ABSTRACT
A pancreatico-pleural fistula (PPF), caused by rupture of a pancreatic pseudocyststectomy or obstruction of the pancreatic duct, is a rare condition. A 48-year-old man with chronic alcoholism was admitted with a massive pleural effusion. Pleural fluid studies revealed elevated amylase and lipase. A PPF complicated by a ruptured pancreatic pseudocyststectomy was diagnosed by computerized tomography scan. Although the symptoms improved with conservative management, (chest tube drainage, NPO, total parenteral nutrition, and a pancreatic secretion inhibitor), a distal pancreatectomy, including a pseudocystectomy and thoracotomy, were performed for an increasing size of the hemorrhagic pancreatic pseudocyststectomy and a recurrent hemorrhagic pleural effusion. There were no post-operative complications and the patient was discharged on post-operative day 27.
Subject(s)
Humans , Middle Aged , Alcoholism , Amylases , Drainage , Fistula , Lipase , Pancreatectomy , Pancreatic Cyst , Pancreatic Ducts , Parenteral Nutrition, Total , Pleural Effusion , Rupture , ThoracotomyABSTRACT
BACKGROUND: Descending necrotizing mediastinitis (DNM) is a life-threatening cervico-mediastinal infection extending from the oropharynx or periodontal space. We reviewed clinical outcomes of DNM patients that underwent surgical management. MATERIAL AND METHOD: We analyzed the demographic and surgical data from 8 patients (6 males and 2 females) that underwent surgical management for DNM between August 2003 and August 2007. RESULT: The mean age was 56.6+/-12.3 (34~72) years. Types of DNM were I (n=2), IIA (n=1), and IIB (n=5), based on the classification system of Endo et al. Four patients were septic at the time of operation. The infectious organism was identified in three cases and turned out to be Streptococcus. ICU stay was 24.3+/-17.9 (3~58) days, and hospital stay was 49.1+/-33.8 (20~125) days. There were two deaths (25%), both of which were due to multi-organ failure. CONCLUSION: Despite aggressive surgical drainage and appropriate medical management, DNM still had a high mortality rate. Early diagnosis and prompt surgical intervention are key to DNM management. In addition, transcervical drainage should be used in limited disease only.
Subject(s)
Humans , Male , Drainage , Early Diagnosis , Length of Stay , Mediastinitis , Necrosis , Oropharynx , StreptococcusABSTRACT
Transcatheter interventions are widely used for diagnosis and treatment of congenital heart disease. Complications associated with transcatheter interventions are uncommon. However, when they occur they are most often self- limited. Rarely, however, serious catheter related complications occur that may require emergent surgical intervention. In this case, the right common iliac artery was disrupted during transcatheter balloon valvuloplasty during the treatment of congenital aortic stenosis in a 2-week-old baby. After immediate surgical intervention with bleeding control using two balloon catheters the baby did well. Here we report this case and review the medical literature.
Subject(s)
Aortic Valve Stenosis , Balloon Valvuloplasty , Catheters , Heart Diseases , Hemorrhage , Iliac Artery , RuptureABSTRACT
BACKGROUND: The histomorphological properties of the left anterior desecending artery (LAD), the left internal thoracic arteries (LITA), the radial arteries (RA) and the intercostal arteries (ICA) were studied for their use as a conduit for coronary artery bypass grafting (CABG), and we compared them with each other. MATERIAL AND METHOD: All the vessels were harvested from nineteen cadavers (17 males and 2 females). The mid-portion of the LAD, the mid-portion of the LITA, the distal RA and the mid-portion of the 5th ICA were obtained. All of them were stained with hematoxylin-eosin and with Van Gieson's elastin stain. The morphological characteristics were examined and the thicknesses of the intima and media (I/M ratio: the intima to media ratio) were compared using one-way ANOVA tests. RESULT: The mean age of the cadavers was 61.5+/-9.6 years. The LITA and ICA were elastic arteries, and the LAD and RA were muscular arteries. The I/M ratio showed statistically significant differences: 0.07+/-0.03 in the LITA, 0.16+/-0.11 in the ICA, 0.45+/-0.29 in the RA and 0.93+/-0.52 in the LAD, respectively. CONCLUSION: This study showed that the degrees of intimal hyperplasia of the CA and the various conduits for CABG were different significantly. The ICA was found to have relatively favorable characteristics as a coronary bypass conduit, but its suitability for clinical use is a challenging issue.
Subject(s)
Humans , Male , Arteries , Cadaver , Coronary Artery Bypass , Coronary Vessels , Elastin , Hyperplasia , Mammary Arteries , Radial Artery , TransplantsABSTRACT
BACKGROUND: Due to the advancement of video assisted thoracoscopic techniques, an operation for primary spontaneous pneumothorax is now considered a common procedure. However, whether a preventive operation is necessary when a contralateral bulla is found on High Resolution Computed Tomography (HRCT) at the time of the first primary spontaneous pneumothorax attack is still unknown. In this retrospective study, it was our intension to find whether contralateral bullae are related to the occurrence of pneumothorax. MATERIAL AND METHOD: Between January 1999 and April 2006, 550 patients were admitted to the Chungnam University hospital with primary spontaneous pneumothorax, which was confirmed by the HRCT scans in 190 patents. In these 190 patients, 159 had not received a bilateral operation after their first primary spontaneous pneumothorax attack. In these 159 patients, the relationship between the presence of contralateral bullae and the occurrence of pneumothorax was measured. RESULT: In these 159 patients, 67 had contralateral bullae confirmed inform the HRCT scan, and 92 had no visible contralateral bullae. During the follow up period, 6 patients (8.9%) with contralateral bullae had an occurrence of contralateral pneumothorax, and 5 patients (5.4%) without contralateral bullae had an occurrence of contralateral pneumothorax. (p=0.529 [Fisher's exact test]) CONCLUSION: In patients with unilateral primary pneumothorax, an HRCT scan is a useful way of confirming contralateral pulmonary bullae. However, the presence of bullae is not a significant predictive sign of an occurrence of contralateral pneumothorax. Also, surgery for pneumothorax is not completely uncomplicated, and bilateral surgery is still doubtful. A further prospective study will be required to find the relationship between the bullae found on HRCT and the occurrence of pneumothorax.
Subject(s)
Humans , Blister , Follow-Up Studies , Pneumothorax , Retrospective StudiesABSTRACT
A 24 year old man visited our hospital, because an intrapulmonary foreign body had been found incidentally. Simple chest X-ray showed a 5 cm sized foreign body of metallic density, and chest CT confirmed the foreign body, which was like a sewing needle, in the left upper lobe. We performed a simple extraction of the foreign body using VATS (Video Assisted Thoracic Surgery). After the operation, the patient was discharged without any complications.
Subject(s)
Humans , Young Adult , Foreign Bodies , Needles , Thoracic Surgery, Video-Assisted , Thoracoscopy , Thorax , Tomography, X-Ray ComputedABSTRACT
A 24 year old man visited our hospital, because an intrapulmonary foreign body had been found incidentally. Simple chest X-ray showed a 5 cm sized foreign body of metallic density, and chest CT confirmed the foreign body, which was like a sewing needle, in the left upper lobe. We performed a simple extraction of the foreign body using VATS (Video Assisted Thoracic Surgery). After the operation, the patient was discharged without any complications.