A Study of Aortic Vasculopathy after Cardiac Allograft / 대한흉부외과학회지

BACKGROUND: Chronic rejection after a cardiac allograft usually occurs about six months after the operation. Vasculopathy due to chronic rejection causes atherosclerosis in the coronary artery of the transplanted heart and then this causes myocardial injury. We intended to discover and document those findings that occur in a transplanted ascending aorta. MATERIAL AND METHOD: In rats weighting 200~300 gm (Spraque-Dawley rat), we carried out heterotopic heart allo-transplantation with the modified Ono-Lindsey method and then the rats were administrated cyclosporine (10 mg/kg/day). After three months survival, we acquired biopsy materials from the native ascending aorta and the allo-transplanted ascending aorta and we compared them. We classified each severity of 1) intimal thickening, 2) medial hyperplasia, 3) medial calcification, 4) medial inflammation and 5) chondroid metaplasia, which are specific biopsy findings for chronic rejection after a cardiac allograft. Each severity was classified, according to the opinion of one pathologist, in the native ascending aorta biopsies (n=9) and the allo-transplanted ascending aorta biopsies (n=13). The data of the control group and the study group were statistically analyzed with using the Mann-Whitney test (SPSS version 12.0 window). RESULT: The important changes of the allo-transplanted aorta were intimal thickening (p<0.0001), medial calcification (p=0.045), medial inflammation (p<0.0001) and chondroid metaplasia (p=0.045), but not medial hyperplasia (p=0.36). CONCLUSION: Cardiac allograft vasculopathy was seen in the transplanted ascending aorta, the same as was seen in the coronary artery, after allograft cardiac transplantation. We have reached the conclusion that chronic rejection also progresses in the aorta.

A Tuberculoma in the Left Lower Lobe of Lung That Was Erroneously Diagnosed as Ectopic Liver / 대한흉부외과학회지

Tuberculoma of the lungs is not an uncommon finding, but an ectopic liver in the lung is extremely rare. Pulmonary tuberculosis presenting as tuberculoma can be diagnosed radiologically, but its definite diagnosis is established by confirmation of the acid-fast bacillus or the unique histology. We report here on a case of tuberculoma of the left lower lobe that was erroneously diagnosed as ectopic liver by ultrasono-guided fine needle aspiration biopsy. An understanding of the normal variants of the liver can prevent a patient from undergoing an unnecessary invasive procedure.

A Case Report of Tension Pneumopericardium Following Blunt Chest Trauma / 대한흉부외과학회지

A 49-year-old man visited our hospital via the emergency room. He had suffered chest trauma by falling down. His chest X-Ray showed pneumomediastinum with pneumopericardium. We checked the Chest CT, and it showed pneumopericardium without any injury to the other organs, the compressed heart and a minimal pneumothorax on the left hemithorax. Closed thoracostomy was then done under local anesthesia. We then performed open pericardiostomy under general anesthesia. We got a good result and so we report on this case.

Short- and Long-Term Results of Triple Valve Surgery: A Single Center Experience

Triple valve surgery is usually complex and carries a reported operative mortality of 13% and 10-yr survival of 61%. We examined surgical results based on our hospital's experience. A total of 160 consecutive patients underwent triple valve surgery from 1990 to 2006. The most common aortic and mitral valve disease was rheumatic disease (82%). The most common tricuspid valve disease was functional regurgitation (80%). Seventy-four percent of the patients were in New York Heart Association (NYHA) class III and IV. Univariate and multivariable analyses were performed to identify predictors of early and late survival. Operative mortality was 6.9% (n=11). Univariate factors associated with mortality included old age, preoperative renal failure, postoperative renal failure, pulmonary complications, and stroke. Of them, postoperative renal failure and stroke were associated with mortality on multivariable analysis. Otherwise, neither tricuspid valve replacement nor reoperation were statistically associated with late mortality. Survival at 5 and 10 yr was 87% and 84%, respectively. Ninety-two percent of the patients were in NYHA class I and II at their most recent follow-up. Ten-year freedom from prosthetic valve endocarditis was 97%; from anticoagulation-related hemorrhage, 82%; from thromboembolism, 89%; and from reoperation, 84%. Postoperative renal failure and stroke were significantly related with operative mortality. Triple valve surgery, regardless of reoperation and tricuspid valve replacement, results in acceptable long-term survival.

Distal Esophageal Perforation Caused by Press-Through-Pack Ingestion / 대한소화기내시경학회지

A 60-year-old man presented with epigastric pain. The patient had no history of foreign body ingestion and had no symptoms of dysphagia or odynophagia. Chest computed tomography scan showed an esophageal perforation with unknown etiology and an emergency operation for thoracic cavity irrigation and drainage was undertaken, followed by fasting and conservative treatment. Two weeks later, a follow-up chest computed tomography scan revealed a suspicious foreign body in the distal esophagus. Endoscopy revealed a press-through-pack (PTP) that had caused an esophageal perforation. Despite extraction of the PTP and antibiotic administration, the patient died. The present case is important since PTP is commonly used in Korea.

Pulmonary Langerhans Cell Histiocytosis Accompanied by Active Pulmonary Tuberculosis / 대한흉부외과학회지

Pulmonary Langerhans cell histiocytosis is very rare, especially when accompanied by active pulmonary tuberculosis. A patient was hospitalized due to excessive dyspnea and she was diagnosed with active pulmonary tuberculosis by a sputum AFB smear. The HRCT taken after hospitalization showed multiple micronodules and tiny cysts. An open lung biopsy confirmed the coexistence of pulmonary Langerhans cell histiocytosis.

An Inflammatory Myofibroblastic Tumor that Originated from the Posterior Mediastinum / 대한흉부외과학회지

An inflammatory myofibroblastic tumor (IMT) is a rare disease and can occur in nearly every site of the body. The usual intrathoracic sites where an IMT has been recorded are the lung and bronchus. An IMT originating from the mediastinum has been rarely reported. A patient with a posterior mediastinal mass that was noticed incidentally on a chest X ray underwent mass extirpation. The pathologic diagnosis was an inflammatory myofibroblastic tumor. The tumor was positive for tuberculosis as determined by PCR. Tuberculosis can be thought to be the causative factor of the IMT in this case.

Surgical Treatment of Well-Differentiated Fetal Adenocarcinoma: A case report / 대한흉부외과학회지

WDFA(Well-differentiated fetal adenocarcinoma) histologically resembles pulmonary blastoma. It is also thought to be a subtype of pulmonary blastoma, which has differentiated epithelial features resembling the fetal lung among its epithelial features and sarcomatous features. We recently encounted a patient who underwent surgery for WDFA. A 19-year-old man had a mass shadow in the upper lobe of the left lung. The tumor was diagnosed as pulmonary blastoma as a result of fine needle aspiration biopsy, and left upper lobe lobectomy was performed. No sarcomatous features was observed on postoperative histologic assessment, and the patient was diagnosed as having WDFA. This case is reported with a discussion of the literatures.

Langerhans' Cell Histiocytosis in Chest Wall / 대한흉부외과학회지

Langerhans' Cell Histiocytosis(LCH) is a disease of unknown origin, characterized by abnormal proliferation of Langerhans' cells. Previously, it has been called histiocytosis X, which included eosinophilic granuloma, Hand-Sch ller-Christian's disease, and Letterer-Siwe disease. Any organs or tissues such as skin, lymph nodes, bone and bone marrow can be involved. However, LCH of chest wall is rarely reported in our country. We experienced a 18 month old male child, who had osteolytic lesion involving the rib with axillary lymph node metastasis. The tumor was confirmed as LCH after surgery.