RÉSUMÉ
A fifty seven-year-old man visited the outpatient department with chest pain and claudication. Coronary angiogram showed coronary artery diseases (3-vessel diseases) and CABG was planned. However, lower extremity angiogram showed stenosis of both common iliac arteries and stent implantation of both iliac arteries were done before CABG. He underwent CABG and IABP was inserted for weaning from cardiopulmonary bypass. After CABG, ischemic change on ends of feet was noted with red-brown colored urine and hyperkalemia. Blood myoglobin level was over 3,000 ng/ml. Microembolism of his lower body was revealed by multiple uptakes on the whole body bone scan study. After management by massive hydration and alkalization of urine with sodium bicarbonate, he was recovered without renal replacement therapy and discharged in good condition.
Sujet(s)
Humains , Pontage cardiopulmonaire , Douleur thoracique , Sténose pathologique , Pontage aortocoronarien , Maladie des artères coronaires , Vaisseaux coronaires , Pied , Hyperkaliémie , Artère iliaque , Membre inférieur , Myoglobine , Patients en consultation externe , Traitement substitutif de l'insuffisance rénale , Rhabdomyolyse , Hydrogénocarbonate de sodium , Endoprothèses , SevrageRÉSUMÉ
A 38-year old man was admitted to our hospital due to a 5x6 cm sized pulsating mass in the right neck. He suffered from intermittent neck pain and hoarseness for two months due to the rapidly growing mass. The radiological examinations revealed an aneurysm of the right common carotid artery near the bifurcation, and it was compressing the internal and external carotid arteries. Endarterectomy of the right internal carotid artery, aneurysmectomy of the right common carotid artery and graft interposition were done, while the cerebral circulation was maintained by an internal shunt. Intraoperative injury to the nerve tissue around the aneurysm was avoided. He was discharged on the postoperative 7th day without any complications.
Sujet(s)
Anévrysme , Artères carotides , Artère carotide commune , Artère carotide externe , Artère carotide interne , Endartériectomie , Enrouement , Cou , Cervicalgie , Tissu nerveux , TransplantsRÉSUMÉ
During long-term anticoagulation treatment with using heparin in a pregnant patient with a mechanical mitral prosthesis, we observed several anticoagulation-related complications, including repeated prosthetic valve thrombosis. This was found to be caused by heparin resistance due to an anti-thrombin III deficiency. Thrombolytic therapy using urokinase or tissue plasminogen activator (tPA) was successful and safe for her as well as her baby.
Sujet(s)
Humains , Grossesse , Anticoagulants , Antithrombine-III , Héparine , Prothèses et implants , Défaillance de prothèse , Traitement thrombolytique , Thrombose , Activateur tissulaire du plasminogène , Activateur du plasminogène de type urokinaseRÉSUMÉ
BACKGROUND: Loss of cardiomyocytes in the myocardial infarction leads to regional contractile dysfunction, and necrotized cardiomyocytes in infracted ventricular tissues are progressively replaced by fibroblasts forming scar tissue. Although cardiomyoplasty, or implantation of ventricular assist device or artificial heart was tried in refractory heart failure, the cardiac transplantation was the only therapeutic modality because these other therapeutic strategies were not permanent. Cell transplantation is tried instead of cardiac transplantation, especially bone marrow is the most popular donated organ. But because bone marrow aspiration procedure is invasive and painful, and it had the fewer amounts of cellular population, the adipose tissue is recommended for harvesting of mesenchymal stem cells. MATERIAL AND METHOD: After adipose tissues were extracted from abdominal subcutaneous adipose tissue and intra-abdominal adipose tissue individually, the cellular components were obtained by same method. These cellular components were tried to transformation with the various titers of 5-azacytidine to descript the appropriate concentration of 5-azacytidine and possibility of transformation ability of adipose tissue. Group 1 is abdominal subcutaneous adipose tissue and Group 2 is intra-abdominal adipose tissue-retroperitoneal adipose tissue and omentum. Cellular components were extracted by collagenase and NH4Cl et al, and these components were cultured by non-induction media-DMEM media containing 10% FBS and inducted by none, 3 micromol/L, 6 micromol/L, and 9 micromol/L 5-azacytidine after the 1st and 2nd subculture. After 4 weeks incubation, the cell blocks were made, immunostaining was done with the antibodies of CD34, heavy myosin chain, troponin T, and SMA. RESULT: Immunostaining of the transformed cells for troponin T was positive in the 6 micromol/L & 9 micromol/L 5-azacytidine of Group 1 & 2, but CD34 and heavy myosin chain antibodies were negative and SMA antibody was positive in the 3 micromol/L & 6 micromol/L 5-azacytidne of Group 2. CONCLUSION: These observations confirm that adult mesenchymal stem cells isolated from the abdominal subcutaneous adipose tissues and intra-abdominal adipose tissues can be chemically transformed into cardiomyocytes. This can potentially be a source of autologous cells for myocardial repair.
Sujet(s)
Adulte , Animaux , Humains , Rats , Tissu adipeux , Anticorps , Azacitidine , Moelle osseuse , Cardiomyoplastie , Transplantation cellulaire , Cicatrice , Collagenases , Fibroblastes , Défaillance cardiaque , Transplantation cardiaque , Coeur artificiel , Dispositifs d'assistance circulatoire , Graisse intra-abdominale , Cellules souches mésenchymateuses , Infarctus du myocarde , Myocytes cardiaques , Myosines , Omentum , Graisse sous-cutanée abdominale , Transplants , Troponine TRÉSUMÉ
Metallic fixations devices are widely used in the surgical management of fractures and dislocations of shoulder. It is known that Kirschner wire (K-wire) may migrate into the thoracic cavity or other organs may occur. We report a case in which a K-wire previously placed in the clavicle migrated into the thoracic cavity without causing any trauma to the major vascular structures and was removed successfully by thoracoscopic surgery.
Sujet(s)
Clavicule , Luxations , Migration d'un corps étranger , Épaule , Cavité thoracique , ThoracoscopieRÉSUMÉ
Mediastinal teratoma is one of the most common lesions found in the anterior mediastinum, accounting for 8~13% of all mediastinal tumors. This tumor is incidentally detected by routine chest roentgengography, but pericardial perforation or pleural effusion occurs rarely. In our patient cardiac tamponade was developed due to anterior chest wall contusion, we confirmed the anterior mediastinal tumor. Vital signs were stabilized after the pericardiocentesis, and the patient underwent the tumor resection in the anterior mediastinum for a definite treatment. On histologic examination, the tumor revealed cystic structures composed of mature squamous epithelium, pilosebaceous glands, mature fat tissue, gastrointestinal mucosa, respiratory epithelium, and pancreatic tissues.
Sujet(s)
Humains , Tamponnade cardiaque , Contusions , Épithélium , Kyste médiastinal , Médiastin , Péricardiocentèse , Épanchement pleural , Muqueuse respiratoire , Tératome , Paroi thoracique , Thorax , Signes vitauxRÉSUMÉ
Systemic lupus erythemotosus (SLE) is an autoimmune disorder with dermal, renal, and cardiac manifestations. It frequently has cardiovascular complications such as pericarditis, myocarditis, and valvular heart diseases. Valvular heart diseases in SLE comes mainly in the form of mitral or aortic insufficiencies. Report of aortic stenosis is extremely rare. Surgical treatments of valvular heart disease in SLE are not done frequently because of complications in other organs. Aortic stenosis developed in a 59 year-old woman with SLE, and aortic valve replacement was done successfully.
Sujet(s)
Femelle , Humains , Adulte d'âge moyen , Valve aortique , Sténose aortique , Endocardite , Valvulopathies , Lupus érythémateux disséminé , Myocardite , PéricarditeRÉSUMÉ
A 70-year-old man with aphasia due to ischemic cerebral events by thromboemboli was admitted. The cause of thromboemboli was investigated, and transesophageal echocardiography and chest MRI revealed an encapsulated cystic mass in the right atrium, not circulating. It was a homogeneous cystic mass suggesting a tumor (Myxoma) rather than thrombus. Right atrial mass was resected together with partial atrial septum under the normothermic cardiopulmonary bypass. Histologically it was an atrial septal aneurysm, closed on itself, filled with blood. We report this rarely seen case with a review of the literatures.