Journal of the Chinese Medical Association : JCMA
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Case Reports
Fulminant myocarditis in an adult with 2009 pandemic influenza A (H1N1 influenza) infection.
The worldwide outbreak of pandemic influenza A (H1N1 influenza) infection in 2009 caused numerous hospitalizations and deaths resulting from severe complications such as pneumonia, sepsis, and acute respiratory distress syndrome. Fulminant myocarditis caused by H1N1 infection has been reported in children but rarely in adults. We present an adult who contracted H1N1 infection followed by fulminant myocarditis. Early implementation of extra-corporeal membrane oxygenation support in conjunction with a specific anti-influenza viral medication (Oseltamivir) led to the patient's complete recovery from cardiogenic shock in 2 weeks.
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The European System for Cardiac Operative Risk Evaluation (EuroSCORE) model is a widely-used risk prediction algorithm for in-hospital or 30-day mortality in adult cardiac surgery patients. Recent studies indicated that EuroSCORE tends to overpredict mortality. The aim of our study is to evaluate the validity of EuroSCORE in Veterans General Hospital Kaohsiung (VGHKS) cardiac surgery including a number of different surgical and risk subgroups. ⋯ EuroSCORE is simple and easy to use. In the present study, the model demonstrated excellent accuracy in all and various surgical subgroups in VGHKS cardiovascular surgery populations. Good calibration ability in all and different risk categories was identified except for isolated CABG group. Recalibration factors of 0.55 and 0.85 were suggested for the various operative subgroups and risk categories.
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Test evaluation in a clinical curriculum is important for medical education. To identify examinee ability and appropriateness of the test content, this study used the Rasch model to analyze an examination in anesthesiology for medical students. ⋯ We demonstrated that statistical item analysis with the Rasch model could provide valuable information related to test reliability, item difficulty and examinee ability, which could be applied to further item modification and future test development of clinical curriculums for medical students.
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Comparative Study
Stereotactic biopsy for brainstem lesion: comparison of approaches and reports of 10 cases.
Stereotactic biopsy for brainstem lesion offers high diagnostic yield with low morbidity. We compared two modalities of biopsy procedure, frame-based and frameless stereotaxy, either transfrontal or transcerebellar route. The benefits and operation considerations are discussed. ⋯ A number of approaches are available for stereotactic brainstem biopsy. Surgical approach should be tailored, according to the location neurological function, with special concern for the patients' safety. In selected condition, frameless stereotaxy biopsy also provides competed diagnostic yield.
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Case Reports
Vein of Galen aneurysmal malformation: prenatal diagnosis and early endovascular management.
A prenatally diagnosed patient was referred to our hospital at 35 weeks of gestation. Antenatal ultrasonography demonstrated cardiomegaly and aneurysm of the vein of Galen. A 3,290 g male baby was delivered by elective cesarean section at 37 weeks of gestation. ⋯ Presently, the patient is 4 years of age and has no neurological abnormality at follow-up. Vein of Galen aneurysmal malformations can cause severe morbidity and mortality in neonates. However, careful obstetric follow-up and early postnatal endovascular treatment of these malformations may lead to a favorable outcome.