Primary Surgical Closure Should Be Considered in Premature Neonates with Large Patent Ductus Arteriosus

BACKGROUND: Treatment for patent ductus arteriosus (PDA) in premature infants can consist of medical or surgical approaches. The appropriate therapeutic regimen remains contentious. This study evaluated the role of surgery in improving the survival of premature neonates weighing less than 1,500 g with PDA. MATERIALS AND METHODS: From January 2008 to June 2011, 68 patients weighing less than 1,500 g with PDA were enrolled. The patients were divided into three groups: a group managed only by medical treatment (group I), a group requiring surgery after medical treatment (group II), and a group requiring primary surgical treatment (group III). RESULTS: The rate of conversion to surgical methods due to failed medical treatment was 67.6% (25/37) in the patients with large PDA (> or =2 mm in diameter). The number of patients who could be managed with medical treatment was nine which was only 20.5% (9/44) of the patients with large PDA. There was no surgery-related mortality. Group III displayed a statistically significantly low rate of development of bronchopulmonary dysplasia (BPD) (p=0.008). The mechanical ventilation time was significantly longer in group II (p=0.002). CONCLUSION: Medical treatment has a high failure rate in infants weighing less than 1,500 g with PDA exceeding 2.0 mm. Surgical closure following medical treatment requires a longer mechanical ventilation time and increases the incidence of BPD. Primary surgical closure of PDA exceeding 2.0 mm in the infants weighing less than 1,500 g should be considered to reduce mortality and long-term morbidity events including BPD.

Primary Surgical Closure Should Be Considered in Premature Neonates with Large Patent Ductus Arteriosus

BACKGROUND: Treatment for patent ductus arteriosus (PDA) in premature infants can consist of medical or surgical approaches. The appropriate therapeutic regimen remains contentious. This study evaluated the role of surgery in improving the survival of premature neonates weighing less than 1,500 g with PDA. MATERIALS AND METHODS: From January 2008 to June 2011, 68 patients weighing less than 1,500 g with PDA were enrolled. The patients were divided into three groups: a group managed only by medical treatment (group I), a group requiring surgery after medical treatment (group II), and a group requiring primary surgical treatment (group III). RESULTS: The rate of conversion to surgical methods due to failed medical treatment was 67.6% (25/37) in the patients with large PDA (> or =2 mm in diameter). The number of patients who could be managed with medical treatment was nine which was only 20.5% (9/44) of the patients with large PDA. There was no surgery-related mortality. Group III displayed a statistically significantly low rate of development of bronchopulmonary dysplasia (BPD) (p=0.008). The mechanical ventilation time was significantly longer in group II (p=0.002). CONCLUSION: Medical treatment has a high failure rate in infants weighing less than 1,500 g with PDA exceeding 2.0 mm. Surgical closure following medical treatment requires a longer mechanical ventilation time and increases the incidence of BPD. Primary surgical closure of PDA exceeding 2.0 mm in the infants weighing less than 1,500 g should be considered to reduce mortality and long-term morbidity events including BPD.

Clinical Significance of Co-expression of Aberrant Antigens in Acute Leukemia / 대한혈액학회지

BACKGROUND: Acute leukemias co-expressing myeloid and lymphoid antigens but does not meet the criteria for biphenotypic acute leukemia (BAL) is common, however its clinical significance is not fully defined. METHODS: In this study, clinical features of 68 co-expressing (myeloid and lymphoid) acute leukemias diagnosed between January 2000 and December 2006 were studied and compared with those of a control group of patients (pure AML or ALL). RESULTS: Age, gender, initial Lactate dehydrogenase (LDH) level and cytogenetics were not different between the co-expressing group and the control group. But, the initial bone marrow blast percent was significantly higher in the co-expressing group (70% vs. 54.5%, P=0.003). Fifty five percent (16/29) of ALL and 30% (52/172) of AML patients showed myeloid and lymphoid markers concomitantly. The lymphoid antigen positive AML (Ly+AML) patients showed significantly shorter survival rates than pure AML patients (4 year survival rate, 17.6% vs. 45.6%, P=0.002). However hematopoietic stem cell transplantation (HST) abrogated the difference (4 year survival rate, 54.7% vs. 50.6%, P=0.894). In ALL patients, survival rate was not affected by myeloid antigen co-expression (4 year survival rate 26.1% vs. 20%, P=0.954). CONCLUSION: Co-expression of lymphoid markers in AML should be regarded as a poor prognostic factor and more aggressive treatment such as HST should be considered.

A case of bladder rhabdomyosarcoma in an adult / 대한내과학회지

Rhabdomyosarcomas, malignant neoplasms exhibiting skeletal muscle differentiation, are the most common childhood sarcomas. Embryonal rhabdomyosarcomas of the genitourinary tract also occur in children but are rare in adults. We report a case of embryonal rhabdomyosarcoma arising in the bladder of a 29-year-old man who presented with dysuria and microscopic hematuria. A partial cystectomy was performed, and he received chemotherapy with vincristine and actinomycin.

A case of bladder rhabdomyosarcoma in an adult / 대한내과학회지

Rhabdomyosarcomas, malignant neoplasms exhibiting skeletal muscle differentiation, are the most common childhood sarcomas. Embryonal rhabdomyosarcomas of the genitourinary tract also occur in children but are rare in adults. We report a case of embryonal rhabdomyosarcoma arising in the bladder of a 29-year-old man who presented with dysuria and microscopic hematuria. A partial cystectomy was performed, and he received chemotherapy with vincristine and actinomycin.

Acute Mitral Regurgitation due to Spontaneous Chordal Rupture in a Patient With Obstructive Hypertrophic Cardiomyopathy

A 69-year-old male presented with obstructive hypertrophic cardiomyopathy, mitral valve regurgitation, and myxomatous mitral valve prolapse. A spontaneous chordal rupture and acute severe mitral regurgitation resulted in abrupt clinical deterioration despite complete relief of severe left ventricular outflow tract obstruction and systolic anterior motion of the anterior mitral leaflet. The patient underwent extensive cardiac surgery due to intractable heart failure. Surgical procedures included a mitral valve replacement, a septal myectomy, and the Maze procedure.

The Mid Term Clinical Result and the Risk Factor Analysis of Isolated Aortic Valve Replacement / 대한흉부외과학회지

BACKGROUND: The aims of this paper were to review the mid term clinical results and to analyze the preoperative risk factors of isolated aortic valve replacement (AVR). MATERIAL AND METHOD: Between January 1992 and February 2003, 80 patients underwent isolated AVR. 58 were male and 22 were female patients, raging from 12 to 75 years of age (mean: 46.8+/-13.0 years). 74 patients except one early death and 5 follow-up loss were contacted by OPD or by telephone. The mean duration of follow-up was 44.2+/-29.7 months and the total cumulative period was 272.8 patient-year. RESULT: The complications in hospital occurred in 35 cases : 12 wound problems (11 superficial, 1 deep), 11 arrhythmias (9 temporary, 2 persistent), 3 low cardiac output, and so forth. The late deaths were 4 cases : the heart-related deaths were 2 cases (0.7%patient-year). CONCLUSION: The risk factors that influenced the early mortality and morbidity were older age (> 60 years)(p=0.04), poor preoperative NYHA functional class (> 3) (p=0.048), high preoperative serum creatinin level (> 1.2 mg/100 ml)(p=0.031), long operation time (aortic clamping time> 90 min)(p=0.042). The same factors influenced the late mortality and morbidity. Freedom from valve-related complication was 86.4+/-5.3%, actuarial survival rate were 96.8+/-2.3% at 3 years and 90.8+/-4.6% at 10 years.

The Systemic Effects of Hypothermic and Normothermic Cardiopulmonary Bypass in Cardiac Surgery / 대한흉부외과학회지

BACKGROUND: This study was prospectively designed to determine the physiologic effects of normothermic CPB and to compare its influences with hypothermic CPB. MATERIAL AND METHOD: Thirty-six adult patients scheduled for elective cardiac surgery were randomly assigned to moderate hypothermic (hypothermic group nasopharyngeal temperature 26~28 degreeC, n=18) or normothermic (normothermic group, nasopharyngeal temperature>35.5 degreeC, n=18) CPB. Arterial blood samples were taken before CPB (Pre-CPB), 10 minutes after the start of CPB (CPB-10), and immediately after CPB stop (CPB-off) for determining total leukocyte counts, neuron-specific enolase (NSE), interleukin-6 (IL-6), endothelin-1 (ET-1), cortisol, troponin I (TNI), aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatinine, blood urea nitrogen (BUN), and the pulmonary index (PI, PaO2/FiO2). Other parameters such as urine output, mechanical ventilating period, ICU-staying period, postoperative complications and hospitalized days were also evaluated. RESULT: Total leukocyte counts, increased rate in NSE, in IL-6 and in cortisol at CPB-10 and CPB-off were significantly higher in normothermic group than in hyphothermic group. Urine output during CPB was lower in normothermic group than in hyphothermic group. The duration of mechanical ventilation, ICU-stay, and hospitalization were longer in normothermic group than in hyphothermic group. CONCLUSION: These findings suggested that normothermic CPB caused higher inflammatory and stress responses than hypothermic CPB during cardiac surgery using cold crystalloid cardioplegia. However, further studies with large number of cases should be carried out to validate this hypothesis.

The Influences of Perfusion Temperature on Inflammatory and Hematologic Responses during Cardiopulmonary Bypass / 대한흉부외과학회지

BACKGROUND: Several studies have demonstrated that conventional hypothermic cardiopulmonary bypass (CPB) causes cellular injury, abnormal responses in peripheral vascular beds and increased postoperative bleeding, whereas normothermic CPB provides protection of the hypothermic-induced effects and better cardiac recovery. The present study was prospectively performed to compare the effects of normothermic CPB to those of hypothermic CPB on the inflammatory and hematologic responses during cardiac surgery. MATERIAL AND METHOD: Thirty-four adult patients scheduled for elective cardiac surgery were randomly assigned to hypothermic CPB (nasopharyngeal temperature 26~28degreesC, n=17) or normothermic CPB (nasopharyngeal temperature>35.5degreesC, n=17) group. In both groups, cold (4degreesC) crystalloid cardioplegia was applied for myocardial protection. Blood samples were drawn from radial artery before (Pre-CPB), 10 minutes after starting (CPB-10) and immediately after ending (CPB-OFF) CPB. Total leukocyte and platelet counts, interleukin-6 (IL-6) level(expressed as percent to the baseline of Pre-CPB), D-dimer level, protein C and protein S activity were measured with the blood samples. The amount of bleeding for postoperative 24 hours and blood transfusion after operation were also assessed. All parameters were compared between the two groups. RESULT: The total leukocyte counts (10,032+/-65/mm3) and the increased ratio of IL-6 (353+/-7.0%) at CPB-OFF in the normothermic group were higher than that (7,254+/-48/mm3 and 298+/-7.3%) of the hypothermic group(p=0.02 and p=0.03). In the normothermic group, protein C activity (32+/-3.8%) and protein S activity (35+/-4.1%) at CPB-OFF were significantly lower than that (45+/-4.3% and 51+/-3.8%) of the hypothermic group (p=0.04 and p=0.009). However, there were no differences in platelet counts and D-dimer concentration. In the normothermic group, the amount of bleeding for postoperative 24 hours (850+/-23.2 mL) and requirements for blood transfusion after operation such as packed cell (1,402+/-20.5 mL), fresh frozen plasma (970+/-20.8 mL) and platelet (252+/-6.4 mL) were higher than that (530+/-21.5 mL, 696+/-15.7 mL, 603+/-18.2 mL and 50+/-0.0 mL) of the hypothermic group. CONCLUSION: These results indicate that normothermic CPB with cold crystalloid cardioplegia was associated with higher increase in inflammatory response, hemostatic abnormalities and postoperative bleeding problem than moderate hypothermic CPB.

Descending Necrotizing Mediastinitis Caused by Yeast: A case report / 대한흉부외과학회지

Descending nectorizing mediastinitis (DNM) represents a virulent form of mediastinal infection requiring prompt diagnosis and treatment to reduce the high morbidity mortality associated with this disease. Intr.avenous broad-spectrum antibiotic therapy alone is not efficient without adequate surgical drainage of the cervical and mediastinal collections, extensive debridement and excision of necrotic tissue, and wide mediastino-pleural irrigation. A 38-year-old man admitted via emergency room with painful left neck swelling and uncontrolled high fever. Chest computed tomogram showed left paratracheal abscess descending into the superior and anterior mediastinum. Transcervical mediastinal drainage was performed with 26 Fr. chest tube and left paratracheal drainage was performed with Penrose drain in urgency. Culture and sensitivity test grew Yeast. The drains removed via gradually shortening on day 39 after surgery.

Young Rabbit Model for Pathophysiologic Study of Acute Lung Injury in Early Childhood / 대한흉부외과학회지

BACKGROUND: Adult respiratory distress syndrome (ARDS) is of particular interest because of its severity of the associated lung injury and its high mortality. However, the pathophysiologies of ARDS in infant and childhood groups are still not well clarified inspite of many previous investigations. To investigate the time course of pathophysiology of ARDS in infant and childhood groups, this study was designed with experimental endotoxin-induced ARDS model using young rabbits (8 week-old). MATERIAL AND METHOD: Rabbits were divided into the control group (n=8) and the endotoxin-treated group (n=32). The endotoxin group was subdivided into 4 groups by the sampling times as 3, 6, 12 and 24 hr-groups (G-E3,6,12,24, each n=8). The experimental ARDS was made by a bolus injection of endotoxin (Escherichia coli serotype O55:B5, 0.50 mg/kg) via rabbit ear vein. For evaluation of the hematologic and inflammatory markers, and superoxide dismutase (SOD) concentrations, the blood samples were taken from the heart. The bronchoalveolar lavage fluid (BALF) were obtained for analysis of the leukocytes and protein concentration. With biopsy of the lung, histopathologic changes of the lung were also evaluated. RESULT: In the endotoxin groups, significant leukopenia (owing to pancytopenia) occurred in 3 and 6-hr groups, which was followed by significant leukocytosis (owing to neutrophilia) in the 12 and 24-hr groups (p<0.05). Serum levels of tumor necrosis factor-alpha (TNF-alpha) and interleukin-1beta (IL-1 beta) in the endotoxin groups were higher than those of control group (p<0.05). Serum levels of superoxide dismutase (SOD) of G-E3 and G-E6 were higher than those of control group, whereas those of G-E12 were lower than those of control groups (p<0.05). Total leukocyte counts and protein concentrations in BALF were significantly elevated in the endotoxin groups compared to the control group (p<0.05). The hemorrhagic pattern of BALF showed occurred in the endotoxin groups. The endotoxin groups (in G-E6) had severe infiltration of inflammatory cells (lymphocyte and monocyte) in the pulmonary interstitium and parenchyma, migrations of neutrophil and eosinophil into alveolar spaces and interstitial widening, which are the evidences of acute lung injury. In the endotoxin groups, there were significant positive correlations between the BALF findings and the immunologic markers (TNF-alpha, IL-1 beta, SOD) (p<0.05). CONCLUSION: Severe acute lung injury occurred in all the endotoxin-treated rabbits. The pathophysiologic findings were so progressive until 6-hr by time dependant pattern, and then recovered slowly. Variable hematologic, immunologic, and pathologic factors were well correlated in the development and progression of endoxin-induced lung injury. The pathophysiologic responses were sensitive and rapid in young rabbit Young rabbit seemed to be a useful experimental animal model for infant and childhood groups.

The Early Results of CABG with Bilateral Internal Thoracic Artery / 대한흉부외과학회지

BACKGROUND: It has been known that internal thoracic artery grafting has a better patency rate compare to other graft conduits in coronary revascularization. Better patency rates can be expected in more coronary arteries with the use of bilateral internal thoracic artery. However, there were some debates on the complications after the use of bilateral internal thoracic artery. The purpose of our study was to reveal the results of bilateral internal thoracic artery. MATERIAL AND METHOD: The 26 coronary artery bypass operations with bilateral internal thoracic artery were performed from July 2001 to May 2002. We compared the results of 8 diabetic patients to those of 18 non-diabetic patients. We compared the results of BITA (bilateral internal thoracic artery) group to those of SITA (single internal thoracic artery) group that were 20 patients and performed during same period. RESULT: There was no mortality. There was one wound complication in the diabetic group and one in the non-diabetic group. There were no significant differences in operation time, duration of mechanical ventilation, amount of bleeding, infusing duration of cardiotonics, and complication between two groups. There were no significant differences in results between the BITA group and the SITA group. CONCLUSION: There were no significant differences in early results between the BITA group and the SITA group, and there were no significant differences in results between the diabetic group and the non-diabetic group. We think coronary artery bypass grafting with the use of bilateral internal thoracic artery is considered in diabetic patients.

Treatment of Atrial Fibrillation with Microwave / 대한흉부외과학회지

BACKGROUND: Cryoablation and radiofrequency ablation have been used to treat the atrial fibrillation. Some reports insisted that the microwave ablation is a better method for a deep and extensive lesion. MATERIAL AND METHOD: From December 2001 to July 2002, we performed 8 microwave ablations in patients who needed mitral valve surgery (7 MVR, 1 MVR+AVR). There were 3 men and 5 women, and their mean age was 43.4+/-8.3 years and mean follow up period was 5.6+/-2.4 months respectively. The microwave was applied on endocardium or epicardium by LynxR (Afx, inc.) using a power of 45 watts for 25 seconds. We studied the left atrial dimension, the left atrial function and the sinus conversion with echocardiography and electrocardiography at three times; 1) before the operation, 2) immediately after the operation, and 3) 6 months after the operation. RESULT: There was no complication and no mortality. The mean aortic clamping time was 104.6+/-25.0 minutes, and the mean total bypass time was 130.5+/-28.7 minutes. The rate of sinus conversion was 75%, A wave across the mitral valve was a mean of 77.0+/-24.8 cm/sec, and the A/E was a mean of 0.46+/-0.17 at 5.6 months postoperatively. CONCLUSION: There was no difference in the early result of microwave ablation compared to other methods. The microwave ablation was an acceptable method due to its convenient application especially in beating heart.

The Effects of Hypercapnia and High Flow on Cerebral Metabolism During Cardiopulmonary Bypass / 대한흉부외과학회지

BACKGROUND: Recent studies have demonstrated that cerebral desaturation during rewarming period of CPB was associated with postoperative neurologic dysfunction. The prevention of cerebral desaturation during CPB may reduce the incidences of neurologic and neuropsychological complications. The present study was prospectively undertaken to compare the clinical effects between two strategies (hypercapnic CPB and high flow CPB) to prevent cerebral desaturation for establishing a proper CPB technique. MATERIAL AND METHOD: Thirty-six adult patients scheduled for elective cardiac surgery were randomized into either hypercapnic (PaCO2 45~50 mmHg, n=18) or high flow group (flow rate 2.75 L/m2/min and PaCO2 35~40 mmHg, n=18) during rewarming period of CPB. In each patient, middle cerebral artery blood flow velocity (VMCA), cerebral arteriovenous oxygen content difference (C(a-v)O2), modified cerebral metabolic rate for oxygen (MCMRO2), cerebral oxygen transport rate (TEO2), incidence of cerebral desaturation (internal jugular bulb blood oxygen saturation < or =50%), increased rate of S-100 beta concentration, and arterial and internal jugular bulb blood gas were measured during the five phases of the operation; Pre-CPB, CPB-10 min (steady-state CPB, nasopharyngeal temperature 29~30 degrees C), Rewarm-1 (rewarming phase, nasopharyngeal temperature 33 degrees C), Rewarm-2 (nasopharyngeal temperature 37 degrees C), and CPB-off. Incidence of postoperative delirium and duration were assessed in all patients. All variables were compared between the two groups. RESULT: VMCA (157.88+/-10.87 vs 120.00+/-6.18%, p=0.006), internal jugular bulb O2 saturation (68.01+/-2.75 vs 61.28+/-2.87%, p=0.03) and O2 tension (41.01+/-2.25 vs 32.02+/-1.67 mmHg, p=0.03), and TEO2 (110.84+/-7.41 vs 81.15+/-8.11%, p=0.003) at rewarming periods were higher in the hypercapnic group than in the high flow group. C(a-v)O2 (4.0+/-0.30 vs 4.84+/-0.38 mg/dL, p=0.04), COE (0.36+/-0.03 vs 0.42+/-0.03, p=0.04), increased rate of S-100 beta(391.67+/-23.40 vs 940.0+/-17.02%, p=0.003), and incidence of cerebral desaturation (2 vs 4 patients, p= 0.04) at rewarming periods, and duration of postoperative delirium (18 vs 34 hr, p=0.02) were low in the hypercapnic group compared to the high flow group. CONCLUSION: These results indicate that hypercapnic CPB may provide relatively diminished cerebral injury and beneficial effects for cerebral metabolism relatively compared to high flow CPB.

Iatrogenic Large Esophageal perforation caused by Sengstaken-Blackmore Tube / 대한흉부외과학회지

This patient was an 53-year-old man who had undergone Sengstaken-Blackmore tube insertion for esophageal varix bleeding. Two days after Sengstaken-Blackmore tube insertion, he developed severe left hemothorax and was transferred to our hospital. The esophagoscopic findings revealed a large perforation lengthening 8-cm in the intrathoracic esophagus. A left thoracotomy was performed 33 days after the injury due to repeated varix bleedings and poor conditions. An 8-cm longitudinal perforation of the intrathoracic esophagus with gross suppurative empyema was found. Primary repair and esophageal exclusion was performed 2cm proximal and distal to the perforation, using rows of nonabsorbable staplers (TA stapler 60x4.8) and large bore thoracostomy tubes were placed for local drainage. Six days after intrathoracic esophageal exclusion, an esophagogram revealed a leakage at just above the proximal stapling site. A cervical esophageal exclusion was performed using the same method. One hundred thirty seven days after exclusion operation for the intra-thoracic esophageal perforation, the patient was able to eat per orally without any secondary esophageal reconstructive surgery.

Comparison of Effects of Normothermic and Hypothermic Cardiopulmonary Bypass on Cerebral Metabolism During Cardiac Surgery / 대한흉부외과학회지

BACKGROUND: Moderate hypothermic cardiopulmonary bypass (CPB)has commonly been used in cardiac surgery.Several cardiac centers recently practice normothermic CPB in cardiac surgery.However,the clinical effect and safety of normothermic CPB on cerebral metabolism are not established and not fully understood.This study was prospectively designed to evaluate the clinical influence of normothermic CPB on brain metabolism and to compare it with that of moderate hypothermic CPB. MATERIAL AND METHOD: Thirty-six adult patients scheduled for elective cardiac surgery were randomized to receive normothermic(nasopharyngeal temperature>34.5 degrees C,n=18)or hypothermic (nasopharyngeal temperature 29~30 degrees C,n=18)CPB with nonpulsatile pump.Middle cerebral artery blood flow velocity(VMCA), cerebral arteriovenous oxygen content difference (CAVO2),cerebral oxygen extraction (COE),modified cerebral metabolic rate for oxygen (MCMRO2),cerebral oxygen transport (TEO2),cerebral venous desaturation (oxygen saturation in internal jugular bulb blood < or =50 %),and arterial and internal jugular bulb blood gas analysis were measured during six phases of the operation:Pre-CPB (control),CPB-10 min,Rewarm-1 (nasopharyngeal temperature 34 degrees Cin the hypothermic group),Rewarm-2 (nasopharyngeal temperature 37 degrees Cin the both groups),CPB-off and Post-CPB (skin closure after CPB-off). Postoperaitve neuropsychologic complications were observed in all patients.All variables were compared between the two groups. RESULT: VMCA at Rewarm-2 was higher in the hypothermic group (153.11 +/-8.98%)than in the normothermic group (131.18 +/-6.94%) (p<0.05).CAVO (2) (3.47 +/-0.21 vs 4.28 +/-0.29 mL/dL,p<0.05),COE (0.30 +/-0.02 vs 0.39 +/-0.02,p<0.05)and MCMRO (2) (4.71 +/-0.42 vs 5.36 +/-0.45,p<0.05)at CPB-10 min were lower in the hypothermic group than in the normothermic group.The hypothermic group had higher TEO (2) than the normothermic group at CPB-10 (1,527.60 +/-25.84 vs 1,368.74 +/-20.03, p<0.05),Rewarm-2 (1,757.50 +/-32.30 vs 1,478.60 +/-27.41,p<0.05)and Post-CPB (1,734.37 +/-41.45 vs 1,597.68 +/-27.50,p<0.05).Internal jugular bulb oxygen tension (40.96 +/-1.16 vs34.79 +/-2.18 mmHg,p<0.05),saturation (72.63 +/-2.68 vs 64.76 +/-2.49 %,p<0.05)and content (8.08 +/-0.34 vs 6.78 +/-0.43 mL/dL,p<0.05)at CPB-10 were higher in the hypothermic group than in the normothermic group.The hypothermic group had less incidence of postoperative neurologic complication (delirium)than the normothermic group (2 vs 4 patients,p<0.05). Lasting periods of postoperative delirium were shorter in the hypothermic group than in the normothermic group (60 vs160 hrs,p<0.01). CONCLUSION: These results indicate that normothermic CPB should not be routinely applied in all cardiac surgery,especially advanced age or the clinical situations that require prolonged operative time. Moderate hypothermic CPB may have beneficial influences relatively on brain metabolism and postoperative neuropsychologic outcomes when compared with normothermic CPB.

Aorto-Esophageal Fistula Complicated by Esophageal Metalic Stent: A case report / 대한흉부외과학회지

Aortoesophageal fistula induced by endoesophageal stent is rare;however,it is usually a fatal disorder,with few survivors reported.We report a case of a 32-year old female with aortoesophaeal fistula after insertion of the esophageal stent in esophageal lye stricture who was successfully diagnosed with endoscopy and treated in a two-stage operation.In the first stage,we performed esophagectomy,primary repair of the fistula site in the descending thoracic aorta,and feeding gastrostomy.After the patient recovered well postoperatively,a retrosternal interposition of the right colon and cervical esophago-colo-grastostomy were performed,to re-establish the gastrointestinal tract.

Pericardial Effusion:Report of Three Unusual Cases

Pericardial effusions can be developed by any form of pericarditis; infective pericarditis such as viral or bacterial infection and non-infective, inflammatory pericarditis related with generalized disease such as end-stage renal disease or connective tissue disease and irradiation, postpericardiectomy syndrome, drugs and non-inflammatory pericarditis by malignancy, hypothyroidism, trauma on chest. In children, pericardial effusions are usually related with viral infection, generalized disease or cardiac surgery. We experienced three unusual cases of pericadial effusion by Mycoplasma pneumonia infection, Rickettsia tsutsugamushi infection and post-thoracotomy effusive constrictive pericarditis.

Early Results of the Nuss Procedure / 대한흉부외과학회지

BACKGROUND: Minimally invasive surgery of pectus excavatum by Dr. Nuss is a new technique that allows the repair of this deformity without any cartilage resection or sternal osteotomy. We describe the early experiences with Nuss procedure. MATERIAL AND METHOD: From December 1999 to January 2001, twenty patients with pectus excavatum underwent repair by Nuss procedure. There were 14 males and 6 females whose mean age was 10.1 +/- 7.7 years, ranging from 1 to 33 years. Most patients(N=19) were below 20 years, except 33 years old female patient(N=1). RESULT: The severity of depression was assessed by computed tomography(CT). CT index was mean 4.9 +/- 5.7(ranged from 3.3 to 8). The average operating time was 85.8 +/- 23.7 minutes. The used metal bars were ranged in length from 8 inches to 16 inches(average 11.8 +/- 14.4 inches). Early postoperative complications were pneumothorax in three patients, paralytic ileus in one, and postoperative chest pain requiring analgesics in all patients. Epidural analgesia was used in one adult patient for control of postoperative pain. In our experiences, there were no serious complications posteoperatively. CONCLUSION: There were good early results with the Nuss procedure that we performed for repairing of pectus excavatum. However, we believe the procedure needs to be observed for the long term results for it to be broadly accepted.

Angiosarcoma in Right Atrium / 대한흉부외과학회지

Primary cardiac tumors are rare, and primary malignant cardiac tumors are even rarer. Of these, angiosarcoma was uncommon. Surgical resection of the tumor was very difficult because symptoms were nonspecific and did not become present until the tumor had advanced. A 15-year-old male patient was diagnosed with primary cardiac angiosarcoma by microscopic examination under surgery and underwent resection of the tumor, which compressed and obstructed the right atrium. He was discharged from the hospital after 15 days without any problems.