• Title/Summary/Keyword: Delayed drainage

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The Utility and Benefits of External Lumbar CSF Drainage after Endovascular Coiling on Aneurysmal Subarachnoid Hemorrhage

  • Kwon, Ou-Young;Kim, Young-Joon;Kim, Young-Jin;Cho, Chun-Sung;Lee, Sang-Koo;Cho, Maeng-Ki
    • Journal of Korean Neurosurgical Society
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    • v.43 no.6
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    • pp.281-287
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    • 2008
  • Objective : Cerebral vasospasm still remains a major cause of the morbidity and mortality, despite the developments in treatment of aneurysmal subarachnoid hemorrhage. The authors measured the utility and benefits of external lumbar cerebrospinal fluid (CSF) drainage to prevent the clinical vasospasm and its sequelae after endovascular coiling on aneurysmal subarachnoid hemorrhage in this randomized study. Methods : Between January 2004 and March 2006, 280 patients with aneurysmal subarachnoid hemorrhage were treated at our institution. Among them, 107 patients met our study criteria. The treatment group consisted of 47 patients who underwent lumbar CSF drainage during vasospasm risk period (about for 14 days after SAH), whereas the control group consisted of 60 patients who received the management according to conventional protocol without lumbar CSF drainage. We created our new modified Fisher grade on the basis of initial brain computed tomography (CT) scan at admission. The authors established five outcome criteria as follows : 1) clinical vasospasm; 2) GOS score at 1-month to 6-month follow-up; 3) shunt procedures for hydrocephalus; 4) the duration of stay in the ICU and total hospital stay; 5) mortality rate. Results : The incidence of clinical vasospasm in the lumbar drain group showed 23.4% compared with 63.3% of individuals in the control group. Moreover, the risk of death in the lumbar drain group showed 2.1 % compared with 15% of individuals in the control group. Within individual modified Fisher grade, there were similar favorable results. Also, lumbar drain group had twice more patients than the control group in good GOS score of 5. However, there were no statistical significances in mean hospital stay and shunt procedures between the two groups. IVH was an important factor for delayed hydrocephalus regardless of lumbar drain. Conclusion : Lumbar CSF drainage remains to playa prominent role to prevent clinical vasospasm and its sequelae after endovascular coiling on aneurysmal subarachnoid hemorrhage. Also, this technique shows favorable effects on numerous neurological outcomes and prognosis. The results of this study warrant clinical trials after endovascular treatment in patients with aneurysmal SAH.

Spontaneous Closure of Delayed Esophageal Perforation: By temporary cervical fistulation with dual drainages (식도천공의 자연폐쇄치료[경부식도루 조성술과 이중배액법에 의한]:1예 보고)

  • Oh, Bong-Seok;Choi, Jong-Beom;Lee, Dong-Jun
    • Journal of Chest Surgery
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    • v.14 no.1
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    • pp.77-82
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    • 1981
  • The esophageal perforation is the most rapidly fatal and most serious perforation of the gastrointestinal tract. The 53 year old male patient was admitted because of substernal and epigastric pain altar esophageal bougienage for the indigestion and the difficult swallowing before about 18 hours. On esophagogram, there was the extravasation of contrast media at the right side of the lower esophagus [retrocardiac segment]. The emergency thoractotomy, debridement and suture closure with drainage were performed. But after 7 days the esophageal leakage was complicated again with pus discharge, although primary repair was done. On the 13th hospital day, the temporary cervical esophageal fistulation with dual drainages was made under general anesthesia. On the 38th day after this procedure, the esophageal leakage was closed spontaneously. On the 63rd hospital day the cervical fistulation was repaired and ever since the esophageal passage was good without leakage or swallowing difficulty.

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Anal Extrusion of Distal V-P Shunt Catheter after Double Perforation of Large Intestine

  • Jang, Hyun-Dong;Kim, Min-Su;Lee, Nam-Hyuk;Kim, Seong-Ho
    • Journal of Korean Neurosurgical Society
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    • v.42 no.3
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    • pp.232-234
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    • 2007
  • We describe the extrusion of a ventriculoperitoneal shunt catheter from the anus after double perforation of the large bowel in a 3-year-old girl with hydrocephalus. She was admitted because the tip of the peritoneal catheter protruded 10 cm from the anus and clear cerebrospinal fluid dripped from the tip. Emergency laparotomy was performed. The distal peritoneal catheter perforated and penetrated the sigmoid colon and re-perforated into the rectal cavity. The distal peritoneal catheter was removed, the proximal catheter was exposed for external drainage, and intravenous broad-spectrum antibiotics were administered for 2 weeks. After control of infection, the shunt system was completely removed. Bowel perforation by a peritoneal catheter is a rare complication. Diagnosis is often difficult, delayed, and its incidence is likely underestimated. Most bowel perforation is the result of infection as opposed to technical errors.

Management of Mediastinitis after Open Heart Surgery (개심술후 발생한 종격동염의 치료)

  • 최세영
    • Journal of Chest Surgery
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    • v.28 no.4
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    • pp.360-364
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    • 1995
  • Between January 1984 and January 1994, 13 patients developed mediastinitis after cardiac operations. There were 7 women and 6 men with a mean age of 24.2 years[range 0.7 - 61 . Initial operation included 7 valve replacements and 6 congenital cardiac repairs. The duration between initial operation and diagnosis was 13.5 days[range 4-57 . Organisms cultured from debridement material included S.aurus[n=9 , S.epidermidis[n=3 and Enterobacter[n=1 . Fever was the most frequent complaint and purulent drainage was noticed in 9 patients[69% . Seven patients were treated with radical debridement followed by closed irrigation. In other 6 patients, the wounds were managed by debridement, open granulation and delayed wound closure. Two hospital deaths [15.4% following open granulation method, resulted from sepsis. The 11 survivors were followed-up for 1-120 months, averaging 42 months and had healed wounds. One late death occurred due to massive hemorrhage.

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Clinical Analysis of Traumatic Pyomyositis in Emergency Patients (응급실로 내원한 외상성 화농성 근염 환자의 분석)

  • Na, Ji Ung;Song, Hyoung Gon
    • Journal of Trauma and Injury
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    • v.19 no.1
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    • pp.81-88
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    • 2006
  • Purpose: Pyomyositis is a rare disease in temperature climate region. The diagnosis of pyomyositis is often delayed, and pyomyositis is often misdiagnosed in the emergency department. Methods: The medical records of 11 patients who were diagnosed as having traumatic pyomyositis in the emergency department at Samsung Medical Center in Seoul, Korea, between 2000 and 2006 were reviewed. Their clinical features, such as history, symptoms, clinical findings, duration from onset of symptoms to diagnosis, medical history, laboratory data, results of imaging studies and clinical course were collected. Results: The psoas muscles were most commonly involved. Computer tomography and magnetic resonance imaging aided in accurate diagnosis of the infection and of the extent of involvement. Incision, drainage, and antibiotics therapy eradicated the infectioin in all patients Conclusion: Pyomyositis should be a part of the differential diagnosis for patients with traumatic muscle pain. Radiologic evaluation, such as computer tomography and magnetic resonance imaging, must be considered in the diagnosis of traumatic pyomyositis.

Arthroscopic Treatment for Septic Arthritis of the Shoulders in Neonates: A Case Report

  • Park, Kyoung-Jin;Lee, Hyung-Ki
    • Clinics in Shoulder and Elbow
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    • v.19 no.3
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    • pp.163-167
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    • 2016
  • Septic arthritis in neonates is a rare condition. A failure to make an early diagnosis of septic arthritis in neonates may leave a permanent disability as a result of a delayed treatment. Thus, septic arthritis, requires a prompt diagnosis and a timely treatment especially in this subset of patients. In this case report, we describe our treatment protocol for septic arthritis and concurrent osteomyelitis in the right shoulder of a 28-day-old newborn. Using 2.4 mm wrist arthroscopy, we performed an arthroscopic irrigation and drainage, to remove intra-articular debris and inflammatory tissue, and multiple drilling. We report a satisfactory clinical outcome without any postoperative complications or side effects.

Sepsis Developed from an Odontogenic Infection (근막간극감염에 의한 패혈증 연구)

  • Jeong, Mi-Ae
    • Proceedings of the KAIS Fall Conference
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    • 2011.12a
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    • pp.326-329
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    • 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 micro-organisms 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.

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농업가뭄의 평가를 위한 가뭄지수의 적용성 분석

  • Park, Gi-Uk;Kim, Jin-Taek;Ju, Uk-Jong;Lee, Yong-Jik
    • KCID journal
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    • v.13 no.1
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    • pp.72-81
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    • 2006
  • The objictive of this study is to analyze regional drought using agricultural drought indicator. Toforecast and evaluate the drought, the drought indices for agriculture were applied. In the present drought preparedness plans of Ministry of Agriculture and Forestry (MAF), it is prescribed that the preparedness levels should be classified by considering the precipitation, reservoir storage, soil moisture in paddy and upland, and the growing status of crops. There are many drought index to analyze and evaluate the drought. However, these indices do not exactly explain all drought events. Thus, we select 4 drought indices to evaluate agricultural drought:reservoir storage index, 3-month delayed SPI, mean rainfall index, and dry day index. Using these ineices, six drought stages are classified. The results show that agricultural drought could be apprppriately analyzed and evaluated by agricultural drought stage and four drought indices.

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Effect of Rice Straw Application on the Tillering of Paddy Rice (볏짚의 시용(施用)이 수도(水稻)의 분벽(分蘖)에 미치는 영향(影響))

  • Huh, Beom-Lyang;Lee, Chang-Duk
    • Korean Journal of Soil Science and Fertilizer
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    • v.14 no.3
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    • pp.146-156
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    • 1981
  • This study was to observe the effect of rice straw application on the tillering of paddy rice with the varying treatments in which the amount of straw, nitrogen, applying location of rice straw and drainage were involved. The results obtained from the experiments were as follow; 1. The increased application of rice straw not only retarded the tillering of plant, but delayed the maximum tillering and heading stage. It also reduced the maturing rate. 2. The retardment of early tillering caused by the application of rice straw was not recovered by increasing nitrogen. Similarly the maximum tillering and heading stage were not influenced by the increased nitrogen application. 3. Drainage and deep application of rice straw had significant effects on reducing the retardment of early tillering. 4. Rice straw application markedly increased organic matter and potassium contents in the soil.

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Consolidation Characteristics of Soft Ground with Artesian Pressure (피압에 따른 연약지반의 압밀 거동)

  • Yun, Daeho;Kim, Jaehong;Kim, Yuntae
    • Journal of the Korean GEO-environmental Society
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    • v.17 no.2
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    • pp.31-39
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    • 2016
  • Vertical drain has usually been used to accelerate the consolidation of soft clay deposits with high moisture content. Busan thick clay deposits are subjected to artesian pressure from an aquifer in sand and gravel layers. However, effect of artesian pressure existing in drainage-installed soft ground on consolidation behaviors is not well known. This paper investigates the consolidation behavior of drainage-installed soft ground at the Nakdong river estuary with artesian pressure and without artesian pressure. A series of one-dimensional large size column test was carried out to find out the consolidation characteristics of clay. Test results indicated that total settlement of clay with artesian pressure was higher than that without artesian pressure because effective stress decreased due to upward flow. Dissipation rate of excess pore water pressure delayed and excess pore water pressure did not fully dissipate in clay layer with artesian pressure. Undrained shear strength of clay ground with artesian pressure was lower than that without artesian pressure.