Retrograde cerebral perfusion under hypothermic circulatory arrest is a simple and useful adjunct to avoid cerebral ischemic injury in the treatment of aortic arch pathology. In the surgery of distal aortic arch and proximal descending aortic lesions through the left thoracotomy incision, right atrium-retrograde cerebral perfusion (RA-RCP) through a venous cannula positioned into the right atrium is simpler than retrograde cerebral perfusion through superior vena cava. The time limits for RA-RCP during aortic arch reconstruction have yet to be clarified. We, herein, present a case with uneventful recovery after RA-RCP of 94 minutes during reconstruction of aortic arch and descending aorta. These data suggest that RA-RCP, as an adjunct to hypothermic circulatory arrest, may prolong the circulatory arrest time and thus prevent ischemic injury of the brain, even when RA-RCP exceeds 90 minutes.
Aneurysm, Dissecting ; Aorta, Thoracic* ; Brain ; Brain Ischemia ; Catheters ; Heart Atria ; Pathology ; Perfusion* ; Thoracotomy ; Vena Cava, Superior

Capillary hemangioma is the most common vascular tumor in childhood; however, its occurrence in the bronchus is extremely rare. We recently performed a sleeve resection of the left main bronchus on a four-month-old infant with a severe emphysema caused by bronchial capillary hemangioma.
Bronchi* ; Capillaries* ; Emphysema ; Hemangioma, Capillary* ; Humans ; Infant*

BACKGROUND: Diaphragm is innervated by phrenic nerve and lower intercostal nerves. For patients with avulsion injury of brachial plexus, an in situ graft of phrenic nerve is frequently used to neurotize a branch of the brachial plexus. We studied short-term and mid-term changes of diaphragmatic level and movement in patients with dissection of phrenic nerve for neurotization. MATERIAL AND METHOD: Thirteen patients with division of either-side phrenic nerve for neurotization of musculocutaneous nerve were included in this study. With endoscopic surgical procedure, the intrathoracic phrenic nerve was entirely dissected and divided just above the diaphragm. The dissected phrenic nerve was taken out through thoracic inlet and neck wound and then anastomosed to the musculocutaneous nerve through a subcutaneous tunnel. With chest films and fluoroscopy, levels and movements of diaphragm were measured before and after operation. RESULT: There was no specific technical difficulty or even minor postoperative complications following endoscopic division of phrenic nerve. After division of phrenic nerve, diaphragm was soon elevated about 1.7 intercostal spaces compared with the preoperative level, but it did not show paradoxical motion in fluoroscopy. More than 1.5 months later, diaphragm returned downward close to the preoperative level (average level difference was 0.9 intercostal spaces; p=NS). Movement of diaphragm was not significantly decreased compared with the preoperative one. CONCLUSION: After division of phrenic nerve, the affected diaphragm did not show a significant decrease in movement, and the elevated diaphragm returned downward with time. However, the decreased lung volumes in the last spirometry suggest the decreased inspiratory force following partial paralysis of diaphragm.
Bays ; Brachial Plexus ; Diaphragm ; Diaphragmatic Eventration ; Endoscopy ; Fluoroscopy ; Humans ; Intercostal Nerves ; Lung ; Musculocutaneous Nerve ; Neck ; Nerve Transfer ; Paralysis ; Phrenic Nerve* ; Postoperative Complications ; Spirometry ; Thorax ; Transplants ; Wounds and Injuries

BACKGROUND: Although variable surgical methods of sympathetic nerve for palmar hyperhidrosis are curative and safe therapeutic options, they have some limitations such as compensatory sweating and anhidrosis of hand in long term satisfaction rate. MATERIAL AND METHOD: Therefore, we tried to decrease severity of compensatory sweating and prevent excessive dryness of hand through selective division of rami communicantes of thoracic sympathetic ganglia distributed to the hands(ramicotomy). RESULT: In postoperative results, about half of the patients maintained humidity of hands and most of them showed no more than mild degree of compensatory sweating. CONCLUSION: Therefore, ramicotomy of thoracic sympathetic ganglia can be recommended as selective and physiologic surgical method for palmar hyperhidrosis.
Ganglia, Sympathetic* ; Hand ; Humans ; Humidity ; Hyperhidrosis* ; Hypohidrosis ; Sweat ; Sweating

BACKGROUND: Substantial alterations in cerebral blood flow(CBF) are known to occur during cardiopulmonary bypass(CPB). Many investigators have speculated that these changes may be responsible for both minor and major cerebral damages after CPB. More recently, these changes in CBF have been observed to be intimately related to the arterial carbon dioxide tension(PaCO2) maintained during CPB. The present study was prospectively designed to investigate the clinical effects of normocapnic and hypercapnic CPB on the cerebral oxygen metabolism in cardiac surgery. MATERIAL AND METHOD: Thirty-six adult patients scheduled for elective cardiac surgery were randomized to either normocapnic group (PaCO2 35~40 mmHg, n=18) or hypercapnic group(PaCO2 45~55 mmHg, n=18) with moderately hypothermic nonpulsatile CPB(nasopharyngeal temperature of 29~30degrees C). In each patient, middle cerebral artery blood flow velocity(VMCA), cerebral arteriovenous oxygen content difference (C(a-v)O2), cerebral oxygen extraction(COE), cerebral metabolic rate for oxygen(CMRO2), cerebral oxygen transport(TEO2), TEO2/CMRO2 ratio, cerebral desaturation(internal jugular bulb blood oxygen saturationsurgery.
Adult ; Carbon Dioxide ; Cardiopulmonary Bypass* ; Humans ; Hypercapnia* ; Incidence ; Metabolism* ; Middle Cerebral Artery ; Oxygen* ; Prospective Studies ; Research Personnel ; Thoracic Surgery

BACKGROUND: The advantages of mitral valve reconstruction have been well established and so mitral valve reconstruction is now considered as the procedure of choice to correct mitral vlave disease. This is the report of intermediate-term results of 38 cases that performed mitral valve reconstruction for valve insufficiency(the total number of mitral valve reconstruction were 49 cases, but 11 cases that performed mitral valve replacement due to incomplete reconstruction were excluded). MATERIAL AND METHOD: From March 1991 to March 2001, 38 patients underwent mitral vlave repair due to mitral valve regurgitation with or without stenosis. Mean age was 47.6+/-14.7 years(range 15 to 70 years) : 11 were men and 27 were women. The causes of mitral valve regurgitation were degenerative in 14, rheumatic in 21, infective in 2 and the other was congenital. RESULT: According to the Carpentier's pathologic classification of mitral valve regurgitation, 3 were type I, 16 were type II and 19 were type III. Surgical procedures were annuloplasty 15, commissurotomy 19, leaflet resection and annular plication 9, chordae shortening 11, chordae transfer 5, new chordae formation 2, papillary muscle splitting 2 and vegetectomy 2. These procedures were combined in most patients. There were 2 early death and the causes of death were respiratory failure, renal failure and sepsis. There was no late death. Valve replacement was done in 6 patients after repair due to valve insufficiency or stenosis 3 weeks, 1,3,51,69,84months later respectively. These patients have been followed up from 1 to 116 months(mean 43.0 months). The mean functional class(NYHA) was 2.36 pre-operatively and improved to 1.70. CONCLUSION: In most cases of mitral valve regurgitation, mitral valve reconstruction when technically feasible is effective operation that can achieve stable functional results and low surgical and late mortality.
Cause of Death ; Classification ; Constriction, Pathologic ; Female ; Humans ; Male ; Mitral Valve Insufficiency* ; Mitral Valve* ; Mortality ; Papillary Muscles ; Renal Insufficiency ; Respiratory Insufficiency ; Sepsis

Ameloblastomas are rare odontogenic epithelial tumors that occur mainly in the mandible. Despite their benign histologic appearance, they are locally aggressive with a high recurrence rate. However, a metastasizing ameloblastoma has been rarely reported. According to the current World Health Organization classification system, the definitive diagnosis of metastasizing ameloblastoma can only be carried out in retrospect, after the event of metastasis. This case report describes a patient with metastatic pulmonary ameloblastoma, 17 years after the surgical excision of an odontogenic tumor, preoperatively misdiagnosed as primary squamous cell carcinoma.
Ameloblastoma* ; Carcinoma, Squamous Cell* ; Classification ; Diagnosis ; Humans ; Lung Neoplasms ; Mandible ; Neoplasm Metastasis ; Odontogenic Tumors ; Recurrence ; World Health Organization

Primary epithelial-myoepithelial carcinoma (EMC) of the lung is an extremely rare neoplasm that originates from submucosal bronchial glands and has been found in the salivary glands, breast tissue, and sweat glands. However, only a few cases in the respiratory tract have been identified. In the literature, most pulmonary EMCs have been reported to have developed endobronchially although a few EMC cases have been presented as intraparenchymatous tumors. We have identified a case of primary EMC that developed in the peripheral lung parenchyma.
Breast ; Lung Neoplasms ; Lung* ; Respiratory System ; Salivary Gland Neoplasms ; Salivary Glands ; Sweat Glands

Mixed squamous cell and glandular papilloma of the lung is an extremely rare benign epithelial tumor showing a mixture of squamous and glandular epithelium. Here, we report a case of mixed squamous cell and glandular papilloma that presented as a solitary nodule in the left lower lobe of a 64-year-old woman. Chest computed tomography demonstrated a lobulated mass in the basal segment of the left lower lobe. The patient underwent a lobectomy under the suspicion of lung malignancy. The histopathological diagnosis was mixed squamous cell and glandular papilloma.
Diagnosis ; Epithelium ; Female ; Humans ; Lung Neoplasms ; Lung* ; Middle Aged* ; Papilloma* ; Thorax

Primary tumors of the lung are uncommon in pediatric patients, particularly bronchioloalveolar carcinoma (BAC). An 11-year-old female suffering from back pain for 1 month was referred to Seoul St. Mary's Hospital for treatment of a pathologic fracture of the lumbar spine. Comprehensive evaluation disclosed numerous pulmonary metastases of rhabdomyosarcoma (stage IV). During chemotherapy, most of the lung lesions regressed, with the exception of two nodules. Wedge resections, intended for diagnosis and cure, yielded a histologic diagnosis of BAC.
Adenocarcinoma, Bronchiolo-Alveolar* ; Back Pain ; Child ; Diagnosis ; Drug Therapy ; Female ; Fractures, Spontaneous ; Humans ; Lung ; Lung Neoplasms ; Neoplasm Metastasis ; Rhabdomyosarcoma ; Seoul ; Spine