Pub Date : 2023-04-05DOI: 10.1097/ec9.0000000000000083
Guanguan Luo, Qinqin Liu, Zhongxiang Zhang, Xiaoqing Jin
{"title":"A retrospective study of patients complaining of nontraumatic acute abdominal pain, admitted in the emergency department of an urban hospital in China","authors":"Guanguan Luo, Qinqin Liu, Zhongxiang Zhang, Xiaoqing Jin","doi":"10.1097/ec9.0000000000000083","DOIUrl":"https://doi.org/10.1097/ec9.0000000000000083","url":null,"abstract":"","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42442367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-05DOI: 10.1097/ec9.0000000000000082
R. Mitchell
{"title":"Triage for resource-limited emergency care: why it matters","authors":"R. Mitchell","doi":"10.1097/ec9.0000000000000082","DOIUrl":"https://doi.org/10.1097/ec9.0000000000000082","url":null,"abstract":"","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45861764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Background This study aimed to evaluate the diagnostic accuracy of magnetocardiograph, a relatively new noninvasive device, in patients with myocardial infarction (MI). Methods To identify studies assessing the diagnostic accuracy of magnetocardiography for MI, we searched four databases on November 7, 2022, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Web of Science, plus ClinicalTrials.gov. Three reviewers screened the studies independently and emailed the authors for more precise data when necessary. The Quality Assessment of Diagnostic Accuracy Studies 2 tool was used to evaluate the quality of the included studies. STATA (version 17; Stata Corporation, College Station, TX, USA) was used for meta-analysis of 2 × 2 contingency table data. Results A total of 6 articles were included in this study. The diagnostic parameters of all included studies were summarized as follows: the pooled sensitivity was 0.91 (95% confidence intervals [95% CIs]: 0.81–0.96; I2 = 88.54); specificity was 0.83 (95% CI: 0.75–0.89; I2 = 83); positive likelihood ratio was 5.3 (95% CI: 3.5–8.2); negative likelihood ratio was 0.1 (95% CI: 0.04–0.24); and diagnostic odds ratio was 51 (95% CI: 16–161). The area under the curve for the receiver operating characteristic curve was 0.92 (95% CI: 0.89–0.94). After metaregression analysis, we found that the number of channels and the way of environmental magnetic noise elimination were heterogeneous sources. Conclusion In summary, our meta-analysis shows that magnetocardiography holds a high accuracy in diagnosing MI and takes the advantages of noninvasive, radiation-free, and noncontact. However, further high-quality studies to confirm its usefulness in diagnosing MI are warranted.
{"title":"Magnetocardiograph as a noninvasive and radiation-free diagnostic device for myocardial infarction: a systematic review and meta-analysis","authors":"Yansong Xu, Xiaole Han, Mingyue Guo, Ruochuan Li, Yiming Dong, Jiaxin Fan, Xiaofei Yin, Fei Xie, J. Pang, Yuguo Chen","doi":"10.1097/EC9.0000000000000085","DOIUrl":"https://doi.org/10.1097/EC9.0000000000000085","url":null,"abstract":"Abstract Background This study aimed to evaluate the diagnostic accuracy of magnetocardiograph, a relatively new noninvasive device, in patients with myocardial infarction (MI). Methods To identify studies assessing the diagnostic accuracy of magnetocardiography for MI, we searched four databases on November 7, 2022, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and Web of Science, plus ClinicalTrials.gov. Three reviewers screened the studies independently and emailed the authors for more precise data when necessary. The Quality Assessment of Diagnostic Accuracy Studies 2 tool was used to evaluate the quality of the included studies. STATA (version 17; Stata Corporation, College Station, TX, USA) was used for meta-analysis of 2 × 2 contingency table data. Results A total of 6 articles were included in this study. The diagnostic parameters of all included studies were summarized as follows: the pooled sensitivity was 0.91 (95% confidence intervals [95% CIs]: 0.81–0.96; I2 = 88.54); specificity was 0.83 (95% CI: 0.75–0.89; I2 = 83); positive likelihood ratio was 5.3 (95% CI: 3.5–8.2); negative likelihood ratio was 0.1 (95% CI: 0.04–0.24); and diagnostic odds ratio was 51 (95% CI: 16–161). The area under the curve for the receiver operating characteristic curve was 0.92 (95% CI: 0.89–0.94). After metaregression analysis, we found that the number of channels and the way of environmental magnetic noise elimination were heterogeneous sources. Conclusion In summary, our meta-analysis shows that magnetocardiography holds a high accuracy in diagnosing MI and takes the advantages of noninvasive, radiation-free, and noncontact. However, further high-quality studies to confirm its usefulness in diagnosing MI are warranted.","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":"3 1","pages":"70 - 77"},"PeriodicalIF":0.0,"publicationDate":"2023-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42819287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-06DOI: 10.1097/ec9.0000000000000076
Junhui Xing
{"title":"Venoarterial extracorporeal membrane oxygenation in acute myocardial infarction","authors":"Junhui Xing","doi":"10.1097/ec9.0000000000000076","DOIUrl":"https://doi.org/10.1097/ec9.0000000000000076","url":null,"abstract":"","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44328796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-06DOI: 10.1097/ec9.0000000000000080
Zhifa Lv, Yun Zhang
{"title":"Effect of packed red blood cell transfusion on the prognosis of patients with upper gastrointestinal bleeding: a retrospective analysis of eICU-CRD v2.0 multicenter critically ill patients database","authors":"Zhifa Lv, Yun Zhang","doi":"10.1097/ec9.0000000000000080","DOIUrl":"https://doi.org/10.1097/ec9.0000000000000080","url":null,"abstract":"","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45192611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-06DOI: 10.1097/EC9.0000000000000073
Bin Song, Yue Sun, Dandan Liu, Guang-Yu Li
Abstract Introduction Pulmonary embolism is a lethal complication during pregnancy and the puerperium. Compared with vaginal delivery, the risk of pulmonary disease is almost twice as high with cesarean section. However, diagnosing a pulmonary embolism can be challenging. Case presentation A 31-year-old nulliparous woman underwent cesarean section. Postoperatively, the patient suddenly developed dyspnea and dull pain in the left back region and cardiopulmonary function deteriorated rapidly. Venous ultrasonography confirmed thrombosis of the left common iliac vein. Transthoracic echocardiography revealed a normal right heart and a dilated left ventricle with a patent foramen ovale. An acute pulmonary embolism was confirmed by pulmonary angiography. Catheter-directed thrombus fragmentation and thrombolysis were then performed. Conclusion Dilated left ventricular echocardiography does not exclude postpartum acute pulmonary embolism. In extreme emergencies, when acute pulmonary embolism is the most likely diagnosis and life-threatening, catheter-directed angiography may be preferred over other approaches.
{"title":"Acute pulmonary embolism immediately after cesarean section despite dilatation of the left ventricle: a case report and literature review","authors":"Bin Song, Yue Sun, Dandan Liu, Guang-Yu Li","doi":"10.1097/EC9.0000000000000073","DOIUrl":"https://doi.org/10.1097/EC9.0000000000000073","url":null,"abstract":"Abstract Introduction Pulmonary embolism is a lethal complication during pregnancy and the puerperium. Compared with vaginal delivery, the risk of pulmonary disease is almost twice as high with cesarean section. However, diagnosing a pulmonary embolism can be challenging. Case presentation A 31-year-old nulliparous woman underwent cesarean section. Postoperatively, the patient suddenly developed dyspnea and dull pain in the left back region and cardiopulmonary function deteriorated rapidly. Venous ultrasonography confirmed thrombosis of the left common iliac vein. Transthoracic echocardiography revealed a normal right heart and a dilated left ventricle with a patent foramen ovale. An acute pulmonary embolism was confirmed by pulmonary angiography. Catheter-directed thrombus fragmentation and thrombolysis were then performed. Conclusion Dilated left ventricular echocardiography does not exclude postpartum acute pulmonary embolism. In extreme emergencies, when acute pulmonary embolism is the most likely diagnosis and life-threatening, catheter-directed angiography may be preferred over other approaches.","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":"3 1","pages":"130 - 135"},"PeriodicalIF":0.0,"publicationDate":"2023-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47537447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-06DOI: 10.1097/EC9.0000000000000081
Hui Liu, Mengjie Song, Li Wang, Jian-guo Xiao, Feihu Zhou
Abstract Background This study aimed to investigate the influence of positive end-expiratory pressure (PEEP) on the right ventricle (RV) of mechanical ventilation–assisted patients through echocardiography. Methods Seventy-six patients assisted with mechanical ventilation were enrolled in this study. Positive end-expiratory pressure was upregulated by 4 cm H2O to treat acute respiratory distress syndrome, wherein echocardiography was performed before and after this process. Hemodynamic data were also recorded. All variables were compared before and after PEEP upregulation. The effect of PEEP was also evaluated in patients with and without decreased static lung compliance (SLC). Results Positive end-expiratory pressure upregulation significantly affected the RV function. Remarkable differences were observed in the following: Tei index (P = 0.027), pulmonary artery pressure (P = 0.039), tricuspid annular plane systolic excursion (P = 0.014), early wave/atrial wave (P = 0.002), diaphragm excursion (P < 0.001), inferior vena cava collapsing index (P < 0.001), and SLC (P < 0.001). There were no significant changes in heart rate, respiratory rate, central venous pressure, mean arterial pressure, and base excess (P > 0.05). Furthermore, the cardiac output of the RV was not significantly affected. In patients with decreased SLC (n = 41), there were more significant changes in diaphragm excursion (P < 0.001), inferior vena cava collapse index (P = 0.025), pulmonary artery pressure (P < 0.001), and tricuspid annular plane systolic excursion (P = 0.007) than in those without decreased SLC (n = 35). Conclusion Positive end-expiratory pressure upregulation significantly affected the RV function of critically ill patients with acute respiratory distress syndrome, especially in those with decreased SLC.
{"title":"Influence of positive end-expiratory pressure upregulation on the right ventricle in critical patients with acute respiratory distress syndrome: an observational cohort study","authors":"Hui Liu, Mengjie Song, Li Wang, Jian-guo Xiao, Feihu Zhou","doi":"10.1097/EC9.0000000000000081","DOIUrl":"https://doi.org/10.1097/EC9.0000000000000081","url":null,"abstract":"Abstract Background This study aimed to investigate the influence of positive end-expiratory pressure (PEEP) on the right ventricle (RV) of mechanical ventilation–assisted patients through echocardiography. Methods Seventy-six patients assisted with mechanical ventilation were enrolled in this study. Positive end-expiratory pressure was upregulated by 4 cm H2O to treat acute respiratory distress syndrome, wherein echocardiography was performed before and after this process. Hemodynamic data were also recorded. All variables were compared before and after PEEP upregulation. The effect of PEEP was also evaluated in patients with and without decreased static lung compliance (SLC). Results Positive end-expiratory pressure upregulation significantly affected the RV function. Remarkable differences were observed in the following: Tei index (P = 0.027), pulmonary artery pressure (P = 0.039), tricuspid annular plane systolic excursion (P = 0.014), early wave/atrial wave (P = 0.002), diaphragm excursion (P < 0.001), inferior vena cava collapsing index (P < 0.001), and SLC (P < 0.001). There were no significant changes in heart rate, respiratory rate, central venous pressure, mean arterial pressure, and base excess (P > 0.05). Furthermore, the cardiac output of the RV was not significantly affected. In patients with decreased SLC (n = 41), there were more significant changes in diaphragm excursion (P < 0.001), inferior vena cava collapse index (P = 0.025), pulmonary artery pressure (P < 0.001), and tricuspid annular plane systolic excursion (P = 0.007) than in those without decreased SLC (n = 35). Conclusion Positive end-expiratory pressure upregulation significantly affected the RV function of critically ill patients with acute respiratory distress syndrome, especially in those with decreased SLC.","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":"3 1","pages":"97 - 103"},"PeriodicalIF":0.0,"publicationDate":"2023-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42462148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Background This study aimed to conduct a systematic review and meta-analysis of the efficacy of hydrocortisone, vitamin C, and thiamine (HVT) in patients with sepsis or septic shock. Methods A literature search was performed in PubMed, Embase, Cochrane Library, and Web of Science from their inception to April 2021. Search terms included hydrocortisone, thiamine, vitamin C, sepsis, and septic shock. Only randomized controlled trials on HVT in treating sepsis and septic shock were analyzed. Risk ratio (RR) was generated using Review Manager 5.3 to evaluate binary variants, whereas mean ± standard deviation (MD) was generated to assess continuous variants. Results A total of 7 randomized controlled trials, with 1233 patients, were included in this meta-analysis. There was no significant difference in long-term mortality (35.3% vs 33.2%; RR: 1.07; 95% confidence interval [95% CI]: 0.90–1.27; P = 0.45; I2 = 0%), intensive care unit (ICU) mortality (17.4% vs 17.5%; RR: 0.99; 95% CI: 0.75–1.30; P = 0.95; I2 = 0%), in-hospital mortality (27.4% vs 25.8%; RR: 1.06; 95% CI: 0.84–1.34; P = 0.63; I2 = 0%), and acute kidney injury morbidity (RR: 1.04; 95% CI: 0.91–1.18; P = 0.60; I2 = 0%) between HVT and control groups. For continuous variables, there was no significant effect of HVT therapy on delta Sequential Organ Failure Assessment (△SOFA) score (MD: −0.44; 95% CI: −1.00 to 0.12; P = 0.12; I2 = 49%), length of ICU stay (MD: 0.43; 95% CI: −0.27 to 1.14; P = 0.23; I2 = 0%), and length of hospital stay (MD: 0.80; 95% CI: −0.38 to 1.97; P = 0.18; I2 = 0%). Only vasopressor duration was significantly reduced in the HVT group (MD: −17.75; 95% CI: −25.56 to −9.94; P < 0.00001; I2 = 38%). Vasopressor duration refers to the time to shock reversal. Alternatively, it is the amount of time (in hours) required for patients to withdraw all vasoactive medication support. Neither HVT nor control △SOFA reached statistical significance. Conclusion Hydrocortisone, vitamin C, and thiamine use was not associated with improved mortality, lower acute kidney injury incidence, lower △SOFA, and shorter ICU and in-hospital stays among patients with sepsis and septic shock. However, the use of vasopressors decreased significantly. Further direct head-to-head studies are needed.
摘要背景本研究旨在对氢化可的松、维生素C和硫胺素（HVT）治疗败血症或感染性休克患者的疗效进行系统综述和荟萃分析。方法检索PubMed、Embase、Cochrane图书馆和Web of Science从成立到2021年4月的文献。搜索词包括氢化可的松、硫胺素、维生素C、败血症和感染性休克。仅对HVT治疗败血症和感染性休克的随机对照试验进行了分析。使用Review Manager 5.3生成风险比（RR）以评估二元变异，而生成平均值±标准差（MD）以评估连续变异。结果本荟萃分析共纳入7项随机对照试验，共1233名患者。长期死亡率（35.3%vs 33.2%；RR:1.07；95%置信区间[95%CI]:0.90-1.27；P=0.45；I2=0%）、重症监护室（ICU）死亡率（17.4%vs 17.5%；RR:0.99；95%CI:0.75-1.30；P=0.95；I2=0%）、住院死亡率（27.4%vs 25.8%；RR:1.06；95%CI:0.84-1.34；P=0.63；I2=0）无显著差异，HVT组和对照组之间的急性肾损伤发病率（RR:1.04；95%CI:0.91–1.18；P=0.60；I2=0%）。对于连续变量，HVT治疗对delta顺序器官衰竭评估没有显著影响(△SOFA）评分（MD:−0.44；95%CI:−1.00至0.12；P=0.12；I2=49%）、ICU住院时间（MD:0.43；95%CI：−0.27至1.14；P=0.23；I2=0%）和住院时间（MD：0.80；95%CI:−0.38至1.97；P=0.18；I2=0%）。HVT组仅血管升压持续时间显著缩短（MD:−17.75；95%CI:−25.56至−9.94；P<0.00001；I2=38%）。升压持续时间是指电击逆转的时间。或者，它是患者撤回所有血管活性药物支持所需的时间（以小时为单位）。既不是HVT也不是控制△SOFA达到统计学显著性。结论氢化可的松、维生素C和硫胺素的使用与提高死亡率、降低急性肾损伤发生率、△SOFA，以及败血症和感染性休克患者更短的ICU和住院时间。然而，血管升压药的使用显著减少。需要进一步的直接面对面研究。
{"title":"Hydrocortisone, vitamin C, and thiamine may not improve the outcome of patients with sepsis or septic shock: a systematic review and meta-analysis","authors":"Zhuang Li, Xiaoli Zhang, Yongliang Wu, Chao Xie, Chengjiang Liu, Xiuyu He, Zehua Wu, Guofang Hua, Yuedong Li","doi":"10.1097/EC9.0000000000000072","DOIUrl":"https://doi.org/10.1097/EC9.0000000000000072","url":null,"abstract":"Abstract Background This study aimed to conduct a systematic review and meta-analysis of the efficacy of hydrocortisone, vitamin C, and thiamine (HVT) in patients with sepsis or septic shock. Methods A literature search was performed in PubMed, Embase, Cochrane Library, and Web of Science from their inception to April 2021. Search terms included hydrocortisone, thiamine, vitamin C, sepsis, and septic shock. Only randomized controlled trials on HVT in treating sepsis and septic shock were analyzed. Risk ratio (RR) was generated using Review Manager 5.3 to evaluate binary variants, whereas mean ± standard deviation (MD) was generated to assess continuous variants. Results A total of 7 randomized controlled trials, with 1233 patients, were included in this meta-analysis. There was no significant difference in long-term mortality (35.3% vs 33.2%; RR: 1.07; 95% confidence interval [95% CI]: 0.90–1.27; P = 0.45; I2 = 0%), intensive care unit (ICU) mortality (17.4% vs 17.5%; RR: 0.99; 95% CI: 0.75–1.30; P = 0.95; I2 = 0%), in-hospital mortality (27.4% vs 25.8%; RR: 1.06; 95% CI: 0.84–1.34; P = 0.63; I2 = 0%), and acute kidney injury morbidity (RR: 1.04; 95% CI: 0.91–1.18; P = 0.60; I2 = 0%) between HVT and control groups. For continuous variables, there was no significant effect of HVT therapy on delta Sequential Organ Failure Assessment (△SOFA) score (MD: −0.44; 95% CI: −1.00 to 0.12; P = 0.12; I2 = 49%), length of ICU stay (MD: 0.43; 95% CI: −0.27 to 1.14; P = 0.23; I2 = 0%), and length of hospital stay (MD: 0.80; 95% CI: −0.38 to 1.97; P = 0.18; I2 = 0%). Only vasopressor duration was significantly reduced in the HVT group (MD: −17.75; 95% CI: −25.56 to −9.94; P < 0.00001; I2 = 38%). Vasopressor duration refers to the time to shock reversal. Alternatively, it is the amount of time (in hours) required for patients to withdraw all vasoactive medication support. Neither HVT nor control △SOFA reached statistical significance. Conclusion Hydrocortisone, vitamin C, and thiamine use was not associated with improved mortality, lower acute kidney injury incidence, lower △SOFA, and shorter ICU and in-hospital stays among patients with sepsis and septic shock. However, the use of vasopressors decreased significantly. Further direct head-to-head studies are needed.","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":"3 1","pages":"122 - 129"},"PeriodicalIF":0.0,"publicationDate":"2023-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49184122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-16DOI: 10.1097/EC9.0000000000000079
Jie Liu, Han Cong, Xu Chen, Yan Deng, Mengmeng Shang, Rong Ma, Pengyu Li, Kunrun Ma, Lei Zhang, Jiang Zhu
Abstract Background Mammary duct ectasia is an acute or chronic inflammatory breast disease that occurs mainly in nonlactating women. It rarely occurs in the accessory breast. The etiology of this condition remains unclear. The long course and complex clinical manifestations of this disease in some patients make it easy to misdiagnose. Case Presentation Herein, we report a case of bilateral accessory breast duct ectasia. A 34-year-old nonlactating Chinese woman presented with a mass in the right axilla. Physical examination and ultrasonography revealed inflammatory lesions in both accessory breasts. Laboratory data and magnetic resonance imaging revealed hyperprolactinemia and pituitary microadenoma. Penicillin and bromocriptine were administered to prevent infection and reduce serum prolactin levels. We performed a simple mastectomy of the bilateral accessory breasts. The outcome was satisfactory. Conclusion This article reports the first case of bilateral accessory breast associated with pituitary microadenoma and reviews the literature to provide a reference for clinicians.
{"title":"Duct ectasia of bilateral accessory breast associated with pituitary microadenoma: a case report and literature review","authors":"Jie Liu, Han Cong, Xu Chen, Yan Deng, Mengmeng Shang, Rong Ma, Pengyu Li, Kunrun Ma, Lei Zhang, Jiang Zhu","doi":"10.1097/EC9.0000000000000079","DOIUrl":"https://doi.org/10.1097/EC9.0000000000000079","url":null,"abstract":"Abstract Background Mammary duct ectasia is an acute or chronic inflammatory breast disease that occurs mainly in nonlactating women. It rarely occurs in the accessory breast. The etiology of this condition remains unclear. The long course and complex clinical manifestations of this disease in some patients make it easy to misdiagnose. Case Presentation Herein, we report a case of bilateral accessory breast duct ectasia. A 34-year-old nonlactating Chinese woman presented with a mass in the right axilla. Physical examination and ultrasonography revealed inflammatory lesions in both accessory breasts. Laboratory data and magnetic resonance imaging revealed hyperprolactinemia and pituitary microadenoma. Penicillin and bromocriptine were administered to prevent infection and reduce serum prolactin levels. We performed a simple mastectomy of the bilateral accessory breasts. The outcome was satisfactory. Conclusion This article reports the first case of bilateral accessory breast associated with pituitary microadenoma and reviews the literature to provide a reference for clinicians.","PeriodicalId":72895,"journal":{"name":"Emergency and critical care medicine","volume":"3 1","pages":"36 - 40"},"PeriodicalIF":0.0,"publicationDate":"2023-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45380610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-16DOI: 10.1097/EC9.0000000000000075
Galdy Wafie, A. H. Nasution, B. Lubis
Abstract Background Acquired brain injury (ABI) is caused by trauma or nontrauma to the brain after birth. Increased intracranial pressure in patients with traumatic or nontraumatic brain injury affects the cerebral perfusion pressure. After traumatic brain injury, there is an increase in air content in the brain and an increase in volume of blood flow to the brain, which can cause increased intracranial pressure, herniation of brain tissue, impaired cerebral perfusion, and brain damage. Most patients with traumatic brain injury die from uncontrolled increases in intracranial pressure. Near-infrared spectroscopy (NIRS) and central venous pressure (CVP) monitoring are also associated with cerebral perfusion. This study aimed to determine the relationship between the Glasgow Coma Scale (GCS) scores and CVP and NIRS values in patients with ABI. Methods This prospective analytical study used a cross-sectional design to compare GCS scores with CVP and NIRS values in patients with traumatic and nontraumatic brain injury in the intensive care unit (ICU) of Haji Adam Malik Hospital Medan. GCS, CVP, and NIRS descriptive data in patients with brain injury were presented in terms of mean and standard deviation if the data were normally distributed, or median (interquartile range) values if the data were not normally distributed. The relationship between GCS scores and CVP and NIRS values was assessed using the Pearson correlation test if the data were normally distributed, or the Spearman test if the data were not normally distributed. Results In this study, the mean GCS score and CVP values were 7.04 ± 2.69 and 5.63 ± 25.82 mmHg, respectively. The right tissue oxygen saturation (StO2) was 55.61% ± 18.72%, and the left StO2 was 57.57% ± 17.48% with normally distributed data. There was no correlation between GCS scores and CVP values (P = 0.829), and no correlation between moderate GCS scores and right and left StO2 (P = 0.343; P = 0.121); however, there was a significantly strong positive correlation between severe GCS scores and right and left StO2 (P = 0.028, r = 0.656; P = 0.005, r = 0.777). Conclusion There was no significant correlation between GCS scores and CVP values, and no correlation between moderate GCS scores and NIRS values; however, there was a significantly strong positive correlation between severe GCS scores and NIRS values in patients with ABI at the ICU of Haji Adam Malik Hospital Medan.
摘要背景获得性脑损伤（ABI）是由出生后大脑的创伤或非创伤引起的。创伤性或非创伤性脑损伤患者的颅内压升高会影响脑灌注压。创伤性脑损伤后，大脑中的空气含量增加，流向大脑的血流量增加，这会导致颅内压升高、脑组织突出、脑灌注受损和脑损伤。大多数创伤性脑损伤患者死于颅内压不受控制的升高。近红外光谱（NIRS）和中心静脉压（CVP）监测也与脑灌注有关。本研究旨在确定ABI患者的格拉斯哥昏迷量表（GCS）评分与CVP和NIRS值之间的关系。方法这项前瞻性分析研究采用横断面设计，将棉兰Haji Adam Malik医院重症监护室（ICU）的创伤性和非创伤性脑损伤患者的GCS评分与CVP和NIRS值进行比较。如果数据呈正态分布，则脑损伤患者的GCS、CVP和NIRS描述性数据以平均值和标准差表示，如果数据不呈正态分布则以中值（四分位间距）表示。如果数据是正态分布的，则使用Pearson相关检验评估GCS评分与CVP和NIRS值之间的关系，如果数据不是正态分布，则使用Spearman检验评估。结果在本研究中，平均GCS评分和CVP值分别为7.04±2.69和5.63±25.82 mmHg。右组织血氧饱和度（StO2）为55.61%±18.72%，左组织血氧饱和度为57.57%±17.48%。GCS评分与CVP值无相关性（P=0.829），中度GCS评分和左右StO2无相关性（P=0.0343；P=0.121）；严重GCS评分与左右StO2呈正相关（P=0.028，r=0.656；P=0.005，r=0.777）；然而，在棉兰Haji Adam Malik医院ICU的ABI患者中，严重GCS评分与NIRS值之间存在显著的强正相关。
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