A Case Report of Takotsubo Cardiomyopathy During Breast Augmentation

PURPOSE: Takotsubo cardiomyopathy is a relatively uncommon type of stress-induced cardiomyopathy characterized by transient left ventricular regional wall motion abnormalities. Emotional and physical stresses play a key role in this type of cardiomyopathy in postmenopausal women. The current hypothesis is that the syndrome represents a form of catecholamine surge due to stress or epinephrine-mediated acute myocardial stunning. METHODS: A 44-year-old woman had suffered premature ventricular contraction following a cardiogenic shock during a breast augmentation surgery under enflurane anesthesia and tumescent solution infiltration. She was treated with cardiopulmonary resuscitation at a local clinic. Then she was brought to the Emergency Department of the authors' hospital. RESULTS: The woman's echocardiogram showed an ejection fraction of 20~25% with associated basal hyperkinesis and left ventricular apical ballooning. The patient was admitted to the ICU and required inotropic support for two weeks. The patient's condition dramatically improved, and her ejection fraction returned to 70%. CONCLUSION: It is believed that there were multiple triggering factors of the onset of Takotsubo cardiomyopathy in the woman's social and family history, including infiltration of a large volume of the tumescent solution and VPCs induced by enflurane anesthesia without premedication. The importance of careful history-taking, careful pre-operative consultation on psychological suffering especially for breast surgery, premedication before surgery, patient reassurance, and post-operative psychosocial and emotional assistance was again seen in this case.

Forehead and Temporal Augmentation with Medium Porosity and High Density ePTFE

In augmentation surgery, one of the important considerations is the selection of artificial implants. Recently, medium-porosity and high-density expanded polytetrafluoroethylene(ePTFE), which has high biocompatibility without gradual loss of volume, has been used as an implant, however, there are not many cases and reports on the post-operative complications and patient satisfactions. Between 2006 and 2009, a total of 23 patients with a flat or depressed forehead/temple underwent augmentation with medium-porosity and high-density ePTFE at our hospital. During follow up periods, 15 patients visited the clinic to fill out a survey and receive a physical examination for any complications, whereas 8 patients underwent a survey on the phone. The patients were asked questions to score their satisfaction rates on a scale of 1 to 10 points. There were no post-operative complications, and, the average score of satisfaction rates on the survey was 8.3 points. Since there were no complications and high rates of satisfaction during follow up periods, this medium-porosity and high- density ePTFE could be considered as a durable implant.

Case Report of Kimura's Disease Treated by Radical Resection and Post Operative Steroid Therapy

PURPOSE: Kimura's disease is a relatively rare head and neck tumor that frequently occurs in young orientals accompanied by eosinophila. We shared our experience of two cases of Kimura's disease, treated by radical resection and post operative steroid therapy, so we report the correlation of eosinophil counts and disease progression. METHODS: A 25 years old male came to the clinic with a mass localized to the right cheek inferior to the right auricle. We could not resect the mass totally. During the follow up period, we checked the eosinophil counts, and steroid therapy was started 7 months after the surgery. A 34 year old female came to the clinic with a mass localized inferior to the left auricle reaching from the posterior portion of the auricle to the left temporal portion. We tried to remove as much tumor as possible, save the temporal region, in regard to the impairment of blood supply to the auricle. After the operation, steroid therapy was started. RESULTS: In the first case, the tumor was easily approachable, and radical resection of the tumor with post operative steroid therapy was an effective treatment. In tumors located at difficult regions to remove, as in the second case, optimal debulking and post operative steroid therapy was also effective in treating Kimura's. There were no recurrences in both cases. Eosinophil counts were always reduced after surgery and steroid therapy, and during the period with low eosinophil counts, there was no recurrence of Kimura's disease. CONCLUSION: Surgery and post operative steroid therapy were effective in treatment of Kimura's disease, and we could assume eosinophil counts as a good indicator for evaluation of the prognosis of Kimura's disease during the follow up period