Fourth Recurrence of Cardiac Myxoma in a Patient with the Carney Complex

Although cardiac myxoma is the most commonly encountered benign cardiac tumor in cardiac surgery practice, recurrent cardiac myxoma is very rare, is most commonly related to the Carney complex, and usually requires multiple cardiac operations with specific requirements in terms of perioperative management. In this report, we describe a patient who experienced the fourth recurrence of cardiac myxoma and review the diagnostic criteria of the Carney complex. This is the first report of such a case in Korea.

Staged Management of a Ruptured Internal Mammary Artery Aneurysm

The rupture of an internal mammary artery (IMA) aneurysm in a patient with type 1 neurofibromatosis (NF-1) is a rare but life-threatening complication requiring emergency management. A 50-year-old man with NF-1 was transferred to the emergency department of Kyungpook National University Hospital, where an IMA aneurysmal rupture and hemothorax were diagnosed and drained. The IMA aneurysmal rupture and hemothorax were successfully repaired by staged management combining endovascular treatment and subsequent video-assisted thoracoscopic surgery (VATS). The patient required cardiopulmonary cerebral resuscitation, the staged management of coil embolization, and a subsequent VATS procedure. This staged approach may be an effective therapeutic strategy in cases of IMA aneurysmal rupture.

Outcomes of Surgery for Total Anomalous Pulmonary Venous Return without Total Circulatory Arrest

BACKGROUND: Recent developments in surgical techniques and hospital care have led to improved outcomes following total anomalous pulmonary venous return (TAPVR) repair. However, the surgical repair of TAPVR remains associated with a high risk of mortality and need for reoperation. We conducted this retrospective study to evaluate mid-term outcomes following in situ TAPVR repair without total circulatory arrest (TCA), and to identify the risk factors associated with surgical outcomes. METHODS: We retrospectively reviewed 29 cases of surgical intervention for TAPVR conducted between April 2000 and July 2015. All patients were newborns or infants who underwent in situ TAPVR repair without TCA. RESULTS: Four anatomic subtypes of TAPVR were included in this study: supracardiac (20 cases, 69.0%), cardiac (4 cases, 13.8%), infracardiac (4 cases, 13.8%), and mixed (1 case, 3.4%). The median follow-up period for all patients was 42.9 months. Two (6.9%) early mortalities occurred, as well as 2 (6.9%) cases of postoperative pulmonary venous obstruction (PVO). Preoperative ventilator care (p=0.027) and preoperative PVO (p=0.002) were found to be independent risk factors for mortality. CONCLUSION: In situ repair of TAPVR without TCA was associated with encouraging mid-term outcomes. Preoperative ventilator care and preoperative PVO were found to be independent risk factors for mortality associated with TAPVR repair.

Clinical Observation of Acute Hematogenous Osteomyelitis in Children / 대한정형외과학회잡지

After the discovery of penicillin by Fleming, a great improvement in the treatment of osteomyelitis was obtained and the mortality rate in the acute stage was markedly decreased. But, because of abuse of the antibiotics and resulting resistant organisms to antibiotics, the incidence of acute hematogenous osteomyelitis tends to increase recently. During the period of 6 years extending from 1979 to 1984, we have treated 45 cases of acute hematogenous osteomyelitis in children and clinical analysis was made about the causes of the development of chronic osteomyelitis with particular emphasis on the time interval from onset to treatment, and on the operative methods in the surgical treatments. The following results were obtained; 1. The incidence in males was 1.5 times greater than females. 2. Age incidence showed that it was most prevalent in the age group of 6 to 15 with 66.2% of the total cases. 3. The most common sites of the involvement was femur and tibia in orders. 4. Most of cases showed pain, local tenderness, pyrexia, loss of motion, swelling, and heat of the involved limbs. 5. Among the causative organisms, staphylococcus aureus was most prevalent one. 6. Cephalosporin, methicillin, gentamicin showed the highest sensitivity while penicillin showed marked resistancy (80%). 7. Time interval from onset to treatment was persistently an important factor in the development of chronicity. 8. Bone fenestration was the best method in the surgical treatments of acute hematogenous osteomyelitis in children. 9. Early diagnosis, adequate antibiotics, and early surgical decompression and drainage (esp. bone fenestration) were considered to be the essential part of management of acute hematogenous osteomyelitis in preventing its chronicity.

The Morphologic Study of the Femoral Vein and Its Tributaries in Korean Adults / 대한정형외과학회잡지

The veins of the lower limb are subdivided into deep veins, superficial veins, and comminucating veins. The deep veins accompany the arteries, while the superficial veins course under the superficial fascia just beneath the skin and they have great, small saphenous veins, and their tributaries. The superficial and deep veins are connected by the commincating veins, which are usually located along the intermuscular septum. There are many reports about the venous system of the lower limb in foreign countries but a few in Korea. It is considerably valuable in the vascular surgery of the lower limb and the surgical management of the varicose veins. This study deals with the Korean cadavers, the authors observed the location of the saphenofemoral junction, medial and lateral femoral circumflex veins, and deep femoral veins, and the termination modes between the superficial veins and great saphenous veins and the femoral circumflex veins to the deep femoral veins or femoral veins. The following results were: 1. Any noticeable anomalies of the femoral vein proper were not present. 2. The saphenofemoral junctions were located at 3.78±0.91cm below the inguinal ligaments, 2.22±1.18cm below the pubic tubercles, 3.99±0.99cm lateral to the pubic tubercles. 3. The termination modes of superficial veins to the great saphenous veins around the fossa ovalis were classified into 3 types, Type I: Superficial epigastric vein, superficial iliac circumflex vein, external pudendal vein emptied into the upper end of the great saphenous vein(45.1%). Type II: One or more veins among above mentioned 3 veins emptied into the lateral accessory saphenous vein (48.8%). Type III: One or more veins among above mentioned 3 veins emptied into the medial accessory saphenous vein(4.9%). One cadaver(1.2%) was not belonged to the above classification, in which above mentioned 3 veins were emptied directly into the femoral vein. 4. The termination level of deep femoral veins into the femoral veins was 8.68±1.92cm below the inguinal ligaments, 6.60±1.98cm below the pubic tubercles, 5.28±51.46cm lateral to the pubic tubercles. 5. The termination level of medial femoral circumflex veins into the femoral veins or deep femoral veins was 5.10±1.73cm below the inguinal ligaments, 3.65±1.92cm below the pubic tubercles, 4.62±1.41cm lateral to the pubic tubercles, and the termination level of the lateral femoral circumflex veins into the femoral veins or deep femoral veins was 7.00±1.48cm below the inguinal ligaments, 5. 05±1. 67 cm below the pubic tubercles, 5. 41±1.21 cm, lateral to the pubic tubercles. 6. The termination modes of femoral circumflex veins were classified into 4 types in male cadavers, Type A: Medial and lateral femoral circumflex veins emptied into the femoral vein. Type B: Medial femoral circumflex vein emptied into the femoral vein and lateral femoralcircumflex vein emptied into the deep femoral vein. Type C: Medial femoral circumflex vein emptied into the deep femoral vein and lateral femoral circumflex vein emptied into the femoral vein. Type D: Medial and lateral femoral circumflex veins emptied into the deep femoral vein. In the right sides, type A was 94.1% and type C was 5.9% while in the left sides, type A was 79.4%, type B was 5.9% and type C was 14.7%. 7. The collateral circulations were identified in 67 observations (81.7%) and venous circles were identified in 46 observations (56.1%).