Pathogenic Classification and Clinical Characteristics of Nontuberculous Mycobacterial Pulmonary Disease in a National Tuberculosis Hospital / 결핵및호흡기질환

BACKGROUND: It has been reported that nontuberculosis mycobacterium(NTM) isolates account for approximately 10% of patients with a positive Acid-Fast Bacilli(AFB) smear. Therefore, it is necessary to consider NTM pulmonary disease when such a positive test is encountered. The aim of this study was to evaluate the etiologies and clinical characteristics of patients with NTM pulmonary disease who had been treated at a national tuberculosis hospital. METHODS: The NTM isolates were recovered from the sputum or bronchial washing specimens submitted to a clinical laboratory of National Masan TB Hospital from August 2002 to July 2003. All samples were identified using a polymerase chain reaction-restriction fragment length polymorphism analysis method, which amplifies the rpoB gene. The patients were diagnosed with NTM disease according to the American Thoracic Society diagnostic criteria. RESULTS: One hundred NTM isolates were recovered from 57 patients. Of the 100 isolates, M. avium complex(MAC) was the most common species, which was found 55%(n=55) of patients, followed by M. abscessus(n=25), and M. fortuitum(n=9). 26(45.6%) patients had NTM disease. Twenty-six (45.6%) patients had NTM disease according to The American Thoracic Society classification. The main organisms involved in NTM disease were MAC(n=19, 73.1%) and M. abscessus(n=5, 19.2%). The pathogenic potential was 67.9% in M. intracellulare and 41.7% in M. abscessus. The predictive factors related to NTM disease were a positive sputum smear (OR 6.4, p=0.02) and the isolation of either MAC or M. abscessus(OR 6.9, p=0.007). Fifteen patients(57.7%) were cured. There were no significant factors associated with the treatment success. CONCLUSION: There was a relatively high proportion of NTM disease in NTM isolates and the common species were MAC and M. abscessus. The predictive factors for NTM disease were a positive sputum smear and the isolation of either MAC or M. abscessus.

The Results of Revision Total Knee Replacement Arthroplasty

PURPOSE: To evaluate the results of revision total knee replacement arthroplasty (TKRA) and compare those outcomes according to the reasons for the revision TKRA. MATERIALS AND METHODS: We reviewed the results of 27 revision TKRAs followed at a minimum of 2 year after revision surgery with American Knee Society clinical and radiological rating system and satis-faction survey. There were 25 females and 1 male with the average age of 65.6 years (52~77). The origi-nal diagnosis was osteoarthritis in 24 cases and rheumatoid arthritis in 3 cases in the study group. The patients were followed for 2 year to 7 years 2 months (average 2 year 11 months). The reasons for revi-sion TKRA were osteolysis and loosening in 10 knees (37%), polyethylene wear in 10 knees (37%), infection in 3 knees (11.1%), stiffness in 3 knees (11.1%) and instability in 1 knee (3.8%). RESULTS: The knee score was average 84.7 (65~100) and function score was 68 (15~100) at final fol-low-up examination. The patients expressed, 11 knees (40.7%) were as very satisfactory knee, 5 knees (18.6%) as satisfactory knee, 8 knees (29.6%) as improved knee and 3 knees (11.1%) as got no change on their knees. There was no stastistically difference on the result from the original diseases and we got a good to excellent results for the infected TKRA with 2 staged revision TKRA. Isolated exchange of the tibial polyethylene insert performed in 10 knees (29%), but there was no statistical significance in the results between isolated polyethylene exchange and revision TKRA with new prosthesis. CONCLUSION: Although we can get 59.3% of the patients' satisfaction and 81.5% of good to excellent results, the overall outcomes of revision TKRA were not as good as primary TKRA. This study clearly does not support the premise that isolated polyethylene exchange is favorable for the long-term results.

A Clinical Study of Midtrimester Amniocentesis / 대한주산의학회잡지

OBJECTIVE: The objective of this study was to analyze the distributions of maternal age, the indications, cytogenetic results and the safety of 334 cases of midtrimester amniocentesis. METHODS: We reviewed retrospectively 334 cases of midtrimester genetic aminiocentesis which were performed in Pusanpaik Hospital, Inje University from February 1996 to January 2003. The distributions of maternal and gestational age, the indications, chromosomal results, the correlation between age and results of chromosomal analysis, the correlation between the indications and results of chromosomal analysis, and the risks and complications of the procedure were analyzed. RESULTS: The most common indication for amniocentesis was abnormal results of maternal serum screenings (46.4%) and which was followed by advanced maternal age (>or=35) (40.1%), previous history of fetal congenital or chromosomal abnomalies (6.3%), abnormal ultrasonographic findings (3.9%). The overall incidence of chromosomal aberration was 2.4% (8 cases) and which was composed of 0.9% (3 cases) of numerical aberrations and 1.2% (4 cases) of structural aberration and 0.3% (1 case) of both numerical and structural aberration. Although there was no statistical significance, the chromosomal aberrations were more commonly detected in the patients aged before 35 years old than in the patients aged above 35 years old (3.5% vs 0.8%) (P>0.05). The incidence of chromosomal aberrations according to indications had no statistical significance (P>0.05). There were three cases (0.9%) of complications, one case of pregnancy loss (0.3%) and 2 other procedure-related complications (1 case of amniotic fluid leakage and 1 case of vaginal bleeding). CONCLUSION: Midtrimester amniocentesis is relatively effective and safe invasive diagnostic procedure for prenatal cytogenetic studies. Although advanced old age (>or=35) is still important indication in midtrimester amniocentesis, abnormal results of maternal serum marker, ultrasonographic findings, and other abnormal conditions might be important indications because of many cases of chromosomal aberrations detected in younger age.

Assessment of Failure Modes in Total Knee Replacement Arthroplasty

PURPOSE: To analyze the causes of revision total knee arthroplasty and evaluate the difference in failure modes according to the revision interval after a primary total knee arthroplasty. MATERIALS AND METHODS: We retrospectively analyzed the failure mode of 60 cases assessable by clinical, radiological and operative findings according to the following intervals after primary total knee arthroplasty: under 5 years; from 5 to 10 years; and after 10 years. RESULTS: In 50% of the cases osteolysis and loosening was the cause for revision total knee arthroplasty. In comparison, tibial polyethylene insert wear occurred in 25% of the cases, infection in 13%, instability in 7%, and stiffness in 5%. The average duration from primary total knee arthroplasty to revision arthroplasty due to infection, stiffness and instability was less than 5 years. In contrast, revision arthroplasty resulting from tibial polyethylene wear, osteolysis and loosening took place after 5 years. CONCLUSION: The most common failure mode is osteolysis and loosening regardless of the revision interval. Infection and instability was common in the under-5-year period and osteolysis and loosening was common after 5 years.

Role of Crural Diaphragm after Esophagogastrectomy / 대한흉부외과학회지

BACKGROUND: The high pressure zone(HPZ) at the gastroesophageal junction is an important barrier for prevention of gastroesophageal reflux. Smooth muscle layers in the lower esophageal sphincter mainly contributes to HPZ at the throacoabdominal junction. The purpose of this study was to investigate the manometric characteristics of the thoracoabdominal junction in patients after surgical removal of the lower esophageal sphincter. MATERIAL AND METHOD: Twenty two patients with prior esophagogastrectomy(10 Ivor-Lewis method and 12 left thoracotomy) and 30 normal adults(control group) were studied manometrically. RESULT: Esophageal manometry showed a HPZ and pressure inversion point distal to the anastomosis in 12 of 22 patients(2 of 10 patients with Ivor-Lewis method and 10 of 12 patients with left thoracotomy) and a HPZ in 30 of 30 normal adults. The location of HPZ from nostril was not significant different between the two groups(42.5+/-0.9cm in patients and 43.9+/-2.1cm in the control), while the length of HPZ was shorter in patients than in the control(2.13+/-0.6cm vs 2.83+/-0.59cm). By SPT and RPT, pressures of HPZ at rest were lower in patients(13.78+/-1.63mmHg, 28.58+/-6.06mmHg) than in control(20.3+/-4.95mmHg, 42.80+/-15.91mmHg). The HPZ relaxed partially in response to deglutition(84.4% in patient, 90.5% in control group) and contracted in response to increased intra- abdominal pressure induced by leg lifts(HPZ/ Intra-abdominal pressure= 1.81+/-0.23 in patient, 2.13+/-0.58 in control group). CONCLUSION: This study shows an HPZ at thoracoabdominal junction after surgical removal of the lower esophageal sphincter. It may be important to perform a crural myoplasty during esophageal reconstruction after esophagogastrectomy because crural diaphragm acts as sphincter like HPZ at the thoracoabdominal junction.

Comparative Analysis of arterial Gases and Acid-base status in Patients with Congenital and Acquired Heart Disease at Preoperative Period, During Extracorporeal Circulation, and Postoperative Period / 대한흉부외과학회지

BACKGROUND: Patients with cardiac diseases who have structural defects in their heart bring about metabolic insult such as preoperative acid-base imbalance. Cardiac operation requires many nonphysiologic procedures such as extracorporeal circulation, hypothermia, and hemodilution. We studied the acid-base status of surgical heart diseases pre-operatively, during extracorporeal circulation, and post-operatively and researched the treatment indications of acid-base disturbances. MATERIAL AND METHOD: From January 1997 to May 1999, fifty two cases of open heart surgery were carried out under extracorporeal circulation, which divided into a set of pediatric and adult groups, congenital and acquired groups, non-cyanotic and cyanotic groups, The alpha-stat arterial blood gas analysis was done in each group during the preoperative period, during the operation with extracorporeal circulation, and during the postoperative period. RESULT: Before surgery, all patients present metabolic acidosis, PaO2 was low in adult group and acquired group and compensatory respiratory alkalosis was noted in cyanotic group. During extracorporeal circulation, adult group revealed alkalosis and normal in acquired group. Pediatric group presents low PaCO2, metabolic acidosis and respiratory alkalosis. Congenital group and non-cyanotic group showed non-compensatory alkalosis trend and non-compensatory respiratory acidosis were observed in cyanotic group during extracorporeal circulation. Postoperative acid-base status of adult group was recovered to normal and the standard bicarbonate was increased in the acquired group. All of the pediatric, congenital non-cyanotic, and cyanotic groups revealed the lack of buffer base. CONCLUSION: In Preoperative period, correction of metabolic acidosis was required in pediatric, congenital and non-cyanotic groups, while treatment of metabolic acidosis and low PaCO2 were required in adult and acquired groups. In the cyanotic group, metabolic acidosis and respiratory alkalosis needed to be corrected preoperatively. Using the extracorporeal circulation, minimal correction was required except acquired group which showed normal acid-base balance. In postoperative period, restriction of bicarbonate was required for acquired group while increase of buffer base was required for pediatric, congenital, non-cyanotic, and cyanotic groups.

Cord-like Atresia of the Abdominal Aorta Due to Takayasu Arteritis in Middle Aged Woman: A case Report / 대한흉부외과학회지

Takayasu arteritis is a chronic non-specific inflammatory arteriopathy that involves primarily the first branches of aortic arch but may also affect the aorta and any of its primary branches. A characteristic trait of the disease is that most of the patients are young females of mainly Asian and South American origin. Recently, we experienced a rare case of Takayasu arteritis which showed a cord-like atresia of abdominal aorta just below renal arteries in 52-year-old woman. We performed a side to side bypass graft from descending thoracic aorta to abdominal aorta just above the aortic bifurcation with a 18mm PTFE(polytetrafluoroethylene) vascular graft. The postoperative course was uneventful.