PURPOSE: The repair of complex chest wall defects presents a challenging problem for the reconstructive surgeon. In particular, a free flap is often required when the defect is large, in which case suitable recipient vessels must be found to insure revascularization. The authors report a case of persistent bronchopleural-cutaneous fistula developed after undergoing lobectomy for lung cancer. METHODS: The defect area was repaired using a free vertical rectus abdominis muscle flap revascularized by microvascular anastomosis to the 6th intercostal pedicle. The flap obliterated the right chest cavity, closed the site of empyema drainage, and aided healing of a bronchopleuralcutaneous fistula. RESULTS: The patient has remained healed for 14 months without any postoperative complications or recurrent infection or fistula. CONCLUSION: We suggest that a rectus abdominis musculocutaneus free flap and intercostal pedicle as a recipient could be a useful method for repair of chest defects.
Cutaneous Fistula ; Drainage ; Empyema ; Fistula ; Free Tissue Flaps ; Humans ; Lung ; Muscles ; Postoperative Complications ; Rectus Abdominis ; Thoracic Wall ; Thorax

There has been a dramatic increase in the number and type of procedures performed in the field of cardiac intervention in the past decade. Percutaneous intervention is becoming an increasingly recognized modality for the management of prosthetic paravalvular leakages (PVLs) in severely symptomatic non-surgical candidates. Herein, we report our experience of percutaneous closure using the Amplatzer duct occluder for a PVL in a patient who underwent tricuspid valve replacement.
Heart Valve Prosthesis ; Humans ; Septal Occluder Device ; Tricuspid Valve ; Tricuspid Valve Insufficiency

BACKGROUND: Anesthetic requirements are affected by the preoperative levels of some hormones. This study investigated to identify the hormonal status such as plasma level and maximal secretary capacity correlating with propofol and remifentanil requirements in pituitary adenoma patients who show various hormonal secretory states perioperatively. METHODS: From 51 adult female pituitary adenoma patients, preoperative basal values and maximal stimulated levels of various hormones related to the axis of hypothalamus-pituitary-target organs on combined pituitary function test were recorded. Total intravenous anesthesia using target controlled infusion with propofol and remifentanil was administered. The effect-site concentration (Ce) of propofol reaching anesthetic induction and the consumed dosages of propofol and remifentanil during operation were measured. Anesthetic maintenance was controlled within 30% of preanesthetic hemodynamic variables by remifentanil and within ranges of BIS 45 +/- 10 by propofol. Spearman correlations between hormonal status and anesthetic requirements such as propofol Ce for induction, total consumed doses of propofol and remifentanil were performed with a statistical significance at P of 0.05. RESULTS: The preoperative basal level of ACTH was correlated positively with propofol induction Ce and maintenance dose, and the maximal secretory capacity of prolactin also correlated positively with propofol induction Ce. Remifentanil consumption dose was not related with any hormones measured regardless of either preoperative basal levels or maximal secretory levels. CONCLUSIONS: Propofol requirements may be related with preoperative plasma level of ACTH or maximal secretory capacity of prolactin.
Adrenocorticotropic Hormone ; Adult ; Anesthesia, Intravenous ; Axis, Cervical Vertebra ; Female ; Hemodynamics ; Humans ; Piperidines ; Pituitary Function Tests ; Pituitary Neoplasms ; Plasma ; Prolactin ; Propofol

PURPOSE: Scopolamine is a nonselective muscarinic cholinergic receptor antagonist, which induces impairment of learning ability and memory function. Exercise is known to ameliorate brain disturbance induced by brain injuries. In the present study, we investigated the effect of treadmill exercise on short-term memory in relation to acetylcholinesterase (AChE) expression in the hippocampus, using a scopolamine-induced amnesia model in mice. METHODS: To induce amnesia, 1 mg/kg scopolamine hydrobromide was administered intraperitoneally once per day for 14 days. A step-down avoidance test for short-term memory was conducted. AChE histochemistry, immunohistochemistry for collagen IV, and doublecortin were performed. RESULTS: Short-term memory deteriorated in the mice with scopolamine-induced amnesia, concomitant with enhanced AChE expression and suppression of angiogenesis in the hippocampus. Critically, treadmill exercise ameliorated short-term memory impairment, suppressed AChE expression, and enhanced angiogenesis in the mice with scopolamine-induced amnesia. CONCLUSIONS: Overexpression of AChE is implicated in both brain and renal disease. The findings of our study indicate that treadmill exercise may be of therapeutic value in neurodegenerative and renal diseases by suppressing the effects of AChE expression.
Acetylcholinesterase ; Amnesia* ; Animals ; Brain ; Brain Injuries ; Collagen ; Exercise Test ; Hippocampus ; Immunohistochemistry ; Learning ; Memory ; Memory, Short-Term* ; Mice ; Rats* ; Scopolamine Hydrobromide

Intraductal papillary mucinous neoplasm of the bile duct (IPMN-B) is frequently found and has recently been recognized as a precancerous lesion leading to invasive carcinoma characterized by papillary growth of the ductal epithelium with rich mucin production and cystic dilatation of the hepatic duct. Surgical resection is the treatment of choice to avoid malignant transformation. Despite a growing number of studies on IPMN-B, there are few reports of its treatment aside from surgery. A 75-year-old woman was incidentally diagnosed as IPMN-B. Considering the patient's age, comorbidity, and preference, we recommended an argon plasma coagulation (APC) as local ablation therapy rather than surgical resection. There was no evidence of remnant tumor on percutaneous transhepatic cholangioscopy 4 weeks after the ablation of tumor mass by using APC. We report a rare case of IPMN-B successfully treated with APC.
Aged ; Argon Plasma Coagulation* ; Argon* ; Bile Duct Neoplasms ; Bile Ducts* ; Bile* ; Comorbidity ; Dilatation ; Epithelium ; Female ; Hepatic Duct, Common ; Humans ; Mucins*

Intraductal papillary mucinous neoplasm of the bile duct (IPMN-B) is frequently found and has recently been recognized as a precancerous lesion leading to invasive carcinoma characterized by papillary growth of the ductal epithelium with rich mucin production and cystic dilatation of the hepatic duct. Surgical resection is the treatment of choice to avoid malignant transformation. Despite a growing number of studies on IPMN-B, there are few reports of its treatment aside from surgery. A 75-year-old woman was incidentally diagnosed as IPMN-B. Considering the patient's age, comorbidity, and preference, we recommended an argon plasma coagulation (APC) as local ablation therapy rather than surgical resection. There was no evidence of remnant tumor on percutaneous transhepatic cholangioscopy 4 weeks after the ablation of tumor mass by using APC. We report a rare case of IPMN-B successfully treated with APC.
Aged ; Argon Plasma Coagulation* ; Argon* ; Bile Duct Neoplasms ; Bile Ducts* ; Bile* ; Comorbidity ; Dilatation ; Epithelium ; Female ; Hepatic Duct, Common ; Humans ; Mucins*

Poststeroid panniculitis is a very rare complication of corticosteroid therapy, and this is characterized by firm subcutaneous nodules on the cheek, neck or upper trunk within days or weeks following rapid systemic steroid tapering or cessation in childhood. It can be identified by the clinical features and a history of using steroid, and if necessary, with a biopsy. There have been just 2 reported cases in adulthood, one was an autopsy case of a 28-year woman and another was a 60-year-old man after massive administration of corticosteroids for congestive heart failure. Herein, we report a case of panniculitis accompanied by Cushing's syndrome in an adult after long-term misuse of systemic steroid for rosacea.
Adrenal Cortex Hormones ; Adult ; Autopsy ; Biopsy ; Cheek ; Cushing Syndrome ; Female ; Heart Failure ; Humans ; Middle Aged ; Neck ; Panniculitis ; Rosacea

PURPOSE: Gluteal perforator is easily identified in the gluteal region and gluteal perforator flap is a very versatile flap in sacral sore reconstruction. We obtained satisfying results using the gluteal perforator flap, so we report this clinical experiences with a review of the literature. METHODS: Between November of 2003 and April 2006, the authors used 16 gluteal perforator flaps in 16 consecutive patients for coverage of sacral pressure sores. The mean age of the patients was 47.4 years (range, 14 to 78 years), and there were 9 male and 7 female patients. All flaps in the series were supplied by musculocutaneous arteries and its venae comitantes penetrating the gluteus maximus muscle and reaching the intrafascial and suprafascial planes, and the overlying skin forming a rich vascular plexus arising from gluteal muscles. Patients were followed up for a mean period of 11.5 months. RESULTS: All flaps survived except one that had undergone total necrosis by patient's negligence. Wound dehiscence was observed in three patients and treated by secondary closure. There was no recurrence during the follow-up period. CONCLUSION: Gluteal perforator flaps allow safe and reliable options for coverage of sacral pressure sores with minimal donor site morbidity, and do not sacrifice the gluteus maximus muscle and rarely lead to post- operative complications. Freedom in flap design and easy-to perform make gluteal perforator flap an excellent choice for selected patients.
Arteries ; Buttocks ; Female ; Follow-Up Studies ; Freedom ; Humans ; Male ; Malpractice ; Muscles ; Necrosis ; Perforator Flap* ; Pressure Ulcer* ; Recurrence ; Skin ; Tissue Donors ; Wounds and Injuries

BACKGROUND: The aim of this study was to investigate the effects of preoperative statin therapy on myocardial protection and morbidity endpoints following off-pump coronary bypass graft surgery (OPCAB) in patients with elevated serum high-sensitivity C-reactive protein (hs-CRP) levels. METHODS: Of the 492 patients who underwent multivessel OPCAB from March 2007 to February 2009, the records of 144 patients whose baseline hs-CRP level > 2 mg/L were reviewed. According to the history of preoperative statin therapy for at least one week, patients were classified as either statin group or control group (72 subjects each). Preoperative and operative characteristics and postoperative data including troponin (Tn)-T level and major morbidity endpoints were obtained and compared. Major morbidity endpoints were defined as permanent stroke, renal dysfunction, hemostatic re-exploration, deep sternal wound infection, and the number of patients requiring prolonged ventilation. RESULTS: Preoperative and operative characteristics were similar between the two groups. There were no significant differences in the incidence of morbidity endpoints between the two groups, except for the number of patients requiring dialysis, which was significantly lower in the statin group (8 vs. 1, P = 0.033). Tn-T level at 24 h after surgery was also significantly lower in the statin group. CONCLUSIONS: In this study, we observed beneficial effects of preoperative statin therapy for at least one week in terms of less myocardial enzyme release and fewer patients requiring dialysis following OPCAB in patients whose preoperative hs-CRP was elevated.
C-Reactive Protein ; Dialysis ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Incidence ; Stroke ; Transplants ; Troponin ; Ventilation ; Wound Infection

BACKGROUND: The aim of this study was to investigate the effects of preoperative statin therapy on myocardial protection and morbidity endpoints following off-pump coronary bypass graft surgery (OPCAB) in patients with elevated serum high-sensitivity C-reactive protein (hs-CRP) levels. METHODS: Of the 492 patients who underwent multivessel OPCAB from March 2007 to February 2009, the records of 144 patients whose baseline hs-CRP level > 2 mg/L were reviewed. According to the history of preoperative statin therapy for at least one week, patients were classified as either statin group or control group (72 subjects each). Preoperative and operative characteristics and postoperative data including troponin (Tn)-T level and major morbidity endpoints were obtained and compared. Major morbidity endpoints were defined as permanent stroke, renal dysfunction, hemostatic re-exploration, deep sternal wound infection, and the number of patients requiring prolonged ventilation. RESULTS: Preoperative and operative characteristics were similar between the two groups. There were no significant differences in the incidence of morbidity endpoints between the two groups, except for the number of patients requiring dialysis, which was significantly lower in the statin group (8 vs. 1, P = 0.033). Tn-T level at 24 h after surgery was also significantly lower in the statin group. CONCLUSIONS: In this study, we observed beneficial effects of preoperative statin therapy for at least one week in terms of less myocardial enzyme release and fewer patients requiring dialysis following OPCAB in patients whose preoperative hs-CRP was elevated.
C-Reactive Protein ; Dialysis ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Incidence ; Stroke ; Transplants ; Troponin ; Ventilation ; Wound Infection