Large Chronic Pseudoaneurysm of Left Ventricle Complicating Anterior Myocardial Infarction

No abstract available.

Valve-Sparing Root Replacement: Aortic Root Remodeling with External Subvalvular Ring Annuloplasty

The original valve-sparing procedures for aortic root aneurysms were remodeling and reimplantation of the aortic root. The remodeling technique provides more physiologic movement of the cusps within 3 reconstructed neo-sinuses, thus preserving root expansibility through the interleaflet triangles. However, the durability of remodeling has been a matter of concern due to the high rate of aortic insufficiency when annular dilation is not addressed. Therefore, a modified approach was developed, combining a physiologic remodeling of the root with a subvalvular annuloplasty. This case report highlights the first case of successful aortic root remodeling with external subvalvular ring annuloplasty in Korea.

Mass-forming Eosinophilic Infiltration Involving the Central Airway: A Case Report of Endobronchial Involvement of Eosinophilic Inflammation Mimicking Bronchogenic Malignancy / 대한내과학회지

We report a very unusual case of endobronchial involvement of eosinophilic inflammation. A 58-year-old woman visited our clinic complaining of cough. A chest computed tomography scan showed a poorly enhancing mass compressing both main bronchi in the subcarinal area. Bronchoscopy also showed stenosis of the two main bronchi with irregular mucosal thickening. A bronchoscopic endobronchial mucosal biopsy revealed eosinophilic inflammation without evidence of malignancy. The subcarinal mass disappeared after systemic steroid treatment. This is the first report of mass-forming eosinophilic infiltration involving the central airway mimicking primary lung cancer.

A Case of Invasive Pulmonary Aspergillosis with Direct Invasion of the Mediastinum and the Left Atrium in an Immunocompetent Patient / 결핵및호흡기질환

We report a case of invasive pulmonary aspergillosis invading the mediastinum and the left atrium. A 70-year-old woman was hospitalized for dyspnea. She had been well controlled for her diabetes mellitus and hypertension. The chest X-ray disclosed mediastinal widening, and the computed tomography scan of the chest showed that there was a large mediastinal mass and this lesion extended into the left atrium and right bronchus. The cardiac echocardiography showed that a huge mediastinal cystic mass compressed in the right atrium and a hyperechoic polypoid lesion in the left. The pathology from the bronchoscopic biopsy observed abundant fungal hyphae which was stained with periodic acid-Schiff and Gomori's methenamine silver. Despite the treatment with antifungal agents, she died from cardiac tamponade after three months. Invasive pulmonary aspergillosis, which involves the mediastinum and the heart, is very rare in immunocompetent patients.

A Case of Invasive Pulmonary Aspergillosis with Direct Invasion of the Mediastinum and the Left Atrium in an Immunocompetent Patient / 결핵및호흡기질환

We report a case of invasive pulmonary aspergillosis invading the mediastinum and the left atrium. A 70-year-old woman was hospitalized for dyspnea. She had been well controlled for her diabetes mellitus and hypertension. The chest X-ray disclosed mediastinal widening, and the computed tomography scan of the chest showed that there was a large mediastinal mass and this lesion extended into the left atrium and right bronchus. The cardiac echocardiography showed that a huge mediastinal cystic mass compressed in the right atrium and a hyperechoic polypoid lesion in the left. The pathology from the bronchoscopic biopsy observed abundant fungal hyphae which was stained with periodic acid-Schiff and Gomori's methenamine silver. Despite the treatment with antifungal agents, she died from cardiac tamponade after three months. Invasive pulmonary aspergillosis, which involves the mediastinum and the heart, is very rare in immunocompetent patients.

Normothermic Cardiac Surgery with Warm Blood Cardioplegia in Patient with Cold Agglutinins

Cold agglutinins are predominately immunoglobulin M autoantibodies that react at cold temperatures with surface antigens on the red blood cell. This can lead to hemagglutination at low temperatures, followed by complement fixation and subsequent hemolysis on rewarming. Development of hemagglutination or hemolysis in patients with cold agglutinins is a risk of cardiac surgery under hypothermia. In addition, there is the potential for intracoronary hemagglutination with inadequate distribution of cardioplegic solutions, thrombosis, embolism, ischemia, or infarction. We report a patient with incidentally detected cold agglutinin who underwent normothermic cardiac surgery with warm blood cardioplegia.

A Case of Renal-limited Lupus-like Nephritis

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease that is clinically heterogeneous and affects multiple organs particularly the kidney. Lupus nephritis is a common and severe manifestation of SLE in which immune-mediated inflammation can lead to permanent damage within the kidney, resulting in end stage renal failure. Recently a renal biopsy showed lupus nephritis on a 40-year old female without any other features of SLE such as clinical symptoms and autoantibodies including antinuclear antibody and anti-dsDNA. The renal biopsy showed that histopathological change of global and segmental sclerosis of glomeluri, diffuse proliferative nephritis with crescent formation compatible with class IV lupus nephritis. She was treated with systemic corticosteroids and pulse cyclophosphamide, followed by mycofenolate mofetil. During two years of follow-up, there have been no clinical or laboratory findings to meet the diagnostic criteria of SLE, suggesting that isolated lupus nephritis could occur without SLE.

Treatment of Massive Hemoptysis Occurred from Destroyed Lung: Prevention of Contralateral Aspiration Using Endobronchial Blocker Followed by Pneumonectomy / 결핵및호흡기질환

Untreated massive hemoptysis, especially in patients with tuberculous-destroyed lung, is a serious complication resulting in considerable morbidity and mortality. We report a case of a patient who had active tuberculosis and a destroyed left lung with massive bleeding. He was transferred to our clinic with intubation of a right-sided Robertshaw double lumen tube and right upper lobe collapse likely due to tube malposition that was presented on chest X-ray. Because hemoptysis had persisted after bronchial arterial embolizaton, we replaced the double lumen tube with a conventional endotracheal tube and inserted an endobronchial blocker into the left main bronchus through an endotracheal tube guided by bronchoscopy to prevent aspiration of blood into the right lung. Left pneumonectomy was performed and hemotpysis was ceased. We suggest that the use of an endobronchial blocker followed by surgery may be a safe and effective modality of treatment in patients with persistent bleeding after bronchial arterial embolization.

Pulmonary Artery Embolization of Intravenous Leiomyomatosis Extending into the Right Atrium

A 43-year-old woman was diagnosed with an intravenous leiomyomatosis at a previous hospital and transferred to our hospital to undergo surgical treatment. Emergency one-stage operation for coincidental removal of intra-abdominal, right atrial, and intravenous masses were planned. Upon arriving at the operating room, she suffered a sudden onset of severe dyspnea and showed hemodynamic instability. Intraoperative TEE showed pulmonary embolization of a right atrial mass. Removal of the pulmonary artery mass and the intra-abdominal mass, and the cardiopulmonary bypass were performed without any complications.

A Case of Mediastinal and Pulmonary Cryptococcosis in a 3-Year-Old Immunocompetent Girl / 소아알레르기및호흡기학회지

Cryptococcosis is an infrequently recognized infection in children, particularly those who are immunocompetent. The disease is mainly caused by Cryptococcus neoformans, a fungal pathogen that primarily affects the central nervous system (CNS) and lungs. Most reports of children with cryptococcosis are of the CNS or disseminated infections among immunocompromised patients. This report is a case of a 3-year-old immunocompetent girl who presented with intermittent fever and cough; a large mass was found in the right infrahilar area on chest X-ray. Chest computed tomography revealed large conglomerated mediastinal lymph nodes caused by C. neoformans, which was confirmed by the polymerase chain reaction as well as a histological evaluation. The patient improved after a prolonged period of antifungal therapy. This is the only known report of mediastinal and pulmonary cryptococcosis in an immunocompetent child.

A Rare Case of Fat-Forming Variant of Solitary Fibrous Tumor Presenting as a Pleural Mass / 결핵및호흡기질환

The fat-forming variant of solitary fibrous tumors (SFTs) is a rare soft tissue neoplasm that was previously referred to as a lipomatous hemangiopericytoma (L-HPC). The most common affected site is deep soft tissue. Here, we present the first case, worldwide, of a fat-forming variant of SFT of the pleura. A 74-year-old man presented with left lower chest pain. Chest radiographs showed a mass-like lesion at the left lower lung field and chest computed tomography revealed a 12 cm fat-containing enhancing mass that was well-separated, lobulated and inhomogeneous. Radiology findings suggested a liposarcoma. Percutaneous needle biopsy was performed and pathological diagnosis of the mass was a fat-forming variant of SFT. Surgical resection was carried out and there has been no recurrence to date. So, a benign fat-forming variant of SFT must be considered as one of the differential diagnoses of lipomatous tumors of the pleura.

A Case of Bronchilolitis Obliterans Organizing Pneumonia in a Patient with Ulcerative Colitis / 결핵및호흡기질환

The ulcerative colitis is a chronic inflammatory bowel disease with an unknown etiology. The major symptoms of ulcerative colitis are diarrhea, abdominal pain and hematochezia. However, arthritis, skin disorders, hepatobiliary inflammation and uveitis are occasionally recognized as systemic complications. Although there are few reports of coexistent pulmonary and inflammatory bowel disease, the lung is not generally considered to be a target organ in ulcerative colitis. We report a patient with ulcerative colitis-related bronchilolitis obliterans organizing pneumonia confirmed by video-assisted thoracoscopic surgery, who responded to corticosteroid therapy.

Nonrotation of the Prearterial Segment of Midgut Presenting as Duodenal Obstruction in a 60-Year-Old Man / 대한소화기학회지

Intestinal malrotation is a developmental anomaly resulting from embryologic failure of fixation and rotation of the gut and predisposed to midgut vovulus and small bowel obstruction. Although various forms of malrotation anomalies in the gut can occur, nonrotation of prearterial segment with the initial symptomatic presentation at advanced age has been rarely reported. Here, we report a case of nonrotation of the prearterial segment of the midgut presenting with duodenal obstruction in a 60-year-old man. To our best knowledge, this is the first case reported about nonrotation of prearterial segment of the midgut in Korea.

Hybrid Endovascular Repair for Type I Endoleak after Stent Grafting of Chronic Stanford Type B Aortic Dissection: A case report / 대한흉부외과학회지

A 67 years old male patient was admitted with back pain that had recurred from 6 months previously. Eleven years previously, he underwent stent grafting at the descending thoracic aorta for a chronic Stanford type B aortic dissection. The preoperative computed tomography showed aortic dissection from the origin of the left subclavian artery to the bifurcation of the abdominal aorta, and there was a type I endoleak at the proximal portion of the stent graft and aneurysmal dilatation of the descending aorta. A hybrid endovascular repair was successfully performed, and this involved debranching and rerouting the aortic arch vessels under extracorporeal cardiopulmonary bypass and then this was followed 13 days later by stenting in the ascending aorta, the aortic arch and the descending aorta. The postoperative computed tomography showed complete exclusion of the type I endoleak. After discharge, he has been followed up for 8 months without any problems.

Nonspecific Interstitial Pneumonitis after Bortezomib and Thalidomide Treatment in a Multiple Myeloma Patient

Bortezomib, an inhibitor of 26S proteosome, is recently approved treatment option for multiple myeloma. Thalidomide, a drug with immunomodulating and antiangiogenic effects, has also shown promise as an effective treatment in multiple myeloma. Pulmonary complications are believed to be rare, especially interstitial lung disease. Here, we describe a patient with dyspnea and diffuse pulmonary infiltrates while receiving bortezomib and thalidomide in combination with dexamethasone for treatment-naive multiple myeloma. Bronchoalveolar lavage demonstrated a significant decrease in the ratio of CD4 : CD8 T lymphocytes (CD4/8 ratio, 0.54). Extensive workup for other causes, including infections, was negative. A lung biopsy under video-assisted thorascopic surgery revealed a diagnosis of nonspecific interstitial pneumonitis. The symptoms and imaging study findings improved after initiating steroid treatment. Physicians should be aware of this potential complication in patients receiving the novel molecular-targeted antineoplastic agents, bortezomib and thalidomide, who present with dyspnea and new pulmonary infiltrates and fail to improve despite treatment with broad-spectrum antibiotics.

Effect of endothelin receptor blockade on monocrotaline-induced pulmonary hypertension in rats / 소아과

PURPOSE: To examine the effect of bosentan, a dual endothelin receptor (ER) antagonist, on the development of monocrotaline (MCT)-induced pulmonary hypertension in rats by especially focusing on the pulmonary vascular morphology changes. METHODS: Sprague-Dawley rats were treated as follows: controls received a subcutaneous saline injection, MCT-treated rats received a subcutaneous MCT injection, and bosentan-treated rats received a MCT injection followed by treatment with bosentan (20 mg/kg/day). To assess the effects of ER blockade on the time course, the animals were exsanguinated, and their hearts and lungs were dissected after 7, 14, or 28 days. RESULTS: The mean body weights of the MCT- and bosentan-treated rats were significantly lower than that of the control rats on days 7, 14, and 28. Bosentan administration significantly inhibited the progression of right ventricular hypertrophy on day 28 (right ventricle/[left ventricle+septum]: 0.71+/-0.10 in MCT-treated rats vs. 0.49+/-0.09 in bosentan-treated rats; P<0.05). Quantitative analysis of peripheral pulmonary arteries revealed that the increase in medial wall thickness after MCT injection was significantly attenuated in the bosentan-treated rats on day 28 (49.96+/-10.06% in MCT-treated rats vs. 47.09+/-10.48% in bosentan-treated rats; P<0.05). In addition, the increase in the number of intra-acinar muscular arteries after MCT injection was reduced by bosentan on days 14 and 28. CONCLUSION: Bosentan administration in intermediate doses exerts inhibitory effects on lung vascular hypertrophy and right ventricular hypertrophy during the development of MCT-induced pulmonary hypertension in rats.

Respiratory Support by Performing Percutaneous CardiopulmonarySupport (PCPS) for Tracheal Resection and Reconstruction in Patients withSevere Distal Tracheal Stenosis / 대한흉부외과학회지

Surgery on the distal trachea or the carina presents special problems for maintaining the airway and systemic oxygenation. Cardiopulmonary bypass is an alternative method for respiratory support for the patients with these conditions. Percutaneous cardiopulmonary support (PCPS) applied under local anesthesia has recently been used for respiratory support in tracheal surgery and the outcome is satisfactory. We encountered a patient who had severe distal tracheal stenosis after prolonged intubation. We had a gratifying result with performing tracheal resection and repair under the support of PCPS.

Nonocclusive Mesenteric Ischemia That Developed during Redo-doubleValve Replacement Surgery, and This Was Caused by Acute Aortic Dissection / 대한흉부외과학회지

Nonocclusive mesenteric ischemia (NOMI) is a rare complication that occurs in about 0.05% of patients after open- heart surgery, and NOMI refers to the mesenteric ischemia that's caused by splanchnic vasospasm without occlusion of the great intestinal vessels. In the presently reported case, NOMI developed to maintain the blood flow to the heart and brain after several minutes of a hypotensive status and the latter was caused by acute aortic dissection that complicated an aortic cannulation procedure. Unfortunately, the patient died even though the problems were diagnosed early and proper treatment was administered. Early diagnosis of NOMI by angiography and the selective infusion of vasodilators are thought to be the only way to improve survival for patients with clinically suspected NOMI.

Early and Late Changes of MMP-2 and MMP-9 in Bleomycin-Induced Pulmonary Fibrosis

PURPOSE: Matrix metalloproteinases (MMPs) have been implicated in the pathogenesis of pulmonary fibrosis. To understand the role of MMP-2 and MMP-9 in pulmonary fibrosis, we evaluated the sequential dynamic change and different cellular sources of the 2 MMPs along the time course and their differential expression in the bronchoalveolar lavage (BAL) fluid and in the lung parenchyma of the bleomycin-induced pulmonary fibrosis models in rats. MATERIALS AND METHODS: The level of MMPs in BAL fluid of 54 bleomycin-treated rats was assessed by zymography from 1 to 28 days after intratracheal bleomycin instillation. The level of MMPs in lung parenchyma was evaluated by immunohistochemistry. RESULTS: MMP-2 and MMP-9 were markedly increased in both the BAL fluid and in the lung parenchyma of the bleomycin-treated rats, especially in the early phase with the peak on the 4th day. The levels of both MMPs in the BAL fluid correlated generally well to those in lung parenchyma, although the level of MMP-9 in BAL fluid was higher than MMP-2. In the lung parenchyma, the 2 MMPs, in early stage, were predominantly expressed in the inflammatory cells. In late stage, type II pneumocytes and alveolar epithelial cells at the periphery of the fibrotic foci retained MMP expression, which was more prominent in the cells showing features of cellular injury and/or repair. CONCLUSION: In bleomycin-induced pulmonary fibrosis, MMP-2 and MMP-9 may play important roles, especially in the early phase. In the late stage, the MMP-2 and MMP-9 may play a role in the process of repair.

The Prognostic Significance of Multiple Station N2 in Patients with Surgically Resected Stage IIIA N2 Non-small Cell Lung Cancer

Mediastinal (N2) lymph node involvement is heterogenous with huge variation in the extent and grouped together under stage IIIA. However, they showed a different survival even in the same stage. We tried to determine the prognostic implication of the multiple station N2 lymph node metastasis in stage IIIA N2 non-small cell lung cancer (NSCLC). The survival of stage IIIA N2 was analyzed according to the number of N2 station and their survival was compared with that of stage IIIB. In stage IIIA N2 NSCLC, multivariate analysis indicated that multiple station N2 was one of the independent prognostic factors for poor survival. The 5-yr survival of multiple station N2 IIIA (20.4%) was lower than that of single station N2 IIIA (33.8%) significantly (p=0.016). but when it was compared with that of stage IIIB (15.5%), there was no difference. Therefore, we suggest that multiple station N2 should be considered similar to stage IIIB disease with regard to predicting survival and accordingly should receive a new position in the TNM staging system.