• Title/Summary/Keyword: Hemorrhagic shock

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A case of ARDS Overlooked Tsutstugamushi Disease that Presented as Simple Cutaneous Lesions (단순 피부병변으로 간과되어 급성 호흡곤란 증후군으로 진행된 쯔쯔가무시병 1예)

  • Ryu, Ki Hyun;Kim, Ki Hong;Kim, Hong Dai;Son, Ji Woong;Na, Moon Jun;Choi, Eugene
    • Tuberculosis and Respiratory Diseases
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    • v.61 no.4
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    • pp.389-393
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    • 2006
  • Tsutstugamushi disease is a major febrile disease that generally occurs in the fall in Korea with hemorrhagic fever with renal syndrome and leptospirosis. This disease is often accompanied by interstitial pneumonia, acute renal failure and liver failure. The causative agent, namely Orientia tsutsugamushi, is transmitted to humans through the bite of a laval trombiculid mite, which is commonly known as a chigger. A 78 year old man was admitted in October 2004 with intractable fever and a drowsy mentality. Two weeks earlier, he visited a private clinic complaining of a simple skin rash. He was treated with antihistamine and steroid, but his symptoms were aggravated and he was referred to our hospital. His physical examination and laboratory findings showed a septic shock status. The maculopapular rash had spread over his face, chest, abdomen and extremities. Eschar was observed in lower back area but it was too difficult to distinguish it from other skin rashes. His chest X-ray appeared as diffuse nodular patchy consolidations in the bilateral lung parenchyme. He was treated with a mechanical ventilator and doxycycline under th suspicion of Tsutstugamushi disease. However, he suffered multiorgan failure accompanied by acute respiratory distress syndrome, acute renal failure and acute hepatitis. He was treated in the intensive care unit for approximately 12 weeks and his general condition was recovered.

Esophageal Injuries -A Report of 213 Cases - (외인성 식도 손상의 치료)

  • 이두연
    • Journal of Chest Surgery
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    • v.23 no.1
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    • pp.95-106
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    • 1990
  • Between May 1979 and April 1989, 213 patients with esophageal injuries visited the Department of the Thoracic and cardiovascular surgery Department, Yonsei University College of Medicine. There were 159 non perforated esophageal injuries accompanied by hematemesis, and 54 perforated esophageal injuries. The causes of non perforated esophageal injuries were Mallory-Weise Syndrome [%], corrosive esophagitis [54], esophageal carcinoma [4], foreign bodies [2], sclerotherapy due to esophageal varices [3]. The causes of perforated esophageal injuries were esophageal anastomosis[13], malignancies[17], esophagoscopy or bougienage[5], chest trauma[5], foreign bodies[5], paraesophageal surgery[3], others[6] In esophageal perforation due to foreign bodies, esophagoscopy or bougienage, there were 6 cervical esophageal perforations and 9 thoracic esophageal perforations. There were no mortalities in the treatment of the cervical esophageal perforations and 5 deaths resulted in the treatment of 9 thoracic esophageal perforations. And four of six patients with thoracic esophageal perforations died in the initiation of treatment over 24 hours, after trauma. There were another 12 deaths in the patients with chest trauma, malignancies or chronic inflammation except esophageal injuries due to foreign bodies or instruments during the hospital stay or less than 30 days after esophageal injuries. One patient with esophageal carcinoma died due to bleeding and respiratory failure after irradiation. Another patient with esophago gastrostomy due to esophageal carcinoma died of sepsis due to EG site leakage. One patient with a mastectomy due to breast cancer followed by irradiation died of sepsis due to an esophagopleural fistula. Two patients with Mallory-Weiss syndrome died; of hemorrhagic shock in one and of respiratory failure due to massive transfusion in the other. One patient with TEF died of respiratory failure and another died of pneumonia and respiratory failure. One patient with esophageal perforation due to blunt chest trauma died of brain damage accompanied with chest trauma.

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Two Pediatric Cases of Dengue Fever Imported from Philippines (필리핀에서 유입된 소아 뎅기열 2례)

  • Oh, Mi Ae;Shim, Jae Won;Kim, Duk Soo;Jung, Hye Lim;Park, Moon Soo;Shim, Jung Yeon
    • Pediatric Infection and Vaccine
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    • v.20 no.2
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    • pp.98-104
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    • 2013
  • Dengue fever is an important health problem for international travelers to all endemic areas. The steadily increasing numbers of tourists visiting endemic areas raise the risk of exposure, and imported dengue cases are increasingly observed in nonendemic area. Dengue has a wide spectrum of clinical presentations, often with unpredictable clinical evolution and outcome. While most patients recover following a self-limiting, non-severe clinical course, a small proportion progress to severe disease such as dengue hemorrhagic fever or dengue shock syndrome. Therefore, it is important to suspect dengue fever in every febrile patient returning from the tropics. Whenever it is suspected, a quick diagnosis and adequate managements are essential to avoid complications. We report two cases of imported dengue fever in Korean children presenting with fever, headache, nausea, and rash.

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Intracardiac Foreign Body by Penetrating Cardiac Injury (관통성 손상에 의한 심장내 이물 - 수술 치험 1례 -)

  • 정진용
    • Journal of Chest Surgery
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    • v.23 no.5
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    • pp.929-935
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    • 1990
  • Violence in our society, combined with improving transport system, resulted in increased numbers of patients with cardiac wounds reaching the hospital alive. Most patients with penetrating cardiac injury, rather than blunt injury, present with a syndrome of either hemorrhagic shock or cardiac tamponade. And they should be operated upon as soon as possible. Often the atrioventricular valves and other important cardiac structures are also damaged by the penetrating instruments or missile. Both intracardiac communications and atrioventricular fistulas may result in significant left-to-right shunts accompanied by congestive heart failure, necessitating surgical correction. Usually, retained cardiac foreign bodies, which are almost always bullets or fragments of missiles, may lie within a cardiac chamber or in the myocardium. Emboli of bullets or other missiles from distant sites to the right side of the heart are numerous enough to require attention. Recently we experienced a case with intracardiac foreign body due to penetrating cardiac injury. A 19 year-old man was admitted to our hospital due to penetrating anterior chest wound by iron segment. The roentgenogram of the chest revealed a radio-opaque metallic shadow in left lower chest around the cardiac apex, mild blunting of left costophrenic space, but no cardiomegaly. During operation the foreign body was noted to be present in the cardiac chamber by the portable C-arm fluoroscopy. But during the manipulation it moved into left inferior pulmonary vein from left ventricle by way of left atrium. So we could manage to remove it from left inferior pulmonary vein by direct approach to the vein. It was iron segment, sized 0.lcm x0.6cmx0.5cm, with sharp margins. The patient had an uneventful postoperative recovery except for chylopericardium and was discharged.

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A Comparative Study of Eejin-tang, Hyangsaeejin-tang and Naeso-san Extracts on Indomethacin-induced Gastric Mucosal Lesions in Mice (Indomethacin으로 유발된 생쥐의 위점막 손상에 대한 이진탕(二陳湯), 향사이진탕(香砂二陳湯) 및 내소산(內消散)의 비교연구)

  • Park, Jung-Han;Baik, Tai-Hyeun
    • The Journal of Internal Korean Medicine
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    • v.34 no.4
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    • pp.412-427
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    • 2013
  • Objectives : This study was carried out to compare the effects of Eejin-tang, Hyangsaeejin-tang and Naeso-san extracts on indomethacin-induced gastric mucosal lesions in mice. Methods : Experimental mice were divided into six groups. The normal group had no gastro-inflammation. In the control group, gastro-inflammation was elicited by indomethacin. Misoprostol, Eejin-tang, Hyangsaeejin-tang and Naeso-san group were those in which misoprostol, Eejin-tang extract, Hyangsaeejin-tang extract and Naeso-san extract were administered after gastro-inflammation is elicited. This study examined the anti-inflammation effects and distribution of mucus secreting cells, zonula occludin-1 (ZO-1), heat shock protein (HSP) 70, periodic acid-schiff reaction stain (PAS), peanut agglutinin (PNA), cyclooxygenase-1 (COX-1), 5-bromo-2'-deoxyuridine (BrdU), nuclear factor kappa-light-chain-enhancer of activated B cells (NF-${\kappa}B$) p65, inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2). Results : 1. The hemorrhagic erosion and damaged mucus secreting cell, the positive reaction HSP70 increased in the control group, but decreased in the Eejin-tang, Hyangsaeejin-tang and Naeso-san groups. 2. The positive reaction of ZO-1, PAS, PNA, COX-1 and BrdU decreased in the control group, but increased in the Eejin-tang, Hyangsaeejin-tang and Naeso-san groups. 3. The positive reaction of NF-${\kappa}B$ p65, iNOS and COX-2 increased in the control group, but decreased in the Eejin-tang, Hyangsaeejin-tang and Naeso-san groups. Conclusions : Among the three extracts, the effects were in the order of Naeso-san, Hyangsaeejin-tang and Eejin-tang group, Naeso-san being the most effective.

Crown removal and endodontic drainage as a last method in active gingival bleeding with liver cirrhosis and periodontitis: a case report (간경화증과 치주염으로 과도한 치은출혈을 보인 응급환자에서 최후 지혈방법으로 치관제거와 치근관 배농술: 증례보고)

  • Choi, Young-Su;Kang, Sang-Hoon;Kim, Moon-Key;Lee, Chun-Ui;Yoo, Jae-Ha
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.36 no.3
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    • pp.221-227
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    • 2010
  • The most common local cause of active gingival bleeding is the vessel engorgement and erosion by severe inflammation. Abnormal gingival bleeding is also associated with the systemic disturbances. Hemorrhagic disorders in which abnormal gingival bleeding is encountered include the following: vascular abnormalities (vitamin C deficiency or allergy), platelet disorders, hypoprothrombinemia (vitamin K deficiency resulting from liver disease), and other coagulation defects (hemophilia, leukemia). There are many conventional methods for gingival bleeding control, such as, direct pressure, electrocoagulation, direct suture, drainage, application of hemostatic agents and crushing and packing. If the active continuous gingival bleeding is not stopped in spite of the application of all conventional bleeding control methods, the life of patient is threatened owing to upper airway obstruction, syncope, vomiting and hypovolemic shock. Therefore, the rapid and correct hemostatic method is very important in the emergency dental care. This is a case report of active gingival bleeding care via dental crown removal and emergency primary endodontic drainage as a last method in liver cirrhosis patient with advanced periodontitis.

Effect of the Extracorporeal Circulation on Renal Function in Adult Open Heart Patients (개심술시 체외순환이 신장기능에 미치는 영향)

  • Lee, Jae-Won;Seo, Gyeong-Pil
    • Journal of Chest Surgery
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    • v.18 no.4
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    • pp.718-731
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    • 1985
  • Renal dysfunction is a common complication of open-heart surgery: a form of controlled hemorrhagic shock, and successful perioperative management of renal dysfunction depends on recognition of the risk factors and optimal management of factors influencing renal function, including cardiopulmonary bypass, and early detection of renal failure. Changes in renal functional parameters including Ccr, Cosm, CH2O, FENa, and RFI were observed prospectively in forty five patients operated on at Dept. of Thoracic and Cardiovascular Surgery, S.N.U.H., from April to June, 1985. They were 23 males and 22 females with 35 acquired and 10 congenital heart diseases and the mean age and body surface area of them were 38.010.3 years [22-63] and 1.5518 M2[1.151.92] respectively. Followings are the conclusion. 1. The Ccr, representative of renal function, is significantly improved from 90.231.3 ml/min/M2 preoperatively to 101.536.4 ml/min/M2 postoperative and day [P<0.05], and all patients were classified as postoperative renal functional class I of Abel, which representing adequate renal protection during our cardiopulmonary bypass. 2. The Cosm is significantly elevated at immediate postperfusion time and remained high at postoperative one day representing osmotic diuresis at that time, but CH2O shows no significant changes at immediate postperfusion period and is decreased significantly at postoperative one day, representing recovery of renal concentrating ability at that time with decreasing urine flow. 3. The absolute value and changing tendency in FENa and RFI during perioperative period shows no diagnostic reliability on these parameters, but those of CH2O appear to reveal future renal function more accurately than Ccr 4. The depth of hypothermia may be protective upon renal function against the ill effects of prolonged nonpulsatile cardiopulmonary bypass. 5. The depth of the hypothermia, pump time of more than 150 minutes, poor cardiac function, and intraoperative events such as embolism appear to be related with immediate postperfusion renal function. 6. Hemoglobinuria and hemolysis, poor preoperative renal function, history of cardiac surgery, and massive transfusion associated with bleeding appear not to be related with renal dysfunction.

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Interventional Treatment of Chemical Pleuritis and Hemothorax Caused by Iatrogenic Internal Jugular Vein Perforation after Central Venous Port System Implantation: A Case Report (중심정맥포트 삽입 후 의인성 속목정맥 천공에 의한 화학적 늑막염과 혈흉의 중재적 치료: 증례 보고)

  • Do Woo Kim;Young Hwan Kim;Ung Rae Kang
    • Journal of the Korean Society of Radiology
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    • v.81 no.6
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    • pp.1459-1465
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    • 2020
  • The perforation of the intrathoracic internal jugular vein during the placement of an implantable central venous chemoport is a rare complication that is manifested by hemothorax or hemorrhagic shock. Furthermore, inappropriate instillation of a chemotherapeutic agent in the chemoport can cause chemical pleuritis, and the diagnosis of these complications prior to the instillation of chemotherapeutic agents and open thoracic surgery is mandatory. We report a patient with chemical pleuritis and hemothorax following an inappropriate instillation of a chemotherapeutic agent, through the perforated right internal jugular vein after placement of an implantable central venous chemoport. Treatment by embolization using coils and N-butyl cyanoacrylate, after percutaneous drainage, was successful.

Interventional Management for Pelvic Trauma (골반 외상 인터벤션)

  • Jung Han Hwang;Jeong Ho Kim;Suyoung Park
    • Journal of the Korean Society of Radiology
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    • v.84 no.4
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    • pp.835-845
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    • 2023
  • Traumatic pelvic injuries usually include high-energy crush injuries and are associated with significant morbidity and mortality. Mortality rates range from 6% to 15% and increase to 36%-54% in cases of fractures that result in increased pelvic volume. Therefore, retroperitoneal hemorrhage can spiral and progress to hemorrhagic shock. Pelvic hemorrhage most commonly occurs secondary to disrupted pelvic veins or fractured bones, and 10%-20% of cases involve arterial injuries. Owing to extensive bleeding and limitations of surgery for pelvic hemorrhage, interventional treatment is at the forefront of pelvic hemorrhage management. CT is an accurate indicator of active hemorrhage in patients with pelvic trauma that affects the diagnosis and management, including interventions. Identification of the site of hemorrhage is necessary for focused interventional treatment. The current trend toward a more conservative approach for treatment of pelvic trauma and advances in interventional radiology in the field of pelvic trauma may favor widespread use of interventional treatment for patients with pelvic injuries. In this review, we discuss therapeutic modalities available to the interventional radiologist and common angiographic treatment strategies and techniques.

The Effect of Hypothermia on Lung Inducible Nitric Oxide Synthase Gene Expression in Intestinal Ischemia-Reperfusion Injury (장 허혈-재관류에서 폐조직의 Inducible Nitric Oxide Synthase유전자 발현에 대한 저체온증의 효과)

  • Kim, Kyuseok;Lee, Jeong Hun;Suh, Gil Joon;Youn, Yeo Kyu;Kang, Young Joon;Kim, Min A;Cho, Sang-Gi;Shin, Hyo-Keun
    • Journal of Trauma and Injury
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    • v.19 no.1
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    • pp.14-20
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    • 2006
  • Purpose: Although hypothermia has been used in many clinical situations, such as post cardiopulmonary resuscitation, stroke, traumatic brain injury, septic shock, and hemorrhagic shock, the mechanism by which it works has not been clearly elucidated. We aimed to evaluate the effect of hypothermia on the plasma nitric oxide (NO) concentration, lung iNOS expression, and histologic changes in intestinal ischemia-reperfusion (IR). Method: Male Sprague-Dawley rats were randomly divided into the hypothermia group (HT, n=8, $27{\sim}30^{\circ}C$) and the normothermia group (NT, n=8, $36{\sim}37^{\circ}C$). They underwent 30 min of intestinal ischemia by clamping the superior mesenteric artery, which was followed by 1.5 h of reperfusion. They were then sacrificed. The acute lung injury (ALI) score, the plasma NO concentration, and lung iNOS gene expression were measured. Results: Compared with the HT group, the NT group showed severe infiltrations of inflammatrory cells, alveolar hemorrhages, and interstitial hypertrophies in lung tissues. There were significant differences in the ALI scores between the NT and the HT groups ($8.7{\pm}1.5/HPF$ in NT vs $5.8{\pm}1.2/HPF$ in HT, p=0.008). Although the plasma NO concentration was slightly lower in the HT group, there was no significant difference between the two groups ($0.80{\pm}0.24{\mu}mol/L$ in NT vs $0.75{\pm}0.30{\mu}mol/L$ in HT, p=0.917). Lung iNOS gene expression was stronger in the NT group than in the HT group. The band density of the expression of iNOS in lung tissues was significantly increased in the NT group compared to the HT group ($5.54{\pm}2.75$ in NT vs$0.08{\pm}0.52$ in HT, p=0.002). Conclusions: This study showed that hypothermia in intestinal IR reduces inflammatory responses, ALI scores, and iNOS gene expression in lung tissues. There was no significant effect of hypothermia on the plasma NO concentration.