A case of angioedema due to acquired C1 esterase inhibitor deficiency masquerading as suspected peritonitis: a case report.

Angioedema due to acquired C1 esterase deficiency is a rare condition and a non-inflammatory disease characterized by episodes of edema of the mucosa of the upper airway or gastrointestinal tract. The purpose of this case report is to heighten awareness among emergency physicians of a peritonitis-like condition that can develop into angioedema due to acquired C1 esterase inhibitor deficiency, and thereby help to prevent false diagnosis resulting in unnecessary surgical intervention. We report the case of a 21-year-old man who presented to the Emergency Department (ED) with abdominal pain. He was later diagnosed with angioedema of the gastrointestinal tract due to acquired C1 esterase deficiency that was initially suspected as peritonitis. Careful evaluation of the acute abdomen in acquired C1 esterase deficiency is very important in the ED to distinguish between medical and surgical causes of an acute abdomen.

Isolated cerebrospinal fluid leakage due to a spinal stab wound in a child.

Spinal stab wounds are relatively rare, especially in children. Moreover, as the pediatric spine anatomy differs from that of an adult, physicians managing stab wounds in this area should keep some special considerations in mind. This study reports an interesting case of spinal cerebrospinal fluid leakage without significant spinal injury in a 32-month-old child.

Occult intraperitoneal bladder injury after a tension-free vaginal tape procedure.

Occult bladder injury may sometimes go unrecognized during tension-free vaginal tape (TVT) procedures. We report a case of occult intraperitoneal bladder injury that occurred during a TVT procedure. There was no sign of bladder perforation on the initial cystoscopy, which was performed just after the insertion of the trocar. Signs of general peritonitis appeared after the patient started to void the next day. A postoperative cystogram and cystoscopy showed an intraperitoneal bladder injury and a pinhead-sized ulcerative lesion in the right lateral wall of the bladder. We suspect that at the time of initial cystoscopy, the trocar passed through the submucosal area without violating the bladder mucosa. The occult bladder injury may have been caused after the initial cystoscopy by advancing the rough edge of the prolene tape during the extraction of the trocar. This report is the first description of such an occult bladder injury during a TVT procedure.

Post-Nargis medical care: experience of a Korean Disaster Relief Team in Myanmar after the cyclone.

The objective of this study was to assess the epidemiology and clinical data of patients observed by the Korean Disaster Relief Team, during its deployment in Myanmar, from 6 to 12 June 2008. A cross-sectional, medical record-based study in the Korean Disaster Relief Team clinic, established a month after the cyclone Nargis devastated Myanmar. Data collected included demographic variables, and whether or not the problem was acute or chronic, and traumatic or medical. We included 2641 patients in the study. Of those, 57.6% presented with an acute condition, and the rest had chronic conditions. Approximately 5% of the patients presented with trauma/injury; and in 29% of the trauma cases, the problem was directly related to the cyclone. The most common diagnostic category was musculoskeletal problems (21.5%), followed by respiratory (15.3%), and digestive (14.6%) abnormalities. A little over 5% of patients had posttraumatic stress disorder, and the odds ratio was 2.62 (95% confidence interval 1.63-4.21) for women to have posttraumatic stress disorder. Most of the patients (97.5%) had minor problems and were sent home. In conclusion, a huge unmet medical need in at-risk populations and a relatively large proportion of chronic medical conditions should be considered in any future planning of a similar type of disaster.

Liquid calcium fertilizer intoxication.

INTRODUCTION: Liquid calcium fertilizer is used for growing vegetables and fruits. Ingestion of large quantities of liquid calcium can induce hyperacute hypercalcemia and can be life-threatening. CASE REPORT: A case of acute liquid calcium fertilizer intoxication with dyspnea and drowsiness is reported. Recovery followed a number of interventions normally applied in other causes of hypercalcemia. DISCUSSION: Hypercalcemia can trigger complications such as arrhythmia and an altered mental status. It requires hospitalization, and treatment depends on the level, the severity of symptoms, and the underlying cause of the problem. CONCLUSION: Liquid calcium fertilizer can be responsible for an acute hypercalcemia.

Inhibition of 6-hydroxydopamine-induced endoplasmic reticulum stress by l-carnosine in SH-SY5Y cells.

Conditions that cause endoplasmic reticulum malfunction (ER stress) play a key role in the development of various human diseases including neurodegenerative diseases. Carnosine is an endogenous peptide, present in excitable tissues such as brain and skeletal muscle. Although there are reports suggesting that carnosine has a biological role independent of its antioxidant activity, there have been no reports of the effects of carnosine on the ER stress response. We investigated the effects of carnosine on 6-hydroxydopamine (6-OHDA)-induced cell death and ER stress in SH-SY5Y cells. After assessing control cell viability in serum-free conditions for 24h (100% viability), we found that 50 microM 6-OHDA reduced cell viability to 76.4% of control values, whereas addition of 10mM carnosine significantly reduced cell death to 96.1% viability in a dose-dependent manner. Consistent with its cytoprotective action, carnosine markedly inhibited subsequent ER stress responses, including phosphorylation of eukaryotic initiation factor 2alpha (eIF2alpha) and c-jun, expression of glucose regulatory protein 78 and C/EBP homologous protein, and mRNA splicing of X-box protein 1. The measurement of reactive oxygen species (ROS) generation by 6-OHDA showed that addition of 10mM carnosine slightly but obviously inhibits the 6-OHDA-induced ROS production. In conclusion, our results show that carnosine almost completely inhibits 6-OHDA-induced ER stress responses and cytotoxicity, and that slight antioxidant activity of carnosine against 6-OHDA is observed. Further in vivo studies are needed to investigate clinical uses for carnosine.

Recurrent massive subcutaneous hemorrhage in neurofibromatosis type 1: a case report.

Neurofibromatosis type 1 (NF-1) is an autosomal dominant disorder that has three major features: multiple neural tumors, cafe-au-lait spots, and pigmented iris hamartomas (Lisch nodules). The purpose of this case report is to advise physicians of the danger associated with the progression of fast-onset massive hemorrhage to hemodynamic instability, which mandates rapid treatment to prevent the development of a life-threatening condition. A 64-yr-old woman with NF-1 was admitted to the Emergency Department (ED) because of a rapidly growing, 10 x 5 x 3 cm-sized mass on the left back area. She had previously undergone surgery for a large subcutaneous hematoma, which had developed on her right back area 30 yr before. She became hemodynamically unstable with hypotension during the next 3 hr after admission to ED. Resuscitation and blood transfusion were done, and the hematoma was surgically removed. The mass presented as a subcutaneous, massive hematoma with pathologic findings of neurofibroma. We report a case of NF-1 that presented as recurrent, massive, subcutaneous hemorrhage on the back region combined with hypovolemic shock.

Hypothermic cardiac arrest.

After being lost for 16 hr, a 7-yr-old boy was admitted to the emergency Department (ED) in a severe hypothermic condition of 23.3 degrees C with cardiac arrest. Active rewarming was conducted with cardiopulmonary resuscitation (CPR). Sixty minutes after admission, return of spontaneous circulation was confirmed. Fever developed 14 hr after admission and continued for 9 days due to frostbite wound of both feet. This case report demonstrates successful resuscitation in severe hypothermic cardiac arrest with complete neurologic recovery in a 7-yr-old boy.

Ileocecal intussusception in an adult: a case report.

Intussusception is relatively rare in adults and differs from the childhood form in its etiology, presentation and treatment. Unlike childhood intussusception, adult intussusception is usually due to underlying pathologic lead points, most probably neoplasms. The main clinical presentation of intussusception in the adult is chronic abdominal pain, and acute adult intussusception is uncommon. Here, we describe an uncommon case of acute ileocecal intussusception due to ileal lymphoid hyperplasia in a 46-year-old woman. Lymphoid hyperplasia of the intestines is a benign reactive process. Intestinal lymphoid hyperplasia has been reported in association with infections and as an allergic response to various foods. In adults, it has been reported to occur in association with immune deficiencies. There were no obvious causes for this patient's ileal lymphoid hyperplasia. We conclude that physicians need to consider intussusception, due to intestinal lymphoid hyperplasia, as a possible cause of acute abdominal pain in adults, even in the absence of any specific medical history.

Surgical management of vaginal wound healing defects after tension-free vaginal tape placement.

The use of tension-free vaginal tape (TVT) made of polypropylene mesh carries the risk of causing vaginal wound healing defects, which are usually detected within 4 weeks of operation. We present three cases of vaginal wound healing defects after TVT procedures. These defects were managed using surgical techniques aimed at preserving the mesh, but all failed. There are many options for dealing with the problems of vaginal wounds following TVT. These include further observation, mesh removal, suturing the wound, or using tissue flaps to cover it. However, the latter two options cannot be recommended as they usually fail.

Establishment of penile fibrosis model in a rat using mouse NIH 3T3 fibroblasts expressing transforming growth factor beta1.

Transforming growth factor (TGF) beta1 has been suggested to have an important role in cavernous fibrosis and resultant erectile dysfunction. For further elucidation of TGFbeta1 signaling in association with cavernous fibrosis, we developed a rat model of cavernous fibrosis using TGFbeta1-producing NIH 3T3 fibroblasts (NIH 3T3-TGFbeta1). The NIH 3T3-TGFbeta1 cells were injected into male Sprague-Dawley rats intracavernously. Masson trichrome staining at 20 days postinjection showed multiple fibrous scars in the rats injected with the NIH 3T3-TGFbeta1 cells (group 3), whereas no histological evidence of cavernous fibrosis was found in the control rats (group 1) or the recombinant human TGFbeta1 protein-injected rats (group 2). Immunohistochemical staining revealed a higher expression of TGFbeta1 and its type II receptor in group 3 than in groups 1 and 2. Electrostimulation of the cavernous nerve revealed that the maximal intracavernous pressure was significantly lower in group 3 than in groups 1 and 2 (P < 0.01). The expression of transgenic TGFbeta1 mRNA continued to 10 days after injection of the cells. The NIH 3T3-TGFbeta1 cells sufficiently induced relatively long-lasting cavernous fibrosis. This novel animal model may contribute to future investigations of the pathogenesis of penile fibrosis associated with TGFbeta1 signaling and the development of new therapeutics targeting this pathway.