Achenbach Syndrome: A Benign Painful Blue Finger with Tip Sparing

Vascular surgeons are often consulted for patients with spontaneous painful discoloration of fingers and toes. In most cases, no diagnosis can be ascertained after extensive investigations and the condition resolves spontaneously. Awareness of Achenbach syndrome among physicians may help mitigate anxiety in patients because it is relatively benign and has a good prognosis. This report presents a case of Achenbach syndrome in an Asian woman along with a literature review.

Phlegmasia Cerulea Dolens after Coronary Artery Bypass Surgery: What Should We Know

Phlegmasia cerulea dolens (PCD) is one of the most critical disorders of acute deep vein thrombosis in that it can cause permanent disability secondary to the compartment syndrome. Although several etiological factors have been proposed, PCD after coronary artery bypass surgery is extremely rare and its definitive pathophysiology is still under debate. We herein present a case of PCD that resulted in the compartment syndrome after coronary artery bypass surgery. Early recognition and decompression of PCD are crucial for saving the affected limbs.

A Case of Early Valve Replacement for Haemophilus parainfluenzae Endocarditis Complicated with Acute Cerebral Infarctions / 감염과화학요법

Haemophilus parainfluenzae, one of the member of the HACEK group of gram-negative oropharyngeal species, is a rare cause of subacute native valve endocarditis. Infective endocarditis caused by H. parainfluenzae appears to carry a high incidence rate of cerebral embolism, often making the timing of surgical intervention difficult. A 52-year-old male was diagnosed with acute endocarditis caused by H. parainfluenzae complicated with acute cerebral infarctions. After institution of antibiotic therapy, this patient was mechanically ventilated because of the sudden onset of dyspnea. Repeated two-dimensional echocardiography demonstrated rate-dependent mitral stenosis without interval change of vegetations on the mitral valve. Making a decision regarding the timing of surgical intervention was difficult because of a fear of clinical deterioration after early valve replacement.

The Clinical Outcome of Pulmonary Thromboendarterectomy for the Treatment of Chronic Pulmonary Thromboembolism / 대한흉부외과학회지

BACKGROUND: Diagnosing chronic pulmonary embolism at an early stage is difficult because of the patient's non-specific symptoms. This condition is not prevalent in Korea, and in fact, there have been only a few case reports on this in the Korean medical literature. We analyzed the surgical outcome of performing pulmonary thromboendarterectomy in patients with chronic pulmonary embolism. MATERIAL AND METHOD: The study subjects included those patients who underwent surgery for chronic pulmonary embolism from 1996 to 2008. For making the diagnosis, echocardiography, chest CT and a pulmonary perfusion scan were performed on the patients who complained of chronic dyspnea. RESULT: Pulmonary endarterectomy was performed as follows: by incision via a mid-sternal approach (7 patients); by incision via a left posterolateral approach (1 patient); using the deep hypothermic circulatory arrest technique (4 patients); under ventricular fibrillation (3 patients); and under cardioplegic arrest (1 patient). The postoperative systolic pulmonary artery blood pressure significantly decreased from a preoperative value of 78.9+/-14.5 mmHg to 45.6+/-17.6 mmHg postoperatively (p=0.000). The degree of tricuspid regurgitation was less than grade II after surgery. Two patients died early on, including one patient who had persistent pulmonary hypertension without improvement and right heart failure. CONCLUSION: Patients who have chronic pulmonary embolism are known to have a poor prognosis. However, we think that early surgical treatment along with making the proper diagnosis before the aggravation of right heart failure can help improve the quality of a patient's life.

Early Extracorporeal Membrane Oxygenation in a Patient with Pandemic Influenza (H1N1 2009) and Acute Respiratory Distress Syndrome / 감염과화학요법

Despite advanced technologies in intensive care, pandemic influenza (H1N1 2009) can rapidly progress to acute respiratory distress syndrome (ARDS) and cause death in a small subset of patients. Extracorporeal membrane oxygenation (ECMO) is expected to provide adequate gas exchange, to reduce ventilator-induced lung injury and, eventually, to improve outcome in these patients. A previously healthy, young female received mechanically ventilatory support because of rapidly progressive respiratory failure caused by 2009 H1N1 influenza. As she failed to respond to high ventilatory support, ECMO was instituted at 6 hours after admission. We describe detailed course of case and literature review on ECMO, helping physicians make a decision to initiate ECMO in patients with influenza-related ARDS.

A case of aortoduodenal fistula and vertebral erosion caused by an abdominal aortic aneurysm / 대한내과학회지

A primary aortoenteric fistula is an uncommon complication of an abdominal aortic aneurysm, but can be fatal due to the high risk of massive bleeding and sepsis. Rarely, an abdominal aortic aneurysm can cause vertebral erosion. We report uncommon complications of an abdominal aortic aneurysm that caused an aortoduodenal fistula and lumbar vertebral erosion. To our knowledge, this is the first case of an abdominal aortic aneurysm complicated by an aortoduodenal fistula and vertebral erosion simultaneously.

Three Reinfection Cases of the Pandemic Influenza (H1N1 2009) / 감염과화학요법

Infection with influenza virus results in acquisition of immunity, preventing reinfection with the homologous virus. Although reinfection following primary infection is rare, its incidence depends on immunity of human body, antigenic diversity of influenza virus, and the presence of outbreak in the community. During the pandemic influenza (H1N1 2009), a child and two women were reinfected by H1N1 influenza virus several weeks after the primary infection, and they were successfully treated again by oseltamivir. This case series will provide additional information on diagnosis, treatment, and prevention of the pandemic influenza (H1N1 2009).

May-Thurner Syndrome and Deep Vein Thrombosis / 대한흉부외과학회지

No abstract available.

Deep Vein as a Graft Conduit: 2 case reports / 대한흉부외과학회지

The ideal graft requires acceptable size, less tissue toxicity, resistance to infection, and long-term durability. Great saphenous veins are gaining popularity as acceptable graft conduits, but they require time to grow in caliber. We report 2 cases of graft bypass and reconstruction using superficial femoral veins to acheive immediate high-flow patency.

The In-hospital Clinical Outcomes of Extracorporeal Life Support after Adult Cardiovascular Surgery / 대한흉부외과학회지

BACKGROUND: We analyzed the clinical results and the factors for survival of patients who underwent extracorporeal life support system after adult cardiovascular surgery. MATERIAL AND METHOD: We retrospectively reviewed the medical record of 44 patients (1.6% of the total adult cardiovascular surgical cases) who underwent the use of a ventricular assisted device or extracorporeal membrane oxygenation from January 2002 to August 2008. There were 32 (72.7%) males and their mean age was 61.7+/-14.9 (range: 20~73) years old. The mean duration of extracorporeal life support system was 5.3+/-3.0 (range: 1~12) days. RESULT: Of these 44 patients, 24 (54.5%) patients were successfully weaned from the extracorporeal device. Eighteen (40.9%) survivors were able to be discharged from the hospital. Complications were noted in 38 patients (86.4%). An emergency operation, no usage of a concomitant intraaortic balloon pump and major complications during use of the extracorporeal life support system such as bleeding, flow instability and renal failure were identified as significant risk factors for poor survival on univariated analysis. Owing to educational support and a continuous renal replacement therapy system, the clinical outcomes of these patients have improved since 2006. On multivariated analysis, renal failure and bleeding during extracorporeal life support were significant risk factors for poor survival. CONCLUSION: Although using extracorporeal life support systems after adult cardiovascular surgery revealed acceptable clinical results, determining the optimal treatment strategy and further well designed larger studies are needed to improve the survival rate of patients who undergo extracorporeal life support after adult cardiovascular surgery

Surgical Venous Thrombectomy for Chronic May-Thurner Sysndrome: 2 cases report / 대한흉부외과학회지

May-Thurner syndrome is a deep vein thrombosis of the ilio-femoral vein due to compression of the left common iliac vein by the overlying right common iliac artery. Although, catheter directed thrombectomy (CDT) and thrombolysis with stent insertion has become the standard treatment method for acute or subacute May-Thurner syndrome, because of technical feasibility and lower recurrence rate, however, sometimes this methods make fatal complications. Furthermore, there are few reports on optimal treatment strategies for patients in a chronic state of May-Thurner syndrome,. We now present two cases of chronic (>1 month since onset of symptoms) May-Thurner syndrome treated by surgical thrombectomy and femoral arteriovenous shunt with simultaneous stent insertion after failed endovascular treatment. This technique may provide a significant benefit for patients who are not suitable for conventional endovascular treatment.

Surgical Treatment of Popliteal Artery Injury as a Complication of Arthroscopic Surgery: 2 case reports / 대한흉부외과학회지

The indications and applications of arthroscopic surgery for the knee joint have increased with the development in surgical techniques and the improvement of arthroscopic equipment. The use of arthroscopic surgery has led to a significant decrease in morbidity for the patient with intra-articular abnormalities, in terms of both the diagnosis and the surgical treatments. Even though arthroscopy is a minimally invasive technique with relatively low morbidity, it is not without risk of complications, of which neurovascular complications are among the most serious and devastating. Here we report on 2 cases of popliteal artery injury during arthroscopic knee surgery and its specific diagnosis and treatment.

Angiographic Results of Radial Artery Grafts that are Used for Myocardial Revascularization / 대한흉부외과학회지

BACKGROUND: The radial artery is gaining widespread acceptance as complementary arterial conduits for surgical myocardial revascularization, but there have been limited reports about its angiographic patency compared with that of internal thoracic artery or saphenous vein. We tried to evaluate angiographic patency of radial artery graft and to compare that of radial artery and other grafts with retrospective manner. MATERIAL AND METHOD: From January 2001 to June 2006, totally 132 patients (male 92, female 40) who underwent coronary artery bypass graft using radial artery were re-admitted to our hospital for follow up angiographic examination. Mean age was 58.2+8.87 and mean follow up duration was 32 month (2~110 month). Off pump and on pump bypass surgery were performed 74 and 58 patients respectively. Along with radial artery, left internal thoracic arteries were used in 57 cases, concomitant left internal thoracic artery and saphenous veins were used in 47 cases and bilateral internal thoracic arteries were used in 20 cases. RESULT: Totally 412 distal anastomosis were performed and 376 anastomosis remained patent (91.2%). Left internal thoracic artery showed the most excellent patency in all of the conduits (98.5%). Radial artery graft patency was 90.8% (169/186). There was no statistical difference of the patency by conduit between on-pump and off-pump group. But radial artery showed more higher patency rate (98/110, 89%) in the severe stenotic lesion that preoperatively revealed more than 90% stenosis than in the lesser severe (<90%) stenotic lesion (60/76, 78%)(p<0.005). Radial artery conduit represented the worst result when it was grafted in the right coronary system. But when it was positioned in the left heart especially diagonal or obtuse marginal area, patency was comparable with left internal thoracic artery. CONCLUSION: Radial artery graft showed good midterm patency when it was used in the severe stenotic lesion more than 90% and left coronary system. But great notice should be taken when it is grafted in the right coronary system or less severe stenotic lesion.

Successful Surgical Treatment of Acute Mediastinitis after Central Catheter Insertion: One case report / 대한흉부외과학회지

Subclavian catheter insertion is now widely used because of its technical feasibility and effectiveness, but some complications related to this procedure have been noted. We present here a rare surgical case of post central line insertion mediastinitis with no mechanical complication.

One-stage Repair of Aortic Arch Anomalies and Intracardiac Defects through Median Sternotomy / 대한흉부외과학회지

BACKGROUND: One-stage repair of aortic arch anomalies and intracardiac defects through median sternotomy has been recently adopted by many institutions since it is known to be safer than the staged repair. The early and midterm results of the one-stage repair of aortic arch anomalies and intracardiac defects were retrospectively evaluated. MATERIAL AND METHOD: 45 patients who underwent one-stage repair of aortic arch anomalies and intracardiac defects performed by one surgeon from January 1996 to July 2003 were included in this retrospective study. The median age of repair was 16 days (range, 3 days~23.7 months) and the mean weight was 3.62+/-1.30 kg. Thirty one (68.9%) had coarctation and 14 (31.1%) had interrupted aortic arch. Associated intracardiac anomalies were VSD in 31 patients (VSD group), TGA or Taussig-Bing anomaly in 10 (TGA group), and others in 4 (ASD in 1, aortopulmonary window 1, truncus arteriosus 1, aortic and mitral stenoses 1, miscellaneous group). The arch obstruction was repaired with end-to-side anastomosis in 23 patients and end-to-end anastomosis in 22. RESULT: Overall postoperative hospital mortality was 22.2% (10/45); 16.1% (5/31) in VSD group, 40% (4/10) in TGA group, and 25% (1/4) in miscellaneous group. There was no mortality in VSD group since 1998, and the mortality in TGA group has remarkably reduced since technical modification for coronary transfer was adopted (75% vs 16.7%). There was no postoperative seizure or other neurological complications. Postoperative aortic restenosis occurred in 5 patients (5/35, 14.3%). Two patients underwent balloon aortoplasty with successful results. There was no reoperation. There was one late death caused by pneumonia 5 months after the operation. Two-year actuarial survival rate including operative death was 72.9%. CONCLUSION: The operative mortality of one-stage repair has been reduced with time and aortic restenosis rate was also acceptable. We concluded that this procedure is a reproducible procedure for aortic arch anomalies associated with intracardiac defects.

Surgical Treatment of Bronchoesophageal Fistula Caused by a Self-Expanding Esophageal Stent / 대한흉부외과학회지

Although the formation of fistula between esophagus and adjacent organ is a known complication of the self- expanding esophageal stent, only a few cases of surgically treated bronchoesophageal fistula have been reported. Increasing application of endoscopic stent for benign esophageal strictures increases the chance for this type of delayed complication. We experienced a case of bronchoesophageal fistula caused by esophageal stent for which we performed fistulectomy and Ivor Lewis operation simultaneously. To the best of our knowledge, this is the first report on the successful surgical treatment of this complication in Korea.

Surgical Treatment of Synchronous Double Cancer of the Lung and Esophagus: A case report / 대한흉부외과학회지

Less than 2% of patients with primary esophageal cancers have synchronous primary lung cancers and many patients with these synchronous tumors are deemed ineligible for radical resection by surgeons due to the poor prognoses of both the diseases. However, we believe that carefully selected patients could benefit from one stage curative resection for these synchronous tumors. We experienced a case of synchronous double cancer of the lung and esophagus and performed bilobectomy and Ivor Lewis operation simultaneously. To the best of our knowledge, this is the first report on the good result of one stage curative resection for these synchronous serious tumors in Korea.

Management for the Newly-Onset Aneurysmal Dilation of the Distal Aorta after an Endovascular Stent Graft Procedure for the Patient with Acute Aortic Dissection Type IIIb / 대한흉부외과학회지

The surgical managements for the complicated aortic disease is still one of most challenging fields for the cardiac surgeons. The endovascular stent graft procedure has been tried recently to avoid serious complications caused by traditional graft replacement technique. However, indications for the procedures or management methods for the complications have not been clearly elucidated so far. We report a case of successful management for the newly-onset aneurysmal dilation of the distal aorta after an endovascular stent graft procedure in a patient with acute aortic dissection type IIIB.

Surgical Treatment for Celiac Trunk Aneurysm: 2 case report / 대한흉부외과학회지

Celiac artery aneurysms are rare, their incidence being reported as only 4% of all visceral artery aneurysms. Atherosclerosis and medial degenerative changes are recognized main pathogenesis. They are usually asymptomatic and diagnosed incidentally, but the mortality rate of ruptured celiac artery aneurysm is approximately 80%. So one should give an aggressive surgical aid to the patients. We report 2 cases of celiac artery aneurysm which were successfully treated by elective aneurysmorrhaphy and anerysmectomy with aortoceliac bypass graft.