Jun Ho Yang

Intracardiac Foreign Body (Bone Cement) after Percutaneous Vertebroplasty

Percutaneous vertebroplasty is a relatively easy and minimally invasive procedure used in treating vertebral fractures. However, the procedure has many complications, one of which is bone cement leakage, which happens frequently. Leakage to the paravertebral venous system, in particular, may lead to especially devastating consequences. Here we report a case of a 65-year-old male patient with an intracardiac foreign body (bone cement) that generated a perforation on the right ventricle, and result in hemopericardium after percutaneous vertebroplasty. We performed open heart surgery to remove the foreign body.

Risk Factors for Pneumonia in Ventilated Trauma Patients with Multiple Rib Fractures

Background Ventilator-associated pneumonia (VAP) is a common disease that may contribute to morbidity and mortality among trauma patients in the intensive care unit (ICU). This study evaluated the associations between trauma factors and the development of VAP in ventilated patients with multiple rib fractures. Methods We retrospectively and consecutively evaluated 101 patients with multiple rib fractures who were ventilated and managed at our hospital between January 2010 and December 2015, analyzing the associations between VAP and trauma factors in these patients. Trauma factors included sternal fracture, flail chest, diaphragm injury, traumatic aortic dissection, combined cardiac injury, pulmonary contusion, pneumothorax, hemothorax, hemopneumothorax, abbreviated injury scale score, thoracic trauma severity score, and injury severity score. Results Forty-six patients (45.5%) had at least 1 episode of VAP, 10 (21.7%) of whom died in the ICU. Of the 55 (54.5%) patients who did not have pneumonia, 9 (16.4%) died in the ICU. Using logistic regression analysis, we found that VAP was associated with severe lung contusion (odds ratio, 3.07; 95% confidence interval, 1.12 to 8.39; p=0.029). Conclusion Severe pulmonary contusion (pulmonary lung contusion score 6–12) is an independent risk factor for VAP in ventilated trauma patients with multiple rib fractures.

Biochemical Markers as Predictors of In-Hospital Mortality in Patients with Severe Trauma: A Retrospective Cohort Study

Background Initial evaluation of injury severity in trauma patients is an important and challenging task. We aimed to assess whether easily measurable biochemical parameters (hemoglobin, pH, and prothrombin time/international normalized ratio [PT/INR]) can predict in-hospital mortality in patients with severe trauma. Methods This retrospective study involved review of the medical records of 315 patients with severe trauma and an injury severity score >15 who were managed at Gyeongsang National University Hospital between January 2005 and December 2015. We extracted the following data: in-hospital mortality, injury severity score, and initial hemoglobin level, pH, and PT/INR. The predictive values of these variables were compared using receiver operation characteristic curves. Results Of the 315 patients, 72 (22.9%) died. The in-hospital mortality rates of patients with hemoglobin levels <8.4 g/dl and ≥8.4 g/dl were 49.8% and 9.9%, respectively (P < 0.001). At a cutoff hemoglobin level of 8.4 g/dl, the sensitivity and specificity values for mortality were 81.9% and 86.4%, respectively. At a pH cutoff of 7.25, the sensitivity and specificity values for mortality were 66.7% and 77.8%, respectively; 66.7% of patients with a pH <7.25 died versus 22.2% with a pH ≥7.25 (P < 0.001). The in-hospital mortality rates for patients with PT/INR values ≥1.4 and <1.4 were 37.5% and 16%, respectively (P < 0.001; sensitivity, 37.5%; specificity, 84%). Conclusions Using the suggested cutoff values, hemoglobin level, pH, and PT/INR can simply and easily be used to predict in-hospital mortality in patients with severe trauma.

The thorax trauma severity score and the trauma and injury severity score: Do they predict in-hospital mortality in patients with severe thoracic trauma?

Abstract Several scoring systems are commonly used to evaluate severity in patients with traumatic injuries. However, there is no generally accepted standard scoring system to assess the severity of thoracic trauma, specifically in patients who have sustained severe injuries. The present study aimed to evaluate the validity of the trauma and injury severity score (TRISS) and the thorax trauma severity score (TTSS) as predictors of in-hospital mortality in patients with severe thoracic trauma. We conducted a retrospective, consecutive review of the medical records of patients with severe thoracic trauma who were managed at our institution between January 2005 and December 2015. Inclusion criteria were patients with severe thoracic injury (injury severity score > 18) who required intensive care therapy and who had no local or systemic infection. We analyzed the association between the trauma severity scores (TTSS and TRISS) and in-hospital mortality in these patients. We also determined the predictive value of the scores using receiver-operating characteristic (ROC) curves. A total of 228 patients with severe thoracic trauma were included in this study. The in-hospital mortality rate was 21.9%. There was a statistically significant association between the TRISS and in-hospital mortality (P < .001), but the association between the TTSS and in-hospital mortality was not statistically significant (P = .547). The ROC curve demonstrated adequate discrimination, as demonstrated by an area under the curve value of 0.787 for the TRISS. At a cut-off value of 25.9%, the TRISS had a sensitivity of 83.6% and specificity of 73.5% to predict in-hospital mortality. The present study demonstrated that the TRISS, but not the TTSS, can be used to predict in-hospital mortality in patients with severe thoracic trauma; hence, additional prospective studies are required.

Side effects associated with the treatment of multidrug-resistant tuberculosis at a tuberculosis referral hospital in South Korea: A retrospective study

Abstract Patients with drug-susceptible tuberculosis (TB) show good tolerance of the medications used and have few side effects. However, medications used to treat multidrug-resistant tuberculosis (MDR-TB) have many known side effects. Here, we studied the occurrence of side effects due to treatment of patients with MDR-TB. We conducted a retrospective and consecutive review of the medical records of 256 patients who received treatment for MDR-TB between January 2006 and December 2011. One or more side effects were observed in 95 (37.1%) of the 256 patients. These side effects led to the suspension of the use of 1 or more drugs from the regimen of individualized treatment prescribed for 44 of the patients (17.2%). The side effects observed most frequently included gastrointestinal disturbance (18.4%), psychiatric disorder (5.5%), arthralgia (4.7%), hepatitis (3.9%), peripheral neuropathy (3.1%), hypothyroidism (2.3%), epileptic seizures (2%), dermatological effects (2%), ototoxicity (1.6%), and nephrotoxicity (1.2%). The treatment was successful in 220 (85.9%) patients with MDR-TB. Our study may help in formulating strategies for the timely and aggressive management of drug side effects. This may reduce the suspension of therapy and increase the rate of clinical success.

Flow Rate Through Pigtail Catheter Used for Left Heart Decompression in an Artificial Model of Extracorporeal Membrane Oxygenation Circuit

In refractory cardiogenic shock, veno-arterial extracorporeal membrane oxygenation (ECMO) can be initiated. Although left heart decompression can be accomplished by insertion of a left atrial (LA) or left ventricular (LV) cannula using a percutaneous pigtail catheter, the venting flow rate according to catheter size and ECMO flow rate is unknown. We developed an artificial ECMO circuit. One liter saline bag with its pressure set to 20 mm Hg was connected to ECMO to mimic LV failure. A pigtail catheter was inserted into the 1 L saline bag to simulate LV unloading. For each pigtail catheter size (5–8 Fr) and ECMO flow rate (2.0–4.0 L/min), the moving distance of an air bubble that was injected through a three-way stopcock was measured in the arterial pressure line between the pigtail catheter and ECMO inflow limb. The flow rate was then calculated. We obtained the following equation to estimate the pigtail catheter flow rate. Pigtail vent catheter flow rate (ml/min) = 8×ECMOflow rate(L /min)+9×pigtail catheter size(Fr)- 57 This equation would aid in designing of a further study to determine optimal venting flow rate. To achieve optimal venting flow, our equation would enable selection of an adequate catheter size.

Invasive thymoma with multiple ring calcifications and osseous metaplasia: A case report: A rare case of invasive thymoma

An 8.0 × 7.0 × 3.0 cm calcified anterior mediastinal mass was found in a 57‐year‐old man during a regular health checkup. The tumor had invaded the pericardium and phrenic nerve. The Masaoka–Koga classification was stage III. Multiple ring calcifications were present in the gross feature, and osseous metaplasia was observed in the histologic examination. World Health Organization histologic classification of the tumor was type B2. The patient is currently undergoing chemotherapy and radiation therapy to prevent tumor recurrence. To our knowledge, this is the first case of multiple ring calcifications and osseous metaplasia in invasive thymoma.

Clinical usefulness of the angle between left main coronary artery and left anterior descending coronary artery for the evaluation of obstructive coronary artery disease

Background A wider angle between the left anterior descending coronary artery (LAD) and left circumflex coronary artery (LCX) has been suggested to induce plaque formation in the arterial system via changes in shear stress. However, the relationship between the left main coronary artery (LM)-LAD angle and LAD stenosis has not been investigated. Therefore, we aimed to evaluate the associations between the LM-LAD and LAD-LCX angles and LAD stenosis. Methods Coronary computed tomography angiographies (CTAs) of 201 patients with suspected coronary artery disease were analyzed. Angle measurements were performed twice by experts using CTA images, and the values were averaged. The patients were divided into two groups, based on the presence of significant LAD stenosis (luminal diameter narrowing ≥50%) on CTA. Results The mean LM-LAD and LAD-LCX angles were 37.46° and 63.04°, respectively. The LM-LAD and LAD-LCX angles of the group with significant LAD stenosis were significantly wider than that of the group with nonsignificant LAD stenosis (P<0.001; P = 0.020, respectively). In a multivariate analysis, an LAD-LCX angle greater than 60° showed a trend toward predicting significant LAD stenosis (HR, 3.14; 95% CI: 0.96–1026; P = 0.058). In contrast, an LM-LAD angle greater than 40° was a significant predictor of significant LAD stenosis (HR, 12.2; 95% CI: 2.60–56.52; P = 0.001). Conclusions The results of the present study may suggest that a wider LM-LAD angle could be used to identify patients at higher risk for coronary artery disease (CAD). Thus, close follow–up and preventive management of other risk factors may be needed in such cases.

A Report of Two Cases of Adventitial Cystic Disease of the Popliteal Artery

Two patients were admitted to our department because of recent aggravation of claudication in the leg, which was exacerbated by walking. They were diagnosed as having a Baker cyst or acute thrombosis in the popliteal fossa at another hospital. There was no evidence of ischemia, and the ankle brachial index was normal. Computed tomography and magnetic resonance imaging were performed, revealing a cystic mass of the popliteal artery (PA). Intraoperatively, the cystic lesion was found within the adventitia of the PA; based on the biopsy findings, both patients were diagnosed as having adventitial cystic disease of the PA.

Comparison of Clinical Outcomes between Surgical Repair and Endovascular Stent for the Treatment of Abdominal Aortic Aneurysm

Purpose This study was performed to compare the treatment outcomes between endovascular aneurysm repair (EVAR) and open surgical repair (OSR) of abdominal aortic aneurysms (AAAs) in a South Korean population. Materials and Methods We performed a retrospective review of the medical records of 99 patients with AAAs who were managed at Gyeongsang National University Hospital between January 2005 and December 2014. We reviewed the demographic characteristics and perioperative treatment outcomes of patients with AAA undergoing EVAR or OSR. In-hospital mortality and reintervention rates were assessed and compared between the EVAR and OSR groups. Results In-hospital mortality was not significantly higher in the OSR group versus the EVAR group (3.8% vs. 8.7%, respectively, P=0.41). Intervention time (209.6 mins vs. 350.9 mins, P<0.001) and length of hospital stay (7.79 days vs. 17.46 days, P<0.001) were significantly longer in the OSR group vs. the EVAR group. Median follow-up time was 24.1±20 months for the EVAR group and 43.9±28 months for the OSR group. The cumulative rate of freedom from reintervention at 60 months was 62.0% for the EVAR group and 100% for the OSR group (P<0.001). Conclusion EVAR was favorable in terms of intervention time and length of hospital stay, but the long-term durability of EVAR remains open for further debate.