Congenital intrapericardial left atrial appendage aneurysms (LAAA) are very rare. Most cases are asymptomatic and this malady is generally incidentally diagnosed in older patients. LAAAs are usually accompanied with supraventricular arrhythmias and life-threatening systemic embolism. Complete surgical correction is recommended immediately after the diagnosis to prevent significant complications, and even for the asymptomatic patients. We report here on the case of a 45-year-old man who presented with cerebral embolism due to LAAA. The patient was successfully treated with a resection of the aneurysm.
Aneurysm ; Arrhythmias, Cardiac ; Atrial Appendage ; Embolism ; Heart Atria ; Humans ; Intracranial Embolism ; Middle Aged ; Stroke

Hydatid disease is a parasitic infection that is caused by the larval stage of Echinococcus granulosus. This disease is distributed worldwide, but it is rare in Korea. A 34-year old foreign male worker from Mongolia presented with cough and chest discomfort. Computed tomography of the chest showed a cystic mass in the upper lobe of the right lung. The cyst was surgically resected, and the pathological study confirmed a hydatid cyst. The patient was given albendazole postoperatively to prevent a relapse. We report here on a surgical case of pulmonary hydatid disease along with a review of the literature.
Albendazole ; Cough ; Echinococcosis ; Echinococcosis, Pulmonary ; Echinococcus granulosus ; Humans ; Korea ; Lung ; Male ; Mongolia ; Parasites ; Recurrence ; Thorax

PURPOSE: To evaluate the relations between progression of glaucoma in visual field and peripapillary area change in normal tension glaucoma (NTG). METHODS: We respectively evaluated 66 patients (66 eyes) with normal tension glaucoma; these patients were classified as progressive glaucoma group and non-progressive glaucoma group by visual field test. Interobserver and intraobserver agreement was evaluated for qualitative assessment. Zone beta change was measured by Image J (National Institute of Health, Bethesda, USA) by two methods. One method used paired t-test and the other method used CV (correlation of variation) to define significant progression of zone beta. RESULTS: 46 patients (46 eyes) were classified as progressive glaucoma and 20 patients (20 eyes) were classified as non-progressive glaucoma. There was no statistically significant different change of zone beta between two groups and there were no changes of zone beta over coefficient of variation (CV). CONCLUSIONS: The measurement of change of zone beta seems to be of no use in recognition of progression in normal tension glaucoma.
Atrophy ; Glaucoma ; Humans ; Low Tension Glaucoma ; Visual Field Tests ; Visual Fields

BACKGROUND: The advances in surgical techniques, anesthesia management, perfusion methodology and postoperative intensive care have markedly decreased the mortality and cardiac morbidity of patients who undergo heart surgery over the past 2 decades. Nevertheless, it is well recognized that cardiac surgery carries a substantial risk for central nervous system complications. This study was conducted to evaluate the prevalence of subclinical cerebrovascular lesions in the head and neck by performing magnetic resonance angiography (MRA), and we investigated the clinical course of patients who had abnormal lesion seen on head and neck MRA. MATERIAL AND METHOD: The subjects were 107 patients (71 men and 36 women ranging in age from 21 to 83 years) who were scheduled for cardiac surgery under nonemergency conditions between October 2005 and June 2008. Informed consent was obtained before the MRA. The carotid arteries, intracranial arteries and brain parenchyme were examined for subclinical cerebrovascular lesions by performing MRA. We reviewed the patients' medical records and MR findings to evaluate the prevalence of neurologically high risk patients and their clinical course. RESULT: The overall prevalence of neurologically high risk patients was 15.7% (17 patients). Among these patients, 11 patients had ischemic heart disease and 6 patients had valvular heart disease. Only 2 patients had a history of cerebrovascular disease. The clinical courses of 14 patients (13.1%) were changed according to their MRI findings. CONCLUSION: The prevalence of subclinical cerebrovascular disease in patients who were scheduled for cardiac surgery was higher than was expected. MR angiography was of value to identify these patients.
Anesthesia ; Angiography ; Arteries ; Brain ; Carotid Arteries ; Central Nervous System ; Female ; Head ; Heart Valve Diseases ; Humans ; Informed Consent ; Critical Care ; Magnetic Resonance Angiography ; Magnetic Resonance Imaging ; Magnetic Resonance Spectroscopy ; Magnetics ; Magnets ; Male ; Mass Screening ; Medical Records ; Myocardial Ischemia ; Neck ; Perfusion ; Preoperative Care ; Prevalence ; Thoracic Surgery

An abnormal origin of the right coronary artery can be responsible for sudden death, myocardial ischemia, arrhythmia and syncope, and it may be associated with the accelerated development of atherosclerotic disease. The mechanisms of ischemia in the case of an abnormal origin of the right coronary artery are currently unclear and several surgical methods have been proposed to treat this malady. Multidetector Computed Tomography shows the course of the abnormal coronary artery, it helps to clarify the mechanism of the ischemia and it aids in choosing the best surgical approach. We report here on a case of acute myocardial infarction with an abnormal origin of the right coronary artery. Coronary artery bypass grafting was subsequently carried out to treat this patient.
Arrhythmias, Cardiac ; Coronary Artery Bypass ; Coronary Vessels ; Death, Sudden ; Ischemia ; Multidetector Computed Tomography ; Myocardial Infarction ; Myocardial Ischemia ; Syncope

BACKGROUND: Development of thoracic aortic aneurysms and aortic dissections (TAAD) is attributed to unbearable wall tension superimposed on defective aortic wall integrity and impaired aortic repair mechanisms. Central to this repair mechanisms are well-balanced and adequately functional cellular components of the aortic wall, including endothelial cells, smooth muscle cells (SMCs), inflammatory cells, and adventitial fibroblasts. Adventitial fibroblasts naturally produce aortic extracellular matrix (ECM), and, when aortic wall is injured, they can be transformed into SMCs, which in turn are involved in aortic remodeling. We postulated the hypothesis that adventitial fibroblasts in patients with TAAD may have defects in ECM production and SMC transformation. MATERIALS AND METHODS: Adventitial fibroblasts were procured from the adventitial layer of fresh aortic tissues of patients with TAAD (Group I) and of multi-organ donors (Group II), and 4-passage cell culture was performed prior to the experiment. To assess ECM production, cells were treated with TNF-alpha (50 pM) and the expression of MMP-2 / MMP-3 was analyzed using western blot technique. To assess SMC transformation capacity, cells were treated with TGF-beta1 and expression of SM alpha-actin, SM-MHC, Ki-67 and SM calponin was evaluated using western blot technique. Fibroblasts were then treated with TGF-beta1 (10 pM) for up to 10 days with TGF-beta1 supplementation every 2 days, and the proportion of transformed SMC in the cell line was measured using immunofluorescence assay for fibroblast surface antigen every 2 days. RESULTS: MMP-3 expression was significantly lower in group I than in group II. TGF-beta1-stimulated adventitial fibroblasts in group I expressed less SM alpha-actin, SM-MHC, and Ki-67 than in group II. SM-calponin expression was not different between the two groups. Presence of fibroblast was observed on immunofluorescence assay after more than 6 days of TGF-beta1 treatment in group I, while most fibroblasts were transformed to SMC within 4 days in group II. CONCLUSION: ECM production and SMC transformation are compromised in adventitial fibroblasts from patients with TAAD. This result suggests that functional restoration of adventitial fibroblasts could well be a novel approach for the prevention and treatment of TAAD.
Actins ; Aneurysm ; Antigens, Surface ; Aorta ; Aortic Aneurysm, Thoracic ; Azides ; Blotting, Western ; Calcium-Binding Proteins ; Cell Culture Techniques ; Cell Line ; Deoxyglucose ; Endothelial Cells ; Extracellular Matrix ; Fibroblasts ; Fluorescent Antibody Technique ; Humans ; Microfilament Proteins ; Myocytes, Smooth Muscle ; Tissue Donors ; Transforming Growth Factor beta1 ; Tumor Necrosis Factor-alpha

PURPOSE: Kienbock's disease can be treated with a vascularized bone graft to provide relief of wrist joint symptoms and prevent collapse of the lunate. We evaluated the functional outcome and subjective satisfaction in patients with Kienbock's disease treated with the 4+5 extensor compartmental vascularized bone graft. MATERIALS AND METHODS: We included 6 patients in the study. 3 males and 3 females with an average age of 37.5 years (range 21-49). Kienbock's disease was staged by Lichtman classifi cation based on plain radiography. Three patients were in stage II and three in stage IIIA. Cooney's wrist function score was used to evaluate changes in severity of pain, functional status, range of motion, and grip strength. We also assessed subjective patient satisfaction, carpal height ratio and bone union on the radiographs, and the occurence of complications. The mean follow-up period was 30 months. RESULTS: Four patients had excellent and two had good outcomes of wrist function. Three patients showed excellent subjective satisfaction, and three were good. All patients showed radiographic bone union and no further progression of lunate necrosis. The presurgical carpal height ratio was similar to the value at last follow-up, and there was no radiographic carpal bone collapse. For two cases of Lichtman stage IIIA, the slight degenerative arthritis at the lunocapitate joint observed preoperatively did not change. Skin necrosis and pin track infection were not observed. CONCLUSION: The 4+5 extensor compartmental vascularized bone graft is a reliable procedure for Lichtman stage II and IIIA patients with Kienbock's disease, as it achieved not only pain relief and improvement of range of motion but also maintenance of the intercarpal bone relationship on radiographs, with relatively few complications.
Bone Transplantation ; Carpal Bones ; Female ; Follow-Up Studies ; Hand Strength ; Humans ; Joints ; Male ; Necrosis ; Osteoarthritis ; Osteonecrosis ; Patient Satisfaction ; Range of Motion, Articular ; Skin ; Track and Field ; Transplants ; Wrist ; Wrist Joint

We report the case of a 16-year-old male patient who was involved in a traffic accident and transferred to the emergency department with mild chest pain. We initially did not find evidence of tracheal injury on computed tomography (CT). Within an hour after presentation, the patient developed severe dyspnea and newly developed subcutaneous emphysema and pneumoperitoneum were discovered. Abdominal CT showed no intra-abdominal injury. However, destruction of the right main bronchus was identified on coronal images of the initially performed CT scan. Emergency exploratory surgery was performed. The amputated right main bronchus was identified. End-to-end tracheobronchial anastomosis was performed, and the patient recovered without any complications.
Accidents, Traffic ; Adolescent ; Bronchi* ; Bronchial Diseases ; Chest Pain ; Dyspnea ; Emergencies ; Emergency Service, Hospital ; Humans ; Male ; Pneumoperitoneum* ; Rupture* ; Subcutaneous Emphysema ; Tomography, X-Ray Computed

BACKGROUND: Postoperative atrial fibrillation (AF) is a common complication after coronary artery bypass graft (CABG) surgery. Although postoperative AF is regarded as benign, transient and self-limited, it has been associated with increased morbidity, thromboembolic events and an increased duration and cost of hospitalization. MATERIAL AND METHOD: From January 1994 to December 2007, 190 patients that had isolated CABG surgery were divided into two groups. Group 1 (n=139) involved those who had postoperative atrial fibrillation, and group 2 (n=51) did not have any such events. We reviewed the medical records retrospectively including the incidence of postoperative AF, patient characteristics, surgery related factors and the outcome of the patients with postoperative AF. RESULT: The frequency of postoperative AF was 26.8%, the conversion rate to regular sinus rhythm before discharge was 82.4%; 82.4% of the AF developed within the first three postoperative days. Although the postoperative AF group was significantly older and had a prolonged postoperative Intensive care unit (ICU) stay, there was no difference in the aortic crossclamp time or duration of hospitalization. No spontaneous defibrillation at declamping, and longer duration of cardiopulmonary bypass were significantly related to the development of postoperative AF. However, postoperative treatment with a beta blocker was associated with a decreased incidence of postoperative AF. The multivariate analysis showed that age and ICU stay were significantly associated with the development of POAF. Spontaneous defibrillation and postoperative beta blocker treatment were significantly associated with a decreased frequency of POAF. CONCLUSION: AF after CABG surgery is a common complication associated with increased morbidity and a longer ICU stay. Therefore, various strategies aimed at reducing AF, and its complications, such as postoperative treatment with a beta blocker should be considered.
Arrhythmias, Cardiac ; Atrial Fibrillation ; Cardiopulmonary Bypass ; Coronary Artery Bypass ; Coronary Vessels ; Hospitalization ; Humans ; Incidence ; Intensive Care Units ; Medical Records ; Multivariate Analysis ; Retrospective Studies ; Transplants

Tuberculomas of the lung are rare in children and one of the more common lesions presenting a solitary pulmonary nodule roetgenorgraphically. We are reporting of a 3-year-old child with a tuberculoma in left upper lobe. The patient was initially diagnosed as the benign mediastinal tumor but in the end as tuberculoma in left uper lobe. Wedge resection including the mass was done. The tumor had brown smooth external surfaces on sectioning including the mass was done. The tumor had brown smooth external surfaces on sectioning show pale gray and soft cut surface was shown. In light electromicroscopy chronic granulomas with multinucleated giant cells and central caseous necrosis were observed which are the characteristics of tuberculoma. The postopeative course was smooth and uneventful and patient has been well for 4 months postoperatively.
Child* ; Child, Preschool* ; Giant Cells ; Granuloma ; Humans ; Lung ; Necrosis ; Solitary Pulmonary Nodule ; Tuberculoma*