OBJECTIVE: The purpose of this study is to evaluate the level of lumbar spine corresponding to the prevertebral major vascular structures and the distance of the prevertebral available disc space (DPADS) of L5-S1 between the common iliac arteries and veins with preoperative magnetic resonance imaging (MRI) study. METHODS: Three hundred and forty seven lumbar MRI films (200males and 147females) from spinal disorder patients were reviewed. The patients' age ranged 14 to 86 years (mean 45 years). The patients were divided into eight groups by 10-year interval from a teen to the eighties. There were evaluated age-related locational changes in the level of lumbar spine corresponding to the aortic bifurcation (AB) and the origin of inferior vena cava (OIVC). In addition, DPADS of L5-S1 between the common iliac arteries and veins were measured. RESULTS: The common sites of the AB for the entire subject group were at the upper body of L4 (from the upper body of L3 to the lower body of L5). The common sites of the OIVC for the entire subject group were at the level of the L4-L5 disc space (from the upper body of L4 to the lower body of L5). The age-related changes in the location of the AB with a downward shift were statistically significant (p< 0.05). Similarly, age-related changes were observed in the OIVC, although this was more prominent in females (p<0.05). The average DPADS of L5-S1 was 34.48+/-10.00 mm. There were 27 cases(7.8%) who had the DPADS less than 20mm, and this narrow DPADS could make it very difficult to access the anterior disc space of L5-S1 because recently the popularly used anterior lumbar fusion materials were over 10 mm in diameter. CONCLUSION: These results may be helpful to minimize potential vascular injury and morbidity in anterior lumbar spinal surgery.
Adolescent ; Female ; Humans ; Iliac Artery ; Magnetic Resonance Imaging ; Spine ; Vascular System Injuries ; Veins ; Vena Cava, Inferior

OBJECTIVE: Several scoring systems have been developed to identify patients who require massive transfusion (MT) after major trauma to improve survival. The primary goal of this study was to investigate the usefulness of enhanced computed tomography attenuation values (CTAVs) of major vessels to determine the need for MT in patients with major blunt trauma.METHODS: This single-center retrospective cohort study evaluated patients aged 16 years or older who underwent contrast-enhanced computed tomography scan of the torso after major blunt trauma. The CTAVs of six major vessel points in both the arterial and portal venous phases at initial computed tomography examination were assessed and compared between the MT and the no MT group. The capability of enhanced CTAVs to predict the necessity for MT was estimated based on the area under the receiver operating characteristic curve.RESULTS: Of the 254 eligible patients, 36 (14%) were in the MT group. Patients in the MT group had significantly higher CTAVs at all sites except the inferior vena cava in both the arterial and portal venous phases than that in the no MT group. The descending aorta in the arterial phase had the highest accuracy for predicting MT, with an AUROC of 0.901 (95% confidence interval, 0.855 to 0.947; P<0.001).CONCLUSION: Initial elevation of enhanced CTAV of the aorta is a predictor for the need for MT. A higher CTAV of the aorta should alert the trauma surgeon or emergency physician to activate their MT protocol.
Aorta ; Aorta, Thoracic ; Cohort Studies ; Emergencies ; Humans ; Retrospective Studies ; ROC Curve ; Torso ; Vena Cava, Inferior ; Wounds and Injuries

Aorta, Abdominal ; injuries ; Blood Loss, Surgical ; prevention & control ; Hemorrhage ; therapy ; Hemostasis, Surgical ; methods ; Humans ; Mesenteric Veins ; injuries ; Splenic Diseases ; therapy ; Vena Cava, Inferior ; injuries

PURPOSE: Deep vein thrombosis (DVT) is a serious disease which causes life-threatening pulmonary embolism and chronic venous insufficiency. In order to prevent pulmonary embolism, inferior vena cava (IVC) filter placement is commonly performed nowadays. We carried out this study to analyze the patterns of the indications for IVC filter placement, the complications associated with procedure, and the follow-up results. METHOD: We treated 42 patients with acute DVT between September 2001 and November 2002 at Gil Medical Center. Our subjects included 10 patients who underwent IVC filter placement during the same period. Duplex sonography and CT venography were performed in all cases. The filter was placed by one interventional radiologist just after checking the nonselective venography. The patients were followed monthly with a physical examination. Plain abdominal film was checked every 3 months, and CT venography every 6 months. RESULT: The mean age was 55.6 years (range 35~72) and the male-to-female ratio was 1:4. The associated diseases were advanced cancer in 3 cases, intracranial hemorrhage in 2 and spinal cord injury and ankylosis of the hip joint in 1. There were 8 cases of hypercoagulable states; 7 of protein S deficiency, 3 of protein C deficiency and 1 of antithrombin III deficiency. Indications for filter insertion were a contraindication to anticoagulation in 5 cases, recurrent pulmonary embolism in 2, floating IVC thrombosis in 2, complication of anticoagulation in 1, prophylactic use before catheter-directed thrombolysis in 1, and quadriplegia in 1. Four Greenfield filters and six TrapEase filters were used. Filters were deployed at infrarenal IVC in 8 cases and suprarenal IVC in 2 cases. There were no major complications related to the procedure. Late complications were not detected during the 7-month follow-up (range 2~16 months). CONCLUSION: We performed 10 IVC filter placements for therapeutic purpose without any serious complications. A wider range of indications, including prophylactic use, might be considered in the future practice for DVT.
Ankylosis ; Antithrombin III Deficiency ; Follow-Up Studies ; Hip Joint ; Humans ; Intracranial Hemorrhages ; Phlebography ; Physical Examination ; Protein C Deficiency ; Protein S Deficiency ; Pulmonary Embolism ; Quadriplegia ; Spinal Cord Injuries ; Thrombosis ; Vena Cava Filters* ; Vena Cava, Inferior* ; Venous Insufficiency ; Venous Thrombosis*

Visual loss and field defects commonly occur after acute blood loss. We present a case of bilateral permanent visual field defect in a 30-year-old man after a massive hemorrhage caused by large vessel injury during a right nephrectomy. His postoperative visual acuity decreased significantly, and his visual field showed peripheral constriction and inferior altitudinal field defect in both eyes. A year and a half after the operation, visual acuity recovered to the preoperative level, but the field did not show improvement. We advance that this is a possible result of extensive injury to the occipital area, excluding the corresponding area of the macula.
Acute Disease ; Adult ; Blindness/*etiology ; Blood Loss, Surgical/*physiopathology ; Cerebral Infarction/complications/*etiology ; Humans ; Male ; Nephrectomy ; Occipital Lobe/pathology ; Vena Cava, Inferior/injuries ; Vision Disorders/*etiology ; *Visual Fields

The occurrence of severe hypotension and bradycardia, following placing to the beach chair position from supine during general anesthesia for repair of tendon injury of the rotator cuff of shoulder in a healthy 50 year-old man was described. The Bezold-Jarisch reflex, which is known to inhibit cardiovascular reflex and composed of three kinds of symptoms such as vasodilation, bradycardia and hypotension, has been reported mainly in peripheral nerve block, and may occur during orthostasis, hypovolemia, hemorrhage, supine inferior vena cava compression in pregnancy, interscalene block for shoulder surgery in the sitting position and so on. The bradycardia and hypotension can be more aggravated when causative elements overlaps each other. Anticholinergics and vasopressor were injected intravenously, and position of the patient was changed to the supine position immediately resulting in a normal vital signs dramatically.
Anesthesia, General ; Arthroscopy ; Bradycardia ; Cholinergic Antagonists ; Dizziness ; Hemorrhage ; Humans ; Hypotension ; Hypovolemia ; Peripheral Nerves ; Pregnancy ; Reflex ; Rotator Cuff ; Shoulder ; Supine Position ; Tendon Injuries ; Vasodilation ; Vena Cava, Inferior ; Vital Signs

Trauma is one of the leading causes of death in children. Abdominal trauma is about 10% of all pediatric trauma. This study describes the sex and age distribution, injury mechanism, site of intraabdominal injury, management and mortality of children aged 16 years or less who suffered abdominal trauma. The hospital records of 63 patients treated for abdominal injury between March 1997 and February 2007 at the department of surgery, Inje University Pusan Paik Hospital, were analyzed retrospectively. The peak age of incidence was between 2 and 10 years (78%) and this report showed male predominance(2.7:1). The most common mechanism of blunt abdominal trauma was pedestrian traffic accident (49%). The most common injured organ was liver. More than Grade IV injury of liver and spleen comprised of 4(12%) and 5(24%), respectively. Fourteen cases (22%) had multiple organ injuries. Forty nine cases (78%) were managed nonoperatively. Three patients (4.8%) died, who had Grade IV liver injury, Grade IV spleen injury, and liver and spleen injury with combined inferior vena cava injury, respectively. All of the three mortality cases had operative management. In conclusion, the liver or spleen injury which was more than Grade 4 might lead to mortality in spite of operation, although many cases could be improved by nonoperative management.
Abdomen ; Abdominal Injuries ; Accidents, Traffic ; Age Distribution ; Busan ; Cause of Death ; Child* ; Hospital Records ; Humans ; Incidence ; Liver ; Male ; Mortality ; Retrospective Studies ; Spleen ; Vena Cava, Inferior

In spite of advances in the management of the victim of trauma, the reported incidence of mortality and significant morbidity after pancreatic and/or duodenal injuries is still remained high. The key to treatment is thought to be early, accurate evaluation and proper management according to the degree of injury. We experienced a case of 26-year-old man who had melena after surgery for gun-shot wound of abdomen. In operation, it was noted that duodenum, superior mesenteric artery, and inferior vena cava were lacerated. He was treated by primary suture and drainage. But, 9 months later, hematochezia was developed. Duodenoscopic findings showed buldging mass with blood oozing at the medial side of duodenum second portion. Abdominal CT and angiography revealed pseudoaneurysm of superior mesenteric artery in the pancreas head. The surgery was postponed because severe adhesion between adjacent structures and pseudoaneurysm was suspected. So we decided medical treatment for him and melena was stopped spontaneously. We report this case with a review of literatures.
Abdomen ; Adult ; Aneurysm, False* ; Angiography ; Drainage ; Duodenum ; Gastrointestinal Hemorrhage ; Head ; Humans ; Incidence ; Melena ; Mesenteric Artery, Superior ; Mortality ; Pancreas ; Sutures ; Tomography, X-Ray Computed ; Vena Cava, Inferior ; Wounds and Injuries

Circumcaval ureter is one of the congenital anomaly in which aberrant development of the inferior vena cava (IVC) causes compression of the deviated ureter medially behind the IVC. The incidence is approximately one in 1500 cadavers and is three to four times more common in male. Although the lesion is congenital, symptoms attributable to this anomaly usually appear in young adulthood. This is a case of 17-year-old spinal cord injured man with a circumcaval ureter who was diagnosed as right hydronephrosis by routine evaluation for neurogenic bladder, incidentally. Suprapubic cystostomy was done for prevention of further urologic complication and the severity of hydronephrosis was not aggravated in follow up studies after 6 months. We suggest early routine evaluation for neurogenic bladder is very important for prevention of developing urologic complication caused by congenital urologic anomaly in the patients with spinal cord injury.
Adolescent ; Cadaver ; Cystostomy ; Follow-Up Studies ; Humans ; Hydronephrosis* ; Incidence ; Male ; Retrocaval Ureter* ; Spinal Cord Injuries ; Spinal Cord* ; Ureter ; Urinary Bladder, Neurogenic ; Vena Cava, Inferior

Central venous catheter (CVC) for long-term venous access is indispensable for various reasons including hyperalimentation, frequent blood sampling, frequent IV drug use in pediatric patients. We report clinical experience of surgical neonates in whom CVC was inserted primarily via great saphenous vein into suprarenal inferior vena cava. From March 2004 to March 2006, we performed CVC insertion via saphenous vein - contralateral side to main wound - into suprarenal inferior vena cava in surgeries of neonates. 2.7Fr or 4.2Fr, single lumen, tunneled Broviac catheters (Bard Access system, Inc, Salt Lake City, Utah) were used. Skin exit site of tunneled catheter was located in ipsilateral flank area just below edge lower rib. At the end of the procedure, location of the catheter tip was confirmed by plain radiography of abdomen. We retrospectively reviewed the admission records of the patients including nursing staff charts. Nine (50.0 %) patients were male and nine (50.0%) were female. Median gestational age was 38 weeks (range, 29-42 weeks) and median birth weight was 3,105 gm (range, 1,040-3,720 gm). Median age at catheter insertion was 38.5 days (range, 1-236 days). The purpose of CVC insertion was short-and long-term hyperalimentation in nine (50.0 %) patients. CVC insertion was performed in operation room under general anesthesia in sixteen (88.9 %) patients (in these cases, CVC insertion was performed just prior to concurrent operation) and neonatal intensive care unit (NICU) under local anesthesia with adequate sedation in two (11.2%). During the admission period (total catheter-indwelling time : 553 days), CVC functioned well without any significant side effects. Transient swelling of the ipsilateral leg (n=1, 5.6 %) and transient migration of catheter tip (n=1, 5.6 %) were noted, which did not affect function of the indwelled CVC. Mean catheter-indwelling time was 30.7days (range, 3-72 days). All catheters were removed electively except two mortality case. Complications, such as thrombosis, infection, kinking or extravasation of drugs, were not observed in our study period. Tunneled trans-great saphenous vein inferior vena cava catheters are not only comparable to cervical CVCs in terms of function and complication rates, but also very beneficial in selected patients, especially those in whom cervical approach is technically impossible or contraindicated.
Abdomen ; Anesthesia, General ; Anesthesia, Local ; Birth Weight ; Catheters* ; Central Venous Catheters ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Intensive Care, Neonatal ; Lakes ; Leg ; Male ; Mortality ; Nursing Staff ; Radiography ; Retrospective Studies ; Ribs ; Saphenous Vein ; Skin ; Thrombosis ; Vena Cava, Inferior ; Wounds and Injuries