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Abdominal Pain over 6 Months 腹痛超过6个月
Pub Date : 2022-12-01 DOI: 10.3904/kjm.2022.97.6.361
Sh Lee, S. Kang
Inflammatory bowel disease includes two major types of disease: Crohn’s disease and ulcerative colitis. The incidence of inflammatory bowel disease is increasing worldwide, including in Korea. This chronic disease progresses gradually, with cycles of improvement and exacerbation. Therefore, a quick diagnosis and appropriate treatment are necessary. In this review, we discuss the clinical symptoms of inflammatory bowel disease, as well as diagnostic methods.
炎症性肠病包括两大类疾病:克罗恩病和溃疡性结肠炎。包括韩国在内的世界范围内,炎症性肠病的发病率正在上升。这种慢性疾病进展缓慢,有改善和恶化的周期。因此,快速诊断和适当治疗是必要的。本文就炎症性肠病的临床症状及诊断方法作一综述。
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引用次数: 0
Evaluation of Diastolic Dysfunction and the Role Thereof in Heart Failure with Preserved Ejection Fraction 评估舒张功能障碍及其在保留射血分数的心力衰竭中的作用
Pub Date : 2022-12-01 DOI: 10.3904/kjm.2022.97.6.368
R. Heo
Evaluation of left ventricular diastolic function is essential, especially in patients with heart failure with preserved ejection fraction. The American Society of Echocardiography/European Association of Cardiovascular Imaging guidelines were released in 2016. Four principal parameters were used to assess left ventricular diastolic function. However, there are grey areas; the situation is complex. Recently, various other indicators have been employed to explore left ventricular diastolic function.
评估左心室舒张功能是必要的,特别是对保留射血分数的心力衰竭患者。美国超声心动图学会/欧洲心血管成像协会指南于2016年发布。四个主要参数用于评估左室舒张功能。然而,也有灰色地带;形势很复杂。最近,各种其他指标被用来探讨左室舒张功能。
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引用次数: 0
Management Strategies for the Successful Establishment and Growth of the Hospitalist System 医院医师制度成功建立与成长的管理策略
Pub Date : 2022-10-01 DOI: 10.3904/kjm.2022.97.5.303
Jongchan Lee
Appropriate management strategies are required to establish, maintain, and promote the growth the hospitalist system. Herein, we discuss strategies for the successful operation of the hospitalist system from the business point of view, particularly in terms of human resources and organizational management. Hospital executives should establish the vision, mission, value, and key value drivers of the hospitalist system from its inception, as well as decide its size and operation pattern according to the situation of each medical institution. Hospitalists are employed through the process of recruitment to increase the number of applicants and allow the selection of suitable candidates. Once the hospitalist system is constructed and operational, the focus must shift toward its growth. The goals and strategies for growth should be decided, leaders must be selected, and assistants must be employed. In the future, the hospitalist system is expected to play an essential role in improving the quality of medical care. Therefore, medical institutions should strategically introduce, maintain, and promote the growth of the hospitalist system.
建立、维持和促进医院系统的发展需要适当的管理策略。在此,我们从商业的角度,特别是在人力资源和组织管理方面,讨论了医院系统成功运作的策略。医院管理者应该从医院系统建立之初就确立医院系统的愿景、使命、价值和关键价值驱动因素,并根据每个医疗机构的情况决定医院系统的规模和运作模式。通过招聘过程雇用医院医生,以增加申请人的数量,并允许选择合适的候选人。一旦医院系统建成并投入使用,重点就必须转向其发展。必须确定增长的目标和战略,必须选择领导者,必须雇用助手。在未来,住院医师制度有望在提高医疗质量方面发挥重要作用。因此,医疗机构应战略性地引进、维护和促进住院医师制度的发展。
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引用次数: 0
Successful Living Donor Kidney Transplantation in a Patient with MTHFR Deficiency and Heparin-Induced Thrombocytopenia: A Case Report MTHFR缺乏和肝素诱发的血小板减少症患者活体肾移植成功一例报告
Pub Date : 2022-10-01 DOI: 10.3904/kjm.2022.97.5.328
Dong Kang, Hanbi Lee, B. Chung, B. Choi, Chul-woo Yang, E. Ko
Perioperative anticoagulation in a kidney transplant recipient with heparin-induced thrombocytopenia is challenging due to paradoxical hypercoagulability. A 49-year-old man with end-stage kidney disease and a previous stroke history was referred for living donor kidney transplantation. After the fifth dialysis session, the platelet count decreased to 10,000/μL, and heparin was immediately discontinued. Five days later, pulmonary thromboembolism with deep vein thrombosis was identified. Anti-heparin PF4 antibody, elevated serum homocysteine, and methylenetetrahydrofolate reductase gene mutations were discovered. Subsequent coronary angiography revealed three-vessel disease. Apixaban, folate, aspirin, and clopidogrel were administered and an inferior vena cava filter was implanted. Thereafter, coronary artery bypass graft surgery was performed using argatroban-bridging without complications. Kidney transplantation was performed 3 months later using the argatroban protocol. The graft kidney functioned well without any complications. In conclusion, we successfully conducted kidney transplantation in a thrombophilic patient with a methylenetetrahydrofolate reductase deficiency and heparin-induced thrombocytopenia by establishing an individualized perioperative anticoagulation protocol.
肝素诱导的血小板减少肾移植受者的围手术期抗凝是具有挑战性的,因为矛盾的高凝性。患者49岁,终末期肾病,既往有中风史,接受活体肾移植。第5次透析后,血小板计数降至10000 /μL,立即停用肝素。5天后确诊为肺血栓栓塞伴深静脉血栓形成。发现抗肝素PF4抗体,血清同型半胱氨酸升高,亚甲基四氢叶酸还原酶基因突变。随后的冠状动脉造影显示三支血管病变。给予阿哌沙班、叶酸、阿司匹林和氯吡格雷,并植入下腔静脉过滤器。此后,冠状动脉搭桥手术使用阿加曲班桥无并发症。3个月后采用阿加曲班方案进行肾移植。移植肾功能良好,无并发症。总之,我们通过建立个体化围手术期抗凝治疗方案,成功地对一名患有亚甲基四氢叶酸还原酶缺乏和肝素诱导的血小板减少症的嗜血栓患者进行了肾移植。
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引用次数: 0
Percutaneous Treatment of Recurrent Stroke Caused by a Cardiac Foreign Body: A Case Report 经皮治疗心脏异物所致复发性脑卒中1例
Pub Date : 2022-10-01 DOI: 10.3904/kjm.2022.97.5.323
JiWung Ryu, jung-Sun Kim, Ji-Sun Seo
We present a case of recurrent ischemic stroke in a 68-year-old man with a linear foreign body in the right atrium and ventricle and a patent foramen ovale (PFO). The patient developed atrial fibrillation despite taking warfarin at a therapeutic dose and had a third acute stroke. We planned left atrial appendage (LAA) occlusion via the PFO, followed by PFO closure and foreign body removal. The percutaneous LAA occlusion and PFO closure were successful. However, it was difficult to remove the radiolucent foreign body. We inserted an Omni™ catheter via the right jugular vein to contact the foreign body in the right atrium directly, grasped its distal end with a snare, and successfully extracted it. The patient was followed-up in the outpatient clinic and had no recurrent stroke.
我们报告一例68岁男性复发性缺血性中风,右心房和心室有线状异物,卵圆孔未闭(PFO)。尽管服用了治疗剂量的华法林,患者还是出现了心房颤动,并发生了第三次急性中风。我们计划通过PFO阻断左心耳(LAA),然后关闭PFO并去除异物。经皮LAA闭塞和PFO闭合均成功。然而,放射状异物很难去除。我们通过右颈静脉插入Omni™导管直接接触右心房异物,用圈套抓住其远端,成功取出异物。患者在门诊随访,无卒中复发。
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引用次数: 0
Diagnostic Approach for Acute Myeloid Leukemia Based on the World Health Organization Classification of Hematologic Neoplasms 基于世界卫生组织血液肿瘤分类的急性髓系白血病诊断方法
Pub Date : 2022-10-01 DOI: 10.3904/kjm.2022.97.5.308
Young-Uk Cho
Acute myeloid leukemias (AMLs) are heterogeneous hematologic neoplasms characterized by myeloblast or promyelocyte proliferation without normal differentiation. The World Health Organization (WHO) classifies AMLs on the basis of chromosomal and genetic aberrations, with different prognoses for each subtype. Therefore, accurate diagnosis and classification of AMLs is critical for timely and appropriate treatment. Initial diagnostic workup includes morphologic assessment of the bone marrow aspirate and trephine biopsies, immunophenotyping using flow cytometry or immunohistochemistry stains, chromosomal analysis using the G-banding technique or fluorescence in situ hybridization, and mutation analysis using polymerase chain reaction, direct sequencing, or next-generation sequencing. The present study provides an algorithm for AML diagnosis and classification based on the WHO criteria and describes different clinicopathological stages of the workup.
急性髓系白血病(AMLs)是一种异质性血液学肿瘤,其特征是成髓细胞或早幼髓细胞增殖而无正常分化。世界卫生组织(世卫组织)根据染色体和遗传畸变对急性粒细胞白血病进行分类,每种亚型的预后不同。因此,准确的诊断和分类对于及时、适当的治疗至关重要。最初的诊断检查包括骨髓抽吸和环肺活检的形态学评估,使用流式细胞术或免疫组织化学染色的免疫表型分析,使用g带技术或荧光原位杂交的染色体分析,以及使用聚合酶链反应,直接测序或下一代测序的突变分析。本研究提供了一种基于WHO标准的AML诊断和分类算法,并描述了不同的临床病理阶段。
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引用次数: 0
Clinical Implication of Molecular Tumor Board 分子肿瘤委员会的临床意义
Pub Date : 2022-10-01 DOI: 10.3904/kjm.2022.97.5.319
Soohyeon Lee
Due to rapid technical advances, steeply declining sequencing costs, and the ever-increasing number of targeted therapies, it is expected that extensive tumor DNA or RNA sequencing will be applied in standard of care. Clinicians will thus be confronted with increasingly complex genetic information and multiple test-platforms to choose from. General medical training, meanwhile, can hardly keep up with the pace of innovation. Consequently, there is a rapidly growing gap between clinical knowledge and genetic potential in cancer care. Multidisciplinary Molecular Tumor Boards (MTBs) have been suggested as a means to address this disparity, as a multidisciplinary approach to keep pace with the growing knowledge of complex molecular alterations in patients with advanced solid cancer. MTBs are designated to interpret these data and provide clinical recommendations. Not all patients with cancer have access to advice of an MTB. We aimed to determine the current status, opportunities, and challenges of the organization of MTBs in the Korea.
由于技术的快速进步,测序成本的急剧下降,以及靶向治疗数量的不断增加,预计肿瘤DNA或RNA测序将广泛应用于标准治疗。因此,临床医生将面临日益复杂的遗传信息和多种测试平台可供选择。与此同时,普通医学培训很难跟上创新的步伐。因此,在癌症治疗中,临床知识和遗传潜力之间的差距正在迅速扩大。多学科分子肿瘤委员会(MTBs)已被建议作为解决这一差距的一种手段,作为一种多学科方法,以跟上晚期实体癌患者复杂分子改变的知识增长。mbs被指定解释这些数据并提供临床建议。并非所有癌症患者都能获得MTB的建议。我们的目的是确定韩国MTBs组织的现状、机遇和挑战。
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引用次数: 0
2021 Korean Thyroid Imaging Reporting and Data System (2021-K-TIRADS) and Imaging-Based Management of Thyroid Nodules: Korean Society of Thyroid Radiology Consensus Statement and Recommendations 2021韩国甲状腺影像报告和数据系统(2021- k - tirads)和基于影像的甲状腺结节管理:韩国甲状腺放射学会共识声明和建议
Pub Date : 2022-10-01 DOI: 10.3904/kjm.2022.97.5.292
S. Jung
The rate of detection of thyroid nodules and carcinomas has increased with the widespread use of ultrasonography (US), which is the primary imaging modality for the detection and risk stratification of thyroid nodules. The appropriate diagnosis and management of these patients is based on the risk factors related to the patients as well as the thyroid nodules. The Korean Society of Thyroid Radiology (KSThR) published consensus recommendations for US-based management of thyroid nodules in 2011 and revised them in 2016. These guidelines have been used as the standard guidelines in Korea. However, recent advances in the diagnosis and management of thyroid nodules have necessitated the revision of the original recommendations. The task force of the KSThR has revised the Korean Thyroid Imaging Reporting and Data System and recommendations for US lexicon, biopsy criteria, US criteria of extrathyroidal extension, optimal thyroid computed tomography protocol, and US follow-up of thyroid nodules before and after biopsy. The biopsy criteria were revised to reduce unnecessary biopsies for benign nodules while maintaining an appropriate sensitivity for the detection of malignant tumors. The goal of these recommendations is to provide the optimal scientific evidence and expert opinion consensus regarding US-based diagnosis and management of thyroid nodules.
随着超声检查(US)的广泛应用,甲状腺结节和癌的检出率增加,超声检查是甲状腺结节检测和风险分层的主要成像方式。这些患者的适当诊断和治疗是基于与患者相关的危险因素以及甲状腺结节。韩国甲状腺放射学会(KSThR)于2011年发布了美国甲状腺结节管理的共识建议,并于2016年对其进行了修订。在韩国,这些指导方针已经成为标准指导方针。然而,最近在诊断和管理甲状腺结节的进展有必要修改原来的建议。KSThR工作组修订了韩国甲状腺成像报告和数据系统,并对美国词典、活检标准、甲状腺外展的美国标准、最佳甲状腺计算机断层扫描方案以及活检前后甲状腺结节的美国随访提出了建议。活检标准的修订,以减少不必要的活检良性结节,同时保持适当的敏感性,以检测恶性肿瘤。这些建议的目的是为基于美国的甲状腺结节诊断和治疗提供最佳的科学证据和专家意见共识。
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引用次数: 3
Post COVID-19 Emerging Infectious Diseases: What is the Next Pandemic Agent? COVID-19后新发传染病:什么是下一个大流行病原体?
Pub Date : 2022-10-01 DOI: 10.3904/kjm.2022.97.5.277
Y. Choi
Emerging infectious diseases are increasing recently and globally. We have a long list of infectious disease epidemic in the 21th century followed by SARS, MERS, Ebola virus disease, and Zika virus infection. COVID-19 is a still ongoing pandemic. What will be the next pandemic agent? The World Health Organization proposed a research and development blueprint regarding global pandemic in 2016. The United Kingdom maintains a list of high consequence infectious diseases and is monitoring them. The Republic of Korea designates Class 1 infectious diseases capable of causing outbreak or epidemic. This article briefly describes several infectious diseases and its causative pathogen that should receive special attention.
最近全球新发传染病不断增加。在21世纪,我们有一个长长的传染病流行清单,紧随其后的是SARS、MERS、埃博拉病毒病和寨卡病毒感染。COVID-19仍是一场持续的大流行。下一个大流行病原体是什么?世界卫生组织在2016年提出了全球流行病的研发蓝图。联合王国保留了一份后果严重的传染病清单,并正在对其进行监测。大韩民国指定了能够引起爆发或流行的第1类传染病。本文简要介绍几种应特别注意的传染病及其病原。
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引用次数: 0
Post-COVID-19 Syndrome Post-COVID-19综合症
Pub Date : 2022-10-01 DOI: 10.3904/kjm.2022.97.5.284
J. Cha
Although acute COVID-19 usually lasts for 12 weeks from the onset of symptoms, some patients experience variable persistent symptoms. Post-COVID-19 syndrome is defined as persistent symptoms and/or long-term complications that appear during or after COVID-19, persist for more than 12 weeks, and cannot be explained by an alternative diagnosis. The common symptoms of post-COVID-19 syndrome include general, pulmonary, hematological, cardiovascular, neuropsychiatric, renal, endocrine, gastroenterological, and dermatological symptoms. As the natural course and pathophysiology of COVID-19 are not yet clear, close monitoring is needed for various sequelae in multiple organs that occur in post-COVID-19 syndrome. In particular, patients who have been hospitalized in the intensive care unit or who have recovered from severe COVID-19 require close monitoring for the development of post-COVID-19 syndrome. Multidisciplinary collaboration is essential to provide integrated outpatient care for patients with post-COVID-19 syndrome.
虽然急性COVID-19通常从症状出现开始持续12周,但一些患者会出现不同的持续性症状。COVID-19后综合征定义为在COVID-19期间或之后出现的持续症状和/或长期并发症,持续时间超过12周,并且无法用其他诊断来解释。covid -19后综合征的常见症状包括全身、肺部、血液、心血管、神经精神、肾脏、内分泌、胃肠和皮肤症状。由于COVID-19的自然病程和病理生理尚不清楚,因此需要密切监测COVID-19综合征后出现的多种多器官后遗症。特别是,需要密切监测在重症监护室住院或从严重COVID-19中康复的患者,以防出现COVID-19后综合征。多学科合作对于为covid -19后综合征患者提供综合门诊护理至关重要。
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引用次数: 0
期刊
Chungang uihak = The Korean central journal of medicine
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