Fourth Recurrence of Cardiac Myxoma in a Patient with the Carney Complex

Although cardiac myxoma is the most commonly encountered benign cardiac tumor in cardiac surgery practice, recurrent cardiac myxoma is very rare, is most commonly related to the Carney complex, and usually requires multiple cardiac operations with specific requirements in terms of perioperative management. In this report, we describe a patient who experienced the fourth recurrence of cardiac myxoma and review the diagnostic criteria of the Carney complex. This is the first report of such a case in Korea.

Staged Management of a Ruptured Internal Mammary Artery Aneurysm

The rupture of an internal mammary artery (IMA) aneurysm in a patient with type 1 neurofibromatosis (NF-1) is a rare but life-threatening complication requiring emergency management. A 50-year-old man with NF-1 was transferred to the emergency department of Kyungpook National University Hospital, where an IMA aneurysmal rupture and hemothorax were diagnosed and drained. The IMA aneurysmal rupture and hemothorax were successfully repaired by staged management combining endovascular treatment and subsequent video-assisted thoracoscopic surgery (VATS). The patient required cardiopulmonary cerebral resuscitation, the staged management of coil embolization, and a subsequent VATS procedure. This staged approach may be an effective therapeutic strategy in cases of IMA aneurysmal rupture.

Overexpression of Insulin Degrading Enzyme could Greatly Contribute to Insulin Down-regulation Induced by Short-Term Swimming Exercise / 한국실험동물학회지

Exercise training is highly correlated with the reduced glucose-stimulated insulin secretion (GSIS), although it enhanced insulin sensitivity, glucose uptake and glucose transporter expression to reduce severity of diabetic symptoms. This study investigated the impact of short-term swimming exercise on insulin regulation in the Goto-Kakizaki (GK) rat as a non-obese model of non-insulin-dependent diabetes mellitus. Wistar (W/S) and GK rats were trained 2 hours daily with the swimming exercise for 4 weeks, and then the changes in the metabolism of insulin and glucose were assessed. Body weight was markedly decreased in the exercised GK rats compare to their non-exercised counterpart, while W/S rats did not show any exercise-related changes. Glucose concentration was not changed by exercise, although impaired glucose tolerance was improved in GK rats 120 min after glucose injection. However, insulin concentration was decreased by swimming exercise as in the decrease of GSIS after running exercise. To identify the other cause for exercise-induced insulin down-regulation, the changes in the levels of key factors involved in insulin production (C-peptide) and clearance (insulin-degrading enzyme; IDE) were measured in W/S and GK rats. The C-peptide level was maintained while IDE expression increased markedly. Therefore, these results showed that insulin down-regulation induced by short-term swimming exercise likely attributes to enhanced insulin clearance via IDE over-expression than by altered insulin production.

Accidental Hypercarbia during Endoscopic Harvesting of Saphenous Vein in Coronary Artery Bypass Graft Surgery: A case report / 대한마취과학회지

Hypercarbia is a potential complication during laparoscopic surgery. However, is more likely to occur in extraperitoneal surgery than in intraperitoneal surgery because insufflated CO2 gas can diffuse easily into the surrounding tissues. We report the anesthetic course and complications encountered during endoscopic harvesting of a saphenous vein with CO2 insufflation in coronary artery bypass surgery. Although the surgery was successful, the patient developed signs and symptom of CO2 absorption: tachycardia, hypertension, hypercarbia and acidosis. Possible mechanisms are presented, along with a discussion of the prompt diagnosis and treatment. For the management of laparoscopic extraperitoneal surgery, care must be taken to monitor the CO2 insufflation pressure, perform a routine examination and palpation of the chest wall, use of N2O with caution, increase the level of ventilation to eliminate CO2, and excluding other causes of subcutaneous emphysema and hypercarbia.

Endoscopic Radial Artery Harvest: Techniques & Results / 대한흉부외과학회지

BACKGROUND: The radial arteries are being used more often for coronary artery bypass grafting. We tried to the endoscopic radial artery harvest to reduce the cosmetic problems and neurologic complications of the conventional open harvesting and report the techniques and early results. MATERIAL AND METHOD: The 86 patients underwent coronary artery bypass grafting between May 2003 and April 2005 had their nondominant radial artery endoscopically removed through a 2 cm incision at the wrist. The radial pedicle was dissected and was divided at antecubial area through a 5 mm counterincision. RESULT: The 23 patients complained of neuralgias on territory of superficial raidal nerve but no one complained of neuralgias on territory of lateral antebrachial cutaneous nerve. There was no functional impairment of the hand. There was no wound complication except a localized hematoma. All patients were contacted by telephone after postoperative 7.9+/-3.6 months. The 4 patients still complained of neuralgia. All the patients were satisfied with the aesthetics of the wounds. The multidetectional tomography was done on the 66 patients for the estimation of early patency of radial artery. There were 2 cases of stenosis and a case of occlusion. CONCLUSION: Endoscopic radial artery harvest had no functional impairment of the hand, lesser rate of neurologic complications and outstanding aesthetics. The results of early patency of the radial artery was similar to conventional methods. Therefore, we think that endoscopic radial artery harvest is the optimal procedure.

Critical Pathway for Management of Primary Spontaneous Pneumothorax / 대한흉부외과학회지

BACKGROUND: With the advances of video technology, thoracoscopic surgery has been applied to various areas of the thoracic surgical fields including major surgeries. Now a days, thoracoscopic surgery is performed as a procedure of choice for primary spontaneous pneumothorax. But the operative indication for the primary spontaneous pneumothorax has not been changed since the last few decades, although the procedure of choice was changed from open thoracotomy to thoracoscopy. Therefore, we thought new treatment strategy will be necessary for the management of primary spontaneous pneumothorax. MATERIAL AND METHOD: Between January 1998 and December 1999, 149 primary spontaneous pneumothorax patients were admitted to the Kyungpook National University Hospital. Result; Of these patients, 177 were first attack pneumothoraces and the number of total attacks were 250. CONCLUSION: Analyzing the amount of pneumothorax, methods of treatment, number of recurrences, recurrence rate and hospital stay, we propose a critical pathway for establishing new treatment strategy for the management of primary spontaneous pneumothorax.

Transposition of Great Arteries and Ventricular Septal Defect in Jehovah's Witnesses / 대한흉부외과학회지

An infant having parents of Jehovah s Witnesses was 4 months old and 5.6 kg in weight. Echocardiographic diagnosis was complete transposition of great arteries(TGA), ventricular septal defect(VSD), atrial septal defect(ASD), patent ductus arteriosus(PDA), and bilateral superior vena cava(SVC). The preoperative hemoglobin level was 14.9 g/dl. We performed an arterial switch operation(ASO) with VSD closure without transfusion and he was discharged uneventfully 16 days after the operation. At that time the hemoglobin level was 12.8 g/dl. We report that we could successfully correct the complex congenital heart disease without transfusion by the combined use of erythropoietin and aprotinin, intraoperative meti-culous hemostasis, and postbypass ultrafiltration.