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Sudden Hypotension Following Electrocauterization during Pneumonectomy under General Anesthesia.

Hye Jin CHOI ; Sung Mi JUNG ; Sang Jin PARK

Keimyung Medical Journal.2015;34(1):84-87.

A 67-year-old man who was diagnosed lung cancer underwent open thoracotomy for left pneumonectomy. For bleeding control, cauterization of hilar site provoked severe hypotension. There were no reasons falling blood pressure such as condition of massive bleeding, excessively deep anesthesia, anaphylaxis or arrhythmia, etc. After interruption of the manipulation, the normal blood pressure returned spontaneously. With the suspicion that the touch of the hilar tissue have induced the hypotension, we used an electrical current carefully; however, the repeat hypotension occurred again and recoverd soon. We conclude that the electrocautery procedures near the hilum may induce the profound hypotension.
Aged ; Anaphylaxis ; Anesthesia ; Anesthesia, General* ; Arrhythmias, Cardiac ; Blood Pressure ; Cautery ; Electrocoagulation ; Hemorrhage ; Humans ; Hypotension* ; Lung Neoplasms ; Pneumonectomy* ; Reflex ; Thoracotomy

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Surgical Treatment in Cervical Myelopathy Combined with Flail Arm Syndrome.

Eun Seok SON ; Jeong Geun LIM ; Du Hwan KIM ; Seok Jung LEE

Keimyung Medical Journal.2015;34(1):80-83.

Flail arm syndrome (FAS) is a variant of the amyotrophic lateral sclerosis also known as Lou Gehrig's disease. FAS is a kind of motor neuron disease that represents a bilateral proximal muscle wasting of upper extremities. Degenerative cervical spondylosis is a common cause of cervical myelopathy and radiculopathy. The coexistence of cervical spondylosis and motor neuron disease can cause difficulties in diagnosis and treatment. This case is a cervical spondylotic myelopathy associated with FAS who had undergone surgical treatment. After the operation, subjective symptoms of the patient was more aggravated and it may be owing to natural history of FAS. The surgical treatment must be made very carefully in cervical spondylotic myelopathy patient combined with motor neuron disease.
Amyotrophic Lateral Sclerosis ; Arm* ; Diagnosis ; Humans ; Motor Neuron Disease ; Natural History ; Radiculopathy ; Spinal Cord Diseases* ; Spondylosis ; Upper Extremity

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Hypoglycemic Encephalopathy with Reversible Unilateral Hippocampal Lesion on Brain MRI.

Hyon Ah YI ; Hyung LEE

Keimyung Medical Journal.2015;34(1):74-79.

There have been few reports of hypoglycemic encephalopathy (HE) with unilateral brain lesion. A 66-year-old male with hypoglycemia, who had history of diabetes and recent poor oral intake, presented with amnesia and confusion. Diffusionweighted imaging (DWI) showed high signal intensity in left hippocampus, which was low on apparent diffusion coefficient (ADC) map. By intravenous glucose, the symptoms improved besides amnesia for hypoglycemic period. Follow-up DWI revealed no lesion and single photon emission computed tomography (SPECT) showed decreased perfusion in left temporo-parieto-frontal area. We experienced a case of HE with a reversible unilateral hippocampal lesion.
Aged ; Amnesia ; Brain* ; Diffusion ; Follow-Up Studies ; Glucose ; Hippocampus ; Humans ; Hypoglycemia ; Magnetic Resonance Imaging* ; Male ; Perfusion ; Tomography, Emission-Computed, Single-Photon

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Thoracic Spine Tumor Mimicking Cauda Equina Syndrome.

Seok Jung LEE

Keimyung Medical Journal.2015;34(1):70-73.

Cauda equina syndrome (CES) is one of the typical symptoms condition requires emergency operation. This syndrome is always accompanied by sciatica. Because schwannomas rarely cause sciatica, it is seldom considered as a pain source in the patient with radiculopathy. A 74-year-old male patient presented with lumbar radiculopathy symptoms with, mild stenosis on lumbar MRI scan. All conservative treatment including medication failed to subside the symptoms. Thoracic spine MRI revealed a large tumor in the thoracic region. The symptoms disappeared after excision of the tumor. The tumor was diagnosed as a schwannoma.
Aged ; Cauda Equina* ; Constriction, Pathologic ; Emergencies ; Humans ; Magnetic Resonance Imaging ; Male ; Neurilemmoma ; Polyradiculopathy* ; Radiculopathy ; Sciatica ; Spine*

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A Patient of Graves' Disease with Methimazole Induced Agranulocytosis Combined with Acute Appendicitis.

Ja Yeon LEE ; Kyung Ae LEE ; Tae Sun PARK ; Hong Sun BAEK ; Heung Yong JIN

Keimyung Medical Journal.2015;34(1):64-69.

Methimazole-induced agranulocytosis is a rare but critical side effect which may cause a life-threatening state during Graves' disease treatment. In management of methimazole-induced agranulocytosis, the most important thing is withdrawal of ATD (anti-thyroid drug) and empirical broad spectrum antibiotics can be used. Also, G-CSF or GM-CSF is generally recommended as it could be helpful in restoration of neutropenia. Pathophysiology of appendicitis is obstruction of the lumen of the appendix caused by infection or hyperplasia of submucosal follicles. Recently, management of appendicitis has been reported to be successful with conservative antibiotics administration without appendectomy. A 27-year-old man visited our hospital experiencing febrile sensation, painful throat, and abdominal pain. The patient had been diagnosed with Graves' disease 1 month previously and had taken methimazole 10 mg daily (tapered dose from initial 30 mg daily). Agranulocytosis was confirmed with neutrophils count and peripheral blood smear, and the finding of ultrasonography and abdominal CT scan were compatible with acute appendicitis. We report a rare case of methimzole-induced agranulocytosis combined with acute appendicitis in the course of Graves' disease treatment. In this case, withdrawal of ATD (anti-thyroid drug) caused thyroid storm and appendectomy was not performed due to operative risk. Thyroid storm was treated with radioiodine ablation, and appendicitis was treated with antibiotics without appendectomy. With the use of G-CSF and conservative management, improvement of not only the clinical manifestation but also agranulocytosis was seen.
Abdominal Pain ; Adult ; Agranulocytosis* ; Anti-Bacterial Agents ; Appendectomy ; Appendicitis* ; Appendix ; Granulocyte Colony-Stimulating Factor ; Granulocyte-Macrophage Colony-Stimulating Factor ; Graves Disease* ; Humans ; Hyperplasia ; Methimazole* ; Neutropenia ; Neutrophils ; Pharynx ; Sensation ; Thyroid Crisis ; Tomography, X-Ray Computed ; Ultrasonography

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A Case of Piriform Sinus Fistula Complicated with Suppurative Thyroiditis Treated with Chemocauterization Using Trichloroacetic Acid.

Kyung Lae SON ; So Young SHIN ; Ye Jee SHIM ; Heung Sik KIM ; Hee Jung LEE ; Chang Ki YEO

Keimyung Medical Journal.2015;34(1):59-63.

A 23 months-old girl visited the hospital because of fever and left neck mass. She was diagnosed as acute suppurative thyroiditis with piriform sinus fistula. Thyroid sonography showed perithyroidal abscess formation and thyroid scan showed decreased uptake of Tc-99m pertechnate of both thyroid glands. Magnetic resonance imaging of neck showed abscess cavity extending to the swollen left thyroid gland. And there was tiny fistula between thyroid and piriform sinus in the barium esophagogram. Streptococcus gordonii was isolated on needle aspiration culture. We report a case of piriform sinus fistula of the neck complicated with suppurative thyroiditis. The fistula was treated with chemocauterization using trichloroacetic acid.
Abscess ; Barium ; Female ; Fever ; Fistula* ; Humans ; Magnetic Resonance Imaging ; Neck ; Needles ; Pyriform Sinus* ; Streptococcus gordonii ; Thyroid Gland ; Thyroiditis, Suppurative* ; Trichloroacetic Acid*

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Magnetic Resonance Neurography Findings in Idiopathic Neuralgic Amyotrophy.

Eun Seok SON ; Du Hwan KIM

Keimyung Medical Journal.2015;34(1):53-58.

Idiopathic neuralgic amyotrophy (INA) is known as Parsonage-Turner syndrome or idiopathic brachial plexitis and is characterized by sudden onset of severe limb pain, followed by weakness and atrophy of limb. There is no specific tests for the diagnosis of INA. The diagnosis of INA is mainly dependent on the clinical history and electrodiagnostic study. It is often confused with more common disorders such as acute cervical radiculopathy, rotator cuff tear, or acute calcific tendinitis. A few recent reports have revealed that magnetic resonance image (MRI) of brachial plexus and shoulder can be helpful in the diagnosis of INA. We report two cases of classic INA in which MRI enhanced specificity and confidence in the diagnosis. MRI of the brachial plexus and corresponding limb as well as cervical spine should be included in patients clinically suspected of INA.
Atrophy ; Brachial Plexus ; Brachial Plexus Neuritis* ; Diagnosis ; Extremities ; Humans ; Magnetic Resonance Imaging ; Radiculopathy ; Rotator Cuff ; Sensitivity and Specificity ; Shoulder ; Spine ; Tendinopathy

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A Case of Salmonella Infection Complicated by Rhabdomyolysis and Acute Kidney Injury.

In Hee LEE ; Gun Woo KANG

Keimyung Medical Journal.2015;34(1):47-52.

Rhabdomyolysis a clinical syndrome characterized by injury to skeletal muscle and release of intracellular contents into the systemic circulation, can develop from infections, although trauma is a more common cause. Myoglobinuric acute kidney injury (AKI) is a potentially life-threatening complication of rhabdomyolysis. Reports of rhabdomyolysis and AKI induced by salmonella infection are rare in the Korean literature. This paper describes a case of salmonella enteritis complicated by rhabdomyolysis and AKI. A 58-year-old man presented to the hospital with a two day history of watery diarrhea, abdominal pain and high fever. Initial blood chemistry revealed a serum creatinine (Cr) level of 3.4 mg/dL, with elevations of serum creatine phosphokinase (CK, 5,635 IU/L) and serum myoglobin (>3,000 ng/mL). Intravenous hydration and empirical antibiotic treatment with ciprofloxacin were initiated. Blood and stool cultures grew salmonella group B, which was sensitive to ciprofloxacin, ampicillin, and ceftazidime. Parenteral ciprofloxacin was continued for 14 days. During the first week of hospitalization, peak levels of serum Cr and CK were 9.5 mg/dL and 89,155 IU/L, respectively. Thereafter clinical and biochemical parameters gradually improved without dialysis. The patient was discharged on the 20th hospital day with normal CK levels except for serum Cr. His renal function normalized (serum Cr 1.0 mg/dL) two months after discharge. Based on the results of this case, prompt fluid therapy and early administration of antibiotics should be performed in patients with salmonella infection complicated by rhabdomyolysis and AKI.
Abdominal Pain ; Acute Kidney Injury* ; Ampicillin ; Anti-Bacterial Agents ; Ceftazidime ; Chemistry ; Ciprofloxacin ; Creatine Kinase ; Creatinine ; Dialysis ; Diarrhea ; Enteritis ; Fever ; Fluid Therapy ; Hospitalization ; Humans ; Middle Aged ; Muscle, Skeletal ; Myoglobin ; Rhabdomyolysis* ; Salmonella Infections* ; Salmonella*

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Percutaneous Extracorporeal Membrane Oxygenation (ECMO) for Acute Fulminant Myocarditis.

Jae Bum KIM ; Jae Hyun KIM

Keimyung Medical Journal.2015;34(1):43-46.

Acute fulminant myocarditis can be developed by viral infection, toxic materials, autoimmune disorder to heart and can cause left ventricular dysfunction that predisposes the patients to critical condition. When conventional therapy failed to manage the patients and the failing myocardium to recovery, cardiovascular collapse or even death was followed. Mechanical circulatory support is a useful option for the patient whose condition is resistant to medical therapy. We report a case which successful management of acute fulminant myocarditis patient with percutaneous extracorporeal membrane oxygenation.
Extracorporeal Membrane Oxygenation* ; Heart ; Humans ; Myocarditis* ; Myocardium ; Ventricular Dysfunction, Left

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Carpal Spasm in a Patient with Hypophosphatemia.

Sang Hyun LEE ; Ye Jee SHIM ; Jin Hyuk CHOI ; Heung Sik KIM

Keimyung Medical Journal.2015;34(1):39-42.

Phosphate is an essential ion and plays a vital role in many physiological processes. Carpopedal spasm is known as a symptom of hypocalcemia, or rarely, hypomagnesemia. We present an unusual case of carpal spasm seen in a patient with hypophosphatemia. A fourteen year old boy was admitted with acute onset of both carpal spasm after vomiting and diarrhea. Biochemical investigation revealed only moderate hypophosphatemia without hypocalcemia. Other laboratory findings including hormone tests were normal. Carpal spasm improved with correction of hypophosphatemia. The phathophysiology of neurologic dysfunction related to hypophosphatemia is not clear yet. Careful observation of serum electrolytes including phosphate is necessary when the patient has neurologic symptoms.
Diarrhea ; Electrolytes ; Humans ; Hypocalcemia ; Hypophosphatemia* ; Male ; Neurologic Manifestations ; Physiological Processes ; Spasm* ; Vomiting

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