No abstract available.
Adult ; Autoantibodies/*blood ; Gangliosides/blood/*immunology ; Humans ; Male ; Ophthalmoplegia/blood/*diagnosis/immunology ; Recurrence ; Syndrome

We describe here two cases of anterior tracheoplasty utilizing an autologous pericardial patch. One patient was a 9 year-old female who had a congenital long tracheal stenosis associated with major vascular anomalies including pulmonary artery sling. One-stage correction was done under the support of an extracorporeal membrane oxygenation system. She required a prolonged ventilation support for 10 days postoperatively until the implanted pericardium was fixed to the mediastinal structures. The other patient was a 8 year-old male who had acquired tracheal stenosis following a complicated tracheostomy. By applying additional support over the pericardial patch with the costal cartilage, an endotracheal tube could be removed immediately after the operation. Both patients have been doing well in a postoperative follow-up of over a year, and there have been evidences of growth in the reconstructed trachea.
Cartilage ; Child ; Extracorporeal Membrane Oxygenation ; Female ; Follow-Up Studies ; Humans ; Male ; Pericardium ; Pulmonary Artery ; Trachea ; Tracheal Stenosis ; Tracheostomy ; Ventilation

BACKGROUND: Minimally invasive technique for various cardiac surgeries has become widely accepted since it has been proven to have distinct advantages for the patients. We describe here the results of our experiences of minimal incision in cardiac surgery. MATERIAL AND METHOD: From February 1997 to November 1998, we successfully performed 31 cases of minimally invasive cardiac surgery. Male and female ratio was 17:14, and the patients age ranged from 1 to 75 years. A left parasternal incision was used in 9 patients with single vessel coronary heart disease. A direct coronary bypass grafting was done under the condition of the beating heart without cardiopulmonary bypass support(MIDCAB). Among these, one was a case of a reoperation 1 week after the first operation due to a kinked mammary artery graft. A right parasternal incision was used in one case of a redo mitral valve replacement. Mini-sternotomy was used in the remaining 21 patients. The procedures were mitral valve replacement and tricuspid annuloplasty in 6 patients, mitral valve replacement 5, double valve replacement 2, aortic valve replacement 1, removal of left atrial myxoma 1, closure of atrial septal defect 2, repair of ventricular septal defect 2, and primary closure of r ght ventricular stab wound 1. The initial 5 cases underwent a T-shaped mini-sternotomy, however, we adopted an arrow-shaped ministernotomy in the remaining cases because it provided better exposure of the aortic root and stability of the sternum after a sternal wiring. RESULT: The operation time, the cardiopulmonary bypass time, the aorta cross-clamping time, the mechanical ventilation time, the amount of chest tube drainage until POD#1, the chest tube indwelling time, and the duration of intensive care unit staying were in an acceptable range. There were two surgical mortalities. One was due to a rupture of the aorta cannulation site after double valve replacement on POD#1 in the mini-sternotomy case, and the other was due to a sudden ventricular arrhythmia after MIDCAB on POD#2 in the parasternal incision case. Postoperative complications were observed in 2 cases in which a cerebral embolism developed on POD#2 after a mini-sternotomy in mitral valve replacement and wound hematoma developed after a right parasternal incision in a single coronary bypass grafting. Neither mortality nor complication was directly related to the incision technique itself. CONCLUSION: Minimally invasive surgery using parasternal or mini-sternotomy incision can be used in cardiac surgeries since it is as safe as the standard full sternotomy incisions.
Aorta ; Aortic Valve ; Arrhythmias, Cardiac ; Cardiopulmonary Bypass ; Catheterization ; Chest Tubes ; Coronary Disease ; Drainage ; Female ; Heart ; Heart Septal Defects, Atrial ; Heart Septal Defects, Ventricular ; Hematoma ; Humans ; Intensive Care Units ; Intracranial Embolism ; Male ; Mammary Arteries ; Mitral Valve ; Mortality ; Myxoma ; Postoperative Complications ; Reoperation ; Respiration, Artificial ; Rupture ; Sternotomy ; Sternum ; Surgical Procedures, Minimally Invasive ; Thoracic Surgery* ; Transplants ; Wounds and Injuries ; Wounds, Stab

Recently, Minimally invasive direct coronary artery bypass(MIDCAB) procedure eliminating cardiopulmonary bypass becomes one of the rapidly developing strategies in cardiac surgery. Here, we report a case of minimally invasive axillocoronary bypass as coronary reoperative procedure in which the previous LAD graft was occluded and the left internal mammary flow was deemed inadequate. The methodology is described with review of the relevant literature.
Cardiopulmonary Bypass ; Coronary Artery Bypass ; Coronary Vessels ; Reoperation* ; Surgical Procedures, Minimally Invasive ; Thoracic Surgery ; Transplants

Endovascular treatment of the aortic aneurysm with a stent graft is rapidly evolving. We describe here a case of hybrid TEVAR (thoracic endovascular aortic repair) in which the stent grafts were placed in the aortic arch after debranching of the arch vessels. The patient had undergone ascending aorta replacement for acute type I aortic dissection 2.5 years earlier. The aneurysmal change of the distal dissection progressed with time. A provisional bypass surgery from the ascending aorta to the innominate artery and left carotid artery was performed and then stent grafts were inserted via an antegrade route that covered the whole aortic arch and proximal descending thoracic aorta.
Aneurysm ; Aneurysm, Dissecting ; Aorta ; Aorta, Thoracic ; Aortic Aneurysm ; Brachiocephalic Trunk ; Carotid Arteries ; Chimera ; Humans ; Stents ; Transplants

BACKGROUND: The number of cases employing thoracic endovascular aortic repair (TEVAR) has been increasing due to lower morbidity and mortality compared to open repair technique. The aim of this study is to evaluate the outcome of TEVAR for thoracic aortic diseases. MATERIALS AND METHODS: Sixteen patients underwent TEVAR from October 2003 to April 2010. Mean age at operation was 59 years (20~78 years), and 11 were male. Indications for TEVAR were large aortic diameter (>5.5 cm) upon presentation in 6 patients, increasing aortic diameter during the follow-up period in 4, traumatic aortic rupture in 3, persistent chest pain in 2, and ruptured aortic aneurysm in one. The mean diameter, length and the number of the stents were 33 mm (26~40 mm), 12 cm (9.5~16.0 cm), and 1.25 (1~2), respectively. Aortography employing Multi-detector computerized tomography (MDCT) technique was performed at one week, and patients were followed up in the out-patient department at one month, 6 months, and one year postoperatively. RESULTS: Primary technical success showing complete exclusion of the aneurysm was achieved in 15 patients. One patient showed a small endo-leak (type 1). Four patients developed perioperative stroke: Three recovered without sequelae, and one showed mild right-side weakness. There was no operative mortality. Diameter of the thoracic aorta covered by stent graft changed within 10% range in 12 patients, decreased by more than 10% in 3, and increased by more than 10% in one during mean follow-up duration of 18 months (1~73 months). There was no recurrence-related death during this period. CONCLUSION: Intermediate-term outcome after TEVAR was encouraging. Indications for TEVAR could be extended for other thoracic aortic diseases.
Aneurysm ; Aorta ; Aorta, Thoracic ; Aortic Aneurysm ; Aortic Diseases ; Aortic Rupture ; Aortography ; Chest Pain ; Follow-Up Studies ; Humans ; Male ; Outpatients ; Stents ; Transplants

In this study, we examined the effects of a two-step culture system, which involves the use of different culture media for early cleavage and later stage embryos, on the in vitro development of bovine embryos. We also investigated the effect of glucose, phosphate and citrate on the in vitro early developmental period of bovine embryos in a two-step culture system. Moreover, the supplementation of different protein sources (BSA-V, BSA-FAF and FBS) during IVC did not affect the frequency of blastocyst development. Using two-step culture, embryos were cultured in protein-free media for an initial 5 days. This was then followed by the same culture media or an FBS supplemented media. The developmental rates of blastocysts in the FBS containing group were significantly higher than in the replaced with no serum containing group. Embryos cultured in mSOF supplemented with 1.5 mM glucose plus 1.2 mM phosphate were significantly inhibited. The inhibition of developmental competence by glucose plus phosphate was consistent with the existence of 0.5 mM sodium citrate. This study indicates that a two-step culture system, which applies different conditions for early cleavage embryos, i.e., serum-free media, vs. later stage embryos, with serum containing media, may be effective for in vitro production systems. In addition, the developmental competence of bovine embryos was depressed in the presence of glucose plus phosphate as compared to either alone or the absence of both. Therefore, the avoidance of this negative effect should allow more optimal conditions to be developed for in vitro production.
Animals ; Blastocyst/drug effects/metabolism ; Cattle/*embryology ; Citric Acid/pharmacology ; Culture Media/*chemistry ; Culture Techniques/*methods ; Ectogenesis/drug effects ; Embryo/*drug effects/embryology/metabolism ; Embryonic and Fetal Development/drug effects ; *Energy Metabolism ; Female ; Fertilization in Vitro ; Glucose/pharmacology ; Male ; Phosphates/pharmacology ; Proteins/*pharmacology ; Zygote/drug effects/metabolism

No abstract available.
Anesthesia ; Thyroid Crisis ; Thyroid Gland

We report here 2 cases of deep-seated mediastinitis combined with sternal osteomyelitis after tracheal reconstruction which were successfully treated with sternectomy, in-situ or free omental transfer, and pectoralis major myocutaneous flap. In case I, an 8 year-old boy with deep seated mediastinitis and sternal osteomyelitis that developed after anterior tracheoplasty through a standard midline sternotomy. In case II, a 50 year-old female patient with mediastinal abcess and sternal osteomyelitis that developed after resection and end-to-end anastomosis of the trachea through an upper midline sternotomy. Treatments consisted of drainage and irrigation followed by wide resection of the infected sternum, placement of the viable omentum into the anterior mediastinal space, and chest wall reconstruction with a pectoralis major myocutaneous flap. The omentum was transferred as an in-situ pedicled graft in case I and a free graft in case II. Both patients have recovered smoothly wit out any events and have been doing well postoperatively.
Child ; Drainage ; Female ; Humans ; Male ; Mediastinitis* ; Middle Aged ; Myocutaneous Flap* ; Omentum ; Osteomyelitis* ; Sternotomy ; Sternum ; Thoracic Wall ; Trachea ; Transplants

A rare case of the nasal cavity and paranasal sinus is encountered and we report the case with the literature review of embryonal rhabdomyosarcoma. The occurrence of embryonal rhabdomyosarcoma in nasal cavity and paranasal sinus is rather uncommon. Most embryonal rhabdomyosarcoma occurs in children younger than 12 years of age, and in adult, the incidence is only 10%, Recently, we experienced a case of adult embryonal rhabdomyosarcoma originating in the nasal cavity. The clinical course and the possible management of this unusual neoplasm are discussed.
Adult* ; Child ; Humans ; Incidence ; Nasal Cavity* ; Rhabdomyosarcoma, Embryonal*