Veno-Venous Extracorporeal Membrane Oxygenation of Acute Respiratory Failure due to Near-drowning: 2 case reports / 대한흉부외과학회지

Extracorporeal membrane oxygenation (ECMO) during acute respiratory failure due to any cause aids in the recovery of respiratory function. The use of ECMO for acute respiratory failure due to near drowning was reported to be a successful therapeutic option in those patients who do not respond to optimal conventional therapies. We performed veno-venous ECMO for 2 acute respiratory failures due to near-drownings. All cannulations were performed percutaneously via both femoral veins. The 2 patients were successfully weaned off ECMO, but one patient experienced diffuse hypoxic brain damage and a subarachnoid hemorrhage.

Lower gastrointestinal bleeding due to cytomegalovirus ileal ulcers in an immunocompetent man

Cytomegalovirus (CMV) infections are commonly reported in severely immunocompromised hosts and ulcers of the alimentary tract are frequently observed in systemic CMV infections. However, invasive and ulcerative disease of the gastrointestinal (GI) tract caused by CMV has also been reported in healthy adults. Many reports show that a CMV infection can produce localized ulcerations in the esophagus, stomach, small intestine, and colon in nonimmunocompromised individuals. The most common site of involvement by CMV infection in the GI tract is the colon followed by the upper GI tract and the least common site is the small intestine. Although GI bleeding is one of the major presenting symptoms of patients with CMV infections of the GI tract, lower GI bleeding due to CMV ileal ulcers in immunocompetent patients, to our knowledge, has not been reported in the English literature. Recently, we experienced a case of lower GI bleeding due to CMV ileal ulcers in a 57-year-old man who had no evidence of immunocompromise. This case suggests that small intestinal ulcers due to CMV infection should be included in the differential diagnosis of lower GI bleeding even in immunocompetent hosts.

A Case of Endobronchial Chondroma / 결핵

Endobronchial chondroma is a cartilaginous benign tumor,which arises from the bronchial cartilage. As a rare benign tumor, endobronchial chondroma differs from cartilaginous hamartoma in that it includes cartilage components only,but hamartoma contains lipomatous and lymphoid tissue.The clinical manifestations of endobronchial chondroma are associated with the extent of mechanical obstruction of bronchus.Symptoms of endobronchial chondroma are nonspecific,such as cough, sputum, fever, or dyspnea on exertion.Endobronchial chondroma is often misdiagnosed as other diseases,such as asthma, chronic obstructive pulmonary disease,or pulmonary tuberculosis. The treatment is usually surgical procedures,such as resection of lung segment or lobe by thoracostomy or resection of tumor by bronchoscopy.We report a case of the patient who was diagnosed to have endobronchial chondroma treated by bronchial resection and end to end anastomosis.

A Case of Asymptomatic Cholecystogastric Fistula / 대한소화기내시경학회지

Biliary enteric fistulas which are caused by gallstone, peptic ulcer and carcinoma are an uncommon disease. Their incidence appears to increase recently with the advent of endoscopy. The usual types of the fistulas are choledochoduodenal, cholecystoduodenal and cholecystocolonic. But, cholecystogastric fistulas are very rare. Their symptoms are usually nonspecific and pneumobilia has been considered as a clue, but the diagnosis is difficult in most cases. At present, endoscopy is very helpful to the diagnosis. The treatment of asymptomatic fistulas is still in dispute. Endoscopic management is being used at times in recent days. We recently experienced a case of cholecystogastric fistula accidentally. During the evaluation for the cause of anemia, we suspected a fistula on endoscopy and confirmed it on endoscopic fistulography and managed it by endoscopic papillotomy and stone extraction.

A Case of Massive Perirenal Hematoma in a Patient with Hemorrhagic Fever with Renal Syndrome / 대한신장학회잡지

Hemorrhagic fever with renal syndrome is characterized clinically by the triad of fever, hemorrhage and renal failure. The hemorrhage in hemorrhagic fever with renal syndrome(HFRS) varies from transient petechial lesions to fulminant and massive bleeding. The latter can be an important cause of death in HFRS. We here report a case of massive perirenal hematoma in a patient with HFRS. A 17-year-old male was admited to our hospital presenting with fever, sore throat, nausea and oliuria. Computed tomography was performed at the 2nd day of hospitalization due to abruptly developing right flank pain and anemia and showed perirenal hematoma on the right kidney. He was diagnosed as HFRS and treated with hemodialysis, fluid infusion, and transfusion. There was no evidence of further blood loss at the 7th day of hospitalization. After conservative treatment, he recovered from HFRS.

Adult-to-Adult Living Donor Liver Transplantation

BACKGROUNDS: Living-donor liver transplantation (LDLT) has been established as an efficacious option to resolve the shortage of cadaveric donor organs for pediatric recipients. This surgical innovation has significantly reduced the pretransplantation mortality for children, but the crisis of increasing scarcity of donor organs in our hospital has led us to extend LDLT to adult recipients. However, the extension of LDLT from pediatric recipients to adult recipients has been made only with limited success largely because of the inability of a relatively small-size left-lobe graft to meet the metabolic demands of an adult recipient. It has been postulated that a left-lobe graft smaller than 40% of the recipient's standard liver volume will not result in a successful adult-to-adult LDLT in chronic parenchymal liver disease. METHODS: From February 1997 to October 1997, 10 LDLTs, using 9 extended left-lobe grafts and 1 right-lobe graft, were performed on patients with end-stage parenchymal liver diseases (9 cases of B-hepatitis-induced cirrhosis with or without an associated hepatocellular carcinoma and 1 case of alcoholic cirrhosis) at the Department of Surgery, Asan Medical Center. The ratios of the graft to the standard liver volume of the recipients were in the range of 30% to 55%. RESULTS: All grafts showed immediate function, but delayed normalization of the serum total bilirubin was demonstrated in all recipients receiving left-lobe grafts. There were no mortalities and serious complications in donors. Two recipients died of sepsis 21 days and 40 days after transplantation, and 8 recipients (80%) are alive with good liver function at a median follow-up of 5.1 months (range 2~10 months). CONCLUSIONS: The aim of this article is to report our experience with adult-to-adult LDLT shows that a graft size greater than 30% of the recipient's standard liver volume is able to meet the metabolic demands of adult recipients with chronic parenchymal liver disease and that LDLT might open a new donor pool for adult recipients when the supply of cadaveric organs is severely restricted.

Changing patterna in the Serum Amylase Level and the Serum Lipase Level Following Hepatic Resection with Pringle's Maneuver

Intermittent clamping of the portal pedicle during hepatic resection may reduce the amount of bleeding but it can induce ischemic injury to the liver. Almost all reports about Pringle's maneuver center around the ischemic insult to the liver and the longest duration time. Recently it was reported that prolongation of portal congestion carries a potential risk of serum amylase elevation and pancreatitis after hepatic resection with the intermittent Pringle maneuver. The aim of this prospective study was to analyze the changing patterns of the serum amylase and the lipase levels and to analyze the factors that may be associated with hyperamylasemia and hyperlipasemia after hepatic resection with intermittent Pringle maneuver. The serum amylase and the lipase levels elevated slowly after hepatic resection and reached to the highest level on postoperative day 11. The serum amylase level and the lipase level in the control group was highest on postoperative day 1 and postoperative day 5 respectively. The elevation of the amylase and lipase levels in the major hepatic resection group, the group in which clamping time was more than 30 minutes, and the patient group with normal liver was higher. These results suggest that a prolonged intermittent Pringle's maneuver and the larger amount of resected hepatic parenchyme may cause hyperamylasemia and hyperlipasemia and the underlying mechanism may be the prolonged congestion of the pancreas.