Background: The main cause of death in pulmonary embolism (PE) is right-heart failure due to acute pressure overload. In this sense, extracorporeal membrane oxygenation (ECMO) might be useful in maintaining hemodynamic stability and improving organ perfusion. Some previous studies have reported ECMO as a bridge to reperfusion therapy of PE. However, little is known about the patients that benefit from ECMO. Methods: Patients who underwent ECMO due to pulmonary thromboembolism at a single university-affiliated hospital between January 2010 and December 2018 were retrospectively reviewed. Results: During the study period, nine patients received ECMO in high-risk PE. The median age of the patients was 60 years (range, 22–76 years), and six (66.7%) were male. All nine patients had cardiac arrests, of which three occurred outside the hospital. All the patients received mechanical support with veno-arterial ECMO, and the median ECMO duration was 1.1 days (range, 0.2–14.0 days). ECMO with anticoagulation alone was performed in six (66.7%), and ECMO with reperfusion therapy was done in three (33.3%). The 30-day mortality rate was 77.8%. The median time taken from the first cardiac arrest to initiation of ECMO was 31 minutes (range, 30–32 minutes) in survivors (n=2) and 65 minutes (range, 33–482 minutes) in non-survivors (n=7). Conclusion High-risk PE with cardiac arrest has a high mortality rate despite aggressive management with ECMO and reperfusion therapy. Early decision to start ECMO and its rapid initiation might help save those with cardiac arrest in high-risk PE.

BACKGROUND: Extracorporeal life support (ECLS) can be applied in brain-dead donors for organ perfusion before donation, thereby expanding the donor pool. The aim of this study was to examine the benefits and early clinical outcomes of ECLS for organ preservation. METHODS: Between June 2012 and April 2017, 9 patients received ECLS with therapeutic intent or for organ preservation. The following data were collected: demographics, purpose and duration of ECLS, cause of death, dose of vasoactive drugs, and need for temporary dialysis before organ retrieval. The early clinical outcomes of recipients were studied, as well as survival and graft function at 1 month. RESULTS: ECLS was initiated for extracorporeal cardiopulmonary resuscitation in 5 patients. The other patients needed ECLS due to hemodynamic deterioration during the assessment of brain death. We successfully retrieved 18 kidneys, 7 livers, and 1 heart from 9 donors. All organs were transplanted and none were discarded. Only 1 case of delayed kidney graft function was noted, and all 26 recipients were discharged without any significant complications. CONCLUSION: The benefits of protecting the vital organs of donors is significant, and ECLS for organ preservation can be widely used in the transplantation field.
Brain Death ; Cardiopulmonary Resuscitation ; Cause of Death ; Demography ; Dialysis ; Extracorporeal Membrane Oxygenation ; Heart ; Hemodynamics ; Humans ; Kidney ; Liver ; Organ Preservation ; Perfusion ; Tissue and Organ Harvesting ; Tissue and Organ Procurement ; Tissue Donors* ; Transplantation ; Transplants*

Nuclear medicine images (SPECT, PET) were widely used tool for assessment of myocardial viability and perfusion. However it had difficult to define accurate myocardial infarct region. The purpose of this study was to investigate methodological approach for automatic measurement of rat myocardial infarct size using polar map with adaptive threshold. Rat myocardial infarction model was induced by ligation of the left circumflex artery. PET images were obtained after intravenous injection of 37 MBq 18F-FDG. After 60 min uptake, each animal was scanned for 20 min with ECG gating. PET data were reconstructed using ordered subset expectation maximization (OSEM) 2D. To automatically make the myocardial contour and generate polar map, we used QGS software (Cedars-Sinai Medical Center). The reference infarct size was defined by infarction area percentage of the total left myocardium using TTC staining. We used three threshold methods (predefined threshold, Otsu and Multi Gaussian mixture model; MGMM). Predefined threshold method was commonly used in other studies. We applied threshold value form 10% to 90% in step of 10%. Otsu algorithm calculated threshold with the maximum between class variance. MGMM method estimated the distribution of image intensity using multiple Gaussian mixture models (MGMM2, em leader MGMM5) and calculated adaptive threshold. The infarct size in polar map was calculated as the percentage of lower threshold area in polar map from the total polar map area. The measured infarct size using different threshold methods was evaluated by comparison with reference infarct size. The mean difference between with polar map defect size by predefined thresholds (20%, 30%, and 40%) and reference infarct size were 7.04+/-3.44%, 3.87+/-2.09% and 2.15+/-2.07%, respectively. Otsu verse reference infarct size was 3.56+/-4.16%. MGMM methods verse reference infarct size was 2.29+/-1.94%. The predefined threshold (30%) showed the smallest mean difference with reference infarct size. However, MGMM was more accurate than predefined threshold in under 10% reference infarct size case (MGMM: 0.006%, predefined threshold: 0.59%). In this study, we was to evaluate myocardial infarct size in polar map using multiple Gaussian mixture model. MGMM method was provide adaptive threshold in each subject and will be a useful for automatic measurement of infarct size.
Animals ; Arteries ; Electrocardiography ; Fluorodeoxyglucose F18 ; Infarction ; Injections, Intravenous ; Ligation ; Myocardial Infarction ; Myocardium ; Nuclear Medicine ; Oligosaccharides ; Perfusion ; Rats

BACKGROUND/AIMS: Elastic band ligation is a well-established method for the treatment of internal hemorrhoids. The aim of this study was to assess the treatment outcomes of flexible endoscopic rubber band ligation of internal hemorrhoids. METHODS: Using a flexible endoscope, 30 patients with symptomatic internal hemorrhoids were evaluated based on change in clinical symptoms (Goligher grade, bleeding score) and endoscopic classifications (range, size) before and after the procedure. RESULTS: Goligher grade and bleeding score showed significant improvement after the procedure (Goligher grade from 2.12 to 0.54, p<0.01, and bleeding score from 1.80 to 0.40, p<0.01). Endoscopic classification scores improved significantly after the procedure (range 3.03 to 1.55, p<0.01, and size from 1.80 to 0.85, p<0.01). As a complication, mild pain developed in 19 patients (90.5%) and severe pain in two patients (9.5%). Most (90.5%) were well controlled by conservative management, but one patient was operated on for hemorrhoidal thrombosis and in another patient the ligated rubber band had to be released promptly for pain relief. One patient (3.3%) experienced mild infection, which was relieved by medical treatment. During the 16.7+/-3.2-month period of follow-up, two patients relapsed, one was treated with additional endoscopic band ligation, and one underwent surgery. CONCLUSIONS: Flexible endoscopic band ligation is an effective and safe method of treatment in patients with symptomatic internal hemorrhoids.
Endoscopes ; Follow-Up Studies ; Hemorrhage ; Hemorrhoids ; Humans ; Ligation ; Rubber ; Thrombosis

Mantle cell lymphoma (MCL) is a relatively rare subgroup of non-Hodgkin's lymphoma that is characterized by an aggressive and severe disease course with frequent involvement of regional lymph nodes and/or early metastasis. Because most cases of MCL are diagnosed in the advanced stages, clinical data on extranodal or early stage MCL is lacking, and MCL that is both extranodal and diagnosed during the early stages is even more rare. There have been several case reports on primary gastric MCL, which comprise a type of extranodal MCLs. However, to our knowledge, there have been no reports on solitary primary gastric MCL without regional lymph node involvement or distant metastasis. Recently, the authors experienced an uncommon case of MCL with the aforementioned characteristics that was managed with chemotherapy followed by allogenic stem cell transplantation.
Lymph Nodes ; Lymphoma, Mantle-Cell ; Lymphoma, Non-Hodgkin ; Neoplasm Metastasis ; Stem Cell Transplantation ; Stomach

Blunt bronchial injuries rarely occur in children. This can be a life threatening condition and respiratory management is important for successful treatment. We present here a pediatric patient who had traumatic bronchial transection with difficult airway management. Surgical treatment was carried out under ventilatory support using extracorporeal membrane oxygenation (ECMO) in the emergency room. During the application of ECMO, systemic heparization was unnecessary and there were no thrombotic complications. In conclusion, ventilatory support using ECMO is useful for treating selected patients with blunt trauma regardless of using heparin.
Airway Management ; Bronchi ; Child ; Emergencies ; Extracorporeal Circulation ; Extracorporeal Membrane Oxygenation ; Heparin ; Humans

PURPOSE: Histological evidence of intraprostatic inflammation is a common finding of transrectal ultrasonography (TRUS)-guided needle biopsy of the prostate in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH). The aim of this study was to evaluate the relationship between intraprostatic inflammation and lower urinary tract symptoms depending on the severity of intraprostatic inflammation. MATERIALS AND METHODS: Between January 2002 and December 2006, 141 BPH patients with prostate-specific antigen (PSA) of 4.0-10.0 ng/ml underwent TRUS-guided biopsy of the prostate. The extent and aggressiveness of intraprostatic inflammation were classified into 4 grades. The relationship between the grades of extent and aggressiveness of inflammation and the International Prostate Symptom Score (IPSS) was evaluated. The IPSS was evaluated according to voiding and storage symptom scores. RESULTS: Mean storage symptom scores were increased by grade of the extent of intraprostatic inflammation (grade 0, 6.3; grade 1, 10.1; grade 2, 11.0; and grade 3, 11.3) (p<0.001). The aggressiveness of intraprostatic inflammation also showed increasing storage symptom scores with grade (grade 0, 6.3; grade 1, 10.2; grade 2, 10.9; and grade 3, 11.6) (p<0.001). Voiding symptom scores had no relationship with extent or aggressiveness of intraprostatic inflammation (p=0.942 and p=0.449, respectively). CONCLUSIONS: BPH patients with intraprostatic inflammation complained of more severe storage symptoms than did patients without inflammation. Therefore, if storage symptoms are severe, we might consider medical treatment for intraprostatic inflammation in BPH patients.
Biopsy ; Biopsy, Needle ; Humans ; Inflammation ; Lower Urinary Tract Symptoms ; Prostate ; Prostate-Specific Antigen ; Prostatic Hyperplasia

BACKGROUND: Since the Nuss procedure for the correction of pectus excavatum is in its early stage, there have been problems that need to be solved. We examined complications in a single-institute experience of the Nuss technique in order to develop possible solutions to prevent them. MATERIAL AND METHOD: 335 consecutive patients, who underwent the modified Nuss procedure between August 1999 and October 2002, were studied retrospectively. Median age was 8 years (range 1 to 46). 264 patients (78.8%) were in pediatric group (age< or=15) and 71 patients (21.2%) were in adult group (age>15). 193 patients (57.6%) had symmetric and 142 patients (42.4%) had asymmetric pectus configurations. Risk factors predicting postoperative complications were analyzed using multivariate logistic regression. RESULT: Postoperative complication rates were 18.9% (61/335) in total patients. Frequent complications were pneumothorax 24 (7.5%), bar displacement 11 (3.4%), and wound seroma 10 (3.1%) in order. Early complications (within a month, 49 cases, 15.2%) were pneumothorax (n=23, 6.9%), wound seroma (n=12, 3.6%), and bar displacement (n=8, 2.4%). Late complications (after a month, 12 cases, 3.7%) were pericarditis and pericardial effusion (n=5, 1.5%), bar displacement (n=4, 1.2%), and hemothorax (n=3, 0.9%). Techniques were modified to prevent complications especially in bar shaping and fixation, which led to decrease complication rate in later experience (Operation Date 1: 15/51 (29.4%) vs Operation Date 2: 34/284 (12.0%), p=0.004). Grand Canyon type (eccentric long canal type) showed higher complication rate than other types (GC type: 12/30(40%) vs Others: 37/305 (12.1%), p<0.001). Major risk factors are severity of pectus (OR=2.88, p=0.038), Grand Canyon type (OR= 2.82, p=0.044), and Op. Date 1 (OR=4.05, p=0.001). CONCLUSION: Major complications were related to severe eccentric type of pectus configuration (Grand Canyon type) and lack of surgeon's experience (Op. Date 1). Complication rate was reduced with accumulation of experience and advancement of surgical techniques. The Nuss procedure can be performed at a low risk of complications with our current technique.
Adult ; Funnel Chest ; Hemothorax ; Humans ; Logistic Models ; Pericardial Effusion ; Pericarditis ; Pneumothorax ; Postoperative Complications ; Retrospective Studies ; Risk Factors* ; Seroma ; Thorax ; Wounds and Injuries

BACKGROUND: With the purpose of identifying significant risk factors in poststernotomy sternal wound infection and mediastinitis, we underwent a retrospective analysis of the whole patients operated on at the our department of cardiovascular surgery for the two years. MATERIAL AND METHOD: From March 2001 to March 2003 at the department of cardiovascular surgery, medical school of Soonchunhyang University, major sternal wound infections had been developed in 12 (9.76%) of 123 consecutive patients. These patients underwent open-heart procedure through a midline sternotomy and survived long enough for infection to appear. For this group of patients, we evaluated possible risk factors such as age, sex, diabetes mellitus, chronic obstructive pulmonary disease, obesity, interval between hospital admission and operation, type of surgical procedure, elective or emergency surgical procedure, reoperation, duration of surgical procedures, duration of cardiopulmonary bypass, amount of blood transfused, postoperative blood loss, chest reexploration, rewiring of a sterile sternal dehiscence, duration of mechanical ventilation, and days of stay in the intensive care unit and analyzed these factors. RESULT: Analysis represented that age, sex, diabetes mellitus, type and mode of surgical procedure, reoperation, duration of operation, duration of cardiopulmonary bypass, and interval between hospital admission and operation were not significantly associated with wound infection. For all other predisposing factors, p-values of less than .05 were demonstrated. Eight emerged as significant: early chest reexploration (p=0.001), sternal rewiring (p<0.0001), chronic obstructive pulmonary disease (p<0.0001), blood transfusions (p<0.05), postoperative bleeding (p=0.008), days of stay in the intensive care unit (p<0.0001), duration of mechanical ventilation (p=0.001), and obesity (p=.003). CONCLUSION: Contamination of patients may occur before, during, and after the operation, and any kind of reintervention may predispose the patient to wound infection.
Blood Transfusion ; Cardiopulmonary Bypass ; Causality ; Diabetes Mellitus ; Emergencies ; Hemorrhage ; Humans ; Intensive Care Units ; Mediastinitis* ; Obesity ; Postoperative Hemorrhage ; Pulmonary Disease, Chronic Obstructive ; Reoperation ; Respiration, Artificial ; Retrospective Studies ; Risk Factors* ; Schools, Medical ; Sternotomy ; Surgical Procedures, Elective ; Thorax ; Wound Infection* ; Wounds and Injuries*