Traumatic Hemothorax Caused by Thoracic Wall and Intrathoracic Injuries:Clinical Outcomes of Transcatheter Systemic Artery Embolization

Purpose@#We aimed to assess the clinical efficacy of transcatheter arterial embolization (TAE) for treating hemothorax caused by chest trauma. @*Materials and Methods@#Between 2015 and 2019, 68 patients (56 male; mean age, 58.2 years) were transferred to our interventional unit for selective TAE to treat thoracic bleeding. We retrospectively investigated their demographics, angiographic findings, embolization techniques, technical and clinical success rates, and complications. @*Results@#Bleeding occurred mostly from the intercostal arteries (50%) and the internal mammary arteries (29.5%). Except one patient, TAE achieved technical success, defined as the immediate cessation of bleeding, in all the other patients. Four patients successfully underwent repeated TAE for delayed bleeding or increasing hematoma after the initial TAE. The clinical success rate, defined as no need for thoracotomy for hemostasis after TAE, was 92.6%. Five patients underwent post-embolization thoracotomy for hemostasis. No patient developed major TAE-related complications, such as cerebral infarction or quadriplegia. @*Conclusion@#TAE is a safe, effective and minimally invasive method for controlling thoracic wall and intrathoracic systemic arterial hemorrhage after thoracic trauma. TAE may be considered for patients with hemothorax without other concomitant injuries which require emergency sur-gery, or those who undergoing emergency TAE for abdominal or pelvic hemostasis.

Traumatic Hemothorax Caused by Thoracic Wall and Intrathoracic Injuries:Clinical Outcomes of Transcatheter Systemic Artery Embolization

Purpose@#We aimed to assess the clinical efficacy of transcatheter arterial embolization (TAE) for treating hemothorax caused by chest trauma. @*Materials and Methods@#Between 2015 and 2019, 68 patients (56 male; mean age, 58.2 years) were transferred to our interventional unit for selective TAE to treat thoracic bleeding. We retrospectively investigated their demographics, angiographic findings, embolization techniques, technical and clinical success rates, and complications. @*Results@#Bleeding occurred mostly from the intercostal arteries (50%) and the internal mammary arteries (29.5%). Except one patient, TAE achieved technical success, defined as the immediate cessation of bleeding, in all the other patients. Four patients successfully underwent repeated TAE for delayed bleeding or increasing hematoma after the initial TAE. The clinical success rate, defined as no need for thoracotomy for hemostasis after TAE, was 92.6%. Five patients underwent post-embolization thoracotomy for hemostasis. No patient developed major TAE-related complications, such as cerebral infarction or quadriplegia. @*Conclusion@#TAE is a safe, effective and minimally invasive method for controlling thoracic wall and intrathoracic systemic arterial hemorrhage after thoracic trauma. TAE may be considered for patients with hemothorax without other concomitant injuries which require emergency sur-gery, or those who undergoing emergency TAE for abdominal or pelvic hemostasis.

Chemical Composition of Artemisia argyi Extract (RW0117) and Protective Effects against Gastric Lesions in vivo

In this study, we investigated the chemical profile and effects of RW0117 (Artemisia argyi 65 .5 % ethanol extract) on gastric lesions in rats. We optimized and validated a method to obtain the chemical profile of RW0117. We then investigated the antioxidant and anti-inflammatory effects in vivo, and the protective effects on gastric lesions in vivo. The IC50 of 2,2-diphenyl-1-picrylhydrazyl free radical scavenging considering the antioxidant effects of RW0117 was 166.55 μg/mL, and the IC50 of nitric oxide scavenging considering the antiinflammatory effects was 41.16 μg/mL. Oral administration of RW0117 at lower concentrations (25, 50, 100 mg/ kg) had similar or greater effects than the daily intake conversion concentration (115mg/kg) of a health functional food (Avexol® ) in the acetic acid-induced ulcer and the ethanol-induced gastric injury rat models. In addition, oral administration of RW0117 increased the expression of prostaglandin E2 , which enhances the protective effect in the gastric mucosa in the ethanol-induced gastric injury rat model. These results suggest that RW0117 may have potential therapeutic uses in the protection of the gastric mucosa.

Chemical Composition of Artemisia argyi Extract (RW0117) and Protective Effects against Gastric Lesions in vivo

In this study, we investigated the chemical profile and effects of RW0117 (Artemisia argyi 65 .5 % ethanol extract) on gastric lesions in rats. We optimized and validated a method to obtain the chemical profile of RW0117. We then investigated the antioxidant and anti-inflammatory effects in vivo, and the protective effects on gastric lesions in vivo. The IC50 of 2,2-diphenyl-1-picrylhydrazyl free radical scavenging considering the antioxidant effects of RW0117 was 166.55 μg/mL, and the IC50 of nitric oxide scavenging considering the antiinflammatory effects was 41.16 μg/mL. Oral administration of RW0117 at lower concentrations (25, 50, 100 mg/ kg) had similar or greater effects than the daily intake conversion concentration (115mg/kg) of a health functional food (Avexol® ) in the acetic acid-induced ulcer and the ethanol-induced gastric injury rat models. In addition, oral administration of RW0117 increased the expression of prostaglandin E2 , which enhances the protective effect in the gastric mucosa in the ethanol-induced gastric injury rat model. These results suggest that RW0117 may have potential therapeutic uses in the protection of the gastric mucosa.

Clinical Effects of Intra-Abdominal Pressure in Critically Ill Trauma Patients

PURPOSE@#There is increasing interest in intra-abdominal pressure (IAP) and intra-abdominal hypertension (IAH) in critically ill patients. This study investigated the effects and outcomes of elevated IAP in a trauma intensive care unit (ICU) population.@*METHODS@#Eleven consecutive critically ill patients admitted to the trauma ICU at Pusan National University Hospital Regional Trauma Center were included in this study. IAP was measured every 8–12 hours (intermittently) for 72 hours. IAP was registered as mean and maximal values per day throughout the study period. IAH was defined as IAP ≥12 mmHg. Abdominal compartment syndrome was defined as IAP ≥20 mmHg plus ≥1 new organ failure. The main outcome measure was in-hospital mortality.@*RESULTS@#According to maximal and mean IAP values, 10 (90.9%) of the patients developed IAH during the study period. The Sequential Organ Failure Assessment (SOFA) score was significantly higher in patients with IAP ≥20 mmHg than in those with IAP <20 mmHg (16 vs. 5, p=0.049). The hospital mortality rate was 27.3%. Patients with a maximum IAP ≥20 mmHg exhibited significantly higher hospital mortality rates (p=0.006). Non-survivors had higher maximum and mean IAP values.@*CONCLUSIONS@#Our results suggest that an elevated IAP may be associated with a poor prognosis in critically ill trauma patients.

Concomitant Avulsion Injury of the Subclavian Vessels and the Main Bronchus Caused by Blunt Trauma

Concomitant rupture of the subclavian vessels and the left main bronchus caused by blunt trauma is a serious condition. Moreover, the diagnosis of a tracheobronchial injury with rupture of the subclavian vessels can be difficult. This report describes the case of a 33-year-old man who suffered from blunt trauma that resulted in the rupture of the left subclavian artery and vein. The patient underwent an operation for vascular control. On postoperative day 3, the left main bronchus was found to be transected on a computed tomography scan and bronchoscopy. The transected bronchus was anastomosed in an end-to-end fashion. He recovered without any notable problems. Although the bronchial injury was not detected early, this case of concomitant rupture of the great vessels and the airway was successfully treated after applying extracorporeal membrane oxygenation.

Stab Wound Extension for the Eviscerated Small Bowel with Severe Ischemic Changes

An abdominal stab wound with evisceration is an indication of an emergency laparotomy. We encountered a case of a very severe ischemic change in the eviscerated small bowel as a result of stabbing. The patient was considered to have a high possibility of progressing to strangulation of the small bowel. Therefore, a stab wound extension was performed as a decompression in the emergency department before definite surgery in the operating room. Most of the small bowel could be saved except for the segment with the damage caused by the stab injury. The patient was discharged without complications.

Peripherally Inserted Central Catheter in Trauma Patients: Early Experience at a Single Institute

PURPOSE: A peripherally inserted central catheter (PICC) provides effective, reliable intravenous access in patients who require long term therapy such as intravenous antibiotics, total parenteral nutrition, transfusion or inotropic agents. This retrospective study evaluated the usefulness of PICC in trauma patients by examining patient characteristics and common complications, including PICC related bloodstream infection. METHODS: We reviewed the trauma patients who underwent PICC at Pusan National University Hospital Trauma Center from January 2016 to February 2017. RESULTS: From January 2016 to February 2017, 32 patients underwent PICC. Total catheter insertion days were 875 days, and the average catheter indwelling time was 27.3±25.02 days. The most common indication for PICC was total parenteral nutrition (n=20, 62.5%), while the remainder was to ensure a long-term fluid administration route (n=12, 37.5%). Catheter related complications included infection (n=3, 9.4%; 3.42 per 1,000 catheter-days), catheter tip malposition (n=2, 6.3%), catheter dislodgement (n=1, 3.1%), insertion site leakage (n=1, 3.1%) and arm swelling (n=1, 3.1%). No statistically significant differences were found between those who developed bloodstream infection and those who did not. CONCLUSION: If the PICC is performed by correcting adjustable factors that increase the risk of infection, effective and reliable intravenous access can be maintained in patients who require long-term therapy without bleeding, pneumothorax, or other complications of central venous catheter insertion.

Delayed Pneumatosis Intestinalis Induced by Blunt Trauma in a Strangulated Small Intestine

An ischemia-reperfusion injury of the intestine due to blunt trauma is very rare. Low blood flow can result in an incarceration and an ischemia-reperfusion injury of the small intestine. A 63-year-old woman fell, producing a splenic rupture. Despite the successful angio-embolization of the splenic rupture, the patient continued to suffer from hypotension. During laparotomy to identify the bowel injury, no intestinal perforation was found. However, we found a hemorrhagic infarction of the small intestine with congestion of the submucosal blood vessels. The part of bowel with the hemorrhagic infarction was resected and reconstructed with a jejuno-colic anastomosis. After surgery, she recovered from the trauma and was discharged without complications. We present this ischemia-reperfusion injury of the intestine due to blunt trauma. Meticulous examination and computed tomography scan is mandatory for diagnosis and assessment of treatment outcome.

Successful Endovascular Management of Post-Traumatic Phlegmasia Cerulea Dolens from Rupture of the External Iliac Vein

We report a rare case of a 47-year-old male with posttraumatic phlegmasia cerulea dolens caused by a ruptured right external iliac vein and treated with an endovascular venous stent graft. The patient was the victim of motor vehicle accident, and suffered direct injuries to the head and abdomen. The patient had a cyanotic and swollen right lower leg. Abdominal and lower extremity computed tomography angiography revealed a large retroperitoneal hematoma caused by a ruptured right external iliac vein, and grade I liver injury. The right external iliac vein rupture was successfully treated with a venous stent graft, followed by inferior vena cava filtering, because a venous thrombus was identified below the stent graft. He initially was hemodynamically unstable but recovered following treatment. The patient was comatose when presenting at the emergency department. He was discharged, fully recovered, on hospital day 18.

Hemodynamically Stable Patient after Inferior Vena Cava Penetrating Injury by Stab Wound

No abstract available.

Claude Bernard's Experimental Medicine: One of the Origins of Modernity and Naturalism of French Literature in the 19th Century / 의사학

Authors studied how Claude Bernard, the first founder of experimental medicine, contributed significantly to establishment of modernism and influenced European modern culture. Authors first studied his views on modernity, comparing with Descartes and Magendie, and on the similarity between "Experimental medicine" and the European literature in the 19th century. Bernard was not exclusively against vitalism, but the dogmatic misuse of vitalism. His objective thinking could be a useful model for the authors, who considered science to be an origin of modernity in literature of naturalism. Especially, Emile Zola was strongly influenced by Bernard's "An introduction to the study of Experimental medicine" and published "Experimental novel," a manifesto of naturalism. Although Bernard's experimental methodology and determinism deeply influenced modern European culture, the relationship between his Experimental medicine and modernism have not been fully investigated yet. His experimental medicine also needs to be discussed from the ecological viewpoints. His anthropo-centrism was unique since he emphasized any human theory could not surpass the principle of nature. Conventional anthropo-centrism claims that human beings are superior enough to own and govern the nature. And Bernard's the necessary determinism contains the ecological principle that all life forms and inanimate objects are organically related and intertwined to each other, irrespectively of their usefulness for the human beings. Although there were some ethical debates related to his medical experiments on living bodies of animal, his strict principle to perform experiments only after animal or human body died was worth considering as an effort to sustain ecological viewpoints. He was also unique in terms of being realistic and candid about his situation which was limited by the 19th century's scientific and medical development. In conclusion, the significance of convergence of literature and medical science in Experimental medicine and the importance of Bernard's ecological viewpoints, need to be further studied in the field of medical history.

Surgical Treatment of Thoracic Menigocele Associated with Neurofibromatosis and Kyphoscoliosis

A 46-year-old man presented with a lateral thoracic meningocele associated with cutaneous neurofibromatosis type I and kyphoscoliosis of the thoracic spine upon medical examination. In the majority of such cases, these meningoceles remain asymptomatic, but surgery is indicated when giant or symptomatic cysts are present. The large thoracic meningocele was successfully extirpated through the transthoracic approach in combination with lumbar puncture and cerebrospinal drainage for decompression of the cyst.

Thoracic Epidural Anesthesia and Analgesia (TEA) in Patients with Rib Fractures

BACKGROUND: We analyzed the results of surgical reduction and fixation of ribs under thoracic epidural anesthesia and analgesia (TEA) in patients who had no more than 3 consecutive rib fractures with severe displacement to examine the clinical usefulness of this method. MATERIALS AND METHODS: From May 2008 to March 2010, 35 patients underwent surgical reduction and fixation of ribs under TEA. We reviewed the indications for this technique, number of fixed ribs, combined surgical procedures for thoracic trauma, intraoperative cardiopulmonary events, postoperative complications, reestablishment of enteral nutrition, and ambulation. RESULTS: The indications of TEA were malunion or nonunion of fractured ribs in 29 (82.9%; first operation) and incompletely ribs under previous general anesthesia in 6 (17.1%; second operation). The average number of fixed ribs per patient was 1.7 (range: 1~3). As a combined operation for thoracic trauma, 17 patients (48.6%) underwent removal of intrathoracic hematomas, and we performed repair of lung parenchyma (2), wedge resection of lung (1) for accompanying lung injury and pericardiostomy (1) for delayed hemopericardium. No patient had any intraoperative cardiopulmonary event nor did any need to switch to general anesthesia. We experienced 3 postoperative complications (8.6%): 2 extrapleural hematomas that spontaneously resolved without treatment and 1 wound infection treated with secondary closure of the wound. All patients reestablished oral feeding immediately after awakening and resumed walking ambulation the day after operation. CONCLUSION: Thoracic epidural anesthesia and analgesia (TEA) may positively affect cardiopulmonary function in the perioperative period. Moreover, this technique leads to an earlier return of gastrointestinal function and early ambulation without severe postoperative complications, resulting in a shortened hospital stay and lowered costs.

Surgical Treatment of Dermatofibrosarcoma Protuberans of the Chest Wall / 대한흉부외과학회지

A 77-year-old man presented with a huge protruding mass on the left anterior chest wall. The tumor was resected and diagnosed as dermatofibrosarcoma protuberans (DFSP). DFSP is an uncommon, intermediate-grade mesenchymal cutaneous tumor which extends deep into subcutaneous tissue and may invade through the fascial planes and into muscle but rarely metastasize. Histologically, DFSP is composed of spindle cells arranged in an irregularly whorled or storiform pattern. The histological diagnosis can be confirmed with immunohistochemical staining for CD34. We report a case of DFSP. The tumor was completely excised and the chest wall was reconstructed using latissimus dorsi muscle flap and skin graft.