Anaphylactic reaction during the perioperative period typically exhibits rapid onset, varying clinical manifestations, and an expected mortality rate of 1.5-9%. Neuromuscular blocking agents are the leading cause of perioperative anaphylaxis. Here, we report a severe case of anaphylaxis that developed in a 66-year-old man due to cisatracurium administration. And he was successfully managed by extracorporeal membrane oxygenation. Cardiopulmonary resuscitation was performed by extracorporeal membrane oxygenation, and the patient was successfully weaned off 24 hours later.
Aged ; Anaphylaxis* ; Cardiopulmonary Resuscitation ; Extracorporeal Membrane Oxygenation* ; Heart Arrest* ; Humans ; Mortality ; Neuromuscular Blocking Agents ; Perioperative Period

Upper extremity deep vein thrombosis (DVT) is an unusual condition compared to lower extremity DVT, and it represents about 10% of all DVTs. We report a case of upper extremity DVT after clavicle fracture and immobilization.

Traumatic blunt aortic injury especially on proximal ascending aorta is a rare injury with a few reports. Generally emergency surgical management was performed. In this case, however, in multiple trauma with brain injury, emergency surgical management of aortic injury might result in unexpected secondary injury of the brain. Herein, we report a case of a 33-year-old man who was driving a truck was injured in a head-on collision. Evaluation revealed a pseudoaneurysm on his ascending aorta concomitant with epidural hemorrhage. He was treated by surgical management of his ascending aorta after 3 days from accident. There were no postoperative and neurologic complications and the patient was discharged after 18 days.

A 73-year-old man, who, in an inebriated state, had slipped in a f lowerbed and was wounded on the left f lank, was transferred to Trauma Center, Gil Medical Center, Gachon University College of Medicine. Based on the chest and abdominopelvic computed tomography, he was diagnosed with multiple rib fractures and hemopneumothorax on the left hemithorax and was found to have a bony fragment in the spleen. He had not presented peritonitis and exsanguinous symptoms during the observation period. Seven days later, computed tomography of the abdomen showed suspected diaphragmatic injury and a retained foreign body in the spleen. On exploration by video assisted thoracoc surgery (VATS), a herniated omentum through the lacerated site of the diaphragm was observed. After omentectomy using Endo Gia, the foreign body in the spleen was observed through the lacerated site of the diaphragm. Traumatic diaphragm rupture with a foreign body, in the spleen, was successfully managed by video assisted thoracic surgery via the lacerated site of the diaphragm.

Objective: When mass casualty incidents occur in Korea, disaster medical assistance teams (DMATs) and public health disaster response teams (PHDRTs) treat casualties at the scene. However, the appropriateness of their on-site responses has not been assessed so far. In this study, we evaluated their response and the variations in their response according to the accessibility of medical care. Methods: We analyzed mass casualty incidents that were reported to the Disaster Emergency Medical Service Situation Room of the National Emergency Medical Center from July 2014 to December 2018. We divided the accident locations into medically underserved areas (MUAs) and adequately served areas (ASAs) and compared the responses of the two teams in each area. Results: Of the 61 incidents, 20 occurred in MUAs, and 41 occurred in ASAs. In MUAs compared to ASAs, time from DMATs' dispatch to arrival was longer (48 [40-58.5] vs. 23 [18-32], P<0.001) but the time taken by the PHDRTs did not vary between two areas (19 [14-35] vs. 15.5 [9-24.5], P=0.263). In MUAs, the time elapsed from the PHDRTs' dispatch to arrival was less than that of the DMATs (48 [40-58.5] vs. 20 [15-35], P<0.001). In MUAs, the distance of the PHDRTs from the scene was lower (31.4 [25-50.95] vs. 13.6 [5.3-19.7], P=0.001) and more members were dispatched to the scene than the DMAT (5 [4-6] vs. 9 [5-10.5], P=0.013). Conclusion Because of the low accessibility to the scene in MUAs, DMATs took a long time to initiate medical support . To provide adequate disaster medical support, the PHDRTs must be specialized and trained.

Objective: When mass casualty incidents occur in Korea, disaster medical assistance teams (DMATs) and public health disaster response teams (PHDRTs) treat casualties at the scene. However, the appropriateness of their on-site responses has not been assessed so far. In this study, we evaluated their response and the variations in their response according to the accessibility of medical care. Methods: We analyzed mass casualty incidents that were reported to the Disaster Emergency Medical Service Situation Room of the National Emergency Medical Center from July 2014 to December 2018. We divided the accident locations into medically underserved areas (MUAs) and adequately served areas (ASAs) and compared the responses of the two teams in each area. Results: Of the 61 incidents, 20 occurred in MUAs, and 41 occurred in ASAs. In MUAs compared to ASAs, time from DMATs' dispatch to arrival was longer (48 [40-58.5] vs. 23 [18-32], P<0.001) but the time taken by the PHDRTs did not vary between two areas (19 [14-35] vs. 15.5 [9-24.5], P=0.263). In MUAs, the time elapsed from the PHDRTs' dispatch to arrival was less than that of the DMATs (48 [40-58.5] vs. 20 [15-35], P<0.001). In MUAs, the distance of the PHDRTs from the scene was lower (31.4 [25-50.95] vs. 13.6 [5.3-19.7], P=0.001) and more members were dispatched to the scene than the DMAT (5 [4-6] vs. 9 [5-10.5], P=0.013). Conclusion Because of the low accessibility to the scene in MUAs, DMATs took a long time to initiate medical support . To provide adequate disaster medical support, the PHDRTs must be specialized and trained.

Occurence of lactic acidosis with adequate tissue oxygenation(type B lactic acidosis) has been described in association with leukemia, lymphoma, small cell carcinoma and breast cancer. However, no such case has been reported in Korea. Therefore, we report a case of type B lactic acidosis in a man with rapidly progressing acute lymphoblastic leukemia which had been transformed from lymphoma.
Acidosis, Lactic* ; Breast Neoplasms ; Korea ; Leukemia ; Leukemia, Lymphocytic, Chronic, B-Cell ; Lymphoma ; Precursor Cell Lymphoblastic Leukemia-Lymphoma*

BACKGROUND AND OBJECTIVES: The exact pathogenesis of middle ear cholesteatoma is still unknown to some extent. Recently, however, advances of immunology have opened a new chapter in investigating the etiology and pathogenesis of cholesteatoma through immunohistochemical techniques. Matrix metalloproteinases (MMPs) are a group of enzymes thought to be responsible for both normal connective tissue matrix remodelling and the accelerated breakdown associated with tumor development. The aim of this study was to investigate the immunohistochemical expression of MMP-2, MMP-3, and MMP-9 in correlation with the expression of basement membrane antigen (laminin), fibronectin and T lymphocyte in middle ear cholesteatoma to compare them with those in external auditory canal skin as a control group. Material and Methods: The biopsy specimens of cholesteatomatous tissue and external auditory canal skin were obtained during undergoing the middle ear surgery. Immunohistochemical staining was carried out using monoclonal mouse antibodies against MMP-2, MMP-3, MMP-9, laminin, fibronectin and pan T lymphocyte (UCHL1) were used. RESULTS: The results are as follows: In cholesteatomatous tissue, a number of T lymphocytes were expressed and a large number of MMPs were expressed in the basal cell layer and in the stroma of cholesteatoma. Both MMP-2 and MMP-3 showed positive signals in the basal and parabasal cell layer. A strong expression of MMP-9 was shown in granuloma area. Expression of MMP-3 had a significant correlation with a distribution of T lymphocyte (r=-0.522, p<0.05). Expression of MMP-2 had a significant correlation with a distribution of laminin (r=0.662, p <0.05). CONCLUSION: These results indicate that spatial distribution of matrix metalloproteinases in the extracellular matrix show a specific relation to extracellular matrix molecules such as laminin, fibronectin and T-lymphocyte in middle ear cholesteatoma especially inflammatory and immune state.
Allergy and Immunology ; Animals ; Antibodies ; Basement Membrane ; Biopsy ; Cholesteatoma ; Cholesteatoma, Middle Ear* ; Connective Tissue ; Ear Canal ; Ear, Middle* ; Extracellular Matrix Proteins* ; Extracellular Matrix* ; Fibronectins ; Granuloma ; Laminin ; Lymphocytes* ; Matrix Metalloproteinases* ; Mice ; Skin ; T-Lymphocytes

We present a patient with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), which was diagnosed and corrected in her 60 s. The patient is the oldest documented survivor of ALCAPA who underwent a surgical repair. ALCAPA should be corrected surgically to restore the dual coronary system at any age and this case shows that the surgical procedure may be performed safely even in an elderly patient.
Aged ; Coronary Vessels ; Female ; Humans ; Pulmonary Artery ; Survivors

Anaphylactic reaction during the perioperative period typically exhibits rapid onset, varying clinical manifestations, and an expected mortality rate of 1.5-9%. Neuromuscular blocking agents are the leading cause of perioperative anaphylaxis. Here, we report a severe case of anaphylaxis that developed in a 66-year-old man due to cisatracurium administration. And he was successfully managed by extracorporeal membrane oxygenation. Cardiopulmonary resuscitation was performed by extracorporeal membrane oxygenation, and the patient was successfully weaned off 24 hours later.
Aged ; Anaphylaxis ; Cardiopulmonary Resuscitation ; Extracorporeal Membrane Oxygenation ; Heart Arrest ; Humans ; Mortality ; Neuromuscular Blocking Agents ; Perioperative Period