An iatrogenic vessel injury occurring during lumbar fusion is a rare but potentially serious complication. In this case report, we present a case of hypovolemic cardiac arrest attributable to an iatrogenic lumbar artery injury that occurred during posterior lumbar interbody fusion (PLIF), which is difficult to diagnose using CECT. A 70-year-old woman underwent PLIF surgery in a primary hospital for the treatment of degenerative spondylolisthesis (L2–L5). During the procedure, she experienced a blood loss of 3 liters, which necessitated the transfusion of packed red blood cells (6 units, about 200–250 mL per unit), fresh frozen plasma (6 units, about 150–170 mL per unit). Despite the transfusions, her vital signs remained unstable, leading to her transfer to our hospital. Upon arrival at our facility, the patient went into cardiac arrest, but spontaneous circulation was successfully restored after two cycles of cardiopulmonary resuscitation. In the emergency department, her hemoglobin level was measured at 2.7 g/dL, platelet level at 56,000/µL, and prothrombin international normalized ratio at 3.56. CECT did not indicate any active bleeding. For the initial 2 hours, her vital signs remained stable with a blood pressure of 92/53 mmHg, heart rate of 104 bpm, respiratory rate of 22 bpm. However, her blood pressure suddenly dropped to 78/43 mmHg. Subsequent angiography revealed active bleeding from the right fourth lumbar artery, prompting the performance of embolization. Following the procedure, the patient’s vital signs stabilized, and she was discharged on the 16th day of hospitalization. Iatrogenic vessel injuries during PLIF may pose challenges in their detection using CECT, especially when extravasation is not definitively visible or when artifacts are created by metal implants. Therefore, it is advisable for emergency physicians to consider emergency angiography in the diagnosis and treatment of such vessel injuries.
{"title":"Emergency treatment for iatrogenic lumbar arterial injury occurred during posterior lumbar interbody fusion: a case report","authors":"","doi":"10.22514/sv.2023.100","DOIUrl":"https://doi.org/10.22514/sv.2023.100","url":null,"abstract":"An iatrogenic vessel injury occurring during lumbar fusion is a rare but potentially serious complication. In this case report, we present a case of hypovolemic cardiac arrest attributable to an iatrogenic lumbar artery injury that occurred during posterior lumbar interbody fusion (PLIF), which is difficult to diagnose using CECT. A 70-year-old woman underwent PLIF surgery in a primary hospital for the treatment of degenerative spondylolisthesis (L2–L5). During the procedure, she experienced a blood loss of 3 liters, which necessitated the transfusion of packed red blood cells (6 units, about 200–250 mL per unit), fresh frozen plasma (6 units, about 150–170 mL per unit). Despite the transfusions, her vital signs remained unstable, leading to her transfer to our hospital. Upon arrival at our facility, the patient went into cardiac arrest, but spontaneous circulation was successfully restored after two cycles of cardiopulmonary resuscitation. In the emergency department, her hemoglobin level was measured at 2.7 g/dL, platelet level at 56,000/µL, and prothrombin international normalized ratio at 3.56. CECT did not indicate any active bleeding. For the initial 2 hours, her vital signs remained stable with a blood pressure of 92/53 mmHg, heart rate of 104 bpm, respiratory rate of 22 bpm. However, her blood pressure suddenly dropped to 78/43 mmHg. Subsequent angiography revealed active bleeding from the right fourth lumbar artery, prompting the performance of embolization. Following the procedure, the patient’s vital signs stabilized, and she was discharged on the 16th day of hospitalization. Iatrogenic vessel injuries during PLIF may pose challenges in their detection using CECT, especially when extravasation is not definitively visible or when artifacts are created by metal implants. Therefore, it is advisable for emergency physicians to consider emergency angiography in the diagnosis and treatment of such vessel injuries.","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":"245 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134884955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hemorrhagic shock (HS) is a common and significant cause of mortality and morbidity, often resulting in structural damage and dysfunction of the intestines. ChaC glutathione-specific gamma-glutamylcyclotransferase 1 (Chac1) has been reported to be involved in the regulation of oxidative stress and ferroptosis in mammals. Herein, we investigate the effects of Chac1 on HS-induced intestinal injury induced by HS both in vitro and in vivo. Sprague-Dawley rat model with HS was established, and our investigations showed upregulation of the mRNA and protein levels of Chac1 in the model’s ileum tissues. Histopathological analysis revealed that knockdown of Chac1 attenuated the intestinal injury induced by HS. Depletion of Chac1 also reduced the increase in intestinal fatty acid binding protein (I-FABP) concentration. Immunofluorescence staining indicated that silencing Chac1 significantly suppressed the downregulation of occludin and zonula occludens-1 (ZO-1). HS-induced changes in lipid peroxidation (LPO), malondialdehyde (MDA), and glutathione (GSH) levels were reversed in the absence of Chac1, suggesting that downregulation of Chac1 alleviated HS-induced oxidative stress. Additionally, HS led to a decrease in glutathione peroxidase 4 (Gpx4) and ferritin heavy chain 1 (Fth1) expression, along with an increase in ferrous ion (Fe2+) concentration. Knockdown of Chac1 significantly inhibited ferroptosis by increasing Gpx4 and Fth1 expression while reducing the Fe2+ concentration. In vitro experiments using the rat small intestine crypt epithelial cells (IEC-6) demonstrated that depletion of Chac1 suppressed oxidative stress and ferroptosis induced by hypoxia/reoxygenation (H/R). In conclusion, our study provides evidence that downregulation of Chac1 mitigates HS-induced intestinal injury by inhibiting oxidative stress and ferroptosis.
{"title":"Chac1 silencing mitigates hemorrhagic shock-induced intestinal injury by inhibiting oxidative stress and ferroptosis","authors":"","doi":"10.22514/sv.2023.113","DOIUrl":"https://doi.org/10.22514/sv.2023.113","url":null,"abstract":"Hemorrhagic shock (HS) is a common and significant cause of mortality and morbidity, often resulting in structural damage and dysfunction of the intestines. ChaC glutathione-specific gamma-glutamylcyclotransferase 1 (Chac1) has been reported to be involved in the regulation of oxidative stress and ferroptosis in mammals. Herein, we investigate the effects of Chac1 on HS-induced intestinal injury induced by HS both in vitro and in vivo. Sprague-Dawley rat model with HS was established, and our investigations showed upregulation of the mRNA and protein levels of Chac1 in the model’s ileum tissues. Histopathological analysis revealed that knockdown of Chac1 attenuated the intestinal injury induced by HS. Depletion of Chac1 also reduced the increase in intestinal fatty acid binding protein (I-FABP) concentration. Immunofluorescence staining indicated that silencing Chac1 significantly suppressed the downregulation of occludin and zonula occludens-1 (ZO-1). HS-induced changes in lipid peroxidation (LPO), malondialdehyde (MDA), and glutathione (GSH) levels were reversed in the absence of Chac1, suggesting that downregulation of Chac1 alleviated HS-induced oxidative stress. Additionally, HS led to a decrease in glutathione peroxidase 4 (Gpx4) and ferritin heavy chain 1 (Fth1) expression, along with an increase in ferrous ion (Fe2+) concentration. Knockdown of Chac1 significantly inhibited ferroptosis by increasing Gpx4 and Fth1 expression while reducing the Fe2+ concentration. In vitro experiments using the rat small intestine crypt epithelial cells (IEC-6) demonstrated that depletion of Chac1 suppressed oxidative stress and ferroptosis induced by hypoxia/reoxygenation (H/R). In conclusion, our study provides evidence that downregulation of Chac1 mitigates HS-induced intestinal injury by inhibiting oxidative stress and ferroptosis.","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135509238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We evaluated the safest approach to treat catheter-related cervicothoracic arterial injuries by reviewing two inadvertent arterial injury cases during central venous catheter insertion and their related complications at an intensive care unit. In the first case, C-arm angiography confirmed accidental catheter placement in the right subclavian artery (SCA). In the second case, accidental catheter placement in the right common carotid artery was confirmed via computed tomography angiography of the neck and chest. The catheter was connected to a high-pressure arterial bag in both cases. The Perclose ProGlide Suture-Mediated Closure System (Abbott Laboratories, IL, USA) was used and successfully operated the two cases of iatrogenic SCA and carotid artery injuries. A follow-up bedside ultrasound at 2 and 6 hours postoperatively revealed normal Doppler waveforms in the inadvertent arterial injury and distal arteries without hematoma at the puncture site in both cases. In conclusion, for inadvertent artery puncture, which occurs in <12% of jugular and subclavian venous procedures, the endovascular approach using a covered stent appears to be safe for treating the accidental catheter placement in the carotid artery, although some cases of post-procedure stroke have been reported. In this regard, the percutaneous arterial suture device (Perclose ProGlide) offers an almost 100% success rate and lowers morbidity and mortality rates compared with open surgical and endovascular approaches for treating iatrogenic SCA and carotid artery injuries. These two cases highlight the effectiveness of minimally invasive percutaneous arterial closure devices in treating this infrequent but potentially lethal injury.
我们通过回顾两例在重症监护病房中心静脉导管插入过程中意外动脉损伤的病例及其相关并发症，评估治疗导管相关颈胸动脉损伤的最安全方法。在第一个病例中，c臂血管造影证实了在右锁骨下动脉(SCA)意外放置导管。在第二个病例中，通过颈部和胸部的计算机断层血管造影证实了导管意外置入右颈总动脉。在这两个病例中，导管都连接到高压动脉袋上。我们使用Perclose ProGlide缝合缝合系统(Abbott Laboratories, IL, USA)成功治疗了2例医源性SCA和颈动脉损伤。术后2小时和6小时的床边超声随访显示，两例患者的非故意动脉损伤和远端动脉的多普勒波形正常，穿刺部位无血肿。综上所述，尽管有一些手术后中风的病例报道，但对于12%的颈静脉和锁骨下静脉手术中发生的意外动脉穿刺，血管内入路使用覆盖支架治疗意外导管置入颈动脉似乎是安全的。在这方面，与开放手术和血管内入路相比，经皮动脉缝合装置(Perclose ProGlide)在治疗医源性SCA和颈动脉损伤方面提供了几乎100%的成功率，并降低了发病率和死亡率。这两个病例强调了微创经皮动脉封闭装置治疗这种罕见但可能致命的损伤的有效性。
{"title":"Management of arterial trauma during central venous catheter insertion using a percutaneous suture-mediated closure device (Perclose ProGlide): a report of two cases and literature review","authors":"","doi":"10.22514/sv.2023.115","DOIUrl":"https://doi.org/10.22514/sv.2023.115","url":null,"abstract":"We evaluated the safest approach to treat catheter-related cervicothoracic arterial injuries by reviewing two inadvertent arterial injury cases during central venous catheter insertion and their related complications at an intensive care unit. In the first case, C-arm angiography confirmed accidental catheter placement in the right subclavian artery (SCA). In the second case, accidental catheter placement in the right common carotid artery was confirmed via computed tomography angiography of the neck and chest. The catheter was connected to a high-pressure arterial bag in both cases. The Perclose ProGlide Suture-Mediated Closure System (Abbott Laboratories, IL, USA) was used and successfully operated the two cases of iatrogenic SCA and carotid artery injuries. A follow-up bedside ultrasound at 2 and 6 hours postoperatively revealed normal Doppler waveforms in the inadvertent arterial injury and distal arteries without hematoma at the puncture site in both cases. In conclusion, for inadvertent artery puncture, which occurs in <12% of jugular and subclavian venous procedures, the endovascular approach using a covered stent appears to be safe for treating the accidental catheter placement in the carotid artery, although some cases of post-procedure stroke have been reported. In this regard, the percutaneous arterial suture device (Perclose ProGlide) offers an almost 100% success rate and lowers morbidity and mortality rates compared with open surgical and endovascular approaches for treating iatrogenic SCA and carotid artery injuries. These two cases highlight the effectiveness of minimally invasive percutaneous arterial closure devices in treating this infrequent but potentially lethal injury.","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135559389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Internal hernias account for fewer than 6% of all small intestinal obstructions; of these, hernias caused by defects in the sigmoid colon are particularly challenging to detect. Misdiagnosis may occur if non-surgical symptoms (such as rebound tenderness) are not observed in the emergency room. We report the case of a consent who visited the emergency room with recurrent non-specific lower abdominal pain. She exhibited an internal hernia that had triggered small intestinal ischemia between the mesosigmoid (mesentery) and ovary. A 36-year-old female patient visited the emergency room of our hospital with acute left-lower abdominal pain, nausea, and vomiting that occurred 1 h after meals. We found no palpable mass or enlarged organ. Abdominal computed tomography (CT) revealed segmental small bowel wall thickening with mesenteric congestion in the left-lower quadrant, and small bowel ischemia attributable to internal herniation or adhesion. In addition, a small amount of pelvic ascites and multiple liver cysts were observed. A surgeon was immediately consulted and emergency laparoscopic surgery was performed.
{"title":"Emergency laparoscopic surgery on a patient who visited the emergency room with lower abdominal pain","authors":"","doi":"10.22514/sv.2023.092","DOIUrl":"https://doi.org/10.22514/sv.2023.092","url":null,"abstract":"Internal hernias account for fewer than 6% of all small intestinal obstructions; of these, hernias caused by defects in the sigmoid colon are particularly challenging to detect. Misdiagnosis may occur if non-surgical symptoms (such as rebound tenderness) are not observed in the emergency room. We report the case of a consent who visited the emergency room with recurrent non-specific lower abdominal pain. She exhibited an internal hernia that had triggered small intestinal ischemia between the mesosigmoid (mesentery) and ovary. A 36-year-old female patient visited the emergency room of our hospital with acute left-lower abdominal pain, nausea, and vomiting that occurred 1 h after meals. We found no palpable mass or enlarged organ. Abdominal computed tomography (CT) revealed segmental small bowel wall thickening with mesenteric congestion in the left-lower quadrant, and small bowel ischemia attributable to internal herniation or adhesion. In addition, a small amount of pelvic ascites and multiple liver cysts were observed. A surgeon was immediately consulted and emergency laparoscopic surgery was performed.","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":"2012 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135355680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study used the Padua Prediction Score (PPS) to guide low-molecular-weight heparin calcium (LMWHC) treatment for the prevention of venous thromboembolism (VTE) in elderly patients with intracerebral hemorrhage (ICH). This study retrospectively analyzed 225 elderly patients who were admitted to the intensive care unit (ICU) between June 2016 and June 2022. Patients were divided into control (n = 124) and study (n = 101) groups. Control patients received routine prevention and treatment of VTE, while patients in the study group received PPS-guided LMWHC treatment for the prevention of VTE. Multiple analytical parameters were assessed including thromboelastography indices, coagulation function parameters, venous blood flow velocity, and the incidence of VTE and recurrent ICH. Thromboelastography indices, coagulation function parameters, and the venous blood flow velocity did not differ significantly between the control and study groups (p > 0.05) before intervention and treatment. However, following PPS-guided LMWHC treatment, a significant improvement in these parameters was observed in the study group compared to the control group (p < 0.05). Furthermore, the incidence of VTE was significantly lower in the study group (5.6%) than the control group (14.5%; p = 0.038). No significance differences in the incidence of recurrent ICH were observed (p > 0.05). Our PPS data indicate that LMWHC treatment could significantly improve the coagulation function of elderly patients with ICH, as well as increase the venous blood flow velocity and prevent the occurrence of VTE.
{"title":"Padua prediction score-guided use of low-molecular-weight heparin calcium treatment for the prevention of venous thromboembolism in elderly patients with intracerebral hemorrhage: a clinical observation","authors":"","doi":"10.22514/sv.2023.091","DOIUrl":"https://doi.org/10.22514/sv.2023.091","url":null,"abstract":"This study used the Padua Prediction Score (PPS) to guide low-molecular-weight heparin calcium (LMWHC) treatment for the prevention of venous thromboembolism (VTE) in elderly patients with intracerebral hemorrhage (ICH). This study retrospectively analyzed 225 elderly patients who were admitted to the intensive care unit (ICU) between June 2016 and June 2022. Patients were divided into control (n = 124) and study (n = 101) groups. Control patients received routine prevention and treatment of VTE, while patients in the study group received PPS-guided LMWHC treatment for the prevention of VTE. Multiple analytical parameters were assessed including thromboelastography indices, coagulation function parameters, venous blood flow velocity, and the incidence of VTE and recurrent ICH. Thromboelastography indices, coagulation function parameters, and the venous blood flow velocity did not differ significantly between the control and study groups (p > 0.05) before intervention and treatment. However, following PPS-guided LMWHC treatment, a significant improvement in these parameters was observed in the study group compared to the control group (p < 0.05). Furthermore, the incidence of VTE was significantly lower in the study group (5.6%) than the control group (14.5%; p = 0.038). No significance differences in the incidence of recurrent ICH were observed (p > 0.05). Our PPS data indicate that LMWHC treatment could significantly improve the coagulation function of elderly patients with ICH, as well as increase the venous blood flow velocity and prevent the occurrence of VTE.","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":"48 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135357546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The European Society of Intensive Care Medicine (ESICM) suggests nine quality and safety indicators of care for critically ill patients. The aim of the present study was to examine the Key Process and Outcome Indicators (KPOIs) chosen according to International Standard Organization (ISO) protocols in a Greek Pediatric Intensive Care Unit (PICU). Two structure, one process, and four outcome indicators were examined in a stepwise approach according to Observe-Plan-Do-Study-Act (OPDSA) cycles, in an observational four-year cohort study (2017–2020). Two structure indicators—that ICUs fulfil national requirements to provide intensive care and 24-h consultant availability were requirements for the creation of the PICU and considered standards of care. One process indicator—Standardized Handover Procedure was transformed from handwritten (2017–2018) into electronic form (2019–2020) and 100% compliance rates throughout the four years were recorded. 96, 85, 103 and 94 patients were admitted in 2017, 2018, 2019 and 2020 with median (IQR) Pediatric Risk of Mortality III-24 h scores of 10 (6.25–17), 10 (6–13), 8 (5–13) and 8 (6.75–12), respectively. Mortality rates were 24%, 11.8%, 17.5%, 16%, and Standardized Mortality Ratio (SMR) were 1.42, 0.92, 1.56 and 1.33, correspondingly. No early (<48 h after PICU discharge) readmissions were recorded for 2017 and 2018, only 1 in 2019 (0.8%) and none in 2020. Catheter Related Bloodstream Infection rates were 1.37:1000, 1.37:1000, 1.26:1000 and 1.39:1000 catheter days, respectively. Unplanned extubation rate was 10.30% in 2019 and 5.72% and 3.91:1000 ventilation days in 2020. In conclusion, ISO implementation of our unit was the trigger for internal PICU audit and external benchmarking. OPDSA cycles, following small steps at a time, in an iterate cycle of evolution, facilitated our actions. The majority of the KPOIs examined in our study was within international PICUs reference values.
{"title":"Key process and outcome indicators on quality and safety of care for critically ill pediatric patients according to international standard organization protocols: a four-year follow-up study","authors":"","doi":"10.22514/sv.2023.085","DOIUrl":"https://doi.org/10.22514/sv.2023.085","url":null,"abstract":"The European Society of Intensive Care Medicine (ESICM) suggests nine quality and safety indicators of care for critically ill patients. The aim of the present study was to examine the Key Process and Outcome Indicators (KPOIs) chosen according to International Standard Organization (ISO) protocols in a Greek Pediatric Intensive Care Unit (PICU). Two structure, one process, and four outcome indicators were examined in a stepwise approach according to Observe-Plan-Do-Study-Act (OPDSA) cycles, in an observational four-year cohort study (2017–2020). Two structure indicators—that ICUs fulfil national requirements to provide intensive care and 24-h consultant availability were requirements for the creation of the PICU and considered standards of care. One process indicator—Standardized Handover Procedure was transformed from handwritten (2017–2018) into electronic form (2019–2020) and 100% compliance rates throughout the four years were recorded. 96, 85, 103 and 94 patients were admitted in 2017, 2018, 2019 and 2020 with median (IQR) Pediatric Risk of Mortality III-24 h scores of 10 (6.25–17), 10 (6–13), 8 (5–13) and 8 (6.75–12), respectively. Mortality rates were 24%, 11.8%, 17.5%, 16%, and Standardized Mortality Ratio (SMR) were 1.42, 0.92, 1.56 and 1.33, correspondingly. No early (<48 h after PICU discharge) readmissions were recorded for 2017 and 2018, only 1 in 2019 (0.8%) and none in 2020. Catheter Related Bloodstream Infection rates were 1.37:1000, 1.37:1000, 1.26:1000 and 1.39:1000 catheter days, respectively. Unplanned extubation rate was 10.30% in 2019 and 5.72% and 3.91:1000 ventilation days in 2020. In conclusion, ISO implementation of our unit was the trigger for internal PICU audit and external benchmarking. OPDSA cycles, following small steps at a time, in an iterate cycle of evolution, facilitated our actions. The majority of the KPOIs examined in our study was within international PICUs reference values.","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135358149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Indemnity private health insurance (PHI) is a type of private insurance that pays actual medical expenses. We investigated the effect of subscriptions to indemnity PHI on emergency department (ED) expenses and the number of ED visits. This study was a retrospective study using Korea Health Panel Data from 2013 to 2017. The exposure variable was subscription of indemnity PHI. The control group did not subscribe to indemnity PHI throughout the study period, while the insured group had not subscribed to indemnity PHI in 2013 to 2014, but had done so in 2016 to 2017. The outcomes were ED expenses (per visit) and the number of ED visits. The outcomes were compared between before and after indemnity PHI subscription and between the insured and control groups. A total of 1919 subjects (265 insured and 1654 control group) were included. Univariable analyses indicated no difference in emergency medical use according to indemnity PHI subscription and the time period. However, multivariable modeling analysis showed that ED expenses were significantly higher for the insured group (US$5.7 more ED expense, p = 0.036; US$4.3 more ED expense per visit, p = 0.035). In addition, education level, chronic disease, disability status, economic activity and body mass index were associated with emergency medical use. This study suggests that indemnity PHI subscription can increase emergency medical expenses without an increase in visit frequency. Further studies are necessary to validate these results using another dataset.
{"title":"Impact of indemnity private health insurance on emergency department visits and expenditures","authors":"","doi":"10.22514/sv.2023.077","DOIUrl":"https://doi.org/10.22514/sv.2023.077","url":null,"abstract":"Indemnity private health insurance (PHI) is a type of private insurance that pays actual medical expenses. We investigated the effect of subscriptions to indemnity PHI on emergency department (ED) expenses and the number of ED visits. This study was a retrospective study using Korea Health Panel Data from 2013 to 2017. The exposure variable was subscription of indemnity PHI. The control group did not subscribe to indemnity PHI throughout the study period, while the insured group had not subscribed to indemnity PHI in 2013 to 2014, but had done so in 2016 to 2017. The outcomes were ED expenses (per visit) and the number of ED visits. The outcomes were compared between before and after indemnity PHI subscription and between the insured and control groups. A total of 1919 subjects (265 insured and 1654 control group) were included. Univariable analyses indicated no difference in emergency medical use according to indemnity PHI subscription and the time period. However, multivariable modeling analysis showed that ED expenses were significantly higher for the insured group (US$5.7 more ED expense, p = 0.036; US$4.3 more ED expense per visit, p = 0.035). In addition, education level, chronic disease, disability status, economic activity and body mass index were associated with emergency medical use. This study suggests that indemnity PHI subscription can increase emergency medical expenses without an increase in visit frequency. Further studies are necessary to validate these results using another dataset.","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":"77 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136217921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ruptured abdominal aortic aneurysms pose a challenge to anesthesiologists. Resus-citative thoracotomy and aorta-cross clamping are used to prevent cardiopulmonary collapse during ruptured abdominal aortic aneurysm repair. Recently, resuscitative endovascular balloon obstruction of the aorta has been introduced as an alternative to resuscitative thoracotomy and aorta-cross clamping. Resuscitative endovascular balloon obstruction of the aorta is a minimally invasive and low risk procedure compared to resuscitative thoracotomy and aorta-cross clamping, with minimal blood-borne pathogen exposure to healthcare workers. A 63-year-old man was scheduled for emergency repair of a ruptured abdominal aortic aneurysms. The patient’s vital signs were unstable, and aggressive treatment with transfusion and vasopressor infusion was not effective. Resuscitative endovascular balloon obstruction of the aorta was performed using the brachial artery. After initiation of resuscitative endovascular balloon obstruction of the aorta, the patient’s vital signs immediately stabilized, and hematoma evacuation and aorta reconstruction were completed successfully. The total balloon inflation time during resuscitative endovascular balloon obstruction of the aorta was approximately 45 min. The patient was discharged on the 62nd postoperative day. Resuscitative endovascular balloon obstruction of the aorta is a promising minimally invasive alternative to resuscitative thoracotomy and aorta-cross clamping in patients with ruptured abdominal aortic aneurysms. Resuscitative endovascular balloon obstruction of the aorta may also be a good treatment option for patients with non-compressible torso bleeding under the diaphragm.
{"title":"Successful management for a ruptured abdominal aortic aneurysm using resuscitative endovascular balloon occlusion of the aorta via the brachial artery route—a case report","authors":"S. Kim, Jaegyok Song, Nayoung Choi","doi":"10.22514/sv.2021.232","DOIUrl":"https://doi.org/10.22514/sv.2021.232","url":null,"abstract":"Ruptured abdominal aortic aneurysms pose a challenge to anesthesiologists. Resus-citative thoracotomy and aorta-cross clamping are used to prevent cardiopulmonary collapse during ruptured abdominal aortic aneurysm repair. Recently, resuscitative endovascular balloon obstruction of the aorta has been introduced as an alternative to resuscitative thoracotomy and aorta-cross clamping. Resuscitative endovascular balloon obstruction of the aorta is a minimally invasive and low risk procedure compared to resuscitative thoracotomy and aorta-cross clamping, with minimal blood-borne pathogen exposure to healthcare workers. A 63-year-old man was scheduled for emergency repair of a ruptured abdominal aortic aneurysms. The patient’s vital signs were unstable, and aggressive treatment with transfusion and vasopressor infusion was not effective. Resuscitative endovascular balloon obstruction of the aorta was performed using the brachial artery. After initiation of resuscitative endovascular balloon obstruction of the aorta, the patient’s vital signs immediately stabilized, and hematoma evacuation and aorta reconstruction were completed successfully. The total balloon inflation time during resuscitative endovascular balloon obstruction of the aorta was approximately 45 min. The patient was discharged on the 62nd postoperative day. Resuscitative endovascular balloon obstruction of the aorta is a promising minimally invasive alternative to resuscitative thoracotomy and aorta-cross clamping in patients with ruptured abdominal aortic aneurysms. Resuscitative endovascular balloon obstruction of the aorta may also be a good treatment option for patients with non-compressible torso bleeding under the diaphragm.","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2021-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43479921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Lee, S. Bae, K. Kim, S. J. Yun, Jong Seok Oh, J. Lim
Hypovolemia is a major risk factor for morbidity and mortality among elderly older patients. The inferior vena cava (IVC) diameter is known to predict the fluid volume status in ill patients. This study aimed to evaluate the predictive performance of the IVC diameter ratio, as determined by computed tomography (CT), for poor outcomes among low risk patients 65 years of age and older. This single-center retrospective study was conducted on patients who taken CT during the clinical process between January 2019 and December 2020. IVC diameter ratio measurement was estimated by dividing the maximum value of the anteroposterior diameter from the maximum value of transverse diameter at the level right above the renal vein. The IVC diameter ratio’s prognostic performance was evaluated by using the area under the receiver operating characteristic (AUROC) curve. The mean IVC diameter ratio was 1.78. Multivariable logistic regression analysis revealed age, pulse rate, aspartate aminotransferase level, and IVC diameter ratio as significant risk factors for in-hospital death. The area under the receiver operating curve for predicting death using the IVC diameter ratio of patients with pulse rates under 95 was 0.701 and the cut-off value was 1.638, with an 88.9% sensitivity and 45.2% specificity. The odds ratio for higher IVC diameter ratio values was statistically significant (p = 0.031) for predicting in-hospital death. IVC measurement using abdomen& pelvic computed tomography (APCT ) demonstrated capability for predicting poor outcomes, including all-cause mortality among older patients with low risk in the emergency department.
{"title":"Utility of inferior vena cava diameter ratio on computed tomography scan among low-risk elderly patients in the emergency department","authors":"S. Lee, S. Bae, K. Kim, S. J. Yun, Jong Seok Oh, J. Lim","doi":"10.22514/sv.2021.212","DOIUrl":"https://doi.org/10.22514/sv.2021.212","url":null,"abstract":"Hypovolemia is a major risk factor for morbidity and mortality among elderly older patients. The inferior vena cava (IVC) diameter is known to predict the fluid volume status in ill patients. This study aimed to evaluate the predictive performance of the IVC diameter ratio, as determined by computed tomography (CT), for poor outcomes among low risk patients 65 years of age and older. This single-center retrospective study was conducted on patients who taken CT during the clinical process between January 2019 and December 2020. IVC diameter ratio measurement was estimated by dividing the maximum value of the anteroposterior diameter from the maximum value of transverse diameter at the level right above the renal vein. The IVC diameter ratio’s prognostic performance was evaluated by using the area under the receiver operating characteristic (AUROC) curve. The mean IVC diameter ratio was 1.78. Multivariable logistic regression analysis revealed age, pulse rate, aspartate aminotransferase level, and IVC diameter ratio as significant risk factors for in-hospital death. The area under the receiver operating curve for predicting death using the IVC diameter ratio of patients with pulse rates under 95 was 0.701 and the cut-off value was 1.638, with an 88.9% sensitivity and 45.2% specificity. The odds ratio for higher IVC diameter ratio values was statistically significant (p = 0.031) for predicting in-hospital death. IVC measurement using abdomen& pelvic computed tomography (APCT ) demonstrated capability for predicting poor outcomes, including all-cause mortality among older patients with low risk in the emergency department.","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2021-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42638427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Liver abscess is a potentially fatal mass associated with liver injury and disease with a mortality rate of 12% if treatment is delayed. Patients usually complain of fever or upper abdominal pain; however, atypical symptoms, such as right shoulder pain, may also appear. We report a case of liver abscess presenting as dyspnea and right-side neck pain without any other symptoms. A 78-year-old man visited the hospital complaining of right-side neck pain, which had persisted for 10 days, and dyspnea that developed over time. The neck pain and dyspnea were aggravated with changes in posture. Arterial blood gas results (pH 7.47, PO2 76 mmHg, PCO2 33 mmHg, SpO2 98%) and chest and neck X-rays were normal, but white blood cell and C-reactive protein levels were higher than normal. A contrast-enhanced computed tomography scan of the chest was performed to differentiate the unexplained dyspnea and neck pain, and the liver abscess, which was diagnosed accidentally. Clinicians should consider liver abscess as a differential diagnosis in patients with dyspnea or neck pain when there is an increase in inflammatory marker, but it is difficult to explain the cause.
{"title":"Liver abscess presenting with dyspnea and right-side neck pain that can be overlooked in the emergency department: a case report","authors":"Sangun Nah, Young Soon Cho, Sangsoo Han","doi":"10.22514/sv.2021.213","DOIUrl":"https://doi.org/10.22514/sv.2021.213","url":null,"abstract":"Liver abscess is a potentially fatal mass associated with liver injury and disease with a mortality rate of 12% if treatment is delayed. Patients usually complain of fever or upper abdominal pain; however, atypical symptoms, such as right shoulder pain, may also appear. We report a case of liver abscess presenting as dyspnea and right-side neck pain without any other symptoms. A 78-year-old man visited the hospital complaining of right-side neck pain, which had persisted for 10 days, and dyspnea that developed over time. The neck pain and dyspnea were aggravated with changes in posture. Arterial blood gas results (pH 7.47, PO2 76 mmHg, PCO2 33 mmHg, SpO2 98%) and chest and neck X-rays were normal, but white blood cell and C-reactive protein levels were higher than normal. A contrast-enhanced computed tomography scan of the chest was performed to differentiate the unexplained dyspnea and neck pain, and the liver abscess, which was diagnosed accidentally. Clinicians should consider liver abscess as a differential diagnosis in patients with dyspnea or neck pain when there is an increase in inflammatory marker, but it is difficult to explain the cause.","PeriodicalId":49522,"journal":{"name":"Signa Vitae","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2021-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43742497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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