Subclinical Hypothyroidism Affects the Long-Term Outcomes of Patients Who Undergo Coronary Artery Bypass Grafting Surgery but Not Heart Valve Surgery

Background@#The aim of this study was to determine the associations between subclinical hypothyroidism (SCH) and long-term cardiovascular outcomes after coronary artery bypass grafting (CABG) or heart valve surgery (HVS). @*Methods@#We retrospectively reviewed and compared all-cause mortality, cardiovascular mortality, and cardiovascular events in 461 patients who underwent CABG and 104 patients who underwent HVS. @*Results@#During a mean±standard deviation follow-up duration of 7.6±3.8 years, there were 187 all-cause deaths, 97 cardiovascular deaths, 127 major adverse cardiovascular events (MACE), 11 myocardial infarctions, one unstable angina, 70 strokes, 30 hospitalizations due to heart failure, 101 atrial fibrillation, and 33 coronary revascularizations. The incidence of all-cause mortality after CABG was significantly higher in patients with SCH (n=36, 55.4%) than in euthyroid patients (n=120, 30.3%), with a hazard ratio of 1.70 (95% confidence interval, 1.10 to 2.63; P=0.018) after adjustment for age, sex, current smoking status, body mass index, underlying diseases, left ventricular dysfunction, and emergency operation. Interestingly, low total triiodothyronine (T3) levels in euthyroid patients who underwent CABG were significantly associated with increased risks of all-cause mortality, cardiovascular mortality, and MACE, but those associations were not observed in HVS patients. Both free thyroxine and thyroid-stimulating hormone levels in euthyroid patients were not related with any cardiovascular outcomes in either the CABG or HVS group. @*Conclusion@#SCH or low total T3 might be associated with a poor prognosis after CABG, but not after HVS, implying that preoperative thyroid hormonal status may be important in ischemic heart disease patients.

Development, validation, and application of a novel tool to measure disease-related knowledge in patients with inflammatory bowel disease

BACKGROUND/AIMS: The Crohn's and Colitis Knowledge (CCKNOW) score does not reflect updated knowledge relating to inflammatory bowel disease (IBD). The aim of this study was to develop, validate, and apply a novel tool to measure disease-related knowledge in IBD patients. METHODS: A questionnaire composed of 24 items regarding knowledge of IBD was developed: Inflammatory Bowel Disease Knowledge (IBD-KNOW). Discriminate ability of IBD-KNOW was validated in three occupational groups (14 doctors, 20 nurses, and 19 clerks). The CCKNOW and IBD-KNOW were administered to IBD patients. Factors affecting the level of IBD-related knowledge were analyzed. RESULTS: The median Inflammatory Bowel Disease Knowledge (IBD-KNOW) score was significantly different among the three groups for validation (22 doctors, 20 nurses, and five clerks; p < 0.001). The IBD-KNOW showed excellent internal consistency (Cronbach α = 0.952) and high correlation with CCKNOW (Spearman ρ = 0.827, p = 0.01). A total of 200 IBD patients (120 Crohn's disease, 80 ulcerative colitis) completed questionnaires. Multivariate analysis showed that a higher IBD-KNOW score than the median was associated with hospitalization history (odds ratio [OR], 2.625; p = 0.003), high education level (OR, 2.498; p = 0.012), and information acquired from patient organization (OR, 3.305, p = 0.035). CONCLUSIONS: The IBD-KNOW demonstrated excellent test characteristics. Hospitalization history, education level, and information acquired from patient organization play an important role in correct IBD-related knowledge.

Report of Nation-wide Questionnaire Survey for Abdominal Aortic Aneurysm Treatment in Korea

While endovascular aneurysm repair (EVAR) is prevailing for the treatment of abdominal aortic aneurysm (AAA) in modern vascular practice, PURPOSE: we conducted nationwide questionnaire survey to investigate the current status of AAA treatment and their results in Korea. METHOD: We reviewed the replies from 28 hospitals (33 departments) to the questionnaire inquiring annual number, clinical features, mode of treatment and results of AAA patients during the period from Jan. 2000 to Jul. 2004. Results: 980 AAA patients were reported including 292 ruptured AAA (29.8%) and 688 non-ruptured AAA (70.2%). For treatment of AAA, 834 (85.1%) surgical repairs (SRs) and 111 (11.3%) endovascualr aneurysm repairs (EVARs) were performed while 35 patients (3.6%) died of AAA rupture before operation. The locations of AAA were infrarenal in 889 (90.7%), juxtarenal in 62 (6.3%), and suprarenal in 29 patients (3.0%). Among 834 patients undergoing SR, 577 patients (69.2%) had non-ruptured AAAs and 257 patients (30.8%) had ruptured AAAs. Mean operative mortality rate was 4.1% after elective SRs, 30.7% after SR for ruptured AAAs, and 2.3% after EVARs. The reported brand name of stent graft devices were various including domestic custom-made in 56 (50.5%), imported brand in 18 (16.2%) while 37 (33.3%) stent grafts were not reported their brand name. The frequencies of type I and III endoleaks after EVAR were reported 5.8% and 5.8% respectively in 86 patients with an available data. CONCLUSION: SR has been used as a major treatment option in Korea for the treatment of AAA patients while EVAR is increasing. The mortality rate of SR of AAA was comparable to western multi-center trial reports but mortality or morbidity rates of EVAR were unable to know in this questionnaire survey.

Formation of an Intestine-Cartilage Composite Graft for Tracheal Reconstruction / 대한흉부외과학회지

BACKGROUND: Tracheal transplantation is necessary in patients with extensive tracheal stenosis, congenital lesions and other oncologic conditions but bears many critical problems compared to other organ transplantations. The purpose of this study was to develop intestine-cartilage composite grafts for potential application in tracheal reconstruction by free intestinal graft. MATERIAL AND METHOD: Hyaline cartilage was harvested from trachea of 2 weeks old New Zealand White Rabbits. Chondrocytes were isolated and cultured for 8 weeks. Cultured chondrocytes were seeded in the PLGA scaffolds and mixed in pluronic gel. Chondrocyte bearing scaffolds and gel mixture were embedded in submucosal area of stomach and colon of 3 kg weighted New Zealand White Rabbits under general anesthesia. 10 weeks after implantation, bowels were harvested for evaluation. RESULT: We identified implantation site by gross examination and palpation. Developed cartilage made a good frame for shape memory. Microscopic examinations included special stain s howed absorption of scaffold and cartilage formation even though it was not fully matured. CONCLUSION: Intestine-cartilage composite graft could be applicable in the future as tracheal substitute and should be further investigated.

Coronary Angiography with Multidetector row Computed Tomography: Part II - Clinical Aspects

An application of the multi-detector computed tomography (MDCT) for cardiac imaging is the non-invasive CT angiographic assessment of the cardiac morphology and the coronary arteries. The most important application is for the non-invasive diagnosis of coronary artery disease, and this includes assessment of coronary artery anomaly and stenosis, the evaluation of non-calcified atherosclerotic plaque and the follow-up examinations after stent deployment and bypass surgery. In the study, we have illustrated a variety of diseases of the coronay artery by using MDCT. These may facilitate the understanding of MDCT features of coronary artery lesions.

Usefulness of Breath-hold T2-w d T2-weighted MR Imaging in Patients with Myocardial Infarction: Comparison with Delayed Enhancement

PURPOSE: To evaluate the usefulness of breath-hold T2-weighted MR imaging in patients with myocardial infarction. MATERIALS AND METHODS: We investigated 11 patients with myocardial infarction who shown delayed enhancement on MR imaging. Infarcted myocardium on T2-weighted MR imaging was classified as high, iso, and low signal area comparing with normal myocardium. The intensity and transmural extent of infracted myocardium was also analyzed. On the basis of clinical information, the stage of infracted myocardium on T2-weighted MR imaging was assessed. RESULTS: It was observed high signal area in 12 segments of 5 patients, low in 12 segments of 6 patients on T2-weighted MR imaging. The high signal intensity of infarcted myocardium was shown as 175+/-9% comparing with that of the normal myocardium, low signal intensity as 73+/-5% (p < 0.05). In the evaluation of transmural extent, the high signal areas on T2-weighted MR imaging were larger than infarct area on delayed enhancement imaging (100% vs. 49%+/-17%), whereas low signal areas on T2-weighted MR imaging correlated. High signal area was visualized on T2-weighted MR imaging within 11days, whereas low-signal area was seen after 7 months. CONCLUSION: Breath-hold T2-weighted MR imaging is useful in the evaluation of stage as well as edema and fibrous scar in patients with myocardial infarction.

Protective Effect of Nitroglycerin on the Ischemia-Reperfusion Model of the Isolated Rat Lung / 대한흉부외과학회지

BACKGROUND: Protection against ischemia-reperfusion injury is crucial for successful transplantation of the lung. It has been known that nitric oxide has many favorable effects on the donor lungs but at the same time, has some potential side effects of cytotoxicity. In this regards, we investigated whether the administration of nitroglycerin could decrease ischemia-reperfusion injury in isolated rat lung reperfusion model for the confirmation of the effect of nitroglycerin, a donor of nitric oxide, on lung transplantation. MATERIAL AND METHOD: 35 Sprague-Dawley species male white rats were used for this experiment. For nitroglycerin group (n=18), nitroglycerin was administered intravenously followed by mixed in flushing solution for preservation. As a control group (n=17), we used the same amount of normal saline. To evaluate the effect of nitroglycerin on the lung, heart-lung block was obtained, weighed and stored in University of Wisconsin Solution at 10oC for 24 hours. In each group of the isolated lungs, reperfusion was carried out with Krebs-Hensleit-diluted human blood for 60 minutes. As parameters of the state of the isolated lung, peak inspiratory and pulmonary arterial pressures were continuously recorded. Oxygen and carbon dioxide tension of reperfusing blood were measured before and after 30, 60 minutes of reperfusion. After sixty minutes of reperfusion, protein content in bronchoalveolar lavage fluid was measured also for the evaluation of the degree of alveolar flooding. Lung myeloperoxidase activity was determined to verify the accumulation of neutrophils. RESULTS: Although statistically significant differences were not noted in peak inspiratory and pulmonary arterial pressure between control and nitroglycerin group, latter group showed lowering tendency of pulmonary arterial pressure during the entire reperfusion period. Oxygen tension was higher (p<0.05) in nitroglycerin group compared with that of the control group, in contrast, there were no differences in carbon dioxide tension, protein content in bronchoalveolar lavage fluid and myeloperoxidase activity between the groups. In the examination of ultrastructural changes, nitroglycerin denoted the protective effect on the pulmonary architecture compared with that of control group. CONCLUSION: Collectively, on the bases of these experimental results, prior treatment of donor lung with nitroglycerin could result in better preservation of the lung. Consequently, these nitroglycerin preserved lungs are thought to be more suitable for successful transplantation of the lung.

Efficacy of Positron Emission Tomography in Diagnosing Pulmonary Tumor and Staging of Lung Cancer: Comparing to Computed Tomography / 대한흉부외과학회지

BACKGROUND: Diagnosing and determining the stage of lung cancer by means of positron emission tomography (PET) has been proven valuable because of the limitations of diagnosis by computed tomography (CT). We compared the efficacy of PET with that of CT in diagnosing pulmonary tumor and staging of lung cancer. MATERIAL AND METHOD: We performed F-18 FDG PET to determine the malignancy and the staging on patients who have been suspicious or were diagnosed as lung cancer by chest X-ray and CT. The findings of PET and of CT of 41 patients (male, 29; female, 12; mean age, 59) were compared with pathologic findings obtained from a mediastinoscopy and thoracotomy. RESULT: Out of 41 patients, 35 patients had malignant lesions (squamous cell carcinoma 19 cases, adenocarcinoma 14 cases, adenosquamous cell carcinoma 2 cases) and 6 patients had benign lesions. Diagnosing of lung cancer, the sensitivity, specificity and accuracy of CT and PET were the same for two method and the numbers were 100 %, 50 %, and 92.7 % respectively. Eighteen LN groups out of 108 mediastinal LN groups who recieved histologic examination proved to be malignant. Pathologic lymph node (LN) stage was N0-N1 31 cases, N2 8 cases, N3 2 cases. The correct identification of the nodal staging with CT, PET scans were 31 cases (75.6%), 28 cases (68.3%) respectively. The LN group was underestimated in each 6 cases of CT and PET. In 4 cases of CT and 7 cases of PET, they were overestimated in compare to histologic diagnosis. In the detection of mediastinal LN groups invasion, the sensitivity, specificity and accuracy of CT were 39.8 %, 93.3 %, and 84.3 % respectively. For PET, they were 61.1 %, 90.0 %, and 85.2 %. When two methods considered together (CT+PET), they were increased to 77.8 %, 93.3 %, and 90.7 % respectively. Conclusion:PET appears to be similar to CT in the diagnosis and the nodal taging of pulmonary tumor. Two tests may stage patients with lung cancer more accurately than CT alone.