• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.11 no.sup2
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• pp.29-34
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• 2008

Upper gastrointestinal bleeding (UGIB) is defined as bleeding in the gastrointestinal tract where the source of bleeding is proximal to the ligament of Treitz. UGIB is uncommon, but a potentially serious lifethreatening problem in children. The clinical manifestation of UGIB in children ranges from asymptomatic microcytic anemia to hypovolemic shock. As the etiology of UGIB varies with age, it is important to be aware of the specific etiologies at different ages when assessing children with UGIB. It is imperative that each child with UGIB be evaluated carefully, including an assessment of the patient's cardiorespiratory status along with other diagnostic studies for determining the underlying cause of bleeding.

• Journal of Chest Surgery
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• v.26 no.4
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• pp.276-281
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• 1993

During the 3 years through December 1992, 118 cases of coronary bypass graft were performed at Department of Cardiothoracic Surgery, Asan Medical Center. They consisted of 80 males and 38 females with the mean age of 59. History of myocardial infarction was noted in 23 cases[20%], congestive heart failure in 11[10%], left ventricular aneurysm in 6, postinfarct VSD in 2, and mitral regurgitation in 1. The angina was stable in 13 cases, and unstable in 104 cases[89%]. Left main stem disease were 41 cases[35%], triple vessel 36[31%], double vessel 30[26%] and single vessel involvement[LAD] in 10. We performed 335 distal bypasses out of 117 cases, with single bypass in 9, double 29, triple 52, quadruple 23, and quintuple 4. Myocardial protections were cardioplegia in 29 and intermittent aortic occlusion 79 and continuous aortic perfusion 7. The ischemic time per graft was 13 minutes[intermittent aortic occlusion group] and 20 minutes [cardioplegia group] respectively, and the mean number of graft per patient is 2.85. Early mortality was 6.8% [8/117]. If we exclude the patients with LV aneurysm, the surgical mortality could be downed to 4.5% [5/111]. The causes of deaths were cardiogenic shock[6], aortic dissection[1], and neurologic complication[1]. We conclude that noncardioplegic myocardial protection may be equally beneficial or sometimes advantageous to cardioplegic technique in aortocoronary bypass graft surgery.

• Journal of Chest Surgery
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• v.20 no.4
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• pp.715-722
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• 1987

A clinical analysis was performed on 823 cases of the chest trauma experienced at department of thoracic & cardiovascular surgery, Kyung Hee University Hospital during the past 8 years from Jan, 1978 to Aug. 1986. 1. the ratio of male to female patient of the chest trauma was 3:1 in male predominance. 2. The common age groups were 3rd, 4th and 5th decades. 3. The most common causes of the chest trauma was traffic accidents [79.8%] were injured due to non-penetrating injuries and the remainders [166/823, 20.2%] were injured due to penetrating injuries 4. The frequently injured site of the chest trauma was left side of the chest [46%], and the right side was 42% 5. The most common injury from non-penetrating trauma was rib fracture [77.5%], and the incidence rate of flail chest was 59% of all cases of rib fractures. 6. The incidence rate of hemopneumothorax was 42.9% in non-penetrating traumas, and 84.3% in penetrating traumas. 7. The most common method of surgical treatment was closed tube thoracostomy [37.3%], and open thoracotomy was performed in 71 cases [8.6%]. 8. the overall mortality was 2.2%, and common causes of death were cerebral damage, respiratory insufficiency, and hypovolemic shock.

• Clinical and Experimental Pediatrics
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• v.54 no.7
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• pp.310-312
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• 2011

A preterm female infant born at 27 weeks of gestation with a birth weight of 990 g developed acute hypotonia, apnea, hypotension and bradycardia mimicking septic shock syndrome at 14h after birth. Laboratory tests indicated a severe hypermagnesemia of 45 mg/dL. The renal function, complete blood count and maternal blood concentrations of magnesium were normal, and the blood cultures were negative. The patient recovered with treatment including exchange transfusion. However, the etiology of the severe hypermagnesemia remains unknown.

• Journal of Trauma and Injury
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• v.27 no.2
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• pp.29-32
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• 2014

Pelvic bone fracture with hemodynamic instability is fatal and the mortality rate can range up to 40%. Despite the big advances in the treatment of massive bleeding and hemorrhagic shock, the mortality associated with hemodynamically unstable pelvic bone fractures remains high. The gold standard of treatment for pelvic bone fracture with hemodynamic instability has not yet been determined and is an issue of main discussion among many doctors. Retroperitoneal packing is not yet wide spread in Korea, but is a good modality for managing of massive bleeding from pelvic bone fractures when an angiography suite or an expert surgeon is not available. A vacuum-assisted closure (VAC) system can also be applied with retroperitoneal packing in the manner of damage control surgery and open abdomen surgery. We present the case of a 51-year-old male who had a pelvic bone fracture with massive bleeding. We performed retroperitoneal gauze packing with a VAC system for the first time. The postoperative vital signs of patient were immediately stable, the massive bleeding was easily and quickly controlled, and the amount of transfusion of blood components was reduced.

• Journal of Chest Surgery
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• v.37 no.7
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• pp.601-605
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• 2004

Addisonian crisis, also commonly referred to as adrenal crisis, occurs when the cortisol produced by the adrenal gland is insufficient to meet the body's needs. Pituitary apoplexy usually occurs as hemorrhagic and ischemic necrosis in the presence of a pre-existing pituitary adenoma, and is a rare sequela of cardiovascular surgery. Most pituitary apoplexy that happens in cardiovascular surgery has been known to be related to harmful effects of the cardiopulmonary bypass. The case presented herein illustrates occult pituitary apoplexy that occurred after off-pump coronary artery bypass grafting. In this patient, . the initial signs of addisonian crisis was similar to those of septic shock, and were overlooked. However, once recognized, they were reduced dramatically with standard stress-dose cortisone.

• Journal of Chest Surgery
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• v.48 no.4
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• pp.281-284
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• 2015

We present the case of a 38-year-old woman admitted to our outpatient clinic with accelerating back pain and fatigue following a kick to her back by her husband. Upon arrival, we detected ST segment elevation in the D1, aVL, and V2 leads and accelerated idioventricular rhythm. She had pallor and hypotension consistent with cardiogenic shock. We immediately performed coronary angiography and found a long dissection starting from the mid-left main coronary artery and progressing into the mid-left anterior descending (LAD) and circumflex arteries. She was then transferred to the operating room for surgery. A saphenous vein was grafted to the distal LAD. Since the patient was hypotensive under noradrenaline and dopamine infusions, she was transferred to the cardiovascular surgery intensive care unit on an extracorporeal membrane oxygenator and intra-aortic balloon pump. During follow-up, her blood pressure remained low, at approximately 60/40 mmHg, despite aggressive inotropic and mechanical support. On the second postoperative day, asystole and cardiovascular arrest quickly developed, and despite aggressive cardiopulmonary resuscitation, she died.

• Journal of Trauma and Injury
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• v.28 no.2
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• pp.83-86
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• 2015

Central venous cannulation is one of the most commonly performed procedures for critically ill patients in the emergency room. Serious complications like a rupture of subclavian artery may occur during this procedure. We report a case of successful stent graft deployment for iatrogenic ruptured subclavian artery after attempted right subclavian vein catheterization in a 31 year-old female patient with hypovolemic shock due to cervical os laceration during vaginal delivery.

• Journal of Chest Surgery
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• v.44 no.2
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• pp.186-188
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• 2011

Ventricular septal rupture (VSR) is a rare but lethal complication of myocardial infarction. The event occurs 2~8 days after an infarction and often precipitates cardiogenic shock. Post myocardial infarction VSR is known for difficult to repair. Especially, Transmural myocardial infarction involved in the posterior VSD area, exposure of the affected site is difficult and postoperative mortality rate is high. We have experienced a case of a 75-year-old female patient who suffered posterior VSD due to acute myocardial infarction, and attained good result by approaching the lesion through right atrial incision and repaired the defect by using patch closure technique.

• Journal of Chest Surgery
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• v.46 no.4
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• pp.285-288
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• 2013

Prosthetic valves are being widely used in the treatment of heart valve disease. Prosthetic valve endocarditis (PVE) is one of the most catastrophic complications seen in these patients. In particular, prosthetic valve dehiscence can lead to acute decompensation, pulmonary edema, and cardiogenic shock. Here, we discuss the medical management of late PVE in a patient with a prior history of late and redo early PVE and recurrent dehiscence. According to the present case, we can summarize the learning points as follows. A prior history of infective endocarditis increases the risk of relapse or recurrence, and these patients should be evaluated very cautiously to prevent late complications. Adequate debridement of infected material is of paramount importance to prevent relapse. A history of dehiscence is associated with increased risk of relapse and recurrent dehiscence.