Chronic Traumatic Femoral Arteriovenous Fistula after Gunshot Vascular Injury: A case report / 대한흉부외과학회지

A 60-year-old man with a history of gunshot vascular injury on the right inguinal area, and this happened in the military service 40 years ago, was admitted to our hospital with claudication and dyspnea on exertion. The patient was diagnosed with a chronic traumatic femoral arteriovenous fistula. The patient underwent a successful operation for arteriovenous fistula closure with bovine pericardium and for femoropopliteal bypass with using a right greater saphenous vein graft. The patient is well at 14 months after the operation.

Penetrating Vascular Trauma to Zone One of the Neck: A report of two cases / 대한흉부외과학회지

Penetrating vascular trauma to zone one of the neck is potentially life-threatening. Trauma in this anatomical location is difficult to access and manage because the neck is a small anatomic area with the anatomical proximity of vital structures. An accurate diagnosis and aggressive surgical intervention are critical to the successful outcome of penetrating zone one vascular trauma in the neck. Here we report two cases with review of the medical literature.

Combined Repair of Coronary Artery Disease and Left Subclavian Artery Occlusion / 대한흉부외과학회지

A 47-year-old male with hypertension, diabetes mellitus and heavy smoking, but no anginal symptoms, presented with claudication of the lower extremities. Extremity angiography with coronary angiography revealed peripheral arterial lesions including a left subclavian artery occlusion with coronary artery disease. The patient underwent an initial off-pump coronary artery bypass with an ascending aorto-axillary bypass. The right internal mammary artery was anastomosed to the left anterior descending coronary artery. The greater saphenous vein graft was connected from the ascending aorto-axillary bypass graft to the diagonal branch. At postoperative day 18, femorofemoral and bilateral femoropopliteal bypasses were performed. We report a case of the combined repair of coronary artery disease and a left subclavian artery occlusion.

Surgical Treatment of Bilateral Coronary to Pulmonary Artery Fistulae with a Saccular Aneurysm: A case report / 대한흉부외과학회지

A 76-year-old woman with a history of chest pain and palpitation, was diagnosed with bilateral coronary to pulmonary artery fistulae with a concomitant saccular aneurysm, which is quite rare. Suture closure of the fistular vessels around the pulmonary artery root, the removal of a saccular aneurysm, and the transpulmonary closure of coronary to pulmonary artery fistulae were performed. The patient was well at 4 months after surgery.

Intracardiac Repair of the Coronary Sinus Laceration during Retrograde Cardioplegia: A case report / 대한흉부외과학회지

Coronary sinus injuries related to the use of retrograde cardioplegia are rare and have potentially lethal complications. This report describes a case of coronary sinus laceration during retrograde cardioplegia in an old patient with mitral valve regurgitation, endocarditis, and left ventricular hypertrophy, and tells the details of the method of intracardiac repair.

Irrigation-suction System for Management of Deep Sternal Wound Infection after Open Heart Surgery: Four cases / 대한흉부외과학회지

Deep sternal wound infection (with or without acute mediastinitis) is a serious complication of open heart surgery, with high rates of associated morbidity and mortality, and prolonged hospitallization. The result of treatment largely depends on timely diagnosis and appropriate surgical management. Postoperative deep sternal wound infections in 4 cases were successfully treated with extensive debridement, pressurized jet irrigation with antibiotic solution, sternal refixation by Robicsek method, and dilute antibiotic irrigation via irrigation-suction system. We report 4 cases with review of articles.

Fibrous Pseudotumor of Paratesticular Region / 대한비뇨기과학회지

A fibrous pseudotumor of the paratesticular region is rare, but one of the most common neoplasma of this area. It has also been called a nodular fibrous proliferation, pseudofibromatous periorchitis, benign fibrous paratesticular tumor, and fibrous mesothelioma (pseudofibroma). Complete surgical excision, by orchiectomy, appears to be curative. A case of a fibrous pseudotumor is reported and the clinical presentation and radiographic and histological findings described.

Repair of Left Ventricular Free Wall Rupture after Acute Myocardial Infarction: Application of Pericardial Patch Covering and Fibrin Glue Compression: A case report / 대한흉부외과학회지

Left ventricular rupture after acute myocardial infarction is a serious complication with high mortality. Emergency operation is usually the only available treatment. A 76-year-old female with persistent chest pain and syncopal attacks was admitted. Transthoracic echocardiography showed the pericardial effusion and generalized hypokinesia of the inferolateral wall of left ventricle. Coronary angiography revealed a total occlusion of the first diagonal branch. After percutaneous transluminal coronary angioplasty with coronary stent and insertion of intraaortic balloon pump, emergency operation was performed. Under cardiopulmonary bypass and cardiac arrest with cold blood cardioplegia, coronary artery bypass graft with saphenous vein, pericardial patch covering on the rupture area with 6-0 polypropylene running sutures, and fibrin glue compression under the patch were performed. We present a case of left ventricular (free wall) rupture after acute myocardial infarction.

Metastatic Ureteral Tumor from the Lung Squamous Cell Carcinoma after Complete Remission / 대한비뇨기과학회지

Ureteral tumors are relatively uncommon, accounting for approximately 1.2% of all urothelial tumors. Metastatic ureteral tumors are even rarer. The primary lesions include breast, melanomas, bladder, colon, stomach, lung, and esophageal, prostate, ovarian, kidney, urethral and vaginal carcinomas. Patients usually have lumbar or flank pain, dysuria, frequency, and in the latter stages, anuria. We report a case of a metastatic ureteral tumor from a lung squamous cell carcinoma after complete remission.

Comparison of Ureteroscopic Lithotripsy and Extracoporeal Shock Wave Lithotripsy in the Treatment of Upper Ureteral Stones / 대한비뇨기과학회지

PURPOSE: Cases of ureteroscopic lithotripsy (URS) were retrospectively reviewed to define the efficacy of an ureteroscopic lithotripsy in the treatment of upper ureteral stones. The success rates, reasons for failure and complications of URS were compared with extracoporeal shock wave lithotripsy (ESWL). MATERIALS AND METHODS: URS for upper ureteral stones was performed in 48 cases, between January, 2000 and December, 2002. A 7.5Fr, or 9.5Fr, rigid ureteroscopy and stone basket were used with, or without, electrohydraulic lithotripsy. There were 29 males and 19 females, with a mean age of 43.3 years. RESULTS: The overall success rate of the URS was 91.6%. According to the stone size, the success rates were 92.1 and 90% in stones smaller than 10mm and larger than 10mm, respectively. With the ESWL treatments, the overall stone free rate was 71.7% with only one session. The stone free rate was significantly affected by the size, was and were 77.9 and 46.3% in stones smaller than 10mm and larger than 10mm, respectively. The stone free rate after the second and third ESWL sessions were 81.3 and 91.3%, respectively. The associated complication rate for URS was 18.1%, with the complications consisting of ureteral mucosal injuries in 3 patient, flank pain (>48 hours) in 2, a ureteral perforation in 1, fever in 1 and a gross hematuria (>48 hours) in 1, which were all treated successfully with conservative treatment. CONCLUSIONS: URS can be a successful and safe treatment modality for upper ureteral stones, even if larger than 10mm.

Ureteroscopic Removal of Multiple Renal Pelvis and Lower Calyceal Stones / 대한비뇨기과학회지

The goal of surgical stone management is to achieve maximal stone clearance with minimal morbidity to the patient. Because of its efficacy, efficiency and low morbidity, extracorporeal shock wave lithotripsy(ESWL) is the first-line treatment for almost all urinary calculi. However, stone clearance after ESWL has been shown to be affected by the stone burden, location, chemical composition and kidney anatomy. Especially, the success rate for ESWL is reduced in lower pole stone(LPS). Percutaneous nephrolithotomy(PNL) and retrograde ureteroscopic intrarenal surgery(RIRS) are alternative treatment options for stones refractory to ESWL such as LPS. Although effective, PNLsubjects the patient to increased morbidity compared to ESWL and RIRS. Because of its low morbidity and relatively high success rate, RIRS for LPS is an attractive treatment modality in selective patients. We report a case of multiple renal pelvis and lower calyceal stones treated with ureteroscopy.

Idiopathic Retroperitoneal Fibrosis Treated with Medical Therapy / 대한비뇨기과학회지

Retroperitoneal fibrosis, although benign, has a malignant course due to an encasement and obstruction of the retroperitoneal structures, particularly the urinary system. The most common treatment is often a surgical exploration followed by urologic intervention. However, steroid or azathioprine therapy has been advocated, with varying results and major side-effects. Recently, the successful medical therapy in patients with an early stage and low malignant potential has been reported. Here we report a male patient who underwent successful treatment of an idiopathic retroperitoneal fibrosis with tamoxifen and prednisolone.

Long-term Results of the Gittes Procedure for Treatment of Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: We evaluated the long-term outcome of the Gittes procedure for treatment of stress urinary incontinence. MATERIALS AND METHODS: A total of 84 women had Gittes bladder neck suspension carried out for the treatment of anatomic stress urinary incontinence. Long term (mean 51.4 months) results were evaluated using a questionnaire. RESULTS: Of the 58 patients assessed, 25 (43.1%) reported cure of stress urinary incontinence, 19 (32.8%) reported improvement, 12 (20.7%) were the same and 2 (3.4%) were worse after Gittes bladder neck suspension. Thirty-seven (63.8%) replied 'satisfactory' for the Gittes bladder neck suspension. Overall success rate was estimated as 62.1%. Depending on follow-up periods success rate was declined with time and by 5 years the success rate was 67.2%. CONCLUSIONS: Although the Gittes procedure was quick and easy to perform and was well tolerated with minimal complications, long term follow-up study of Gittes bladder neck suspension showed a declining success rate with time. Therefore it may not be a satisfactory procedure for the management of anatomic stress urinary incontinece in women.

A Clinical Study of Mitral Valve Repair for the Treatment of Mitral Valve Insufficiency

BACKGROUND AND OBJECTIVES: Mitral valve repair is the main procedure for the treatment of mitral valve insufficiency. The aims of this study were to review the applied techniques. and to evaluate postoperative residual mitral valve insufficiency, to compare preoperative and postoperative cardiac functions and dimensions, to compare the effects of rigid and flexible ring annuloplasty, and to assess overall freedom from valve failure-related reoperation. SUBJECTS AND METHODS: From March 1996 to September 1999, 34 patients underwent mitral valve repair for the treatment of mitral valve insufficiency at our department. This group comprised ten males and twenty four females, aged 8 to 65 years. The causes of mitral valve insufficiency were of degenerative origin in 12 patients, rheumatic in 10, congenital in 9, cardiomyopathic in 2, and ischemic in 1. The applied valve repair techniques included annuloplasty, quadrangular resection, leaflet slicing, cleft repair, chordae shortening, chordae transfer, secondary chordae resection, new chordae formation, papillary muscle splitting, commissuroplasty, and commissurotomy. RESULTS: There was no early or late mortality. We encountered 8 residual mitral valve insufficiencies (more than grade II), 2 of which worsened and eventually required correction by valve replacement. There were no statistical differences seen between the effects of rigid and flexible ring annuloplasty on left ventricular function either before or 1 year following annuloplasty. The cardiac dimensions decreased significantly. The actuarial freedom from valve failure-related reoperation was 93.01% at 43 months. CONCLUSION: Mitral valve repair with preserved valvular apparatus showed that the repaired valves functioned well and cardiac dimensions recovered satisfactorily. There were no statistical differences between the effects of rigid and flexible ring annuloplasty on cardiac functions and dimensions either before or 1 year following annuloplasty.

A Case of Priapism Caused by Malignant Lymphoma / 대한비뇨기과학회지

Priapism is a relatively rare condition of prolonged painful penile erection, unrelated to sexual activity. It is caused by idiopathic, leukemia, sickle cell disease, oral medication, intracavernosal injection therapy, spinal cord injury and malignant cell infiltration. Malignant lymphoma involving the genitourinary system is uncommon and when it occurs the testes is the most common site. However malignant lymphoma involving the penis is even more rare, with only 20 cases reported in literature. To our knowledge, priapism caused by penile lymphoma has not been reported previously in literature. We report a case with a brief review of literature.

Pulmonary Trunk Translocation from LV to RV in Double-Outlet Left Ventricle: A case report / 대한흉부외과학회지

Double-outlet left ventricle(DOLV) is a rare congenital cardiac malformation, defined as the origin of both the aorta and the pulmonary artery being entirely or predominantly above the morphologically left ventricle, which is difficult to diagnose accurately. A 3-year old male was admitted for cyanosis and dyspnea. At the age of 2 months, he had undergone pulmonary artery banding and coarctoplasty. He was diagnosed as DOLV with subaortic ventricular septal defect(VSD). Biventricular repair was achieved by patch closure of VSD, primary closure of PFO, and pulmonary trunk translocation from left ventricle to right ventricle. The advantages of this procedure using native tissue for right ventricular outflow tract reconstruction are growth potential and preserved valve function, which contribute to a decreased likelihood of reoperation related to the right ventricular dysfunction related to pulmonary insufficiency.

A Case of Inflammatory Pseudotumor of the Bladder / 대한비뇨기과학회지

Inflammatory pseudotumor of the bladder is an unusual benign lesion arising from the bladder submucosa. This benign lesion must be differentiated histologically from several malignant lesions of the bladder. Complete surgical excision, either by transurethral resection or partial cystectomy, appears to be curative. We report a case and describe the clinical presentation, and radiographic and histological findings.

Closure of VSD in a Patient with Tracheostoma: A case report / 대한흉부외과학회지

Open heart surgery in a patient with tracheostoma by standard median sternotomy increases the risk of wound infection or mediastinitis. In adults, the risk of mediastinal infection is decreased by using the high tracheostomy and minimally invasive approach for cardiac surgery. However the modified surgical approach is needed in infants due to their short neck. We have successfully performed the closure of ventricular septal defect, using the transverse sternotomy, in an infant with tracheostoma due to tracheomalacia.

A Case of Fournier's Gangrene associated with Sparganosis in the Scrotum / 대한비뇨기과학회지

No abstract available.

Tetralogy of Fallot with Pulmonary Arteriovenous Fistula: A Case Report / 대한흉부외과학회지

Pulmonary arteriovenous fistula can occur in a variety of clinical situations including liver diseases, infections, metastatic carcinomas, systemic disorders, and after the palliation of congenital heart diseases. A 72-day-old male infant with Tetralogy of Fallot and pulmonary atresia underwent surgical correction without difficulty. However, ventilator weaning in the ICU failed initially because of an unexplained postoperative hypoxemia(FiO2: 0.8, PaO2: 40 mmHg, SaO2: 80~90%). Postoperative follow-up lung perfusin scan at postoperative 15 days showed right-to-left shunt(33.6%) and ventilator weaning was performed on the 20th day after the operation (FiO2: 0.4, PaO2, 50mmHg, SaO2: 86.9%). Arterial oxygen saturation under room air was 80~85% at 7 months postoperatively. One and half year follow-up lung perfusion scan showed decreased amount of right-to-left shunt (11.2%). We report a case with a review of the literatures.