Anterior papillary muscle rupture caused by occlusion of the first diagonal branch is reported to be very rare. A 66-year-old woman was transferred to our hospital for acute myocardial infarction and cardiogenic shock. Echocardiography and angiography revealed severe mitral regurgitation caused by rupture of the anterior papillary muscle and the complete occlusion of the first diagonal branch. In an emergent setting, she had been successfully treated by mitral valve replacement and coronary artery bypass grafting. She was discharged on postoperative twelfth day without any event.
Aged ; Angiography ; Coronary Artery Bypass ; Echocardiography ; Female ; Humans ; Mitral Valve ; Mitral Valve Insufficiency ; Myocardial Infarction ; Papillary Muscles* ; Rupture* ; Shock, Cardiogenic

BACKGROUND: Mediastinal neurogenic tumors are generally benign lesions and they are ideal candidates for performing resection via video-assisted thoracoscopic surgery (VATS). However, benign neurogenic tumors at the thoracic apex present technical problems for the surgeon because of the limited exposure of the neurovascular structures, and the optimal way to surgically access these tumors is still a matter of debate. This study aims to clarify the feasibility and safety of the VATS approach for performing surgical resection of benign apical neurogenic tumors (ANT). MATERIAL AND METHOD: From January 1996 to September 2008, 31 patients with benign ANT (15 males/16 females, mean age: 45 years, range: 8~73), were operated on by various surgical methods: 14 VATS, 10 lateral thoracotomies, 6 cervical or cervicothoracic incisions and 1 median sternotomy. 3 patients had associated von Recklinhausen's disease. The perioperative variables and complications were retrospectively reviewed according to the surgical approaches, and the surgical results of VATS were compared with those of the other invasive surgeries. RESULT: In the VATS group, the histologic diagnosis was schwannoma in 9 cases, neurofibroma in 4 cases and ganglioneuroma in 1 case, and the median tumor size was 4.3 cm (range: 1.2~7.0 cm). The operation time, amount of chest tube drainage and the postoperative stay in the VATS group were significantly less than that in the other invasive surgical group (p<0.05). No conversion thoracotomy was required. There were 2 cases of Hornor's syndrome and 2 brachial plexus neuropathies in the VATS group; there was 1 case of Honor's syndrome, 1 brachial plexus neuropathy, 1 vocal cord palsy and 2 non-neurologic complications in the invasive surgical group, and all the complications developed postoperatively. The operative method was an independent predictor for postoperative neuropathies in the VATS group (that is, non-enucleation of the tumor) (p=0.029). CONCLUSION: The VATS approach for treating benign ANT is a less invasive, safe and feasible method. Enucleation of the tumor during the VATS procedure may be an important technique to decrease the postoperative neurological complications.
Ants ; Brachial Plexus Neuropathies ; Chest Tubes ; Drainage ; Female ; Ganglioneuroma ; Humans ; Mediastinum ; Neurilemmoma ; Neurofibroma ; Retrospective Studies ; Sternotomy ; Thoracic Surgery, Video-Assisted ; Thoracoscopy ; Thoracotomy ; Vocal Cord Paralysis

BACKGROUND: Complicated pleural space occupying lesions (SOL) have been treated by thoracentesis, closed thoracotomy drainage (CTD) or surgical intervention with using a video thoracosocpe or open thoracotomy depending on the extent of the disease. With the development of video assisted thoracoscopic surgery (VATS), VATS pleural adhesiolysis and decortication have revealed good results as compared to those for open thorcotomy. To assess the effectiveness of VATS pleural adhesiolysis and decortication, we retrospectively analyzed the medical record and radiologic findings of the patients with complicated pleural SOL and who were treated by this surgery. MATERIAL AND METHOD: From May 1996 to April 2006, 64 patients (mean age: 41.8 years) with complicated pleural SOL underwent 65 VATS. To analyze the surgical outcome, we classified the postoperative findings on the simple chest X-rays into 4 classes as Class I: no or minimal pleural lesion, Class II: blunting of the cardiophrenic angle and mild pleural thickening, Class III: an elevated diaphgram or persistent lung collapse and Class IV: complicated or recurrent effusion. RESULT: Before VATS, the patients underwent the diagnostic or therapeutic procedures: single or repeat diagnostic tapping for 41, thoracoscotomy drainage for 11, pigtail catheter drainage for 10 and intrapleural fibrinolytics for 10. The mean duration between the onset of symptom and surgery was 18.4 days. There was neither mortality nor severe complications. The surgical outcomes were class 1 for 28, class 2 for 13, class 3 for 19 and class 4 for 5. There were statistically significant differences between the symptom duration and the classes, and between the operation time and the classes. CONCLUSION: VATS pleural adhesiolysis and decortication are effective, safe treatments for managing complicated pleural SOL, and an earlier operation is needed for obtaining a better surgical outcome.
Catheters ; Drainage ; Humans ; Medical Records ; Pleural Effusion ; Polymethyl Methacrylate ; Pulmonary Atelectasis ; Retrospective Studies ; Thoracic Surgery, Video-Assisted ; Thoracotomy ; Thorax

Endoscopic removal is acceptable for the treatment of endotracheal/endobronchial mass, because it is less invasive in high-risk patients and a conservative procedure for benign tumors. Two benign tumors in the lumen of the trachea (pure lipoma) and in the intermediate bronchus (hamartoma) were completely eradicated by our procedures, which involved diathermic snaring and residual mass removal with biopsy forceps under the guidance of fiberoptic bronchoscopy. No tumor recurrence was evident after extended follow-up (6 years for endotracheal lipoma and 2.5 years for endobroncheal hamartoma). Our method is safe and less invasive for the patient and provides the surgeon with better view during procedure.
Biopsy ; Bronchi ; Bronchial Neoplasms ; Bronchoscopy ; Follow-Up Studies ; Humans ; Lipoma ; Recurrence ; SNARE Proteins ; Surgical Instruments ; Trachea ; Tracheal Neoplasms

BACKGROUND: The treatment of tracheal stenosis includes less invasive bronchoscopic intervention and more invasive segmental resection & anastomosis. Depending on the patient's clinical features, sometimes all these methods are inappropriate. Silicone T-tube stenting has recently been used as an alternative, safe management of tracheal stenosis. We studied the short term and Intermediate term results of using T-tubes in patients with tracheal stenosis, and this tracheal stenosis was caused by various underlying diseases. MATERIAL AND METHOD: We retrospectively reviewed 57 patients with tracheal stenosis and who were treated with T-tubes between Jan 1997 and Apr 2007. Based on the patient's medical records and the imaging studies, we evaluated the clinical findings and status of T-tube removal. RESULT: There was no T-tube related morbidity or mortality in this series. On follow-up, one patient underwent sleeve resection and end-to-end anastomosis. The T-tube could be successfully removed from 13 patients (13/57, 22.8%) without additional interventions. For another four patients, a T-tube was again inserted after removal of the first T-tube due to tracheomalacia or recurrent stenosis. Four patients died of underlying disease and cancer. The patients' gender and previous tracheostomy significantly affected T-tube removal. By contrast, multiple logistic regression analysis identified gender as a predictor of successfully removing a T-tube. Gender (p=0.033) and previous tracheostomy (p=0.036) were the two factors for success or failure of T-tube removal. CONCLUSION: A T-tube provided reliable patency of a stenotic airway that was caused by any etiology. We have proven that using a T-tube is safe and effective therapy for patients with tracheal stenosis for the short term or the intermediate term.
Constriction, Pathologic ; Follow-Up Studies ; Humans ; Logistic Models ; Medical Records ; Retrospective Studies ; Silicones ; Stents ; Tracheal Stenosis ; Tracheomalacia ; Tracheostomy

BACKGROUND: The pulmonary nodules (PN), when indicated, need thoracoscopic resection, especially in cases of non-diagnostic or technically infeasible PCNA (percutaneous needle aspiration). In the difficult situations of small or deeply seated PN, several techniques facilitating thoracoscopy have been used for detecting them. Our new protocol for managing PN was developed and prospectively reviewed. MATERIAL AND METHOD: In the procedure of PCNA, we firstly placed the tip of the needle in the center of, or just in contact with PN under CT guidance, and loaded one or two segments of platinum radiomarker inside the needle after removing the stylet. Then, we forced the radiomarker to move to the tip of the needle by pushing the stylet. Finally, if the tip of the needle was not within PN, it was reoriented to the their center to obtain the sample for PCNA. RESULT: Between May 1999 and May 2000, radiomarkers were successfully placed in 28 PN of 26 patients, with the exception of one. In 18 (85%) of 21 nodules needing throacoscopy, intraoperative fluoroscopy was used to detect them or guide stapling resection during thoracoscopy. CONCLUSION: The advantages of this technique are that there is that there is no need for further localization for thoracoscopy even in cases of unsuccessful PCNA, and it was more effective in respect to both cost and time. Therefore, this strategy for PN expecting thoracoscopy will be helpful to patients and medical staff alike.
Fluoroscopy ; Humans ; Medical Staff ; Needles ; Platinum ; Proliferating Cell Nuclear Antigen ; Prospective Studies ; Thoracoscopy

A 68-yr-old man complaining of sudden, postprandial chest pain visited the emergency room. His symptom had been aggravated during the preceding two days. Upper gastrointestinal contrast study with gastrographin showed leakage of dye from the epiphrenic diverticulum in the lower third of the esophagus. The primary repair was urgently carried out. Upper gastrointestinal contrast study 14 days after operation revealed an esophageal leakage which was small and confined. The patient was managed with conservative treatments such as intravenous hyperali-mentation and broad-spectrum antibiotics. Forty-two days after the operation, a gastrographin swallow study showed the absence of leaks. This is the first report-ed case of a perforated epiphrenic esophageal diverticulum repaired by delayed primary repair in Korea.
Aged ; Diverticulum, Esophageal/complications/*diagnosis/*surgery ; Esophageal Perforation/*diagnosis/etiology/*surgery ; Esophagectomy/*methods ; Humans ; Male ; Research Support, Non-U.S. Gov't ; Time Factors ; Treatment Outcome

Background: Data on the status of long-term follow-up (LTFU) care for childhood cancer survivors (CCSs) in Korea is lacking. This study was conducted to evaluate the current status of LTFU care for CCSs and relevant physicians’ perspectives. Methods: A nationwide online survey of pediatric hematologists/oncologists in the Republic of Korea was undertaken. Results: Overall, 47 of the 74 board-certified Korean pediatric hematologists/oncologists currently providing pediatric hematology/oncology care participated in the survey (response rate = 63.5%). Forty-five of the 47 respondents provided LTFU care for CCSs five years after the completion of primary cancer treatment. However, some of the 45 respondents provided LTFU care only for CCS with late complications or CCSs who requested LTFU care. Twenty of the 45 respondents oversaw LTFU care for adult CCSs, although pediatric hematologists/ oncologists experienced more difficulties managing adult CCSs. Many pediatric hematologists/oncologists did not perform the necessary screening test, although CCSs had risk factors for late complications, mostly because of insurance coverage issues and the lack of Korean LTFU guidelines. Regarding a desirable LTFU care system for CCSs in Korea, 27 of the 46 respondents (58.7%) answered that it is desirable to establish a multidisciplinary CCSs care system in which pediatric hematologists/oncologists and adult physicians cooperate. Conclusion The LTFU care system for CCS is underdeveloped in the Republic of Korea. It is urgent to establish an LTFU care system to meet the growing needs of Korean CCSs, which should include Korean CCSs care guidelines, provider education plans, the establishment of multidisciplinary care systems, and a supportive national healthcare policy.

BACKGROUND/AIMS: The delay between the onset of myocardial infarction symptoms and primary percutaneous coronary intervention (PCI) is an important prognostic factor in patients with ST-segment elevation acute myocardial infarction (STEMI). We reviewed this delay in patients with STEMI and analyzed clinical outcomes. METHODS: The study enrolled 3,399 patients (age, 61.4 +/- 12.8 years; 25.6% women) with STEMI who underwent primary PCI within 12 hours of symptom onset between October 2005 and February 2008 from the Korea Acute Myocardial Infarction Registry. The patients were divided into two groups according to the symptom-to-balloon time: group I (< or = 3 hours, n = 955) and group II (> 3 hours, n = 2444). The in-hospital mortality rates and 1-year mortality and major adverse cardiac event (MACE) rates were compared between the two groups. RESULTS: The mean time interval from the onset of symptoms to arrival at the emergency room (ER) was 188.0 +/- 133.6 minutes (median, 152 minutes). The mean time interval from the ER to reperfusion (door-to-balloon time) was 97.8 +/- 67.9 minutes (median, 80 minutes). The mean time interval from the onset of symptoms to reperfusion (symptom-to-balloon time) was 285.8 +/- 146.2 minutes (median 250 minutes). The in-hospital mortality rate was significantly lower in group I as compared with group II (3.6% versus 5.2%, p = 0.044). The 1-year mortality rate was also significantly lower in group I (4.7% versus 7.2%, p = 0.012), while the 1-year MACE rate was not significantly different between groups (17.9% versus 20.4%, p = 0.179). CONCLUSIONS: This study demonstrates that there is a significant pre-hospital time delay in patients with STEMI in Korea and this time delay is associated with increased 1-year mortality.
Angioplasty ; Emergencies ; Hospital Mortality ; Humans ; Korea ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Reperfusion ; Time Factors

This retrospective study investigated the clinical characteristics and outcomes of second malignant neoplasms (SMNs) in survivors of childhood cancer from multiple institutions in Korea. A total of 102 patients from 11 institutions who developed SMN after childhood cancer treatment between 1998 and 2011 were retrospectively enrolled. The most common primary malignant neoplasms (PMNs) were central nervous system (CNS) tumors (n = 17), followed by acute lymphoblastic leukemia (n = 16), non-Hodgkin lymphoma (n = 13), and osteosarcoma (n = 12). The most common SMNs were therapy-related myeloid neoplasms (t-MNs; acute myeloid leukemia [AML], 29 cases; myelodysplastic syndrome [MDS], 12 cases), followed by thyroid carcinomas (n = 15) and CNS tumors (n = 10). The median latency period was 4.9 years (range, 0.5-18.5 years). Among 45 patients with solid tumors defined as an SMN, 15 (33%) developed the lesion in a field previously subjected to radiation. The 5-year overall survival (OS) rate of patients with an SMN was 45% with a median follow-up time of 8.6 years. Patients with AML, MDS, and CNS tumors exhibited the poorest outcomes with 5-year OS rates of 18%, 33%, and 32%, respectively, whereas those with second osteosarcoma showed comparable outcomes (64%) to patients with primary counterpart and those with second thyroid carcinoma had a 100% OS rate. Further therapeutic efforts are recommended to improve the survival outcomes in patients with SMNs, especially in cases with t-MNs and CNS tumors.
Adolescent ; Antineoplastic Agents/therapeutic use ; Central Nervous System Neoplasms/diagnosis/drug therapy/radiotherapy ; Child ; Child, Preschool ; Disease-Free Survival ; Hospitals ; Humans ; Infant ; Leukemia, Myeloid, Acute/diagnosis/epidemiology/mortality/therapy ; Myelodysplastic Syndromes/diagnosis/epidemiology/mortality/therapy ; Neoplasms, Second Primary/*diagnosis/epidemiology/mortality/therapy ; Osteosarcoma/diagnosis/epidemiology ; Retrospective Studies ; Stem Cell Transplantation ; Survival Rate ; Transplantation, Autologous ; Young Adult