Comparison of upper and lower body forced air blanket to prevent perioperative hypothermia in patients who underwent spinal surgery in prone position: a randomized controlled trial / 대한마취과학회지

Background@#We compared upper- and lower-body forced-air blankets in terms of their ability to prevent perioperative hypothermia, defined as a reduction in body temperature to < 36.0°C, during the perioperative period in patients undergoing spine surgery in the prone position. @*Methods@#In total, 120 patients scheduled for elective spine surgery under general anesthesia were divided into an upper-warming group (n = 60) and a lower-warming group (n = 60). After inducing anesthesia and preparing the patient for surgery, including prone positioning, the upper and lower bodies of the patients in the upper- and lower-warming groups, respectively, were warmed using a forced-air warmer with specified upper and lower blankets. Body temperature was measured using a tympanic membrane thermometer during the pre- and post-operative periods and using a nasopharyngeal temperature probe during the intraoperative period. Patients were evaluated in terms of shivering, thermal comfort, and satisfaction in the post-anesthesia care unit (PACU). @*Results@#The incidence of intraoperative and postoperative hypothermia was lower in the upper-warming group than in the lower-warming group ([55.2% vs. 75.9%, P = 0.019] and [21.4% vs. 49.1%, P = 0.002]). Perioperative body temperature was higher in the upper-warming group (P < 0.001). However, intraoperative blood loss, postoperative thermal comfort scale and shivering scores, patient satisfaction, and PACU duration were similar in the two groups. @*Conclusions@#The upper-body blanket was more effective than the lower-body blanket for preventing perioperative hypothermia in patients who underwent spine surgery in the prone position.

Early and Atypical Radiologic Presentations of Pulmonary Langerhans Cell Histiocytosis:A Report of Two Cases

Pulmonary Langerhans cell histiocytosis (PLCH) is a rare, multi-systemic disease primarily affecting young male adults with a history of smoking. The two patients with PLCH in our report showed relatively early and atypical radiologic presentations at initial evaluation. On chest CT, PLCH presents variable radiologic features depending on the evolutional stage of the disease. Atypical CT features of PLCH may render precise radiologic diagnosis difficult and usually require lung biopsy for a confirmation of the diagnosis. Our case review is aimed at raising the awareness of radiologists on the atypical CT features of PLCH, to help make accurate radiologic diagnosis and prevent unnecessary and invasive diagnostic procedures.

Early and Atypical Radiologic Presentations of Pulmonary Langerhans Cell Histiocytosis:A Report of Two Cases

Pulmonary Langerhans cell histiocytosis (PLCH) is a rare, multi-systemic disease primarily affecting young male adults with a history of smoking. The two patients with PLCH in our report showed relatively early and atypical radiologic presentations at initial evaluation. On chest CT, PLCH presents variable radiologic features depending on the evolutional stage of the disease. Atypical CT features of PLCH may render precise radiologic diagnosis difficult and usually require lung biopsy for a confirmation of the diagnosis. Our case review is aimed at raising the awareness of radiologists on the atypical CT features of PLCH, to help make accurate radiologic diagnosis and prevent unnecessary and invasive diagnostic procedures.

Total Arch Replacement for Chronic Aortic Aneurysmal Dissection Patient with Aberrant Subclavian Artery

The aberrant subclavian artery is a rare vascular malformation, the aberrant vessel may arise from the proximal descending aorta. Reports of aortic dissection or aortic aneurysm in patients with aberrant subclavian artery have been reported to be rare. Author report a successful total aortic arch replacement under selective antegrade brain perfusion using an occlusion catheter rather than right axillary artery cannulation in a patient with chronic aortic aneurysmal dissection with aberrant subclavian artery.

Successful Intraoperative Management to Minimize Blood Loss Using the Combination of Tranexamic Acid and Hemocoagulase for Jehovah’s Witnesses Patient with Liver Cirrhosis

A 78-year-old Jehovah’s Witnesses women with hepatitis B viral liver cirrhosis scored as Child-Pugh A was scheduled for debulking operation of peritoneal carcinomatosis due to right ovarian cancer. Despite the need for preoperative strategies for correction of anemia and coagulopathy due to the risk of significant intraoperative hemorrhage, preoperative management was missing. In addition, she exhibited preoperative hemoglobin, hematocrit levels, and platelet count of 10.5 g/dL, 33.6%, and 85,000/μL, respectively. To minimize intraoperative blood loss, we used the combination of tranexamic acid and hemocoagulase, intraoperative blood loss counted about 700 mL, and the immediate postoperative hemoglobin was 9.0 g/dL. She recovered well without any anemic complications or thromboembolic events.

Role and Prognosis of Extracorporeal Life Support in Patients Who Develop Cardiac Arrest during or after Office-Based Cosmetic Surgery

Background@#Cardiac arrest during or after office-based cosmetic surgery is rare, and little is known about its prognosis. We assessed the clinical outcomes of patients who developed cardiac arrest during or after cosmetic surgery at office-based clinics. @*Methods@#Between May 2009 and May 2016, 32 patients who developed cardiac arrest during or after treatment at cosmetic surgery clinics were consecutively enrolled. We compared clinical outcomes, including complications, between survivors (n=19) and non-survivors (n=13) and attempted to determine the prognostic factors of mortality. @*Results@#All 32 of the patients were female, with a mean age of 30.40±11.87 years. Of the 32 patients, 13 (41%) died. Extracorporeal life support (ECLS) was applied in a greater percentage of non-survivors than survivors (92.3% vs. 47.4%, respectively; p=0.009). The mean duration of in-hospital cardiopulmonary resuscitation (CPR) was longer for the non-survivors than the survivors (31.55±33 minutes vs. 7.59±9.07 minutes, respectively; p=0.01).The mean Acute Physiology and Chronic Health Evaluation score was also higher among non-survivors than survivors (23.85±6.68 vs. 16.79±7.44, respectively; p=0.01). No predictor of death was identified in the patients for whom ECLS was applied. Of the 19 survivors, 10 (52.6%) had hypoxic brain damage, and 1 (5.3%) had permanent lower leg ischemia.Logistic regression analyses revealed that the estimated glomerular filtration rate was a predictor of mortality. @*Conclusion@#Patients who developed cardiac arrest during or after cosmetic surgery at office-based clinics experienced poor prognoses, even though ECLS was applied in most cases. The survivors suffered serious complications. Careful monitoring of subjects and active CPR (when necessary) in cosmetic surgery clinics may be essential.

Total Arch Replacement for Chronic Aortic Aneurysmal Dissection Patient with Aberrant Subclavian Artery

The aberrant subclavian artery is a rare vascular malformation, the aberrant vessel may arise from the proximal descending aorta. Reports of aortic dissection or aortic aneurysm in patients with aberrant subclavian artery have been reported to be rare. Author report a successful total aortic arch replacement under selective antegrade brain perfusion using an occlusion catheter rather than right axillary artery cannulation in a patient with chronic aortic aneurysmal dissection with aberrant subclavian artery.

Successful Intraoperative Management to Minimize Blood Loss Using the Combination of Tranexamic Acid and Hemocoagulase for Jehovah’s Witnesses Patient with Liver Cirrhosis

A 78-year-old Jehovah’s Witnesses women with hepatitis B viral liver cirrhosis scored as Child-Pugh A was scheduled for debulking operation of peritoneal carcinomatosis due to right ovarian cancer. Despite the need for preoperative strategies for correction of anemia and coagulopathy due to the risk of significant intraoperative hemorrhage, preoperative management was missing. In addition, she exhibited preoperative hemoglobin, hematocrit levels, and platelet count of 10.5 g/dL, 33.6%, and 85,000/μL, respectively. To minimize intraoperative blood loss, we used the combination of tranexamic acid and hemocoagulase, intraoperative blood loss counted about 700 mL, and the immediate postoperative hemoglobin was 9.0 g/dL. She recovered well without any anemic complications or thromboembolic events.

Isolated Congenital Left Ventricular Diverticulum in Adults

Isolated congenital left ventricular diverticulum is a rare cardiac malformation. Here, we report the case of a 33-year-old woman who had suffered from recurrent transient ischemic attacks for 6 years. Preoperative cardiac magnetic resonance imaging and computed tomography angiography revealed a diverticulum near the apex. The diverticulum was successfully obliterated by cardiopulmonary bypass. We suggest that isolated congenital left ventricular diverticulum can be easily corrected with a low surgical risk by patch repair and plication techniques.

Vacuum-assisted Closure for the Treatment of Lymphorrhea Following Surgery of the Femoral Artery / 대한흉부외과학회지

Lymphorrhea is a common complication after inguinal dissection for exposure of the femoral artery. Injury of the lymphatics occurs frequently because they are anatomically close to blood vessels. Uncontrolled lymph drainage increases postoperative morbidity, and wound infection may follow. Despite current treatment options, lymphorrhea after inguinal dissection is still difficult to manage and results in a prolonged hospital stay. A vacuum-assisted closure device was used in a 72-year-old woman who had lymphorrhea after vascular surgery by groin incision. Vacuum-assisted control for lymphorrhea resulted in earlier closure of the wound and reduced the length of hospital stay.

An Influence of Modified Robicsek Sternal Wiring after Median Sternotomy on the Postoperative Sternal Wound Infection / 대한흉부외과학회지

BACKGROUND: In the majority of cases, sternal instability and wound infection concomitantly present after a cardiac operation following conventional median sternotomy, and these complications have a major influence on the postoperative course. The aim of this study is to compare the results of the different sternal wiring techniques on sternal infection. MATERIAL AND METHOD: Between April 2004 and December 2008, 157 adult patients underwent cardiac operation through a median sternotomy. 86 patients who had undergone standard peristernal wiring were included in group A, whereas 71 patients who had undergone modified Robicsek sternal wiring were included in group B. The incidences of sternal wound complications in the two groups were assessed. RESULT: The mean age of the group B patients was older than that of the group A patients (61+/-10 years vs 57+/-13 years). The incidence of preoperative left ventricular dysfunction (ejection fraction <30%), chronic obstructive pulmonary disease, renal failure requiring dialysis and diabetes mellitus were significantly higher in Group B, whereas the other perioperative risk factors for infection were not significantly different between the two groups. Two patients in group A experienced superficial wound infection, whereas 4 patients in group B displayed superficial wound infection, but the difference was not statistically significant (p=0.255). Yet poststernotomy deep sternal wound infection appeared in 6 patients of group A, whereas none of the patients in group B displayed this malady. CONCLUSION: The modified Robicsek sternal wiring technique showed greater sternal stability even for the patient with a high risk for infection, and the technique caused a lower incidence of deep sternal wound infection.

Emergency Aortic Valve Replacement for a 95-year-old Patient / 대한흉부외과학회지

As the average age of the general population increases, a growing number of elderly patients are presenting for cardiac operations. Although aortic valve replacement in patients aged 80 years and older has been shown to have excellent outcomes with good long-term survival rates, some physicians are still hesitant to refer elderly patients for surgical intervention. A 95-years old female was admitted to our hospital with cardiogenic shock and an emergency operation was required. She was successfully treated with emergency aortic valve replacement. We report here on a case of successful emergency surgical treatment for aortic stenosis in a 95 years old woman.