Aneurysmectomy and graft interposition for giant thrombosed proximal internal carotid artery aneurysm: Technical details

A giant thrombosed extracranial internal carotid artery aneurysm (ECCA) is extremely rare and its treatment is challenging. Despite the advance of endovascular technique, open surgery is still considered a first-line treatment in giant thrombosed ECCA. We describe a case of giant thrombosed ECCA which was successfully treated by aneurysmectomy and graft interposition with the technical details.

Improved immune responses and safety of foot-and-mouth disease vaccine containing immunostimulating components in pigs

Background@#The quality of a vaccine depends strongly on the effects of the adjuvants applied simultaneously with the antigen in the vaccine. The adjuvants enhance the protective effect of the vaccine against a viral challenge. Conversely, oil-type adjuvants leave oil residue inside the bodies of the injected animals that can produce a local reaction in the muscle. The longterm immunogenicity of mice after vaccination was examined. ISA206 or ISA15 oil adjuvants maintained the best immunity, protective capability, and safety among the oil adjuvants in the experimental group. @*Objectives@#This study screened the adjuvant composites aimed at enhancing foot-andmouth disease (FMD) immunity. The C-type lectin or toll-like receptor (TLR) agonist showed the most improved protection rate. @*Methods@#Experimental vaccines were fabricated by mixing various known oil adjuvants and composites that can act as immunogenic adjuvants (gel, saponin, and other components) and examined the enhancement effect on the vaccine. @*Results@#The water in oil (W/O) and water in oil in water (W/O/W) adjuvants showed better immune effects than the oil in water (O/W) adjuvants, which have a small volume of oil component. The W/O type left the largest amount of oil residue, followed by W/O/W and O/W types. In the mouse model, intramuscular inoculation showed a better protection rate than subcutaneous inoculation. Moreover, the protective effect was particularly weak in the case of inoculation in fatty tissue. The initial immune reaction and persistence of long-term immunity were also confirmed in an immune reaction on pigs. @*Conclusions@#The new experimental vaccine with immunostimulants produces improved immune responses and safety in pigs than general oil-adjuvanted vaccines.

New foot-and-mouth disease vaccine, O JC-R, induce complete protection to pigs against SEA topotype viruses occurred in South Korea, 2014–2015

Foot-and-mouth disease (FMD) is an acute epidemic that spreads rapidly among cattle and pigs. In 2014, in Korea, despite enforced vaccination, the type O Southeast Asia (SEA) topotype viruses (Mya-98 lineage) infected mainly cattle and pigs simultaneously, thereby causing enormous damage. If a vaccine that is completely protective against this FMD virus is developed and used, it can become a very important preventive measure in Asia, which is where this type of virus mainly circulates. The SEA topotype has been steadily evolving and transforming into new variations since it became epidemic in Asia. Therefore, it became necessary to develop a new vaccine that could provide protection against the FMD virus strain that was responsible for the 2014–2015 outbreak in Korea. This study aimed to develop a vaccine that would provide complete protection against the SEA topotype FMD virus to control sporadic FMD outbreaks, which occur despite the enforcement of vaccination, and to completely prevent virus shedding, thereby preventing the virus from spreading. The vaccine candidate virus developed in this study showed low pathogenicity and can be distinguished from the wild-type FMD virus strain. The developed vaccine was able to protect mice from SEA and Middle East–South Asia topotype virus strains and induced high titers of antibodies against both virus strains in pigs, thereby confirming the sufficiency of its protective function. In particular, the results of the SEA topotype virus challenge test in pigs revealed that perfect immunity was created in the vaccinated pigs, without virus shedding and viremia.

Primary sinonasal mucosal melanoma simulated as cystic lesions: a case report

Sinonasal mucosal melanoma (SNMM) in the maxillary sinus is a rare disease condition. Compared to oral mucosal melanoma, SNMM has a bulky, exophytic, and polypoid appearance, is weakly pigmented, and associated with unspecific symptoms. Due to these features, SNMM in the maxillary sinus has been misdiagnosed as nasal polyps and chronic sinusitis. In this case report, we described SNMM occurring in the right maxillary sinus simulated as a cystic or benign lesion. Cortical bone thinning and expansion were observed around the mass. The excised soft mass was encapsulated and weakly pigmented. The mass was clearly excised and covered with a pedicled buccal fat pad graft. Diagnosis using immunohistochemistry with S-100 and homatropine methylbromide-45 (HMB-45) is critical for proper treatment.

Primary sinonasal mucosal melanoma simulated as cystic lesions: a case report

Sinonasal mucosal melanoma (SNMM) in the maxillary sinus is a rare disease condition. Compared to oral mucosal melanoma, SNMM has a bulky, exophytic, and polypoid appearance, is weakly pigmented, and associated with unspecific symptoms. Due to these features, SNMM in the maxillary sinus has been misdiagnosed as nasal polyps and chronic sinusitis. In this case report, we described SNMM occurring in the right maxillary sinus simulated as a cystic or benign lesion. Cortical bone thinning and expansion were observed around the mass. The excised soft mass was encapsulated and weakly pigmented. The mass was clearly excised and covered with a pedicled buccal fat pad graft. Diagnosis using immunohistochemistry with S-100 and homatropine methylbromide-45 (HMB-45) is critical for proper treatment.

The effect of botulinum toxin-A injection into the masseter muscles on prevention of plate fracture and post-operative relapse in patients receiving orthognathic surgery / 대한악안면성형재건외과학회지

BACKGROUND: Botulinum toxin-A (BTX-A) injection into muscle reduces muscular power and may prevent post-operative complication after orthognathic surgery. The purpose of this study was (1) to evaluate BTX-A injection into the masseter muscle on the prevention of plate fracture and (2) to compare post-operative relapse between the BTX-A injection group and the no injection group. METHODS: Sixteen patients were included in this study. Eight patients received BTX-A injection bilaterally, and eight patients served as control. All patients received bilateral sagittal split ramus osteotomy for the mandibular setback and additional surgery, such as LeFort I osteotomy or genioplasty. Post-operative plate fracture was recorded. SNB angle, mandibular plane angle, and gonial angle were used for post-operative relapse. RESULTS: Total number of fractured plates in patients was 2 out of 16 plates in the BTX-A injection group and that was 8 out of 16 plates in the no treatment group (P = 0.031). However, there were no significant differences in post-operative changes in SNB angle, mandibular plane angle, and gonial angle between groups (P > 0.05). CONCLUSIONS: BTX-A injection into the masseter muscle could reduce the incidence of plate fracture.

Diabetic Ketoacidosis with Spontaneous Pneumomediastinum: A Case Report / 임상당뇨병

Spontaneous pneumomediastinum (SPM) is defined as the presence of extraluminal gas in the mediastinal space without any clear traumatic cause. It has been reported in association with asthma exacerbation, emesis, childbirth, seizure, excessive shouting, drug inhalation and diabetic ketoacidosis (DKA). SPM complicated by DKA is infrequently accompanied with chest pain and DKA can lead to changes in respiratory rate and depth; this complication might be underestimated. Here, we report a 21-year-old male with throat pain on swallowing due to SPM complicated by DKA. Clinicians need to consider this complication in differential diagnoses.

A Case of Primary Leiomyosarcoma of the Femur / 대한내과학회지

Primary leiomyosarcoma rarely occurs in bone; when it occurs, it is more frequent in middle-aged individuals and frequently metastasizes to the lung. Here, we report a case of primary leiomyosarcoma of the femur in a 47-year-old woman who complained of pain in the left hip. The plain x-ray revealed an osteolytic lesion in the greater trochanter of the femur. The histopathological and immunohistochemical evaluation revealed a moderately differentiated leiomyosarcoma. Computed tomography of the chest and abdomen revealed no other potential primary lesions. The patient was diagnosed with primary leiomyosarcoma of the bone. Although surgical removal was recommended, the patient refused surgery. As an alternative, she was given radiotherapy and chemotherapy. No local progression or distant metastasis has been observed during the 4-year follow-up period.

Effects of natural raw meal (NRM) on high-fat diet and dextran sulfate sodium (DSS)-induced ulcerative colitis in C57BL/6J mice

BACKGROUND/OBJECTIVES: Colitis is a serious health problem, and chronic obesity is associated with the progression of colitis. The aim of this study was to determine the effects of natural raw meal (NRM) on high-fat diet (HFD, 45%) and dextran sulfate sodium (DSS, 2% w/v)-induced colitis in C57BL/6J mice. MATERIALS/METHODS: Body weight, colon length, and colon weight-to-length ratio, were measured directly. Serum levels of obesity-related biomarkers, triglyceride (TG), total cholesterol (TC), low density lipoprotein (LDL), high density lipoprotein (HDL), insulin, leptin, and adiponectin were determined using commercial kits. Serum levels of pro-inflammatory cytokines including tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-1beta, and IL-6 were detected using a commercial ELISA kit. Histological study was performed using a hematoxylin and eosin (H&E) staining assay. Colonic mRNA expressions of TNF-alpha, IL-1beta, IL-6, inducible nitric oxide synthase (iNOS), and cyclooxygenase-2 (COX-2) were determined by RT-PCR assay. RESULTS: Body weight and obesity-related biomarkers (TG, TC, LDL, HDL, insulin, leptin, and adiponectin) were regulated and obesity was prevented in NRM treated mice. NRM significantly suppressed colon shortening and reduced colon weight-to-length ratio in HFD+DSS induced colitis in C57BL/6J mice (P < 0.05). Histological observations suggested that NRM reduced edema, mucosal damage, and the loss of crypts induced by HFD and DSS. In addition, NRM decreased the serum levels of pro-inflammatory cytokines, TNF-alpha, IL-1beta, and IL-6 and inhibited the mRNA expressions of these cytokines, and iNOS and COX-2 in colon mucosa (P < 0.05). CONCLUSION: The results suggest that NRM has an anti-inflammatory effect against HFD and DSS-induced colitis in mice, and that these effects are due to the amelioration of HFD and/or DSS-induced inflammatory reactions.

Association of body mass index with airway hyperresponsiveness and lung function in adult asthmatics

PURPOSE: Obesity is commonly regarded as a risk factor for asthma development, poor asthma control, and poor response to asthma therapy. However, its relationships are not always consistent. Gender difference has been reported to influence asthma severity and asthma control. We investigated the contribution of obesity to airway hyperresponsiveness (AHR) and lung function before and after treatment in adult asthmatics. METHODS: The medical records of a total of 323 adult asthmatics were analyzed retrospectively. Asthma was diagnosed based on the positive result of methacholine bronchial provocation test (PC20 or =12% and 200-mL improvement in forced expiratory volume in 1 second after inhalation of a bronchodilator). Follow-up spirometry was performed in 113 patients after at least 3 months of asthma treatment with controller medication. Percent change between spirometry before and after treatment was defined as {[(value after treatment-value before treatment)/value before treatment]x100}. Body mass index (BMI, weight [kg]/height [m2]) was categorized into underweight (30) according to the world health organization classification. RESULTS: BMI did not show any significant correlation with PC20 value of methacholine provocation test and each lung function parameter before and after treatment. When we divided the study subjects according to gender and age, BMI was negatively correlated with PC20 value only in female adult asthmatics under 65 years old (r=-0.024, P=0.036). CONCLUSION: Obesity is positively correlated with the intensity of AHR in female adult asthmatics. Gender seems to differentially contribute to the relationship between BMI and AHR.

Influence of 5-HT3b Receptor AAG Deletion Mutation and CYP2D6*10 on the Ondansetron Treatment / 대한마취과학회지

BACKGROUND: Postoperative nausea and vomiting (PONV) are common problems in patients undergoing general anesthesia. Ondansetron is widely used for this problems. But, some patients treated with ondansetron do not respond to therapy. We hypothesized that patients with genetic variation in 5-HT3b receptor and CYP2D6 gene might respond differently to ondansetron treatment. METHODS: 135 patients undergoing gynecologic surgery were given 4 mg ondansetron 15 min before extubation. The assessment of PONV was performed during < 2 hours and 2-24 hours. DNA was extracted from blood and was analyzed by using restriction fragment-length polymorphism (RFLP) and site-specific PCR. RESULTS: In 5-HT3b AAG deletion mutation, the incidence of nausea and vomiting < 2 hr were 25% and 12.5% for wild, 23.4% and 12.2% for heteromutant. The incidence of nausea and vomiting 2-24 hr were 3.2% and 1.1% for wild, 4.9% and 2.4% for heteromutant. This showed no significant differences between two groups. In CYP2D6*10 mutation, the incidence of nausea and vomiting < 2 hr were 28.6% and 19.6% for wild, 22.8% and 8.8% for heteromutant and 23.5% and 5.9% for homomutant. The incidence of nausea and vomiting 2-24 hr were 5.4% and 1.8% for wild, 3.2% and 1.6% for heteromutant, 0% and 0% for homomutant. This showed no significant differences among three groups. CONCLUSIONS: The incidence of PONV were not different among the genotype of CYP2D6*10 and 5HT3b AAG mutation.

Operative Treatment of Humerus Nonunion after Surgery / 대한정형외과학회잡지

PURPOSE: To analyze the cause and treatment method of humerus nonunions which were initially treated by operation. The causes of nonunion were analyzed according to the initial treatment method. We report upon treatment options. MATERIALS AND METHODS: We reviewed 15 cases of humerus nonunion, which were initially treated surgically (7 cases of dynamic compression plate, 4 of Ender nail, 3 of interlocking intramedullary nail, 1 of K-wire) from January 1992 to January 2001. RESULTS: The causes of nonunion were determined to be as follows ; inadequate internal fixation or technical failure (9 cases), postoperatively applied improper external immobilization (5 cases), inadequate choice of implant (1 case). We treated the nonunion as follows; dynamic compression plate and bone graft in 11 cases, intramedullary nailing with small plate augumentation and bone graft in two, maintenance of initial nail with small plate augumentation and bone graft in two. All cases had bone union at an average of 15.9 weeks without complications, such as osteomyelitis, radial nerve palsy, or joint stiffness. CONCLUSION: Plate fixation is considered to be superior to intramedullary fixation in the treatment of nonunion. However, cases that received interlocking intramedullary nailing can be treated easily with small plate augumentation and bone graft without initial nail removal.

Clinical Evaluation of Risk Factors Affection Postoperative Morbidity and Mortality in the Surgical Treatment of Tuberculous Destroyed Lung / 대한흉부외과학회지

BACKGROUND: This retrospective study tries to identify specific risk factors that may increase complication rates after the surgical treatment of tuberculous destroyed lung. MATERIAL AND METHOD: A retrospective study was performed on forty-seven patients, who received surgical treatment for tuberculous destroyed lung in the Department of Thoracic and Cardiovascular Surgery at Hanyang University Hospital from 1988 to 1998, to identify specific preoperative risk factors related to postoperative complications. Fisher's exact test was used to identify the correlations between the complications and right pneumonectomy, preoperative FEV1, predicted postoperative FEV1, massive hemoptysis, postoperative persistent empyema. RESULT: Hospital mortality and morbidity rates of the patients who received surgical treatment for tuberculous destroyed lung were 6.4% and 29.7%, respectively. In view of the hospital mortality and morbidity rates as a whole, predicted postoperative FEV1 less than 0.8L(p<0.005), preoperative FEV1 less than 1.8L(p=0.01), massive hemoptysis(p<0.005), postoperative persistent positive sputum cultures(p<0.0005), and the presence of multi drug resistant tuberculosis(p<0.05) presented statistically significant correlations. Among the postoperative complications, bronchopleural fistula, the most common complication, was found to have statistically significant corrleations with the preoperative empyema(p<0.05) and postoperative persistent positive sputum cultures(p<0.05). CONCLUSIONS: Although mortality and morbidity rates after surgical treatment of tuberculous destroyed lung were relatively low, when predicted postoperative FEV1 was less than 0.8L, when preoperative FEV1 was less than 1.8L, when massive hemoptysis was present, when postoperative sputum cultures were persistently positive, and when multi drug resistant tuberculosis was present, the rates were significantly higher.

Primary pulmonary synovial sarcoma with brain metastasis / 대한흉부외과학회지

Synovial sarcoma is a malignant soft tissue tumor originated from the primitive mesencymal cell. It occurs primarily in the extremities, especially in the lower extremities. Primary pulmonary synovial sarcoma has been rarely reported in literatures. We experienced a case of intrapulmonary synovial sarcoma with brain metastasis which originated from the lung.

The Successfully Redoaugmentation of Budd-Chiari Syndrome with Using Gore-Tex Patch of the IVC Obstruction / 대한흉부외과학회지

Budd-Chiari syndrome is a state of hepatic failure caused by impairment of blood flow anywhere from the inferior vena cava to the right atrium. In this case, a 45 year old patient had undergone membranotomy and dilatation with autogenous pericardial graft due to obstruction of the inferior vena cava caused by a congenital membrane in 1987. Ten years after the operation, restenosis occurred. Although a noninvasive method with a Gianturco stent dilatation was performed, a satisfactory result was not obtained. A reoperation was performed. The stenotic segment of inferior vena cava was excised and after augmentation with a prepared pentagon shaped Gore-Tex artificial graft allowing passage of two fingers. The patient's postoperative course was uneventful without signs of rebleeding or any other complications and the patient was discharged at postoperative two weeks without the use of anticoagulants. An excellent result was obtainable after operation using a prepared Gore-Tex graft and such a result. Reoperational case of Budd-Chiari syndrome may require rapid and excellent the operative techenic by prevention of massive bleeding under use of extracorporeal circulation.

Experimental Model of Cardiac Xenograft , Mouse Heart to Rat / 대한흉부외과학회지

BACKGROUND: The transplantation of organs between phylogenetically disparate or harmonious species has invariably failed due to the occurrence of hyperacute rejection or accerelated acute rejection. But concordant cardiac xenograft offer us an opportunity to study xenotransplantation in the absence of hyperacute rejection. Current therapeutics for the prolongation of survival of rodent concordant xenotransplantation are not ideal with many regimens having a high mortality rate. Cyclosporine A & Mycophenolate Mofetil are new immunosuppresive agent which has been shown to be effective at prolonging survival of allograft, as purine synthesis inhibitor. MATERIAL AND METHOD: We used white mongrel rats as recipient and mice as donor, divided 4 groups(n=6), control group(Group 1) has no medication or pretreatment, Group 2 has splenectomy as pretreatment 7~10 days before transplantation, Group 3 has Cyclosporine A treatment group, Group 4 has combined treatment of Cyclosporine A & Mycophenolate Mofetil(RS 61443). We compared survival time. RESULT: We can't find significant difference of survival time between each groups. CONCLUSION: We concluded that rejection of cardiac xenograft was different from rejection of allograft, and new immunossuppresive Agent(Mycophenolate Mofetil, Cyclosporine A) was not effective for prolongation of survival time after cardiac xenograft.

Transsternal Approach for BPF closure: A Case Report / 대한흉부외과학회지

A patient with post-pneumonectomy empyema was treated sucessfully by modification of Clagett's operation after closure of bronchopleural fistula using a transsternal, transpericardial approach. His primary disease was pulmonary tuberculosis, and he had a past history of left upper lobe lobectomy 34 year ago. Recently recurred pulmonary tuberculosis with aspergilloma in the remaining left lung, empyema with bronchopleural fistula had developed on the post-operative 4th day after completion pneumonectomy. Closed thoracostomy was done at the lowest point of the left pleural cavity immediately. The pleural cavity was irrigated with small amount of normal saline through pigtail catheter. The 2nd operation was done by closure of bronchopleural fistula using a stapler through transsternal, transpericardial approach, and then the pleural space was irrigated with normal saline with Tobramycin which shows sensitivity to isolated organism from pleural cavity. After negative conversion of pleural fluid culture, we performed modified Clagett's operation under local anesthesia. The patient had no evidence of recurrence of empyema and discharged from hospital after 10 days of the 3rd procedure.

Review of Primary Chest wall Tumors / 대한흉부외과학회지

BACKGROUND: Chest wall tumors can classified into soft tissue tumors and bone tissue tumors and can be subclassified into benign and malignant tumors. MATERIALS AND METHODS: We report an analysis of 68 patients with primary chest wall tumors treated at the department of thoracic and cardiovascular surgery at Hanyang University Hospital from January, 1973 to September 1997. RESULTS: Among a total of 68 patients 33 (48.5%) were males and 35 (51.5%) were females. The ages of the patients ranged from 10 to 79 years with a mean age of 39.3 years. According to the age distribution, 23 patients (33.8%) were from the 4th decade, 12 patients (17.6%) were from the 6th decade, and 10 patients (14.7%) were from the 5th decade. Among the primary chest wall tumors, 53 cases were benign and 15 cases were malignant. Among the benign tumors, 17 cases (32.1%) were in the 4th decade and among the malignant tumors, 6 cases (40%) were in the 4th decade. In both malignant and benign tumors the most common ages were in the 4th decade. The most common tumors were fibrous dysplasia and chondroma, each with a total of 14 cases (26.4%). Osteochondroma and lipoma each had 8 cases (15.1%). Among malignant tumors, osteosarcoma was most common with 8 cases (53.3%). According to location, 49 cases occured in both bone and cartilage tissue, 19 cases occurred in cartilage. Among the presenting symptoms, palpable mass was present in all cases. Fifty-one patients complained of tenderness and among cases with involvement of the lung, 3 patients had complained of respiratory distress. Among the malignant tumors 6 cases underwent a radical operation and 4 cases of benign tumors underwent a radical operation. Postoperativly, there was one case with recurrence from a desmoid tumor. There were no deaths postoperativly and no deaths due to complications (and their postoperative courses were uneventful). CONCLUSIONS: Most patients with primary chest wall tumors initially present with mass at admission. Resection is sufficient treatment for benign tumors but in malignant tumors wide resection of the chest wall is needed and mchest wall reconstruction.

Case Analysis of Pulmonary Sequestration / 대한흉부외과학회지

BACKGROUND: Pulmonary sequestration is not common and it's diagnosis needs special care such as an aortogram ar tomography. MATERIAL AND METHOD: We have experienced 13 patients who had pulmonary sequestration from January 1990 to September 1997. RESULT: Six men and seven women were treated and their mean age was 25.8+/-14.3 years. Their chief complaints were coughing, chest pain, and no symptoms in decreasing order. There were nine intralobar (ILS) and three extralobar (ELS) pulmonary sequestrations and one patient had both. There was no preference in location of either left or right. They were mainly diagnosed by aortography and their feeding arteries commonly originated from the lower thoracic aorta. The patients with ILS were treated by lobectomy and those with ELS by sequestrectomy. CONCLUSION: to treat pulmonary sequestration properhy, aortogram or chest CT is warranted to iidenty the abnormal origin of feeding artery.

Poland Syndrome: One Case Report / 대한흉부외과학회지

The chest wall deformity associated with Poland's syndrome is a very rare anomaly which consists of congenital unilateral absence of the sternal head of the pectoralis major muscle and various abnormalities of the upper extremity. Other clinical features associated with Poland's syndrome include deficiency or absence of the breast and nipple, deficiency of subcutaneous fat and axillary hair, and abnormalities of costal cartilages and anterior ends of ribs. The origin remains uncertain, but is considered not to be hereditary. Poland's syndrome may pose a serious psychologic and cosmetic problem, early recognition and surgical correction may prove beneficial. A 37 year old patient with Poland's syndrome was encountered and underwent satisfactory surgical correction.