1.Recent advances in venous air embolism.
Jing XIA ; Lin-Lin ZHANG ; Xin-Shan CHEN
Journal of Forensic Medicine 2007;23(6):447-449
Air embolism, a life-threatening complication of medical procedure, is a frequently encountered challenge in the forensic practices. It can be easily missed due to ignorance by forensic examiner or it could be difficult to be identified due to prolonged storage of the cadaver. This article reviews the etiological factors, pathophysiological changes, clinical manifestation, diagnosis, and the medicolegal identification of air embolism. The authors suggest that modern imaging techniques including echocardiogram, computer tomography, and magnetic resonance imaging play animportant role in the clinical diagnosis and forensic identification of air embolism.
Cause of Death
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Echocardiography
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Embolism, Air/pathology*
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Forensic Pathology
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Humans
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Postmortem Changes
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Pulmonary Embolism/etiology*
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Tomography, X-Ray Computed
2.Four Cases of a Cerebral Air Embolism Complicating a Percutaneous Transthoracic Needle Biopsy.
Soo Jung UM ; Soo Keol LEE ; Doo Kyung YANG ; Choonhee SON ; Ki Nam KIM ; Ki Nam LEE ; Yun Seong KIM
Korean Journal of Radiology 2009;10(1):81-84
A percutaneous transthoracic needle biopsy is a common procedure in the practice of pulmonology. An air embolism is a rare but potentially fatal complication of a percutaneous transthoracic needle biopsy. We report four cases of a cerebral air embolism that developed after a percutaneous transthoracic needle biopsy. Early diagnosis and the rapid application of hyperbaric oxygen therapy is the mainstay of therapy for an embolism. Prevention is the best course and it is essential that possible risk factors be avoided.
Adult
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Aged
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Biopsy, Needle/*adverse effects/methods
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Embolism, Air/*etiology/therapy
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Female
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Humans
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Hyperbaric Oxygenation
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Intracranial Embolism/*etiology/therapy
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Lung/*pathology
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Male
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Radiography, Interventional
3.Massive Paradoxical Air Embolism in Brain Occurring after Central Venous Catheterization: A Case Report.
Seon Sook HAN ; Sam Soo KIM ; Hyun Pyo HONG ; Seo Young LEE ; Seung Joon LEE ; Bong Ki LEE
Journal of Korean Medical Science 2010;25(10):1536-1538
Cerebral air embolism is a rare but fatal complication of central venous catheterization. Here, we report a case of paradoxical cerebral air embolism associated with central venous catheterization. An 85-yr-old man underwent right internal jugular vein catheterization, and became obtunded. Brain MR imaging and CT revealed acute infarction with multiple air bubbles on the side of catheter insertion. The possibility of cerebral air embolism should be considered in patients developing neurological impairment after central venous catheterization, and efforts should be made to limit cerebral damage.
Aged, 80 and over
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Brain/pathology
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Catheterization, Central Venous/*adverse effects
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Echocardiography, Transesophageal
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Embolism, Air/*etiology/ultrasonography
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Embolism, Paradoxical/*etiology/ultrasonography
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Humans
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Intracranial Embolism/*etiology/ultrasonography
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Magnetic Resonance Imaging
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Male
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Tomography, X-Ray Computed
4.Fatal Biliary-Systemic Air Embolism during Endoscopic Retrograde Cholangiopancreatography: A Case with Multifocal Liver Abscesses and Choledochoduodenostomy.
Sung Tae CHA ; Chang Il KWON ; Han Gyung SEON ; Kwang Hyun KO ; Sung Pyo HONG ; Seong Gyu HWANG ; Pil Won PARK ; Kyu Sung RIM
Yonsei Medical Journal 2010;51(2):287-290
We report a rare case of a massive fatal embolism that occurred in the middle of endoscopic retrograde cholangiopancreatography (ERCP) and retrospectively examine the significant causes of the event. The patient was a 50-year old female with an uncertain history of previous abdominal surgery for multiple biliary stones 20 years prior. The patient presented with acute right upper quadrant pain. An abdominal computed tomographic (CT) scan revealed the presence of multiple stones in the common bile duct (CBD) and intra-hepatic duct (IHD) with biliary obstruction, multifocal liver abscesses, and air-biliarygram. Emergency ERCP showed a wide and straight opening of choledochoduodenostomy, which may have been created during a previous surgery, and multiple filling defects in the CBD. With the use of a forward endoscope, mud stones were extracted through the opening of the choledochoduodenostomy. Cardiac arrest suddenly developed during the procedure, and despite immediate resuscitation, the patient died due to a massive systemic air embolism. We reviewed previously reported fatal cases and accessed factors facilitating air embolisms in this case.
Cholangiopancreatography, Endoscopic Retrograde/*methods
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Choledochostomy/*methods
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Common Bile Duct/radiography
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Embolism, Air/*complications
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Fatal Outcome
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Female
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Humans
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Liver Abscess/pathology
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Middle Aged
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Tomography, X-Ray Computed
5.A Case of Crohn's Disease Presenting with Free Perforation and Portal Venous Gas.
Na Rae HA ; Hang Lak LEE ; Oh Young LEE ; Byung Chul YOON ; Ho Soon CHOI ; Joon Soo HAHM ; Dong Hoo LEE ; Min Ho LEE
The Korean Journal of Gastroenterology 2007;50(5):319-323
Crohn's disease is characterized by its chronic course and transmural inflammation of gastrointestinal tract. The accompanying fibrous reaction and adhesion to adjacent viscera appears to limit the complication of free perforation. The true incidence of free bowel perforation is difficult to assess, however, the anticipated occurrence rate is 1-2% during the course of illness. Moreover, portal venous gas is also an uncommon event in the natural history of Crohn's disease. Portal venous gas occurs when intraluminal gas from the gastrointestinal tract or gas-forming bacteria enters the portal venous circulation. The finding of portal venous gas associated with Crohn's disease does not always mandate surgical intervention. We experienced a case of Crohn's disease presenting with free perforation and portal venous gas. The literatures on the cases with perforation and portal venous gas associated with Crohn's disease were reviewed.
Adult
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Colonoscopy
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Crohn Disease/complications/drug therapy/*pathology
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Diagnosis, Differential
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Embolism, Air/*diagnosis/etiology
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Humans
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Intestinal Perforation/*diagnosis/etiology
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Male
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*Portal Vein
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Tomography, X-Ray Computed
6.Incidence of Venous Air Embolism during Myomectomy: The Effect of Patient Position.
Jiwon AN ; Seo Kyung SHIN ; Ja Young KWON ; Ki Jun KIM
Yonsei Medical Journal 2013;54(1):209-214
PURPOSE: Venous air embolism (VAE) is characterized by the entrainment of air or exogenous gases from broken venous vasculature into the central venous system. No study exists regarding the effect of patient positioning on the incidence of VAE during abdominal myomectomy. The purpose of this study was to assess the incidence and grade of VAE during abdominal myomectomy in the supine position in comparison to those in the head-up tilt position using transesophageal echocardiography. MATERIALS AND METHODS: In this study, 84 female patients of American Society of Anesthesiologist physical status I or II who were scheduled for myomectomy under general anesthesia were included. Patients were randomly divided into two groups: supine group and head-up tilt group. Transesophageal echocardiography images were videotaped throughout the surgery. The tapes were then reviewed for VAE grading. RESULTS: In the supine group, 10% of the patients showed no VAE. Moreover, 10% of the patients were classified as grade I VAE, while 50% were categorized as grade II, 22.5% as grade III, and 7.5% as grade IV. In the head-up tilt group, no VAE was detected in 43.2% of the patients. In addition, 18.2% of the patients were classified as grade I VAE, 31.8% as grade II, and 6.8% as grade III; no patients showed grade IV. VAE grade in the head-up tilt group was significantly lower than that in the supine group (p<0.001). CONCLUSION: The incidence and grade of VAE in the head-up tilt group were significantly lower than those in the supine group during abdominal myomectomy.
Abdomen/pathology
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Adult
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Echocardiography, Transesophageal
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Embolism, Air/epidemiology/*etiology
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Female
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Humans
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Incidence
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Middle Aged
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Myoma/pathology/*surgery
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*Posture
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Supine Position
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Uterine Myomectomy/adverse effects/*methods
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Uterus/pathology/ultrasonography
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Veins/*ultrasonography
7.Estimation of postmortem interval with multivoxel-voxel proton 1H-MR spectroscopy.
Tian-Tong YANG ; Zhen-Wei LI ; Liang LIU ; Na ZHENG
Journal of Forensic Medicine 2007;23(6):405-408
OBJECTIVE:
The purpose of our study was to evaluate the postmortem interval with multi-voxel 1H-MR spectroscopy.
METHODS:
Twelve healthy rabbits were studied and the quantities of N-acetylaspartate, total choline, phosphocreatine and creatine were measured by 1H-MR spectroscopy after death at 0.5, 1, 2, 4, 6, 8, 12, 16, and 24 h.
RESULTS:
The levels of Naa/Cr and Naa/Ch decreased following death, while the level of Ch/Cr increased initially and then decreased following death.
CONCLUSION
Multi-voxel proton MR spectroscopy for Naa/Cr and Ch/Cr metabolic ratio could be used in future postmortem interval studies.
Animals
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Aspartic Acid/metabolism*
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Biomarkers/metabolism*
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Brain/pathology*
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Choline/metabolism*
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Creatine/metabolism*
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Disease Models, Animal
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Embolism, Air
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Female
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Magnetic Resonance Spectroscopy/methods*
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Male
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Phosphocreatine/metabolism*
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Postmortem Changes
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Protons
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Rabbits
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Regression Analysis
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Time Factors