• Journal of Chest Surgery
• /
• v.48 no.6
• /
• pp.443-446
• /
• 2015

A 36-year-old man, who had undergone thoracoscopic anterior spinal fusion using the plate system and posterior screw fusion three months previously, presented to our hospital with left flank pain and fever. Computed tomography indicated the presence of a psoas muscle abscess. However, after two days of percutaneous catheter drainage, a mycotic abdominal aortic pseudoaneurysm was detected via computed tomography. We performed in situ revascularization using a prosthetic graft with omental wrapping. Methicillin-resistant Staphylococcus aureus was identified on blood and pus culture, and systemic vancomycin was administered for one month. Although the abscess recurred, it was successfully treated with percutaneous catheter drainage and systemic vancomycin administration for three months, without the need for instrumentation removal. The patient remained asymptomatic throughout two years of follow-up.

• Parasites, Hosts and Diseases
• /
• v.47 no.4
• /
• pp.405-407
• /
• 2009

On July 2009, 5 fly larvae were discovered inside the nose of a 76-year-old female. She was living in Cheonansi, and in a state of coma due to rupture of an aortic aneurysm. Surgery was performed on the day of admission, and the larvae were found 4 days later. By observing their posterior spiracle, the larvae were identified as Lucilia sericata. Considering the rapid development of this species, the infection was likely acquired during hospitalization. Further investigation on the hospital environment should be needed to know the origin of the infection.

• Journal of Chest Surgery
• /
• v.52 no.3
• /
• pp.186-188
• /
• 2019

We report an unusual case of delayed bleeding after open surgical repair of a thoracoabdominal aortic aneurysm. A 79-year-old man developed a massive retroperitoneal hematoma 49 days after Crawford type III thoracoabdominal aorta replacement. During emergency surgery, a tear was found in the prosthetic vascular graft caused by a sharp bony spur arising from the second lumbar vertebral body. This rare, but potentially lethal, complication indicates that attention should be paid to sharp bony structures during open repair of the descending aorta.

• Journal of Chest Surgery
• /
• v.43 no.6
• /
• pp.781-784
• /
• 2010

A 74-year-old woman presented at our hospital with hemoptysis. Three months ago, she had endovascular stent-grafting done by a general surgeon for a saccular thoracic aneurysm that was found accidentally following an episode of fever and chills. Despite a lasting fever after the procedure, she was discharged without further treatment and follow-up. She was subsequently admitted to the hospital for evaluation and several exams were performed. Chest CT scans and an esophagoscopy identified an aorto-esophageal fistula at the level of the aorta that was covered by a previous stent-graft. After extensive administration of antibiotics, surgery was done - esophagectomy, cervical esophago-gastrostomy and replacement of the thoracic aorta. She was later discharged uneventfully.

• Clinical and Experimental Pediatrics
• /
• v.49 no.3
• /
• pp.287-291
• /
• 2006

Purpose : Aneurysms of sinus valsalva are rare anormalies thought to be primarily congenital in origin, progressing into death by acute heart failure in cases of rupture. Surgical correction is the only method of treatment. With these clinical implications, we reviewed the clinical characteristics and surgical results of patients with ruptured sinus of valsalva aneurysm. Methods : Between January 1991 and February 2004, 17 patients with ruptured sinus of valsalva aneurysm were retrospectively reviewed for their clinical symptoms, physical findings, past history, coexistent cardiac anormalies, surgical results, and mid-term prognosis. Results : The 17 patients included 13 men and four women, with a mean age of 30 years(10-59 years). Preoperatively accompanying cardiac anormalies were ventricular septal defect(VSD, eight cases of doubly committed juxta-arterial VSD) and aortic insufficiency(11 cases). During operations, patterns of fistulous tracts were found to be right colonary sinus-right ventricle in 13 patients, right coronary sinus-right atrium in one, noncoronary sinus - right ventricle in two, noncoronary sinus - right atrium in one, and VSD was noticed in 14 patients(all were doubly committed juxta-arterial in type). The defects were closed with a patch in 13 patients, without a patch in four, with concommitant aortic valve replacement in four and with aortic valvuloplasty in two. There were no mortalities during operations or the mid-term follow-up periods($40{\pm}49$ months). Conclusion : Because, at least in Orientals, VSD(especially doubly committed juxta-arterial) was accompanied in large numbers of patients with aneurysms of sinus valsalva, preoperative evaluations of this congenital heart disease should be made very careful. And we may need to revise the algorithm of treatment policy in small sized doubly committed juxta-arterial VSD.

• Journal of Chest Surgery
• /
• v.35 no.7
• /
• pp.530-534
• /
• 2002

Background: In aortic surgery, division and ligation of the left brachiocephalic vein(LBV) may improve exposure of the aortic arch but controversy continues about the safety of this division and whether a divided vein should be reanastomosed after arch replacement was completed. The safety of LBV division and the fate of the left subclavian venous drainage after LBV division were studied. Material and Method: From November 1998 to January 2001, planned division and ligation of the LBV on the mid-line after median sternotomy was peformed in 10 patients during the aortic surgery with the consideration of local anatomy and distal aortic anastomosis. Assessment for upper extremity edema and neurologic symptoms, measurement of venous pressure in the right atrium and left internal jugular vein, and digital subtraction venography(DSV) of the left arm were made postoperatively. Result: In 10 patients there was improvement in access to the aortic arch for procedures on the ascending aorta or aortic arch. The mean age of patients was 62 years(range 24 to 70). Follow-up ranged from 3 weeks to 13 months. One patient died because of mediastinitis from methicilline-resistant staphylococcus aureus strain. All patients had edema on the left upper extremity, but resolved by the postoperative day 4. No patient had any residual edema or difficulty in using the left upper extremity during the entire follow-up period. No patient had postoperative stroke. Pressure difference between the right atrium and left internal jugular vein was peaked on the immediate postoperative period(mean peak pressure difference = 25mmHg), but gradually decreased, then plated by the postoperative day 4. In all DSV studies left subclavian vein flowed across the midline through the inferior thyroid venous plexus. Conclusion: We conclude that division of LBV is safe and reanastomosis is not necessary if inferior thyroid vein, which is developed as a main bridge connecting the left subclavian vein with right venous system, is preserved.

• Journal of Trauma and Injury
• /
• v.18 no.1
• /
• pp.70-79
• /
• 2005

Background: Abdominal compartment syndrome has multiple etiologies that are not only related to trauma but also any problem condition in the absence of abdominal injury. To determine whether prevention of the abdominal compartment syndrome after celiotomy for trauma victims justifies the use of temporary abdominal coverage with monofilament knitted polypropylene mesh (Malex mesh) in severely injured patients. Method: Medical records at the Ajou University Medical Center were reviewed for a 32-month period from May 1st, 2002 to December 31st, 2004. Twenty-nine consecutive patients requiring celiotomy who were survived until at the end of celiotomy received temporary abdominal coverage and staged abdominal repairs with Malex mesh. One of them was dissecting aortic aneurysm patient and the others were all trauma victims. Malex mesh prosthesis coverage was used in cases of abdominal compartment syndrome due to excessive fascial tension, severe bowel edema and retroperitoneal hemorrhage or edema followed by staged abdominal repairs. Result: Eighteen of twenty-nine patients were survived. Demographic characteristics, injury severity number of abdominal-pelvic bone injuries, mortality rate, complications, number of operations for permanent closure, required time for permanent closure showed no difference between man and women or child and adult. Except one dissecting aortic aneurysm patient, trauma cases showed $3.24{\pm}0.98$ injury sites. All cases that received temporary abdominal coverage and staged abdominal repairs did not show abdominal compartment syndrome. $10.08{\pm}5.85$ days and $2.27{\pm}0.82$ times of operation required making permanent abdominal closure after temporary abdominal coverage followed by staged abdominal repairs. Most of surviving patients have shown antibiotic-resistant organism and fungus infection. Patients who received permanent closure recovered from infectious problem completely. Conclusion: The use of Malex mesh for temporary abdominal coverage in severely injured patients undergoing celiotomy was effective treatment method.

• Proceedings of the KOR-BRONCHOESO Conference
• /
• 1982.05a
• /
• pp.8.2-8
• /
• 1982

Hoarseness is the change of voice quality which represents the abnormal function of phonation and is the main symtom of the laryngeal diseases. The etiology of hoarseness are known more than 50 causes, among them, viral upper respiratory infection is the main cause of hoarseness and the laryngeal nodule and polyp, laryngeal paralysis, laryngeal cancer, laryngeal papilloma and the laryngeal tuberculosis are the other causes of hoarseness in that order. Recently, the authors experienced 4 cases of uncommon etiology of hoarseness, so we present the cases with the brief review of literatures. Case 1. 29 years old male Admitted in Dept. of neurosurgery due to Traffic Accident. He had a trauma on the anterior neck. Hoarseness was developed on 1 month after the accident. Laryngoscopic finding; Paramedian paralysis of left vocal cord. Displacement of left arytenoid cartilage. Case 2. 53 years old male Admitted in Dept. of General Surgery due to Clonorchis Sinensis, under the general endotracheal anesthesia, Choledochostomy was performed. Laryngoscopic finding; Median paralysis of left vocal cord. Case 3. 56 years old male Admitted in Dept. of Internal Medicine due to Aortic Aneurysm. Hoarseness was developed on 3 months prior to admission. Laryngoscopic finding; Intermediated position paralysis of left vocal cord. Displacement of left arytenoid cartilage. Case 4. 74 years old male Admitted in Dept. of Internal Medicine due to Bronchogenic carcinoma. Hoarseness was developed on 3 years prior to admission. Laryngoscopic finding; Paramedian paralysis of right vocal cord.

• Journal of Chest Surgery
• /
• v.26 no.7
• /
• pp.513-520
• /
• 1993

Surgical treatment of aneurysm or dissection involving the ascending aorta and aortic arch still poses one of the most complicated technical and tactical challenges in surgery. The use of total circulatory arrest[TCA] with profound hypothermia in the surgical treatment of aneurysmal dissection involving the ascending aorta and aortic arch has been reported as popular surgical methods. However, the safe period of prolonged circulatory arrest with hypothermia remains controversial and ischemic damage to the central nervous system and uncontrollable perioperative bleeding have been the major problem. We have found profound hypothermic circulatory arrest with retrograde cerebral perfusion via the superior vena cava to achieve cerebral protection. We experiment the aortic anastomosis in 7 adult mongrel dogs, using profound hypothermic circulatory arrest with continuous retrograde cerebral perfusion[RGCP] via superior vena cava. We also studied the extent of cerebral protection using above surgical methods, by gas analysis of retrograde cerebral perfusion blood and returned blood of aortic arch, preoperative, intraoperative and postoperative electroencephalography and microscopic findings of brain tissue. The results were as follows: 1. The cooling time ranged from 15 minutes to 24 minutes[19.71$\pm$ 3.20 minutes] ; Aorta cross clamp time ranged from 70 minutes to 89 minutes[79.86 $\pm$ 7.54 minutes] ; Rewarming time ranged from 35 minutes to 47 minutes[42.86$\pm$ 4.30 minutes] ; The extracorporeal circulation time ranged from 118 minutes to 140 minutes[128.43$\pm$ 8.98 minutes] [Table 2]. 2. The oxygen content in the oxygenated blood after RGCP was 12.66$\pm$ 1.25 ml/dl. At 5 minutes after the initiation of RGCP, the oxygen content of returnedlood was 7.58$\pm$ 0.21 ml/dl, and at 15 minutes 7.35$\pm$ 0.17 ml/dl, at 30 minutes 7.20$\pm$ 0.19 ml/dl, at 60 minutes 6.63$\pm$ 0.14 ml/dl [Table 3]. 3. Intraoperative electroencephalographic finding revealed low amplitude potential during hypothermia, and no electrical impulse throughout the period of circulatory arrest and RGCP. Electrical activity appeared after reperfusion, and the electroencephalographic reading also recovered rapidly as body temperature returned to normal [Fig. 2]. 4. The microscopic finding of brain tissue showed widening of the interfibrillar spaces. But there was no evidence of tissue necrosis or hemorrhage [Fig. 3]. We concluded the retrograde cerebral perfusion during hypothermic circulatory arrest is a simplified technique that may have a excellent brain protection.

• Journal of Korean Neurosurgical Society
• /
• v.53 no.2
• /
• pp.72-76
• /
• 2013

Objective : Cerebral aneurysm (CA) is an important acquired cerebrovascular disease that can cause catastrophic results. MicroRNAs (miRNAs) are small non-coding RNAs, playing essential roles in modulating basic physiologic and pathological processes. Currently, evidences have been established about biologic relationship between miRNAs and abdominal aortic aneurysms. However, biologic roles of miRNAs in CA formation have not been explained yet. We employed microarray analysis to detect and compare miRNA expression profiles in late stage of CA in rat model. Methods : Twenty-six, 7-week-old male Sprague-Dawley rats underwent a CA induction procedure. The control animals (n=11) were fed a normal diet, and the experimental animals (n=26) were fed a normal diet with 1% normal saline for 3 months. Then, the rats were sacrificed, their cerebral arteries were dissected, and the five regions of aneurysmal dilation on the left posterior communicating artery were cut for miRNA microarrays analysis. Six miRNAs (miRNA-1, miRNA-223, miRNA-24-1-5p, miRNA-551b, miRNA-433, and miRNA-489) were randomly chosen for validation using real-time quantitative PCR. Results : Among a set of differentially expressed miRNAs, 14 miRNAs were over-expressed more than 200% and 6 miRNAs were down-expressed lower than 50% in the CA tissues. Conclusion : The results show that miRNAs might take part in CA formation probably by affecting multiple target genes and signaling pathways. Further investigations to identify the exact roles of these miRNAs in CA formation are required.