• Journal of Chest Surgery
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• 제27권6호
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• pp.481-482
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• 1994

Blunt cardiac trauma is typified by the injury caused by the steering wheel in automobile collision. We experienced a case of IVC rupture due to in-car TA. The operation was performed under deep hypothermia with circulatory arrest to close the ruptured site by continuous over and over suture method with 3-0 prolene.

• Journal of Trauma and Injury
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• 제35권3호
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• pp.181-188
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• 2022

Purpose: Inferior vena cava (IVC) collapse is related to hypovolemia. Sonography has been used to measure the IVC diameter, but there is variation depending on the skill of the operator and it is difficult to obtain accurate measurements in patients who have a large amount of intestinal gas or are obese. As a modality to obtain accurate measurements, we measured the diameters of the IVC and aorta on trauma computed tomography scans and investigated the correlation between the IVC to aorta ratio and the shock index in blunt trauma patients. Methods: We retrospectively analyzed the medical records of 588 trauma patients who were transferred to the regional trauma center (level 1) of Wonkang University Hospital from March 2020 to February 2021. We included trauma patients 18 years or older who met the trauma activation criteria and underwent trauma computed tomography scans with intravenous contrast within 40 minutes of admission. The shock index was calculated from vital signs before trauma computed tomography scan, and measurements of the anteroposterior diameter of the IVC (AP), the transverse diameter of the IVC (T), and aorta were made 10 mm above the right renal vein in the venous phase. Results: Overall, 271 patients were included in this study, of whom 150 had a shock index ≤0.7 and 121 had a shock index >0.7. The T to AP ratio and AP to aorta ratio were significantly different between groups. Cutoffs were identified for the T to AP ratio and AP to aorta ratio (2.37 and 0.62, respectively) that produced clinically useful sensitivity and specificity for predicting a shock index >0.7, demonstrating moderate accuracy (T to AP ratio: area under the curve, 0.71; sensitivity, 59%; specificity, 87% and AP to aorta ratio: area under the curve, 0.70; sensitivity, 55%; specificity, 91%). Conclusions: The T to AP ratio and AP to aorta ratio are useful for predicting hemorrhagic shock in trauma patients.

• Journal of Chest Surgery
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• 제17권4호
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• pp.715-722
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• 1984

From 1978 to April 30 84 thirteen cases of cardiac injured patients were operated under general anesthesia at Department of Thoracic and Cardiovascular Surgery in Chonnam National University. These patients were divided Into two groups according to their cause of trauma: Group 1, penetrating cardiac injury and Group II, blunt cardiac injury. 1.In 7 cases of Group 1, 6 cases were stab wound and one case was gunshot wound, and among 6 cases of Group II, 3 cases traffic accident, 2 cases pedestrian, 1 case agrimotor accident. 2.The sites of cardiac injury in penetrating trauma were right ventricle mainly and the next left ventricle and in blunt trauma right ventricle, myocardial contusion, right atrium, and inferior vena cava in order. 3.In most of cases central venous pressure was elevated above 15 cmH2O and in 5 of 13 cases revealed cardiomegaly in simple chest X-ray. 4.The relationship between the condition on arrival and the time to operation is not significant. 5.Associated injuries in penetrating cardiac trauma were hemothorax, pneumothorax, laceration of lung and in blunt trauma hemothorax, sternal fracture, rib fracture and pneumothorax in order. 6.One case of gunshot injury died after operation.

• Journal of Chest Surgery
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• 제19권2호
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• pp.288-294
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• 1986

During the period from Mar. 1983 to Feb. 1986, 22 patients with vascular trauma were treated at Capital Armed General Hospital. 1] 11 patients had arterial injury alone, 6 patients had venous injury alone, and 5 patients had both arterial and venous injuries. 2] The mechanism of injury in these 22 patients was 7 penetrating non-gun shot wounds, 5 blast fragments injuries, 4 iatrogenic injuries, 4 blunt injuries, 2 gun shot wounds. 3] The method of 16 arterial repair was 5 autogenous saphenous vein graft, 8 synthetic vascular graft, 1 end to end anastomosis, 2 lateral suture. Midterm patency of 16 repairs was 100% within 1 months. 4] The method of 11 venous repair was 1 autogenous saphenous vein graft, 2 onlay vein patch, 2 ligation, 1 lateral suture. The thrombotic obstructions occurred in 4 repairs [36.4%], but they were resolved somewhat with heparinization. 5] Uncommon cases of false aneurysm of internal carotid artery and laceration of retrohepatic inferior vena cava were summarized.

• Journal of Chest Surgery
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• 제9권1호
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• pp.63-68
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• 1976

Cardiac injury is a relatively uncommon entity, which calls for emergency surgical treatment. During the period from 1974 up to 1975, three cases of stab wound of the heart were treated in Department of Thoracic Surgery. Capital Armed Forces General Hospital among 70 chest injury cases. All of the cases had stab wounds on the heart by knife. Injured sites were found in two cases on the right ventricle, and one case on the right atrium and intrapericardial inferior vena cava. All patients were treated by thoracotomized and sutured with 000 silk for myocardial stab wounds. One of these died of cerebral hypoxia, who was resuscitated from cardiac arrest during operation. Pericardial tamponade signs were not definite except one case.

• Journal of Trauma and Injury
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• 제28권4호
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• pp.262-265
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• 2015

An arteriovenous fistula (AVF) from the renal artery following a penetrating abdominal trauma is not common. We report the case of a 19-year-old male who presented with a knife stab wound in the right upper quadrant. Due to unstable vital signs and to the protrusion of the mesentery through the stab wound, providing definite evidence of peritoneal violation, an emergent exploratory laparotomy was carried out. There were injuries at the proximal transverse mesocolon and the second portion of the duodenum, with bile leakage. There was also a mild amount of retroperitoneal hematoma near the right kidney, without signs of expansion or pulsation. The mesocolon and the duodenum were repaired. After the operation, abdominal computerized tomography (CT) was performed, which revealed contrast from the right renal artery shunting directly into the vena cava. Transcatheter arterial embolization with a coil and vascular plug was performed, and the fistula was repaired. The patient recovered completely and was discharged without complication. For further and thorough evaluation of an abdominal trauma, especially one involving the retroperitoneum, a CT scan is recommended, when possible, either prior to surgery or after surgery when the patient is stabile. Furthermore, a lateral retroperitoneal hematoma and an AVF after a penetrating trauma may not always require exploration. Sometimes, it may be safely treated non-operatively or with embolization.

• Journal of Trauma and Injury
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• 제27권3호
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• pp.89-93
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• 2014

Bile leaks are complications that are much more frequent after a high-grade liver injury than after a low-grade liver injury. In this report, we describe the management of bile leaks that were encountered after angiographic embolization in a 27-year-old man with a high-grade blunt liver injury. He had undergone an abdominal irrigation and drainage with a laparotomy on post-injury day (PID) 16 due to bile peritonitis and continuous bile leaks from percutaneous abdominal drainage. He required three percutaneous drainage procedures for a biloma and liver abscesses in hepatic segments 4, 5 and 8, as well as endoscopic retrograde cholangiopancreatography with biliary stent placement into the intrahepatic biloma via the common bile duct. We detected communication between the biloma and the bilateral intrahepatic duct by using a tubogram. Follow-up abdominal computed tomography on PID 47 showed partial thrombosis of the inferior vena cava at the suprahepatic level, and the patient received anticoagulation therapy with low molecular weight heparin and rivaroxaban. As symptomatic improvement was achieved by using conservative management, the percutaneous drains were removed and the patient was discharged on PID 82.

• Advances in pediatric surgery
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• 제13권2호
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• pp.119-126
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• 2007

Trauma is one of the leading causes of death in children. Abdominal trauma is about 10 % of all pediatric trauma. This study describes the sex and age distribution, injury mechanism, site of intraabdominal injury, management and mortality of children aged 16 years or less who suffered abdominal trauma. The hospital records of 63 patients treated for abdominal injury between March 1997 and February 2007 at the department of surgery, Inje University Pusan Paik Hospital, were analyzed retrospectively. The peak age of incidence was between 2 and 10 years (78%) and this report showed male predominance(2.7:1). The most common mechanism of blunt abdominal trauma was pedestrian traffic accident (49%). The most common injured organ was liver. More than Grade IV injury of liver and spleen comprised of 4(12%) and 5(24%), respectively. Fourteen cases (22%) had multiple organ injuries. Forty nine cases (78%) were managed nonoperatively. Three patients (4.8%) died, who had Grade IV liver injury, Grade IV spleen injury, and liver and spleen injury with combined inferior vena cava injury, respectively. All of the three mortality cases had operative management. In conclusion, the liver or spleen injury which was more than Grade 4 might lead to mortality in spite of operation, although many cases could be improved by nonoperative management.

• Journal of Chest Surgery
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• 제35권10호
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• pp.755-759
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• 2002

64세 남자가 혈뇨를 주소로 입원하여 하대정맥으로 종양 혈전이 파급된 우측 신세포암으로 진단받았다. 우신 적출술 시행 후 역행성 뇌관류하면서 심도 저체온 순환정지 하에 하대정맥 혈전 제거술을 시행하였다. 종양 혈전은 우 신에서 기원하여 하대정맥으로 자라면서 좌 신정맥의 생식선정맥 유입구까지, 위로는 간정맥 유입부까지, 아래로는 신정맥 하방 3cm까지 파급되어 있었다. 심도 저체온 순환 정지 하에서 하대정맥 손상 없이 혈전을 완전히 제거하였고 술 후 경과는 순조로웠다. 술 후 인터페론 면역 치료를 받았고 특별한 문제없이 추적관찰 중이다.

• Tuberculosis and Respiratory Diseases
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• 제42권5호
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• pp.781-786
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• 1995

간세포암에 이환된 61세 남자에서 lipiodol과 doxorubicin을 이용하여 간동맥 항암 화학 색전술을 시행하였고 3일 후 급성 호흡 부전증이 발병하였으며 임상 양상 및 방사선학적 소견상 급성 폐부종 및 폐렴에 의한 급성 폐손상에 합당하였다. 감염, 혈전 및 종괴에 의한 폐색전증, 울혈성 심부전에 의한 급성 호흡 부전증의 가능성을 배제하기 위하여 혈액, 객담 배양 검사를 시행하였으나 균주는 동정되지 않았고 복부 전산화 단층 촬영, 복부 핵자기 공명 영상, 심 초음파 등을 시행하였으나 심장이나 하대 정맥에서 종괴나 혈전을 발견할 수 없었으며 심기능은 정상이었다. 상기 소견으로 본 환자의 급성 호홉 부전증의 원인으로서 lipiodol에 의한 폐 지방전색증을 추정하게 되었다. 환자는 보전적 요법을 시행받고 증상 발현 4주 후 임상증상 및 흉부 단순 촬영상 호전을 보여 퇴원하였다. 저자 등은 lipiodol과 doxorubicin을 이용하여 간세포암의 화학색전술을 시행 후 lipiodol에 의한 폐지방 색전증이 원인인 급성 폐손상이 발생한 종례를 경험하였기에 문헌고찰과 함께 보고하는 바이다.