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Clinical Experience of Symptomatic Spontaneous Isolated Splanchnic Artery Dissection
고진,박제훈,노영남 대한혈관외과학회 2013 Vascular Specialist International Vol.29 No.4
Purpose: Symptomatic spontaneous isolated splanchnic artery dissection (SSISAD) is a rare disease entity. The treatment guideline for SSISAD has not been established. Isolated dissection of splanchnic artery can be clinically asymptomatic or symptomatic. Symptomatic dissection is more important because it can indicate ischemia of abdominal organ. Methods: A retrospective study was conducted on 15 consecutive patients (mean age, 47.0 years; male, 87%) with SSISAD from January 2006 to July 2013. Each patient had acute onset abdominal pain and was diagnosed with SSISAD by abdominal-pelvic computed tomography. Results: Median follow-up duration was 14.5±27.7 months (range, 1 to 79 months). Splanchnic arterial dissection involved celiac artery in three patients and superior mesentery artery in 12 patients. Conservative management (including bowel rest, hypertension medication, anticoagulation, and prophylactic antibiotics) was done in 14 patients. Endovascular treatment with stent insertion was performed in one patient. We experienced favorable clinical outcomes with SSISAD, even though one case needed endovascular treatment. Conclusion: Conservative management and selective revascularization could be a treatment option in patients with SSISAD.
기관 내 삽관을 시행한 환자를 대상으로 한 유도철사 보조 비위관 삽입의 유용성
고진,김현종,김승환,유제성,김민정,정현수,정성필,이한식 대한중환자의학회 2013 Acute and Critical Care Vol.28 No.4
Background: The purpose of this study is to identify the usefulness of guidewire-assisted nasogastric tube insertion in intubated patients with cervical spine immobilization or unstable vital signs in an emergency center. Methods: Thirty-four intubated patients in an emergency center were enrolled in the study. Patients were randomly allocated to the control group or the guidewire group. All patient necks were kept in neutral position during the procedure. In the control group, the nasogastric tube was inserted with the conventional method. A guidewire-supporting nasogastric tube was used in the guidewire group. The success rates of the first attempts and overall were recorded along with complications. Results: The first attempt success rate was 88.2% in the guidewire group compared with 35.2% in the control group (p < 0.001). The overall success rate was 94.2% in the guidewire group and 52.9% in the control group (p = 0.017). Five cases of self-limiting nasal bleeding were reported in the guidewire group, and two cases occurred in the control group. No statistical differences were identified between groups. Conclusions: Guidewire-assisted nasogastric tube insertion is a simple and useful method in intubated patients with cervical spine immobilization or unstable vital signs.