• 제목/요약/키워드: hemostasis

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Clinical Analysis of Spontaneous Hemopneumothorax (자연성 혈기흉에 관한 임상적 고찰)

  • 이양행;박동욱;조광현
    • Journal of Chest Surgery
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    • v.31 no.11
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    • pp.1076-1080
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    • 1998
  • Background: Spontaneous hemopneumothorax, occurring in 1% to 12% of patients with spontaneous pneumothorax, is a rare disorder that can potentially lead to life-threatening complications. Materials and methods: We have experienced 15 cases (2.28%) with spontaneous hemopneumothorax among 659 episodes of spontaneous pneumothorax for eight years, from 1990 to 1997, at our hospital. We studied our previously treated patients by retrospective case studies to determine the nature of optimal management. Results: There were 14 male and 1 female patients whose mean age was 27.5 years, ranging from 19 to 58. The sides with disorder were as following: right in 10 cases and left in 5, unilaterally. The amount of initial bleeding ranged from 400 to 1,500 mL and 8 patients received a homologous blood transfusion. Patients exhibited symptoms of chest pain, dyspnea, chest discomfort, and hypovolemic shock. We concluded that causes of this disease in our patients were a torn pleural adhesion (14 cases) and a rupture of vascularized bullae (1 case with an underlying intrinsic lung disease, tuberculosis). All patients underwent closed thoracostomy and had good results except for 3. One patient underwent thoracotomy within 3 days from the onset because of continuous active hemorrhage. Decortication was required in one case because of a reactive fluid collection in the pleural space, which led to impaired lung expansion. Another patient underwent thoracotomy due to a ipsilateral recurrent pneumothorax without blood collection. Conclusions: The goals of treatment include hemostasis and reexpansion of the collapsed lung. Thus, if patients arrive early at hospital, closed thoracostomy and transfusion are thought to be sufficient treatments, although early surgical repair has been considered recently.

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MILD HEMOPHILIA A DETECTED BY DELAYED BLEEDING: A CASE REPORT (지연된 출혈로 밝혀진 경증 혈우병 A에 대한 증례 보고)

  • Song, Je-Seon;Choi, Byung-Jai;Kim, Seong-Oh;Lee, Jae-Ho;Son, Heung-Gyu;Kim, Hyung-Jun;Choi, Hyung-Jun
    • The Journal of Korea Assosiation for Disability and Oral Health
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    • v.4 no.2
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    • pp.73-76
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    • 2008
  • Hemophilia A is an X-linked disorder resulting from a deficiency in factor VIII. Hemophilia A is classified into severe, moderate, and mild forms. A 12-month old boy visited for uncontrolled bleeding on the upper labial frenum area. Spontaneous bleeding occurred about 13 days ago. We sutured the wound. However, the patient returned after 6 days with large hematoma formation. Consultation to the hematologist and laboratory examination were carried out. Activated PTT was elongated and factor VIII was only 6%. He was diagnosed as mild hemophilia A. Fresh frozen plasma (FFP) was provided and hemostasis was achieved. At 5-day check-up, no more bleeding was observed. For the management of prolonged bleeding in hemophilia A patient, not only local hemostatic measures, but factor VIII replacement therapy, antifibrinolytics, and Desmopressin are also available. Mild hemophilia A often occurs without either familial or medical history. It is often first detected by dental trauma.

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Clinical Evaluation of Video-Assisted Thoracic Surgery (VATS) (비디오 흉강경 수술의 임상적 고찰)

  • 원경준;최덕영
    • Journal of Chest Surgery
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    • v.29 no.10
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    • pp.1133-1137
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    • 1996
  • From September 1994 to October 1995, we are reporting clinical results of 67 patients whom underwent video-assisted trio rabic surgery(VATS). 1. They were diagnosed as spontaneous pneumothorax In )5, diffuse interstitial lung disease in 9, empyema in 7, hemothorax in 5, malignant pleural effusion in 3, hyperhidrosis in 3, foreign body in chest cavity in 2, mesothelioma in 1, miliary tuberculosis in 1 and organizing pneumonia in 12. In pneumothorax, bullectomy in 33 and open bellectoiny in 2 due to pleural adhesion was done Hemostasis in 5, irrigation in 7, foreign body removal in 2, talcum powder insufrlation in 3, sympathectomy 3 as done. Thoracoscopic biopsy watt done In 12 3. For pneumothorax, operation was indicated as recurrent pneumothorax in 18, persistent air leak in 12, visible bullae In chest X-ray in 5. 4 Thoracoscopic biopsy was done in 12. They were interstitial pulmonary fibrosis in 9, miliary tuberculosis in 1, mesothelioma in 1, and organizing pneumonia in 1 .Among interstitial pulmonary fibrosis, usual interstitial pneumonia were 2 and diffuse interstitial pneumonia were 7. 5. Wo complication was found in 6) patients among 67 patients. The complication was found in 4 patients (2 persistent air leak, 2 contralateral lung atelectasis). We concluded that VATS was safe and beneficial in reducing postoperative complication and the role of thoracic surgery will increase markefdly.

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Dental Management in a Patient with Glanzmann's Thrombasthenia : A Case Report (글란즈만 혈소판무력증 환자의 치과적 관리)

  • Han, Miran;Kim, Jongsoo
    • Journal of the korean academy of Pediatric Dentistry
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    • v.47 no.3
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    • pp.352-358
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    • 2020
  • Glanzmann's thrombasthenia (GT) is a rare, autosomal recessive inherited congenital disorder, characterized by impaired blood coagulation due to platelet dysfunction. It was first reported by the pediatrician Glanzmann in 1918. GT affects both males and females, and it is more common in regions of the Middle East, India, and France, where intermarriage is common. It has an incidence of about 1 in 1,000,000 people. In South Korea, according to the Division of Rare Diseases, Korea Centers for Disease Control and Prevention, around 200 cases have been reported in 2018. Clinical symptoms include petechia, ecchymosis, epistaxis, and gingival bleeding. The spontaneous loss of deciduous teeth can result in excessive bleeding with that blood transfusion should be considered. Preventing hemorrhages and hemostasis are most important factors in dental treatment. Local bleeding can be controlled by compression, but platelet transfusion can be required by prolonged bleeding. Pediatric dentists can minimize the gingival bleeding by control of the oral hygiene to prevent gingivitis and dental caries. The importance of oral hygiene and periodic recall check-up should be emphasized. During dental treatment, the examination and the treatment plan of patient should be modified to prevention of hemorrhages carefully. A 6-year-old girl with GT was referred for the treatment of dental caries, and resin restoration was performed under nitrous oxide inhalation sedation. After treatment, compression was required for the bleeding control.

Inhibitory Effects of Cordycepin on Platelet Activation via Regulation of Cyclic Adenosine Monophosphate-downstream Pathway

  • Lee, Dong-Ha
    • Biomedical Science Letters
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    • v.23 no.3
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    • pp.251-260
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    • 2017
  • Platelet activation is essential at the sites of vascular injury, which leads to hemostasis through adhesion, aggregation, and secretion process. However, potent and continuous platelet activation may be an important reason of circulatory disorders. Therefore, proper regulation of platelet activation may be an effective treatment for vascular diseases. In this research, inhibitory effects of cordycepin (3'-deoxyadenosine) on platelet activation were determined. As the results, cordycepin increased cAMP and cGMP, which are intracellular $Ca^{2+}$-antagonists. In addition, cordycepin reduced collagen-elevated $[Ca^{2+}]_i$ mobilization, which was increased by a cAMP-dependent protein kinase (PKA) inhibitor (Rp-8-Br-cAMPS), but not a cGMP-protein kinase (PKG) inhibitor (Rp-8-Br-cGMPS). Furthermore, cordycepin increased $IP_3RI$ ($Ser^{1756}$) phosphorylation, indicating inhibition of $IP_3$-mediated $Ca^{2+}$ release from internal store via the $IP_3RI$, which was strongly inhibited by Rp-8-Br-cAMPS, but was not so much inhibited by Rp-8-Br-cGMPS. These results suggest that the reduction of $[Ca^{2+}]_i$ mobilization is caused by the cAMP/A-kinase-dependent $IP_3RI$ ($Ser^{1756}$) phosphorylation. In addition, cordycepin increased the phosphorylation of VASP ($Ser^{157}$) known as PKA substrate, but not VASP ($Ser^{239}$) known as PKG substrate. Cordycepin-induced VASP ($Ser^{157}$) phosphorylation was inhibited by Rp-8-Br-cAMPS, but was not inhibited by Rp-8-Br-cGMPS, and cordycepin inhibited collagen-induced fibrinogen binding to ${\alpha}IIb/{\beta}_3$, which was increased by Rp-8-Br-cAMPS, but was not inhibited by Rp-8-Br-cGMPS. These results suggest that the inhibition of ${\alpha}IIb/{\beta}_3$ activation is caused by the cAMP/A-kinase-dependent VASP ($Ser^{157}$) phosphorylation. In conclusion, these results demonstrate that inhibitory effects of cordycepin on platelet activation were due to inhibition of $[Ca^{2+}]_i$ mobilization through cAMP-dependent $IP_3RI$ ($Ser^{1756}$) phosphorylation and suppression of ${\alpha}IIb/{\beta}_3$ activation through cAMP-dependent VASP ($Ser^{157}$) phosphorylation. These results strongly indicated that cordycepin might have therapeutic or preventive potential for platelet activation-mediated disorders including thrombosis, atherosclerosis, myocardial infarction, or cardiovascular disease.

Early Clinical Experience with Transurethral Electrovaporization of the Prostate for Benign Prostatic Hyperplasia: Comparison with Transurethral Resection of the Prostate and Visual Laser Ablation of the Prostate (경요도전립선전기기화술의 초기 임상경험 : 경요도전립선절제술 및 레이저 전립선절제술과의 비교)

  • Kim, Jung-Hyun;Moon, Ki-Hak;Jung, Hee-Chang;Park, Tong-Choon
    • Journal of Yeungnam Medical Science
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    • v.15 no.2
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    • pp.297-305
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    • 1998
  • Recently, several alternatives have been attempted in the management of benign prostatic hyperplasia (BPH) to reduce morbidity of traditional transurethral resection of the prostate (TURP). Among new modalities, transurethral electrovaporization (TEVP) is considered as a promising alternative. To evaluate the safety and initial efficacy of JEVP using the roller loop electrode (ProSurg Inc. USA) on BPH patients, we compared the results of TEVP with those of TURP and visual laser ablation of the prostate (VLAP). In this study, a total of 115 patients with symptomatic BPH were underwent TEVP (n=17), TURP (n=59) or VLAP (n=39) since 1995. Before treatment, patients were evaluated with an International Prostate Symptom Score (IPSS) and the measurement of maximal uroflow rate (MFR) and postvoid residual urine (PVR). After treatment, the operative and hospital records were reviewed. The uroflowmetry and IPSS were re-evaluated 3-10 months after treatment. In clinical outcome of re-evaluation compared to the preoperative parameters, there was a clinically significant improvement in three procedures. TEVP resulted in 62% reduction in IPSS (TURP, 73% : VLAP, 69%), 84% improvement in MFR (TURP, 113% : VLAP, 91%), and 74% reduction in PVR (TURP, 88% : VLAP, 78%). TEVP had shorter duration of hospitalization and catheterization than the others. TEVP was associated with lower rates of treatment-related complication than TURP. In conclusions, TEVP is considered as a useful procedure to treat symptomatic BPH. And, the advantages of TEVP over TURP include excellent intraoperative hemostasis, lower morbidity, shorter hospital stay and simple technique. In addition the advantages over VLAP include lower cost, shorter duration of catheterization and early symptom improvement.

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Characteristics of Dental Emergency Patients at Busan Paik Hospital (부산백병원 응급실로 내원한 치과 응급환자에 대한 임상적 연구)

  • Kim, So-Hyun;Kim, Do-Young;Baek, Joon-Seok;Jung, Tae-Young;Park, Sang-Jun
    • Maxillofacial Plastic and Reconstructive Surgery
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    • v.34 no.1
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    • pp.58-64
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    • 2012
  • Purpose: Dental emergencies vary from toothaches to oral and maxillofacial traumas. Because the number of dental emergency cases has increased recently, we analyzed characteristics of patients seen during the last 2 years, in an effort to find a trend. Methods: This study was carried out with emergency room patients visiting the Department of Oral and Maxillofacial Surgery from 2009 to 2010. Results: The total number of patients studied was 1,162; the ratio of males to females was 1.73:1. The most frequent age group was 0 to 9 years, followed by 20 to 29 years. Trauma (58.7%) was the most frequent cause followed by acute toothache, oral hemorrhage, infection, and temporomandibular (TMJ) disorder. In the trauma group, injuries of soft tissue and alveolus were prevalent. The most common causes of soft tissue injury were falls, safety violations and assault. The highest incidence of emergencies was seen in patients 0 to 9 years old (41.8%). The most common causes of jaw fracture were falls, assaults, and traffic accidents in that order. In the acute toothache group, most patients had pulpitis (41.2%). In the infection group, most had buccal space abscesses (40.0%). In the hemorrhage group, post-operative bleeding cases (80.5%) were the majority, and hemostasis was obtained mostly by pressure dressings. For the TMJ disorder group, masticatory muscle disorder (65.4%) was more common than TMJ dislocation. Conclusion: In this study, trauma was the most frequent reason for patients who visited the emergency room. However, acute toothache, hemorrhage, infection and TMJ disorders were also seen frequently. Dental emergency patients could be better treated by understanding patterns of dental emergencies and performing proper diagnoses.

Treatment of Gingival Irritation Fibroma Using $CO_2$ Laser (이산화탄소 레이저($CO_2$ laser)를 이용한 치은에 발생한 자극성 섬유종의 치료)

  • Choi, Young-Chan;Park, Ju-Hyun;Ahn, Hyung-Joon
    • Journal of Oral Medicine and Pain
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    • v.35 no.2
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    • pp.119-122
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    • 2010
  • Carbondioxide($CO_2$) laser is one of the most widely employed lasers in oral soft tissue surgery because of its excellent affinity for water based soft tissues. It has some inherent advantages such as hemostasis, less postoperative swelling, reduction of bacterial population at surgical site, less need for suturing, less scarring, and less postoperative pain compared to conventional surgical therapies including the use of scalpel, diathermy, cryotherapy and electrosurgery. A 30-years-old male was presented with gingival swelling. Clinical examination revealed a well?defined pedunculated fibrotic mass on the buccal gingiva near right maxillary 1st molar. In radiographic examination, no remarkable abnormality was seen. Excisional biopsy was performed with $CO_2$ laser (continuous wave mode, 4.0W). Histological diagnosis was "Irritation fibroma". $CO_2$ laser has advantages those are suitable for surgical treatment of intraoral lesion. If appropriate training and experience are provided, the dentist would be able to manage intraoral lesions more efficiently and successfully with the use of the $CO_2$ laser.

Giant Neurofibroma on Both Buttocks (양측 엉덩이의 거대 신경섬유종)

  • Kim, Ji Hoon;Burm, Jin Sik;Kim, Yang Woo;Kang, So Ra;Kim, Hyoung Kyoung
    • Archives of Plastic Surgery
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    • v.36 no.4
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    • pp.512-515
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    • 2009
  • Purpose: Neurofibromatosis(NF) is an autosomal - dominant systemic disease. Up to fifty percent of patients with NF are reported to have concomitant vascular abnormalities. In the resection of a larger NF, the risk of uncontrolled hemorrhage is much higher due to the difficulty of hemostasis of large vessels within the tumor. We ligated the base of the giant NF with a simple loop - shaped ligation before removal of the giant NF in both buttocks. And then we could successfully reduce the amount of hemorrhage during the operation. Methods: A 46 - year - old female patient presented for giant masses of both gluteal area, which has been growing slowly for the last ten years. Each mass was about $30{\times}20cm$ in size. After designing the elliptical resection margin, we tightened the tumor base by using continuous loop - shaped suture ligation(weaving the thread up and down in a loop - shaped pattern, leaving a space of 2 cm between each loop) with a straight needle and prolene 2 - 0. After skin incision, we proceeded the dissection toward the central and inferior side of the mass obliquely while we avoided breaking large vascular sinuses. We resected the tumor in a wedged - shape. Subcutaneous tissue was sutured layer by layer and skin was closed by vertical mattress and interrupted suture. The loop - shaped ligation of the base was removed and compressive dressing was done with gauzes and elastic bandages. Results: Postoperative complications such as infection, hemorrhage, hematoma, and dehiscense did not occur. Perioperatively the patient was sufficiently transfused with five units of blood and two units of fresh frozen plasma. During the subsequent 1 year follow - up, the functional and cosmetic result was excellent. Conclusion: A continuous loop - shaped suture ligation procedure along the base of the giant NF effectively reduced the amount of hemorrhage during the operation, made dissection and ligation of vessels easily and quickly, and shorten the operating time and postoperative recovery time.

Anti-colorectal Cancer and Anti-oxidant Activities of Rubiae radix Ethanol Extract in vitro (천초근 에탄올 추출물의 항산화 효능 및 대장암 세포 억제 효과)

  • Nho, Jong Hyun;Sim, Mi Ok;Jung, Ho Kyung;Lee, Mu Jin;Jang, Ji Hun;Jung, Da Eun;Sung, Tae Kyoung;An, Byeong Kwan;Cho, Hyun Woo
    • Korean Journal of Plant Resources
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    • v.31 no.2
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    • pp.102-108
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    • 2018
  • Rubiae radix is root of Runia akane Nakai, it has been used to hemostasis and blood stasis in Korean and China. This study investigated that anti-oxidant and anti-colorectal cancer effect of ERA (ethanol extract of Rubiae radix) and WRA (water extract of Rubiae radix) using RAW 264.7 (murine macrophage from blood) and HCT-116 cells (human colorectal cancer cell line). ERA contained polyphenol ($45.77{\pm}2.03mg/g$) and flavonoid ($22.82{\pm}1.33mg/g$). $500{\mu}M$ $H_2O_2$-induced ROS generation was diminished by $500{\mu}g/m{\ell}$ ERA treatment in RAW 264.7 cells, but not WRA (125, 250, and $500{\mu}g/m{\ell}$). Moreover, caspase-3 activity and DNA fragmentation increased by $500{\mu}g/m{\ell}$ ERA treatment during apoptotic cell death in HCT-116. Results demonstrated that anti-cancer effect of ERA against human colorectal cancer cells is mediated apoptotic cell death and DNA fragmentation through caspase-3 activation. However, further study is required to what active ingredient of ERA are important for anti-oxidant and anti-colorectal cancer effect in vivo.