Incidentally Discovered Deep Neck Infection in a Septic Patient / 대한구급학회지

We incidentally discovered a case of deep neck infection during the treatment of a patient who presented with complaints of decreased consciousness, abdominal distension, and electrolyte imbalance. The patient had neither clinical symptoms nor radiologic findings indicative of deep neck infection; rather, the findings indicated intra-abdominal sepsis and adrenal crisis, for which the symptomatic treatment was provided. When the expected improvement was not observed, we retrospectively reviewed the patient's test records and discovered deep neck infection. Empiric parenteral antibiotic therapy and infection source control, as appropriate for this patient, were administered within 72 hours of hospital admission, without which the condition may have proved fatal. In this report we discuss the best approach for the management of unresolved infectious disease and review the clinical features of deep neck infection.

Use of video-assisted thoracoscopic surgery to retrieve a broken guidewire / 대한외과학회지

Subclavian venous catheterization was once widely used for volume resuscitation, emergency venous access, chemotherapy, parenteral nutrition, and hemodialysis. However, its use has drastically reduced recently because of life-threatening complications such as hemothorax, pneumothorax. In this case, a patient admitted for a scheduled operation underwent right subclavian venous catheterization for preoperative, intraoperative, and postoperative volume resuscitation and parenteral nutrition. The procedure was performed by an experienced senior resident. Despite detecting slight resistance during the guidewire insertion, the resident continued the procedure to the point of being unable to advance or remove it, then attempted to forcefully remove the guidewire, but it broke and became entrapped within the thorax. We tried to remove the guidewire through infraclavicular skin incision but failed. So video-assisted thoracoscopic surgery was used to remove the broken guidewire. This incident demonstrates the risks of subclavian venous catheterization and the importance of using a proper and gentle technique.

Pinch-off syndrome / 대한외과학회지

Subclavian venous catheterization was previously frequently performed, but because of life-threatening complications such as hemothorax, pneumothorax, mediastinal hematoma, and myocardial injury, its use has become less common. However, this practice has some advantages in patient mobility, secured dressing, and rapidity and adequacy of vascular access. In some situations where patient comfort is an especially important consideration, such as with totally implantable venous port insertion for chemotherapy, the subclavian route can be a good choice if an experienced and well-trained faculty is available. The authors have had recent experience with pinch-off syndrome-in other words, spontaneous catheter fracture-in 3 patients who had undergone venous port implantation through the right subclavian route. Through these cases, we intend to review the dangers of subclavian venous catheterization, the causes of pinch-off syndrome, and its clinical presentation, progress, treatments, and prevention.