• Journal of Gastric Cancer
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• 제13권2호
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• pp.121-125
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• 2013

Gastric cancer patients with acute disseminated intravascular coagulation experiences a rare but severe complication resulting in a dismal prognosis. We report a case of advanced gastric cancer complicated with disseminated intravascular coagulation with intractable tumor bleeding which was successfully treated with chemotherapy consisting of 5-fluorouracil and oxaliplatin. The patient was a 63-yearold man who complained of abdominal pain, melena, and dyspnea on 24 November 2010. We diagnosed stage IV gastric cancer complicated by disseminated intravascular coagulation. Gastric tumor bleeding was not controlled after procedures were repeated three times using gastrofiberscopy. With the patient's consent, we selected the 5-fluorouracil and oxaliplatin combination chemotherapy for treatment. After one cycle of 5-fluorouracil and oxaliplatin therapy, symptoms of bleeding improved and the disseminated intravascular coagulation process was successfully controlled. The primary tumor and multiple metastatic bone lesions were remarkably shrunken and metabolically remitted after eight cycles of chemotherapy. In spite of progression, systemic chemotherapy is effective in disease control; further, the patient gained the longest survival time among cases of gastric cancer with disseminated intravascular coagulation.

• The Korean Journal of Pain
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• 제22권1호
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• pp.52-57
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• 2009

Background: Transforaminal epidural injection (TEI) may be useful to treat unilateral pain that has a dermatomal distribution. In this approach, the needle tip can be placed closer to the dorsal root ganglion and ventral aspect of the nerve root. However many studies have reported that serious complications following TEI occurred more frequently when it was conducted at the cervical level. One of the presumptive mechanisms of the complication is intravascular injection. Therefore this study was conducted to identify the incidence of complications in response to intravascular injections at cervical segments. Methods: This study included all patients, who visited our pain clinic and had radicular symptoms or herpes zoster associated pain. All procedures were conducted under fluoroscopic guidance with contrast enhancement by one of the authors. After the ideal needle position was confirmed by biplanar fluoroscopy, the blood aspiration through the needle hub was evaluated, and a 3 ml mixture of nonionic contrast (2 ml) with normal saline (1 ml) was injected at a rate of 0.3-0.5 ml/sec continuously under real time fluoroscopic visualization. We then classified the contrast spreading pattern as neural, simultaneous neural and vascular, or vascular. Results: A total 71 cervical TEIs were performed. In 26 cases (36.6%), the contrast only spread to the nerve sheath. However, 45 cases (63.4%) showed an intravascular spreading pattern, 37 (52.1%) of which showed a neural and vascular pattern and 8 (11.3%) of which showed only a vascular pattern. Conclusions: Approximately two thirds of the cases of cervical TEI were found to lead to intravascular spreading, which is much higher than the incidence reported in previous studies.

• The Korean Journal of Pain
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• 제20권1호
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• pp.26-30
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• 2007

Background: Epidural steroid injections (ESI) are a common treatment for spinal disorders. Previous research has shown that aspiration of the syringe is not a sensitive test for placement of an intravascular needle. Serious complications have been reported from injection of steroids and local anesthetics into the vascular space. In addition to safety concerns, the efficacy may decline with partial injection outside the desired epidural location. We hypothesized that incidence of vascular problems is increased in patients who undergo spine surgery compared with the patients who don't undergo spine surgery. We investigated the incidence of vascular problems during lumbosacral transforaminal ESI and we compared the difference of vascular problems between the patients who undergo spinal surgery and those patients who don't undergo spinal surgery. Methods: Two hundreds and three patients were consecutively recruited and they received 299 fluoroscopically guided lumbosacral transforaminal ESIs. Injection of contrast was performed under live dynamic fluoroscopy with using digital substraction analysis. The observed uptake pattern was classified into one of three categories: flashback, aspirated, and positive contrast with negative flashback and aspiration. Results: The vascular incidence rate was 20.4%. Transforaminal ESIs performed at S1 had avascular incidence rate of 27.8% compared with 17.7% for all the other lumbar injection sites. The sensitivity of spontaneous observation of blood in the needle hub or blood aspirate for predicting an intravascular injection in lumbar transforaminal ESIs was 70.4%. Conclusions: There is a high incidence of intravascular problems when performing transforaminal ESIs, and this is significantly increased in patients with previous spine surgery. Using a flash or blood aspiration to predict an intravascular injection is not sensitive therefore; a negative flash or aspiration is not reliable. Fluoroscopically guided procedures without contrast confirmation are prone to instill medications intravascularly. This finding confirms the need for not only fluoroscopic guidance, but also for contrast injection instillation when performing lumbosacral transforaminal ESIs, and especially for patients with previous spine surgery.

• Anatomy and Cell Biology
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• 제56권4호
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• pp.435-440
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• 2023

Few studies have examined the basilar venous plexus (BVP) and to our knowledge, no previous study has described its histology. The present anatomical study was performed to better elucidate these structures. In ten cadavers, the BVP was dissected. The anatomical and histological evaluation of the intraluminal trabeculae within this sinus were evaluated. Once all gross measurements were made, the clivus and overlying BVP were harvested and submitted for histological analysis. A BVP was identified in all specimens and in each of these, intraluminal trabeculae were identified. The mean number of trabeculae per plexus was five. These were most concentrated in the upper half of the clivus and were more often centrally located. These septations traveled in a posterior to anterior direction and usually, from inferiorly to superiorly however some were noted to travel horizontally. In a few specimens the trabeculae had wider bases, especially on the posterior attachment to the meningeal layer of dura mater. More commonly, the trabeculae ended in a denticulate form at their two terminal ends. The trabeculae were on average were 0.85 mm in length. The mean width of the trabeculae was 0.35 mm. These septations were consistent with the cords of Willis as are found in the lumen of some of the other intradural venous sinuses. An understanding of the internal anatomy of the BVP can aid in our understanding of venous pathology. Furthermore, this knowledge will benefit patients undergoing interventional treatments that involve the BVP.

• 대한치과마취과학회지
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• 제12권1호
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• pp.39-43
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• 2012

One of the most common procedures in dentistry is the inferior alveolar nerve block anesthesia but visual problem can occur during this procedure. Transient visual acuity decrease after inferior alveolar nerve block anesthesia can result from unintended intravascular injection. In this case report, we present ocular complication that has rarely been reported. The understanding of anatomy related to this case is discussed with suggestions for proper management of the patients. The dental management for ocular complications includes a correct diagnosis, management by understanding of patient's anatomic variations. This will prevent intravascular injection.

• Journal of Korean Neurosurgical Society
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• 제29권8호
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• pp.1107-1112
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• 2000

Recently various operative procedures including microsurgery or endovascular surgery have been increasing for the management of ischemic cerebrovascular diseases. Carotid endarterectomy(CEA), extracranial-intracranial(EC-IC) arterial bypass, embolectomy, decompressive craniectomy, arterial transposition, intravascular thrombolysis, and percutaneous transarterial angioplasty and stenting (PTAS) are available surgical modalities for ischemic stroke. This article focuses the complications and perioperative management of patients treated with CEA and carotid PTAS among various surgical managements for ischemic stroke.

• 대한영상의학회지
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• 제84권2호
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• pp.418-426
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• 2023

목적 경피적 혈관내 시술 시 급격한 분지 각도를 가지는 혈관의 선택적 진입이 어려운 경우에 활용할 수 있는 새로운 guidewire shaping 방법인 folded-loop guidewire remodeling 방법을 소개한다. 대상과 방법 0.014 inch 미세 guidewire tip을 pigtail loop 형태로 만든 후, metal introducer를 이용하여 guidewire를 microcatheter로 진입시킨다. 혈관 내에서 guidewire를 회전시키면 기존의 pigtail loop 형태로 쉽게 guidewire tip을 변형시킬 수 있다. Guidewire를 뒤로 당기면 guidewire tip이 작은 U형으로 변형되면서 분지 혈관으로 쉽게 진입된다. 결과 2019년 12월부터 2022년 1월까지 동맥 색전술 시 기존 방법으로 분지동맥의 선택적 진입이 어려웠던 64명의 환자(남/여, 49/15; 평균나이 66.8 ± 9.5세)에서 본 방법을 시행하였으며, 98%의 성공률을 확인하였다. 색전술의 적응증은 transcatheter arterial chemoembolization, 위장관 출혈, 객혈, 외상출혈, 종양출혈이었다. 결론 Folded-loop guidewire remodeling 방법은 기존의 보편적 방법으로 선택이 어려웠던 급격한 분지 각도를 가지는 혈관의 선택적 진입에 효과적인 방법이다.

• Archives of Plastic Surgery
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• 제47권5호
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• pp.404-410
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• 2020

Background Some patients who need surgery refuse a blood transfusion because of their religious beliefs or concerns about blood-borne infections. In recent years, bloodless surgery has been performed successfully in many procedures, and is therefore of increasing interest in orthognathic surgery. Methods Ten Jehovah's Witnesses who visited our bloodless surgery center for orthognathic surgery participated in this study. To maintain hemoglobin (Hb) levels above 10 g/dL before surgery, recombinant erythropoietin (rEPO) was subcutaneously administered and iron supplements were intravenously administered. During surgery, acute normovolemic hemodilution (ANH) and induced hypotensive anesthesia were used. To elevate the Hb levels to >10 g/dL after surgery, a similar method to the preoperative approach was used. Results The 10 patients comprised three men and seven women. Their average Hb level at the first visit was 11.1 g/dL. With treatment according to our protocol, the average preoperative Hb level rose to 12.01 g/dL, and the average Hb level on postoperative day 1 was 10.01 g/dL. No patients needed a blood transfusion, and all patients were discharged without any complications. Conclusions This study presents a way to manage patients who refuse blood transfusions while undergoing orthognathic surgery. rEPO and iron supplementation were used to maintain Hb levels above 10 g/dL. During surgery, blood loss was minimized by a meticulous procedure and induced hypotensive anesthesia, and intravascular volume was maintained by ANH. Our practical approach to orthognathic surgery for Jehovah's Witnesses can be applied to the management of all patients who refuse blood transfusions.

• Archives of Plastic Surgery
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• 제45권1호
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• pp.14-22
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• 2018

Background Liposuction has become one of the most frequently performed procedures in the field of aesthetic surgery. Fat embolism syndrome after liposuction can easily be overlooked or underestimated; however, occasionally, fulminating fat embolism syndrome can develop and lead to a critical situation within 2-3 days after lipoplasty. Changes over time in the amount of circulating fat particles and the histology of major organs have not yet been studied. Methods This study was conducted using 18 male Sprague-Dawley rats aged 12 weeks and weighing 500-628 g (average, 562 g). Fifteen rats were used as the experimental group and 3 as the control group. Under general anesthesia, tumescent-technique liposuction was performed at the lateral flank areas and abdomen for 1 hour. Blood, lung, and brain tissue specimens were obtained at 1 hour, 1 day, and 2 days after the liposuction procedure. Results The average number of fat particles in the blood samples was 25,960/dL at 1 hour, 111,100/dL at 24 hours, and 21,780/dL at 48 hours. The differences between study groups were statistically significant. Both intravascular and extravascular fat particles with inflammation were seen in all 15 rats, as were inflammatory cell infiltration, hemorrhage, and consolidation with shrinkage of the lung alveoli. Conclusions These results imply that there is a strong possibility of fat embolism syndrome after liposuction in real clinical practice, and the first 24-48 hours after the operation were found to be the most important period for preventing pulmonary embolism and progression to fulminating fat embolism syndrome.

• 대한영상의학회지
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• 제83권6호
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• pp.1418-1425
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• 2022

고령의 만성 음주력이 있는 환자들이 지속되는 흑색변, 복통과 빈혈을 주소로 내원하였다. 입원하여 시행한 복부 전산화단층촬영상 출혈을 동반한 췌장 낭성 병변이 보였다. 저자들은 카테터 경유 혈관조영술로 명확한 활동성 출혈 소견을 확인하였으며, 동맥색전술을 시행하였다. 시술 이후 출혈 증상은 호전되었다. 저자들은 위장관 출혈의 드문 원인인 췌장염에 합병된 hemosuccus pancreaticus와 췌장대장루를 혈관중재시술을 통해 치료한 2예를 보고하고자 한다.