No abstract available.
Seoul*

Emergency surgical repair for acute traumatic aortic ruptures has been associated with a high peri-procedural mortality rate. Endovascular stent-grafting, as a less invasive procedure, has shown encouraging results. This report describes a patient with a short landing zone, who was treated by transposing the supra-aortic branch without sternotomy, followed by covered stent-grafting with an extended proximal bare portion to enhance fixation.
Acute Disease ; Aged ; Aortic Rupture/diagnosis/radiography/*surgery ; Female ; Humans ; Stents ; Sternotomy ; Subclavian Artery ; Surgical Procedures, Minimally Invasive ; Tomography, X-Ray Computed

A 23 years old single nulligravida woman underwent laparoscopic removal of a huge cystic adnexal mass that occupied her entire abdomen, giving the appearance of a full term pregnancy. After anesthesia, a vertical infra-umbilical incision, 1 cm long, was made and a telescope was introduced through the port to determine the status of the intra-abdomen and the surface contour of the mass. A needle tipped with a laparoscopic suction apparatus was inserted into the cyst through the infra-umbilical port, directly under the mass. Subsequently, 3, 200 ml of cystic fluid was aspirated without spillage. A huge cyst, reaching to the level of the xyphoid process was effectively excised through the operative laparoscopy after prelaparoscopic drainage. Operation time was 140 minutes and hospital stay was 2 days. There were no complications during hospital stay and after discharge. It seems the size of the cyst is not a criteria for the contraindication of laparoscopic surgery.
Abdomen ; Anesthesia ; Drainage ; Female ; Humans ; Laparoscopy ; Length of Stay ; Needles ; Ovarian Cysts* ; Pregnancy ; Suction ; Telescopes ; Young Adult

The authors report one case of akinetic mutism with obstructive hydrocephalus. The patient suffered from multiple shunt failures and shunt revision. After multiple shunt revision, the patient fell into an akinetic-mute state. She appeared awake but was no response to painful somatosensory, loud auditory or threatening visual stimuli and she required total nursing care. This behavioral syndrome was no response to shunt revision but we were able to successfully treat a case of akinetic mutism after combination theraphy of Bromocryptine and Ephedrine.
Akinetic Mutism* ; Bromocriptine* ; Ephedrine* ; Humans ; Hydrocephalus ; Nursing Care

BACKGROUND: The choice between a bioprosthetic and a mechanical valve is an important decision in cardiac valve surgery, and the durability of the tissue valve is a major decision factor. We retrospectively evaluated the midterm results of bioprosthetic valve replacement in the mitral position. MATERIAL AND METHOD: The subjects were all patients who had undergone mitral bioprosthesis replacement between July 1989 and August 2007. Among the 216 patients, there were 236 surgical cases. The mean age was 63+/-15 years, and the male to female ratio was 1:3. We retrospectively analyzed hospital and outpatient records such that the total follow-up duration amounted to 760.2 patient-years, and the mean follow-up duration was 41.9+/-40.7 months (range 0~212 months). RESULT: Early death occurred in 18 patients (8.3%), and 13 of these underwent concomitant cardiac procedures. The survival rate after 5 years was 79.9+/-3.5%, and the survival rate after 8 years was 65.5+/-5.5%, while freedom from structural valve deterioration (SVD) was 96.2+/-2.2% at 5 years and 85.9+/-5.3% at 8 years. Freedom from reoperation was 96.0+/-1.7% at 5 years and 90.4+/-4.2% at 8 years, while freedom from reoperation for SVD was 98.1+/-1.2% at 5 years and 92.3+/-4.1% at 8 years. On multivariate analysis of preoperative risk factors, small valve size (between 25 mm and 27 mm) was a significant risk factor for reoperation, and low LV ejection fraction (<40%) was a significant risk factor for SVD and mortality. CONCLUSION: Survival and freedom from reoperation for SVD in mitral bioprosthesis replacement had acceptable midterm results, but freedom from SVD was relatively low. In particular, since SVD increased sharply at the eighth postoperative year, frequent follow-up and echocardiograms around that time will be helpful for the early detection of SVD. It will be necessary to conduct further studies involving long-term follow-up and more patients.
Bioprosthesis ; Female ; Follow-Up Studies ; Freedom ; Heart Valves ; Humans ; Male ; Multivariate Analysis ; Outpatients ; Prosthesis Failure ; Reoperation ; Retrospective Studies ; Risk Factors ; Survival Rate

Selection of a treatment modality for traumatized renal rupture depends on the renal injury grade, hemodynamic stability, combined organ injury, and the physician's experience. Treatment for renal injury tends to be conservative to maintain renal function and lessen the morbidity of surgery. If renal injuries were well-staged and selected by radiologic evaluation, hemodynamically stable patients with significant injuries (grades II through V) can usually be managed without surgical exploration. We report 3 cases of grade 4 renal injuries successfully treated with selective renal arterial embolization.
Emergencies ; Hemodynamics ; Hemorrhage ; Humans ; Rupture

OBJECTIVE: This study aimed to assess the surgical morbidity and mortality of thoracic endovascular repair (TEVAR) as compared with open surgical repair (OSR) for isolated descending thoracic aortic disease. MATERIALS AND METHODS: From January 1, 2006 through May 31, 2010, a total of 68 patients with isolated descending thoracic aortic disease were retrospectively reviewed for the presence of perioperative complication, 30-day mortality, and clinical success. The patients were divided into two groups (group 1, OSR, n = 40 vs. group 2, TEVAR, n = 28) and these groups were compared for major variables and late outcomes. RESULTS: The mean age was 58 years (group I = 54 vs. group II = 63 years, p = 0.011). Significant perioperative complications occurred in 12 patients: 8 (20%) in group I and 4 (13%) in group II (p = 0.3). There were five 30 day mortalities of which 4 occurred in group I and 1 in group II (p = 0.23). Clinical success (effective aortic remodeling and complete false lumen obliteration or thrombosis) was achieved in 20 patients (71%). Mean Kaplan-Meier survival rate at 1 year was similar for both groups (group 1 = 87% vs. group 2 = 80%, p = 0.65). CONCLUSION: Thoracic endovascular repair for isolated thoracic aortic disease shows comparable results to OSR. However, the potential for endoleak or rupture remains a challenge that needs to be addressed in the future. Therefore, close follow-up study is needed for the evaluation of satisfactory long-term outcomes.
*Aorta, Thoracic ; Aortic Diseases/mortality/*surgery ; Chi-Square Distribution ; Drainage ; Endovascular Procedures/*methods ; Female ; Humans ; Logistic Models ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Postoperative Complications ; Retrospective Studies ; Risk Factors ; Survival Rate ; Thoracotomy ; Treatment Outcome

Minimally invasive cardiac surgery using AESOP (Automated Endoscope System for Optimal Positioning) offers certain advantages such as better a cosmetic outcome, a shortened post operative recovery time and a shorten hospital stay, and these advantages are not achieved by conventional cardiac surgery. We report here on our first robot-assisted (AESOP) left minithoracotomy surgery in a 26 year-old female with a subarteral ventricular septal defect, and this might have been treated by median sternotomy before the development of AESOP.
Cosmetics ; Endoscopes ; Female ; Heart Septal Defects, Ventricular ; Humans ; Length of Stay ; Robotics ; Sternotomy ; Thoracic Surgery

BACKGROUND: Although the high efficiency of conversion into sinus rhythm has been demonstrated after performing the Cox-Maze procedure in patients with atrial fibrillation associated with mitral valve disease, the changes in the mechanical function and size of the left atrium have not been determined. The aim of this study was to evaluate the effect of the Maze procedure on the left atrial size and contractile transport function. MATERIAL AND METHOD: From July 1997 to July 2008, 647 consecutive patients were operated on for chronic atrial fibrillation associated with mitral valve disease. Among these, 211 patients that (1) were able to be followed up for 2 years after surgery, (2) had sustained normal sinus rhythm, regardless of whether they were taking anti-arrhythmic medications and (3) did not have valvular regurgitation greater than grade III or they did not have moderate grade valvular stenosis were selected for evaluation. The left atrial size and contractile transport function were assessed by transthoracic echocardiography at the postoperative base line (1 year) and at regular follow-up periods (2 years, 3 years, 4 years and 6 year). RESULT: The left atrial dimension was increased and the contractile transport function was decreased during the follow-up period. The longer the follow-up period, the greater was the statistical significance of the left atrial size increase and contractile transport function decrease. CONCLUSION: In patients who sustain normal sinus rhythm conversion after a Maze III procedure with a mitral valve operation, there is a gradual increase of the left atrial dimensions and a decrease of contractile transport function during the follow-up period. Therefore, scrupulous follow-up is needed for these patients.
Arrhythmias, Cardiac ; Atrial Fibrillation ; Constriction, Pathologic ; Echocardiography ; Follow-Up Studies ; Heart Atria ; Heart Valve Diseases ; Humans ; Mitral Valve

BACKGROUND: Mitral valve repair (MVP) is the optimal procedure for mitral regurgitation (MR), however, failure and subsequent reoperations are the limitations. The current study assessed the procedure in relation to the primary valve related causes of recurrent MR. MATERIAL AND METHOD: MR was treated in 493 patients undergoing MVP from January of 1994 to January of 2002. The causes of MR were degenerative (n=252, 51.5%), rheumatic (n=156, 31.6%), and others (n=85, 16.9%). Surgery comprised 446 ring annuloplasties (90.5%), 227 new chordae formations (46%), 125 quadriangular resections (25.3%), 28 chordae transfers (5.7%), and 8 Alfieri's stitches (1.6%). The mean follow up was 29.04+/-22.81 months. RESULT: There were 5 early (1.01%), and 5 late deaths (1.01%). The reoperation rate was 1.42%. There were 45 (9.1%) recurrent MR (grade III or IV). Of these, 24 were procedure related including incomplete repair (n=14), discordant new chordae length (n=8) and others (n=2). In 21 patients, the cause was valve related including rheumatic disease progression (n=10), recurrent chordae elongation or prolapse (n=5) and others (n=6). Severe MR was higher after incomplete repair (p <0.001), and valve related failure strongly correlated with rheumatic progression (p <0.05). CONCLUSION: Since completeness of operation is the prime risk factor that determine the repair durability, intra-operative assessment of the initial repair with trans-esophageal echocardiography is essential.
Echocardiography ; Follow-Up Studies ; Humans ; Mitral Valve ; Mitral Valve Insufficiency* ; Prolapse ; Reoperation ; Rheumatic Diseases ; Risk Factors