The difference of detection rate of avian influenza virus in the wild bird surveillance using various methods

Korea is located within the East Asian-Australian flyway of wild migratory birds during the fall and winter seasons. Consequently, the likelihood of introduction of numerous subtypes and pathotypes of the Avian influenza (AI) virus to Korea has been thought to be very high. In the current study, we surveyed wild bird feces for the presence of AI virus that had been introduced to Korea between September 2017 and February 2018. To identify and characterize the AI virus, we employed commonly used methods, namely, virus isolation (VI) via egg inoculation, real-time reverse transcription-polymerase chain reaction (rRT-PCR), conventional RT-PCR (cRT-PCR) and a newly developed next generation sequencing (NGS) approach. In this study, 124 out of 11,145 fresh samples of wild migratory birds tested were rRT-PCR positive; only 52.0% of VI positive samples were determined as positive by rRT-PCR from fecal supernatant. Fifty AI virus specimens were isolated from fresh fecal samples and typed. The cRT-PCR subtyping results mostly coincided with the NGS results, although NGS detected the presence of 11 HA genes and four NA genes that were not detected by cRT-PCR. NGS analysis confirmed that 12% of the identified viruses were mixed-subtypes which were not detected by cRT-PCR. Prevention of the occurrence of AI virus requires a workflow for rapid and accurate virus detection and verification. However, conventional methods of detection have some limitations. Therefore, different methods should be combined for optimal surveillance, and further studies are needed in aspect of the introduction and application of new methods such as NGS.

Blood Conservation Strategy during Cardiac Valve Surgery in Jehovah's Witnesses: a Comparative Study with Non-Jehovah's Witnesses / 대한구급학회지

BACKGROUND: We compared the clinical outcomes of cardiac valve surgery in adult Jehovah's Witness patients refusing blood transfusion to those in non-Jehovah's Witness patients without any transfusion limitations. METHODS: From 2005 to 2014, 25 Jehovah's Witnesses (JW group) underwent cardiac valve surgery using a blood conservation strategy. Twenty-five matched control patients (non-JW group) were selected according to sex, age, operation date, and surgeon. Both groups were managed according to general guidelines of anticoagulation for valve surgery. RESULTS: The operative mortality rate was 4.0% in the JW group and 0% in the non-JW group (p = 1.000). There was no difference in postoperative major complications between the groups (p = 1.000). The overall survival rate at 5 and 10 years was 85.6% ± 7.9% and 85.6% ± 7.9% in the JW group, respectively, and 100.0% ± 0.0% and 66.7% ± 27.2% in the non-JW group (p = 0.313). The valve-related morbidity-free survival rates (p = 0.625) and late morbidity-free survival rates (p = 0.885) were not significantly different between the groups. CONCLUSIONS: Using a perioperative strategy for blood conservation, cardiac valve surgery without transfusion had comparable clinical outcomes in adult patients. This blood conservation strategy could be broadly applied to major surgeries with careful perioperative care.

Blood Conservation Strategy during Cardiac Valve Surgery in Jehovah's Witnesses: a Comparative Study with Non-Jehovah's Witnesses / 대한중환자의학회지

BACKGROUND: We compared the clinical outcomes of cardiac valve surgery in adult Jehovah's Witness patients refusing blood transfusion to those in non-Jehovah's Witness patients without any transfusion limitations. METHODS: From 2005 to 2014, 25 Jehovah's Witnesses (JW group) underwent cardiac valve surgery using a blood conservation strategy. Twenty-five matched control patients (non-JW group) were selected according to sex, age, operation date, and surgeon. Both groups were managed according to general guidelines of anticoagulation for valve surgery. RESULTS: The operative mortality rate was 4.0% in the JW group and 0% in the non-JW group (p = 1.000). There was no difference in postoperative major complications between the groups (p = 1.000). The overall survival rate at 5 and 10 years was 85.6% ± 7.9% and 85.6% ± 7.9% in the JW group, respectively, and 100.0% ± 0.0% and 66.7% ± 27.2% in the non-JW group (p = 0.313). The valve-related morbidity-free survival rates (p = 0.625) and late morbidity-free survival rates (p = 0.885) were not significantly different between the groups. CONCLUSIONS: Using a perioperative strategy for blood conservation, cardiac valve surgery without transfusion had comparable clinical outcomes in adult patients. This blood conservation strategy could be broadly applied to major surgeries with careful perioperative care.

The Tip Level of the Conus Medullaris by Magnetic Resonance Imaging and Cadaver Studies in Korean Adults / 체질인류학회지

The spinal cord is part of the central nervous system, and its caudal end is named as the conus medullaris. Many researchers have reported the tip level of the conus medullaris by magnetic resonance imaging studies; others by cadaver dissection. The tip level of magnetic resonance imaging studies seemed to be higher than that of cadaver studies. We evaluated the tip level the conus medullaris with magnetic resonance imaging and cadaver dissection in Korean adult population. MR data were scanned with T1-weighted, mid-sagittal magnetic resonance imaging of 248 living persons (mean age, 42.3±16.0 years; range, 12-85 years) and cadaver data were collected by dissections of 118 cadavers (mean age, 56.0±14.9 years; range, 16-94 years). The mean level of conus tip was found to be at the middle third of 1st lumbar vertebra (range, lower third T12 - lower third L2) from magnetic resonance imaging study and the upper third of 2nd lumbar vertebra (range, lower third T12 - lower third L3) from cadaver dissection study. The tip level of conus medullaris from magnetic resonance imaging study was higher than that from cadaver dissection study (p<0.05).

Single and Multiple Valve Surgery in Native Valve Infective Endocarditis

BACKGROUND: Surgical treatment of infective endocarditis (IE) remains a challenge, especially in cases of multiple valve surgery. We evaluated the clinical outcomes of native valve IE and compared the outcomes of single valve surgery with those of multiple valve surgery. MATERIALS AND METHODS: From 1997 to 2011, 90 patients underwent surgery for native valve IE; 67 patients with single valve surgery (single valve group) and 23 patients with multiple valve surgery (multiple valve group). The mean follow-up duration was 73.1+/-47.4 months. RESULTS: The surgical mortality in the total cohort was 4.4%. The overall survival (p=0.913) and valve-related event-free survival (p=0.204) did not differ between the two groups. The independent predictor of postoperative complications was New York Heart Association class (p=0.001). Multiple valve surgery was not a significant predictor of surgical mortality (p=0.225) or late mortality (p=0.936). Uncontrolled infection, urgent or emergency surgery, and postoperative complications were identified as independent predictors of valve-related morbidity, excluding multiple valve surgery (p=0.072). CONCLUSION: In native valve IE, multiple valve surgery as a factor was not an independent predictor of mortality and morbidity. The number of surgically corrected valves in native IE seems to be unrelated to perioperative and long-term outcomes.

A Case of Partial Congenital Pericardial Defect Presenting as Acute Coronary Syndrome

Congenital pericardial defects are rare and asymptomatic for both partial and complete defects. However, some patients can experience syncope, arrhythmia, and chest pain. When a patient experiences a symptom, it may be caused by herniation and dynamic compression or torsion of a heart structure including the coronary arteries. Diagnosis of a congenital pericardial defect may be difficult, especially in old patients with concomitant coronary artery disease. The clinical importance of congenital pericardial defect has not been stressed and congenital pericardial defects are regarded as benign, but in this case, pericardial defect was responsible for myocardial ischemia. The authors report a case of partial congenital pericardial defect causing herniation and dynamic compression of the coronary arteries, presenting as an acute coronary syndrome in an old man, with an emphasis on the unique features of the coronary angiogram that support the diagnosis of partial pericardial defects.

Aortic Root and Ascending Aortic Aneurysm in an Adult with a Repaired Tetralogy of Fallot

Surgical repair of the tetralogy of Fallot is one of the most successful operations in the treatment of congenital heart diseases. We report the case of a 65-year-old man who had an aortic valve replacement at the time of complete repair of the tetralogy of Fallot at the age of forty-three. He subsequently had progressive aortic root and ascending aorta dilation to 9 cm. The aortic root and ascending aorta replacement was done using a composite valve-graft and was performed along with other procedures. Thus, meticulous follow-up of aortic root and ascending aorta after corrective surgery for tetralogy of Fallot is recommended following initial curative surgery.

Aortic Root and Ascending Aortic Aneurysm in an Adult with a Repaired Tetralogy of Fallot

Surgical repair of the tetralogy of Fallot is one of the most successful operations in the treatment of congenital heart diseases. We report the case of a 65-year-old man who had an aortic valve replacement at the time of complete repair of the tetralogy of Fallot at the age of forty-three. He subsequently had progressive aortic root and ascending aorta dilation to 9 cm. The aortic root and ascending aorta replacement was done using a composite valve-graft and was performed along with other procedures. Thus, meticulous follow-up of aortic root and ascending aorta after corrective surgery for tetralogy of Fallot is recommended following initial curative surgery.

Preoperative Extracorporeal Membrane Oxygenation for Severe Ischemic Mitral Regurgitation: 2 case reports

Indication for extracorporeal membrane oxygenation (ECMO) has been extended as the experience of ECMO in various clinical settings accumulates and the outcome after ECMO installation improves. We report two cases of successful mitral valve surgery for severe ischemic mitral regurgitation in patients on ECMO support for cardiogenic shock which developed upon coronary angiography.

Application of a Single-pulsatile Extracorporeal Life Support System for Extracorporeal Membrane Oxygenation: An experimental study / 대한흉부외과학회지

BACKGROUND: Extracorporeal life support (ECLS) system is a device for respiratory and/or heart failure treatment, and there have been many trials for development and clinical application in the world. Currently, a non-pulsatile blood pump is a standard for ECLS system. Although a pulsatile blood pump is advantageous in physiologic aspects, high pressure generated in the circuits and resultant blood cell trauma remain major concerns which make one reluctant to use a pulsatile blood pump in artificial lung circuits containing a membrane oxygenator. The study was designed to evaluate the hypothesis that placement of a pressure-relieving compliance chamber between a pulsatile pump and a membrane oxygenator might reduce the above mentioned side effects while providing physiologic pulsatile blood flow. MATERIAL AND METHOD: The study was performed in a canine model of oleic acid induced acute lung injury (N=16). The animals were divided into three groups according to the type of pump used and the presence of the compliance chamber. In group 1, a non-pulsatile centrifugal pump was used as a control (n=6). In group 2 (n=4), a single-pulsatile pump was used. In group 3 (n=6), a single-pulsatile pump equipped with a compliance chamber was used. The experimental model was a partial bypass between the right atrium and the aorta at a pump flow of 1.8~2 L/min for 2 hours. The observed parameters were focused on hemodynamic changes, intra-circuit pressure, laboratory studies for blood profile, and the effect on blood cell trauma. RESULT: In hemodynamics, the pulsatile group II & III generated higher arterial pulse pressure (47+/-10 and 41+/-9 mmHg) than the nonpulsatile group I (17+/-7 mmHg, p<0.001). The intra-circuit pressure at membrane oxygenator were 222+/-8 mmHg in group 1, 739+/-35 mmHg in group 2, and 470+/-17 mmHg in group 3 (p<0.001). At 2 hour bypass, arterial oxygen partial pressures were significantly higher in the pulsatile group 2 & 3 than in the non-pulsatile group 1 (77+/-41 mmHg in group 1, 96+/-48 mmHg in group 2, and 97+/-25 mmHg in group 3; p<0.05). The levels of plasma free hemoglobin which was an indicator of blood cell trauma were lowest in group 1, highest in group 2, and significantly decreased in group 3 (55.7+/-43.3, 162.8+/-113.6, 82.5+/-25.1 mg%, respectively; p<0.05). Other laboratory findings for blood profile were not different. CONCLUSION: The above results imply that the pulsatile blood pump is beneficial in oxygenation while deleterious in the aspects to high pressure generation in the circuits and blood cell trauma. However, when a pressure-relieving compliance chamber is applied between the pulsatile pump and a membrane oxygenator, it can significantly reduce the high circuit pressure and result in low blood cell trauma.

End-to-End Anastomosis for Benign Esophageal Stricture-2 Cases / 대한흉부외과학회지

End-to-end anastomosis for benign esophageal stricture (BES) is technically easier and relatively lower in morbidity than esophago-enterostomy. We performed segmental resection and end-to-end anastomosis in 2 cases of short segmental BES who were failed repeated endoscopic dilatation. A 13-month-old female with postoperative stricture was treated successfully. However, a 27-year-old female with corrosive stricture required second operative management of esophago-colo-gastrostomy following end-to-end anastomosis. Our experiences suggested that end-to-end anastomosis for BES could be used as a valid procedure for well selected patients. However, further studty is needed to compare with esophago-enterostomy.

Experimental Fluid Percussion Brain Injury Induces Temporally and Regionally Specific Expressions of Heat Shock Protein Genes / 대한해부학회지

Although the induction of various members of hsp (heat shock protein) gene family has been linked to the resistance to apoptosis by a range of diverse stress stimuli, detail information has not been available yet as to the temporal and spatial expression patterns of various hsp genes after traumatic brain injury. In the present study, using a lateral fluid percussion (FP) injury as a model of traumatic brain injury, expression profiles of stress induced hsp genes were comparatively evaluated in the adult rat brain by in situ hybridization (ISH). We found that the temporal and regional expression patterns between the hsp70 superfamily members, hsp110 and hsp70, and the small hsp member, hsp25 are distinct. While the hsp110 and hsp70 expression was observed as early as 1 hr after injury and maximally induced at 3 hr after injury, the hsp25 expression appeared 6 hr after injury and the expression sustained until 6 days after the injury. Moreover, the expression of hsp110 and hsp70 was localized primarily in the impact site, that of the small hsp25 was observed throughout the ipsilateral cortical area in the distant regions remote from the impact site as well as in the impact site following injury. These results suggest that the sequential and combinatorial manipulation of various hsp genes can be exploited in reducing acute and delayed post-traumatic apoptosis and associated neurological dysfunction.

Video Assisted Thoracoscopic Sympathetic Ramus Clipping in Essential Hyperhidrosis: Cadaver Fitting Test and Clinical Application / 대한흉부외과학회지

BACKGROUND: It has been known that the most effective treatment method of hyperhidrosis is video-assisted thoracoscopic sympathetic nerve block. Postoperative compensatory hyperhidrosis and anhidrosis are major factors that decrease the postoperative satisfaction. Although sympathetic rami have been selectively blocked to decrease the complications, technical difficulties and excessive bleeding have prevented the universal application. MATERIAL AND METHOD: Three pre-fixative cadavers were dissected before clinical application. Bilateral sympathetic chains were exposed in supine position after the whole anterior chest wall was removed. Second and third sympathetic rami were blocked using clips. After the sympathetic chains including ganglia were removed, we evaluated the extents of rami block. Twenty-five patients were subjected to the clinical application. Surgeries were performed in semi- fowlers position under general anesthesia and bilateral ventilation. 2 mm thoracoscopy and 5 mm trocar were introduced through third and fourth intercostal space, respectively. Second and third sympathetic rami were blocked using thoracoscopic clips. The postoperative complications, satisfaction, and compensatory hyperhidrosis rate were evaluated retrospectively. RESULT: Sympathetic rami were completely blocked in cadaver dissection study. Hyperhidrosis symptom was improved in all patients without operative complication. Operative time was shorter than that of traditional ramicotomy. All patients, except four, were satisfied with postoperative palmar hyperhidrosis. Compensatory hyperhidrosis was more severely happened in fifteen patients (60%). The remaining six patients had no complaint. Two patients had a minimal degree of gustatory hyperhidrosis. CONCLUSION: This operative method had shorter operative time and less complication rate, compared with traditional ramicotomy. Operative success rate was similar to the traditional sympathicotomy; lower extent and occurrence rate of compensatory hyperhidrosis. The thoracic sympathetic rami clipping was suggested as an alternative method for treatment of palmar hyperhidrosis.

Treatment of Bilateral Diaphragmatic Paralysis after Resection of Thymic Carcinoma: One case report / 대한흉부외과학회지

Bilateral diaphragmatic paralysis is a rare disease. It is caused by trauma, cardiothoracic surgery, neuromuscular disorders, cervical spondylosis, and infection. A 60 year-old male patient developed bilateral diaphragmatic paralysis after an en-bloc resection of thymic carcinoma which invaded the right upper lobe, pericardium, superior vena cava and innominate vein. Severe respiratory difficulty developed and ventilator weaning was impossible. We performed bilateral diaphragmatic plication. After the operation, satisfactorily ventilator weaning and sleeping in supine position were possible; therefore, we report this case.

The Reduction Effect of Leukocyte Fragments by Leukodepletion Filter / 대한수혈학회지

BACKGROUND: The efficiency of leukocyte removal filter is influenced by many factors. But, filtration efficiency of leukocyte fragments was not well known. We performed this study to evaluate whether the filtration efficiency for packed red blood cells can be influenced by leukocyte fragments according to storage time. METHODS: Leukocyte fragments in packed red blood cells (three units) which were artificially made by incubation for 4 hrs at 56degrees C and each four units of packed red blood cells according to storage time (0 days, 10 days, 20 days, and 30 days) were filtered using Sepacell R-500A (Asahi medical Co, Japan). The leukocyte concentrations of the pre-leukodepleted samples were estimated using an automated hematology analyzer (XE-2100, Sysmex, Japan). The ratio between the number of normal leukocytes and leukocyte fragments on Wright Giemsa stained slide was used in the analysis. The leukocyte concentrations of the post-leukodepleted samples were performed by the conventional counting methods using Nageotte hemocytometer. RESULTS: The ratios of fragmented to total leukocytes in packed red blood cells at pre- and post leukoreduction according to storage times were 1.5% and 16.3% within 1 days, 4.5% and 30.0% at 10 days, 6.3% and 35.0% at 30 days, and 8.3% and 42.5% at 40 days, respectively. Leukoreduction efficiencies of normal leukocytes in packed red blood cells were 99.99 +/- 0.01%, 99.97 +/- 0.02%, 99.98 +/- 0.01%, and 99.86 +/- 0.09%, respectively. The 36.0% of leukocytes in packed red blood cells were changed to fragmented leukocytes, residual fragmented leukocytes ratio was 95.0% and filter efficiencies of normal leukocytes was low(99.28%, p<0.05). CONCLUSIONS: The leukodepleted efficiency for leukocyte fragments were lower than for normal leukocytes. Leukocytes fragments may be influenced to lower the leukodepleted efficiency of normal leukocytes with storage time elapse.

Two Cases of ABO Discrepancy due to Hypogammaglobulinemia / 대한수혈학회지

Two cases of ABO discrepancy were observed in thirty-year old woman with gall bladder abscess and fifty-five-year old woman with hepatocellular carcinoma. Their red cells were typed as group O and their serum had only anti-A antibody. Absence of A and B antigens on their RBCs were confirmed by adsorption elution test and saliva test. The B transferase activities were not demonstrated in their serum. Their ABO genotypes were O/O by sequence specific polymerase chain reaction. Their serum protein electrophoresis showed hypogammaglobulinemia pattern, and immunoglobulin levels (IgG, IgA, IgM) were decreased (39 mg/dL, 46 mg/dL, <5 mg/dL and 63 mg/dL, 65 mg/dL, 12 mg/dL, respectively).

Cadaver Fitting Test of Mechanical Circulatory Assist Device Including Korean Artificial Heart (AnyHeart) in Korea / 대한해부학회지

Preclinical cadaver fitting study is paramount in the development of various implantable medical devices. It helps to evaluate the fitness of the size, shape, structure of the devices in the human anatomy, to locate the most optimal site for implantation, and to develope the clinically available surgical techniques. The purpose of this study was to observe the anatomical feasibility of Korean artificial heart (AnyHeart) in 12 human cadavers after obtaining the permission from the Korea University Anatomical Research Committee. The observation was focused on proper position of the artificial heart in various thoracic incisions (median sternotomy, right thoracotomy, left thoracotomy, transsternal incision), localization of inflow as well and outflow tract, cannulation sites, and so on. Results showed that Korean artificial heart had excellent anatomical feasibility in the human body and that a novel surgical technique of right thoracotomy approach was proved to be clinically applicable. Conclusively, the above results will provide the rationales of clinical trial and demonstrate the significance of human cadaver study in development of implantable medical devices.

A case of Congenital Cardiac Anomaly Associated with DiGeorge Syndrome / 대한흉부외과학회지

The DiGeorge syndrome is a rare congenital abnormality consisting of aplasia or hypoplasia of the thymus and parathyroid glands resulting from malformation of the third and fourth pharyngeal pouches. This syndrome usually includes congenital cardiac anomalies and abnormal facial features. We experienced a case of congenital cardiac anomaly associated with DiGeorge syndrome. The patient was 1 month old boy weighing 3.5 kg. The congenital cardiac anomalies included ventricular septal defect, atrial septal defect, coactation of aorta, and patent ductus arteriosus. We performed one-stage operation with two separate incisions for these cardiac anomalies. Postoperative course was uneventful and the patient at 6 months of follow up is doing well.

Detection of TNF-alpha in Serum as the Effect of Corticosteroid to the Myocardial Protection in Cardiopulmonary Bypass / 대한흉부외과학회지

Proinflammatory cytokines such as tumor necrosis factor-alpha (TNF-alpha) have been implicated in myocardial and organ dysfunction associated with postperfusion syndrome. We tested the hypothesis that cytokine productions are depressed by preoperative cortiosteroid injection for cardiopulmonary bypass (CPB) and the postoperative courses will be better than without steriod pretreated cases. Cardiac surgery was performed in randomized blind fashion for 20 patients from June 1996 to September 1996. In the steroid group (n=10), corticosteroid (dexamethasone 1 mg/kg) was injected 1 hour before anesthetic induction, but in the control group (n=10), nothing was injected. Each of groups were sampled 11 times as scheduled for TNF-alpha bioassays. We have checked EKG, cardiac enzymes (CPK, LDH with isoenzyme), WBC count preoperative day, one day and three days after operation. Viatal signs were continuously monitored for three postoperaive days. In the postoperative period three patients in the control group had elevated body temperature and four patients had hypotension that required considerable intravenous fluid administration. But steroid injected patients showed normal body temperture and acceptable blood pressures without supportive treatment. CPK enzymes rose in control group higher than steroid group at postoperative 1st and 3rd day (CPK; 1122+/-465 vs 567+/-271, 864+/-42 vs 325+/-87), and CPK-MB enzymes rose in control group higher than steroid group at postoperative 1st day (106.4+/-115.1 vs 29.5+/-22.4) (P=0.02). Arterial tumor necrosis factor-alpha rose during cardiopulmonary bypass, peaking at 5 minutes before the end of aortic cross clamping (ACC-5min) in steroid group (11.9+/-4.7 pg/ml), and 5 minutes before the end of cardiopulmonary bypass (CPB-5min) in control group (22.3+/-6.8 pg/ml). The steroid pretreated patients had a shorter period of time in respirator suport time, ICU stay day, hospital admission day. We conclude that corticosteroid suppress cytokine production during and after cardiopulmonary bypass, and may improve the postoperative course through inhibition of reperfusion injury such as myocardial stunning and hemodynamic instability.

Clinical Study of 80 Cases of Mitral Valve Operations Via Extended Transseptal Approach / 대한흉부외과학회지

BACKGROUND: Among the various techniques for the adequate exposure of the mitral valve, the extended transseptal approach is the essential prerequisite for accurate repair or replacement of the mitral apparatus. But the efficacy and safty of the extended transseptal approach has not determined in Korea yet. MATERIALS AND METHODS: Retrospective data of 80 consecutive patients, operated from September 1992 to July 1997 were reviewed. Seventy- eight patients underwent mitral valve replacement and 2 patients underwent excision of left atrial myxoma. Thirty-eight of 78 patients had other concomitant procedures such as aortic valve replacement (n=22), tricuspid annulopasty (n=14), coronary artery bypass graft (n=1) and closure of ventricular septal defect (n=1). Mean follow up was 23.3+/-15.0 months and total follow up was 1792 patient-months. RESULTS: The hospital mortality rate was 3.8% (3 patients). Two deaths were due to low cardiac output and one due to postoperative bleeding of coagulopathy. Among the 46 patients who had atrial fibrillation preoperatively, 45 had atrial fibrillation postoperatively and 1 converted to sinus rhythm. All 34 patients who were in normal sinus rhythm preoperatively remained in sinus rhythm after the operation. Mean aortic cross clamping time was 62 minutes for isolated mitral procedure and 90 minutes for concomitant procedures. There were no specific complications related to this approach. CONCLUSIONS: We suggest that the extended transseptal approach is an easy and good method for mitral valve surgery, especially in patients with small sized left atrium.