Endovascular repair for thoracic aortic aneurysm is widespread and recently, the advent of new device-fenestrated stent graft enables endovascular repair for aortic aneurysm to be close or involved in the orifice of left subclavian artery. However, fenestrated stent graft is not available in Korea. We report herein a case in which endovascular repair for thoracic aortic aneurysm closed to the orifice of left subclavian artery using custom made fenestrated stent graft. The aneurysm was successfully repaired by a total endovascular approach without open surgical repair.
Aneurysm ; Aortic Aneurysm ; Aortic Aneurysm, Thoracic ; Korea ; Stents ; Subclavian Artery ; Transplants

Intramural esophageal dissection (IED) is an uncommon disorder characterized by separation of the mucosal and submucosal layers of the esophagus. Iatrogenic intervention is the most common cause of IED, but spontaneous dissection is rare. We report an unusually complicated case of spontaneous IED that involved the full-length of the esophagus that necessitated surgical intervention due to infection of the false lumen. In this case, chest computed tomography successfully established the diagnosis and aided in pre-operative evaluation with the use of various image post-processing techniques.
Esophageal Diseases/*radiography/*surgery ; Esophagoscopy/methods ; Esophagus/injuries/radiography ; Humans ; Male ; Middle Aged ; *Multidetector Computed Tomography ; Rare Diseases/*radiography/*surgery ; Rupture, Spontaneous/radiography/surgery

BACKGROUND: In hypertensive patients, the left ventricular hypertrophy(LVH) is very important as an independent risk factor along with developing complications. The present study was attempted to assess whether LVE assessed by echocardiography is related to diurnal variations of blood pressure in patiens with essential hypertension. METHOD: After 24hr ambulatory blood pressure monitoring, echocardiographic parameters were investigated in 30 healthy normotensive subjects and 17 patients with diurnal variation of blood pressure and 19 patients without diurnal variation respectively. RESULTS: Left ventricular mass index was higher in essential hypertensive patients than normotensive subjects. In patients without nocturnal fall in systolic blood pressure, left ventricular mass tended to be higher than in patients with a nocturnal fall without statistic significance. In the hypertensive patients with nocturnal fall, there was a correlationship between LVMI and changes in systolic blood pressure, but no correlation between left ventricular mass index and changes in diastolic blood pressure. In the hypertensive patients without nocturnal fall, changes of both systolic and diastolic pressure did not affect LVMI. CONCLUSION: It is suggested strongly that left ventricular hypertrophy may occur highly in the hypertensive patients without nocturnal(diurnal) variation in blood pressure and may be associated with changes in diastolic and systolic blood pressure. But in hypertensive patient with nocurnal fall, left ventricular hypertrophy may be associated with changes in systolic blood pressure.
Blood Pressure Monitoring, Ambulatory ; Blood Pressure* ; Echocardiography ; Humans ; Hypertension* ; Hypertrophy, Left Ventricular ; Risk Factors

Aorto-iliac artery aneurysms are very rare and the natural course of this disease is not well known. However, the risk of rupture is high and the mortality rate after rupture is extremely high. Preserving the pelvic circulation is important for the treatment of aorto-iliac artery aneurysms. We report here on a case of a patient suffering with aorto-iliac artery aneurysms, and these were treated by a hybrid endovascular operation that combined an open bypass of both iliac vessels with endovascular repair.
Aneurysm ; Aorta, Abdominal ; Arteries ; Chimera ; Humans ; Rupture ; Stents ; Stress, Psychological

BACKGROUND: Pulsatile pumps for extracorporeal circulation have been known to be better for tissue perfusion than non-pulsatile pumps but be detrimental to blood corpuscles. This study is intended to examine the risks and benefits of T-PLS(TM) through the comparison of clinical effects of T-PLS(TM) (pulsatile pump) and Bio-pump(TM) (non-pulsatile pump) used for coronary bypass surgery. MATERIAL AND METHOD: The comparison was made on 40 patients who had coronary bypass using T-PLS(TM) and Bio-pump(TM) (20 patients for each) from April 2003 to June 2005. All of the surgeries were operated on pump beating coronary artery bypass graft using cardiopulmonary extra-corporeal circulation. Risk factors before surgery and the condition during surgery and the results were compared. RESULT: There was no significant difference in age, gender ratio, and risk factors before surgery such as history of diabetes, hypertension, smoking, obstructive pulmonary disease, coronary infarction, and renal failure between the two groups. Surgery duration, hours of heart-lung machine operation, used shunt and grafted coronary branch were little different between the two groups. The two groups had a similar level of systolic arterial pressure, diastolic arterial pressure and mean arterial pressure, but pulse pressure was measured higher in the group with T-PLS(TM) (46+/-15 mmHg in T-PLS(TM) vs 35+/-13 mmHg in Bio-pump(TM), p<0.05). The T-PLS(TM)-operated patients tended to produce more urine volume during surgery, but the difference was not statistically significant (9.7+/-3.9 cc/min in T-PLS(TM) vs 8.9+/-3.6 cc/min in Bio-pump(TM), p=0.20). There was no significant difference in mean duration of respirator usage and 24-hour blood loss after surgery between the two groups. Plasma free Hb was measured lower in the group with T-PLS(TM) (24.5+/-21.7 mg/dL in T-PLS(TM) versus 46.8+/-23.0 mg/dL in Bio-pump(TM), p<0.05). There was no significant difference in coronary infarction, arrhythmia, renal failure and morbidity rate of cerebrovascular disease. There was a case of death after surgery (death rate of 5%) in the group tested with T-PLS(TM), but the death rate was not statistically significant. CONCLUSION: Coronary bypass was operated with T-PLS(TM) (Pulsatile flow pump) using a heart-lung machine. There was no unexpected event caused by mechanical error during surgery, and the clinical process of the surgery was the same as the surgery for which Bio-pump(TM) was used. In addition, T-PLS(TM) used surgery was found to be less detrimental to blood corpuscles than the pulsatile flow has been known to be. Authors of this study could confirm the safety of T-PLS(TM).
Arrhythmias, Cardiac ; Arterial Pressure ; Blood Cells ; Blood Pressure ; Cardiopulmonary Bypass ; Coronary Artery Bypass ; Extracorporeal Circulation ; Heart-Lung Machine ; Humans ; Hypertension ; Infarction ; Lung Diseases, Obstructive ; Mortality ; Perfusion* ; Plasma ; Pulsatile Flow ; Renal Insufficiency ; Risk Assessment ; Risk Factors ; Smoke ; Smoking ; Transplants ; Ventilators, Mechanical

A 50-year-old male visited the emergency room due to the cervical edema caused by a traffic accident. At the cervial CT, diagnosis was confirmed as extensive cervical subcutaneous emphysema secondary to tracheal laceration as a thyroid cartilage fracture. The patient showed loss of symptom after conservative treatment. Thyroid cartilage fracture is rare and tracheal laceration as a result of thyroid cartilage fracture has never been reported in the literatures. Thus we herein report this one case.
Accidents, Traffic ; Diagnosis ; Edema ; Emergency Service, Hospital ; Emphysema ; Humans ; Lacerations* ; Male ; Middle Aged ; Subcutaneous Emphysema ; Thyroid Cartilage* ; Thyroid Gland*

A right pleural mass was detected incidentally in a 52-year-old woman and chest computed tomography showed lobulated pleural mass. Thoracoscopic excision was performed. Histology showed solitary fibrous tumor with extensive cystic change. Solitary fibrous tumor with extensive cystic change is very rare and we treated this tumor successfully with video-assisted thoracic surgery.
Female ; Humans ; Middle Aged ; Pleural Neoplasms ; Pneumothorax ; Solitary Fibrous Tumor, Pleural* ; Solitary Fibrous Tumors* ; Thoracic Surgery, Video-Assisted ; Thorax

The esophageal lymphoma is a very rare feature among gastrointestinal lymphoma, and there was no surgical report in Korea. A 62-year-old male patient with submucosal tumor detected on routine esophagoscopy had resection of tumor including the esophageal mucosa, which was confirmed as esophageal lymphoma. As the severe leakage was detected on esophagogram on post-op 7th day, esophagectomy and esophagogastrostomy was followed. Though adjuvant chemotherapy was not performed, there were no evidence of recurrence for 1 year follow up. We experienced a patient with esophageal lymphoma and reported with brief review of literature.
Chemotherapy, Adjuvant ; Esophagectomy ; Esophagoscopy ; Follow-Up Studies ; Humans ; Korea ; Lymphoma* ; Male ; Middle Aged ; Mucous Membrane ; Recurrence

BACKGROUND: This study assessed the early results of endovascular repair of acute type B aortic dissection and the aortic wall changes following endovascular repair. MATERIAL AND METHOD: From July 2008 to May 2009, the preoperative and follow-up computed tomography (CT) scans of 5 patients with acute type B aortic dissection were evaluated, and these patients had underwent stent graft implantation within 13 days of the onset of dissection (mean: 7 days; range: 3~13). The whole lumen (WL), true lumen (TL) and false lumen (FL) diameters were measured at the proximal (p), middle (m) and distal (d) third of the descending thoracic aorta. RESULT: The study included four men and one woman with an average age of 59.4+/-20.1 years (age range: 37~79 years). The follow-up CT was performed and evaluated at 7 days and 6 months. The primary tear was completely sealed in all the patients. No paraplegia, paresis or peripheral ischemia occurred and none of the patients died. No endoleaks developed in any of the patients during follow-up. The TL diameters increased from 20.4 to 33.5 mm in the proximal third (p/3), from 19.5 to 29.8 mm in the middle third (m/3) and from 15.2 to 23.5 mm in the distal third (d/3). The FL diameters decreased from 18.7 to 0 mm in the p/3, from 15.4 to 0 mm in the m/3 and from 21.4 to 8.7 mm in the d/3. The changes in the TL diameter were statistically significant in the middle and distal aorta, and those changes in the FL diameter were not statistically significant. There was a decrease in the WL after repair, but this was not statistically significant. In three patients, the false lumen disappeared completely on follow-up CT at 6 months. Two patients had patent false lumens and no thrombosis. CONCLUSION: The early results showed that endovascular repair was effective in treating acute type B aortic dissection, and endovascular repair promoted positive aortic wall changes.
Aorta ; Aorta, Thoracic ; Endoleak ; Female ; Follow-Up Studies ; Humans ; Ischemia ; Male ; Paraplegia ; Paresis ; Stents ; Transplants

An aortoesophageal fistula (AEF) is an extremely rare, potentially fatal condition, and aortic surgery is usually performed together with extracorporeal circulation. However, this surgical method has a high rate of surgical complications and mortality. This report describes an AEF caused by tuberculous esophagitis that was treated successfully using a two-stage operation. A 52-yr-old man was admitted to the hospital with severe hematemesis and syncope. Based on the computed tomography and diagnostic endoscopic findings, he was diagnosed with an AEF and initially underwent thoracic endovascular aortic repair. Esophageal reconstruction was performed after controlling the mediastinal inflammation. The patient suffered postoperative anastomotic leakage, which was treated by an endoscopic procedure, and the patient was discharged without any further problems. The patient received 9 months of anti-tuberculosis treatment after he was diagnosed with histologically confirmed tuberculous esophagitis; subsequently, he was followed as an outpatient and has had no recurrence of the tuberculosis or any further issues.
Aortic Diseases/etiology/*surgery ; Eosinophilic Esophagitis/*complications/*surgery ; Esophageal Fistula/etiology/*surgery ; Esophagoscopy/*methods ; Humans ; Male ; Middle Aged ; Treatment Outcome ; Tuberculosis/*complications/surgery ; Vascular Surgical Procedures/methods