No abstract available.
Antibodies* ; Coxiella burnetii* ; Coxiella* ; Prevalence*

Pulmonary arteriovenous fistula (PAVF) is a complication of the Glenn shunt. A 57-year-old tetralogy of Fallot (TOF) patient, who had undergone a Glenn shunt and TOF total correction, complained of dyspnea and cyanosis. PAVFs were present in the right lung, and right lung perfusion was nearly absent. After coil embolization, takedown of the Glenn shunt, and reconstruction of the right pulmonary artery, the patient's symptoms were relieved. Extrapulmonary radioisotope uptake caused by the PAVFs shown in lung perfusion scans decreased, and right lung perfusion increased gradually. Although the development and resolution of PAVFs after a Glenn shunt have been reported in the pediatric population, this may be the first report on this change in old age.
Arteriovenous Fistula* ; Cyanosis ; Dyspnea ; Embolization, Therapeutic ; Fontan Procedure ; Hepatopulmonary Syndrome ; Humans ; Lung ; Middle Aged* ; Perfusion ; Pulmonary Artery ; Tetralogy of Fallot*

Pectus arcuatum is a rare complex chest wall deformity. A 31-year-old female presented with a severely protruding upper sternum combined with a concave lower sternum. We planned a modified Ravitch-type operation. Through vertical mid-sternal incision, chondrectomies were performed from the second to fifth costal cartilages, saving the perichondrium. Horizontal osteotomy was performed in a wedge shape on the most protruding point, and followed by an additional partial osteotomy at the most concaved point. The harvested wedge-shape bone fragments were minced and re-implanted to the latter osteotomy site. The osteotomized sternum was fixed with multiple wirings. With chondrosternoplasty, a complex chest wall deformity can be corrected successfully.
Adult ; Bone Transplantation ; Congenital Abnormalities ; Costal Cartilage ; Female ; Funnel Chest ; Humans ; Osteotomy ; Pectus Carinatum ; Sternum ; Thoracic Wall

No abstract available.
Hemorrhage* ; Kidney Transplantation*

One of the complications of permanent pacemaker implantation is unintended phrenic nerve stimulation. A 15-year-old boy with a permanent pacemaker presented with chest discomfort due to synchronous chest wall contraction with pacing beats. Even after reprogramming of the pacemaker, diaphragmatic stimulation persisted. Therefore, we performed thoracoscopic phrenic nerve insulation using a Gore-Tex patch to insulate the phrenic nerve from the wire. A minimally invasive approach using a thoracoscope is a feasible option for retractable phrenic nerve stimulation after pacemaker implantation.
Adolescent ; Humans ; Male ; Minimally Invasive Surgical Procedures ; Pacemaker, Artificial ; Phrenic Nerve* ; Polytetrafluoroethylene ; Thoracic Wall ; Thoracoscopes ; Thoracoscopy ; Thorax

PURPOSE: To evaluate the efficacy of focal verteporfin photodynamic therapy (PDT) in patients diagnosed with chronic central serous chorioretinopathy (CSC).METHODS: This study enrolled 52 eyes of 52 patients with chronic CSC who had received verteporfin PDT. The laser spot size of 26 eyes covering only the localized hyperfluorescent area in indocyanine green angiography was classified as focal PDT. The PDT spot size of the other 26 eyes covered the total area of retinal pigment epithelial detachment including the leaking point and was defined as conventional PDT. The central subfield thickness and subfoveal choroidal thickness were measured using Heidelberg Spectralis optical coherence tomography before PDT and at months 1, 3, 6, and 12 after PDT.RESULTS: The mean spot size of the PDT was 1,995 µm in the focal group and 2,995 µm in the conventional group. Central subfield thickness steadily decreased in both groups. The mean baseline subfoveal choroidal thickness for the two groups was 334.95 and 348.35 µm, respectively, with no significant difference (p = 0.602). Subfoveal choroidal thickness decreased significantly to 304.20 µm at 1 month, 284.85 µm at 3 months, 271.60 µm at 6 months, and 265.95 µm at 12 months in the focal group (p < 0.001, p < 0.001, p < 0.001, and p < 0.001, respectively, compared with baseline). In the conventional group, subfoveal choroidal thickness decreased significantly to 318.75, 300, 284, and 272 µm at 1, 3, 6, and 12 months, respectively (p < 0.001, p < 0.001, p < 0.001 and p < 0.001 compared with baseline). There were no significant differences between the two groups in subfoveal choroidal thickness based on PDT spot size at 1, 3, 6, and 12 months (p = 0.633, p = 0.625, p = 0.676, and p =0.755, respectively).CONCLUSIONS: Focal verteporfin PDT for CSC significantly decreased the subretinal fluid and sufoveal choroidal thickness to the same extent as conventional PDT.
Angiography ; Central Serous Chorioretinopathy ; Choroid ; Humans ; Indocyanine Green ; Photochemotherapy ; Retinal Detachment ; Subretinal Fluid ; Tomography, Optical Coherence

Ebstein anomaly is a rare congenital heart malformation typically involving the tricuspid valve and the right ventricle that has a wide range of anatomical and pathophysiological presentations. Various surgical repair techniques for Ebstein anomaly have been reported because of its near-infinite anatomical variability. Cone repair for Ebstein anomaly can achieve nearly anatomical reconstruction of the tricuspid valve with promising outcomes.In this article, the surgical techniques for cone repair in adult patients with Ebstein anomaly are described in detail, and clinical experiences and technically challenging cases are presented.

No abstract available.
Humans ; Patient Satisfaction*

Purpose: Computed tomography (CT) is commonly used for the clinical staging of bladder cancer. However, a previous transurethral resection (TUR) often results in an overestimation of a proper muscle and perivesical fat invasion in the CT. The purpose of this study was to evaluate the effects of a TUR on CT staging in patients with bladder cancer. MATERIALS AND METHODS: A total of 67 patients who underwent a radical cystectomy for primary bladder cancer were included in this study. CT was performed before a TUR in 38 patients (group 1) and after a TUR in 29 (group 2). In each patient, CT evaluated the presence or absence of a proper muscle and perivesical fat invasion and the findings were then compared with the histopathologic findings following the radical cystectomy. RESULTS: CT had an overall staging accuracy of 79.1% for a proper muscle invasion and 67.2% for a perivesical fat invasion. For a proper muscle invasion, there was a significant difference between both groups in the CT specificity (76.9% vs. 30.0%, p=0.024) while no difference in the sensitivity (92.0% vs. 89.5%) was noted. For a perivesical fat invasion, there was also a significant difference between the two groups in terms of the CT specificity (75.0% vs. 35.7%, p=0.022) while there was no difference in the sensitivity (72.2% vs. 80.0%). CONCLUSIONS: A TUR before a CT may cause a false positive result in the clinical staging of bladder cancer using CT. Therefore, to minimize the confounding effect of a TUR on CT staging, it is strongly recommended that a CT be performed before a TUR in the case of a highly suspicious invasive bladder cancer.
Cystectomy ; Humans ; Neoplasm Staging ; Sensitivity and Specificity ; Urinary Bladder Neoplasms* ; Urinary Bladder*

BACKGROUND: Although the oncologic validity and perioperative complications of midline mandibulotomy are well described, little attention has been directed toward the functional problems that may be associated with its use. METHOD: A retrospective evaluation of 14 patients who had undergone this procedure were examined to assess postoperative sensation, temporomandibular joint function, dental occlusion, and cosmesis. RESULTS: All patients had some sequelae but these were minor in nature. Nine of 14 patients had abnormal postoperative sensation, 8 of 14 patients had symptoms of TMJ abnormality, 11 of 14 patients were noted with a changed occlusion, but 71.4% patients had relatively good cosmetic outcomes. CONCLUSION: Although most sequelae are negligible and further treatment is not required, patients who have undergone midline mandibulotomy can expect to experience one or more relatively minor long-term functional sequelae. To minimize this problem, meticulous surgical repair and aggressive postoperative physical therapy are required.
Dental Occlusion ; Humans ; Retrospective Studies ; Sensation ; Temporomandibular Joint