• Archives of Plastic Surgery
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• v.43 no.4
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• pp.360-364
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• 2016

Background Venous thromboembolism, a spectrum of diseases ranging from deep venous thrombosis to pulmonary embolism, is a major source of morbidity and mortality. The majority of cases described in plastic surgery involve abdominoplasty. Risk assessment and prophylaxis are paramount in such patients. General recommendations were recently developed, but the evidence in the literature was insufficient to prepare exhaustive guidelines regarding the medication, dosage, timing, or length of the prophylaxis. Methods A thromboprophylaxis protocol was developed for patients undergoing abdominoplasty. The protocol consisted of preoperative, intraoperative, and postoperative measures. Enoxaparin was administered as chemoprophylaxis in selected patients. The study involved 253 patients. The patients were analyzed for age, body mass index, enoxaparin dosage, risk factors, and complications. Results Deep venous thrombosis was documented in two cases (0.8%). No pulmonary embolism occurred. Three patients (1.2%) presented mild subcutaneous abdominal hematoma within the first postoperative week that spontaneously resorbed with neither aesthetic nor functional complications. Two patients (0.8%) presented severe hematoma requiring surgical re-intervention for drainage and hemostasis revision. Statistical analysis showed no significant correlation between enoxaparin dosage and hematoma (P=0.18) or deep venous thrombosis (P=0.61). Conclusions The described thromboprophylaxis protocol proved to be effective in the prevention of thrombotic events, with an acceptable risk of hemorrhagic complications. Furthermore, it provides new evidence regarding the currently debated variables of chemoprophylaxis, namely type, dosage, timing, and length.

• Vascular Specialist International
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• v.34 no.4
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• pp.103-108
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• 2018

Purpose: Surgery is the most common risk factor for pulmonary embolism (PE) in patients with a recent venous thromboembolism (VTE). This study reviewed clinical outcomes of preoperative inferior vena cava filter (IVCF) use in patients with acute VTE during abdominal-pelvic cancer or lower extremity orthopedic surgeries. Materials and Methods: We retrospectively analyzed 122 patients with a recent VTE who underwent IVCF replacement prior to abdominal-pelvic cancer or lower extremity orthopedic surgery conducted between January 2010 and December 2016. Demographics, clinical characteristics, postoperative IVCF status, risk factors for a captured thrombus, and clinical outcomes were collected for these subjects. Results: Among the 122 study patients who were diagnosed with acute VTE in the prior 3 months and underwent preoperative IVCF replacement, 70 patients (57.4%) received abdominal-pelvic cancer surgery and 52 (42.6%) underwent lower extremity orthopedic surgery. There were no perioperative complications associated with IVCF in the study population and no cases of symptomatic PE postoperatively. A captured thrombus in the filter was identified postoperatively in 16 patients (13.1%). Logistic regression analysis indicated that postoperative anticoagulation within 48 hours significantly reduced the risk of a captured thrombus (odds ratio [OR], 0.28; 95% confidence interval [CI], 0.08-0.94; P=0.032). Conclusion: A captured thrombus in preoperative IVCF was identified postoperatively in 16 patients (13.1%). Postoperative anticoagulation within 48 hours reduces the risk of captured thrombus in these cases.

• The Journal of Korean Obstetrics and Gynecology
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• v.22 no.1
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• pp.53-78
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• 2009

Purpose: In this study, we investigated the anti-thrombotic and antiinflammatory efficacy of "Gamijoukyungtang(GJKT)". Methods: We studied inhibitory effects of platelet aggregation, FXa activation, $TXB_2$ and $PGE_2$ biosynthesis and suppressive effects of GPIIb/IIIa activity and oxidative damage, pro-inflammatory cytokine reduction effects of 'GJKT(by press extractor)/GJKT-1(by pressless extractor)' in vitro. Also, we studied suppression of pulmonary embolism, AV shunt model in rats and shortening of Rat tail bleeding time in vivo. Results: GJKT/GJKT-1 extract showed inhibitory effects on GPIIb/IIIaactivities and platelet aggregation induced by ADP, epinephrine, collagen and arachidonic acid. They suppressed biosynthesis of $PGE_2$ but GJKT-1 only supressed biosynthesis of $TXB_2$. In FXa assay, they inhibited activation of FXa. they suppressed pulmonary embolism triggered by collagen and epinephrine. In AV shunt model, they decreased the weights of AV shunt thrombus. they inhibited pro-inflammatory cytokines and decreased oxidative damages caused by DPPH. Conclusion: We confirmed the anti-thrombosis, and ant-inflammatory efficacy of 'GJKT(by press extractor)/GJKT-1(by pressless extractor)'.

• Journal of Yeungnam Medical Science
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• v.33 no.1
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• pp.25-28
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• 2016

Nephrotic syndrome is associated with a hypercoagulable state, which results in thromboembolism as one of its main complications. Various pathogenetic factors that cause the hypercoagulable state in nephrotic syndrome have been recognized. We report on a 19-year-old female with a minimal-change disease who developed pulmonary thromboembolism combined with intracardiac thrombus while on tapering steroid. Our patient showed hypoalbuminemia with an episode of shock, and was successfully treated with thrombolysis and anticoagulation therapy.

• Journal of Yeungnam Medical Science
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• v.31 no.1
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• pp.28-32
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• 2014

Pulmonary thromboembolism (PTE) increases the pressure of the right ventricle and leads to symptoms and signs, such as dyspnea and hypoxia. If PTE causes hemodynamic instability, thrombolytic therapy should be considered. A mechanical thrombectomy is an alternative treatment to thrombolytic therapy and should be considered when thrombolytic therapy is contraindicated. Various devices are used in mechanical maceration and catheter-directed thrombolysis, but there is no standard mechanical device for PTE as yet. We report here on 2 clinical experiences of mechanical thrombectomy using the Arrow-Trerotola percutaneous thrombolytic device to remove residual clots after systemic thrombolysis in patients with massive PTE.

• Korean Journal of Pharmacognosy
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• v.31 no.4
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• pp.373-382
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• 2000

This study was performed to investigate the antithrombotic activity and protective effect of hexane fraction of Kamihyulbuchukeotang (KHCTH) on brain injury by KCN and MCA occlusion a prescription of HCT added with Lumbricus and Notoginseng Radix. Experiemental parameters are brain ischemia by MCA occlusion assay, KCN-induced brain injury, pulmonary thrombosis and platelet aggregation assay. The results were summarized as follows; 1. KHCTH extracts significantly inhibited the duration of KCN-induced coma (67%) and mortality (80%). 2. KHCTH extracts significantly suppressed brain ischemic area and edema following MCA occlusion and protected neuron cells as compared with control data. 3. KHCTH extracts inhibited pulmonary thrombosis induced by collagen and epinephrine. 4. KHCTH extracts inhibited platelet aggregation induced by collagen, ADP as agonist up to 76.9% and 32.3% respectivey at 1 mg/ml more effective than water extract of KHCT These data suggested that KHCTH could be applied as the protector of brain ischemia and injury and antithrombotic agent.

• Journal of Yeungnam Medical Science
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• v.31 no.2
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• pp.99-102
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• 2014

Diabetic ketoacidosis (DKA), a fatal acute diabetic complication, is characterized by severe metabolic decompensation and intravascular volume depletion. These conditions may result in hypercoagulability and prothrombic state. Pulmonary thromboembolism (PTE) could be presented as an uncommon and life-threatening complication of DKA. Reported herein is a case involving a 54-year-old male patient who was admitted with DKA due to chronic alcohol consumption and stopping the intake of oral antidiabetic drugs. After low-molecular-weight heparin and warfarin treatment because of PTE during the DKA treatment, the patient's condition improved over the week that he was discharged on insulin and warfarin.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.28 no.2
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• pp.178-182
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• 2006

Pulmonary edema is a well known phenomenon in medicine, physical findings indicative of this condition include frothy pink sputum, dispnea, and chest X-ray may present cephalization of vessels, perihilar edema, or diffused increase of density. It is one of the most serious, life threatening situation and should be diagnosed and managed instantly. Early diagnosis and intensive treatment are mandatory in order to effectively resolve the situation. The most common etiology for this pathology is cardiogenic, such as left ventricular failure and valvular disease. The one following is noncardiogenic, such as transfusion, infectious pneumonia, inhaled toxins, shock lung in association with trauma. Other forms of pulmonary edema which have not been clearly explained result from pulmonary embolism, drug overdose, after anesthesia, epinephrine overdose, exposure to high altitude, neurogenic, etc. We experienced two cases of pulmonary edema during two jaw surgeries(Le Fort I Osteotomy & BSSRO). These patients were young and physically healthy individuals on preoperative evaluation. Thus we report and discuss the etiology, diagnosis, prognosis, and treatment with journals review.

• Journal of Chest Surgery
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• v.32 no.3
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• pp.315-317
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• 1999

The complications associated with the use of pulmonary artery catheter include dysrhythmias, heart block, pulmonary artery rupture, pulmonary infarction, endocardial damage, balloon rupture, arterial puncture, thromboembolism, air embolism, infection, pneumothorax, and knotting of the catheter. Knotting of the catheter is a rare complication and it should be anticipated if there is an excessive advancement of the pulmonary artery catheter beyond the normally expected distance. We report a successful surgical removal of knotted pulmonary artery catheter by sternotomy and cardiopulmonary bypass.

• Journal of Chest Surgery
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• v.39 no.8 s.265
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• pp.626-632
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• 2006

Background: Pulmonary hypertension caused by chronic pulmonary embolism is underrecognized and carries a poor prognosis. Medical therapy is generally unsatisfactory and palliative. With the improvement of operative technique and postoperative management, pulmonary endarterectomy has been the treatment of choice for this condition. Material and Method: Between January 2001 and December 2005, eleven patients were received pulmonary endarterectomy. All patients had chronic dyspnea and exercise intolerance. Diagnosis was made with cardiac echocardiography, lung perfusion scan and computed tomography. Before the operation, Greenfield vena cava filter were placed in all patient except one. Deep hypothermic circulatory arrest was used for the distal-most portion of the endarterectomy procedure. More than moderate degree of tricuspid reguirgitation was repaired during operation. Result: There was no early and late death. Right ventricular systolic pressure was reduced significantly after operation from $91{\pm}21$ mmHg to $40{\pm}17$ mmHg on echocardiography (p=0.001). NYHA class and tricuspid reguirgitaion were improved postoperatively. Although mild reperfusion injury in three case and postoperative delirium in one case were observed, all of them recovered without complication. Conclusion: Pulmonary thromboendarterctomy offers to patient an acceptable morbidity rate and anticipation of clinical improvement. This method is safe and effective operation for pulmonary hypertension caused by chronic pulmonary thromboembolism.