Veno-Veno Extracorporeal Membrane Oxygenation in Post-Traumatic Acute Lung Injury

Patients with severe lung injury and hemorrhagic shock, may develop acute respiratory failure syndrome during resuscitation, and may require extracorporeal membrane oxygenation (ECMO) support to ensure adequate oxygenation to sustain life. In this case study, a 69 year-old female was hit by a motor vehicle whilst riding her bicycle. She was in a state of hemorrhagic shock due to polytrauma and was resuscitated with massive fluid transfusion during the initial management. After admission to the intensive care unit, she suffered from hypoxia which required mechanical ventilation using 100% oxygen. However, hypoxia did not improve, so she was placed on venoveno ECMO support after 4 days of intensive care treatment. Although trauma and bleeding are considered as relative contraindications for ECMO support, veno-veno ECMO allows for lung rest, and improvement of pulmonary function.

Veno-Veno Extracorporeal Membrane Oxygenation in Post-Traumatic Acute Lung Injury

Patients with severe lung injury and hemorrhagic shock, may develop acute respiratory failure syndrome during resuscitation, and may require extracorporeal membrane oxygenation (ECMO) support to ensure adequate oxygenation to sustain life. In this case study, a 69 year-old female was hit by a motor vehicle whilst riding her bicycle. She was in a state of hemorrhagic shock due to polytrauma and was resuscitated with massive fluid transfusion during the initial management. After admission to the intensive care unit, she suffered from hypoxia which required mechanical ventilation using 100% oxygen. However, hypoxia did not improve, so she was placed on venoveno ECMO support after 4 days of intensive care treatment. Although trauma and bleeding are considered as relative contraindications for ECMO support, veno-veno ECMO allows for lung rest, and improvement of pulmonary function.

The Benefits and Risks of Performing Incidental Appendectomy

Acute appendicitis is the most common indication for emergency abdominal surgery worldwide. The risks and benefits of incidental appendectomy during other operations have been debated for over a century. There is no right answer to the question of whether or not to perform incidental appendectomy. Although there are only a few indications where it is explicitly recommended such as in gynecological surgery, malrotation, and Ladd's procedure, incidental appendectomy is cost-effective in selected patient groups, especially in the young, without an increase in morbidity and mortality. In this review, the literature on incidental appendectomy was assessed from several perspectives.

Right-sided diaphragmatic rupture in a poly traumatized patient

Traumatic diaphragmatic rupture (TDR) is uncommon, and may be associated with other severe life-threatening injuries after blunt trauma. Recently, we experienced a right-sided TDR patient with other multiple life-threatening injuries. A 59-year-old female inflicted with a right-sided TDR accompanied by herniated liver was treated with thoracoscopic exploration. We successfully managed associated life-threatening injuries such as traumatic brain injury and pelvic bone fractures with bleeding, simultaneously.

Endovascular stent graft for traumatic splenic vein aneurysm via percutaneous transsplenic access

Traumatic splenic vein aneurysm (SVA) is an extremely rare entity. Traditionally, treatment varied from noninvasive followup to aneurysm excision with splenectomy. However, there has been no prior report of traumatic SVA treated with endovascular stent graft for SVA via percutaneous transsplenic access. Therefore, we report the case of a 56-year-old man successfully treated with endovascular stent graft for traumatic SVA via percutaneous transsplenic access.

Endovascular stent graft for traumatic splenic vein aneurysm via percutaneous transsplenic access

Traumatic splenic vein aneurysm (SVA) is an extremely rare entity. Traditionally, treatment varied from noninvasive followup to aneurysm excision with splenectomy. However, there has been no prior report of traumatic SVA treated with endovascular stent graft for SVA via percutaneous transsplenic access. Therefore, we report the case of a 56-year-old man successfully treated with endovascular stent graft for traumatic SVA via percutaneous transsplenic access.

Appendiceal transection associated with seat belt restraint

The seat belt is designed for safety in a motor vehicle and should be worn to prevent severe injuries. But, the seat belt itself can be an injury factor in combination with deceleration forces applied to fixation points of mobile viscera. Here, we present a 23-year-man with traumatic transection of the appendix, highly mobile viscera, following seat belt injury.

Inferior Vena Cava (IVC) Filter Retrieval Rates after Catheter Directed Thrombolysis or Pharmacomechanical Thrombectomy in Deep Vein Thrombosis (DVT) and Its Characteristics

PURPOSE: Inferior vena cava (IVC) filter is commonly practiced to prevent pulmonary embolism during endovascular therapy of deep vein thrombosis (EndoDVT). When the thrombus is trapped inside the filter during intervention, its removal is quite challenging. The purpose of this study is to determine retrieval rates of IVC filter after EndoDVT and its characteristics. METHODS: Patients who underwent EndoDVT in Inha Unversity Hospital from June 2004 to May 2009 were reviewed retrospectively. Retrievable IVC filter was inserted before EndoDVT. EndoDVT was done by catheter directed thrombolysis or pharmacomechanical thrombectomy using urokinase. IVC filter retrieval was decided according to computed tomography after 2 weeks. RESULTS: 126 patients were treated with EndoDVT. Optease (n=101) and Tulip (n=25) IVC filters were inserted. IVC filters were retrieved in 42.9% (54/126). There was no IVC filter related complication during its insertion and removal. IVC filter was not retrieved in 72 patients. Reasons for its failure include residual thrombosis in IVC filter (n=28), high risk for recurrent DVT (n=34), massive pulmonary embolism (n=8), and death (n=2). Residual thrombus inside IVC filter disappeared in 5 patients during 6-month follow up. CONCLUSION: IVC filters retrieval rate after EndoDVT was 42.9%. This can be improved by thorough patient follow up and extended retrievability.

Incidental Findings of Thyroid Detected by PET-CT during Cancer Follow-up / 대한내분비외과학회지

PURPOSE: The incidence of thyroid cancer is increasing in Korea, partially owing to the development of diagnostic tools. Positron emission tomography (PET)-computed tomography (CT), in particular, has generally been used for evaluation of metastasis and follow-up of malignancy. METHODS: We retrospectively investigated 2,833 patients with PET-CT for metastasis work-up or cancer follow-up, which was performed between January 1998 and May 2008 at Inha University Hospital. Of them, abnormal thyroid findings were discovered in 181 patients and we studied the result of further evaluation or follow-up PET-CT. RESULTS: Thyroid cancer was diagnosed in 26 patients, including metastatic cancer in 3 patients, and non-operated primary cancer in 2 patients. Other 21 patients received operation, which in all histopathologically revealed papillary carcinoma. The mean age of the 21 patients was 55.4 years. Nine patients had a history of radiotherapy. The site of malignant nodule was discordant between PET-CT and histopathologic result in 6 patients. The mean size of malignant nodules was 9.45 mm (0.1~23 mm) with microcarcinoma in 10 patients (47.6%). The mean interval between diagnoses was 15.8 months, and in 4 patients operations for two malignancies were performed in a same day. The incidence of thyroid cancer was significantly high in female patients, but the differences of incidence among different cancer groups were not significant for female patients. CONCLUSION: Early diagnosis of synchronous or secondary thyroid cancer by PET-CT in cancer patients can make early treatment and better strategies for multiple malignancies possible.

Malignant Adenomyoepithelioma of the Breast Presenting as a Large Mass that Grew Slowly without Metastasis / 한국유방암학회지

An adenomyoepithelioma (AME) is an uncommon neoplasm characterized by proliferation of both epithelial and myoepithelial cells in the salivary gland, skin, lung and breast. AMEs can recur, progress to malignancy and metastasize. A 68-year-old woman presented a large mass occupying her whole right breast. The mass had grown slowly for about 20 years and the preoperative biopsy of the mass was chondroid syringoma. The mass was completely resected and the postoperative biopsy revealed malignant AME with a negative resection margin. The patient didn't receive any adjuvant therapy and has been free of recurrence or metastasis up to now. We report herein a case of a malignant AME that was diagnosed in the largest breast mass reported to date. This mass grew slowly and without metastasis. Clinicians should consider this rare disease entity in the differential diagnosis of a breast mass and remember the importance of complete excision of this tumor.

Gallbladder Torsion: A Case Report and a Review of the Literature

Gallbladder torsion, also known as volvulus, is a rare condition that can be fatal unless surgery is performed expediently.AWe report a case of gallbladder torsion. A 92-year-old woman presented with acute abdominal pain. Laboratory parameters were all within normal limits, with the exception of leukocytosis. Plain abdominal radiography showed no remarkable findings. Abdominal CT revealed an abnormal gallbladder with wall thickening, suggesting the presence of acute cholecystitis. At operation, the gallbladder was twisted, and the wall of was thickened with acute inflammation. We report the details of this case along with a review of the literature.