Benign schwannoma of the esophagus is very rare. Diagnosis requires histology and immunohistochemical staining. We are reporting a case of benign schwannoma of the esophagus, incidentally diagnosed as a submucosal tumor of the esophagus in 66 year-old woman during the regular check-up. The tumor was enucleated through right thoracotomy, and was diagnosed as a benign schwannoma by immunohistochemical pathologic test. There has been no evidence of recurrence during 1 year follow-up.
Aged ; Diagnosis ; Esophageal Neoplasms ; Esophagus* ; Female ; Follow-Up Studies ; Humans ; Neurilemmoma* ; Recurrence ; Thoracotomy

A 50-year-old male visited the emergency room due to the cervical edema caused by a traffic accident. At the cervial CT, diagnosis was confirmed as extensive cervical subcutaneous emphysema secondary to tracheal laceration as a thyroid cartilage fracture. The patient showed loss of symptom after conservative treatment. Thyroid cartilage fracture is rare and tracheal laceration as a result of thyroid cartilage fracture has never been reported in the literatures. Thus we herein report this one case.
Accidents, Traffic ; Diagnosis ; Edema ; Emergency Service, Hospital ; Emphysema ; Humans ; Lacerations* ; Male ; Middle Aged ; Subcutaneous Emphysema ; Thyroid Cartilage* ; Thyroid Gland*

Pumonary mucormycosis is an uncommon but a fatal, opportunistic fungal infection that occurs primarily in patients who are immunocompromised such as hematologic malignancies, renal failure, or diabetes mellitus. The patient was a 32 year-old male with a 3-year history of diabetes(type I) and hyperthyroidism, and has been suffering from coughing, fever and left-sided chest pain for 1 month. The patient was diagnosed by the bronchoscopic examination with transbronchial lung biopsy and underwent a left lower lobectomy. On 21th postoperative day, multiple loculated pleural effusion was detected by follow-up chest X-ray and thus, drained using thoracoscopy. On 23rd day after the thoracoscopic drainage, the patient was discharged without postoperative complication. Previous reports have suggested that aggressvie and early surgical intervention may further enhance survival in operative candidates with mucormycosis confined to one lung.
Adult ; Biopsy ; Chest Pain ; Cough ; Diabetes Mellitus ; Drainage ; Fever ; Follow-Up Studies ; Fungi ; Hematologic Neoplasms ; Humans ; Hyperthyroidism ; Lung ; Male ; Mucormycosis* ; Pleural Effusion ; Postoperative Complications ; Renal Insufficiency ; Thoracoscopy ; Thorax

Ehlers-Danlos syndrome type IV(the arterial-ecchymotic type) which has skin fragility, easy bruisability, and j oint hyperextensibility is occasionally combined with large vessel involve-ment and spontaneous catastrophic bleeding. As even a small inj ury can cause profound vascular tearing and damage, surgical management is hazardous and often unrewarding. We report a successful surgical treatment of an acute type A aortic dissection associated with Ehlers-Danlos syndrome.
Ehlers-Danlos Syndrome* ; Hemorrhage ; Skin

It is difficult to perform Off-pump Coronary Artery Bypass Grafting(OPCAB) for the posterior vessels in patients with cardiomegaly and left ventricular dysfunction due to hemodynamic instability and poor exposure. Right heart supported OPCAB may facilitate posterior vessel approach during OPCAB in those patients, in addition to those advantages of avoiding cardiopulmonary bypass and aortic cannulation. We experienced 2 cases of right heart supported OPCAB for those patients with cardiomegaly and left ventricle dysfunction.
Cardiomegaly ; Cardiopulmonary Bypass ; Catheterization ; Coronary Artery Bypass ; Coronary Artery Bypass, Off-Pump ; Heart Ventricles ; Heart* ; Hemodynamics ; Humans ; Surgical Procedures, Minimally Invasive ; Ventricular Dysfunction, Left

A 28-year-old man who had undergone bilateral thoracoscopic T2, T3 thoracic sympa-thectomy due to palmar hyperhidrosis 4 years earlier complained of coldness on right hand. Coldness of hand after thoracic sympathectomy is a rare phenomena. I report this case with brief review of the literatures.
Adult ; Hand* ; Humans ; Hyperhidrosis* ; Postoperative Complications ; Sympathectomy*

BACKGROUND: Recently, video-assisted thoracoscopic surgery(VATS) has been accepted as the standard treatment for spontaneous pneumothorax. However, comparatively high recurrent rate and cost-effectiveness are still controversial. The recurrent rate after bullectomy with VATS is reported to be as high as 5-10% whereas it is below 2% in thoracotomy. There is no statistical report on cost-effectiveness in Korean health care system. Material and METHOD: Our retrospective analysis was performed on 173 cases of surgically treated primary spontaneous pneumothorax at Kangbuk Samsung Hospital, Sungkyunkwan University, School of medicine, from January 1997 to July 1999. There were 104 cases VATS and 69 cases of thoracotomy. We analysed the operative indication, gender, operating time, amounts of the staples used, tube drainage, tube stay time, postoperative complications, recurrent rate, operation room cost, and total cost. RESULT: Operation time was 71.3 +/-29.5minutes in VATS group and 141 +/-52minutes in thoracotomy group(P<0.05). The postoperative tube stay and hospital stay are 3.93days and 7.5days in VATS group and 7.0 days and 13.4days in thoracotomy group, respectively(P<0.05, P<0.05). The number of recurrence after the operation in VATS group(6/104, 5.6%) was significantly higher than in thoracotomy group (1/69, 1.4%; P<0.05). The operation room cost was significantly higher in VATS group than in thoracotomy group (won 1,202,192 +/-178,992, won 1,005,669 +/-311,531; P<0.05), but considering the total cost, there was no significant difference between the two groups( won 1,946,110 +/- 487,440, won 1,793,912 +/-308,079; P=0.18). CONCLUSION: Although operative procedure and discharge policy may affect the recurrent rate and cost, there was no benefit of cost-effectiveness in VATS group and recurrent rate was higher in VATS group than in throacotomy group. It would be helpful to set up a prospective trial comparing cost and results of VATS versus minithoracotomy.
Cost-Benefit Analysis ; Delivery of Health Care ; Drainage ; Humans ; Length of Stay ; Pneumothorax* ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Surgical Procedures, Operative ; Thoracic Surgery, Video-Assisted* ; Thoracoscopy ; Thoracotomy*

BACKGROUND: Because the development of medicine, the survival of ESRD(end stage renal disease) patients were improved and the chance of secondary arteriovenous fistula formation was increased. The purpose of this study is to evaluate the patency rate of one of the secondary arteriovenous fistula formation. MATERIAL AND METHOD: From January 1995 to September 1998, arteriovenous fistulae were made in 365 patients with ESRD. Among them, 62 patients underwent revisional arteriovenous fistula. RESULT: The patency rate for revisional arteriovenous fistula was 78.8% at 6 months, 72% at 12 months, 63% at 24 months, 56.9% at 36 months. CONCLUSION: Revision is a reliable procedure for salvaging a failed and inadequate fistula, which yields an acceptable patency rate.
Arteriovenous Fistula* ; Fistula ; Forearm* ; Humans ; Kidney Failure, Chronic

BACKGROUND: Thoracoabdominal aortic aneurysms are very extensive disease entity and in the aspect of visceral organ and spinal cord protection, they still have high operative morbidity and mortality. We reviewed the operative results, complication rates, and mortality rates. MATERIAL AND METHOD: From Jan 1990 to Dec 1999, there were 38 patients with thoracoabdominal aortic aneurysms. We performed a retrospective study of the medical chart reviews. RESULT: Male to female ratio was 22:16, and mean age was 46.2 +/-12.3 years. According to the classification of thoracoabdominal aortic aneurysms by Crawford, there were were 13 patients in type I (34.2%), 19 patients in type II(50%), 4 patients in type III (11%), and 2 patients in type IV (4.8%) patients. The most common underlying diseases were chronic aortic dissection (29 cases, 76.3%) and Marfan syndrome (9 cases, 23.7%). Distal aortic perfusion was performed in 35 cases, and, among them, partial cardiopulmonary bypass was done in 31 cases and left atrium to femoral artery bypass was done in 4 cases. We used profound hypothermic total circulatory arrest in 4 of the 31 patients who underwent partial cardiopulmonary bypass. We did selective visceral perfusion during aorta clamping. The maximal diameter of aortic aneurysms was 8.2 +/-2.4 cm, and aneurysmal rupture occurred in 11 cases(28.9%). We performed aorta replacement using sequential clamping technique. We anastomosed Adamkiewicz arteries which were located between the T8 to T 12 levels and have relatively larger diameter and back-bleeding. Three early deaths occurred and the causes were cardiopulmonary bypass weaning failure in two cases and sudden hypotension with metabolic acidosis in one case. Early complications were hoarseness (5 cases), bleeding(5 cases), wound infection(3 cases) and long-term ventilatory care (3 cases). Paraplegia occurred in 2 cases and in 1 of them, we could not perform intercostal anastomoses due to severe aortic wall calcification. We traced 35 patients for 103.1 +/-6.1 months. Cumulative survival rates were 93.8% in 2 years, 86.1% in 5 years and 80.7% in 8 years. During the follow-up period, we observed 4 late deaths and the causes were 1 aortoesophageal fistula and 1 aneurysmal rupture in left common carotid artery, and 2 unknown. Late complications were abdominal aortic aneurysms (2 cases), ascending aorta and aortic root dilatation(1 case), aortopleural fistula (1 case), incisional hernia (1 case) and retrograde ej aculation (1 case). CONCLUSION: Our technique described here provides substantial protection against paraplegia. Furthermore, it allows complex operations to be performed on the thoracoabdominal aorta to be performed with acceptable morbidity and mortality.
Acidosis ; Aneurysm ; Aorta ; Aortic Aneurysm ; Aortic Aneurysm, Abdominal ; Aortic Aneurysm, Thoracic* ; Arteries ; Cardiopulmonary Bypass ; Carotid Artery, Common ; Classification ; Constriction ; Female ; Femoral Artery ; Fistula ; Follow-Up Studies ; Heart Atria ; Hernia ; Hoarseness ; Humans ; Hypotension ; Male ; Marfan Syndrome ; Mortality ; Paraplegia ; Perfusion ; Retrospective Studies ; Rupture ; Spinal Cord ; Survival Rate ; Weaning ; Wounds and Injuries

BACKGROUND: With mitral valvular heart disease, chronic atrial fibrillation(AF) is not likely to return to sinus rhythm after the operation. We evaluate the long term results and factors in recurrence of AF after modified Maze operation with mitral valve surgery. MATERIAL AND METHOD: From 1990 to 1996, 35 patients with chronic AF underwent modified Maze operation with mitral valve procedure in patients with chronic AF. The mean duration of AF was 7.7 +/-4.5 years. The concomitant operations were 34 mitral valve replacement(with 4 tricuspid annuloplasty and 3 tricuspid valve replacement)and 1 mitral valve repair. We analyzed the long term results and factors in recurrence of AF. RESULT: At immediate postoperatively, 33 of the 35 patients(93.9%) were converted to sinus rhythm. There was one operative death. However, AF recurred in 12 out of 35 patients during hospitalization and AF in these 12 patients were treated with antiarrhythmic drugs and electrical defibrillation 2-3 months later. Two out of twelve patients were failed in conversion to sinus rhythm after cessation of medication with side effects. During follow-up(71.1 +/-17.5 months, range 3-9 years), AF recurred in 9 patients and overall conversion rate to sinus rhythm was 73.5%. Predictors of postoperative AF included: duration of preoperative AF(maintenance group: recurrence group=6.3 years VS. 10.3 years, p=0.008) and cardiothoracic ratio on preoperative chest X-ray(0.58 VS. 0.72, p=0.009). CONCLUSION: AF surgery with mitral valve procedure increase the chance of recovery into sinus rhythm, reduce the incidence of atrial arrhythmia, and reduce the left atrial size with decreasing wall stress simultaneously. In order to decrease the incidence of postoperative arrhythmia, proper modification of the surgery with medical therapy should be considered.
Anti-Arrhythmia Agents ; Arrhythmias, Cardiac ; Atrial Fibrillation* ; Heart Valve Diseases ; Hospitalization ; Humans ; Incidence ; Mitral Valve ; Recurrence ; Thorax ; Tricuspid Valve