Leigh's syndrome, which is characterised by progressive neurodegeneration involving the brainstem and basal ganglia, belongs to a family of disorders classified as mitochondrial myopathies. It is most commonly transmitted by an autosomal recessive mode of inheritance, but can sometimes occur in a mitochondrial pattern. It typically presents during infancy with developmental delay and deterioration of brainstem function. Respiratory failure is the common cause of death and postoperative morbidity in patients with Leigh's disease. Herein, we report the case of a 17-year-old female patient with Leigh's syndrome who underwent general anaesthesia for a tracheostomy, which was performed in view of the patient's requirement for long-term ventilation and frequent toileting for secretions. Her respiratory complications included central hypoventilation secondary to brainstem involvement, and obstructive sleep apnoea due to obesity and muscle dystonia. She was hospitalised for acute respiratory decompensation secondary to hospital-acquired pneumonia. We review the anaesthetic implications of this disease and discuss its impact on preoperative, intraoperative and postoperative management.
Adolescent ; Anesthesia, General ; methods ; Anesthetics ; therapeutic use ; Dystonia ; pathology ; Female ; Humans ; Hypoventilation ; complications ; diagnosis ; Leigh Disease ; complications ; drug therapy ; Mitochondria ; pathology ; Postoperative Complications ; Sleep Apnea, Obstructive ; complications ; Ventilation

Cervical myelopathy and radiculopathy are common pathologies that often improve with spinal decompression and fusion. Postoperative complications include pseudarthrosis, which can be challenging to diagnose and manage. We reviewed the literature with regard to risk factors, diagnosis, controversies, and management of cervical pseudarthrosis.
Decompression ; Diagnosis* ; Pathology ; Postoperative Complications ; Pseudarthrosis* ; Radiculopathy ; Risk Factors* ; Spinal Cord Diseases ; Spine*

Optical coherence tomography (OCT) has been recently applied to investigate coronary artery disease in interventional cardiology. Compared to intravascular ultrasound, OCT is able to visualize various vascular structures more clearly with higher resolution. Several validation studies have shown that OCT is more accurate in evaluating neointimal tissue after coronary stent implantation than intravascular ultrasound. Novel findings on OCT evaluation include the detection of strut coverage and the characterization of neointimal tissue in an in-vivo setting. In a previous study, neointimal healing of stent strut was pathologically the most important factor associated with stent thrombosis, a fatal complication, in patients treated with drug-eluting stent (DES). Recently, OCT-defined coverage of a stent strut was proposed to be related with clinical safety in DES-treated patients. Neoatherosclerosis is an atheromatous change of neointimal tissue within the stented segment. Clinical studies using OCT revealed neoatherosclerosis contributed to late-phase luminal narrowing after stent implantation. Like de novo native coronary lesions, the clinical presentation of OCT-derived neoatherosclerosis varied from stable angina to acute coronary syndrome including late stent thrombosis. Thus, early identification of neoatherosclerosis with OCT may predict clinical deterioration in patients treated with coronary stent. Additionally, intravascular OCT evaluation provides additive information about the performance of coronary stent. In the near future, new advances in OCT technology will help reduce complications with stent therapy and accelerating in the study of interventional cardiology.
Atherosclerosis/diagnosis/pathology/ultrasonography ; Coronary Artery Disease/*diagnosis/pathology/ultrasonography ; Humans ; Postoperative Complications/diagnosis/pathology/ultrasonography ; Stents/*adverse effects ; Tomography, Optical Coherence/*methods ; Ultrasonography, Interventional

Coronary-subclavian steal through the left internal mammary graft is a rare cause of myocardial ischemia in patients who have had a coronary bypass surgery. We report a 70-year-old man who presented with sustained monomorphic ventricular tachycardia 5 years after the surgical creation of a left internal mammary to the left anterior descending artery. Cardiac catheterization illustrated that the left subclavian artery was occluded proximally and that the distal course was visualized by retrograde filling through the left internal mammary graft. Clinical ventricular tachycardia was reproducibly induced with a single ventricular extrastimulus, and antitachycardia pacing terminated the tachycardia. Restoration of blood flow by way of a Dacron graft placed between the descending aorta and the subclavian artery resulted in the total relief of symptoms. Ventricular tachycardia could not be induced during the control electrophysiologic study after surgical revascularization.
Aged ; Coronary Artery Bypass/adverse effects ; Coronary Artery Disease/*diagnosis/etiology/*pathology ; Humans ; Male ; Postoperative Complications/diagnosis/etiology ; Subclavian Steal Syndrome/*diagnosis/etiology/*pathology ; Tachycardia, Ventricular/*pathology

No abstract available.
*Abdominal Wall ; Adult ; *Cesarean Section, Repeat ; Endometriosis/*diagnosis/etiology/pathology ; Female ; Humans ; Peritoneal Diseases/*diagnosis/pathology ; Postoperative Complications/*diagnosis/pathology ; Pregnancy ; Tomography, X-Ray Computed

Intramural duodenal hematoma is an uncommon condition, which usually develops after blunt abdominal trauma. It is also reported as a complication of anticoagulant therapy, blood dyscrasia, pancreatic disease, and diagnostic and therapeutic endoscopy. The typical clinical pictures of intramural duodenal hematoma consist of upper abdominal pain, vomiting, fever, and hematochezia, and it is rarely accompanied by intestinal obstruction, peritonitis, and pancreatitis as its complication. We report a case of intramural duodenal hematoma extended to peritoneal cavity, and accompanied by acute pancreatitis following therapeutic endoscopy for duodenal ulcer bleeding in a 32-year-old man who was on maintenance of anti-coagulation therapy after valvular heart surgery.
Acute Disease ; Adult ; Diagnosis, Differential ; Duodenal Diseases/*diagnosis/pathology/surgery ; Duodenal Ulcer/*complications ; Hematoma/*diagnosis/pathology/surgery ; *Hemostasis, Endoscopic ; Humans ; Male ; Pancreatitis/complications/*diagnosis ; Peptic Ulcer Hemorrhage/*therapy ; Postoperative Complications ; Tomography, X-Ray Computed

Cervical disc disease and spondylosis have troubled human beings since the earliest recording of human ailment, encountered in term of one's life and still is one of the most intricated neurosurgical disorders, although there are a good many kind of diagnostic and surgical advances. Cervical disc disease has been studied more extensively and also diagnostic studies have developed considerably in recent times including myelography, computerized tomographic scan and magnetic resonance imaging. The treatment for cervical disc disease may be medical, surgical, or both but surgery, is increasingly popular owing to development of microanatomy, pathology, diagnostic tools and microsurgery. The surgical approaches to cervical disc disease have developed as the clinical syndrome, mechanisms of disease, and pathological changes that ensue have been better defined. Dramatic result of posterior decompressive laminectomy was reported by Horsley in 1901 and modified by Scoville, Kahn, Fager, and others. The anterior approach to compressive lesions, a more recent development by Robinson in 1955, by Cloward in 1958, and Boldrey, has become increasingly popular. The anterolateral approach, offered by Verbiest in 1968, provided an third avenue to the pathological cervical disc disease. Surgical results for cervical root compression can be relieved well, but myelopathy responds less well to decompression, provided the preoperative diagnosis is accurate and the operation is done carefully from either anterior or posterior approach. The authors has reviewed 79 cases cervical disc disease which treated surgically in Kyung Hee Medical Center from March, 1984 to May, 1990, the result as follows: 1) Cervical disc disease were more frequently encountered between 5th and 6th decades(67%) and the ratio of male to female was 2:1. 2) The symptom onset was acute in 58% of patients but the causes could not define clearly in 76% of patients. 3) The most frequent clinical symptom was pain in the neck(88.6%). 4) The most frequent site of disc herniation was C5-6 level as a single lesion, but the multiple level was effected in 12.7% of patients. 5) Postoperative complications were occurred in 11.4% of patients. 6) The prognosis was influenced by age, sex, time interval between the symptom onset and operation, and direction and character of disc herniation.
Decompression ; Diagnosis ; Female ; Humans ; Laminectomy ; Magnetic Resonance Imaging ; Male ; Microsurgery ; Myelography ; Pathology ; Postoperative Complications ; Prognosis ; Spinal Cord Diseases ; Spondylosis

The authors experienced three cases of cholangiocarcinoma associated with profuse mucin production. We intended to review and summarize the clinical features of these patients to emphasize the clinical importance of mucin-producing cholangiocarcinoma. All patients were female. Symptoms were mainly right upper quadrant pain and jaundice. Diagnosis was made by characteristic endoscopic retrograde cholangiographic findings and computed tomography. Bile ducts were dilatated and obstructive jaundice had developed as a result of the accumulation of mucin realeased by the tumor. Treatments were hepatic lobectomies for two intrahepatic cholangiocarcinoma patients and extrahepatic bile duct resection and hepaticojejunostomy for one patient. There was no postoperative complication. Pathologies were well differentiated papillary adenocarcinoma in two cases. Two patients are still living without recurrence for over three and four years respectively. One patient who had T4 lesion died of recurrence 38 months after operation. Conclusively, aggressive surgical treatment may be justified in the treatment of mucin hypersecreting cholangiocarcinoma even in advanced stage in view of the favorable outcome after radical operation. Further study is needed to clarify its biological behavior.
Adenocarcinoma, Papillary ; Bile Ducts ; Bile Ducts, Extrahepatic ; Cholangiocarcinoma* ; Diagnosis ; Female ; Humans ; Jaundice ; Jaundice, Obstructive* ; Mucins ; Pathology ; Postoperative Complications ; Recurrence

Aged ; Antigens, CD34 ; Humans ; Immunohistochemistry ; Lymphangioma ; diagnosis ; etiology ; pathology ; Male ; Orthopedic Procedures ; adverse effects ; Platelet Endothelial Cell Adhesion Molecule-1 ; Postoperative Complications ; Skin Neoplasms ; diagnosis ; etiology ; pathology

PURPOSE: The purpose of this study was to identify the effects of a Progressive Walking program (PW) on physical activity, exercise tolerance, recovery, and post-operative complications for patients with a lung resection. METHODS: A nonequivalent control group non-synchronized design was utilized and 37 participants with a lung resection (22 for control group, 15 for experimental group) were recruited at A university hospital from December 2012 to August 2013. The PW consisted of preoperative education, goal setting, and feedback, provided to the experimental group, and usual care to the control group. Data were analyzed using the SPSS WIN 18.0. RESULTS: A higher proportion of patients in the experimental group showed adequate levels of physical activity (p=.001), shorter period of chest tube retention (< or = 7 days; p=.011), and shorter stay in the hospital (< or = 10 days; p=.036) than patients in the control group. Patients in the experimental group reported longer 6-minute walking distance (p=.032) and lower levels of dyspnea (p=.049) than patients in the control group. The PW did not influence the occurrence of pulmonary complications. CONCLUSION: The findings of this study suggest that the PW could be a useful strategy for improving patients' post-operative health and reducing cost after lung resection.
Aged ; Dyspnea/diagnosis ; Exercise Tolerance ; Female ; Humans ; Length of Stay ; Lung Neoplasms/pathology/*surgery ; Male ; Middle Aged ; Postoperative Care ; Postoperative Complications ; Questionnaires ; Treatment Outcome ; *Walking