• Title/Summary/Keyword: intravascular

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Temporary Closure for Sternotomy in Patient with Massive Transfusion Might Be Lethal

  • Kim, Maru;Kim, Joongsuck;Kim, Sung Jeep;Cho, Hang Joo
    • Journal of Trauma and Injury
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    • v.30 no.1
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    • pp.12-15
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    • 2017
  • A 58-year-old male visited our emergency room for multiple traumas from explosion. On initial evaluation, hemopneumoperitoneum with liver laceration (grade 4) and colon perforation was identified. Hemopericardium with cardiac tamponade was also identified. Shrapnel was detected in the right ventricle. Damage control surgery was planned due to condition of hypotension. In operation room, control over bleeding was achieved after sternotomy, pericardiotomy, and laparotomy. Massive transfusion was done during operation. After gauze packing, operation was terminated with temporary closure (TC). Sanguineous fluid was drained profusely. Disseminated intravascular coagulopathy was confirmed through laboratory findings. No extravasation was discovered at hepatic angiogram. On re-operation, there was no active bleeding but oozing from sternotomy site was identified. Bone bleeding was impossible to control. Finally, reoperation was ended after gauze packing and TC all over again. The patient could survive for only a day after re-operation.

A Case of Intestinal Hemangioma Complicated with Thrombocytopenia (Kasabach-Merritt syndrome) in Premature Infant (미숙아에서 혈소판 감소증에 의해 발견된 장 혈관종(Kasabach-Meritt 증후군) 1례)

  • Lee, Young-Jin;Bae, Sul-Hee;Song, Eun-Song;Choi, Soo-Jin-Na;Kim, Yoon-Ha;Choi, Young-Youn
    • Neonatal Medicine
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    • v.17 no.1
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    • pp.116-122
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    • 2010
  • Kasabach-Merritt syndrome is a rare thrombocytopenic consumptive coagulopathy associated with a giant hemangioma. We experienced a case of unexplained ascites with thrombocytopenia in a 32 week premature infant. An exploratory laparotomy was performed to determine the cause of the refractory ascites and thrombocytopenia. An intestinal hemangioma was found, but, surgical removal was not performed due to the extensive involvement. Hemangioma was confirmed by SPECT (single-photon emission computed tomography) and the thrombocytopenia was treated with steroid therapy. It is recommended that hemangioma of the visceral organs should be suspected when unexplained thrombocytopenia and disseminated intravascular coagulopathy persist.

Effects of Kyejibokryoughwan, Jeodangtang, Kyejibokryounghwan & Jeodangtangon on Intravascular Coagulation Induced by Endotoxin in Rats (계지복령환(桂枝茯笭丸) 저당탕(抵當湯) 및 계지복령환합저당탕(桂枝茯笭丸合抵當湯)이 Endotoxin으로 유발(誘發)된 백서(白鼠)의 혈전증(血栓症)에 미치는 영향(影響))

  • Moon, Jong-mo;Kim, Seong-Hun
    • Journal of Haehwa Medicine
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    • v.4 no.2
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    • pp.91-103
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    • 1996
  • This study was performed to prove the clinical effects of Kyejibokryoung hwan(KBH), Jeodangtang(JDT), Kyejibokryounghwan & Jeo-dangtang(KJT) by way of experimental methods. The intravascular coagulation was induced by injection of endotoxin into the caudal vein of rats. And liquid extracts of Kyejibokryounghwan, Jeodangtang, Kyejibokryounghwan & Jeodang- tang were administerd orally to the rats. Then the number of platelets, concentration of fibrinogen, FDP(fibrin-fibrinogen degradation products), prothrombin time and PTT(partial thromboplastin time) were measured. The results were obtained as follows ; 1. The number of platelets was significantly increased in KBH and KJT-treated groups in comparison with the control group. 2. Fibrinogen was significantly increased in all sample groups as compared with the control group. 3. FDP was insignificantly decreased in all sample groups but have not significant. 4. Prothrombin time was significantly shortened in JDT and KJT-treated groups as compared with the control group. 5. PTT was significantly shortened in only KJT -treated groups as compared with the control group. From the above results, it was concluded that Kyejibokryounghwan, Jeodang tang, Kyejibokryounghwan & Jeodangtang can be applied effectively in the disease of thrombosis.

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Use of succimer as an alternative antidote in copper sulfate poisoning: A case report (황산구리 중독에서 대안 해독제로의 succimer 사용 1례)

  • Han, Sang Kyoon;Park, Sung Wook;Cho, Young Mo;Wang, Il Jae;Bae, Byung Kwan;Yeom, Seok Ran;Park, Soon Chang
    • Journal of The Korean Society of Clinical Toxicology
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    • v.19 no.1
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    • pp.59-63
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    • 2021
  • Copper sulfate is widely used as a fungicide and pesticide. Acute copper sulfate poisoning is rare but potentially lethal in severe cases. Copper sulfate can lead to cellular damage of red blood cells, hepatocytes, and myocytes. Toxic effects include intravascular hemolysis, acute tubular necrosis and, rhabdomyolysis. A 76-year-old man presented with vomiting and epigastric pain. He had ingested a copper-containing fungicide (about 13.5 g of copper sulfate) while attempting suicide 2 hours prior to presentation. From day 3 at the hospital, laboratory findings suggesting intravascular hemolysis were noted with increased serum creatinine level. He was treated with a chelating agent, dimercaptosuccinic acid (succimer). His anemia and acute kidney injury gradually resolved with a 19-day regimen of succimer. Our case suggests that succimer can be used for copper sulfate poisoning when other chelating agents are not available.

Hemostatic Dysfunction in a Dog with Mammary Gland Carcinoma

  • Rankyung Jung;Hyeona Bae;ARom Cho;Young Ju Kim;Yeseul Jun;Minji Kim;Sumin Cha;Min-Jeong Kang;Tae-Sung Hwang;Hee-Chun Lee;Kyu-Woan Cho;Dong-In Jung;Dae Young Kim;DoHyeon Yu
    • Journal of Veterinary Clinics
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    • v.39 no.6
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    • pp.373-377
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    • 2022
  • Hypercoagulability is the most common coagulopathy seen in dogs with neoplasia, whereas a hypocoagulable state is relatively rare. A 16-year-old spayed female miniature Schnauzer presented with bilateral epistaxis, bilateral hindlimb swelling, and lameness. Previously, the dog was diagnosed with intermediate grade solid carcinoma after mastectomy, and then showed generalized ecchymoses on the abdomen and bilateral hindlimbs on presentation. Laboratory tests revealed a hypocoagulable state, including thrombocytopenia, hypofibrinogenemia, and delayed prothrombin and activated partial thromboplastin time. Thromboelastography demonstrated a prolonged K time with a decreased alpha angle and low maximal amplitude, reflecting a decrease in clot strength. The hypocoagulable state of disseminated intravascular coagulopathy was speculated based on the presence of an underlying tumor, clinical symptoms, and laboratory results of the hypocoagulable state. This case shows the incidence of hemostatic dysfunction as a paraneoplastic syndrome in a dog with mammary gland carcinoma.

Analysis of Coronary Artery Atheromatous Plaque by Cardiac Computed Tomographic Angiography : Retrospective Analysis of Intravascular Ultrasound Results (심장전산화단층촬영을 이용한 관상동맥 죽상경화반의 분류 : 혈관내초음파 결과를 통한 후향적 분석)

  • Choi, Jae-Sung;Han, Jae-Bok;Choi, Nam-Kil
    • The Journal of the Korea Contents Association
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    • v.12 no.10
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    • pp.349-356
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    • 2012
  • In the diagnosis of coronary artery atheromatous plaque, Cardiac computed tomography (Cardiac Computed Tomographic Angiography: CCTA) compared with IVUS(Intravascular Ultrasound: IVUS) investigate the diagnostic accuracy, Interested in CCTA atheromatous plaque in computed tomography values (Hounsfield Unit: HU) try to find out. From April 2006 to August 2008 among coronary artery disease(Coronary Artery Disease: CAD) patients with confirmed or suspicious of CAD by CCTA performed atherosclerotic plaques and found 200 patients who underwent IVUS were enrolled. 200 patients who underwent CCTA and IVUS results from the 476 plaque was found, IVUS results of the soft plaque(n; 84), fibrous plaque(n; 63), mixed plaque (n; 97), calcific plaque(n; 232). The results are classified according to the IVUS plaque in HU in the soft plaque : $53.8{\pm}10.5$, fibrous plaque : $108.1{\pm}20.0$, mixed plaque : $371.2{\pm}113.1$, and calcific plaque : $731.0{\pm}160.4$. CCTA had sensitivity of 97% and confidence interval of 95.0-98.3. This study that is the diagnosis of coronary atheromatous plaque for using CCTA, we confirm the high sensitivity and the confidence interval Based on IVUS results CCTA atheromatous plaque with HU in the analysis could be classified to characterize in the treatment of patients with CAD is expected to help.

Fabrication and Evaluation of High Frequency Ultrasound Receive Transducers for Intravascular Photoacoustic Imaging (혈관내 광음향 영상을 위한 고주파수 초음파 수신 변환기 제작 및 평가)

  • Lee, Jun-Su;Chang, Jin Ho
    • The Journal of the Acoustical Society of Korea
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    • v.33 no.5
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    • pp.300-308
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    • 2014
  • Photoacoustic imaging is a useful tool for the diagnosis of atherosclerosis because it is capable of providing anatomical and pathological information at the same time. A photoacoustic signal detector is a pivotal element to achieve high spatial resolution, so that it should have broadband spectrum with a high center frequency. Since a photoacoustic imaging probe is directly inserted into blood vessel to diagnose atherosclerosis, the total size of the photoacoustic signal detector should be less than 1 mm. The main purpose of this paper is to demonstrate that PVDF can be used as an active material for the photoacoustic signal detector with a high frequency and broadband characteristic. The photoacoustic signal detector developed in this study was a single element ultrasound transducer with an aperture of $0.5{\times}0.5mm$ and the total size of 1 mm. In the design stage, the natural focal depth was adjusted for an effective focal area to cover the region of interest, i.e., 1~5 mm in depth. This was because geometrical focusing could not be used due to the small aperture. Through a pulse-echo test, it was ascertained that the developed photoacoustic signal detector has the -6 dB bandwidth ranging between 40.1 and 112.8 MHz and the center frequency of 76.83 MHz.

Intravascular Plugging in Clinical and Experimental Coronary Artery Occlusion and Recanalization (허혈 및 재관류시 관상혈관내 혈전형성에 관한 임상 및 실험적 연구)

  • Kim, Ho-Dirk;Jung, Hye-Lim;Oh, Seung-Hwan;Rah, Bong-Jin
    • Applied Microscopy
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    • v.23 no.1
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    • pp.139-163
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    • 1993
  • Background: It has been well established and is now no longer a controversial issue that ischemia produces a series of inflammatory reactions and the ischemic myocardium cannot survive without adequate restoration of coronary flow, ie, reperfusion. Nevertheless, controversies that intravascular pluggings (IVP) by polymorphonuclear leukocytes (PMNs) or platelets may cause contractile dysfunction in ischemia and even in repefusion still remain. Accordingly, we attempted to examine the intravascular plug fomation as well as the ultrastructural changes in myocytes and microvessels and to determine the relation among them. Methods: 1) Human (n= 10, 39-63 years of age; 3 females and 7 males): left ventricular myocardium (LVM) was biopsied from chronic ischemic heart disease patient during bypass surgery. 2) Calf (Holstein-Friesian species, n=4): Circumflex branch of the left coronary artery (LCx) was occluded (ischemia) for 45 minutes and recanalized (reperfusion) for 3 and 6 hours, respectively and LVMs were biopsied after occlusion and recanalization, respectiverly. 3) Rat (Sprague-Dawley species, n=20): Left coronary artery (LCA) was occluded for 20 minutes and recanalized for an hour as the method described by Selye et al., (1960) and hearts were removed after occlusion and recanalization, respectively. 4) Pig (landrace type, n=7): Anterior ascending branch of the left coronary artery (LAD) was coccluded for 45 minutes and recanalized for 2 hours and LVMs were biopsied after occlusion and recanalization, repectively. All of the LVMs were routinely prepared for transmissiom electron microscopy. Rseults: In human, most of the LVM showed irreversible ultrastructural changes in myocytes and frequent IVPs by PMNs or platelets without any significant correlation with age or sex. In the animal LVM, myocytes showed reversible ultrastructural changes with slight variations in accordance with the species, duration of ischemia and reperfusion or site of biopsy, however, injuries were more severe in the subendocardial myocytes and IVPs by PMNs or platelets were frequently observed. Ultrastructural changes in the myocytes seemed to be gradually improved by recanalization, howerver, IVPs were still observed after recanalization. Conclusion: These results suggest that microvessels are more resistant to ischemic insult than the myocytes themselves and IVP by PMNs and platelets may play an important role to produce ischemic or reperfusion injuries. Thus, it is favorable that angioplasty is preceded by thrombolysis and it is likely that restoration of myocardial function requires relarively long period of time even after recanalization.

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A Study of Classified Comparison between Intravascular Laser Irradiation Therapy(ILIT) and Extravascular Laser Irradiation Therapy(ELIT) on Hypercholesterolemia (침습, 비침습 혈관레이저에 의한 고콜레스테롤혈증의 치료 효과 환자 유형별 비교)

  • Kwon, Mi-Jung;Kim, Min-Kyu;Heo, Sung-Woong;Youn, Hyoun-Min;Kim, Won-Il;Kwon, Jung-Nam;Kim, Young-Kyun
    • Journal of Pharmacopuncture
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    • v.9 no.2
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    • pp.141-154
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    • 2006
  • Objective : The purpose of this study was to compare and analyze the effect of ILIT and ELIT according to sex, age, disease on Hypercholesterolemia. Methods : The 73 patients who were irradiated to the Intravascular Laser and the 57 patients who were irradiated to the Extravascular Laser from 1999 to 2005 in Sam-se oriental medicine hospital were the study group. They were irradiated two or three times a week and checked total cholesterol before and after ten times of irradiation. The checked total cholesterol point, 150-199 were normal, 200-239 were borderline, over 240 were abnormal. They were classified into male and female(43 persons, 87 persons), adult and 01d(62 persons, 68 persons), cardiovascular disease and the other diseases(70 persons, 60 persons). Results : 1. Male, adult, and the other diseases groups were more effective in cholesterol reduction and in convertible change of each group than female, old, and cardiovascular disease groups, but only the convertible change of each group had statistic significance. 2. In male, old, and cardiovascular disease, ELIT was more effective than ILIT in cholesterol reduction and convertible change of each group, but this result didn't have statistic significance. 3. In female, ELIT was more effective than ILIT in cholesterol change but this result didn't have statistic significance. ILIT was more effective than ELIT in convertible change of each group and this result had statistic significance. 4. In adult and the other diseases, ILIT was more effective in cholesterol reduction, but this result didn't have statistic significance. ILIT was more effective than ELIT in convertible change of each group too and this result had statistic significance. Conclusion: It was thought to be undesirable to decide which is more effective treatment, but to be more desirable to choose one of ILIT or ELIT according to sex, age, disease than to decide it indiscriminately.

Changes of Renal Function and Treatment after CABG in Patients with Elevated Serum Creatinine (크레아티닌치가 높은 환자에서 관상동맥우회술 후 신장기능의 변화와 처치)

  • Choi Jong Bum;Lee Mi Kyuong;Lee Sam Youn
    • Journal of Chest Surgery
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    • v.38 no.2 s.247
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    • pp.146-151
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    • 2005
  • Background: Preoperative elevated serum creatinine values are associated with increased risk for both morbidity and mortality in patients undergoing on-pump coronary artery bypass surgery (CABG). We investigated the postoperative changes of renal function and proper management in the patients. Material and Method: Among 74 consecutive patients who underwent isolated on-pump CABG, 17 patients with increased serum creatinine level $(creatinine\;\geqq\;1.5\;mg/dL)$ within preoperative one week wereincluded in the study. Seven patients showed pre­operative serum creatinine level of 2.0 mg/dL or higher, and 3 of them had been undergoing hemodialysis. Preoperative hemodialysis was performed in the 3 patients due to end-stage renal failure (ESRD) the day before the operation. We started peritoneal dialysis immediately after the cardiopulmonary bypass in patients with ESRD or postoperative acute renal failure if it was necessary to remove intravascular volume and lower serum creatinine level. Result In most of the patients with CABG, postoperative serum creatinine level increased and recovered to the preoperative level at the discharge. In 2 of the 4 patients with serum creatinine level of 2.0 mg/dL or higher and 3 patients with ESRD, intravascular volume, serum creatinine level and serum electrolyte were controlled with peritoneal dialysis. Conclusion: Postoperative serum creatinine level increased transiently in most of CABG patients, and intravascular volume and serum creatinine level were controlled by peritoneal dialysis only in the patients with acute renal failure postoperatively and those depending on hemodialysis.