Acute mediastinitis secondary to delayed vascular injury by a central venous catheter and total parenteral nutrition

Vascular injury caused by a central venous catheter (CVC) has been reported to be a rare complication, especially delayed vascular injury due to CVC has a few cases and it can be fatal because of delayed recognition and more serious complications. A 59-year-old woman with no available medical history was admitted for treatment of ovarian cancer. For the surgery, a triple-lumen CVC was placed through the left subclavian vein. Parenteral nutrition through the CVC was used for postoperative nutritional management in the first postoperative day. On the sixth postoperative day (POD), the patient suddenly complained of dyspnea. The CT revealed bilateral pleural effusion and irregular soft tissue density and air bubble in anterior mediastinum suggesting migration of the distal portion of the CVC into the anterior mediastium. In the intensive care unit (ICU) bilateral thoracentesis and percutaneous drainage were performed. She was discharged from the ICU in 3 days later and transferred to the general ward. This case emphasizes the possibility of the delayed vascular injury related to CVC and some strategies for prevention of vascular injury.

Diver Death due to Underwater Explosion / 대한법의학회지

A 44-year-old man was cutting an outer plate of a ship, at a depth of 25 m below sea level. Following a sudden explosion, he was discovered unconscious and was carried to the surface by other divers. There was no evidence of vital signs upon arrival at the hospital. Postmortem computed tomography, which was performed prior to autopsy, revealed massive pneumocephalus in the brain, pneumohemothorax, diffuse lung contusions with multiple traumatic lung cysts, air-fluid level in the cardiac chamber of the chest, and pneumoperitoneum in the abdomen. Postmortem external examination showed a circular abrasion on the jaw, diffuse subcutaneous emphysema, and contusion in the right upper arm. An internal examination revealed intravascular air bubbles in all four chambers of the heart, and diffuse pulmonary trauma including contusion, laceration, and multiple traumatic cysts. Blast injury to the chest, and air embolism due to the underwater explosion were established as the underlying cause of death.

Combined Peritumoral and Subareolar Injection of Blue Dye Improves Sentinel Lymph Node Localization Rates

PURPOSE: The sentinel lymph node (SLN) biopsy was recently introduced into the treatment of early breast cancer. However, there have been varying degrees of success in identifying the SLNs. Lymphatic mapping in breast cancer performed solely by intraparenchymal injection of blue dye remains an accepted method of identifying SLNs, largely because of its simplicity. This article describes the technical aspect and improved results of combined peritumoral and subareolar injection of isosulfan blue dye. METHODS: From Jan. 2000 to Jul. 2000, 55 patients with breast cancer (size<5 cm and clinically negative axillary nodes) were enrolled for SLN biopsy by peritumoral and subareolar injection of 1% isosulfan blue dye. And all patients underwent a complete axillary dissection. RESULTS: The identification rate of SLN was 96.4% (in 53 of 55 patients). Of these 53 patients, 11 patients (20.8%) had positive SLNs and 42 patients had negative SLNs. In 42 patients with negative SLNs, one patients was found to have disease on complete dissection, for a false-negative rate of 8.3% (1/12). CONCLUSION: Compared with other series of blue dye- directed lymphatic mapping, the present study of peritumoral plus subareolar plexus dye-only injection demonstrates a high SLNs localization rate and rapid learning curve. On the basis of these results, it is expected that subareolar lymphatic plexus is the central route to sentinel lymph nodes and the optimal way to perform dye-only lymphatic mapping of the breast.

Combined Peritumoral and Subareolar Injection of Blue Dye Improves Sentinel Lymph Node Localization Rates / 한국유방암학회지

PURPOSE: The sentinel lymph node (SLN) biopsy was recently introduced into the treatment of early breast cancer. However, there have been varying degrees of success in identifying the SLNs. Lymphatic mapping in breast cancer performed solely by intraparenchymal injection of blue dye remains an accepted method of identifying SLNs, largely because of its simplicity. This article describes the technical aspect and improved results of combined peritumoral and subareolar injection of isosulfan blue dye. METHODS: From Jan. 2000 to Jul. 2000, 55 patients with breast cancer (size<5 cm and clinically negative axillary nodes) were enrolled for SLN biopsy by peritumoral and subareolar injection of 1% isosulfan blue dye. And all patients underwent a complete axillary dissection. RESULTS: The identification rate of SLN was 96.4% (in 53 of 55 patients). Of these 53 patients, 11 patients (20.8%) had positive SLNs and 42 patients had negative SLNs. In 42 patients with negative SLNs, one patients was found to have disease on complete dissection, for a false-negative rate of 8.3% (1/12). Conclusion: Compared with other series of blue dye- directed lymphatic mapping, the present study of peritumoral plus subareolar plexus dye-only injection demonstrates a high SLNs localization rate and rapid learning curve. On the basis of these results, it is expected that subareolar lymphatic plexus is the central route to sentinel lymph nodes and the optimal way to perform dye-only lymphatic mapping of the breast.