Acute and Critical Care

Hae Kyu Kim

13 Articles

A Case of Hemoperitoneum due to Spontaneous Rupture of Visceral Artery Aneurysm after Ingestion of Puffer Fish: Do Won Lee, Hae Kyu Kim, Hyun Jung Lee, Jung Min Hong, Jae Young Kwon; Korean J Crit Care Med. 2013;28(3):210-213.; DOI: https://doi.org/10.4266/kjccm.2013.28.3.210

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Abstract PDF: Ingestion of puffer fish can cause intoxication, which produces a wide range of symptoms due to the presence of neurotoxins, such as tetrodotoxin, in puffer fish. Abdominal pain is just one of the symptoms that should be treated with symptomatic and supportive therapy. This study reports a case of a 56-year-old male patient with abdominal pain, who was admitted to the emergency room with a diagnosis of puffer fish poisoning. In this case, the abdominal pain did not improve, but rather, the symptoms worsened. Finally, the cause of the abdominal pain was found to be hemoperitoneum due to active bleeding at the greater omentum, as observed on abdominal computed tomography; the source of bleeding was the right colic artery branch. Embolization was performed successfully, and the post-intervention course was uneventful. The patient was discharged without any complications within 13 days after admission.

Hypertensive Crisis during Removal of Retroperitoneal Mass in a Patient with Undiagnosed Paraganglioma - A Case Report -: Hee Young Kim, Joo Yun Kim, Hae Kyu Kim, Seung Hoon Baek; Korean J Crit Care Med. 2013;28(1):64-66.; DOI: https://doi.org/10.4266/kjccm.2013.28.1.64

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Abstract PDF: Paragangliomas have been reported on multiple locations. A diagnosis of a catecholamine-secreting tumor was considered only after induction of anesthesia, when BP (blood pressure) increased. A 61-year-old male patient was referred for removal of a retroperitoneal mass suspected hemangiopericytoma. He was on medications for hypertension. There was a surge of ABP (arterial blood pressure) to 186/117 mmHg when the tumor was manipulated at the beginning of the surgery, and this was treated by bolus of diltiazem. After resection of the tumor, ABP dropped to 57/36 mmHg. In order to improve the patient's hemodynamic parameters, crystalloid fluid was given, and ephedrine was administered intravenously. Persistent hypotension was treated with titrated vasopressors (epinephrine and norepinephrine). When paraganglioma is suspected due to a sudden hypertensive crisis during surgery, the surgeon must decide whether to proceed with the surgical procedure or to stop and restart the surgery after proper management of the crisis.

The Changes of Regional Cerebral Blood Flow according to Inhalational Anesthetic Agents after Transient Bilateral Carotid Artery Occlusion in the Rabbit: Hyeong Geun Joo, Hae Kyu Kim; Korean J Crit Care Med. 2005;20(2):121-130.

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Abstract PDF: BACKGROUND
Cerebral hyperperfusion syndrome is a recognized complication of carotid endarterectomy, with a reported incidence of 0.3 to 1.2%. Monitoring of regional cerebral blood flow (rCBF) may limit neurological damage. This study was planned to investigate the changes of rCBF according to inhalational anesthetic agents. METHODS: 2.40+/-0.04 kg weighed New Zealand White Rabbits were undergone transient brain ischemia by bilateral carotid artery ligation for 20 minutes. The rCBF was measured by Bowman Perfusion Monitor.
RESULTS
The value of rCBF in pre-ligation state was not significantly different among the three groups. rCBF in sevoflurane group was decreased to 46% of baseline value during ischemia and increased to 143% just after reperfusion. rCBFs in isoflurane and enflurane groups were abruptly increased instead of decrease like sevoflurane group. The values of rCBF was more increasing after reperfusion in isoflurane and enflurane groups. rCBFs in all groups were return to baseline value 10 minutes after reperfusion. CONCLUSIONS: This results was suggested that sevoflurane might be contributed to create a neurologic damage during ischemia and the hyperperfusion was seen in all three anesthetic agents. The clinical investigation may be needed to establish the value of this experiment.

The Effects of Moderate Hypothermia on the Formation of Apoptosis in Transient F degrees Cal Cerebral Ischemia Model in Rats: Tae Jung Woo, Seong Wan Baik, Kyoo Sub Chung, Inn Se Kim, Hae Kyu Kim, Jae Young Kwon; Korean J Crit Care Med. 2002;17(1):12-18.

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Abstract PDF: BACKGROUND
Delayed neuronal injury after cerebral ischemia came major neurologic complication after stroke or cardiac arrest. Apoptosis formation after ischemia may be one of a mechanism of delayed neuronal injury. This study was conducted to evaluate the effect of moderate hypothermia on apoptosis formation after one hour of middle cerebral artery degrees Cclusion in rats.
METHODS
Ten Sprague-Dawley rats (300 g) were freely fed till just before operation. Anesthesia was induced with 4 vol% isoflurane in oxygen and then maintained with 2 vol% isoflurane in oxygen. Middle cerebral artery degrees Cclusion (MCAO) was induced by intraluminal monofilament nylon with blunted tip. All rats were divided randomly into two groups. In group 1 (n=5), rectal temperature was maintained at 38 degrees C. In group 2 (n=5), rectal temperature was maintained at 32 degrees C. Rectal temperature was monitored during experiment. After 60 minutes of MCAO, intraluminal monofilament was removed and all rats were returned to cages. Brain were quickly removed and cerebral hemispheres were separated after 23 hours reperfusion. Apoptosis formation were counted with TUNEL stain.
RESULTS
In group 1, after 60 minutes of MCAO and 23 hours reperfusion, 51 3.6% of hipp degrees Campal neurons were TUNEL-positive stained apoptotic cells. In group 2, TUNEL-positve neurons were 26.1 6.5% and significantly less than those of group 1 (p<0.05).
CONCLUSIONS
Sixty minutes of MCAO and 23 hours reperfusion induce hipp degrees Campal neuronal apoptosis. Moderate hypothermia of 32 degrees C reduces apoptosis of hipp degrees Campal neurons after 60 minutes of MCAO and 23 hours reperfusion.

Molecular Biologic Study on the Changes of Glutamate Receptor (mGluR5) in Rat Hippocampus after Brain Ischemia: Hae Kyu Kim, Pyong Ju Kim, Seong Wan Baik, Inn Se Kim, Kyoo Sub Chung; Korean J Crit Care Med. 2000;15(2):75-81.

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Abstract PDF: BACKGROUND
Metabotropic glutamate receptors (mGluRs) participate in the induction of synaptic plasticity phenomena, such as long-term potentiation and long-term depression that are thought to be at the origin of learning and memory. They are also likely to play a role in modulating glutamate-induced neurotoxicity. It will become apparent that mGluRs are excellent targets for the development of drugs that modulate excitatory synaptic transmission. But there were several controversies about the exact role of group 1 mGluRs subtype 5 (mGluR5). This study was designed for evaluation of the neuroprotective role of mGluR5.
METHODS
Fifty male Sprague-Dawley rats were divided into three groups, control, MK-801 and lamotrigine. The hippocampus and basal ganglia were removed at 6 hours and 3 days after the one hour transient middle cerebral artery occlusion. The gene expression of mRNA of the brain samples were evaluated by using reverse transcriptase polymerase chain reaction technique.
RESULTS
The gene expression of mGluR5 mRNA in hippocampus was increased by 101.96 +/- 18.45% at 6 hours after ischemia and decreased by 50.70 +/- 15.73% at 3 days after ischemia (p<0.01). MK-801 and lamotrigine attenuated the ischemia-induced increases of gene expression of mGluR5 mRNA. In MK-801 group, the expression in basal ganglia was increased by only 0.23 +/- 5.41% at 6 hours after ischemia and decreased by 9.82 +/- 4.35% at 3 days after ischemia. In MK-801 group, the expression in hippocampus was decreased by 3.45 +/- 8.24% and 9.35 5.69% at 6 hours and 3 days after ischemia. In lamotrigine group, the expressions in hippocampus and basal ganglia were decreased by 26.66 +/- 9.85% and 9.45 +/- 5.22% at 6 hours after ischemia.
CONCLUSIONS
From these results, the role of mGluR5 was defined as a mediator for neuronal damage after transient focal cerebral ischemia in hippocampus and basal ganglia.

Quality Assessment of Blood Transfusion in Operating Room: Myoung Gil Chae, Byeung Ho Byeun, Dong Hee Kang, Hae Kyu Kim, Seong Wan Baik, Kyoo Sub Chung; Korean J Crit Care Med. 1998;13(2):234-238.

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Abstract PDF: BACKGOUND: Transfusion of red blood cells is a life saving measure in the management of a variety of surgical conditions. A guideline for blood transfusion during elective surgical procedure is necessary to reduce the risks of transfusion-associated complications, excessive blood bank workload, excessive blood request and overtransfusion, and the cost. From this, a program of quality assessment was adopted to improve blood transfusion practice and to establish the guideline for blood transfusion in elective surgery at Pusan National University Hospital.
METHODS
Fifty-six patients undergoing elective surgery was divided 2 groups. Transfusion (T) group was 18 persons. Non-transfusion (NT) group was 38 persons. The preoperative, pre-transfusion, postoperative, and post-transfusion hemoglobin (Hb), hematocrit, mean arterial blood pressure (MAP), heart rate (HR), average amount of transfused red blood cell units, allowable blood loss, and the amount of infused crystalloids and colloids was estimated for 9 months in Pusan National University Hospital.
RESULTS
There were no significant differences in Hb between T & NT group. Hb decreased significantly until postoperative 3rd day in NT group. Platelet count decreased in NT group on postop. 3rd day. There were no significant differences in MAP & HR. One-ninth of T group was overestimated blood loss & 18.4% of NT group was underestimated blood loss. One-third of transfusion patient were overtransfused & 36.2% of transfused RBC was unnecessary. Nearly 90% of patient was transfused packed RBC with FFP concurrently.
CONCLUSIONS
To minimize overtransfusion, transfusion based on intraoperative hematocrit is necessary. If possible, single use of packed RBC is recommended when the blood loss is below allowable blood loss. In massive bleeding above allowable blood loss, combined administration of FFP and packed RBC or transfusion of whole blood will be better.

The Effects of Repeated Toluene Exposure on Amino Acid Neurotransmitters in the Rat Brain: Hae Kyu Kim, Seung Kyung Baeck, Sie Jeong Ryu, Inn Se Kim; Korean J Crit Care Med. 1998;13(1):33-42.

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Abstract PDF: Introduction: It was aimed to investigate the effect of chronic toluene exposure on amino acid neurotransmitters in the rat brain, corpus striatum.
METHODS
Twenty four male Sprague-Dawley rats were divided into one of three groups, control, acute, and chronic. Each groups was for the microdialysis to estimate the changes of amino acid neurotransmitters, aspartate, glutamate, and citrulline before, during, and after 3,000 ppm toluene exposure for 2 hours.
RESULTS
The results were as follows; 1) Aspartate and glutamate concentration were generally decreased in the toluene inhalation groups compared with the control group and more significantly decreased in chronic inhalation group than other groups. 2) Citrulline that expressed the activity of nitric oxide synthase and taurine as an inhibitory amino acid showed no significant differences between all groups. Based on these results, it is suggested that the decreasing excitatory amino acids, aspartate and glutamate, are partly contributed to the toxic mechanisms of toluene in rat brain.

Profound Hypothermia and Circulatory Arrest for Adult PDA Surgery: Case report: Seung Hun Baek, Sang Wook Shin, Hae Kyu Kim, Seong Wan Baik, Inn Se Kim, Kyoo Sub Chung; Korean J Crit Care Med. 1997;12(2):187-191.

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Abstract PDF: Correction of a calcified patent ductus arteriosus (PDA) is a difficult surgical procedure. Simple ligation or division of PDA is not possible if diffuse circumferential calcification is present. Several techniques using cardiopulmonary bypass and closure of PDA from within the aorta or pulmonary artery have been introduced. And the surgical procedure is performed under profound hypothermia and circulatory arrest. Total ischemia time should be less than 30 minutes, which is free from the organ damage by the circulatory arrest. Barbiturates, calcium channel blockers and steroids are used for brain protection. We experienced successful use of these techniques for adult female patch closure of PDA and reviewed the anesthetic considerations of the profound hypothermia and circulatory arrest for cardiac surgery.

Acute Lung Edema from Unknown Cause: A case report: Changgi Rho, Sang Wook Shin, Hae Kyu Kim, Seong Wan Baik, Inn Se Kim, Kyoo Sub Chung; Korean J Crit Care Med. 1997;12(1):75-80.

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Abstract PDF: Acute lung edema during anesthesia and operation is not common. We experienced a case of 7 year-old boy who developed acute lung edema during open reduction for his fractured lateral condyle of right humerus under general anesthesia with enflurane. In his previous history, we couldn't detect any abnormal finding that could induce lung edema intraoperatively. Preoperative routine laboratory findings and chest x-ray findings were within normal ranges. In the end of operation, increased airway resistance and sudden facial cyanosis were detected and he received immediate, careful supportive respiratory management. He improved from severe lung edema, but hypoxic brain damage and motor dysfunction resulted. We couldn't find any evidence that he had heart failure, hypoalbuminemia, sepsis, severe trauma, fluid overloading. Authors couldn't get exact causes of acute lung edema in this case.

The experimental study on the effects of Ringer's lactate andpentastarch infusion in hemorrhagic dogs: Woog Seong Kim, Jae Young Kwon, Hae Kyu Kim, Inn Se Kim, Kyoo Sub Jung; Korean J Crit Care Med. 1992;7(2):105-112.

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Abstract PDF: No abstract available.

The change of brain temperature during forebrain ischemia in rat: Yoon Seob Na, Jae Young Kwon, Hae Kyu Kim, Soung Wan Baik, Inn Se Kim, Kyoo Sub Chung; Korean J Crit Care Med. 1992;7(1):35-40.

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Abstract PDF: No abstract available.

The effects of steroid, barbiturate, and calcium channel blocker onforebrain ischemic rats: Hae Kyu Kim, Inn Se Kim, Si Chan Seong, Moon Sub Shim; Korean J Crit Care Med. 1992;7(1):27-33.

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Abstract PDF: No abstract available.

Hemothorax after subclavian vein catheterization: Won Bae Moon, Hae Kyu Kim, Seong Wan Baik, Inn Se Kim, Kyoo Sub Chung; Korean J Crit Care Med. 1991;6(1):53-56.

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Abstract PDF: No abstract available.

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