Background: Nasal bone fractures are frequently encountered in clinical practice. Although fracture reduction is simple and correction requires a short operative time, low patient satisfaction and relatively high complication rates remain issues for many surgeons. These challenges may result from inaccuracies in fracture recognition and assessment or inappropriate surgical planning. Findings from immediate postoperative computed tomography (CT) scans and those performed at 4 to 6 weeks postoperatively were compared to evaluate the accuracy and outcomes of nasal fracture reduction. Methods: This retrospective study included patients diagnosed with nasal bone fractures at our department who underwent closed reduction surgery. Patients who did not undergo additional CT scans were excluded from the study. Clinical examinations, patient records, and radiographic images were evaluated in 20 patients with nasal bone fractures. Results: CT findings from immediately after surgery and a 1month follow-up were compared in 20 patients. Satisfactory nasal projection and aesthetically acceptable results were observed in patients with accurate correction or mild overcorrection, while undercorrection was associated with unfavorable results. Conclusion Closed reduction surgery for correcting nasal bone fractures usually provides acceptable outcomes with relatively few complications. If available, immediate postoperative CT scans are recommended to guide surgeons in the choice of whether to perform secondary adjustments if the initial results are unsatisfactory. Based on photogrammetric data, nasal bone reduction with accurate correction or mild overcorrection achieved acceptable and stable outcomes at 1 month postoperatively. Therefore, when upward dislocation is observed on postoperative CT, one can simply observe without a subsequent intervention.

Background: Nasal bone fractures are frequently encountered in clinical practice. Although fracture reduction is simple and correction requires a short operative time, low patient satisfaction and relatively high complication rates remain issues for many surgeons. These challenges may result from inaccuracies in fracture recognition and assessment or inappropriate surgical planning. Findings from immediate postoperative computed tomography (CT) scans and those performed at 4 to 6 weeks postoperatively were compared to evaluate the accuracy and outcomes of nasal fracture reduction. Methods: This retrospective study included patients diagnosed with nasal bone fractures at our department who underwent closed reduction surgery. Patients who did not undergo additional CT scans were excluded from the study. Clinical examinations, patient records, and radiographic images were evaluated in 20 patients with nasal bone fractures. Results: CT findings from immediately after surgery and a 1month follow-up were compared in 20 patients. Satisfactory nasal projection and aesthetically acceptable results were observed in patients with accurate correction or mild overcorrection, while undercorrection was associated with unfavorable results. Conclusion Closed reduction surgery for correcting nasal bone fractures usually provides acceptable outcomes with relatively few complications. If available, immediate postoperative CT scans are recommended to guide surgeons in the choice of whether to perform secondary adjustments if the initial results are unsatisfactory. Based on photogrammetric data, nasal bone reduction with accurate correction or mild overcorrection achieved acceptable and stable outcomes at 1 month postoperatively. Therefore, when upward dislocation is observed on postoperative CT, one can simply observe without a subsequent intervention.

Recently, stent-graft insertion has been widely used along with surgery for treatment of thoracic and abdominal aortic aneurysm. However, use of stent-graft insertion is controversial in descending aortic dissection. We report here on our experience of a patient who received a stent-graft for descending aortic dissection that nearly ruptured. Based on CT findings at three months follow up, results were satisfactory.
Aortic Aneurysm, Abdominal ; Follow-Up Studies ; Humans ; Stents

BACKGROUND: Most surgeons favor the pledgeted suture technique for heart valve replacements because they believe it decreases the risk of paravalvular leak (PVL). We hypothesized that the use of nonpledgeted rather than pledgeted sutures during mitral valve replacement (MVR) may decrease the incidence of prosthetic valve endocarditis (PVE) and risk of a major PVL. METHODS: We analyzed 263 patients, divided into 175 patients who underwent MVR with nonpledgeted sutures from January 2003 to December 2013 and 88 patients who underwent MVR with pledgeted sutures from January 1995 to December 2001. We compared the occurrence of PVL and PVE between these groups. RESULTS: In patients who underwent MVR with or without tricuspid valve surgery and/or a Maze operation, PVL occurred in 1.1% of the pledgeted group and 2.9% of the nonpledgeted group. The incidence of PVE was 2.9% in the nonpledgeted group and 1.1% in the pledgeted group. No differences were statistically significant. CONCLUSION: We suggest that a nonpledgeted suture technique can be an alternative to the traditional use of pledgeted sutures in most patients who undergo MVR, with no significant difference in the incidence of PVL.
Endocarditis ; Heart Valves ; Humans ; Incidence ; Mitral Valve* ; Suture Techniques* ; Sutures ; Tricuspid Valve

BACKGROUND: The axillary artery is frequently used for cardiopulmonary bypass, especially in acute aortic dissection. We have cannulated the axillary artery using a side graft or by directly using Seldinger's technique. The purpose of this study was to assess the technical problems and complications of both cannulation techniques. MATERIALS AND METHODS: From January 2003 to December 2009, 53 patients underwent operations using the axillary artery for arterial cannulation. The axillary artery was cannulated with a side graft in 35 patients (side graft group) and directly using Seldinger's technique in 18 patients (direct group). RESULTS: The results were compared between two groups, focusing on cannulation-related morbidities including neurologic morbidity. Arterial damage or dissection of the axillary artery occurred in 1 (2.9%) patient in the side graft group and in 1 (5.6%) patient in the direct group. Malperfusion and insufficient flow did not occur in either group. There were no postoperative complications related to axillary cannulation, such as brachial plexus injury, compartment syndrome, or local wound infection, in either group. CONCLUSION: Technical problems and complications of the axillary arterial cannulation in both techniques were rare. Direct arterial cannulation using Seldinger's technique was done safely and more simply than the previous technique. It was concluded that both axillary arterial cannulation techniques are acceptable and it remains the surgeon's preference which technique should be used.
Axillary Artery ; Brachial Plexus ; Cardiopulmonary Bypass ; Catheterization ; Compartment Syndromes ; Focus Groups ; Humans ; Postoperative Complications ; Transplants ; Wound Infection

Acute malperfusion syndrome is a serious complication of acute aortic dissection. A 76-year-old female patient was admitted with acute type B aortic dissection and developed renal malperfusion during medical therapy. We are reporting a clinically successful result from the thoracic endovascular aortic repair used for malperfusion syndrome that occurred by acute type B aortic dissection.
Aged ; Aorta ; Female ; Humans ; Stents ; Transplants

BACKGROUND: The improvements in endoscopic equipment and surgical robots has encouraged the performance of minimally invasive cardiac operations. Yet only a few Korean studies have compared this procedure with the sternotomy approach. MATERIAL AND METHOD: Between December 2005 and July 2007, 48 patients (group A) underwent minimally invasive cardiac surgery with AESOP through a small right thoracotomy. During the same period, 50 patients (group B) underwent conventional surgery. We compared the operative time, the operative results, the post-operative pain and the recovery of both groups. RESULT: There was no hospital mortality and there were no significant differences in the incidence of operative complications between the two groups. The operative (292.7+/-61.7 and 264.0+/-47.9 min, respectively; p=0.01) and CPB times (128.4+/-37.6 and 101.7+/-32.5 min, respectively; p<0.01) were longer for group A, whereas there was no difference between the aortic cross clamp times (82.1+/-35.0 and 87.8+/-113.5 min, respectively; p=0.74) and ventilator times (18.0+/-18.4 and 19.7+/-9.7 hr, respectively; p=0.57) between the groups. The stay on the ICU (53.2+/-40.2 and 72.8+/-42.1 hr, respectively; p=0.02) and the hospitalization time (9.7+/-7.2 and 14.8+/-11.9 days, respectively; p=0.01) were shorter for group A. The patients in group B had more transfusions, but the difference was not significant. For the overall operative intervals, which ranged from one to four weeks, the pain score was significantly lower for the patients of group A than for the patients of group B. In terms of the postoperative activities, which were measured by the Duke Activity Scale questionnaire, the functional status score was clearly higher for group A compared to group B. The analysis showed no difference in the severity of either post-repair of mitral (0.7+/-1.0 and 0.9+/-0.9, respectively; p=0.60) and tricuspid regurgitation (1.0+/-0.9 and 1.1+/-1.0, respectively; p=0.89). In both groups, there were no valve related complications, except for one patient with paravalvular leakage in each group. CONCLUSION: These results show that compared with the median sternotomy patients, the patients who underwent minimally invasive surgery enjoyed significant postoperative advantages such as less pain, a more rapid return to full activity, improved cosmetics and a reduced hospital stay. The minimally invasive surgery can be done with similar clinical safety compared to the conventional surgery that's done through a median sternotomy.
Cosmetics ; Hospital Mortality ; Hospitalization ; Humans ; Incidence ; Length of Stay ; Operative Time ; Surveys and Questionnaires ; Robotics ; Sternotomy ; Thoracic Surgery ; Thoracotomy ; Tricuspid Valve Insufficiency ; Ventilators, Mechanical

Sclerosing mesenteritis is a rare benign disease with a prevalence of 0.16–3.4% and is characterized by chronic nonspecific inflammation and extensive fibrosis in the adipose tissue of the mesentery although the exact pathogenesis is still elusive. A 65-year-old woman was referred with suspicion of an abdominal mass and biliary stones on abdominal ultrasonography and CT. Bile duct stones were confirmed by endoscopic ultrasonography and successfully treated by endoscopic retrograde cholangiography with stone removal. Furthermore, a 4.7 cm conglomerated mass on small intestinal mesentery was suspected as sclerosing mesenteritis based on the features on abdominal MRI. However, because it could not be differentiated from malignancy without histologic examination, laparoscopic excisional biopsy was performed; it showed only inflammatory cells with extensive fibrosis. Therefore, the abdominal mass was confirmed as sclerosing fibrosis and the patient was followed-up without any treatments because no mass-related symptoms accompanied the findings. Six months later, abdominal CT showed no significant change in the mass. Herein, we report a rare case of incidentally found idiopathic sclerosing mesenteritis.
Adipose Tissue ; Aged ; Bile Ducts ; Biopsy ; Cholangiography ; Endosonography ; Female ; Fibrosis ; Humans ; Immunoglobulins* ; Inflammation ; Magnetic Resonance Imaging ; Mesentery ; Panniculitis, Peritoneal ; Prevalence ; Sclerosis* ; Tomography, X-Ray Computed ; Ultrasonography

Multiple endocrine neoplasia type 1 (MEN 1) is the association of neoplastic transformation of parathyroid, pituitary, and pancreatic islet cells. This syndrome is inherited as an autosomal dominant trait. A 38-year-old woman presented with general weakness and mental changes. She had experienced same symptoms 7 years ago, after then her weight gradually increased. Insulinoma was suspected by markedly decreased blood glucose level (20mg/dL) and the increased insulin/glucose ratio (0.43) that sampled in emergency room at the time of mental change. Unusually large pancreatic tail mass and Lt, adrenal gland mass were detected by abdominal CT. Percutaneous transhepatic portal vein catheterization with insulin sampling showed sudden step up of insulin/glucose ratio at the middle portion of pancreas. Measuring of basal pituitary hormones as a screening procedure of MEN showed increased basal prolactin level. Combined pituitary stimulation test showed blunted response of prolactin to TRH and sellar magnetic resonance imaging showed intrasellar mass. Thyroid nodule was palpated on her anterior neck. Thyroid scintigram showed cold nodule, and there was no lymphadenopathy around the nodule by the thyroid sonogram. Fine needle aspiration cytology showed benign hyperplastic follicular cells only. Serum ionized calcium and parathyroid hormone level were normal. Under the impression of MEN type I, the distal pancreatectomy, splenectomy, Lt. thyroid lobectomy and Lt. adrenalectomy was performed at the same time. Histologic examination of the surgically removed tissues revealed pancreas islet cell tumor, adrenal cortical adenoma and thyroid adenoma. Transient hyperglycemia was developed after surgical intervention, but thereafter she never felt any symptoms of hypoglycemia till now and her blood glucose showed completely normal level with oral glucose tolerance tests. We present this case with a review of literature.
Adenoma, Islet Cell ; Adrenal Glands ; Adrenalectomy ; Adrenocortical Adenoma ; Adult ; Biopsy, Fine-Needle ; Blood Glucose ; Calcium ; Catheterization ; Catheters ; Emergency Service, Hospital ; Female ; Glucose Tolerance Test ; Humans ; Hyperglycemia ; Hypoglycemia ; Insulin ; Insulinoma ; Islets of Langerhans ; Lymphatic Diseases ; Magnetic Resonance Imaging ; Male ; Mass Screening ; Multiple Endocrine Neoplasia Type 1* ; Multiple Endocrine Neoplasia* ; Neck ; Pancreas ; Pancreatectomy ; Parathyroid Hormone ; Pituitary Hormones ; Portal Vein ; Prolactin ; Splenectomy ; Thyroid Gland ; Thyroid Neoplasms ; Thyroid Nodule ; Tomography, X-Ray Computed

OBJECTIVE: The purpose of this study was to assess the time-response of clip compression model for the relationship between the duration of the injury on the rat thoracic spinal cord, and histological and functional outcome measures. METHODS: After laminectomy at T9 in Sprague-Dawley rats, a modified aneurysm clip with a closing force of 30-gram was applied extradurally around the spinal cord at T9, and then rapidly released with cord compression persisting for 1, 5, and 10 minutes, respectively. The locomotor function, according to the Basso-Beattie-Bresnahan (BBB) scale, was assessed weekly for 4 weeks after the injury. The injured spinal cord was then examined histologically including quantification of cavitation. RESULTS: Spinal cord injury by clip compression resulted in worsened BBB scale scores. However, there was spontaneous functional improvement in times for all 3 injury severities, with the greatest improvement in the 1-minute compression group. From 1 week after the injury, BBB scores in the 1-minute group were significantly higher than in the 5 or 10-minutes groups until the end of the follow-up period (p<0.05). For histological analysis, the cavitation area and cavity volume at 4 weeks was directly proportional to the severity of the injury. CONCLUSION: The results of this study show that the rat thoracic cord clip compression model is a reliable and reproducible spinal cord injury model. The duration of clip compression injury in the rat thoracic cord has been correlated with both functional and histologic outcome measures.
Aneurysm ; Animals ; Follow-Up Studies ; Laminectomy ; Outcome Assessment (Health Care) ; Rats ; Rats, Sprague-Dawley ; Spinal Cord ; Spinal Cord Injuries