Purpose: To report a case of peripapillary subretinal hemorrhage and vitreous hemorrhage after riding a roller coaster.Case summary: A 15-year-old female visited our clinic complaining of blurred vision in her left eye after repetitive roller coaster riding. The initial best-corrected visual acuity (BCVA) was 1.0 (right eye) and 0.4 (left eye). The light reflex, relative afferent pupillary defect, and intraocular pressure were within the normal range. On fundus examination, the patient was found to have a peripapillary subretinal hemorrhage, subhyaloid hemorrhage, and vitreous hemorrhage in her left eye. The BCVA of her left eye improved to 1.0 from 0.4 without any treatment after 2 weeks. The peripapillary subretinal hemorrhage and vitreous hemorrhage were completely absorbed after 7 months. Conclusions In the case of unexplained retinal hemorrhage in healthy patients without other retinal or systemic diseases, a detailed medical history should be collected to determine the possibility of disorders related to damages from riding a roller coaster.

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

PURPOSE: To evaluate the effects of bevacizumab on expression of B-cell leukemia/lymphoma (Bcl)-2 and apoptosis in retinal pigment epithelial (RPE) cells under oxidative stress conditions. METHODS: RPE cells were treated with H2O2 (0, 100, 200, 300, and 400 microM) and bevacizumab at or above the doses normally used in clinical practice (0, 0.33, 0.67, 1.33, and 2.67 mg/mL). Cell apoptosis was measured using flow cytometry with annexin V-fluorescein isothiocyanate. The expression of Bcl-2 mRNA was determined using reverse transcription polymerase chain reaction. RESULTS: Under low oxidative stress conditions (H2O2 100 microM), cell apoptosis was not significantly different at any concentration of bevacizumab, but Bcl-2 mRNA expression decreased with increasing concentration of bevacizumab (0.33, 0.67, 1.33, and 2.67 mg/mL). Under moderate oxidative stress conditions (H2O2 200 microM), Bcl-2 mRNA expression decreased with increasing concentration of bevacizumab (0.33, 0.67, 1.33, and 2.67 mg/mL), but cell apoptosis increased only at 2.67 mg/mL of bevacizumab. Under high oxidative stress (300 microM) conditions, cell apoptosis increased at high concentrations of bevacizumab (1.33 and 2.67 mg/mL), but it did not correlate with Bcl-2 expression. CONCLUSIONS: Withdrawal of vascular endothelial growth factor can lead to RPE cell apoptosis and influences the expression of anti-apoptotic genes such as Bcl-2 under oxidative stress conditions. Since oxidative stress levels of each patient are unknown, repeated injections of intravitreal bevacizumab, as in eyes with age-related macular degeneration, might influence RPE cell survival.
Angiogenesis Inhibitors/*pharmacology ; Apoptosis/*drug effects ; Bevacizumab/*pharmacology ; Cell Line ; Enzyme-Linked Immunosorbent Assay ; Flow Cytometry ; Gene Expression Regulation/physiology ; Humans ; Hydrogen Peroxide/toxicity ; Oxidative Stress/drug effects ; Proto-Oncogene Proteins c-bcl-2/*genetics ; RNA, Messenger/genetics ; Real-Time Polymerase Chain Reaction ; Retinal Pigment Epithelium/*drug effects/metabolism/pathology ; Vascular Endothelial Growth Factor A/antagonists & inhibitors

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

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

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

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.

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