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

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*

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

BACKGROUND: Elevated plasma total homocysteine is a risk factor for cardiovascular diseases. The authors investigated the parameters such as habit, body index, cardiovascular risk factors, nutrition relative to the plasma homocysteine concentration. METHODS: The subjects were 6,223 adults (3,377 males, 2,846 females) who were over 18 years of age and visited a health promotion center of a university hospital from March 2002 to January 2003. We assessed the relationship between the homocysteine level and the following parameters: sex, age, weight, body mass index, waist circumference, smoking, alcohol, systolic and diastolic blood pressure (BP), triglyceride, total cholesterol, high density lipoprotein cholesterol, creatinine, albumin and hemoglobin. RESULTS: The homocysteine levels was 10.5+/-5.9micromol/L in males, 7.3+/-2.6micromol/L in female. Thus it was significantly higher in males (P <0.001). After adjusting for variables that affect the homocysteine, the subjects over the age of 54 showed 10.7micromol/L (9.5, 12.0, 95% Confidence Interval), which was significantly (P=0.002) higher than the below the age of 38 groups 8.5micromol/L (7.8, 9.2, 95% CI). Non-smoking group showed 8.6micromol/L (8.4, 8.9, 95% CI), while over 28 pack-year group showed 9.6micromol/ L (9.2, 10.0, 95% CI), which was significantly (P <0.000) higher than the non-smoking groups. For the group with systolic BP over 132mmHg, it was 9.3micromol/L (8.8, 9.5, 95% CI). This was significantly (P=0.004) higher than 8.7micromol/L (8.4, 9.0, 95% CI) in the group whose systolic BP was less than 108 mmHg. The homocysteine was 10.4micromol/L (10.1, 11.7, 95% CI) for the group with creatinine over 1.0 mg/dL, which was significantly (P <0.000) higher than 7.9micromol/L (7.6, 8.2, 95% CI) in the group whose creatinine was less than 0.8 mg/dL. CONCLUSION: After adjusting for variables that affect the homocysteine, significant difference in its values was found between males and females. The homocysteine was significantly increased in the group whose age, systolic BP, amount of smoking, and creatinine were higher.
Adult ; Blood Pressure ; Body Weight ; Cardiovascular Diseases ; Cholesterol ; Cholesterol, HDL ; Creatinine ; Female ; Health Promotion ; Homocysteine* ; Humans ; Male ; Plasma ; Risk Factors ; Smoke ; Smoking ; Triglycerides ; Waist Circumference

Under median sternotomy and left thoracotomy, extra-anatomic aorta bypass between ascending aorta and descending thoracic aorta without cardiopulmonary bypass support has been done effectively and easily without complications for a selected case of atypical coarctation associated with hypoplasia of aortic arch. It should be considered as an alternative operative technique for complex aortic arch reconstruction.
Aorta* ; Aorta, Thoracic ; Aortic Coarctation ; Cardiopulmonary Bypass ; Sternotomy ; Thoracotomy ; Transplants*