Pancreatic cancer is well known as a relentlessly progressive and fatal disease. Although distant metastasis is common at the time of diagnosis, brain metastasis originating from pancreatic cancer is rare and its clinical manifestation remains poorly described. Additionally, it is generally known that the prognosis for patients with pancreatic cancer and brain metastasis is very poor. Surgical resection of brain metastasis may play a limited role or may allow long-term survival in patients for whom the primary pancreatic cancer is well controlled. We present a case of brain metastasis in patient with pancreatic cancer after pylorus-preserving pancreaticoduodenectomy and complete response to chemotherapy for hepatic metastases. Brain metastasis was resected successfully, but survival period was relatively short, even though the patient received curative treatment for pancreatic cancer. This case demonstrated that resection of brain metastatic lesion from pancreatic cancer being controlled may be helpful, but the timing of resection is also important.
Brain* ; Diagnosis ; Drug Therapy ; Humans ; Neoplasm Metastasis* ; Pancreas ; Pancreatic Neoplasms* ; Pancreaticoduodenectomy ; Prognosis

Rastelli repair has been considered the procedure of choice for surgically repairing transposition of the great arteries combined with ventricular septal defect and pulmonary stenosis. However, the long term results have been less than optimal and these patients who ungo this procedure can eventually display conduit obstruction, left ventricular outflow tract obstruction and arrhythmias. Many new procedures are now available and they are technically challenging for making a more normal anatomic repair. In our hospital, two patients who had a TGA with VSD and PS have been repaired with a Half Turned Truncal Switch Operation and a Lecompte maneuver in 2003 and 2006, respectively. We report on our two experiences with performing a Half Turned Truncal Switch Operation, and we discuss the changes of the biventricular outflow tract.
Arrhythmias, Cardiac ; Arteries ; Heart Septal Defects, Ventricular ; Humans ; Pulmonary Valve Stenosis ; Transposition of Great Vessels

Pulmonary hypoplasia is an entity of pulmonary agenesis. Pulmonary agenesis is a rare congenital anomaly, usually diagnosed soon after birth. It is commonly associated with other anomalies, mainly of the cardiovascular systems. Although it may hasten the death of a child, sometimes it is compatible with normal growth. We report a right lateral thoracotomy approach for mitral valve repair in a young woman with pulmonary hypoplasia, in whom preoperative computed tomography showed severe right side shifting of the mediastinum and total collapse of the right lung.
Cardiovascular System ; Child ; Female ; Humans ; Lung ; Mediastinum ; Mitral Valve* ; Parturition ; Thoracotomy

BACKGROUND: Remarkable progress has recently been made in achieving successful early repair of congenital heart disease with using cardiopulmonary bypass in the neonatal period. The aim of this study is to evaluate our short-term outcomes for performing neonatal cardiac surgery under extracorporeal circulation. MATERIAL AND METHOD: Fifty five neonates underwent open heart surgery from February 2002 to December 2007. The mean ages and body weight was 13.5 days and 3.2 kg, respectively. The diagnoses of the patients were transposition of the great arteries (14), total anomalous pulmonary venous connection (7), large ventricular septal defect (VSD) (7), coarctation of the aorta with VSD (6), interrupted aortic arch (5) and others (16). RESULT: Six patients had difficulties being weaned from extracorporeal circulation. Four patients left the operating room with an open sternum. Low cardiac output syndrome and acute renal insufficiency were observed in 3 patients each, respectively. Post-operative complications were observed in 27 patients (49.1%). The postoperative mortality was 12.7% (7 patients); 5 patients experienced early hospital death and 2 experienced late death (2). CONCLUSION: In our hospital, early surgical repair with extracorporeal circulation in neonates was feasible with tolerable mortality. Further follow-up is required to establish the long-term survival and complications.
Acute Kidney Injury ; Aorta, Thoracic ; Aortic Coarctation ; Arteries ; Body Weight ; Cardiac Output, Low ; Cardiopulmonary Bypass ; Extracorporeal Circulation ; Follow-Up Studies ; Heart ; Heart Diseases ; Heart Septal Defects, Ventricular ; Humans ; Infant, Newborn ; Operating Rooms ; Sternum ; Thoracic Surgery

BACKGROUND: Composite valve graft replacement is currently the treatment of choice for a wide variety of the lesions of aortic root disease. The purpose of this study was to explore the results of aortic root replacement after using the Cabrol technique over a 13-year period at our institution, and we analyzed the results to help surgeons make better decisions when repairing aortic root disease. MATERIAL AND METHOD: Between January 1994 and December 2006, twenty-five patients underwent a Cabrol technique operation at our institution. The mean patient age was 43.7+/-14.1 years old (range: 6~65 years) and the male and female ratio was 21:4 (84%:16%). The patients' follow-up was 100% complete, and the mean follow-up period was 60.7+/-50.4 (range: 1~162) months. Annuloaortic ectasia (n=18) was the most frequent cause of aortic disease in this series, followed by aortic dissection (n=7). The mean cardiopulmonary bypass time was 177.2+/-44.9 minutes and the mean aortic cross clamping time was 123.4+/-34.1 minutes. Nine patients were checked with MDCT (Multidetector computed tomography) for evaluating a well functioning secondary graft and the coronary anastomosis site. RESULT: The early mortality rate was 4% (1 of 25 patients). A significant stenosis, kinking or occlusion of the secondary graft was detected by MDCT in 4 patients. The overall survival rate was 88%. CONCLUSION: The Cabrol technique demonstrated a significant incidence of long-term complications such as secondary graft stenosis or obstruction. It could be used when the modified Bentall technique is not feasible.
Aortic Aneurysm, Thoracic ; Aortic Diseases ; Cardiopulmonary Bypass ; Constriction ; Constriction, Pathologic ; Dilatation, Pathologic ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Survival Rate ; Transplants

BACKGROUND: At present, many surgeons prefer axillary artery cannulation because it facilitates antegrade cerebral perfusion and may diminish the risk of cerebral embolization. However, axillary artery cannulation has not been established as a routine procedure because there is controversy about its clinical advantage. MATERIALS AND METHODS: We examined 111 patients diagnosed with acute type A aortic dissection between January 2000 and December 2009. The right axillary artery was cannulated in 58 patients (group A) and the femoral artery was cannulated in 53 (group F). The postoperative outcomes were retrospectively reviewed and compared between the two groups. RESULTS: There were 46 male and 65 female patients with a mean age of 58.9+/-13.1 years (range, 26 to 84 years). The extent of aortic replacement in both groups did not differ. There were 8 early deaths (7.2%) and 2 late deaths (1.8%). The mean follow-up duration was 46.0+/-32.6 months (range, 1 month to 10 years). Transient neurologic dysfunction was observed in 11 patients (19.0%) in group A and 14 patients (26.4%) in group F. A total of 11 patients (9.9%) suffered from a permanent neurologic dysfunction. Early and delayed stroke were observed in 6 patients (10.3%) and 2 patients (3.4%), respectively, in group A as well as 2 patients (3.8%) and 1 patient (1.9%), respectively, in group F. There were no statistical differences in the cannulation-related complications between both groups (3 in group A vs. 0 in group F). CONCLUSION: There were no differences in postoperative neurologic outcomes and cannulation-related complications according to the cannulation sites. The cannulation site in an aortic dissection should be carefully chosen on a case-by-case basis. It is important to also pay attention to the possibility of intraoperative malperfusion syndrome occurring and the subsequent need to change the cannulation site.
Axillary Artery ; Cardiopulmonary Bypass ; Catheterization ; Cinnarizine ; Female ; Femoral Artery ; Follow-Up Studies ; Humans ; Male ; Neurologic Manifestations ; Perfusion ; Retrospective Studies ; Stroke

Lateral fat pad impingement syndrome is rare disease characterized by anterior knee pain, painful click and palpable cord-like thickening at the lateral side of patellar tendon. We report a case of lateral fat pad impingement syndrome on walking, which developed in a 22-year-old female and was treated successfully with arthroscopic resection of enlarged fat pad.
Adipose Tissue* ; Female ; Humans ; Knee ; Patellar Ligament ; Rare Diseases ; Walking ; Young Adult

PURPOSE: During interlocking nailing the displaced butterfly fragments can be left in situ or reduced by opening the fracture site. The purpose of this study is to investigate the fate of the displaced comminuted butterfly fragments when left unreduced and factors that influences fracture union in comminuted femoral fracture after closed interlocking nailing. MATERIALS AND METHODS: Out of 95 closed interlocking nailings done for fractured femur from July 1990 to July 1993, 43 femoral fractures that had comminuted fragments larger than 1 cm were followed for more than 18 months postoperatively, The correlations between the size of the comminuted fragments, its distance from the femoral shaft, the angulation of the fragment, the gap of the main fracture sites and bone union were analyzed. RESULTS: The distance between the fragment and the femoral shaft and angulation spontaneously decreased gradually, even the fractures having inverted fragments were united uneventfully, and the union rate of the fractures with gap less than 3 mm was higher than those with gap greater than 3 mm. CONCLUSIONS: The displaced fragment need not be reduced by open method and minimizing the fracture gap is recommended in increasing the union rate.
Butterflies ; Femoral Fractures* ; Femur ; Fractures, Comminuted

PURPOSE: This study evaluated the diagnosis, treatment and related results for cases with a deep infection after instrumented posterior fusion. MATERIALS AND METHODS: Among the 306 cases of posterior instrumented spinal fusion, Seventeen cases who developed deep infection were reviewed retrospectively. RESULTS: The incidence of deep infections was 5.6% and the mean age of the cases with a deep infection was 55 years old. Nine out of 17 cases had the preoperative risk factors such as old age, diabetes, malnutrition, obesity, etc. The mean duration to diagnosis of a postoperative infection was 12.9 days (4-8 days). The clinical manifestations were fever, night pain and abscess drainage. In all cases, the value of the WBC, ESR and CRP were elevated. All cases were treated surgically as soon as possible with abscess drainage, debridement and the insertion of antibiotics-mixed cement beads without the removal of the instrument. The most common bacterial organisms were Coagulase negative Staphylococcus aureus in 11 cases. Vancomycin was used as the antibiotic. During the follow-up period, 2 cases were treated with the removal of the instruments due to metal failure and a delayed deep infection with loosening. The average follow-up was 32 months (12-56 months). 15 cases were controlled successfully without needing to remove the instruments and without complications. CONCLUSION: The meticulous care for a deep infection after posterior instrumented spinal fusion is essential. Favorable results can be achieved by surgery with drainage, debridement, and the insertion of antibiotics-mixed cement beads along with systemic antibiotics as soon as possible without removing the instruments.
Abscess ; Anti-Bacterial Agents ; Coagulase ; Debridement ; Diagnosis ; Drainage ; Fever ; Follow-Up Studies ; Humans ; Incidence ; Malnutrition ; Middle Aged ; Obesity ; Retrospective Studies ; Risk Factors ; Spinal Fusion ; Spine ; Staphylococcus aureus ; Vancomycin

BACKGROUND AND OBJECTIVES: The aim of this study was to evaluate the non-dissected anatomic structures and abnormal computed tomographic findings that contribute to the recurrence of chronic rhinosinusitis (CRS) or the trail of revision endoscopic sinus surgery (ESS). SUBJECTS AND METHOD: The medical records of 34 subjects who were diagnosed with recurrent chronic rhinosinusitis, and required to undergo revision endoscopic sinus surgery were collected retrospectively. The subjects' computed tomography results were examined by a radiology specialist. RESULTS: The most common anatomic factors associated with the revision ESS for recurrence of CRS or retained inflammation were residual uncinate process (47.0%) and residual anterior ethmoidal cells followed by undissected posterior ethmoidal cells (38.2%) and obstructed sphenoid sinus ostium (32.3%). In addition, the uncorrected septal deviation, retained agger nasi cells or Haller cells and lateralized middle turbinate were also identified in the patients. CONCLUSION: From these data, we analyzed anatomical structures and CT findings related to the failure of primary ESS. We suggest that careful attention be given to these structures after primary ESS so as to reduce the failure rate and increase successful outcomes.
Humans ; Inflammation ; Medical Records ; Recurrence ; Retrospective Studies ; Sinusitis ; Specialization ; Sphenoid Sinus ; Turbinates