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Computed Tomography and Magnetic Resonance Imaging Features of a Huge Cavernous Hemangioma in the Pleural Space: A Case Report 胸膜间隙巨大海绵状血管瘤的计算机断层和磁共振成像特征:1例报告
Pub Date : 2022-12-30 DOI: 10.15746/sms.22.031
Kyung Eun Shin, Susie Chin
A 44-year-old male with a huge left pleural mass was admitted due to chest discomfort. Chest computed tomography showed a large pleural mass with punctate calcification and serpentine-shaped enhancement in the left pleural space. Magnetic resonance imaging showed markedly high signal intensity with septa on fat-suppressed T2-weighted imaging (WI) and gradual peripheral delayed enhancement on dynamic-enhancing T1-WI. With hemangioma as the suspected diagnosis, the entire mass was surgically removed carefully and the final histopathological diagnosis was confirmed to be a cavernous hemangioma. Cavernous hemangioma of the pleural space is a rare benign vascular tumor. Precise radiologic diagnosis is important before the surgical operation of hemangiomas because of risk of massive hemorrhage requiring meticulous bleeding control.
一名44岁男性,左胸膜巨大肿块,因胸部不适入院。胸部计算机断层扫描显示左侧胸膜间隙有一巨大胸膜肿块伴点状钙化及蛇形强化。磁共振成像显示脂肪抑制型t2加权成像(WI)呈明显高信号强度伴间隔,动态增强型T1-WI呈渐进式外周延迟强化。怀疑诊断为血管瘤,仔细手术切除整个肿块,最终病理诊断为海绵状血管瘤。摘要胸膜腔海绵状血管瘤是一种罕见的良性血管瘤。由于血管瘤有大出血的危险,需要细致的出血控制,因此在手术前精确的影像学诊断是很重要的。
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引用次数: 0
A Retrospective Analysis of Bone Marrow Examination Results from a Single Center Institution: In What Situations Is Bone Marrow Examination Helpful? 单中心机构骨髓检查结果的回顾性分析:在什么情况下骨髓检查是有用的?
Pub Date : 2022-12-30 DOI: 10.15746/sms.22.019
Young-kyu Lee, Min Jung Kim, M. Lee, Kyoungha Kim, N. Lee, J. Won, S. Yoon
Objective: Bone marrow (BM) examinations are performed to evaluate hematological abnormalities. Focusing on patients with cytopenia, we aimed to determine the circumstances under which a BM examination can assist in the diagnosis of hematologic diseases.Methods: The medical records of 738 patients who underwent BM examination from March 2011 to March 2019 at Soonchunhyang University Seoul Hospital were reviewed. In total, 234 patients underwent a BM examination to identify the cause of cytopenia. Excluded from the analysis were BM examinations performed to diagnose specific diseases and evaluate disease status.Results: Results suggesting suboptimal outcome (n=6) or BM invasion of solid tumors (n=13) were excluded. Immune thrombocytopenic purpura patients (n=52) with normal BM examination results were also excluded. One hundred sixty-three patients who underwent BM examination to determine the cause of cytopenia were included in the analysis. A comparison of non-specific results (n=56) to those pointing to an underlying hematologic disease (n=107) showed that patients with severe neutropenia or severe thrombocytopenia were more likely to be diagnosed with a hematologic disease. Specifically, as the number of severe cytopenias increased, the likelihood of a hematologic disease diagnosis was significantly augmented. Patients with end-stage renal disease, autoimmune disease, or liver cirrhosis were more likely to receive non-specific results.Conclusion: In conclusion, seeking the underlying disease or drug should be a primary target for patients with cytopenia. In cases of severe cytopenia in more than one lineage, BM examination should be strongly considered to diagnose an underlying hematologic disease.
目的:骨髓(BM)检查评估血液学异常。以细胞减少症患者为研究对象,我们旨在确定在何种情况下BM检查可以帮助诊断血液病。方法:回顾2011年3月至2019年3月在顺天香大学首尔医院接受BM检查的738例患者的病历。总共有234例患者接受了BM检查以确定细胞减少的原因。排除了诊断特定疾病和评估疾病状态的BM检查。结果:排除亚理想预后(n=6)或BM侵袭实体瘤(n=13)的结果。排除了BM检查结果正常的免疫性血小板减少性紫癜患者(n=52)。163例患者接受了BM检查以确定细胞减少的原因。非特异性结果(n=56)与指向潜在血液病的结果(n=107)的比较显示,严重中性粒细胞减少症或严重血小板减少症患者更有可能被诊断为血液病。具体来说,随着严重细胞减少的数量增加,血液病诊断的可能性显著增加。终末期肾病、自身免疫性疾病或肝硬化患者更有可能获得非特异性结果。结论:寻找潜在疾病或药物应是治疗细胞减少患者的首要目标。在超过一个谱系的严重细胞减少病例中,应强烈考虑BM检查来诊断潜在的血液学疾病。
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引用次数: 2
A Case of Hyperinsulinemic Hypoglycemia in Premature Infant Treated with Oral Diazoxide 口服二氮氧化物治疗早产儿高胰岛素血症性低血糖1例
Pub Date : 2022-12-30 DOI: 10.15746/sms.22.028
Jeong Eun Pyeon, H. Jeong, J. Koh
Neonatal hyperinsulinism, whether permanent or transient, results in prolonged hypoglycemia, which increases the risk of hypoglycemic brain injury. Therefore, prompt diagnosis and management of hyperinsulinemic hypoglycemia is important. Drawing a “critical sample” at the time of hypoglycemia is useful for diagnosis. Genetic testing for defective insulin-regulating genes in pancreatic beta-cells might also be helpful in cases of prolonged hypoglycemia. High-calorie feeding or glucose infusion is necessary to maintain normoglycemia. Diazoxide is the treatment of choice for hyperinsulinism and should be continued until the hypoglycemia resolves. We describe a case of transient neonatal hyperinsulinemia hypoglycemia in a small-for-gestational-age preterm infant who underwent diazoxide treatment and achieved a favorable outcome.
新生儿高胰岛素血症,无论是永久性的还是短暂的,都会导致长期的低血糖,从而增加低血糖性脑损伤的风险。因此,及时诊断和治疗高胰岛素性低血糖是很重要的。在低血糖时抽取“临界样本”对诊断是有用的。对胰腺β细胞中有缺陷的胰岛素调节基因进行基因检测,可能对长期低血糖也有帮助。高热量喂养或葡萄糖输注是维持正常血糖的必要条件。二氮氧化合物是治疗高胰岛素血症的首选药物,应持续使用直至低血糖消退。我们描述了一个病例的短暂新生儿高胰岛素血症低血糖在小胎龄早产儿谁接受了二氮氧化合物治疗,并取得了良好的结果。
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引用次数: 0
Possible Association between Differences in Nasalance Scores and Early Spread of COVID-19 Based on Linguistic Analysis 基于语言分析的Nasalance评分差异与COVID-19早期传播的可能关联
Pub Date : 2022-12-30 DOI: 10.15746/sms.22.020
Kong-Geun Lee, S. Shim, Jae Heon Kim
Objective: The World Health Organization (WHO) declared a pandemic on March 11, 2020 after more than 118,000 cases of coronavirus disease 2019 (COVID-19) had been reported in 114 countries. Our study analyzed the cumulative incidence rate based on WHO data starting with the first confirmed patient until the peak of transmission. In addition, the numerical values of nasometry from normal subjects were quantified to analyze the linguistic features.Methods: This study consisted of two main methodologies including a meta-analysis based on nasometry data involving normal adults and cumulative incidence rate based on WHO data. In addition, the numerical values of nasometry from normal subjects were quantified to analyze the linguistic features.Results: The pooled overall mean differences (MDs) for oral text nasalance among linguistic families were 14.655 (95% confidence interval [CI], 7.986–21.324) in Arabic, 24.441 (95% CI, 17.920–30.962) in Chinese, 14.964 (95% CI, 13.677–16.251) in European, and 11.437 (95% CI, 9.880–12.994) in Ural-Altaic. The pooled overall MDs for cumulative incidence rate of COVID-19 were 190.3 (95% CI, 56.10–324.60) in Arabic, 283.20 (95% CI, 1.80–564.60) in European, and 5.70 (95% CI, 4.90–6.60) in Ural-Altaic. Correlation between oral nasalance score and cumulative incidence was significant (P=0.0004).Conclusion: Our study showed the possible association between language characteristics and early spread of COVID-19. Further studies are needed to validate our outcomes based on various epidemiologic and behavioral factors including mask wearing.
2020年3月11日,在114个国家报告了超过11.8万例2019冠状病毒病(COVID-19)病例后,世界卫生组织(世卫组织)宣布全球大流行。我们的研究根据世卫组织数据分析了从第一位确诊患者开始直至传播高峰的累积发病率。此外,对正常受试者的鼻测量值进行量化,分析其语言特征。方法:本研究包括两种主要方法,一种是基于正常成人鼻测量数据的荟萃分析,另一种是基于世卫组织数据的累积发病率。此外,对正常受试者的鼻测量值进行量化,分析其语言特征。结果:语族间口语文本鼻音平衡的总平均差异(MDs)为阿拉伯语14.655(95%可信区间[CI], 7.986-21.324),汉语24.441 (95% CI, 17.920-30.962),欧洲语系14.964 (95% CI, 13.677-16.251),乌拉尔-阿尔泰语系11.437 (95% CI, 9.88 - 12.994)。COVID-19累积发病率的总MDs在阿拉伯地区为190.3 (95% CI, 56.10-324.60),欧洲地区为283.20 (95% CI, 1.80-564.60),乌拉尔-阿尔泰地区为5.70 (95% CI, 4.90-6.60)。口腔鼻翼平衡评分与累计发病率有显著相关性(P=0.0004)。结论:我们的研究显示语言特征与COVID-19的早期传播可能存在关联。需要进一步的研究来验证我们基于各种流行病学和行为因素(包括戴口罩)的结果。
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引用次数: 0
Ultrasound-Guided Nerve Hydrodissection for Neuropathic-Like Pain Arising from Hemodialysis: A Case Report 超声引导下神经水解剖治疗血液透析引起的神经性疼痛1例
Pub Date : 2022-12-30 DOI: 10.15746/sms.22.032
Mungyu Kim, Y. Jang, Keun Her, Chang Bong Lee
Peripheral neuropathy is very common in patients with chronic renal failure. The pain arising from hemodialysis can be caused by vascular problems (such as vascular stenosis and steal syndrome) and neuropathy. Hemodialysis patients who need to be dialyzed three times a week should not be told to endure worsening pain every time they are dialyzed. We report that the pain arising from hemodialysis in the lower arm was a concern due to the nerve entrapment in the axillary area, and it was successfully controlled with ultrasound-guided nerve hydrodissection.
周围神经病变在慢性肾功能衰竭患者中非常常见。血液透析引起的疼痛可由血管问题(如血管狭窄和血管偷窃综合征)和神经病变引起。每周需要透析三次的血液透析患者不应该被告知每次透析都要忍受加重的疼痛。我们报告,由于腋窝区域的神经卡压,下臂血液透析引起的疼痛是一个值得关注的问题,并通过超声引导下的神经水解剖成功地控制了疼痛。
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引用次数: 0
Early Postoperative Pulmonary Edema Attributable to Reverse Stress-Induced Cardiomyopathy in a Recently Infected COVID-19 Patient: A Case Report 1例新近感染COVID-19患者可逆应激性心肌病术后早期肺水肿
Pub Date : 2022-12-30 DOI: 10.15746/sms.22.023
J. Yoo
The coronavirus disease 2019 (COVID-19) pandemic has increased the incidence of stress-induced cardiomyopathy (SICMP). A 33-year-old woman without any notable medical history underwent an emergency operation to treat a ruptured ectopic pregnancy. She entered hemorrhagic shock attributable to massive bleeding of the ruptured ectopic sac, followed by rapid transfusion and hydration, and vasopressor therapy. Her COVID-19 rapid antigen test was negative before surgery. After surgery, her vital signs were stable and she was mentally alert. However, about 1 hour later, she developed pulmonary edema, was re-intubated, and was admitted to the intensive care unit. There, echocardiography revealed reverse SICMP, and a COVID-19 polymerase chain reaction test was positive. She recovered well on conservative treatment. After 9 days, her echocardiography profile was normal and she was discharged without any cardiac symptoms or complications. Anesthesiologists should be aware that COVID-19-infected patients may develop postoperative SICMP.
2019冠状病毒病(COVID-19)大流行增加了应激性心肌病(SICMP)的发病率。一位33岁无明显病史的妇女因异位妊娠破裂接受紧急手术治疗。她进入失血性休克,归因于破裂的异位囊大量出血,随后迅速输血和水合,血管加压治疗。术前COVID-19快速抗原检测呈阴性。手术后,她的生命体征稳定,精神清醒。然而,大约1小时后,她出现肺水肿,再次插管,并住进重症监护室。在那里,超声心动图显示SICMP逆转,COVID-19聚合酶链反应试验呈阳性。经保守治疗,她恢复得很好。9天后,她的超声心动图显示正常,出院时没有任何心脏症状或并发症。麻醉师应该意识到covid -19感染的患者可能会在术后发生SICMP。
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引用次数: 0
Difficult Airway and Failed Tracheal Intubation in a Patient with Mucopolaysaccharidoses Type II: A Case Report II型粘多糖中毒患者气道困难和气管插管失败1例报告
Pub Date : 2022-06-30 DOI: 10.15746/sms.22.015
A. Cho, B. Koo, Y. Chung, Misoon Lee, Jaewoong Jung, Eun Young Ko, Seri Park, Jihun Yu
Mucopolysaccharidoses are rare lysosomal storage diseases resulting from defects in lysosomal enzymes involved in degradation of glycosaminoglycans. Different mucopolysaccharidoses are caused by different enzyme deficiencies The anesthetic complications are related to the organs involved. Patients with mucopolysaccharidoses are rare, and few anesthetists encounter such patients. We experienced a case of mucopolysaccharidoses type II. Several endotracheal intubation attempts were tried, but we experienced failed endotracheal intubation. And we decided to proceed with surgery under bag-mask ventilation because of the short operation time. There’s no desaturation time. And the patient’s spontaneous ventilation was recovered and awakened. We have also briefly discussed the pathophysiology, clinical features, and possible airway management options for patients with mucopolysaccharidoses type II.
粘多糖病是一种罕见的溶酶体贮积病,是由参与糖胺聚糖降解的溶酶体酶缺陷引起的。不同的粘多糖病是由不同的酶缺乏引起的,麻醉并发症与受累器官有关。粘多糖病是罕见的,很少有麻醉师遇到这样的病人。我们有一例II型粘多糖病。我们尝试了几次气管插管,但我们经历了气管插管失败。由于手术时间短,我们决定在气囊面罩通气下进行手术。没有饱和时间。患者的自主呼吸功能恢复并苏醒。我们还简要讨论了II型粘多糖病患者的病理生理学、临床特征和可能的气道管理选择。
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引用次数: 0
Comparative Efficacy of Mechanical Patient-Controlled Analgesia Pump Operated in Patient Optimizing Background Infusion Mode and Conventional Nonmechanical Pump after Laparoscopic Surgery 腹腔镜术后患者自控机械式镇痛泵与传统非机械式镇痛泵在患者优化背景输注模式下的疗效比较
Pub Date : 2022-06-30 DOI: 10.15746/sms.22.002
N. Kim, Sul Ki Park
Objective: The aim of this study was to evaluate the efficacy and side effects of the mechanical patient-controlled analgesia (PCA), pumps operated in patient optimizing background infusion (POBI) mode, compared with the conventional nonmechanical PCA after laparoscopic gynecologic surgery.Methods: In total, 211 patients were randomized to nonmechanical pump (n=106, group A) or mechanical pump (n=105, group P) postoperative pain treatment groups. A single blinded observer evaluated and recorded postoperative nausea and vomiting (PONV) score as well as the background infusion rate, Numeric Rating Scale (NRS), use of an additional antiemetic or analgesic, degree of sedation, and other side effects at 30 minutes, 2 hours, 8 hours, and 24 hours postoperatively. The degree of patient satisfaction was evaluated at 2 and 24 hours postoperatively.Results: There was no significant difference in the overall NRS score between the two groups. However, the use of rescue analgesics was significantly higher in group A (P=0.007). The incidence of PONV did not significantly differ between the two groups at 0.5 hours postoperatively; however, at 2 hours, it was significantly higher in group P than in group A (P=0.003). In contrast, the incidence of PONV was significantly lower in group P than in group A at 24 hours postoperatively (P=0.033). No significant group difference was observed in patient satisfaction.Conclusion: With an appropriate waiting time, a mechanical pump operating in POBI mode could be an effective PCA pump to reduce postoperative pain and side effects.
目的:本研究的目的是评价在患者优化背景输注(POBI)模式下运行的机械患者自控镇痛(PCA)泵与常规非机械PCA在腹腔镜妇科手术后的疗效和副作用。方法:211例患者随机分为非机械泵组(n=106, A组)和机械泵组(n=105, P组)。在术后30分钟、2小时、8小时和24小时,单盲观察者评估并记录术后恶心和呕吐(PONV)评分以及背景输注速率、数字评定量表(NRS)、额外止吐或镇痛药的使用、镇静程度和其他副作用。分别于术后2小时和24小时对患者满意度进行评估。结果:两组患者NRS总分差异无统计学意义。而A组的镇痛药物使用率明显高于对照组(P=0.007)。术后0.5 h,两组间PONV的发生率无显著差异;但在2 h时,P组明显高于A组(P=0.003)。P组术后24小时PONV发生率明显低于A组(P=0.033)。两组患者满意度无显著差异。结论:在适当的等待时间下,机械泵在POBI模式下工作可以成为有效的PCA泵,减少术后疼痛和副作用。
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引用次数: 0
Idiopathic Omental Infarction to Be a Rare Cause of Acute Abdomen: A Case Report 特发性大网膜梗死是一种罕见的急腹症:1例报告
Pub Date : 2022-06-30 DOI: 10.15746/sms.22.009
G. Song
Omental infarction is a rare entity, representing hemorrhagic omental necrosis as a result of impaired omental perfusion. It can occur secondary to omental torsion or to inflammatory and neoplastic infiltration of the omental segment from adjacent organs. If the foregoing reasons can be excluded, omental infarction is called primary or idiopathic omental infarction. Occlusions of small omental arteries are rare and may be found in patients with thromboembolic disease, arteriolosclerosis, arteritis, or amyloidosis. The author presents a case of idiopathic omental infarction in a 66-year-old male presenting with abdominal pain. The patients underwent an emergent operation and recovered without any complication after surgery.
大网膜梗死是一种罕见的疾病,是由于大网膜灌注受损而导致出血性大网膜坏死。它可继发于网膜扭转或邻近器官对网膜节段的炎症和肿瘤浸润。如能排除上述原因,则称为原发性或特发性大网膜梗死。小网膜动脉闭塞是罕见的,可能在血栓栓塞性疾病、小动脉硬化、动脉炎或淀粉样变患者中发现。作者提出了一个特发性大网膜梗死的情况下,在一个66岁的男性表现为腹痛。患者接受紧急手术,术后恢复无并发症。
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引用次数: 0
Survey and Proposal of Critical Value Reporting and Management in Clinical Chemistry 临床化学关键值报告与管理的调查与建议
Pub Date : 2022-06-30 DOI: 10.15746/sms.22.004
Y. A. Yoon
Objective: It is one of the major functions of the clinical laboratory to clearly, accurately, and quickly communicate critical values directly to the patient care providers. Laboratory professionals are often confronted with many obstacles in critical value reporting, including establishing critical values, notifying the critical values to provider, and ensuring that the provider understands the severity of a critical result.Methods: A total of 30 laboratory directors voluntarily answered the questionnaire by e-mail. The questionnaire covered demographic characteristics, establishing and updating critical values lists in clinical chemistry, thresholds of critical values, appropriate timeframes for critical results, notification process, and so on.Results: Of the 30 participating institutions, 12 were general hospitals, three were commercial laboratories, and 15 were tertiary hospitals. The tests included in critical value lists are as follows in order of frequency: potassium, glucose, sodium, total calcium, chloride, ionized calcium, creatinine, magnesium, total bilirubin, phosphorus, pH, and so on. Ten of the 30 institutions notified critical value reports to the patient care providers within 1 hour.Conclusion: This study presents the status of critical value reporting policy in Korean hospitals and a literature review on critical value reporting. In addition, this article provides core components and current regulatory requirements for critical value reporting. Critical value reporting systems should be approved, reviewed, and revised periodically.
目的:清晰、准确、快速地将关键值直接传达给患者护理提供者是临床实验室的主要职能之一。实验室专业人员在报告临界值时经常面临许多障碍,包括建立临界值,通知临界值给供应商,并确保供应商理解临界结果的严重性。方法:30名实验室主任自愿通过电子邮件填写问卷。调查问卷涵盖了人口学特征、建立和更新临床化学的关键值列表、临界值的阈值、关键结果的适当时间框架、通知过程等。结果:30家参与机构中,综合医院12家,商业实验室3家,三级医院15家。临界值列表中包括的试验按频率顺序如下:钾、葡萄糖、钠、总钙、氯化物、离子钙、肌酐、镁、总胆红素、磷、pH等。30家机构中有10家在1小时内向患者护理提供者通报了临界值报告。结论:本研究介绍了韩国医院临界价值报告政策的现状,并对临界价值报告的文献进行了综述。此外,本文还提供了关键值报告的核心组件和当前法规要求。应定期批准、评审和修订临界值报告系统。
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引用次数: 0
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Soonchunhyang Medical Science
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