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

PURPOSE: The objective of our study was to evaluate the immunohistochemical expression of p53 and bax proteins as prognostic markers in FIGO stage IIb invasive squamous cell carcinoma of the uterine cervix. MATERIALS AND METHODS: Sixty-five cases of squamous cell carcinoma of the cervix (stage IIb) that were diagnosed from October 1996 to December 2003 were analyzed retrospectively for the bax and p53 expression. These expressions were determined immunohistochemically and they were correlated to the patients' overall survival and disease-free survival. RESULTS: The overall 5-year survival (OS) rate and the disease-free survival (DFS) rate were 65.1% and 62.9%, respectively. p53 and bax immunoreactivity was seen in 26.2% and 52.3% of cases, respectively, with variable levels of expression. On the univariate analysis, only p53 positivity correlated with poor survival in DFS (log-rank test p=0.027), but this significance was not maintained on multivariated analysis by Cox's regression. The nine cases with the immunophenotype p53+/bax- had the poorest survival. CONCLUSION: Neither p53 nor bax expression are independent predictors of the prognosis for stage IIb cervical squamous cancers. Evaluation of p53 and bax co-expression may affect the clinical outcome and further investigation is needed.
bcl-2-Associated X Protein ; Carcinoma, Squamous Cell ; Cervix Uteri ; Disease-Free Survival ; Female ; Humans ; Prognosis ; Retrospective Studies

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.

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

Anterior spinal artery syndrome, also known as Beck's syndrome, is defined as ischemia or infarction of the spinal cord. Beck's syndrome occurs from aortic thrombus, embolism, or dissection blocking the blood flow to the great radicular artery (GRA) of Adamkiewicz. Abdominal artery embolism due to trauma is relatively rare and urgent detection of vascular injury is substantial to fair clinical outcome of the patient, therefore, we report on a case of traumatic artery dissection presenting as lower leg weakness.
Anterior Spinal Artery Syndrome ; Arteries ; Automobiles ; Embolism ; Humans ; Infarction ; Ischemia ; Leg ; Paresis ; Spinal Cord ; Spinal Cord Ischemia ; Thrombosis ; Vascular System Injuries

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*