ABSTRACT
Percutaneous suture closure device is known as relatively safe and convenient tool, which can decrease not only bed rest period of patient but also time consuming effort of manual compression of doctor after femoral artery puncture. However [C1], there are also some reports on complication of its use. We report a 62-year-old male patient who had femoral artery endarteritis [0] with pseudoaneurysm as a complication of percutaneous suture closure device after percutaneous coronary angiography [C2]. He was treated successfully by appropriate antibiotics and vessel reconstruction using autologous saphenous vein patch.
Subject(s)
Humans , Male , Middle Aged , Aneurysm, False , Angioplasty, Balloon, Coronary , Anti-Bacterial Agents , Bed Rest , Coronary Angiography , Endarteritis , Femoral Artery , Punctures , Saphenous Vein , SuturesABSTRACT
Innominate artery injury by blunt chest trauma is rarely reported. This report describes a 40-year-old male who had innominate artery dissection and pseudoaneurysm caused by blunt chest trauma and was treated successfully by ascending aorta to innominate artery bypass graft. The patient recovered without any complications and was discharged one week after the operation.
Subject(s)
Adult , Humans , Male , Aneurysm, False , Aorta , Brachiocephalic Trunk , Thorax , TransplantsABSTRACT
BACKGROUND: Traumatic cardiac injury is very rare but mortality is very high when the diagnosis and management are delayed. We reviewed our case retrospectively. MATERIAL AND METHOD: From March 1995 to July 2003, 17 patients were diagnosed as having traumatic cardiac rupture. Five patients were stabbed, seven patients were motor vehicle accidents, four patients had fallen down, and the cause was unknown in one patient. Emergency operations were done and six patients were operated under CPB. RESULT: Four patients died during or after operation. The mean ICU stay period was 3.86+/-3.35 days and the mean hospital stay was 18.27+/-14.99 days. No mortality was observed in those whose vital signs were stable in the operating room. CONCLUSION: Preoperative vital status was very important and thoracic traumatic patient should be suspected as having cardiac injury.
Subject(s)
Humans , Diagnosis , Emergencies , Heart Injuries , Length of Stay , Mortality , Motor Vehicles , Operating Rooms , Retrospective Studies , Vital SignsABSTRACT
A 4-day-old patient with Down syndrome (DS) visited out patient department (OPD) because of jaundice and VSD. Peripheral blood smear showed 21% of myeloblast. After 4 weeks of observation, WBC count was 55,100/mm3 (blast 90%). BM aspirate showed AML (M7) and treatment was started with low dose Ara-C (20 mg/m2 for 21 days). After remission, maintenance therapy was done with low dose Ara-C (16 mg/m2 for 21 days), 6-TG (40 mg/m2 for 21 days) and low dose IL-2 (0.5 106U/m2 for 21 days) alternatively for 2 years. The patient remained in complete remission and VSD was corrected at 9 months of age. This case shows that remission can be achieved with low dose Ara-C and it can be maintained thereafter with low dose Ara-C, 6-TG and IL-2. Low dose IL-2 has the advantage of selectively activating immune cells with high affinity receptors, low treatment related morbidity, good compliance which can be injected at OPD. As the patients with DS have defect in IL-2 secretion, IL-2 may have an beneficial effects on treating AML in DS.
Subject(s)
Humans , Compliance , Cytarabine , Down Syndrome , Drug Therapy , Granulocyte Precursor Cells , Interleukin-2 , Jaundice , Leukemia, Myeloid, AcuteABSTRACT
Lymphangioma(or cystic hygroma) of the chest wall is rare case. We experienced one such case in a 16-year-old girl who complained of a large recurrent mass on her right upper post erolateral chest wall which had developed several years ago. The diagnosis was made following a physical examination, chest magnetic resonance imaging(MRI), and radio isotope (RI) lymphangiogrphy and was confirmed by a histopathological examination. We performed total excision of the lesion followed by a repeated sclerosing therapy with intralesional injection of Vibramycin.
Subject(s)
Adolescent , Female , Humans , Diagnosis , Doxycycline , Injections, Intralesional , Lymphangioma , Physical Examination , Thoracic Wall , ThoraxABSTRACT
Native valve endocarditis (NVE) without preexisting structural valve or congenital cardiac malformation especially in pediatric group is rare. A case of isolated tricuspid valve endocarditis in a 7-year-old child without any cardiac malformation is described. This child had suffered from fever and productive cough for 3 weeks. Blood culture grew Staphylococcus aureus. Fever was not controlled even with proper antibiotic treatment. Transthoracic echocardiogram and lung perfusion scan revealed a large vegetation on the tricuspid valve with multiple embolism Surgical procedures included vegetectomy partial cusps resection and pericardial patch valvuloplasty. Th patient was in NYHA class I during follow up.
Subject(s)
Child , Humans , Cough , Embolism , Endocarditis , Endocarditis, Bacterial , Fever , Follow-Up Studies , Lung , Perfusion , Staphylococcus aureus , Tricuspid ValveABSTRACT
BACKGROUND: Patients who are considered for major pulmonary resection are generally evaluated by spirometry and clinical assessment to predict morbidity and mortality. Despite this, none has yet proved to be a convenient and reliable estimate of risk. MATERIAL AND METHOD: A retrospective analysis was performed in 167 patients who were diagnosed for lung cancer, bronchiectasis, pulmonary tuberculosis, and other benign pulmonary disease, and who underwent major lung resections. The relationship of 25 preoperative or postoperative variables to 19 postoperative events were classified into categories as operative mortality, pulmonary or cardiovascular morbidity, and other morbidity was assessed. Logistic regression analysis and x2 analysis were used to identify the relationship of the operative risk factors to the grouped postoperative complications. RESULT: The best single predictor of complications was the percent predicted postoperative diffusing capacity (pulmonary morbidity, p<0.009; cardiovascular morbidity, p<0.003: overall morbidity, p<0.004). CONCLUSION: The diffusing capacity of the lung for carbon monoxide was an important predictor of postoperative complications than the spirometry, and it usually should be a part of the evaluation of patients being considered for pulmonary resection.
Subject(s)
Humans , Bronchiectasis , Carbon Monoxide , Logistic Models , Lung , Lung Diseases , Lung Neoplasms , Mortality , Postoperative Complications , Retrospective Studies , Risk Factors , Spirometry , Tuberculosis, PulmonaryABSTRACT
Supravalvular aortic stenosis is an uncommon, congenital narrowing of the ascending aorta which originates just distal to the level of the ostium of the coronary artery. We conducted a successful surgical treatment in a 39 year- old female patient with a congenital supravalvular aortic stenosis and aortic regurgitation who did not show signs of William's syndrome. After we performed an inverted Y-shaped aortotomy toward the noncoronary sinus and right coronary sinus, pantaloon shaped prosthetic patch(Vascutek, Ino, USA) was used to repair the narrowing sinotubular junction. The aortic valve was replaced concommittently using Sorin Bicarbon 19mm. Her postoperative course was uneventful. The patient discharged at 9th postoperative day in good health.
Subject(s)
Female , Humans , Aorta , Aortic Stenosis, Supravalvular , Aortic Valve , Aortic Valve Insufficiency , Coronary Sinus , Coronary VesselsABSTRACT
From June 1995 to May 1997, we have implanted 52 Sorin Bicarbon mechanical valves in 41 patients. They were 16 men and 25 women, and their mean age was 47.4+/-14.8 (range; 18~74 y.o.). 35 (27 mm~31 mm) were in mitral position, 15 (19 mm~25 mm) in aortic position, and 2 (31 mm) in tricuspid position. 3 CABGs and a tumor excision were taken concomittantly. 35 patients were primary operation, and 6 were re-do operations. By intraoperative transesophageal doppler echocardiography, transvalvular peak/mean pressure gradient was 6.1+/-2.7/2.4+/-1.4 mmHg in mitral position and 27.6/10.7 mmHg in aortic position. The effective valve opening area in mitral position was 3.2+/-0.6 cm2. Follow-up was total 508.6 patient-months, and mean follw-up was 12.7+/-9.2 months. NYHA class was improved from 2.6+/-0.6 to 1.2+/-0.3 in average postoperatively. During that period, there was no operative death. 2 late non-valve related deaths were occurred. One was died of COPD, and the other was possible acute myocardial infarction. Among 7 postoperative complications, one valve related complication (minimal paravalvular leakage) was noticed. In conclusion, Sorin Bicarbon mechanical valve is believed one of the safe choice in clinical settings. It showed excellent hemodynamic and mechanical functions, and very low postoperative valve related complications in short term clinical experience.
Subject(s)
Female , Humans , Male , Echocardiography, Doppler , Follow-Up Studies , Heart Valve Diseases , Heart Valve Prosthesis , Hemodynamics , Myocardial Infarction , Postoperative Complications , Pulmonary Disease, Chronic Obstructive , ReoperationABSTRACT
Castleman's disease was first described in 1956 in a group of patients with localized mediastinal lymph node enlargement characterized by hyperplasia of lymphoid follicles and marked capillary proliferation with endothelial hyperplasia. They have been divided into 2 histologic types: the hyaline-vascular type, which was more common and usually asymptomatic, was characterized by small hyaline-vascular follicles and interfollicular capillary proliferation; the plasma-cell type was characterized by large follicles with intervening sheets of plasma cells. Systemic manifestations, such as fever, anemia and hyperglobulinemia, were frequently associated with the plasma cell type. Localized lesions have behaved in a benign fashion, and complete surgical excision has been curative. But recent years, reports have described a multicentric variety with severe systemic manifestations, exorable clinical course and poor outcome. Although Castleman's disease has been described at all ages, the disease is rare in childhood. This paper describes a case of plasma cell type Castleman's disease in a 12-year-old boy and review of the literature. We conclude that the Castleman's disease must be considered in childhood lymphadenopathy and the clinicians should be mindful of the malignant potential of the disease and their possible multicentricity. Appropriate treatment plan, close follow-up and periodic surveillance are necessary.
Subject(s)
Child , Humans , Male , Anemia , Capillaries , Fever , Follow-Up Studies , Castleman Disease , Hyperplasia , Lymph Nodes , Lymphatic Diseases , Plasma Cells , PlasmaABSTRACT
Computerized tomography (CT) is an effective technique in the initial evaluation of the abdomen and head following blunt trauma. To evaluate the efficacy of CT of the thorax, a retrospective study comparing early thoracic CT scanning with initial chest roentgenogram (CXR) was carried out on 134 patients with blunt trauma on the chest. Among 134 patients, 45 patients had normal initial chest roentgenogram and 24 patients showed normal CT findings. Sensitivities of diagnosing pneumothorax and pleural effusion by CXR were low (46.2 and 62.9% respectively), whereas 71.4% (45/63) of patients had thoracostomy only by CXR. Although sometimes abused, CT of the thorax is effective in the initial diagnosis.
Subject(s)
Humans , Abdomen , Diagnosis , Head , Pleural Effusion , Pneumothorax , Retrospective Studies , Thoracostomy , Thorax , Tomography, X-Ray ComputedABSTRACT
PURPOSE: In order to determine the value of first-pass MR imaging in the diagnosis of myocardial ischemia, first-pass perfusion abnormality of coronary artery stenosis was observed in MRI after gadopentate dimeglumine (Gd-DTPA) enhancement. MATERIALS AND METHODS: The left anterior descending (LAD) coronary arteries of six dogs were subjected to approximately 70% stenosis confirmed by coronary angiography. Half an hour after adenosine and 99mTc-sestamibi infusion, Gd-DTPA (0.2 mmol/kg) and methylene blue were administered and termination was induced with potassium chloride. SE T1-weighted and single-photon emission computed tomography (SPECT) images were subsequently obtained and the findings of perfusion defect compared with specimen stain. Three dimensionally reconstructed MR images were used to measure signal intensity (SI) of normal myocardium and perfusion defect from their sectional and total volume. RESULTS: Five of six dogs with LAD artey stenosis ranging from 66% to 73% displayed perfusion defect on MRI, SPECT, and specimen stain, but the remaining dog with stenosis of 58% showed no such defect. MRI showed the perfusion defect as distinct low SI, enabling the measurement of percentage perfusion defect (24.4+/-5.4%), which increased inferiorly. SI of normal myocardium and perfusion defect decreased inferiorly; their difference indicated stenosis-induced perfusion loss according to section location. Volumetric SI of normal myocardium and perfusion defect were 3.42+/-0.52 and 2.16+/-0.45, respectively (p < 0.05). CONCLUSION: Gd-DTPA enhanced MRI displayed first-pass perfusion abnormality of coronary artery stenosis as perfusion defect with distinct low SI ; this enabled the measurement of its volume and SI changes according to section location, and thus indicated the value of first-pass MR imaging in the diagnosis of myocardial ischemia.