We experienced a case of a primary aortoduodenal fistula, which was successfully diagnosed and repaired. This diagnosis must be considered in cases of gastrointestinal bleeding with an abdominal aortic aneurysm. If the correct diagnosis can be made promptly, surgical repair of the fistula is possible.
Aortic Aneurysm, Abdominal ; Diagnosis ; Fistula* ; Hemorrhage

Mucous impaction in surgical patients can lead to a large area of atelectasis, hypoxemia, and pulmonary vasoconstriction in sequence. We describe two cases of mucous impaction following endotracheal intubation in children with an upper respiratory infection (URI) that were successfully treated with a rigid or fiberoptic bronchoscopy. These cases show that the administration of general anesthesia to children with a URI is not benign and that these children require close observation and management in the preoperative and perioperative phase of their surgical procedure.
Anesthesia, General ; Anoxia ; Bronchoscopy ; Child* ; Humans ; Intubation, Intratracheal* ; Pulmonary Atelectasis ; Vasoconstriction

PURPOSE: To investigate the change in mitogen-activated protein kinase pathways in the brain tissue after therapeutic hypothermia in the swine cardiac arrest model. METHODS: After the return of spontaneous circulation by cardiopulmonary resuscitation, following a 6 min of no-flow time induced by ventricular fibrillation, pigs (n=24) were randomly assigned to one of four groups (sham, normothermia, 24 hr of therapeutic hypothermia, 48 hr of therapeutic hypothermia). After 24 or 48 hr of therapeutic hypothermia (core temperature 32-34℃), the pigs were then rewarmed to 36℃ for a period of 8 hr. At 60 hr upon the return of spontaneous circulation, the pigs were sacrificed and brain tissues were harvested. RESULTS: We measured the tissue levels of p38, JNK, and ERK pathway expressions from the hippocampus of the swine brain in all four groups. The phosphorylated p38-to-p38 ratio and phosphorylated JNK-to-JNK ratio were significantly increased in all of the intervention groups compared with the sham group. The phosphorylated ERK-to-ERK ratio was increased only in the therapeutic hypothermia groups (p-value=0.026 in the 24 hr of therapeutic hypothermia group and p-value=0.002 in the 48 hr of therapeutic hypothermia group, compared with the sham group). CONCLUSION: The p38 and JNK pathways were also activated during therapeutic hypothermia and normothermia. However, the ERK pathway was activated only in therapeutic hypothermia. Therapeutic hypothermia activated the ERK pathway in ischemia-reperfusion injury of the brain tissue after cardiac arrest, which seemed to be dependent on the duration of therapeutic hypothermia.
Brain* ; Cardiopulmonary Resuscitation ; Heart Arrest* ; Hippocampus ; Hypothermia, Induced* ; MAP Kinase Signaling System ; Mitogen-Activated Protein Kinases ; Protein Kinases* ; Reperfusion Injury ; Swine* ; Ventricular Fibrillation

PURPOSE: The autologous greater saphenous vein (GSV) is the most frequently used graft for leg artery bypass. But vein harvesting with long open incision as traditional method can be complicated by wound problem. Since we experienced endoscopic vein harvesting in leg artery bypass, we reviewed its advantage and indication. METHOD: Six patients received the endoscopic saphenous vein harvesting procedure for their leg artery bypass surgery. The endoscopic procedure was limited above knee avoiding of the injury to saphenous vein because it has more branching at below knee. We studied endoscopic using time, number of branch ligated, wound closure time, wound complication, postoperative pain and admission duration. RESULT: In one patient the procedure was failed because many branch and small GSV. In five patients mean endoscopic using time was twenty two minutes and 2.2 branch was ligated. There was no wound complication. Wound closure time and operation time was decreased but the statistical variables difficult to decide. In one patient for redo operation, contralateral GSV was harvested. CONCLUSION: Endoscopic GSV harvesting is technically simple procedure, which can reduce wound size in using reversed way of GSV in leg artery bypass. We also believe it reduce operation time, wound pain, hospital stay. But it needs further study and skill in our study.
Arteries* ; Humans ; Knee ; Leg* ; Length of Stay ; Postoperative Complications ; Saphenous Vein* ; Transplants ; Veins ; Wounds and Injuries

PURPOSE: The contribution of perforating vein incompetence to the hemodynamic derangement in the chronic venous disease (CVD) remains a topic of debate. This study was designed to define the characteristics of IPV according to CEAP classification with development of CVD. METHOD: From March 1999, to August 2001, 145 patients were treated for CVD in our hospital. Of these, 15 patients with CEAP class 4, 5, 6 (Group I) and 130 patients with class 2 (Group II). Medial side of calf was assessed in the sitting position for looking IPVs by duplex scan. The number, location, and diameter at the fascia level of IPVs were determined. The characteristics of IPVs between two group were compared. Airplethysmogram (APG) was checked pre and postoperatively in 18 patients with class 2 without any procedure to IPVs. RESULT: 17 IPVs were found in 11/15 (73%) patients in group I, and 36 IPVs were found in 29/145 (20%) in group II. The mean number of IPVs in each limb of group I and II was 1.54, 1.09 (P>0.05) and the mean diameter was 0.52 cm, 0.38 cm (P=0.001). The 96% (51/56) of IPVs were found in lower half of the calf. All hemodynamic parameter of APG was improved statistically significantly after operation without ligation of IPVs in class 2 patients. CONCLUSION: With advancing of CVD (class 4, 5, 6), IPVs was found more and larger. This suggest significant hemodynamic role of IPVs in progression of CVD. So careful attention should be payed to IPVs in treatment of CVD. But it was doubted benefit of direct treatment of IPVs in class 2.
Classification* ; Extremities ; Fascia ; Hemodynamics ; Humans ; Ligation ; Veins*

No abstract available.
Choline*

A temporary balloon occlusion of internal carotid artery (ICA) was performed in 3 patients for carotid artery endarterectomy and 1 patient require sacrifice ICA with neck malignancy. EEG monitoring and neurologic evaluation was done during the test. In one patient who has bilateral ICA stenosis more than 95% shows slurred speech and aphasia during test. Another 3 patients shows no clinical change during test, and operation was done without shunt. There were no postoperative neurologic complication. We believe that preoperative balloon occlusion of ICA provide another helpful criteria to decide using shunt. But it needs another hemodynamic analysis tool according to other's report.
Aphasia ; Balloon Occlusion ; Carotid Arteries* ; Carotid Artery, Internal ; Constriction, Pathologic ; Electroencephalography ; Endarterectomy ; Hemodynamics ; Humans ; Neck

Coronavirus disease 2019 (COVID-19) is one of the most widespread viral infections in human history. As a breakthrough against infection, vaccines have been developed to achieve herd immunity. Here, we report the first case of microscopic polyangiitis (MPA) following BNT162b2 vaccination in Korea. A 42-year-old man presented to the emergency room with general weakness, dyspnea, and edema after the second BNT162b2 vaccination. He had no medical history other than being treated for tuberculosis last year. Although his renal function was normal at last year, acute kidney injury was confirmed at the time of admission to the emergency room. His serum creatinine was 3.05 mg/dL. Routine urinalysis revealed proteinuria (3+) and hematuria. When additional tests were performed for suspected glomerulonephritis, the elevation of myeloperoxidase (MPO) antibody (38.6 IU/mL) was confirmed. Renal biopsy confirmed pauci-immune anti-neutrophil cytoplasmic antibody (ANCA)-related glomerulonephritis and MPA was diagnosed finally. As an induction therapy, a combination of glucocorticoid and rituximab was administered, and plasmapheresis was performed twice. He was discharged after the induction therapy and admitted to the outpatient clinic 34 days after induction therapy. During outpatient examination, his renal function had improved with serum creatinine 1.51 mg/dL. We suggest that MPA needs to be considered if patients have acute kidney injury, proteinuria, and hematuria after vaccination.

Nephrogenic systemic fibrosis (NSF) is a progressive systemic fibrosing disease that may occur after gadolinium contrast exposure. It can lead to severe complications and even death.NSF is highly prevalent among patients with advanced chronic kidney disease (CKD). In this report, however, we describe the case of a patient with NSF that occurred during early CKD. A 65-year-old man with stage 3a CKD was transferred to our hospital because of lower extremity edema. The medical history revealed that he was exposed to gadolinium 185 days earlier, and the result of his tibial skin biopsy was consistent with NSF. The patient underwent a combined therapy with ultraviolet-A1 phototherapy and methotrexate and steroid therapy for 6 months. The combined therapy stopped the systemic progression of NSF.

OBJECTIVE: To evaluate safety and efficacy of systemic or local methotrexate(MTX) injection to patients with unruptured ectopic pregnancy METHODS: From October 1995 to October 1999, 35 unruptured ectopic pregnancies were eligible for the conservative management. 25 tubal pregnancies, 4 cervical pregnancies, 4 pregnancies of previous cesarean section scar, and 2 cornual pregnancies diagnosed by ultrasonography & serumbeta-hCG were evaluated. Patients were treated with one of following three protocols : (1) A single-dose of 50mg/m2 of intramuscullar(IM) MTX(7 cases) (2) Two to four doses of 1.0mg/kg of IM MTX with citrovorum rescue(20 cases) (3) Transvaginal ultrasonogram-guided intra-amniotic instillation of 50mg methotrexate (8 cases) The mean age of these patients was 30.8 yrs (range 24-42) and gestational age at diagnosis ranged from 22-75 days (mean 47). Initial level of serumbeta-hCG ranged from 166.4-55363.8 mIU/mL (mean 9069.2). Patients were monitored with serumbeta-hCG titers three times per week ,and then weekly until the serumbeta-hCG level was less then 10 mIU/mL. RESULT: 31 of 35 patients (88.6%) were successfully treated and remaining 4 patients failed conservative therapy and so required surgery. Mean duration of resolution was 38.5 days (range 11-105). Side effect rate was 45.7% but severity of symptoms were so mild that no treatment was needed in most cases. CONCLUSION: Nonsurgical conservative management of MTX appears to be effective and safe treatment modality for some selected unruptured ectopic pregnancy. But further comparative studies and long-term follow-up are needed to evaluate reproductive outcome and reduce side effects of MTX.
Cesarean Section ; Cicatrix ; Diagnosis ; Female ; Follow-Up Studies ; Gestational Age ; Humans ; Methotrexate* ; Pregnancy ; Pregnancy, Ectopic* ; Pregnancy, Tubal ; Ultrasonography