ABSTRACT
BACKGROUND: Acute respiratory distress syndrome (ARDS) is characterized by severe inflammatory pulmonary edema of unknown pathogenesis. To investigate the pathogenesis of ARDS associated with neutrophilic oxidative stress, the role of phospholipase A2 (PLA2) was evaluated by the inhibition of calcium channel. METHODS: In Sprague-Dawley rats, acute lung injury (ALI) was induced by the instillation of E.coli endotoxin (ETX) into the trachea. At the same time, diltiazem was given 60 min prior to tracheal instillation of ETX. Parameters of ALI such as lung and neutrophil PLA2, lung myeloperoxidase (MPO), BAL neutrophils, protein, surfactant were measured. Production of free radicals from neutrophils was measured also. Morphological studies with light microscope and electron microscope were carried out and electron microscopic cytochemistry for detection of free radicals was performed also. RESULTS: Diltiazem had decreased the ALI parameters effectively in ETX given rats and decreased the production of free radicals from neutrophils and lung tissues. Morphological studies denoted the protective effects of diltiazem. CONCLUSION: Diltiazem, a calcium channel blocker, was effective in amelioration of ALI by the suppression of neutrophilic oxidative stress mediated by PLA2 activation.
Subject(s)
Animals , Rats , Acute Lung Injury , Calcium Channels , Diltiazem , Free Radicals , Histocytochemistry , Lung , Neutrophils , Oxidative Stress , Peroxidase , Phospholipases A2 , Pulmonary Edema , Rats, Sprague-Dawley , Respiratory Distress Syndrome , TracheaABSTRACT
A 45 year-old man who suffered with palpitation and dyspnea for 3 years visited our hospital. He was dianosed as mitral insufficieny due to isolated cleft mitral valve in anterior mitral leaflet on the basis of transthoracic echocardiogram In our case edges of the cleft were relatively thin and smooth. The entire length of the cleft was sutured with 5-0 Prolene(R) interrupted sutures. We report a case of direct suture repair in a patient with isolated cleft in anterior mitral valve leaflet.
Subject(s)
Humans , Middle Aged , Dyspnea , Mitral Valve Insufficiency , Mitral Valve , SuturesABSTRACT
Primary cardiac lymphoma is an extranodal malignant lymphoma of any cell type involving only heart and pericardium without dissemination. Patients usually present symptoms of heart failure, arrhythmias, pericardial effusion and cardiac tamponade. Diagnosis of primary cardiac lymphoma can be performed by echocardiogram, CT and MRI and cytologic examination of pericardial effusion or transvenously biopsied cardiac tissue. Prognosis of primary cardiac lymphoma is poor. Because of poor prognosis, early diagnosis and complete surgical excision is essential and postoperative systemic chemotherapy or radiotherapy is useful. In this case extensive tumor infiltration on the right ventricle and atrioventricular groove preclude surgical excision. Tissue biopsy revealed primary cardiac lymphoma. After postoperative chemotherapy and radiotherapy, the size of intracardiac mass is decreased in follow up chest CT scan and echocardiogram and symptoms of patient are relieved. Therefore, we report a case of primary cardiac lymphoma with review of literatures.
Subject(s)
Humans , Arrhythmias, Cardiac , Biopsy , Cardiac Tamponade , Diagnosis , Drug Therapy , Early Diagnosis , Follow-Up Studies , Heart , Heart Failure , Heart Neoplasms , Heart Ventricles , Lymphoma , Lymphoma, Non-Hodgkin , Magnetic Resonance Imaging , Pericardial Effusion , Pericardium , Prognosis , Radiotherapy , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: In an attempt to investigate the role of oxidants in the activation of phospholipase A2(PLA2) and endogenous oxidative stress in the lung, acute inflammatory lung injury was induced by the instillation of hydrogen peroxide into the trachea of Sprague-Dawley rats. MATERIAL AND METHOD: To prove the hypothesis that released oxidants from neutrophils activate the PLA2 retrogradely, activities of PLA2 and lysoplatelet activating factor acetyltransferase(lysoPAF AT) were assayed 5 hours after instillation of hydrogen peroxide. In addition, to confirm the impairing effects of the activation of PLA2 associated with endogenous oxidative stress, lung weight/body weight ratio(Lx10(-3)/B), protein contents(mg/two lungs) in bronchoalveolar lavage(BAL) were measured. As neutrophilic respiratory burst has been known to play a pivotal role in the genesis of endogenous oxidative stress associated with acute inflammatory lung injury, BAL neutrophils counts and level of lung myelperoxidase(MPO) were measured after hydrogen peroxide insult. Morphological and histochemical studies were also performed to identify the effect of the endogenous oxidative stress. RESULT: Five hours after hydrogen peroxide instillation, lungs showed marked infiltration of neutrophils and increased weight. Protein contents in BAL increased significantly compared to those of normal rats. PLA2 activity was enhanced in the hydrogen peroxide instilled group. Interestingly, the accelerated production of platelet activating factor(PAF) was confirmed by the increased activity of lysoPAF AT in the H2O2 employed lung. Morphologically, light microscopic findings of lungs after instillation of hydrogen peroxide showed atelectasis and infiltration of inflammatory cells, which was thought to be caused by lipid mediators produced by PLA2 activation. In cerium chloride cytochemical electron microscopy, dense deposits of cerrous perhydroxide were identified. In contrast, no deposit of cerrous perhydroxide was found in the normal lung. CONCLUSION: As all these findings were consistent with the lung injury caused by neutrophilic oxidative stress, it is suggested that the activation of PLA2 by oxidants might participate in the genesis of endogenous oxidative stress. Collectively, the positive feedback loop between oxidative stress and PLA2 activation may participate in the pathogenesis of Adult Respiratory Distress Syndrome(ARDS).
Subject(s)
Adult , Animals , Humans , Rats , Acute Lung Injury , Blood Platelets , Cerium , Hydrogen Peroxide , Hydrogen , Lung , Lung Injury , Microscopy, Electron , Neutrophils , Oxidants , Oxidative Stress , Phospholipases A2 , Phospholipases , Pulmonary Atelectasis , Rats, Sprague-Dawley , Respiratory Burst , TracheaABSTRACT
Lung cancer with pleural seeding has poor prognosis and is generally treated by intravenous anticancer chemotherapy only. We performed intrapleural perfusion hyperthermic-chemotherapy in two lung cancer patients with pleural seeding. Herein, we report our outcome with literature review.
Subject(s)
Humans , Drug Therapy , Hyperthermia, Induced , Lung Neoplasms , Lung , Neoplasm Seeding , Perfusion , Pleural Effusion , Pleurodesis , PrognosisABSTRACT
No abtract available.
ABSTRACT
Pulmonary arteriovenous malformation (PAVM) is an uncommon congenital anomaly. As PAVM is a direct communication between branches of the pulmonary artery and vein, severe hypoxemia, paradoxical embolism, and massive hemorrhage can result. We present a 39-year-old woman with severe hypoxemia after the induction of one lung ventilation (OLV) for resection of a PAVM in her right lower lobe. We analyzed the cause of hypoxemia by an arterial blood gas analysis and estimated shunt equation. The preoperative value of an intrapulmonary shunt (Qs/Qt) was 15%. However, after the OLV, the values of Qs/Qt increased to 48% with 92.1% arterial oxygen saturation (SaO2). After the resection of PAVM, the value of Qs/Qt decreased to 36% during the OLV, and postoperative value of Qs/Qt and SaO2 were in the normal range. These findings represent that PAVM patients are prone to severe hypoxemia and an abnormally high Qs/Qt, which might be induced by the increase of pulmonary vascular resistance during OLV.
Subject(s)
Adult , Female , Humans , Hypoxia , Arteriovenous Malformations , Blood Gas Analysis , Embolism, Paradoxical , Hemorrhage , One-Lung Ventilation , Oxygen , Pulmonary Artery , Reference Values , Vascular Resistance , VeinsABSTRACT
BACKGROUND: Surgical correction of partial anomalous pulmonary venous connection to the superior vena cava has been associated with postoperative venous obstruction and sinus node dysfunction. In this paper we describe our current approach and its short-term results. MATERIAL AND METHOD: Between April 1999 and January 2000, 5 consecutive patients, ranging from 2 months to 66 years old, underwent corrective operation for partial anomalous pulmonary venous connection to the superior vena cava at Sejong General Hospital and Daegu Catholic University Medical Center. Surgical correction involved diversion of the pulmonary venous drainage to the left atrium using a right atrial flap(2 patients) or prosthetic patch(3 patients) with division of the superior vena cava superior to the entrance site of the pulmonary veins and reimplantation on the right atrial appendage to restore systemic venous drainage. RESULT: All patients were discharged between postoperative day 9 and 15 without complications. One Russian boy returned to his country, therefore, he was lost to follow-up after discharge. Remaining 4 patients were asymptomatic and in normal regular sinus rhythm at a mean follow-up of 17.75+/-4.27 months. Follow-up echocardiographic study (range, 12 to 24 months) revealed no incidence of narrowing of the venous pathways or of residual shunt. CONCLUSION: Our current approach is relatively simple and reproducible in achieving unobstructive pulmonary venous and SVC pathways. By avoiding incision across the cavoatrial junction, surgical injury to the sinus node and its artery may be minimized. The presented surgical technique can be safely and effectively applied to the selected patients.
Subject(s)
Aged , Humans , Male , Academic Medical Centers , Anastomosis, Surgical , Arteries , Atrial Appendage , Drainage , Echocardiography , Follow-Up Studies , Heart Atria , Hospitals, General , Incidence , Intraoperative Complications , Lost to Follow-Up , Pulmonary Veins , Replantation , Sick Sinus Syndrome , Sinoatrial Node , Vena Cava, SuperiorABSTRACT
Descending necrotizing mediastinitis (DNM) is one of the most lethal form of mediastinitis originating from an oropharyngeal infection. It requires an early and aggressive sugical treatment, but the operative approach and optimal form of mediastinal drainage remains controversial. We report a case of DNM in a 45-year-old male who underwent right cervicomediastinotomy to drain the deep neck space, upper mediastinum and anterior mediastinal drainage was accomplished through a subxiphoid approach. After this procedure, he steadily improved and was dischrged on hospital day 36. We report this case with a brief review of the literature.
Subject(s)
Humans , Male , Middle Aged , Drainage , Mediastinitis , Mediastinum , NeckABSTRACT
A case of primary malignant fibrous histiocytoma(MFH) of the lung occurring in a 62-year-old man is presented. After preoperative bronchial brushing and washing cytologic diagnosis of poorly differentiated carcinoma, surgical resection and lymph nodes dissection were performed. Subsequent histologic examination revealed a primary MFH. The diagnosis was confirmed by electron microscopic and immunohistochemical examinations. The review of the bronchial brushing and washing cytologic features disclosed many bipolar and a few unipolar spindle tumor cells with a "comet" configuration, mainly single cells, but also forming loose clusters. The nuclei were elongated and hyperchromatic and contained one or more irregular nucleoli. Scattered bizarre, multinucleated tumor giant cells were also present.
Subject(s)
Humans , Middle Aged , Diagnosis , Giant Cells , Histiocytoma, Malignant Fibrous , Lung , Lymph NodesABSTRACT
BACKGROUND: To investigate epidemiology of a specific strain, and evaluate correlation between Mycobacterium tuberculosis restriction fragment length polymorphism (RFLP) and antimicrobial susceptibility, we studied about Mycobacterium tuberculosis RFLP isolated from Taegu area. METHODS: From Oct. 1997 and Mar. 1999, we isolated 54 strains of M. tuberculosis from the patients visiting Catholic University of Taegu Hyosung, Taegu, Korea. We studied their drug susceptibility and analyzed the Pvu treated RFLP using digoxigenin labeled IS6110 probe. RESULTS: Fifty-three had more than 6 bands of RFLP and strains with 10 bands were predominant (15 strain). Cluster analysis reveals eleven distinct clusters showing 57.4% of clustered rate (31 strains from A to K) and 35 independent patterns showing 64.8% of the diversity rate at 70% similarity level. Cluster A was the largest group (7 strains) and the next was cluster B (5 strains). Most of the patients with cluster A lived in Taegu city (85.7%) and all of 2 cluster K patients lived in Euisung area. There was no correlation between RFLP pattern and antimicrobial susceptibility, but all two strains of cluster H were resistant to isoniazid. Strains of clustered were also prevalent in the people of middle class. CONCLUSIONS: Compared to the RFLP analysis in the developed countries, Korea disclosed lower rate of diversity and higher clustered patterns of M. tuberculosis. The clustered strains were also prevalent among the people of middle class.
Subject(s)
Humans , Developed Countries , Digoxigenin , Epidemiology , Isoniazid , Korea , Mycobacterium tuberculosis , Mycobacterium , Polymorphism, Restriction Fragment Length , TuberculosisABSTRACT
We experienced a case of Trichosporon beigelii esophagitis in a 16-month-old boy who was presented with hematemesis with a large amorphous material. A spit-out material was silky, 10 x 1.2 cm in size and like a part of hollow viscus organ. Emergent gastrofiberscopy revealed that this silky material was teared up from upper and to lower esophagus and was threw with hematemesis. It was suggested that pseudomembrane on esophagus was peeled off followed by mucosal bleeding. Pathologic study revealed this material was pseudomembrane with esophageal mucosa of T. beigelii esophagitis and was teared at lamina propria level from submucosa.
Subject(s)
Humans , Infant , Male , Esophagitis , Esophagus , Hematemesis , Hemorrhage , Mucous Membrane , TrichosporonABSTRACT
BACKGROUND: Post-pneumonectomy empyema(PPE) is an uncommon but a serious complication. The management remains as challenge for general thoracic surgeons. MATERIAL AND METHOD: During the period of January 1990 to December 1996, we evaluated the results of 20 patients with post-pneumonectomy empyema. RESULT: Sex ratio were 15 male and 5 female patients with mean age of 41.5+/-21.5 yrs. The occurrence ratio of left to right side was 8:12. The most common disease for prior pneumonectomy was pulmonary tuberculosis. The duration between pneumonectomy and PPE was variable in 1 month to 6yrs. Fever was the most frequent symptom and S. aureus was the most frequent pathogen. In 13 cases, there were combined with BPF. Four patients underwent trans-sternal closure, and Clagett procedure was performed. There was one recurrence that later underwent muscle plombage and omentopexy later. Nine patients underwent omentopexy, muscle plombage and thoracoplasty. There were 7 cases that were not combined with BPF. All 7 patients underwent thoracoplasty, and two of them were combined with muscle plombage. Mean follow-up duration is 40+/-32.3 months. There were no late deaths nor recurrences of PPE. CONCLUSION: We conclude that early diagnosis and proper drainage in PPE patients are important in its initial stage of management, and also management is completely achieved in thoracoplasty with muscle plombage or omentopexy.
Subject(s)
Female , Humans , Male , Drainage , Early Diagnosis , Empyema , Fever , Follow-Up Studies , Pneumonectomy , Recurrence , Sex Ratio , Thoracoplasty , Tuberculosis, PulmonaryABSTRACT
BACKGROUND: As living and dead Mycobacteria could be amplified by polymerase chain reaction(PCR), it was considered that PCR was inappropriate for the monitoring of pulmonary tuberculosis after treatment. But we found negative conversion of PCR after successful treatment. We would like to know about the negative conversion rate of PCR and its conversion time after antituberculous treatment. METHODS: We collected 113 sputums from the 16 patients of pulmonary tuberculsosis visiting Catholic University Hospital of Taegu Hyosung. We consecutively tested AFB smear, AFB culture and PCR by 2 to 4 weeks after antituberculous therapy. The patients were classified according 13 the chest X ray findings. RESULTS: We detectsd negative conversion of PCR from all 16 patients of the pulmonary tuberculosis within 30 weeks after treatment. The average negative conversion time was 16 +/- 8 weeks. The conversion time according to the chest X-ray findings were as follows : For the 8 cases of minimum were 9 +/- 5 weeks,4 cases of modreate advanced were 20 +/- 8 weeks, and 4 cases of far advanced were 23 +/- 2 weeks. The product of PCR was gradually decreased according to the duration of treatment. CONCLUSIONS: From the results of our study, we could utilize M. tubercuosis PCR for the prediction of therapy response and monitoring of the patient with pulmonary tuberculosis after treatment.
Subject(s)
Humans , Polymerase Chain Reaction , Sputum , Thorax , Tuberculosis, PulmonaryABSTRACT
We reviewed data of 64 patients who underwent reoperation because of prosthetic valve malfunction from January 1991 to December 1995. The indications for reoperation were prosthetic valve failure(primary tissue failure: 53 patients, 82.8%), prosthetic valve thrombosis(6 patients, 9.4%), paravalvular leak(3 patients, 4.7%), prosthetic valve endocarditis(2 patients, 3.6%). Prosthetic valve failure developed most frequently in mitral portion(40 patients, 75%), prosthetic valve thrombosis also in mitral portion(4 patients, 67%), paravalvular leak significantly in aortic portion(3 patients, 100%). Explant period was longest in prosthetic valve failure(mean 107.4+/-24.6 months), shortest in prosthetic valve endocarditis with prosthetic valve thrombosis(1 patient, 1 month). Mean explant period, defined as from first valve replacement operation to redo-valve replacement operatopn, was 109.2+/-10.7 months in mitral portion, 97.8+/-10.4 months in aortic portion, 109.5+/-10.4 months in total. Overall hospital mortality was 9.38%. The most common cause of death was the low cardiac output(4 patients), other causes were bleeding(1 patient), CNS injury(1 patient). Preoperative NYHA class IV(P=0.011), emergency operation(P=0.011), prosthetic valve endocarditis(P=0.001) were the independent risk factors, but age, sex, explant period, ACC time, double valve replacement, valve position, second reoperation did not appear to be significant risk factors. Mean follow up period was 28.8+/-17.8 months. Actuarial survival at 3 year was 92.0+/-6.2%, 2 year event-free survival was 84.3+/-6.1%. We propose that patients undergoing reoperation because of prosthetic valve failure are carfully controlled and selected in regarding to above mentioned risk factors - NYHA class IV, emergency operation, prosthetic valve endocarditis in preoperative state. About other risk factors possible, there is necessary of following study.
Subject(s)
Humans , Cause of Death , Disease-Free Survival , Emergencies , Endocarditis , Follow-Up Studies , Heart Valve Prosthesis , Heart Valves , Heart , Hospital Mortality , Reoperation , Risk Factors , ThrombosisABSTRACT
No abstract available.
ABSTRACT
No abstract available.