Method for providing information on likelihood of spontaneous rupture of intercostal artery

Abstract

The present invention relates to a method for providing information on the likelihood of spontaneous rupture of an intercostal artery, the method comprising a step of providing information that spontaneous rupture of an intercostal artery is more likely to occur in those who receive hemodialysis than those who do not.

Description

Method for providing information on predicting spontaneous intercostal artery rupture

[0001] The present invention relates to a method for providing information on the prediction of spontaneous intercostal artery rupture.

[0002] Intercostal arteries are vital blood vessels that supply blood to the chest muscles and skin along the thorax. Generally, intercostal artery rupture can occur due to external physical trauma or during medical procedures. However, spontaneous intercostal artery rupture occurs without external physical trauma and is a very rare phenomenon. Spontaneous intercostal artery rupture is an emergency requiring rapid diagnosis and treatment, and failure to detect it early can lead to fatal consequences.

[0003] Major causes of spontaneous intercostal artery rupture include weakening of the blood vessel wall, blood clotting disorders, connective tissue diseases, and aging. When the blood vessel wall weakens or is damaged due to these causes, the risk of rupture increases. Spontaneous intercostal artery rupture is generally accompanied by the following symptoms: chest pain, shortness of breath, abdominal pain, dizziness, and shock. Since these symptoms can also occur in other diseases, it can be difficult to diagnose spontaneous intercostal artery rupture quickly.

[0004]

[0005] The present invention aims to provide a method for providing information on the prediction of spontaneous intercostal artery rupture.

[0006]

[0007] 1. A method for providing information on the prediction of spontaneous intercostal artery rupture, comprising the step of providing information that patients undergoing hemodialysis are more likely to experience spontaneous intercostal artery rupture compared to those who are not.

[0008] 2. A method for providing information on the prediction of spontaneous intercostal artery rupture in the above 1, wherein the patient undergoing hemodialysis suffers from chronic kidney disease and also suffers from hypertension or diabetes.

[0009] 3. A method for providing information on the prediction of spontaneous intercostal artery rupture in cases other than those described in 1 above, in which the person is a healthy general person or a patient not suffering from chronic kidney disease.

[0010]

[0011] The present invention can predict the possibility of spontaneous intercostal artery rupture in a patient undergoing hemodialysis and allow them to receive medical measures in consideration of this.

[0012]

[0013] Fig. 1. Contrast-enhanced computed tomography of the abdomen and pelvis showing extravascular leakage of the contrast agent into the retroperitoneum, increasing active hemorrhage (black arrow) and ascites in the right posterolateral region. Transverse (A, B) and coronal (C, D).

[0014] Fig. 2. (A). Angiography of the subcostal artery shows a pseudoaneurysm (black arrow) and extravasation of the diffusion contrast agent (arrowhead) indicating active hemorrhage. (B). There was no additional extravasation of the contrast agent after embolization using gel foam via hyperselection of the hemorrhagic artery.

[0015]

[0016] The present invention will be described in detail below.

[0017]

[0018] The present invention relates to a method for providing information on the prediction of spontaneous intercostal artery rupture.

[0019] The method of the present invention includes the step of providing information that a patient undergoing hemodialysis is more likely to experience spontaneous intercostal artery rupture compared to a patient who is not.

[0020] Patients undergoing hemodialysis are typically patients suffering from end-stage renal disease. Their kidney function may have decreased to, for example, less than 10%, a state in which the kidneys are no longer able to properly filter blood and remove waste products.

[0021] Patients undergoing hemodialysis may, for example, have diabetes or high blood pressure.

[0022] In other cases, the person may be a healthy general individual who is not undergoing hemodialysis, or a patient who has a disease other than those mentioned above but is in a condition where hemodialysis is not required.

[0023] Intercostal arteries are blood vessels that supply blood to the chest muscles and skin along the thorax. Generally, they can be damaged during trauma or medical procedures, but spontaneous intercostal artery rupture occurs without trauma and is very rare.

[0024] Spontaneous intercostal artery rupture can occur due to causes such as weakening of the blood vessel wall, blood clotting disorders, connective tissue diseases, and aging, and when it occurs, symptoms such as chest pain, shortness of breath, abdominal pain, dizziness, and shock may occur.

[0025] The method of the present invention can provide information that patients undergoing hemodialysis are more likely to experience spontaneous intercostal artery rupture compared to those who are not. Accordingly, it is possible to predict the occurrence of spontaneous intercostal artery rupture in advance or to perform medical measures in consideration of it.

[0026]

[0027] The present invention will be explained in more detail with reference to the following examples.

[0028]

[0029] Examples

[0030] Case presentation

[0031] A 41-year-old Korean man visited the hospital emergency room complaining of abdominal pain and dizziness that had started five hours prior. He suffered from end-stage renal disease and diabetes for 20 years and had been taking dialysis (HD) three times a week since 2018. He also had diabetic retinopathy in both eyes and had previously had his left leg amputated below the knee prior to starting dialysis. He had a radiological fistula in his left arm. His last HD schedule was three days prior, and there had been no issues since the last HD session. During the HD sessions, he received intravenous unfractionated heparin for anticoagulation. He was also given 2,000 IU of erythropoietin-alpha intravenously after each dialysis session. Despite strict medical supervision, he frequently skipped scheduled HDs due to personal reasons. His usual weight gain between dialysis sessions was 6–8 kg, making it nearly impossible to meet his dry weight target after each HD session. He suffered from uncontrolled ascites due to his failure to properly adhere to scheduled HDs. He strongly denied having any recent bruising on his abdomen or chest, or any physical trauma. He also denied coughing and sneezing. The medications he was currently taking were aspirin 100 mg, fimasartan 60 mg, carvedilol 50 mg, nifedipine 60 mg, and minoxidil 5 mg. His blood pressure (BP) measured at the end of the last HD session was 142 / 88 mmHg, and his hemoglobin level measured 14 days prior was 10.3 g / dL.

[0032] Upon arrival at the emergency room, his initial vital signs were as follows: blood pressure, 65 / 40 mmHg; heart rate, 113 beats / min; respiratory rate, 20 breaths / min; body temperature, 36.7°C. His mental state was mildly drowsy, but neurological examination revealed no abnormalities. On physical examination, the conjunctiva was anemic but the sclera was absent. Examination of the neck revealed no thyroid enlargement or palpable lymphadenopathy. Breath sounds were free of clicking or wheezing. The heart rate was regular, and no murmurs were heard at the cardiac margins. The abdomen was distended, and the blunt movement was positive. Bowel sounds were decreased on auscultation. Tenderness was present in the upper right quadrant of the abdomen, but there was no rebound tenderness throughout the abdomen. No skin lesions, including contusions, were found anywhere on the body. Two benign pretibial foramen edemas were found on both legs.

[0033] The electrocardiogram showed sinus tachycardia. His initial laboratory results are as follows: white blood cell count 5.56 x 10 9 / L(Range: 4.0-10.0 Х 10 9 / L), hemoglobin 6.5 g / dL (range: 12-16 g / dL), platelet count 167 X 10 9 / L(Range: 130-400 Х 10 9 / L); calcium, 8.5 mg / dL (range: 8.8-10.6 mg / dL); phosphate, 4.8 mg / dL (range: 2.5-4.5 mg / dL); blood urea nitrogen, 35.6 mg / dL (range: 8.0-20.0 mg / dL); creatinine, 14.22 mg / dL (range: 0.51-0.95 mg / dL); total protein, 5.3 g / dL (range: 6.6-8.7 g / dL); albumin, 3.1 g / dL (range: 3.5-5.2 g / dL); total bilirubin, 0.56 mg / dL (range: 0.3-1.2 mg / dL); aspartate aminotransferase, 18 U / L (range: 1-37 U / L); Alanine aminotransferase, 13 U / L (range: 1-41 U / L); HbA1c, 7.2% (range: 4.2-5.9%); parathyroid hormone, 95.72 pg / mL (range: 15.0-65.0 pg / mL); prothrombin time, 15.2 sec (range: 11.9-14.3 sec); aPTT, 37.4 sec (range: 29.1-43.5 sec). No aortic dilation was observed in the chest or abdomen on computed tomography (CT). Abdominal CT revealed a large amount of ascites and an intensified area, as well as active leakage of contrast agent into the abdominal cavity from the right posterolateral region (Fig. 1), suggesting active hemorrhage without solid organ damage or adjacent fractures.

[0034] To control hypovolemic shock, a 100 cc / h infusion of normal saline was initiated, and 400 mL of packaged red blood cells (RBCs) were transfused. Aortography and angiography performed 2 hours after the CT scan detected a pseudoaneurysm and diffusion leakage of contrast agent in the right 12th ICA (Fig. 2A), but no aneurysm changes were observed in the ICA. After hyperselecting the hemorrhagic artery with a microcatheter, embolization was performed using a removable coil and gel foam. Subsequent angiography revealed no further contrast agent leakage (Fig. 2B).

[0035] Two hours after arterial occlusion, blood pressure was 117 / 78 mmHg, and the patient was admitted to the ward. On the second day of admission, hemoglobin was 6.9 g / dL, and an additional 2 units of packaged RBCs were transferred during a 4-hour hemodia filtering session. Starting on the third day of admission, 2 liters of ascites fluid were drained daily for four days. The ascites fluid was bloody but odorless. No pathogens were detected in the ascites fluid. Follow-up hemoglobin levels and blood pressure measured on the fourth day of admission were 9.4 g / dL and 145 / 90 mmHg, respectively. The patient was safely discharged eight days after arterial occlusion. The patient was followed up at the HD Center without recurrence of ICA hemorrhage.

Claims

1. A method for providing information on the prediction of spontaneous intercostal artery rupture, comprising the step of providing information that patients undergoing hemodialysis are more likely to experience spontaneous intercostal artery rupture compared to those who are not.

2. A method for providing information on the prediction of spontaneous intercostal artery rupture according to claim 1, wherein the patient undergoing hemodialysis suffers from chronic kidney disease and further suffers from hypertension or diabetes.

3. A method for providing information on the prediction of spontaneous intercostal artery rupture according to claim 1, wherein the cases not mentioned above are healthy general persons or patients not suffering from chronic kidney disease.

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