We have experienced two cases of mycotic aneurysms of the superior mesenteric artery. The first case originated from septic embolism of infective endocarditis and the second case originated from salmonella enteritis eight months before. The aneurysms were diagnosed by abdominal ultrasonography and comfirmed by computed tomogram and angiography but the blood culture was negative in both cases at the time of the surgery. Both patient were successfully treated by resection only and the restorations of vascular continuity were not neccesary because of adequate collateral circulations to the intestine. Both patient's postoperative courses were uneventful after the follow up of one year and nine months, respectively.
Aneurysm ; Aneurysm, Infected* ; Angiography ; Collateral Circulation ; Embolism ; Endocarditis ; Enteritis ; Follow-Up Studies ; Humans ; Intestines ; Mesenteric Artery, Superior* ; Salmonella ; Ultrasonography

We present a retrospective analysis of arterial embolectomies performed at the Inje University Seoul Paik Hospital. During the period of March 1987 - Feburary 1996 twenty-six patients underwent embolectomies, eighteen patients were male and eight patients were female, mean age of patients was 56.8 years. Rest pain was the chief complaint in 24 patients, the remaining two patients complained of long term history of claudication after recovery of acute symtoms. But only 10 patients had sensory/motor symtoms. Heart was the most common source of embolization and frequent predisposing factor of embolism was ischemic heart disease in 8 cases and valvular heart disease in 11 cases. The sites of embolization were upper extremities artery in 6 cases, saddle embolism in 2 cases, lower extremities artery in 18 cases and the most common site of embolism was femoral artery in 11 cases. Preoperative angiography was taken in the diagnosis and planning of the embolectomy in 13 patients while in the other patient preoperative angiography was not taken. Only two cases were operated within the golden period of 6 hours and other cases were operated in more than 6 hours after embolization. In all patients, the Fogarty embolectomy catheter was used without bypass surgery via bachial ateriotomy in the embolism of upper extremities artery, bilateral groin approaches in the saddle embolism and transfemoral approach in the embolism of lower extremities artery. However 3 patients were re-operated via transpopliteal approach in the distal poplitiotibial embolism. Eighteen patients received perioperative anticoagulation therapy by heparin or fraxiparine and wafarin was used in 17 patients at the time of discharge and the indication of anticogulation was patients of valvular heat disease and/or atrial fibrillation, peripheral artery atherosclerosis and recurrent embolism. Postoperative results of the embolectomy were as follows: fouteen pateints had excellent results, five cases had symtom improvement after re-operation, B.K. amputation in 1 case who had sever atherosclerosis of lower extremities, recurrent embolism in 1 case and death in 2 cases the cause of death were acute renal failure and cerebral artery embolism, respectively. The complications of the embolectomy were reperfusion syndrome, pseudoaneurysm and intimal dissection in one case each. Conclusively the problems of embolism is delayed diagnosis and increasing number of old aged patient who had suffered ischemic heart diease. Preoperative angiography was not always needed for embolectomy. Selective anticoagulation therapy can decrease incidence of re-embolism. In the distal poplitiotibial embolism, seletive embolectomy of tibial artery was difficult.
Acute Kidney Injury ; Amputation ; Aneurysm, False ; Angiography ; Arteries* ; Atherosclerosis ; Atrial Fibrillation ; Catheters ; Causality ; Cause of Death ; Cerebral Arteries ; Delayed Diagnosis ; Diagnosis ; Embolectomy* ; Embolism ; Extremities* ; Female ; Femoral Artery ; Groin ; Heart ; Heart Valve Diseases ; Heparin ; Hot Temperature ; Humans ; Incidence ; Lower Extremity ; Male ; Myocardial Ischemia ; Nadroparin ; Reperfusion ; Retrospective Studies ; Seoul ; Tibial Arteries ; Upper Extremity

We present a retrospective analysis of arterial embolectomies performed at the Inje University Seoul Paik Hospital. During the period of March 1987 - Feburary 1996 twenty-six patients underwent embolectomies, eighteen patients were male and eight patients were female, mean age of patients was 56.8 years. Rest pain was the chief complaint in 24 patients, the remaining two patients complained of long term history of claudication after recovery of acute symtoms. But only 10 patients had sensory/motor symtoms. Heart was the most common source of embolization and frequent predisposing factor of embolism was ischemic heart disease in 8 cases and valvular heart disease in 11 cases. The sites of embolization were upper extremities artery in 6 cases, saddle embolism in 2 cases, lower extremities artery in 18 cases and the most common site of embolism was femoral artery in 11 cases. Preoperative angiography was taken in the diagnosis and planning of the embolectomy in 13 patients while in the other patient preoperative angiography was not taken. Only two cases were operated within the golden period of 6 hours and other cases were operated in more than 6 hours after embolization. In all patients, the Fogarty embolectomy catheter was used without bypass surgery via bachial ateriotomy in the embolism of upper extremities artery, bilateral groin approaches in the saddle embolism and transfemoral approach in the embolism of lower extremities artery. However 3 patients were re-operated via transpopliteal approach in the distal poplitiotibial embolism. Eighteen patients received perioperative anticoagulation therapy by heparin or fraxiparine and wafarin was used in 17 patients at the time of discharge and the indication of anticogulation was patients of valvular heat disease and/or atrial fibrillation, peripheral artery atherosclerosis and recurrent embolism. Postoperative results of the embolectomy were as follows: fouteen pateints had excellent results, five cases had symtom improvement after re-operation, B.K. amputation in 1 case who had sever atherosclerosis of lower extremities, recurrent embolism in 1 case and death in 2 cases the cause of death were acute renal failure and cerebral artery embolism, respectively. The complications of the embolectomy were reperfusion syndrome, pseudoaneurysm and intimal dissection in one case each. Conclusively the problems of embolism is delayed diagnosis and increasing number of old aged patient who had suffered ischemic heart diease. Preoperative angiography was not always needed for embolectomy. Selective anticoagulation therapy can decrease incidence of re-embolism. In the distal poplitiotibial embolism, seletive embolectomy of tibial artery was difficult.
Acute Kidney Injury ; Amputation ; Aneurysm, False ; Angiography ; Arteries* ; Atherosclerosis ; Atrial Fibrillation ; Catheters ; Causality ; Cause of Death ; Cerebral Arteries ; Delayed Diagnosis ; Diagnosis ; Embolectomy* ; Embolism ; Extremities* ; Female ; Femoral Artery ; Groin ; Heart ; Heart Valve Diseases ; Heparin ; Hot Temperature ; Humans ; Incidence ; Lower Extremity ; Male ; Myocardial Ischemia ; Nadroparin ; Reperfusion ; Retrospective Studies ; Seoul ; Tibial Arteries ; Upper Extremity

BACKGROUND: Although tetanus infections have diminished dramatically since the advent of tetanus vaccination, this disease has not disappeared. Those 60 years and older are still very much at risk for this infection. Thus, we investigated the tetanus antibody titers in people 60 years and older in Korea. METHODS: Our subjects included those visiting eight emergency departments from March 2009 to February 2010 after an injury with stable vital signs and without acute disease. Samples obtained were tested using the tetanus immunoglobulin enzyme-linked immunosorbent assay method. The resultant tetanus antibody titers were analyzed. RESULTS: The number of subjects enrolled was 462. The mean titer was 0.09+/-0.14 IU/mL. Twenty-two percent of the subjects had a safe titer level (>0.1 IU/mL). Males and urban subjects had higher tetanus antibody titers than did females and suburban subjects. Subjects living in Incheon, Gangwon-do, Chungcheong-do, and Jeju-do had lower titers. CONCLUSION: The results of this study showed that Koreans 60 years and older did not have a protective mean level of tetanus antibody titer and that 78% of the subjects did not have a seroprotective level after tetanus exposure. Therefore, a national effort to administer tetanus vaccination to elderly Koreans is needed.
Acute Disease ; Aged ; Emergencies ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Immunoglobulins ; Korea ; Male ; Tetanus ; Vaccination ; Vital Signs