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Successful laparotomy for intra-abdominal hypertension following veno-venous extracorporeal membrane oxygenation after severe thoracoabdominal trauma: a case report
No full textVeno-venous (VV) extracorporeal membrane oxygenation (ECMO) is often used as a life-saving therapy for lung injuries; however, it presents challenges, including bleeding risks and potential reductions in ECMO flow. This case report details the intricate management of a 16-year-old boy who suffered severe thoracoabdominal trauma following a nine-floor fall. The patient sustained severe lung injury and damage to multiple solid organs, including liver lacerations, and was placed on VV-ECMO. When initiating ECMO, it is crucial to carefully consider anticoagulation to avoid potential bleeding complications. Therefore, despite the usual risks associated with ECMO, such as bleeding and reduced flow rates, anticoagulation was withheld due to the risk of hemorrhage from the liver injury. While on ECMO support, the patient experienced a sudden decrease in flow and blood pressure, suggesting an increase in intra-abdominal pressure. An immediate decompressive laparotomy revealed a significant hemoperitoneum, primarily caused by oozing from the liver laceration. The prompt recognition of abdominal distension and the timely decision to proceed with surgery without further imaging were key to the successful treatment. Postoperatively, the patient showed good recovery, with gradual weaning from ECMO, extubation, and eventual discharge. In conclusion, this case highlights the importance of ongoing monitoring for patients with complex trauma who are on ECMO. External factors, including elevated intra-abdominal pressure, can impair ECMO performance. Meticulous management and a multidisciplinary approach are essential in these intricate cases, which involve the nonsurgical treatment of solid organ damage accompanied by severe lung injury
Atypical pulmonary cysts in lung cancer screening: prevalence, outcomes, and clinical implications
No full textOBJECTIVE: We aimed to examine the prevalence and clinical outcomes of atypical pulmonary cysts (APCs) in lung cancer screening (LCS) and evaluate the impact of APC introduction on Lung-RADS v2022 categorization. MATERIALS AND METHODS: We reviewed 2968 low-dose baseline chest CT scans from LCS participants between June 2017 and April 2023. Two thoracic radiologists assessed the presence and type of APCs and evaluated interval changes. We also investigated how the introduction of APC changed Lung-RADS categories. Interobserver agreement was assessed using Cohen's kappa coefficient. RESULTS: Of the 2968 participants (2900 men, 68 women; median age: 61 years [IQR: 57-65]), 18 (0.6%) had APCs. The interobserver agreement for APC presence was fair (kappa = 0.33; 95% CI: 0.07-0.44). Among the 16 APC cases with follow-up CTs (median follow-up: 22 months), lung cancer was confirmed in three cases (18.8%). Among the remaining 13 APCs, 4 (30.8%) showed growth, 7 (53.8%) showed no change and 2 (15.4%) exhibited decreased wall thickness. Histological confirmation was not obtained for these 13 cases, indicating a minimum cancer rate of 18.8%. The introduction of APC led to a positive result change in 0.4% of participants (12/2968), with two lung cancer cases among them. CONCLUSION: APCs were infrequent in LCS, with a 0.6% prevalence, but had a high cancer rate (18.8%). Although the introduction of APC led to a 0.4% increase in positive screenings, this is considered acceptable as it included two lung cancer cases, highlighting the importance of recognizing APCs for early lung cancer detection. KEY POINTS: Question What is the prevalence and clinical significance of APCs detected during LCS, and how do they impact diagnostic outcomes? Findings APCs were detected in 0.6% of participants, with a high cancer rate of at least 18.8%, and increased screening positive results by 0.4%. Clinical relevance APCs during LCS, although uncommon, are crucial because of their high risk of lung cancer. This enhances early detection of lung cancer and improves patient management strategies
Left Renal Vein Transection and Reconstruction for Functional Paraganglioma Resection: A Case Report
No full textParagangliomas are rare neuroendocrine tumors originating from extra-adrenal chromaffin cells and often require surgical management. We report the case of a 55-year-old male with a retroperitoneal paraganglioma diagnosed by imaging and elevated catecholamine metabolite levels. Preoperative management included alpha-blocker administration to control blood pressure. The tumor was located behind the inferior vena cava and the left renal vein, necessitating careful surgical planning. During surgery, the left renal vein was temporarily clamped and transected for tumor excision, followed by vascular reconstruction. Periodic declamping was performed to mitigate renal congestion. Postoperatively, the biochemical markers of catecholamine secretion normalized, and renal function remained stable. The patient was discharged without complications. This case underscores the importance of preoperative planning, intraoperative vascular management, and postoperative monitoring in the surgical treatment of functional retroperitoneal paragangliomas. It also demonstrates the feasibility of left renal vein transection and reconstruction for complete tumor resection while preserving renal function
Effects of treatment on extracellular fluid changes in the lower extremities of patients with chronic venous insufficiency using bioelectrical impedance analysis
No full textThe Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification to describe patients with chronic venous disease (CVD) has limitations in that it cannot be quantitatively evaluated. Thus, we aimed to determine whether measuring changes in extracellular fluid (ECF) can be an objective and quantitative indicator after CVD treatment. In this retrospective, single-center study, changes in ECF and symptoms of CVD were analyzed using bioelectrical impedance analysis at baseline (V0), after 1 month (V1), and after 3 months (V2) between April and November 2023. Subgroup analysis was performed to determine whether sex, body mass index (BMI), baseline CEAP grade, and additional diuretic use could affect further ECF reduction. Compared with V0, ECF in both legs significantly reduced over the intervention period. At V1, compared with V0, significant ECF reduction in the right leg (-0.47%, P = .0085) and left leg (-0.57% and P = .0021) were observed. ECF reduction at V2 was more pronounced compared to 1 month after treatment in the right leg (-0.66%, P = .001) and left leg (-0.71% and P = .0003). Sex, baseline CEAP grade, and additional diuretic use did not affect the difference in the decline of ECF after treatment, but BMI caused significant differences in the degree of ECF reduction after treatment. Changes in ECF evaluated by bioelectrical impedance analysis can be an objective indicator of the treatment effect of chronic venous insufficiency. Diuretic combination with a venoactive drug did not bring additional benefits. The decrease in ECF after CVD treatment was more pronounced in patients with BMI < 23
Right patient to the right place: the impact of a 6-year regional trauma centre-led prehospital education programme on EMS triage and patient outcomes
No full textBACKGROUND: In regional trauma systems, emergency medical service (EMS) providers play a crucial role by performing prehospital triage for severely injured patients and transporting them to regional trauma centres. Since 2016, a regional trauma centre has provided prehospital medical guidance to EMS providers through a trauma hotline, facilitated by a trauma surgeon, to guide field triage, treatment, and transport. This study analysed the effects and clinical outcomes of a regional trauma centre-led performance improvement programme that followed closed-loop principles for EMS providers. METHODS: We collected data from regional trauma centre databases (2016-2021) of patients with trauma with Injury Severity Scores > 15 in the Gyeonggi Province. The primary outcome was the undertriage rate, and the secondary outcomes were in-hospital mortality, hospital length of stay (LOS), intensive care unit LOS, and duration of mechanical ventilation. After severity and demographic adjustments through propensity score matching, clinical outcomes were analysed using the Mann-Whitney U and chi-squared test. The results were expressed as medians with interquartile ranges. RESULTS: Among the 3017 patients included in the 6-year study period, correct triage and undertriage were performed in 2528 and 489, respectively. From 2016 to 2021, prehospital medical guidance and feedback provision increased from 432 times (32.1%) to 1505 times (96.8%) (p < 0.001); the undertriage rate decreased from 32.7% (n = 55/168) to 6.3% (n = 52/820) (p < 0.001); and the overall mortality decreased from 21.4 to 10% (p < 0.001). After propensity score matching, 484 correctly triaged and 484 undertriaged patients were identified for subgroup analyses. The in-hospital mortality of undertriaged and correctly triaged patients was 20% (n = 99) and 13% (n = 61) (p = 0.001), respectively. CONCLUSION: Undertriage of severely injured patients was associated with significantly increased mortality (20% vs. 13%, p = 0.001). Implementation of a trauma center-led education and hotline program coincided with a marked reduction in undertriage rates from 32.7 to 6.3% over the study period. These findings underscore the critical role of regional trauma centers in enhancing prehospital triage through systematic education and real-time medical guidance, particularly in the early phases of trauma system development. Special attention to elderly patients and those with comorbidities is essential for optimizing triage accuracy and reducing preventable trauma deaths
Outcomes and prognostic factors in patients with combined severe traumatic brain injury and abdominal trauma: a retrospective observational study
No full textPURPOSE: Severe traumatic brain injury (TBI) is a leading cause of death and disability. Approximately one-third to one-half of cases of TBI are associated with severe extracranial injuries, particularly abdominal trauma. This combination is associated with high mortality rates. However, studies describing the outcomes and prognostic factors of patients with combined severe head and abdominal trauma are lacking. Therefore, this study aimed to compare the clinical characteristics and outcomes and identify prognostic factors in this patient population. METHODS: This single-centre, retrospective observational study included patients with major trauma, TBI, and abdominal injury admitted to a Level 1 trauma centre from 2016 to 2020. The inclusion criteria were TBI with an Abbreviated Injury Scale (AIS) score >/= 3 and abdominal injury with an AIS score >/= 3. The primary outcomes were in-hospital mortality and Glasgow Outcome Scale (GOS) scores at discharge. RESULTS: Of 4,554 patients screened, 160 met the inclusion criteria. The in-hospital mortality rate was 20.6%, and 63.1% of the patients had favourable functional outcomes. Multivariate analysis identified factors associated with increased mortality: lower initial mean arterial pressure (OR: 0.95, 95% CI: 0.91-0.98, p = 0.006), higher base deficit (OR: 1.22, 95% CI: 1.03-1.45, p = 0.022), lower initial Glasgow Coma Scale (GCS) score (OR: 0.75, 95% CI: 0.62-0.91, p = 0.004), prolonged activated partial thromboplastin time (OR: 1.03, 95% CI: 1.00-1.05, p = 0.029), lower platelet count (OR: 0.99, 95% CI: 0.98-1.00, p = 0.008), and lower fibrinogen level (OR: 1.01, 95% CI: 1.00-1.01, p = 0.014). For unfavorable functional outcomes, independent predictors included lower initial GCS score (OR: 0.86, 95% CI: 0.78-0.95, p = 0.002), head AIS score of 5 (OR: 3.52, 95% CI: 1.32-9.40, p = 0.012), lower platelet count (OR: 0.99, 95% CI: 0.99-1.00, p = 0.012), and massive transfusion requirement (OR: 2.92, 95% CI: 1.23-6.95, p = 0.015). CONCLUSION: This study demonstrates a 20.6% mortality rate in patients with combined severe head and abdominal injuries. The findings identified key prognostic factors, including initial GCS score and platelet count. These results suggest that platelet dysfunction plays a crucial role in both mortality and functional outcomes. Early recognition and management of these factors are crucial for improving outcomes in critically injured patients. CLINICAL TRIAL NUMBER: Not applicable
Adolescents with Low Body Mass Index Are More Vulnerable to Pediatric Nondisplaced Femoral Neck Fractures
No full textBACKGROUND: Femoral neck fracture is a rare condition among fractures in the pediatric population. However, its potential for grave complications such as avascular necrosis or severe limb length discrepancy warrants prompt diagnosis and management. Much effort has been made to assess fracture risk in young adolescents in relation to obesity, low vitamin D levels, or young age osteoporosis. However, to our knowledge, there has been no literature that highlights a higher incidence of femoral neck fracture in adolescents with low body mass index (BMI). METHODS: At a level I trauma center, 22 early adolescents aged 10 years and older who had femoral neck fractures and underwent surgical treatment were included in the study. At the time of injury, BMI of each patient was stratified into 5 categories (underweight, normal weight, overweight, moderate obesity, and extreme obesity) based on BMI for age. Underweight was defined as a BMI below the 5th percentile, normal weight as between the 5th and 85th percentile, overweight as between the 85th and 95th percentile, and obese as above the 95th percentile. Then the patients were divided into 2 groups according to trauma degree: high-energy trauma and low-energy trauma. Low-energy fractures were defined as those caused by all types of trauma except for accidents involving motor vehicles, bicycles, or ski and all falls from greater than standing height. Independent samples t-tests and Pearson's chi-square tests were conducted between the 2 trauma groups. RESULTS: Excluding 2 patients lost to follow-up, 4 of 13 patients (30.77%) in the low-energy fracture group were underweight, whereas none in the high-energy fracture group were underweight. Including valgus impacted femoral neck fractures, 7 femoral neck fractures were nondisplaced, while 13 were complicated with displacement and required closed reduction. Avascular necrosis was observed in 4 cases and limb length discrepancy in 3 cases. The mean BMI percentile differed statistically significantly between the 2 trauma groups (p < 0.05). CONCLUSIONS: Low-energy femoral neck fractures in adolescents appeared to be associated with low BMI. Future studies are required to clarify the relationship between low BMI and fracture risk
BIGPN: Biologically informed graph propagational network for plasma proteomic profiling of neurodegenerative biomarkers
No full textNeurodegenerative diseases involve progressive neuronal dysfunction, requiring identification of specific pathological features for accurate diagnosis. Although cerebrospinal fluid analysis and neuroimaging are commonly employed, their invasiveness and high-cost limit widespread clinical use. In contrast, blood-based biomarkers offer a non-invasive, cost-effective, and accessible alternative. Recent advances in plasma proteomics combined with machine learning (ML) have further improved diagnostic accuracy; however, the integration of underlying biological information remains largely overlooked. Notably, many ML-based plasma proteomic profiling approaches overlook protein-protein interactions (PPI) and the hierarchical structure of molecular pathways. To address these limitations, we propose Biologically Informed Graph Propagational Network (BIGPN), a novel ML model for plasma proteomic profiling of neurodegenerative biomarkers. BIGPN employs graph neural network-based architecture to harness a PPI network and propagates independent effects of proteins through the PPI network, capturing higher-order interactions with global awareness of PPIs. BIGPN then applies a multi-level pathway structure to extract biologically meaningful feature representations, ensuring that the model reflects structured biological mechanisms, and it provides clear explainability of the pathway structure in the context of importance through probabilistically represented parameters. Experimental validation on the UK Biobank dataset demonstrated the superior performance of BIGPN in neurodegenerative risk prediction, outperforming comparison methods. Furthermore, the explainability of BIGPN facilitated detailed analyses of the discriminative significance of synergistic effects, the predictive importance of proteins, and the longitudinal changes in biomarker profiles, reinforcing its clinical relevance. Overall, BIGPN's integration of PPIs and pathway structure addresses critical gaps in ML-based plasma proteomic profiling, offering a powerful approach for improved neurodegenerative disease diagnosis
Successful airway resuscitation and removal of a life-threatening subglottic foreign body in an infant: a case report
No full textAirway foreign body (FB) removal is challenging and a time-limited and lifesaving procedure. Herein, we report successful removal of a life-threatening FB in the subglottic airway in an infant by physically forcing the FB further into the distal airway to block one lung and save the other. A 12-month-old boy presented in the emergency department with choking. Upon arrival, his mental status was alert. However, respiratory failure rapidly progressed and respiratory arrest occurred. We attempted to move the FB distally by pushing the endotracheal tube as deep as possible and inserting the stylet further. The patient was successfully resuscitated, and bronchoscopic FB removal was performed. The patient was discharged without respiratory or neurologic sequelae
Sarpogrelate Delivered via Osmotic Pump Improves Residual Hearing Preservation After Cochlear Implantation
No full textOBJECTIVES: This study evaluated the effects of sarpogrelate, a selective 5-hydroxytryptamine (5-HT) 2A receptor antagonist, on the preservation of residual hearing and modulation of inflammatory responses following cochlear implantation (CI) in an animal model. METHODS: The damaging effects of CI were simulated in male albino guinea pigs using a dummy electrode. Animals were allocated to three groups: control (n=12, dummy electrode insertion only), SPG-1004 (n=7, low-capacity pump delivering sarpogrelate), and SPG-2004 (n=6, high-capacity pump delivering sarpogrelate). Sarpogrelate was administered via osmotic pumps at two different volumes, and its effects on hearing thresholds, histological outcomes, and expression of inflammation-related genes were assessed. Hearing was evaluated using auditory brainstem response (ABR) thresholds measured at baseline (preoperatively) and at 1, 7, and 30 days postoperatively. RESULTS: Administration of sarpogrelate via an osmotic pump resulted in significant hearing preservation across all tested frequencies at 1 month post-surgery (P<0.05) compared with the control group, which underwent dummy electrode insertion only. Histological analysis revealed that cochlear fibrosis and inflammatory cell infiltration were markedly reduced in the sarpogrelate-treated groups, especially in the group receiving the higher pump volume. Gene expression analysis supported these findings by showing a significant reduction in inflammation-related markers in the sarpogrelate-treated groups. CONCLUSION: Sarpogrelate exhibited a protective effect against the loss of residual hearing after CI, likely due to its anti-inflammatory and antifibrotic properties. In addition, the osmotic pump enabled controlled, sustained delivery of the drug over time. These findings indicate that administering sarpogrelate via an osmotic pump represents a promising pharmacological strategy for improving postoperative outcomes in CI patients by preserving residual hearing