• Journal of Chest Surgery
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• 제23권2호
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• pp.275-284
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• 1990

A serious problem after cardiovascular surgery known as Multiple Organ Failure[MOF] whereby several vital organs successively demonstrate dysfunction in spite of intensive postoperative treatment has recently arisen. We have made a retrospective study of the clinical records of 137 patients who underwent cardiovascular surgery during past two years [1987-1988]. Fourteen patients [10%] developed multi-organ failure postoperatively with the results of seven death [50%]. In fatal group, preoperative poor cardiac function [Cardiac Index<2.0L/min/m2] was considered important prognostic factor and infection 5 disseminated intravascular coagulation complicating gastrointestinal bleeding were the leading cause of death. In conclusion, evaluation of multiple factors concerning multi-organ failure demonstrates preoperative poor functional preservation of vital organs is the main factor. So early diagnosis k management for each of the failing organs & prevention of infection are mandatory of the treatment of these critically ill patients.

• Tuberculosis and Respiratory Diseases
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• 제45권4호
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• pp.888-895
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• 1998

Malaria is one of the most common infectious diseases in the world. Plasmodium falciparum, accounting for nearly all malaria mortality, kills an estimated 1 to 2 million persons yearly and has several features that make it deadlist of malarias. While cerebral malaria is the most common presentation of severe disease, acute lung injury associated with malaria is uncommon but serious and fatal complication. We report two cases of severe malaria with ARDS and multi-organ failure. All two patients traveled to foreign countries, Kenya, Papua New Guinea where choroquine-resistant malaria is distributed. The first case, which developed cerebral malaria, hypoglycemia, multi-organ failure, and ARDS, treated with quinine and mechanical ventilator, but expired due to oxygenation failure. Autopsy showed acute necrotizing infiltration, diffuse eosinophilic fibrinoid deposits along the alveolar space, and alveolar macrophage with malaria pigment The second case also developed multi-organ failure, followed by ARDS, and was treated with quinine, exchange transfusion, plasmapheresis, and mechanical ventilator. He recovered with residual restrictive lung change after treatment.

• 대한임상독성학회지
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• 제5권2호
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• pp.119-122
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• 2007

Paraquat poisoning is a fatal type of herbicide intoxication. It is characterized by multi-organ failure and pulmonary fibrosis with respiratory failure. Intravenous and intramuscular injection of paraquat is rarely described. However, We encountered two fatal cases of acute poisoning caused by paraquat injection. Two patients were admitted to our emergency unit after intravenous and intramuscular injection of 23.8% paraquat (about 476 mg of paraquat). A 37-year-old man diluted 2 ml of 23.8% paraquat solution with 1 ml of normal saline and injected it both intravenously into his left antecubital fossa and intramuscularly into his abdomen in a suicide attempt. He died 5 days later from respiratory failure and acute renal failure. A 92-year-old man was injected intravenously into his right antecubital fossa by his grandson with 2 ml of 23.8% paraquat solution diluted with 1 ml of normal saline. He died 2 days later from early circulatory collapse and multi-organ failure (metabolic acidosis, acute renal failure, coagulopathy). Intravenous and intramuscular injection with a small quantity of paraquat resulted in fatal toxicity in our patients.

• 대한임상독성학회지
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• 제10권2호
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• pp.118-121
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• 2012

Chromic acid is a strong metal acid and acute poisoning is very rare. However, chromic acid causes serious complications, such as skin injuries, as well as renal and hepatic failure. We report on a case of a 47-year-old male who accidentally had chromic acid spilled over his nose and face. For the first few days, he was treated with ascorbic acid and massive hydration. However, after three days, his condition began to worsen. He was treated with hemodialysis for anuria and acute renal failure, and antibiotics for pneumonia. On day 10 of hospitalization, he expired of multi-organ failure. We suggest firm control and close supervision of chromic acid in the work place, and, considering severe complications of chromic acid, we propose a nearly and aggressive treatment.

• Journal of Medicine and Life Science
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• 제15권2호
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• pp.108-111
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• 2018

Extra-corporeal membrane oxygenation (ECMO) has the potential to rescue patients in cardiac arrest or respiratory failure. ECMO has two systems such as veno-arterial and veno-venous circulation. In cardiac arrest resulting from acute myocardial infarction, veno-arterial ECMO is mandatory for systemic circulation and oxygenation. A 75-year old female patient underwent primary coronary intervention for acute myocardial infarction. Despite successful revascularization, recurrent ventricular tachycardia and heart failure were progressing. We performed a veno-arterial ECMO through the femoral artery and vein, then the patient seemed to be stable clinically. However, laboratory studies, echocardiography, and vital signs indicated multi-organ failure and decreasing cardiac function. We found out an error that we performed veno-venous ECMO instead of veno-arterial ECMO. We added a femoral artery cannula and exchange the circuit system to veno-arterial ECMO. While the systemic circulation seemed to be recovered, the left ventricular function was decreased persistently. A hypovolemia resulting from pulmonary hemorrhage was occurred, which lead to ECMO failure. The patient died of cardiac arrest and multi-organ failure 23 hours after ECMO. Because the color of arterial and venous circuits represent the position and efficacy of ECMO, if unexpected or abnormal circuit colors are detected, prompt and aggressive evaluation for ECMO function is mandatory.

• 대한임상독성학회지
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• 제9권1호
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• pp.14-19
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• 2011

Purpose: Most paraquat poisonings are easily diagnosed by history taking on physical examination, however, some are failed to be diagnosed initially if the poisoning was veiled. The purpose of this study was to explore the clinical characteristics of veiled paraquat poisoning. Methods: We retrospectively reviewed the medical records of patients whose discharge diagnosis was paraquat poisoning in one university teaching hospital between 1 Jan, 2001 and 31 Dec, 2010. Veiled paraquat poisoning was determined when there was a positive urine paraquat kit in patients who did not mention paraquat poisoning in an initial physical examination or had unknown cause of pulmonary fibrosis, acute renal failure, or multi-organ failure. Results: Of the 117 patients with paraquat poisoning during the study period, 6 patients (5.1%) had veiled paraquat poisoning. The clinical characteristics were 1) proteinuria - 6 (100%), 2) increased creatinine - 4 (66.7%), 3) green skin stains - 2 (33.3%), 4) mucosal ulcer - 3 (50%). Blood chemistry results were variable. Conclusion: We should suspect veiled paraquat poisoning for patients who have proteinuria, increased creatinine, green skin stain, mucosal ulcer and vomiting, or if they have rapidly progressing acute renal failure or multi-organ failure with unknown cause, even if patients didn't mention about paraquat poisoning upon the initial physical examination. In cases with the above clinical conditions, a thorough repeated physical examination including history taking and use of urine paraquat kits should be performed.

• Investigative Magnetic Resonance Imaging
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• 제21권3호
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• pp.125-130
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• 2017

Purpose: To evaluate the clinical significance of T1 high signal intensity on the globus pallidus as a predictor of severe hepatic encephalopathy in patients with acute-on-chronic liver failure (ACLF), which is a distinct syndrome characterized by multi-organ dysfunction including cerebral failure. Materials and Methods: From January 2002 to April 2014, we retrospectively reviewed the magnetic resonance imaging (MRI) findings and clinical and magnetic resonance (MR) features of 74 consecutive patients (44 men and 30 women; mean age, 59.5 years) with liver cirrhosis. The chronic liver failure-sequential organ failure assessment score was used to diagnose ACLF. The pallidal index (PI), calculated by dividing the mean signal intensity of the globus pallidus by that of the subcortical frontal white matter were compared according to ACLF. The PI was compared with the Model for End-Stage Liver Disease (MELD) score in predicting the development of ACLF. Results: Fifteen patients who were diagnosed with ACLF had higher hepatic encephalopathy grades (initial, P = 0.024; follow-up, P = 0.002), MELD scores (P < 0.001), and PI (P = 0.048). In the ACLF group, the mean PI in patients with cerebral failure was significantly higher than that in the patients without cerebral failure (1.33 vs. 1.20, P = 0.039). In patients with ACLF, the area under the curve (AUC) for PI was 0.680 (95% confidence intervals [CI], 0.52-0.85), which was significantly lower than that for the MELD score (AUC, 0.88; 95% CI, 0.77-0.99) (P = 0.04). Conclusion: The PI can be an ancillary biomarker for predicting the development of ACLF and severe hepatic encephalopathy.

• 대한약학회:학술대회논문집
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• 대한약학회 2002년도 Proceedings of the Convention of the Pharmaceutical Society of Korea Vol.2
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• pp.431.2-432
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• 2002

Mucopolysaccharidosis (MPS) is a genetic disorder with deficiency of Iysomal enzymes needed for the degradation of glycosaminoglycans(GAGs). This storage disease is characterized by intra-lysosomal accumulation of GAGs. progressive mental and physical deterioration. multi-organ failure and premature death. Quality of life (QOL) is very low in MPS patients. The MOS 36-ltem Short Form Health Survey (SF-36) was designed to measure the eight (8) dimensions of health in clinical and general population settings. (omitted)

• Tuberculosis and Respiratory Diseases
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• 제60권5호
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• pp.548-553
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• 2006

연구배경 : 알코올성 케톤산증은 대부분 예후가 양호하나 여러 장기부전을 동반한 경우 중환자실 치 료가 필요하다. 이런 중증환자에 대한 보고가 부족하여 저자들은 중증 알코올성 케톤산증의 증례를 분석하였다. 방 법 : 2000년 1월 1일부터 2005년 6월 30일까지 서울아산병원 중환자실에서 입원하여 치료받았던 합병증을 가진 알코올성 케톤산증 10례를 선정하여 분석하였다. 결 과 : 모두 남자환자였고, 평균 나이는 $52.7{\pm}12.4$ 세, 평균 $20{\pm}13$년의 음주력이 있었다. 내원시 주증상은 복통,구토등의 소화기증상이 50%로 가장 많았다. 주요 검사실 소견상 Lactic acid (mmol/L) $57.89{\pm}55.35$, 동맥혈 pH $6.828{\pm}0.139$, Osmolar Gap (mOsm/L) $37.28{\pm}24.55$, Anion Gap (mOsm/L) $31.43{\pm}11.61$이었다. 동반된 주된 합병증으로 횡문근 융해증(80%), 패혈증(20%), 췌장염(10%) 순이었다. 70% 환자에서 투석이 80% 환자에서 기계환기가 실시되었다. 사망자 (60%) 들은 모두 3일이내에 쇼크로 인해서 사망하였다. 생존자들은 12시간안에 동맥혈 pH 7.15 이상으로 회복되었다. 결 론 : 중증 알코올성 케톤산증은 횡문근 융해증 및 급성 신부전이 주된 합병증으로 동반되며 사망률이 높다.

• Journal of Chest Surgery
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• 제45권2호
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• pp.116-119
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• 2012

A 61-year-old female patient was diagnosed with dilated cardiomyopathy with severe left ventricle dysfunction. Two days after admission, continuous renal replacement therapy was performed due to oliguria and lactic acidosis. On the fifth day, an intra-aortic balloon pump was inserted due to low cardiac output syndrome. Beginning 4 days after admission, she was supported for 15 days thereafter with an extracorporeal left ventricular assist device (LVAD) because of heart failure with multi-organ failure. A heart transplant was performed while the patient was stabilized with the LVAD. She developed several complications after the surgery, such as cytomegalovirus pneumonia, pulmonary tuberculosis, wound dehiscence, and H1N1 infection. On postoperative day 19, she was discharged from the hospital with close follow-up and treatment for infection. She received follow-up care for 10 months without any immune rejection reaction.