Journal of Yeungnam Medical Science

Case reports

Reverse Takotsubo cardiomyopathy with left bundle branch block after anesthesia induction in a patient with subarachnoid hemorrhage: a case report: Eun Kyung Choi, Jong-Hoon Kim, Minhyun Kim; J Yeungnam Med Sci. 2022;39(2):172-178. Published online October 25, 2021; DOI: https://doi.org/10.12701/yujm.2021.01354

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Abstract PDF: Cardiac dysfunction after subarachnoid hemorrhage (SAH) is described as Takotsubo or reverse Takotsubo cardiomyopathy that shows transient left ventricular wall motion abnormalities with electrocardiogram (ECG) changes. ST change followed by T inversion is a common ECG finding complicated with these disorders, left bundle branch block (LBBB) may be a potential ECG pattern which is seen. In this case, we describe the clinical profile and outcomes of a patient with LBBB and reverse Takotsubo cardiomyopathy after anesthetic induction, which was scheduled as an emergent external ventricular drainage after SAH. This is the first report of an LBBB pattern in reverse Takotsubo cardiomyopathy.

Isolated hemorrhage in the cerebellar vermis with vertigo and body lateropulsion to the contralesional side: Dong Hyun Lee, Se-Jin Lee; Yeungnam Univ J Med. 2019;36(3):269-272. Published online September 9, 2019; DOI: https://doi.org/10.12701/yujm.2019.00318

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Abstract PDF: There have been several reports of patients with isolated lesions of the cerebellar vermis presenting with clinical features similar to those of peripheral vestibulopathy. We report a case of small, isolated hematoma in the cerebellar vermis in a patient who presented with vertigo, ipsilesional nystagmus, and body lateropulsion to the contralesional side without the usual signs or symptoms of cerebellar dysfunction. Although they present with symptoms that mimic those of peripheral vestibulopathy, and brain computed tomography shows no abnormality, as there may be a small, isolated hematoma or infarction in the cerebellar vermis. Thus, brain magnetic resonance imaging should be performed in elderly patients with vascular risk factors.

Case Reports

A Case of Gastric Lipoma with Upper Gastrointestinal Bleeding.: Min Geun Gu, Kook Hyun Kim, Byung Sam Park, Sung Yun Jung, Yo Han Jeong, Dong Won Lee, Hyeong Chan Shin, Mi Jin Gu; Yeungnam Univ J Med. 2013;30(2):132-135. Published online December 31, 2013; DOI: https://doi.org/10.12701/yujm.2013.30.2.132

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Abstract PDF: Gastric lipoma is a typical benign submucosal tumor that is usually asymptomatic and is generally detected incidentally when performing gastroscopy. However, depending on its size and location, an atypical gastrointestinal lipoma can cause abdominal pain, diarrhea, constipation, intestinal obstruction, intussuception and life-threatening gastrointestinal bleeding. We report herein a case of gastric lipoma with bleeding in a 43-year-old man. The gastroscopy showed a 4x4 cm ulcero-fungating submucosal mass at the anterior wall of the gastric antrum. Laparoscopic gastric wedge resection was performed and the lesion was diagnosed as gastric lipoma.

Retroperitoneal Hemorrhage after Thrombolysis in ST Elevation Myocardial Infarction.: Min Young Moon, Jong Young Lee, Sung Hyun Won, Jeong Seok Kim, Kwang Woo Nam, Chang Lae Kim, Jin Seo Lee, Won Jun Ji; Yeungnam Univ J Med. 2012;29(2):125-128. Published online December 31, 2012; DOI: https://doi.org/10.12701/yujm.2012.29.2.125

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Abstract PDF: Bleeding is the most common and serious complication of thrombolysis in ST elevation myocardial infarction. Most bleeding cases are associated with an intervention or operation, but spontaneous bleeding such as gastro-intestinal bleeding or intracranial hemorrhage can happen. This is a report on the case of a 76-year-old female patient with retroperitoneal hemorrhage due to spontaneous right colic artery branch bleeding after thrombolysis in ST elevation myocardial infarction.

A Case of Traumatic Bilateral Adrenal Hemorrhage Mimicking Bilateral Adrenal Adenomas.: Min Jung Lee, Gi Ae Kim, Jung Eun Jang, Hyo In Choi, Seo Hyun Lee, Gwang Beom Koh, Ga Hee Kim, Min Seon Kim; Yeungnam Univ J Med. 2012;29(1):35-37. Published online June 30, 2012; DOI: https://doi.org/10.12701/yujm.2012.29.1.35

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Abstract PDF

Adrenal hemorrhages caused by blunt abdominal trauma have been frequently reported, and most of the lesions are unilateral. In contrast, bilateral hemorrhage of the adrenal glands after trauma rarely occurs in subjects with predisposing conditions such as coagulopathy, thromboembolism, and sepsis. Furthermore, bilateral hemorrhage of the adrenal glands is potentially fatal by inducing acute adrenal insufficiency. Here,a case of a 40-year-old man who developed traumatic bilateral adrenal hemorrhage after a car accident, without any predisposing condition, is reported. The spontaneous shrinkage of the bilateral lesions revealed in the follow-up abdominal computed tomography (CT) scansupported the aforementioned diagnosis. Fortunately, the patient had no clinical or biochemical evidence suggesting acute adrenal insufficiency. To these authors' knowledge, this is the first South Korean report of traumatic bilateral adrenal hemorrhage in a subject with no predisposing factors.

Citations

Citations to this article as recorded by

Adrenal hematoma following falling in a 5-year-old boy
Fateme Guitynavard, Seyed Saeed Tamehri Zadeh, Hossein Zabihi Mahmoudabadi, Seyed Mohammad Kazem Aghamir
Urology Case Reports.2021; 34: 101480. CrossRef

Original Article

Effects of Combined Antiplatelets on Bleeding in Off-Pump Coronary-Artery Bypass Surgery.: Su Kyeong Lee, Tae Jin Kim, Song Yun Seok, Sun Ho Jung, Kyung Ho Yang, Kang Joo Choi, Young Bok Kim; Yeungnam Univ J Med. 2011;28(2):124-132. Published online December 31, 2011; DOI: https://doi.org/10.12701/yujm.2011.28.2.124

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Abstract PDF: BACKGROUND
Antiplatelet agent administration is critical in managing coronary-artery disease, but there is a concern regarding operation-related bleeding and an increase in blood transfusion in such, especially when delivering combined antiplatelet agents. This study was conducted to evaluate the effect of the administration of antiplatelet agents on off-pump coronary-artery bypass surgery (OPCAB). METHODS: From March 2003 to December 2009, 49 patients who had undergone OPCAB were collected retrospectively. The patients were divided into three groups according to the administration of antiplatelet agents before the OPCAB operation: 21 patients were given an aspirin agent (group 1), 19 patients were given combined agents (aspirin+clopidogrel) (group 2), and nine patients were not given any antiplatelet agent (group 3). The three groups' perioperative hematologic and coagulation profiles, including their platelet counts, hemoglobin levels, hematocrit, prothrombin times, and aPTTs (activated partial thromboplastin times), and their postoperative bleeding, related complications, transfusion requirements, and operation times, were compared. RESULTS: The operation time in group 2 was 4.3 hours, longer than those in the two other groups, and urgent operation was significantly most frequent in group 2 (63%). The amount of blood loss and the number of patients who received blood transfusion were not different in the three groups. The perioperative hemoglobin level, hematocrit, platelet count, prothrombin time, and aPTT were also not significantly different among the three groups. CONCLUSION: The continuous administration of antiplatelet agents to the patients in this study did not increase their postoperative bleeding or operation-related complications. Therefore, OPCAB may well be considered even if combined antiplatelet agents are being administered.

Case Reports

A Case of Valsalva Retinopathy Associated with Straining at Stool.: Tae Yoon Lee, Woo Hyok Chang; Yeungnam Univ J Med. 2006;23(2):227-231. Published online December 31, 2006; DOI: https://doi.org/10.12701/yujm.2006.23.2.227

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Abstract PDF: The Valsalva maneuver is described as an expiratory effort against a closed glottis or airway. It leads to elevation of retinal venous pressure and may result in retinal hemorrhage. A fifty two-year-old man presented with an acute reduction of central visual acuity in his right eye which occurred after considerable straining at stool. Detailed past medical history revealed that he suffered from chronic constipation and hypertension. There were one disc sized subhyaloid hemorrhage and three small intraretinal hemorrhages around the fovea at the dilated fundus examination. After three months of follow-up without any treatment, the retinal hemorrhages resolved without any sequelae. Here we report a patient with sudden visual loss and retinal hemorrhage.

Anesthesia for a Jehovah's Witness Patient Experiencing Unexpected Perioperative Hemorrhage: A Case Report.: Seoung Ki Lim, Dae Lim Jee; Yeungnam Univ J Med. 2006;23(1):96-102. Published online June 30, 2006; DOI: https://doi.org/10.12701/yujm.2006.23.1.96

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Abstract PDF

Jehovah's Witnesses refuse a transfusion of blood or blood products because of religious beliefs; this refusal at times presents a dilemma for the treating physician. We report a case of a 25-year-old Jehovah's Witness patient who underwent a reoperation for a previous proximal humerus shaft fracture and experienced unexpected massive hemorrhage intraoperatively and postoperatively. The postoperative lowest hemoglobin level was 2.9 g/dl. The patient recovered from the severe anemia without any clinical sequala. We review the legal, ethical and religious issues and suggest the best possible medical care that Jehovah's Witness patient would permit.

Citations

Citations to this article as recorded by

Experience of a bloodless operation and care for Jehovah's Witnesses - Two cases report -
Sung Hwan Cho, Bon Sung Koo, Sang Hyun Kim, Won Seok Chai, Hee Cheol Jin, Yong Ik Kim
Korean Journal of Anesthesiology.2008; 55(5): 621. CrossRef

Original Article

The Usefulness of Capsule Endoscopy in Diagnosis of Small Bowel Diseases.: Jong Ryul Eun, Byung Ik Jang; Yeungnam Univ J Med. 2006;23(1):45-51. Published online June 30, 2006; DOI: https://doi.org/10.12701/yujm.2006.23.1.45

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Abstract PDF: BACKGROUND
This study was conducted to evaluate the usefulness of capsule endoscopy (CE) for the diagnosis of small bowel diseases. MATERILAS AND METHODS: We reviewed the medical records of 66 patients (mean age: 52.1 years, male/female: 39/27), who underwent CE at Yeungnam University Hospital from August 2003 to March 2006. RESULTS: Suspicious gastrointestinal (GI) bleeding presenting as anemia or history of gross bleeding was the most common reason to perform CE (71.2%). Other indications included GI symptoms (21.2%) such as abdominal pain/discomfort, nausea, diarrhea, and others (7.6%). In studies performed for GI bleeding (n=47), ulcer/erosion was the most common finding (n=22, 46.8%) followed by tumor (n=5, 10.6%), angiodysplasia (n=3, 6.4%), polyp (n=3, 6.4%), active bleeding (n=1, 2.1 %), ulcer with stenosis (n=1, 2.1%), and normal findings (n=12, 25.5%). Of these, a bleeding focus was detected in 32 cases (68.1%) undergoing CE studies. Among 14 patients with GI symptoms, only two patients had typical findings related with symptoms. Surgical resection was performed in five cases with tumor. Of these, four were diagnosed as gastrointestinal stromal tumor and the other one was a lymphangioma. There were no complications associated with the CE procedure. CONCLUSION: Capsule endoscopy is a safe, noninvasive diagnostic tool for small bowel diseases and may be useful for the diagnosis of small bowel hemorrhage including obscure bleeding. However, further studies are needed to confirm its utility for abdominal symptoms other than hemorrhage because of the low diagnostic yield.

Case Report

A Case of Microscopic Polyangiitis with Diffuse Alveolar Hemorrhage.: Sang Jin Lee, Jae Woung Lee, Hye Jin Kim, Kyeong Cheol Shin, Jin Hong Chung, Kwan Ho Lee, Hye Jung Park; Yeungnam Univ J Med. 2004;21(1):101-107. Published online June 30, 2004; DOI: https://doi.org/10.12701/yujm.2004.21.1.101

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Abstract PDF: Diffuse alveolar hemorrhage is a rare but serious and frequently life-threatening complication of a variety of conditions. The first goal in the management of patients with diffuse alveolar hemorrhage is to achieve or preserve stability of the respiratory status. Subsequently, the differential diagnosis is aimed at the identification of a remediable cause of the alveolar hemorrhage. The most common causes of diffuse alveolar hemorrhage with glomerulonephritis are microscopic polyangiitis and Wegener's granulomatosis, followed by Goodpasture syndrome and systemic lupus erythematosus. Microscopic polyangiitis (MPA) is a distinct systemic small vessle vasculitis affecting small sized vessels with few or no immune deposits and with no granulomatosus inflammation. The disease may involve multiple organs such as kidney, lung, skin, joint, muscle, gastrointestinal tract, eye, and nervous system. MPA is strongly associated with antineutrophil cytoplasmic autoantibody (ANCA) that is a useful serological diagnostic marker for the most common form of necrotizing vasculitis. Our report concerns a case of microscopic polyangiitis with diffuse alveolar hemorrhage in a 54-year-old man. He was admitted to our hospital due to dyspnea upon exertion and recurrent hemoptysis. Laboratory findings showed hematuria, proteinuria and deterioration of renal function. In the chest CT scan, diffuse ground glass appearance was seen in both lower lungs. A lung biopsy revealed small vessel vasculitis with intraalveolar hemorrhage and showed a positive reaction to against perinuclear ANCA. The patient was treated with prednisolone and cyclophosphamide. Chest infiltration decreased and hemoptysis and hypoxia improved. He is still being followed up in our hospital with a low dose of prednisolone.

Original Articles

Clinical observation of the bilateral branch vein occlusion.: Young Hoon Park, Duk Kee Hahn, Sang Beon Lee; Yeungnam Univ J Med. 1993;10(1):77-81. Published online June 30, 1993; DOI: https://doi.org/10.12701/yujm.1993.10.1.77

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Abstract PDF: The clinical evaluation was done in eight eyes of four patients with bilateral branch retinal vein occlusion. The onset of age was from 36 to 65 years, and three pa dents were women. Hypertension was the most common associated systemic disease. Retinal neovascularization was complicated in six eyes, and five eyes had vitreous hemorrhage. The vitrectomy was performed in three eyes. We believe that branch retinal vein occlusion associated with hypertension should be followed carefully in the fellow eyes.

Correlation of changes of intracranial pressure and clinical manifestations in spontaneous intracerebral hemorrhage.: Eul Soo Chung, Sam Kyu Ko, Oh Lyong Kim, Yung Chul Chi, Byung Yearn Choi, Soo Ho Cho; Yeungnam Univ J Med. 1991;8(2):35-44. Published online December 31, 1991; DOI: https://doi.org/10.12701/yujm.1991.8.2.35

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Abstract PDF: Recently, many authors have reported about the relationship of the volumes of hemorrhage in the brain parenchyma, hemorrhagic sites, optimal operation time, and the effects of mannitol and steroid on control of ICP to clinical manifestations. Many attempts to measure ICP in hydrocephalus, brain tumor, and head injury have been reported. But the measurements of intracranial pressure in spontaneous intracerebral hemorrhage are rare. Intracranial pressure was monitored prospectively in 30 patients who had stereotaxic surgery for spontaneous intracerebral hemorrhage. The results are as follows. 1. Intracranial pressure was increased in high PaCO₂. 2. There were no correlation in ICP, rebleeding and ADL ad discharge (P>0.05). 3. ICP was the most high level in 72 hours after operation. 4. There was 63.2% decrease in ICP after irrigation with 6000 IU urokinase in the site of hemorrhage. 5. There was no correlation between the numbers of natural drainage and ADL at discharge (P>0.05). 6. The higher the initial GCS, the higher the postoperative GCS.

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