• Advances in pediatric surgery
• /
• 제2권1호
• /
• pp.72-76
• /
• 1996

Annular pancreas is a rare congenital anomaly with the descending duodenum encircled by a ring of pancreatic tissue, which may cause partial or complete obstruction of the duodenum. In newborn, the symptoms can be those of duodenal stasis resulting from partial intestinal obstruction secondary to some degree of duodenal stenosis. A male newborn weighing 2.0 Kg was born by C-section delivery at 37 weeks' gestation to a 27-year-old mother who had a hydramnios. He was in relatively good condition at birth except regurgitation of saliva and intermittent apnea. A plain film of the abdomen showed the double-bubble of gas filled stomach and proximal duodenum, and upper gastrointestinal series showed a dilated proximal duodenum, with a complete obstruction of the descending duodenum. Intraoperative finding revealed encirclement of the duodenal second portion by pancreatic tissue. Duodenojejunostomy was performed. After the operation, he had developed two serious complications, neonatal septicemia by Enterobacter cloacae on postoperative day 12 and systemic candidiasis on postoperative day 19, and been managed with ventilatory support, antibiotics, and antifungal agents with recovery.

• 대한기관식도과학회지
• /
• 제13권1호
• /
• pp.29-32
• /
• 2007

Background and Objectives: Improvements in the fields of neonatology and surgical subspecialities make tracheotomy possible to the younger population. But complication rates for infantile tracheotomy are significantly higher than that for the other pediatric tracheotomy. This study was designed to present our 9-year experiences of infantile tracheotomy and to evaluate the effect of several factors of complications. Materials and Methods: From 1996 through 2004, 60 tracheotomies were performed. Charts were reviewed with respect to indications for tracheotomy, underlying diseases, success rate in decannulation and length of support time until decannulation, complication and mortality rate. Results: There were 41 male patients and 19 female patients. Ventilatory support for neurological impairment(38.3%) was the leading indication for tracheotomy, followed by subglottic stenosis(36.7%), laryngomalacia(13.3%). Decannulation was accomplished in 60.0% of infants with an average of 56.5momths with tracheotomy. Complications occurred in 43.3%. There was one tracheotomy-related mortality in case of tracheal atresia. Most common complication was subglottic stenosis. Conclusion: Infantile tracheotomy had significant morbidities and its outcomes are thought to be usually related to the underlying disease and age. To prevent complication, early decannulation is advisable, and for long-term tracheotomy patients, regulation of reflux and infection may be necessary.

• 대한임상독성학회지
• /
• 제2권1호
• /
• pp.7-11
• /
• 2004

Purpose: We would evaluate the cardiovascular manifestations of the patients with acute organophosphate and carbamate poisoning in the emergency department. Methods: This was retrospectively studied with the review of patient's charts, included total 38 patients were admitted during the past two years in the emergency department of Yeungnam university hospital with the diagnosis of organophosphate or carbamate poisoning. Results: Cardiovascular complications were variously developed in many patients. Electrocardiographic findings were as follows; 4 ($10.5\%$) cardiac arrhythmias included 1 cardiac arrest caused by ventricular fibrillation, 14 ($36.8\%$) sinus tachycardias, 3 ($7.9\%$) sinus bradycardias, and 17 ($44.7\%$) normal sinus rhythms. Conduction disturbances were 23 ($60.5\%$) like as prolonged QTc, 4 ($10.5\%$) ST-T changes, 2 (5.3%) first degree AV block, and 3 ($7.9\%$) right bundle branch block were shown. Other cardiovascular complications were 22 ($57.9\%$) hypertensives, 4 ($10.5\%$) hypotensives, 15 ($39.5\%$) tachycardias, 2 ($5.3\%$) bradycardias, 18 ($47.4\%$) hypoxemics, 12 ($31.6\%$) metabolic acidosis, and 9 ($23.7\%$) pulmonary edemas. Sixteen patients ($42.1\%$) needed ventilatory support because of respiratory paralysis. No patients died in hospital and 36 ($94.7\%$) patients were alive-discharged. Conclusion: Cardiovascular complications are variously in patients with acute organophosphate and carbamate poisoning. Especially, some findings included ventricular arrhythmias, QTc prolongation, hypoxemia, acidosis, and blood pressure changes are known as major precipitating factors to increase the mortality. So, intensive support and aggressive treatment are needed in patients shown various cardiovascular manifestations in the emergency department.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• 제33권5호
• /
• pp.445-448
• /
• 2011

Mortality associated with maxillofacial infection is relatively low due to the development of antibiotics, and improved oral care. However, inappropriate treatment, delayed treatment, old age, underlying systemic disease, and drug-resistant microorganisms can potentially result in life threatening situations such as cavernous sinus thrombosis, mediastinitis, and sepsis. Sepsis is the most dangerous state with high mortality, ranging from 20~60%. The treatment of sepsis involves properly monitoring vital functions, fluid resuscitation, surgical drainage, and empirical use of high doses of antibiotics until culture results are available. Ventilatory support maybe be required as well. We encountered a 64-year-old patient who died from sepsis that developed as the result of an odontogenic infection. The initial diagnosis was right temporal, infraorbital, buccal, pterygomandibular space abscess. Despite surgical and medical supportive care, the condition progressed to sepsis and after four days the patient died due to multiple organ failure.

• 대한간호학회지
• /
• 제23권2호
• /
• pp.245-254
• /
• 1993

The purpose of this study was to identify effective methods to minimize increases in intracranial pressure(IICP ) during endotracheal suction by means of comparing two methods of hyperventilation and oxygen supply before and after endotracheal suction. In order to evaluate the effects of these two methods, the ICP during suctioning and the sustained time of IICP were measured. For hyperventilation, ambu-bagging was done 10 times for 30 seconds with a tidal volume of 800-900m1. For oxygen supply, 100 percent oxygen was supplied for 2 minutes before and after suction. The subjects for this study were 12 neurosurgical patients who had had a subarachnoid bolt inserted for ICP monitoring and they were all on mechanical ventilatory support in a surgical intensive care unit of Seoul National University Hospital from July 1, 1991 to March 31, 1992. In each patient hyperventilation was performed five times and oxygen supply was given five times and intracranial pressures were measured immediately before and every 30 seconds for 15 minutes after suction. For case assignments counterbalancing and repeated measure designs were combined. And so the total number of experiments were sixty for each group. The effects of hyperventilation and oxygen supply on the IICP and the sustained time of IICP after suction were analyzed by t-test. The results of study were as follows 1. There was a significant difference between the two groups in the increased ICP during suction (t=2.49, p=.014). 2. The sustained time of IICP after suctioning in the oxygen supply group was shorter than that in the hyperventilation group(t=2.35, p=.020) In summary, the Increase in the ICP during suction was lower and the time for the ICP to return to the presuction level was shorter in the oxygen supply group as compared to the hyperventilation group. Therefore, oxygen supply can be re commended before and after endotracheal suction.

• Parasites, Hosts and Diseases
• /
• 제51권5호
• /
• pp.551-555
• /
• 2013

Complicated malaria is mainly caused by Plasmodium falciparum, but, increasingly, Plasmodium vivax is also being reported as a cause. Since the reemergence of indigenous vivax malaria in 1993, cases of severe malaria have been steadily reported in Korea. Herein, we report a case of vivax malaria complicated by adult respiratory distress syndrome (ARDS) that was successfully managed with extracorporeal membrane oxygenation (ECMO). A 59-year-old man presented at our hospital with fever and abdominal pain, which had persisted for 10 days. On admission, the patient had impaired consciousness, shock, hypoxia and haziness in both lungs, jaundice, thrombocytopenia and disseminated intravascular coagulation, metabolic acidosis, and acute kidney injury. A peripheral blood smear and a rapid diagnostic test verified P. vivax mono-infection. Ten hours after admission, hypoxia became more severe, despite providing maximal ventilatory support. The administration of antimalarial agents, ECMO, and continuous venovenous hemofiltration resulted in an improvement of his vital signs and laboratory findings. He was discharged from the hospital 7 weeks later, without any sequelae.

• Neonatal Medicine
• /
• 제15권2호
• /
• pp.123-133
• /
• 2008

Purpose: The purpose of this study was to determine the outcomes of extremely low birth weight infants (ELBWI) who were born at the Asan Medical Center and evaluate the recent status of neonatal intensive care and associated problems. Methods:We retrospectively evaluated 120 inborn ELBWI who were admitted to the NICU of the Asan Medical Center between 2003 and 2006. The survival rate, neurodevelopmental outcomes, maternal and infant factors, and infant mordibities were evaluated and the relationships with survival and catch-up growth were investigated. Results:The survival rate of the ELBWI was 82% at a mean gestational age of 27+2 weeks, and with a mean birth weight of 801.3${\pm}$129.0 g. The duration of hospitalization was 85.7${\pm}$27.2 days, the duration of O2 use was 43.9${\pm}$35.4 days, and the duration of ventilatory support was 20.9${\pm}$20.9 days among the survivors. The incidence of respiratory distress syndrome, chronic lung disease, severe intraventricular hemorrhage, and periventricular leukomalacia were 41.8%, 61.2%, 3%, and 4%, respectively. The mean mental developmental index and psychomotor development index of Bailey Scales of Infant Development (II) at follow-up were 83.4${\pm}$18.2 and 83.3${\pm}$20.3, respectively. Among the infants who had >18 months of follow-up, 50.8% had catch-up growth at 12 months. Conclusion:The survival rate of ELBWI has improved; however, the morbidities remain high, thus indicating further efforts must be implemented to reduce morbidity and improve neurodevelopmental outcomes.

• Journal of Chest Surgery
• /
• 제29권2호
• /
• pp.239-243
• /
• 1996

역행성 호흡 운동을 방지 하고 종격동내의 구조물을 보호하는 흥곽의 기능을 고려해야 하기 때문에 흉벽 재건은 임상적으로 간단하지가 않다. 영남대 학교병원 흉부외과에서는 교통사고로 좌측 전흉부의 전층에 걸친 흉벽 결손을 가진 37세 남자 환자에게 흉벽 재건술을 시행하였다. 외상직후 변연 절제와 지혈을 위해 1차 응급 수술이 시행되었고, 수술후25일째 흉벽 재건을 위한 2차수술을 시행하였다. 흉벽재건에는 흉배동맥을 피판경으로한 광배근피판과 좌측 대퇴부로부터 피부이식이 이용되었다. 흉벽 재건 수술후 인공호흡기 보조없이 자가 호흡이 가능하였으며, 수술후 3개월에 시행한 폐기능 검사(FVC, FEV1.0)는 예측치의 80%로 나타났다. 광배근피판을 이용한 흉벽 재건의 수술후 경과는 생리학적, 해부학적 그리고 미학적으로도 만족할만 하였다.

• 대한임상독성학회지
• /
• 제16권1호
• /
• pp.1-8
• /
• 2018

Purpose: Extremely hazardous pesticides are classified as World Health Organization (WHO) hazard class Ia. However, data describing the clinical course of WHO class Ia OP (organophosphate) poisonings in humans are very scarce. Here, we compare the clinical features of patients who ingested hazard class Ia OPs. Methods: This retrospective observational case study included 75 patients with a history of ingesting ethyl p-nitrophenol thio-benzene phosphonate (EPN), phosphamidon, or terbufos. The patients were divided according to the chemical formulation of the ingested OP. Data regarding mortality and the development of complications were collected and compared among groups. Results: There were no differences in the baseline characteristics and severity scores at presentation between the three groups. No fatalities were observed in the terbufos group. The fatality rates in the EPN and phosphamidon groups were 11.8% and 28.6%, respectively. Patients poisoned with EPN developed respiratory failure later than those poisoned with phosphamidon and also tended to require longer mechanical ventilatory support than phosphamidon patients. The main cause of death was pneumonia in the EPN group and hypotensive shock in the phosphamidon group. Death occurred later in the EPN group than in the phosphamidon group. Conclusion: Even though all three drugs are classified as WHO class Ia OPs (extremely hazardous pesticides), their clinical courses and the related causes of death in humans varied. Their treatment protocols and predicted outcomes should therefore also be different based on the chemical formulation of the OP.

• Journal of Trauma and Injury
• /
• 제35권2호
• /
• pp.76-83
• /
• 2022

Purpose: Ventilator-associated pneumonia is the most common nosocomial infection in patients with mechanical ventilation. In 2013, the new concept of ventilator-associated events (VAEs) replaced the traditional concept of ventilator-associated pneumonia. We analyzed risk factors for VAE occurrence and in-hospital mortality in trauma patients who received mechanical ventilatory support. Methods: In this retrospective review, the study population comprised patients admitted to the Jeju Regional Trauma Center from January 2020 to January 2021. Data on demographics, injury characteristics, and clinical findings were collected from medical records. The subjects were categorized into VAE and no-VAE groups according to the Centers for Disease Control and Prevention/National Healthcare Safety Network VAE criteria. We identified risk factors for VAE occurrence and in-hospital mortality. Results: Among 491 trauma patients admitted to the trauma center, 73 patients who received ventilator care were analyzed. Patients with a chest Abbreviated Injury Scale (AIS) score ≥3 had a 4.7-fold higher VAE rate (odds ratio [OR], 4.73; 95% confidence interval [CI], 1.46-17.9), and those with a glomerular filtration rate (GFR) <75 mL/min/1.73 m² had 4.1-fold higher odds of VAE occurrence (OR, 4.15; 95% CI, 1.32-14.1) and a nearly 4.2-fold higher risk for in-hospital mortality (OR, 4.19; 95% CI, 1.30-14.3). The median VAE-free duration of patients with chest AIS ≥3 was significantly shorter than that of patients with chest AIS <3 (P=0.013). Conclusions: Trauma patients with chest AIS ≥3 or GFR <75 mL/min/1.73 m² on admission should be intensively monitored to detect at-risk patients for VAEs and modify the care plan accordingly. VAEs should be closely monitored to identify infections early and to achieve desirable results. We should also actively consider modalities to shorten mechanical ventilation in patients with chest AIS ≥3 to reduce VAE occurrence.