BACKGROUND Immunoglobulin G4-related disease(IgG4-RD)is a complex immune-mediated condition that causes fibrotic inflammation in several organs.A significant clinical feature of IgG4-RD is hypertrophic pachymeningitis...BACKGROUND Immunoglobulin G4-related disease(IgG4-RD)is a complex immune-mediated condition that causes fibrotic inflammation in several organs.A significant clinical feature of IgG4-RD is hypertrophic pachymeningitis,which manifests as inflammation of the dura mater in intracranial or spinal regions.Although IgG4-RD can affect multiple areas,the spine is a relatively rare site compared to the more frequent involvement of intracranial structures.CASE SUMMARY A 70-year-old male presented to our hospital with a two-day history of fever,altered mental status,and generalized weakness.The initial brain magnetic resonance imaging(MRI)revealed multiple small infarcts across various cerebral regions.On the second day after admission,a physical examination revealed motor weakness in both lower extremities and diminished sensation in the right lower extremity.Electromyographic evaluation revealed findings consistent with acute motor sensory neuropathy.Despite initial management with intravenous immunoglobulin for presumed Guillain-Barrésyndrome,the patient exhibited progressive worsening of motor deficits.On the 45th day of hospitalization,an enhanced MRI of the entire spine,focusing specifically on the thoracic 9 to lumbar 1 vertebral level,raised the suspicion of IgG4-related spinal pachymeningitis.Subsequently,the patient was administered oral prednisolone and participated in a comprehensive rehabilitation program that included gait training and lower extremity strengthening exercises.CONCLUSION IgG4-related spinal pachymeningitis,diagnosed on MRI,was treated with corticosteroids and a structured rehabilitation regimen,leading to significant improvement.展开更多
BACKGROUND The optimal treatment for heart failure(HF)is a combination of appropriate medications.Controlling the disease using only medical therapy is difficult in patients with HF,severe hypercapnia,and desaturation...BACKGROUND The optimal treatment for heart failure(HF)is a combination of appropriate medications.Controlling the disease using only medical therapy is difficult in patients with HF,severe hypercapnia,and desaturation.These patients should first receive ventilator support followed by pulmonary rehabilitation(PR).CASE SUMMARY We report two cases in which arterial blood gas(ABG)improved and PR was possible with appropriate ventilator support.Two patients with extreme obesity complaining of worsening dyspnea–a 47-year-old woman and a 36-year-old man both diagnosed with HF–were hospitalized because of severe hypercapnia and hypoxia.Despite proper medical treatment,hypercapnia and desaturation resolved in neither case,and both patients were transferred to the rehabilitation department for PR.At the time of the first consultation,the patients were bedridden because of dyspnea.Oxygen demand was successfully reduced once noninvasive ventilation was initiated.As the patients’dyspnea gradually improved to the point where they could be weaned off the ventilator during the daytime,they started engaging in functional training and aerobic exercise.After 4 mo of followup,both patients were able to perform activities of daily living and maintain their lower body weight and normalized ABG levels.CONCLUSION Symptoms of patients with obesity and HF may improve once ABG levels are normalized through ventilator support and implementation of PR.展开更多
BACKGROUNDAutonomic dysreflexia (AD) can be a life-threatening condition in patients withspinal cord injury. It is important to prevent bladder overdistension in thesepatients as it may trigger AD. Sensation-dependent...BACKGROUNDAutonomic dysreflexia (AD) can be a life-threatening condition in patients withspinal cord injury. It is important to prevent bladder overdistension in thesepatients as it may trigger AD. Sensation-dependent bladder emptying (SDBE), asa method of bladder management, improves the quality of life and allowsphysiologic voiding. In this study, we report disruption of the SDBE habit afterbladder overdistension leading to AD with chest pain.CASE SUMMARYA 47-year-old male with a diagnosis of C4 American Spinal Cord InjuryAssociation impairment scale A had been emptying his bladder using the cleanintermittent catheterization method with an itchy sensation in the nose as asensory indication for a full bladder for 23 years, and the usual urine volume wasabout 300-400 mL. At the time of this study, the patient had delayed catheterizationfor approximately five hours. He developed severe abdominal pain andheadache and had to visit the emergency room for bladder overdistension (800mL) and a high systolic blood pressure (205 mmHg). After control of AD, ahypersensitive bladder was observed despite using anticholinergic agents. Thesensation indicating bladder fullness changed from nose itching to pain in theabdomen and precordial area. Moreover, the volume of the painful bladder fillingsensation became highly variable and was noted when the bladder urine volumeexceeded only 100 mL. The patient refused intermittent clean catheterization Finally, a cystostomy was performed, which relieved the symptoms.CONCLUSIONPatients using physiologic feedback, such as SDBE, for bladder management arerecommended to avoid bladder overdistension.展开更多
BACKGROUND Axillary thoracotomy and muscle flap are muscle-and nerve-sparing methods among the surgical approaches to bronchopleural fistula(BPF).However,in patients who are vulnerable to a nerve compression injury,ne...BACKGROUND Axillary thoracotomy and muscle flap are muscle-and nerve-sparing methods among the surgical approaches to bronchopleural fistula(BPF).However,in patients who are vulnerable to a nerve compression injury,nerve injury may occur.In this report,we present a unique case in which the brachial plexus(division level),suprascapular,and long thoracic nerve injury occurred after BPF closure surgery in a patient with ankylosing spondylitis and concomitant multiple joint contractures.CASE SUMMARY A 52-year-old man with a history of ankylosing spondylitis with shoulder joint contractures presented with right arm weakness and sensory impairment immediately after axillary thoracotomy and latissimus dorsi muscle flap surgery for BPF closure.During the surgery,the patient was positioned in a lateral decubitus position with the right arm hyper-abducted for approximately 6 h.Magnetic resonance imaging and ultrasound revealed subclavius muscle injury or myositis with brachial plexus(BP)compression and related neuropathy.An electrodiagnostic study confirmed the presence of BP injury involving the wholedivision level,long thoracic,and suprascapular nerve injuries.He was treated with medication,physical therapy,and ultrasound-guided injections.Ultrasoundguided steroid injection at the BP,hydrodissection with 5%dextrose water at the BP and suprascapular nerve,and intra-articular steroid and hyaluronidase injection at the glenohumeral joint were performed.On postoperative day 194,the pain and arm weakness were resolved,and a follow-up electrodiagnostic study showed marked improvement.CONCLUSION Clinicians should consider the possibilities of multiple nerve injuries in patients with joint contracture,and treat each specific therapeutic target.展开更多
BACKGROUND Sleep-disordered breathing,including hypoventilation and obstructive sleep apnea,is often observed in Prader-Willi syndrome(PWS).Particularly in adolescence,scoliosis causes a progressive restrictive pulmon...BACKGROUND Sleep-disordered breathing,including hypoventilation and obstructive sleep apnea,is often observed in Prader-Willi syndrome(PWS).Particularly in adolescence,scoliosis causes a progressive restrictive pulmonary pattern,leading to hypoventilation,so timely corrective surgery is required.However,the effect is controversial.In addition,since mental retardation of PWS,patient effort-based respiratory tests may be less reliable.So far,no studies have accurately reported on the comparison of respiratory function before and after corrective surgery,and appropriate respiratory function measurement method in PWS.CASE SUMMARY We present two cases of adolescent PWS with typical characteristics,including obesity,mental retardation,and scoliosis.Two boys,aged 12 and 13,diagnosed with PWS,both underwent scoliosis correction surgery.Before and immediately after surgery,arterial blood tests showed no abnormalities and no respiratory symptoms occurred.However,after 6-7 mo,both patients complained of daytime sleepiness,difficulty sleeping at night,dyspnea on exertion,and showed cyanosis.Hypercapnia and hypoxia were confirmed by polysomnography and transcutaneous CO2 monitoring during sleep and were diagnosed with obstructive sleep apnea and alveolar hypoventilation.It was corrected by nighttime noninvasive ventilation application and normal findings of arterial blood gas were maintained after 6-8 mo follow-up.CONCLUSION Even after scoliosis surgery,“periodic”monitoring of respiratory failure with an“objective”test method is needed for timely respiratory support.展开更多
文摘BACKGROUND Immunoglobulin G4-related disease(IgG4-RD)is a complex immune-mediated condition that causes fibrotic inflammation in several organs.A significant clinical feature of IgG4-RD is hypertrophic pachymeningitis,which manifests as inflammation of the dura mater in intracranial or spinal regions.Although IgG4-RD can affect multiple areas,the spine is a relatively rare site compared to the more frequent involvement of intracranial structures.CASE SUMMARY A 70-year-old male presented to our hospital with a two-day history of fever,altered mental status,and generalized weakness.The initial brain magnetic resonance imaging(MRI)revealed multiple small infarcts across various cerebral regions.On the second day after admission,a physical examination revealed motor weakness in both lower extremities and diminished sensation in the right lower extremity.Electromyographic evaluation revealed findings consistent with acute motor sensory neuropathy.Despite initial management with intravenous immunoglobulin for presumed Guillain-Barrésyndrome,the patient exhibited progressive worsening of motor deficits.On the 45th day of hospitalization,an enhanced MRI of the entire spine,focusing specifically on the thoracic 9 to lumbar 1 vertebral level,raised the suspicion of IgG4-related spinal pachymeningitis.Subsequently,the patient was administered oral prednisolone and participated in a comprehensive rehabilitation program that included gait training and lower extremity strengthening exercises.CONCLUSION IgG4-related spinal pachymeningitis,diagnosed on MRI,was treated with corticosteroids and a structured rehabilitation regimen,leading to significant improvement.
基金Supported by The“Research Base Construction Fund Support Program”funded by Jeonbuk National University in 2021.
文摘BACKGROUND The optimal treatment for heart failure(HF)is a combination of appropriate medications.Controlling the disease using only medical therapy is difficult in patients with HF,severe hypercapnia,and desaturation.These patients should first receive ventilator support followed by pulmonary rehabilitation(PR).CASE SUMMARY We report two cases in which arterial blood gas(ABG)improved and PR was possible with appropriate ventilator support.Two patients with extreme obesity complaining of worsening dyspnea–a 47-year-old woman and a 36-year-old man both diagnosed with HF–were hospitalized because of severe hypercapnia and hypoxia.Despite proper medical treatment,hypercapnia and desaturation resolved in neither case,and both patients were transferred to the rehabilitation department for PR.At the time of the first consultation,the patients were bedridden because of dyspnea.Oxygen demand was successfully reduced once noninvasive ventilation was initiated.As the patients’dyspnea gradually improved to the point where they could be weaned off the ventilator during the daytime,they started engaging in functional training and aerobic exercise.After 4 mo of followup,both patients were able to perform activities of daily living and maintain their lower body weight and normalized ABG levels.CONCLUSION Symptoms of patients with obesity and HF may improve once ABG levels are normalized through ventilator support and implementation of PR.
文摘BACKGROUNDAutonomic dysreflexia (AD) can be a life-threatening condition in patients withspinal cord injury. It is important to prevent bladder overdistension in thesepatients as it may trigger AD. Sensation-dependent bladder emptying (SDBE), asa method of bladder management, improves the quality of life and allowsphysiologic voiding. In this study, we report disruption of the SDBE habit afterbladder overdistension leading to AD with chest pain.CASE SUMMARYA 47-year-old male with a diagnosis of C4 American Spinal Cord InjuryAssociation impairment scale A had been emptying his bladder using the cleanintermittent catheterization method with an itchy sensation in the nose as asensory indication for a full bladder for 23 years, and the usual urine volume wasabout 300-400 mL. At the time of this study, the patient had delayed catheterizationfor approximately five hours. He developed severe abdominal pain andheadache and had to visit the emergency room for bladder overdistension (800mL) and a high systolic blood pressure (205 mmHg). After control of AD, ahypersensitive bladder was observed despite using anticholinergic agents. Thesensation indicating bladder fullness changed from nose itching to pain in theabdomen and precordial area. Moreover, the volume of the painful bladder fillingsensation became highly variable and was noted when the bladder urine volumeexceeded only 100 mL. The patient refused intermittent clean catheterization Finally, a cystostomy was performed, which relieved the symptoms.CONCLUSIONPatients using physiologic feedback, such as SDBE, for bladder management arerecommended to avoid bladder overdistension.
文摘BACKGROUND Axillary thoracotomy and muscle flap are muscle-and nerve-sparing methods among the surgical approaches to bronchopleural fistula(BPF).However,in patients who are vulnerable to a nerve compression injury,nerve injury may occur.In this report,we present a unique case in which the brachial plexus(division level),suprascapular,and long thoracic nerve injury occurred after BPF closure surgery in a patient with ankylosing spondylitis and concomitant multiple joint contractures.CASE SUMMARY A 52-year-old man with a history of ankylosing spondylitis with shoulder joint contractures presented with right arm weakness and sensory impairment immediately after axillary thoracotomy and latissimus dorsi muscle flap surgery for BPF closure.During the surgery,the patient was positioned in a lateral decubitus position with the right arm hyper-abducted for approximately 6 h.Magnetic resonance imaging and ultrasound revealed subclavius muscle injury or myositis with brachial plexus(BP)compression and related neuropathy.An electrodiagnostic study confirmed the presence of BP injury involving the wholedivision level,long thoracic,and suprascapular nerve injuries.He was treated with medication,physical therapy,and ultrasound-guided injections.Ultrasoundguided steroid injection at the BP,hydrodissection with 5%dextrose water at the BP and suprascapular nerve,and intra-articular steroid and hyaluronidase injection at the glenohumeral joint were performed.On postoperative day 194,the pain and arm weakness were resolved,and a follow-up electrodiagnostic study showed marked improvement.CONCLUSION Clinicians should consider the possibilities of multiple nerve injuries in patients with joint contracture,and treat each specific therapeutic target.
文摘BACKGROUND Sleep-disordered breathing,including hypoventilation and obstructive sleep apnea,is often observed in Prader-Willi syndrome(PWS).Particularly in adolescence,scoliosis causes a progressive restrictive pulmonary pattern,leading to hypoventilation,so timely corrective surgery is required.However,the effect is controversial.In addition,since mental retardation of PWS,patient effort-based respiratory tests may be less reliable.So far,no studies have accurately reported on the comparison of respiratory function before and after corrective surgery,and appropriate respiratory function measurement method in PWS.CASE SUMMARY We present two cases of adolescent PWS with typical characteristics,including obesity,mental retardation,and scoliosis.Two boys,aged 12 and 13,diagnosed with PWS,both underwent scoliosis correction surgery.Before and immediately after surgery,arterial blood tests showed no abnormalities and no respiratory symptoms occurred.However,after 6-7 mo,both patients complained of daytime sleepiness,difficulty sleeping at night,dyspnea on exertion,and showed cyanosis.Hypercapnia and hypoxia were confirmed by polysomnography and transcutaneous CO2 monitoring during sleep and were diagnosed with obstructive sleep apnea and alveolar hypoventilation.It was corrected by nighttime noninvasive ventilation application and normal findings of arterial blood gas were maintained after 6-8 mo follow-up.CONCLUSION Even after scoliosis surgery,“periodic”monitoring of respiratory failure with an“objective”test method is needed for timely respiratory support.
