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Fixed Pupillary Light Reflex due to Peripheral Neuropathy after Liver Transplantation 肝移植后周围神经病变引起的固定瞳孔光反射
Pub Date : 2015-08-31 DOI: 10.4266/KJCCM.2015.30.3.191
Kwan Hyung Kim, Namo Kim, S. Na, Jaewon Jang, Jeongmin Kim
A 46year-old female patient was admitted to the intensive care unit (ICU) after liver transplantation. About an hour later after the ICU admission, she had no pupillary light reflex. Both pupils were also fixed at 5 mm. Patients who undergo liver transplantation are susceptible to neurologic disorders including hepatic encephalopathy, thromboembolism and intracranial hemorrhage. Abnormal pupillary light reflex usually indicates a serious neurologic emergency in these patients; however, benign neurologic disorders such as peripheral autonomic neuropathy or Holmes-Adie syndrome should also be considered. We experienced a case of fixed pupillary light reflex after liver transplantation diagnosed as peripheral autonomic neuropathy.
46岁女性患者肝移植后入住重症监护病房(ICU)。入ICU约1小时后,瞳孔光反射消失。两个瞳孔也固定在5毫米。肝移植患者易发生肝性脑病、血栓栓塞和颅内出血等神经系统疾病。瞳孔光反射异常通常表明这些患者有严重的神经系统急症;然而,良性神经系统疾病,如周围自主神经病变或霍姆斯-阿迪综合征也应考虑。我们报告一例肝移植术后瞳孔光反射固定,诊断为周围自主神经病变。
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引用次数: 0
Refractory Septic Shock Treated with Nephrectomy under the Support of Extracorporeal Membrane Oxygenation 体外膜氧合支持下肾切除术治疗顽固性感染性休克
Pub Date : 2015-08-31 DOI: 10.4266/KJCCM.2015.30.3.176
Young Kun Lee, J. Ryu, Jeong Hoon Yang, C. Park, G. Suh, K. Jeon, C. Chung
Conventional medical therapies have not been very successful in treating adults with refractory septic shock. The effects of direct hemoperfusion using polymyxin B and veno-arterial extracorporeal membrane oxygenation (ECMO) for refractory septic shock remain uncertain. A 66-year-old man was admitted to the emergency department and suffered from sepsis-induced hemodynamic collapse. For hemodynamic improvement, we performed direct hemoperfusion using polymyxin B. Computed tomography scan of this patient revealed emphysematous pyelonephritis (EPN), for which he underwent emergent nephrectomy with veno-arterial ECMO support. To the best of our knowledge, this is the first report of successful treatment of EPN with refractory septic shock using polymyxin B hemoperfusion and nephrectomy under the support of ECMO.
传统医学疗法在治疗成人难治性感染性休克方面并不十分成功。多粘菌素B直接血液灌流和静脉-动脉体外膜氧合(ECMO)治疗难治性脓毒性休克的效果尚不明确。一名66岁男性因败血症引起的血流动力学衰竭而入院急诊科。为了改善血流动力学,我们使用多粘菌素b进行了直接血液灌流,该患者的计算机断层扫描显示肺气肿性肾盂肾炎(EPN),因此他在静脉-动脉ECMO支持下进行了紧急肾切除术。据我们所知,这是首个在ECMO支持下应用多粘菌素B血液灌流和肾切除术成功治疗EPN合并难治性脓毒性休克的报道。
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引用次数: 1
Successful Immunoglobulin Treatment in Severe Cryptogenic Organizing Pneumonia Caused by Dermatomyositis 免疫球蛋白成功治疗皮肌炎引起的严重隐源性组织性肺炎
Pub Date : 2015-08-31 DOI: 10.4266/KJCCM.2015.30.3.212
Dong Hoon Lee, J. H. Yeo, Youngil Kim, Seungjun Gim, J. Sohn, J. Yhi
In connective tissue diseases, autoantibodies cause pulmonary interstitial inflammation and fibrosis, and patients require treatment with an immunosuppressive agent such as a steroid. Dermatomyositis is an incurable, uncommon form of connective tissue disease that occasionally causes diffuse pulmonary inflammation leading to acute severe respiratory failure. In such cases, the prognosis is very poor despite treatment with high-dose steroid. In the present case, a 46-year-old man was admitted to our hospital with dyspnea. He was diagnosed with dermatomyositis combined with cryptogenic organizing pneumonia (COP) with respiratory failure and underwent treatment with steroid and an immunosuppressive agent, but the COP was not improved. However, the respiratory failure did improve after treatment with intravenous immunoglobulin, which therefore can be considered a treatment option in cases where steroids and immunosuppressive agents are ineffective.
在结缔组织疾病中,自身抗体引起肺间质炎症和纤维化,患者需要使用免疫抑制剂如类固醇治疗。皮肌炎是一种无法治愈的、罕见的结缔组织疾病,偶尔会引起弥漫性肺部炎症,导致急性严重呼吸衰竭。在这种情况下,尽管使用大剂量类固醇治疗,预后仍很差。在本病例中,一名46岁的男性因呼吸困难入院。他被诊断为皮肌炎合并隐源性组织性肺炎(COP)并呼吸衰竭,并接受类固醇和免疫抑制剂治疗,但COP没有改善。然而,在静脉注射免疫球蛋白治疗后,呼吸衰竭确实有所改善,因此,在类固醇和免疫抑制剂无效的情况下,静脉注射免疫球蛋白可以被认为是一种治疗选择。
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引用次数: 1
The Effect of the Valsalva Maneuver on the External Jugular Vein Valsalva手法对颈外静脉的影响
Pub Date : 2015-08-31 DOI: 10.4266/KJCCM.2015.30.3.158
H. Moon, S. Jung, S. H. Yoo, J. Ji, H. Lee
Background: The external jugular vein (EJV) is a useful intravenous (IV) cannulation site for anesthesiologists, although it has a relatively high failure rate. Unlike other central veins, visualization of the EJV is important during IV cannulation, and the Valsalva maneuver distends the jugular venous system. However, the relationship between the maneuver and EJV visibility remains unknown. This study compared EJV visibility before and after the Valsalva maneuver. Methods: This was a prospective observational study that included 200 participants. After the induction of anesthesia, EJV visibility grade, depth from the skin to the EJV superficial surface (EJV depth), and EJV cross-sectional area (CSA) before the Valsalva maneuver were measured. The same parameters were measured after the Valsalva maneuver was performed. The EJV visibility grade was defined as grade A: good appearance and good palpation, grade B: poor appearance and good palpation, and grade C: poor appearance and poor palpation. Results: Patient body mass index and EJV depth affected the EJV visibility grade before the Valsalva maneuver (p < 0.05), although EJV CSA did not. The Valsalva maneuver distended EJV CSA and reduced EJV depth, although these changes were not correlated with EJV visibility grade. With regard to EJV visibility, 34.0% of grade B cases and 20.0% of grade C cases were improved by the Valsalva maneuver. Conclusions: Although the Valsalva maneuver improved EJV CSA and EJV depth, it did not greatly affect EJV visibility grade.
背景:颈外静脉(EJV)是麻醉师常用的静脉(IV)插管部位,但其失败率较高。与其他中心静脉不同,静脉置管过程中EJV的可视化很重要,Valsalva手法可以扩张颈静脉系统。然而,机动和EJV可见度之间的关系仍然是未知的。本研究比较了Valsalva机动前后EJV的能见度。方法:这是一项前瞻性观察性研究,包括200名参与者。麻醉诱导后测量EJV可视性等级、皮肤到EJV浅表的深度(EJV depth)和Valsalva动作前EJV横截面积(CSA)。在Valsalva动作完成后测量相同的参数。EJV可见度等级定义为:A级:外观好、触诊好;B级:外观差、触诊好;C级:外观差、触诊差。结果:Valsalva手法前患者体重指数和EJV深度对EJV可视性评分有影响(p < 0.05),而EJV CSA对EJV可视性评分无影响。Valsalva机动增加了EJV的CSA,降低了EJV的深度,尽管这些变化与EJV的能见度等级无关。在EJV能见度方面,34.0%的B级病例和20.0%的C级病例通过Valsalva手法得到改善。结论:Valsalva机动虽然提高了EJV的CSA和EJV深度,但对EJV的能见度等级影响不大。
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引用次数: 1
Lung Transplantation in Acute Respiratory Distress Syndrome Caused by Influenza Pneumonia 流行性肺炎所致急性呼吸窘迫综合征的肺移植治疗
Pub Date : 2015-08-31 DOI: 10.4266/KJCCM.2015.30.3.196
Youjin Chang, Sang Oh Lee, T. Shim, Saerown Choi, Hyung Ryul Kim, Yong-Hee Kim, D. K. Kim, Seung-Il Park, Sang-Bum Hong
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Department of Infectious Disease, Asan Medical Center, College of Medicine University of Ulsan, Department of Pulmonary and Critical Care Medicine, Asan Medical Center, College of Medicine University of Ulsan, Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, College of Medicine University of Ulsan, Seoul, Korea
清州市忠北大学医院内科肺重症医学科、蔚山大学医学院峨山医疗中心感染科、蔚山大学医学院峨山医疗中心肺重症医学科、蔚山大学医学院峨山医疗中心胸心血管外科学科
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引用次数: 2
Toxic Shock Syndrome following Tattooing 纹身后的中毒性休克综合征
Pub Date : 2015-08-30 DOI: 10.4266/KJCCM.2015.30.3.184
Ki Young Jeong, K. Kim, G. Suh, W. Kwon
Toxic shock syndrome (TSS) is a rare but life-threatening illness that is mainly caused by toxigenic strains of Staphylococcus aureus. Although TSS is classically known to be associated with tampon use, the number of TSS cases with non-menstrual causes such as skin and soft tissue infection has been increasing. Tattooing can result in several complications such as localized and systemic infections, inflammatory skin eruptions and neoplasms. We recently experienced a 26-year-old man diagnosed with typical TSS following tattooing. He complained of fever, chills and erythematous rash at tattoo site. Subsequently, the patient developed sign of shock. The skin cultures on the tattoo site were positive for methicillin-sensitive Staphylococcus aureus. The patient was successfully treated with vasopressor infusion and intravenous antibiotics and was discharged without complications. On discharge from the hospital 7 days later, desquamations on the tattoo site, fingers and toes were observed.
中毒性休克综合征(TSS)是一种罕见但危及生命的疾病,主要由金黄色葡萄球菌的产毒菌株引起。虽然TSS通常被认为与卫生棉条的使用有关,但与非月经原因(如皮肤和软组织感染)有关的TSS病例数量一直在增加。纹身会导致一些并发症,如局部和全身感染、皮肤炎症性爆发和肿瘤。我们最近遇到了一个26岁的男人,他在纹身后被诊断为典型的TSS。他说纹身部位有发烧、寒战和红疹。随后,患者出现休克症状。纹身部位的皮肤培养对甲氧西林敏感的金黄色葡萄球菌呈阳性。患者经血管加压素输注和静脉注射抗生素治疗成功,无并发症出院。出院7天后,纹身部位、手指和脚趾出现脱屑。
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引用次数: 4
Therapeutic Hypothermia in Traumatic Brain injury; Review of History, Pathophysiology and Current Studies 低温治疗在颅脑外伤中的应用历史、病理生理学和当前研究综述
Pub Date : 2015-08-30 DOI: 10.4266/KJCCM.2015.30.3.143
Do-Keun Kim, Dong-Keun Hyun
The fact that therapeutic hypothermia (TH) has lowered intracranial pressure and protected brain in severe traumatic brain injury (TBI) is well known throughout past sources and experimental data. In this paper, the result of TH in TBI needs to be confirmed. The result of North American Brain Injury Study; Hypothermia (NAVIS-H) 1 and 2, Eurotherm3235, Japan trauma society study was reviewed throughout randomized controlled study which performed recently. The prognosis was not confirmed throughout TH in NAVIS-H1; however, there was statistical significance among the group of 45 years or less and below 35 degree in celcius which checked when he or she visited initially. Hence, NAVIS-H2 study was preceded. In patient who had surgically removed hematoma, the effects of TH were proved compared to diffuse brain damage in NAVIS-H2 study. This was found in the result of Japan neurotrauma data bank. Eurotherm study has been doing, which leads to collect many data later on. The TBI of TH makes them better prognosis in patients who had surgically removed hematoma and lowered initial body temperature. Later on, it is considered further study is necessary.
治疗性低温(TH)在严重创伤性脑损伤(TBI)中具有降低颅内压和保护大脑的作用,这一事实在过去的文献和实验数据中都是众所周知的。在本文中,TH在TBI中的结果有待证实。北美地区脑损伤研究结果低温症(NAVIS-H) 1和2,Eurotherm3235,日本创伤学会研究回顾了最近进行的随机对照研究。NAVIS-H1患者在整个TH期预后不确定;然而,在45岁以下和35摄氏度以下的人群中,有统计学意义,当他或她第一次访问时进行检查。因此,NAVIS-H2研究先行。在NAVIS-H2研究中,在手术切除血肿的患者中,与弥漫性脑损伤相比,TH的作用得到了证实。这是在日本神经外伤数据库中发现的。Eurotherm一直在做的研究,这导致了后来收集的许多数据。经手术清除血肿并降低初始体温的患者,TBI使其预后较好。后来,人们认为有必要进一步研究。
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引用次数: 0
Massive Hemoptysis due to Acute Mitral Regurgitation with Sporadic Primary Mitral Valve Prolapse 急性二尖瓣反流引起的大咯血伴散发性原发性二尖瓣脱垂
Pub Date : 2015-08-30 DOI: 10.4266/KJCCM.2015.30.3.202
Won Young Chae, Sun Jin Park, Chiwoo Song, B. Lee, S. H. Kim, J. H. Lee
The most common cardiac cause of massive hemoptysis is mitral stenosis. Mitral regurgitation is rarely complicated by massive hemoptysis. A 48-year-old man with no significant medical history was admitted to our hospital with hemoptysis and production of 500 mL of blood within 24 hours. A pan-systolic murmur was found on chest examination. A chest computed tomography showed airspace consolidation in the right upper and middle lobes, with faint bilateral ground glass opacity. Echocardiography revealed mitral valve prolapse and grade IV mitral regurgitation. The patient was diagnosed with sporadic primary mitral valve prolapse. After mitral valve repair surgery, the patient recovered fully.
大咯血最常见的心脏原因是二尖瓣狭窄。二尖瓣反流很少并发大咯血。患者48岁,无明显病史,因咯血24小时内出血500ml入院。胸部检查发现泛收缩期杂音。胸部计算机断层扫描显示右上叶和中叶空域实变,双侧磨玻璃影微弱。超声心动图显示二尖瓣脱垂和IV级二尖瓣返流。患者被诊断为散发性原发性二尖瓣脱垂。二尖瓣修复手术后,患者完全康复。
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引用次数: 3
Nasogastric Tube Syndrome: Why Is It Important in the Intensive Care Unit? 鼻胃管综合征:为什么在重症监护室很重要?
Pub Date : 2015-08-30 DOI: 10.4266/KJCCM.2015.30.3.231
Taehyun Kim, Seongmin Kim, Sung Birm Sohn, Yeon Ho Lee, Sang Youn Lim, J. Sim
Although the nasogastric tube (NGT) is widely used in critically ill patients, most intensivists do not give much thought to it or its possible complications. NGT syndrome is a rare but fatal complication characterized by throat pain and vocal cord paralysis in the presence of NGT. Recently, we experienced a case of NGT syndrome developed in an 86-year-old female twelve days after NGT insertion. We immediately removed the NGT and secured the airway by tracheostomy. She was treated successfully with an intravenous antibiotic, steroid and proton pump inhibitor and the syndrome did not recur after reinsertion of the NGT.
虽然鼻胃管(NGT)在危重病人中被广泛使用,但大多数重症医师并没有考虑到它或它可能引起的并发症。NGT综合征是一种罕见但致命的并发症,其特征是存在NGT时喉咙疼痛和声带麻痹。最近,我们经历了一位86岁的女性,在NGT植入12天后出现了NGT综合征。我们立即取出NGT并通过气管切开术固定气道。她成功地接受了静脉注射抗生素、类固醇和质子泵抑制剂的治疗,重新注入NGT后,该综合征没有复发。
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引用次数: 0
Delayed Presentation of Catheter-Related Subclavian Artery Pseudoaneurysm 导管相关锁骨下动脉假性动脉瘤的延迟表现
Pub Date : 2015-08-01 DOI: 10.4266/KJCCM.2015.30.3.222
H. Kang, Jin Yong Park, J. Kim, Yook Kim, M. Kang, Youjin Chang, K. Choe, K. Lee, J. An
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引用次数: 1
期刊
The Korean Journal of Critical Care Medicine
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