PURPOSE: The bedside lung ultrasound in emergency (BLUE) protocol is an excellent diagnostic tool for acute respiratory failures requiring admission to the intensive care unit. We incorporated cardiac ultrasound in the BLUE algorithm because cardiac origin is also necessary to examine in an emergency setting. We studied the usefulness of the emergency department (ED)-BLUE protocol for patients complaining of dyspnea in an emergency department. METHODS: At first, we assessed lung sliding, artifacts (Alines and B-lines), alveolar consolidation and pleural effusion on stage I and II evaluation. Then, we checked heart to detect 3Es (Effusion, Equality, and Ejection fractions). We divided all the possible conditions into 10 categories. We compared it with final diagnosis and examined the agreements using kappa statistics. We compared the physician's level of confidence for the first impression. The 10 categories were: 1) normal or inconclusive, 2) pulmonary embolism, 3) airway disease (chronic obstructive pulmonary disease or asthma), 4) pneumothorax, 5) large pleural effusion, 6) alveolar consolidation, 7) acute pulmonary edema due to systolic congestive heart failure, 8) acute respiratory distress syndrome, 9) chronic interstitial lung disease with exacerbation, and 10) pericardial effusion with/without tamponade. RESULTS: This prospective study was performed for 172 patients over 18-years-of-age with dyspnea during a 25-month period. Kappa value between the diagnosis after ED-BLUE and final diagnosis was 0.812(p<0.001). The mean of physician's full term for LOC for the first impression before and after ED-BLUE was 3.09+/-0.83 and 4.36+/-0.70 (paired t-test, p<0.001). CONCLUSION: ED-BLUE protocol could help the emergency physician make an accurate diagnosis in patients with dyspnea in the emergent setting.
Artifacts ; Dyspnea ; Emergencies ; Heart ; Heart Failure ; Humans ; Intensive Care Units ; Lung ; Lung Diseases, Interstitial ; Lung Diseases, Obstructive ; Pericardial Effusion ; Pleural Effusion ; Pneumothorax ; Prospective Studies ; Pulmonary Edema ; Pulmonary Embolism ; Respiratory Distress Syndrome, Adult

BACKGROUND/AIMS: Mirizzi syndrome is a rare complication of longstanding gallstone disease which resulting in obstructive Jaundice. It is benign stricture of common hepatic duct because of stone impacted with in the cystic duct or Hartmann pouch of the gallbladder. The aim of this study is to evaluate our experience of Mirizzi syndrome and consider its surgical treatment. METHODS: During the years 1994 to 2001 at Asan medical center, 23 cases of Mirizzi syndrome were diagnosed on the basis of preoperative and postoperative findings and they were retrospectively reviewed. RESULTS: There were 12 patients with Csendes type I, 6 patients with type II, and 5 patients with Type III. Average age was 61 years (range: 31 to 83 years) For preoperative evaluation Endoscopic retrograde cholangiopancreatography (ERCP) and Ultrasonography were performed in all cases. Laparoscopic cholecystectomy was tried in 7 type I cases. 5 were successfully treated and 2 conversions were reported, all because of unclear anatomy. In 6 type II cases open cholecystrctomy, CHD repair and T tube insertion were performed. 5 patients with type III were required hepaticojejunostomy. CONCLUSIONS: High index of suspicion is required for diagnosis of Mirizzi syndrome and laparoscopic approach is permissible in specialized center especially in the case of suspected Mirizzi type I, under the recognition of biliary anatomy through preoperative imaging studies. If there is fistula or unclear anatomy, we recommend open operative techniques for the safety and the efficiency.
Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy, Laparoscopic ; Chungcheongnam-do ; Constriction, Pathologic ; Cystic Duct ; Diagnosis ; Fistula ; Gallbladder ; Gallstones ; Hepatic Duct, Common ; Humans ; Jaundice, Obstructive ; Mirizzi Syndrome* ; Retrospective Studies ; Ultrasonography

Objectives: Intraoperative navigation reduces the risk of major complications and increases the likelihood of optimal surgical outcomes. This paper presents an augmented reality (AR)-based simulation technique for ventriculostomy that visualizes brain deformations caused by the movements of a surgical instrument in a three-dimensional brain model. This is achieved by utilizing a position-based dynamics (PBD) physical deformation method on a preoperative brain image. Methods: An infrared camera-based AR surgical environment aligns the real-world space with a virtual space and tracks the surgical instruments. For a realistic representation and reduced simulation computation load, a hybrid geometric model is employed, which combines a high-resolution mesh model and a multiresolution tetrahedron model. Collision handling is executed when a collision between the brain and surgical instrument is detected. Constraints are used to preserve the properties of the soft body and ensure stable deformation. Results: The experiment was conducted once in a phantom environment and once in an actual surgical environment. The tasks of inserting the surgical instrument into the ventricle using only the navigation information presented through the smart glasses and verifying the drainage of cerebrospinal fluid were evaluated. These tasks were successfully completed, as indicated by the drainage, and the deformation simulation speed averaged 18.78 fps. Conclusions This experiment confirmed that the AR-based method for external ventricular drain surgery was beneficial to clinicians.

Vaccination is considered a frequently used tool to prevent and control foot-and-mouth disease (FMD). However, the effectiveness of conventional FMD virus (FMDV) vaccines in pigs has been controversial because the massive prophylactic vaccination could not elicit proper immune response nor prevent the broad spread of FMD outbreak, mainly in pig farms, in South Korea during outbreaks of 2014. In addition, there has been little information on the efficacy of inactivated, high potency, multivalent, oil-based FMDV vaccine in pigs, because an evaluation of FMDV vaccines had been mainly carried out using cattle. In this study, we evaluated the genetic identification of commercial inactivated FMDV vaccine and monitored the immune responses in pigs under the field condition. Results implied that it contained three different serotypes with a high level of antigen payload. However, serological results showed low mean percentage of inhibition, and positive rate reached its peak at 6-week post-vaccination, indicating current FMDV vaccine need to improve for a prophylactic vaccination policy in pigs. Therefore, there is an imperative need to develop FMDV vaccine that can provide rapid and long-lasting protective immunity in pigs.
Agriculture ; Animals ; Antibody Formation ; Cattle ; Disease Outbreaks ; Foot-and-Mouth Disease Virus* ; Foot-and-Mouth Disease* ; Korea ; Real-Time Polymerase Chain Reaction ; Serogroup ; Swine* ; Vaccination ; Vaccines

Abdominal Muscles ; Adipose Tissue ; Artificial Intelligence ; Dataset ; Intra-Abdominal Fat ; Learning ; Muscle, Skeletal ; Muscles ; Sarcopenia ; Spine ; Subcutaneous Fat ; Tomography, X-Ray Computed