• Journal of Trauma and Injury
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• 제30권3호
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• pp.107-111
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• 2017

The fat embolism syndrome (FES) represents a condition, usually with traumatic etiology, which may pose challenges to diagnosis while its treatment usually requires supportive measures in the intensive care units (ICUs). The clinical criteria, including respiratory and cerebral dysfunction and a petechial rash, along with imaging studies help in diagnosis. Here we present three case reports of young male who developed FES and were admitted to our ICUs after long bones fractures emerging after vehicle crashes and we briefly review FES literature. All patients' treatment was directed towards: 1) the restoration of circulating volume with fresh blood and/or plasma; 2) the correction of acidosis; and 3) immobilization of the affected part. All patients recovered and were released to the orthopedic wards. The incidence of cases of patients with FES admitted in our ICUs records a significant decrease. This may be explained in terms effective infrastructure reforms in Greece which brought about significant improvement in early prevention and management.

• Tuberculosis and Respiratory Diseases
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• 제78권2호
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• pp.128-132
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• 2015

Bronchopulmonary dysplasia (BPD) is related to decreased lung function throughout life. However, the pathology and radiology pattern of BPD of adults are not documented well yet. In this case report, we present BPD case of an adult monozygotic twin showing nearly identical lesions on chest computed tomography (CT). CT images showed mixed areas of ground-glass and reticular opacities in both lungs. They had common histories of pneumonias requiring mechanical ventilations in period of infants. Pulmonary function test of one patient showed a pulmonary insufficiency with airway obstruction. Pathologic findings showed bronchiolar hyperplasia and peribronchiolar fibrosis which was similar to classic BPD patients. Our twin case report might help provide distinguishing pathology and radiology pattern of an adult pulmonary sequelaes of BPD. It might be reasonable to make close follow-up for BPD patients to evaluate the long-term outcomes of BPD survivors.

• Neonatal Medicine
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• 제15권1호
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• pp.84-88
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• 2008

저자들은 짧은 목과 짧은 흉곽, 경추에서 흉추에 걸쳐 척추열, 척추분절, 척추반측이상, 척추부재 등의 척추기형과 짧은 늑골, 늑골 융합과 늑골의 부재 등의 늑골기형과 함께 우측 신장이 좌측 신장에 융합된 신장기형을 동반한 Jarcho-Levin 증후군 1례를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

• Journal of Trauma and Injury
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• 제34권4호
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• pp.284-287
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• 2021

We report a case of delayed chest wall reconstruction after thoracotomy. A 53-yearold female, a victim of a motor vehicle accident, presented with bilateral multiple rib fractures with flail motion and multiple extrathoracic injuries. Whole-body computed tomography revealed multiple fractures of the bilateral ribs, clavicle, and scapula, and bilateral hemopneumothorax with severe lung contusions. Active hemorrhage was also found in the anterior pelvis, which was treated by angioembolization. The patient was transferred to the surgical intensive care unit for follow-up. We planned to perform surgical stabilization of rib fractures (SSRF) because her lung condition did not seem favorable for general anesthesia. Within a few hours, however, massive hemorrhage (presumably due to coagulopathy) drained through the thoracic drainage catheter. We performed an exploratory thoracotomy in the operating room. We initially planned to perform exploratory thoracotomy and "on the way out" SSRF. In the operating room, the hemorrhage was controlled; however, her condition deteriorated and SSRF could not be completed. SSRF was completed after about a month owing to other medical conditions, and the patient was weaned successfully.

• 대한임상독성학회지
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• 제20권1호
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• pp.22-24
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• 2022

Elapid snakes have neurotoxic venom which causes diverse neuroparalytic manifestations, including fatal respiratory failure. In South Korea, since elapid snakebites are very rare, the cobra antivenom, which is effective against neurotoxicity, was only introduced recently. Most physicians in South Korea have little experience in the treatment of patients who have been bitten by elapid snakes. A 19-year-old man was brought to the emergency department with sudden diplopia, 1 hour after a snakebite on the left 2nd finger. The patient presented with drowsiness and complained of mild dizziness and binocular diplopia. After 1 hour, he had sudden onset of dyspnea and dysphagia and appeared to be agitated. He was immediately intubated and received mechanical ventilation as he was unable to breathe on his own. A total of 2.5 mg of neostigmine diluted with normal saline was slowly infused, and 1 vial of cobra antivenom was infused for an hour, 5 times every 2 hours, for a total of 5 vials. He slowly recovered self-breathing; on the 3rd day of hospitalization, he showed tolerable breathing and was extubated. He was discharged without any neurological deficits or other complications.

• Tuberculosis and Respiratory Diseases
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• 제43권4호
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• pp.491-499
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• 1996

연구배경 : 흉막염은 임상에서 흔히 접하게 되는 질환이나 폐기능에 미치는 영향 및 천자 후 변화는 많이 연구되어져 있지 않다. 이전의 보고들은 흉막 천자 후 폐기능 변화와 동맥혈 산소 분압은 거의 없거나 작은 호전을 보인다고 보고하였다. 이에 흉막액이 폐기능에 미치는 영향, 흉막천자 후 폐기능 및 동맥혈 간소 분압의 개선 정도와 장기 경과 관찰후 폐기능의 변화를 살펴보고자 하였다. 방법 : 1994년 2월부터 1995년 9월까지 이화여대부속병원에 결핵성 흉막염으로 입원한 환자 27명을 대상으로 하여 흉막액의 경중도와 발현되는 증상, 증상 발현 기간에 따라 폐기능을 비교하고 천자 전후의 변화를 측정하였다. 결과 : 1. 흉막염은 제한성 폐기능 장애를 야기시키며 소기도 뿐 아니라 대기도의 기능 장애도 유발시킨다. 2. 흉막 천자후 MMFR, $FEV_1$, Raw, $PO_2$는 조기(median 1주)부터 현저히 호전되었으며, 합병증이 없는 환자에서 장기(median 17주) 경과 관찰시 경한 제한성 폐기능 장애가 남았다. 3. 흉막 삼출이 심한 정도에 따라 FVC, $FEV_1$ 및 TLC가 유사한 정도로 제한되며 이에 따라 산소 분압도 상대적으로 저하되었다. 4. 증상 발현 기간이 1주 이내인 경우와 주소가 호흡곤란인 경우 폐기능 장애가 가장 심하였다. 5. Flow-Volume Curve 에서 흉막천자 후 Lung Volume이 큰 부위에서 작은 부위보다 Flow Rate가 상대적으로 증가하는 양상을 보였으며 말기 호흡으로 갈수록 영향을 적게 받았다. 6. 초회 천자량과 $FEV_1$(r=0.47), FVC(r=0.44), 및 TLC(r=0.39) 의 호전된 변화량과는 유의한 상관관계를 보였으며 흉막염 1L천자시 $FEV_1$은 0.44L, FVC는 0.41L, TLC는 0.73L의 호전이 예측된다. 결론 : 흉막염은 제한성 폐기능 장애를 야기시키며 소기도 뿐 아니라 대기도의 기능 장애도 유발시키고, 흉막천자 후 점차로 호전되어 회복 후에는 경한 제한성 폐기능 장애를 남긴다.

• Tuberculosis and Respiratory Diseases
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• 제61권4호
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• pp.356-365
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• 2006

연구배경: 패혈증에서 혈중 스테로이드 농도는 유의한 예후인자로서 알려져 있다. 또한 최근에는 이러한 스테로이드의 절대적 및 상대적 결핍 현상이 알려지고 있으며, 이는 스테로이드 보충 치료의 지표로도 이용되고 있다. 본 연구에서는 패혈증 환자에서 혈중 스테로이드 농도, 24시간 뇨 스테로이드 양 및 상대적 부신결핍의 임상적 의의와 기타 패혈증의 혈중 지표와의 연관성에 대하여 알아보고자 하였다. 방 법: 패혈증 환자 26예를 대상으로 초기 혈중 스테로이드와 ACTH, ADH, lactate 등의 농도를 측정하고 24시간 뇨 유리 코티졸 양을 측정하였으며, rapid ACTH stimulation test를 시행하였다. 결 과: 패혈증 환자들에서 사망군은 생존군에 비해 기저 무작위 혈청 코티졸 농도가 유의하게 증가되어 있었다. 중증패혈증 환자들에서 24시간 뇨 유리 코티졸은 경증패혈증 환자군에 비해 유의하게 증가되어 있었다. 혈청 코티졸 농도는 ADH, lactate농도와 유의한 상관관계를 나타내었고, 24시간 뇨 유리 코티졸은 혈청 코티졸, lactate 농도와 유의한 상관관계를 보였다. 상대적 부신결핍의 정도는 혈청 코티졸, ADH, lactate 농도와 상관성이 있었다. 결 론: 패혈증 환자들에서 혈청 코티졸 농도 및 24시간 뇨 유리 코티졸은 유의한 예후평가인자로서 나타났으며, 기타 예후 인자들과 유의한 상관성을 보였다. 상대적 부신 결핍의 정도도 유의한 중증도의 지표로 나타났다.

• Tuberculosis and Respiratory Diseases
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• 제67권2호
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• pp.135-139
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• 2009

Human metapneumovirus (hMPV) is a recently recognized human respiratory pathogen, which is known to be associated with upper and lower respiratory tract infections mainly in children, immunocompromised patients, and the elderly. The clinical manifestations of hMPV infections are similar to those of the human respiratory syncytial virus infection, which range from mild upper respiratory tract infection to severe bronchiolitis and pneumonia. Recently, hMPV has come to be thought of as the cause a similar spectrum of disease in adults as that seen in children; however, most of the reports of hMPV infections have focused on infection in children. We report a case of severe hMPV pneumonia requiring mechanical ventilation in an immunocompetent adult in Korea.

• Tuberculosis and Respiratory Diseases
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• 제68권5호
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• pp.259-266
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• 2010

Background: Pulmonary tuberculosis (TB), requiring the intensive care unit (ICU) care, has been a high-mortality condition until now. In the present study, we aimed to investigate clinical features and parameters associated with TB mortality. Methods: From August 2003 to December 2008, patients with microbiologically or histologically confirmed pulmonary TB then admitted to the ICU, were retrospectively enrolled into the study. Upon enrollment, their medical records were reviewed. Results: Forty three patients (30 males, 13 females) were included and their mean age was 63.8 years (range: 17~87 years). Twelve patients died, an overall in-hospital mortality of 27.8%. The main reason for the ICU care was dyspnea or hypoxemia requiring mechanical ventilation (n=17). Other diagnoses for ICU care were hemoptysis, monitoring after procedures, neurologic dysfunction, shock, and gastrointestinal bleeding. On univariate analysis, the factors affecting the mortality were malnutrition-related parameters including low body mass index, hypoalbuminemia, lymphocytopenia, and hypocholersterolemia, as well as severity-related variables such as high acute physiology and chronic health evaluation (APACHE) score, number of involved lobes, and high C-reactive protein. In addition, respiratory failure requiring mechanical ventilation and acute respiratory distress syndrome contributed to patient fatality. It was shown on multivariate analysis that respiratory failure and hypoalbuminemia were significantly independent variables associated with the mortality. Conclusion: Acute respiratory failure is the most common reason for the ICU care and also the most important factor in predicting poor outcome. In addition, our data suggest that the parameters associated with malnutrition could be possible factors contributing to mortality.

• Journal of Korean Neurosurgical Society
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• 제64권5호
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• pp.791-798
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• 2021

Objective : The period of mechanical ventilator (MV)-dependent respiratory failure after cervical spinal cord injury (CSCI) varies from patient to patient. This study aimed to identify predictors of MV at hospital discharge (MVDC) due to prolonged respiratory failure among patients with MV after CSCI. Methods : Two hundred forty-three patients with CSCI were admitted to our institution between May 2006 and April 2018. Their medical records and radiographic data were retrospectively reviewed. Level and completeness of injury were defined according to the American Spinal Injury Association (ASIA) standards. Respiratory failure was defined as the requirement for definitive airway and assistance of MV. We also evaluated magnetic resonance imaging characteristics of the cervical spine. These characteristics included : maximum canal compromise (MCC); intramedullary hematoma or cord transection; and integrity of the disco-ligamentous complex for assessment of the Subaxial Cervical Spine Injury Classification (SLIC) scoring. The inclusion criteria were patients with CSCI who underwent decompression surgery within 48 hours after trauma with respiratory failure during hospital stay. Patients with Glasgow coma scale 12 or lower, major fatal trauma of vital organs, or stroke caused by vertebral artery injury were excluded from the study. Results : Out of 243 patients with CSCI, 30 required MV during their hospital stay, and 27 met the inclusion criteria. Among them, 48.1% (13/27) of patients had MVDC with greater than 30 days MV or death caused by aspiration pneumonia. In total, 51.9% (14/27) of patients could be weaned from MV during 30 days or less of hospital stay (MV days : MVDC 38.23±20.79 vs. MV weaning, 13.57±8.40; p<0.001). Vital signs at hospital arrival, smoking, the American Society of Anesthesiologists classification, Associated injury with Injury Severity Score, SLIC score, and length of cord edema did not differ between the MVDC and MV weaning groups. The ASIA impairment scale, level of injury within C3 to C6, and MCC significantly affected MVDC. The MCC significantly correlated with MVDC, and the optimal cutoff value was 51.40%, with 76.9% sensitivity and 78.6% specificity. In multivariate logistic regression analysis, MCC >51.4% was a significant risk factor for MVDC (odds ratio, 7.574; p=0.039). Conclusion : As a method of predicting which patients would be able to undergo weaning from MV early, the MCC is a valid factor. If the MCC exceeds 51.4%, prognosis of respiratory function becomes poor and the probability of MVDC is increased.