Pub Date : 2024-05-22DOI: 10.4103/jmedsci.jmedsci_34_24
Hsuan-Yun Hsu, Chih-Wei Tsao
Urologists are experiencing difficulties managing ureteral strictures (US). Several treatment options have been used to treat US. Here, we present two patients with US. The first case is a 49-year-old woman with a history of squamous cell carcinoma of the cervix, status postlaparoscopy-assisted vaginal hysterectomy and radical parametrectomy, and bilateral pelvic lymph node dissection with recurrence. She regularly underwent double-J catheterization for bilateral US. The second case is a 66-year-old woman with a history of serious papillary adenocarcinoma of the endometrium, poststaging laparotomy with extrafascial hysterectomy + bilateral salpingo-oophorectomy + bilateral pelvic, common iliac, and para-aortic lymph node dissection + omentectomy. She regularly underwent double-J catheterization because of bilateral US. Allium stents have been used to treat US. Hydronephrosis improved in both patients. Renal function improved in one patient. A new self-expanding, large-caliber ureteral stent is another treatment option for patients requiring internal ureteral drainage.
{"title":"A New Self-expanding, Large-caliber Ureteral Stent Applied for Bilateral Long-segment Ureteral Strictures — A Case Report","authors":"Hsuan-Yun Hsu, Chih-Wei Tsao","doi":"10.4103/jmedsci.jmedsci_34_24","DOIUrl":"https://doi.org/10.4103/jmedsci.jmedsci_34_24","url":null,"abstract":"\u0000 Urologists are experiencing difficulties managing ureteral strictures (US). Several treatment options have been used to treat US. Here, we present two patients with US. The first case is a 49-year-old woman with a history of squamous cell carcinoma of the cervix, status postlaparoscopy-assisted vaginal hysterectomy and radical parametrectomy, and bilateral pelvic lymph node dissection with recurrence. She regularly underwent double-J catheterization for bilateral US. The second case is a 66-year-old woman with a history of serious papillary adenocarcinoma of the endometrium, poststaging laparotomy with extrafascial hysterectomy + bilateral salpingo-oophorectomy + bilateral pelvic, common iliac, and para-aortic lymph node dissection + omentectomy. She regularly underwent double-J catheterization because of bilateral US. Allium stents have been used to treat US. Hydronephrosis improved in both patients. Renal function improved in one patient. A new self-expanding, large-caliber ureteral stent is another treatment option for patients requiring internal ureteral drainage.","PeriodicalId":16486,"journal":{"name":"Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141108098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-22DOI: 10.4103/jmedsci.jmedsci_2_24
Hao-Wen Chang, Chen-Liang Tsai
Surgical drainage, particularly pericardiotomy, which has a low recurrence rate, can safely and efficiently treat symptomatic pericardial effusion in patients with cancer. A thoracoscopic video-assisted pericardiectomy is an effective treatment option for rare instances of recurrent localized pericardial effusion. A 63-year-old male presented with a rare form of recurrent pericardial effusion that was initially circumferential, but recurred in a loculated form. On the right side, a loculated pericardial effusion caused right ventricular dysfunction and lower leg edema. The patient’s clinical symptoms, especially severe pedal edema, improved significantly after video-assisted thoracoscopic surgery with pericardiectomy through the right chest wall. Infrequent instances of recurrent loculated pericardial effusion after pericardiotomy may manifest with atypical symptoms. In addition to echocardiography, chest computed tomography can be used to examine in great detail local lesions caused by postoperative pericardial adhesions or scarring. Video-assisted thoracic surgery improves visualization and effectively treats loculated pericardial effusion during pericardiectomy.
{"title":"A Case Report of Video-assisted Thoracoscopic Pericardiectomy for Postpericardiotomy Recurrent Loculated Pericardial Effusion","authors":"Hao-Wen Chang, Chen-Liang Tsai","doi":"10.4103/jmedsci.jmedsci_2_24","DOIUrl":"https://doi.org/10.4103/jmedsci.jmedsci_2_24","url":null,"abstract":"\u0000 Surgical drainage, particularly pericardiotomy, which has a low recurrence rate, can safely and efficiently treat symptomatic pericardial effusion in patients with cancer. A thoracoscopic video-assisted pericardiectomy is an effective treatment option for rare instances of recurrent localized pericardial effusion. A 63-year-old male presented with a rare form of recurrent pericardial effusion that was initially circumferential, but recurred in a loculated form. On the right side, a loculated pericardial effusion caused right ventricular dysfunction and lower leg edema. The patient’s clinical symptoms, especially severe pedal edema, improved significantly after video-assisted thoracoscopic surgery with pericardiectomy through the right chest wall. Infrequent instances of recurrent loculated pericardial effusion after pericardiotomy may manifest with atypical symptoms. In addition to echocardiography, chest computed tomography can be used to examine in great detail local lesions caused by postoperative pericardial adhesions or scarring. Video-assisted thoracic surgery improves visualization and effectively treats loculated pericardial effusion during pericardiectomy.","PeriodicalId":16486,"journal":{"name":"Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141108887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Urine electrolyte assessment is vital for diagnosing and managing neonatal conditions. However, the challenge of urine collection in neonates has resulted in a lack of standardized urine electrolyte reference values. This study seeks to explore the reference levels and potential trends in serum and urine electrolytes to better understand how the kidneys handle these substances. Healthy neonates were prospectively enrolled following normal births. Using biochemical methods, blood and urine samples were collected and analyzed on the 1st and 5th postnatal days. Statistical analysis was performed using descriptive statistics and the Wilcoxon matched-pairs signed-rank test. This prospective study enrolled 55 healthy neonates. Significant changes in serum electrolyte concentrations were observed between the 1st and 5th days after birth. Notably, sodium, creatinine, urea nitrogen, and uric acid levels decreased, whereas potassium, calcium, and phosphate levels increased. Urine analysis revealed significant increases in the tubular maximum phosphate reabsorption per glomerular filtration rate and decreases in the fractional excretion of potassium and uric acid by Day 5. This study challenges prevailing assumptions about the stability of neonatal urine electrolytes and highlights dynamic changes in the first postnatal week. These insights lay the groundwork for further research into electrolyte disorders in newborns and have potential implications for improving neonatal care practices.
{"title":"Dynamics of Urine Electrolytes in Term Neonates during the 1st Week of Life","authors":"Sheng-Yuan Ho, Kai-Li Wang, Hueng-Chuen Fan, Jhao-Jhuang Ding","doi":"10.4103/jmedsci.jmedsci_8_24","DOIUrl":"https://doi.org/10.4103/jmedsci.jmedsci_8_24","url":null,"abstract":"\u0000 \u0000 \u0000 Urine electrolyte assessment is vital for diagnosing and managing neonatal conditions. However, the challenge of urine collection in neonates has resulted in a lack of standardized urine electrolyte reference values.\u0000 \u0000 \u0000 \u0000 This study seeks to explore the reference levels and potential trends in serum and urine electrolytes to better understand how the kidneys handle these substances.\u0000 \u0000 \u0000 \u0000 Healthy neonates were prospectively enrolled following normal births. Using biochemical methods, blood and urine samples were collected and analyzed on the 1st and 5th postnatal days. Statistical analysis was performed using descriptive statistics and the Wilcoxon matched-pairs signed-rank test.\u0000 \u0000 \u0000 \u0000 This prospective study enrolled 55 healthy neonates. Significant changes in serum electrolyte concentrations were observed between the 1st and 5th days after birth. Notably, sodium, creatinine, urea nitrogen, and uric acid levels decreased, whereas potassium, calcium, and phosphate levels increased. Urine analysis revealed significant increases in the tubular maximum phosphate reabsorption per glomerular filtration rate and decreases in the fractional excretion of potassium and uric acid by Day 5.\u0000 \u0000 \u0000 \u0000 This study challenges prevailing assumptions about the stability of neonatal urine electrolytes and highlights dynamic changes in the first postnatal week. These insights lay the groundwork for further research into electrolyte disorders in newborns and have potential implications for improving neonatal care practices.\u0000","PeriodicalId":16486,"journal":{"name":"Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141109146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-15DOI: 10.4103/jmedsci.jmedsci_4_24
Fu-Yao Xiao, Yi Liu, Yu-Kai Lin, Chia-Kuang Tsai
Autoimmune encephalitis is complex and gradually being recognized. Anti-N-methyl-D-aspartate Receptor (Anti-NMDAR) encephalitis was the most well-known and its unique electroencephalography (EEG) pattern is extreme delta brush (EDB). Anti-Yo encephalitits is far less than common anti-NMDAR encephalitis (anti-NMDARE). A 78-year-old male presented with progressive apathy, hypotension, unsteady gait, and depressed consciousness. EEG revealed an EDB pattern while the serum test was positive for anti-Yo antibodies. The patient then received 10 rounds of plasma exchange, and his blood pressure stability improved. Consequently, urine cytology and abdominal computed tomography revealed atypical cells and linear enhancement in the bladder dome, respectively. However, instead of further pathological confirmation and treatment, the patient’s family requested hospice care. As a result, the patient died of desaturation 7 days later after the withdrawal of ventilatory support. First recognized in 2012, EDB is believed to be specific to NMDARE. However, to date, EDB has not been well described, and no description is available regarding its reactivity. To our knowledge, this is the first case of EDB with anti-Yo encephalitis. Similar to the cases of EDB with anti-NMDARE, our patient did not have satisfied prognosis despite no further investigation and treatment of the possible underlying malignancy. As the prevalence and underlying mechanism of this EEG pattern are unclear, further studies are warranted to identify the potentially similar mechanisms and correlation between anti-NMDAR and anti-Yo encephalitis.
{"title":"Extreme Delta Brush Electroencephalography Pattern in Anti-yo Encephalitis: A Case Report","authors":"Fu-Yao Xiao, Yi Liu, Yu-Kai Lin, Chia-Kuang Tsai","doi":"10.4103/jmedsci.jmedsci_4_24","DOIUrl":"https://doi.org/10.4103/jmedsci.jmedsci_4_24","url":null,"abstract":"\u0000 Autoimmune encephalitis is complex and gradually being recognized. Anti-N-methyl-D-aspartate Receptor (Anti-NMDAR) encephalitis was the most well-known and its unique electroencephalography (EEG) pattern is extreme delta brush (EDB). Anti-Yo encephalitits is far less than common anti-NMDAR encephalitis (anti-NMDARE). A 78-year-old male presented with progressive apathy, hypotension, unsteady gait, and depressed consciousness. EEG revealed an EDB pattern while the serum test was positive for anti-Yo antibodies. The patient then received 10 rounds of plasma exchange, and his blood pressure stability improved. Consequently, urine cytology and abdominal computed tomography revealed atypical cells and linear enhancement in the bladder dome, respectively. However, instead of further pathological confirmation and treatment, the patient’s family requested hospice care. As a result, the patient died of desaturation 7 days later after the withdrawal of ventilatory support. First recognized in 2012, EDB is believed to be specific to NMDARE. However, to date, EDB has not been well described, and no description is available regarding its reactivity. To our knowledge, this is the first case of EDB with anti-Yo encephalitis. Similar to the cases of EDB with anti-NMDARE, our patient did not have satisfied prognosis despite no further investigation and treatment of the possible underlying malignancy. As the prevalence and underlying mechanism of this EEG pattern are unclear, further studies are warranted to identify the potentially similar mechanisms and correlation between anti-NMDAR and anti-Yo encephalitis.","PeriodicalId":16486,"journal":{"name":"Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140973938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-15DOI: 10.4103/jmedsci.jmedsci_35_24
Shih-Syuan Lin, Zhi-Fu Wu, H. Lai
{"title":"An Alternative Way to Manage Intraoperative Tear of Cuff Inflation Line of the Endotracheal Tube during Ophthalmic Surgery","authors":"Shih-Syuan Lin, Zhi-Fu Wu, H. Lai","doi":"10.4103/jmedsci.jmedsci_35_24","DOIUrl":"https://doi.org/10.4103/jmedsci.jmedsci_35_24","url":null,"abstract":"","PeriodicalId":16486,"journal":{"name":"Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140978085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lipopolysaccharide (LPS) injection can lead to depression and mood disorders by reducing tryptophan availability through increased activity of the enzyme indoleamine 2,3-dioxygenase. Tryptophan, sourced from fruits such as pineapple (Ananas cosmosus), is vital for the body, especially the serotonergic system. This study aims to assess how pineapple pulp (PP) counters LPS-induced depressive behaviors in male Wistar rats. The experiment involved force-feeding PP for 28 days before LPS injection (0.5 mg/kg intraperitoneal [i.p.]) in 30 male Wistar rats, divided into five groups. Groups I (normal) and II (LPS control) received 15 ml aquadest/kg/day. Test Groups III, IV, and V were given varied doses of PP; low dose (3.75 ml/kg/day), medium dose (7.5 ml/kg/day), and high dose (15 ml/kg/day). At the study's end, rats underwent the open field test (OFT) and the tail suspension test (TST). In addition, blood and brain samples were analyzed for neuroendocrine markers related to depression. LPS triggers depressive symptoms, as evidenced by increased immobility time in the TST and altered behaviors indicative of anxiety in the OFT, especially in groups not receiving PP. This is followed by decreased serotonin levels in both plasma and brain when compared to groups given PP. In addition, higher corticosterone levels were observed in the LPS group than in the PP-treated group. Administering PP at 7.5 ml/kg/day for 28 days can alleviate the depressive effects induced by LPS injection. PP may have antidepressant properties, potentially by mitigating behaviors leading to depressive symptoms.
{"title":"Pineapple (Ananas comosus) Ameliorates Depressant-like Behaviors in Rats Induced by Lipopolysaccharide","authors":"Herlin Ajeng Nurrahma, A. Meliala, Nura Eky Vikawati, Paramita Narwidina, Irwan Supriyanto","doi":"10.4103/jmedsci.jmedsci_256_23","DOIUrl":"https://doi.org/10.4103/jmedsci.jmedsci_256_23","url":null,"abstract":"\u0000 \u0000 \u0000 Lipopolysaccharide (LPS) injection can lead to depression and mood disorders by reducing tryptophan availability through increased activity of the enzyme indoleamine 2,3-dioxygenase. Tryptophan, sourced from fruits such as pineapple (Ananas cosmosus), is vital for the body, especially the serotonergic system.\u0000 \u0000 \u0000 \u0000 This study aims to assess how pineapple pulp (PP) counters LPS-induced depressive behaviors in male Wistar rats.\u0000 \u0000 \u0000 \u0000 The experiment involved force-feeding PP for 28 days before LPS injection (0.5 mg/kg intraperitoneal [i.p.]) in 30 male Wistar rats, divided into five groups. Groups I (normal) and II (LPS control) received 15 ml aquadest/kg/day. Test Groups III, IV, and V were given varied doses of PP; low dose (3.75 ml/kg/day), medium dose (7.5 ml/kg/day), and high dose (15 ml/kg/day). At the study's end, rats underwent the open field test (OFT) and the tail suspension test (TST). In addition, blood and brain samples were analyzed for neuroendocrine markers related to depression.\u0000 \u0000 \u0000 \u0000 LPS triggers depressive symptoms, as evidenced by increased immobility time in the TST and altered behaviors indicative of anxiety in the OFT, especially in groups not receiving PP. This is followed by decreased serotonin levels in both plasma and brain when compared to groups given PP. In addition, higher corticosterone levels were observed in the LPS group than in the PP-treated group. Administering PP at 7.5 ml/kg/day for 28 days can alleviate the depressive effects induced by LPS injection.\u0000 \u0000 \u0000 \u0000 PP may have antidepressant properties, potentially by mitigating behaviors leading to depressive symptoms.\u0000","PeriodicalId":16486,"journal":{"name":"Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141001711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-22DOI: 10.4103/jmedsci.jmedsci_133_23
Hsing-Wei Yu, G. Liao, Ting-Ying Lee, De-Chuan Chan
Patients with gastric cancer (GC) and malignant ascites (MA) usually have poor outcomes and a high risk of recurrence and mortality, even after curative gastrectomy or chemotherapy. Systemic chemotherapy has been prescribed for patients with GC and MA; however, most of these patients expire within 1 year. To evaluate the outcomes of laparoscopic hyperthermic intraperitoneal chemotherapy (LHIPEC) plus neoadjuvant intraperitoneal and systemic chemotherapy (NIPS) in the outcomes of GC patients with MA. We enrolled 62 patients with GC and MA between January 1, 2016, and March 1, 2021. Four patients were excluded because of extraperitoneal metastasis, and two patients were ineligible. A total of 56 patients underwent biweekly staging laparoscopy and LHIPEC with NIPS. We also performed staging laparoscopy to evaluate the effectiveness of LHIPEC + NIPS. The mean survival time of the 56 patients was 20.8 months. The overall complication rate was 33.93%. After the LHIPEC + NIPS intervention, the peritoneal cancer index score (P < 0.001), ascites volume (P = 0.003), and cytology (P < 0.001) significantly improved compared to before the intervention; quality of life (Eastern Cooperative Oncology Group) was also better than before the intervention (P = 0.002), and no discomfort was noted postintervention. LHIPEC + NIPS is feasible for the treatment of GC with MA and may improve patients’ quality of life.
{"title":"Laparoscopic Hyperthermic Intraperitoneal Chemotherapy plus Neoadjuvant Intraperitoneal and Systemic Chemotherapy for Gastric Cancer with Malignant Ascites","authors":"Hsing-Wei Yu, G. Liao, Ting-Ying Lee, De-Chuan Chan","doi":"10.4103/jmedsci.jmedsci_133_23","DOIUrl":"https://doi.org/10.4103/jmedsci.jmedsci_133_23","url":null,"abstract":"\u0000 \u0000 \u0000 Patients with gastric cancer (GC) and malignant ascites (MA) usually have poor outcomes and a high risk of recurrence and mortality, even after curative gastrectomy or chemotherapy. Systemic chemotherapy has been prescribed for patients with GC and MA; however, most of these patients expire within 1 year.\u0000 \u0000 \u0000 \u0000 To evaluate the outcomes of laparoscopic hyperthermic intraperitoneal chemotherapy (LHIPEC) plus neoadjuvant intraperitoneal and systemic chemotherapy (NIPS) in the outcomes of GC patients with MA.\u0000 \u0000 \u0000 \u0000 We enrolled 62 patients with GC and MA between January 1, 2016, and March 1, 2021. Four patients were excluded because of extraperitoneal metastasis, and two patients were ineligible. A total of 56 patients underwent biweekly staging laparoscopy and LHIPEC with NIPS. We also performed staging laparoscopy to evaluate the effectiveness of LHIPEC + NIPS.\u0000 \u0000 \u0000 \u0000 The mean survival time of the 56 patients was 20.8 months. The overall complication rate was 33.93%. After the LHIPEC + NIPS intervention, the peritoneal cancer index score (P < 0.001), ascites volume (P = 0.003), and cytology (P < 0.001) significantly improved compared to before the intervention; quality of life (Eastern Cooperative Oncology Group) was also better than before the intervention (P = 0.002), and no discomfort was noted postintervention.\u0000 \u0000 \u0000 \u0000 LHIPEC + NIPS is feasible for the treatment of GC with MA and may improve patients’ quality of life.\u0000","PeriodicalId":16486,"journal":{"name":"Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140675117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-17DOI: 10.4103/jmedsci.jmedsci_280_23
Chih-Wei Lin, Kuang-I Cheng, Zhi-Fu Wu
Sedation in patients with morbid obesity undergoing gastrointestinal endoscopy (GIE) frequently causes respiratory depression. Remimazolam, a gamma-aminobutyric acid receptor agonist, is safer than propofol as it has fewer cardiovascular and respiratory adverse effects. We report a case of successful GIE under sedation and analgesia with a combination of remimazolam and remifentanil, respectively, in a patient with morbid obesity experiencing obstructive sleep apnea (OSA). Remimazolam ensured safe sedation, preventing complications such as respiratory depression and hypotension. Dose adjustment of remifentanil can minimize its adverse effects. Therefore, the combination of remimazolam and remifentanil is a promising choice for performing GIE in patients with morbid obesity and OSA.
病态肥胖患者在接受消化道内窥镜检查（GIE）时，镇静剂经常会导致呼吸抑制。雷马唑仑是γ-氨基丁酸受体激动剂，比丙泊酚更安全，因为它对心血管和呼吸系统的不良反应更少。我们报告了一例分别使用雷马唑仑和瑞芬太尼进行镇静和镇痛的 GIE 成功病例，患者患有阻塞性睡眠呼吸暂停 (OSA)，属于病态肥胖。雷美唑仑可确保安全镇静，防止出现呼吸抑制和低血压等并发症。调整瑞芬太尼的剂量可将其不良反应降至最低。因此，在对病态肥胖和OSA患者进行GIE时，联合使用雷美唑仑和瑞芬太尼是一种很有前景的选择。
{"title":"Combination of Remimazolam and Remifentanil for Procedural Sedation and Analgesia in a Patient with Morbid Obesity Undergoing Gastrointestinal Endoscopy under Continuous Positive Airway Pressure: A Case Report","authors":"Chih-Wei Lin, Kuang-I Cheng, Zhi-Fu Wu","doi":"10.4103/jmedsci.jmedsci_280_23","DOIUrl":"https://doi.org/10.4103/jmedsci.jmedsci_280_23","url":null,"abstract":"\u0000 Sedation in patients with morbid obesity undergoing gastrointestinal endoscopy (GIE) frequently causes respiratory depression. Remimazolam, a gamma-aminobutyric acid receptor agonist, is safer than propofol as it has fewer cardiovascular and respiratory adverse effects. We report a case of successful GIE under sedation and analgesia with a combination of remimazolam and remifentanil, respectively, in a patient with morbid obesity experiencing obstructive sleep apnea (OSA). Remimazolam ensured safe sedation, preventing complications such as respiratory depression and hypotension. Dose adjustment of remifentanil can minimize its adverse effects. Therefore, the combination of remimazolam and remifentanil is a promising choice for performing GIE in patients with morbid obesity and OSA.","PeriodicalId":16486,"journal":{"name":"Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140692969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-12DOI: 10.4103/jmedsci.jmedsci_270_23
Yu-Chi Tu, Po-Yang Chen, Kuang-I Cheng, Zhi-Fu Wu
Malignant hyperthermia (MH), a life-threatening complication during general anesthesia, primarily triggers hypermetabolism and skeletal muscle damage. The common MH signs include elevated body temperature, tachycardia, hypercapnia, muscle rigidity, rhabdomyolysis, hyperkalemia, and metabolic acidosis. However, MH-related skin lesions are rarely documented. Here, we present a case of a 3-year-old patient experiencing self-resolving skin rash during an MH episode. A healthy 3-year-old girl underwent strabismus surgery under general anesthesia, displaying the MH episode during the procedure. The significant vital signs included hypercapnia, tachycardia, and hyperthermia, peaking 120 min postinduction. Prompt measures, including sevoflurane discontinuation, hydration, cooling, and alternative anesthesia, swiftly stabilized the patient. Intriguingly, an hour later, an isolated skin rash emerged on the right calf and toes, which gradually resolved without intervention. Postoperative examinations revealed no adverse effects. Despite its rarity, the occurrence of MH-associated skin rashes emphasizes the need for vigilance, especially in pediatric strabismus surgeries, despite minimal documented incidents. In summary, our case highlights the self-limiting nature of MH-related skin rash, occurring post-MH resolution. Its causative mechanisms warrant further investigation. Proactive avoidance of MH trigger agents remains crucial for optimal care during pediatric strabismus surgeries.
{"title":"Self-limiting Skin Rash Found in a Patient with Suspected Malignant Hyperthermia Attack - A Case Report","authors":"Yu-Chi Tu, Po-Yang Chen, Kuang-I Cheng, Zhi-Fu Wu","doi":"10.4103/jmedsci.jmedsci_270_23","DOIUrl":"https://doi.org/10.4103/jmedsci.jmedsci_270_23","url":null,"abstract":"\u0000 Malignant hyperthermia (MH), a life-threatening complication during general anesthesia, primarily triggers hypermetabolism and skeletal muscle damage. The common MH signs include elevated body temperature, tachycardia, hypercapnia, muscle rigidity, rhabdomyolysis, hyperkalemia, and metabolic acidosis. However, MH-related skin lesions are rarely documented. Here, we present a case of a 3-year-old patient experiencing self-resolving skin rash during an MH episode. A healthy 3-year-old girl underwent strabismus surgery under general anesthesia, displaying the MH episode during the procedure. The significant vital signs included hypercapnia, tachycardia, and hyperthermia, peaking 120 min postinduction. Prompt measures, including sevoflurane discontinuation, hydration, cooling, and alternative anesthesia, swiftly stabilized the patient. Intriguingly, an hour later, an isolated skin rash emerged on the right calf and toes, which gradually resolved without intervention. Postoperative examinations revealed no adverse effects. Despite its rarity, the occurrence of MH-associated skin rashes emphasizes the need for vigilance, especially in pediatric strabismus surgeries, despite minimal documented incidents. In summary, our case highlights the self-limiting nature of MH-related skin rash, occurring post-MH resolution. Its causative mechanisms warrant further investigation. Proactive avoidance of MH trigger agents remains crucial for optimal care during pediatric strabismus surgeries.","PeriodicalId":16486,"journal":{"name":"Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140711104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Muhammad Idrees, Muhammad Waqas, M. Rehman, Huma Riaz, Muhammad Ihtesham Khan, Inayatur Rahman
Objectives: To study the changes in red cell indices and counts over a period of 42 days in blood stored in blood bags. Materials and Methods: This research was done in Blood Bank, Khyber Teaching Hospital, Peshawar in collaboration with the main laboratory, Khyber Teaching Hospital, Peshawar. About 450 ml of whole blood was taken from 200 donors into Citrate Phosphate Dextrose Adenine blood bags. The storage temperature for the blood bags was maintained between 2–8°C. Blood samples were collected from blood bags. At days 1 and 42, using a haematology analyser, parameters including haemoglobin, RBC count, WBC count, haematocrit, mean corpuscular volume, mean corpuscular haemoglobin, mean corpuscular haemoglobin concentration and platelet counts were measured. Mean and standard deviation were used for quantitative variables. Frequency and percentages were used for qualitative variables. Results: Through days 1 to 42, Haemoglobin (Hb) level decreased from 13.4gm/dl to 12.78 gm/dl, white cell count (WBC) decreased from 6.03x109/l to 2.95 x109/l, platelets count fell from 207 x109/l to 121 x109/l, neutrophils decreased from 59.6% to 23.8% while lymphocyte count increased from 28.36% to 66.3%. Conclusion: There is a decrease in haemoglobin level and white cell count over a period of 42 days of storage of blood bags. Lymphocyte counts increased during the storage duration of blood bags.
{"title":"DELINEATION OF HEMATOLOGICAL CHANGES OCCURRING IN STORED CITRATE PHOSPHATE DEXTROSE ADENINE CPDA-1 BLOOD","authors":"Muhammad Idrees, Muhammad Waqas, M. Rehman, Huma Riaz, Muhammad Ihtesham Khan, Inayatur Rahman","doi":"10.52764/jms.24.32.1.18","DOIUrl":"https://doi.org/10.52764/jms.24.32.1.18","url":null,"abstract":"Objectives: To study the changes in red cell indices and counts over a period of 42 days in blood stored in blood bags.\u0000Materials and Methods: This research was done in Blood Bank, Khyber Teaching Hospital, Peshawar in collaboration with the main laboratory, Khyber Teaching Hospital, Peshawar. About 450 ml of whole blood was taken from 200 donors into Citrate Phosphate Dextrose Adenine blood bags. The storage temperature for the blood bags was maintained between 2–8°C. Blood samples were collected from blood bags. At days 1 and 42, using a haematology analyser, parameters including haemoglobin, RBC count, WBC count, haematocrit, mean corpuscular volume, mean corpuscular haemoglobin, mean corpuscular haemoglobin concentration and platelet counts were measured. Mean and standard deviation were used for quantitative variables. Frequency and percentages were used for qualitative variables.\u0000Results: Through days 1 to 42, Haemoglobin (Hb) level decreased from 13.4gm/dl to 12.78 gm/dl, white cell count (WBC) decreased from 6.03x109/l to 2.95 x109/l, platelets count fell from 207 x109/l to 121 x109/l, neutrophils decreased from 59.6% to 23.8% while lymphocyte count increased from 28.36% to 66.3%.\u0000Conclusion: There is a decrease in haemoglobin level and white cell count over a period of 42 days of storage of blood bags. Lymphocyte counts increased during the storage duration of blood bags.","PeriodicalId":16486,"journal":{"name":"Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140259226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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