injuries between the two groups. We analyzed the effect of each of the above each factors on renal injury by using a logistic regression analysis. RESULTS: Forty-three children were included, and the median age was 15 years. Five children had a significant renal injury. No significant differences, except age and microscopic hematuria (more than 30 red blood cells per high power field (RBC/HPF), p = 0.005) existed between the insignificant and the significant injury groups. A positive correlation existed between renal injury and microscopic hematuria (rho = 0.406, p = 0.007), but renal injury was not correlated with shock and deceleration injury. In the multivariate regression analysis, microscopic hematuria was the only factor correlated with renal injury (p = 0.042). CONCLUSION: If a microscopic hematuria of more than 30 RBC/HPF exists, the use of CT should be considerd, regardless of shock and deceleration injury to detect significant renal injury in pediatric blunt abdominal trauma patients.
Adult ; Child ; Deceleration ; Erythrocytes ; Hematuria ; Humans ; Kidney ; Logistic Models ; Retrospective Studies ; Shock

Acute generalized exanthematous pustulosis is a rare, drug-induced disease that is occasionally accompanied by acute renal failure. It is characterized by the abrupt onset of widespread pustules on an erythematous base and rapid spontaneous healing. We report a case involving a 47-year-old male who presented with exanthematous pustules after taking medication. Azotemia was found in the resulting blood test. We were able to achieve the final diagnosis by skin biopsy. After instructing the patient not to take the previous medication, oral steroids were prescribed. He recovered within 2 weeks with just desquamations remaining.
Acute Generalized Exanthematous Pustulosis ; Acute Kidney Injury ; Azotemia ; Biopsy ; Hematologic Tests ; Humans ; Male ; Middle Aged ; Skin ; Steroids

Internal iliac artery aneurysm (IIAA) is a type of abdominal aneurysm that is a rare cause of lower urinary tract symptoms because of its anatomic location. If diagnosed after rupture, it can be lethal and surgery is mandatory. A 57-year-old male presented with acute urinary retention and syncope. An intra-abdominal mass initially thought to be an aneurysm was apparent by ultrasound. A computed tomography scan of the abdomen confirmed an internal iliac artery aneurysm accompanied by rupture. The patient was discharged without any complications within 20 days after receiving a vascular graft and resection of the aneurysm.
Abdomen ; Aneurysm ; Humans ; Iliac Aneurysm ; Iliac Artery ; Lower Urinary Tract Symptoms ; Male ; Middle Aged ; Rupture ; Syncope ; Transplants ; Urinary Retention

Emphysematous pyelonephritis (EPN) is a necrotizing infection of the renal parenchyma and its surrounding tissues that results in the accumulation of gas in the renal parenchyma, collecting system or perinephric tissue. EPN is a potentially life-threatening condition, which is most commonly associated with poorly controlled diabetes. We describe a case of emphysematous pyelonephritis associated with emphysematous ureteritis and cystitis in a 68-year-old diabetic woman, who was cured with medical treatment and surgical intervention.
Aged ; Cystitis ; Female ; Humans ; Pyelonephritis ; Ureter

Extramedullary plasmacytoma (EMP) is a common plasma cell tumor often involving the upper aerodigestive tract. Although extremely rare, mediastinal involvement is possible. An 81-year-old man was presented to our emergency department with chest and back pain with weakness in both legs. Chest X-ray showed a large mass in the upper right mediastinum; subsequently, computed tomography and magnetic resonance imaging evaluated the mass. He was diagnosed with mediastinal EMP, which progressed to spinal cord compression. The patient was treated with radiotherapy and chemotherapy. Spinal cord compression, due to metastatic tumor, is an emergency clinical situation that requires prompt diagnosis and treatment. Emergency medicine physicians should be aware of the clinical presentation and complications associated with EMP.
Aged, 80 and over ; Back Pain ; Diagnosis ; Drug Therapy ; Emergencies ; Emergency Medicine ; Emergency Service, Hospital ; Humans ; Leg ; Magnetic Resonance Imaging ; Mediastinum ; Multiple Myeloma ; Plasmacytoma* ; Radiotherapy ; Spinal Cord Compression* ; Spinal Cord* ; Thorax

Objective: Troponin I is a cardiac biomarker to diagnose acute myocardial infarction and is known to be elevated in sepsis patients as well. Recent studies have shown a correlation between troponin I results the prognosis of sepsis patients. We attempted to correlate the serial measurements of high-sensitivity troponin I (Hs-TnI) results with the prognosis of sepsis patients visiting the emergency room (ER). Methods: We conducted a retrospective study of patients who visited the ER from December 2019 to May 2021 with a diagnosis of infectious disease and a quick Sequential Organ Failure Assessment (qSOFA) score of over two. Those who had been administered the 3-hour interval Hs-TnI test were selected and the difference between two Hs-TnI (delta Hs-TnI) results were correlated with the prognosis of the patient. Results: A total of 76 patients were included in the study, including 56 28-day survivors and 20 28-day non-survivors. The delta Hs-TnI was higher in the non-survivor group and associated with a poorer prognosis (P=0.004). Multivariate logistic regression was used, and log(delta Hs-TnI) showed an odds ratio (OR) of 2.227 (95% confidence interval [CI], 1.171-5.818), (P=0.023) while the Sequential Organ Failure Assessment (SOFA) score showed an OR of 1.478 (95% CI, 1.229-1.777) (P<0.001). The area under the curve (AUC) was calculated using the receiver operating characteristic curve and the AUC for the SOFA score was 0.893 and that from the log(delta Hs-TnI) was 0.724. Conclusion An increase in delta Hs-TnI is correlated with the poorer prognosis of sepsis patients. Hence, it would be useful to check the serial Hs-TnI to predict the 28-day outcome of sepsis patients visiting the ER.

PURPOSE: Early detection and appropriate treatment of pelvic inflammatory disease (PID) are important to prevent adverse sequelae. The purpose of this study was to evaluate the usefulness of computed tomography (CT) for diagnosis of PID in an emergency department (ED). METHODS: We undertook a retrospective review of patients with acute low abdominal pain who were checked by abdominal CT in the ED at a tertiary hospital between June 2009 and December 2009. Inclusion criteria were PID on CT or non specific findings on CT and a consultation to the gynecology department. Exclusion criteria were age less than 15 years, age greater than 60 years, definite other causes for the acute low abdominal pain seen on CT, intact virginity, and transfer to another hospital. We compared clinical characteristics and laboratory findings between group A (clinically diagnosed PID patients) and group B (non-PID patients). We calculated sensitivity and specificity of CT findings to predict clinical diagnosis of PID. RESULTS: A total of 68 patients were enrolled in this study. Median age was 31 years (24-39). Group A consisted of 51 patients; group B of 17 patients. Cervical motion tenderness (p=0.001) and WBC count (p=0.013) were significantly different between the two groups. The accuracy of PID findings on CT for predicting the clinical diagnosis of PID was 85.29%. The sensitivity and specificity were 92.16% and 64.71%, respectively. Leukorrhea had a sensitivity of 76.47% and a specificity of 47.06%. Cervical motion tenderness had a sensitivity of 87.18% and a specificity of 75%. CONCLUSION: Abdominal CT performed in the ED is a useful method for the clinical diagnosis of PID.
Abdominal Pain ; Emergencies ; Female ; Gynecology ; Humans ; Leukorrhea ; Pelvic Inflammatory Disease ; Retrospective Studies ; Sensitivity and Specificity ; Sexual Abstinence ; Tertiary Care Centers ; Tomography, Spiral Computed

Pyometra is the accumulation of pus in the uterine cavity. The incidence of pyometra in elderly patients is approximately 13.6%. Abdominal pain, fever, and vaginal discharge are the usual symptoms, but about half of the cases of uncomplicated pyometra have no specific symptoms. Spontaneous uterine rupture, resulting from complications of pyometra, is extremely rare. We report a case of spontaneous uterine rupture due to pyometra. A 77-year-old female patient who complained of nausea, abdominal pain, and poor oral intake (which started the day before) was transferred from the local hospital after having taken an abdominal CT. She had been bedridden for a year and had a history of hypertension, cerebral infarction, and colon cancer (for which she had a successful operation 12 years prior). Upon arrival, the patient was alert and her vital signs were: blood pressure of 113/78 mmHg, temperature of 36.9degrees C, respiratory rate of 22/min, and a pulse rate of 99/min. Her bowel sound was normal and physical examinations indicated a rigid abdomen with tenderness and rebound tenderness. Free air was observed in the abdominal CT and panperitonitis, due to uterine perforation resulting from pyometra, was also suggested. Hence, an emergency operation was undertaken. During the operation, the fundus of the uterus was found to be perforated with a 1 cmx1 cm-sized passage and a purulent discharge was apparent. Both the adnexa and bowel showed adhesion, but there was no bowel perforation or evident cancerous lesion. Entercoccus faecalis was cultured from both the cervical discharge and tissue obtained during operation. In summary, emergency physicians may consider uterine perforation due to pyometra in elderly woman with peritonitis.
Abdomen ; Abdominal Pain ; Aged ; Blood Pressure ; Cerebral Infarction ; Colonic Neoplasms ; Emergencies ; Female ; Fever ; Heart Rate ; Humans ; Hypertension ; Incidence ; Nausea ; Peritonitis ; Physical Examination ; Pyometra* ; Respiratory Rate ; Suppuration ; Tomography, X-Ray Computed ; Uterine Perforation* ; Uterine Rupture ; Uterus ; Vaginal Discharge ; Vital Signs

Cervical spine epidural hematoma is a rare disease, which can sometimes be misdiagnosed as acute ischemic stroke when a patient shows hemiparesis. A 68-year-old woman visited the emergency department with right side motor weakness without signs of facial palsy or cranial nerve deficit. She also complained of accompanying neck pain. Acute ischemic stroke was suspected initially and a non-contrast computed tomography of the brain was taken, which showed no cerebral hemorrhage. Brain and cervical spine magnetic resonance imaging (MRI) was performed for further evaluation. No evidence of cerebral infarction. However, an epidural hematoma was detected on cervical spine MRI. The patient was consulted to the neurosurgery department and decompressive laminectomy and hematoma evacuation was performed. Emergency physicians should consider cervical spine epidural hematoma in cases of sudden onset hemiparesis with accompanying neck pain.
Aged ; Brain ; Cerebral Hemorrhage ; Cerebral Infarction ; Cerebrovascular Disorders ; Cranial Nerves ; Emergencies ; Emergency Service, Hospital ; Facial Paralysis ; Female ; Hematoma* ; Hematoma, Epidural, Spinal ; Humans ; Laminectomy ; Magnetic Resonance Imaging ; Neck Pain ; Neurosurgery ; Paresis ; Rare Diseases ; Spine* ; Stroke*

Cervical spine epidural hematoma is a rare disease, which can sometimes be misdiagnosed as acute ischemic stroke when a patient shows hemiparesis. A 68-year-old woman visited the emergency department with right side motor weakness without signs of facial palsy or cranial nerve deficit. She also complained of accompanying neck pain. Acute ischemic stroke was suspected initially and a non-contrast computed tomography of the brain was taken, which showed no cerebral hemorrhage. Brain and cervical spine magnetic resonance imaging (MRI) was performed for further evaluation. No evidence of cerebral infarction. However, an epidural hematoma was detected on cervical spine MRI. The patient was consulted to the neurosurgery department and decompressive laminectomy and hematoma evacuation was performed. Emergency physicians should consider cervical spine epidural hematoma in cases of sudden onset hemiparesis with accompanying neck pain.
Aged ; Brain ; Cerebral Hemorrhage ; Cerebral Infarction ; Cerebrovascular Disorders ; Cranial Nerves ; Emergencies ; Emergency Service, Hospital ; Facial Paralysis ; Female ; Hematoma* ; Hematoma, Epidural, Spinal ; Humans ; Laminectomy ; Magnetic Resonance Imaging ; Neck Pain ; Neurosurgery ; Paresis ; Rare Diseases ; Spine* ; Stroke*