Objective: This study evaluated the usefulness of cystatin C as a prognostic predictor in heart failure patients admitted to the emergency department. Methods: This study was conducted retrospectively on patients with heart failure admitted to the emergency department between January and December 2018. Patients newly and previously diagnosed with heart failure underwent both N-terminal prohormone of brain natriuretic peptide and cystatin C tests. To assess the patients’ prognosis, a poor prognosis was defined as the occurrence of one or more of the following events: intubation, admission to an intensive care unit, coronary angiography, continuous renal replacement therapy, extracorporeal membrane oxygenation, cardiopulmonary resuscitation, and death. The patients were divided into two groups based on the occurrence of these events; the characteristics between the groups with and without events were compared. Results: Seventy-four patients were included in the study analysis: 35 and 39 in the group without and with events, respectively. The number of patients with a history of diabetes, hypertension, troponin T, and cystatin C levels were significantly higher in the group with events than in the group without events (P=0.028, P=0.041, P<0.001, and P=0.002, respectively). Multiple logistic regression analyses showed that cystatin C is a significant prognostic predictor of events. Conclusion An increased cystatin C level has been shown to clinically predict a poor prognosis of heart failure patients admitted to emergency departments.

Objective: Rapid determination of acute coronary syndrome (ACS) in the emergency department (ED) is very important for patients presenting with ischemic symptoms. The aim of this study was to determine the predictive value of HEART score for ACS and significant coronary artery stenosis (SCS). Methods: We retrospectively analyzed data of patients who visited the ED with chest discomfort and were admitted to the cardiology department. Enrolled patients were classified into ACS and non-ACS groups according to their discharge diagnosis. Patients who underwent imaging were further divided into SCS and non-SCS groups according to study results. We compared age, sex, vital signs, risk factors, electrocardiogram, troponin, and HEART score for each group. For ACS and SCS predictive performance, the test characteristics of HEART score was calculated using sensitivity, specificity, predictive value, likelihood ratio, and receiver operating characteristic (ROC) curve analysis. Results: Of 207 patients, 112 had ACS. Among enrolled patients, 155 underwent imaging workup, of whom 67 had SCS. HEART score ≤3 had 93% sensitivity for ACS and 97% for SCS. HEART score ≥7 had 82% specificity for ACS and 83% for SCS. HEART score area under ROC curve for ACS was 0.706 (95% confidence interval, 0.627–0.776) and 0.737 (95% confidence interval, 0.660–0.804) for SCS. Conclusion HEART score was a fair predictor of ACS and SCS in ED patients who presented with chest symptoms and were admitted to the cardiology department. The predictive power of HEART score was better for SCS than for ACS.

BACKGROUND: The use of aroma oils dates back to at least 3000 B.C., where it was applied to mummify corpses and treat the wounds of soldiers. Since the 1920s, the term “aromatherapy” has been used for fragrance therapy with essential oils. The purpose of this study was to determine whether the essential oil of Eucalyptus (EOE) affects pain pathways in various pain conditions and motor coordination. METHODS: Mice were subjected to inhalation or intraperitoneal injection of EOE, and its analgesic effects were assessed by conducting formalin, thermal plantar, and acetic acid tests; the effects of EOE on motor coordination were evaluated using a rotarod test. To determine the analgesic mechanism, 5′-guanidinonaltrindole (κ-opioid antagonist, 0.3 mg/kg), naltrindole (δ-opioid antagonist, 5 mg/kg), glibenclamide (δ-opioid antagonist, 2 mg/kg), and naloxone (μ-opioid antagonist, 4, 8, 12 mg/kg) were injected intraperitoneally. RESULTS: EOE showed an analgesic effect against visceral pain caused by acetic acid (EOE, 45 mg/kg); however, no analgesic effect was observed against thermal nociceptive pain. Moreover, it was demonstrated that EOE did not have an effect on motor coordination. In addition, an anti-inflammatory effect was observed during the formalin test. CONCLUSIONS: EOE, which is associated with the μ-opioid pain pathway, showed potential effects against somatic, inflammatory, and visceral pain and could be a potential therapeutic agent for pain.
Acetic Acid ; Analgesics ; Animals ; Aromatherapy ; Cadaver ; Eucalyptus ; Formaldehyde ; Glyburide ; Humans ; Inhalation ; Injections, Intraperitoneal ; Mice ; Military Personnel ; Naloxone ; Narcotic Antagonists ; Nociceptive Pain ; Oils ; Oils, Volatile ; Pain Measurement ; Rotarod Performance Test ; Visceral Pain ; Wounds and Injuries

OBJECTIVE: The quick sequential organ failure assessment (qSOFA) score, which includes mentation, systolic blood pressure, and respiratory rate, was developed to identify serious sepsis in out-of-hospital or emergency department (ED) settings. We evaluated the ability of the qSOFA score to predict poor outcome in South Korean ED patients with suspected infection.METHODS: The qSOFA score was calculated for adult ED patients with suspected infection. Patients who received intravenous or oral antibiotics in the ED were considered to have infection. In-hospital mortality rate, admission rate, intensive care unit (ICU) admission rate, length of hospital stay (LOS), and lactate levels were compared between the qSOFA score groups. Receiver operating characteristic curves and area under the receiver operating characteristic curve values for in-hospital mortality were calculated according to qSOFA cut-off points and lactate levels.RESULTS: Of 2,698 patients, in-hospital mortality occurred in 134 (5.0%). The mortality rate increased with increasing qSOFA score (2.2%, 6.4%, 17.5%, and 42.4% for qSOFA scores 0, 1, 2, and 3, respectively, P<0.001). The admission rate, ICU admission rate, LOS, and lactate level also increased with increasing qSOFA score (all P<0.001). The area under the receiver operating characteristic curve values for predicting in-hospital mortality associated with qSOFA score, lactate ≥2 mmol/L, and lactate ≥4 mmol/L were 0.719 (95% confidence interval [CI], 0.670 to 0.768), 0.657 (95% CI, 0.603 to 0.710), and 0.632 (95% CI, 0.571 to 0.693), respectively.CONCLUSION: Patients with a higher qSOFA score had higher admission, ICU admission, and in-hospital mortality rates, longer LOS, and higher lactate level. The qSOFA score showed better performance for predicting poor outcome than lactate level.
Adult ; Anti-Bacterial Agents ; Blood Pressure ; Emergencies ; Emergency Service, Hospital ; Hospital Mortality ; Humans ; Intensive Care Units ; Lactic Acid ; Length of Stay ; Mortality ; Respiratory Rate ; ROC Curve ; Sepsis

PURPOSE: The aim of this study was to determine the relationship between the injury severity and pain intensity according to age in patients with extremity injuries. METHODS: Adult patients with an extremity injury who visited the emergency department (ED) from June 1, 2016 to November 31, 2016 were analyzed retrospectively. The major injury was defined as structural damage below the muscle layer, such as muscle, ligament, and bone. Minor injury group and major injury group were separated according to this definition. The relationship of age and pain score assessed with the numerical rating scale (NRS) with the injury severity was analyzed. RESULTS: Of a total of 1,441 patients, the number of patients with a minor and major injury was 854 (59.3%) and 587 (40.7%), respectively. The proportion of patients aged 65 and older was 6.1% and 25.7% in the minor and major injury group, respectively. Age and NRS scale showed significantly positive associations with the injury severity (p < 0.001). In all NRS scores, the overall proportion of major injuries in the older age group was higher than that in the younger age group. Regardless of the younger ( < 65 years) or older (≥65 years) age group, the NRS score was positively related to the injury severity (young age group [odds ratio, 3.944]; older age group [odds ratio, 5.754]). CONCLUSION: The pain intensity is positively related to the severity of injury regardless of age. The pain intensity is the important factor of a patient assessment and treatment in the emergency department.
Adult ; Emergency Service, Hospital ; Extremities* ; Humans ; Ligaments ; Pain Measurement ; Retrospective Studies ; Trauma Severity Indices

Acute cerebellitis is a rare inflammatory disorder that occurs most frequently in children. The typical clinical course of acute cerebellitis is benign. However, in some cases of acute cerebellitis, fulminant cerebellar swelling with obliteration of the fourth ventricle causes brain stem compression and acute obstructive hydrocephalus, which can be life-threatening and require emergent neurosurgical procedures. We describe the case of a 4-year-old girl whose acute cerebellitis caused brain stem compression, acute obstructive hydrocephalus, and death. The patient was admitted to the emergency department because of a severe headache that had persisted for 5 days. Neurological examinations revealed no specific abnormality. Brain magnetic resonance imaging (MRI) demonstrated diffuse swelling and high signal intensity lesions in the cerebellar hemispheres and vermis, obliteration of the fourth ventricle, and brain stem compression on T2-weighted images in conjunction with mild hydrocephalus. Cerebrospinal fluid (CSF) analysis revealed white blood cell and red blood cell counts of 180/mm³ and 0/mm³, respectively; protein and glucose concentrations of 263.6 mg/dL and 37 mg/dL, respectively; and negative culture results. Despite aggressive treatment, the patient developed sudden cardiorespiratory arrest on day 2. Although emergency neurosurgery was performed after cardiopulmonary resuscitation, her condition progressed to brain death, and she died on day 29. This case suggests that timely and appropriate neurosurgery should be actively considered to relieve increased intracranial pressure in the early phases of acute cerebellitis.
Brain Death ; Brain Stem* ; Brain* ; Cardiopulmonary Resuscitation ; Cerebrospinal Fluid ; Child ; Child, Preschool ; Emergencies ; Emergency Service, Hospital ; Erythrocyte Count ; Female ; Fourth Ventricle ; Glucose ; Headache ; Humans ; Hydrocephalus* ; Intracranial Hypertension ; Intracranial Pressure ; Leukocytes ; Magnetic Resonance Imaging ; Neurologic Examination ; Neurosurgery ; Neurosurgical Procedures

Craniocervical artery dissection is an uncommon cause of acute ischemic stroke in children, although it is an important cause of stroke in young and middle-aged patients. Among craniocervical artery dissection, internal carotid artery (ICA) dissection usually presents with focal neurologic deficits, such as acute hemiparesis. However, if it presents with only non-localizing signs, such as headache and seizure, ICA dissection may be overlooked in a differential diagnosis. Here we describe an 8-year-old boy who had spontaneous internal carotid artery dissection presenting as a seizure without focal neurologic signs. The patient was admitted to the emergency department because of seizure. On arrival at the emergency department, focal neurologic signs, such as motor weakness, were not observed. The patient had no recent trauma history. Magnetic resonance imaging revealed diffusion-restriction in the left basal ganglia. Magnetic resonance angiography, computed tomography angiography, and cerebral angiography demonstrated occlusion of the left distal ICA with tapered stenosis (so-called “string sign”). The patient was treated with aspirin and oxcarbazepine to prevent thrombosis and further seizures. Three-month follow-up MRA revealed apparent improvement of the occlusion of the left distal internal carotid artery. The patient had no neurologic deficits or further seizures in the outpatient clinic 13 months after discharge. This case demonstrated that acute ischemic stroke resulting from ICA dissection can occur with seizures without focal neurologic signs. In addition, ICA dissection should be considered as a possible cause of acute ischemic stroke even in children with no history of trauma.
Ambulatory Care Facilities ; Angiography ; Arteries ; Aspirin ; Basal Ganglia ; Carotid Artery, Internal* ; Carotid Artery, Internal, Dissection* ; Cerebral Angiography ; Child ; Constriction, Pathologic ; Diagnosis, Differential ; Emergency Service, Hospital ; Follow-Up Studies ; Headache ; Humans ; Magnetic Resonance Angiography ; Magnetic Resonance Imaging ; Male ; Neurologic Manifestations* ; Paresis ; Seizures* ; Stroke ; Thrombosis

Craniocervical artery dissection is an uncommon cause of acute ischemic stroke in children, although it is an important cause of stroke in young and middle-aged patients. Among craniocervical artery dissection, internal carotid artery (ICA) dissection usually presents with focal neurologic deficits, such as acute hemiparesis. However, if it presents with only non-localizing signs, such as headache and seizure, ICA dissection may be overlooked in a differential diagnosis. Here we describe an 8-year-old boy who had spontaneous internal carotid artery dissection presenting as a seizure without focal neurologic signs. The patient was admitted to the emergency department because of seizure. On arrival at the emergency department, focal neurologic signs, such as motor weakness, were not observed. The patient had no recent trauma history. Magnetic resonance imaging revealed diffusion-restriction in the left basal ganglia. Magnetic resonance angiography, computed tomography angiography, and cerebral angiography demonstrated occlusion of the left distal ICA with tapered stenosis (so-called “string sign”). The patient was treated with aspirin and oxcarbazepine to prevent thrombosis and further seizures. Three-month follow-up MRA revealed apparent improvement of the occlusion of the left distal internal carotid artery. The patient had no neurologic deficits or further seizures in the outpatient clinic 13 months after discharge. This case demonstrated that acute ischemic stroke resulting from ICA dissection can occur with seizures without focal neurologic signs. In addition, ICA dissection should be considered as a possible cause of acute ischemic stroke even in children with no history of trauma.
Ambulatory Care Facilities ; Angiography ; Arteries ; Aspirin ; Basal Ganglia ; Carotid Artery, Internal* ; Carotid Artery, Internal, Dissection* ; Cerebral Angiography ; Child ; Constriction, Pathologic ; Diagnosis, Differential ; Emergency Service, Hospital ; Follow-Up Studies ; Headache ; Humans ; Magnetic Resonance Angiography ; Magnetic Resonance Imaging ; Male ; Neurologic Manifestations* ; Paresis ; Seizures* ; Stroke ; Thrombosis

BACKGROUND/AIMS: With the progress of product development, single-step endoscopic ultrasound (EUS)-guided transmural drainage can overcome some disadvantages of the blind or two-step procedures used in the treatment of pancreatic pseudocysts. We therefore evaluated the technical feasibility, efficacy, and safety of single-step EUS-guided transmural drainage of pancreatic pseudocysts. METHODS: Endoscopic drainage of pancreatic pseudocysts was performed in 47 patients (median age, 46 years; range, 38 years to 59 years; 40 men) by using interventional echoendoscopes with a single-step device suitable for ballooning, bougination, and plastic-stent insertion. RESULTS: Endoscopic stent placement was successful in 42 patients (89%; transgastric approach, 34/38; transduodenal approach, 8/9) and failed in 5 patients because of acute angulation (n=4) or small cyst (n=1). The volume of the pseudocyst was reduced by more than 90% or it disappeared completely in all of 41 patients (100%), based on a mean follow-up period of 17 months (range, 11 months to 20 months). The overall recurrence rate was 12% (5/41) after improvement by the procedure. Minor complications (one case of bleeding, three cases of pneumoperitoneum, and one case of peritonitis) occurred after the procedure in five patients (11%), but there were no major complications. CONCLUSIONS: Single-step EUS-guided transmural drainage can be used to treat pancreatic pseudocysts with acceptable feasibility, efficacy, and safety.
Drainage ; Endosonography ; Follow-Up Studies ; Hemorrhage ; Humans ; Pancreatic Pseudocyst ; Pneumoperitoneum ; Recurrence ; Stents

BACKGROUND/AIMS: We aimed to evaluate survival time and prognostic factors in patients with advanced unresectable cholangiocarcinoma who have not received surgery, chemotherapy, or radiotherapy. METHODS: A total of 1,377 patients, who were diagnosed with primary cholangiocarcinoma between 1996 and 2002, were reviewed retrospectively according to the following inclusion criteria: histologically proven primary adenocarcinoma arising from the bile-duct epithelium, advanced unresectable stages, no severe comorbidity that can affect survival time, and no history of surgery, chemotherapy, or radiotherapy. RESULTS: Of the 1,377 cases reviewed, 330 patients complied with the inclusion criteria and were thus eligible to participate in this study; 203 had intrahepatic cholangiocarcinoma and 127 had hilar cholangiocarcinoma. The overall survival time of the entire cohort (n=330) was median 3.9 months (range; 0.2 to 67.1). The survival time was significantly shorter in the intrahepatic cholangiocarcinoma group (3.0+/-5.3 months) than in the hilar cholangiocarcinoma group (5.9+/-10.1 months; Kaplan-Meier survival analysis). Multivariate analysis revealed that distant metastasis was a poor prognostic factor for intrahepatic cholangiocarcinoma (p< 0.001), baseline serum albumin >3.0 g/dL was a favorable prognostic factor (p=0.02), and baseline serum carcinoembryonic antigen level >30 ng/mL was a poor prognostic factor for hilar cholangiocarcinoma (p=0.01). CONCLUSIONS: The median survival of advanced unresectable cholangiocarcinoma is dismal.
Adenocarcinoma ; Carcinoembryonic Antigen ; Cholangiocarcinoma ; Cohort Studies ; Comorbidity ; Epithelium ; Humans ; Liver Neoplasms ; Multivariate Analysis ; Natural History ; Neoplasm Metastasis ; Retrospective Studies ; Serum Albumin ; Cholangiocarcinoma