• Tuberculosis and Respiratory Diseases
• /
• v.68 no.2
• /
• pp.62-66
• /
• 2010

Background: Extracorporeal membrane oxygenation (ECMO) during severe acute respiratory failure helps to recover the pulmonary function. This study evaluated our experience with veno-venous ECMO in adult patients with acute respiratory failure. Methods: From January 2007 to July 2009, ECMO was used on 54 patients. Of these 54 patients, 7 were placed on veno-venous ECMO for acute respiratory failure. The indications of ECMO were based on the lung dysfunction measured as a $PaO_2/FiO_2$ ratio <100 mm Hg on $FiO_2$ of 1.0, or an arterial blood gas pH <7.25 due to hypercapnia despite the optimal treatment. $EBS^{(R)}$, $Bio-pump^{(R)}$, and Centrifugal Rotaflow $pump^{(R)}$ were used and all cannulations were performed percutaneously via both femoral veins. When the lung function was improved, an attempt was made to wean on ECMO at moderate ventilator settings followed by decannulation. Results: Five of the 7 patients were male and the mean age was $46.3{\pm}18.3$. The causes of acute respiratory failure were 3 cases of pneumonia, 2 near-drownings, 1 pulmonary hemorrhage due to acute hepatic failure and 1 mercury vapor poisoning. The mean support time of ECMO was $17.3{\pm}13.7$ days. Of the 7 patients implanted with ECMO, 5 patients (71%) were weaned off ECMO and 3 patients (43%) survived to hospital discharge after a mean 89.6 hospital days. Conclusion: The early use of ECMO for acute respiratory failure in adults due to any cause is a good therapeutic option for those unresponsive to the optimal conventional treatments.

• Journal of Trauma and Injury
• /
• v.36 no.4
• /
• pp.441-446
• /
• 2023

Inferior vena cava (IVC) injuries, while accounting for fewer than 0.5% of blunt abdominal trauma cases, are among the most difficult to manage. Despite advancements in prehospital care, transportation, operative techniques, and perioperative management, the mortality rate for IVC injuries has remained at 20% to 66% for several decades. Furthermore, 30% to 50% of patients with IVC injuries succumb during the prehospital phase. A 65-year-old male patient, who had been struck in the back by a 500-kg excavator shovel at a construction site, was transported to a regional trauma center. Injuries to the right side of the infrarenal IVC and the right external iliac vein (EIV) were suspected, along with fractures to the right iliac bone and sacrum. The injury to the right side of the infrarenal IVC wall was repaired, and the right internal iliac artery was ligated. However, persistent bleeding around the right EIV was observed, and we were unable to achieve proximal and distal control of the right EIV. Attempts at prolonged manual compression were unsuccessful. To decrease venous return, we ligated the right superficial femoral vein. This reduced the amount of bleeding, enabling us to secure the surgical field. We ultimately controlled the bleeding, and approximately 5 L of blood products were infused intraoperatively. A second-look operation was performed 2 days later, by which time most of the bleeding sites had ceased. Orthopedic surgeons then took over the operation, performing closed reduction and external fixation. Five days later, the patient underwent definitive fixation and was transferred for rehabilitation on postoperative day 22.

• Korean Journal of Veterinary Research
• /
• v.38 no.4
• /
• pp.867-881
• /
• 1998

The studies were carried out to investigate the phygiological changes in deep hypothermia in rabbits. Sixty rabbits were continuously cooled with femoral arterio-venous bypass circulation to rectal temperatures of $34.0{\pm}0.3^{\circ}C$(mild hypothermia), $30.0{\pm}0.3^{\circ}C$(moderate hypothermia), and $25.0{\pm}0.3^{\circ}C$(deep hypothermia). The results obtained in these experiments were summarized as follows : In mild, moderate, and deep hypothermia, MAP, HR, RR, pH, $pCO_2$, $pO_2$, $Na^+$, $K^+$, HCT, PLT, glucose, L-lactate, BUN, and creatinine were analyzed. During hypothermia, a statistically significant decrease of MAP occurred between $30^{\circ}C$ and early $25^{\circ}C$(Start) of rectal temperature while significant increases occurred between baseline($38.7^{\circ}C$) and $30^{\circ}C$. Significant decreases of HR and RR were observed in the rabbits, particularly those changes appeared to similar patterns in proportion to hypothermia. Significant decreases of pH occurred between $34^{\circ}C$ and $25^{\circ}C$, and significant increases of $pO_2$ and $pCO_2$ were observed continuously in the hypothermic rabbits. The hypothermia had no significant effect on blood $Na^+$ and serum creatinine. Blood $K^+$ significantly decreased from $3.1{\pm}0.5$(baseline) to $2.6{\pm}0.6mmol/l$($34^{\circ}C$) with the hypothermia for about 30 minutes, and significantly increased from $2.4{\pm}0.6$($25^{\circ}C$(S)) to $2.7{\pm}0.5mmol/l$($25^{\circ}C$(E)) with the hypothermia for 2 hrs. HCT significantly increased to $34^{\circ}C$, thereafter, continuously increased to $25^{\circ}C$(Start, End). PLT increased to $34^{\circ}C$, thereafter, continuously decreased to $25^{\circ}C$(Start, End). Also PLT decreased significantly from 414.3($30^{\circ}C$) to $308.8{\times}103/mm^3$($25^{\circ}C$, Start). Significant increases of blood glucose and L-lactate occurred between $30^{\circ}C$ and $25^{\circ}C$ (Start, End). Slight increase of serum BUN continuously appeared with the hypothermia. These results, such as characteristic changes of the significant decrease of pH and PLT at $34^{\circ}C$, the significant decrease of MAP at $30^{\circ}C$, and the significant increase of glucose and l-lactate at $30^{\circ}C$, suggest that homeostasis of rabbits to hypothermia rapidly decreases at $34{\sim}30^{\circ}C$ of rectal temperature. Therefore, we suggest that, during the period with the rapidly decreased homeostasis, the very carefully control and treatment need to recover hypothermic animals under the circumstances of the various hypothermic experiments and emergency medicine.

• Archives of Reconstructive Microsurgery
• /
• v.14 no.1
• /
• pp.57-62
• /
• 2005

Microvascular anastomosis with suture technique is a basic skill but there are several problems such as stenosis, thrombosis and long operating time. Recently plastic surgeons have developed non-suturing mechanical coupling devices for microvascular anastomosis. The authors applied non-penetrating vascular clips (VCS clips) in the field of free flap surgery of head and neck area. Between August of 2004 and January of 2005, we performed 9 free flaps (16 vessels) using small-sized VCS clips. Four stay sutures were applied first and then VCS clips were placed between sutures about 1 mm apart. Vascular pedicle of free flap included the descending branch of lateral circumflex femoral vessel, thoracodorsal vessel, deep inferior epigastric vessel and cephalic vein. The recipient vessels were the superior thyroid artery, superficial temporal artery, internal jugular vein, external jugular vein, and superficial temporal vein. We performed 13 end-to-end (4 arteries and 9 veins) and 3 venous end-to-side anastomoses. No flap related complication occurred but we applied additional clips or sutures in two cases due to blood leakage after completion of anastomosis. Primary patency rates seemed to be good and more rapid anastomosis could be done than conventional suture technique. Advantages of VCS technique are high patency rate, low thrombogenecity and rapidity. Although the high cost of VCS instrument may be a problem, this clip could be applied safely in microvascular free tissue transfer.

• Archives of Plastic Surgery
• /
• v.34 no.4
• /
• pp.485-489
• /
• 2007

Purpose: The basic vascular anatomy and versatility of the anterolateral thigh flap was reported firstly by Song in 1984 and then by Zhang who introduced the reverse flow pattern of this flap. In this case, the authors reviewed various articles and their experiences with the distally based anterolateral thigh flap and applied it for coverage of bone-exposed wound occurred at the distal of the disarticulated knee stump. We consequently reported the reliability and resourcefulness of this flap in the difficult and limited situation. Methods: A 67-year-old-man who had suffered from arteriosclerotic obliterans inevitably underwent the disarticulation at knee joint due to clinical deterioration. He presented to our clinic with soft tissue necrosis and bone exposure at the stump. We debrided the wound and conducted the distally based anterolateral thigh island flap by transecting proximal portion of descending branch of the lateral circumflex femoral artery and the $14{\times}10cm$ sized flap was transferred to cover the defect. The pedicle measured 14 cm in length with pivot point 7 cm above the patella. Results: The postoperative course was mainly uneventful except early venous congestion for 4 days and subsequent partial skin loss. The wound was healed by secondary intension and no other sequelae had been observed during follow-up period of 12 months. Conclusion: Despite the presence of various reconstructive choices, the distally based anterolateral thigh island flap can be designed to repair soft tissue defects around the knee region, providing its reliable blood supply and long pedicle length, especially in the challenging cases.

• Journal of Chest Surgery
• /
• v.2 no.1
• /
• pp.85-104
• /
• 1969

This experiment was carried out to study the effect of rapid hemorrhage on cardiopulmonary hemodynamics of the cooled dogs. Hypothermia was induced by means of body surface cooling with ice water. Lowest esophageal temperatures ranged from 24 to 26 degree. Dogs were bled via the femoral artery into a reservoir in amount of the equivalent blood volume of 3% of body weight of the dogs. Some dogs were reinfused with the same amount of blood which they lost and others infused with 5% dextrose solution. Fourty adult mongrel dogs were divided into three groups: group I[15 dogs]; dogs were bled in normothermic state. Five dogs had no further treatment, but five dogs were reinfused with blood and five infused with 5% dextrose solution 30 minutes after bleeding. GroupII[10 dogs]; dogs were bled as group I after having been cooled. Five dogs were reinfused with blood as group I. Group III[15 dogs]; dogs were first bled and then cooled. Reinfusion procedures were the same as in group l Results were as follow: 1. The heart rate showed a slight decrease after bleeding in group I and then increased over the control level after 60 minutes. After reinfusion and infusion, the heart rate was also increased gradually and after three hours almost returned to the control level. In group II and groupIll, the heart rate decreased remarkably and after reinfusion showed a light increase but after infusion tended to decrease cotinually. 2. The stroke volume showed remarkable decrease after bleeding in group I., and recovered to control level after reinfusion and infusion,and then gradually decreased again. In group III, the stroke volume showed no remarkable change after hypothermia, and tended to decrease after reinfusion. In group III, the stroke volume decreased remarkably after bleeding and hypothermia,and clearly increased after reinfusion and infusion and then returned to control level. 3. Femoral mean pressure declined very rapidly and significantly right after bleeding and showed a remarkable prompt rise after reinfusion and infusion in group I [67% recovery]. On the other hand, it declined remarkably after hypothermia and bleeding and showed a slight rise after reinfusion and infusion in group II[46% recovery] and III [41% recovery]. 4. Venous pressure declined slightly after bleeding and tended to return to the control level after reinfusion and infusion,in group I. In group II, it did not change significantly during hypothermia but showed a slight decline after bleeding and returned toward control level after reinfusion. In group III, it declined slightly after bleeding and showed no significant change after hypothermia and rose over the control level after reinfusion and infusion. 5. Right ventricular systolic pressure decreased markedly after bleeding and then increased progressively after 30 minutes. It increased after reinfusion and infusion as well, approaching the control level in group I. In group II, it showed no significant change during hypothermia, but decreased remarkably after bleeding and then returned to near control level after reinfusion. In group III, it was decreased markedly after bleeding but did not change significantly during hypothermia and showed a slight increase after reinfusion. 6. The respiratory rate increased gradually after bleeding and decreased gradually after reinfusion but did not return to the control level, whereas it decreased near to the control level after infusion,and tended to increase in group I. In group II, it decreased significantly after hypothermia and bleeding but returned near to the control level after reinfusion. In group III, it showed a remarkable decrease after hypothermia and increased slightly after reinfusion and infusion but did not returned to the control level. In group I, the tidal volume decreased slightly after hemorrhage, and increased gradually to near the control level after 3 hours following reinfusion.

• Journal of Chest Surgery
• /
• v.39 no.7 s.264
• /
• pp.505-510
• /
• 2006

Background: Small animal cardiopulmonary bypass (CPB) model would be a valuable tool for investigating path-ophysiological and therapeutic strategies on bypass. The main advantages of a small animal model include the reduced cost and time, and the fact that it does not require a full scale operating environment. However the rat CPB models have a number of technical limitations. Effective maintenance and control of core temperature by a heat exchanger is among them. The purpose of this study is to confirm the effect of rectal temperature maintenance using a heat exchanger of cardioplegia system in cardiopulmonary bypass model for rats. Material and Method: The miniature circuit consisted of a reservoir, heat exchanger, membrane oxygenator, roller pump, and static priming volume was 40 cc, Ten male Sprague-Dawley rats (mean weight 530 gram) were divided into two groups, and heat exchanger (HE) group was subjected to CPB with HE from a cardioplegia system, and control group was subjected to CPB with warm water circulating around the reservoir. Partial CPB was conducted at a flow rate of 40 mg/kg/min for 20 min after venous cannulation (via the internal juglar vein) and arterial cannulation (via the femoral artery). Rectal temperature were measured after anesthetic induction, a ter cannulation, 5, 10, 15, 20 min after CPB. Arterial blood gas with hematocrit was also analysed, 5 and 15 min after CPB. Result: Rectal temperature change differed between the two groups (p<0.01). The temperatures of HE group were well maintained during CPB, whereas control group was under progressive hypothermia, Rectal temperature 20 min after CPB was $36.16{\pm}0.32^{\circ}C$ in the HE group and $34.22{\pm}0.36^{\circ}C$ in the control group. Conclusion: We confirmed the effect of rectal temperature maintenance using a heat exchanger of cardioplegia system in cardiopulmonary bypass model for rats. This model would be a valuable tool for further use in hypothermic CPB experiment in rats.