Indefinite-for-neoplasia is an expression used to describe lesions in which carcinoma or dysplasia cannot be clearly and conclusively established via biopsy. Gastric indefinite-for-neoplasia may represent a reactive change secondary to inflammation in some patients; however, some lesions are eventually diagnosed as dysplasia or carcinoma. Follow-up endoscopic biopsy is commonly performed in patients with gastric indefinite-for-neoplasia lesions. Nonetheless, patients may undergo resection based on a high index of clinical suspicion for dysplasia or carcinoma based on endoscopic findings. Accurate target biopsies of the lesion and effective communication with pathologists are required to improve diagnostic accuracy and avoid unnecessary re-examinations. It is important to establish endoscopic findings useful in differentiating lesions that require resection. In this review, we describe the approach for the management of indefinite-for-neoplasia lesions detected on gastric mucosal biopsy and the characteristics of lesions that require resection.

A 36-year-old man, who had undergone thoracoscopic anterior spinal fusion using the plate system and posterior screw fusion three months previously, presented to our hospital with left flank pain and fever. Computed tomography indicated the presence of a psoas muscle abscess. However, after two days of percutaneous catheter drainage, a mycotic abdominal aortic pseudoaneurysm was detected via computed tomography. We performed in situ revascularization using a prosthetic graft with omental wrapping. Methicillin-resistant Staphylococcus aureus was identified on blood and pus culture, and systemic vancomycin was administered for one month. Although the abscess recurred, it was successfully treated with percutaneous catheter drainage and systemic vancomycin administration for three months, without the need for instrumentation removal. The patient remained asymptomatic throughout two years of follow-up.
Abscess ; Adult ; Aneurysm, False* ; Aneurysm, Infected ; Catheters ; Drainage ; Fever ; Flank Pain ; Follow-Up Studies ; Humans ; Methicillin-Resistant Staphylococcus aureus ; Psoas Abscess* ; Psoas Muscles ; Spinal Fusion* ; Suppuration ; Transplants ; Vancomycin

Aortic and pulmonary valve endocarditis with patent ductus arteriosus (PDA) is uncommon in adult. A 60-year-old woman was diagnosed with aortic and pulmonary valve endocarditis and PDA. We describe our surgical experience for treating PDA with double valve endocarditis.
Adult ; Ductus Arteriosus, Patent ; Endocarditis ; Female ; Humans ; Middle Aged ; Pulmonary Valve

BACKGROUND: CT angiography is now available to evaluate the early graft patency after coronary bypass surgery. We investigated whether patency or occlusion of the bypass grafts can be visualized by CT angiography and what factors effect the visuality. MATERIAL AND METHOD: Fifty patients underwent scanning with a 4-slice computed tomographic scanner (Somatom Volume ZoomTM; Siemens, Germany) before being discharged after coronary artery bypass grafting. To evaluate graft patency and relationship between the quality of graft image and the characteristics of the diseased coronary vessels, 50 internal thoracic artery grafts, 18 radial artery grafts, and 56 vein grafts were included in this study. RESULT: All vein grafts (24 grafts; 32 anastomoses) to left coronary artery system were well visualized, but 3 grafts (4.7%) of 30 vein grafts (35 anastomoses) to right coronary artery system were not visualized. The latter was also occluded in invasive coronary angiographic study. Thirty-nine (78%) internal thoracic artery grafts were well visualized, 8 (16%) faintly visualized, and 3 (6%) not visualized, but all the internal artery grafts were well patent in invasive coronary angiographic study. CONCLUSION: Unvisualized vein grafts in CT angiography means occlusion of the grafts, but unvisualized arterial grafts in CT angiography may not mean occlusion of the graft but result from competitive flow between the graft and coronary artery. To confirm patency of the unvisualized arterial grafts, invasive coronary angiography is needed.
Angiography* ; Arteries ; Coronary Angiography ; Coronary Artery Bypass* ; Coronary Vessels* ; Humans ; Mammary Arteries ; Radial Artery ; Transplants* ; Vascular Patency ; Veins

BACKGROUND: Retrospective study was carried out on patients with primary spontaneous pneumothorax with the aim of determining if conventional thoracoscopic wedge resection is superior to modified transaxillary minithoracotomy with thoracoscopy in the surgical treatment. MATERIALS AND METHOD: 160 patients, aged 14 to 35 years with primary spontaneous pneumothorax were involved in this study. Patients were assigned to two groups by surgical technique; Conventional thoracoscopic wedge resection (group A; n=80) and modified transaxillary minithoracotomy with thoracoscopy (group B; n=80). Apical pleural abrasion & talc poudrage were performed in all cases. This study evaluated the following factors: duration of operation, days of analgesics used after operation, number of no air leak on the first postoperative day, duration of indwelling chest tube, hospital stay, postoperative complications, chronic chest pain (during follow-up) and resumption of normal activity. Relapses (ipsilateral recurrence after discharge) during follow-up periods were evaluated. RESULT: No significant differences were found in any of the factors studied in either group. CONCLUSION: Conventional thoracoscopic wedge resection and modified transaxillary minithoracotomy with thoracoscopy offer similar results in the surgical treatment of primary spontaneous pneumothorax. The rate of complication is low and the level of pain is acceptable without long-term sequele. Therefore, modified transaxillary minithoracotomy with thoracoscopy method appears as a valuable alternative surgical technique.
Analgesics ; Chest Pain ; Chest Tubes ; Follow-Up Studies ; Humans ; Length of Stay ; Pneumothorax* ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Talc ; Thoracoscopy* ; Thoracotomy

BACKGROUND: The Y-composite graft of internal thoracic artery and radial artery is commonly used in coronary bypass surgery. The aim of this study is to look for a way to raise the free flow of the internal thoracic graft and to see flow dynamics of the Y-graft. MATERIAL AND METHOD: In 15 patients undergoing coronary bypass surgery, free flow of the in-situ internal thoracic artery graft was measured using two different papaverine application methods; extraluminal papaverine spray in 7 patients and intraluminal papaverine injection in 8. In 18 other patients for whom the Y-graft was used, total free flow and flow changes from the two ends were measured. RESULT: The free flow of the in-situ internal thoracic artery graft almost doubled with internal papaverine injection than with external papaverine spray (47.7+/-9.6 mL/min vs. 100.8+/-26.3 mL/min, p<0.001). Total flow of the Y-composite graft was significantly more than either flow of the internal thoracic artery end or radial artery graft end (173.3+/-45.3 mL/min vs. 121.1+/-34.3 mL/min or 117.5+/-42.8 mL/min). When both ends of the Y-composite graft were opened, free flows from the two ends were similar (85.4+/-27.8 mL/min vs. 87.9+/-42.4 mL/min, p=0.772). The flow of one end of the Y-composite graft was increased significantly by clamping of the other-end than when both ends were opened. CONCLUSION: Intraluminal papaverine injection is very effective in raising free flow of the internal thoracic artery graft, and the free flow of the Y-composite graft of in-situ internal thoracic artery and free radial artery graft is more than that of the in-situ internal thoracic artery graft. The flow of one end flow of the Y-graft may be altered by the flow change of the other end.
Arteries* ; Constriction ; Coronary Artery Bypass ; Humans ; Mammary Arteries* ; Papaverine ; Radial Artery ; Transplants*

BACKGROUND: Prolonged air leakage and pleural fluid drainage from a chest tube may delay removing the chest tube after a patient undergoes video-assisted thoracoscopic wedge resection and the patient is otherwise ready for discharge. We reviewed 37 outpatients patients who were being managed with a postoperative chest tube (a Panda Pneumothorax set with a Heimlich valve). MATERIAL AND METHOD: From January 2005 to December 2007, 294 patients underwent video-assisted thoracoscopic wedge resections & pleurodesis. Of them, 37 patients met the criteria for outpatient chest drainage management with using a Panda Pneumothorax set with a Heimlich valve. The patients received written instructions, and they demonstrated competence with using the Panda system. The patients returned for chest tube removal after satisfactory resolution of their air leak and pleural fluid drainage. RESULT: The patients discharged with a Panda pneumothorax set had a longer duration of hospital stay (mean: 10.3+/-1.7 days, range: 11 to 17 days) as compared with the patients without a Panda pneumothorax set (mean: 6.2+/-1.5 days, range: 4 to 7 days). The chest tube was removed successfully from the patients with a Panda pneumothorax set at an average of 9.8+/-1.6 days (range: 9~18 days) after discharge. There were no major complications. Four patients experienced minor complications. Thirty six patients (97.3%) experienced uneventful and successful outpatient chest tube management. CONCLUSION: Successful postoperative outpatient chest tube management with using the Panda set was accomplished in 36 selected patients. This program resulted in a substantially reduced hospital cost and enhanced patient satisfaction by allowing earlier discharge.
Chest Tubes ; Drainage ; Hospital Costs ; Humans ; Length of Stay ; Mental Competency ; Outpatients ; Patient Satisfaction ; Pleurodesis ; Pneumothorax ; Thorax

Birt-Hogg-Dubé syndrome (BHD) is a rare autosomal dominant disorder characterized by the formation of hair follicle tumors, kidney tumors, and pulmonary cysts with recurrent spontaneous pneumothorax. A 44-year-old woman visited Wonkwang University Hospital with mild dyspnea. A chest X-ray on admission revealed pneumothorax in both lung fields. Chest computed tomography (CT) revealed both pneumothorax and multiple, irregularly shaped, variable-sized cysts in both lung fields. Upon physical examination, white dome-shaped papules were observed on the face. Histological examination of the skin lesion confirmed fibrofolliculoma, and genetic studies revealed a folliculin gene mutation. Abdominal CT revealed a 1-cm small solid renal mass at the lower pole of the right kidney. We surgically removed the renal tumor, and a histological diagnosis of oncocytoma was made. Here, we report a case of BHD that demonstrated all three clinical manifestations; this is the first case report of its kind in Korea.
Adenoma, Oxyphilic ; Adult ; Birt-Hogg-Dube Syndrome ; Diagnosis ; Dyspnea ; Estrone ; Female ; Hair Follicle ; Humans ; Kidney ; Kidney Neoplasms ; Korea ; Lung ; Physical Examination ; Pneumothorax ; Skin ; Thorax ; Tomography, X-Ray Computed

Birt-Hogg-Dubé syndrome (BHD) is a rare autosomal dominant disorder characterized by the formation of hair follicle tumors, kidney tumors, and pulmonary cysts with recurrent spontaneous pneumothorax. A 44-year-old woman visited Wonkwang University Hospital with mild dyspnea. A chest X-ray on admission revealed pneumothorax in both lung fields. Chest computed tomography (CT) revealed both pneumothorax and multiple, irregularly shaped, variable-sized cysts in both lung fields. Upon physical examination, white dome-shaped papules were observed on the face. Histological examination of the skin lesion confirmed fibrofolliculoma, and genetic studies revealed a folliculin gene mutation. Abdominal CT revealed a 1-cm small solid renal mass at the lower pole of the right kidney. We surgically removed the renal tumor, and a histological diagnosis of oncocytoma was made. Here, we report a case of BHD that demonstrated all three clinical manifestations; this is the first case report of its kind in Korea.

Conventional endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) have been reported to be effective therapeutic options in sporadic non-ampullary duodenal tumors, but the rate of perforation is higher than that of other gastrointestinal lesions. Underwater EMR (UW EMR) has been reported to be a safe alternative to conventional EMR and ESD for superficial non-ampullary duodenal adenomas. We reviewed the medical chart and endoscopic report of patients who underwent endoscopic resection between August 2018 and February 2020. A total of 12 duodenal tumors were resected by UW EMR. The mean specimen and lesion sizes were 6.7 mm (2~16 mm) and 5.3 mm (2~10 mm), respectively. Of the 12 lesions, nine (75.0%) were located in the 2nd portion, and three (25.0%) were in the bulb. The mean procedural time was 7.8 minutes (3.2~18.7 minutes). Histologic results showed 10 dysplasia (nine low-grade, one high-grade) and two neuroendocrine tumors. UW EMR showed favorable efficacy and safety within small dysplastic lesions compared to previous studies’ results. Furthermore, it might be considered a treatment option with caution in patients with the duodenal subepithelial tumor within the third layer.