Prophylactic Pancreatic Stent Placement for Endoscopic Duodenal Ampullectomy: A Single-Center Retrospective Study

BACKGROUND/AIMS: We investigated the efficacy of prophylactic pancreatic stent placement for preventing postprocedure pancreatitis in patients undergoing endoscopic papillectomy. METHODS: This retrospective study included 82 consecutive patients who underwent endoscopic papillectomy for benign ampullary neoplasm at Samsung Medical Center between August 2002 and June 2011. The patients were subdivided into two groups, namely, those who received prophylactic pancreatic stent placement and those who did not. Patient demographics, baseline blood test, tumor characteristics, and endoscopic treatment data were collected. The primary endpoint was postprocedure pancreatitis. RESULTS: There was no difference in the development of postprocedure pancreatitis between the stent group and the no stent group (6/54, 10.5% and 2/28, 7.14%, respectively; p=1.00). At baseline, there were no significant differences between the two groups in terms of their risk factors for pancreatitis except pancreatic duct dye injection. The stent group was more likely to have dye injection than the nonstent group (100% vs 42.8%, p<0.001). However, in a logistic regression analysis, no significant difference was observed in the risk factors for pancreatitis including dye injection. CONCLUSIONS: Our data suggest that routine prophylactic pancreatic duct stent placement in all patients undergoing endoscopic papillectomy may not be necessary and that large-scale prospective studies are required to identify the subgroup of patients who would benefit.

Surgical Repair of Retrograde Type A Aortic Dissection after Thoracic Endovascular Aortic Repair

It is expected that the stent graft will become an alternative method for treating aortic diseases or reducing the extent of surgery; therefore, thoracic endovascular aortic repair has widened its indications. However, it can have rare but serious complications such as paraplegia and retrograde type A aortic dissection. Here, we report a surgical repair of retrograde type A aortic dissection that was performed after thoracic endovascular aortic repair.

A Case of Pulmonary Artery Intimal Sarcoma Masquerading as Pulmonary Embolism / 결핵및호흡기질환

Pulmonary artery intimal sarcoma is a rare tumor with no characteristic symptoms. It is frequently misdiagnosed as pulmonary embolism. We report a case of pulmonary artery intimal sarcoma in a 48-year-old man with dyspnea, cough and blood-tinged sputum. He was initially suspected and treated as a pulmonary embolism. Computed tomography of the chest showed filling defects occupying the entire luminal diameter of the right and left pulmonary artery as well as extraluminal extension of the intraluminal mass. Surgical resection of the tumor confirmed pulmonary artery intimal sarcoma. After surgery, he received 8 cycles of combined chemotherapy consisting of doxorubicin and ifosfamide. After 8 cycles, Computed tomography of the chest showed interval regression of the residual tumor. Radiotherapy was done as total 6,000 cGy for 5 weeks, following the 8th chemotherapy. The patient's condition was successfully stabilized with chemotherapy and radiotherapy.

Comparison of the Long-Term Outcome of Coronary Artery Bypass Grafting between Percutaneous Coronary Intervention in End Stage Renal Disease Patients / 대한신장학회지

PURPOSE: Coronary artery disease is the main cause of morbidity and mortality in dialysis patients. Some observational studies proposed that coronary artery bypass graft (CABG) might provide higher survival benefit than percutaneous coronary intervention (PCI) in dialysis patients. There were not many studies of the comparison between the methods of coronary artery reperfusion therapy. Therefore, we compared the long term survival between PCI and CABG groups in dialysis patients. METHODS: We selected 104 patients with end stage renal disease (ESRD) who had PCI (N=75) or CABG (N=29) in Ilsan-Paik Hospital from December 1999 to February 2010. We collected data from medical records and performed a retrospective analysis in ESRD patients hospitalized for the first coronary revascularization procedure. RESULTS: There was no difference in the basic characteristics between the two groups. However, the frequency of more than 3-vessel lesions or less than 30% ejection fraction was higher in the group of CABG than that of PCI. One and three-year survival rates were higher in the PCI group than those in the CABG group. However, there was no difference in the 5 year survival rate between the groups. In subgroup analysis for severe patients with 3-vessel coronary diseases or less than 30% of ejection fraction, there were no statistical differences in the 1, 3 and 5 year survival rates between the groups. In subgroup analysis for the patients maintaining dialysis more than three months, 1, 3, and 5 year survival rates were not statistically different. CONCLUSION: In ESRD and dialysis patients, there was no difference in the long-term survival between PCI and CABG.

Tricuspid Valvular Myxoma: Unusual Case of Tricuspid Valve Myxoma Mimicking Thrombus after Pulmonary Artery Embolectomy and Tricuspid Annuloplasty in Pulmonary Thromboembolism Patient

A 55-year-old man with massive pulmonary thromboembolism underwent thrombolysis, pulmonary artery embolectomy and tricuspid annuloplasty. Nine months later, a mobile echogenic intra-cardiac mass was found in the tricuspid valve. Because the patient had undergone annuloplasty, thrombosis was suspected as the most likely diagnosis and thrombolytic therapy was instituted. However, the size of the cardiac mass did not change and after surgical excision the mass was found to be a myxoma. Cardiac valvular tumors are uncommon and when they occur they are usually slow growing fibroelastomas. In this case, the rapid growing cardiac myxoma on the tricuspid valve was found after the occurrence of pulmonary thromboembolism. To our knowledge, this is first reported case of tricuspid valve myxoma in Korea.

Surgical Management of Left Ventricular Outflow Tract Obstruction after Biventricular Repair of Double Outlet Right Ventricle

Regardless of the preoperative morphology and the type of operation, left ventricular outflow tract obstruction (LVOTO) after biventricular repair of double outlet right ventricle (DORV) may develop. This report presents our 10-yr experience with surgical management of LVOTO after biventricular repair of DORV. Between 1996 and 2006, 15 patients underwent reoperation for subaortic stenosis after biventricular repair of DORV. The mean age at biventricular repair was 23.3+/-18.3 months (1.1-64.2). Biventricular repairs included tunnel constructions from the left ventricle to the aorta in 14 cases and an arterial switch operation in one. The mean left ventricle-to-aorta peak pressure gradient was 54.0+/-37.7 mmHg (15-140) after a mean follow-up of 9.5+/-6.3 yr. We performed extended septoplasty in nine patients and fibromuscular resection in six. There were no early or late mortality. There was one heart block and one aortic valve injury after an extended septoplasty, and two and one after a fibromuscular resection. No patient required reoperation for recurrent subaortic stenosis. The mean pressure gradient was 11.2+/-11.4 mmHg (0-34) after a mean follow-up of 5.6+/-2.7 yr. Extended septoplasty is a safe and effective method for the treatment of subaortic stenosis, especially in cases with a long-tunnel shaped LVOTO.

One-Stage Management of Ascending Aorta Replacement and Percutaneous Endovascular Repair for Ascending and Descending Aortic Aneurysms : A case report / 대한흉부외과학회지

A stent graft has been accepted as an alternative method for treating aortic diseases or to reduce the extent of surgery. We report here on a one-stage Management of Ascending Aorta Replacement and Percutaneous Endovascular Repair for the seperate aneurysmal lesions on the ascending and descending aorta.

A Case of Native Valve Endocarditis due to Staphylococcus epidermidis

Although Staphylococcus epidermidis is a frequent cause of prosthetic valve endocarditis (PVE), it is regarded as a rare pathogen of native valve endocarditis (NVE). We report a case of NVE caused by methicillin-resistant S. epidermidis in a 62-year-old man. The bacterium was isolated from blood and tissue culture. The patient underwent valve replacement due to heart failure and was successfully treated by surgery and vancomycin administration for 7 weeks.

A Case of Native Valve Endocarditis due to Staphylococcus epidermidis

Although Staphylococcus epidermidis is a frequent cause of prosthetic valve endocarditis (PVE), it is regarded as a rare pathogen of native valve endocarditis (NVE). We report a case of NVE caused by methicillin-resistant S. epidermidis in a 62-year-old man. The bacterium was isolated from blood and tissue culture. The patient underwent valve replacement due to heart failure and was successfully treated by surgery and vancomycin administration for 7 weeks.

A case of metastatic mycotic pseudoaneurysms that developed after aortic surgery / 대한내과학회지

Multiple mycotic pseudoaneurysms that develop after aortic surgery are a rare infectious complication. The clinical course of this disease is severe and associated with a high mortality. Few published cases have described mycotic pseudoaneurysms that are localized mainly in the brain, heart, and aorta. In this case, a 33-year-old woman was admitted with abdominal pain and mild fever after graft surgery for a ruptured thoracic aorta that occurred following a vehicle accident. Thoracoabdominal computed tomography (CT), angiography, and transesophageal echocardiography (TEE) demonstrated multiple pseudoaneurysms and thromboembolic obstructions in the thoracic aorta and its branches. She was treated with anticoagulation, coil embolization, and surgical resection. Microscopically, a resected pseudoaneurysm showed the characteristic features of fungal colonies with thrombi. This patient has been well for 2 months after removing the pseudoaneurysms and treatment with systemic antifungal agents.

Three Cases of Arterial Occlusion That Occurred After the Use of Angioseal(R)

Femoral arterial closure devices are now commonly used after both diagnostic and therapeutic coronary procedures. They have been shown to reduce the time to ambulation and to decrease the length of the hospital stay. Angioseal is a commercially available femoral artery closure device that has been approved by the Food and Drug Administration (FDA). The device sandwiches an intra-arterial absorbable anchor on the luminal side of the vessel and a thrombin plug on the surface of the vessel with using a self-cinching stitch. We report here on three patients who presented with acute and delayed arterial occlusive complications that were found to be due to an Angioseal anchor that was not appropriately reabsorbed.

Low Grade Fibromyxoid Sarcoma of the Visceral Pleura: A case report / 대한흉부외과학회지

Low grade fibromyxoid sarcoma (LGFM) is a rare, deep soft-tissue malignant tumor. Although its histologic features are benign, the clinical course is malignant. The usual tumor locations are the lower extremity and chest wall. LGFM originating from the visceral pleura is extremely rare. We report here on a 37 year old man with a LGFM of the visceral pleura. Thirty three months after surgery, the patient is alive without any sign of local recurrence or distant metastasis.

Surgical Management of Multiple Coronary Artery Aneurysms: A case report / 대한흉부외과학회지

Multiple coronary aneurysms are rare in adults. The cause may be atherosclerosis, congenital malformations, post-traumatic or post-syphilitic vascular lesions, connective tissue diseases like Marfan and Ehler-Danlos syndromes or Kawasaki disease, all of which cause weakening of the media. Surgical intervention is indicated to prevent rupture, embolization or compression symptoms. The successful management of multiple coronary artery aneurysms, associated with previous rupture and arrhythmia, originating from proximal potions of ramus intermedius and left circumflex artery are reported.

A case of primary cutaneous nocardiosis in a patient with lung cancer / 대한내과학회지

Nocardiosis is a rare opportunistic bacterial infection. The majority of nocardial infections are acquired through inhalation and smaller numbers of cutaneous nocardiosis are caused by traumatic inoculation of organisms percutaneously. We experienced a patient with lung cancer that developed a primary cutaneous nocardiosis. A 57-year-old man was admitted to the Samsung Medical Center because of a painful swelling lesion of the right foot that developed 3 weeks prior. Three months prior, the patient had been diagnosed with a non-small cell lung cancer, and then underwent palliative bronchial stent insertion, radiation therapy and corticosteroid treatment for an obstructive endobronchial lesion. Incision and drainage was performed as magnetic resonance imaging (MRI) of the foot showed an abscess cavity. Nocardia was isolated from the pus. The antibiotic therapy was changed to oral trimethoprim/ sulfamethoxazole (TMP/SMX) treatment. The skin lesion was improving and the patient was discharged 20 days later. TMP/SMX was continued for a total of three months. The patient has been in good health and the skin lesion had completely healed two months after discharge.

A Case of Gastric Bezoar Treated by an Endoscopic Coca-Cola Injection / 대한소화기내시경학회지

Bezoars are the most common foreign bodies in the stomach as seen endoscopically with a frequency of approximately 0.4%. They consist of persistent concretions or hard accumulations of non-digestible vegetable matter, hair or more unusual materials. Gastric bezoars develop in patients with previous gastric surgery, gastric outlet obstruction, or poor gastric emptying such as gastroparesis due to hypothyroidism, diabetes mellitus or mixed connective tissue disease. The clinical presentations of gastric bezoars include epigastric pain, a palpable mass, a gastrointestinal obstruction and peptic ulceration. The treatment options include surgery, enzymatic dissolution or endoscopic mechanical fragmentation and/or removal. Recently, the efficacy of the administration or lavage of 'Coca-Cola' for the effective dissolution of gastric bezoars has been reported. We report a case of a 27-year-old woman with a large gastric bezoar that was successfully removed by the direct endoscopic injection of a carbonated beverage ('Coca-Cola light', a sugar free product; Coca cola Co., Seoul, South Korea) into the bezoar, which led to fragmentatio

Management of Complete Tracheal Disruption after a Fall

A complete tracheal rupture due to blunt trauma is rare, and a high proportion of patients with this injury die prior to arrival at medical centers. Early diagnosis and prompt management is essential in order to reduce morbidity and mortality. A 38-year-old woman visited the emergency department after a fall from the 4th floor of a building. We confirmed that a complete tracheal disruption 4 cm above the carina by chest CT. We could not insert an endotracheal tube because the distal stump of the trachea was separated by 4 cm from the proximal stump, so we used percutaneous cardiopulmonary bypass for the prevention of hypoxia during the initial operative procedures. We performed resections and reconstruction of the injured trachea. Fourteen days after the operation we confirmed normal healing of the trachea with bronchoscopy. One year after the operation, the patient is healthy with no tracheal problems.

A Case of Spontaneous Left Atrial Intramural Hematoma Causing Vaso-occlusive Cardiogenic Shock

Intramural hematoma of the cardiac muscle is a rare clinical condition. Only a few cases have been reported in the medicosurgical conditions related to post cardiac surgery, chest trauma and dissecting aneurysms of the aorta. Moreover, there are few cases of spontaneous left atrial intramural hematoma and they may occur in the medical conditions related to calcified mitral annulus dissection or amyloidosis. We experienced a case of spontaneous intramural left atrial hematoma in a 29 year-old male resulting in vaso-occlusive cardiogenic shock. We report the clinical manifestation and treatment of this case with a review of literatures.

Treatment of Tumor Involving Thoracic Inlet by Using Transmanubrial Osteomuscular Sparing Approach: One case report / 대한흉부외과학회지

The operative case of transmanubrial osteomuscular sparing approach for the tumor involving thoracic inlet is reported. A 69-year-old man visited the hospital due to right upper extremity weakness. Chest roentgenogram showed bronchiectasis, chronic pulmonary tuberculosis, and fungal ball in right upper lobe. On computed tomogram, tumor was located in epidural space of the 6th, the 7th cervical, and the 1st thoracic spine and extended to the apex of the right thorax. A neurosurgeon performed laminectomy and removed the tumor located in the spinal canal. A thoracic surgeon performed a transmanubrial osteomuscular sparing approach and removed the tumor involving thoracic inlet. The tumor was diagnosed as hemangiopericytoma. The patient recovered without complication.

A case of pulmonary coccidioidomycosis mimicking lung cancer / 대한내과학회지

Coccidioidomycosis is a fungal infection caused by the soil fungus Coccidioides immitis, which is endemic to the south-western United States. Increasingly, cases are being recognized outside the endemic area, due to travelers who have visited the endemic area. Here, we report a case of pulmonary coccidioidomycosis in a Korean man who has traveled in Arizona, U.S.A. Cardinal clinical symptoms were fever, central lung mass with mediastinal lymphadenopathy on the chest X-ray which mimicked lung cancer, and a 14% eosinophilia in the peripheral blood. Coccidioidomycosis was diagnosed by serology and mediastinoscopic biopsy by identifying typical spherules. The symptoms disappeared spontaneously without specific treatment. Coccidioidomycosis must be considered in the differential diagnosis of pulmonary infiltrates with peripheral eosinophilia, especially if patient has lived in or visited endemic area.

Early & Midterm Results after Redo Coronary Artery Bypass Grafting / 대한흉부외과학회지

BACKGROUND: As the experience of coronary artery bypass grafting (CABG) has been accumulated, the number of reoperation after CABG is increasing. We analyzed our clinical experience of redo-CABG. MATERIAL AND METHOD: Fourteen patients who underwent redo-CABG between Jan. 1994 and Dec. 2002 were included in this study. The mean period from the first operation to reoperation was 66+/-56 (3~57) months, and the average ages were 62.8+/-8.7 (51~8) years. The survivors were followed up 39+/-29 (4~01) months postoperatively. Indications of reoperation were stenosis or occlusion of previous grafts in 11 patients, progression of native coronary artery disease in one patient, and both etiologies in two patients. RESULT: There were two in-hospital mortalities (14.3%) resulting from low cardiac output syndrome. Postoperative morbidities were perioperative myocardiac infarction in 2 patients (14.3%), mediastinitis in one patient (7.2%), duodenal perforation in one patient, ischemic necrosis of the lower extremity in one patient, gastric perforation after mesenteric infarct in one patient, delayed brain infarct in one patient, and intraoperative splenic rupture in one patient. There was one late mortality at six months postoperatively during the follow up. There was no angina recurrence during the follow up. CONCLUSION: Although redo CABG demonstrated relatively high operative mortalities and morbidities, postoperative status and clinical outcome of the survivors were favorable.