Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 170
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
J Clin Sleep Med ; 2020 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-32026803

RESUMO

STUDY OBJECTIVES: Drug-induced sleep endoscopy (DISE) has been suggested to be a valuable method for determining the obstruction patterns causing sleep-disordered breathing. However, since DISE is not performed throughout the duration of sleep but for less than an hour, the reproducibility and reliability of DISE are questionable. Therefore, we aimed to determine the test-retest reliability of DISE using midazolam. METHODS: Thirty-four patients diagnosed with obstructive sleep apnea were prospectively included in this study. The patients underwent two separate DISE examinations that were performed at different days using the same drug and technique. For a more accurate comparison, the depth of sleep and examination time were identically controlled. VOTE classification was used to classify the obstruction findings, and the findings of upper airway obstruction were compared between the two tests. RESULTS: There were 30 men and four women; the mean age was 45.4 ± 13.1 years. The mean apnea-hypopnea index was 38.3 ± 22.6, and the lowest oxygen saturation was 77.5% ± 12.4%. The lateral wall of the oropharynx, tongue base, and epiglottis showed very good agreement, and the velum showed good agreement between the first and second DISE examinations. CONCLUSIONS: The reliability of DISE is debatable because it only observes a small portion of the total sleep, but this study suggests that DISE is a reliable test because the findings of two separate DISE examinations on different days showed a high concordance rate.

2.
Neuroradiology ; 2020 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-32055943

RESUMO

PURPOSE: Acute vertebrobasilar occlusion (VBO) has a grave clinical course; however, thrombectomy in VBO patients has rarely been reported. We retrospectively evaluated the clinical and radiological outcomes of thrombectomy in VBO patients. METHODS: From March 2010 to December 2017, 38 patients with 40 acute VBOs underwent thrombectomy at our hospital. Thrombectomy was performed using catheter aspiration (n = 11, 26.8%) or a stent retriever (n = 29, 70.7%). RESULTS: Good clinical outcomes (3-month modified Rankin scale (mRS) of 2 or lower) were achieved in 9 cases (22.5%), and successful recanalization (thrombolysis in cerebral infarction (TICI) grade of 2b or 3) was achieved in 35 cases (87.5%). Good clinical outcomes were significantly related to aetiologies other than atherosclerosis (p = 0.020) and lower National Institutes of Health Stroke Scale (NIHSS) scores on admission (p = 0.025). The clinical and radiological outcomes did not differ significantly between catheter aspiration and stent retriever thrombectomy (p = 1.000 and p = 0.603, respectively); however, stent retriever thrombectomy had a shorter procedure time than catheter aspiration (59.7 ± 31.2 vs. 84.5 ± 35.1 min, p = 0.037). CONCLUSION: In our series, good clinical outcomes were associated with a lower NIHSS score on admission and stroke aetiologies other than atherosclerosis. The two thrombectomy modalities showed similar clinical and radiological outcomes. However, stent retrievers seemed to allow more rapid recanalization than catheter aspiration in VBO.

3.
Phys Chem Chem Phys ; 2020 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-31971533

RESUMO

The kinetic energy dependent reactions of Re+ with SO2 were studied with guided ion beam tandem mass spectrometry. ReO+, ReO2+, and OReS+ species were observed as products, all in endothermic reactions. Modeling of the kinetic energy dependent cross sections yields 0 K bond dissociation energies (BDEs, in eV) of 4.78 ± 0.06 (Re+-O), 5.75 ± 0.02 (Re+-O2), and 4.35 ± 0.14 (Re+-SO). The latter two values can be combined with other information to derive the additional values 6.05 ± 0.05 (ORe+-O) and 4.89 ± 0.19 (ORe+-S). BDEs of ReO+ and ReO2+ agree with literature values whereas the values for OReS+ are the first measurements. The former result is obtained even though formation of ground state ReO+ is spin-forbidden. Quantum mechanical calculations at the B3LYP level of theory with a def2-TZVPPD basis set yield results that agree reasonably well with experimental values. Additional calculations at the BP86 and CCSD(T) levels of theory using def2-QZVPPD and aug-cc-pVxZ (x = T, Q, and 5) basis sets were performed to compare thermochemistry with experiment to determine that ReO2+ rather than the isobaric ReS+ is formed. Product ground states are 3Δ3(ReO+), 3B1(OReO+), 5Π-1(ReS+), and 3A''(OReS+) after including empirical spin-orbit corrections, which means that formation of ground state products is spin-forbidden for all three product channels. The potential energy surfaces for the ReSO2+ system were also explored at the B3LYP/def2-TZVPPD level and exhibited no barriers in excess of the endothermicities for all products. BDEs for rhenium oxide and sulfide diatomics and triatomics are compared and discussed. The present result for formation of ReO+ is compared to that for formation of ReO+ in the reactions of Re+ + O2 and CO, where the former system exhibited interesting dual cross section features. Results are consistent with the hypothesis that the distinction of in-plane and out-of-plane CS symmetry in the triatomic systems might be the explanation for the two endothermic features observed in the Re+ + O2 reaction.

4.
Sci Rep ; 10(1): 1036, 2020 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-31974454

RESUMO

The optimum sequence of bronchial brushing and washing for diagnosing peripheral lung cancer, defined as an invisible endobronchial tumour, is not clear and requires further study. We prospectively obtained washing samples after brushing in patients with peripheral lung tumours during non-guided flexible bronchoscopy (FB) to investigate the diagnostic yield of these samples and conducted a retrospective review of the prospectively collected data. The study included 166 patients who met the inclusion criteria. The overall diagnostic yield of bronchial brushing and washing for peripheral lung cancer was 52.4%. The diagnostic yields of brushing and washing were 37.3% and 46.4%, respectively, and that of washing was superior according to McNemar's test (p = 0.017, κ = 0.570). Furthermore, washing was diagnostic, whereas brushing was not, in 15.1% of all cases. Comparison of positive washing cytology (brushing) with the respective pathological diagnosis yielded a concordance rate of 88.3% (90.3%), with κ = 0.769 (0.801) (p < 0.001). Performing washing after brushing during non-guided FB is a very safe, cost-effective procedure that may help improve the diagnostic yield in patients with suspected peripheral lung cancer. Our information will also benefit clinicians performing diagnostic bronchoscopy in patients with suspected peripheral lung cancer when fluoroscopic guidance or advanced bronchoscopy techniques are not available.

5.
Clin Exp Otorhinolaryngol ; 13(1): 47-51, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31422653

RESUMO

OBJECTIVES: Crosshatching incision has been considered a useful method for correcting cartilaginous septal deviation. The aim of this study was to determine the utility and limitations of this approach. METHODS: This retrospective case-control study included 353 patients who underwent septoplasty performed by a senior surgeon between January 2004 and December 2010. Patients were classified into two groups according to whether crosshatching incision was performed (n=151) during septoplasty or not (n=202). All other techniques performed during septoplasty were identical. The parameters of surgical success (improvement of nasal obstruction, correction of deviation, and acoustic rhinometry results and adverse effects were compared between the groups. RESULTS: There were no significant differences in the parameters of surgical success between the groups (improvement of nasal obstruction, P=0.333; correction of deviation, P=0.608; acoustic rhinometry results P=0.322 for the difference in the minimal cross-sectional area; P=0.919 for difference in volume). Relative to patients who did not undergo the cross-hatching incision, patients with whom the technique was performed showed a significantly higher incidence of saddle nose (0/202 vs. 4/151 cases, P=0.033) and overcorrection (0/202 vs. 5/151 cases, P=0.014). CONCLUSION: Crosshatching incision during septoplasty did not produce better surgical outcomes; however, it caused adverse effects such as saddle nose and overcorrection. Therefore, the use of crosshatching incision should be re-evaluated.

6.
J Cerebrovasc Endovasc Neurosurg ; 21(1): 5-10, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31832381

RESUMO

Objective: Selecting an appropriate guiding catheter to provide both sufficient supportability for working devices and sufficient distal navigability is essential for ensuring the success of a procedure. This study aimed to evaluate the advantages and disadvantages of using the ENVOY 6F distal access (DA) guiding catheter in coil embolization of anterior circulation cerebral aneurysms. Methods: We included 98 patients (72 [73.5%] women, median age: 63 [range: 25-84] years) who underwent endovascular coiling with the ENVOY 6F DA guiding catheter from May to November 2016. We analyzed data on patient demographics and the number of co-axial techniques to position the guiding catheter, initial and final location of the catheter, and complications related to the catheter. Results: The co-axial technique was used to position the ENVOY 6F DA guiding catheter in the internal carotid artery (ICA) in 20 cases (20.41%). The initial position of the ENVOY 6F DA guiding catheter involved the cervical ICA (79.6%), horizontal petrous ICA (17.3%), and vertical petrous ICA (3.1%). Final control angiograms after endovascular coiling showed proximal change in the final, compared to the initial, position of the ENVOY 6F DA guiding catheter in 25 cases (25.51%). Procedure-related complications were observed in nine patients (9.18%), involving vasospasm in all cases; however, there was no symptomatic case. Conclusion: The ENVOY 6F DA guiding catheter had relatively sufficient distal navigability without symptomatic procedural complications. However, the change in the catheter position after endovascular coiling denoted insufficient supportability.

7.
Medicine (Baltimore) ; 98(52): e17802, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876702

RESUMO

RATIONALE: Epistaxis is a common otorhinolaryngological emergency, but septal abscess has not been reported before as a complication of epistaxis. PATIENT CONCERNS: We report a case of a 51-year-old man complaining of nasal obstruction and facial numbness for 3 weeks. He had a history of epistaxis, and had been treated with electrocauterization of the left nasal septum at a local clinic 1 month earlier. DIAGNOSES: On nasal endoscopy, swelling of the septum was noticed; computed tomography (CT) was performed, and revealed a septal abscess. INTERVENTIONS: The patient was treated with incision and drainage under local anesthesia. A left vertical hemitransfixion incision was made and 4 mL of purulent material was drained. There was no quadrangular septal cartilage. OUTCOMES: On the 5th postoperative day, the patient complained of blurred vision in his right eye. Visual acuity of the left eye was 0.5, but acuity of the right eye was finger count at 50 cm. Examination of the right eye revealed a whitish fan-shaped corneal opacity on the medial side with neovascularization, diagnostic of lipid keratopathy. CONCLUSION: Electrocautery of epistaxis should be performed carefully during hemostasis, and there should be careful follow-up after the procedure to detect the occurrence of septal hematoma or septal abscess. These conditions should be treated as early as possible to avoid further serious complications. Since lipid keratopathy is difficult to treat once it occurs, care should be taken to avoid a septal abscess.


Assuntos
Abscesso/diagnóstico , Doenças da Córnea/diagnóstico , Septo Nasal , Doenças Nasais/diagnóstico , Abscesso/diagnóstico por imagem , Abscesso/etiologia , Abscesso/terapia , Doenças da Córnea/etiologia , Drenagem , Eletrocoagulação/efeitos adversos , Epistaxe/complicações , Epistaxe/terapia , Humanos , Lipídeos , Masculino , Pessoa de Meia-Idade , Obstrução Nasal/etiologia , Septo Nasal/diagnóstico por imagem , Doenças Nasais/etiologia , Tomografia Computadorizada por Raios X
8.
Korean J Neurotrauma ; 15(2): 159-163, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31720270

RESUMO

It is well known that the presence of arachnoid cysts (ACs) in young patients is a risk factor for developing a chronic subdural hematoma (CSDH) after a minor head injury. Although there have been controversies with the treatment, most authors recommend only draining the CSDH if the AC is asymptomatic. This judgement is based on the facts that this surgical approach has shown good clinical outcomes, and the AC usually remains unchanged after the surgery. Our case demonstrates that the AC of a young patient who developed a CSDH after a minor head injury completely disappeared after a burr hole drainage of the CSDH. Although the chances of an AC disappearing are low, this case shows that an AC might disappear after only draining a CSDH when a rupture of the AC membrane is identified. In such cases, we recommend first draining only the CSDH for the treatment of AC-associated CSDHs.

9.
Acute Crit Care ; 34(1): 71-78, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31723907

RESUMO

Background: It is well known that assessing the RAP index along with intracranial pressure (ICP) monitoring in traumatic brain injury patients is helpful. We will discuss the usefulness of this assessment tool as a clinical guide for surgically treated poor grade aneurysmal subarachnoid hemorrhage (SAH). Methods: This retrospective study included 35 patients with aneurysmal SAH who presented with World Federation of Neurosurgical Societies (WFNS) grade V SAH and received surgical treatment from January 2013 to December 2018. Emergency surgical clipping, hematoma removal, extraventricular drainage, and if needed, wide decompressive craniectomy were combined as the proper surgical treatments. Outcomes were assessed based on in-hospital survival and the Glasgow outcome scale score at 14-day follow-up. We compared the mortality rate of two groups of seven patients: ICP monitoring only (n=5) and ICP monitoring combined with the RAP index (n=2). Results: The in-hospital 14-day mortality rate by brain lesion was 48.5% (n=17). Seven patients had real-time ICP monitoring. Before 2018, three of five patients with poor WFNS grade who received real-time ICP monitoring only died. There were no deaths in the group of two patients receiving real-time ICP monitoring and the RAP index. Conclusions: Our data indicate that combining the RAP index and ICP monitoring can be used as markers for critical intracranial physiological parameters in poor grade WFNS patients.

10.
Dent J (Basel) ; 7(4)2019 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-31766205

RESUMO

Primary care and healthcare providers can facilitate children's timely referral to a dental home. However, there are few studies of providers' oral health knowledge and clinical skills. This study aims to improve future healthcare providers' knowledge, confidence, attitude, and clinical competence in assessing children's oral health. Sixty-five health professional students participated in a 10-week didactic and clinical curriculum on children's oral health. Fifty students completed pre- and post-training questionnaires and were assessed in their knowledge, confidence, and attitude. Calibrated examiners graded students' clinical skills on a 24-point grading criterion. Descriptive statistics, paired sample t-test, and Pearson correlation were used in data analyses. Students were in dentistry (46%), nursing (28%), medicine (22%), and pharmacy (3%). Students significantly improved in knowledge (t = -7.71, p < 0.001), confidence (t = -10.30, p = <0.001), and attitude (t = -4.24, p = <0.001). Students on average scored 83% on clinical competence, with the highest average for fluoride varnish application (96%) and lowest for providing anticipatory guidance (69%). There was a moderate correlation between improvement in knowledge and their clinical skills (r = 0.39, p = 0.010). Interprofessional education improves students' knowledge, confidence, attitude, and clinical competence in assessing children's oral health. Such education is necessary in guiding future providers to gain adequate competence in serving children's oral health needs.

11.
J Clin Sleep Med ; 15(10): 1503-1508, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31596216

RESUMO

STUDY OBJECTIVES: The modified jaw-thrust maneuver (MJTM) during drug-induced sleep endoscopy (DISE) is known to predict the treatment effect of mandibular advancement devices. However, its effect on the depth of sedation and potential to provoke arousal by awakening patients during the maneuver has not been studied so far. This study investigated the effect of the MJTM on the depth of sedation during DISE. METHODS: Forty patients on whom the MJTM was performed during DISE were included. The effect of the maneuver was evaluated at the levels of the velum, lateral wall of the oropharynx, base of the tongue, and epiglottis. Obstruction was defined as the collapse of the upper airway exceeding 75%, and improvement with the MJTM was defined as the widening of the upper airway by more than 50% during the maneuver. A bolus injection of midazolam was used to induce sedation and control the depth of sedation (bispectral index value of 60 to 80). RESULTS: Obstructions were present in the velum of all patients, lateral wall of the oropharynx of 13 patients, base of the tongue of 28 patients, and epiglottis of 6 patients. After the MJTM, improvement of the obstruction was observed in 57.5%, 61.5%, 82%, and 66.7% of patients with velum, lateral wall of the oropharynx, base of the tongue, and epiglottis obstructions, respectively. An increase in the bispectral index value of more than 20 was observed in 8 patients. Four patients awakened during the procedure. CONCLUSIONS: The MJTM significantly relieved obstruction during DISE, especially at the base of the tongue. However, this might have been caused by an increase in the degree of awakening during the maneuver. Therefore, MJTM's effect on the depth of sedation may help in improving the degree of airway obstruction.

12.
Neurosurgery ; 2019 Oct 18.
Artigo em Inglês | MEDLINE | ID: mdl-31625579

RESUMO

BACKGROUND: Flow visualization in time-of-flight magnetic resonance angiography (TOF MRA) is limited for treated intracranial aneurysms owing to magnetic susceptibility and radiofrequency shielding. OBJECTIVE: To assess the clinical usefulness of noncontrast-enhanced magnetic resonance angiography (MRA) using a silent scan (silent MRA) as a follow-up imaging modality in patients with treated intracranial aneurysms. METHODS: A total of 119 patients with 126 treated aneurysms underwent silent MRA and TOF MRA during the same scan session. Two neuroradiologists independently assessed overall image quality and visualization of the treated site using a 5-point Likert scale to compare the 2 image sets. We used receiver operating characteristic (ROC) curve analysis to investigate the diagnostic performance of the 2 MRA methods in evaluating aneurysm occlusion. Interobserver reliability was also assessed using weighted kappa statistics. RESULTS: The overall image quality scores of silent MRA and TOF MRA were 4.04 ± 0.22 and 4.64 ± 0.48, respectively (P < .001), and interobserver agreement was substantial (P < .001). For the treated site, the score of flow visualization on silent MRA was higher than that on TOF MRA, 3.94 ± 0.94 vs 2.59 ± 1.37 (P < .001), with substantial interobserver agreement (P < .001). ROC curve analysis showed that silent MRA was superior to TOF MRA in diagnostic performance (area under the curve [AUC] = 0.962; 95% CI: 0.931-0.982 vs AUC = 0.843; 95% CI: 0.792-0.886; P < .001). CONCLUSION: Silent MRA can be useful to evaluate treated intracranial aneurysms during follow-up without radiation exposure and use of contrast material. It is characterized by higher diagnostic performance and superior visualization for the treated site.

13.
Polymers (Basel) ; 11(9)2019 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-31500182

RESUMO

The present study deals with the potential application of chitosan nonwoven for biomedical textiles based on enzyme immobilization. For this, chitosan nonwoven was first cross-linked with glutaraldehyde to introduce aldehyde groups at optimal conditions. To immobilize the enzyme trypsin onto glutaraldehyde-pre-activated chitosan nonwoven, several parameters such as pH, enzyme concentration, and reaction times were investigated. In addition, the pH, thermal stability, storage stability, and reusability of immobilized trypsin were examined. We found that the optimal immobilization conditions for trypsin were pH 8.5, enzyme concentration of 8% (owf), and treatment time of 30 min. Trypsin was immobilized at 25 °C efficiently. The immobilized trypsin showed lower pH stability and better thermal stability than free trypsin. The immobilized trypsin showed 50% of its initial activity after being used 15 times and 80% of that after 20 days of storage at 4 °C. SEM analysis also confirmed that trypsin was immobilized on chitosan nonwoven.

14.
Sci Rep ; 9(1): 12750, 2019 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-31484946

RESUMO

Despite a substantial population of patients with a restrictive spirometric pattern, few studies have evaluated postoperative pulmonary complications (PPCs) after non-cardiothoracic surgery in these patients. We conducted a retrospective cohort study of 681 adults with a normal or restrictive spirometric pattern who were referred for preoperative evaluation of PPC risk before non-cardiothoracic surgery between March 2014 and January 2015. Overall, 8.7% (59/681) of study participants developed a PPC following non-cardiothoracic surgery. The occurrence of PPCs in patients with a restrictive spirometric pattern was higher than that in those with normal spirometry (12.4% [35/282] vs. 6.0% [24/399], P = 0.003). The occurrence of PPCs increased across the categories of restrictive spirometric pattern severity (6.0% with a normal spirometric pattern vs. 6.5% with a mild restrictive spirometric pattern [60 ≤ forced vital capacity (FVC) < 80% predicted] vs. 21.2% with a moderate-to-severe restrictive spirometric pattern [FVC < 60% predicted], P for trend test < 0.001). The length of hospital stay (P for trend = 0.002) was longer, and all-cause mortality at 30 days (P for trend = 0.008) and 90 days (P for trend = 0.001) was higher across the restrictive spirometric pattern severity. In multivariable-adjusted analyses, a moderate-to-severe restrictive spirometric pattern was associated with a higher risk of PPCs compared with a normal spirometric pattern (adjusted odds ratio 2.64, 95% confidence interval 1.22-5.67). The incidence of PPCs in patients with a restrictive spirometric pattern was higher than that in those with a normal spirometric pattern, especially in patients with a moderate-to-severe restrictive spirometric pattern. Patients with a moderate-to-severe restrictive spirometric pattern should be regarded as high risk for developing PPCs following non-cardiothoracic surgery.

15.
J Craniofac Surg ; 30(5): e432-e433, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31299804

RESUMO

Angiofibroma is a rare tumor that accounts for about 0.05% of all head and neck tumors; it mainly occurs in the region of the nasopharynx. To date, no study originating in the frontal sinus has been reported. The authors report a report of an 18-year-old male complaining of severe pain in the right periocular area, forehead, and temporal area for 1 week. Endoscopic sinus surgery in combination with trephination was used to remove the tumor and the tumor was diagnosed as angiofibroma from histopathologic examination. It is hard to consider a tumor as being angiofibroma when it is not located in the nasopharynx. In particular, although extranasopharyngeal angiofibroma can occur in all head and neck regions, a tumor which has developed in the frontal sinus is more difficult to diagnose as angiofibroma because no patients have been reported until now. With this study, surgeons now need to be aware of the possibility of occurrence of angiofibroma in the frontal sinus.


Assuntos
Angiofibroma/diagnóstico por imagem , Seio Frontal/diagnóstico por imagem , Neoplasias dos Seios Paranasais/diagnóstico por imagem , Adolescente , Angiofibroma/cirurgia , Testa/cirurgia , Seio Frontal/cirurgia , Humanos , Masculino , Nasofaringe , Neuroendoscopia , Neoplasias dos Seios Paranasais/cirurgia , Trepanação
16.
J Craniofac Surg ; 30(8): e713-e714, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31261332

RESUMO

Nasal septal abscesses are commonly caused by nasal trauma, infection, and nasal surgery. As delayed treatment of nasal septal abscesses can cause various complications, including saddle nose, a prompt diagnosis with the relevant intervention is important. However, the diagnosis of nasal septal abscesses is difficult when nasal pain occurs after cauterization because there have been no formal reports of nasal septal abscesses owing to cauterization for epistaxis. Here, the authors report the first case of a nasal septal abscess that developed after cauterization. A 48-year-old woman underwent radiofrequency cauterization as a treatment for epistaxis. She developed nasal pain 10 days following cauterization, and a computed tomography scan revealed a nasal septal abscess. Careful observation should be undertaken in patients who undergo cauterization of the nasal septum, especially in patients complaining of nasal pain.


Assuntos
Abscesso/etiologia , Cauterização/efeitos adversos , Epistaxe/cirurgia , Doenças dos Seios Paranasais/etiologia , Abscesso/diagnóstico , Abscesso/diagnóstico por imagem , Feminino , Humanos , Pessoa de Meia-Idade , Septo Nasal/lesões , Doenças dos Seios Paranasais/diagnóstico por imagem , Doenças dos Seios Paranasais/cirurgia , Tomografia Computadorizada por Raios X
17.
J Korean Med Sci ; 34(25): e179, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31243937

RESUMO

BACKGROUND: The lack of medical personnel has led to the employment of hospitalists in Korean hospitals to provide high-quality medical care. However, whether hospitalists' care can improve patients' outcomes remains unclear. We aimed to analyze the outcome in patients cared for by hospitalists. METHODS: A retrospective review was conducted in 1,015 patients diagnosed with pneumonia or urinary tract infection from March 2017 to July 2018. After excluding 306 patients, 709 in the general ward who were admitted via the emergency department were enrolled, including 169 and 540 who were cared for by hospitalists (HGs) and non-hospitalists (NHGs), respectively. We compared the length of hospital stay (LOS), in-hospital mortality, readmission rate, comorbidity, and disease severity between the two groups. Comorbidities were analyzed using Charlson comorbidity index (CCI). RESULTS: HG LOS (median, interquartile range [IQR], 8 [5-12] days) was lower than NHG LOS (median [IQR], 10 [7-15] days), (P < 0.001). Of the 30 (4.2%) patients who died during their hospital stay, a lower percentage of HG patients (2.4%) than that of NHG patients (4.8%) died, but the difference between the two groups was not significant (P = 0.170). In a subgroup analysis, HG LOS was shorter than NHG LOS (median [IQR], 8 [5-12] vs. 10 [7-16] days, respectively, P < 0.001) with CCI of ≥ 5 points. CONCLUSION: Hospitalist care can improve the LOS of patients, especially those with multiple comorbidities. Further studies are warranted to evaluate the impact of hospitalist care in Korea.


Assuntos
Modelos Teóricos , Pneumonia/patologia , Qualidade da Assistência à Saúde , Infecções Urinárias/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Mortalidade Hospitalar , Médicos Hospitalares , Humanos , Tempo de Internação , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Pneumonia/epidemiologia , Pneumonia/mortalidade , República da Coreia/epidemiologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Infecções Urinárias/epidemiologia , Infecções Urinárias/mortalidade
18.
Artigo em Inglês | MEDLINE | ID: mdl-31246243

RESUMO

Importance: Drug-induced sleep endoscopy (DISE) has been suggested to be a valuable technique for identifying the obstruction site associated with sleep-disordered breathing. However, the reliability of DISE findings is controversial because the procedure uses sedative drugs, which may have implications for the obstruction patterns observed on DISE. Objective: To compare the obstruction patterns during DISE with the obstruction patterns during natural sleep endoscopy (NSE). Design, Setting, and Participants: This prospective cohort study was conducted between June 2013 and May 2018 in Kyungpook National University Chilgok Hospital in Daegu, South Korea. All analysis took place from June 1 to July 31, 2018. Participants had an obstructive sleep apnea diagnosis, were older than 18 years, and had an apnea hypopnea index higher than 5 on type I polysomnography. The patients initially enrolled were excluded from the study for not reaching adequate sleep depth and waking up during insertion of the nasopharyngoscope. Intervention: Patients underwent DISE using midazolam and NSE without sedatives on 2 different days. Main Outcomes and Measures: Obstruction findings were observed only in the same range (65-75) of the bispectral index on both days. Obstruction findings were classified according to the VOTE (velum, oropharynx lateral wall, tongue base, and epiglottis) classification. The extent of agreement between DISE and NSE findings was evaluated using Cohen weighted κ value. Results: The study included 26 patients with snoring or obstructive sleep apnea (mean [SD] age, 44.7 [10.3] years; predominantly male [22 (85%)]). The mean (SD) apnea hypopnea index was 41.9 (17.2) and the lowest mean (SD) oxygen saturation was 79.8% (12.2%). The degree of agreement in upper-airway obstruction between DISE and NSE was 76.9% (Cohen weighted κ = 0.42; 95% CI, 0.02-0.83) in the velum, 88.5% (Cohen weighted κ = 0.84; 95% CI, 0.67-1.01) in the oropharynx lateral wall, 69.2% (Cohen weighted κ = 0.66; 95% CI, 0.46-0.86) in the tongue base, and 92.3% (Cohen weighted κ = 0.67; 95% CI, 0.24-1.11) in the epiglottis. Agreement of configuration of the velum was 88.5% (Cohen weighted κ = 0.50; 95% CI, -0.03 to 1.03) and the epiglottis was 92.3% (Cohen weighted κ = 0.67; 95% CI, 0.24-1.11). Conclusions and Relevance: Obstruction patterns of the upper airway appeared to be in agreement between DISE and NSE, suggesting that DISE may be a reliable test; future studies of multiple positions and sleep stages with larger sample sizes may confirm these results.

19.
Medicine (Baltimore) ; 98(23): e15652, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31169668

RESUMO

RATIONALE: Tetanus is caused by a neurotoxin (tetanospasmin) secreted by a spore forming gram-positive, anaerobic rod-shaped motile bacillus, Clostridium tetani. The most common symptoms of tetanus are trismus (100%), dysphagia (70.5%), dysarthria (35.2%), and neck stiffness (29.4%). Respiratory failure, laryngeal spasm, seizure, chest pain, nausea/vomiting, opisthotonus, back pain, and rigid abdominal wall can also be observed during progression of the disease. However, there has been no report of periocular discomfort as an initial manifestation after endoscopic sleep surgery in a patient with tetanus. Here, we report a patient who underwent endoscopic sleep surgery with a concurrent diagnosis of tetanus infection presenting with atypical periocular discomfort as the initial symptom. PATIENT CONCERNS: A 63-year-old man complaining of sleep apnea, snoring, and daytime sleepiness visited our department. He subsequently underwent sleep surgery (anterior pharyngoplasty with tonsillectomy, septoplasty, microdebrider-assisted inferior turbinoplasty, and an endoscopic sinus surgery) for the treatment of his newly diagnosed obstructive sleep apnea. After 3 weeks of surgery, he visited the outpatient clinic of our department with right side periocular discomfort. DIAGNOSES: Four days after presenting with periocular discomfort, he was diagnosed with tetanus by presenting trismus, jaw pain, dysphagia, and ptosis at an emergency department of a different hospital. INTERVENTIONS: Tetanus immunoglobulin and antibiotics were administered. OUTCOMES: His symptoms then resolved after a month without sequelae. LESSONS: Although periocular discomfort is atypical and is not uncommon after nasal and oral surgeries, care should be taken when patients present with periocular pain because it could be a rare initial symptom of tetanus.


Assuntos
Clostridium tetani , Endoscopia/efeitos adversos , Infecções Oculares Bacterianas/patologia , Complicações Pós-Operatórias/patologia , Tétano/patologia , Infecções Oculares Bacterianas/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/microbiologia , Síndromes da Apneia do Sono/cirurgia , Tétano/microbiologia
20.
Medicine (Baltimore) ; 98(21): e15674, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31124945

RESUMO

RATIONALE: A postoperative maxillary mucocele (POMM) is a delayed complication of maxillary sinus surgery. Although transoral enucleation is a conventional approach for its treatment, the intraoperative risk of injury to the inferior rectus muscle increases when there is an orbital floor defect. The transnasal endoscopic marsupialization has also been used widely for treatment. However, it has a potential risk of postoperative stenosis of the meatal antrostomy site, especially when the medial wall of the maxillary sinus is thick. PATIENT CONCERNS: A 60-year-old man who underwent a right Caldwell-Luc operation about 30 years ago came to the emergency room with pain and swelling in the right periorbital region. DIAGNOSIS: He was diagnosed with a POMM accompanied by an orbital floor defect and a thick medial wall of the maxillary sinus. INTERVENTIONS: Transnasal endoscopic marsupialization was performed, and a cylindrical penrose drain was placed at the antrostomy site for one month. OUTCOMES: The patient's periorbital pain disappeared after surgery. After 3 months, the postoperative computed tomography scan showed good opening at the meatal antrostomy site. LESSONS: In a patient with POMM with an orbital floor defect and a thick medial wall of the maxillary sinus, transnasal endoscopic marsupialization with penrose drain insertion could prevent both injury of the inferior rectus muscle and postoperative stenosis.


Assuntos
Drenagem/métodos , Seio Maxilar/cirurgia , Mucocele/cirurgia , Órbita/patologia , Complicações Pós-Operatórias/cirurgia , Endoscopia/métodos , Humanos , Masculino , Pessoa de Meia-Idade
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA