RESUMO
BACKGROUND: The impact of myocardial damage on the prognosis of patients with septic shock is not clearly elucidated because complex hemodynamic changes in sepsis obscure the direct relationship. We evaluated left ventricular (LV) conditions that reflect myocardial damage independently from hemodynamic changes in septic shock and their influence on the prognosis of patients. METHODS: We retrospectively enrolled 208 adult patients who were admitted to the intensive care unit and underwent echocardiography within 7 days from the diagnosis of septic shock. Patients who were previously diagnosed with structural heart disease or coronary artery disease were excluded. Left ventricular ejection fraction (LVEF) was divided into four categories: normal, ≥ 50%; mild, ≥ 40%; moderate, ≥ 30%; and severe dysfunction, < 30%. Wall motion impairment was categorized into the following patterns: normal, diffuse, ballooning, and focal. RESULTS: There were 141 patients with normal LVEF. Among patients with impaired LV wall motion, the diffuse pattern was the most common (34 patients), followed by the ballooning pattern (26 patients). Finally, 102 patients died, and in-hospital mortality was significantly higher in patients with severe LV systolic dysfunction (hazard ratio [HR], 1.97; 95% confidence interval [CI], 1.04-3.75; P = 0.039) and in patients with diffuse pattern of LV wall motion impairment (HR, 2.28; 95% CI, 1.19-4.36; P = 0.013) than in those with a normal LV systolic function. CONCLUSION: Severe LV systolic dysfunction and diffuse pattern of LV wall motion impairment significantly affected in-hospital mortality in patients with septic shock. Conventional echocardiographic evaluation provides adequate information on the development of myocardial damage and accurately predicts the prognosis of patients with septic shock.
Assuntos
Sepse , Choque Séptico , Disfunção Ventricular Esquerda , Idoso , Ecocardiografia , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Prognóstico , Sepse/complicações , Sepse/mortalidade , Choque Séptico/complicações , Choque Séptico/mortalidade , Disfunção Ventricular Esquerda/complicações , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/mortalidade , Função Ventricular EsquerdaRESUMO
We measured serum concentrations of trace elements and evaluated their clinical significance in relation to treatment outcomes of critically ill patients. A total of 167 participants (105 men and 62 women; average age, 61.4 years; age range, 18-90 years) were enrolled. Arterial blood concentrations of the trace elements zinc, copper, selenium, and manganese were measured every 14 days. At the time of intensive care unit (ICU) admission, serum concentrations of zinc, selenium, copper, and manganese were lower than the normal values in 75.1, 1.8, 37.8, and 2.1% of patients, respectively. Serum trace element concentrations measured on day 14 of ICU stay were higher than those measured at the time of ICU admission for zinc (53.3 â 80.7 µg/L) and copper (87.1 â 102.3 µg/L). Increased serum zinc and copper concentrations during ICU care were associated with a significantly lower mortality compared to decreased concentrations of zinc (15.6 vs. 83.3%, p = 0.003) and copper (5.6 vs. 50.0%, p = 0.013). At the time of ICU admission, low serum levels of zinc and copper were observed. Patients with increased serum concentrations of zinc and copper had significantly lower mortality.
Assuntos
Cobre/sangue , Estado Terminal/mortalidade , Manganês/sangue , Selênio/sangue , Oligoelementos/sangue , Zinco/sangue , APACHE , Cuidados Críticos , Feminino , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , República da CoreiaRESUMO
We evaluated the relationship between blood pressure variability (BPV) and the development of hypertension during pregnancy. A total of 4163 pregnant women with normal blood pressure (BP) before 20 weeks of gestation were included in this study. The visit-to-visit blood pressure variability (VVV) was evaluated using the standard deviation (SD) of the systolic BP taken three times during pregnancy at approximately 10, 20, and 30 weeks of gestation. The VVV gradually decreased during pregnancy in normotensive subjects (SD: 7.2 ± 4.2 mmHg, 6.8 ± 3.9 mmHg, and 6.3 ± 3.6 mmHg at 10, 20, and 30 weeks, respectively). However, the VVV of hypertensive subjects did not decrease (SD: 8.2 ± 5.7 mmHg, 7.6 ± 5.0 mmHg, and 8.3 ± 5.3 mmHg at 10, 20, and 30 weeks, respectively) and was significantly greater than the VVV of normotensive subjects (p < 0.001). The VVV was significantly higher in patients who developed hypertension, and there was no decrease in VVV during pregnancy. Pregnancy complications were significantly increased in women with higher VVV at 10 and 30 weeks. Therefore, increased VVV during pregnancy may be a predictor of poor pregnancy outcomes.
Assuntos
Pressão Sanguínea , Hipertensão Induzida pela Gravidez/fisiopatologia , Adulto , Feminino , Humanos , Gravidez , Resultado da Gravidez , Estudos RetrospectivosRESUMO
OBJECTIVE: There is a growing demand for cuffless blood pressure (BP) measurement as an easy alternative to cuff-occlusion-based BP measurement. We assessed the accuracy of a new cuffless, watch-style BP monitor with a magnetoplethysmography (MPG) sensor compared to two standard auscultatory and oscillatory BP monitors. SUBJECTS AND METHODS: A total of 34 patients with uncontrolled hypertension (systolic BP ≥150 mm Hg or diastolic BP ≥95 mm Hg) were enrolled in the study. BP was measured by two conventional monitors and the new device during the pre-exercise phase, during isometric handgrip exercise, and during the recovery phase (5 min after exercise). The correlation between monitors was assessed using intraclass correlation coefficient (ICC) and Bland-Altman plots. RESULTS: Although two reference monitors produced highly correlated BP measurements, each was differentially correlated with BP measurements obtained by the new MPG monitor. During exercise, the mean difference between systolic BP obtained by the MPG and oscillatory monitors was >7 mm Hg with an ICC of 0.549 (95$ CI 0.264-0.746) in systole and 0.737 (95$ CI 0.534-0.859) in diastole. The ICC between the auscultatory monitor and the MPG monitor was 0.753 (95$ CI 0.559-0.868) in systole and 0.841 (95$ CI 0.706-0.918) in diastole after exercise. Bland-Altman plots also indicated that the performance of the new MPG device was very similar to that of the auscultatory monitor. CONCLUSION: Although the performance of the new MPG monitor was comparable to that of the reference monitors used in this study, improved stability and accuracy are necessary for accurate BP evaluation during dynamic activity.
RESUMO
BACKGROUND: Previous reports on anaphylaxis in Asia are limited to relatively small-scale studies. We performed this study to identify the nationwide prevalence of anaphylaxis and epinephrine prescription rates by age groups. METHODS: The total number of patients, yearly and overall prevalence, percentage of emergency department visits, and epinephrine prescription rates were calculated for patients diagnosed with anaphylaxis based on the Korean National Health Insurance database from 2010 to 2014. RESULTS: The mean prevalence of anaphylaxis in Korea was 26.23 (95% confidence interval, CI 25.78-26.68) per 100,000 person-years during the 5 years. It increased from 20.55 (95% CI 20.15-20.10) in 2010 to 35.33 (95% CI 34.81-35.85) per 100,000 person-years in 2014. The average prevalence was > 35 per 100,000 person-years among 50-69 year-olds, and the mean crude prevalence in children was 22.3 (0-2 years), 17.3 (3-6 years), 12.1 (7-12 years), and 14.9 (13-17 years) per 100,000 person-years, respectively. The overall prevalence increased 1.7-fold, with the highest rate of increase in 0-2 years of age. The overall percentage of emergent anaphylaxis patients was 88.4%, and the prevalence of emergent anaphylaxis increased from 18.63 (95% CI 18.25-19.01) to 31.28 (95% CI 30.79-31.77) per 100,000 person-years. In-hospital epinephrine prescription rate increased from 31.5 to 39.7%. CONCLUSIONS: The mean prevalence of anaphylaxis in Korea was 26.2 per 100,000 person-years during the study period. The total number of anaphylaxis patients increased 1.7-fold from 2010 to 2014, with the most noticeable increment being in young children.
RESUMO
BACKGROUND: Histologic grade is the most important predictor of the clinical outcome of non-muscle invasive (Ta, T1) papillary urothelial carcinoma (NMIPUCa), but its ambiguous criteria diminish its power to predict recurrence/progression for individual patients. We attempted to find an objective and reproducible histologic predictor of NMIPUCa that correlates well with the clinical outcome. METHODS: A total of 296 PUCas were collected from the Departments of Surgical Pathology of 11 institutions in South Korea. The clinical outcome was grouped into no event (NE), recurrence (R), and progression (P) categories. All 25 histological parameters were numerically redefined. The clinical pathology of each case was reviewed individually by 11 pathologists from 11 institutions based on the 2004 WHO criteria and afterwards blindly evaluated by two participants, based on our proposed parameters. Univariate and multivariate logistic regression analyses were performed using the R software package. RESULTS: The level of mitoses was the most reliable parameter for predicting the clinical outcome. We propose a four-tiered grading system based on mitotic count (> 10/10 high-power fields), nuclear pleomorphism (smallest-to-largest ratio of tumor nuclei >20), presence of divergent histology, and capillary proliferation (> 20 capillary lumina per papillary core). CONCLUSIONS: The level of mitoses at the initial bladder biopsy and transurethral resection (TUR) specimen appeared to be an independent predictor of the Ta PUCa outcome. Other parameters include the number of mitoses, nuclear pleomorphism, divergent histology, and capillary proliferation within the fibrovascular core. These findings may improve selection of patients for a therapeutic strategy as compared to previous grading systems.
Assuntos
Carcinoma de Células de Transição/patologia , Gradação de Tumores/métodos , Neoplasias da Bexiga Urinária/patologia , Idoso , Biópsia , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mitose , Prognóstico , República da CoreiaRESUMO
PURPOSE: We investigated bioelectrical impedance analysis (BIA)-derived parameters in critically ill patients to evaluate any differences between survivors and nonsurvivors. METHODS: We calculated severity scores for 241 critically ill surgical patients (161 male and 80 female; mean age, 62.9years) using three severity scoring systems (Acute Physiology and Chronic Health Evaluation II, Sequential Organ Failure Assessment, and Simplified Acute Physiology Score III). Body composition was measured using a portable BIA device for segmental BIA. RESULTS: Among the BIA values, impedance (odds ratio [OR], 0.99; P<0.001), reactance (OR 0.90; P<0.001), and phase angle (PhA) (OR, 0.53; P<0.001) were highly statistically significant for predicting mortality in univariate and multivariate logistic regression analysis. Comparison of area under the curve (AUC) between severity scoring systems and BIA values showed statistically significant differences between reactance and PhA with all three severity scoring systems. Covariate-adjusted receiver operating characteristic curve analysis showed that compared with severity scoring, all three BIA values (impedance, reactance, and PhA) had higher AUC values. CONCLUSIONS: PhA, impedance, and reactance determined by BIA in critically ill patients were associated with mortality outcomes and revealed stronger predictive power for mortality than severity scoring systems commonly used in an intensive care unit.
Assuntos
Biomarcadores , Estado Terminal/mortalidade , Impedância Elétrica , Índice de Gravidade de Doença , APACHE , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Valor Preditivo dos Testes , Curva ROC , Escore Fisiológico Agudo SimplificadoRESUMO
OBJECTIVES: To determine the ultrasound elasticity of the brain in neonates METHODS: Strain elastography was performed in 21 healthy neonates (mean gestational age [GA], 34 weeks; range, 28-40 weeks). Elastographic scores were assigned to the following structures on a 5-point color scale (1-5): ventricle, periventricular white matter, caudate, subcortical, cortical gray matter, and subdural space. Three elastographic images were evaluated in each patient, and median elastographic scores were calculated. The scores were compared between regions and were correlated with the corrected GA. Interobserver agreements for assignment of elastographic scores were analyzed. RESULTS: The ventricle and subdural space showed an elasticity score of 1 in all patients. The cortical gray matter (median, 3.0; first-third quartiles, 2.33-3.33) showed higher elasticity compared to the periventricular white mater (4.0; 3.00-4.00; P < .001), caudate (4.3; 3.67-4.67; P < .001), and subcortical white matter (4.0; 4.00-4.00; P < .001). The caudate showed lower elasticity compared to periventricular white matter (P = .004). The periventricular white matter showed higher elasticity compared to subcortical white matter (P = .009). There was a positive trend between the corrected GA and cortical gray matter elastographic score (γ = 0.376; P = .093). Interobserver agreement was moderate to almost perfect (κ = 0.53-0.89). CONCLUSIONS: Neonatal intracranial regions showed different elasticity, which could be accessed by strain elastography. These normal findings should prompt future studies investigating the use of ultrasound elastography in the neonatal brain.
Assuntos
Encéfalo/diagnóstico por imagem , Encéfalo/fisiologia , Técnicas de Imagem por Elasticidade/métodos , Interpretação de Imagem Assistida por Computador/métodos , Ultrassonografia Pré-Natal/métodos , Módulo de Elasticidade/fisiologia , Feminino , Humanos , Recém-Nascido , Masculino , Tamanho do Órgão/fisiologia , Projetos Piloto , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Estresse MecânicoRESUMO
BACKGROUND: Trigeminal nerve block (Tnb) with alcohol for trigeminal neuralgia (TN) may not be used widely as a percutaneous procedure for medically intractable TN in recent clinical work, because it has been considered having a limited duration of pain relief, a decrease in success rate and increase in complications on repeated blocks. OBJECTIVES: To evaluate the clinical outcome of the Tnb with alcohol in the treatment of medically intractable TN. METHODS: Six hundred thirty-two patients were diagnosed with TN between March 2000 and February 2010. Four hundred sixty-five out of 632 underwent Tnb with alcohol under a fluoroscope. Pain relief duration were analyzed and compared in the individual branch blocks. Outcomes were compared between patients with and without a previous Tnb with alcohol. RESULTS: Tnb with alcohol were performed in a total 710 (1st-465, 2nd-155, 3rd-55, 4th-23, 5th-8, 6th-4) cases for a series of consecutive 465 patients during the study period. Forty hundred sixty two out of the 465 patients experienced immediate complete pain relief (99%) at the first Tnb. Of the 465 patients, 218 patients (46.9%) did not require any further treatment after the first Tnb with alcohol during an entire study period. One hundred fifty nine (34.2 %) out of the 465 patients experienced recurring pain after the first block, among whom 155 patients received subsequent blocks, and the remaining 4 patients decided to take medication. According to the Kaplan-Meier analysis, the probabilities of remaining pain relief for 1, 2, 3, and 5 years after the procedures were 86.2%, 65.5%, 52.5%, and 33.4%, respectively. There was no significant difference in the probability of pain relief duration between patients with and without previous Tnb with alcohol. Median (95% CI) pain relief durations of the first and repeated blocks were 39 (36-51) and 37 (28-54) months, respectively. There was no significant difference in occurrence of complications between patients with and without previous Tnb with alcohol (p <0.076). All the complications recovered spontaneously within 6 months. There was no mortality related to the procedure. CONCLUSIONS: Tnb with alcohol for the pain management of TN can provide considerably long lasting pain relief. Repeated Tnb with alcohol has pain relief duration as long as the first block, and seems to produce less complication as well. Tnb with alcohol is a valuable treatment modality of TN as a percutaneous procedure.
Assuntos
Etanol/uso terapêutico , Bloqueio Nervoso/métodos , Neuralgia do Trigêmeo/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVE Young patients with moyamoya disease can exhibit infarction after revascularization surgery. This analysis of the characteristics of infarction after encephaloduroarteriosynangiosis (EDAS) in young patients with moyamoya disease was undertaken in an effort to elucidate the infarction mechanism. METHODS The authors retrospectively collected clinical information and reviewed pre- and postoperative MRI studies from cases involving patients younger than 18 years who underwent EDAS for the treatment of moyamoya disease between January 2012 and February 2015. Infarction patterns were categorized into watershed, territorial, or mixed pattern. The Wilcoxon rank sum test, chi-square test, and Fisher exact test were used to compare the clinical and imaging variables between patient groups. The characteristics of patients with and without postoperative infarction were compared using univariate and multivariate analysis. The cumulative proportion of patients without postoperative infarction according to operation stage was calculated using the Kaplan-Meier method and the resulting curves were compared using the log-rank test. RESULTS In 100 patients, 171 EDAS procedures had been performed. There were 38 cases of preoperative infarction in 35 patients and 20 cases of postoperative infarction in 13 patients. Territorial infarction was more frequent in the postoperative infarction group than in the preoperative infarction group (55.0% vs 37.8%, p = 0.037). Infarction was more common on the bilateral or contralateral side of the operation after first-stage EDAS (9 [75.0%] of 12 infarctions) than in the second-stage operation (2 [25.0%] of 8 infarctions), but the difference was not statistically significant (p = 0.068). The frequency of postoperative infarction was not significantly different depending on the stage of the operation (p = 0.694). CONCLUSIONS An acute infarction pattern after EDAS was more frequently territorial, suggesting an underlying occlusive mechanism. Operation stage did not affect the rate of postoperative infarction occurrence.
Assuntos
Infarto Cerebral/diagnóstico , Doença de Moyamoya/diagnóstico , Doença de Moyamoya/cirurgia , Complicações Pós-Operatórias/diagnóstico , Adolescente , Infarto Cerebral/etiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Complicações Pós-Operatórias/etiologia , Estudos RetrospectivosRESUMO
BACKGROUND/AIMS: We evaluated the prognostic implication of circulating microRNA (miR)-21, miR-26a, and miR-29a in hepatocellular carcinoma (HCC) patients who underwent curative treatment. METHODS: The study included 120 hepatitis B virus-related HCC patients who underwent hepatic resection (n=63) or radiofrequency ablation (n=57). MiR-21, miR-26a, and miR-29a expression levels in pretreatment plasma and several clinical variables were analyzed to identify prognostic bio-markers. RESULTS: Old age, low albumin level, low platelet count, advanced tumor stage (modified Union for International Cancer Control stages III, IV), low miR-26a (hazard ratio [HR]=1.72; 95% confidence interval [CI]=1.04-2.83; P=0.035), and low miR-29a (HR=1.75; 95% CI=1.04-2.94; P=0.035) were identified as independent risk factors for predicting poor disease-free survival. Low miR-21, miR-26a, and miR-29a were associated with poor liver transplantation (LT)-free survival in the univariate analysis. Multivariate Cox regression analysis showed that low miR-26a (HR=3.41; 95% CI=1.32-8.82; P=0.011) and low miR-29a (HR=2.75; 95% CI=1.10-6.85; P=0.030), low platelet count, and advanced tumor stage were significantly associated with poor LT-free survival. Remarkable correlation was found between miR-26a and miR-29a (Spearman's rho=0.734, P<0.001). CONCLUSION: Pretreatment levels of circulating miR-26a and miR-29a are independent prognostic markers for poor disease-free survival and LT-free survival in hepatitis B virus-related HCC patients.
Assuntos
Carcinoma Hepatocelular/genética , MicroRNA Circulante/sangue , Neoplasias Hepáticas/genética , Adulto , Idoso , Carcinoma Hepatocelular/cirurgia , Carcinoma Hepatocelular/virologia , Intervalo Livre de Doença , Feminino , Hepatite B , Humanos , Neoplasias Hepáticas/cirurgia , Neoplasias Hepáticas/virologia , Transplante de Fígado , Masculino , MicroRNAs/sangue , Pessoa de Meia-Idade , Prognóstico , Fatores de RiscoRESUMO
OBJECTIVES: This study was performed to evaluate long-term outcome of indeterminate nodules detected on cirrhotic liver and to develop risk prediction model for hepatocellular carcinoma (HCC) progression of indeterminate nodules on hepatitis B virus (HBV)-related cirrhotic liver. METHODS: Indeterminate nodules up to 2 cm with uncertain malignant potential detected on computed tomography of cirrhotic liver during HCC surveillance were analyzed retrospectively. HCC risk prediction model of indeterminate nodules in HBV-related cirrhotic liver was deduced based on result of Cox regression analysis. RESULTS: A total of 494 indeterminate nodules were included. Independent risk factors of HCC progression were old age, arterial enhancement, large nodule size, low serum albumin level, high serum α-fetoprotein (AFP) level, and prior HCC history in all included subjects. In subjects with chronic hepatitis B, old age (year; hazard ratio (HR)=1.06; P<0.001), arterial enhancement (HR=2.62; P=0.005), large nodule size (>1 cm; HR=7.34; P<0.001), low serum albumin level (≤3.5 g/dl; HR=3.57; P=0.001), high serum AFP level (≥100 ng/ml; HR=6.04; P=0.006), prior HCC history (HR=4.24; P=0.001), and baseline hepatitis B e antigen positivity (HR=2.31; P=0.007) were associated with HCC progression. We developed a simple risk prediction model using these risk factors and identified patients at low, intermediate, and high risk for HCC; 5-year cumulative incidences were 1%, 14.5%, and 63.1%, respectively. The developed risk score model showed good performance with area under the curve at 0.886 at 3 years, and 0.920 at 5 years in leave-one-out cross-validation. CONCLUSIONS: We developed a useful and accurate risk score model for predicting HCC progression of indeterminate nodules detected on HBV-related cirrhotic liver.
Assuntos
Carcinoma Hepatocelular/epidemiologia , Hepatite B Crônica/complicações , Cirrose Hepática/complicações , Neoplasias Hepáticas/epidemiologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/etiologia , Carcinoma Hepatocelular/metabolismo , Progressão da Doença , Feminino , Hepatite B Crônica/metabolismo , Humanos , Hipoalbuminemia/epidemiologia , Incidência , Fígado/diagnóstico por imagem , Fígado/patologia , Cirrose Hepática/metabolismo , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/etiologia , Neoplasias Hepáticas/metabolismo , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , República da Coreia/epidemiologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Tomografia Computadorizada por Raios X , Adulto Jovem , alfa-Fetoproteínas/metabolismoRESUMO
BACKGROUND: The urinary tract dilation (UTD) classification system was proposed in 2014. OBJECTIVE: To evaluate the correspondence and reliability of two US grading systems for postnatal urinary tract dilatation in infants: the Society for Fetal Urology (SFU) and the UTD systems. MATERIALS AND METHODS: We assessed 180 kidneys in infants younger than 1 year. Four radiologists assessed the kidneys twice using both the SFU system (grades 0 to 4) and the UTD system (grades normal, P1, P2, P3). The SFU system was re-categorized into SFU-A (grades 0, 1-2, 3, 4) and into SFU-B (grades 0-1, 2, 3, 4). The Cohen kappa statistic was used for estimating agreement of both UTD-SFU-A and UTD-SFU-B. RESULTS: The Cohen kappa was significantly higher between UTD and SFU-B as compared to the UTD and SFU-A (0.75 vs. 0.50, P < 0.001). Intra-observer agreement was similar for the two grading systems (SFU 0.64-0.88 vs. UTD 0.48-0.92, P = 0.050-0.885). SFU grades 2 and 3 showed fair to moderate inter-observer agreement and corresponding UTD grades P1 and P2 showed moderate to substantial agreement. The overall inter-observer agreement was significantly higher for the UTD system than for the SFU system during the first assessment (95% confidence interval [CI]: right kidney, -0.069 to -0.062; left kidney, -0.048 to -0.043). CONCLUSION: Correspondence between the systems was poor using a recommended re-categorization (SFU-A). An alternative re-categorization (SFU-B) was found to be more appropriate for establishing correspondence between the systems. Both systems were reliable, with good intra- and inter-observer agreement for the assessment of infant kidneys, but the UTD system had better inter-observer agreement.
Assuntos
Hidronefrose/classificação , Hidronefrose/diagnóstico por imagem , Dilatação Patológica/classificação , Dilatação Patológica/diagnóstico por imagem , Feminino , Humanos , Lactente , Rim/anormalidades , Rim/diagnóstico por imagem , Masculino , Reprodutibilidade dos Testes , Estudos RetrospectivosRESUMO
Hypoglycemia commonly occurs in patients who are being treated for diabetes. In some cases, these patients suffer from severe hypoglycemia that requires medical assistance and which can unfortunately result in long-term disabilities. Therefore, we investigated risk factors associated with severe hypoglycemia requiring medical assistance (HMA) and the resulting neurological sequelae in patients with diabetes. This investigation was a case-control study that assessed 129 patients with diabetes and documented hypoglycemia from a single tertiary hospital between February 2013 and May 2015. They were treated with oral hypoglycemic agents alone (54%) or with insulin with/without oral hypoglycemic agents (46%). If a patient with diabetes visited the emergency department due to hypoglycemia, this was defined as HMA. The control group was composed of patients with documented, nonsevere hypoglycemia who visited the outpatient clinic during the same period. The degree of neurological disability in the HMA patients was measured using the modified Rankin Scale. A multivariate analysis revealed that independent risk factors of HMA were associated with a lack of the self-monitoring of blood glucose (SMBG) and previous episodes of severe hypoglycemia. In the HMA group, 15 patients (22%) had neurological sequelae at the time of discharge. Patients with neurological sequelae were older than those without sequelae (74.3 years vs 65.8 years, Pâ=â0.006) and had increased psychological evidence of disorders such as insomnia, dementia, and depression (40% vs 11%, Pâ=â0.017). Patients with sequelae were also more likely to live in rural areas (47% vs 19%, Pâ=â0.04) and to have a longer time from last seen normal till glucose administration (5.2âhours vs 1.6âhours, Pâ=â0.027). In the present study, absence of SMBG and previous severe hypoglycemic episodes were independent risk factors of HMA and patients with an older age, a psychological disorder, a rural residence, and a prolonged duration of hypoglycemia had higher risks of neurological sequelae. Therefore, the present findings suggest that physicians should aim to prevent hypoglycemia in patients with a history of hypoglycemia and provide education for these patients regarding regular SMBG.
Assuntos
Encefalopatias/etiologia , Diabetes Mellitus/tratamento farmacológico , Hipoglicemia/tratamento farmacológico , Hipoglicemia/etiologia , Hipoglicemiantes/uso terapêutico , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
OBJECTIVE: The aim of this study was to compare treatment outcomes of primary concurrent chemoradiation therapy (CCRT) versus radical hysterectomy (RH) followed by adjuvant RT or CCRT in patients with FIGO stage IB-IIA cervical cancer with focal disruption of the cervical stromal ring on magnetic resonance imaging (MRI). METHODS: We retrospectively analyzed the clinicopathological data of 156 patients with FIGO stage IB-IIA cervical cancer showing a focal disruption of the stromal ring on MRI between March 2000 and March 2015. Treatment outcomes were compared between the RT-based (n=54) group and RH-based group (n=54) after propensity score matching of each of the patients using a logistic regression model, including age, tumor size on MRI, pelvic lymph node enlargement on MRI, and histology. RESULTS: Five-year disease-free survival rate was 83.1% for the RT-based group and 77.4% for the RH-based group (p=0.228). Five-year disease-specific survival rate was 84.3% for the RT-based group and 83.5% for the RH-based group (p=0.434). Incidence rates of late grade 3 genitourinary adverse reactions (14.8% vs. 0.0%, p=0.006) were significantly higher in the RH-based group than those in the RT-based group. CONCLUSIONS: Primary CCRT might be the preferred treatment for FIGO stage IB-IIA cervical cancer patients with focal disruption of cervical stromal ring on MRI given that no difference in patient's survival was found, but higher incidence of treatment-related complications was observed in the RH-based group. Also, primary radical surgery should be done more cautiously in these patients.
Assuntos
Colo do Útero/patologia , Imageamento por Ressonância Magnética/métodos , Pontuação de Propensão , Neoplasias do Colo do Útero/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimiorradioterapia , Feminino , Humanos , Histerectomia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Resultado do Tratamento , Neoplasias do Colo do Útero/diagnóstico por imagem , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/terapiaRESUMO
BACKGROUND AND OBJECTIVES: Single-incision transaxillary robotic thyroidectomy (START) requires substantial tissue disruption, which produces moderate-to-severe pain in the axilla and neck areas during the early postoperative period. This study aimed to investigate the analgesic effects of ultrasound-guided serratus-intercostal plane blocks and intermediate cervical plexus blocks (CPBs) on the early postoperative pain after START. METHODS: We randomized 22 patients to undergo either ultrasound-guided serratus-intercostal plane and intermediate CPBs (the block group, n = 11) or to not undergo any block (the control group, n = 11). We compared postoperative axillary pain, postoperative neck pain, and analgesic use between the groups during the first 24 hours. The rescue analgesics were intravenous fentanyl (0.5 µg/kg) in the postanesthesia care unit, and intravenous ketorolac tromethamine (30 mg) in the general ward. RESULTS: The block group showed consistently lower pain scores than the control group in the axillary area in the first 24 hours and in the neck area only in the first 3 hours after surgery. The numbers (proportions) of patients who required analgesics were 11 (100%) in the control group and 6 (54.5%) in the block group during the first 24 hours (P = 0.035). No adverse effect was observed related to the peripheral nerve blocks. CONCLUSIONS: After START, a serratus-intercostal plane block performed at the level of the third rib was an effective analgesic technique for axillary pain; however, the clinical effectiveness of intermediate CPB for neck pain may be limited.
Assuntos
Bloqueio do Plexo Cervical , Cervicalgia/prevenção & controle , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Tireoidectomia/efeitos adversos , Ultrassonografia de Intervenção , Adulto , Analgésicos Opioides/administração & dosagem , Bloqueio do Plexo Cervical/efeitos adversos , Inibidores de Ciclo-Oxigenase/administração & dosagem , Feminino , Humanos , Cetorolaco de Trometamina/administração & dosagem , Masculino , Pessoa de Meia-Idade , Cervicalgia/diagnóstico , Cervicalgia/etiologia , Bloqueio Nervoso/efeitos adversos , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Estudos Prospectivos , República da Coreia , Tireoidectomia/métodos , Fatores de Tempo , Resultado do TratamentoRESUMO
Opioids are used as a treatment for coughing. Recent studies have reported an antitussive effect of remifentanil during recovery from general anesthesia by suppressed coughing. The coughing reflex may differ throughout the respiratory tract from the larynx to the bronchi. But the proper dose of remifentanil to prevent cough during double-lumen tube (DLT) extubation is unknown.Twenty-five ASA physical status 1 and 2 patients, 20 to 65 years of age who were undergoing video-assisted thoracoscopic lung surgery requiring 1-lung ventilation were enrolled. The effective effect-site concentration (Ce) of remifentanil for 50% and 95% of patients (EC50 and EC95) for preventing cough was determined using the isotonic regression method with a bootstrapping approach, following the Dixon up-and-down method. Recovery profiles and hemodynamic values after anesthesia were compared between patients with cough and patients without cough.EC50 and EC95 of remifentanil was 1.670âng/mL [95% confidence interval (95% CI) 1.393-1.806] and 2.275âng/mL (95% CI 1.950-2.263), respectively. There were no differences in recovery profiles and hemodynamic values after anesthesia between patients with/without cough. No patients suffered respiratory complications during the emergence period.Remifentanil can be a safe and reliable method of cough prevention during emergence from sevoflurane anesthesia after thoracic surgery requiring DLT. EC50 and EC95 of remifentanil that suppresses coughing is 1.670 and 2.275âng/mL, respectively.
Assuntos
Extubação/efeitos adversos , Tosse/prevenção & controle , Éteres Metílicos/administração & dosagem , Piperidinas/administração & dosagem , Adulto , Idoso , Analgésicos Opioides/administração & dosagem , Anestésicos Inalatórios/administração & dosagem , Tosse/etiologia , Relação Dose-Resposta a Droga , Quimioterapia Combinada , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Remifentanil , Sevoflurano , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: In keeping with increasing interest in dementia, few recent studies suggest that clinical course of mild cognitive impairment vary across different studies with hospital-based subjects showing higher rates of conversion than community-based subjects. OBJECTIVE: The main objective of the present study was to assess whether the clinical conversion or reversion rates differ according to recruitment source. METHODS: The baseline study subjects comprised of patients who were diagnosed with mild cognitive impairment in community-based GDEMCIS or hospital-based CREDOS. The two studies had nearly the same protocol and were performed over a similar period. We used propensity score matching for baseline comparability. After that, Cox proportional hazards regression analyses were conducted to estimate the hazard ratios and 95% confidence intervals of clinical conversion or reversion. RESULTS: Based on 89 GDEMCIS subjects, 1â:â4 propensity score matching was conducted and 356 CREDOS subjects were selected. After adjusting for covariates including baseline demographics, comorbidity, depression, disability, and neuropsychological result, Cox proportional hazard regression analysis for time to clinical conversion indicated that recruitment from hospital-based CREDOS exhibited hazard ratio of 2.13 (95% CI, 1.08-4.21), as compared to recruitment from community-based GDEMCIS. Similarly, Cox proportional hazard regression analysis for time to reversion indicated that recruitment from hospital-based CREDOS exhibited hazard ratio of 0.34 (95% CI, 0.20-0.59), as compared to recruitment from community-based GDEMCIS. CONCLUSION: The present study demonstrated that even after the matching process and adjustments for baseline covariates, recruitment source greatly affected the course of mild cognitive impairment.
Assuntos
Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/epidemiologia , Demência/diagnóstico , Demência/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Centros Comunitários de Saúde , Progressão da Doença , Feminino , Hospitais , Humanos , Estimativa de Kaplan-Meier , Estudos Longitudinais , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Modelos de Riscos Proporcionais , Escalas de Graduação Psiquiátrica , República da Coreia , Fatores de TempoRESUMO
Lung cancer has high mortality and incidence rates. The leading causes of lung cancer are smoking and radon exposure. Indeed, the World Health Organization (WHO) has categorized radon as a carcinogenic substance causing lung cancer. Radon is a natural, radioactive substance; it is an inert gas that mainly exists in soil or rock. The gas decays into radioactive particles called radon progeny that can enter the human body through breathing. Upon entering the body, these radioactive elements release α-rays that affect lung tissue, causing lung cancer upon long-term exposure thereto. Epidemiological studies first outlined a high correlation between the incidence rate of lung cancer and exposure to radon progeny among miners in Europe. Thereafter, data and research on radon exposure and lung cancer incidence in homes have continued to accumulate. Many international studies have reported increases in the risk ratio of lung cancer when indoor radon concentrations inside the home are high. Although research into indoor radon concentrations and lung cancer incidence is actively conducted throughout North America and Europe, similar research is lacking in Korea. Recently, however, studies have begun to accumulate and report important data on indoor radon concentrations across the nation. In this study, we aimed to review domestic and foreign research into indoor radon concentrations and to outline correlations between indoor radon concentrations in homes and lung cancer incidence, as reported in ecological studies thereof. Herein, we noted large differences in radon concentrations between and within individual countries. For Korea, we observed tremendous differences in indoor radon concentrations according to region and year of study, even within the same region. In correlation analysis, lung cancer incidence was not found to be higher in areas with high indoor radon concentrations in Korea. Through our review, we identified a need to implement a greater variety of statistical analyses in research on indoor radon concentrations and lung cancer incidence. Also, we suggest that cohort research or patient-control group research into radon exposure and lung cancer incidence that considers smoking and other factors is warranted.