Spontaneous bilateral cerebellar infarction in the territory of the superior cerebellar arteries is extremely rare. Occasionally there have been reports of bilateral cerebellar infarction due to vertebrobasilar atherosclerotic occlusion or stenosis, whereas no report of bilateral cerebellar infarction due to complicated hemodynamic changes. In this report, we present a patient with bilateral cerebral infarctions related to stenoses of bilateral internal carotid arteries, in whom vertebrobasilar system was supplied by multiple collaterals from both posterior communicating arteries and right external carotid artery. We performed stent-angioplasty of bilateral internal cerebral arterial stenosis, and then acute infarction developed on bilateral superior cerebellar artery territories. The authors assumed that the infarction occurred due to hemodynamic change between internal carotid artery and external carotid artery after stent-angioplasty for stenosis of right internal carotid artery.
Arteries* ; Carotid Artery, External ; Carotid Artery, Internal* ; Carotid Stenosis* ; Cerebral Infarction ; Constriction, Pathologic ; Hemodynamics ; Humans ; Infarction*

PURPOSE: Proteomics is a peptide screening approach to identify proteins related to physiological and pathological changes. Our objective was to analyze changes in serum proteome profiles in patients suffering from septic shock, during the first 24-h period of therapy and to determine whether these changes were associated with prognosis. METHODS: This was a retrospective observational study based on prospectively collected data that was conducted in an emergency intensive care unit (ICU) of a tertiary referral hospital. Consecutive patients admitted to the ICU with septic shock were enrolled. We obtained serum samples from the patients at admission (0 h) and 24 h after admission (24 h). Then, we analyzed the serum proteome profiles, performed Western blots, and measured serum lipid profiles. RESULTS: Twenty-seven patients were enrolled. Thirteen patients were grouped into the survivors (SURV) group and fourteen into the non-survivors group on day 30 (NON-SURV). Proteomic analyses and Western blot showed that the expression intensities of proapolipoprotein AI remained unchanged in SURV but decreased in NON-SURV during the first 24-h period of septic shock (p=0.015). Serum high density lipoprotein (HDL) cholesterol level also remained unchanged in SURV but decreased in NON-SURV (p=0.036). CONCLUSION: The decrease in serum proapolipoprotein AI expression during the first 24-h period of therapy was associated with a consistently low serum HDL cholesterol level and a poor prognosis in patients with septic shock.
Apolipoprotein A-I ; Blotting, Western ; Cholesterol ; Cholesterol, HDL ; Emergencies ; Humans ; Intensive Care Units ; Lipoproteins ; Lipoproteins, HDL ; Mass Screening ; Prognosis ; Prospective Studies ; Proteins ; Proteome ; Proteomics ; Retrospective Studies ; Shock ; Shock, Septic ; Stress, Psychological ; Survivors ; Tertiary Care Centers

No abstract available.
Humans*

PURPOSE: N-acetylcysteine (NAC) has been known to have protective effects on the prevention of radiocontrast induced nephropathy (RCIN) in chronic renal failure (CRF). We investigated the effects of NAC in acute renal failure (ARF). METHODS: From January to June 2006, we retrospectively enrolled patients with ARF who were checked with contrast computed tomography (CT) at an emergency department. We divided patients into the NAC group and the control group. We compared baseline demographic characteristics, underlying diseases, infused fluid volume, blood urea nitrogen (BUN), and serum creatinine (Cr) level before and after CT scan. ARF was defined as serum Cr>1.5. mg/dL. RCIN was defined as an increase in serum Cr level of at least 0.5 mg/dL or 25% 48 hours after CT. RESULTS: Of a total 106 cases, 23 patients were the NAC group and 83 were the control group. There were no significant differences in baseline findings including underlying disease, cause of ARF and serum Cr level. The volume of infused fluid before and after CT were not different between the two groups (before; p=0.183 after; p=0.149). After CT scan, BUN and serum Cr level were decreased without statistical significance in both groups (NAC vs control group: BUN; 21.0+/-12.9 vs 20.5+/-14.2 p=0.863 Cr; 1.3+/-0.5 vs 1.4+/-0.5 p=0.451). RCIN developed in total 3 cases, 2 cases in the NAC group and 1 in the control group (p=0.524) and one of the NAC group performed hemodialysis. CONCLUSION: In case of patients with ARF, there was no protective effect of NAC on RCIN.
Acetylcysteine* ; Acute Kidney Injury* ; Blood Volume ; Creatinine ; Emergency Service, Hospital ; Humans ; Kidney Failure, Chronic ; Nitrogen ; Renal Dialysis ; Retrospective Studies ; Tomography, X-Ray Computed ; Urea

No abstract available.
Sparganosis*

PURPOSE: This study was performed to investigate whether therapeutic hypercapnia could attenuate systemic inflammatory responses in hemorrhagic shock in rats. METHODS: Male Sprague-Dawley rats were mechanically ventilated and underwent pressure-controlled (mean arterial pressure: 38+/-1 mmHg) hemorrhagic shock. At 10 minutes after the induction of hemorrhagic shock, the rats were divided into the normocapnia (PaCO2=35-45 mmHg, n=10) and the hypercapnia (PaCO2=60-70 mmHg) groups. The PaCO2 concentration was adjusted by using the concentration of inhaled CO2 gas. After 90 minutes of hemorrhagic shock, rats were resuscitated with shed blood for 10 minutes and were observed for 2 hours. The mean arterial pressure (MAP) and the heart rate were monitored continuously, and the results of arterial blood gas analyses, as well as the plasma concentrations of interleukin (IL)-6, IL-10, and nitrite/nitrate were compared between the normocapnia and the hypercapnia groups. RESULTS: The MAP and the heart rate were not different between the two groups. The plasma concentration of IL-6 was significantly lower in the hypercapnia group than in the normocapnia group (p<0.05). The IL-10 concentration was not different and the IL-6 to IL-10 ratio was significantly lower in the hypercapnia group compared to the normocapnia group. The plasma nitrite/nitrate concentration of the hypercapnia group was lower than that of the normocapnia group. CONCLUSION: Therapeutic hypercapnia attenuates systemic inflammatory responses in hemorrhagic shock.
Animals ; Arterial Pressure ; Blood Gas Analysis ; Cytokines ; Heart Rate ; Humans ; Hypercapnia ; Inflammation ; Interleukin-10 ; Interleukin-6 ; Interleukins ; Male ; Nitric Oxide ; Plasma ; Rats ; Rats, Sprague-Dawley ; Shock, Hemorrhagic

OBJECTIVE: The time to positivity (TTP) of blood culture reflects bacterial load and has been reported to be associated with outcome in bloodstream infections. This study was performed to evaluate the relationship between the TTP of blood culture and the mortality rates associated with sepsis and septic shock according to the site of infection. METHODS: We performed a retrospective cohort study on patients with sepsis and septic shock. The rates of blood culture positivity and mortality as well as the relationship between the TTP and 28-day mortality rate were compared among patients with different sites of infection, such as the lungs, abdomen, urogenital tract, and other sites. RESULTS: A total of 2,668 patients were included, and the overall mortality rate was 21.6%. The rates of blood culture positivity and mortality were different among the different infection sites. There was no relationship between the TTP and mortality rates of total, lung, and urogenital infections. Patients with abdominal infections showed a negative correlation between the TTP and 28-day mortality rate. In patients with abdominal infections, a TTP < 20 hours was independently associated with 28-day mortality compared with patients with negative blood culture (hazard ratio, 1.73; 95% confidence interval, 1.16–2.58). However, there was no difference in mortality rates of patients with a TTP≥20 hours and a negative blood culture. CONCLUSION: The shorter TTP in patients with abdominal infections in sepsis and septic shock was associated with a higher 28-day mortality rate.
Abdomen ; Bacterial Load ; Cohort Studies ; Humans ; Lung ; Mortality* ; Retrospective Studies ; Sepsis* ; Shock, Septic

Background: Rapid electrocardiography diagnosis within 10 minutes of presentation is critical for acute myocardial infarction (AMI) patients in the emergency department (ED).However, the coronavirus disease 2019 (COVID-19) pandemic has significantly impacted the emergency care system. Screening for COVID-19 symptoms and implementing isolation policies in EDs may delay the door-to-electrocardiography (DTE) time. Methods: We conducted a cross-sectional study of 1,458 AMI patients who presented to a single ED in South Korea from January 2019 to December 2021. We used multivariate logistic regression analysis to assess the impact of COVID-19 pandemic and ED isolation policies on DTE time and clinical outcomes. Results: We found that the mean DTE time increased significantly from 5.5 to 11.9 minutes (P < 0.01) in ST segment elevation myocardial infarction (STEMI) patients and 22.3 to 26.7 minutes (P < 0.01) in non-ST segment elevation myocardial infarction (NSTEMI) patients.Isolated patients had a longer mean DTE time compared to non-isolated patients in both STEMI (9.2 vs. 24.4 minutes) and NSTEMI (22.4 vs. 61.7 minutes) groups (P < 0.01). The adjusted odds ratio (aOR) for the effect of COVID-19 duration on DTE ≥ 10 minutes was 1.93 (95% confidence interval [CI], 1.51–2.47), and the aOR for isolation status was 5.62 (95% CI, 3.54–8.93) in all patients. We did not find a significant association between in-hospital mortality and the duration of COVID-19 (aOR, 0.9; 95% CI, 0.52–1.56) or isolation status (aOR, 1.62; 95% CI, 0.71–3.68). Conclusion Our study showed that ED screening or isolation policies in response to the COVID-19 pandemic could lead to delays in DTE time. Timely evaluation and treatment of emergency patients during pandemics are essential to prevent potential delays that may impact their clinical outcomes.

PURPOSE: This study was designed to prove the efficacy of neutralization with weak acid against strong alkali ingestion and to evaluate exothermic reaction of neutralization therapy. METHODS: 30 New Zealand White rabbits were anesthetized with intravenous injection of ketamine and xylazine. After gastric lavage was done, a orogastric catheter and a electric thermometer probe were inserted into stomach. And then the rabbits were divided into six groups. The first group was given 3M NaOH 16.5 mL only. The second and third groups were given 3M NaOH 16.5 mL and then 1M C H3COOH 52.14 mL one and three minutes later, respectively. The fourth and fifth groups were given tap water instead of CH3COOH, and the sixth group was given C H3COOH only. We monitored intragastric temperature continuously, compared arterial pHs before alkali infusion and 15 minutes later, measured gastric pH 15 minutes later, and examined pathologic findings of stomach after sacrificing. RESULTS: There was no significant thermal effect in all groups, and gastric pH of neutralization groups was much lower than alkali alone or dilution groups. Changes of arterial pH after 15 minutes were greater in alkali alone and dilution groups than neutralization groups. In gross and microscopic findings of stomach, only mucosal injuries were observed in neutralization groups, especially in one minute group. But all stomach layers were destroyed in alkali alone and dilution groups. CONCLUSION: Neutralization therapy never makes additional thermal injury, and has protective effects against local tissue destruction and systemic alkalemia. Dilution therapy shows little or no effects.
Alkalies* ; Catheters ; Eating* ; Gastric Lavage ; Hydrogen-Ion Concentration ; Injections, Intravenous ; Ketamine ; Rabbits ; Stomach ; Thermometers ; Water ; Xylazine

PURPOSE: This study was designed to evaluate the characteristics of exertional heat stroke between the non-survival and the survival groups. METHODS: From January 1996 to December 2002, patients with exertional heat stroke who came to the emergency department of a military hospital were enrolled. Data on individual factors, atmospheric conditions, pre-hospital management, initial vital signs, laboratory findings, presence of seizure attack, and performance of intubation were reviewed retrospectively and compared between the nonsurvival and the survival groups. RESULTS: During the study period, 22 patients were diagnosed as suffering from exertional heat stroke and 5 patients died. Most of the episodes occurred during the summer days with high ambient temperature (mean 30.6+/-3.0 degrees C) and humidity (mean 75.6+/-7.7%), and 13 patients were unacclimatized recruits. The non-survival group showed a lower initial systolic blood pressure, platelet count, arterial pH, and HCO3 - level, and a higher serum creatinine, ALT, and amylase level than did the survival group (p<0.05). However there were no significant differences in individual factors, atmospheric conditions, pre-hospital management, initial pulse rate, temperature, white blood cell count, hemoglobin count, and the sodium, potassium, BUN and AST levels between the two groups. CONCLUSION: Initial systolic blood pressure, platelet count, and arterial pH, as well as HCO3 -, serum creatinine, ALT, and amylase levels seem to be important factors for the prognosis of exertional heat stroke.
Amylases ; Blood Pressure ; Creatinine ; Emergency Service, Hospital ; Heart Rate ; Heat Stroke* ; Hospitals, Military ; Hot Temperature* ; Humans ; Humidity ; Hydrogen-Ion Concentration ; Intubation ; Leukocyte Count ; Military Personnel* ; Platelet Count ; Potassium ; Prognosis ; Retrospective Studies ; Seizures ; Sodium ; Vital Signs