ABSTRACT
BACKGROUND: Type A ascending aortic dissection, either acute or chronic, requires surgical treatment to prevent death from proximal aortic rupture or malperfusion. The application of deep hypothermic circulatory arrest (DHCA) with retrograde cerebral perfusion (RCP), which has originally been used for the cerebral protection during aortic arch surgery, to apply to type A ascending aortic dissection for the open distal anastomosis has been suggested. A retrospective study was conducted to evaluate the efficacy of DHCA with RCP in patients with type A aortic dissection. METHOD: From May 1998 to April 2002, eleven patients (7 men and 4 women; mean age=55.4 years) underwent repair of type A aortic dissection (9 acute and 2 chronic). All patients underwent resection and graft replacement of the ascending aorta and/or aortic arch. Open distal anastomosis was performed under DHCA (less than 19oC) with RCP, while the retrograde flow rate through the superior vena cava ranged from 200 to 500 ml/minute, to maintain internal jugular venous pressure between 15 and 25 mmHg. RESULT: Mean DHCA/RCP duration was 49.2 (27~85) minutes. Postoperatively, three patients died of arch rupture, right ventricular failure, and brain edema, and operative mortality was 27.3%. Eight patients survived and recovered their consciousness in 3 to 70 hours (mean, 11.6 hours) after operation. Among the eight patients whose DHCA/RCP duration was longer than 40 minutes, six patients survived with little neurological complications. During the follow-up period (mean, 22.8 months), one patient who underwent composite valve graft replacement died of ventricular tachyarrhythmia, However, the remaining seven patients were free from major events. CONCLUSION: This limited data indicates that RCP can provide an improved cerebral protection, by extending the safe time limit of DHCA, as well as an open distal anastomosis without aortic cross-clamping for the repair of type A aortic dissection.
Subject(s)
Female , Humans , Male , Aorta , Aorta, Thoracic , Aortic Rupture , Brain Edema , Circulatory Arrest, Deep Hypothermia Induced , Consciousness , Follow-Up Studies , Mortality , Perfusion , Retrospective Studies , Rupture , Tachycardia , Transplants , Vena Cava, Superior , Venous PressureABSTRACT
Tracheal bronchus is an aberrant, accessory or ectopic bronchus arising almost invariably from the right lateral wall of the trachea and may be related to inflammatory conditions affecting the lung, including recurrent pneumonia, bronchiectasis. Recently we experienced a case of tracheal bronchus associated with pulmonary actinomycosis. The 37- year-old male patient had suffered recurrent hemoptysis and had been medicated as a presumptive diagnosis of tuberculosis, but either clinical or radiologic improvement was not seen. Right upper lobectomy was performed and pulmonary actinomycosis was confirmed by the histologic examination. Postoperatively, the patient was medicated with penicillin and ampicillin for 3 months and completely recovered without any evidence of recurrence during the 6- month follow-up period.
Subject(s)
Humans , Male , Actinomycosis , Ampicillin , Bronchi , Bronchiectasis , Diagnosis , Follow-Up Studies , Hemoptysis , Lung , Penicillins , Pneumonia , Recurrence , Trachea , TuberculosisABSTRACT
Acute or chronic aortic dissection may lead to the rupture, which is the major cause of death. A dissecting aneurysm of ascending aorta(Stanford type A dissection) can rupture into the superior vena cava producing a aortocaval fistula, which is rare, but has been reported mostly in the cases of abdominal aortic aneurysm. We report a case of 67-year-old man with type A chronic dissection and aortocaval fistula, presenting symptoms of superior vena syndrome. The preoperative diagnosis was composed of radiologic examinations, including computed tomography, magnetic resonance imaging angiography and aortography. The dissecting aneurysm was resected and replaced, and the aortocaval fistula was repaired under deep hypothermic circulatory arrest. The details are described here.
Subject(s)
Aged , Humans , Aortic Dissection , Angiography , Aortic Aneurysm, Abdominal , Aortography , Cause of Death , Circulatory Arrest, Deep Hypothermia Induced , Diagnosis , Fistula , Magnetic Resonance Imaging , Rupture , Vena Cava, SuperiorABSTRACT
Tracheal bronchus is a aberrant, accessory or ectopic bronchus arising almost invariably from the right lateral wall of the trachea and may be related to inflammatory conditions affecting the lung, including recurrent pneumonia and bronchiectasis. Recently we experienced a case of tracheal bronchus associated with pulmonary actinomycosis. The 37-year-old male patient had suffered recurrent hemoptysis and had been medicated as a presumptive diagnosis of tuberculosis, but neither clinical nor radiologic improvement was not seen. Right upper lobectomy was performed and pulmonary actinomycosis was confirmed by the histologic examination. Postoperatively, the patient was medicated with penicillin and ampicillin for 3 months and completely recovered without any evidence of recurrence during the 6-month followup period.
Subject(s)
Adult , Humans , Male , Actinomycosis , Ampicillin , Bronchi , Bronchiectasis , Diagnosis , Follow-Up Studies , Hemoptysis , Lung , Penicillins , Pneumonia , Recurrence , Trachea , TuberculosisABSTRACT
Though leiomyoma is the most common tumor of esophagus, it accounts for only 1% of all esophageal tumors. Most of the leiomyomas are intramural type originating from the muscularis propria and only 1% of them is intraluminal pedunculated type originating from muscularis mucosae. Recently, a 30-year-old male was admitted to our hospital because of dysphagia. Radiologic examination showed that intraluminal tumor 5cm in diameter was found at the cervical esophagus. Endoscopic examination showed that the tumor was covered with normal mucosa. The patient underwent surgical excision through the left cervical approach. After full, longitudinal esophagotomy, the intraluminal pedunculated tumor was successfully enucleated. Esophageal leiomyoma was confirmed histopathologically. Postoperative course was uneventful and the patient was relieved from dysphagia.
Subject(s)
Adult , Humans , Male , Deglutition Disorders , Esophageal Neoplasms , Esophagus , Leiomyoma , Mucous MembraneABSTRACT
BACKGROUND: MUC1 mucin is a heavily glycosylated large glycoprotein and is expressed aberrantly in carcinoma. CD44 is polymorphic family of cell surface glycoproteins participating in cell-cell adhesion and modulat ion of the cell-matrix interaction. MUC1 mucin and CD44 expression have been implicated in a tumor invasion and metastasis in certain malignancies. In this study, the expression of MUC1 and the standard form of CD44(CD44s) was examined in non-small cell lung cancer (NSCLC). METHODS: Immunohistochemical staining using monoclonal antibodies including MUC1 glycoprotein and CD44s was performed on 80 NSCLC surgical specimens. The association between MUC1 and CD44s expression and the histological type and tumor stage was investigated. RESULTS: Depolarized MUC1 expression in more than 10% of cancer cells was found in 12 (27.9%) out of 43 squamous cell carcinomas (SCCs) and 12 (32.4%) out of 37 adenocarcinomas (ACs). It was not associated with the tumor histological type and the TNM-stage in SCCs. Depolarized MUC1 expression correlated with the N-stage in ACs (p=0.036). CD44s was expressed in 36 (83.7%) out of 43 SCCs and 14(37.8%) out of 37ACs. Reduced CD44s expression correlated with the N-stage (p=0.031) and the TNM-stage (p=0.0006) in SCCs. CONCLUSIONS: Depolarized MUC1 expression was related to the nodal stage in NSCLC adenocarcinoma. Reduced CD44s expression was related to nodal involvement and the TNM-stage in squamous cell carcinoma. This suggests that MUC1 and CD44s expression in NSCLC might play important roles in tumor progression and can be used as prognostic variables.
Subject(s)
Humans , Adenocarcinoma , Antibodies, Monoclonal , Carcinoma, Non-Small-Cell Lung , Carcinoma, Squamous Cell , Glycoproteins , Immunohistochemistry , Membrane Glycoproteins , Mucin-1 , Neoplasm MetastasisABSTRACT
PURPOSE: Overcrowding of emergency departments remains an unsolved international issue and has led to not a few unfavorable consequences. For a solution of this, appropriate patient triage and selection of appropriate hospitals to which to be transported will be essential. METHODS: The authors performed a prospective analysis of 690 patients transported via emergency transport services to the Emergency Department of Pusan National University Hospital between May 1, 2000 and June 30, 2000. RESULTS: Five hundred five cases (73.2%) were considered as appropriate transport, but 185 (26.8%) were not. In 300 cases (43.5%), the hospitals to which the patients were transported had been decided by the patient's family members, in 283 cases (41.0%) by medical professionals, in 70 cases (10.1%) by EMS personnels, and in 37 cases (5.4%) by the patients themselves. In the selection of the hospital to be transported to, patients and family members took the patient's medical condition into consideration less seriously than the other groups, but they had the greatest influence on the decision. CONCLUSION: The patients and their family members turned out to be unsuitable for the selection of the hospital to be transported to, but they actually had the greatest influence on the selection. The EMS personnels had limited influence on the selection, and they were lacking in ability to select appropriate hospital with the consideration of the patient's condition. For now there's no active regional ambulance destination policy or decision scheme. For the optimization of emergency transport activity, every effort should be made to enhance the role and ability of EMS personnels in patient triage and selection of transported hospital and to develope well-functioning ambulance destination policies as soon as possible.
Subject(s)
Humans , Ambulances , Emergencies , Emergency Service, Hospital , Prospective Studies , TriageABSTRACT
BACKGROUND: The p16INK4a (p16) tumor suppressor gene is frequently inactivated in human non-small cell lung cancers (NSCLCs), predominantly through homozygous deletion or in association with aberrant promotor hypermethylation. Death-associated protein kinase (DAPK) gene influences interferon γ-induced apoptotic cell death and has important role in metastasis of lung cancer in animal model. Hypermethylation of promoter region of DAP kinase gene may suppress the expression of this gene. METHODS: This study was performed to investigate the aberrant methylation of p16 or DAP kinase in 35 resected primary NSCLCs by methylation-specific PCR (MSP), and demonstrated frequency, diagnostic value and clinical implication of aberrant methylation of two genes. RESULTS: Thirty-two cases were male patients, and 3 cases were female patients with an average age was 57.8±10.5 years. The histologic types of lung cancer were 22 of squamous cell carcinoma, 12 of adenocarcinoma, 1 of large cell carcinoma. Pathologic stages were 11 cases of stage I(1 IA,10 IB), 13 cases of stage II (1 IIA, 12 IIB), and 11 cases of stage III(9 IIIA, 2 IIIB). Regarding for the cancer tissue, p16 aberrant methylation was noted in 13 case of 33 cases (39.4%), DAP kinase in 21 cases of 35 cases (60%). Age over 55 year was associated with p16 aberrant methylation significantly (p<0.05). Methylation status of two genes was not different by smoking history, histologic type, size of tumor, lymph node metastasis and disease progression of lung cancer. There was no correlation between p16 and DAP kinase hypermethylation. CONCLUSION: This investigation demonstrates that aberrant methylation of p16 tumor suppressor gene or DAP kinase showed relatively high frequency (74.3%) in NSCLCs, and that these genes could be a biologic marker for early detection of lung cancer.
Subject(s)
Female , Humans , Male , Adenocarcinoma , Biomarkers , Carcinoma, Large Cell , Carcinoma, Squamous Cell , Cell Death , Death-Associated Protein Kinases , Disease Progression , DNA Methylation , Genes, Tumor Suppressor , Interferons , Lung Neoplasms , Lung , Lymph Nodes , Methylation , Models, Animal , Neoplasm Metastasis , Polymerase Chain Reaction , Promoter Regions, Genetic , Protein Kinases , Smoke , SmokingABSTRACT
BACKGROUND: Even though there were developments in various treatment techniques for acute arterial occlusion this disease still has high rate of mortalities and limb amputations. We investigated the combined diseases symptoms location of occlusion type of treatment complication and prognosis in our patients. MATERIAL AND METHODS: This study recruited 48 patients (42 men, 6 women, mean age 57.7 years) who received the operation from January 1995 toDecember 1998. We investigated the post-operation course via medical record review or telephone interview with patients or their family members. RESULT: The most common combined diseases were atherosclerosis in 30 patients. other diseases were 17 diabetes mellitus 16 hypertension and 12 atrial firillation. Pain and clod sensation were noticed in all patients paresthesia in 5 patients fibrillation. Pain and cold sensation were noticed in all patients paresthesia in 5 patients and lower extremity paralysis in 11 patients. In 29 patients the time interval from the onset of symptom to admission was over 72 hours and 15 patients were admitted within 24 hours. The distribution of arterial occlusion location was at 28 femoral arteries 14 popliteal arteries and 6 iliac arteries. All the patients were received embolectomy and 5 patients were received additional bypass grafting. Postoperative complications were 12 reocclusions. 6 compartment syndromes 6 skin necrosis and 2 acute renal failure. The mortality rate was 16.7% (8/48) and the amputation rate was 25%. CONCLUSION: This study revealed 25% reocclusion 25% limb amputation and 16.7% mortaliyt. To improve the prognosis of acute lower extrements arterial occlusion early diagnosis and understand the underlying diseases prompt treatment and operation additional operation including interventional radiologic examination and thorough postoperative care would be appreciated.
Subject(s)
Female , Humans , Male , Acute Kidney Injury , Amputation, Surgical , Atherosclerosis , Compartment Syndromes , Diabetes Mellitus , Early Diagnosis , Embolectomy , Extremities , Femoral Artery , Hypertension , Iliac Artery , Interviews as Topic , Lower Extremity , Medical Records , Mortality , Necrosis , Paralysis , Paresthesia , Popliteal Artery , Postoperative Care , Postoperative Complications , Prognosis , Sensation , Skin , TransplantsABSTRACT
Chronic sclerosing mediastinitis is a rare disease of unknown etiology, pathologically characterized by chronic inflammation and fibrosis of mediastinal soft tissue. The process is often progressive and can occur either focally or diffusely throughout the mediastinum. This can result in compression of adjacent mediastinal structures, most commonly the low-pressure superior vena cava but also the pulmonary artery and vein, trachea and bronchi, esophagus and can result in a variety of functional and roentgenographic manifestation and occasionally death. We experienced a case of chronic sclerosing mediastinitis of unknown cause, which was confirmed by biopsy with thoracotomy, so reported it with a review of literature.
Subject(s)
Biopsy , Bronchi , Esophagus , Fibrosis , Inflammation , Mediastinitis , Mediastinum , Pulmonary Artery , Rare Diseases , Thoracotomy , Trachea , Veins , Vena Cava, SuperiorABSTRACT
No abstract available.