Erratum: Predictive Value of Procalcitonin for Infection and Survival in Adult Cardiogenic Shock Patients Treated with Extracorporeal Membrane Oxygenation / 전남의대학술지

In the published article, the Figure 4 was published with incorrect y-axis and legend.

Predictive Value of Procalcitonin for Infection and Survival in Adult Cardiogenic Shock Patients Treated with Extracorporeal Membrane Oxygenation / 전남의대학술지

Procalcitonin (PCT) is a predictive marker for the occurrence of bacterial infection and the decision to terminate antibiotic treatment in critically ill patients. An unusual increase in PCT, regardless of infection, has been observed during extracorporeal membrane oxygenation (ECMO) support. We evaluated trends and the predictive value of PCT levels in adult cardiogenic shock during treatment with ECMO. We reviewed the clinical records of 38 adult cardiogenic shock patients undergoing veno-arterial ECMO support between January 2014 and December 2016. The exclusion criteria were age 10 ng/mL during the first week of ECMO support was significantly associated with mortality (p < 0.01). The change in PCT level was not useful in predicting new infection during ECMO support. However, higher PCT levels within the first week of the ECMO run are associated with significantly higher mortality.

Nosocomial Infection in Adult Patients Undergoing Veno-Arterial Extracorporeal Membrane Oxygenation

Data on the frequency of nosocomial infections during extracorporeal membrane oxygenation (ECMO) in adult populations remain scarce. We investigated the risk factors for nosocomial infections in adult patients undergoing venoarterial ECMO (VA-ECMO) support. From January 2011 to December 2015, a total of 259 patients underwent ECMO. Of these, patients aged 17 years or less and patients undergoing ECMO for less than 48 hours were excluded. Of these, 61 patients diagnosed with cardiogenic shock were evaluated. Mean patient age was 60.6 ± 14.3 years and 21 (34.4%) patients were female. The mean preoperative Sequential Organ Failure Assessment (SOFA) score was 8.6 ± 2.2. The mean duration of ECMO support was 6.8 ± 7.4 days. The rates of successful ECMO weaning and survival to discharge were 44.3% and 31.1%, respectively. There were 18 nosocomial infections in 14 (23.0%) patients. These included respiratory tract infections in 9 cases and bloodstream infections in a further 9. In multivariate analysis, independent predictors of infection during ECMO were the preoperative creatinine level (hazard ratio [HR], 2.176; 95% confidence interval [CI], 1.065–4.447; P = 0.033) and the duration of ECMO support (HR, 1.400; 95% CI, 1.081–1.815; P = 0.011). A higher preoperative creatinine level and an extended duration of ECMO support are risk factors for infection. Therefore, to avoid the development of nosocomial infections, strategies to shorten the length of ECMO support should be applied whenever possible.

Cardioprotective Effect of Fimasartan, a New Angiotensin Receptor Blocker, in a Porcine Model of Acute Myocardial Infarction

Cardioprotective effect of fimasartan, a new angiotensin receptor blocker (ARB), was evaluated in a porcine model of acute myocardial infarction (MI). Fifty swine were randomized to group 1 (sham, n=10), group 2 (no angiotensin-converting enzyme inhibitor [ACEI] or ARB, n=10), group 3 (perindopril 2 mg daily, n=10), group 4 (valsartan 40 mg daily, n=10), or group 5 (fimasartan 30 mg daily, n=10). Acute MI was induced by occlusion of the left anterior descending artery for 50 min. Echocardiography, single photon emission computed tomography (SPECT), and F-18 fluorodeoxyglucose cardiac positron emission tomography (PET) were performed at baseline, 1 week, and 4 weeks. Iodine-123 meta-iodobenzylguanidine (MIBG) scan was done at 6 weeks for visualization of cardiac sympathetic activity. Left ventricular function and volumes at 4 weeks were similar between the 5 groups. No difference was observed in groups 2 to 5 in SPECT perfusion defect, matched and mismatched segments between SPECT and PET at 1 week and 4 weeks. MIBG scan showed similar uptake between the 5 groups. Pathologic analysis showed similar infarct size in groups 2 to 5. Infarct size reduction was not observed with use of fimasartan as well as other ACEI and ARB in a porcine model of acute MI.

The Influence of Admission Hypoglycemia on Clinical Outcomes in Acute Myocardial Infarction Patients with Diabetes Mellitus / 대한내과학회지

BACKGROUND/AIMS: There are controversies surrounding strict control of blood glucose levels in diabetic patients. Therefore, we evaluated the influence of hypoglycemia at admission on the clinical outcomes of patients with acute myocardial infarction (AMI). METHODS: We analyzed 5,249 diabetic patients who enrolled in the Korean Acute Myocardial Infarction Registry from November 2005 to March 2013. The patients were divided into three groups according to their blood glucose level at admission; Group I: hypoglycemia ( or = 140 mg/dL). We assessed in-hospital mortality and the major adverse cardiac events based on blood glucose levels at admission. RESULTS: The mean age was older in group I at 72.6 +/- 11.0 years compared to 71.3 +/- 10.7 in group II and 70.3 +/- 11.1 in group III (p < 0.006). A total of 344 patients died during hospitalization. In-hospital mortality was higher in group I at 12.9%, compared to 5.2% in group II and 6.8% in group III (p < 0.006). Multivariable logistic regression analysis determined that the independent predictors of 1-month mortality were age, Killip class III-IV, cerebrovascular disease, chronic renal failure, acute renal failure, cardiogenic shock, ventricular tachycardia, ejection fraction < 40% and hypoglycemia in admission. The mortality rate at 1 month was significantly higher in group I compared to group II (odds ratio [OR] 3.571; 95% confidence interval [CI] 1.465-8.705, p = 0.005) compared to group II and group III (OR 4.088; 95% CI 1.757-9.511, p = 0.001). CONCLUSIONS: Hypoglycemia on admission was an important predictor of in-hospital and one-month mortality in AMI patients with diabetes mellitus.

The Influence of Admission Hypoglycemia on Clinical Outcomes in Acute Myocardial Infarction Patients with Diabetes Mellitus / 대한내과학회지

BACKGROUND/AIMS: There are controversies surrounding strict control of blood glucose levels in diabetic patients. Therefore, we evaluated the influence of hypoglycemia at admission on the clinical outcomes of patients with acute myocardial infarction (AMI). METHODS: We analyzed 5,249 diabetic patients who enrolled in the Korean Acute Myocardial Infarction Registry from November 2005 to March 2013. The patients were divided into three groups according to their blood glucose level at admission; Group I: hypoglycemia ( or = 140 mg/dL). We assessed in-hospital mortality and the major adverse cardiac events based on blood glucose levels at admission. RESULTS: The mean age was older in group I at 72.6 +/- 11.0 years compared to 71.3 +/- 10.7 in group II and 70.3 +/- 11.1 in group III (p < 0.006). A total of 344 patients died during hospitalization. In-hospital mortality was higher in group I at 12.9%, compared to 5.2% in group II and 6.8% in group III (p < 0.006). Multivariable logistic regression analysis determined that the independent predictors of 1-month mortality were age, Killip class III-IV, cerebrovascular disease, chronic renal failure, acute renal failure, cardiogenic shock, ventricular tachycardia, ejection fraction < 40% and hypoglycemia in admission. The mortality rate at 1 month was significantly higher in group I compared to group II (odds ratio [OR] 3.571; 95% confidence interval [CI] 1.465-8.705, p = 0.005) compared to group II and group III (OR 4.088; 95% CI 1.757-9.511, p = 0.001). CONCLUSIONS: Hypoglycemia on admission was an important predictor of in-hospital and one-month mortality in AMI patients with diabetes mellitus.

Fatal Left Ventricular Thrombosis in an Infant Receiving Extracorporeal Membrane Oxygenation Support: A Case Report / 대한구급학회지

Thromboembolism in patients receiving extracorporeal membrane oxygenation (ECMO) support is a feared complication. Systemic anticoagulation during ECMO in patients with a massively dilated left ventricle (LV) and decreased LV systolic function is still debated. Hearin, we report a case of a 5-month old infant on ECMO support who had fatal thrombus formation in the massively dilated LV and a consequent thromboembolic event.

Unusual Cause of Acute Right Ventricular Dysfunction: Rapid Progression of Superior Vena Cava Aneurysm Complicated by Thrombosis and Pulmonary Thromboembolism

Aneurysms of the major thoracic veins are rare. They are usually asymptomatic and thus treated conservatively. We report an extremely rare case of rapidly progressing superior vena cava (SVC) aneurysm complicated by thrombosis and acute pulmonary thromboembolism (PTE) with right ventricular dysfunction. Thrombolytic therapy for hemodynamically significant acute PTE was harmful to the patient in the present case, because it induced further thrombosis and mobilization of the thrombi within the aneurysm, subsequently causing de novo PTE. Surgical aneurysmectomy combined with pulmonary artery embolectomy would be a treatment of choice in patients with SVC aneurysm complicated by acute PTE.

Mid- to Long-term Results of Surgical Treatment of ASD in Patients over 60 Years Old

BACKGROUND: There is controversy about the benefit of surgical correction of an atrial septal defect (ASD) in patients over 60 years old. The purpose of this study was to determine whether surgical treatment is beneficial in those 60 years of age or older. MATERIALS AND METHODS: We reviewed the clinical course of 57 patients (mean age: 63.54+/-5.59 years) diagnosed with an isolated secundum ASD after the age of 60. The 24 patients (group A) who underwent surgical repair were compared with the 33 patients (group B) who were treated non-surgically. The mean follow-up period was 6.8+/-4.5 years. RESULTS: One operative death, 5 late deaths (20.8%) in group A, and 9 deaths (27.3%) in group B occurred in the study period. Symptomatic improvement was noted in 18 patients (75%) of group A after surgery. However 13 patients (39.4%) of group B showed symptomatic improvement during the follow-up period (p=0.012). The incidence of new atrial arrhythmia of the two groups was significantly different (16.7% vs 36.7%, p=0.038). The actuarial 10 year survival rate was 79% in group A and 73% in group B. CONCLUSION: Although surgical correction of ASD did not increase survival in patients over 60 years old, the surgical outcomes of ASD showed low operative mortality and resulted in symptomatic improvement in the majority of these patients. This study has shown the benefits of surgical closure of ASD even in advanced age in comparison to medical treatment.

Aortic Thrombus with Myocardial Infarction: 2 case reports / 대한흉부외과학회지

A thrombus in the aorta is a rare condition that is generally detected after cerebral, visceral or peripheral emboli. We reported here on two cases of aortic thrombus with myocardial infarction.

Occult Papillary Thyroid Carcinoma Presenting as a Huge Mediastinal Cystic Metastasis / 대한흉부외과학회지

The initial presentation of distant metastases in patients with papillary thyroid carcinoma is quite rare. Most distant metastases are solid nodular lesions. A 67-year-old man who complained of severe dyspnea underwent surgery due to a large mediastinal cystic mass compressing the trachea and great vessels. Pathologically, the cystic mass was a metastatic thyroid papillary carcinoma. The thyroid evaluations were compatible with a well differentiated thyroid carcinoma. An occult thyroid carcinoma presenting as a large mediastinal cystic lesion is extremely rare.

Clinical Analysis of Video Assisted Thoracic Surgery for the Treatment of Thoracic Empyema / 대한흉부외과학회지

BACKGROUND: Thoracic empyema remains a serious problem despite the availability of modern diagnostic methods and appropriate antibiotics. The condition presents in many different forms and stages that require different therapeutic options. Video-assisted thoracic surgery (VATS) has become increasingly popular for use in the treatment of empyema. MATERIAL AND METHOD: From January 2005 to May 2009, VATS was performed in 36 patients with pleural empyema and for whom chest-tube drainage and antibiotic therapy had failed or the CT scan showed multiseptate disease. The perioperative clinical factors were analyzed for all the study patients. RESULT: All the patients underwent VATS, but it was necessary to convert to thoracotomy in one patient. The mean operation time was 90+/-38.5 min. For the operative evaluation, 11 patients were compatible with ATS stage III. The duration of chest-tube insertion was 11.9+/-5.8 (3~24) days. One patient did not improve and therefore this patient underwent additional open drainage. At discharge, costophrenic angle blunting was observed in 22 patients, pleural thickening was noted in 20 patients, both were noted in 17 patients and neither was noted in 11 patients. However, at follow-up, each of these changes was observed in 9, 7, 4 and 24 patients, respectively. All except one patient showed radiographic improvement. CONCLUSION: VATS is suitable for the treatment of early and fibrinopurulent thoracic empyema, and even in selected patients with stage III disease.

The Clinical Effects of Surgical Treatment for Hemoptysis due to Inflammatory Lung Disease / 대한흉부외과학회지

BACKGROUND: Many studies have demonstrated the various therapeutic options for treating hemoptysis caused by inflammatory lung disease. However, there is debate over the surgical management of the ongoing hemoptysis. Therefore, we evaluated the clinical results of pulmonary resection that was done due to hemoptysis in patients with concomitant inflammatory lung disease. MATERIAL AND METHOD: We performed a retrospective analysis of 75 patients who received pulmonary resection for hemoptysis and concomitant inflammatory lung disease between 2001 and 2007. The mean age was 52.1+/-12.5 years old, and the male; female ratio was 52:23. RESULT: The underlying disease was aspergilloma in 30 patients (40%), pulmonary tuberculosis in 20 patients, bronchiectasis in 18 patients and other causes in 7 patients. The surgical treatment included lobectomy in 55 patients, bilobectony in 2 patients, pneumonectomy in 17 patients and wedge resection in 1 patient. There were 3 early deaths, and the causes of death were pneumonia in 1 patient and BPF in 2 patients. The early mortality was statistically higher for such risk factors as a preoperative Hgb level <10 g/dL, COPD and an emergency operation. CONCLUSION: In conclusion, pulmonary resection for treating hemoptysis showed the acceptable range of mortality and it was an effective method for the management of hemoptysis in patients with inflammatory lung disease. However, relatively high rates of mortality and morbidity were noted for an emergency operation, and so meticulous care is needed in this situation.

Papillary Fibroelastoma of Pulmonary Valve with Congestive Heart Failure: A case report / 대한흉부외과학회지

Cardiac papillary fibroelastomas are the second most common primary tumor of the heart and they most commonly affect the left cardiac valves. However, occurrence of this tumor on the right side of the heart has been rarely reported, with only a few cases having been documented on the pulmonary valve. We present here a rare case of a papillary fibroelastoma that occurred on the pulmonary valve and this was successfully managed by replacing the pulmonary valve in a patient with congestive heart failure.

Intracardiac Varix in the Right Atrium: 2 case reports / 대한흉부외과학회지

Intracardiac varix is an endocardial, unilocular, blood-filled cyst that's lined by endothelial cells and it is filled with organizing thrombi. It has been reported that intracardiac varix is an extremely rare entity. We report here on two cases of intracardiac varix in the right atrium and these cases had been preoperatively misdiagnosed as myxoma.

Adenoid Cystic Carcinoma of the Esophagus : A case report / 대한흉부외과학회지

Adenoid cystic carcinoma (ACC) commonly originates in the major salivary glands and respiratory tract, but it is extremely rare to find ACC in the esophagus. ACC of the esophagus is clinopathologically different from the salivary gland variant. It shows more aggressive malignant behavior and a very poor prognosis. We report here on the surgical and clinopathologic findings of an ACC of the esophagus in a 65-year-old man, and we also include a review of the relevant medical literature

Two Cases of Pulmonary Hyalinizing Granuloma: 2 cases report / 대한흉부외과학회지

Pulmonary hyalinizing granuloma (PHG) is a rare disease that usually presents with multiple bilateral pulmonary nodules and characteristic histological findings, with hyalinized collagen lamellae. Because of the absence of characteristic radiologic and clinical features, PHG is usually diagnosed after surgical resection or biopsy. We performed thoracoscopic wedge resection for a pulmonary nodule located in the right lower lobe that proved to be PHG histopathologically. We report two cases along with a review of the literature.

Fracture of an Implantable Central Catheter Due to Pinch Off Syndrome / 대한흉부외과학회지

Implantable central venous catheters (Chemoport) are increasingly being used for vascular access, parenteral nutrition and administering chemotherapeutic agents. As with most invasive procedures, central venous catheterization is associated with numerous potential complications such as infection, thoromboembolism and occlusion. A rare but serous complication is the catheter fracture. We present here three cases of catheter fracture as a consequence of Pinch off syndrome, and we include a review of the relevant literature.

Elastofibroma Dorsi in the Right Chest Wall / 대한흉부외과학회지

A 71-year-old woman visited our hospital with the chief complain of a mass in her infrascapular region. We performed tumor excision and we diagnosed it as elastofibroma dorsi. Elastofibromas are benign soft tissue tumors that mostly arise in the infrascapular lesion; it is a slowly growing lesion that's characterized by the proliferation of fibrous tissue with elastin. Its incidence is very low and its pathogenesis remains unclear. We report here on this case, and we include a review of the relevant literature.

The Effects of alpha-Adrenergic Drugs on the Myocardial Preconditioning in Rats / 대한흉부외과학회지

BACKGROUND: Ischemic preconditioning(IP) is known to be effective in the protection of myocardial necrosis, arrhythmia, and the restoration of the myocardial function in the ischemia-reperfusion state of the heart. However the exact mechanism is not clearly understood. The purpose of this study was to elucidate the trigger mechanism of IP on the restoration of the myocardial function after ischemia-reperfusion. MATERIAL AND METHOD: By connecting a Langendorff perfusion apparatus with an isolated heart of a rat, the normal temperature of the heart was maintained. The experiment was conducted in seven groups, which were divided according to the preconditioning stimuli and blockage methods: Group I(n=10) was a group without IP, Group II(n=10) a group of three-minute IP, Group III(n=10) a group of PEIP, Group IV(n=10) a group of clonidine IP, Group V(n=10) a group of IP after reserpine, Group VI(n=10) a group of PE & prazosin IP, and Group VII(n=10) a group of clonidine & yohimbine IP. Hemodynamic parameters of DP, LVEDP, +/-dP/dT and the changes of perfusion in the coronary artery were evaluated. RESULT: Developed pressure and +dP/dT changed per unit time. After 20 minutes of reperfusion, those of Group II and III were 63.1+/-3.7%, 64.8+/-4.6% and 64.5+/-4.6%, 63.8+/-4.4%, which improved more significantly than those of Group I(P<0.05). However, there were no significant differences between the Groups V and VI, and Group I. CONCLUSION: The Brief ischemic preconditioning and pharmacological preconditioning using alpha-receptor sympathomimetics have protecting effects on the restoration of myocardial function after reperfusion. And the protecting effect of preconditioning seems to be related to sympathetic neurotransmitters and to the selective action of the alpha1-adrenergic receptor.