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Synovial Sarcoma of the Rib: Report of a Case.

Yong Soo CHOI ; Kwhan Mien KIM ; Jin Gook KIM ; Young Mog SHIM

The Korean Journal of Thoracic and Cardiovascular Surgery.1997;30(11):1154-1157.

Synovial sarcoma is an uncommon malignant mesenchymal tumor that occurs in the vicinity of the joints, bursae, and tendon sheaths. Typically the lesions are located in the extremities, especially in the lower extremities. They also occur in the abdominal and thoracic walls, but rarely in the head and neck. We experienced a case of synovial sarcoma of the rib in 17-year -old woman. We performed en bloc chest wall resection including the right second rib tumor, first and third ribs. The postoperative course was uneventful. She received chemotherapy because of a relapse of the tumor in sternum and both lung during follow-up.
Drug Therapy ; Extremities ; Female ; Follow-Up Studies ; Head ; Humans ; Joints ; Lower Extremity ; Lung ; Neck ; Recurrence ; Ribs* ; Sarcoma, Synovial* ; Sternum ; Tendons ; Thoracic Wall

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Re-Expansion Pulmonary Edema Associated with Resection of Ruptured Mediastinal Thymic Cyst: A Case Report.

Deog Gon CHO ; Jong Ho LEE ; Moon Sub KWACK ; Se Wha KIM

The Korean Journal of Thoracic and Cardiovascular Surgery.1997;30(11):1149-1153.

Unilateral reexpansion pulmonary edema(RPE) is generally considered a rare complication, occurring when a chronically atelectatic lung is rapidly reexpanded by tube thoracostomy or thoracentesis. It can also take place when the lung collapse is of short duration or when the lung is reexpanded without intrapleural suction. We experienced a case of RPE following surgical resection in mediastinal thymic cyst. A 26 year old female patient suffered from long-standing atelectasis of the right lung due to a huge mediastinal cyst that was misrecognized as tuberculous pleural effusion. Empyema developed after iatrogenic rupture of mediastinal cyst by pig-tailed tube thoracostomy. We successfully managed the ruptured mediastinal thymic cyst, empyema and postoperatively developed RPE following reexpansion of the collapsed lung. The patient was treated with drugs and mechanical ventilation with positive end-expiratory pressure for RPE. The remainder of her hospital course was uneventful.
Adult ; Empyema ; Female ; Humans ; Lung ; Mediastinal Cyst* ; Mediastinal Neoplasms ; Pleural Effusion ; Positive-Pressure Respiration ; Pulmonary Atelectasis ; Pulmonary Edema* ; Respiration, Artificial ; Rupture ; Suction ; Thoracostomy

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Acquired Herniation of Lung: a report of two cases.

Il Yong HAN ; Yang Haeng LEE ; Youn Ho HWANG ; Kwang Hyun CHO

The Korean Journal of Thoracic and Cardiovascular Surgery.1997;30(11):1145-1148.

Lung hernia is defined as a protrusion of lung parenchyma beyond the confines of the musculoskeletal thorax. To date, less than 300 cases have been reported in the literature. The patients were 37 and 57-year-old men who had traumatic rib fractures in the past, whose chief complaint was a painless soft bulging mass increased in size during expiration or coughing and diminished during inspiration or quiet breathing. The primary repair was performed without any postoperative recurrance. We report two cases of acquired herniation of lung first time in Korea with a brief review of literature.
Cough ; Hernia ; Humans ; Korea ; Lung* ; Male ; Middle Aged ; Respiration ; Rib Fractures ; Thorax

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Arterioesophageal Fistula Due to an Aberrant Right Subclavian Artery: A case report.

Kyung Hwan HWANG ; Eui Do HWANG ; Soo Young YOON ; Jae Hyeon YU ; Myung Hoon NA ; Sung Pyoung LIM ; Young LEE

The Korean Journal of Thoracic and Cardiovascular Surgery.1997;30(11):1142-1144.

A case of fatal hematemesis due to an aberrant right subclavian arterioesophageal fistula which is a rare complication of the vascular ring is presented. A 42-year-old man with multiple injury by traffic accident presented severe upper gastrointestinal bleeding and was taken emergent operation. He was keeping tracheostomy tube and nasogastric tube for 7 weeks. We could find an aberrant right subclavian arterioesophageal fistula through left thoracotomy which was made by irritation of the prolonged nasogastric tube. We carried division of the aberrant right subclavian artery and fistulectomy. He was doing well postoperatively. But massive bleeding occurred at the fifth postoperative day. We performed emergent reoperation at CCU and found the tear point on the suture site of the aorta, which might be developed due to irritation of the chest tube and/or infection of the surrounding tissues. He was expired at the 8th postoperative day due to ischemic brain damage.
Accidents, Traffic ; Adult ; Aorta ; Brain ; Chest Tubes ; Fistula* ; Hematemesis ; Hemorrhage ; Humans ; Multiple Trauma ; Reoperation ; Subclavian Artery* ; Sutures ; Thoracotomy ; Tracheostomy

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Minimally Invasive Aortic Valve Surgery: A Report of Two Cases.

Wan Ki BAEK ; Hyun Tae KIM ; Sang Suk SHIM ; Sang Rock CHO ; Hyun Hee PARK

The Korean Journal of Thoracic and Cardiovascular Surgery.1997;30(11):1139-1141.

Recently, minimally invasive approach via limited incision becomes one of the rapidly developing strategy in cardiac surgery as it gives less surgical trauma and is more satisfactory to the patients in respect to operative scar although the surgical technique is more demanding. Here, we report two cases of aortic valve replacement via limited transsternal incision. The methodology is described with review of the relevant literature.
Aortic Valve* ; Cicatrix ; Humans ; Surgical Procedures, Minimally Invasive ; Thoracic Surgery

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Cyclosporine-Associated Central Neurotoxicity after Hearat Transplantation: 1 Case Report.

Young Hee KIM ; Hyun SONG ; Meong Gun SONG

The Korean Journal of Thoracic and Cardiovascular Surgery.1997;30(11):1136-1138.

A 45-year-old man underwent heart transplantation due to dilated cardiomyopathy. Cyclosporine, 2 mg/kg per day, was intravenously given postoperatively. As central neurotoxicity signs that were included pin-point pupil, no light reflex, coma, were presented at 8 postoperative hours, cyclosporine was decreased to 1 mg/kg per day. At that time the cyclosporine level was 345 micro gram/L, the serum creatinine level was 1.8mg/dl and the serum magnesium level was within normal limit. He awaked at 31 postoperative hours and all sign of cyclosporine-induced central neurotoxicity was resolved after postoperative days. He was discharged without sequale at postoperative day 28.
Cardiomyopathy, Dilated ; Coma ; Creatinine ; Cyclosporine ; Heart Transplantation ; Humans ; Magnesium ; Middle Aged ; Pupil ; Reflex

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Pectus Excavatum and Pectus Carinatum: Associated Conditions, Family History, and Postoperative Patient Satisfaction.

Pinar KURU ; Aylin CAKIROGLU ; Aynur ER ; Hincal OZBAKIR ; Ali Emin CINEL ; Busra CANGUT ; Merve IRIS ; Berkay CANBAZ ; Ebru PICAK ; Mustafa YUKSEL

The Korean Journal of Thoracic and Cardiovascular Surgery.2016;49(1):29-34. doi:10.5090/kjtcs.2016.49.1.29

BACKGROUND: Pectus excavatum (PE) and pectus carinatum (PC) are the most common chest wall deformities. In this study, we aimed to characterize how patients obtained information about these deformities, as well as patients' family history, associated medical problems, and postoperative satisfaction after the Nuss and Abramson procedures. METHODS: This cross-sectional retrospective study included patients who were operated by a single surgeon between 2006 and 2013. Follow-up calls were made after approval of our institution's ethics committee. We reached 207 of the 336 PE patients (61.6%) and 73 of the 96 PC patients (76%). RESULTS: The majority of the patients were male (85% of the PE patients and 91.8% of the PC patients). The age of diagnosis of PE was 14.52+/-0.51 years and the age at the time of operation was 17.89+/-0.42 years; for PC patients, the corresponding ages were 15.23+/-0.55 years and 16.77+/-0.55 years, respectively. A total of 70% of the PE patients and 63.8% of the PC patients obtained information about pectus deformities through the Internet. In 27.1% of the PE patients with an associated anomaly, 57.1% (n=13) had scoliosis, while 41.1% of the PC patients with an associated anomaly had kyphosis (n=5). Postoperative satisfaction, as evaluated on a scale from 0 to 10, was 8.17+/-0.15 for PE patients and 8.37+/-0.26 for PC patients. The postoperative pain duration was 51.93+/-5.18 days for PE patients and 38.5+/-6.88 days for PC patients. CONCLUSION: In this study, we found that most patients with pectus deformities were male. The Internet was an important resource for patients to learn about their deformities. Family history and associated anomalies were identified as important aspects for consideration in the clinical setting. The patients reported high levels of postoperative satisfaction, and pain management was found to be one of the most important elements of postoperative care.
Congenital Abnormalities ; Diagnosis ; Ethics Committees ; Follow-Up Studies ; Funnel Chest* ; Humans ; Internet ; Kyphosis ; Male ; Pain Management ; Pain, Postoperative ; Patient Satisfaction* ; Postoperative Care ; Retrospective Studies ; Scoliosis ; Thoracic Wall

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Selective Carotid Shunting Based on Intraoperative Transcranial Doppler Imaging during Carotid Endarterectomy: A Retrospective Single-Center Review.

Jun Woo CHO ; Yun Ho JEON ; Chi Hoon BAE

The Korean Journal of Thoracic and Cardiovascular Surgery.2016;49(1):22-28. doi:10.5090/kjtcs.2016.49.1.22

BACKGROUND: Carotid endarterectomy (CEA) with selective shunting is the surgical method currently used to treat patients with carotid artery disease. We evaluated the incidence of major postoperative complications in patients who underwent CEA with selective shunting under transcranial Doppler (TCD) at our institution. METHODS: The records of 45 patients who underwent CEA with TCD-based selective shunting under general anesthesia from November 2009 to June 2015 were reviewed. The risk factors for postoperative complications were analyzed using univariate and multivariate analysis. RESULTS: Preoperative atrial fibrillation was observed in three patients. Plaque ulceration was detected in 10 patients (22.2%) by preoperative computed tomography imaging. High-level stenosis was observed in 16 patients (35.5%), and 18 patients had contralateral stenosis. Twenty patients (44.4%) required shunt placement due to reduced TCD flow or a poor temporal window. The 30-day mortality rate was 2.2%. No cases of major stroke were observed in the 30 days after surgery, but four cases of minor stroke were noted. Univariate analysis showed that preoperative atrial fibrillation (odds ratio [OR], 40; p=0.018) and ex-smoker status (OR, 17.5; p=0.021) were statistically significant risk factors for a minor stroke in the 30-day postoperative period. Analogously, multivariate analysis also found that atrial fibrillation (p<0.001) and ex-smoker status (p=0.002) were significant risk factors for a minor stroke in the 30-day postoperative period. No variables were identified as risk factors for 30-day major stroke or death. No wound complications were found, although one (2.2%) of the patients suffered from a hypoglossal nerve injury. CONCLUSION: TCD-based CEA is a safe and reliable method to treat patients with carotid artery disease. Preoperative atrial fibrillation and ex-smoker status were found to increase the postoperative risk of a small embolism leading to a minor neurologic deficit.
Anesthesia, General ; Atrial Fibrillation ; Carotid Artery Diseases ; Constriction, Pathologic ; Embolism ; Endarterectomy, Carotid* ; Humans ; Hypoglossal Nerve Injuries ; Incidence ; Mortality ; Multivariate Analysis ; Neurologic Manifestations ; Postoperative Complications ; Postoperative Period ; Retrospective Studies* ; Risk Factors ; Stroke ; Ulcer ; Ultrasonography, Doppler, Transcranial ; Wounds and Injuries

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The Risk Factors and Outcomes of Acute Kidney Injury after Thoracic Endovascular Aortic Repair.

Yun Ho JEON ; Chi Hoon BAE

The Korean Journal of Thoracic and Cardiovascular Surgery.2016;49(1):15-21. doi:10.5090/kjtcs.2016.49.1.15

BACKGROUND: We aimed to evaluate the incidence, predictive factors, and impact of acute kidney injury (AKI) after thoracic endovascular aortic repair (TEVAR). METHODS: A total of 53 patients who underwent 57 TEVAR operations between 2008 and 2015 were reviewed for the incidence of AKI as defined by the RIFLE (risk, injury, failure, loss, and end-stage kidney disease risk) consensus criteria. The estimated glomerular filtration rate was determined in the perioperative period. Comorbidities and postoperative outcomes were retrospectively reviewed. RESULTS: Underlying aortic pathologies included 21 degenerative aortic aneurysms, 20 blunt traumatic aortic injuries, six type B aortic dissections, five type B intramural hematomas, three endoleaks and two miscellaneous diseases. The mean age of the patients was 61.2+/-17.5 years (range, 15 to 85 years). AKI was identified in 13 (22.8%) of 57 patients. There was an association of preoperative stroke and postoperative paraparesis and paraplegia with AKI. The average intensive care unit (ICU) stay in patients with AKI was significantly longer than in patients without AKI (5.3 vs. 12.7 days, p=0.017). The 30-day mortality rate in patients with AKI was significantly higher than patients without AKI (23.1% vs. 4.5%, p=0.038); however, AKI did not impact long-term survival. CONCLUSION: Preoperative stroke and postoperative paraparesis and paraplegia were identified as predictors for AKI. Patients with AKI experienced longer average ICU stays and greater 30-day mortality than those without AKI. Perioperative identification of high-risk patients, as well as nephroprotective strategies to reduce the incidence of AKI, should be considered as important aspects of a successful TEVAR procedure.
Acute Kidney Injury* ; Aortic Aneurysm ; Comorbidity ; Consensus ; Endoleak ; Glomerular Filtration Rate ; Hematoma ; Humans ; Incidence ; Intensive Care Units ; Kidney Failure, Chronic ; Mortality ; Paraparesis ; Paraplegia ; Pathology ; Perioperative Period ; Retrospective Studies ; Risk Factors* ; Stroke

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Repair of Tetralogy of Fallot in Infancy via the Atrioventricular Approach.

Hamid BIGDELIAN ; Mohsen SEDIGHI

The Korean Journal of Thoracic and Cardiovascular Surgery.2016;49(1):9-14. doi:10.5090/kjtcs.2016.49.1.9

BACKGROUND: Tetralogy of Fallot (TOF) is a well-recognized congenital heart disease. Despite improvements in the outcomes of surgical repair, the optimal timing of surgery and type of surgical management of patients with TOF remains controversial. The purpose of this study was to assess outcomes following the repair of TOF in infants depending on the surgical procedure used. METHODS: This study involved the retrospective review of 120 patients who underwent TOF repair between 2010 and 2013. Patients were divided into three groups depending on the surgical procedure that they underwent. Corrective surgery was done via the transventricular approach (n=40), the transatrial approach (n=40), or a combined atrioventricular approach (n=40). Demographic data and the outcomes of the surgical procedures were compared among the groups. RESULTS: In the atrioventricular group, the incidence of the following complications was found to be significantly lower than in the other groups: complete heart block (p=0.034), right ventricular failure (p=0.027) and mediastinal bleeding (p=0.007). Patients in the atrioventricular group had a better postoperative right ventricular ejection fraction (p=0.001). No statistically significant differences were observed among the three surgical groups in the occurrence of tachycardia, renal failure, and tricuspid incompetence. The one-year survival rates in the three groups were 95%, 90%, and 97.5%, respectively (p=0.395). CONCLUSION: Combined atrioventricular repair of TOF in infancy can be safely performed, with acceptable surgical risk, a low incidence of reoperation, good ventricular function outcomes, and an excellent survival rate.
Cardiopulmonary Bypass ; Congenital Abnormalities ; Heart Block ; Heart Defects, Congenital ; Hemorrhage ; Humans ; Incidence ; Infant ; Renal Insufficiency ; Reoperation ; Retrospective Studies ; Stroke Volume ; Survival Rate ; Tachycardia ; Tetralogy of Fallot* ; Tricuspid Valve Insufficiency ; Ventricular Function

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