A Single-Center Experience of Transfusion Free Surgical Treatment over 13 Years in Korea

OBJECTIVE: Patient' desire of transfusion free surgery has been increasing due to blood transfusion risks. We analyzed the perioperative parameters and perioperative management of transfusion free surgical treatment in Soonchunhyang University Seoul Hospital. METHODS: Operation quantity and blood unstoring count from blood bank between 2000 and 2012 were collected from chronological records. Perioperative parameters including preoperative hemoglobin level, postoperative hemoglobin level, and lowest hemoglobin level were collected from medical records. Perioperative blood management such as acute normovolemic hemodilution, intraoperative blood cell salvage, or hematinic agents and complication were assessed. RESULTS: A total of 3,088 patients underwent transfusion free surgery at Soonchunhyang University Seoul Hospital between 2000 and 2012. Postoperative hemoglobin level <5.0 g/dL were 33 patients. Four patients expired at postoperative period with serious perioperative complications. Average of expired patient's hemoglobin was 3.22 g/dL and overall mortality was 0.12%. Operation was increased as years go by. The amount of blood use bank wasn't increased in general patients with transfusion. CONCLUSION: Careful perioperative blood management for transfusion free surgical treatment was responsible for safety and results in good clinical outcomes. Overall transfusion rate was decreased in spite of increasing operation quantity.

Extracorporeal Life Support After Prolonged Resuscitation for In-Hospital Cardiac Arrest due to Refractory Ventricular Fibrillation: Two Cases Resulting in a Full Recovery

Extracorporeal life support (ECLS) has well demonstrated its efficacy in treating in-hospital cardiac arrest and is being used for broader indications. However, ECLS after prolonged cardiopulmonary resuscitation (CPR) has been traditionally contraindicated and is now challenging. Here, we introduce two cases of successful ECLS after prolonged CPR, resulting in a immediate and full recovery. Both these acute ST elevation myocardial infarction patients waiting for primary percutaneous coronary intervention (PCI) suddenly collapsed due to ventricular fibrillation (VF), which was refractory to conventional treatment. After 2 hours of conventional CPR, the ECLS had been implemented and primary PCI could be performed. Subsequent to successful revascularization, the VF was stopped with a single electric shock. In our second case, normal sinus rhythm was spontaneously restored after ECLS implementation, which was completed after 45 minutes of conventional resuscitation. Both patients made a full neurological recovery on the day of the event and were discharged with only minor complications.

Retrospective Study of Thoracoscopic Apical Pleurectomy and Mechanical Pleural Abrasion for Spontaneous Pneumothorax / 대한흉부외과학회지

BACKGROUND: Pleural symphysis is regarded as an important treatment option in reducing recurrence rates after surgical treatment of spontaneous pneumothorax. However, there is much debate over the best method for achieving pleural symphysis. We retrospectively compared apical pleurectomy (AP) with mechanical pleural abrasion (MPA). MATERIAL AND METHOD: Between January 2000 and December 2007, 83 patients underwent video-assisted thoracoscopic surgery (VATS) for spontaneous pneumothorax. In addition to wedge resection of bullae, MPA was performed in 21 patients (group A) and AP in 62 patients (group B). RESULT: There were no significant differences in age, gender and site of pneumothorax between the two groups. Operative time was 97+/-44 minutes in group A and 77+/-18 minutes in group B (p>0.05). The mean amount of pleural drainage through the chest tube on the first postoperative day was 156+/-87 cc in group A and 147+/-87 cc in group B (p>0.05). There was no mortality or significant morbidity in all patients with the exception of reoperation for bleeding in two patients in group B. In the postoperative course, there were no statistical differences between the two groups in the rate of residual air space, air leak and indwelling time of chest tube, and hospital stay. Mean follow up time was 31.7+/-25.3 months, and the recurrence rate of pneumothorax was 9.5% (2/21) in group A and 6.5% (4/62) in group B, without statistical significance. CONCLUSION: AP was no more advantageous than MPA in terms of operative time, postoperative course and prevention of recurrent pneumothorax. Therefore, complete resection of bullae and existence of residual bullae are more important factors in reducing the incidence of recurrent pneumothorax than pleural symphysis.

Vacuum-assisted Closure for the Treatment of Lymphorrhea Following Surgery of the Femoral Artery / 대한흉부외과학회지

Lymphorrhea is a common complication after inguinal dissection for exposure of the femoral artery. Injury of the lymphatics occurs frequently because they are anatomically close to blood vessels. Uncontrolled lymph drainage increases postoperative morbidity, and wound infection may follow. Despite current treatment options, lymphorrhea after inguinal dissection is still difficult to manage and results in a prolonged hospital stay. A vacuum-assisted closure device was used in a 72-year-old woman who had lymphorrhea after vascular surgery by groin incision. Vacuum-assisted control for lymphorrhea resulted in earlier closure of the wound and reduced the length of hospital stay.

An Influence of Modified Robicsek Sternal Wiring after Median Sternotomy on the Postoperative Sternal Wound Infection / 대한흉부외과학회지

BACKGROUND: In the majority of cases, sternal instability and wound infection concomitantly present after a cardiac operation following conventional median sternotomy, and these complications have a major influence on the postoperative course. The aim of this study is to compare the results of the different sternal wiring techniques on sternal infection. MATERIAL AND METHOD: Between April 2004 and December 2008, 157 adult patients underwent cardiac operation through a median sternotomy. 86 patients who had undergone standard peristernal wiring were included in group A, whereas 71 patients who had undergone modified Robicsek sternal wiring were included in group B. The incidences of sternal wound complications in the two groups were assessed. RESULT: The mean age of the group B patients was older than that of the group A patients (61+/-10 years vs 57+/-13 years). The incidence of preoperative left ventricular dysfunction (ejection fraction <30%), chronic obstructive pulmonary disease, renal failure requiring dialysis and diabetes mellitus were significantly higher in Group B, whereas the other perioperative risk factors for infection were not significantly different between the two groups. Two patients in group A experienced superficial wound infection, whereas 4 patients in group B displayed superficial wound infection, but the difference was not statistically significant (p=0.255). Yet poststernotomy deep sternal wound infection appeared in 6 patients of group A, whereas none of the patients in group B displayed this malady. CONCLUSION: The modified Robicsek sternal wiring technique showed greater sternal stability even for the patient with a high risk for infection, and the technique caused a lower incidence of deep sternal wound infection.

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.

Emergency Aortic Valve Replacement for a 95-year-old Patient / 대한흉부외과학회지

As the average age of the general population increases, a growing number of elderly patients are presenting for cardiac operations. Although aortic valve replacement in patients aged 80 years and older has been shown to have excellent outcomes with good long-term survival rates, some physicians are still hesitant to refer elderly patients for surgical intervention. A 95-years old female was admitted to our hospital with cardiogenic shock and an emergency operation was required. She was successfully treated with emergency aortic valve replacement. We report here on a case of successful emergency surgical treatment for aortic stenosis in a 95 years old woman.

A Case of 'True' Fungus-Infected Aneurysm of Abdominal Aorta in an Immunocompetent Patient / 감염과화학요법

Infected aneurysms are uncommon, frequently fatal lesions. "True" fungus-infected aneurysms are even rarer. Fungal infections have high morbidity and mortality. However, diagnosis is frequently difficult, since the symptoms are non-specific and standard diagnostic procedures are often insensitive. We experienced a patient with persistent fever and negative blood cultures. The patient was immunocompetent and had no risk factors, and was diagnosed with a fungus-infected aneurysm based on computed tomography and vascular surgery. The vascular tissue revealed some narrow-based budding yeast within the thrombus, suggesting Candida infection. Seventeen cases of infected aneurysm of the abdomen were reported in Korea from 1988 to 2007, although none were "true" fungus-infected aneurysms, making this the first fungus-infected aneurysm of the abdomen in Korea. Prompt diagnostic procedures and aggressive treatment modalities are necessary for patients with occult infection and negative blood cultures, regardless of their immunocompetence, because of the high morbidity and mortality of this condition.

Short Term Results of Endovenous Laser Treatment with Ultrasound Guided Ligation of the Sapheno-femoral Junction or Sapheno-popliteal Junction in Patients with Varicose Vein

PURPOSE: The main cause of recurrence of varicosity after endovenous laser treatment (EVLT) is incomplete occlusion of the sapheno-femoral junction (SFJ) or the sapheno-popliteal junction (SPJ). To reduce the recurrence and complications of EVLT, we have tried to ligate the SFJ or SPJ under ultrasonic guidance. METHOD: Two separate parallel punctures were made under ultrasonic guidance 1 cm inferior to and alongside the SFJ or SPJ with using a 16 gauge needle. A hook was passed through beneath the saphenous vein and it was pulled out through the puncture holes. A black silk thread was passed through backward with the hook and then the thread was tied. Low energy EVLT was then performed in a continuous fashion with using a 980 nm multidiode laser. RESULT: Between December, 2007 and February, 2008, 21 patients (males: 14, females: 7, 28 legs, mean age: 45 years old) with including 20 great saphenous veins (GSV) and 8 small saphenous veins (SSV) were managed using our protocol. The mean energy density (ED) was 9.8J/cm for the GSV and 9.5J/cm for the SSV. The pullback speed on the fiber was 69.5 sec at the GSV and 28sec at the SSV. No recurrence was noted. The complications were bruise (7 limbs/24%), fibrotic cord (4 limbs/14%), pain (8 limbs/31%), inguinal pain and paresthesia (1 limb/3%) and hematoma (4 limbs/14%). These complications were well controlled without any further problems. CONCLUSION: During EVLT, ultrasound (US) guided ligation of the SFJ is cosmetically satisfactory and effective in reducing the amount of required endovenous laser energy. The complication rate and severity were not reduced, but they under control.

A Case of 'True' Fungus-Infected Aneurysm of Abdominal Aorta in an Immunocompetent Patient / 감염과화학요법

Infected aneurysms are uncommon, frequently fatal lesions. "True" fungus-infected aneurysms are even rarer. Fungal infections have high morbidity and mortality. However, diagnosis is frequently difficult, since the symptoms are non-specific and standard diagnostic procedures are often insensitive. We experienced a patient with persistent fever and negative blood cultures. The patient was immunocompetent and had no risk factors, and was diagnosed with a fungus-infected aneurysm based on computed tomography and vascular surgery. The vascular tissue revealed some narrow-based budding yeast within the thrombus, suggesting Candida infection. Seventeen cases of infected aneurysm of the abdomen were reported in Korea from 1988 to 2007, although none were "true" fungus-infected aneurysms, making this the first fungus-infected aneurysm of the abdomen in Korea. Prompt diagnostic procedures and aggressive treatment modalities are necessary for patients with occult infection and negative blood cultures, regardless of their immunocompetence, because of the high morbidity and mortality of this condition.

Video-assisted Talc Poudrage for the Treatment of Malignant Pleural Effusion: Analysis of Effects and Benefits / 대한흉부외과학회지

BACKGROUND: Malignant pleural effusion is a common condition in neoplastic patients and palliative therapy is the usual treatment. Talc has been generally accepted to be the most effective sclerosant for chemical pleurodesis, but the optimal route of administration remains controversy. We compared the results of video-assisted thoracoscopic talc poudrage (VTP) with administering a bedside talc slurry through a chest tube (BTS) for the treatment of malignant pleural effusion. MATERIAL AND METHOD: From December 2004 to May 2006, 20 patients with malignant pleural effusion underwent chemical pleurodesis via VTP (group A, n=10), and BTS (group B, n=10). RESULT:The durations of chest tube placement after the procedure were 7.0+/-4.0 days (group A) and 6.7+/-3.6 days (group B). The hospital stays were 24.3+/-9.4 days (group A) and 30.7+/-21.5 days (group B), respectively. The symptoms of dyspnea were much more improved in group A (p-value=0.014) after discharge (mean f/u group A=8.5+/-2.2 months, group B 8.0+/-7.4 months). The collapsed portions of lung were better expanded in group A than in group B (p-value= 0.011). CONCLUSION: We recommend VTP for the selected patients with malignant pleural effusion because of the advantages of dissecting the fibrous peel to relieve the atelectasis and dyspnea, and excising the pleura for diagnosis with direct viewing of the lesion.

Ideal Right Ventricular Outflow Tract Size in Tetralogy of Fallot Total Correction / 대한흉부외과학회지

BACKGROUND: The surgical repair of a tetralogy of Fallot (TOF) has been performed successfully with a favorable early and late outcome. However, the later development of pulmonary regurgitation and stenosis remains a problem. The development of pulmonary regurgitation and stenosis may be changed by the size of right ventricular outflow tract (RVOT) reconstruction at the initial total correction. Hence, it is necessary to investigate the ideal size of RVOT reconstruction. MATERIAL AND METHOD: This prospective study was carried out to determine how a surgical strategy and the RVOT size affect the occurrence of pulmonary regurgitation and stenosis. From January 2002 to December 2004, 62 patients underwent the TOF total correction. The RVOT size (diameter of pulmonary valve annulus) of each case was measured after the RVOT reconstruction and converted to a Z value. A pre-scheduled follow up (at discharge, 6 months, 1 year, 2 years and 3 years) was carried out by echocardiography to evaluate the level of pulmonary regurgitation and stenosis. RESULT: The patients were divided to two groups (transannular group n=12, nontransannular group n=50) according to the method of a RVOT reconstruction. The Z value of RVOT=iameter of pulmonary valve annulus) (transannular group -1, range -3.6~-0.8; nontransannular group -2.1, range -5.2~1.5) and the average pRV/LV after surgery (transannular group 0.44+/-0.09, nontransannular group 0.42+/-0.09) did not show any significant difference between two groups. The occurrence of pulmonary regurgitation above a moderate degree was more frequent in the transannular group (p0, p<0.02) and the progressing pulmonary stenosis more than mild to moderate degree developed in the patients with smaller RVOT size (Z value<-1.5, p<0.05). A moderate degree of pulmonary stenosis developed for 4 nontransannular patients. Three underwent additional surgery and one underwent a balloon valvuloplasty. Their Z value of RVOT were -3.8, -3.8 -2.9, -1.8, respectively. CONCLUSION: When carring out a TOF total correction, transannular RVOT reconstruction group has significantly more pulmonary regurgitation. In the nontransannular RVOT reconstruction, the size of the RVOT should be maintained from Z value -1.5 to 0. If the Z value is less than -1.5, we should follow up carefully for the possibility of pulmonary stenosis.

Ideal Right Ventricular Outflow Tract Size in Tetralogy of Fallot Total Correction / 대한흉부외과학회지

BACKGROUND: The surgical repair of a tetralogy of Fallot (TOF) has been performed successfully with a favorable early and late outcome. However, the later development of pulmonary regurgitation and stenosis remains a problem. The development of pulmonary regurgitation and stenosis may be changed by the size of right ventricular outflow tract (RVOT) reconstruction at the initial total correction. Hence, it is necessary to investigate the ideal size of RVOT reconstruction. MATERIAL AND METHOD: This prospective study was carried out to determine how a surgical strategy and the RVOT size affect the occurrence of pulmonary regurgitation and stenosis. From January 2002 to December 2004, 62 patients underwent the TOF total correction. The RVOT size (diameter of pulmonary valve annulus) of each case was measured after the RVOT reconstruction and converted to a Z value. A pre-scheduled follow up (at discharge, 6 months, 1 year, 2 years and 3 years) was carried out by echocardiography to evaluate the level of pulmonary regurgitation and stenosis. RESULT: The patients were divided to two groups (transannular group n=12, nontransannular group n=50) according to the method of a RVOT reconstruction. The Z value of RVOT=iameter of pulmonary valve annulus) (transannular group -1, range -3.6~-0.8; nontransannular group -2.1, range -5.2~1.5) and the average pRV/LV after surgery (transannular group 0.44+/-0.09, nontransannular group 0.42+/-0.09) did not show any significant difference between two groups. The occurrence of pulmonary regurgitation above a moderate degree was more frequent in the transannular group (p0, p<0.02) and the progressing pulmonary stenosis more than mild to moderate degree developed in the patients with smaller RVOT size (Z value<-1.5, p<0.05). A moderate degree of pulmonary stenosis developed for 4 nontransannular patients. Three underwent additional surgery and one underwent a balloon valvuloplasty. Their Z value of RVOT were -3.8, -3.8 -2.9, -1.8, respectively. CONCLUSION: When carring out a TOF total correction, transannular RVOT reconstruction group has significantly more pulmonary regurgitation. In the nontransannular RVOT reconstruction, the size of the RVOT should be maintained from Z value -1.5 to 0. If the Z value is less than -1.5, we should follow up carefully for the possibility of pulmonary stenosis.

Bilateral Elastofibroma Dorsi in the Infrascapular Region: A case report / 대한흉부외과학회지

An 81-year-old woman was admitted to our hospital with bilateral chest wall mass in the infrascapular region. Considering the possible diagnosis of a malignant chest wall tumor at such location, we performed excision and biopsy. Both masses were histologically diagnosed as elastofibroma. We experienced this rare disease, bilateral elastofibroma, so we report this case with a bibliography.

An Unusual Case of Todd's Paralysis Mimicking Large Cerebral Infarction after Open Heart Surgery / 대한흉부외과학회지

Improved operative, anesthetic, and cardiopulmonary bypass (CPB) techniques have significantly reduced postoperative complications; however, neurologic disorders remain a serious complication after open heart surgery. Possible explanations for neurologic complications are microembolism from CPB, decreased cerebral perfusion pressure due to intraoperative hypotension and unexpected metabolic changes. Amomg these, seizure has low incidence and Todd`s paralysis after open heart surgery is extremely rare. Todd's paralysis is a complication of a seizure due to neuronal exhaustion mimicking large cerebral infarction after open heart surgery.

Analysis of Complications Associated with the Nuss Procedure: Risk Factors and Preventive Measures / 대한흉부외과학회지

BACKGROUND: Since the Nuss procedure for the correction of pectus excavatum is in its early stage, there have been problems that need to be solved. We examined complications in a single-institute experience of the Nuss technique in order to develop possible solutions to prevent them. MATERIAL AND METHOD: 335 consecutive patients, who underwent the modified Nuss procedure between August 1999 and October 2002, were studied retrospectively. Median age was 8 years (range 1 to 46). 264 patients (78.8%) were in pediatric group (age15). 193 patients (57.6%) had symmetric and 142 patients (42.4%) had asymmetric pectus configurations. Risk factors predicting postoperative complications were analyzed using multivariate logistic regression. RESULT: Postoperative complication rates were 18.9% (61/335) in total patients. Frequent complications were pneumothorax 24 (7.5%), bar displacement 11 (3.4%), and wound seroma 10 (3.1%) in order. Early complications (within a month, 49 cases, 15.2%) were pneumothorax (n=23, 6.9%), wound seroma (n=12, 3.6%), and bar displacement (n=8, 2.4%). Late complications (after a month, 12 cases, 3.7%) were pericarditis and pericardial effusion (n=5, 1.5%), bar displacement (n=4, 1.2%), and hemothorax (n=3, 0.9%). Techniques were modified to prevent complications especially in bar shaping and fixation, which led to decrease complication rate in later experience (Operation Date 1: 15/51 (29.4%) vs Operation Date 2: 34/284 (12.0%), p=0.004). Grand Canyon type (eccentric long canal type) showed higher complication rate than other types (GC type: 12/30(40%) vs Others: 37/305 (12.1%), p<0.001). Major risk factors are severity of pectus (OR=2.88, p=0.038), Grand Canyon type (OR= 2.82, p=0.044), and Op. Date 1 (OR=4.05, p=0.001). CONCLUSION: Major complications were related to severe eccentric type of pectus configuration (Grand Canyon type) and lack of surgeon's experience (Op. Date 1). Complication rate was reduced with accumulation of experience and advancement of surgical techniques. The Nuss procedure can be performed at a low risk of complications with our current technique.

Minimally Invasive Repair of Pectus Excavatum Based on the Nuss Principle: An Evolution of Techniques and Early Results on 322 Patients / 대한흉부외과학회지

BACKGROUND: The Nuss procedure is a recently developed technique for minimally invasive repair of pectus excavatum using a metal bar. Although its technical simplicity and cosmetic advantages are remarkable, applications have been limited to children with standard pectus excavatum. We report a single center experience of the technique that has been evolving in order to correct asymmetric pectus configurations and adult patients. MATERIAL AND METHOD: Between August 1999 and June 2002, 322 consecutive patients underwent repair by the Nuss technique and its modifications. Among them, 71 (22%) were adults. For the precise correction, morphology of the pectus was classified as symmetric and asymmetric types. Asymmetric type was subdivided into eccentric and unbalanced types. In repair, differently shaped bars were applied to individual types of pectus to achieve symmetric correction. RESULT: Symmetric type was 57.5% (185/322) and asymmetric type was 42.5% (137/322). Eccentric, unbalanced, and combined types were 71, 47 and 19, respectively. Major modifications were bar shaping and fixation. In asymmetric group, different shapes of asymmetric bars were applied (n=125, 38.8%). For adult patients, double bar or compound bar technique was used (n=51, 15.8%). To prevent bar rotation, multipoint wire fixations to ribs were used. Major postoperative complications were pneumothorax (n=24, 7.5%) and bar displacement (n=11, 3.4%). 42 patient had bar removal 2 years after the initial procedure. CONCLUSION: The Nuss procedure is safe and effective.Modifications of the techniques in accordance with precise morphological classification enabled the correction of all variety of pectus excavatum including asymmetric types and adult patients.

Analysis of Risk Factors in Poststernotomy Sternal Wound Infection and Mediastinitis after Open-heart Surgery / 대한흉부외과학회지

BACKGROUND: With the purpose of identifying significant risk factors in poststernotomy sternal wound infection and mediastinitis, we underwent a retrospective analysis of the whole patients operated on at the our department of cardiovascular surgery for the two years. MATERIAL AND METHOD: From March 2001 to March 2003 at the department of cardiovascular surgery, medical school of Soonchunhyang University, major sternal wound infections had been developed in 12 (9.76%) of 123 consecutive patients. These patients underwent open-heart procedure through a midline sternotomy and survived long enough for infection to appear. For this group of patients, we evaluated possible risk factors such as age, sex, diabetes mellitus, chronic obstructive pulmonary disease, obesity, interval between hospital admission and operation, type of surgical procedure, elective or emergency surgical procedure, reoperation, duration of surgical procedures, duration of cardiopulmonary bypass, amount of blood transfused, postoperative blood loss, chest reexploration, rewiring of a sterile sternal dehiscence, duration of mechanical ventilation, and days of stay in the intensive care unit and analyzed these factors. RESULT: Analysis represented that age, sex, diabetes mellitus, type and mode of surgical procedure, reoperation, duration of operation, duration of cardiopulmonary bypass, and interval between hospital admission and operation were not significantly associated with wound infection. For all other predisposing factors, p-values of less than .05 were demonstrated. Eight emerged as significant: early chest reexploration (p=0.001), sternal rewiring (p<0.0001), chronic obstructive pulmonary disease (p<0.0001), blood transfusions (p<0.05), postoperative bleeding (p=0.008), days of stay in the intensive care unit (p<0.0001), duration of mechanical ventilation (p=0.001), and obesity (p=.003). CONCLUSION: Contamination of patients may occur before, during, and after the operation, and any kind of reintervention may predispose the patient to wound infection.

A Case of Primary Esophageal B-cell Lymphoma of MALT type, Presenting as a Submucosal Tumor

The primary esophageal lymphoma is extremely rare, and shows various morphologic characteristics. Only a single case of mucosa-associated lymphoid tissue (MALT) type lymphoma confined to the esophagus has been reported in the literature. A 61-yr-old man was referred to our hospital for evaluation of an esophageal submucosal tumor (SMT) that had been detected incidentally by endoscopy. He had a history of pulmonary tuberculosis with long-term anti-tuberculosis medication 15 yr before, and also had a history of syphilis, which had been treated one year before. He had been taking a synthetic thyroid hormones for the past 10 months because of an autoimmune thyroiditis. Endoscopy showed a longitudinal round and tubular shaped smooth elevated lesion, which was covered with intact mucosa and located at the mid to distal esophagus, 31 cm to 39 cm from the incisor teeth. Endoscopic ultrasonography (EUS) showed a huge longitudinal growing intermediate- to hypo-echoic mass located in the submucosal layer with internal small, various sized honeycomb-like anechoic lesions suggesting germinal centers. Subsequently, he underwent a surgery, which confirmed the mass as a primary esophageal low-grade B-cell lymphoma of MALT type.

A case report of Churg-Strauss syndrome / 천식및알레르기

The characteristic features of Churg-Strauss syndrome are vasculitis, both intra- and extravascular granuloma formation with eosinophilic tissue infiltration, and strong association with asthma and peripheral eosinophilia. Churg-Strauss syndrome with pleural effusion is relatively common and only a few cases have previously been reported in Korea. We report a case of Churg-Strauss syndrome with pleural effusion confirmed by VATS.