Single and Multiple Valve Surgery in Native Valve Infective Endocarditis

BACKGROUND: Surgical treatment of infective endocarditis (IE) remains a challenge, especially in cases of multiple valve surgery. We evaluated the clinical outcomes of native valve IE and compared the outcomes of single valve surgery with those of multiple valve surgery. MATERIALS AND METHODS: From 1997 to 2011, 90 patients underwent surgery for native valve IE; 67 patients with single valve surgery (single valve group) and 23 patients with multiple valve surgery (multiple valve group). The mean follow-up duration was 73.1+/-47.4 months. RESULTS: The surgical mortality in the total cohort was 4.4%. The overall survival (p=0.913) and valve-related event-free survival (p=0.204) did not differ between the two groups. The independent predictor of postoperative complications was New York Heart Association class (p=0.001). Multiple valve surgery was not a significant predictor of surgical mortality (p=0.225) or late mortality (p=0.936). Uncontrolled infection, urgent or emergency surgery, and postoperative complications were identified as independent predictors of valve-related morbidity, excluding multiple valve surgery (p=0.072). CONCLUSION: In native valve IE, multiple valve surgery as a factor was not an independent predictor of mortality and morbidity. The number of surgically corrected valves in native IE seems to be unrelated to perioperative and long-term outcomes.

Retrospective Study of Thoracoscopic Apical Pleurectomy and Mechanical Pleural Abrasion for Spontaneous Pneumothorax / 대한흉부외과학회지

BACKGROUND: Pleural symphysis is regarded as an important treatment option in reducing recurrence rates after surgical treatment of spontaneous pneumothorax. However, there is much debate over the best method for achieving pleural symphysis. We retrospectively compared apical pleurectomy (AP) with mechanical pleural abrasion (MPA). MATERIAL AND METHOD: Between January 2000 and December 2007, 83 patients underwent video-assisted thoracoscopic surgery (VATS) for spontaneous pneumothorax. In addition to wedge resection of bullae, MPA was performed in 21 patients (group A) and AP in 62 patients (group B). RESULT: There were no significant differences in age, gender and site of pneumothorax between the two groups. Operative time was 97+/-44 minutes in group A and 77+/-18 minutes in group B (p>0.05). The mean amount of pleural drainage through the chest tube on the first postoperative day was 156+/-87 cc in group A and 147+/-87 cc in group B (p>0.05). There was no mortality or significant morbidity in all patients with the exception of reoperation for bleeding in two patients in group B. In the postoperative course, there were no statistical differences between the two groups in the rate of residual air space, air leak and indwelling time of chest tube, and hospital stay. Mean follow up time was 31.7+/-25.3 months, and the recurrence rate of pneumothorax was 9.5% (2/21) in group A and 6.5% (4/62) in group B, without statistical significance. CONCLUSION: AP was no more advantageous than MPA in terms of operative time, postoperative course and prevention of recurrent pneumothorax. Therefore, complete resection of bullae and existence of residual bullae are more important factors in reducing the incidence of recurrent pneumothorax than pleural symphysis.

Vacuum-assisted Closure for the Treatment of Lymphorrhea Following Surgery of the Femoral Artery / 대한흉부외과학회지

Lymphorrhea is a common complication after inguinal dissection for exposure of the femoral artery. Injury of the lymphatics occurs frequently because they are anatomically close to blood vessels. Uncontrolled lymph drainage increases postoperative morbidity, and wound infection may follow. Despite current treatment options, lymphorrhea after inguinal dissection is still difficult to manage and results in a prolonged hospital stay. A vacuum-assisted closure device was used in a 72-year-old woman who had lymphorrhea after vascular surgery by groin incision. Vacuum-assisted control for lymphorrhea resulted in earlier closure of the wound and reduced the length of hospital stay.

Mediastinal Heterotopic Thyroid Tissue : A case report / 대한흉부외과학회지

A 47-year old woman was admitted to our hospital for removal of a known mass that was located on the suprasternal notch; specifically, the mass was located on the supero-anterior mediastinuum. The mass was removed by a cervical incision and the histopathologic diagnosis of the resected specimen was hererotopic thyroid tissue with nodular hyperplasia. Mediastinal hererotopic thyroid tissue is a rare malady, so we report here on a case of mediastinal hererotopic thyroid tissue and we review the relevant medical literature.

Emergency Aortic Valve Replacement for a 95-year-old Patient / 대한흉부외과학회지

As the average age of the general population increases, a growing number of elderly patients are presenting for cardiac operations. Although aortic valve replacement in patients aged 80 years and older has been shown to have excellent outcomes with good long-term survival rates, some physicians are still hesitant to refer elderly patients for surgical intervention. A 95-years old female was admitted to our hospital with cardiogenic shock and an emergency operation was required. She was successfully treated with emergency aortic valve replacement. We report here on a case of successful emergency surgical treatment for aortic stenosis in a 95 years old woman.

An Influence of Modified Robicsek Sternal Wiring after Median Sternotomy on the Postoperative Sternal Wound Infection / 대한흉부외과학회지

BACKGROUND: In the majority of cases, sternal instability and wound infection concomitantly present after a cardiac operation following conventional median sternotomy, and these complications have a major influence on the postoperative course. The aim of this study is to compare the results of the different sternal wiring techniques on sternal infection. MATERIAL AND METHOD: Between April 2004 and December 2008, 157 adult patients underwent cardiac operation through a median sternotomy. 86 patients who had undergone standard peristernal wiring were included in group A, whereas 71 patients who had undergone modified Robicsek sternal wiring were included in group B. The incidences of sternal wound complications in the two groups were assessed. RESULT: The mean age of the group B patients was older than that of the group A patients (61+/-10 years vs 57+/-13 years). The incidence of preoperative left ventricular dysfunction (ejection fraction <30%), chronic obstructive pulmonary disease, renal failure requiring dialysis and diabetes mellitus were significantly higher in Group B, whereas the other perioperative risk factors for infection were not significantly different between the two groups. Two patients in group A experienced superficial wound infection, whereas 4 patients in group B displayed superficial wound infection, but the difference was not statistically significant (p=0.255). Yet poststernotomy deep sternal wound infection appeared in 6 patients of group A, whereas none of the patients in group B displayed this malady. CONCLUSION: The modified Robicsek sternal wiring technique showed greater sternal stability even for the patient with a high risk for infection, and the technique caused a lower incidence of deep sternal wound infection.

The Effect of Food Restriction on the Expression of Neuropeptides in Olfactory Bulb of Rat / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Food restriction increases life span, reduces aging rate and affects a wide variety of biological functions. Neurotransmitter is a substance released from the axon terminal of a presynaptic neuron on excitation, which diffuses across the synaptic cleft to either excite or inhibit the target cell. The nervous system makes use of neurotransmitters for signaling. We investigated the change of immunoreactivity of neuropeptides in olfactory bulb of rat after food restriction. MATERIALS AND METHOD: Of 10-week old Sprague-Dawley rats used in this study. six rats were killed at the beginning of the experiment. Thirty rats which had been restricted to only half of their normal voluntary mean food intake (12 g instead of 24 g per day) were killed at 3 days, 1, 2, 4 and 9 weeks after food restriction (n=6 per time point). Olfactory bulbs of the rats were cut into 40 micrometer-thick coronal sections and immunostained. RESULTS: On the layers of glomerular, outer plexiform, granular cell and subependymal zone of olfactory bulb, immunoreactivities of cholecystokinin (CCK), tyrosine hydrolase (TH), and neuropeptide-Y (NPY) were increased at one week of food restriction. On all layers, immunoreactivities of CCK and TH were increased at 2 weeks of food restriction. However, immunoreactivity of NPY was increased on the only layers of glomerular, and granular cell of olfactory bulb at week 2. After 4th week, the immunoreactivity of NPY was the same as the control group; after 9th week, the mmunoreactivity of CCK and TH were the same as the control group. CONCLUSION: Our results demonstrated that CCK, TH, and NPY could be expressed in different manners on the layers of olfactory bulb of rat after food restriction, and that food restriction may improve olfactory sensitivity owing to the change of neuropeptides.

Clinical Manifestations of Postnasal Drip

BACKGROUND AND OBJECTIVES: Postnasal drip is a common presentation to the medical practitioner. It is a result of disturbance to the normal drainage or an increase in secretion of the paranasal sinuses. However, sometimes no underlying cause can be found and the patient has to be reassured, and that they may just have to live with it. The aim of this study is to evaluate the clinical manifestations of patients with postnasal drip. MATERIAL AND METHOD: There were 90 patients complaining with postnasal drip. We performed a prospective study about accompanying symptoms and physical and psychiatric evaluation. CONCLUSION: Postnasal drip is more common in females over 30 years and the duration of symptoms is usually long. Anatomical nasal abnormality and sinusitis are common. There is no correlation with postnasal drip and psychiatric problems. But several items are concerned with postnasal drip. So we need detailed history taking and physical examination on patients who complained of postnasal drip.

A Case of the Treatment of a Cystic Hygroma with the Use of Picibanil / 대한이비인후과학회지

Cystic hygroma is an uncommon lymphatic tumor seen rarely in adults. The majority of cystic hygromas occur in the head and neck, particularly in the posterior triangle. We present an unique case of a postpartum woman who experienced sudden onset of a large cystic hygroma in the neck without history of antecedent swelling, infection, or trauma. And we show the safety of the sclerotherapy by picibanil, a lyophilised incubation mixture of group A Streptococcus pyogenes of human origin, in the cystic hygroma.

A case of oropharyngeal branchial cyst / 대한이비인후과학회지

A rare case of oropharyngeal branchial cyst in a fourteen-year-old boy is described. The cyst was located in the right lateral wall of the oropharynx. Histological examination revealed that the cyst was lined with a pseudostratified layer of the ciliated columnar epithelium and the lymphoid follicle. The position of the cyst and pathological feature were assumed to originate in the second branchial pouch.

Effect of speech therapy on alveolar sound after lingual frenulotomy in tongue-tie patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Many research papers showed that the most common articulation disorder in tongue-tie children was the error of alveolar sound. We performed speech therapy on alveolar sound after lingual frenulotomy to prove that the speech therapy after lingual frenulotomy improves the articulation of alveolar sound and that this effect is maintained. MATERIALS AND METHODS: We collected 28 children who never had speech therapy but could afford to have the speech therapy. The accuracy rate of consonant sound was calculated using a picture consonant test 2 weeks following the lingual frenulotomy. The speech therapy, called the phonetic placement and paired-stimulus technique, was performed 18 times for 3 months. This therapy decreased incidence rate of error. RESULTS: The incidence rate of alveolar sound error, which was calculated before speech therapy, was about 65%. And the incidence rate of alveolar sound error after speech therapy was 5-10%, which proved the effect of speech therapy. We divided alveolar sounds into target sounds and non-target sounds. And we performed speech therapy only on target sounds so the appearance rate of alveolar sound error decreased and the incidence rate of non-target sounds also decreased. We performed speech therapy after 2 weeks and the effect was maintained. CONCLUSION: The incidence rate of alveolar sound error decreased by using speech therapy and the effect was maintained. So the speech therapy must be performed after lingual frenulotomy.