• Journal of Trauma and Injury
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• 제25권2호
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• pp.37-43
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• 2012

Purpose: A tube thoracostomy is an invasive procedure that places patients at risk for complications. Tube thoracostomies are frequently performed by emergency medicine residents. Thus, the purpose of the study was to assess both the complication rate for tube thoracostomies performed by emergency medicine residents and the factors associated with these complications. Methods: A retrospective chart review of all patients who had undergone a tube thoracostomy performed by emergency medicine residents between January 2008 and February 2009 was conducted at a university hospital. Complications were divided into major and minor complications and into immediate and delayed complications. Complications requiring corrective surgical intervention, requiring the administration of blood products, or involving situations requiring intravenous antibiotics were defined as major. Complications that were detected within 2 hours were defined as immediate. Results: Tube thoracostomies were performed in 189 patients, and 70 patients(37%) experienced some complications. Most complications were immediate and minor. In multiple logistic regressions, BMI, hypotension and resident seniority were significantly associated with complications. Conclusion: The prevalence of complications was similar to these in previous reports on the complications of a tube thoracostomy. Most complications from tube thoracostomies performed by emergency medicine residents were immediate and minor complications. Thus, emergency medicine residents should be allowed to perform closed tube thoracostomies instead of thoracic surgeons.

• Tuberculosis and Respiratory Diseases
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• 제67권2호
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• pp.140-144
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• 2009

The majority of flexible bronchoscopies are performed under topical anesthesia with lidocaine being the most commonly used agent. Anaphylaxis rarely occurs after local administration of lidocaine, but can be a fatal complication. We experienced a case of unexpected anaphylaxis. A 66-year-old woman was scheduled for flexible bronchoscopy to evaluate a tracheal mass and stenosis. The oral and nasal mucosa were pretreated with lidocaine. About 2~3 minutes later, the patient developed hypotension and we treated for anaphylaxis in the emergency room. Then, we decided to perform rigid bronchoscopy in this patient, under conditions of general anesthesia. A rigid bronchoscopy was performed in this patient, safely and successfully. The tracheal mass was determined to be squamous cell carcinoma.

• Archives of Plastic Surgery
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• 제44권6호
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• pp.509-515
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• 2017

Background Skin flap necrosis is a common complication after mastectomy and breast reconstruction. It has been proven that nitroglycerin ointment, as a topical vasodilator, can decrease the rate of skin flap necrosis after mastectomy and breast reconstruction. However, nitroglycerin can cause several side effects, including headache, dizziness, and hypotension. The purpose of this study was to evaluate whether the application of a low dose of nitroglycerin ointment reduced the rate of skin flap necrosis in breast reconstruction after skin-sparing or nipple-sparing mastectomy. Methods A total of 73 cases of breast reconstruction after nipple-sparing and skin-sparing mastectomy at our institution from March 2012 to January 2017 were retrospectively studied. Of these patients, 52 received nitroglycerin ointment (4.5 mg) application to the skin around the nipple-areolar complex from August 2015 to January 2017, while 21 received fusidic acid ointment from March 2012 to August 2015. The number of patients who experienced necrosis of the breast skin flap was counted in both groups. Results Skin flap necrosis developed in 2 (3.8%) patients who were treated with nitroglycerin ointment and 5 (23.8%) patients who did not receive nitroglycerin ointment treatment. Patients who did not receive nitroglycerin ointment treatment had a significantly higher risk of mastectomy skin flap necrosis than patients who did (odds ratio=7.81; 95% confidence interval, 1.38 to 44.23; P=0.02). Conclusions Low-dose nitroglycerin ointment administration significantly decreased the rate of skin flap necrosis in patients who underwent breast reconstruction after skin-sparing or nipple-sparing mastectomy, without increasing the incidence of the side effects of nitroglycerin.

• Pediatric Infection and Vaccine
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• 제24권2호
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• pp.112-116
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• 2017

가와사키병은 다른 원인이 없는 발열과 함께 피부점막에 특징적인 병변을 보이는, 소아에서는 비교적 흔한 질환으로 일반적으로 급성기에는 혈역학적으로 안정적이다. 저자들은 심한 저혈압과 함께 급성 신손상이 있는 상태에서 내원한 8세 남아가 치료 중에 가와사키병으로 진단된 증례를 경험하였다. 최근에는 가와사키병 초기에 불안정한 혈역학적 상태를 가와사키병 쇼크증후군이라는 개념으로 정의하고 있다. 환아는 면역글로불린 치료 후 임상적으로 회복되었으나 관상동맥 확장 합병증이 확인되어 아스피린을 복용하고 있으며, 가와사키병의 합병증으로서는 비교적 드문 고혈압이 확인되어 베타 차단제를 사용하고 있다. 본 증례를 통해 가와사키병 쇼크증후군의 임상 양상을 알고, 혈관염이라는 가와사키병의 특성을 고려해볼 때 혈압 모니터링의 중요성을 깨닫게 되었다.

• Pediatric Infection and Vaccine
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• 제28권2호
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• pp.66-81
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• 2021

코로나바이러스감염증-19는 전 세계적으로 유행하고 있으며, 2021년 7월 15일 기준으로 1.88억명 이상의 확진자와 406만명 이상의 사망자가 발생하였다. 소아청소년에서는 성인에 비해 비교적 중증 감염 발생이 낮으나, 일부에서는 SARS-CoV-2 감염 약 2-6주후소아다기관염증증후군(multisystem inflammatory syndrome in children, MIS-C)라는 합병증이 발생할 수 있다. MIS-C는 어린영아부터 청소년까지 다양한 연령에서 발생할 수 있으며, 발열을 포함하여 다양한 장기와 관련된 증상을 보일 수 있다. 소화기 및 신경계 증상이 흔하며, 많은 경우 가와사키병과 유사한 피부점막증상 등이 나타난다. 특히 심장관련 증상으로 좌심실 기능저하, 심근염 등이 나타날 수 있으며, 관상동맥확장 및 관상동맥류가 나타날 수 있다. 경우에 따라 저혈압, 쇼크를 동반하며, 중환자실 치료 및 기계환기요법을 요하나, 적절한 치료 후 대체로 회복을 보이는 것으로 보고된다. 이와 같이 MIS-C는 소아청소년에서 SARS-CoV-2 이후 드물게 발생하는 중요한 합병증으로, 임상증상을 잘 인지하고 조기에 적절한 치료를 하는 것이 중요하다. 이에 본 종설에서는 MIS-C의 역학 및 임상 증상, 추정되는 병태생리, 진단적 접근 및 치료에 대해 다루고자 한다.

• Journal of Chest Surgery
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• 제27권3호
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• pp.177-186
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• 1994

Pentastarch is a hydroxyethyl starch similar to hetastarch, but lower average molecular weight and fewer hydroxyethyl groups which result in enhanced enzymatic hydrolysis and faster renal elimination.This report was performed to compare the clinical efficacy and safety of 10 % pentastarch[Pentaspan , group I] for plasma volume expansion after open heart surgery with that of 5% albumin[Plasmanate, group II]. There were no statistically significant differences between the group I [n=18] and group II [n:19] in the preoperative parameters [age, sex, body weight] and operative parameters[bypass time, aorta cross clamping time]. During the first 24 hours after arrival of the patient in the surgical intensive care unit, colloid solution [500--1000 ml] was infused to maintain left atrial pressure of more than 8 mmHg, or cardiac index of 2.0 L/min/M2 of more. In results, there were 3 complications of hypotension immediately after infusion of 5 % albumin solution and 2 among the 3 patients were excluded for the study. However there was no complication after infusion of 10 % pentastarch solution. Hemodynamic responses to infusion was similar for both groups, although in group I a greater increase in both left atrial pressure[mean 1.8 versus 0.7 mmHg, p< 0.05] and right atrial pressure [mean 2.2 versus 1.7 mmHg, p < 0.05] was observed during infusion of the first 500 ml. There were no significant differences in any of the measured respiratory parameters[PaO2, intrapulmonary shunt, and effective lung compliance]. Homodilution with colloid significantly reduced hemoglobin [mean 1.2 versus 0.8 gm/dl], and serum protein and albumin level[total protein;4.8$\pm$ 0.5 versus 5.2 $\pm$0.5 gm/dl, p < 0.05: albumin: 3.2 $\pm$0.4 versus 3.6 $\pm$0.6 gm/dl, p < 0.05] by 6:00 AM on 1 day postoperatively, however there were no significant differences on 7 day postoperatively. The mean serum colloid osmotic pressure and osmolarity was similar in both group.There were no abnormal findings of liver function and kidney function in all the patients. There were no significant between-group differences in bleeding time, platelets, prothrombin time, activated partial thromboplastin time and amount of chest tube output measured on 1st and 7th postoperative day. These findings demonstrated that 10% pentastarch is more effective and safe for plasma volume expension than 5 % albumin solution with no adverse effects on coagulation. Also 10 % pentastarch is less expensive than 5 % albumin and it would appeare to be a reasonable first choice for plasma volume expansion.

• Journal of Chest Surgery
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• 제18권4호
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• pp.753-758
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• 1985

Hemorrhage is an important complication after operation with cardiopulmonary bypass and sometimes necessitates a further emergency operation. Between July, 1962 and June, 1985, reoperation for hemorrhage was carried out on 81 patients [3.1%] out of a total 2634 patients who had previously undergone cardiopulmonary bypass surgery at the Department of Thoracic and Cardiovascular Surgery, Yonsei University Medical Center. There were 38 males and 43 females, with an average age of 25 years [ranging 6 months to 60 years] and an average body weight of 38 kg [ranging 5 to 77 kg].There were 43 patients of cyanotic heart disease, 32 patients of acquired valvular heart disease, 4 patients of coronary artery occlusive disease, 2 patients of ascending aorta aneurysm and annuloaortic ectasia. The average amount of blood loss in the case of cyanotic heart disease was 71.7140ml/kg, in acyanotic heart disease 45.16.3ml/kg, in acquired heart disease, 56.514.4ml/kg and in coronary artery occlusive disease, 50.618.7ml/kg during first post operative day. But there was no statistical difference [p>0.05]. The mean blood loss below 10 years old was 70.412.1 ml/kg. Those below 10 years old were believed to bleed more than any other group. But there was also no statistical difference [p>0.05]. Indications for reoperation were continued excessive blood loss [74%], cardiac tamponade or hypotension [23%] and radiological evidence of a large hematoma in the thorax and pericardium [2%]. Average bypass time was 2.10.1 hours [ranging 30 minutes to 5 hours]. The interval between operation and reoperation was as follows; less than 12 hours in 49 patients [60%], 12 to 24 hours in 20 patients [25%], 24 to 48 hours in 8 patients [10%], more than 48 hours in 4 patients [5%]. The commonest sites for bleeding were chest wall [36%], heart [34%], aorta [12%], pericardium [6%], thymus [5%] and others [6%]. But no definite source was found in ll patients [31%]. Twenty seven out of 81 patients [31%] had wound problems and 5 patients [6%] were expired. [Mean SEM]. In conclusion, in order to decrease the amount of blood loss after open heart surgery with cardiopulmonary bypass, shortening of bypass time and bleeding control at the wire suture site during chest wall closure were important. If the amount of blood loss was over 45 ml/kg or 8 m/kg/hour, reoperation should be considered as soon as possible. After operating, careful wound dressings were applied to prevent wound problems.

• 구강회복응용과학지
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• 제37권3호
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• pp.171-176
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• 2021

종격동기종은 치과 영역에서 매우 드물고 잠재적으로 위험한 합병증이다. 이의 흔한 원인으로는 핸드피스와 고압 공기/물 주사기를 사용하는 발치, 근관치료, 잇몸 밑 치은연하 소파술 등이 있다. 본 증례는 임플란트 식립을 위한 전 치료로 주사기를 이용하여 상악동에 골이식을 시행받은 61세 여자에게서 발생한 대량의 종격동기종과 피하기종의 증례이다. 환자는 치료 도중 갑작스럽게 발생한 구강 통증과 함께 의식 소실이 발생하였고, 응급실로 전원 되었다. 영상학적 검사상 종격동기종과 함께 얼굴과 목부위 전체에 피하기종이 발견되었다. 예방적 항생제, 산소 흡입, 금식 등의 보존적 치료가 이루어졌고, 합병증 없이 7일 만에 퇴원하였다. 환자의 실신은 시술 중 상악동 천공 후 과량의 공기유입으로 인해 발생한 종격동기종에 의해 순간적인 강한 흉부 압박으로 혈압 감소와 통증 쇽에 의한 것으로 생각된다. 치과 치료 중 환자가 의식을 잃었다면 기도 폐쇄의 위험성이 있기 때문에 종격동기종을 즉각적으로 감별하고 치료해야 한다.

• 대한응급의학회지
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• 제29권5호
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• pp.500-508
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• 2018

Objective: The aim of this study was to evaluate the clinical characteristics of heat stroke in a bath facility and investigate predictive factors of multiple major complications in heat stroke patients. Methods: This was a retrospective study on heat stroke patients who visited an urban emergency center from January 2010 to March 2018. We compared clinical characteristics, complication, and outcomes of heat stroke patients in bath and non-bath facilities. Multivariate logistic regression analysis were performed to identify independent predictors of multiple major complications in heat stroke patients. Results: A total of 67 heat stroke patients with heat stroke were enrolled, of which 42 (62.6%) were in a bath facility and 25 (37.3%) were in a non-bath facility. Patients with heat stroke in the bath facility were characterized by old age, past medical history of hypertension and diabetes mellitus, and high incidence of hypotension compared with those in the non-bath facility but also low incidence of acute renal failure, seizure, and multiple major complications. In the multivariate analysis, predictive factors of multiple major complications in heat stroke patients were non-bath facility (odds ratio [OR], 5.4; 95% confidence interval [CI], 1.2-29.9), Glasgow Coma Scale (GCS)${\leq}8$ (OR, 8.2; 95% CI, 1.3-49.4), and mean arterial pressure (MAP), body temperature above $40.5^{\circ}C$ (OR, 8.1; 95% CI, 1.1-58.8) <60 mmHg (OR, 14.8; 95% CI, 1.8-122.9). Conclusion: Heat stroke in the bath facility resulted in less major complications, and high body temperature, GCS ${\leq}8$, and MAP <60 mmHg were independent predictive factors of multiple major complications in heat stroke patients.