Résumé
Mycotic aneurysms of the hepatic artery are usually caused by mycotic infection in patients suffering with bacterial endocarditis. Mycotic aneurysms have become very rare recently due to early intensive antibiotic treatment for infective endocarditis. Despite of the non-specific symptoms, these aneurysms show a high possibility of sudden death if thye ruptured. Therefore, early detection and surgical repair of aneurysms are very important. We report here on a case of hepatic artery mycotic aneurysm that presented as sudden shock and rupture.
Sujets)
Humains , Anévrysme , Anévrysme infectieux , Mort subite , Endocardite , Endocardite bactérienne , Artère hépatique , Corée , Rupture , ChocRésumé
Surgical anterior ventricular endocardial restoration (SAVER) is a technique that improves hemodynamic status by excluding akinetic or dyskinetic portions of the left ventricle, restores the ventricle to normal elliptical shape and reduces ventricular wall tension to normal level in patients with acute anterior wall myocardial infarction that accompanies aneurysm. We performed redo-SAVER procedure in a 40-year old man with remodeled dilated ventricle who had already underwent LV aneurysmectomy 12 years earlier, and the results were satisfactory.
Sujets)
Adulte , Humains , Anévrysme , Infarctus du myocarde antérieur , Ventricules cardiaques , HémodynamiqueRésumé
Heart-lung transplantation is a widely accepted treatment for Eisenmenger's syndrome. The patient is a 41-years-old male diagnosed with Eisenmenger's syndrome due to patent ductus arteriosus. The pressures were checked as follows: aorta 130/80 mean 100 mmHg, pulmonary artery 130/80 mean 109 mmHg, and right ventricle 130/20 mmHg, right atrium mean 20 mmHg. The patient needed heart-lung transplantation due to enlarged right pulmonary artery (diameter 7.5 cm). The donor was a 24 years-old male diagnosed as brain death due to subdural hematoma. Ligation of patent ductus arteriosus was performed under the cardiopulmonary bypass followed by heart-lung transplantation. Patient was extubated on postoperative day one, transferred to the general ward on day 3, and was discharged on postoperative day 33. Cardiac and lung biopsy was performed on postoperative day 41 with no signs of rejection.
Sujets)
Humains , Mâle , Jeune adulte , Aorte , Biopsie , Mort cérébrale , Pontage cardiopulmonaire , Persistance du canal artériel , Complexe d'Eisenmenger , Atrium du coeur , Ventricules cardiaques , Transplantation coeur-poumon , Hématome subdural , Hypertension pulmonaire , Ligature , Poumon , Chambre de patient , Artère pulmonaire , Donneurs de tissusRésumé
BACKGROUND: Sclerotherapy has been introduced as a new treatment modality of varicose vein. MATERIAL AND METHOD: Ninety-four patients with the diagnosis of varicose vein were treated with sclerotherapy at Yongdong Severance Hospital, Yonsei University Medical College from September, 1997 to August, 1999. History taking, physical examinations and laboratory examinations were performed. The short term outcome and the complications were reviewed. RESULT: The age of the patients were ranged from 20 to 70 years with the mean age of 43.4 years. All the patients(28 men, 66 women) had protruding superficial leg veins and 2 local pain, 2 fatigue, 1 heaviness. Complications were fever, phlebitis and ulceration. Fifty patients were satisfied after 1 procedure. CONCLUSION: Sclerotherapy is an effective treatment modality with cosmetic superiority for the patients with varicose veins.
Sujets)
Humains , Mâle , Diagnostic , Fatigue , Fièvre , Jambe , Phlébite , Examen physique , Sclérothérapie , Ulcère , Varices , VeinesRésumé
A 34-year-old woman was admitted to the hospital because of recently aggravated right heart failure without angina for 5 months. When she was 25 years old, patch repair with Polytetrafluoroethylene (PTFE) was performed for the secondum type of atrial septal defect (ASD) with moderate pulmonary hypertension. The chest PA, echocardiography and cardiac catheterization at current admission revealed Eisenmenger syndrome without intracardiac shunt. Chest CT scan with contrast revealed markedly dilated pulmonary trunk, both pulmonary arteries and concave disfigurement of the left side of the ascending aorta suggesting extrinsic compression, as well as total occlusion of the ostium of the left main coronary artery that was retrogradly filled with collateral circulation from the right coronary artery. The coronary angiography showed normal right coronary artery and the collaterals that come out from the conus branch to the mid-left anterior descending artery (LAD) and that from distal right coronary artery to the left circumflex artery (LCX) and to the distal LAD, respectively. On aortography, the left main coronary artery was not visualized with no stump, suggestive of total occlusion of the ostium of the left main coronary artery. From our experience, it is possible to say that the occlusion of the ostium of the left main coronary can be induced by the dilated pulmonary artery trunk due to ASD with pulmonary hypertension and that, if the ASD closure was too late, the narrowing or obstruction of the left coronary artery could not be resolved even after operation owing to irreversible pulmonary hypertension.
Sujets)
Adulte , Femelle , Humains , Sténose pathologique/étiologie , Maladie coronarienne/étiologie , Dilatation pathologique/étiologie , Complexe d'Eisenmenger/diagnostic , Communications interauriculaires/complications , Hypertension pulmonaire/complications , Artère pulmonaire/imagerie diagnostiqueRésumé
The lymphoproliferative disease after the organ transplantation is more commonly seen with the increase according to the increasing number of the organ transplantations and it occurs more frequently in the cases of heart and lung transplantations that needs more aggressive immunosuppression. It demands urgent evaluation and management because of poor prognosis. We transplanted left lung of a man to the woman who suffered from severe dyspnea due to terminal pulmonary emphysema in discrepancy of ABO blood type. Postoperatively, We used triple regimen immunotherapy(cyclosporin, azathioprine, prednisolone) and followed up in the out patient clinic. During the follow up, we found abnormal mass lesion on the transplanted lung and performed gun biopsy. We confirmed malignant lymphoma on the pathologic examination and two cycled chemotherapy was given after reducing dose of immunosupression. The patient died of sudden onset of pulmonary edema of the transplanted lung.
Sujets)
Femelle , Humains , Azathioprine , Biopsie , Traitement médicamenteux , Dyspnée , Études de suivi , Coeur , Immunosuppression thérapeutique , Transplantation pulmonaire , Poumon , Lymphomes , Syndromes lymphoprolifératifs , Transplantation d'organe , Complications postopératoires , Pronostic , Oedème pulmonaire , Emphysème pulmonaire , TransplantsRésumé
Although the effects of adenosine on the heart, including the clinical suppression of cardiac arrhythmias, have been recognized for more than half a century, it is only in the last decade that the therapeutic potential of adenosine has been recognized. The objective of this study was to determine if augmentation of myocardial adenosine levels during global ischemia improves functional recovery after reperfusion. We used to modified Langendorff system to evaluate myocardial protective effect. Isolated rat hearts were subjected to 90 minutes of deep hypothermic arrest(15degrees C) with modified St. Thomas' Hospital cardioplegic solution used to provide myocardial protection. Myocardial adenosine levels were augmented during ischemia by providing exogenous adenosine in the cardioplegic solution. Two groups of hearts were studied: (1) control group(n=10) - cardioplegia alone; (2) adenosine group(n=10) - adenosine(0.75mg/Kg/min) added to the cardioplegic solution. Significantly better percent recovery(p<0.01) in hemodynamics(except heart rate) at 60 minutes after reperfusion was evident compared to baseline values in the adenosine group. (systolic aortic pressure : 78.5+/-3.6% vs 66.6+/-5.9%, aortic overflow volume : 61.7+/- 11.6% vs 37.2+/-15.4%, coronary flow volume : 77.1+/-7.5% vs 57.2+/-11.1%, and cardiac output : 65.6+/-11.5% vs 44.2+/-12.4%). Heart rate was similar in two groups(94.4+/-4.8% vs 95.3 +/- 6.8%). Adenosine groups resulted in significantly rapid recovery time of heart beat after reperfusion(p<0.01) (24.5+/-7.6 sec. vs 179.0+/-131.1sec.). In biochemical study, CPK levels(0.1+/-0.3U/L vs 1.4+/-0.8U/L) and lactic acid levels(0.08+/-0.1mmol/L vs 0.34+/-0.2 mmol/L) were significantly low in adenosine groups(p<0.01). We concluded that adenosine included cardioplegia have better recovery effects after reperfusion in myocardial ischemia compared to adenosine free cardioplegia.