Hemolytic Anemia Case Caused by an Inverted Inner Felt after Bentall Operation

A 26-yr-old male patient reported worsened dyspnea, dizziness one year after an emergency Bentall operation for type A aortic dissection. There was evidence of hemolytic anemia and aortogram revealed a significant stenosis at the distal anastomosis site. During the reoperation, we found the inner felt at the distal anastomosis was inverted causing a significant stenosis. The reoperation successfully resolved this problem. Here, we report a rare case of hemolytic anemia caused by an inverted inner felt after Bentall operation.

Complications of a Tube Thoracostomy Performed by Emergency Medicine Residents

PURPOSE: A tube thoracostomy is an invasive procedure that places patients at risk for complications. Tube thoracostomies are frequently performed by emergency medicine residents. Thus, the purpose of the study was to assess both the complication rate for tube thoracostomies performed by emergency medicine residents and the factors associated with these complications. METHODS: A retrospective chart review of all patients who had undergone a tube thoracostomy performed by emergency medicine residents between January 2008 and February 2009 was conducted at a university hospital. Complications were divided into major and minor complications and into immediate and delayed complications. Complications requiring corrective surgical intervention, requiring the administration of blood products, or involving situations requiring intravenous antibiotics were defined as major. Complications that were detected within 2 hours were defined as immediate. RESULTS: Tube thoracostomies were performed in 189 patients, and 70 patients(37%) experienced some complications. Most complications were immediate and minor. In multiple logistic regressions, BMI, hypotension and resident seniority were significantly associated with complications. CONCLUSION: The prevalence of complications was similar to these in previous reports on the complications of a tube thoracostomy. Most complications from tube thoracostomies performed by emergency medicine residents were immediate and minor complications. Thus, emergency medicine residents should be allowed to perform closed tube thoracostomies instead of thoracic surgeons.

PNEUMOMEDIASTINUM AND PNEUMOTHORAX AFTER ORTHOGNATHIC SURGERY: A CASE REPORT

Anti-inflammatory and Anti-oxidant Effects of Sophora flavescens Root Extraction in Lipopolysaccharide-activated Raw 264.7 Cells / 대한의진균학회지

BACKGROUND: The macrophages activated by lipopolisaccharide produce numerous molecules and proteins, such as tumor necrotic factor-alpha (TNF-alpha), interleukin-6 (IL-6), IL-1beta, inducible nitric oxide synthase (iNOS), cyclooxygenase-2 (COX-2), and free radicals, associated with inflammation. The response was occurred by intracellular cascaded, NF-kappaB pathway. So, the regulation of this pathway is very important in control of inflammation. OBJECTIVE: In this study, the anti-inflammatory and anti-oxidant effects of Sophora flavescens that is used empirically in oriental medicine and folk remedy were evaluated and the mechanism of the effects was studied. METHODS: By using the root extracts of Sophora flavescens, we performed experiment in LPS and interferon-gamma (IFN-gamma)-activated Raw 264.7 cells. We measured the production of NO, PGE2 and expression of iNOS and COX-2 in activated Raw 264.7 cells with Sophora flavescens root extract. Also, we tested anti-oxidant effect of Sophora flavescens root extracts by ELISA kit in activated Raw 264.7 cells, and the free radical scavenging effect of material itself by DPPH assay. RESULTS: The Sophora flavescens root extracts decreased the production of NO (p<0.001) and PGE2 (p<0.01) in Raw 264.7 cells activated by LPS and IFN-gamma. The expression of proteins, iNOS and COX-2, suppressed along with the elevated concentration of Sophora flavescens root extracts. The result of DPPH assay was that the test material itself had scavenging effect for free radical (p<0.001). And the antioxidant activity in activated Raw 264.7 cells was increased with the level of the Sophora flavescens root extracts (p<0.05). CONCLUSION: The Sophora flavescens root extracts suppressed the production of NO and PGE2 through the decreased expression of iNOS and COX-2. And the Sophora flavescens root extracts had the scavenging effect about free radicals itself and increased the antioxidant activity in activated macrophages.

HLA-DRB1 Study of DNA from Ancient Human Skeleton by Sequence-based Typing / 체질인류학회지

The analysis of ancient human DNA is increasingly used recently in the study of anthropology and human evolution. Although mitochondrial DNA and Y chromosomal DNA has commonly been the target in the field of human DNA study, HLA analysis of ancient human DNA is extremely rare. This study aimed to develop the PCR method of ancient human DNA for analyzing the sequence of HLA. Authors established a new method for HLA-DRB1 analysis by sequence-based typing. Alleles of HLA-DRB1 were analyzed and typed by sequencing with DNA of ancient human skeletons from Korea and Mongolia 3000-500 years ago. The types of HLA-DRB1 were determined by comparing the sequences with those of HLA database (http://www. ebi.ac.uk/Tools/blast2/nucleotide.html). The alleles of HLA-DRB1 of ancient human DNA from Korea and Mongolia were classified by types. The frequencies of HLA-DRB1 types of Mongolia were also presented according to the geography such as West, Central, East, and North. In summary, our method was successful in the analyzing the type of HLA-DRB1 from DNA of ancient human bones. Authors anticipate that many researchers could do their research in a better way to get the genetic information for the kinship analysis between individuals or communities from ancient human bones.

Dorsal Cavoatrial Bypass for Congenital Interruption of IVC / 대한흉부외과학회지

Congenital interruption of the inferior vena cava (IVC) can lead to secondary hepatic congestion, portal hypertension, and liver cirrhosis. A 49-year-old woman was admitted to the gynecology department with symptoms of menorrhalgia, known uterine myoma, and anemia. Abdominal computed tomography (CT) and venography performed at our hospital revealed congenital interruption of the IVC. The patient underwent retrohepatic cavoatrial bypass surgery with a polytetrafluoroethylene (PTFE) 16-mm ringed graft via posterolateral thoracotomy, and recovered without major complications. A retroperitoneal approach via posterolateral thoracotomy provides appropriate visualization during dorsal cavoatrial bypass in treating patients with congenital interruption of IVC.

Vein Crossover Bypass Surgery for a Chronic Femoral Vein Ligation: A case report / 대한흉부외과학회지

A twenty six year old man was admitted to our clinic for bleeding from a venous ulcer of the left leg. His left femoral vein had been ligated for bleeding control after a traffic accident that happened when he was 5 years old. He had a varicose vein, stasis dermatitis, and a venous ulcer on his left leg. To shunt left femoral venous return to the right femoral vein, we did a crossover bypass with arteriovenous fistula using the right greater saphenous vein. To get good patency of the arteriovenous fistula, the bypass graft was closed 6 weeks after the initial operation. He maintained his left leg circumference relatively well for 6 months after the operation. We report the case of a patient who had a vein crossover bypass for a chronic femoral vein ligation.

Intravenous Remifentanil Infusion during EVLT for Varicose Vein / 대한흉부외과학회지

BACKGROUND: We compared the analgesic effects of an intravenous infusion of remifentanil with local lidocaine injection during endovenous laser treatments (EVLT) for varicose veins. MATERIAL AND METHOD: In order to compare the efficacy of analgesia between the lidocaine group (n=15) and the remifentanil group (n=15), we measure the pain intensity of the patients, with using the visual analogue scale, during EVLT and at the first week, the second week, the third week and the fourth week after EVLT. RESULT: The remifentanil group showed significantly less pain intensity during EVLT (p0.3). CONCLUSION: The result showed that the intravenous infusion of remifentanil during EVLT can be a good option to reduce pain during EVLT for treating varicose veins.

Angioleiomyosarcoma Arising from the Deep Femoral Vein: A report of one case / 대한흉부외과학회지

A 69-year-old man was admitted to our hospital for deep vein thrombosis, and he had experienced two episodes of left leg swelling: one happened after an 11 hour-air trip from Europe in June 2007, and the other developed 3 days after an operation for a herniated lumbar disc in July 2007. We treated him for a deep vein thrombosis of the deep femoral vein after admission. However, we arrived at the final diagnosis of angioleiomyosarcoma after the operation for the tentative diagnosis of deep vein thrombosis. We removed the firmly engorged deep femoral vein on the second operation. We report here on a case of angioleiomyosarcoma that arose from the deep femoral vein.

Changes of Tight Junction and Epithelial Cells after Treatment of Cadmium / 체질인류학회지

Cadmium (Cd) affects cell proliferation, differentiation, apoptosis and other cellular activities and can cause numerous molecular lesions that would be relevant to carcinogenesis. The mechanism of adverse effects of Cd has been poorly understood and, especially on the tight junction. Since there is rare information about the effect of Cd on tight junction protein, we here investigated whether Cd can alter the localization of the proteins. This study examined Cd effects on of tight junction (occludin, ZO-1, and ZO-2) using MDCK cell culture. The change of MDCK cell and tight junction was investigated after treatment of cadmium with phase contrast microscopy, TEER, cell viability, Transmission electron microscopy and confocal laser microscopy. After treatment of cadmium, transendothelial electrical resistance decreased with time and concentration dependent manner. AlamarBlue assay revealed that decreased cell viability also decreased with time and concentration dependent manner. The tight junction moved down between intercellular spaces with decreased density and the cellular thickness around cell junctions decreased with increasing concentration and exposure time of CdCl2. The MDCK cells eventually showed cell death with. Confocal laser microscopy revealed that immunofluorescent reaction of occludin, ZO-1 and ZO-2 decreased. Occludin, ZO-1 and ZO-2 were disrupted at tight junction. These data suggest that after treatment of Cd, increased permeability of MDCK cell monolayer increased. This might be accompanied with disruption of occludin, ZO-1 and ZO-2.

The Effects of Chest Injury in the Early Deaths of Trauma Patients / 대한흉부외과학회지

BACKGROUND: In the studies of the distribution of time to death in trauma patients, the early deaths within several hours after injury were a large component of total trauma deaths. Due to the development of trauma system, overall mortality of trauma was decreased, but trauma is still the major cause of deaths. MATERIAL AND METHOD: From January 1994 to December 2003, trauma patients who had been admitted and had expired at tertiary hospital were enrolled. There was a total of 400 cases, a retrospective study was done to determine the distribution of trauma mortality according to the part of the body that were severely injured part and compared the difference between early deaths within 6 hours and late deaths after 6 hours. We also analysed the risk factors of early deaths due to trauma. RESULT: In severe injury to the head and abdomen, the distribution of mortality was bimodal. But, in severe chest injuries, the distribution was log-shape and most early deaths were almost of trauma related. The average of GCS were 5.86+/-4.15 for the early deaths and 8.24+/-5.02 for the late deaths (p <0.05). The AIS of thorax were 2.66+/-1.87 for the early deaths and 1.55+/-1.76 for late deaths. The risk factors for early mortality were non-EMS transportation (odds ratio 3.474), high AIS (odds ratio 1.491) and GCS (odds ratio 0.859). CONCLUSION: In trauma patients, the causes of early mortality were severe brain injury and massive hemorrhage. Also severe chest injuries were the major cause of the early deaths in truama. Early diagnosis of chest injury can frequently be missed in the acute trauma setting. Therefore, high index of suspicion, a careful examination, and aggressive surgical treatment are important in multiple trauma patients.

Transformation of Adult Mesenchymal Stem Cells into Cardiomyocytes with 5-azacytidine: Isolated from the Adipose Tissues of Rat / 대한흉부외과학회지

BACKGROUND: Loss of cardiomyocytes in the myocardial infarction leads to regional contractile dysfunction, and necrotized cardiomyocytes in infracted ventricular tissues are progressively replaced by fibroblasts forming scar tissue. Although cardiomyoplasty, or implantation of ventricular assist device or artificial heart was tried in refractory heart failure, the cardiac transplantation was the only therapeutic modality because these other therapeutic strategies were not permanent. Cell transplantation is tried instead of cardiac transplantation, especially bone marrow is the most popular donated organ. But because bone marrow aspiration procedure is invasive and painful, and it had the fewer amounts of cellular population, the adipose tissue is recommended for harvesting of mesenchymal stem cells. MATERIAL AND METHOD: After adipose tissues were extracted from abdominal subcutaneous adipose tissue and intra-abdominal adipose tissue individually, the cellular components were obtained by same method. These cellular components were tried to transformation with the various titers of 5-azacytidine to descript the appropriate concentration of 5-azacytidine and possibility of transformation ability of adipose tissue. Group 1 is abdominal subcutaneous adipose tissue and Group 2 is intra-abdominal adipose tissue-retroperitoneal adipose tissue and omentum. Cellular components were extracted by collagenase and NH4Cl et al, and these components were cultured by non-induction media-DMEM media containing 10% FBS and inducted by none, 3 micromol/L, 6 micromol/L, and 9 micromol/L 5-azacytidine after the 1st and 2nd subculture. After 4 weeks incubation, the cell blocks were made, immunostaining was done with the antibodies of CD34, heavy myosin chain, troponin T, and SMA. RESULT: Immunostaining of the transformed cells for troponin T was positive in the 6 micromol/L & 9 micromol/L 5-azacytidine of Group 1 & 2, but CD34 and heavy myosin chain antibodies were negative and SMA antibody was positive in the 3 micromol/L & 6 micromol/L 5-azacytidne of Group 2. CONCLUSION: These observations confirm that adult mesenchymal stem cells isolated from the abdominal subcutaneous adipose tissues and intra-abdominal adipose tissues can be chemically transformed into cardiomyocytes. This can potentially be a source of autologous cells for myocardial repair.

Clinical Characteristics of Patients with Traumatic Diaphragm Injury and Comparison of Scoring Systems as Predictors / 대한흉부외과학회지

BACKGROUND: Because of high morbidity and mortality, traumatic diaphragm injury remains a diagnostic challenge. In this study, we evaluate that some factors and scores can be used as predictors. MATERIAL AND METHOD: From May 1995 to June 2003, 23 patients with traumatic diaphragm injury were enrolled. We examined the clinical features of patients. RTS, TRISS, ISS and APACHE II scores for each patient are calculated for analyzing the relationship of mortality and ICU duration. RESULT: The study identified 15 men (65.2%) and 8 women (34.8%). There are right sided diaphragmatic injury in 11 patients (47.8%), left sided in 11 (47.8%), and both sided in 1 (0.4%). Plain X-ray, CT, upper GI contrast study and esophagogastroscopy were used as diagnostic tools. Age, hemodynamic status, early diagnosis are not associated with outcome. As prognostic factor, RTS and ISS are associated with mortality and there was negative relationship between RTS and ICU duration (r=0.737, p=0.026). CONCLUSION: An early diagnosis of traumatic diaphragm injury can frequently be missed in the acute trauma setting. So high index of suspicion and a careful examination are important in multiple trauma patients. An RTS can probably be used effectively as a predictor for the severity and prognosis in patients with traumatic diaphragm injury.

The Role of BF-7 on Neuroprotection and Enhancement of Cognitive Function

Amyloid beta-peptide (A beta) contributes to the pathogenesis of Alzheimer's disease (AD), causing neuronal death through apoptosis. In this study, the neuroprotective role of BF-7, extracted form sericultural product, was examined against A beta -induced toxicity in cultured human neuronal cell SKN-SH. In order to know if the BF-7 has positive role on the cognition and memory in human, the mixture of BF-7, DHA and EPA (BDE) was examined using Rey Kim and K-WAIS test with 50 healthy high school student. We report here that BDE significantly attenuated A beta-induced apoptosis through the reduction of ROS accumulation, and diminished caspase-like protease activity. Moreover, the memory index and memory preservation, and attentative concentration of BDE treated group for 1 month were significantly improved, in contrast to the case of placebo control treated with DHA and EPA. This result represent that the BF-7 play significant positive role on learning memory. Taken together, our result suggested the natural product BF-7 is a good substance for the brain functionally and physiologically.

Clinical Manifestations and Treatment Outcomes of Pulmonary Aspergilloma

BACKGROUND: Pulmonary aspergilloma usually results from the ingrowth of colonized Aspergillus from a damaged bronchial tree, a pulmonary cyst, or from the cavities of patients with underlying lung diseases. In the present study, we analyzed the clinical features, diagnostic methods, and managements of 36 patients with pulmonary aspergilloma. METHODS: Thirty-six patients were diagnosed as having pulmonary aspergilloma at Chung-Ang University Hospital between February 1988 and February 2000. Their medical records were reviewed retrospectively. RESULTS: The age of patients (median +/- SD) was 53.3 +/- 11.8 years, the male to female ratio was 2.36: 1, and the most frequent symptom was hemoptysis, which occurred in 24 patients (65%). The most common underlying disease was pulmonary tuberculosis (81%), and the upper lobes of both lungs were the most frequently involved sites. Nine patients received a chest CT in the prone position and seven of these showed a movable fungus ball. Eleven patients were positive for the precipitin antibody to A. fumigatus. Twenty patients underwent surgical resection, and post-operative complications were reported in seven cases. The post-operative mortality was 5.6% (2/36). CONCLUSION: Pulmonary aspergilloma usually develops in the patients with underlying lung diseases. Resectional lung surgery is considered the mainstay of therapy for pulmonary aspergilloma. However, this operation is associated with significant complications and death in some cases. Therefore, it is necessary to develop reasonable criteria for selection of candidates for such surgery.

Inflammatory Pseudotumor Involving the Pulmonary Artery: Case Report

Pulmonary inflammatory pseudotumor is the most common primary lung mass seen in children, but extraparenchymal involvement is relatively rare. We report here on a case of inflammatory pseudotumor involving the mediastinum and the pulmonary artery. A 48-year-old man presented with enlargement of the right hilum on a simple chest radiograph. He had a history of exertional dyspnea for 1 year. A non-homogeneous enhancing mass was noted in the right pulmonary artery on computed tomography. Mediastinotomy and pulmonary artery angiography with a forcep biopsy revealed inflammatory pseudotumor of the mediastinum and pulmonary artery.

Development of In Vitro Blood-Brain Barrier Model with Bovine Brain Microvessel Endothelial Cells / 체질인류학회지

The in vitro blood-brain barrier (BBB) model was established with bovine brain microvessel endothelial cells (BBMECs). The characteristics of BBMECs were identified by morphological and functional studies. BBMECs began to grow as spindle shaped cells and distinctly formed the monolayer of whirling appearance by 6 to 7 days after plating. Transendothelial electrical resistance (TEER) of the monolayer increased through 11 days and then started to decrease. The gamma-GTP activity (1791.5+/-397.8 nmol/min/mg of protein) and alkaline phosphatase activity (15.0+/-7.8 micromol/min/mg of protein) were high. BBMECs in culture were characterized by the binding of anti-vWF, anti-ZO-1, anti-vimentin, and anti-fibronectin antibodies. They failed to react with anti-GFAP, anti-GalC, and antineurofilament 160/200 kD antibodies, markers for astrocyte, oligodendrocyte, and neuron, respectively. Decreasing order of the permeability through the BBMEC monolayers of paracellular transport model drugs was mannitol, sucrose, and PEG-4000. The permeability of transcellular transport model drugs, progesterone and propranolol was much higher than that of paracellular transport model drugs. The BBMECs cultured on porous membrane have been qualified as an in vitro BBB model and also can be used for the BBB transport study in the drug development and for the BBB transport mechanism of drugs.

Attenuated Ceramide-induced Neuronal Apoptosis by Acanthopanax senticous / 체질인류학회지

Both Acanthopanax senticosus and Acorus gramineus Soland are typical Oriental herbs. They have been used as a tonic, anti-rheumatic, anti-inflammatory, anti-stress, anti-cancer agent. But, it is still unclear how they effectively regulate their various biological properties. Ceramide is emerging as a second messenger of apoptotic cell death and there is increasing evidence that ceramide is involved in neurodegenerative disease and the process of senescence. The present study investigated the different effects of A. senticosus and A. gramineus on ceramide-induced apoptosis in human neuroblastoma SK-N-SH cells. We showed that ceramide induced apoptosis through the mediation of reactive oxygen species(ROS) production and A. senticosus, as an effective antioxidant, significantly inhibited the increase of ROS generation, thereby preventing apoptosis. Furthermore, an increase of caspase activity (apoptosis executors) resulted from ceramide reduced by A. senticosus. But A. gramineus had almost no protective effects. These results implicate that ROS play on important roles in ceramide-induced apoptosis, also A. senticosus protects effectively via inhibition of ROS generation by ceramide through selective pathway.

Clinical investigation of pulmonary aspergilloma / 대한내과학회지

BACKGROUND: Pulmonary aspergilloma usually results from the ingrowth of the colonized Aspergillus in the damaged bronchial tree, pulmonary cyst, or cavities of patients with underlying lung diseases. We analyzed the clinical features, diagnostic methods, and managements of 36 patients with pulmonary aspergilloma. METHODS: From February 1988 to February 2000, medical records of 36 patients who were diagnosed as pulmonary aspergilloma at Chung Ang university hospital were reviewed retrospectively. RESULTS: The mean age (mean+/-SD) was 53.3+/-11.8 years, The male to female ratio was 2.36:1. The most frequent symptom was hemoptysis which occured in 24 patients (65%). The most common underlying disease was pulmonary tuberculosis (81%). The upper lobe was most commonly involved area. In 9 patients, chest CT was taken with prone position and 7 of them showed movability of the fungus ball. Eleven patients showed positive test for precipitin antibody of Aspergillus species. As for the treatment, 20 patients underwent surgical resection. Post-operative complications were reported in 7 cases. The post-operative mortality was 5.6% (2/36). CONCLUSION: Pulmonary aspergillomas usually develop in patients with underlying respiratory diseases. Resectional lung surgery is considered to be the mainstay of therapy for pulmonary aspergilloma. However, operation is associated with significant complication rate and even deaths. Therefore, it is necessary to develop a reasonable criteria for the selection of suitable candidates with aspergilloma for the surgery.

Outcome of Cardiopulmonary Resuscitation for In-hospital Cardiac Arrest in a Tertiary Emergency Department

PURPOSE: The "In-hospital Utstein Style" is an internationally recommended guideline for reporting outcome data from inhospital resuscitation events. This study was designed to evaluate the current status of in-hospital cardiopulmonary resuscitation (CPR) in a tertiary emergency department and to provide basic data for a unified report guidelines for resuscitation in Korea. METHODS: A clinical analysis of 249 cases of in-hospital CPR performed in a tertiary emergency department from August 1995 to December 2001 was conducted. The evaluation was made using Utstein reporting guidelines. RESULTS: During the period, 232 patients received 249 resuscitations. The immediate precipitating causes of cardiac arrest were cardiogenic in 61 cases (24.5%), traumatic in 58 cases (23.3%), respiratory in 41 cases (16.5%), and metabolic in 28 cases (11.3%). Initial EKG rhythms were bradyarrhythmia in 115 cases (46.2%), pulseless electrical activity in 69 cases (27.7%), ventricular fibrillation/tachycardia (VF/VT) in 36 cases (14.5%), and asystole in 26 cases (10.4%). The spontaneous circulation was returned in 153 of the 249 resuscitations (61.5%). In 59 of the 249 resuscitations (23.7%), spontaneous circulation was maintained for more than 24 hours. Sixteen of the 232 patients (6.9%) were discharged alive. The VF/VT group of initial EKG rhythm had a better outcome in comparison with non-VF/VT group. The prognosis for respiratory arrest was better (78% probability of survival) than it was for other causes of arrest. Patients suffering from traumatic arrest showed the worst outcomes (9% probability of survival). CONCLUSION: Although the "In-hospital Utstein Style" is very subjective as a report determining the outcome of resuscitation, it has many complementary factors. However, even with the "Utstein Style", new guidelines compatible with the actual circumstances of our emergency department must be developed.