Mycotic Abdominal Pseudoaneurysm due to Psoas Abscess after Spinal Fusion

A 36-year-old man, who had undergone thoracoscopic anterior spinal fusion using the plate system and posterior screw fusion three months previously, presented to our hospital with left flank pain and fever. Computed tomography indicated the presence of a psoas muscle abscess. However, after two days of percutaneous catheter drainage, a mycotic abdominal aortic pseudoaneurysm was detected via computed tomography. We performed in situ revascularization using a prosthetic graft with omental wrapping. Methicillin-resistant Staphylococcus aureus was identified on blood and pus culture, and systemic vancomycin was administered for one month. Although the abscess recurred, it was successfully treated with percutaneous catheter drainage and systemic vancomycin administration for three months, without the need for instrumentation removal. The patient remained asymptomatic throughout two years of follow-up.

Predictive Factors of Sustained Sinus Rhythm and Recurrent Atrial Fibrillation after the Maze Procedure

BACKGROUND: We examined perioperative predictors of sustained sinus rhythm (SR) in patients undergoing the Cox maze operation and concomitant cardiac surgery for structural heart disease. MATERIALS AND METHODS: From October 1999 to December 2008, 90 patients with atrial fibrillation (AF) underwent the Cox maze operation and other concomitant cardiac surgery. Eighty-nine patients, all except for one postoperative death, were followed-up with serial electrocardiographic studies, 24-hour Holter monitoring tests, and regular echocardiographic studies. RESULTS: Eighty-nine patients undergoing the maze operation were divided into two groups according to the presence of SR. At the time of last follow-up (mean follow-up period, 51.0+/-30.8 months), 79 patients (88.8%) showed SR (SR group) and 10 patients (11.2%) had recurrent AF (AF group). Factors predictive of sustained SR were the immediate postoperative conversion to SR (odds ratio, 97.2; p=0.001) and the presence of SR at the 6th month postoperatively (odds ratio, 155.7; p=0.002). Duration of AF, mitral valve surgery, number of valves undergoing surgery, left atrial dimension, and perioperative left ventricular dimensions and ejection fractions were not predictors of postoperative maintenance of SR. CONCLUSION: Immediate postoperative SR conversion and the presence of SR at the 6th postoperative month were independent predictors of sustained SR after the maze operation.

Early experience of thoracic endovascular aortic repair: a local single hospital experience / 대한외과학회지

PURPOSE: The purpose of this retrospective study was to evaluate the short- to mid-term results of thoracic endovascular aortic repair (TEVAR) in Wonkwang University School of Medicine & Hospital. METHODS: Between February 2009 and May 2011, 8 consecutive patients had undergone endovascular stent-grafting for thoracic aortic diseases. Five patients were treated for traumatic thoracic aortic injuries, two patients were treated for thoracic aneurysms and one patient was treated for a pseudoaneurysm due to penetrating aortic ulcers. Attempted stent-graft deployment was performed electively in 6 patients and emergently in 2. Follow-up was performed at 1-month, 6-month, 1-year, and annually thereafter. RESULTS: Technical success rates were achieved in 87.5% and the 30-day mortality rate was 0%. Mean hospital length of stay after TEVAR was 30 days in traumatic thoracic aortic injuries and 10 days in thoracic aneurismal diseases. Intra-operative Type I endoleak due to migration at deflation was visualized in 1 patient, which was treated by insertion of another stent-graft. During follow-up, a major complication was encountered in one patient who received carotid-subclavian bypass to relieve left arm ischemia. After 5 months he was treated with arch replacement for aortic arch aneurysm with type I endoleak at proximal site after endovascular treatment. The 30-day mortality rate was 0%. However, 1 case of mortality (12.5%) was observed during the follow-up period. CONCLUSION: The short and mid-term results of endovascular repair of thoracic aortic diseases are promising. TEVAR is an effective procedure in the management of thoracic aortic diseases.

Induction of Autophagy by Low Dose of Cisplatin in H460 Lung Cancer Cells / 결핵및호흡기질환

BACKGROUND: Most lung cancer patients receive systemic chemotherapy at an advanced stage disease. Cisplatin-based chemotherapy is the main regimen for treating advanced lung cancer. Recently, autophagy has become an important mechanism of cellular adaptation under starvation or cell oxidative stress. The purpose of this study was to determine whether or not autophagy can occurred in cisplatin-treated lung cancer cells. METHODS: H460 cells were incubated with RPMI 1640 and treated in 5 micrometer or 20 micrometer cisplatin concentrations at specific time intervals. Cells surviving cisplatin treatment were measured and compared using an MTT cell viability assay to cells that underwent apoptosis with autophagy by nuclear staining, apoptotic or autophagic related proteins, and autophagic vacuoles. The development of acidic vascular organelles was using acridine orange staining and fluorescent expression of GFP-LC3 protein in its transfected cells was observed to evaluate autophagy. RESULTS: Lung cancer cells treated with 5 micrometer cisplatin-treated were less sensitive to cell death than 20 micrometer cisplatin-treated cells in a time-dependent manner. Nuclear fragmentation at 5 micrometer was not detected, even though it was discovered at 20 micrometer. Poly (ADP-ribose) polymerase cleavages were not detected in 5 micrometer within 24 hours. Massive vacuolization in the cytoplasm of 5 micrometer treated cells were observed. Acridine orange stain-positive cells was increased according in time-dependence manner. The autophagosome-incorporated LC3 II protein expression was increased in 5 micrometer treated cells, but was not detected in 20 micrometer treated cells. The expression of GFP-LC3 were increased in 5 micrometer treated cells in a time-dependent manner. CONCLUSION: The induction of autophagy occurred in 5 micrometer dose of cisplatin-treated lung cancer cells.

Induction of Autophagy by Low Dose of Cisplatin in H460 Lung Cancer Cells / 결핵및호흡기질환

BACKGROUND: Most lung cancer patients receive systemic chemotherapy at an advanced stage disease. Cisplatin-based chemotherapy is the main regimen for treating advanced lung cancer. Recently, autophagy has become an important mechanism of cellular adaptation under starvation or cell oxidative stress. The purpose of this study was to determine whether or not autophagy can occurred in cisplatin-treated lung cancer cells. METHODS: H460 cells were incubated with RPMI 1640 and treated in 5 micrometer or 20 micrometer cisplatin concentrations at specific time intervals. Cells surviving cisplatin treatment were measured and compared using an MTT cell viability assay to cells that underwent apoptosis with autophagy by nuclear staining, apoptotic or autophagic related proteins, and autophagic vacuoles. The development of acidic vascular organelles was using acridine orange staining and fluorescent expression of GFP-LC3 protein in its transfected cells was observed to evaluate autophagy. RESULTS: Lung cancer cells treated with 5 micrometer cisplatin-treated were less sensitive to cell death than 20 micrometer cisplatin-treated cells in a time-dependent manner. Nuclear fragmentation at 5 micrometer was not detected, even though it was discovered at 20 micrometer. Poly (ADP-ribose) polymerase cleavages were not detected in 5 micrometer within 24 hours. Massive vacuolization in the cytoplasm of 5 micrometer treated cells were observed. Acridine orange stain-positive cells was increased according in time-dependence manner. The autophagosome-incorporated LC3 II protein expression was increased in 5 micrometer treated cells, but was not detected in 20 micrometer treated cells. The expression of GFP-LC3 were increased in 5 micrometer treated cells in a time-dependent manner. CONCLUSION: The induction of autophagy occurred in 5 micrometer dose of cisplatin-treated lung cancer cells.

The Effect of Autophagy to Cell Death in Nutrient-Deprived H460 Cells / 결핵및호흡기질환

BACKGROUND: Autophagy is an important adaptive mechanism in normal development and in response to changing environmental stimuli in cancer. Previous papers have reported that different types of cancer underwent autophagy to obtain amino acids as energy source of dying cells in nutrient-deprived conditions. However, whether or not autophagy in the process of lung cancer causes death or survival is controversial. Therefore in this study, we investigated whether nutrient deprivation induces autophagy in human H460 lung cancer cells. METHODS: H460, lung cancer cells were incubated in RPMI 1640 medium, and the starved media, which are BME and RPMI media without serum, including 2-deoxyl-D-glucose according to time dependence. To evaluate the viability and find out the mechanism of cell death under nutrient-deprived conditions, the MTT assay and flow cytometry were done and analyzed the apoptotic and autophagic related proteins. It is also measured the development of acidic vascular organelles by acridine orange. RESULTS: The nutrient-deprived cancer cell is relatively sensitive to cell death rather than normal nutrition. Massive cytoplasmic vacuolization was seen under nutrient-deprived conditions. Autophagic vacuoles were visible at approximately 12 h and as time ran out, vacuoles became larger and denser with the increasing number of vacuoles. In addition, the proportion of acridine orange stain-positive cells increased according to time dependence. Localization of GFP-LC3 in cytoplasm and expression of LC-3II and Beclin 1 were increased according to time dependence on nutrient-deprived cells. CONCLUSION: Nutrient deprivation induces cell death through autophagy in H460 lung cancer cells.

Infective Endocarditis with Patent Ductus Arteriosus at 60 Years Old Patient / 대한흉부외과학회지

Aortic and pulmonary valve endocarditis with patent ductus arteriosus (PDA) is uncommon in adult. A 60-year-old woman was diagnosed with aortic and pulmonary valve endocarditis and PDA. We describe our surgical experience for treating PDA with double valve endocarditis.

The Influence of Simplified Surgical Procedures on the Surgical Treatment for Atrial Fibrillation with using the Cut-and-Sew Technique / 대한흉부외과학회지

BACKGROUND: The Cox maze-III procedure is considered as the most effective surgical treatment for atrial fibrillation. Because this procedure takes a long time and it complicates the concomitant cardiac surgery, some surgeons perform a left atrial maze procedure or pulmonary vein isolation only to reduce the operation time. This study was performed to evaluate how the modified procedures, with using cut-and-sew techniques, can influence the treatment of atrial fibrillation. MATERIAL AND METHOD: Between Feb 1999 and June 2005, 40 patients (17 males and 23 females) with organic heart disease and atrial fibrillation underwent the Cox maze-III procedure (23), the left atrial maze procedure (10) or pulmonary vein isolation (7). The cut-an-sew technique was used to ablate the atrial wall, but cryoablation was used instead of the cut-and-sew technique for the coronary sinus and the inferior wall between the pulmonary vein and the mitral annulus. RESULT: After a mean follow-up period of 50.0+/-21.6 months, all (100%) of the 23 patients who underwent the Cox maze-III procedure had regular sinus or atrial rhythm conversion, and 7 (70%) of 10 with a left atrial maze procedure and 4 (57.1%) of 7 with pulmonary vein isolation had regular sinus or atrial rhythm conversion (p=0.002). CONCLUSION: To obtain a high conversion rate from atrial fibrillation to a regular sinus rhythm or a regular atrial rhythm, the standard Cox maze-III procedure should be performed in both atria. The limited modified procedures like the left atrial maze procedure or pulmonary vein isolation may reduce the cure rate of atrial fibrillation.

Clinical Results Following T3, 4 vs T3 Thoracoscopic Sympathicotomy in 30 Axillary Hyperhidrosis Patients / 대한흉부외과학회지

BACKGROUND: Video-assisted thoracic sympathicotomy is a definitive minimally invasive treatment for axillary hyperhidrosis. Different techniques exist for controlling axillary hyperhidrosis, but they are temporary and expensive. We compared the results after using two different levels of sympathicotomy for treating axillary hyperhidrosis: T3-T4 and T4. MATERIAL AND METHOD: Between June 2002 and May 2007, 30 patients with isolated axillary hyperhidrosis underwent either T3-T4 or T4 thoracoscopic sympathicotomy in the Department of Thoracic & Cardiovascular Surgery at Wonkwang University Hospital. The patients were divided into two groups. Group I (n=15) was composed of patients who underwent T3-T4 sympathicotomy (thermal ablation), and Group II (n=15) was composed of patients who underwent T4 sympathicotomy (thermal ablation). The procedures were bilateral and simultaneous, involving the use of two 2-mm trocars and a 0-degree 2-mm thoracoscope under general anesthesia with single endotracheal intubation. Outcome parameters included satisfaction rate of treatment, degree of compensatory sweating, and postoperative complications. Patients were interviewed by telephone regarding satisfaction and compensatory hyperhidrosis. RESULT: There were no differences in age between group I and group II. The mean follow-up for the T3-T4 group was 38.7+/-2.3 months, and the mean follow-up for the T4 group was 18.7+/-3.6 months. The immediate therapeutic success rate (within 2 weeks postoperative) was 100% in both groups, and there were no recurrences in either group during the long-term follow-up period. The satisfaction rate was higher (93.3%) in the T4 group than in the T3-T4 group (53.3%), and the incidence of compensatory hyperhidrosis was lower in the T4 group (6.7%) than in the T3-T4 group (46.7%). Postoperative complications included one mild pneumothorax and two instances of intercostal neuralgia. Digital infrared thermographic imaging (DITI) correlated well with postoperative satisfaction. CONCLUSION: Both techniques proved effective for controlling isolated axillary hyperhidrosis. The T4 group had a higher satisfaction rate and lower severity of compensatory hyperhidrosis. Hence, thermal ablation of the lower interganglionic fibers of the third thoracic sympathetic ganglion on the fourth rib is a more practical and minimally invasive treatment than is the T3-T4 surgical method, according to the degree of compensatory sweating in isolated axillary hyperhidrosis.

Escape of Mechanical Valve: A case report / 대한흉부외과학회지

Incidence of valve leaflet escape after mechanical valve replacement is very low. We report a case of leaflet fracture and escape in an Edwards TEKNA bileaflet valve.

Clinical Results Following Early Tailoring Thoracoplasty in Patients Undergoing Pulmonary Resection / 대한흉부외과학회지

BACKGROUND: Thoracoplasty has become a rarity in current clinical practice, although it has been widely employed for well over a century as a procedure for reducing the capacity of the thoracic cavity. Yet we have perform tailoring thoracoplasty following or concomitant with pulmonary resection in 20 patients. The aim of this study is to evaluate the early and late clinical results and also the significance of tailoring thoracoplasty. MATERIAL AND METHOD: From March 1995 to June 2005, modified thoracoplasty following or concomitant with pulmonary resection was performed in 20 patients out of a total of 298 pulmonary resections for closing air leaks and for treating persistent pleural space following pulmonary resections, and to tailor the thoracic cavity to accept a diminished lung volume. Of the 20 patients, 14 patients had tailoring thoracoplasty performed concomitant with pulmonary resection, and the remaining 6 patients also had tailoring thoracoplasty performed following pulmonary resection. The subjects ages ranged from 24 to 77 (mean 59.1+/-6.4) and a male preponderance was noted (17:3); the number of left and right surgeries was equal. The preoperative primary underlying diseases were lung cancer in 7 patients, pneumothorax with giant bullous change in 6 patients, bronchiectasis in 2 patients, previous pulmonary tuberculosis associated with aspergilloma in 2 patients, empyema with fibrothorax in 2 patients and multiple lung abscesses & destruction due to previous trauma in 1 patient. The operative methods were apicolysis and subperiosteal removal of the 2nd, 3rd and 4th ribs (the costochondral junction to the posterior portions of the ribs) with preservation of the first rib and compression of the anterior chest via cotton bags and elastic bandages. RESULT: The mean duration of the air leaks after thoracoplasty was 1.6+/-0.2 days (range: 0~7 days) and the mean duration of an indwelling chest tube was 7 days (range: 5~11 days); the mean duration of hospitalization was 19.2+/-2.8 days (range: 8~47 days). The postoperative complications were wound infection (2) and pneumonia (2); reoperation was done due to bleeding (1) in one patient who underwent concomitant thoracoplasty and there was 1 case of wound infection (1) after postresection thoracoplasty. The mortality was 1 patient in the early phase and 4 patients in the late phase. CONCLUSION: We conclude that tailoring thoracoplasty may be performed to close anticipated persistent pleural spaces and to accommodate the diminished lung volume with acceptable cosmetic results when this procedure is combined with pulmonary resection in selected patients.

Myxofibrosarcoma Originating from Chest Wall / 대한흉부외과학회지

Myxofibrosarcoma represents one of the most common soft tissue sarcomas of the extremities in adult and elderly patients. However, it only rarely occurs in the chest wall. A 58 years old woman presented with a huge painless lump (8x6.5 cm) in the right lower parasternal area which recurred a few months following excision from General surgery of our hospital. Histology showed an infiltrative deep seated dermal and subcutaneous tumor. It had a distinctive lobular growth pattern with prominent myxoid change and moderate cellularity. Tumor cells were spindle-shaped with varying degrees of pleomorphism and frequent mitotic figures. Numerous blood vessels with curvilinear growth pattern were also seen. Immunostains for S-100, CD68, Mac 387, and FX IIIa were all negative, but positive for Vimentin. The histologic feature was of an intermediate grade myxofibrosarcoma. Wide excision was performed and recovered in good condition without any physical disabilities and was discharged at one month later. Currently she is waiting for the skin graft without chemotherapy and radiotherapy.

The Influence of Gender on the Long-term Outcome of Coronary Artery Bypass Surgery / 대한흉부외과학회지

BACKGROUND: Female sex was known to be a risk factor for mortality after coronary bypass grafting (CABG), and women showed higher in-hospital mortality than men. MATERIAL AND METHOD: Between 1992 and 1996, 147 consecutive patients (98 men and 49 women) undergoing CABG were included in the study. Most patients had undergone CABG with left internal thoracic artery and saphenous vein under cardiopulmonary bypass. We examined the influence of gender on survival after CABG and looked for risk factors for survival. RESULT: There was no in-hospital mortality in women, but 3 death (3.0%) in men. During the mean follow-up period of 138.5+/-23.0 months, mortality was lower in women than in men (20.4% vs 44.9%, p=0.004), and the most common cause of death in women was chronic renal failure (40%). Survival in women at 1, 5, 10, and 14 years was 100%, 98.0+/-2.0%, 81.2+/-5.6%, and 78.4+/-6.1%, respectively, which was better than in men (p=0.004). Although preoperative left ventricular ejection fraction was higher in women than in men, this did not affect early and long-term survival difference between two sexes (p=0.15). Risk factor for long-term survival in women was diabetes (p=0.033) and in men number of diseased coronary artery (p=0.006). CONCLUSION: Long-term survival after CABG was better in women than men. Risk factor for long-term survival in women was morbid disease rather than cardiac disease.

Repair of Postinfarction Ventricular Septal Defect / 대한흉부외과학회지

BACKGROUND: Ventricular septal defect (VSD) is rare but feared complication after acute myocardial infarction. The patient could survive by surgery only, but the surgical mortality is still high. We investigate the surgical result and predictors for early surgical mortality. MATERIAL AND METHOD: Between August 1993 and February 2006, 8 patients (male, 2; female, 6) with postinfarct VSD underwent surgical repair. Seven patients had one-vessel disease of left anterior descending artery, and 6 of them had wide extension of infarction to posterior septal wall as well as anterior septal wall of both ventricles. One patient had concomitant coronary bypass grafting to a coronary lesion unrelated to the infarction. Two patients had concomitant tricuspid annuloplasty and 1 patient mitral valvuloplasty. RESULT: Surgical mortality was 37.5% (3 patients). They all had only one-vessel disease of left anterior descending artery, which made extended posterior septal wall infarction as well as anterior septal wall infarction of both ventricles. In preoperative M-mode echocardiographic study of left ventricle, they had lower ejection fraction than survivors (34.9+/-4.2 vs. 54.8+/-12.3; p=0.036). CONCLUSION: Most of patients with postinfarction VSD had one-vessel disease of left anterior descending artery. Early surgical mortality occurred in the patients with poor ejection fraction of left ventricle and the wide anterior septal wall infarction extending to the posterior septum.

Changes of Renal Function and Treatment after CABG in Patients with Elevated Serum Creatinine / 대한흉부외과학회지

BACKGROUND: Preoperative elevated serum creatinine values are associated with increased risk for both morbidity and mortality in patients undergoing on-pump coronary artery bypass surgery (CABG). We investigated the postoperative changes of renal function and proper management in the patients. MATERIAL AND METHOD: Among 74 consecutive patients who underwent isolated on-pump CABG, 17 patients with increased serum creatinine level (creatinine > or = 1.5 mg/dL) within preoperative one week were included in the study. Seven patients showed preoperative serum creatinine level of 2.0 mg/dL or higher, and 3 of them had been undergoing hemodialysis. Preoperative hemodialysis was performed in the 3 patients due to end-stage renal failure (ESRD) the day before the operation. We started peritoneal dialysis immediately after the cardiopulmonary bypass in patients with ESRD or postoperative acute renal failure if it was necessary to remove intravascular volume and lower serum creatinine level. RESULT: In most of the patients with CABG, postoperative serum creatinine level increased and recovered to the preoperative level at the discharge. In 2 of the 4 patients with serum creatinine level of 2.0 mg/dL or higher and 3 patients with ESRD, intravascular volume, serum creatinine level and serum electrolyte were controlled with peritoneal dialysis. CONCLUSION: Postoperative serum creatinine level increased transiently in most of CABG patients, and intravascular volume and serum creatinine level were controlled by peritoneal dialysis only in the patients with acute renal failure postoperatively and those depending on hemodialysis.

Comparison of Conventional Thoracoscopic Wedge Resection and Modified Transaxillary Minithoracotomy with Thoracoscopy for the Treatment of Primary Spontaneous Pneumothorax / 대한흉부외과학회지

BACKGROUND: Retrospective study was carried out on patients with primary spontaneous pneumothorax with the aim of determining if conventional thoracoscopic wedge resection is superior to modified transaxillary minithoracotomy with thoracoscopy in the surgical treatment. MATERIALS AND METHOD: 160 patients, aged 14 to 35 years with primary spontaneous pneumothorax were involved in this study. Patients were assigned to two groups by surgical technique; Conventional thoracoscopic wedge resection (group A; n=80) and modified transaxillary minithoracotomy with thoracoscopy (group B; n=80). Apical pleural abrasion & talc poudrage were performed in all cases. This study evaluated the following factors: duration of operation, days of analgesics used after operation, number of no air leak on the first postoperative day, duration of indwelling chest tube, hospital stay, postoperative complications, chronic chest pain (during follow-up) and resumption of normal activity. Relapses (ipsilateral recurrence after discharge) during follow-up periods were evaluated. RESULT: No significant differences were found in any of the factors studied in either group. CONCLUSION: Conventional thoracoscopic wedge resection and modified transaxillary minithoracotomy with thoracoscopy offer similar results in the surgical treatment of primary spontaneous pneumothorax. The rate of complication is low and the level of pain is acceptable without long-term sequele. Therefore, modified transaxillary minithoracotomy with thoracoscopy method appears as a valuable alternative surgical technique.

Repair of Acute Aortic Arch Dissection with Hypothermic Circulatory Arrest and Retrograde Cerebral Perfusion / 대한흉부외과학회지

BACKGROUND: Acute thoracic aortic dissections involving the aortic arch differ in diagnosis, surgical procedures, and operative results compared to those that do not involve the aortic arch. In general cerebral perfusion under deep hypothermic circulatory arrest (HCA) is performed during the repair of the aortic arch dissection. Here, we report our surgical results of the aortic arch dissection repair using retrograde cerebral perfusion (RCP) and its safety. MATERIAL AND METHOD: Between January 1996 and June 2002, 22 consecutive patients with aortic arch dissection underwent aortic arch repair. In 20 of them RCP was performed under HCA. RCP was done through superior vena cava in 19 patients and by systemic retrograde venous perfusion in 1, in whom it was difficult to reach the SVC. When the patient's rectal temperature reached 16 to 18oC, systemic circulation was arrested, and the amount of RCP amount was 481.1+/-292.9 ml/min with perfusion pressure of 20~30 mm Hg. RESULT: There were two in-hospital deaths (4.5%) and one late death (9.1%). Mean circulatory arrest time (RCP time) was 54.0+/-13.4 minutes (range, 7 to 145 minutes). RCP time has no correlation with the appearance of consciousness, recovery of orientation, or ventilator weaning time (p=0.35, 0.86, and 0.92, respectively). Ventilator weaning was faster in patients with earlier recovery of consciousness and orientation (r=0.850, r=926; p=0.000, respectively). RCP of more than 70 minutes did not affect the appearance of consciousness, recovery of orientation, ventilator weaning time, exercise time, or hospital stay (p= 0.42, 0.57, 0.60, 0.83, and 0.51, respectively). CONCLUSION: Retrograde cerebral perfusion time under hypothermic circulatory arrest during repair of aortic arch dissection may not affect recovery of orientation, ventilator weaning time, neurologic complications, and postoperative recovery.

Relation between Changes of DITI and Clinical Results according to the Level and Extent of Sympathicotomy in Essential Hyperhidrosis / 대한흉부외과학회지

BACKGROUND: Video-assisted sympathicotomy is a safe and effective method for the treatment of essential hyperhidrosis with immediate symptomatic improvement. However, this is offset by the occurrence of a high rate of side-effects, such as embarrassing compensatory hyperhidrosis. Therefore, by comparing and assessing the relationship between temperature change measured by DITI (digital infrared thermographic imaging) and clinical results according to the level and extent of sympathicotomy in essential hyperhidrosis. we tried to obtain a more precisely and objectively, the distribution and degree of compensatory sweating by DITI and also for ascertaining the clinical usefulness. MATERIAL AND METHOD: From January 2000 to June 2002, the thoracoscopic sympathicotomy was performed in 28 patients suffering from essential hyperhidrosis in Dept. of Thoracic and Cardiovascular Surgery, Wonkwang University Hospital. The patients were divided into four groups, Group I: patients having undergone T2 sympathicotomy, Group II: patients having undergone T3 sympathicotomy, Group III: patients having undergone T3,4 sympathicotomy, and Group IV: patients having undergone T2,3,4 sympathicotomy. The parameters were composed of the satisfaction rate of treatment, the degree of compensatory and plantar sweating, and temperature changes of entire body measured by DITI RESULT: There was no difference in age and follow-up period among the groups. All of the treated patients obtained satisfactory alleviation of essential hyperhidrosis in immediate postoperative period. However, the rate of long-term satisfaction were 85.8%, 85.8%, 42.9%, and 28.6% in group I, II, III, and IV (p<0.05). More than embarrassing compensatory sweating was present in 14.2%, 14.2%, 57.1%, 71.4% in group I, II, III, and IV (p<0.05) In regard to plantar sweating, decrease in sweating was expressed in each of four groups, but was not significant between groups. An apparent increase of temperature measured by DITI indicated sufficient denervation and predicted long-lasting relief of essential hyperhidrosis and also decrease in temperature of trunk and lower extremity by DITI had correlated well with postoperative satisfaction, and also postoperative compensatory sweating. CONCLUSION: We suggested that the incidence and degree of compensatory sweating was closely related to the site and the extent of thoracic sympathicotomy. Resection of the lower interganglionic neural fiber of the second thoracic sympathetic ganglion on the third rib is the most practical and minimally invasive treatment than other surgical methods. We were also to anticipated the distribution and degree of compensatory sweating by DITI precisely and objectively and for ascertaining the clinical usefulness.

Aortic Valve Replacement in a Patient with Aortic Arch Syndrome Secondary to Takayasu's Arteritis: One case / 대한흉부외과학회지

Aortic regurgitation is not a rare complication of Takayasu's disease. Aortic regurgitation may aggravate cerebral ischemic syndrome like syncope in patients with stenotic or occlusive lesions in cerebral branches of aorta secondary to acute or progressive inflammation. In a 34-yrs-old male patient who complained of syncope and exertional dyspnea with occlusion of both carotid arteries and severe stenoses of both subclavian arteries, occlusion of right coronary artery, and aortic regurgitation, his symptom was improved with perioperative aggressive steroid therapy, stent insertion in both subclavian arteries, and aortic valve replacement.

Free Flow in Internal Thoracic Artery and Internal Thoracic Artery-Radial Artery Composite Graft / 대한흉부외과학회지

BACKGROUND: The Y-composite graft of internal thoracic artery and radial artery is commonly used in coronary bypass surgery. The aim of this study is to look for a way to raise the free flow of the internal thoracic graft and to see flow dynamics of the Y-graft. MATERIAL AND METHOD: In 15 patients undergoing coronary bypass surgery, free flow of the in-situ internal thoracic artery graft was measured using two different papaverine application methods; extraluminal papaverine spray in 7 patients and intraluminal papaverine injection in 8. In 18 other patients for whom the Y-graft was used, total free flow and flow changes from the two ends were measured. RESULT: The free flow of the in-situ internal thoracic artery graft almost doubled with internal papaverine injection than with external papaverine spray (47.7+/-9.6 mL/min vs. 100.8+/-26.3 mL/min, p<0.001). Total flow of the Y-composite graft was significantly more than either flow of the internal thoracic artery end or radial artery graft end (173.3+/-45.3 mL/min vs. 121.1+/-34.3 mL/min or 117.5+/-42.8 mL/min). When both ends of the Y-composite graft were opened, free flows from the two ends were similar (85.4+/-27.8 mL/min vs. 87.9+/-42.4 mL/min, p=0.772). The flow of one end of the Y-composite graft was increased significantly by clamping of the other-end than when both ends were opened. CONCLUSION: Intraluminal papaverine injection is very effective in raising free flow of the internal thoracic artery graft, and the free flow of the Y-composite graft of in-situ internal thoracic artery and free radial artery graft is more than that of the in-situ internal thoracic artery graft. The flow of one end flow of the Y-graft may be altered by the flow change of the other end.