Descending necrotizing mediastinitis (DNM) is one of the most lethal form of mediastinitis originating from an oropharyngeal infection. It requires an early and aggressive sugical treatment, but the operative approach and optimal form of mediastinal drainage remains controversial. We report a case of DNM in a 45-year-old male who underwent right cervicomediastinotomy to drain the deep neck space, upper mediastinum and anterior mediastinal drainage was accomplished through a subxiphoid approach. After this procedure, he steadily improved and was dischrged on hospital day 36. We report this case with a brief review of the literature.
Drainage ; Humans ; Male ; Mediastinitis* ; Mediastinum ; Middle Aged ; Neck

Aortic thrombi are important because it can cause the central and peripheral embolizations. Aortic thrombi can occur anywhere in the aorta but extremely rare in ascending aorta without atherosclerosis, aneurysm, cardiosurgical or traumatic state. Systemic sclerosis (SSc) is an autoimmune disorder of connective tissue and it can involve multisystem. Enhanced coagulation pathways, decreased fibrinolysis, and endothelial dysfunction probably contribute to vascular events in SSc. We report a case of a highly mobile thrombus in the ascending aorta, presented as an acute embolic stroke in the patient with systemic sclerosis. Surgical removal was performed to prevent recurrent embolic events.
Aneurysm ; Aorta ; Atherosclerosis ; Connective Tissue ; Fibrinolysis ; Humans ; Scleroderma, Systemic ; Stroke ; Thrombosis

Synovial sarcoma is a malignant soft tissue tumor that primarily occurs in the paraarticular regions, especially in the knee. They are composed of keratin-positive epithelial cells and vimentin-positive spindle cells. We report a 76 year old woman with a primary synovial sarcoma in the mediastinum that had severe adhesion to the right side of pericardium. Primary synovial sarcoma in the mediastinum is extremely rare and this is the first case reported in the Korean literature. The mass including the pericardium was resected and the defect was closed with Gore-Tex patch. The patient is well and free of disease 6 months after the operation.
Aged ; Epithelial Cells ; Female ; Humans ; Knee ; Mediastinum* ; Pericardium ; Polytetrafluoroethylene ; Sarcoma, Synovial*

PURPOSE: The efficacy of magnetic resonance imaging for evaluating coronary artery disease has been reported. In this study, we evaluated the usefulness of breath-hold segmented K-space cine MR imaging for evaluating the patency of coronary artery bypass grafts (CABG). MATERIALS AND METHODS: Thirty eight patients with a total of 92 CABGs (36 internal thoracic arteries and 56 saphenous vein grafts) were evaluated using segmented Kspace cardiac-gated fast gradient echo sequence (2D-FASTCARD) MR imaging. MR magnitude images were evaluated from the hard copies by two independent observers. A graft was defined as patent if it was seen as a bright small round area on at least two consecutive images throughout the cardiac cycle at a position consistent with the expected location for that graft. RESULTS: MR images were obtained successfully for 23 patients (61%). The sagittal planes were most helpful in visualizing the cross-section of sapheneous vein bypass graft to left circumflex artery branch, whereas the transverse planes were used for identification of internal mammary artery grafts to left anterior descending coronary artery or its branch and identification of saphenous vein grafts to right coronary artery. Forty five grafts were visible using this MR technique, while the grafts were not visible on seven saphenous vein grafts and two internal mammary artery grafts. In two patients showing symptoms of myocardial ischemia, one or two bypass grafts were not visible. Imaging, perpendicular plane to a CABG was important to visualize the flow inside the CABG with maximum sensitivity. CONCLUSION: Evaluation of patency of the bypass graft was clinically feasible by 2DFASTCARD MR imaging, whereas any invisible bypass grafts should be further studied by contrast-enhanced MR angiography or by conventional angiography for confirmation of abnormalities.
Angiography ; Arteries ; Coronary Artery Bypass* ; Coronary Artery Disease ; Coronary Vessels* ; Feasibility Studies* ; Humans ; Magnetic Resonance Imaging* ; Mammary Arteries ; Myocardial Ischemia ; Saphenous Vein ; Transplants ; Veins

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No abstract available.
Hematoma*

No abstract available.

In this study we evaluated the effects of the genetic polymorphism of aldehyde dehydrogenase2 (ALDH2) on toluene metabolism and determined biological exposure indices (BEIs) for toluene by the genotypes of ALDH2. The study subject were 77 men workers who are handling toluene in a video tape manufacturing factory and a textile company. Through the face-to-face interview, the information about smoking and drinking behavior wag obtained. For determination of ALDH2 poly morphism, 5 ml of venous blood sample was obtained from each subject after informed consent. DNA was extracted from the buffy coat and ALDH2 genotyping were performed using a polymerase chain reaction (PCR) method. The genotype of ALDH2 was classified into the homozygous genotype of normal ALDH2 (NN), and the heterozygous genotype of normal and inactive ALDH2 (ND), and homozygous genotype of an inactive ALDH2(DD). The concentration of hippuric acid (HA), the main metabolite of toluene, was determined in urine specimens collected at the end of shift, corrected with creatinine (HA/C), and compared with BEI for toluene, which is 2.5 g/g creatinine. The personal exposure level of toluene were monitored, using personal air sampler and analyzed by gas chromatography. The frequencies of the three genotypes in this study subjects were, NN : 45 (58.4%), ND : 26 (33.8%) and DD : 6 (7.8%), and frequencies of the genotypes in the middle or heavy toluene exposure workers were not significantly different from those in the mild toluene exposure workers. The frequencies of the DD type of ALDH2 was lower among alcohol drinkers than among non-drinkers. The urinary HA concentration of DD group was significantly lower than that of the NN or ND group, which suggests that the HA formation from toluene decreased in DD group. Regression lines were used to estimate the BEIs of the NN, ND, and DD groups. NN : y = 0.0085x + 0.23, r = 0.90 ND : y = 0.0074x + 0.21, r = 0.85 DD : y = 0.0041x + 0.82, r = 0.83 The three regression lines revealed that the estimated urinary HA concentration of NN, ND, and DD groups at 377 mg/m3 toluene(TLV-TWA) exposure were 3.43, 3.00, and 2.37 g/g creatinine, respectively. The HA concentration of the NN, and ND group were higher than that of the ACGIH BEI (2.5 g/g creatinine) ; however, the HA level of DD group was lower than the BEI. These results suggests that the ACGIH BEI is not adequate to estimate the toluene exposure of the NN, ND and DD groups at the same time. Based upon those results, a new BEI for ALDH2 deficient workers may be necessary.
Chromatography, Gas ; Creatinine ; DNA ; Drinking Behavior ; Genotype ; Humans ; Informed Consent ; Male ; Metabolism ; Polymerase Chain Reaction ; Polymorphism, Genetic* ; Smoke ; Smoking ; Textiles ; Toluene*

Struma ovarii is a rare tumor of the ovary pathologically resembling teratomas with thyroid components. The presenting clinical, radiological, and pathological features of patie-nts with consequent struma ovarii is diverse and does not give substantial information with regard to the nature of the ovarian tumor. Ten cases collected over a period of eight years from two institutes are presented which showed a wide diversity of clinical features, and in which the diagnosis was only made later by strict pathological criteria. The treatment for struma ovarii, and in even rarer cases, malignant struma ovarii, remains highly controvers-ial, but it is suggested that conservative treatment by tumor excision only may be sufficie-nt. Surgical treatment also greatly ameliorates any accompanying hydrothorax and ascites.
Academies and Institutes ; Ascites ; Diagnosis ; Female ; Hydrothorax ; Ovary ; Struma Ovarii* ; Teratoma ; Thyroid Gland

Conventional surgery for aortic arch aneurysms have many postoperative complications and a high mortality rate due to prolonged cardiopulmonary bypass time, especially in high risk patients. In this report, we present two cases of a hybrid procedure that involves open brachiocephalic bypass with concomitant endovascular arch stent grafting in high risk patients with distal aortic arch aneurysm.
Aneurysm ; Aorta, Thoracic ; Cardiopulmonary Bypass ; Chimera ; Humans ; Postoperative Complications ; Stents ; Transplants