Extracorporeal Membrane Oxygenation in Pediatric Patients with Respiratory Failure: Early Experience with the Double- Lumen Cannula Over 2 Years

Background@#The double-lumen cannula (DLC) has begun to be used worldwide for venovenous (VV) extracorporeal membrane oxygenation (ECMO). We aimed to examine whether the DLC could be an effective tool in the treatment of pediatric respiratory failure in Korea. @*Methods@#We reviewed the records of patients weighing under 15 kg who underwent ECMO due to respiratory failure between January 2017 and December 2018. Outcomes of ECMO using a DLC and conventional ECMO using central method or 2 peripheral cannulas were compared. @*Results@#Twelve patients were treated with ECMO for respiratory failure. Among them, a DLC was used in 5 patients, the median age of whom was 3.8 months (interquartile range, 0.1–49.7 months). In these patients, the median values of pH, partial pressure of carbon dioxide, and partial pressure of oxygen were 7.09, 74 mm Hg, and 37 mm Hg before ECMO and corrected to 7.31, 44 mm Hg, and 85 mm Hg, respectively, after ECMO cannulation. Median blood flow rate in the patients treated with ECMO using a DLC was slightly higher than that in the conventional ECMO group, but this difference was not statistically significant (86.1 mL/kg/min and 74.3 mL/kg/min, respectively; p=1.00). One patient from the DLC group and 3 patients from the conventional group were weaned off ECMO. @*Conclusion@#VV ECMO using a DLC provided adequate oxygenation, ventilation, and blood flow rate in Korean pediatric patients with respiratory failure. Further prospective and randomized studies are warranted.

A Case Report of Rare Complications after Epicardial Permanent Pacemaker Implantation in an Infant: Airway Compression, Skin Necrosis, and Bowel Perforation

Insertion of an epicardial pacemaker is a useful treatment for pediatric patients with an abnormal heart rhythm. However, there are limitations and concerns when implanting epicardial pacemakers in infants and neonates due to their small body size. We report a patient who experienced rare complications after implantation of a permanent pacemaker.

Severe Hyponatremia with Mental Change after Ingestion of Picosulfate Sodium/Magnesium Citrate for Bowel Preparation / 대한내과학회지

Picosulfate sodium/Magnesium citrate (PS/MC) is a common bowel cleansing agent for colonoscopy. It is equally effective and better tolerated by patients with regard to taste and volume than polyethylene glycol. However, because of its osmotically active characteristics, PS/MC can cause plasma volume depletion and electrolyte disturbances, such as hyponatremia. Here, we report a case of severe hyponatremia combined with loss of consciousness in a 59-year-old woman following ingestion of PS/MC as bowel preparation for a screening colonoscopy. Upon arrival, serum sodium level was 109 mEq/L and urine osmolality and sodium levels were 393 mOms/Kg and 99 mmol/L, respectively. She was euvolemic and showed normal kidney, thyroid, and adrenal function. Based on these findings, inappropriate anti-diuretic hormone syndrome (SIADH) was diagnosed. She was treated with 3% hypertonic saline and completely recovered without any neurologic sequelae. This case shows that SIADH can be caused by PS/MC (not accompanied by dehydration), even in patients without any underlying renal, heart, or liver diseases.

Hypereosinophilic Syndrome Presenting as Intussusception in Adults / 대한내과학회지

Hypereosinophilic syndrome (HES) is characterized by persistent eosinophilia associated with damage to multiple organs. Although the diagnostic criteria for HES include sustained hypereosinophilia for at least 6 months, early initiation of therapy may be recommended in patients exhibiting HES symptoms. Eosinophilic enteritis has been reported as a cause of intussusception in several cases. However, HES as a cause of intussusception has not yet been reported. In the present report, we describe a case of HES that manifested as jejunojejunal intussusception. Although long-standing hypereosinophilia was not confirmed, the patient required eosinophil-lowering therapy for an intestinal obstruction. The patient was treated with systemic corticosteroids, after which the symptoms and multiple organ involvement, including intussusception, improved dramatically, as noted on the radiological investigation. Moreover, surgery was not necessary.

Hypereosinophilic Syndrome Presenting as Intussusception in Adults / 대한내과학회지

Hypereosinophilic syndrome (HES) is characterized by persistent eosinophilia associated with damage to multiple organs. Although the diagnostic criteria for HES include sustained hypereosinophilia for at least 6 months, early initiation of therapy may be recommended in patients exhibiting HES symptoms. Eosinophilic enteritis has been reported as a cause of intussusception in several cases. However, HES as a cause of intussusception has not yet been reported. In the present report, we describe a case of HES that manifested as jejunojejunal intussusception. Although long-standing hypereosinophilia was not confirmed, the patient required eosinophil-lowering therapy for an intestinal obstruction. The patient was treated with systemic corticosteroids, after which the symptoms and multiple organ involvement, including intussusception, improved dramatically, as noted on the radiological investigation. Moreover, surgery was not necessary.