Yonsei medical journal
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Yonsei medical journal · Jun 2004
Case ReportsPerimortem cesarean delivery following severe maternal penetrating injury.
The case of a severely traumatized pregnant patient, in whom a perimortem cesarean section, in the emergency department, led to the birth of a viable baby, with long-term survivor, is described. A postmortem cesarean section, resulting in fetal survival, performed after 45 minutes of maternal cardiopulmonary resuscitation is reported in a patient with multiple penetrating injuries. A 27-year-old primigravida suffered cardiopulmonary arrest at the 34th week of gestation following multiple knife injuries. ⋯ A low segment cesarean delivery was performed, and a female baby was delivered. The time interval between cardiopulmonary arrest and delivery, prior maternal health status, and continued cardiopulmonary resuscitation are important determinants of fetal survival. A perimortem cesarean section is advised in case of multiple penetrating injuries, even after 45 minutes of cardiopulmonary resuscitation, since it may result in fetal salvage.
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A traumatic abdominal wall hernia (TAWH) is a rare type of hernia, which follows blunt trauma to the abdomen, where disruption of the musculature and fascia occurs, with the overlying skin remaining intact. The case of a sixty five year old female that developed a TAWH, following the collapse of the roof of her house, is reported. She underwent a laparotomy for suspected liver injury, followed by repair of the hernia using a fascia lata graft taken from the thigh. The etiology, pathogenesis and management of this rare hernia are discussed.
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Yonsei medical journal · Jun 2004
Clinical and echocardiographic characteristics of pericardial effusion in patients who underwent echocardiographically guided pericardiocentesis: Yonsei Cardiovascular Center experience, 1993-2003.
Percutaneous pericardiocentesis guided by two-dimensional echocardiography was introduced in 1983 as an alternative to electrocardiographically or fluoroscopically guided puncture for the management of pericardial effusion. The objective of this study was to investigate echocardiographically (echo)- guided pericardiocenteses performed at Yonsei Cardiovascular Center from January 1, 1993 to December 31, 2003, and also to determine whether patient profiles, etiology, and practice patterns have changed over this 11-year period. The medical records of 272 patients were examined and a follow-up survey was conducted. ⋯ Malignancy was the leading cause of a pericardial effusion requiring pericardiocentesis (45.6%). The incidence of pericardial effusion following cardiothoracic surgery and percutaneous coronary intervention procedures accounted for nearly 20% of all pericardiocenteses performed. Echo-guided pericardiocentesis has become a safe, standard practice for clinically significant pericardial effusion, in line with the changes of patients profiles over the 11 years of the study.
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Yonsei medical journal · Jun 2004
Case ReportsA case of pulmonary artery intimal sarcoma diagnosed with multislice CT scan with 3D reconstruction.
Pulmonary artery intimal sarcoma is a rare highly lethal disease, with additional retrograde extension to pulmonic valve and right ventricle being an extremely rare condition. It is frequently mistaken for pulmonary thromboembolism. ⋯ After excision of the mass, the patient's condition improved dramatically, and the pathologic findings revealed pulmonary intimal sarcoma. This report emphasizes that helical chest CT with 3D reconstruction can be an important tool to differentiate the characteristics of pulmonary artery lesions, such as intimal sarcoma and thromboembolism.
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Yonsei medical journal · Apr 2004
Discharge decision-making by intensivists on readmission to the intensive care unit.
Patients readmitted to the intensive care unit (ICU) have a significantly higher mortality rate. The role of intensivists in judging when to discharge patients from the ICU is very important. We undertook this study to evaluate the effect of the intensivists' discharge decision-making on readmission to ICU. ⋯ Respiratory failure was the major cause of readmission. In the non-survivors out of the readmitted patients, the Acute Physiology and Chronic Health Evaluation (APACHE) scores on the initial discharge and readmission, the multiple organ dysfunction syndrome (MODS) scores on the initial admission, discharge and readmission were higher than the corresponding indices in the survivors. We conclude that the readmission rate was lower when intensivists participated in the discharge decision-making, and that APACHE and MODS scores on the first discharge and readmission were significant prognostic factors in respect of the readmitted patients.