A Report of Two Cases of Adventitial Cystic Disease of the Popliteal Artery

Two patients were admitted to our department because of recent aggravation of claudication in the leg, which was exacerbated by walking. They were diagnosed as having a Baker cyst or acute thrombosis in the popliteal fossa at another hospital. There was no evidence of ischemia, and the ankle brachial index was normal. Computed tomography and magnetic resonance imaging were performed, revealing a cystic mass of the popliteal artery (PA). Intraoperatively, the cystic lesion was found within the adventitia of the PA; based on the biopsy findings, both patients were diagnosed as having adventitial cystic disease of the PA.

Autotransplantation of the Heart for Recurrent Inflammatory Myofibroblastic Tumor

We report a rare case of dyspnea caused by a cardiac tumor in a 53-year-old woman. The patient had undergone a cardiac tumor (inflammatory myofibroblastic tumor, 6.2 × 4.2 × 3.3 cm) resection at our institute 13 months earlier. We performed preoperative evaluations which revealed a cardiac tumor originating from the posterior wall of the left atrium. Cardiac autotransplantation surgery (cardiac explantation, ex vivo tumor resection, cardiac reconstruction, and cardiac reimplantation) was successfully performed for the complete resection of the recurrent tumor without major postoperative complications. The patient showed good physical conditions for 21 months after the surgery. Cardiac autotransplantation is a safe and feasible technique for the complete resection of complex left atrial tumors.

Ectopic Cervical Thymoma: A Case Report and Review

In the embryo, the thymus originates from the third and fourth pharyngeal pouches and migrates from the superior neck to the mediastinum. Ectopic cervical thymoma (ECT) is an extremely rare tumor that originates from ectopic tissue, and is caused by the aberrant migration of the embryonic thymus. Our patient was a 30-year-old woman who had a nodular lesion in the neck for several years. Ultrasonography and computed tomography were performed. She underwent surgery, and a histological examination resulted in a diagnosis of type AB thymoma. Herein, we report a case of ECT that was resected through a transcervical approach.

Biochemical Markers as Predictors of In-Hospital Mortality in Patients with Severe Trauma: A Retrospective Cohort Study / 대한중환자의학회지

BACKGROUND: Initial evaluation of injury severity in trauma patients is an important and challenging task. We aimed to assess whether easily measurable biochemical parameters (hemoglobin, pH, and prothrombin time/international normalized ratio [PT/INR]) can predict in-hospital mortality in patients with severe trauma. METHODS: This retrospective study involved review of the medical records of 315 patients with severe trauma and an injury severity score >15 who were managed at Gyeongsang National University Hospital between January 2005 and December 2015. We extracted the following data: in-hospital mortality, injury severity score, and initial hemoglobin level, pH, and PT/INR. The predictive values of these variables were compared using receiver operation characteristic curves. RESULTS: Of the 315 patients, 72 (22.9%) died. The in-hospital mortality rates of patients with hemoglobin levels <8.4 g/dl and ≥8.4 g/dl were 49.8% and 9.9%, respectively (P < 0.001). At a cutoff hemoglobin level of 8.4 g/dl, the sensitivity and specificity values for mortality were 81.9% and 86.4%, respectively. At a pH cutoff of 7.25, the sensitivity and specificity values for mortality were 66.7% and 77.8%, respectively; 66.7% of patients with a pH <7.25 died versus 22.2% with a pH ≥7.25 (P < 0.001). The in-hospital mortality rates for patients with PT/INR values ≥1.4 and <1.4 were 37.5% and 16%, respectively (P < 0.001; sensitivity, 37.5%; specificity, 84%). CONCLUSIONS: Using the suggested cutoff values, hemoglobin level, pH, and PT/INR can simply and easily be used to predict in-hospital mortality in patients with severe trauma.

Biochemical Markers as Predictors of In-Hospital Mortality in Patients with Severe Trauma: A Retrospective Cohort Study / 대한구급학회지

BACKGROUND: Initial evaluation of injury severity in trauma patients is an important and challenging task. We aimed to assess whether easily measurable biochemical parameters (hemoglobin, pH, and prothrombin time/international normalized ratio [PT/INR]) can predict in-hospital mortality in patients with severe trauma. METHODS: This retrospective study involved review of the medical records of 315 patients with severe trauma and an injury severity score >15 who were managed at Gyeongsang National University Hospital between January 2005 and December 2015. We extracted the following data: in-hospital mortality, injury severity score, and initial hemoglobin level, pH, and PT/INR. The predictive values of these variables were compared using receiver operation characteristic curves. RESULTS: Of the 315 patients, 72 (22.9%) died. The in-hospital mortality rates of patients with hemoglobin levels <8.4 g/dl and ≥8.4 g/dl were 49.8% and 9.9%, respectively (P < 0.001). At a cutoff hemoglobin level of 8.4 g/dl, the sensitivity and specificity values for mortality were 81.9% and 86.4%, respectively. At a pH cutoff of 7.25, the sensitivity and specificity values for mortality were 66.7% and 77.8%, respectively; 66.7% of patients with a pH <7.25 died versus 22.2% with a pH ≥7.25 (P < 0.001). The in-hospital mortality rates for patients with PT/INR values ≥1.4 and <1.4 were 37.5% and 16%, respectively (P < 0.001; sensitivity, 37.5%; specificity, 84%). CONCLUSIONS: Using the suggested cutoff values, hemoglobin level, pH, and PT/INR can simply and easily be used to predict in-hospital mortality in patients with severe trauma.

Evaluation of Preoperative Predictors of 30-Day Mortality in Patients with Ruptured Abdominal Aortic Aneurysm

PURPOSE: Ruptured abdominal aortic aneurysm (RAAA) is a rare, extremely dangerous condition. Previous studies have published preoperative, intraoperative, and postoperative data; however, there are not enough studies on the preoperative factors alone. Here we studied the preoperative predictors of 30-day mortality in patients with RAAA. MATERIALS AND METHODS: We conducted a retrospective, consecutive review of the medical records of 57 patients who received management for RAAA between February 2005 and December 2016. We analyzed the association between preoperative predictors and 30-day mortality in patients with RAAA. The initial systolic blood pressure (SBP) and hemoglobin level (HbL), which were proven as significant predictors by multivariate logistic regression analysis, were compared using receiver operating characteristic curves. RESULTS: Overall, early mortality was 29.8%. Results of logistic regression analysis found that 30-day mortality in patients with RAAA was associated with the initial SBP (odds ratio [OR], 0.922; 95% confidence interval [CI], 0.874–0.973; P=0.003) and initial HbL (OR, 0.513; 95% CI, 0.289–0.91; P=0.023). Area under the curves were 0.89 for the initial SBP and 0.78 for the initial HbL. The initial SBP with a cut-off value of 90 mmHg had a sensitivity of 85% and specificity of 88.2%. At a cut-off of 10.5, the sensitivity and specificity of HbL for death were 75% and 70.6%, respectively. CONCLUSION: The initial SBP and HbL are independent preoperative predictors of early mortality in patients with RAAA.

Risk Factors for Pneumonia in Ventilated Trauma Patients with Multiple Rib Fractures

BACKGROUND: Ventilator-associated pneumonia (VAP) is a common disease that may contribute to morbidity and mortality among trauma patients in the intensive care unit (ICU). This study evaluated the associations between trauma factors and the development of VAP in ventilated patients with multiple rib fractures. METHODS: We retrospectively and consecutively evaluated 101 patients with multiple rib fractures who were ventilated and managed at our hospital between January 2010 and December 2015, analyzing the associations between VAP and trauma factors in these patients. Trauma factors included sternal fracture, flail chest, diaphragm injury, traumatic aortic dissection, combined cardiac injury, pulmonary contusion, pneumothorax, hemothorax, hemopneumothorax, abbreviated injury scale score, thoracic trauma severity score, and injury severity score. RESULTS: Forty-six patients (45.5%) had at least 1 episode of VAP, 10 (21.7%) of whom died in the ICU. Of the 55 (54.5%) patients who did not have pneumonia, 9 (16.4%) died in the ICU. Using logistic regression analysis, we found that VAP was associated with severe lung contusion (odds ratio, 3.07; 95% confidence interval, 1.12 to 8.39; p=0.029). CONCLUSION: Severe pulmonary contusion (pulmonary lung contusion score 6–12) is an independent risk factor for VAP in ventilated trauma patients with multiple rib fractures.

Comparison of Clinical Outcomes between Surgical Repair and Endovascular Stent for the Treatment of Abdominal Aortic Aneurysm

PURPOSE: This study was performed to compare the treatment outcomes between endovascular aneurysm repair (EVAR) and open surgical repair (OSR) of abdominal aortic aneurysms (AAAs) in a South Korean population. MATERIALS AND METHODS: We performed a retrospective review of the medical records of 99 patients with AAAs who were managed at Gyeongsang National University Hospital between January 2005 and December 2014. We reviewed the demographic characteristics and perioperative treatment outcomes of patients with AAA undergoing EVAR or OSR. In-hospital mortality and reintervention rates were assessed and compared between the EVAR and OSR groups. RESULTS: In-hospital mortality was not significantly higher in the OSR group versus the EVAR group (3.8% vs. 8.7%, respectively, P=0.41). Intervention time (209.6 mins vs. 350.9 mins, P < 0.001) and length of hospital stay (7.79 days vs. 17.46 days, P < 0.001) were significantly longer in the OSR group vs. the EVAR group. Median follow-up time was 24.1±20 months for the EVAR group and 43.9±28 months for the OSR group. The cumulative rate of freedom from reintervention at 60 months was 62.0% for the EVAR group and 100% for the OSR group (P < 0.001). CONCLUSION: EVAR was favorable in terms of intervention time and length of hospital stay, but the long-term durability of EVAR remains open for further debate.

Successful Anticoagulation Therapy for Antiphospholipid Syndrome with Mobile Aortic Thrombi

Hypercoagulable states have been associated with aortic thrombosis. Antiphospholipid syndrome (APS) is one of the commonest types of acquired thrombophilia. We report the case of successful anticoagulation management in an APS patient with mobile thrombi within the aorta. A 58-year-old male patient presented to the emergency department (ED) with right-sided hemiparesis. His first symptoms were noted approximately 12–16 hours before presentation to the ED. Magnetic resonance imaging of the brain showed acute embolic infarction of the left frontal and parietotemporal lobes. Transesophageal echocardiography (TEE) and computed tomography angiography (CTA) demonstrated mobile thrombi attached to the wall of the ascending aorta and aortic arch. The patient was diagnosed with APS based on positivity of anti-beta-2 glycoprotein 1 antibodies, and was initiated on anticoagulation therapy. Repeated TEE and CTA revealed complete resolution of the thrombi after 12 days of treatment; the patient was discharged well.

Inferior Mesentery Artery and Internal Iliac Artery Preservation with Covered Self-Expanding Stents during Endovascular Aneurysm Repair

We report an endovascular aneurysm repair in a patient with isolated bilateral common iliac artery aneurysms, a prominent inferior mesentery artery (IMA), and bilateral proximal internal iliac artery (IIA) aneurysms using covered self-expanding stents to preserve the IMA and bilateral internal iliac arteries. A follow-up computed tomography angiography was obtained at 1 month. Pelvic circulation was well preserved without bowel ischemia. IMA and bilateral IIA preservation with covered self-expanding stents during endovascular aneurysm repair is a safe and effective method.

Association between Body Mass Index and Sputum Culture Conversion among South Korean Patients with Multidrug Resistant Tuberculosis in a Tuberculosis Referral Hospital

BACKGROUND: Multidrug-resistant tuberculosis (MDR-TB) is an important global health problem. Furthermore, the time to identify a positive sputum culture is an important risk factor for the spread of tuberculosis, and several factors can predict a prolonged time to culture conversion. Moreover, the relationship between poor nutritional status and infectious disease is clearly established. Therefore, the present study aimed to investigate the association between body mass index (BMI) and sputum culture conversion within 3 months among patients with MDR-TB. MATERIALS AND METHODS: We retrospectively evaluated 218 patients with MDR-TB who were treated at a large tuberculosis referral hospital in South Korea between January 2005 and December 2010. The outcome of interest was defined as sputum culture conversion within 3 months, and we analyzed the association between BMI and this outcome. RESULTS: Among the 218 patients, 53 patients (24.3%) had a low BMI (<18.5 kg/m²). In the multivariate Cox proportional-hazards regression analysis, failure to achieve sputum culture conversion within 3 months was independently associated with having a low BMI (hazard ratio [HR]: 1.741, 95% confidence interval [CI]: 1.006–3.013; P = 0.047) and a positive sputum smear at the initiation of therapy (HR: 8.440, 95% CI: 1.146–62.138, P = 0.036). CONCLUSION: Low BMI (<18.5 kg/m²) was an independent risk factor for failure to achieve sputum culture conversion within 3 months among patients with MDR-TB.

Risk Factors for Poor Outcomes in Patients with Multi-Drug Resistant Tuberculosis in South Korea / 한양의대학술지

BACKGROUND/AIMS: Multidrug-resistant tuberculosis (MDR-TB) is an important public health problem in South Korea. MDR-TB is difficult to control, and treatment is less effective than for drug-sensitive tuberculosis. The aim of this report is to determine the risk factors for poor outcomes for MDR-TB. METHODS: We retrospectively and consecutively analyzed the clinical outcomes of MDR-TB patients registered at a single tuberculosis-specialized hospital in South Korea from January 2005 to February 2011. We used standard treatment outcome definitions for MDR-TB and used the combination of “defaulted”, “treatment failed”, and “died” as a composite poor outcome variable. We analyzed the risk factors associated with poor outcome. RESULTS: Among the 258 patients sampled, 91 (35.3%) had MDR-TB on their first tuberculosis infection, while 167 patients (64.7%) who had previously been treated for tuberculosis had MDR-TB over the study period. Treatment outcomes revealed that 207 patients (80.2%) were cured of their infection, 15 (5.8%) completed their treatment, one (0.4%) defaulted treatment, 6 (2.3%) died, and treatment failed for 29 patients (11.3%). Multivariate Cox proportional-hazards regression analysis found that poor outcome were associated with a body mass index <18.5 kg/m2 (hazard ratio [HR]: 2.57; 95% confidence interval [CI]: 1.28-5.15, p = 0.008), being susceptible to four or fewer drugs at the start of treatment (HR: 3.89; 95% CI: 1.38-10.96, p = 0.01), and ofloxacin resistance (HR: 2.49; 95% CI: 1.06-5.81, p = 0.035). CONCLUSIONS: Being underweight, susceptibility to four or fewer drugs, and ofloxacin resistance are independent prognostic factors of poor outcome for MDR-TB patients.

Risk Factors for Poor Outcomes in Patients with Multi-Drug Resistant Tuberculosis in South Korea / 한양의대학술지

BACKGROUND/AIMS: Multidrug-resistant tuberculosis (MDR-TB) is an important public health problem in South Korea. MDR-TB is difficult to control, and treatment is less effective than for drug-sensitive tuberculosis. The aim of this report is to determine the risk factors for poor outcomes for MDR-TB. METHODS: We retrospectively and consecutively analyzed the clinical outcomes of MDR-TB patients registered at a single tuberculosis-specialized hospital in South Korea from January 2005 to February 2011. We used standard treatment outcome definitions for MDR-TB and used the combination of “defaulted”, “treatment failed”, and “died” as a composite poor outcome variable. We analyzed the risk factors associated with poor outcome. RESULTS: Among the 258 patients sampled, 91 (35.3%) had MDR-TB on their first tuberculosis infection, while 167 patients (64.7%) who had previously been treated for tuberculosis had MDR-TB over the study period. Treatment outcomes revealed that 207 patients (80.2%) were cured of their infection, 15 (5.8%) completed their treatment, one (0.4%) defaulted treatment, 6 (2.3%) died, and treatment failed for 29 patients (11.3%). Multivariate Cox proportional-hazards regression analysis found that poor outcome were associated with a body mass index <18.5 kg/m2 (hazard ratio [HR]: 2.57; 95% confidence interval [CI]: 1.28-5.15, p = 0.008), being susceptible to four or fewer drugs at the start of treatment (HR: 3.89; 95% CI: 1.38-10.96, p = 0.01), and ofloxacin resistance (HR: 2.49; 95% CI: 1.06-5.81, p = 0.035). CONCLUSIONS: Being underweight, susceptibility to four or fewer drugs, and ofloxacin resistance are independent prognostic factors of poor outcome for MDR-TB patients.

Intracardiac Foreign Body (Bone Cement) after Percutaneous Vertebroplasty

Percutaneous vertebroplasty is a relatively easy and minimally invasive procedure used in treating vertebral fractures. However, the procedure has many complications, one of which is bone cement leakage, which happens frequently. Leakage to the paravertebral venous system, in particular, may lead to especially devastating consequences. Here we report a case of a 65-year-old male patient with an intracardiac foreign body (bone cement) that generated a perforation on the right ventricle, and result in hemopericardium after percutaneous vertebroplasty. We performed open heart surgery to remove the foreign body.

Left Ventricular Outflow Tract Obstruction Caused by Accessory Mitral Valve Tissue in a Child: A case report / 대한흉부외과학회지

Accessory mitral valve tissue is a very rare congenital cardiac malformation and it is an uncommon cause of left Ventricular outflow tract obstruction (LVOTO). The pathogenetic mechanism of subaortic obstruction is thought to be systolic ballooning of the abnormal valve tissue into LVOT. We are reporting a case of an accessory mitral valve tissue that was associated with LVOTO, and this was completely relieved after trans-aortic surgical excision of the accessory tissue.

Cystic Lymphangioma in the Chest Wall of the Child: A case report / 대한흉부외과학회지

Lymphangioma is a developmental anomaly that is known to occur in the neck and axilla, and only rarely in the mediastinum, retroperitoneum, groin and pelvis. An isolated chest wall lymphangioma is a rare benign neoplasm. In case of large sized lymphangioma, surgical excision is preferably recommended as the treatment of choice. We operated on a three-year old female for excision of chest wall. In pathologic diagnosis, it diagnosed the mass as chest wall lymphangioma.

Cystic Lymphangioma in the Chest Wall of the Child: A case report / 대한흉부외과학회지

Lymphangioma is a developmental anomaly that is known to occur in the neck and axilla, and only rarely in the mediastinum, retroperitoneum, groin and pelvis. An isolated chest wall lymphangioma is a rare benign neoplasm. In case of large sized lymphangioma, surgical excision is preferably recommended as the treatment of choice. We operated on a three-year old female for excision of chest wall. In pathologic diagnosis, it diagnosed the mass as chest wall lymphangioma.

Effects of nicotine on the formation of osteocalcin and osteoprotegerin and synthesis of its mRNA in MG63 osteoblast-like cell / 대한치과교정학회지

The purpose of this study was to evaluate the correlation between nicotine and the activity of bone forming cell. MG63 osteoblast-like cells were used for this study. Several factors were examined including the proliferation of cell, alkaline phosphatase activity, the formation of osteocalcin and osteoprotegerin, and the synthesis of its mRNA. MG63 osteoblast-like cells were incubated for 1, 2, 3 and 6 days with nicotine added to the culture medium in 1.0 micrometer, 1.0 mM, 2.5 mM, 5.0 mM, 7.5 mM, and 10.0 mM concentrations. The proliferation of MG63 osteoblast-like cells was temporarily activated at the low nicotine concentrations. At high concentrations (>5.0 mM), however, it was suppressed. Alkaline phosphatase activity was suppressed in a dose-dependent manner as the concentration of nicotine increased. Osteocalcin decreased in a dose-dependent manner at high nicotine concentrations of more than 7.5 mM and the same result was show when the osteoblasts were treated with low concentrations for longer than 3 days. There was a difference in the influence of nicotine on the synthesis of osteocalcin mRNA and formation of osteocalcin itself at 1 and 3 days. Generally, osteoprotegrin notably declined in all experimental groups. However, the level of its mRNA inc-reased at high nicotine concentrations of more than 7.5 mM after 3 days and more than 5.0 mM after 6 days.

The study of the relapse of hard and soft tissue after maxillary protraction / 대한치과교정학회지

The purpose of this stdudy was to evaluate the effect of maxillary protraction and the relapse of hard and soft tissue after maxillary protraction. For this study 29 patients who were treated with maxillary protractor and labiolingual archwire were selected. Their mean age was 9 years 4 months and mean treatment period was 8.5 months. Lateral cephalograms were taken at pretreatment, immediately after treatment and one to three months after removal of the maxillary protractor. They were traced on skeletodental and soft tissue structures based on Burstone's analysis and analyzed by QuickCeph Image Digitizing System(ORTHODONTIC PROCESSING). The mean and standard deviation between pretreatment and posttreatment and between posttreatment and retention period for each cephalometric variable were calculated. Student t-test was used to determine the statistical significance of the changes in each variable. Correlation coefficients between hard tissue and soft tissue I were used to determine interrelationship. The results were as follows: 1. After maxillary protraction, the maxilla and maxillary dentition moved antero-inferiorly, the mandibld and mandibular dentition moved postero-inferiorly and palatal plane rotated antem-superiorly by 0.59degrees. 2. After maxillary protraction, the soft tissue of upper lip moved antero-inferiorly with the movement of hard tissue but the antero-posterior position of lower lip was stable in spite of the change of hard tissue. The thickness of upper lip was decreased and that of lower lip was increased after maxillary protraction. 3. During the retention period, the position of jaws was relatively stable but upper and lower anterior teeth and antero-superiorly rotated palatal plane relapsed to original position. 4. During the retention period, the soft tissue of lips was stable antero-posteriorly and moved more inferiorly than posttreatment 5. The correlation coefficients between the postion of upper and lower incisal edge and that position of lips were high, especially in horizontal change.