Successful Simultaneous Endovascular Repair of Traumatic Portal Vein Pseudoaneurysm and Aortic Injury

Seon Uoo Choi,김선희,Sung Jin Park,Chan Ik Park,Up Huh,송승환,김창원,Hyuk Jin Choi 대한외상중환자외과학회 2018 Journal of Acute Care Surgery Vol.8 No.2

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동해 울릉분지 시추 퇴적물에서 안정 Pb 동위원소를 이용한 Pb의 기원 추정

최만식,우준식,김동선,Choi, Man-Sik,Uoo, Jun-Sik,Kim, Dong-Seon 한국해양학회 2007 바다 Vol.12 No.4

동해 울릉분지 퇴적물에서 오염 기원 Pb의 근원지 및 이동 경로를 추정하기 위하여 2005년 4개의 박스형 시추퇴적물(30cm 길이)을 채취하였고 연대별 Pb 농도 및 Pb 동위원소 비율을 MC ICP/MS를 이용하여 분석하였다. 연구지역에서 1M HCl 용출 부분의 Pb 농도 및 동위원소 비율($^{207}Pb/^{206}Pb$ 과 $^{208}Pb/^{206}Pb$)은 1930년 전 약 300년 동안 거의 일정한 값을 보였으나 그 후로는 현재까지 지속적으로 증가하여 농도가 거의 2배 수준, 동위원소 비율은 3.41% 및 1.70% 증가한 값을 보였고 잔류 부분의 Pb 농도는 지난 400년 동안 거의 유사하였다. 오염 Pb의 축적률은 심해분지해역에서 1990년대 이후 $3.1-3.5mg/m^2/yr$ 범위로 대기로부터의 총 강하량과 유사하였고 대륙사면에서는 퇴적물 축적률에 비례하는 정도 이상으로의 급격한 증가를 보였다. 오염 기원 Pb의 축적률과 동위원소 비율의 시 공간적인 변화 그리고 오염 기원 Pb의 동위원소 비율과 가능한 오염원 물질의 동위원소 비율의 비교를 통하여 울릉분지에 축적되는 오염 기원 Pb의 근원지와 이동 경로를 설명할 수 있었다. 즉, 1930년대부터 중국 및 한국의 석탄 연소에 의해 오염 Pb의 축적이 이루어졌으며 여기에 유연 휘발류 사용으로 1990년대 초반까지 대기로부터의 강하량이 증가하여 오염 Pb 축적률이 계속 증가하였으며 수입 광상(호주 Broken Hill)의 비율 또한 점차 증가하였다. 1990년대 이후에는 한국 및 중국의 유연 휘발류 사용 금지 및 중국의 석탄 사용 급증에 의해 심해분지 해역에서는 그 이전과 매우 유사한 오염 Pb의 축적률을 보였으나, 대륙사면 해역에서는 1990년대 이후부터 급증한 국지적 오염원의 영향으로 급격한 오염 Pb 축적이 이루어지고 있었다. This study investigated temporal and spatial variation of Pb and stable Pb isotopes accumulated in Ulleung Basin core sediments (4) using MC ICP/MS in order to identify the sources of anthropogenic Pb in the East/Japan Sea. Leached (1M HCl) Pb concentration and isotope ratios ($^{207}Pb/^{206}Pb\;and\;^{208}Pb/^{206}Pb$) were nearly constant during 300 yrs past than 1930, but increased up to twice in concentration and as much as 3.41% (1.70%) after 2000. On the other hand, residual Pb concentrations were nearly constant for past 400 yrs. The accumulation rates of anthropogenic Pb in the basin area were in the range of $3.1-3.5mg/m^2/yr$, which were similar levels to total atmospheric Pb deposition fluxes from 1990s to the present. In the slope area, more increase of anthropogenic Pb accumulation than the levels expected from mass accumulation rate could be found after the middle of 1990s. From the detailed evaluation for the temporal and spatial variation of accumulation rate and isotope ratios of anthropogenic Pb, we proposed probable sources and pathways of anthropogenic Pb. Pb emmision by coal burning from the China and Korea initiated the accumulation of anthropogenic Pb in the sediments of East/Japan Sea from 1930s. The accumulation of Pb increased by the addition of anti-nocking agents from both countries untill the beginning of 1990s, but from the middle of 1990s to the present, the phase-out of gasoline additives and the rapid increase of coal burning from the China maintained the atmospheric Pb levels in the Ulleung basin nearly similar to before. However, the local sources within this basin might take an important role in the rapid increase of anthropogenic Pb accumulation in slope areas from the middle of 1990s.

늑골 골절에 의해 발생한 지연성 대동맥 손상에 대한 치험 1례

김창완 ( Chang Wan Kim ),최선우 ( Seon Uoo Choi ),김선희 ( Seon Hee Kim ),김재훈 ( Jae Hun Kim ),황정주 ( Jung Joo Hwang ),조현민 ( Hyun Min Cho ),송승환 ( Seung Hwan Song ),조정수 ( Jeong Su Cho ) 대한외상학회 2015 大韓外傷學會誌 Vol.28 No.1

Traumatic aortic injury is well recognized as a primary cause of instantaneous death in victims of thoracic blunt trauma presenting with an aortic rupture or dissection, particularly after a deceleration injury. However, a direct aortic injury caused by a fractured rib segment after blunt thoracic trauma is extremely rare. We report the case of a 43-yearold male patient who experienced an aortic injury caused by the sharp edge of a fractured rib after multiple rib fractures due to blunt thoracic trauma. [ J Trauma Inj 2015; 28: 31-33 ]

Spontaneous Retroperitoneal Hemorrhage Caused by Idiopathic Acquired Hemophilia A Misdiagnosed as a Delayed Traumatic Hematoma: A Case Report

김선희,Sung Jin Park,Chan Ik Park,Seon Uoo Choi,Jae Hun Kim 대한외상중환자외과학회 2019 Journal of Acute Care Surgery Vol.9 No.2

Acquired hemophilia A (AHA) is a rare disease where typically coagulation factor VIII is inhibited by autoantibodies. It occurs in patients with no personal or familial history of bleeding. In this case study a 61-year-old male presented with a huge psoas hematoma. He had no history of bleeding disorders. He was initially diagnosed with delayed traumatic hematoma. Despite conservative and surgical treatments, coagulopathy was not resolved and postoperative bleeding continued. Consequently, coagulation factor tests were performed and showed reduced activity of factor VIII (2.7%). In addition, factor VIII inhibitor was detected. The patient was diagnosed with AHA and administered recombinant factor VIII for 3 days which resulted in the cessation of bleeding. AHA can lead to a life-threatening hemorrhage, and needs to be considered in differential diagnoses in any patients presenting with unexplained and repeated bleeding, where there is no personal or familial history of bleeding disorders.

Successful Endoscopic Treatment of Hepatic Duct Confluence Injury after Blunt Abdominal Trauma: Case Report

( Chan Ik Park ),( Sung Jin Park ),( Sang Bong Lee ),( Kwang Hee Yeo ),( Seon Uoo Choi ),( Seon Hee Kim ),( Jae Hun Kim ),( Dong Hoon Baek ) 대한외상학회 2016 大韓外傷學會誌 Vol.29 No.3

Hepatic duct confluence injury, which is developed by blunt abdominal trauma, is rare. Conventionally, bile duct injury was treated by surgical intervention. In recent decades, however, there had been an increase in radiologic or endoscopic intervention to treat bile duct injury. In a hemodynamically stable patient, endoscopic intervention is considered as the first-line treatment for bile duct injury. A 40 year-old man was transferred to the emergency department of OO trauma center after multiple blunt injuries. Contrast-enhanced abdominal computed tomography performed in another hospital showed a liver laceration with active arterial bleeding, fracture of the sacrum and left inferior pubic ramus, and intraperitoneal bladder rupture. The patient presented with hemorrhagic shock because of intra-peritoneal hemorrhage. After resuscitation, angiographic intervention was performed. After angiographic embolization of the liver laceration, emergency laparotomy was performed to repair the bladder injury. However, there was no evidence of bile duct injury on initial laparotomy. On posttrauma day (PTD) 4, the color of intra-abdominal drainage of the patient changed to a greenish hue; bile leakage was revealed on magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography (ERCP). Bile leakage was detected near the hepatic duct confluence; therefore, a biliary stent was placed into the left hepatic duct. On PTD 37, contrast leakage was still detected but both hepatic ducts were delineated on the second ERCP. Stents were placed into the right and left hepatic ducts. On PTD 71, a third ERCP revealed no contrast leakage; therefore, all stents were removed after 2 weeks (PTD 85). ERCP and biliary stenting could be effective treatment options for hemodynamically stable patients after blunt trauma. [ J Trauma Inj 2016; 29: 93-97 ]

Evaluation of Zone 2 Thoracic Endovascular Aortic Repair Performed with and without Prophylactic Embolization of the Left Subclavian Artery in Patients with Traumatic Aortic Injury

Bae Miju,Jeon Chang Ho,Kwon Hoon,김진혁,Choi Seon Uoo,Song Seunghwan 대한영상의학회 2021 Korean Journal of Radiology Vol.22 No.4

Objective: To report the authors’ experience in performing thoracic endovascular aortic repair (TEVAR) for zone 2 lesions after traumatic aortic injury (TAI). Materials and Methods: This retrospective review included 10 patients who underwent zone 2 TEVAR after identification of aortic isthmus injury by CT angiography (CTA) upon arrival at the emergency room of a regional trauma center from 2016 to 2019. Patients were classified into two groups: those who underwent left subclavian artery (LSA) embolization concurrently with the main TEVAR procedure, and those in whom LSA embolization was not performed during the main procedure, but was planned as a bailout treatment if type II endoleak was noted on follow-up CTA images. Pre-procedural and procedurerelated factors and post-procedure prognosis were compared between the groups. Results: There were no differences in pre-procedural factors, occurrence of endoleaks, and post-procedure prognosis (including mortality) between patients in the two groups. The duration of the procedure was shorter in the non-LSA embolization group (61 minutes vs. 27 minutes, p = 0.012). During follow-up, type II endoleak did not occur in either group. Conclusion: Delaying preventative LSA embolization until stabilization of the patient would be desirable when performing zone 2 TEVAR for TAI, in the absence of endoleak on the completion aortography image taken after complete deployment of the stent graft.

Clinical Effects of Intra-Abdominal Pressure in Critically Ill Trauma Patients

( Dong Yeon Ryu ),( Hohyun Kim ),( June Pill Seok ),( Chan Kyu Lee ),( Kwang-hee Yeo ),( Seon-uoo Choi ),( Jae-hun Kim ),( Hyun Min Cho ) 대한외상학회 2019 大韓外傷學會誌 Vol.32 No.2

Purpose: There is increasing interest in intra-abdominal pressure (IAP) and intra-abdominal hypertension (IAH) in critically ill patients. This study investigated the effects and outcomes of elevated IAP in a trauma intensive care unit (ICU) population. Methods: Eleven consecutive critically ill patients admitted to the trauma ICU at Pusan National University Hospital Regional Trauma Center were included in this study. IAP was measured every 8-12 hours (intermittently) for 72 hours. IAP was registered as mean and maximal values per day throughout the study period. IAH was defined as IAP ≥12 mmHg. Abdominal compartment syndrome was defined as IAP ≥20 mmHg plus ≥1 new organ failure. The main outcome measure was in-hospital mortality. Results: According to maximal and mean IAP values, 10 (90.9%) of the patients developed IAH during the study period. The Sequential Organ Failure Assessment (SOFA) score was significantly higher in patients with IAP ≥20 mmHg than in those with IAP <20 mmHg (16 vs. 5, p=0.049). The hospital mortality rate was 27.3%. Patients with a maximum IAP ≥20 mmHg exhibited significantly higher hospital mortality rates (p=0.006). Non-survivors had higher maximum and mean IAP values. Conclusions: Our results suggest that an elevated IAP may be associated with a poor prognosis in critically ill trauma patients.

복부 둔상에 의한 얕은엉덩휘돌이동맥 파열의 혈관조영색전술을 통한 성공적인 치료: 증례보고

이상봉 ( Sang Bong Lee ),박성진 ( Sung Jin Park ),여광희 ( Kwang Hee Yeo ),김호현 ( Ho Hyun Kim ),박찬용 ( Chan Yong Park ),김재훈 ( Jae Hun Kim ),김창완 ( Chang Wan Kim ),최선우 ( Seon Uoo Choi ),김선희 ( Seon Hee Kim ),황정주 ( 대한외상학회 2015 大韓外傷學會誌 Vol.28 No.1

Lat. abdominal wall hematoma with active bleeding is very rare but need prompt bleeding control. We report successful treatment by angiographic embolization of superficial circumflex iliac artery rupture caused by blunt trauma. A 60- year-old woman presented painful, enlarging, lat. abdominal wall mass with ecchymosis caused by blunt abdominal trauma. Contrast leakage of superficial circumflex iliac a. within the lt. ext. oblique m. hematoma was confirmed by abdominal computed tomography. Angiographic embolization was performed successfully. Patient was discharged at 4th day after trauma without complication. Angiographic embolization is important treatment option of lat. abdominal wall hematoma with active bleeding replacing emergency surgery. [ J Trauma Inj 2015; 28: 39-42 ]