輔仁醫學期刊最新文献

{"title":"急性單側垂瞼：如何在急診快速鑑別診斷重症","authors":"周盈甄 周盈甄, 王秉承 Ying-Chen Chou","doi":"10.53106/181020932023032101004","DOIUrl":"https://doi.org/10.53106/181020932023032101004","url":null,"abstract":"\u0000 在急診，主訴急性單側垂瞼但無其他明顯神經學異常並不少見；身為急診醫師，從徵象中找出會致命的疾病是非常重要的。這篇研究主要是建立有效的流程診斷單側垂瞼，在其中迅速找出嚴重的疾病：包括內頸動脈剝離表現出霍納氏症候群、後交通動脈瘤壓迫導致動眼神經麻痺。這篇研究主要參考國外文獻，如何快速鑑別診斷出重症，建立簡潔明瞭流程圖。研究發現，動眼神經麻痺比霍納氏症候群垂瞼明顯，明顯瞳孔反射異常需快速安排影像檢查排除頭頸部血管疾患，眼外肌異常或複視在霍納氏症後群不常見，重症肌無力危象會出現明顯神經學異常或呼吸衰竭。因此，在急診室，我們能用有效率的檢查流程，包括：垂瞼程度、瞳孔檢查、眼外肌運動檢查，快速找出會致命的疾病，把握治療的黃金時間。\u0000 Background and Purpose: Acute unilateral ptosis in Emergency department(ED) without other focal neurologic impairment isn’t uncommon chief compliant. From internal carotid artery dissection presented with Horner’s syndrome to Posterior communicating(PCOM)aneurysm caused oculomotor nerve (CN III) palsy , our job as ED doctor is to find critical illness. Afterwards, the efficient algorithm for differential diagnosis of acute unilateral ptosis is important. Methods: We use key words” unilat-eral ptosis” and “diagnosis” in PubMed and total 44 full text papers in recent 5 years, which we concluded practical results and finally 25 papers as reference for this article. Results: The eyelid position of ptosis pattern is vary with CN III palsy and Horner’s syndrome. Pupillary involvement requires neuroimaging for the presence of an aneu-rysm that may be compressing the nerve which causing CN III palsy. Horner’s syn-drome only do not appear EOM limitation or diplopia. Beware of bulbar symptoms such as shortness of breath, dysphagia, or dysarthria as these can indicate an impend-ing myasthenic crisis(MG crisis). Conclusion: We can use fast algorithm to find emergent illness of acute unilateral ptosis. By examination of eyelid position, pupillary examination, and extraocular motility(EOM), we may find the possibility of Horner’s syndrome or CN III palsy. Timely treatment can initiation after confirmed image done.\u0000 \u0000","PeriodicalId":188376,"journal":{"name":"輔仁醫學期刊","volume":"201 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124400601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"探討於中風急性後期復健之早期強度介入之長期臨床效益","authors":"徐子銘 徐子銘, 劉倩秀 Zih-Ming Syu, 范詩辰 Chien-Hsiou Liu","doi":"10.53106/181020932023032101001","DOIUrl":"https://doi.org/10.53106/181020932023032101001","url":null,"abstract":"\u0000 背景與目的：台灣國家健康保險局中風急性後期整合照護計畫(PAC-CVA)於住院期之臨床效益已獲證實，然而長期的效益則未被完全探討。本研究之目的在探討其一年期追蹤之日常活動表現、認知能力、平衡、和心肺表現等功能性恢復。方法：共有13位受試者參與本研究。他們皆接受PAC-CVA之復建計畫，並於病發後之3、6、12月接受成效評估。以功能獨立量表、動作活動量表、柏格氏平衡量表、六分鐘行走測驗、聲音數字廣度測試、空間數字廣度測試、和符號數字測驗進行功能量測。結果：本研究於聲音數字廣度測試、柏格氏平衡量表、六分鐘行走測驗測驗皆發現顯著的持續功能進步，然而在動作活動量表品質分量表和總分量表則呈現顯著的退步。結論：根據長期觀察指出，個案的聲音工作記憶、平衡、和心肺能力等在一年之內由持續進步。PAC-CVD復健計畫改善個案之平衡、心肺功能、和聽覺工作記憶能力，然而在一年之長期評估中亦發現未促進患側肢體之使用。\u0000 Background and purpose: The clinical effectiveness of a post-acute care cere-brovascular disease program (PAC-CVD) in Taiwan’s National Health Insurance (NHI) system has been evidenced during hospitalization, but the long-term effectiveness has not been thoroughly investigated. The purpose of this research was to investigate functional recovery in daily living performance, cognitive ability, balance, and cardiorespiratory capacity at one-year follow-up. Methods: Thirteen participants were recruited. Participants received rehabilitation according to the PAC-CVD program, and outcome measures were collected at 3 months, 6 months, and 12 months after onset. Several functional measurements were used: the Functional Independent Measurement (FIM) and motor activity log (MAL) for daily living performance, the Berg Balance Scale (BBS) for balance, and the 6-minute walk test (6-MWT) for car-diorespiratory capacity. Cognitive ability was measured with the auditory digit span test (DS–auditory), spatial digit span test (DS–visual), and Symbolic Digit Modalities Test (SDMT). Results: The DS–Auditory, BBS, and 6-MWT indicated significant improvements in function over time, but the MAL-Quality subscale and MAL-total subscale revealed significant declines. Conclusion: Long-term observation indicated functional recovery in auditory working memory, balance, and cardiorespiratory ca-pacity that persisted for one year. At the 12-month follow-up, improvements in bal-ance, cardiorespiratory capacity, and auditory working memory, could be ascribed to the PAC-CVD program, but no treatment effect was found on the use of the affected upper extremity.\u0000 \u0000","PeriodicalId":188376,"journal":{"name":"輔仁醫學期刊","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122727251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"TBC1D21結合蛋白RAB5C參與於精子型態生成","authors":"黃家彥 黃家彥, 林佑樺 Chia-Yen Huang, 郭昱廷 Yu-Hua Lin, 汪雅雲 Yu-Ting Kuo, 柯智群 Ya-Yun Wang, 詹景全 Chih-Chun Ke, 林盈宏 Chying-Chyuan Chan","doi":"10.53106/181020932023032101002","DOIUrl":"https://doi.org/10.53106/181020932023032101002","url":null,"abstract":"\u0000 背景與目的: 不孕是重要的公眾健康議題，造成不孕的因素其中一半與男性相關。其中造成男性不孕的一項重要病因是畸型精子症。在先前的研究中，我們以cDNA微晶片比較造精功能正常與異常的睪丸組織中各別基因的表現量。其中發現一個與不孕相關Rab GTPase激活蛋白，名為TBC1D21蛋白。TBC1D21特異的表現於減數分裂後期精細胞中。而於Tbc1d21基因剔除小鼠模式中發現嚴重精子尾部的中節區域損壞。進一步我們以蛋白質質體學方法鑑定出與TBC1D21結合蛋白。於本研究中我們聚焦於其中一個TBC1D21結合蛋白RAB5C。研究方法與結果: RAB5C蛋白表現於小鼠睪丸組織切片中的精子細胞的頂體與尾部。於成熟精子中，RAB5C蛋白濃縮於頭部頂體與散落於尾部中節區域。其中有趣的是精子經過頂體反應後，於頂體的RAB5C蛋白量明顯下降消失。最後我們利用共同免疫染色法確認RAB5C與TBC1D21共同散落於成熟精子尾部中節區域。結論:基於以上結果，我們發現TBC1D21 交互作用蛋白RAB5C參與於精子頭部頂體與尾部中節的形成。\u0000 Background and purpose: Infertility is a critical public health issue, and half of its causes are related to male factors. Teratozoospermia is one of major cause of male infertility. In our previous studies, we identified the TBC1 domain family member 21 (TBC1D21) gene, a Rab GTPase-activating protein (GAP), as a sterility-related gene in cDNA microarray compared to normal and spermatogenic testicular tissues. TBC1D21 is specifically expressed in post-meiotic male germ cells. Furthermore, the loss of Tbc1d21 allele in mice results in severe defects in the midpiece of the sperm’s tail. Additionally, TBC1D21 interactors were selected using proteomic assays. Herein, we focused on RAB5C, which is a TBC1D21 interactor. Methods and Results: RAB5C was localized in the acrosomal region and elongating tail in spermatids of murine testicular sections. In a mature sperm cell, RAB5C signals were concentrated in the acrosome and were scattered around the midpiece. Interestingly, RAB5C pro-tein levels decreased in the acrosome after triggering acrosomal reaction. Finally, we confirmed that the interspersed RAB5C signals were co-localized with TBC1D21 within the midpieces of the mature sperm cells. Conclusion: Based on these results, we suggest RAB5C, a TBC1D21 interactor, was involved in acrosomal and midpiece formation.\u0000 \u0000","PeriodicalId":188376,"journal":{"name":"輔仁醫學期刊","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126196791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"表現異常的肝臟神經母細胞瘤","authors":"林隆煌 林隆煌","doi":"10.53106/181020932023032101003","DOIUrl":"https://doi.org/10.53106/181020932023032101003","url":null,"abstract":"\u0000 我們報告了一例4個月大嬰兒肝臟中轉移性神經母細胞瘤的病例，神經母細胞瘤起源於原始神經脊，其產生交感神經細胞，包括交感神經節（在頸部、後縱隔、腹膜後和腹部）和腎上腺髓質細胞，因此，神經母細胞瘤可發生於腎上腺和交感神經，包括顱內、眼眶、胸、腹、盆等部位，一半以上見於腹部，臨床表現多取決於原發灶和轉移灶的位置，本病例在腹部超音波、電腦斷層與核磁共振檢查發現腫瘤類似肝母細胞瘤，後來病理切片證實為神經母細胞瘤。儘管肝母細胞瘤是兒童中最常見的原發性肝臟腫瘤，通常在出生後的前 3 年內會被診斷出來，對於嬰兒肝臟腫瘤，除肝母細胞瘤外，還必須考慮轉移性神經母細胞瘤，本文還討論了嬰兒神經母細胞瘤的臨床病理特徵和治療。肝臟中有多個不同大小的高迴聲實性腫塊作為神經母細胞瘤之臨床表現是非常罕見的，我們希望本文能提高對嬰兒肝臟神經母細胞瘤的認識以及臨床超音波醫師對於嬰兒腹部佔位性病變的瞭解。\u0000 Neuroblastoma is a rare cancer type that mostly affects infants and young chil-dren. It can spread to other organs, including bone marrow, bone, lymph nodes, liver, and skin. The purpose herein is to present the case of a four-month-old male infant with no prior systemic disease. The patient’s father discovered the abdominal disten-sion two months before presentation at our center. Plain abdominal radiograph showed hepatomegaly; abdominal ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI)revealed multiple solid masses of varying sizes affecting two liver lobes, which we suspected as hepatoblastoma or metastatic neuroblastoma. The patient then underwent open biopsy and pathology indicated neuroblastoma. He then received chemotherapy. Three months later, follow-up liver CT showed significant tumor resolution and urine vanillylmandelic acid (VMA)had dropped to a normal value (1.14 mg/day). The patient is presently stable. Hepatoblastoma is the most common primary liver tumor in children and is typically diagnosed within the first three years of life; nevertheless, in addition to hepatoblastoma, metastatic neuro-blastoma must also be considered in infants.\u0000 \u0000","PeriodicalId":188376,"journal":{"name":"輔仁醫學期刊","volume":"22 4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125925804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"利用貝氏量表評估台灣長期照護之男性老年居民的營養不良風險","authors":"石娉雯 石娉雯, 王肇 王肇, 王雅君 王雅君, 楊雅惠 Ya-June Wang, 蔡瑞修 Ya-Hui Yang, 吳信昇 吳信昇","doi":"10.53106/181020932022122004002","DOIUrl":"https://doi.org/10.53106/181020932022122004002","url":null,"abstract":"\u0000 目的：營養不良是老年中常見的健康問題。在台灣，老年人必須在巴氏量表（BI）達到90分以上，才有資格申請入護理機構；但是，不需要有營養評估。本研究的目的是當老年人要求轉診護理機構時，是否可以以BI去評估營養狀況。方法：這是一個多中心的橫斷式研究。在2010年11月至2011年5月之間對台灣三個療養院的居民進行評估。其中包括251位年齡在70歲以上的個案。我們收集了個案的背景資料、BI評分、迷你營養評估以及調查牙齒健康和吞嚥能力的問卷。結果：平均年齡和BI評分分別為82.9（SD5.6）和88.8（SD21.7）。在研究樣本中，確定有營養不良風險的個案為123名（49.0％）。在預測營養不良的風險上，BI有高度的準確性（ROC曲線為79.1％）。較低的BI分數與較高的營養不良風險相關。所有BI項目中，爬樓梯項目與營養狀況之間的相關性最強（Cohen：0.90），其次是活動能力和輪椅到床的移動（ES：0.76）。結論：我們強調早期預防老年營養不良是相當重要。本研究顯示，BI可以協助初步評估營養狀況。\u0000 Objective: Malnutrition is a common health concern among the older population. In Taiwan, older adults are required to score 90 or higher on the Barthel Index (BI) to qualify for admission to public long-term care institutions; however, they are not ob-ligated to undergo nutritional assessments. This study demonstrated the utility of the BI in determining nutritional status when older adults are referred to public long-term institutions. Methods: In this multicentre cross-sectional study, 251 residents aged 70 years or older at three nursing homes in Taiwan were evaluated between November 2010 and May 2011. Information on participants’ health history was collected, in-cluding BI scores, Mini Nutritional Assessment results, and previous responses to a questionnaire on dental health and swallowing capacity. Results: The mean age and BI score were 82.9 (SD 5.6) and 88.8 (SD 21.7), respectively. Among the study sample, 123 (49.0%) participants were identified as having a risk of malnutrition. The BI had high accuracy (area under the receiver operating characteristic curve, 79.1%) when used to predict the risk of malnutrition. Lower BI scores were associated with a higher risk of malnutrition. Of all BI items, the stair-climbing item had the highest correlation with nutritional status (Cohen’s standardised effect size [ES]: 0.90), followed by mobility and chair–bed transfers (both ESs: 0.76). Conclusion: We emphasise that preventing worsening malnutrition in older long-term care residents is crucial. The present study revealed that the BI can help with the primary assessment of nutritional status in older adult men, although it cannot be a decisive tool by itself for nutritional status assessment.\u0000 \u0000","PeriodicalId":188376,"journal":{"name":"輔仁醫學期刊","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115270443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"基督教歌曲應用於慢性思覺失調症患者歌唱團體之療效因子研究","authors":"鄭伊真 鄭伊真, 吳佳純 Yi Chen Cheng, 施以諾 Chia-Chun Wu","doi":"10.53106/181020932022122004001","DOIUrl":"https://doi.org/10.53106/181020932022122004001","url":null,"abstract":"\u0000 背景：思覺失調症是值得社會關注的常見慢性精神疾病。過去許多研究均發現歌唱有助於促進人的心理健康，其中也包括宗教歌曲. 然而，很少人從療效因子的角度去看唱宗教歌曲對慢性思覺失調症患者心理健康的助益. 本文的目的即是從療效因子的角度去比較自由歌唱團體跟基督宗教歌曲歌唱團體對思覺失調病人的助益。方法：本研究之收案對象主要為新北市某兩家精神科康復之家共38位思覺失調症患者，分別接受較具結構化之歌唱團體治療介入、曲目以基督教勵志歌曲為素材，並也讓他們從事非結構化的一般自由歌唱團體，例如卡拉ok。經過八週後，使用療效因子問卷分析這兩種歌唱團體所分別發揮的療效因子之差異。結果：結果發現病人對於12個療效因子的感受皆是較具結構化、以基督教勵志歌曲為素材之歌唱團體治療高於自由歌唱活動，且皆達統計上的顯著值。若比較性別對於音樂治療團體療效因子之影響，發現女性病人在對於「宣洩」這個療效因子的感受比男性強，且達統計上之顯著值。而教育程度對所發揮的療效因子在本研究中並無影響，但年齡對於發展社交技巧、灌輸希望、存在性因子這三個療效因子呈負相關，並達統計上的顯著值。結論：本研究發現較具結構化、以基督教勵志歌曲為素材之歌唱團體治療可比自由放任式的歌唱團體更容易產生療效因子，可供未來研究或臨床做參考。\u0000 Background and purpose: Schizophrenia is a serious contemporary mental illness, and many previous investigations have demonstrated that singing is beneficial to people’s mental health, including religion songs. However, few investigations have utilized therapeutic factors to study the benefits of group religion song singing to pa-tients with chronic schizophrenia. The purpose of this investigation is to compare the therapeutic factors between Christian song singing group and free-style singing group of patients with schizophrenia. Methods: This investigation gathered 38 patients with chronic schizophrenia, living at two residential institutions for psychiatric rehabilita-tion, as research subjects. They participated in two singing groups: Christian song singing group, and a general singing group. The differences in therapeutic factors be-tween the two singing groups were analyzed using a therapeutic-factors assessment tool after eight weeks of study. Results: Analytical results show that patients felt more favorably about group religion song singing than about general free-style singing ac-tivity for all 12 therapeutic factors. Additionally, female patients tend to experience “catharsis” more than their male counterparts in therapeutic singing groups. Education level has no influence on therapeutic factors, and age is negatively correlated to three therapeutic factors, namely developing socializing techniques, instillation of hope and existential factor. Conclusion: This study concludes that group religion song singing offers more therapeutic benefits than general free-style group singing for schizophre-nia patients. The latter group therefore is worthy of further promotion.\u0000 \u0000","PeriodicalId":188376,"journal":{"name":"輔仁醫學期刊","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116815416","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"台灣護理與COVID-19疫苗接種程序概要","authors":"傅秀雲 傅秀雲","doi":"10.53106/181020932022122004005","DOIUrl":"https://doi.org/10.53106/181020932022122004005","url":null,"abstract":"\u0000 本篇文章主要是探討面對COVID19，相關的護理安全管理所面臨的挑戰以及訂定疫苗接種步驟準則的適切性。文中提到，當目前國內缺乏COVID19疫苗接種標準程序時，護理人員必須具備「高階護理能力」。研究方法採實地訪查與個別性討論：由衛生所參與Covid-19疫苗分發作業的六名專業註冊護理師(RN)和兩名護理長(HN)進行「護理人員在施打疫苗步驟上如何能更安全進行」這項議題的討論。歸納出以下二點：一、民眾和護理師之間良善的互動和溝通，可有效反應出疫苗真正需求的數量，能夠幫助未來建立分配疫苗的適切模式。在護理環境快速變動的當下，不斷求新更知亦是護理人員的職責所在。二、在幫助民眾施打疫苗時，在疫苗分配與控管過程中採取的預防性安全措施，能夠使疫苗管理更有效率，進而增強民眾與護理人員之間的信任關係。\u0000 Background and Purpose: The purpose of this report is to discuss the challenges and procedures for the safety management and vaccination protocol for nurses in rela-tion to COVID-19. The lack of which dictates that nurses must possess advanced nursing skills, especially in the field of vaccination protocol. Methods: Six professional registered nurses (RN) and two leader nurses in the community health center were engaged in individual interviews regarding the Covid-19 vaccine distribution, and the related safety practice issues between July 2021 to December 2021. Results: A crucial factor between a client and a nurse’s interaction and communication is related to the lucid understanding of vaccine determinants in the distribution of the vaccine using a proper framework. Nurses also require updated information for their duties in these truly unpredictable times. Conclusion: Precautional safety taken within the allocation and control of vaccines for public use will give credence to correct vaccine management procedures that can augment a more effective relationship and better communication between nurses and the public.\u0000 \u0000","PeriodicalId":188376,"journal":{"name":"輔仁醫學期刊","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128128947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"新冠疫苗引起免疫血栓性血小板低下症合併腦靜脈竇栓塞－診斷與治療","authors":"周盈甄 周盈甄, 王秉承 王秉承","doi":"10.53106/181020932022122004003","DOIUrl":"https://doi.org/10.53106/181020932022122004003","url":null,"abstract":"\u0000 台灣自5月新冠疫情爆發以來，民眾陸續接種疫苗；但隨之而來的疫苗副作用患者湧現全台急診室；其中，腦靜脈竇栓塞為新冠疫苗引起的免疫血栓性血小板低下症之一，少見但發生在育齡女性最多。這篇研究主要參考國外文獻，如何診斷及治療疫苗後腦靜脈竇栓塞，建立簡潔明瞭流程圖。研究發現，AZ疫苗產生免疫血栓性血小板低下症為最多，發生時間為疫苗後5-24天內；腦靜脈竇栓塞占此病症多數，以小於60歲的女性患病為大宗。診斷以臨床症狀及影像為主，病患會出現頭痛、神經學異常甚至癲癇；最精確的影像診斷為核磁共振靜脈造影。抗凝血劑的治療降低靜脈血流壓力進而減少腦出血機率，改善病人預後。如果病人打完疫苗1個月內，出現嚴重頭痛、神經學異常，合併血小板下降、D-dimer上升，佐以影像學診斷；診斷後給予新型口服抗凝血劑或是進一步以血栓溶解術治療。\u0000 Background and Purpose: Since COVID-19 pandemic outbreaks on May in Taiwan this year, people have received vaccination in succession. However, patients suffered from side effects flocked to emergent department. Cerebral venous sinus thrombosis(CVST), one of Vaccine Induced Immune Thrombotic Thrombocytope-nia(VITT),is a rare form of cerebrovascular disease that typically affects young women of childbearing age. This article is aimed to summarize flow chart for diagno-sis and treatment of CVST to help patients in ED. Methods: We use key words” COVID-19 Vaccine” and “Cerebral Venous Sinus Thrombosis” in PubMed and total 49 full text papers in recent 5 years, which we concluded the diagnosis and treatment and finally 21 papers as reference for this article. Results: VITT occurs at a 4-fold higher frequency with AstraZeneca vaccine. The most common thrombotic event as-sociated with VITT is CVST. The diagnosis of CVST is typically based on clinical suspicion and imaging confirmation. Magnetic resonance venogram (MRV) is the most preferred diagnostic modality for CVST. Patients have a favorable clinical outcome with anticoagulant therapy. Conclusions: Patient appeared severe headache, neurological deficit within 1 month after vaccination added to decreased platelet count ,elevated D-dimer. Image test can confirm the diagnosis. New oral anticoagu-lants (NOACs), endovascular thrombolysis are choices of treatment.\u0000 \u0000","PeriodicalId":188376,"journal":{"name":"輔仁醫學期刊","volume":"56 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130184466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"或能以質子密度脂肪抑制核磁共振影像早期發現與地諾單抗相關連非典型股骨骨折之前驅骨髓水腫：一則案例報告","authors":"余侑達 余侑達, 劉哲瑋 劉哲瑋, 林希鼎 林希鼎","doi":"10.53106/181020932022122004004","DOIUrl":"https://doi.org/10.53106/181020932022122004004","url":null,"abstract":"\u0000 背景和目的：非典型股骨骨折(AFF)為長期以抗骨吸收藥物治療骨質疏鬆相關的嚴重不良事件。過往文章多報導與AFF發生前長期使用雙膦酸鹽相關的前驅髖痛；前驅期亦可以MRI證明骨髓水腫。然地諾單抗是一種生物抗骨吸收劑；其與AFF前驅之相關特色尚未被明確描述。方法：本報告回顧分析一例68歲家庭主婦長期使用地諾單抗後發生AFF的病歷；雙膦酸鹽未開立處方亦未曾使用。結果：本例展示長期使用地諾單抗可於AFF前驅期發生骨髓水腫；此篇記錄從開始使用到發生AFF及其後續之臨床過程。結論：本病例報告強調早期發現並及時調整用藥的重要。儘管患者因缺乏預防而經歷AFF，本報告目的是提高認識；通過及時調整藥物應能預防AFF。\u0000 Background and Purpose: Atypical femoral fracture (AFF) is a severe adverse event associated with long-term use of antiresorptive agent for pharmacological treatment of osteoporosis. Many previously published articles had reported prodromal hip pain associated with long-term use of bisphosphonates before occurrence of AFF; additionally, bone marrow edema might also be demonstrated using MRI during the prodromal phase. However, denosumab, a biological antiresorptive agent, is not yet as well characterized regarding its association with prodromal phase of AFF. Methods: This report retrospectively reviewed a case of 68-year-old housewife experiencing AFF after long-term use of denosumab; bisphosphonates were never prescribed and were never used. Results: This is a case to demonstrate that bone marrow edema can occur during the prodromal phase of AFF with long-term use of denosumab; clinical course from the start of its usage until occurrence of AFF and its sequela were cap-tured. Conclusion: In this case report, crucial importance of early detection along with timely adjustment of medication is emphasized. Although the patient reported had experienced AFF due to lack of prevention, the purpose of this case report is to raise the awareness that AFF can be prevented with timely adjustment of medications.\u0000 \u0000","PeriodicalId":188376,"journal":{"name":"輔仁醫學期刊","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134351487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"微創傷口之超音波晶體乳化術提供外傷性白內障合併水晶體內異物個案良好視力之個案報告","authors":"梅凡 梅凡, 高姿芸 Fan Mei","doi":"10.53106/181020932022092003003","DOIUrl":"https://doi.org/10.53106/181020932022092003003","url":null,"abstract":"\u0000 背景與目的：眼內異物會因為不同的情況影響到視力的預後，包含受傷的機轉、異物的構成、位置等。創傷性白內障合併水晶體內異物為罕見眼科急症，我們提出一個水晶體內異物的案例，在階段性手術後得到良好視力預後‧方法：回溯性個案報告‧結果：這是一位59歲女性，因鐵屑噴入右眼視力模糊一天後就醫。檢查後發現角膜全層穿刺傷，水晶體內異物，以及嚴重的創傷性白內障。儘管就醫時嚴重的視力不良，經過超音波晶體乳化術和二次人工水晶體置入後，病患視力得到良好的恢復。結論：在嚴重創傷合併水晶體內異物個案，仔細評估考量病人的病史和檢查結果，可以提供不同的手術選擇，讓病人得到良好的預後。\u0000 Purpose: Intraocular foreign body (IOFB) injuries can lead to different clinical outcomes as a result of various factors, including the mechanism of injury, character-istics of the IOFB, and the location of the IOFB. We report a rare case of a patient with an intralenticular foreign body who was able to achieve substantial visual recov-ery after phacoemulsification was performed. Observation: A woman aged 59 years presented with blurred vision in the right eye for 1 day after being splashed in the eye with iron dust. On examination, the patient was noted to have an intralenticular for-eign body with a resultant visually significant cataract. Despite poor visual acuity up-on admission, she made a good visual recovery after removal of the IOFB, phacoemulsification, and secondary intraocular lens implantation. Conclusions and importance: This report highlights that in order to provide complete patient care, a detailed history and physical examination of the patient should be performed. Phacoemulsification and sequential intraocular lens implantation may be associated with faster visual recovery in selected cases.\u0000 \u0000","PeriodicalId":188376,"journal":{"name":"輔仁醫學期刊","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131296512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}