• 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.

• Journal of Chest Surgery
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• v.37 no.8
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• pp.711-714
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• 2004

We report a case of mature cystic teratoma of the anterior mediastinum that ruptured into the pulmonary artery requiring an emergent surgical treatment. A 39-year-old woman presented an episode of massive hemoptysis and treated with bronchial artery embolization (BAE). On the 10th day after BAE, however, she developed sudden massive hemoptysis and had a deteriorated mental status. For a definitive treatment, she underwent the left pneumonectomy and the tumor resection in the anterior mediastinum. On histologic examination, the tumor disclosed cystic structures composed of mature squamous epithelium, pilosebaceous glands, mature fat tissue, cartilage and bone tissue. Also, there was intrapulmonary hemorrhage due to left pulmonary artery invasion of the tumor.

• The Korean Journal of Blood Transfusion
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• v.29 no.3
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• pp.262-272
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• 2018

Background: Massive hemorrhage due to trauma is one of the major causes of death in trauma patients, and the quick supply of appropriate blood products is critical in order to reduce the mortality rate. We introduced a massive transfusion protocol (MTP) for safe and rapid transfusion of trauma patients. Using records collected since its adoption, we compared the characteristics of MTP applied group (MTP group) and MTP not applied group (non-MTP group) to determine whether there is an indicator for predicting patients to be treated with MTP. Methods: We retrospectively reviewed the electronic medical records and laboratory findings of patients who received massive transfusions in the trauma emergency room of a single tertiary hospital from February to August 2018. We analyzed various laboratory test results, the amount and ratio of the transfused blood products, and the time required for blood products to be released for the MTP group and the non-MTP group. Results: Of the 54 trauma patients who received massive transfusions, 31 were in the MTP group and 22 in the non-MTP group. There was no significant difference in initial vital signs (except blood pressure) and laboratory test results. Also there was no difference in the amount and ratio of blood products, but the time required for blood product release was shorter in the MTP group. Conclusion: There was no significant difference in clinical findings such as initial vital signs and laboratory test results between the MTP and non-MTP groups, but required blood products were prepared and released more quickly for the MTP group.

• Journal of Trauma and Injury
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• v.26 no.3
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• pp.233-237
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• 2013

Delayed traumatic intracerebral hemorrhage (DT-ICH) is a rare event in head trauma patients. However, it develops unexpectedly and results in very severe brain damage. Thus, close monitoring of the neurologic status is needed for every trauma patient. Sometimes, however, neurologic monitoring cannot be done because of sedation, especially in cases of abdominal surgery. In this case report, we describe the case of a 37-yr-old, male patients who had hemoperitoneum because of spleen and renal injury. At the initial operation, massive bleeding was found, so gauze-packing surgery was done first. After the first operation, we sedated the patient for about two days, after which the packed gauze was removed, and the abdominal wound was closed. Immediately after the second operation, we found pupil dilation. Emergent CT was performed. The CT revealed DT-ICH with severe brain edema and midline shifting. However, the patient condition deteriorated progressively despite emergency operation, he expired 2 days after hematoma evacuation.

• Tuberculosis and Respiratory Diseases
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• v.59 no.1
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• pp.86-92
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• 2005

Goodpasture's syndrome is a disease that is characterized by hemoptysis, anemia, and glomerulonephritis with renal failure. Goodpasture reported a case of a young man who expired as a result of a pulmonary hemorrhage and glomerulonephritis at the recovery phase after an influenza infection in 1919. In 1958, Stanton et al. described a combined case of these two diseases as Goodpasture's syndrome. Since then, antiglomerular basement membrane antibody(anti-GBM Ab) has been confirmed to play an important role in the mechanism of this syndrome, and it was reported that this syndrome was an autoimmune disease. The triad of alveolar hemorrhage, glomerulonephritis and circulating anti-GBM Ab forms the basis of a diagnosis of Goodpasture's syndrome. When patients are affected by disease, the relief of symptoms can be accomplished by eliminating the anti-GBM Ab from the circulatory system through hemodialysis, plasmapheresis and immunoabsorption. However, the patients usually die from a massive pulmonary hemorrhage when the diagnosis or treatment is delayed. The incidence of Goodpasture's syndrome is common in the western world, but it is extremely rare in Korea with only five cases being reported. In three of these cases, pulmonary hemorrhage and renal failure was the initial manifestation. Therefore, hemodialysis or plasmapheresis were absolutely essential treatments. We report a case of Goodpasture's syndrome in Korea with a normal renal function.

• Tuberculosis and Respiratory Diseases
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• v.53 no.2
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• pp.216-220
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• 2002

A 43 years old woman with a previous history of healed tuberculosis presented with a recurrent hemoptysis. On a bronchoscopy inspection, three nodular shaped mass-like lesions (0.5cm in diameter) were found on the right lower lobar bronchus. Massive hemoptysis occurred when the specimen were taken during bronchoscopy. The bleeding could not be controlled by non-surgical treatment. Consequently, she underwent a right lower lobectomy in order to control the bleeding. The patient died of respiratory failure 3 days later. A bronchoscopic biopsy revealed an abnormal blood vessel just beneath the bronchial respiratory epithelium.

• Korean Journal of Head & Neck Oncology
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• v.23 no.1
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• pp.54-57
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• 2007

Fine needle aspiration biopsy(FNAB) has been used for many decades in the diagnosis of benign and malignant tumors of thyroid gland. Complications of thyroid fine-needle aspiration biopsy(FNAB) are extremely rare. Hematoma formation is the most commonly encountered complication. However, massive intrathyroid unilateral hemorrhage and hematoma formation inducing upper airway distress rarely occurs. Here, we report two cases diagnosed as having hematoma that caused upper airway distress after FNAB for thyroid nodule.

• Journal of Korean Neurosurgical Society
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• v.49 no.6
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• pp.373-376
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• 2011

We report a case of a non traumatic spinal subdural hematoma or subarachnoid hematoma manifesting as lumbago, leg pain and bladder dysfunction that showed angiographically occult vascular malformation (AOVM). Although the spinal angiogram did not reveal any vascular abnormality, the follow-up magnetic resonance image showed AOVM. Complete surgical removal was performed due to the aggravated bladder dysfunction. This case highlights the need to consider bleeding due to spinal AOVM, even when angiography is negative.

• Journal of Korean Neurosurgical Society
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• v.42 no.5
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• pp.416-418
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• 2007

Hematomas caused by ruptured traumatic pseudoaneurysms of the middle meningeal artery (MMA) usually present with extradural hematomas, whereas intradural intraparenchymal hematomas are extremely rare. We report a case of traumatic pseudoaneurysm of the MMA giving rise to an intracerebral hematoma after head trauma. A 70-year-old man suffered a massive intracerebral temporoparietal hemorrhage after a head injury. CT angiogram of the brain revealed a large hematoma in the right middle cranial fossa extending to the right sylvian fissure. Cerebral angiogram also revealed a pseudoaneurysm of the MMA, which was successfully treated surgically. Although traumatic MMA pseudoaneurysm producing intracerebral hematoma (ICH) is rare, it should be considered as a possible cause of intracerebral hematoma.

• Journal of Chest Surgery
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• v.28 no.4
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• pp.360-364
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• 1995

Between January 1984 and January 1994, 13 patients developed mediastinitis after cardiac operations. There were 7 women and 6 men with a mean age of 24.2 years[range 0.7 - 61 . Initial operation included 7 valve replacements and 6 congenital cardiac repairs. The duration between initial operation and diagnosis was 13.5 days[range 4-57 . Organisms cultured from debridement material included S.aurus[n=9 , S.epidermidis[n=3 and Enterobacter[n=1 . Fever was the most frequent complaint and purulent drainage was noticed in 9 patients[69% . Seven patients were treated with radical debridement followed by closed irrigation. In other 6 patients, the wounds were managed by debridement, open granulation and delayed wound closure. Two hospital deaths [15.4% following open granulation method, resulted from sepsis. The 11 survivors were followed-up for 1-120 months, averaging 42 months and had healed wounds. One late death occurred due to massive hemorrhage.