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Cardiac arrest due to coronary vasospasm after sugammadex administration -a case report-
Boo Ki Yung,Park Sang Hyun,Park Sun Kyung,Na Changrock,Kim Hyun Jung 대한마취통증의학회 2023 Korean Journal of Anesthesiology Vol.76 No.1
Backgroud: Sugammadex is a widely used medication for the reversal of aminosteroid neuromuscular blockades. Although sugammadex is generally regarded to be safe, concerns about the risk of serious complications have emerged. Case: A 57-year-old man without a history of coronary disease was scheduled for general anesthesia to undergo cardiac radiofrequency catheter ablation due to symptomatic persistent atrial fibrillation and flutter. At the end of the procedure, he was given 400 mg of sugammadex. A little later, the electrocardiogram showed a sudden ST elevation on the inferior leads, followed by cardiac arrest. The urgent coronary angiography demonstrated total collapse of the right coronary artery. After two injections of intra-coronary nitroglycerin, the vasospasm of the right coronary artery was completely resolved. The patient recovered without sequelae and was discharged on postoperative day 5. Conclusions: Clinicians should pay close attention to the potential risk of coronary vasospasm, even cardiac arrest, after sugammadex administration.
( Ki Yung Boo ),( Jong Hoo Lee ) 대한결핵 및 호흡기학회 2015 Tuberculosis and Respiratory Diseases Vol.78 No.4
Pneumothorax is an extremely rare complication of non-tuberculous mycobacterial infection. A 52-year-old man presenting with difficulty breathing and chest pain was admitted to our hospital. A right-sided pneumothorax was observed on chest radiography and chest computed tomography showed multiple cavitating and non-cavitating nodules with consolidation in the upper to middle lung zones bilaterally. Serial sputum cultures were positive for Mycobacterium kansasii, and he was diagnosed with pulmonary M. kansasii disease complicated by tension pneumothorax. After initiation of treatment including decortications and pleurodesis, the patient made a full recovery. We herein describe this patient’s course in detail and review the current relevant literature.
A Case of Pulmonary Mycobacterium kansasii Disease Complicated with Tension Pneumothorax
Boo, Ki Yung,Lee, Jong Hoo The Korean Academy of Tuberculosis and Respiratory 2015 Tuberculosis and Respiratory Diseases Vol.78 No.4
Pneumothorax is an extremely rare complication of non-tuberculous mycobacterial infection. A 52-year-old man presenting with difficulty breathing and chest pain was admitted to our hospital. A right-sided pneumothorax was observed on chest radiography and chest computed tomography showed multiple cavitating and non-cavitating nodules with consolidation in the upper to middle lung zones bilaterally. Serial sputum cultures were positive for Mycobacterium kansasii, and he was diagnosed with pulmonary M. kansasii disease complicated by tension pneumothorax. After initiation of treatment including decortications and pleurodesis, the patient made a full recovery. We herein describe this patient's course in detail and review the current relevant literature.
A Case of Posterior Mediastinal Plasmacytoma Confounded by Community-Acquired Pneumonia
Heo, Dahee,Boo, Ki Yung,Jwa, Hyeyoung,Lee, Hwa Young,Kim, Jihyun,Kim, Seong Taeg,Seo, Hye Mi,Han, Sang Hoon,Maeng, Young-Hee,Lee, Jong Hoo The Korean Academy of Tuberculosis and Respiratory 2015 Tuberculosis and Respiratory Diseases Vol.78 No.3
Plasmacytomas are extramedullary accumulations of plasma cells originating from soft tissue. Mediastinal plasmacytoma is a rare presentation. A 67-year-old man recovered after antibiotic treatment for community-acquired pneumonia. However, on convalescent chest radiography after 3 months, mass like lesion at the right lower lung field was newly detected. Follow-up chest computed tomography (CT) revealed an increase in the extent of the right posterior mediastinal mass that we had considered to be pneumonic consolidations on previous CT scans. Through percutaneous needle biopsy, we diagnosed IgG kappa type extramedullary plasmacytoma of the posterior mediastinum.
( Dahee Heo ),( Ki Yung Boo ),( Hyeyoung Jwa ),( Hwa Young Lee ),( Jihyun Kim ),( Seong Taeg Kim ),( Hye Mi Seo ),( Sang Hoon Han ),( Young Hee Maeng ),( Jong Hoo Lee ) 대한결핵 및 호흡기학회 2015 Tuberculosis and Respiratory Diseases Vol.78 No.3
Plasmacytomas are extramedullary accumulations of plasma cells originating from soft tissue. Mediastinal plasmacytoma is a rare presentation. A 67-year-old man recovered after antibiotic treatment for community-acquired pneumonia. However, on convalescent chest radiography after 3 months, mass like lesion at the right lower lung field was newly detected. Follow-up chest computed tomography (CT) revealed an increase in the extent of the right posterior mediastinal mass that we had considered to be pneumonic consolidations on previous CT scans. Through percutaneous needle biopsy, we diagnosed IgG kappa type extramedullary plasmacytoma of the posterior mediastinum.
Jae-Geun Lee,Ki Yung Boo 제주대학교 의과학연구소 2023 The Journal of Medicine and Life Science Vol.20 No.3
Here, we present a case of a 56-year-old man with acute myocardial infarction. The patient underwent percutaneous coronary intervention (PCI) at the left main bifurcation and mid-left anterior descending artery using drugeluting stents. Four months after the PCI, the patient was readmitted for cardiac arrest. Coronary angiography (CAG) revealed stent thrombosis in the left main-toproximal left anterior descending artery and in-stent restenosis in the left main-toproximal left circumflex artery. We performed balloon angioplasty at the left main to mid-left anterior descending artery and left main to proximal left circumflex artery stents; subsequently, blood flow was fully restored. However, contrast agent extravasation was observed outside the mid-portion of the left main artery to the proximal left anterior descending artery stent, indicating the presence of a coronary artery aneurysm (CAA) outside the stent. After guideline-directed medical therapy with dual antiplatelet agents and high-intensity statins, follow-up CAG revealed near-resolution of the CAA, absence of stenotic lesions, and good blood flow.
Kim Seong Taeg,Ko Yeekyoung,Beom Jong-Wook,Boo Ki Yung,이재근,Choi Joon-Hyouk,김송이,주승재 대한고혈압학회 2021 Clinical Hypertension Vol.27 No.3
Background: Arterial stiffness is associated with myocardial ischemia and incident coronary artery disease (CAD), and indexes of arterial stiffness are usually increased in patients with CAD. However, these indexes are often increased in elderly without CAD. Arterial stiffness in patients with CAD may become more evident after isometric handgrip exercise which increases systolic pressure and ventricular afterload. We investigated the association of the change of stiffness indexes after isometric handgrip exercise with the lesion extent of CAD and the necessity for coronary revascularization. Methods: Patients who were scheduled a routine coronary angiography via a femoral artery were enrolled. Arterial waveforms were traced at aortic root and external iliac artery using coronary catheters at baseline and 3 min after handgrip exercise. Augmentation index (AIx) was measured on the recorded aortic pressure waveform, and pulse wave velocity (PWV) was calculated using the ECG-gated time difference of the upstroke of arterial waveforms and distance between aortic root and external iliac artery. Results: Total 37 patients were evaluated. Both PWV and AIx increased after handgrip exercise. ΔPWV was significantly correlated with ΔAIx (r = 0.344, P = 0.037). Patients were divided into higher and lower ΔPWV or ΔAIx groups based on the median values of 0.4 m/sec and 3.3%, respectively. Patients with higher PWV had more 2- or 3-vessel CAD (69% vs. 27%, P = 0.034), and underwent percutaneous coronary intervention (PCI) more frequently (84% vs. 50%, P = 0.038), but higher ΔAIx was not associated with either the lesion extent or PCI. Area under curve (AUC) of ΔPWV in association with PCI by C-statistics was 0.70 (95% confidence interval [CI] 0.51–0.88; P = 0.056). In multiple logistic regression analysis, ΔPWV was significantly associated with PCI (odds ratio 7.78; 95% CI 1.26–48.02; P = 0.027). Conclusions: Higher ΔPWV after isometric handgrip exercise was associated with the lesion extent of CAD and the necessity for coronary revascularization, but higher ΔAIx was not.
Jae-Geun Lee,Yeekyoung Ko,Joon Hyouk Choi,Jeong Rae Yoo,Misun Kim,Ki Yung Boo,Jong Wook Beom,Song-Yi Kim,Seung-Jae Joo 제주대학교 의과학연구소 2022 The Journal of Medicine and Life Science Vol.19 No.2
The incidence of fever complicating percutaneous coronary intervention (PCI) is rare. However, little is known regarding the cause of fever after PCI. Therefore, this study aimed to determine the clinical characteristics of patients with acute myocardial infarction (AMI), with or without fever, after PCI. We enrolled a total of 926 AMI patients who underwent PCI. Body temperature (BT) was measured every 4 hours or 8 hours for 5 days after PCI. Patients were divided into two groups according to BT as follows: BT<37.7°C (nofever group) and BT ≥37.7°C (fever group). The 2 years clinical outcomes were compared subsequently. Fever after PCI was associated with higher incidence of major adverse cardiac events (MACE) (hazard ratio [HR], 1.56; 95% confidence interval [CI], 1.07-2.28; P=0.021), all-cause death (HR, 2.32; 95% CI, 1.18-4.45; P=0.014), cardiac death (CD) (HR, 2.57; 95% CI, 1.02-6.76; P=0.049), and any revascularization (HR, 1.69; 95% CI, 1.02-2.81; P=0.044) than without fever. In women, prior chronic kidney disease, lower left ventricular (LV) ejection fraction, higher LV wall motion score index, white blood cell count, peak creatine kinasemyocardial band level, and longer PCI duration were associated with fever after PCI. Procedures such as an intra-aortic balloon pump, extracorporeal membrane oxygenation, continuous renal replacement therapy, central and arterial line insertion, and cardiopulmonary resuscitation were related to fever after PCI. Fever after PCI in patients with AMI was associated with a higher incidence of MACE, all-cause death, CD, and any revascularization at the 2 years mark than in those without fever.