Replacement of the aortic root with a pulmonary autograft; short term results from 8 patients / 대한내과학회지

BACKGROUND: Ross procedure is the pulmonary valve autograft in the aortic valve disease, and its use trends to increase after introduced by Ross in 1967, firstly. The most important point is that it is a permanent valve replacement. It is to be ideal method to the young patient because the graft is a viable tissue to be able to grow, and hemodynamically, most similar to the normal aortic valve, and doesn't need to do anticoagulation therapy due to not having the thromboembolism, but not popular because it has a lot of technical problem and doesn't have the long-term follow-up METHODS: The patients were 8 admitted between October 1997 and October 1998, the age from 15 to 39 ; 6 males and 2 females. The causes of disease were 4 patients of rheumatic disease, 1 of a infective endocarditis with the aortic annular abscess,1 of recurred severe aortic insufficiency 2 years after replacement. Two patients used the homograft and 6 patients switched a diseased aortic valve with the pulmonary autograft. RESULTS: There were no death and the preoperative dyspnea nearly disappeared (NYHA FC III-IV -> I-II). The diastolic diameter of left ventricle decreased significantly when we compared to the previous echocardiography 1 month after the operation, and we observed the mild aortic valve insufficiency in 3 patients, severe in 4, mild pulmonary valve insufficiency in 4, severe in 1, and mild pulmonary valve stenosis in 4. CONCLUSION: The operative death rate of Ross procedure in the aortic valve disease was not higher than the artificial valve replacement. Therefore, if we find the appropriate indication of operation, we can expect better results and think that we should have the long-term follow-up furthermore.

Left Main Coronary Artery Dissection, Tricuspid Insufficiency, Mitral Insufficiency and Pericardial Rupture Detected 1 Year Following a Blunt Chest Trauma

Coronary artery and valvular injuries after blunt chest trauma are an unusual condition. This diagnosis is very difficult to estabilish, but prompt diagnosis and proper management are important in life saving. We report one patient who develop left main coronary artery dissection, tricuspid insufficiency, mitral insufficiency and pericardial rupture following blunt chest trauma. One year ago, he had suffered a frontal impact in a traffic accident and recieved anti-tuberculosis medication for 10 months for chest discomfort. The correct diagnosis was confirmed noninvasively by transesophageal echocardiography and the patient was treated left main coronary artery dissection flap removal, mitral valve replacement, tricuspid valvuloplasty and repair of ruptured pericardium. The postoperative course was uneventful and the patient was fully recovered.

Two Cases of Falciparum Malaria with Acute Respiratory Distress Syndrome / 결핵

Malaria is one of the most common infectious diseases in the world. Plasmodium falciparum accounting for nearly all malaria mortality, kills an estimated 1 to 2 million persons yearly and has several features thai make it deadlist of malarias. While cerebral malaria is the most common presentation of severe disease, acute lung injury associated with malaria is uncommon but serious and fatal complication. We report two cases of severe malaria with ARDS and multi-organ failure. All two patients traveled to foreign countries, Kenya, Papua New Guinea where choroquine-resistant malaria is distributed. The first case, which developed cerebral malaria hypoglycemia, multi-organ failure, and ARDS, treated with quinine and mechanical ventilator, but expired due to oxygenation failure. Autopsy showed acute necrotizing infiltration, diffuse eosinophilic fibrinoid deposits along the alveolar space, and alveolar macrophage with malaria pigment The second case also developed multi-organ failure, followed by ARDS, and was treated with quinine, exchange transfusion, plasmapheresis, and mechanical ventilator. He recovered with residual restrictive lung change after treatment.

A Case of Biliary Papillomatosis which Underwent Curative Resection / 대한소화기내시경학회지

Biliary Papillomatosis is an extremely rare pathologic entity. Only about 40 cases of intrahepatic or diffuse intra- and extrahepatic papillomatosis have been described since the first report in 1959 by Caroli. Although this is a histologically benign lesion, its course is unfavaurable because of its tendency to extend to the entire biliary tract, high recurrence rate following local excision and the probability of progression to malignancy. We described herein a case of biliary papillomatosis associated with diffuse bile duct dilatation. The patient, a 59-year-old male, was admitted to our hospital because of right upper abdominal pain and weight loss. Cholangiogram revealed multiple round filling defects in common hepatic duct with intrahepatic bile duct dilatation. The patient underwent Whipple's operation with right lobectomy. Grossly, multiple small pin-head sized polypoid masses were seen in common bile duct, common hepatic duct and right intrahepatic duct. Microscapically, papillary epithelial hyperplasia with moderate cellular atypia was seen and there was no evidence of stromal invasion. He is healthy with a follow-up for 7 months.

A Case of Adenoequamous Carcinoma of the Pancreas with Unusual Pancreatographic Findings / 대한소화기내시경학회지

Adenosquamous carcinoma of the pancreas is a rare form of pancreatic cancer. Its biological behavior and clinical features are known to be similar to the much more common ductal adenocarcinoma or to pure squamous cell carcinoma, another rare form of pancreatic malignancy. However, the unusual manifestations of cancer, including cystic degeneration and extravasation of contrast to the mass, have also been reported. A 64-year-old man was admitted complaining of abdominal pain. An abdomial CT scan demonstrated an ovoid and cyst-like lesion in the pancreatic head and endoscopic retrograde balloon pancreatography showed segmental narrowing of the main pancreatic duct associated with extravasation of contrast into the cyst-like lesion. Under the impression of pancreatic pseudocyst with chronic pancreatitis, medical therapy including pancreatic stent insertion was given to the patient for four weeks. Finally, a laparotomy was performed due to persistent abdominal pain and a poorly demarcated mass with cystic cavity was resected. Histologic findings were consistent with adenosquamous carcinoma of the pancreas. The unusual features of this rare malignancy which led us to an errorneous initial diagnosis were emphasized.

Endoscopic Stenting with Minor PapilIa Sphincterotomy in a Patient with Pancreas Divisum and Recurrent Pancreatitis / 대한소화기내시경학회지

A 50-year-old woman presented with recurrent pancreatitis and pancreas divisum. Minor papilla sphincterotomy and endoscopic stent placement were done for the drainage of dorsal pancreatic duct. After stenting of the minor papilla, abdominal pain has disappeared and pancreatitis has not developed during 9 month follow-up.

A Case of Crohn's Disease Associated with Takayasu's Arteritis / 대한소화기내시경학회지

Vascular manifestations as extraintestinal symptoms of inflammatory bowel diseases have rarely been reported, More than 10 case reports in the worldwide literature have suggested that Takayasu's arteritis be one of the rare vascular complications in inflammatory bowel diseases. We describe herein a 33-year-old woman with Takayasu's arteritis who was subsequently found to have Crohn's disease. Aortic arch angiogram showed typical findings of Takayasu's arteritis, and the diagnosis of Crohn's disease was made by colonoscopic and radiologic findings, clinical course, and the response to medical therapy. To our knowledge, this is the first case report in Korea.