RESUMO
BACKGROUND: Sternoclavicular septic arthritis manifests serious complications such as abscess, osteomyelitis, mediastinitis and empyema; therefore, a prompt diagnosis and appropriate treatment are necessary. MATERIAL AND METHOD: The treatment results of eight patients with sternoclavicular septic arthritis and who had been surgically treated at our institutions between September 2005 and July 2008 were retrospectively reviewed. The surgical treatment they underwent was en bloc resection, including partial resection of the sternum, the clavicular head and the 1st rib. RESULT: The patients ranged in age from 40 to 74 years with an average of 55.1+/-10.3 years. Five were men and three were women. There were 6 patients with spontaneous sternoclavicular septic arthritis and 2 patients had their condition induced by central venous catheters. The pathogens isolated from the patients' blood and wounds were MRSA (3), Streptococcus intermedius (1), Streptococcus agalactiae (1) and Pseudomonas luteola (1). One patient expired from aggravation of preoperative sepsis on POD 31. CONCLUSION: The life-threatening complications from sternoclavicular septic arthritis can progress and lead to death unless appropriate treatment is administered. A prompt diagnosis, appropriate antibiotics therapy and effective surgical treatment such as radical en bloc resection can reduce the morbidity and mortality of this malady.
Assuntos
Feminino , Humanos , Masculino , Abscesso , Antibacterianos , Artrite Infecciosa , Cateteres Venosos Centrais , Cabeça , Mediastinite , Staphylococcus aureus Resistente à Meticilina , Osteomielite , Pseudomonas , Estudos Retrospectivos , Costelas , Sepse , Articulação Esternoclavicular , Esterno , Streptococcus agalactiae , Streptococcus intermedius , Resultado do TratamentoRESUMO
BACKGROUND: Esophageal perforation is an emergency that requires early diagnosis and effective treatment. A delay in diagnosis and treatment significantly increases morbidity and mortality. MATERIAL AND METHOD: Thirty-seven patients with esophageal perforation were surgically treated at our institutions between January 1990 and December 2006. We retrospectively reviewed the results of surgical treatment for esophageal perforation to understand the risk factors affecting survival in patients. RESULT: Patients ranged in age from 21 to 87 years, with an average age of 52.7+/-16.98 years. Thirty-one of the patients were men and six were women. There were 23 patients (62%) with spontaneous perforations, 10 patients (27%) with a traumatic perforation, and 4 patients (11%) with an iatrogenic perforation. The site of esophageal perforation was the cervical esophagus in 5 patients, the thoracic esophagus in 31 patients, and the abdominal esophagus in one patient. Twenty-nine patients underwent primary closure of the perforation and five patients had T-tube drainage. Exclusion-diversion procedures were performed in two patients and an esophagectomy was performed in one patient. There were six cases of mortality (16.22%) and 25 cases of postoperative complications in 15 patients (40.5%). Patients that were treated later than 24 hours after detection of the perforation showed a statistically significant high morbidity and mortality rate (p<0.05). CONCLUSION: The most important risk factor of esophageal perforation was the time interval between detection of the perforation and the initiation of treatment. A prompt diagnosis and effective treatment are necessary to decrease morbidity and mortality.
Assuntos
Feminino , Humanos , Masculino , Drenagem , Diagnóstico Precoce , Emergências , Perfuração Esofágica , Esofagectomia , Esôfago , Complicações Pós-Operatórias , Estudos Retrospectivos , Fatores de RiscoRESUMO
BACKGROUND: Endovenous laser treatment has recently been introduced as a less invasive technique, with many good results reported. A 980-nm diode laser was used on the great saphenous vein (GSV) occlusions in patients with varicose veins, due to GSV reflux, and the therapeutic effects analyzed. MATERIAL AND METHOD: Between September 2003 and February 2006, 238 patients (332 cases) with GSV reflux underwent endovenous laser treatment with a 980-nm diode laser. Operative procedures were simultaneous endovenous laser treatment and ambulatory phlebectomy. The preoperative clinical findings, postoperative complications and postoperative duplex US follow up results at 1 and 3 months were reviewed. RESULT: Postoperative complications were ecchymosis in almost cases, paresthesia 68 cases (20.5%) and skin burn in 3 cases (0.9%). Follow up duplex US revealed 26 and 10 cases at 1 and 3 months of GSV reflux or partial recanalization, with therapeutic success rates of 91.3 and 87.9%, respectively. CONCLUSION: The treatment of GSV occlusion with an endovenous laser is less invasive than traditional GSV stripping, but relatively high recanalization was experienced, possibly due to inadequate laser power, laser fiber pullback speed or an extremely dilated GSV. However, continuous attempts will be required to reduce the recanalization after the procedure, with accurate follow up using duplex US.
Assuntos
Humanos , Queimaduras , Equimose , Seguimentos , Lasers Semicondutores , Parestesia , Complicações Pós-Operatórias , Veia Safena , Pele , Procedimentos Cirúrgicos Operatórios , VarizesRESUMO
A congenital diaphragmatic hernia, which mainly occurs in the left thorax, requires an emergency operative procedure during the neonatal periods. A right-sided congenital diaphragmatic hernia is rare, and often detected after the neonatal period due to the mild symptoms. Traditionally, the treatment repairs the diaphragmatic defect via a thoracotomy. However, good results of thoracoscopic repairs have been reported. Herein, the case of a 5-month-old girl, who received a thoracoscopic repair of a right-sided congenital diaphragmatic hernia, is reported.
Assuntos
Feminino , Humanos , Lactente , Diafragma , Emergências , Hérnia Diafragmática , Procedimentos Cirúrgicos Operatórios , Toracoscopia , Toracotomia , TóraxRESUMO
Inferior sinus venosus ASD (atrial septal defect) is a rare congenital cardiac deformity, that occurs on between the inferior vena cava and right atrium. Diagnosis of inferior sinus venosus ASD is difficult because of its infero-posterior location of the fossa ovalis. Therefor, exact anatomical diagnosis by preoperative and intraoperative transesophageal echocardiography is necessary at preoperation and during the operation. We present a case of residual ASD, which was diagnosed secundum ASD and repaired when the patient was 10 years old. Residual ASD was diagnosed by cardiac echocardiography in preparation of otorhinolaryngology operation. Therefore, reoperation of residual ASD was done when the patient was 24 years old. The patient had secundum ASD and inferior sinus venosus ASD, but in the prior operation, inferior sinus venosus ASD wasn't found and only secundum ASD was repaired. In reoperation, inferior sinus venosus ASD was reveled and patch closure was done.
Assuntos
Criança , Humanos , Adulto Jovem , Anormalidades Congênitas , Diagnóstico , Ecocardiografia , Ecocardiografia Transesofagiana , Átrios do Coração , Comunicação Interatrial , Otolaringologia , Reoperação , Veia Cava InferiorRESUMO
BACKGROUND: There has been an increase in the number of elderly patients considered for coronary artery bypass grafting (CABG). Recently, there were many satisfactory reports of coronary artery bypass grafting (CABG) in old age due to the development in operative technique and postoperative management. We evaluated operative and follow-up results of patients 70 years of age and older compared to 60 years old. MATERIAL AND METHOD: We retrospectively studied the cases of 74 consecutive patients 70 years or older (group A) who underwent a elective CABG from January 2000 to December 2003 and compared that of relatively young age group (group B, 60-69 years old). We compared preoperative characteristics, operation technique, postoperative results that effect outcome, also we investigated late mortality and cardiac events at follow-up periods. RESULT: Preoperative demographic and clinical characteristics of two groups were not different, except preoperative renal dysfunction(serum creatinine: > or= 1.4 mg/dl) (group A 17, 23% vs group B 14, 9%) (p=0.024). There was no difference of the mean number of distal anastomosis and the left ventricular ejection fraction in group A decreased significantly from 53.7+/-13% preoperatively to 49.9+/-12% postoperatively (p=0.02), but not changed in group B. There was no difference at operative mortality rate and postoperative major morbidity rate, but wound problem of saphenous vein harvest site was significantly higher in group A than group B (6.8% vs 0.7%, p=0.02). The mean follow up duration was 24.3+/-13 months and the cumulative survival were 95.4% at 2 year and 79.9% at 4 year in group A and 95.4% at 2 year and 90.1% at 4 year in group B (p=ns). CONCLUSION: We conclude that age is not a factor of determination when we decide about operation because coronary artery bypass grafting in elderly more than 70 years old can be performed with a low mortality rate and acceptable morbidity rate.
Assuntos
Idoso , Humanos , Pessoa de Meia-Idade , Fatores Etários , Ponte de Artéria Coronária , Vasos Coronários , Creatinina , Seguimentos , Mortalidade , Estudos Retrospectivos , Veia Safena , Volume Sistólico , Ferimentos e LesõesRESUMO
Combined large cell neuroendocrine carcinoma is an uncommon lung cancer that include large cell neuroendocrine carcinoma with components of adenocarcinoma, squamous cell carcinoma, giant cell carcinoma and/or spindle cell carcinoma histologically. We report a case that pathologically diagnosed as combined large cell neuroendocrine carcinoma with component of adenocarcinoma after right pneumonectomy and mediastinal lymph node dissection. A 44-year-old man with intermittent chest pain was referred to our hospital for lung mass on the right mid lung field.
Assuntos
Adulto , Humanos , Adenocarcinoma , Carcinoma de Células Gigantes , Carcinoma Neuroendócrino , Carcinoma de Células Escamosas , Dor no Peito , Pulmão , Neoplasias Pulmonares , Excisão de Linfonodo , PneumonectomiaRESUMO
Chylothorax is a rare but serious and well-recognized complication of thoracic and cardiac procedures. A postoperative chylothorax developed in a 3-month-old male patient after ligation of patent ductus arteriosus and repair of coarctation of aorta. He was treated successfully with conservative management using a combination of parenteral octreotide and medium-chain triglyceride (MCT) -enriched fomula with pleural drainage. We report a case of successful conservative treatment using octreotide for postoperative chylothorax.
Assuntos
Humanos , Lactente , Masculino , Coartação Aórtica , Quilotórax , Drenagem , Permeabilidade do Canal Arterial , Ligadura , Octreotida , Complicações Pós-Operatórias , TriglicerídeosRESUMO
Solitary fibrous tumor is an uncommon submesothelial mesenchymal neoplasm that arises primarily from the pleura. Extrapleural solitary fibrous tumors are rare. Solitary Fibrous tumors are often asymptomatic and discovered incidentally but may become symptomatic when vital structures are involved or they grow large. In general, solitary fibrous tumor is diagnosed on the basis of radiologic findings and its histologic features, with immunohistochemistry serving to support the diagnosis. Most solitary fibrous tumors pursue a benign course, and the single most important predictor of clinical outcome is the ability to excise the entire lesion. We experienced a case of intrapulmonary solitary tumor arising from the right lower lobe which was treated with wedge resection. We report this case of the patient.
Assuntos
Humanos , Diagnóstico , Imuno-Histoquímica , Neoplasias Pulmonares , Pleura , Tumores Fibrosos SolitáriosRESUMO
Langerhans Cell Histiocytosis (LCH) is a pathologic proliferation and infiltration of various organs by Langerhans' cells of unknown cause. Incidence rate of one million parties 3~4 is seen in young child but the incidence is not sure in adult. Organ systems involved by LCH may include skin, ear, bone marrow, liver, spleen, lung, pituitary gland-hypothalamus and GI tracts. In case pituitary-hypothalamus axis are involved, diabetes insipidus happened. Primary Pulmonary Langerhans Cell Histiocytosis(PLCH) with uninvolvement of other organs is rare and accompanied diabetes insipidus is more rare. There are many cases of LCH with diabetes insipidus involve such as central nervous system except lung. PLCH accompany central diabetes insipidus is only 1 case. We report a case of PLCH that accompany central diabetes insipidus with literature investigation inDepartment of Thoracic and Cardiovascular Surgery, Hallym University.
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Adulto , Criança , Humanos , Vértebra Cervical Áxis , Medula Óssea , Sistema Nervoso Central , Diabetes Insípido , Diabetes Insípido Neurogênico , Orelha , Trato Gastrointestinal , Histiocitose , Histiocitose de Células de Langerhans , Incidência , Fígado , Pulmão , Neoplasias Pulmonares , Pele , BaçoRESUMO
Hemangioma in the esophagus is an uncommon tumor. There have only been about 30 cases reported in the world literatures. It occurs predominantly in men and although majority are asymptomatic, may cause bleeding and dysphagia. Hemangioma in the esophagus was diagnosed with a barium swallowed esophagography and endoscopy. The main treatment modes recommended are surgery and endoscopic resection. We experienced one case of cav ernous hemangioma occurring at the distal esophagus. The patient was a forty-six year old male with dysphagia and indigestion. Barium esophagogram showed a filling defect at the distal portion. Esophagoscopy showed a bluish polypoid mass. Surgical resection was per formed and the pathologic diagnosis was confirmed as cavernous hemangioma. Postoperative course was uneventful and the patient had been followed up without any problems.
Assuntos
Humanos , Masculino , Bário , Transtornos de Deglutição , Diagnóstico , Dispepsia , Endoscopia , Neoplasias Esofágicas , Esofagoscopia , Esôfago , Hemangioma , Hemangioma Cavernoso , HemorragiaRESUMO
The pectus carinatum or anterior protrusion of the sternum is a less common than pectus excavatum. It occurs more frequently in boys than girls and associated musculoskeletal abnormalities, spinal scoliosis is most common. Ravitch first reported correction of chondromanubrial prominence in 1952, resecting the multiple deformed costal cartilages and performing a double osteotomy on sternum. We have experienced one case of pectus carinatum and obtained satisfactory postoperative results. The deformity was corrected by the subchondral resection of multiple deformed costal cartilage, bilaterally, with single osteotomy on sternum and fracture of the posterior cortex to correct anterior angulation. Postoperative course was uneventful. We report this case with brief review of the literature.
Assuntos
Feminino , Humanos , Cartilagem , Anormalidades Congênitas , Tórax em Funil , Anormalidades Musculoesqueléticas , Osteotomia , Escoliose , EsternoRESUMO
Classic pulmonary blastoma is a variant of carcinosarcoma which is seen almost exclusively in adults. By contrast, most cases of pulmonary blastoma in children have been described as having an exclusive mesenchymal composition, which was proposed as pleuropulmonary blastoma. Recently we experienced a case of pleuropulmonary blastoma, type 1. This 27-month-old male baby was transferred to our hospital due to the left tension pneumothorax. Chest CT revealed a subpleural pulmonary cystic lesion on the left upper lung and an open cystectomy was performed. Histologically the lesion was composed of variable-sized cystic structures lined with a single layer of respiratory-type epithelium. the underlying stroma was composed of sheets of small, round to oval, primitive tumor cells. Some of them had eccentric, eosinophilic cytoplasm, suggestive of rhabdomyoblastic differentiation. These rhabdomyoblastic cells were fuchsinophilic and positive with desmin and vimentin on immunohistochemistry.
Assuntos
Criança , Adulto , Masculino , Feminino , HumanosRESUMO
No abstract available.
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From July 1994 to August 1995, 32 patients underwent coronary artery bypass surgery. There were 14 men and 18 women. The mean age was 59 years(range from 37 to 81 years). Preoperatively 26 patients had unstable angina pectoris and 6 patients had stable angina pectoris. Nine patients had previous myocardial infarction history. Five patients had preoperative left ventricular ejection fraction of 40% or less. The involved risk factors were as follows ; smoking 19 cases, hypertension 16 cases, hypercholesterolemia 14 cases, diabetes mellitus 6 cases, and obesity 3 cases. 21 patients had three-vessel disease, 7 patients had two-vessel disease, 2 patients had one-vessel disease and 2 patients had left main coronary artery disease. We performed 103 distal bypasses out of 32 cases, and the mean number of grafts per patients is 3.22. We used arterial grafts (left internal mammary artery ; 31, radial artery ; 2) in 32% of total grafts. Postoperative complications were low cardiac output, perioperative myocardial infarction, respiratory failure and atrial fibrillation, etc. Early mortality was 6.25% (2/32). The causes of deaths were low cardiac output (1), and perioperative myocardial infarction(1).
Assuntos
Feminino , Humanos , Masculino , Angina Estável , Angina Instável , Fibrilação Atrial , Baixo Débito Cardíaco , Causas de Morte , Ponte de Artéria Coronária , Doença da Artéria Coronariana , Vasos Coronários , Diabetes Mellitus , Hipercolesterolemia , Hipertensão , Artéria Torácica Interna , Mortalidade , Infarto do Miocárdio , Obesidade , Complicações Pós-Operatórias , Artéria Radial , Insuficiência Respiratória , Fatores de Risco , Fumaça , Fumar , Volume Sistólico , TransplantesRESUMO
From July 1994 to August 1995, 32 patients underwent coronary artery bypass surgery. There were 14 men and 18 women. The mean age was 59 years(range from 37 to 81 years). Preoperatively 26 patients had unstable angina pectoris and 6 patients had stable angina pectoris. Nine patients had previous myocardial infarction history. Five patients had preoperative left ventricular ejection fraction of 40% or less. The involved risk factors were as follows ; smoking 19 cases, hypertension 16 cases, hypercholesterolemia 14 cases, diabetes mellitus 6 cases, and obesity 3 cases. 21 patients had three-vessel disease, 7 patients had two-vessel disease, 2 patients had one-vessel disease and 2 patients had left main coronary artery disease. We performed 103 distal bypasses out of 32 cases, and the mean number of grafts per patients is 3.22. We used arterial grafts (left internal mammary artery ; 31, radial artery ; 2) in 32% of total grafts. Postoperative complications were low cardiac output, perioperative myocardial infarction, respiratory failure and atrial fibrillation, etc. Early mortality was 6.25% (2/32). The causes of deaths were low cardiac output (1), and perioperative myocardial infarction(1).