Effects of Reduced Plantar Cutaneous Sensation on Static Postural the Kinematic Strategy Control in Individuals with or without Chronic Ankle Instability / 대한스포츠의학회지

PURPOSE: To investigate the alteration of lower extremity movement during maintaining balance test with their eyes closed in chronic ankle instability (CAI) patients compared to healthy group with and without plantar cutaneous sensation. METHODS: Ten healthy volunteers (age, 23.40±2.22 years; height, 165.42±6.67 cm; weight, 60.93±13.42 kg) and 10 CAI patients (age, 23.90±2.56 years; height, 166.89±10.50 cm; weight, 67.43±12.96 kg), were recruited. Subjects immersed both feet in an ice water for 10 minutes and performed three trials of a single-leg stance balance test with their eyes closed while standing on a force plate for 10 seconds. RESULTS: CAI group showed increased knee flexion, reduced knee external rotation, and hip internal rotation compared to the healthy group from single-limb stance with eyes closed after diminished plantar cutaneous sensation. However, there was no significant interaction between group and time. CONCLUSION: These findings indicate that the postural kinematic analyses revealed that individuals with CAI used different strategy of controlling their lower extremities, which alters transverse plane motion of hip and knee compared to the healthy group in order to compensate for their ankle deficits after freezing the plantar cutaneous.

Surgical Repair of Retrograde Type A Aortic Dissection after Thoracic Endovascular Aortic Repair

It is expected that the stent graft will become an alternative method for treating aortic diseases or reducing the extent of surgery; therefore, thoracic endovascular aortic repair has widened its indications. However, it can have rare but serious complications such as paraplegia and retrograde type A aortic dissection. Here, we report a surgical repair of retrograde type A aortic dissection that was performed after thoracic endovascular aortic repair.

AFP-producing acinar cell carcinoma treated by pancreaticoduodenectomy in a patient with a previous radical subtotal gastrectomy by gastric cancer

We report a case of alpha-fetoprotein (AFP)-producing acinar cell carcinoma (ACC) of the pancreas. The tumor was diagnosed in a 72 yearold female after radical subtotal gastrectomy (Billroth I) due to early gastric cancer six months before. The initial serum AFP levels were increased to 2,254.1 IU/ml and preoperative imaging studies showed a mass with approximately 2.5 cm in diameter near the neck of the pancreas. A pancreaticoduodenectomy was performed. The pathologic examination revealed an ill-defined lobulating tumor confined to the pancreas (T1 stage). Immunohistochemical study showed that the tumor cells expressed AFP. The Adenosine triphosphate-based chemotherapy response assay (ATP-CRA) suggested that cisplatin would be more desirable than gemcitabine in AFP-producing ACC of the pancreas as an adjuvant chemotherapy. However, the adjuvant chemotherapy was not performed due to the early pathological stage. The patient died from carcinomatosis and pneumonia. Even if the tumor was on a relatively early stage, an adjuvant treatment should be considered ACC.

Comparison of the Long-Term Outcome of Coronary Artery Bypass Grafting between Percutaneous Coronary Intervention in End Stage Renal Disease Patients / 대한신장학회지

PURPOSE: Coronary artery disease is the main cause of morbidity and mortality in dialysis patients. Some observational studies proposed that coronary artery bypass graft (CABG) might provide higher survival benefit than percutaneous coronary intervention (PCI) in dialysis patients. There were not many studies of the comparison between the methods of coronary artery reperfusion therapy. Therefore, we compared the long term survival between PCI and CABG groups in dialysis patients. METHODS: We selected 104 patients with end stage renal disease (ESRD) who had PCI (N=75) or CABG (N=29) in Ilsan-Paik Hospital from December 1999 to February 2010. We collected data from medical records and performed a retrospective analysis in ESRD patients hospitalized for the first coronary revascularization procedure. RESULTS: There was no difference in the basic characteristics between the two groups. However, the frequency of more than 3-vessel lesions or less than 30% ejection fraction was higher in the group of CABG than that of PCI. One and three-year survival rates were higher in the PCI group than those in the CABG group. However, there was no difference in the 5 year survival rate between the groups. In subgroup analysis for severe patients with 3-vessel coronary diseases or less than 30% of ejection fraction, there were no statistical differences in the 1, 3 and 5 year survival rates between the groups. In subgroup analysis for the patients maintaining dialysis more than three months, 1, 3, and 5 year survival rates were not statistically different. CONCLUSION: In ESRD and dialysis patients, there was no difference in the long-term survival between PCI and CABG.

Surgical Management of Left Ventricular Outflow Tract Obstruction after Biventricular Repair of Double Outlet Right Ventricle

Regardless of the preoperative morphology and the type of operation, left ventricular outflow tract obstruction (LVOTO) after biventricular repair of double outlet right ventricle (DORV) may develop. This report presents our 10-yr experience with surgical management of LVOTO after biventricular repair of DORV. Between 1996 and 2006, 15 patients underwent reoperation for subaortic stenosis after biventricular repair of DORV. The mean age at biventricular repair was 23.3+/-18.3 months (1.1-64.2). Biventricular repairs included tunnel constructions from the left ventricle to the aorta in 14 cases and an arterial switch operation in one. The mean left ventricle-to-aorta peak pressure gradient was 54.0+/-37.7 mmHg (15-140) after a mean follow-up of 9.5+/-6.3 yr. We performed extended septoplasty in nine patients and fibromuscular resection in six. There were no early or late mortality. There was one heart block and one aortic valve injury after an extended septoplasty, and two and one after a fibromuscular resection. No patient required reoperation for recurrent subaortic stenosis. The mean pressure gradient was 11.2+/-11.4 mmHg (0-34) after a mean follow-up of 5.6+/-2.7 yr. Extended septoplasty is a safe and effective method for the treatment of subaortic stenosis, especially in cases with a long-tunnel shaped LVOTO.

Comparison of Different Methods of Aortic Valve Conduit Xenograft Preservation in an Animal Experiment Model; Fresh Cryopreservation versus Acellularized Cryopreservation / 대한흉부외과학회지

BACKGROUND: The commercially used vascular xenografts have some problems such as calcification, fibrosis and tissue degeneration that are associated with inflammatory and immunologic reactions. We compared two methods of xenograft preservation (fresh cryopreservation versus acellularized cryopreservation) of goat aorta. MATERIAL AND METHOD: Aortic valved xenografts were harvested from adult pigs, and these were preserved using fresh cryopreservation (FC group, n=4) or acellularized crypreservation (AC group, n=4). These xenografts were implanted into adult goats. There were 2 short-term survivors (less than 100 days) and 2 long-term survivors in each group. These xenografts were explanted and they underwent microscopic examination. RESULT: The goats survived 31, 40, 107 and 411 days in the FC group and the other goats survived 5, 40, 363 and 636 days in the AC group. All the short-term survivors in each group expired because of rupture at the proximal anastomosis site. Marked neutrophil infiltration was observed in the FC group FC and lymphocytes were observed in the AC group. There were no differences in the occurrence of calcification, fibrosis and thrombosis among the groups. CONCLUSION: Some goats survived more than 100 days after the xenograft implantation irrespective of the methods of preservation. Because severe tissue degeneration developed in both groups, we think these methods are not appropriate for xenograft preservation of aorta. It was worth a preliminary trial for improving the preservation method or to modify the processing of xenografts.

Intravenous Recombinant Tissue Plasminogen Activator Thrombolysis in a Patient with Acute Ischemic Stroke Secondary to Aortic Dissection

BACKGROUND: Acute ischemic stroke secondary to aortic dissection (AoD) is challenging in the era of thrombolysis owing to the diagnostic difficulty within a narrow time window and the high risk of complications. CASE REPORT: A 64-year-old woman with middle cerebral artery occlusion syndrome admitted to the emergency room within intravenous recombinant tissue plasminogen activator (rt-PA) time window. Her neurological symptoms improved during thrombolysis, but chest and abdominal pain developed. Repeated history-taking, physical examination, and imaging studies led to the timely diagnosis and surgical treatment of AoD, which produced a successful outcome. CONCLUSIONS: Clinical suspicion is invaluable for the diagnosis of this rare cause of stroke. Considering the stroke mechanism and complications, the risks of thrombolysis might outweigh its benefits.

One-Stage Management of Ascending Aorta Replacement and Percutaneous Endovascular Repair for Ascending and Descending Aortic Aneurysms : A case report / 대한흉부외과학회지

A stent graft has been accepted as an alternative method for treating aortic diseases or to reduce the extent of surgery. We report here on a one-stage Management of Ascending Aorta Replacement and Percutaneous Endovascular Repair for the seperate aneurysmal lesions on the ascending and descending aorta.

Congenital Clubfoot Treated with the Ponseti Method / 대한정형외과학회잡지

PURPOSE: This study examined the Ponseti method for the nonsurgical treatment of a congenital clubfoot. MATERIALS AND METHODS: A total of 35 patients (52 clubfeet) were evaluated. All patients were treated by serial manipulation and casting as described by Ponseti. The patients were divided in two groups (Group 1: the result was successful and did not require extensive corrective surgery, Group 2: the result was unsuccessful and required extensive corrective surgery). The outcome in the two groups was compared in terms of the severity of initial deformity, initial roentgenographic findings, Achilles tenotomy, numbers of Ponseti casts before the Achilles tenotomy, total numbers of casting, age at the initial treatment, bilaterality, gender and compliance of the brace. RESULTS: Twenty eight patients (42 feet, 80.7%) were corrected successfully without extensive corrective surgery (Group 1). Six patients (10 feet, 19.3%) required extensive corrective surgery (Group 2). The requirement of extensive corrective surgery was not related to the initial roentgenographic findings, number of Ponseti casts before the Achilles tenotomy, total numbers of castings, age at the initial treatment, bilaterality and gender. However, it was related to the severity of the initial deformity and compliance of the brace. CONCLUSION: The result of a congenital clubfoot treated with the Ponseti method was successful in more than 80% of patients. It was affected by the severity of the initial deformity and compliance of the brace. However, a long-term follow-up will be needed to evaluate the recurrence and residual deformities.

A Successful Direct Phrenic Nerve Reconstruction in the Course of Malignant Thymoma Resection / 대한흉부외과학회지

We performed nerve resection and reconstruction of the phrenic nerve in a 63-year-old female patient who underwent complete resection of a malignant thymoma. The left phrenic nerve was completely encased by the tumor for 2 cm. Thus, a 3 cm long piece of phrenic nerve with 5 mm margins of safety on each end was resected and it was directly anastomosed in an end-to-end fashion. At 11 months after reconstruction, fluoroscopy demonstrated adequate and symmetric motion of both hemidiaphragms, which indicated the restoration of phrenic nerve function. The pulmonary function test results were comparable to those obtained preoperatively at 30 months. There has been no evidence of recurrence at the recent follow up visits.

Preoperative and Postoperative Evaluation of Multiple Giant Coronary Aneurysms by the Use of Coronary CT Angiography with 64-MDCT: A Case of Multiple Giant Coronary Aneurysms Treated with Aneurysmectomy and Coronary Artery Bypass Surgery

A coronary artery aneurysm is an uncommon disorder and is seen as a characteristic dilatation of a localized portion of the coronary artery. Clinical manifestation of a coronary artery aneurysm varies from an asymptomatic presentation to sudden death of a patient. Although coronary aneurysms are typically diagnosed by the use of coronary angiography, a new generation of coronary 64-slice multidetector computed tomography (64-MDCT) scanners have successfully been used for evaluating this abnormality in a noninvasive manner. In the present case, we performed coronary 64-MDCT scanning preoperatively and postoperatively on a patient with multiple giant coronary aneurysms. The use of coronary 64-MDCT may provide an evaluation technique not only for diagnosis but also for follow-up after surgery for this condition.

Lateral Closing Wedge Supracondylar Osteotomy of the Humerus in Children with Cubitus Varus Deformity / 대한정형외과학회잡지

PURPOSE: To evaluate the effectiveness, cosmetic and functional improvement of a supracondylar lateral closing wedge osteotomy of the humerus as a treatment for cubitus varus deformity in children. MATERIALS AND METHODS: Forty-eight children with cubitus varus underwent a lateral closing wedge osteotomy, and were followed up for at least 1 year. RESULTS: There were no complications such as a loss of correction, infection, or neurapraxia. The immediate postoperative lateral condylar prominence and secondary lazy S deformity was in proportion to the preoperative severity of the cubitus varus. However, it was lower at the last follow-up, and was related to the extent of preoperative cubitus varus, length of follow-up and age. CONCLUSION: A supracondylar lateral closing wedge osteotomy of humerus is an easy and effective surgical treatment for a posttraumatic cubitus varus of children. In addition, it shows good cosmetic results with good remodeling of the lateral condylar prominence of children.

Three Cases of Arterial Occlusion That Occurred After the Use of Angioseal(R)

Femoral arterial closure devices are now commonly used after both diagnostic and therapeutic coronary procedures. They have been shown to reduce the time to ambulation and to decrease the length of the hospital stay. Angioseal is a commercially available femoral artery closure device that has been approved by the Food and Drug Administration (FDA). The device sandwiches an intra-arterial absorbable anchor on the luminal side of the vessel and a thrombin plug on the surface of the vessel with using a self-cinching stitch. We report here on three patients who presented with acute and delayed arterial occlusive complications that were found to be due to an Angioseal anchor that was not appropriately reabsorbed.

Low Grade Fibromyxoid Sarcoma of the Visceral Pleura: A case report / 대한흉부외과학회지

Low grade fibromyxoid sarcoma (LGFM) is a rare, deep soft-tissue malignant tumor. Although its histologic features are benign, the clinical course is malignant. The usual tumor locations are the lower extremity and chest wall. LGFM originating from the visceral pleura is extremely rare. We report here on a 37 year old man with a LGFM of the visceral pleura. Thirty three months after surgery, the patient is alive without any sign of local recurrence or distant metastasis.

Successful Resuscitation of Cardiac Arrest with Acute Massive Pulmonary Embolism during Operation Using Percutaneous Cardiopulmonary Support (PCPS): A case report / 대한흉부외과학회지

Since the introduction of extracorporeal cardiopulmonary support of cardiac arrest in 1983, emergent cardiopulmonary support has been used to treat cardiac arrest. Acute massive pulmonary embolism is associated with a high mortality rate and it poses a challenge for both the anesthesiologist and the surgeons especially during operations. This report describes the use of the emergent bypass system in the effective management of an intraoperative massive pulmonary embolism and cardiac arrest in a 56-year-old woman. The patient was discharged on warfarin and there was no recurrence of the pulmonary embolism at the follow-up visit.

Surgical Management of Mechanical Valve Thrombosis: Twenty-Six Years' Experience

In the present study, the authors investigated the management of mechanical valve thrombosis (MVT). From January 1981 through March 2006, 2,908 mechanical valve replacements were performed in 2,298 patients at our institution. Twenty (0.87%) patients presented with MVT, 14 (70.0%) were women, and the mean age of the patients was 42.0+/-14.0 (27-66) yr. Thrombosis involved mitral in 14 (70.0%), aortic in 2 (10.0%), tricuspid/aortic in 1 (5%), and tricuspid in 3 (15%). The interval from first operation to valve thrombosis was 121.8+/-75.4 (0.9-284.7) months. The most frequent clinical presentation was heart failure (13/20, 65%), and predisposing causes of MVT were: poor compliance with warfarin (7), pregnancy (5), drug interaction (2), and unknown (6). All 20 patients underwent valve replacement: mitral (14, 70.0%), tricuspid (3, 15.0%), aortic (2, 10%) and tricuspid/aortic (1, 5%). One early death occurred due to left ventricular failure, but no late mortality occurred during 63.3+/-49.9 (0.5-165.1) months of follow-up. MVT was treated successfully, and pregnancy and inadequate anticoagulation were found to influence the occurrence of this rare complication.

Surgical Management of Multiple Coronary Artery Aneurysms: A case report / 대한흉부외과학회지

Multiple coronary aneurysms are rare in adults. The cause may be atherosclerosis, congenital malformations, post-traumatic or post-syphilitic vascular lesions, connective tissue diseases like Marfan and Ehler-Danlos syndromes or Kawasaki disease, all of which cause weakening of the media. Surgical intervention is indicated to prevent rupture, embolization or compression symptoms. The successful management of multiple coronary artery aneurysms, associated with previous rupture and arrhythmia, originating from proximal potions of ramus intermedius and left circumflex artery are reported.

Management of Complete Tracheal Disruption after a Fall

A complete tracheal rupture due to blunt trauma is rare, and a high proportion of patients with this injury die prior to arrival at medical centers. Early diagnosis and prompt management is essential in order to reduce morbidity and mortality. A 38-year-old woman visited the emergency department after a fall from the 4th floor of a building. We confirmed that a complete tracheal disruption 4 cm above the carina by chest CT. We could not insert an endotracheal tube because the distal stump of the trachea was separated by 4 cm from the proximal stump, so we used percutaneous cardiopulmonary bypass for the prevention of hypoxia during the initial operative procedures. We performed resections and reconstruction of the injured trachea. Fourteen days after the operation we confirmed normal healing of the trachea with bronchoscopy. One year after the operation, the patient is healthy with no tracheal problems.

Degenerative Change of Femoral Head Cartilage in the Elderly with Hip Fracture / 대한정형외과학회잡지

PURPOSE: To evaluate the incidence, grade and extent of the degenerative changes in the femoral head articular cartilage in the elderly with hip fracture through gross, histological and immunohistochemical studies. MATERIALS AND METHODS: The study examined 30 femoral heads obtained from patients over 65 years with no arthrosis by radiograph, who had undertaken bipolar hemiarthroplasty due to hip fracture. The mean age of patients was 79.7 years and the study examined three weight bearing zones (anterior, middle and posterior) and one non-weight bearing zone (inferior) of each femoral head. RESULTS: The gross findings showed significant correlation with the Mankin grade for each zone (p<0.05). Twenty four cases (80%) showed mild degeneration according to the Mankin grade and the others moderate. The mean Mankin score at each zone of all femoral heads was 5 points, which indicated mild degeneration. No significant difference was found between the weight bearing zone and the non-weight bearing zone (p=0.75). The distribution of type II collagen antibody stainabilities mainly showed normal or mild degeneration (93.3%). CONCLUSION: Degeneration of the articular cartilage of the femoral heads in the elderly with hip fracture and no arthrosis by radiograph was mostly mild, and showed generalized changes regardless of the zone.

A Case of Spontaneous Left Atrial Intramural Hematoma Causing Vaso-occlusive Cardiogenic Shock

Intramural hematoma of the cardiac muscle is a rare clinical condition. Only a few cases have been reported in the medicosurgical conditions related to post cardiac surgery, chest trauma and dissecting aneurysms of the aorta. Moreover, there are few cases of spontaneous left atrial intramural hematoma and they may occur in the medical conditions related to calcified mitral annulus dissection or amyloidosis. We experienced a case of spontaneous intramural left atrial hematoma in a 29 year-old male resulting in vaso-occlusive cardiogenic shock. We report the clinical manifestation and treatment of this case with a review of literatures.