Geriatric Emergency Medicine: Providing Older Missourians with the Care They Need and Deserve.

Emergency care of older adults evolved in an effort to meet the needs of our aging population. The pace of improving the quality and cost-effectiveness of emergency department (ED) care for older adults is accelerating with the development of Geriatric Emergency Department Accreditation (GEDA) and research initiatives forged by the Center for Leading Innovation and Collaboration (CLIC) and Geriatric Emergency care Applied Research (GEAR). The innovations of two Missouri EDs are highlighted, including how each approached fall risk and quality improvement efforts for aging populations with multimorbidity.

Fulminant hepatic failure caused by acute fatty liver of pregnancy treated by orthotopic liver transplantation.

A previously healthy 35-year-old woman was seen at 37 weeks' gestation with a 10-day history of fever, vomiting, diarrhea and malaise. Serum laboratory findings included elevation of serum bilirubin and AST, prolongation of serum prothrombin time and a positive monospot. A tentative diagnosis of acute fatty liver of pregnancy was made, and a healthy male infant was delivered by emergency cesarean section because of fetal distress.

Chlamydia trachomatis perihepatitis with ascites.

Chlamydia trachomatis as an etiological agent in the Fitz-Hugh-Curtis syndrome has recently been reported; however, the condition has not been typically associated with ascites. We report a case of Chlamydia trachomatis perihepatitis in a young woman who had exudative ascites as a predominant clinical feature of her disease. Laparoscopy revealed characteristic "violin string" adhesions which were also identified on abdominal computerized tomographic scan.

Unusual cardiac complications of Wegener's granulomatosis.

Wegener's granulomatosis most commonly involves the sinuses, lungs and kidneys with necrotizing granulomatous vasculitis. In 12 percent of a large series of patients with Wegener's granulomatosis there was cardiac involvement, largely manifested by pericarditis and coronary arteritis. We present three patients with this disease who developed unusual cardiac complications.