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Primary Orthostatic Tremor in Adolescence 青少年原发性直立性震颤
Pub Date : 2021-12-30 DOI: 10.15746/sms.21.032
Sung Soo Kim
Tremor is an involuntary rhythmic muscle contraction, which causes a regular oscillation of a part of the body. Orthostatic tremor is a rare neurological movement disorder characterized by unsteadiness while standing that is relieved when sitting, walking, or lying down. Neurological examination of primary orthostatic tremor is reported to be normal. The pathophysiological mechanism of this condition is not entirely unknown. Symptoms usually start in the sixth decade. Clonazepam is widely used as a first-line medication in the treatment. A 14-year-old girl patient was admitted due to tremor activated on standing, absent while seated or lying, and improved by walking or leaning. Her brain magnetic resonance imaging and laboratory workup were normal. Tremor completely disappeared with clonazepam in 10 days. I report a case of primary orthostatic tremor in adolescence.
震颤是一种不自觉的有节奏的肌肉收缩,它会引起身体某一部分的有规律的摆动。直立性震颤是一种罕见的神经运动障碍,其特征是站立时不稳定,坐下、行走或躺下时缓解。据报道,原发性直立性震颤的神经学检查正常。这种情况的病理生理机制并非完全未知。症状通常开始于60岁。氯硝西泮被广泛用作治疗的一线药物。一名14岁女孩患者因站立时震颤而入院,坐下或躺着时震颤消失,通过行走或倾斜改善。她的脑磁共振成像和实验室检查正常。服用氯硝西泮后10天震颤完全消失。我报告一例原发性直立性震颤在青春期。
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引用次数: 0
Successful Anesthetic Management of Myotonic Dystrophy Type I Using Sugammadex: A Case Report Sugammadex成功麻醉治疗I型肌强直性营养不良1例
Pub Date : 2021-12-30 DOI: 10.15746/sms.21.031
Suro Kim, H. Chun, J. Chung
Myotonic dystrophy (DM) is an uncommon inherited disease. Anesthesia for DM patients is tough due to its potency of cardiogenic and pulmonary problems, but a series of studies have shown how to manage and avoid complications and situations. We describe a case of a 33-year-old male patient who was scheduled for an elective excision & biopsy on the left axillae for hidradenitis suppurativa with DM type I. Anesthesia was induced and maintained with propofol, remifentanil, and rocuronium. Sugammadex is used as a reversal agent of neuromuscular blockade. He didn’t show myotonia during surgery and emergence. He also didn’t show postoperative pulmonary complications.
肌强直性营养不良(DM)是一种罕见的遗传性疾病。由于糖尿病患者的心源性和肺部问题的效力,麻醉是困难的,但一系列研究已经表明如何管理和避免并发症和情况。我们描述了一例33岁的男性患者,他因DM型化脓性汗腺炎被安排在左腋下进行选择性切除和活检。麻醉由异丙酚、瑞芬太尼和罗库溴铵诱导和维持。Sugammadex被用作神经肌肉阻滞的逆转剂。他在手术和急诊期间没有出现肌强直。他也没有出现术后肺部并发症。
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引用次数: 0
In-Hospital Cardiac Arrest: Patient Characteristics and Factors Influencing Survival and Neurologic Outcomes 院内心脏骤停:患者特征和影响生存和神经预后的因素
Pub Date : 2021-12-30 DOI: 10.15746/sms.21.015
Y. Cho
Objective: We aimed to determine the characteristics of in-hospital cardiac arrest (IHCA) patients, as well as the factors influencing survival to discharge and good neurologic outcome.Methods: We examined patients who experienced IHCA from January 1, 2011, to December 31, 2013, in Soonchunhyang University Seoul Hospital. They were divided into a survival group and non-survival group. The patient characteristics, including age, sex, comorbid disease, arrest time, arrest location, witnessed arrest, monitoring, arrest cause, arrest rhythm, and cardiopulmonary resuscitation (CPR) duration, were compared between the groups. Moreover, we assessed the factors associated with survival to discharge and good neurologic outcomes by using multivariate logistic regression analysis.Results: In total, 453 patients of IHCA were observed. The comorbidities in the survival group included neurologic disease (P < 0.001), arrhythmia (P = 0.001), and myocardial infarction (P = 0.032), pneumonia (P = 0.016). Other characteristics included cardiac arrest at daytime (P = 0.032), cardiogenic arrest cause (P = 0.019), and CPR duration < 15 minutes (P < 0.001). The factors associated with survival to discharge included comorbid neurologic disease (odds ratio [OR], 2.191; P = 0.031), arrhythmia (OR, 3.027; P = 0.009), pneumonia (OR, 3.243; P = 0.002), and CPR duration < 15 minutes (OR, 9.638; P < 0.001). The factors influencing good neurologic outcomes included age < 65 years (OR, 3.158; P = 0.007), comorbid disease as arrhythmia (OR, 4.921; P = 0.001), pneumonia (OR, 4.551; P = 0.001), hypotension (OR, 4.264; P = 0.021), and CPR duration < 15 minutes (OR, 6.652; P = 0.001).Conclusion: The factors influencing survival to discharge and good neurologic outcomes among IHCA patients included comorbidities, arrest cause, and CPR duration.
目的:了解院内心脏骤停(IHCA)患者的特点,以及影响其存活至出院和神经系统预后良好的因素。方法:对2011年1月1日至2013年12月31日在顺天香大学首尔医院发生IHCA的患者进行调查。他们被分为生存组和非生存组。比较两组患者的年龄、性别、合并症、骤停时间、骤停地点、目击骤停、监测、骤停原因、骤停节律、心肺复苏时间等特征。此外,我们通过多变量逻辑回归分析评估了与出院存活率和良好神经系统预后相关的因素。结果:共观察IHCA患者453例。生存组的合并症包括神经系统疾病(P < 0.001)、心律失常(P = 0.001)、心肌梗死(P = 0.032)、肺炎(P = 0.016)。其他特征包括白天心脏骤停(P = 0.032)、心源性骤停原因(P = 0.019)和CPR持续时间< 15分钟(P < 0.001)。与存活至出院相关的因素包括共病性神经系统疾病(优势比[OR], 2.191;P = 0.031),心律失常(OR, 3.027;P = 0.009),肺炎(OR, 3.243;P = 0.002), CPR持续时间< 15分钟(OR, 9.638;P < 0.001)。影响神经系统预后良好的因素包括:年龄< 65岁(OR, 3.158;P = 0.007),合并症为心律失常(OR, 4.921;P = 0.001),肺炎(OR, 4.551;P = 0.001)、低血压(OR, 4.264;P = 0.021), CPR持续时间< 15分钟(OR, 6.652;P = 0.001)。结论:影响IHCA患者存活至出院和神经系统预后良好的因素包括合并症、骤停原因和CPR持续时间。
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引用次数: 0
Three Staged Revision Arthroplasty Using Structural Allograft in Chronic Periprosthetic Joint Infection Accompanied by Fracture: A Case Report 同种异体结构移植治疗慢性假体周围关节感染并骨折1例
Pub Date : 2021-12-30 DOI: 10.15746/sms.21.023
S. Kwon
Revision arthroplasty for chronic periprosthetic joint infection is complex and determined by many variables. Generally, two-staged revision arthroplasty is the standard treatment for the management of chronic periprosthetic joint infection. However, it is difficult to resolve chronic infection accompanied by large bone deficiency due to pathologic fracture. I report a case of successful three-staged revision arthroplasty using frozen structural allograft in chronic periprosthetic knee joint infection accompanied by extensive bone defect due to fracture.
慢性假体周围关节感染的翻修关节置换术是复杂的,由许多变量决定。一般来说,两阶段翻修关节置换术是治疗慢性假体周围关节感染的标准治疗方法。然而,由于病理性骨折导致的慢性感染伴大量骨缺乏是难以解决的。我报告一例使用冷冻同种异体结构移植物成功治疗慢性假体周围膝关节感染伴骨折引起的广泛骨缺损的三期翻修关节置换术。
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引用次数: 0
Regional Anesthesia for Abdominal Surgery in a Patient with Severe Chronic Respiratory Failure: A Case Report 腹部手术区域麻醉治疗严重慢性呼吸衰竭1例报告
Pub Date : 2021-12-30 DOI: 10.15746/sms.21.029
Misoon Lee, Y. Woo, Jaewoong Jung, Y. Chung, B. Koo, S. Cho
General anesthesia is associated with a risk for postoperative pulmonary complications. The risk is even higher in patients with chronic respiratory failure, and postoperative mortality rates are high. Proper perioperative anesthetic management is important in such patients. Therefore, it is essential to optimize the patient’s physical status before anesthesia and to determine the optimal anesthesia technique based on the pre-anesthesia evaluation of the patient’s pulmonary function. We successfully performed abdominal surgery under spinal anesthesia in a patient with severe chronic respiratory failure.
全身麻醉与术后肺部并发症的风险相关。慢性呼吸衰竭患者的风险甚至更高,术后死亡率也很高。适当的围手术期麻醉管理对此类患者非常重要。因此,在麻醉前优化患者的身体状态,并根据麻醉前对患者肺功能的评估来确定最佳的麻醉技术是非常必要的。我们成功地在脊髓麻醉下为一个患有严重慢性呼吸衰竭的病人进行了腹部手术。
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引用次数: 1
A Case Giving Proof of Pathogenesis of Abdominoscrotal Hydrocele: A Case Report 证明腹阴囊积液发病机制的1例报告
Pub Date : 2021-12-30 DOI: 10.15746/sms.21.022
Heejo Yang, M. Son, D. Kim
An abdominoscrotal hydrocele (ASH) is an uncommon condition characterized by cystic mass that occupies the scrotum and abdomen. The characteristic aspect is the presence of two hydrocele sacs in the abdominal cavity and the scrotum, and compression of one side causes enlargement of the other side, thereby connecting the two sacs. There are several hypotheses regarding the occurrence of ASH. However, the evidence of the hypotheses is lacking. The patient was a 52-year-old male. During observation of the right inguinoscrotal hydrocele, the patient complained of a palpable mass lesion on the right lower quadrant of the abdomen. Physical examination revealed ASH that occurred with the growth of the inguinoscrotal hydrocele. This was further confirmed by sequential imaging test thereby proposing the verification of cephalad extension of hydrocele. The surgical excision was recommended and inguinal exploration was performed under general anesthesia. No evidence of relapse was observed during the 2-year follow-up period after surgery. The present case proves the cephalad extension of hydrocele among other hypotheses on the etiology of ASH.
摘要腹膜阴囊积液是一种罕见的疾病,其特征是囊性肿块占据了阴囊和腹部。其特征是在腹腔和阴囊内存在两个鞘膜积液囊,一侧的压迫导致另一侧的增大,从而将两个囊连接起来。关于ASH的发生有几种假设。然而,这些假设缺乏证据。患者为52岁男性。在观察右腹股沟阴囊鞘膜积液时,患者主诉在右下腹可见肿块病变。体格检查显示ASH随腹股沟阴囊积液的增长而发生。序贯影像学检查进一步证实了这一点,从而提出了脑膜积液延伸的验证。建议手术切除,全麻下行腹股沟探查。术后2年随访期间无复发迹象。本病例证明了在ASH病因学的其他假设中,鞘膜积液的头部延伸。
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引用次数: 0
A Mortality Case Caused by Thrombotic Microangiopathy after Successful Bloodless Living Donor Liver Transplantation 无血活体肝移植成功后血栓性微血管病变致死亡1例
Pub Date : 2021-12-30 DOI: 10.15746/sms.21.020
Sun Young Park, H. Cho, Gyu Wan You, K. Kim
Thrombotic microangiopathy (TMA) after solid organ transplantation is infrequent and its etiology remains still unclear. Nevertheless, if early diagnosis and early therapies are not performed, it can lead to severe life-threatening complications and even death. A 54-year-old female (a Jehovah’s Witness) was diagnosed with drug-induced toxic hepatitis and was decided to undergo bloodless living donor liver transplantation (LDLT). After the successful LDLT, the patient’s condition deteriorated, and she was diagnosed with TMA during further evaluation. We tried to proceed with plasma exchange-based treatment, but she and her family declined according to their religious beliefs. The patient expired 4 days after the diagnosis. Physicians should maintain a high level of suspicion for TMA after liver transplantation when clinical manifestations are observed.
实体器官移植后的血栓性微血管病(TMA)并不常见,其病因尚不清楚。然而,如果不进行早期诊断和早期治疗,它可能导致严重的危及生命的并发症,甚至死亡。一名54岁的女性(耶和华见证人)被诊断患有药物性中毒性肝炎,并决定接受无血活体肝移植(LDLT)。LDLT成功后,患者病情恶化,在进一步评估时被诊断为TMA。我们试图继续进行血浆交换治疗,但她和她的家人基于宗教信仰拒绝了。患者在确诊后4天死亡。当观察到肝移植术后的临床表现时,医生应保持对TMA的高度怀疑。
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引用次数: 0
Torsion of a Wandering Spleen Treated by Laparoscopic Surgery: A Case Report 腹腔镜手术治疗游离脾扭转1例
Pub Date : 2021-12-30 DOI: 10.15746/sms.21.028
I. Cho
The spleen is an organ located in the upper left portion of the abdomen. Wandering spleen is defined as the location of the spleen is the shift to other parts of the abdomen rather than the left upper quadrant. Wandering spleen is a rare clinical condition and can lead to hilar torsion and subsequent infarction requiring emergency surgery. The author presents a case of torsion of a wandering spleen in a 34-year-old female presenting with abdominal pain. The patients underwent emergent laparoscopic splenectomy. She had an uncomplicated postoperative course and recovered well.
脾脏是位于腹部左上方的一个器官。游走脾的定义是脾的位置是向腹部其他部位而不是左上象限移动。游离脾是一种罕见的临床疾病,可导致肝门扭转和随后的梗塞,需要紧急手术。作者提出了一个病例的扭转游离脾在一个34岁的女性表现为腹痛。患者接受急诊腹腔镜脾切除术。术后过程简单,恢复良好。
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引用次数: 0
Analysis of Clinicopathological Features and Risk Factors for Severe Complications after Gastrectomy for Gastric Cancer in Elderly Patients 老年胃癌患者胃切除术后严重并发症的临床病理特征及危险因素分析
Pub Date : 2021-12-30 DOI: 10.15746/sms.21.018
F. Zhao, In Cho
Objective: As life expectancy is increasing, the number and proportion of elderly patients with gastric cancer are also expanded. This study aimed to investigate the clinicopathological features for elderly gastric cancer patients undergoing gastrectomy and analyze risk factors for developing severe complications.Methods: A total of 514 patients treated surgically for gastric cancer between January 2016 and December 2019 were enrolled in this retrospective study. Patients were divided into two groups: younger group ( ≤ 69 years) and elderly group ( ≥ 70 years). Clinicopathological characteristics and operative outcomes including the complications and mortality were compared between two groups. Risk factors for severe complications in elderly gastric cancer patients were also investigated.Results: Of the 514 patients, 145 (28.2%) were elderly group. Comorbidity (P < 0.001), differentiated histology (P = -0.006), deeper in tumor depth (P = 0.012), and frequent lymph node metastasis (P = 0.028) were observed in elderly group. Overall complications (P = 0.046) and severe complications (P = 0.049) were significantly higher in elderly group. Multivariate analysis indicated that extent of resection (P = 0.044) was associated with severe complications in elderly gastric cancer patients.Conclusion: Elderly patients have a significantly higher probability of complications and severe complications than younger patients after gastrectomy for gastric cancer. Especially, when total gastrectomy was performed in elderly gastric cancer patients, the risk of developing serious complications was significantly higher more than 3 times. Therefore, surgeons should pay attention to gastric cancer patients over the age of 70 who require total gastrectomy.
目的:随着预期寿命的增加,老年胃癌患者的数量和比例也在不断扩大。本研究旨在探讨老年胃癌患者行胃切除术的临床病理特点,并分析发生严重并发症的危险因素。方法:2016年1月至2019年12月,514例接受手术治疗的胃癌患者被纳入回顾性研究。患者分为两组:年轻组(≤69岁)和老年组(≥70岁)。比较两组患者的临床病理特点和手术结果,包括并发症和死亡率。并对老年胃癌患者严重并发症的危险因素进行了调查。结果:514例患者中,老年组145例(28.2%)。老年组共病(P < 0.001)、组织学分化(P = -0.006)、肿瘤深度加深(P = 0.012)、淋巴结转移频繁(P = 0.028)。老年组总并发症(P = 0.046)和严重并发症(P = 0.049)明显高于老年组。多因素分析显示,老年胃癌患者的严重并发症与切除程度(P = 0.044)有关。结论:老年患者胃癌切除术后出现并发症和严重并发症的概率明显高于年轻患者。特别是老年胃癌患者行全胃切除术时,发生严重并发症的风险明显高于3倍以上。因此,外科医生应重视70岁以上需要全胃切除术的胃癌患者。
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引用次数: 0
Clinical Outcomes of Operative Repair for Patients Who Fail to Conserve the Complete Rupture of the Collateral Ligament in the Proximal Interphalangeal Joint 近端指间关节副韧带完全断裂未能保存的手术修复的临床效果
Pub Date : 2021-12-30 DOI: 10.15746/sms.21.019
Young Hwan Kim
Objective: The purpose of this study was to compare the preoperative and postoperative outcomes of surgical treatment for patients who fail to conserve the complete rupture of the collateral ligament in the proximal interphalangeal (PIP) joint.Methods: A complete rupture of the collateral ligament was confirmed by a radiologist using ultrasound or magnetic resonance imaging for patients who had symptoms after 4 weeks of conservative treatment. Eleven patients underwent operative collateral ligament repair using an anchor. All patient was followed up for at least 6 months postoperatively. We evaluated clinical outcomes preoperatively and at 6 months follow-up: (1) range of motion of the PIP, (2) joint stability, (3) Visual Analog Scale score, (4) fusiform index of the PIP joint, and (5) functional & cosmetic satisfaction.Results: There was no instability in the lateral stress test at 6-month follow-up. The ranges of motion of the PIP were not statistically different between preoperative and at 6-month follow-up. Patients had less pain but the cosmetic appearance of the PIP joint did not improve. Functional satisfaction differed statistically, but there was no difference in cosmetic satisfaction.Conclusion: Surgical treatment for patients who fail to conserve the complete rupture of the collateral ligament in the PIP joint can provide good joint stability, functional recovery.
目的:本研究的目的是比较手术治疗未能保存近端指间关节(PIP)副韧带完全断裂的患者的术前和术后结果。方法:对保守治疗4周后出现症状的患者,由放射科医师用超声或磁共振成像确诊为副韧带完全断裂。11例患者行手术侧副韧带固定修复术。所有患者术后随访至少6个月。我们评估了术前和随访6个月的临床结果:(1)PIP的活动范围,(2)关节稳定性,(3)视觉模拟量表评分,(4)PIP关节的梭状指数,(5)功能和美容满意度。结果:随访6个月,侧应力试验无不稳定性。术前和6个月随访时,PIP的活动范围无统计学差异。患者疼痛减轻,但PIP关节的外观没有改善。功能满意度有统计学差异,但外观满意度无统计学差异。结论:手术治疗PIP关节副韧带完全断裂未能保存的患者可提供良好的关节稳定性和功能恢复。
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引用次数: 0
期刊
Soonchunhyang Medical Science
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