ABSTRACT
BACKGROUND: Coronary artery bypass graf t (CABG) has been settled as most safe surgery among the open heart surgeries. However, in patients with cardiogenic shock, the emergency CABG has higher mortality than elective CABG. We analyzed thirty four patients who underwent emergency CABG and report the middle and long-term results. MATERIAL AND METHOD: From June 1994 to December 2001, 34 patients who underwent emergency CABG at Kang-dong Sacred Heart Hospital were include in this study. On the basis of hospital databases and Out Patient Department (OPD) follow up data, preoperative diagnosis, risk factor, coronary artery anatomy, operation technique, postoperative mortality, complication, recurrence of symptom, and mid and long term mortality were analyzed retrospectively. RESULT: Indications for emergency CABG were 29 cardiogenic shocks (85.3%), 4 intractable chest pains (11.8%), and 1 polymorphic ventricular tachycardia (2.9%). Preoperative angiographic diagnoses were triple vessel disease in 16 (47.1%) and left main disease in 8 (23.5%) patients. We used saphenous vein grafts in 81 and left internal thoracic artery grafts in 14 anastomosis. The mean number of grafts per patients was 2.8+/-0.8. The mean aortic cross clamp time was 91.9+/-34.6 minutes and the mean cardiopulmonary bypass time was 262.7+/-198.3 minutes. Early mortality was 50% and the most common cause of early mortality was low cardiac output in 7 (20.6%) patients. The mean follow-up period was 30.9+/-35.7 months. There were no recurrences of symptom and late mortality. CONCLUSION: In the case of emergency operation, aggressive and proper management with drugs and IABP should be done for preoperative hemodynamic stability and early surgical intervention is the most important factor for patient salvage.
Subject(s)
Humans , Cardiac Output, Low , Cardiopulmonary Bypass , Chest Pain , Coronary Artery Bypass , Coronary Vessels , Diagnosis , Emergencies , Emergency Treatment , Follow-Up Studies , Heart , Hemodynamics , Mammary Arteries , Mortality , Recurrence , Retrospective Studies , Risk Factors , Saphenous Vein , Shock, Cardiogenic , Tachycardia, Ventricular , TransplantsABSTRACT
Epithelial-myoepithelial carcinoma is a rate low-grade malignant salivary neoplasm that usually occurs in the parotid gland but can also arise in minor salivary glands. We report a case of a primary epithelial-myoepithelial carcinoma of the lung neoplasm. The patient was 48-year-old women who presented with dry cough of 1 month duration. A right middle lobe endobronchial lesion was identified bronchoscopically. The bilobectomy of RML & RLL was performed, the pathologic result was epithelial-myoepithelial carcinoma.
Subject(s)
Female , Humans , Middle Aged , Cough , Lung Neoplasms , Lung , Parotid Gland , Salivary Glands, MinorABSTRACT
BACKGROUND: We analyzed five hundred patients who underwent either isolated or concomitant coronary artery bypass grafting(CABG) between November 1981 and June 1997. MATERIAL AND METHOD: There were 330 males and 170 females with a mean age of 57.4+/-8.9 years. To evaluate the preoperative status, we performed electrocardiograghy, echocardiography, MIBI scan, Duplex sonogram, common blood test including CK and LDH and coronary angiography. RESULT: Preoperative clinical diagnoses were unstable angina in 282 (56.4%), stable angina in 141 (28.2%), postinfarction angina in 58 (11.6%), acute myocardial infarction in 8 (1.6%), variant angina in 7 (1.4%) and failed percutaneous transluminal coronary angioplasty in 4 (0.8%) patients. Preoperative angiographic diagnoses were three-vessel disease in 263 (52.6%), two-vessel disease in 93 (18.6%), one-vessel disease in 71 (14.2%), left main disease in 68 (13.6%), and others in 5 (1.0%) patients. Patients had various risk factors for coronary disease, and the frequency of the risk factors such as hypertension, diabetes and smoking showed increasing tendency year by year. We used saphenous vein grafts in 1143, internal thoracic artery grafts in 442, radial artery graft in 17, and gastroepiploic artery graft in 1 anastomosis. The mean number of grafts was 3.2+/-1.2 per patient. Concomitant operations were prosthetic valve replacement or valvuloplasty in 31, coronary endarterectomy and angioplasty in 27, left main coronary angioplasty in 13, carotid endarterectomy in 5, and neurologic problems, bleeding, and perioperative myocardial infarction. The mean follow-up period was 25+/-23 months and there were 5 cases of reoperation. CONCLUSION: We hope that the surgical results would improve with the accumulation of experience, application of new myocardial protection technique, and timely intervention of mechanical assisted devices.
Subject(s)
Female , Humans , Male , Angina, Stable , Angina, Unstable , Angioplasty , Angioplasty, Balloon, Coronary , Coronary Angiography , Coronary Artery Bypass , Coronary Disease , Coronary Vessels , Diagnosis , Echocardiography , Endarterectomy , Endarterectomy, Carotid , Follow-Up Studies , Gastroepiploic Artery , Hematologic Tests , Hemorrhage , Hope , Hypertension , Mammary Arteries , Myocardial Infarction , Radial Artery , Reoperation , Risk Factors , Saphenous Vein , Smoke , Smoking , TransplantsABSTRACT
BACKGROUND: Complement activation with transpulmonary leukocyte sequestration is considered a main mediator leading to ischemia-reperfusion lung(I-R) injury. We studied the role of leukocytes in the formation of I-R injury in ovine cardiopulmonary bypass(CPB) model with a membrane oxygenator. MATERIAL AND METHOD: Five sheep were used. CPB circuitry consisted of a roller pump(American Optical Corp., Greenwich, CT, USA) and a membrane oxygenator(UNIVOX-IC, Bentley, Baxter Health Corp, Irvine, CA, USA). The CPB time was fixed at 120 min. Ten minutes after the start of CPB, total CPB was established. Thereafter a total CPB of 100 min was performed, followed by another 10 min of partial CPB. The CPB was discontinued and the animals were fully recovered. For measuring left and right atrial leukocyte counts, blood samples were taken before thoracotomy, 5 min and 109 in after the start of CPB, and 30 min and 120 min after weaning. C3a was measured before thoracotomy, 109 min after the start of CPB, and 30 min and 120 min after weaning. Plasma malondialdehyde(MDA) was checked before thoracotomy, 109 min after the start of CPB, and 30 min after weaning. One to two grams of lung tissue were taken for water content measurement before thoracotomy, 109 min after the start of CPB, and 30 min after weaning. Lung biopsy specimens were examined by light and electron microscopy. RESULT: Of 5 animals, 4 survived the experimental procedures. Of these, 3 animals survived on a long-term basis. No significant differences in transpulmonary gradients of leukocyte were found and no significant complement activation was expressed by C3a levels. MDA level did not show significant changes related to lung reperfusion despite an increase after the start of CPB. On both light and electron microscopic examinations, mild to moderate acute lung change was observed. Interstitial edema, leakage of erythrocytes into the alveolar space and endothelial cell swelling were the main findings. Water content of the lung showed a slight increase after the start of CPB, but there was no statistical significance. CONCLUSION: These findings indicate that ischemia-repersusion lung injury may not be from complement activation-leukocyte sequestration but from another source of oxygen free radicals related to CPB.
Subject(s)
Animals , Biopsy , Cardiopulmonary Bypass , Complement Activation , Complement System Proteins , Edema , Endothelial Cells , Erythrocytes , Free Radicals , Leukocyte Count , Leukocytes , Lung Injury , Lung , Membranes , Microscopy, Electron , Organ Preservation , Oxygen , Oxygenators, Membrane , Plasma , Reperfusion , Reperfusion Injury , Sheep , Thoracotomy , WeaningABSTRACT
The author studied on a case of coats' disease which occurred in the left eye of a 3 years old Korean female. This reveals the fundus picture of three large bulbous yellowish-white masses with telang iectatic blood vessels. Histologically the mass shows a total retinal detachment with subretinal serous exudates. The author described the histopathologic finding of this case with a brief review of relating Iiteratures.
Subject(s)
Child, Preschool , Female , Humans , Blood Vessels , Exudates and Transudates , Retinal DetachmentABSTRACT
The authors experienced a case of falciform retinal fold which occurred congenitally in the right eye of a 13 years old Korean female. This was situated in the inferior nasal quadrant in the extreme periphery of the retina and was associated with abnormal shape and position of disc and macula without foveal reflex. Visual acuity of right eye was 20/50 and refractive error was not present. We described the characteristic fundus findings of this case with brief review of relating literature.
Subject(s)
Adolescent , Female , Humans , Reflex , Refractive Errors , Retina , Retinaldehyde , Visual AcuityABSTRACT
The authors experienced a case of embryonal rhabdomyosarcoma. The patient was 13 years old bov who had exophthalmos, ocular deviation to upper direction and visual disturbance of his left eye. We excised the exposed mass of tumor by exploration of the orbit and postoperative irradiation with Cobalt-60 was followed. There were no signs of recurrence of the tumor or metastasis to the other part of body until now, 7 months after surgery. We had a study of the histopathologic findings for a case of rhabdomyosarcoma with a brief review of relating literature.