• Journal of Chest Surgery
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• 제50권3호
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• pp.137-143
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• 2017

Acute complicated type B aortic dissection (TBAD) is a potentially catastrophic, life-threatening condition. If left untreated, there is a high risk of aortic rupture, irreversible organ or limb damage, or death. Several risk factors have been associated with acute complicated TBAD, including age and refractory hypertension. In the acute phase, even uncomplicated patients are more prone to develop complications if hypertension and pain are left medically untreated. Innovations in stent graft technologies have incrementally improved outcomes since their first use for this condition in 1999, though improvement is needed in mitigating periprocedural complications, adverse events, and mortality. In the past decade, endovascular repair has become the preferred treatment because of its superior outcomes to open repair and medical therapy. The Valiant Captivia Thoracic Stent Graft System is a third-generation endovascular stent graft with advancements in minimally invasive delivery, conformability to the anatomy, and the minimization of adverse sequelae. Herein, this stent graft is briefly reviewed and its 3-year outcomes are presented. Freedom from all-cause and dissection-related mortality was 79.1% and 90.0%, respectiv ely. The Valiant Captiv ia Stent Graft represents a safe, effective intervention for acute complicated TBAD. Continued surveillance is needed to verify its longer-term durability.

• Journal of Yeungnam Medical Science
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• 제32권1호
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• pp.17-21
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• 2015

Amlodipine, a calcium channel blocker of the dihydropyridine group, is commonly used in management of hypertension, angina, and myocardial infarction. Amlodipine overdose, characterized by severe hypotension, arrythmias, and pulmonary edema, has seldom been reported in Korean literature. We report on a fatal case of amlodipine intoxication with complications including rhabdomyolysis and oliguric acute kidney injury. A 70-year-old woman with a medical history of hypertension was presented at the author's hospital 6 hours after ingestion of 50 amlodipine (norvasc) tablets (total dosage 250 mg) in an attempted suicide. Her laboratory tests showed a serum creatinine level of 2.5 mg/dL, with elevated serum creatine phosphokinase and myoglobin. The patient was initially treated with fluids, alkali, calcium gluconate, glucagon, and vasopressors without a hemodynamic effect. High-dose insulin therapy was also started with a bolus injection of regular insulin (RI), followed by continuous infusion of RI and 50% dextrose with water. Despite intensive treatment including insulin therapy, inotropics, mechanical ventilation, and continuous venovenous hemodiafiltration, the patient died of refractory shock and cardiac arrest with no signs of renal recovery 116 hours after her hospital admission.

• Clinical and Experimental Pediatrics
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• 제50권11호
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• pp.1041-1048
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• 2007

Not a few patients in children and adolescents are suffering from right ventricular (RV) dysfunction resulting from various conditions such as chronic lung disease, left ventricular dysfunction, pulmonary hypertension, or congenital heart defect. The RV is different from the left ventricle in terms of ventricular morphology, myocardial contractile pattern and special vulnerability to the pressure overload. Right ventricular failure (RVF) can be evaluated in terms of decreased RV contractility, RV volume overload, and/or RV pressure overload. The management for RVF starts from clear understanding of the pathophysiology of RVF. In addition to correction of the underlying disease, management of RVF per se is very important. Meticulous control of volume status, inotropic agents, vasopressors, and pulmonary selective vasodilators are the main tools in the management of RVF. The relative importance of each tool depends on the individual clinical status. Medical assist device and surgery can be considered selectively in case of refractory RVF to optimal medical treatment.

• 대한임상독성학회지
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• 제6권1호
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• pp.45-48
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• 2008

A 57-year-old man was transferred to our emergency department with decreased mental status after organophosphate intoxication. He had a four year history of benzodiazepine and hypnotic medication use for chronic insomnia and a depressive mood disorder. He had no previous history of seizures, diabetes mellitus, and hypertension. By hospital day 5, the patient was noted to be awake and to have repetitive jerking movements involving the left upper extremity, and appeared apathetic, depressed and less responsive to external stimuli. A benzodiazepine withdrawal syndrome was subsequently apparent when he developed several generalized tonic clonic seizures and status epilepticus. Using a continuous midazolam intravenous infusion, we successfully controlled the refractory seizure without complications. We present a rare case of status epilepticus from a benzodiazepine withdrawal that developed during the treatment for organophosphate intoxication.

• Journal of Chest Surgery
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• 제27권5호
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• pp.399-401
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• 1994

We experienced one case of surgical treatment of A-V fistula between the right common iliac artery and the right common iliac vein after lumbar laminectomy. The average vascular surgeon does not have extensive experience with this disorder owing to its rarity. Arteriovenous fistula of the aorta and its major branches present an unparalleled challenge in patient care. Because of their central location, blood flow through these fistulas may be massive;the associated complications are usually dramatic, resulting in severe refractory congestive heart failure, massive venous hypertension, or extensive hemorrhage during an illfated surgical repair.For this reason, it behooves one to become well acquainted with the problem in order to avoid morbid complications and thus ensure optimal patient care.

• Journal of Chest Surgery
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• 제40권3호
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• pp.220-224
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• 2007

소아에서 체외막 산소화 장치는 중증호흡부전, 약물에 반응하지 않는 심부전, 패혈증, 폐동맥고혈압에서 뿐만 아니라 심장이식의 가교로서도 기계적인 심폐보조를 제공한다. 그렇지만 소아에서 부정맥에 의해 생긴 저심박출증에 대해 체외막 산소화 장치를 이용하여 심장보조를 시행한 증례는 많지 않다. 본 저자들은 부분 양심실 교정을 받은 엡스타인 기형에서 심실성 부정맥 때문에 순환 부전에 빠진 15세 여자 환자를 체외막 산소화 장치를 이용하여 치료하였기에 문헌 고찰과 함께 보고하는 바이다.

• Journal of Chest Surgery
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• 제35권9호
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• pp.664-667
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• 2002

선천성 심질환에 대한 개심술후 발생한 폐동맥 고혈압 위기증이 혈관확장제 등의 내과적 치료에 반응하지 않는 경우에 체외막 산소화 장치를 사용함으로써, 안정적인 산소공급의 확보를 통한 폐혈관 저항의 상승 방지, 심박출량의 상당 부분의 바이패스를 통한 폐관류압의 감소, 우심실의 용적 부하 감소 및 심실보조 기능을 통한 우심부전 및 저심박출의 예방 등의 치료 효과를 기대할 수 있다. 본 증례의 경우, 동맥관 개존증과 이차성 폐동맥 고혈압이 합병되어 있었던 37세 남자에서 수술후 발생한 폐동맥 고혈압 위기증에 대한 치료시 체외막 산소화 장치를 함께 사용하여 좋은 결과를 얻었기에 보고하는 바이다.

• 대한유전성대사질환학회지
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• 제15권1호
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• pp.9-17
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• 2015

당원병 Ia형은 glucose-6-phosphatase 효소의 결핍으로 인해 발생되는 상염색체열성 질환으로 특징적인 임상양상으로 대부분 영아기에 진단되나 증상의 경중에 따라 진단 연령이 늦어지기도 한다. 또한 환자 진단 시 유전 양식을 고려한 올바른 유전 상담과 더불어 형제, 자매에 대한 스크리닝이 중요하겠다. 본 연구는 성인기에 진단된 GSD Ia 자매에서의 임상양상의 차이를 기술하고 성인기 합병증에 대한 문헌을 고찰하여, 특히 간질환, 신부전 또는 대사성 질환으로 진료 받는 성인 환자들에서 당원병에 대한 감별과 당원병 진단 시 합병증에 대한 검사와 관리에 대해 필요성을 보고하는 바이다. 저혈당, 고지혈증, 고요산증, 젖산혈증, 대사성 산증, 기관 내 당원 축척에 대한 적절한 검사 및 약물 요법을 통해 급성 및 만성 합병증 예방과 적절한 치료를 위해 의료진의 체계적인 접근 및 노력이 필요하겠다.

• Korean Circulation Journal
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• 제53권7호
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• pp.425-451
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• 2023

Most patients with heart failure (HF) have multiple comorbidities, which impact their quality of life, aggravate HF, and increase mortality. Cardiovascular comorbidities include systemic and pulmonary hypertension, ischemic and valvular heart diseases, and atrial fibrillation. Non-cardiovascular comorbidities include diabetes mellitus (DM), chronic kidney and pulmonary diseases, iron deficiency and anemia, and sleep apnea. In patients with HF with hypertension and left ventricular hypertrophy, renin-angiotensin system inhibitors combined with calcium channel blockers and/or diuretics is an effective treatment regimen. Measurement of pulmonary vascular resistance via right heart catheterization is recommended for patients with HF considered suitable for implantation of mechanical circulatory support devices or as heart transplantation candidates. Coronary angiography remains the gold standard for the diagnosis and reperfusion in patients with HF and angina pectoris refractory to antianginal medications. In patients with HF and atrial fibrillation, longterm anticoagulants are recommended according to the CHA₂DS₂-VASc scores. Valvular heart diseases should be treated medically and/or surgically. In patients with HF and DM, metformin is relatively safer; thiazolidinediones cause fluid retention and should be avoided in patients with HF and dyspnea. In renal insufficiency, both volume status and cardiac performance are important for therapy guidance. In patients with HF and pulmonary disease, beta-blockers are underused, which may be related to increased mortality. In patients with HF and anemia, iron supplementation can help improve symptoms. In obstructive sleep apnea, continuous positive airway pressure therapy helps avoid severe nocturnal hypoxia. Appropriate management of comorbidities is important for improving clinical outcomes in patients with HF.

• Journal of Korean Neurosurgical Society
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• 제44권4호
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• pp.211-216
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• 2008

Objective : The cranioplasty and ventriculoperitoneal (VP) shunt operation have been used to treat a large cranial defect with posttraumatic hydrocephalus (PTH). The aim of this study was to evlauate the difference of outcomes between in the shunting after the cranioplasty (group 1) and the cranioplasty after the shunting (group 2) in a large flaccid cranial defect with PTH. Methods : In this study, a retrospective review was done on 23 patients undergoing the cranioplasty and VP shunt operation after the decompressive craniectomy for a refractory intracranial hypertension from 2002 to 2005. All of 23 cases had a large flaccid concave cranial defect and PTH. Ten cases belong to group 1 and 13 cases to group 2. The outcomes after operations were compared in two groups 6 months later. Results : The improvement of Glasgow outcome scale (GOS) was seen in 8 cases (80.0%) of total 10 cases in group 1, and 6 cases (46.2%) of 13 cases in group 2. Three (75.0%) of 4 cases with hemiparesis in group 1 and 3 of 6 cases (50.0%) in group 2 were improved. All cases (2 cases) with decrease of visual acuity were improved in each group. Dysphasia was improved in 3 of 5 cases (60%) in group 1 and 4 of 6 cases (66.6%) in group 2. Conclusion : These results suggest that outcomes in group 1 may be better than in group 2 for a large flaccid concave cranial defect with PTH.