Critical Decision Making at the Point of Care / 대한내과학회지

Optimal decision-making requires an understanding of the principles of evidence-based medicine to judge the quality of the evidence. Numerous pitfalls exist in diagnostic reasoning and decision-making. There are also many considerations with regard to evidence-based prescription. Increasingly, hospitalists have to work in wards organized as Accountable Care Units (ACUs). Practice guidelines and systematic reviews represent the highest quality of evidence available. There is great clinical importance in rapid access to precise answers, especially those based on summary literatures, to various challenging questions. In practice, a culture of education, updates to support hospitalists, and integration of evidence-based medicine into clinical practice, using diverse digital medical resources and cloud storage, are necessary.

A Case of Primary Biliary Cirrhosis Mimicking Acute Hepatitis B in the Clinic, Republic of Korea / 가정의학회지

Primary biliary cirrhosis (PBC) is a slowly progressive cholestatic autoimmune liver disease characterized by progressive bile duct injury. The most common symptoms of this disease include fatigue and pruritus. The diagnosis of PBC is based on cholestatic biochemical liver tests, presence of antimitochondrial antibodies, and characteristic histological biopsy findings. We report a case of a patient with PBS, who was initially suspected to be in the window period of hepatitis B by a private doctor in a local clinic based on the detection of isolated immunoglobulin M antibody against hepatitis B core antigen. The presence of this antibody is the most useful index in diagnosing acute hepatitis B (+) by immunoserological test. The final diagnosis of the patient in Good Gang-An Hospital was PBC through additional tests. The patient is receiving outpatient treatment.

Splenic Injury after Colonoscopy in Patient on Anti-Platelet Agents : A Case Study / 계명의대학술지

Colonoscopy is frequently used for lower GI tract screening tests. Although rare, splenic injury may develop in the high-risk patients on anticoagulants or antiplatelet agents. A 78-year-old female visited our hospital complaining of chest pain. She had taken antihyperlipidemic and antiplatelet agent with hyperlipidemia and 20%-stenosis in the left anterior descending artery. She was taken polypectomy after colonoscopy 4 years ago. The next day, after a follow-up colonoscopy for polypectomy, she complained epigastric and left upper abdominal discomfort. Pain intensity was not high, but next day, epigastric pain was increased, so coronary angiography was performed 2 days later using anticoagulants. Coronary angiography showed 40~50%-stenosis in the left anterior descending artery. Another antiplatelet agent was added. After 72 hours on colonoscopy, her pain was localized upper left abdominal area. Abdominal CT showed intracapsular bleeding in the spleen with a small amount of hemoperitoneum in the pelvis. Since her vital signs were stable, she was treated with conservative management. Her pain improved and discharged. One month later, she was taken Abdominal CT. CT showed the size of intracapsular fluid collection in the spleen was increased, but the whole fluid collection was liquidized. 2 weeks later, follow-up sonography showed the size of fluid collection conspicuously was reduced. The case reported herein is a splenic Injury after Colonoscopy in patient on antiplatelet agents.

Simultaneous Development of ST-Segment Elevation Myocardial Infarction and Pulmonary Embolism in an Healthy Elderly Woman

A 73-year-old woman who presented with chest discomfort visited the emergency room. The 12-lead electrocardiography showed ST-segment elevation in II, III, and lead augmented vector foot. Emergent coronary angiography revealed a thrombus in the distal right coronary artery. Percutaneous coronary angioplasty with a stent was performed. After the procedure, persistent dyspnea occurred. Her chest computed tomography (CT) showed occlusion of the bilateral pulmonary artery. We could not find a source for the embolization or a hypercoagulable state. We started a course of dual antiplatelets with oral anticoagulants. Pulmonary embolism was resolved at follow-up chest CT scan. Aspirin, clopidogrel and warfarin were given for 6 months. The patient is doing well now 1 year after the episode.