BACKGROUND: High thoracic epidural anesthesia allows awake coronary artery bypass grafting, avoiding the drawbacks of mechanical ventilation and general anesthesia. Materian and Method: From April, 2005 to September, 2005, 12 patients were underwent awake coronary artery bypass grafting using high thoracic epidural anesthesia. There were 1 female and 11 male patients, with a mean age of 66+/-6 years. Off pump coronary artery bypass grafting was performed through a median sternotomy using arterial grafts. RESULT: There were no mortality. Pneumothorax was developed during surgery in 8 patients. Five patients required secondary intubation because of pneumothorax (n=3), bowel herniation (n=1), and hemothorax after chest tube insertion (n=1). Postoperative coronary angiography was performed before discharge in all patients and all the grafts were patent. CONCLUSION: Our intial experience demonstrated the feasibility of awake off-pump coronary artery bypass grafting. Further study is required to define the indications, advantages and limitations of this strategy.
Anesthesia ; Anesthesia, Epidural ; Anesthesia, General ; Chest Tubes ; Coronary Angiography ; Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump ; Female ; Hemothorax ; Humans ; Intubation ; Male ; Mortality ; Pneumothorax ; Respiration, Artificial ; Sternotomy ; Transplants

BACKGROUND: High thoracic epidural anesthesia allows awake coronary artery bypass grafting, avoiding the drawbacks of mechanical ventilation and general anesthesia. Materian and Method: From April, 2005 to September, 2005, 12 patients were underwent awake coronary artery bypass grafting using high thoracic epidural anesthesia. There were 1 female and 11 male patients, with a mean age of 66+/-6 years. Off pump coronary artery bypass grafting was performed through a median sternotomy using arterial grafts. RESULT: There were no mortality. Pneumothorax was developed during surgery in 8 patients. Five patients required secondary intubation because of pneumothorax (n=3), bowel herniation (n=1), and hemothorax after chest tube insertion (n=1). Postoperative coronary angiography was performed before discharge in all patients and all the grafts were patent. CONCLUSION: Our intial experience demonstrated the feasibility of awake off-pump coronary artery bypass grafting. Further study is required to define the indications, advantages and limitations of this strategy.
Anesthesia ; Anesthesia, Epidural ; Anesthesia, General ; Chest Tubes ; Coronary Angiography ; Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump ; Female ; Hemothorax ; Humans ; Intubation ; Male ; Mortality ; Pneumothorax ; Respiration, Artificial ; Sternotomy ; Transplants

PURPOSE: Sleep disorder is common in childhood and adolescence with prevalence of 27-62%, and the patients could have trouble with their daily life due to fatigue and headache; and it can also cause developmental disability, learning disorder, anxiety disorder, and depressive disorder. We studied the prevalence of anxiety and depressive disorder in childhood and adolescence with sleep disorder. METHODS: We studied 34 cases of patients under twenty-year-old who took a sleep polysomnography test at Sleep Center of Keimyung University Dongsan Medical Center and who could answer sleep survey questionnaires; and we used testing methods of Questionnaire for insomnia, Epworth sleepness scale, Hospital Anxiety Depression Scale, and Back Depression Inventory. We studied sleep disorder as two categories of sleep apnea and other sleep disorders and also the relationships of sleep and anxiety and depressive disorder with chi-square test. RESULTS: 29.4% of sleep disorder patients had anxiety disorder, and 47.1% depressive disorder. Considering the two categories of sleep disorder, anxiety disorder was significantly higher(P<0.005) in sleep apnea group with 43.5% than in other sleep disorder group with 9.1%. Depressive disorder was also significantly higher(P<0.05) in sleep apnea group with 65.6% than in other sleep disorder group with 36.4%. CONCLUSION: The patients with sleep disorder also had a tendency of having mood disorder, with prevalence of 29.4% of anxiety disorder and 47.1% of depressive disorder; especially in the group of sleep apnea, mood disorders was significantly higher than other sleep disorder group, which means more aggressive diagnosis and treatment are needed for the combined condition of sleep and mood disorder.
Adolescent ; Anxiety ; Anxiety Disorders ; Depression ; Depressive Disorder ; Developmental Disabilities ; Fatigue ; Humans ; Learning Disorders ; Mood Disorders ; Polysomnography ; Prevalence ; Surveys and Questionnaires ; Sleep Apnea Syndromes ; Sleep Wake Disorders ; Sleep Initiation and Maintenance Disorders

A 50 year old male patient was admitted due to fever and left upper-quadrant abdominal pain. He had a history of previous treatment for pulmonary TB and splenectomy due to aplastic anemia. A large peritoneal abscess with connection to a chronic left side tuberculous empyema thoracis was diagnosed on admission. Chest CT also revealed a soft tissue lesion on the left anterior chest wall. Staged drainage of the peritoneal lesion followed by left side pleuropneumonectomy with chest wall resection was performed. The pathologic studies showed a high grade sarcoma of the chest wall.
Abdominal Pain ; Abscess ; Anemia, Aplastic ; Drainage ; Empyema ; Empyema, Tuberculous ; Fever ; Humans ; Male ; Sarcoma ; Splenectomy ; Thoracic Wall ; Thorax

'Takotsubo cardiomyopathy' or 'stress-induced cardiomyopathy' is a newly described clinical entity that's characterized by transient left ventricular apical ballooning and left ventricular apical dyskinesis in the absence of any angiographic feature of significant coronary artery disease. The cause of takotsubo cardiomyopathy is unclear, but catecholamines probably play a role in the genesis of takotsubo cardiomyopathy. We report here on two cases of takotsubo cardiomyopathy that occurred during ICU care.
Catecholamines ; Coronary Artery Disease ; Takotsubo Cardiomyopathy

BACKGROUND: Bulla is an air-filled space within the lung parenchyma resulting from deterioration of the alveolar tissue. Molecular mechanism of the formation of the bulla is not well described. Fibroblast growth factor(FGF)-7, bone morphogenetic protein(BMP) receptor, and transforming growth factor(TGF)-beta receptor are known to have a stimulatory or inhibitory role in the lung formation. We investigated to see if these growth factor or cytokine receptors are involved in the bulla formation by immunohistochemical staining of bullous lung tissues from patients with primary spontaneous pneumothorax. MATERIAL AND METHOD: Bullous lung tissues were obtained from 31 patients with primary spontaneous pneumothorax, including 30 males and 1 female from 15 to 39 years old. The bullous tissues were obtained by video-thoracoscopic surgery and/or mini-thoracotomy and fixed in formalin. Blocks of the specimens were embedded with paraffin and cut into 5~6 micrometer thick slices. The sections were deparaffinized and hydrated and then incubated with primary antibodies against FGF-7, BMP-RII, or TGF-RII. RESULT: Of the 31 patients, 24 were TGF-RII positive including 18 strong and 6 weak positives. Observation with high magnification showed that strong immunostaining was detected in the boundary region between bullous and normal lung tissues. In contrast, all of the sections were negative with FGF-7 or BMP-RII antibodies. CONCLUSION: These results suggest that overexpression of TGF-beta RII may be involved in the formation of bulla, although further molecular studies are needed to find out more detailed molecular mechanisms.
Adult ; Antibodies ; Female ; Fibroblasts ; Formaldehyde ; Humans ; Lung ; Male ; Paraffin ; Pneumothorax* ; Receptors, Cytokine ; Transforming Growth Factor beta

Coronary artery spasm plays an important role for evoking myocardial ischemia and infarction as well as sudden cardiac death in patients with variant angina. The coronary anatomy in patients with variant angina has been defined both at autopsy and during coronary arteriography. Severe porximal coronary atherosclerosis of at least one major vessel occurs in 3/4 of patients and the remainder have normal coronary arteries. Coronary angiography is a relatively insensitive diagnostic tool especially in the early stages of coronary artery disease. Due to arterial remodelling, angiographic luminogram may show little or no narrowing even though a large part of the total vessel area is occupied by plaque. Intravascular ultrasonography(IVUS) enables accurate determination of vessel dimensions and wall characteristics and is more sensitive in delineating early intimal changes than angiography. We experienced 2 cases that IVUS showed focal or diffuse atherosclerosis in spastic segments of the coronary arteries, even though they appeared angiographically normal.
Angiography ; Atherosclerosis ; Autopsy ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels* ; Death, Sudden, Cardiac ; Humans ; Infarction ; Muscle Spasticity* ; Myocardial Ischemia ; Spasm

Benign gastrobronchial fistula (GBF) after Ivor Lewis operation is a very rare and serious complication. We describe a patient with GBF who was successfully managed on the single-stage repair, 15 months after the Ivor Lewis operation. After the division of the GBF, the bronchial and gastric defects were closed directly. The omental flap and the pedicled 5th. intercostal muscle flap were interposed between the closed defects. The literature of this subject is reviewed and discussed.
Esophageal Neoplasms ; Esophagectomy* ; Fistula* ; Gastric Fistula ; Humans ; Intercostal Muscles

Neonatal tension pneumopericardium is a serious disease that requires prompt diagnosis and treatment. If untreated, it may lead to cardiac tamponade and death. We report a case of neonatal tension pneumopericardium which was succesfully treated by open pericardial window operation with review of literatures.
Cardiac Tamponade ; Diagnosis ; Humans ; Infant, Newborn ; Mediastinal Emphysema ; Pneumopericardium*

A 32-yr-old male patient with recurrent pneumothorax associated with bronchial atresia of the subsegmental branch of the posterior segmental bronchus of the right upper lobe was successfully treated with right upper lobectomy. Before surgery, the bronchial atresia with pneumothorax was suspected on the chest radiograph and CT scans, which showed the findings of bronchocele with localized hyperinflation of the right upper lobe. The examination of surgical specimen from the resected right upper lobe suggests that the cause of the recurrent pneumothorax was the rupture of the subpleural bullae in the hyperinflated lung segment distal to the atretic bronchus.
Adult ; Bronchi/*abnormalities/pathology ; Bronchial Diseases/*diagnosis ; Human ; Male ; Pneumothorax/*diagnosis ; Respiratory System Abnormalities/*pathology ; Tomography, X-Ray Computed