A Rare Cause of Peripheral Vascular Thrombosis: Hypereosinophilia Caused by Toxocara canis Infection / 대한내과학회지

Hypereosinophilia is often associated with eosinphilic infiltration of tissue, which can lead to severe and irreversible organ damage. One of the most characteristic and critical complications is development of thrombosis in cardiac ventricles, and occasionally in deep veins. We report a rare case of hypereosinophilia, with peripheral vascular thrombosis, caused by Toxocara canis infection.

Histologic Characteristics and Mechanical Properties of Bovine Pericardium Treated with Decellularization and alpha-Galactosidase: A Comparative Study

BACKGROUND: Bioprostheses for cardiovascular surgery have limitations in their use following as calicification. alpha-galactosidase epitope is known as a stimulant of immune response and then shows a progressing calcification. The objective of this study was to evaluate histologic characteristics and mechanical properties of decellularization and treated with alpha-galactosidase. MATERIALS AND METHODS: Bovine pericardial tissues were allocated into three groups: fixation only with glutaraldehyde, decellularization with sodium dodesyl sulfate and decellularization plus treatment with alpha-galactosidase. We confirmed immunohistological characteristics and mechanical properties as fatigue test, permeability test, compliance test, tensile strength (strain) test and thermal stability test. RESULTS: Decellularization and elimination of alpha-gal were confirmed through immunohistologic findings. Decellularization had decreased mechanical properties compared to fixation only group in permeability (before fatigue test p=0.02, after fatigue test p=0.034), compliance (after fatigue test p=0.041), and tensile strength test (p=0.00). The group of decellularization plus treatment with alpha-galactosidase had less desirable mechanical properties than the group of decellularization in concerns of permeability (before fatigue test p=0.043) and strain test (p=0.001). CONCLUSION: Favorable decellularization and elimination of alpha-gal were obtained in this study through immunohistologic findings. However, those treatment including decellularization and elimination of alpha-gal implied the decreased mechanical properties in specific ways. We need more study to complete appropriate ioprosthesis with decellularization and elimination of alpha-gal including favorable mechanical properties too.

Right Ventricular Inflow Obstruction Caused by Supratricuspid Ring after the Conventional Biventricular Repair of Congenitally Corrected Transposition of Great Arteries: A case report

A seventeen-month-old male baby, who had received conventional biventricular repair for congenitally corrected transposition of the great arteries, underwent excision of supratricuspid ring. Although tricuspid valve annulus was marginally small on direct inspection in the operating theater, circumferential excision of supratricuspid ring alone completely relieved the right ventricular inflow obstruction.

Intrapericardial Implantation of an Implantable Cardioverter-Defibrillator in a Child

Implantable cardioverter defibrillator (ICD) can be a crucial therapeutic modality for pediatric patients with congenital heart disease, Brugada syndrome, long QT syndrome and cardiomyopathy. Because transvenous implantation of ICD is mostly unfeasible for pediatric patients due to anatomical and technical limitations, epicardial patch type or subcutaneous type ICD have been used. Implantation of these alternative ICDs, however, was reported to be frequently associated with significant complications. We report a case of successful intrapericardial implantation of a single coil-type ICD through the transverse sinus in a 27 month-old child weighing lesser than 10 kg, and it was inferred from this experience that this alternative technique may decrease complications and morbidities after ICD implantation in children.

Cardiac Transplantation for a Patient with Intra-aortic Balloon Pump and Extracorporeal Membrane Oxygenator due to Cardiogenic Shock after Acute Myocardial Infarction: A Case Report / 대한구급학회지

A 66-year-old male patient who suffered from chest pain and dyspnea was admitted to our hospital. He was diagnosed as having an acute myocardial infarction, and recovered from cardiogenic shock after cardiopulmonary-cerebral resuscitation. Under the support of extracorporeal membrane oxygenator (ECMO) he underwent successful percutaneous coronary intervention. After this, an intra-aortic balloon pump (IABP) was inserted to increase coronary perfusion and reduce the impedance to left ventricular ejection. After 6 days, the patient was weaned from ECMO support; however, IABP therapy and infusion of inotropic agents were required to maintain adequate hemodynamic status. One week later, cardiac transplantation was performed successfully without major complications.

Bloodless Cardiac Surgery in a Neonate Weighing 2.8 kg / 대한흉부외과학회지

Despite increased interest in bloodless cardiac surgery, its use has been mostly confined to adult patients. Especially, bloodless pediatric cardiovascular surgery using cardiopulmonary bypass has been avoided mainly due to hemodilution. Authors recently experienced a case of bloodless cardiac surgery in a 2.8 kg-weighing neonate whose parents were Jehovah's Witness.

Effect of Trypsin on Physico-dynamic and Histological Changes after Decellularization of Bovine Pericardium / 대한흉부외과학회지

BACKGROUND: Various decellularization methods have been studied in order to develop tissue graft which is less immunogenic and more durable. This study was performed to investigate the physico-dynamic and histological effect of trypsin pretreatment on decellularization protocols. MATERIAL AND METHOD: Two groups of bovine pericardium specimen each underwent decellularization process based on SDS and Triton X-100 or N-lauroylsarcosinate and Triton X-100. Two more groups additionally underwent pretreatment with 0.1% Trypsin/0.1% EDTA. After decellularization process, mechanical tensile strength was tested, then iomechanical test of permeability and compliance was tested before and after fatigue test. Light microscopy and electron microscopy was performed to observe histological findings. RESULT: There was no difference in mechanical tensile strength between groups, but permeability and compliance was decreased in trypsin pretreated groups. Light microscopic and electron microscopic findings revealed damage of the extracellular matrix in trypsin pretreated groups and in groups which underwent the fatigue test also. CONCLUSION: Trypsin pretreatment in decellularizing process of bovine pericardium damages extracellular matrix and increases permeability and compliance of the bovine pericardium, but did not decrease tensile strength. Further studies are needed to use enzymatic treatments in decellularization protocols.

The Comparison of Video Assisted Thoracic Surgery (VATS) with 10 mm Thoracoscopy to 2 mm Thoracoscopy for Primary Spontaneous Pneumothorax / 대한흉부외과학회지

BACKGROUND: The video-assisted thoracic surgery (VATS) with 2 mm thoracoscopy in primary spontaneous pneumothorax (PSP) was known to be unreliable in its accuracy and recurrence rate. We compared 10 mm VATS with 2 mm VATS in the results of operation. MATERIAL AND METHOD: From Sept. 1998 to Dec. 2002, 176 cases (10 mm VATS; 73 cases, 2 mm VATS; 103 cases) of PSP were treated by VATS bleb resection at Korea University Ansan Hospital. 10 mm thoracoscope, 5 mm port, and 5 mm instruments were used in 10 mm VATS group, and 2 mm thoracoscope, 2 mm ports and 2 mm instruments used in 2 mm VATS group. In the two groups, staples were inserted through 11.5 mm port for chest tube. RESULT: The mean follow-up duration was 20.8+/-16.1 months in 10 mm VATS group, and 13.9+/-8.2 months in 2 mm VATS. The most common indication of operation was a recurrent pneumothorax (34%) in 10 mm VATS and patient's desire (40%) in 2 mm VATS, respectively. The operation time, number of staples used in operation, postoperative chest tube keeping days, postoperative total amount of drainage, and postoperative hospitalization days were statistically lower in 2 mm VATS. Other significant variables affecting the operation time in linear regression analysis were the number of staples that used in operation, the presence of pleural adhesion, and type of pleurodesis and thoracoscope used in operation. However, R2 values were lower than 0.1. The postoperative recurrence rate was 2.7% in 10 mm VATS and 2.9% in 2 mm VATS. It was not significant statistically. Recurrent cases developed within 1 year in both groups but the difference was statistically insignificant. CONCLUSION: Although there were differences in follow-up duration between two groups, the operation time, number of staples that used in operation, postoperative chest tube keeping days, postoperative total amount of drainage, and postoperative hospitalization days were statistically lower in 2 mm VATS. And in 2 mm VATS, there were no technical difficulties during operation and no differences in recurrence rate from 10 mm VATS. As a result, we suggest that 2 mm VATS can be used in the treatment of PSP.

Treatment of Mediastinal Growing Teratoma Syndrome: A case report / 대한흉부외과학회지

A 15-year-old male was admitted with right-sided chest pain and cough for one month. On chest computed tomographic scan, a 10 x 15 x 16 cm-sized huge mediastinal mass was occupied in the right hemithorax. Radiologically, it seemed that the tumor was severely adhesive on the heart and the superior vena cava. Therefore we decided on chemotherapy and radiotherapy first instead of surgery. The tumor marker was nearly normalized afterwards, but the tumor size was seemed to be bigger on chest tomographic scan. This suggests the growing teratoma syndrome. After the successful resection, he showed symptomatic improvement and is being followed up without any symptoms in an out patient department up to now.

Comparison of Pulsatile and Non-Pulsatile Extracorporeal Circulation on the Pattern of Coronary Artery Blood Flow / 대한흉부외과학회지

BACKGROUND: In sudden cardiac arrest, the effective maintenance of coronary artery blood flow is of paramount importance for myocardial preservation as well as cardiac recovery and patient survival. The purpose of this study was to directly compare the effects of pulsatile and non-pulsatile circulation to coronary artery flow and myocardial preservation in cardiac arrest condition. MATERIAL AND METHOD: A cardiopulmonary bypass circuit was constructed in a ventricular fibrillation model using fourteen Yorkshire swine weighing 25~35 kg each. The animals were randomly assigned to group I (n=7, non-pulsatile centrifugal pump) or group II (n=7, pulsatile T-PLS pump). Extracorporeal circulation was maintained for two hours at a pump flow of 2 L/min. The left anterior descending coronary artery flow was measured with an ultrasonic coronary artery flow measurement system at baseline (before bypass) and at every 20 minutes after bypass. Serologic parameters were collected simultaneously at baseline, 1 hour, and 2 hours after bypass in the coronary sinus venous blood. The Mann-Whitney U test of STATISTICA 6.0 was used to determine intergroup significances using a p value of <0.05. RESULT: The resistance index of the coronary artery was lower in group II and the difference was significant at 40 min, 80 min, 100 min and 120 min (p <0.05). The mean velocity of the coronary artery was higher in group II throughout the study, and the difference was significant from 20 min after starting the pump (p <0.05). The coronary artery blood flow was higher in group II throughout the study, and the difference was significant from 40 min to 120 min (p <0.05) except at 80 min. Serologic parameters showed no differences between the groups at 1 hour and 2 hours after bypass in the coronary sinus blood. CONCLUSION: In cardiac arrest condition, pulsatile extracorporeal circulation provides more blood flow, higher flow velocity and less resistance to coronary artery than non-pulsatile circulation.

Intramural Hematoma of the Descending Thoracic Aorta Misdiagnosed as Aortic Rupture: A case report / 대한흉부외과학회지

The treatment modalities of the intramural hematoma (IMH) remain controversial. Nowadays, the IMH of the descending thoracic aorta is generally classified in the medical treatment category. We describe a patient with IMH of the descending thoracic aorta who received the medical treatment. During the follow-up, we speculated that the IMH had been aggravated leading to an aortic rupture including hemothorax. Therefore, we performed an emergency operation. Contrary to our expectations, operative findings showed a well-organized aortic wall and serous pleural effusion. The exact diagnosis was IMH of the descending thoracic aorta with penetrating atherosclerotic ulcer (PAU). This case reminded us of the importance of accurate diagnosis and proper treatment.

Early and Mid-Term Results of MIDCAB / 대한흉부외과학회지

BACKGROUND: The significance of MIDCAB is emerging topics recently as OPCAB is going to be universalized, and long-term outcome of bypass graft surgery was proved to be more excellent than balloon dilation or stent insertion. We report our MIDCAB results in 73 patients in the last three years. MATERIAL AND METHOD: Retrospective analysis of medical records was done from November 1, 2000 through November 31, 2003. There were 47 males and 26 females ranging in age from 31 years to 79 years (average 61.3+/-9.8 years). Observation periods after operative procedures were 10 to 1238 days (average 763+/-319.8 days). Left longitudinal parasternal incision as a standard procedure was done to approach the heart after dissection of the left internal thoracic artery by partial or total resection of 3rd to 5th ribs. RESULT: Of those patients, 46 patients were transferred to ICU after extubation at operation room and 58 patients were extubated within 3 hours after operation. Average ICU staying periods was 26.8+/-11.5 hours. Follow-up angiography during admission was done in 36 patients and showed 100% patency. Only one patient died on the 10th post operative day because of sudden CVA. Complications included wound problems in 4 patients, and constructing pericardial window using thoracoscopy due to continuous pericardial effusion in 1. Permanent pacemaker was inserted in one patient owing to sick sinus syndrome. In one patient with recurrence of angina 8 months after operation, stenosis at anastomic site was found and improved with balloon dilatation. CONCLUSION: We were satisfied with our results of MIDCAB in single and multi-vessel coronary artery disease. These results have made the cardiologists tried to operate positively and we expect widening operative indications including hybrid revascularization.

Pulmonary Features of Hyperimmunoglobulin E (Job's)syndrome / 결핵

Hyperimmunoglobulin E syndrome, otherwise known as Job's syndrome, is an immune disorder characterized by an abnormal elevation of the circulating immunoglobulin E level, and recurrent infections of the skin and sinopulmo nar tract. The syndrome has various ppulmonary featurea, e.g., pneumonia, pneumatocele, pneumothorax, lung abscesses and empyema. We report a case of hyperimmunoglobulin E syndrome, with various respiratory clinical manifestation. Medical therapy, including prophylactic antibiotics, has been the cornerstone for the treatment of hyperimmunoglobulin E syndrome. Even if surgical intervention is required, minimal pulmonary parenchymal resection is recommended.