No abstract available.
Mediastinal Emphysema* ; Subcutaneous Emphysema*

Background: Although traumatic thoracic aortic rupture is potentially a fatal condition requiring surgical attention, the presence of concomitant injury involving other parts of the body may greatly increase the risk of cardiopulmonary bypass. We report our experience of treating associated injuries prior to the thoracic aortic rupture in these patients. Material and Method: From 1997 to 2003, the medical records of 24 traumatic aortic rupture patients were retrospectively reviewed and checked for the presence of associated injury, surgical method, postoperative course, and complications. Surgical technique comprised thoracotomy with proximal anastomosis under deep hypothermic circulatory arrest followed by side arm perfusion to reestablish cerebral circulation. CSF drainage was performed to prevent lower extremity paraplegia. Result: Major concomitant injuries (n=83) were noted in all of the reviewed patients. Of these, there were 49 thoracic injuries, 18 musculoskeletal injuries, and 13 abdominal injuries. Operations for associated injuries (n=16) were performed in 12 patients on mean 7.6+/-12.6 days following the injury. The diagnosis of aortic rupture at the time of injury was detected in only 18 patients. Delayed surgery of the thoracic aorta was performed on average 695+/-1350 days after injury and there were no deaths or progression of rupture in any of these patients during the observation period There were no operative deaths and no major postoperative complications. Conclusion: Treating concomitant major injuries prior to the aortic injury in traumatic aortic rupture may reduce surgical mortality and morbidity.
Abdominal Injuries ; Aorta, Thoracic* ; Aortic Rupture ; Arm ; Cardiopulmonary Bypass ; Circulatory Arrest, Deep Hypothermia Induced ; Diagnosis ; Drainage ; Humans ; Intraoperative Complications ; Lower Extremity ; Medical Records ; Mortality ; Paraplegia ; Perfusion ; Postoperative Complications ; Retrospective Studies ; Rupture* ; Thoracic Injuries ; Thoracotomy

We report a case of colobronchial fistula, which is an extremely rare complication of esophagocologastrostomy. A 53-year-old man developed recurrent respiratory symptoms 30 months after colon interposition for corrosive esophageal and gastric strictures. Chest radiographs and computed tomography showed an aspiration pneumonia and total atelectasis of the left lower lobe(LLL). Esophagoscopy and barium esophagogram revealed fistula between the colon just below the esophagocolostomy and superior segment of the LLL. The colobronchial fistulectomy and left lower lobe lobectomy were performed. This rare complication should be considered in patients who develop recurrent productive cough whenever they drink or eat something after esophagocologastrostomy.
Barium ; Colon ; Constriction, Pathologic ; Cough ; Esophagoscopy ; Fistula* ; Humans ; Middle Aged ; Pneumonia, Aspiration ; Postoperative Complications ; Pulmonary Atelectasis ; Radiography, Thoracic

We report a case of colobronchial fistula, which is an extremely rare complication of esophagocologastrostomy. A 53-year-old man developed recurrent respiratory symptoms 30 months after colon interposition for corrosive esophageal and gastric strictures. Chest radiographs and computed tomography showed an aspiration pneumonia and total atelectasis of the left lower lobe(LLL). Esophagoscopy and barium esophagogram revealed fistula between the colon just below the esophagocolostomy and superior segment of the LLL. The colobronchial fistulectomy and left lower lobe lobectomy were performed. This rare complication should be considered in patients who develop recurrent productive cough whenever they drink or eat something after esophagocologastrostomy.
Barium ; Colon ; Constriction, Pathologic ; Cough ; Esophagoscopy ; Fistula* ; Humans ; Middle Aged ; Pneumonia, Aspiration ; Postoperative Complications ; Pulmonary Atelectasis ; Radiography, Thoracic

Abdominal tumors that can grow through vascular lumen and spread to the right heart are rare. Intravenous leiomyomatosis is a rare tumor that originates from the uterus and spreads through the vessels. Although histologically benign, tumor extension with mechanical obstruction of the inferior vena cava, right cardiac cavities, or even the pulmonary artery, may occasionally result in fatal outcome. The best treatment is complete surgical resection of the entire tumor using cardiopulmonary bypass and total circulation arrest. We report a case of intravenous leiomyomatosis of the uterus that showed intravascular growth up to the right atrium. The patient underwent successful resection of the tumor by one-stage cardiotomy with laparotomy.

Diffuse panbronchiolitis is a chronic inflammatory lung disease of unknown etiology which is characterized by chronic airflow limitation and airway inflammation, predominantly localized in the respiratory bronchioles with infiltration of inflammatory cells, and has typical clinical, radiological and pathological features. Obstructive respiratory functional impairment, occasional symptoms of wheezing, and also cough and sputum resemble the feature of emphysema, bronchial asthma, or chronic bronchitis, respectively. We experienced a case of pathologically proven advanced diffuse panbronchiolitis in a 55-year-old man with productive cough and exertional dyspnea. The chest radiography showed multiple tiny nodular densities on whole lung fields. It was confirmed by thoracoscopy-guided lung biopsy and the patient was improved after initiation of treatment with low-dose erythromycin
Asthma ; Biopsy ; Bronchioles ; Bronchitis, Chronic ; Cough ; Dyspnea* ; Emphysema ; Erythromycin ; Humans ; Inflammation ; Lung Diseases ; Lung* ; Middle Aged ; Radiography ; Respiratory Sounds ; Sputum ; Thorax

Malignant fibrous histiocytoma(MFH) is a deep-seated pleomorphic sarcoma, which occurs principally as a mass of the extremities, abdominal cavity, or retroperitoneum in adults. However, it only rarely occurs in the chest wall. An 85-year-old man had undeergone excision of a small mass on the right posterior chest wall under local anesthesia 14 months age. However, the lesion did not heal and the mass recurred. He was referred to our hospital after the mass had grown to a size of 10.5x8x4cm with a 3x3cm skin defect. Intraoperative frozen biopsy revealed MFH. An en-bloc wide resection and thin-thickness skin graft from his thigh were performed. Although distant metastasis to the lund developed 14 months later and the patient died 2 months later, there was no local recurrence. Thin-thickness skin graft is a simple method for a wide range skin defect, especially in the old age. He recovered in good condition without any physical disabilities.
Abdominal Cavity ; Adult ; Aged, 80 and over ; Anesthesia, Local ; Biopsy ; Extremities ; Humans ; Neoplasm Metastasis ; Recurrence ; Sarcoma ; Skin ; Thigh ; Thoracic Wall* ; Thorax* ; Transplants

A 17-year-old-boy with a bilateral incomplete cervical rib, upon abduction of his left arm at 45 degrees, had immediately begun to show symptoms of severe tingling, claudication, pallor, and weakness of his left upper extremity. These symptoms were aggravated at 90 degrees, leaving him debilitated from his work in the printing office. Transfemoral positional subclavian arteriography revealed total occlusion of the subclavian artery immediately distal to a cervical rib during 90 degrees abduction. Resection of the anterior scalene and medial aspect of the middle scalene muscles, cervical and first ribs, and arteriolysis were performed via a combined supraclavicular and infraclavi cular approach. He has returned to work as a printer with marked relief of symptoms and has remained asymptomatic over follow-up periods of 10 months.
Angiography ; Arm ; Cervical Rib ; Follow-Up Studies ; Muscles ; Pallor ; Ribs ; Subclavian Artery ; Thoracic Outlet Syndrome* ; Upper Extremity

Heart and kidney transplantation has made great progress in the modern era. Coupled with the growing successes in individual solid organ transplantation, there has also been an increase in the number of multiple organ transplants, such as heart-kidney transplantation. This trend has been in part due to a better understanding of immunobiology, advances in surgical technique and postoperative care, and an often-common pathologic association between dual-organ failure. This pathologic course is representative for end-stage heart failure leading to secondary renal dysfunction or failure, or for end-stage renal failure as a cause for (uremic) cardiomyopathy. However, refractory cardiac failure has long been considered a contraindication to kidney transplantation. Additionally, cardiac transplantation has been denied for patients with end-stage renal disease. Over recent years, combined heart-kidney transplantation has been offered to select patients who were once denied transplantation. We report the first experience of combined heart-kidney transplantation with one year follow-up results.
Cardiomyopathies* ; Follow-Up Studies ; Heart Failure ; Heart Transplantation ; Heart* ; Humans ; Kidney Failure, Chronic ; Kidney Transplantation* ; Kidney* ; Organ Transplantation ; Postoperative Care ; Postpartum Period* ; Renal Insufficiency* ; Transplants

The incidence of reoperative coronary artery bypass grafting (CABG) has increased because of the rise in the number of patients who have undergone initial CABG. In addition, recent technological advances have resulted in widespread application of off pump coronary artery bypass (OPCAB). We report a case of redo OPCAB through thoracotomy and small laparotomy in 76-year-old man with recurrent unstable angina.
Aged ; Angina, Unstable ; Coronary Artery Bypass* ; Coronary Artery Bypass, Off-Pump ; Coronary Vessels* ; Humans ; Incidence ; Laparotomy* ; Reoperation ; Thoracotomy*