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A case report: Anaesthetic management of a patient with sub acute intestinal obstruction with chilaiditi syndrome coming for surgery 一例亚急性肠梗阻伴chilaiditis综合征手术患者的麻醉处理
Pub Date : 2023-08-15 DOI: 10.18231/j.sajcrr.2023.015
Ashok Kumar Balasubramanian
Chilaiditi syndrome is associated with hepatodiaphragmatic interposition of the colon and the small intestines. The radiological finding of colonic interposition between the liver and diaphragm is called chilaiditi sign. This is a rare anomaly incidentally seen on chest or abdominal radiographs. We present a case report of a 52 year old male who got admitted with complaints of abdominal distension and occasional pain after food intake for 5 months duration. The pain was dull aching and not radiating. He gave history of weight loss of about 10 kg over 5 months. His mother had similar complaints of dull aching abdominal pain of which she died. X ray chest showed gross dilatation of descending and transverse colon causing mediastinal shift to right. The CT chest showed emphysematous bullae on the left lobe. The working diagnosis of Chilaiditi syndrome was made. The patient came for surgery with subacute intestional obstruction. Here, in this case report we discuss the anaesthetic management.
Chilaiditi综合征与肝膈结肠和小肠的介入有关。肝脏与横膈膜之间结肠间置的影像学表现称为chilaiditi征象。这是一种罕见的异常,偶然出现在胸部或腹部x线片上。我们报告一位52岁男性病患,在进食5个月后,因腹部膨胀及偶尔疼痛而入院。隐隐作痛,没有放射性疼痛。他有5个月内体重减轻约10公斤的病史。他的母亲也有类似的隐痛腹痛,并因此去世。胸部X线显示降结肠和横结肠明显扩张,纵膈向右移位。胸部CT示左肺叶肺气肿大泡。对Chilaiditi综合征进行工作诊断。病人因亚急性肠梗阻来做手术。在这里,在这个病例报告中,我们讨论麻醉管理。
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引用次数: 0
Ileum neuroendocrine tumor: Case report and literature review 回肠神经内分泌肿瘤1例并文献复习
Pub Date : 2023-05-15 DOI: 10.18231/j.sajcrr.2023.006
Sunil Vitthalrao Jagtap, Shubham Sunil Jagtap, Pranjal Shah, Devika Borade, Nidhi Goswami
Ileal neuroendocrine tumors are rare primary epithelial neoplasm arising from enterochromaffin cells. A 65-year-old male presented with complaints of recurrent abdominal pain of 1 year duration. The pain was more aggravated in last 7 days associated with vomiting, loss of appetite and diarrhea. On radioimaging ultrasonography finding impression of small bowel mass lesion suggestive of ileac carcinoid tumor with ischemic bowel disease was given. Computerized tomograph abdomen pelvis showed a well-defined hypodense, round, hetergenous, enhancing mass measuring 2.6x1.6x1.2 cm., showing arterial enhancement in mesentery in close relation to ileum and metastatic lymph node mass- indicating likeness of neuroendocrine tumor. The surgical resection of ileum with mass and enlarged mesenteric nodes were done. On gross examination ileum specimen on cut open showed multiple, irregular mucosal thickenings with foci of ulceration. The submocosa showed single, circumscribed, round tumor measuring 3 x 2.5x1.5 cm. Cut section of tumor was yellowish, tan, well circumscribed and solid. The mesenteric lymph nodes were enlarged. The microscopic examination ileum showed a tumor composed of uniform, round cells having to oval nuclei with salt and pepper chromatin. Tumor cells were arranged in trabecular, nests, ribbons and in areas pseudo glandular pattern. Increased mitotic activity was noted (4/10 high power field). Mesenteric lymph nodes were involved by tumor. On histopathology reported as Well-differentiated neuroendocrine tumors (NET), G2, intermediate grade of ileum. The immunohistochemical stain were positive for synaptophysin, chromogranin A. The Ki-67 expression was <1%. Herewith we are presenting rare case of well-differentiated neuroendocrine tumor NET, G2, intermediate grade of ileum for its clinical, radio imaging ,pathological features and management.
回肠神经内分泌肿瘤是由肠嗜铬细胞引起的罕见原发上皮性肿瘤。65岁男性,主诉复发性腹痛1年。最后7天疼痛加重,伴有呕吐、食欲不振和腹泻。超声造影发现小肠肿块病灶提示回肠类癌合并缺血性肠病。腹部骨盆电脑断层显示一个明确的低密度、圆形、非均匀、增强的肿块,大小为2.6x1.6x1.2 cm。肠系膜动脉强化,与回肠及转移性淋巴结肿块密切相关,提示与神经内分泌肿瘤相似。手术切除回肠肿物及肠系膜结肿大。切开的回肠大体检查显示多发不规则粘膜增厚伴溃疡灶。mocosa下呈单个圆形肿瘤,大小为3 × 2.5 × 1.5 cm。肿瘤切面呈黄褐色,边界分明,实性。肠系膜淋巴结肿大。回肠镜下检查显示肿瘤由均匀的圆形细胞组成,细胞核卵圆形,染色质呈盐和胡椒状。肿瘤细胞呈小梁状、巢状、带状排列,呈伪腺状。有丝分裂活性增加(4/10高倍视场)。肿瘤累及肠系膜淋巴结。组织病理学报告为高分化神经内分泌肿瘤(NET), G2,中等级别回肠。免疫组化染色显示synaptophysin、chromogranin a阳性,Ki-67表达率为<1%。在此,我们报告一例罕见的高分化神经内分泌肿瘤NET, G2,中段回肠的临床,影像学,病理特点和处理。
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引用次数: 0
Palatal perforation due to disseminated histoplasmosis as the first presentation of HIV-AIDS 由弥散性组织胞浆菌病引起的腭穿孔是HIV-AIDS的第一个表现
Pub Date : 2023-05-15 DOI: 10.18231/j.sajcrr.2023.010
Archana Lakshmanan, None Radhika M, Jithesh Balan, None Rajesh K.R
Histoplasmosis is a systemic fungal infection caused by H. capsulatum usually in immunocompromised individuals such as those with HIV-AIDS. Though oral manifestations are rare, they could be the only and initial manifestation of HIV-AIDS. We report the case of a 23-year-old female who presented with oral ulcer and palatal perforation and detected to be suffering from disseminated histoplasmosis. She also turned out to be HIV positive. Her CD4+ count was undetectable. She responded well to intravenous liposomal Amphotericin B, oral itraconazole and antiretroviral therapy. To the best of our knowledge, histoplasmosis presenting as palatal perforation as the first manifestation of HIV-AIDS has not been reported from South India previously. A high index of suspicion is needed in such cases of exaggerated oral lesions even in states like Kerala to avoid delay in diagnosis and therapy.
组织胞浆菌病是由荚膜胞浆菌引起的一种全身性真菌感染,通常发生在免疫功能低下的个体,如艾滋病患者。虽然口腔表现很少见,但它们可能是HIV-AIDS的唯一和最初表现。我们报告一例23岁的女性谁提出了口腔溃疡和腭穿孔,并检测到患有播散性组织胞浆菌病。她也被证明是艾滋病毒阳性。她的CD4+计数检测不到。静脉注射两性霉素B脂质体、口服伊曲康唑和抗逆转录病毒治疗对她有良好的反应。据我们所知,组织胞浆菌病以腭穿孔为HIV-AIDS的第一表现,以前在南印度没有报道过。即使在喀拉拉邦这样的州,对这种严重的口腔病变病例也需要高度的怀疑,以避免延误诊断和治疗。
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引用次数: 0
Impact of COVID-19 containment measures on children with cancer in Indonesia COVID-19防控措施对印度尼西亚患癌儿童的影响
Pub Date : 2023-05-15 DOI: 10.18231/j.sajcrr.2023.008
Ibrahim El Salih, Pudjo Hagung Widjajanto, Sri Sutrisni, Iris Hoogland, Gertjan Kaspers, Saskia Mostert
Containment measures to limit COVID-19 spreading profoundly impact children around the globe, especially in low- and middle-income countries such as Indonesia. The aim of this case series study is to uncover the impact that COVID-19 measures have on Indonesian children with cancer and their families. A case series study was conducted in July 2021. Investigators identified three children diagnosed with cancer at an Indonesian referral hospital and studied their medical records. Caretakers were interviewed inside the hospital by an independent interviewer using a semi-structured questionnaire. This study presents three children with cancer and their families. Access to proper healthcare was hindered during COVID-19 pandemic due to mobility restrictions, medical staff shortage, limited chemotherapy and blood products availability, postponed medical procedures, and delayed or modified treatment administration. Financial hardships resulted because caretakers lost their jobs due to lockdowns and medication costs were no longer fully covered by health-insurance. Children and their relatives suffered from mental health issues. Anxiety, depression, stress and loneliness were caused by the fear of receiving suboptimal cancer treatment, serious concerns about financial difficulties, and restricted social interactions. All families believed that COVID-19 measures worsened their children’s survival chances. COVID-19 measures adversely impact children with cancer and their families in Indonesia, and most likely in other low- and middle-income countries as well. Disruptions in timely and adequate childhood cancer treatment administration may importantly deteriorate survival chances. Governments and policymakers should take these indirect effects into account to protect vulnerable children and their families.
限制COVID-19传播的遏制措施对全球儿童产生了深远影响,特别是在印度尼西亚等低收入和中等收入国家。本案例系列研究的目的是揭示COVID-19措施对印度尼西亚癌症儿童及其家庭的影响。2021年7月进行了一系列案例研究。调查人员在印度尼西亚一家转诊医院确定了三名被诊断患有癌症的儿童,并研究了他们的医疗记录。护理人员在医院内由一名独立的采访者使用半结构化问卷进行访谈。这项研究展示了三个患有癌症的孩子和他们的家庭。在COVID-19大流行期间,由于行动限制、医务人员短缺、化疗和血液制品供应有限、医疗程序推迟以及治疗管理延迟或修改,阻碍了获得适当医疗保健的机会。由于封锁导致护理人员失业,医疗保险不再全额支付药费,因此造成了经济困难。儿童及其亲属患有心理健康问题。焦虑、抑郁、压力和孤独是由于害怕接受不理想的癌症治疗,严重担心经济困难,以及限制社交而引起的。所有家庭都认为,COVID-19措施恶化了他们孩子的生存机会。针对COVID-19的措施对印度尼西亚的癌症儿童及其家庭产生了不利影响,很可能对其他低收入和中等收入国家也是如此。中断及时和充分的儿童癌症治疗可能会严重降低生存机会。政府和决策者应考虑到这些间接影响,以保护弱势儿童及其家庭。
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引用次数: 0
Unusually large number of gall stones removed through laparoscopic cholecystectomy from a single patient- A case report 通过腹腔镜胆囊切除术从单个患者中取出异常大量的胆结石-一例报告
Pub Date : 2023-05-15 DOI: 10.18231/j.sajcrr.2023.007
Aradhita Maheshwari, Bimal Shah
Gallstone disease is characterized by the formation of calculi in the gall bladder or the biliary tract. It may be asymptomatic or present as biliary colic or with complicated disease. Laparoscopic cholecystectomy is the mainstay of treatment for symptomatic gall stones. We describe a case of Gallstone disease in a 43-year-old female, where over seven thousand stones were removed through a Laparoscopic procedure.
胆结石疾病的特点是在胆囊或胆道内形成结石。它可能无症状或表现为胆道绞痛或伴有并发症。腹腔镜胆囊切除术是治疗症状性胆结石的主要方法。我们描述了一例胆结石疾病在一个43岁的女性,其中超过七千结石被移除通过腹腔镜手术。
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引用次数: 0
Manual jet ventilation to rescue a patient with pinhole tracheal stenosis: A case report 人工喷射通气抢救针孔气管狭窄1例
Pub Date : 2023-05-15 DOI: 10.18231/j.sajcrr.2023.009
Soumi Pathak, Mamta Dubey, Nitesh Goel
Airway management of patients with tracheal stenosis is highly challenging and even establishing a surgical airway may be difficult in these patients. A 24 year old female developed pinhole tracheal restenosis after undergoing tracheal web resection and reconstruction. After other modes of ventilation had failed, we used the Manual jet ventilator endotracheal tube assembly as a rescue device and performed intermittent low-frequency jet ventilation until a definitive surgical airway could be established. : Central airway obstruction in severe tracheal stenosis can cause life-threatening hypoxia. Jet ventilation through the pin hole opening buys some time for the surgeon to secure the airway.
气管狭窄患者的气道管理极具挑战性,甚至在这些患者中建立外科气道可能很困难。一位24岁女性在气管网切除重建后出现针孔气管再狭窄。在其他通气方式失败后,我们使用手动喷射呼吸机气管内管组件作为抢救装置,并进行间歇性低频喷射通气,直到确定手术气道。严重气管狭窄的中央气道阻塞可引起危及生命的缺氧。通过针孔开口喷射通气为外科医生保护气道赢得了一些时间。
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引用次数: 0
Assessment of Maximal Expiratory Pressure Among Adults Against Reference Standard Value 成人最大呼气压对照参考标准值的评估
Pub Date : 2012-06-01 DOI: 10.15373/22778179/JAN2013/68
J. Patel
The present study was cross-sectional in design and carried out in Indian adults. The aim of this study was to assess the MEP (maximal expiratory pressure) and compare with reference standard value. The MEP is part of pulmonary function test and its give idea about expiratory muscle strength, which will be helpful in clinical physiology. The clinical mercury sphygmomanometer was used to measure Maximal Expiratory Pressure, comparisons was made with reference value. The results shows that observed MEP was significantly lower than reference value and also shows gender based variation. So, at the end of study we can conclude that results of this study might be due to variation of body physique, ethnicity and technique. For future development we recommend that MEP value should be revised as par Indian standard and it should be implement in routine pulmonary function testing. Assessment of Maximal Expiratory Pressure in Adult Against Reference Standard Value Introduction: The Maximum Expiratory Pressure (MEP) measures the expiratory pressure in respiratory system which has been used as indicators of respiratory muscle strength in adults and in children (Tomalak, Pogorzelski, & Prusak, 2002). The MEP is part of respiratory efficiency test as pulmonary function test and it is simple, convenient and non-invasive indices of respiratory muscle strength. It’s give idea about expiratory muscle strength which is helpful in physiological and clinical evaluation of respiratory muscle strength. The values of this parameter as reported in the various studies vary considerably because of wide age range of subjects, different types of instruments used to make the measurements (Smyth, Chapman, & Rebuck, 1984), and the possible differences in the method used for making the measurements also due to ethnicity and race of subjects. As previous study shows variation in MEP, basis on this the Present study was carried out in Indian adults and compare with reference standard value. Aims and Objectives: 1. To assess the maximal expiratory pressure in apparently healthy adults and compare it with reference standard value 2. To compare the maximal expiratory pressure in male and female. Materials and Method: The present study is Cross-sectional in design; was carried out in 59 apparently healthy Indian adult subjects (mean age 18.06 ± 0.31 year). Clinical mercury sphygmomanometer was used to measure Maximal Expiratory Pressure. The Single best reading out of three was taken for measurement of MEP as observed value and it compare with predicted reference standard value. The observed value of MEP is also compare with LLN (lower limit of normal). Reference standard value and LLN value of MEP in adults, were pressure in cmH2o and age in years (Evans & Whitelaw, 2009), as reference and LLN value in cmH2o for analysis it converted in mmhg; • Male MEP Reference value; 174 – (0.83 age) • Male MEP LLN value; 117 – (0.83 age) • Female MEP Reference value; 131 – (0.86 age) • Female MEP
本研究采用横断面设计,在印度成年人中进行。本研究的目的是评估MEP(最大呼气压),并与参考标准值进行比较。MEP是肺功能检查的一部分,它能反映出呼气肌的力量,对临床生理学有帮助。采用临床汞柱血压计测量最大呼气压,与参考值进行比较。结果表明,实测MEP显著低于参考值,且存在性别差异。因此,在研究结束时,我们可以得出结论,本研究的结果可能是由于身体体质,种族和技术的变化。为了今后的发展,我们建议将MEP值修订为par印度标准,并在常规肺功能检查中实施。简介:最大呼气压力(MEP)测量呼吸系统的呼气压力,已被用作成人和儿童呼吸肌力量的指标(Tomalak, Pogorzelski, & Prusak, 2002)。MEP是呼吸效率试验与肺功能试验的组成部分,是一种简单、方便、无创的呼吸肌力指标。对呼气肌力有一定的认识,有助于呼吸肌力的生理和临床评价。由于受试者的年龄范围广,用于测量的仪器类型不同(Smyth, Chapman, & Rebuck, 1984),并且由于受试者的种族和种族,用于测量的方法可能存在差异,因此在各种研究中报告的该参数的值差异很大。由于先前的研究显示了MEP的差异,因此本研究在印度成年人中进行,并与参考标准值进行比较。宗旨和目标:目的评估表面健康成人的最大呼气压,并与参考标准值进行比较。比较男女最大呼气压。材料与方法:本研究采用横断面设计;在59例明显健康的印度成人(平均年龄18.06±0.31岁)中进行。采用临床汞柱血压计测量最大呼气压。取三个读数中的最佳读数作为观测值,并与预测参考标准值进行比较。MEP的观测值也与LLN(正常下限)进行了比较。成人MEP的参考标准值和LLN值分别为cmh20的压力和年龄(Evans & Whitelaw, 2009)作为参考,cmh20的LLN值换算为mmhg进行分析;•男性MEP参考值;174 -(0.83岁)•男性MEP LLN值;117 -(0.83岁)•女性MEP参考值;131 -(0.86岁)•女性MEP LLN值;95 -(0.57岁)研究组按性别分为男35岁和女24岁两组。首先比较男性和女性的MEP,然后比较MEP与参考标准值和男女的LLN值。采用IBM SPSS 20.0中的学生T集进行分析。观察和结果:表1:描述性分析显示的意思和SD研究小组性N±SD年龄(年)男性35 18.02±0.30女24 18.13±0.33高度(m)男性35 01.72±0.05女性24 01.57±0.06体重(公斤)男性35 62.29±11.64女24 53.33±11.63表2:比较男性和女性议员的性意味着±SD p值议员(毫米汞柱)男性(N = 35) 75.77±17.31 < 0.01 * *女(N = 24) 51.25±11.36 * *平均差在0.01水平具有重要意义。表3:MEP实测值与参考标准值的比较数值Mean±SD p value男性MEP (mmHg) (N=35)观察值75.77±17.31 < 0.01**参考值116.97±0.30女性MEP (mmHg) (N=24)观察值51.25±11.36 < 0.01**参考值84.88±0.33 **在0.01水平上差异有统计学意义。表3:MEP观测值与LLN(正常下限)值的比较数值Mean±SD p值男性MEP (mmHg) (N=35)观察75.77±17.31 NS LLN 74.97±0.30女性MEP (mmHg) (N=24)观察51.25±11.36 < 0.01** LLN 62±0.00 **在0.01水平上差异有统计学意义,NS;不显著,LLN;正常讨论下限:男女(表1)年龄差异不显著,但身高、体重差异显著。
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引用次数: 1
Learning Habits Evaluation Of First M.B.B.S Students 第一届mba学员学习习惯评价
Pub Date : 1900-01-01 DOI: 10.5455/IJMSPH.2012.1.81-86
P. A. Patel, C. Shah, Shailesh M. Patel, J. Diwan, H. Mehta
Background: The learning habit of a learner is the way he handles new information and experiences, and determines its outcomes. Various types of learning habits are adopted by students, including visual (V; learning from graphs, charts, and flow diagrams), auditory (A; learning from speech), read-write(R; learning from reading and writing), and kinesthetic (K; learning from touch, hearing, smell, taste, and sight).Understanding their preferred learning habits as visual, auditory, read-write or kinesthetic learners will help to improve the teaching methods adopted. Facilitators and supporters themselves may need guidance and training in how to identify feedback and adapt learning to individual's habits. Objective: To assess different learning habits of medical students and hence provide student oriented education, producing efficient doctors. Materials and Methods: This study was performed at Department of physiology in Govt. Medical College, Bhavnagar in March 2011.Eighty four (84) medical students of first MBBS were participated in the study. By using the English version of the visual, auditory, reading or writing, kinesthetic (VARK) questionnaire, we measured the difference in learning habits of First year medical students. Results: In Unimodal learning habit highest preference was given to auditory mode (48.57%), then to Kinesthetic (28.57%) & then to read (14.29%) & visual (8.57%). Among Multimodal learning habit students (n=44), 64.29% students preferred bimodal, 2.38% students preferred trimodal and 33.33% students preferred quadrimodal learning habit. Conclusion: Knowing that students have different preferred learning modes, will help medical instructors in our faculty develop appropriate learning approaches and explore opportunities so that they will be able to make the educational experience more productive. The results will help faculty to develop appropriate learning approaches and explore opportunities, so that they will able to make the educational experience more productive.
背景:学习者的学习习惯是他处理新信息和经验的方式,并决定其结果。学生采用了各种类型的学习习惯,包括视觉(V);从图形、图表和流程图中学习),听觉(A;从言语中学习),读写(R;从阅读和写作中学习),以及动觉(K;通过触觉、听觉、嗅觉、味觉和视觉来学习)。了解他们作为视觉型、听觉型、读写型或动觉型学习者的首选学习习惯将有助于改进所采用的教学方法。促进者和支持者自己可能需要指导和培训,以了解如何识别反馈并使学习适应个人习惯。目的:了解医学生不同的学习习惯,以学生为本,培养高效的医生。材料和方法:本研究于2011年3月在巴夫纳加尔政府医学院生理学系进行。84名第一MBBS的医学生参与了研究。采用英文版的视觉、听觉、阅读或写作动觉(VARK)问卷,对医学生在学习习惯上的差异进行了测量。结果:在单模学习习惯中,听觉模式的偏好最高(48.57%),其次是动觉模式(28.57%),其次是阅读模式(14.29%)和视觉模式(8.57%)。在多模态学习习惯的学生(n=44)中,64.29%的学生喜欢双峰态学习习惯,2.38%的学生喜欢三模态学习习惯,33.33%的学生喜欢四模态学习习惯。结论:了解学生有不同的学习模式偏好,将有助于我们的医学教师制定合适的学习方法和探索机会,从而使他们能够使教育体验更富有成效。研究结果将帮助教师开发适当的学习方法和探索机会,使他们能够使教育经验更富有成效。
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引用次数: 11
期刊
The Southeast Asian Journal of Case Report and Review
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