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

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: 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

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

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

BACKGROUND: Pulmonary endarterectomy is widely accepted as a treatment for chronic thromboembolic pulmonary hypertension. Based on our experiences, we sought to find ways to reduce perioperative complications and to improve surgical outcomes in patients undergoing pulmonary endarterectomy. MATERIAL AND METHOD: This study was designed as a retrospective analysis of 20 patients with pulmonary hypertension who underwent pulmonary endarterectomy between January 1998 and March 2008. All patients presented with chronic dyspnea. Deep vein thrombosis (DVT) was the major cause of chronic pulmonary thromboembolism (55%). Seventeen patients (85%) underwent inferior vena cava (IVC) filter placement. Thirteen patients underwent surgery under total circulatory arrest, while the others underwent surgery while on low flow cardiopulmonary bypass. Concomitant tricuspid annuloplasty was done in 6 patients (66%) whose tricuspid regurgitation was as severe as grade IV/IV. The mean follow-up duration was 45+/-32 months. RESULT: Using of University of California, San Diego (UCSD), thromboembolism classification, 4 patients (20%) were type I, 8 patients (40%) were type II, and 8 patients (40%) were type III. Right ventricular systolic pressure was reduced significantly from 77+/-29 mmHg to 37+/-19 mmHg after pulmonary endarterectomy (p<0.001). The degree of tricuspid regurgitation and the NYHA functional class were all improved postoperatively. Reperfusion edema occurred in 7 cases (35%). The incidence of reperfusion edema was higher in the UCSD type III group than in the other group (25% vs 50%, p=0.25) and the length of postoperative intensive care unit stay was longer in type III group (5+/-2 days vs 9+/-7 days, p=0.07). The early mortality rate was 10%, and the late mortality rate was 15% (n=3); one death was due to progression of underlying non-Hodgkin's lymphoma, and the other deaths were related to recurrent thromboembolism and persistent pulmonary hypertension, respectively. CONCLUSION: Pulmonary endarterectomy, as a curative surgical method for treating chronic thromboembolic pulmonary hypertension, should be performed aggressively in patients diagnosed with chronic thromboembolic pulmonary hypertension, and an effort should be made to reduce the frequency of perioperative complications and to improve surgical outcomes.
Blood Pressure ; California ; Cardiopulmonary Bypass ; Dyspnea ; Edema ; Endarterectomy ; Follow-Up Studies ; Humans ; Hypertension, Pulmonary ; Incidence ; Intensive Care Units ; Lymphoma, Non-Hodgkin ; Nitric Oxide ; Pulmonary Embolism ; Reperfusion ; Retrospective Studies ; Thromboembolism ; Tricuspid Valve Insufficiency ; Vena Cava, Inferior ; Venous Thrombosis

Little is known regarding long-term survival and changes in systolic function following surgery after the occurrence of a severe left ventricular (LV) dysfunction in patients with severe aortic stenosis. Inclusion criteria were an aortic valve area less than 1 cm2 and an LV ejection fraction (EF) less than 35%. Between January 1990 and July 2007, 41 (male: 30) patients were identified. The pre-operative mean EF and mean aortic valve area were 26.7+/-6.1% and 0.54+/-0.2 cm2, respectively. Concomitant coronary artery bypass surgery was performed in 8 patients (19.6%). Immediate post-operative echocardiogram showed to be much improved in LV EF (27.2+/-5.5 vs. 37.4+/-11.3, P<0.001), LV mass index (244.2+/-75.3 vs. 217.5+/-71.6, P=0.006), and diastolic LV internal diameter (62.5+/-9.3 vs. 55.8+/-9.6, P<0.001). Post-operative LV changes were mostly complete by 6 months, and were maintained thereafter. There was one in-hospital mortality (2.4%) and 12 late deaths including one patient diagnosed with malignancy in whom LV function was normal. Multivariate analysis showed pre-operative atrial fibrillation and NYHA FC IV to be significant risk factors for cardiac-related death. Aortic valve replacement in patients with significant aortic stenosis and severe LV dysfunction showed acceptable surgical outcomes. Moreover, LV function improved significantly in many patients.
Adult ; Aged ; Aortic Valve/*surgery ; Aortic Valve Stenosis/complications/*mortality/surgery ; Atrial Fibrillation/diagnosis ; Coronary Artery Bypass/methods ; Coronary Artery Disease/diagnosis ; Echocardiography ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Risk Factors ; Severity of Illness Index ; Treatment Outcome ; Ventricular Dysfunction, Left/complications/*mortality/surgery