Upregulation of receptor tyrosine kinase-like orphan receptor 2 in idiopathic pulmonary fibrosis

Background/Aims@#Receptor tyrosine kinase-like orphan receptor 2 (ROR2) is a major regulator of Wnt signaling, which is involved in fibroblast dysfunction. Because its role has not been evaluated in idiopathic pulmonary fibrosis (IPF), we examined the clinical implications of ROR2 expression. @*Methods@#ROR2 mRNA expression was measured using reverse transcription polymerase chain reaction in lung tissue-derived fibroblasts from IPF patients (n = 14) and from controls (n = 10). ROR2 protein was measured using enzyme-linked immunosorbent assay in primary fibroblasts from IPF patients (n = 14) and controls (n = 10), and in bronchoalveolar lavage (BAL) fluids obtained from normal controls (NC; n = 30). IPF patients (n = 84), and other patients with interstitial lung diseases, including nonspecific interstitial pneumonia (NSIP; n = 10), hypersensitivity pneumonitis (HP; n = 10), and sarcoidosis (n = 10). @*Results@#ROR2 mRNA and protein levels were significantly higher in IPF fibroblasts than in controls (p = 0.003, p = 0.0017, respectively). ROR2 protein levels in BAL fluids from patients with IPF were significantly higher than in those from NC (p < 0.001), and from patients with NSIP (p = 0.006), HP (p = 0.004), or sarcoidosis (p = 0.004). Receiver operating characteristic curves showed a clear difference between IPF and NC in ROR2 protein level (area under the curve, 0.890; confidence interval, 0.829 to 0.950; p < 0.001). ROR2 protein levels were significantly higher in GAP stage III than in GAP stages I and II (p = 0.016). @*Conclusions@#ROR2 may be related to the development of IPF, and its protein level may be a useful and severity-dependent candidate marker for IPF.

Upregulation of receptor tyrosine kinase-like orphan receptor 2 in idiopathic pulmonary fibrosis

Background/Aims@#Receptor tyrosine kinase-like orphan receptor 2 (ROR2) is a major regulator of Wnt signaling, which is involved in fibroblast dysfunction. Because its role has not been evaluated in idiopathic pulmonary fibrosis (IPF), we examined the clinical implications of ROR2 expression. @*Methods@#ROR2 mRNA expression was measured using reverse transcription polymerase chain reaction in lung tissue-derived fibroblasts from IPF patients (n = 14) and from controls (n = 10). ROR2 protein was measured using enzyme-linked immunosorbent assay in primary fibroblasts from IPF patients (n = 14) and controls (n = 10), and in bronchoalveolar lavage (BAL) fluids obtained from normal controls (NC; n = 30). IPF patients (n = 84), and other patients with interstitial lung diseases, including nonspecific interstitial pneumonia (NSIP; n = 10), hypersensitivity pneumonitis (HP; n = 10), and sarcoidosis (n = 10). @*Results@#ROR2 mRNA and protein levels were significantly higher in IPF fibroblasts than in controls (p = 0.003, p = 0.0017, respectively). ROR2 protein levels in BAL fluids from patients with IPF were significantly higher than in those from NC (p < 0.001), and from patients with NSIP (p = 0.006), HP (p = 0.004), or sarcoidosis (p = 0.004). Receiver operating characteristic curves showed a clear difference between IPF and NC in ROR2 protein level (area under the curve, 0.890; confidence interval, 0.829 to 0.950; p < 0.001). ROR2 protein levels were significantly higher in GAP stage III than in GAP stages I and II (p = 0.016). @*Conclusions@#ROR2 may be related to the development of IPF, and its protein level may be a useful and severity-dependent candidate marker for IPF.

Pneumomediastinum and Subcutaneous Emphysema after Use of a High-Speed Dental Handpiece

Subcutaneous facial emphysema after dental treatment is an uncommon complication caused by dental procedures. However, in severe cases, it can spread to the neck, mediastinum, and thorax, resulting in pneumomediastinum and pneumothorax. Here we report two cases of subcutaneous emphysema and pneumomediastinum after dental treatment using an air-compressed, high-speed dental handpiece. We describe the diagnosis and treatment of iatrogenic pneumomediastinum.

Two-stage Surgery for an Aortoesophageal Fistula Caused by Tuberculous Esophagitis

An aortoesophageal fistula (AEF) is an extremely rare, potentially fatal condition, and aortic surgery is usually performed together with extracorporeal circulation. However, this surgical method has a high rate of surgical complications and mortality. This report describes an AEF caused by tuberculous esophagitis that was treated successfully using a two-stage operation. A 52-yr-old man was admitted to the hospital with severe hematemesis and syncope. Based on the computed tomography and diagnostic endoscopic findings, he was diagnosed with an AEF and initially underwent thoracic endovascular aortic repair. Esophageal reconstruction was performed after controlling the mediastinal inflammation. The patient suffered postoperative anastomotic leakage, which was treated by an endoscopic procedure, and the patient was discharged without any further problems. The patient received 9 months of anti-tuberculosis treatment after he was diagnosed with histologically confirmed tuberculous esophagitis; subsequently, he was followed as an outpatient and has had no recurrence of the tuberculosis or any further issues.

Bypass Using Autologous Pericardium in the Inflammatory Pseudotumor of the Superior Vena Cava

Among the causes of superior vena cava (SVC) syndrome, intraluminal tumor, especially the inflammatory pseudotumor is very rare. We report a 33-year old male patient who had been suffering from facial edema and flushing for 3 weeks before admission. On physical examination, facial edema and venous engorgement on upper extremities and upper chest wall were showed. The chest computed tomography (CT) scan showed a long intraluminal mass lesion resulting in a near total obstruction of the SVC. Surgery was performed through median sternotomy. After complete resection of the tumor, we make bypass of SVC with autologous pericardium. The follow up chest CT scan revealed no abnormality 3 months after the operation.

Surgical Treatment of Thoracic Desmoid Tumors: 2 case reports / 대한흉부외과학회지

Desmoid tumor is histologically benign, but this tumor is clinically considered to be malignant. Surgical resection is one of the most effective therapeutic options for patients with this tumor and resection is the best choice for cases of recurrence. We experienced two cases of recurrence of thoracic desmoid tumor, and the patients were repeatedly treated by surgical resection. The patients were discharged without any complications, and careful follow up has been performed periodically. Therefore, we report on these cases of recurrent desmoid tumor along with a review of the related literature.

Endovascular Repair of Acute Type B Aortic Dissection: The Early Results and Aortic Wall Changes / 대한흉부외과학회지

BACKGROUND: This study assessed the early results of endovascular repair of acute type B aortic dissection and the aortic wall changes following endovascular repair. MATERIAL AND METHOD: From July 2008 to May 2009, the preoperative and follow-up computed tomography (CT) scans of 5 patients with acute type B aortic dissection were evaluated, and these patients had underwent stent graft implantation within 13 days of the onset of dissection (mean: 7 days; range: 3~13). The whole lumen (WL), true lumen (TL) and false lumen (FL) diameters were measured at the proximal (p), middle (m) and distal (d) third of the descending thoracic aorta. RESULT: The study included four men and one woman with an average age of 59.4+/-20.1 years (age range: 37~79 years). The follow-up CT was performed and evaluated at 7 days and 6 months. The primary tear was completely sealed in all the patients. No paraplegia, paresis or peripheral ischemia occurred and none of the patients died. No endoleaks developed in any of the patients during follow-up. The TL diameters increased from 20.4 to 33.5 mm in the proximal third (p/3), from 19.5 to 29.8 mm in the middle third (m/3) and from 15.2 to 23.5 mm in the distal third (d/3). The FL diameters decreased from 18.7 to 0 mm in the p/3, from 15.4 to 0 mm in the m/3 and from 21.4 to 8.7 mm in the d/3. The changes in the TL diameter were statistically significant in the middle and distal aorta, and those changes in the FL diameter were not statistically significant. There was a decrease in the WL after repair, but this was not statistically significant. In three patients, the false lumen disappeared completely on follow-up CT at 6 months. Two patients had patent false lumens and no thrombosis. CONCLUSION: The early results showed that endovascular repair was effective in treating acute type B aortic dissection, and endovascular repair promoted positive aortic wall changes.

Low Dose Spinal Anesthesia for Ambulatory Surgery of Varicose Vein / 대한흉부외과학회지

\BACKGROUND: Bupivacaine with fentanyl might be suitable as the spinal anesthesia for performing ambulatory surgery to treat varicose vein. MATERIAL AND METHOD: Thirty patients who underwent spinal anesthesia for a varicose vein operation were enrolled in this study. They were classified into 2 groups of either fentanyl 25 ug mixed with bupivacaine 4 mg (group FB4) or bupivacaine 8 mg (group B8). We compared the groups for the success of the analgesia, the recovery time from sensory and motor block, the side effects and the postoperative complications. RESULT: The groups did not differ significantly regarding the success of analgesia (13 of 15 [group FB4], 15 of 15 [group B8]). None of the patients were converted to general anesthesia due to surgical pain. None of the patients required medication for hypotension and/or bradycardia. The operative and nonoperative side effects of motor block (tested for by using a modified Bromage scale) was significantly lower in group FB4 than that in group B8, as checked at 2 hours after spinal anesthesia (p<0.05). Recovery from spinal block was significantly quicker in group FB4 than that in group B8 (p<0.05). The first voluntary micturition time did not differ significantly (6.5 hours v 4.5 hours [p=0.143]) between the groups, but a nelatone catheter was inserted into 2 of the group B8 patients due to dysuria. CONCLUSION: Adequate intraoperative analgesia and hemodynamic stability and faster mobilization were achieved using bupivacaine 4 mg with fentanyl 25 ug. Low dose spinal anesthesia with fentanyl is suitable for performing ambulatory surgery to treat varicose vein.

Hybrid Endovascular Operation for Aorto-Iliac Artery Aneurysm: A case report / 대한흉부외과학회지

Aorto-iliac artery aneurysms are very rare and the natural course of this disease is not well known. However, the risk of rupture is high and the mortality rate after rupture is extremely high. Preserving the pelvic circulation is important for the treatment of aorto-iliac artery aneurysms. We report here on a case of a patient suffering with aorto-iliac artery aneurysms, and these were treated by a hybrid endovascular operation that combined an open bypass of both iliac vessels with endovascular repair.

Interleukin-13 and Its Receptors in Idiopathic Interstitial Pneumonia: Clinical Implications for Lung Function

Idiopathic interstitial pneumonia (IIP) is characterized by varying degrees of interstitial fibrosis. IL-13 and IL-4 are strong inducers of tissue fibrosis, whereas IFN-gamma has antifibrotic potential. However, the roles of these substances in IIP remain unknown. IL-13, IL-4, and IFN-gamma were measured in the BAL fluid of 16 idiopathic pulmonary fibrosis (IPF) patients, 10 nonspecific interstitial pneumonia (NSIP) patients, and 8 normal controls. The expression of IL-13 and IL-13Ralpha1/alpha2 in lung tissues was analyzed using ELISA and immunohistochemistry. IL-13 levels were significantly higher in IPF patients than the others (P<0.05). IL-4 levels were higher in both IPF and NSIP patients than in normal controls (P<0.05), and IFN-gamma levels were lower in NSIP patients than in normal controls (P=0.047). IL-13 levels correlated inversely with FVC% (r=-0.47, P=0.043) and DLCO% (r=-0.58, P=0.014) in IPF and NSIP patients. IL-13 was strongly expressed in the smooth muscle, bronchial epithelium, alveolar macrophages and endothelium of IPF patients. IL-13Ralpha1, rather than IL-13Ralpha2, was strongly expressed in the smooth muscle, bronchial epithelium, and endothelium of IPF patients. IL-13 and its receptors may contribute to the pathogenesis of fibrosis in IIP and appear to be related to the severity of the disease.

Comparative Analysis of Surgical Thrombectomy with Revision and Percutaneous Thrombectomy with Angioplasty for Treating Obstruction of a Dialysis Graft / 대한흉부외과학회지

BACKGROUND: Salvaging prosthetic arteriovenous grafts can be performed using surgical or endovascular techniques. We conducted a retrospective analysis to compare the efficacy of these two methods for restoring dialysis graft function. MATERIAL AND METHOD: We studied 41 patients who had received surgical thrombectomy with revision (Group A) or percutaneous thrombectomy with angioplasty (Group B) from January 2006 to December 2007. We compared them according to the patient characteristics and the location of stenotic lesions, and we analyzed the postintervention primary patency rates. RESULT: 21 patients underwent surgery and 20 patients underwent percutaneous balloon angioplasty. There were no significant differences of the patients' characteristics between the two groups. Venous anastomotic stenosis was the most common cause of graft thrombosis in both groups. In Group A, 90.5% of the grafts remained functional at 6 months and 38.1% remained functional at 12 months. In Group B, 55.0% of the grafts were functional at 6 months and 20.0% of the grafts were functional at 12 months. The post-intervention primary patency rate was significantly better in Group A (p=0.034). CONCLUSION: Surgical treatment resulted in significantly longer post-intervention primary patency in this study, and this supports its use as the primary method of management for most patients in whom dialysis graft obstruction develops.

Treatment of a Nail in the Intestine after a Neck Injury from Accidental Firing of the Nail Gun: A case report / 대한흉부외과학회지

A 42-year-old male was admitted because of an anterior neck injury due to accidental firing of a nail gun. On chest X-ray, the nail was stuck in the anterior neck, migrated to the chest, and then to the abdomen. Only the trachea was damaged, leaving no injury in the esophagus. The nail in the intestine was removed by colonoscopy. The patient showed complete recovery without complications after fasting and conservative treatment. We report this case with a literature review.

A Forgotten Surgical Gauze after Surgery that Mimicked Aspergilloma: A case report / 대한흉부외과학회지

A 55-year-old male presented with intermittent cough and blood-tinged sputum. 35 years earlier in the Army Armed Forces, he had undergone lung surgery of the right upper lobe because of tuberculosis. Chest CT showed a mass-like lesion with an internal air-meniscus sign in the right lung. The mass was 5x7 cm in the right upper lobe and it was a well marginated lesion. The resected mass contained a foreign body, that is, a retained surgical gauge. Herein we report on a rare case of retained gauze after surgery that mimicked aspergilloma.

Veno-veno Bypass for Central Vein Occlusion in Hemodialysis Patients: Two cases report

Central venous stenosis or occlusion is a serious complication in end-stage renal disease patients undergoing maintenance hemodialysis. It is mostly secondary to trauma caused by temporary or permanent hemodialysis catheter placement. Venous hypertension may cause pain, edema of the ipsilateral arm and increased venous pressure prevents acceptable flow rates during dialysis. Venous bypass to the internal jugular vein, the external jugular vein, or axillary vein to saphenous vein bypass have been described as alternative options of surgical management. Our patients underwent internal jugular vein bypass. We think it is an effective and low risk surgical option.

Surgical Resection of Renal Cell Carcinoma Extended to the Inferior Vena Cava Using Pump Driven Veno-venous Bypass / 대한흉부외과학회지

In a 46 year-old man who has complained of epigastric pain and dyspnea for 10 days including melena for 1 month, abdominal ultrasonography and computerized tomography revealed a large, solid mass in the right kidney and thrombus of inferior vena cava (IVC) that extended to the cavoatrial junction. Renal cell carcinoma was performed by percutaneous needle biopsy. IVC thromboembolectomy was performed using centrifugal pump driven veno-venous bypass without cardiac arrest and cardiopulmonary bypass (CPB).

The Comparative Study of on Pump CABG during Pulsatile (T-PLS(TM)) and Nonpulsatile (Bio-pump(TM)) Perfusion / 대한흉부외과학회지

BACKGROUND: Pulsatile pumps for extracorporeal circulation have been known to be better for tissue perfusion than non-pulsatile pumps but be detrimental to blood corpuscles. This study is intended to examine the risks and benefits of T-PLS(TM) through the comparison of clinical effects of T-PLS(TM) (pulsatile pump) and Bio-pump(TM) (non-pulsatile pump) used for coronary bypass surgery. MATERIAL AND METHOD: The comparison was made on 40 patients who had coronary bypass using T-PLS(TM) and Bio-pump(TM) (20 patients for each) from April 2003 to June 2005. All of the surgeries were operated on pump beating coronary artery bypass graft using cardiopulmonary extra-corporeal circulation. Risk factors before surgery and the condition during surgery and the results were compared. RESULT: There was no significant difference in age, gender ratio, and risk factors before surgery such as history of diabetes, hypertension, smoking, obstructive pulmonary disease, coronary infarction, and renal failure between the two groups. Surgery duration, hours of heart-lung machine operation, used shunt and grafted coronary branch were little different between the two groups. The two groups had a similar level of systolic arterial pressure, diastolic arterial pressure and mean arterial pressure, but pulse pressure was measured higher in the group with T-PLS(TM) (46+/-15 mmHg in T-PLS(TM) vs 35+/-13 mmHg in Bio-pump(TM), p<0.05). The T-PLS(TM)-operated patients tended to produce more urine volume during surgery, but the difference was not statistically significant (9.7+/-3.9 cc/min in T-PLS(TM) vs 8.9+/-3.6 cc/min in Bio-pump(TM), p=0.20). There was no significant difference in mean duration of respirator usage and 24-hour blood loss after surgery between the two groups. Plasma free Hb was measured lower in the group with T-PLS(TM) (24.5+/-21.7 mg/dL in T-PLS(TM) versus 46.8+/-23.0 mg/dL in Bio-pump(TM), p<0.05). There was no significant difference in coronary infarction, arrhythmia, renal failure and morbidity rate of cerebrovascular disease. There was a case of death after surgery (death rate of 5%) in the group tested with T-PLS(TM), but the death rate was not statistically significant. CONCLUSION: Coronary bypass was operated with T-PLS(TM) (Pulsatile flow pump) using a heart-lung machine. There was no unexpected event caused by mechanical error during surgery, and the clinical process of the surgery was the same as the surgery for which Bio-pump(TM) was used. In addition, T-PLS(TM) used surgery was found to be less detrimental to blood corpuscles than the pulsatile flow has been known to be. Authors of this study could confirm the safety of T-PLS(TM).

The Necessity for Coronary Angiography in Atherosclerotic Arterial Obstruction in the Lower Extremities and the Clinical Features of Accompanied Coronary Arterial Diseases / 대한흉부외과학회지

BACKGROUND: Peripheral arterial disease is frequently accompanied with systemic arteriosclerosis and more than half of the cause of deaths is due to the development of coronary arterial disease. Moreover, it is known that the most frequent cause of death after a bypass surgery of chronic arterial obstruction is heart related complications. Especially in patients with atherosclerotic arterial obstruction in the lower extremities who had no history of heart disease or had no presenting symptoms of ischemic heart disease showed a high rate of postoperative mortality and for this reason we suggest preoperative evaluation in these patients to evaluate whether or not coronary arterial disease is accompanied. MATERIAL AND METHOD: Since Feb. 2001 to Oct. 2004, we analyzed 52 patients who were operated on for atherosclerotic arterial obstruction in the lower extremities, with the exception of patients with a past history of heart disease or symptoms of ischemic heart disease. They underwent on the same day a coronary and femoral angiography for evaluation of accompanying coronary arterial disease. Of among these patients, we compared those who received bypass surgery of the arteries of the peripheral extremities alone to those who underwent combined coronary artery bypass surgery. RESULT: 63% of the reported cases of atherosclerotic arterial obstruction in the lower extremities were accompanied with coronary arterial disease. Old age, hypertension, diabetes mellitus, smoking, and hypercholesterolemia are known risk factors for arteriosclerosis and of these, only old age and hypertension had statistically significance in patients with severe atherosclerotic arterial obstruction in the lower extremities accompanied with coronary arterial disease. Diabetes, smoking, and hypercholesterolemia showed no statistical significance in this group. With the increase in severity of the range and the degree of atherosclerotic arterial obstruction, coronary arterial disease is frequently accompanied and its severity also increased. Patients who received both peripheral artery and coronary artery bypass surgery showed no difference in the period of hospitalization and ICU stay period compared with patients who received bypass surgery of the arteries of the lower extremities alone. CONCLUSION: Patients with atherosclerotic arterial obstruction in the lower extremities without symptoms of ischemic heart disease should undergo a preoperative coronary angiography to evaluate coronary arterial disease for active treatment, especially in the patients with old age, hypertension and high AVD scores.

The Necessity for Coronary Angiography in Atherosclerotic Arterial Obstruction in the Lower Extremities and the Clinical Features of Accompanied Coronary Arterial Diseases / 대한흉부외과학회지

BACKGROUND: Peripheral arterial disease is frequently accompanied with systemic arteriosclerosis and more than half of the cause of deaths is due to the development of coronary arterial disease. Moreover, it is known that the most frequent cause of death after a bypass surgery of chronic arterial obstruction is heart related complications. Especially in patients with atherosclerotic arterial obstruction in the lower extremities who had no history of heart disease or had no presenting symptoms of ischemic heart disease showed a high rate of postoperative mortality and for this reason we suggest preoperative evaluation in these patients to evaluate whether or not coronary arterial disease is accompanied. MATERIAL AND METHOD: Since Feb. 2001 to Oct. 2004, we analyzed 52 patients who were operated on for atherosclerotic arterial obstruction in the lower extremities, with the exception of patients with a past history of heart disease or symptoms of ischemic heart disease. They underwent on the same day a coronary and femoral angiography for evaluation of accompanying coronary arterial disease. Of among these patients, we compared those who received bypass surgery of the arteries of the peripheral extremities alone to those who underwent combined coronary artery bypass surgery. RESULT: 63% of the reported cases of atherosclerotic arterial obstruction in the lower extremities were accompanied with coronary arterial disease. Old age, hypertension, diabetes mellitus, smoking, and hypercholesterolemia are known risk factors for arteriosclerosis and of these, only old age and hypertension had statistically significance in patients with severe atherosclerotic arterial obstruction in the lower extremities accompanied with coronary arterial disease. Diabetes, smoking, and hypercholesterolemia showed no statistical significance in this group. With the increase in severity of the range and the degree of atherosclerotic arterial obstruction, coronary arterial disease is frequently accompanied and its severity also increased. Patients who received both peripheral artery and coronary artery bypass surgery showed no difference in the period of hospitalization and ICU stay period compared with patients who received bypass surgery of the arteries of the lower extremities alone. CONCLUSION: Patients with atherosclerotic arterial obstruction in the lower extremities without symptoms of ischemic heart disease should undergo a preoperative coronary angiography to evaluate coronary arterial disease for active treatment, especially in the patients with old age, hypertension and high AVD scores.

Nodular Fasciitis on an Anterior Chest Wall / 대한흉부외과학회지

A 40-year-old woman was admitted to the hospital due to a palpable tumor on an anterior chest wall. The tumor was diagnosed with a nodular fasciitis. It is a rare benign soft-tissue tumor which has a characteristic referred to as proliferation of fibroblast, and a surgical removal is the best effective treatment. Therefore, we report this case with documents and considerations after the surgical removal.

Gastrointestinal Stromal Tumor of the Esophagus / 대한흉부외과학회지

A 46-year-old man who had been diagnosed with esophageal tumor by PET-CT was admitted to our hospital for operation. Preoperative examination and intraoperative findings showed leiomyoma-like lesion and enucleation was done, but an immunohistochemical test on the case found gastrointestinal stromal tumor (GISTs). GISTs are very rarely found in the esophagus. As GISTs differ from leiomyoma pathogenetically and clinically, different treatments and follow-up strategies are required. The patient is under continuous observation to check recurrence and metastasis.