An Acute Pulmonary Embolism Accompanying Greater Saphenous Vein Thrombosis / 대한내과학회지

Pulmonary embolism is most commonly related to deep vein thrombosis of the lower extremities. However, recent studies show that the thrombosis of superficial veins can also progress to deep vein thrombosis and pulmonary embolism. To our knowledge, there is no Korean report of pulmonary embolism associated with superficial vein thrombosis. We experienced an 82-year-old woman complaining of dyspnea and chest pain. On chest dynamic computed tomography (CT), pulmonary embolism was diagnosed. To evaluate the origin of the pulmonary embolism, abdominal CT, Doppler ultrasonography, and ascending venography of both lower extremities were done. We found no deep vein thrombosis, while thrombus of the proximal left greater saphenous vein was seen. We report a case of pulmonary embolism accompanying greater saphenous vein thrombosis without deep vein thrombosis.

Delayed Transfer of Major Trauma Patients Under the Current Emergency Medical System in Korea

PURPOSE: Major trauma patients should be transferred to a definitive care facility as early as possible because prompt management will prevent death. This study was designed to discover the obstacles leading to delayed transfers under the current emergency medical system in Korea and whether there are any negative outcomes associated with conducting procedures at primary care hospitals prior to transferring patients to higher levels of care. METHODS: The medical records of major trauma patients with an Injury Severity Score above 15 within the past year were reviewed. Patients were divided three groups as follows: (A) came directly to our emergency center, (B) were transferred without CT or MRI scan at the primary care hospital and (C) transferred with CT or MRI scans. The transfer time of each group were compared and analyzed statistically. Additionally, the number and type of imaging performed at the primary care hospital were analyzed. RESULTS: All qualified patients (n=276) were enrolled in this study: 121 patients in group A; 104 in group B; 51 in group C. There was a statistically significant difference in the transfer time between the three groups (p-value<0.001), and 79 (28.6%) were transferred to an emergency medical center within one hour. In group C, CT or MRI scans were performed an average of 1.86 times at the primary care hospital, and the median transfer time was 4 hours 5 minutes. CONCLUSION: Only 28.6% of the cases in the study arrived within the golden hour at a definitive care facility. Such delays are in part the result of prolonged times at the primary care hospital for radiologic examinations, such as CT or MRI scans. Major multiple trauma patients should be transferred to a definitive care facility directly or as soon as the primary survey and the resuscitation of Advanced Trauma Life Support guideline are completed at the primary care hospital.

The Clinicopathologic Characteristics of Patients with Gastric Carcinoid Tumor

PURPOSE: We wanted to analyze the clinicopathologic characteristics of patients with gastric carcinoid tumor, which is a rare gastric tumor (less than 2% of all gastric tumors). MATERIALS AND METHODS: We reviewed all the carcinoid patients who were treated from 1996 to 2006. The clinicopathologic characteristics, the treatment modalities and the survival rates were retrospectively analysed. RESULTS: There were 8 type I patients and 10 type III patients, but there were no type II patients. The mean age of onset for type I was 47.75 years and that for type III was 57.90 years. More type III patients were female, but the gender ratio of type I patients was equal at a ratio of 1:1. There were 4 cases of solitary tumor, which were all T1 except for one case, and there was neither distant metastasis nor lymph node involvement for the type T1 cases. In the 13 patients who had no metastasis, 5 underwent endoscopic mucosal resection and 8 underwent surgery, and their combined 5 year survival rate was 92.3%. For the 5 cases who had metastastses, their mean survival was 22 months and especially, 3 of them underwent palliative surgery and their median survival were 24 months (95%, +/-6.52). CONCLUSION: Higher incidence of type III gastric carcinoid tumor and less multiplicity in type I gastric tumor were identified in our study compared with previous reports. For the type III cases, there were some noteable differences compared with the Western country's survival rate for the patients who underwent palliative surgery, so physicians must pay close attention to the definite clinicopathologic characteristics of gastric carcinoid patients.

Removal of Visualized Nasal Foreign Bodies with a Clip

PURPOSE: Nasal foreign bodies in children are often encountered in emergency medicine and treated using many methods. This study was conducted to describe the benefit of a clip used in the removal of visualized nasal foreign bodies in the emergency department (ED) and in outpatient settings. METHODS: The charts of all patients who presented to the ED of our hospital with the diagnosis of a "foreign body in the nose" between January 2006 and May 2007 were reviewed. The information recorded included age, the type of foreign body, the method of extraction, the need for an otolaryngology referral, and complications. RESULTS: Eighty-two charts were reviewed. The mean patient age was 3 years; 47 patients were girls. The objects in the nose included the following: beans (25 [30.5%]), beads (23 [28.0%]), BB pellets (5 [6.1%]), buttons (4 [4.9%]), toys (4 [4.9%]), rocks (3 [3.7%]), and others. The ED physicians removed foreign bodies from 76 patients with clips (71 [86.6%]) and forceps (5 [6.1%]). The nasal foreign bodies of six patients were removed using forceps with the aid of a fiber endoscope by the otolaryngology staff. CONCLUSION: A clip with a curved hook is easy to fashion using common ED equipment, and removal of visualized foreign bodies with such a clip is relatively safe without complications.

Valor crítico da citrulina para as complicações do enxerto no transplante de intestino / Critical value of citrulline for complications of intestinal transplant graft

OBJETIVO: Analisar, numa ampla amostra, o valor crítico da citrulina que confirma a presença das principais complicações do enxerto: rejeição e infecção. MÉTODOS: Foram coletadas 2135 amostras de citrulina sérica, na forma de gota de sangue seca, de 57 doentes submetidos a transplante de intestino/multivisceral no Jackson Memorial Hospital na Universidade de Miami, de março de 2004 a abril de 2006. Todas as amostras são do pós-operatório três meses em diante, passada a conhecida curva de elevação da citrulina após a recuperação das lesões causadas pela isquemia e reperfusão do pós-transplante. RESULTADOS: Utilizando um valor limite menor que 13 µmoles/L, a sensibilidade da citrulina foi de 96,4 por cento para detectar rejeicão celular aguda (RCA) moderada ou grave. A especificidade para as complicações mais freqüentes, rejeição e infecção foi de 54 por cento-74 por cento nas crianças e 83 por cento-88 por cento nos adultos, e o valor preditivo negativo (VPN) foi > 99 por cento. CONCLUSÃO: A citrulina pode ser utilizada como método não-invasivo para avaliar a evolução do enxerto intestinal após três meses do TI. Os episódios de RCA moderado e grave podem ser afastados quando o valor da citrulina for maior que 13 µmoles/L devido ao alto valor preditivo negativo.

OBJECITIVE: A biochemical marker for detection of acute cellular rejection following small intestine transplantation has been sought. Citrulline, a non- protein amino acid synthesized mainly by functioning enterocytes, has been proposed. Trial sensitivity has been reportedly high but with low specificity. Thus, the goal was to determine, in a sufficiently large analysis, the significant value of citrulline level in the post-transplant setting, which would correlate with complications such as rejection and infection. METHODS: Since March, 2004 2,135 dried blood spot (DBS) citrulline samples were obtained from 57 small intestine transplant recipients three months or more after post-transplant, i.e., once the expected period of recovery in the citrulline levels had occurred. RESULTS: Using a <13 vs. > 13 µmoles/L cut off point, sensitivity of DBS citrulline for the detection of moderate or severe ACR was extremely high (96.4 percent). Furthermore, specificity estimates (given the absence of ACR and these particular infections), while controlling for time-to-DBS sample were reasonably high (54 percent-74 percent in children and 83 percent-88 percent in adults), and the negative predictive value (NPV) was >99 percent. CONCLUSION: Citrulline is a non-invasive marker to evaluate problems of the intestinal graft after three months post-transplant. Due to the high NPV, a moderate or severe ACR can be ruled out, based exclusively on knowledge of a high value for DBS citrulline.

Peripheral Facial Palsy Caused by Trichloroethylene Vapor Exposure

Trichloroethylene (TCE) is a halogenated hydrocarbon widely used as a solvent in industrial and household settings. This report describes an acute trichloroethylene (TCE) exposure that resulted in the development of pheripheral facial palsy, which is a very rare occurrence. Most reports of palsy symptoms involve cranial nerves, especially the trigeminal nerve. The patient complained of numbness of the left side of the face. Clinical manifestations, laboratory values and treatment are discussed. The presentation of peripheral facial palsy is very similar to Bell's palsy but has a slightly different clinical course.

A Case of Wandering Spleen in a Patient Who Presented at the ED with Mild Abdominal Pain in the Left Upper Quadrant

A wandering spleen is a rare entity characterized by incomplete fixation of the spleen by lienorenal and gastrosplenic ligaments. The spleen can migrate to the lower abdomen or pelvis and the condition can be congenital or acquired. We report a case of torsion of a wandering spleen in a patient presenting with progressing mild left upper quadrant pain.

Short Bowel Syndrome Due to Infarction of the Superior Mesenteric Artery

The syndrome of mesenteric ischemia remains clinically challenging despite decades of surgical experience, and occlusive disease involving the arteries to the viscera is associated with the life-threatening complications of intestinal infarction. Total parenteral nutrition has been shown to be an excellent treatment modality that has allowed many patients with intestinal failure to survive with a reasonable quality of life. However, only with the development of successful intestinal transplantation of the gut will the short bowel syndrome be cured. If intestinal transplantation could be performed with acceptable morbidity and mortality rates, it would offer a more physiologic and economic approach to the problem of short bowel syndrome. We report a case of short bowel syndrome due to infarction of the superior mesenteric artery along with a review of the literature.

Pancreas-Intestinal Transplantation in Familial Adenomatous Polyposis Patients

Familial adenomatous poliposis is autosomal, predominantly inherited, premalignant disease, which is caused by a mutation in adenomatous poliposis coli gene in chromosome 5q21. Intestinal transplantation is an evolving procedure and has become a lifesaving procedure for pediatrics and adults with intestinal failure who cannot be managed by conventional therapies. Long-term outcome and cost effectiveness continue to improve and will be comparable to those of total parenteral nutrition. The short gut syndrome is the most common indication. Pancreas transplantation, as a solid organ, vascularized graft, has im proved the quality of life for diabetic patients by establishing an insulin-independent, constant normo glycemic state and is a well-established treatment for patients with insulin-dependent diabetes. The bene ficial effect is the maintenance of normoglycemia and possibly the reversal of diabetic complications, such as vasculopathy, neuropathy, and nephropathy. We report a case of pancreas-intestinal transplantation in a familial adenomatous polyposis patient along with a review of the literature.

Current problems and perspectives of liver transplantation in Pittsburgh: Retransplantation and Split, Reduced size liver transplantation / 한국간담췌외과학회지

No abstract available.

An Experience of Axillary-Subclavian Vein Thrombosis after Left Subclavian Vein Catheterization in Polycythemia Vera

Deep venous thrombosis (DVT) of the upper extremity has been recently been recognized as being more common than previously reported (probably because of the increasingly frequent use of subclavian venous access). Since the initial descriptions of axillary-subclavian vein thrombosis more than 100 years ago, studies cites a 1.3% to 2.1% incidence of all DVT that occurs in the axillary or subclavian veins. Axillary-subclavian vein thrombosis is commonly associated with significant morbidity. The most serious aspect of morbidity and mortality is pulmonary embolization. Venography or digital subtraction studies are most reliable in allowing detection of thrombosis and Duplex imaging of vein is useful in following the course and assessing the effect of treatment. Early diagnosis and initiation of treatment before thrombus organization are important for successful outcome. Polycythemia vera are at an especially high risk for both thrombotic and hemorrhghic events and postoperative complications. We report a case of axillary-subclavian vein thrombosis after left subclavian vein catheterization in polycythemia vera.

Mesenteric Cysts Report on three cases and review of the literature

A mesenteric cyst is an uncommon cause of a palpable abdominal mass. Such cysts occur along the Gastrointestinal(G-I) tract, from the duodenum to the rectum and are commonly found in the mesentery of small bowel rather than in the mesocolon. They can present themselves as chronic abdominal pain, an abdominal mass, and abdominal pain, and the most common physical finding is an abdominal mass which is movable transversely but not longitudinally. Diagnostic aids include abdominal computed tomography and ultrasound. An upper gastrointestinal series, barium enema, and intravenous pyelogram exclude GI and genitourinary cysts and tumors. Complete excision of the cyst, including a bowel resection, if necessary, is the treatment of choice and it has excellent postoperative results. The authors experienced three new cases of mesenteric cysts from March 1986 to July 1997 in Chonbuk National University Hospital. These cases are reported in this paper, along with a review of the literature on mesenteric cysts.

Retroperitoneal, Mesenteric and Omental Cysts

Retroperitoneal, mesenteric, and omental cysts are rare intra-abdominal tumors. The most common symptom and physical finding is abdominal pain and a smooth, nontender, mobile, palpable mass. With increasing availability of ultrasound and computed tomography, the preoperative diagnosis of intra-abdominal cyst is being made more frequently. The upper gastrointestinal(GI) series, barium enema, and intravenous pyelogram exclude GI and genitourinary cysts and tumors. However, in the past, the correct preoperative diagnosis was made in only 25% of the other previously reported cases. Complete enucleation of the cyst, including a bowel resection, if necessary, is the treatment of choice and it has excellent postoperative results. In this study, the records of 15 patients with retroperitoneal, mesenteric, and omental cysts who underwent surgery at Chonbuk National University Hospital between January 1975 and July 1997 were retrospectively reviewed. The results are as follows: 1) The peak age was past the 4th decade (53.3%), and sex ratio of females to males was 6.5 : 1. 2) An abdominal palpable mass and abdominal pain existed in 10 cases (66.6%) and 5 cases (33.3%), respectively. Other clinical symptoms were abdominal distention, nausea, vomiting, constipation, diarrhea, fever, urinary frequeny. 3) The cyst was located on small bowel mesentey in 5 cases (33.3%), transverse colon mesentery in 4 cases (27%), retroperitoneurn in 2 cases (13%), and omentum in 2 cases (13%), and most cases were single. 4) Ultrasonography and computed tomography were helpful to know the presence of intra-abdominal mass and its location and relationship to adjacent organs. 5) The most common operation methods was complete enucleation of the cyst and next best alternative would be excion of the cyst with the resection of a portion of the adjacent bowel.