A Case of Unruptured Aneurysm of the Right Sinus of Valsalva with Right Ventricular Outflow Obstruction

A 66-year-old man presented with exertional dyspnea. He was found to have an unruptured aneurysm of the right sinus of Valsalva causing significant right ventricular outflow obstruction. This aneurysm was diagnosed by transthoracic two-dimensional echocardiography, transthoracic three-dimensional echocardiography, transesophageal echocardiography, contrast echocardiography and 64-slice multidetector cardiac computed tomography. Because unruptured aneurysms of the sinus of Valsalva are rarely symptomatic, they can be difficult to detect. However, the unruptured aneurysm of the right sinus of Valsalva in this case caused significant right ventricular outflow tract obstruction, resulting in exertional dyspnea.

An adult asymptomatic pulmonary artery sling / 영남의대학술지

A pulmonary artery sling is a very rare congenital abnormality in which the left pulmonary artery rises from the posterior surface of the right pulmonary artery and then passes between the trachea and the esophagus, causing tracheal compression. It is associated with tracheo-bronchial abnormalities (50%) and cardiovascular abnormalities (30%). It may produce respiratory symptoms through the airway compression of the abnormal left pulmonary artery and congenital abnormalities associated with it. Because most (90%) pulmonary artery sling patients present symptoms during infancy, their condition is often diagnosed in the first year of life. However, a pulmonary artery sling is occasionally found in adults. It is usually asymptomatic and found incidentally. This is a very rare case of an asymptomatic pulmonary artery sling in an adult. A 38-year-old man presented symptoms of mild exertional dyspnea. His spiral computed tomography showed a pulmonary artery sling. He was discharged without specific treatment because his symptoms improved without specific treatment and might not have been associated with a pulmonary artery sling. We report an adult case of an asymptomatic pulmonary artery sling diagnosed via spiral computed tomography, accompanied by a literature review.

A Case of Duodenal Anisakiasis with Duodenal Ulcer / 전남의대학술지

Humans can be incidentally parasitized by third-stage larvae of Anisakis species following the ingestion of raw or undercooked seafood. Acute gastric anisakiasis is one of the most frequently encountered complaints in Korea. However, duodenal anisakiasis with duodenal ulcer had not been reported in Korea, despite the habit of eating raw fish. In this case, a 47-year-old man was hospitalized because of sharp epigastric pain and repeated vomiting after eating raw fish 3 days previously. On admission, esophagogastroduodenoscopic examination revealed an active duodenal bulb ulcer. At 5 mm away from the ulcer margin, a whitish linear worm was found with half of its body penetrating the duodenal mucosa. Herein, we report this case of duodenal anisakiasis accompanied by duodenal ulcer.

A Case of Duodenal Anisakiasis with Duodenal Ulcer / 전남의대학술지

Humans can be incidentally parasitized by third-stage larvae of Anisakis species following the ingestion of raw or undercooked seafood. Acute gastric anisakiasis is one of the most frequently encountered complaints in Korea. However, duodenal anisakiasis with duodenal ulcer had not been reported in Korea, despite the habit of eating raw fish. In this case, a 47-year-old man was hospitalized because of sharp epigastric pain and repeated vomiting after eating raw fish 3 days previously. On admission, esophagogastroduodenoscopic examination revealed an active duodenal bulb ulcer. At 5 mm away from the ulcer margin, a whitish linear worm was found with half of its body penetrating the duodenal mucosa. Herein, we report this case of duodenal anisakiasis accompanied by duodenal ulcer.

Clinical Characteristics and Outcomes of Geriatric Patients in Upper Gastrointestinal Bleeding

BACKGROUND: The incidence of upper gastrointestinal bleeding has decreased in the general population but has increased in geriatric patients worldwide. The aim of this study was to evaluate the clinical characteristics and outcomes of geriatric patients (aged 65 or older) with upper gastrointestinal bleeding and to compare them with non-geriatric patients (less than 65 years old). METHODS: We conducted a retrospective study of 288 patients with upper gastrointestinal bleeding from January 2007 to August 2010. We compared the clinical characteristics and outcomes of geriatric patients (n=148, 51.4%) with those of non-geriatric patients (n=140, 48.6%). RESULTS: Cardiovascular disease, hypertension, and cerebrovascular accidents were more prevalent in the geriatric group, compared with those in the non-geriatric group (p<0.05). Vital signs were more unstable in the geriatric group than those in the non-geriatric group (p<0.05). The geriatric group had taken more ulcerogenic drugs than those in the non-geriatric group (p<0.05). The most common cause of upper gastrointestinal bleeding was peptic ulcer (72.3%) in the geriatric group, whereas it was variceal bleeding (41.4%) in the non-geriatric group. Treatment methods, transfusion volume, operation rate, and mortality were not different between the two groups. The length of hospital stay and length of intensive care unit (ICU) stay were significantly longer in geriatric patients than those in the non-geriatric group (p<0.05). CONCLUSION: Geriatric patients with upper gastrointestinal bleeding had longer ICU and hospital stays than those of non-geriatric patients. Important emerging etiologies such as ulcerogenic drugs and associated chronic illness should be monitored and treated early in these patients.

Atypical Hepatic Hemangiomas with Multiple Calcifications Mimicking Hepatic Metastases: Case Report

Although hepatic hemangioma is the most common benign tumor of the liver, it is rarely associated with calcifications. We report on the case of an asymptomatic 58-year-old man in whom multiple hepatic masses containing calcifications were discovered incidentally at ultrasonography. The radiologic features mimicked those of multiple hepatic metastases.

Video Assisted Thoracic Surgery(VATS) of Pericardial Window Operation / 대한흉부외과학회지

BACKGROUND: Pericardial effusions result from various conditions such as inflammation, malignancies, open heart surgery and uremia. Recently, video assisted thoracic surgery (VATS) has been used for diagnostic and therapeutic purposes in the management of pericardial effusion and intrathoracic lesions due to its ability to provide outstanding visibility of intrathoracic structures with less pain, superior cosmetic effects, and shorter hospital stay. MATERIAL AND METHOD: From April 1995 to October 2001, 51 patients received pericardial window operation via either thoracoscopic(Group A, n=37, m:f=18:19, mean age=56.4 yrs)or thoracotomy approach(Group B, n=14, m:f=8:6, mean age=58.4 yrs). RESULT: In group A, the operation time, duration of chest tube insertion, recurrence rate of pericardial effusion, and postoperative hospital stay were 61.2 minutes, 9.3 days, 2.7%, 16.2 days, respectively while in group B these values were 58.4 minutes, 12.2 days, 7.1%, and 17.3 days. The number of injections for pain control in group A were 4.2 times, whereas in group B it was 6.3 times. Although there was a tendency for the mean hospital stay and duration of chest tube insertion to be shorter in group A than in group B, these differences did not reach statistical significance. There was also no significant difference in the operation time and recurrence rate between the two groups. CONCLUSION: The safety and effectiveness of VATS in the management of pericardial effusion is comparable to the open thoracotomy method. It allows for a shorter hospital stay, duration of chest tube insertion, lesser postoperative pain and a smaller skin incision.

Mucoepidermoid Carcinoma of The Bronchus in a 10-Year-Old Child: A Case Report / 대한흉부외과학회지

Mucoepidermoid cancer of the bronchus in childhood is extremely rare. These tumors generally produce symptoms of airway obstruction, often misdiagnosed as unresolved tuberculosis. Distant metastasis is an uncommon finding of this malignancy, therefore complete surgical resection is treatment of choice. The prognosis of these tumors correlates with the histologic grade of the tumor. We report our clinical experience of mucoepideromoid cancer in a 10-year-old child who visited our hospital with symptoms of recurrent cough and fever. The patients underwent successful removal of tumor by bilobectomy via thoracotomy after bronchoscopic biopsy.

Prognostic Value of HSP 70 in Colorectal Cancer

PURPOSE: To evaluate the relationships between the expression of HSP 70 and prognostic factors, including T-stage, lymph node metastasis, distant metastasis, stage, differentiation and survival rate in colorectal cancer. METHODS: We studied 62 patients with colorectal cancer in order to evaluate the relationships between the expression of HSP 70 and multiple prognostic factors, including T-stage, lymph node metastasis, distant metastasis, stage and differentiation. RESULTS: There was no statistically significant correlation among HSP 70, T-stage, lymph node metastasis, distant metastasis, stage and differentiation. However, in our study, the expression of HSP 70 was slightly elevated in case with no lymph node metastasis, a lower stage and well differentiated colorectal cancer. In regards to survival, the overall survival rate was lower in the group with positive HSP 70 vice the negative group, and this was statistically significant. CONCLUSION: HSP 70 expression and the prognostic factors of colorectal cancer appear not to be correlated to each other, although HSP 70 may play a certain role in colorectal cancer. Further studies are required for determining the prognostic factors in colorectal cancer.

Proliferative Properties and Cytokine Secretion of Lung Fibroblast Cell Lines of the Patients with Idiopathic Pulmonary Fibrosis / 결핵

BACKGROUND: It is well known that various cytokines and growth factors secreted mainly from alveolar macrophages do the key role in the pathogenesis of IPF. But recently it has been known that structural cells like fibroblast can also release cytokines. So the phenotypic changes in fibroblasts of IPF may do a role in continuous progression of fibrosis. The aim of this study is to find out whether there is a change in the biologic properties of the lung fibroblasts of IPF. SUBJECTS AND METHOD: The study was done on 13 patients with IPF diagnosed by open or thoracoscopic lung biopsy and 7 control patients who underwent resectional surgery for lung cancer. Lung fibroblast cell lines (FB) were established by explant culture technique from the biopsy or resected specimen RESULT: Basal proliferation of the fibroblast of IPF(IFB) measured by BrdU uptake tended to be highter than control fibroblast(NFB) (0.212+/- 0.107 vs 0.319+/-0.143, p= 0.0922), also there was no signifrcant difference in proliferation after the stimulation with PDGF or 10% serum. On the contrary, the degree of inhibition in proliferation by PGE2 was significantly lower(33.0+/-13.1%) in IFB than control(46.7+/-10.0%, p= 0.0429). The IFB secreted significantly higher amount of MCP-1(1574+/-1283 pg/ml) spontaneously than NFB(243+/-100 pg/ml) and also after the stimulation with TGF-beta (3.23+/-1.31 ng/ml vs 0.552+/-0.236 ng/ml, p= 0.0012). Similarly IL-8 and IL-6 seretion of IFB was significantly higher than NFB at basal state and with TGF-beta stimulation. But after the maximal stimulation with IL-1beta, no significant difference in cytokine secretion was found between IFB and NFB. CONCLUSION: Above data suggest that the fibroblasts of IPF were phenotypically changed and these change may do a role in the pathogenesis of IPF.

Immunohistochemical Analysis of the EGFR and VEGF Expression in Human

The EGFR has been proposed as a stimulator of cell growth in some neoplasms. The VEGF play an important role in angiogenesis of several tumors. This study aimed to determine the EGFR and VEGF expression in colorectal adenocarcinoma and to correlate the expression of these gene with variable prognostic factors. Significant relationship was observed between the EGFR and histopathologic differentiation or lymph node involvement. But EGFR had no relation to depth of invasiveness or serum CEA level. On the other hand, VEGF had only relation to histopathologic differentiation. VEGF had no relation to lymph node involvement, depth of tumor invasiveness or serum CEA level. We conclude that EGFR expression in human colorectal adenocarcinoma was significantly associated with prognosis. But VEGF expression was not associated with prognosis. More studies are needed to determine whether EGFR expression is a clinically valuable prognostic factor.