No abstract available.
Atrial Fibrillation* ; Mitral Valve*

A 76-years old man with a ruptured abdominal aortic aneurysm underwent an emergency abdominal aortic replacement with artificial graft. The patient developed abdominal compartment syndrome at the day of the operation and he received secondary decompression operation the next day. At 45 hours after the second operation the patient was returned to operation room to close the abdominal fascia, and sigmoid colon necrosis was found so we performed sigmoid colectomy with colostomy. After 22 days from the last operation, the abdominal wound was closed completely and the patient was discharged at the 42nd postoperative day with a colostomy state. We report here on this complex case together with a review of the recent articles.
Aged ; Aortic Aneurysm, Abdominal* ; Colectomy ; Colon* ; Colon, Sigmoid ; Colostomy ; Compartment Syndromes ; Decompression ; Emergencies ; Fascia ; Humans ; Intra-Abdominal Hypertension* ; Ischemia* ; Necrosis ; Transplants ; Wounds and Injuries

PURPOSE: The removal of varicose vein using a minimally invasive, transilluminated vein-extracting device (TriVex system) with cutaneous transillumination and tumescent anesthesia technique was newly developed and became popular in USA. This study was performed to evaluate its efficacy and safety. METHOD: The author performed TIPP (Transilluminated powered phlebectomy) procedure in 90 patients 118 legs from Feb 2001 to March 2002. The patients were 26 men and 64 women and their age ranged in from 19 to 65 (46.3 +/- 10.7) years. The preoperative evaluation was performed with Dupplex Doppler ulatrasound scan. All patients were admitted before the day of the surgery and discharged on the day or the next day of the surgery. The operation was performed under spinal or general anesthesia. The greater saphenous vein was ligated and in the saphenofemoral junction and stripped out to the knee with stripper under inguinal incision and then the varicose vein was removed with TriVex system. After the operation the patients were discharged at the day of the surgery and followed up at OPD for an average of 43 16 days. RESULT: The mean operative time was 61.6 +/- 25.7 min, the average numbers of small incision per leg were 3.4 +/- 1.3, and the average admission period was 1.6 +/- 0.8 days. These data were far different from those of conventional varicosectomy in previous periods. There were 2 cases of subcutaneous infection at medial calf and one case of remnant varicsoe vein which need reoperation with the TIPP. There was no permanent complication like paresthesia or skin changes. The pain and cosmetic outcome were so excellent that all patient had no limitation in daily life in a week after the procedures. CONCLUSION: The transilluminated powered phlebectomy in varicose vein is safe, efficacious and cosmetically satisfactory.
Anesthesia ; Anesthesia, General ; Female ; Humans ; Knee ; Leg ; Male ; Operative Time ; Paresthesia ; Reoperation ; Saphenous Vein ; Skin ; Transillumination ; Varicose Veins* ; Veins

Varicose vein is one of the ancient diseases, which has its evidence in Greek sculpture. Nowadays varicose vein has become a popular disease because of the media, so that many people want to treat their varicose vein and many medical doctors from a variety of fields seek a varicose clinic, accordingly. Since the introduction of the great saphenous vein stripping, the treatment of varicose vein has not been changed very much for about 100 years. Recently, however, many doctors in the outpatient varicose clinic prefer less invasive treatment and some innovative techniques that have become available recently. Endovascular treatment or transilluminated powered phlebectomy is one of them. Some dermatologists try to treat all kinds of varicose vein with sclerotherapy. But the long-term results of the treatment reveal that the gold standard of the treatment of typical varicose vein is a groin-to-knee inversion stripping of the great saphenous vein with stab avulsion of the varicose cluster. The application of the color Doppler duplex ultrasonogram to the leg vein has made it possible to evaluate the reflux of axial veins and perforator veins more thoroughly and less invasively. Therefore ultrasonography is the method of choice for the diagnosis of varicose vein preoperatively and postoperative follow-up studies for recurrent cases. The recurrence of varicose vein after treatment is mostly from the remnant reflux in the saphenofemoral junction and its tributary. Thus more meticulous treatment of the tributaries of saphenofemoral junction is needed.
Diagnosis ; Follow-Up Studies ; Humans ; Leg* ; Outpatients ; Recurrence ; Saphenous Vein ; Sclerotherapy ; Sculpture ; Ultrasonography ; Varicose Veins* ; Veins

Infection is one of the most feared complications in vascular surgery, especially when it involves the aortoiliac segment. There are many controversies in the treatment of aortoiliac graft infection with varying results reported. The author treated 2 cases of graft infection after an aortobiiliac bypass. These patients had an abdominal aortic aneurysm with aortoenteric fistula before or after the bypass surgery. Both developed graft infection within about 1 year after the first operation. One was treated with an extra-anatomic bypass after complete removal of the infected graft; and the other was treated with a re-aortobifemoral bypass with bilateral femoral vein graft. Both patients showed no recurrence of infection nor limb loss.
Aortic Aneurysm, Abdominal* ; Extremities ; Femoral Vein ; Fistula ; Humans ; Recurrence ; Transplants*

No abstract available.
Myasthenia Gravis* ; Thymectomy*

BACKGROUND: Aortic diseases tend to involve the entire aorta. Hence, there is the constant possibility of the need for a secondary operation at the remnant aorta. This study analyzed our cases of secondary aortic surgery in order to determine its characteristics and problems. MATERIAL AND METHOD: Between April 2003 and June 2007, 12 patients (6 male and 6 female) underwent thoracoabdominal aortic replacement as a secondary aortic operation. Their clinical courses were analyzed. Four of the patients underwent lower thoracobadominal aortic replacement under the normothermic femorofemoral bypass, and the others underwent an entire thoracobdominal aortic replacement under deep hypothermic circulatory arrest. RESULT: There was no death or paraplegia. As local complications, there were 3 cases of wound infection and 2 cases of an immediate reoperation caused by bleeding and one case of delayed wound revision for a contaminated perigraft hematoma. As a systemic complication, there was one case of renal insufficiency, which required hemodialysis and one case of respiratory insufficiency that needed prolonged ventilator care. The mean admission period was 30+/-21 days. All the patients were followed up for 626+/-542 days without reoperation or other problems. CONCLUSION: Using properly selected patients and a careful approach, thoracoabdominal aortic replacement can be performed safely as a secondary aortic surgery.
Aorta ; Aortic Diseases ; Circulatory Arrest, Deep Hypothermia Induced ; Hematoma ; Hemorrhage ; Humans ; Male ; Paraplegia ; Renal Dialysis ; Renal Insufficiency ; Reoperation ; Respiratory Insufficiency ; Ventilators, Mechanical ; Wound Infection

BACKGROUND: Pneumonectomy for inflammatory lung disease has been of major concern because of its associated morbidity and mortality, particularly with respect to pleuropneumonectomy. The purpose of this study is to evaluate the surgical outcomes, and identify the risk factors contributing to postoperative complications in patients undergoing pleuropneumonectomy. MATERIAL AND METHOD: Ninety-eight patients underwent pneumonectomy for benign inflammatory lung disease were retrospectively analyzed. Pleuropneumonectomy (Group A) was done in 48 patients and standard pneumonectomy (Group B) was done in 50 patients. Clinical characteristics, postoperative complications were examined and compared between 2 groups. In pleuropneumonectomy group, postoperative risk factors affecting morbidity were evaluated. RESULT: There was one in-hospital death. Twenty-three major postoperative complications occurred in 21 patients (21.4%). The common complications were empyema and bronchopleural fistula (BPF) in 8 (8.4%), re-exploration due to bleeding in 8. At least one postoperative complication occurred in 14 of 48 patients from Group A (29.2%) and in 7 of 50 patients from Group B (14%). In Group A, empyema and BPF encountered in 6 and re-exploration for bleeding in 6 were the most common complication. In univariate analysis, right pneumonectomy, completion pneumonectomy, large amount of blood loss (>1,000 mL), and intrapleural spillage were risk factors contributing to postoperative complications in Group A. In multivariate analysis, intrapleural contamination during operation was a risk factor of postoperative complication. CONCLUSION: The morbidity and mortality rates of pneumonectomy for chronic inflammatory lung disease are acceptably. However, we confirm that pleuropneumonectomy is a real technical challenge and a high-risk procedure and technically demanding. Meticulous surgical techniques are very important in preventing serious and potentially lethal complications.
Empyema ; Fistula ; Hemorrhage ; Humans ; Lung Diseases* ; Lung* ; Mortality ; Multivariate Analysis ; Pneumonectomy ; Postoperative Complications ; Retrospective Studies ; Risk Factors

BACKGROUND: Replacing the ascending aorta is a standard surgical option for treating acute type A aortic dissection. But replacing the aortic arch has recently been reported as an acceptable procedure for this disease. We compared the effects of aortic arch replacement for treating acute type A aortic dissection with the effects of ascending aortic replacement. MATERIAL AND METHOD: From 2002 to 2006, 25 patients underwent surgical treatment for acute type A aortic dissection. 12 patients underwent ascending aortic replacement and 13 patients underwent aortic arch replacement. Among the aortic arch group, an additional distal stent-graft was inserted during the operation in 5 patients. 19 patients (11 arch replaced patients and 8 ascending aortic replaced patients) were followed up at the out patient clinic for an average of 756+/-373 days. All the patients underwent CT scanning and we analyzed their distal aortic segments. RESULT: 4 patients who underwent ascending aortic replacement died, so the overall mortality rate was 16%. Among the 11 long term followed-up arch replacement patients, 2 patients (18.1%) developed distal aortic dilatation and one of them underwent thoracoabdominal aortic replacement later on. However, among the 8 the ascending aortic replaced patients, 5 patients (62.5%) developed distal aortic dilatation. CONCLUSION: Aortic arch replacement is one of the safe options for treating acute type A aortic dissection. Aortic arch replacement for treating acute type A aortic dissection could contribute to a reduced distal aortic dilatation rate and fewer secondary aortic procedures.
Aorta* ; Aorta, Thoracic* ; Dilatation ; Humans ; Mortality ; Tomography, X-Ray Computed

BACKGROUND: The thoracic and thoracoabdominal aortic surgery is a complicated procedure that has various method of approach and protection. The authors have performed several methods to treat these diseases. Therefore, we attempt to analyze their results and risks. MATERIAL AND METHOD: From June of 1992 to August of 2001, we performed 26 cases of thoracic aortic surgery and 10 cases of thoracoabdominal aortic surgery. There were 17 aortic dissections, 17 aortic aneurysms, one coarctation of aorta and one traumatic aortic aneurysm. The thoracic aortic replacement was performed under a femorofemoral bypass, an LA to femoral bypass, or a deep hypothermic circulatory arrest. The thoracoabdominal aortic replacement was performed under a femorofemoral bypass or a pump assisted rapid infusion. RESULT: There were 7 renal failures, 11 hepatopathies, 7 cerebral vascular accidents, 2 heart failures, 5 respiratory insufficiencies, and 2 sepsis in postoperative period. There were 9 hospital mortalities which were from 2 bleedings, 2 heart failures, 2 renal failures, a sepsis, a respiratory failure, and a cerebral infarction. There were 3 late deaths which were from ruptured distal anastomosis, cerebral infarction, and pneumonia. CONCLUSION: Deep hypothermic circulatory arrest was not good supportive methods for thoracic aortic replacement. Total thoracoabdominal aortic replacement was a high risk operation.
Aorta, Thoracic ; Aortic Aneurysm ; Aortic Aneurysm, Thoracic ; Aortic Coarctation ; Cerebral Infarction ; Circulatory Arrest, Deep Hypothermia Induced ; Heart ; Hospital Mortality ; Pneumonia ; Postoperative Period ; Renal Insufficiency ; Respiratory Insufficiency ; Sepsis