Bilateral pneumothorax in a patient with anaplastic thyroid carcinoma and lung metastasis during lenvatinib therapy: a case report.

The prognosis of anaplastic thyroid carcinoma (ATC) is very poor. In most patients, ATC presents with cervical lymph node metastasis, and more than 40% of patients have distant metastasis at the time of diagnosis. Lenvatinib, a multi-targeted tyrosine kinase inhibitor, is a novel drug that has antitumor effects on radioactive iodine-refractory papillary cancer and anaplastic cancer. The development of bilateral pneumothorax during targeted therapy is very rare in patients with thyroid cancer. We recently encountered a case of bilateral pneumothorax in a patient with ATC and lung metastasis during lenvatinib therapy. The patient underwent video-assisted thoracoscopic surgery (VATS) in both the lungs because the pneumothorax continued to aggravate even after the insertion of chest tubes. Clinicians need to be aware that the development of pneumothorax is a possibility during lenvatinib therapy for ATC and lung metastasis. The case is reported herein, along with a review of relevant literature.

Mild Ischemic Mitral Regurgitation: Is Revascularization Enough for Every Patient?

BACKGROUND: The progress of mild ischemic mitral regurgitation (MR) after isolated coronary artery bypass is not clear. We aimed to determine the proportion of patients with mild ischemic MR undergoing isolated coronary artery bypass grafting (CABG) presenting with regression of or persistent MR one year after CABG and to identify the significantly different echocardiographic variables between regressing and persistent MR. METHODS: Sixty-three patients with preoperative mild ischemic MR were categorized into an MR- regression or an MR-persistence group one year after isolated CABG. The echocardiographic indices, indicating mitral leaflet configuration and remodeling of the left ventricle (LV), were measured before and one year after the surgery. RESULTS: One year after CABG, MR regressed in 60% (38/63) and persisted in 40% (25/63) of the patients. The left ventricular diameter, volume, and sphericity and anteroposterior diameter of the mitral annulus improved only in the MR-regression group, while the ejection fraction improved in both groups (47.7% ± 12.4% from 40.1% ± 11.3%, P < .001 in the regression group and 43.2% ± 14.0% from 39.3% ± 11.6%, P = .035 in the persistence group). A >15% decrease in the LV end-systolic volume was noted more frequently in the MR-regression group (60.5% versus 30%, P = .027). The leaflet angle did not show asymmetry or significant changes in both groups. CONCLUSIONS: Isolated CABG improved mild MR in most patients with mild ischemic MR. These patients showed greater reverse remodeling after revascularization than the patients with persistent MR after isolated CABG. Additional tests, which can predict LV reverse remodeling, are needed to predict persistent MR.

Primary Pulmonary Chordoid Meningioma.

Primary pulmonary meningioma is a rare disease, and chordoid meningioma is an uncommon variant of meningioma in the central nervous system (CNS) with a high recurrence rate. We report a case of primary pulmonary chordoid meningioma that presented as a solitary pulmonary nodule (SPN). The SPN was resected by thoracoscopic wedge resection and was revealed to have characteristics of chordoid meningioma. After confirming the absence of a meningioma in the CNS by brain imaging, the nodule was diagnosed as a primary pulmonary chordoid meningioma. The patient remained disease-free after 26 months postoperatively. To our knowledge, this is the third case of primary pulmonary chordoid meningioma to be reported.

Robotic Thyroidectomy: Comparison of a Postauricular Facelift Approach with a Gasless Unilateral Axillary Approach.

OBJECTIVES: Robotic thyroidectomy using remote access approaches has gained popularity with patients seeking to avoid neck scarring and enhanced cosmetic satisfaction. The aim of this study was to compare the efficacy and advantages of a postauricular facelift approach vs a gasless unilateral axillary (GUA) approach in robotic thyroidectomy. STUDY DESIGN: Case series with chart review. SETTING: University tertiary care hospital. SUBJECTS AND METHODS: We retrospectively analyzed the data of 65 patients who underwent robotic thyroidectomy with or without central neck dissection using a GUA approach (45 patients) or a postauricular facelift approach (20 patients) between September 2013 and December 2014. We excluded patients who underwent simultaneous lateral neck dissection or completion thyroidectomy. RESULTS: Robotic procedures were completed without being converted to an open procedure in all patients. There were no significant differences in terms of patient and tumor characteristics, extent of thyroidectomy and central neck dissection, operative time, complications, and postoperative pain between the 2 approaches, except the higher female ratio in the GUA approach group (female ratio, 95.6% vs 75%, P = .042). Cosmetic satisfaction evaluated by a questionnaire was not significantly different between the 2 groups, and most patients of both groups (85.7%) were satisfied with postoperative cosmesis. CONCLUSION: Both GUA and postauricular facelift approaches are feasible, with no significant adverse events in patients, and result in excellent cosmesis. However, a GUA approach seems to be superior when performing total thyroidectomy using a unilateral incision based on the preliminary result.

Radioactive iodine treatment for node negative papillary thyroid cancer with capsular invasion only: Results of a large retrospective study.

AIM: With thyroid carcinoma the decision to use radioactive iodine (RAI) ablation depends on the risk of poor outcomes. Although extrathyroid extension (ETE) is well known as a risk of poor outcomes for papillary thyroid carcinoma (PTC), the definition of minimal ETE is too broad, as it encompasses both microscopic invasion of the thyroid capsule (capsular invasion [CI]) and macroscopic invasion of the sternothyroid muscle. METHODS: We conducted a retrospective study to analyze the prognostic benefit of RAI ablation according to the presence of CI in a consecutive series of patients with PTC between October 1997 and December 2008. We studied two groups of patients, including those who received RAI (group I, n = 121) and those who did not (group II, n = 108). During follow-up, we assessed the locoregional recurrence of all patients. RESULTS: There were no statistically significant difference between the groups regarding locoregional recurrence at follow-up (13.2% for group I vs 9.3% for group II, P = 0.441). The association between RAI and locoregional recurrence in PTC patients with CI remained insignificant after adjusting for potential confounders, such as age, tumor size, sex, lymphatic invasion, vascular invasion and tumor multiplicity (P = 0.409, hazard ratio = 0.698, 95% confidence interval, 0.298-1.639). CONCLUSIONS: This retrospective study suggests that RAI treatment is not associated with less locoregional recurrence in PTC patients who only demonstrate CI, although further prospective studies are required to confirm these findings.

Synergistic effect between celecoxib and luteolin is dependent on estrogen receptor in human breast cancer cells.

The anti-cancer effects of celecoxib and luteolin are well known. Although our previous study demonstrated that the combination of celecoxib and luteolin synergistically inhibits breast tumor growth compared with each of the treatments alone, we did not uncover the molecular mechanisms of these effects. The aims of our present study were to compare the effects of a celecoxib and luteolin combination treatment in four different human breast cell lines and to determine the mechanisms of action in vitro and in vivo. The synergistic effects of a celecoxib and luteolin combination treatment yielded significantly greater cell growth inhibition in all four breast cancer cell lines compared with the single agents alone. In particular, combined celecoxib and luteolin treatment significantly decreased the growth of MDA-MB-231 cancer cells in vivo compared with either agent alone. The celecoxib and luteolin combination treatment induced synergistic effects via Akt inactivation and extracellular signal-regulated kinase (ERK) signaling inhibition in MCF-7 and MCF7/HER18 cells and via Akt inactivation and ERK signaling activation in MDA-MB-231 and SkBr3 cells. These results demonstrate the synergistic anti-tumor effect of the celecoxib and luteolin combination treatment in different four breast cancer cell lines, thus introducing the possibility of this combination as a new treatment modality.

Left ventricular pseudoaneurysm after valve replacement.

We present a case of left ventricular pseudoaneurysm, which is a very rare and fatal complication of cardiac procedures such as mitral valve replacement. A 55-year-old woman presented to the Department of Thoracic and Cardiovascular Surgery at Hanyang University Seoul Hospital with chest pain. Ten years prior, the patient had undergone double valve replacement due to aortic regurgitation and mitral steno-insufficiency. Surgical repair was successfully performed using a prosthetic pericardial patch via a left lateral thoracotomy.

Primary Sternal Osteomyelitis Caused by Actinomyces israelii.

Primary sternal osteomyelitis is a rare disease. Common infectious organisms causing primary sternal osteomyelitis include Staphylococcus aureus and Pseudomonas aeruginosa. Actinomyces species are common saprophytes of the oral cavity, but there have been few reports in the literature of primary sternal osteomyelitis caused by Actinomyces species. We describe a case of primary sternal osteomyelitis caused by Actinomyces israelii without pulmonary involvement.

Surgical Ligation on Significant Patent Ductus Arteriosus in Very Low Birth Weight Infants: Comparison between Early and Late Ligations.

BACKGROUND: We aimed to evaluate the efficacy and safety of early surgical ligation (within 15 days of age) over late surgical ligation (after 15 days of age) by a comparative analysis of very low birth weight (VLBW) infants undergoing surgical correction for symptomatic patent ductus arteriosus (PDA) over the course of 6 years in our hospital. METHODS: We retrospectively reviewed all the medical records in the neonatal intensive care unit at Hanyang University Seoul Hospital, from March 2007 to May 2013, to identify VLBW infants (< 1,500 g) who underwent surgical PDA ligation. RESULTS: The gestational age (GA) in the late ligation (LL) group was significantly younger than in the early ligation (EL) group (p=0.010). The other baseline characteristics and preoperative conditions did not differ significantly between the two groups. The intubation period before surgery (p < 0.001) and the age at surgery (p < 0.001) were significantly different. The postoperative clinical outcomes of the study patients, including major morbidity and mortality, are summarized. There were no significant differences in bronchopulmonary dysplasia, sepsis, or mortality between the EL and the LL groups. However, the LL group was significantly associated with an increased risk of necrotizing enterocolitis (p=0.037) and with a prolonged duration of the total parenteral nutrition (p=0.046) after adjusting for GA. CONCLUSION: Early surgical ligation for the treatment of PDA that failed to close after medical treatment or in cases contraindicated for medical treatment might be desirable to reduce the incidence of necrotizing enterocolitis and to alleviate feeding intolerance in preterm infants.

Antioxidant effect of captopril and enalapril on reactive oxygen species-induced endothelial dysfunction in the rabbit abdominal aorta.

BACKGROUND: Reactive oxygen species (ROS) are known to be related to cardiovascular diseases. Many studies have demonstrated that angiotensin-converting enzyme inhibitors have beneficial effects against ROS. We investigated the antioxidant effect of captopril and enalapril in nitric oxide mediated vascular endothelium-dependent relaxations. MATERIALS AND METHODS: Isolated rabbit abdominal aorta ring segments were exposed to ROS by electrolysis of the organ bath medium (Krebs-Henseleit solution) after pretreatment with various concentrations (range, 10(-5) to 3×10(-4) M) of captopril and enalapril. Before and after electrolysis, the endothelial function was measured by preconstricting the vessels with norepinephrine (10(-6) M) followed by the cumulative addition of acetylcholine (range, 3×10(-8) to 10(-6) M). The relevance of the superoxide anion and hydrogen peroxide scavenging effect of captopril and enalapril was investigated using additional pretreatments of diethyldithiocarbamate (DETCA, 0.5 mM), an inhibitor of Cu/Zn superoxide dismutase, and 3-amino-1,2,4-triazole (3AT, 50 mM), an inhibitor of catalase. RESULTS: Both captopril and enalapril preserved vascular endothelium-dependent relaxation after exposure to ROS in a dose-dependent manner (p<0.0001). Pretreatment with DETCA attenuated the antioxidant effect of captopril and enalapril (p<0.0001), but pretreatment with 3AT did not have an effect. CONCLUSION: Both captopril and enalapril protect endothelium against ROS in a dose-dependent fashion in isolated rabbit abdominal aortas. This protective effect is related to superoxide anion scavenging.

Emergent surgical intervention for embolization of atrial septal defect closure device.

The percutaneous transcatheter closure of secundum atrial septal defect has recently become an increasingly widespread alternative to surgical closure in many centers. Although immediate, short, and intermediate term results of percutaneous transcatheter septal closure are promising, the procedure is not free from inherent complications that could be lethal. We report a case of device embolization necessitating emergent surgical retrieval.

Congenital cystic adenomatoid malformation with bronchial atresia in elderly patients.

UNLABELLED: Congenital cystic adenomatoid malformation (CCAM) is an uncommon, nonhereditary anomaly caused by arrest of lung. Patients with CCAM may present with respiratory distress as newborns, or may remain asymptomatic until later in life. CCAM type I is rarely found in association with bronchial atresia (BA) in adults; we present such a case. CASE: A 54-year-old female presented with chronic cough and blood-tinged sputum. Physical examination and laboratory tests were unremarkable. Chest radiographs and a CT scan of the chest showed multiple large air-filled cysts consistent with a CCAM in the right lower lobe, and an oval-shaped opacity in the distal right middle lobal bronchus. Based on the radiologic findings, right middle lobectomy and a medial basal segmentectomy of the right lower lobe were performed via a thoracotomy. These lesions were consistent with Stocker's Type I CCAM and BA in the different lobes.

Postinfarct ventricular septal defect after coronary covered stent implantation.

We report a case of a postinfarction ventricular septal defect caused by an acute recurrent occlusion after the implantation of a covered stent, which was performed as a rescue procedure for the ruptured left anterior descending artery during a percutaneous coronary intervention. Although the emergent implantation of a covered stent for the ruptured coronary arteries such as the left main coronary artery or the origins of the left anterior descending artery can be performed during a percutaneous coronary intervention, and a coronary bypass surgery should be considered in order to decrease the risk of complete occlusion, thus providing a superior long term patency.

Silastic molding method for pectus excavatum correction using a polyvinyl alcohol (ivalon) sponge.

Pectus excavatum is rare, but it is the most common type of sternal congenital disorder. There are many surgical methods to correct pectus excavatum such as the Ravitch method, Wada method, Silastic mold method, and the Nuss operation. We report a case of minimal invasive surgery for pectus excavatum using a polyvinyl alcohol sponge.

Omental mesothelial cyst herniated to the thorax through the esophageal hiatus: a case report.

Both mesothelial cyst in the omentum and omental herniation through the esophageal hiatus without abdominal visceral involvement are rare. We report a case of omental mesothelial cyst herniated to the thorax through the esophageal hiatus.

Parosteal lipoma of the rib.

Parosteal lipoma is a rare benign tumor that is composed mainly of benign mature lipocytes, and it has an intimate association with the underlying periosteum of affected bone. Parosteal lipoma involving the rib is quite rare. We believe that only four cases have been previously reported in the English literature. Here we describe an exceedingly rare case of parosteal lipoma that developed in the right seventh rib, which presented in a 50-year-old man having a previous history of trauma at this site.

Diagnosis and prognosis of traumatic pulmonary psuedocysts: a review of 12 cases.

BACKGROUND: Traumatic pulmonary pseudocysts or post-traumatic pneumatocoeles are a relatively rare-encountered condition occurring after trauma and an even rarer talked about subject. Most resolve within a few weeks, but if complicated by hematoma, may persist for months. This study intends to evaluate the resolution times of traumatic pulmonary pseudocysts and their clinical significance. METHODS: We report a case analysis of 12 cases from Hanyang University Guri Hospital dating from July 1997 through October 2004. RESULTS: The overall mean time for complete resolution was 85.6 days. The mean time for resolution for the uncomplicated traumatic pulmonary pseudocysts was 25.3 days (n=6) and the mean time for resolution for the complicated (blood filled) traumatic pulmonary pseudocysts was 145.8 days (n=6). When resolution times were compared according to size, those less than 2 cm showed a mean resolution time of 23.6 days (n=5) and those greater than or equal to 2 cm showed a mean resolution time of 129.9 days (n=7). CONCLUSIONS: Comparisons between completely blood-filled pseudocysts and uncomplicated pseudocysts have shown statistically significant differences in resolution times. Statistical significance has also been found between pseudocysts of sizes less than 2 cm and those greater than or equal to 2 cm. Conservative treatment is generally the rule; close follow-up and symptomatic treatment are necessary.

Calcifying fibrous pseudotumor of the pleura.

Calcifying fibrous pseudotumor is an uncommon benign lesion that has unique histologic features. We report a case of calcifying fibrous pseudotumor of the pleura occurring in a 31-year-old woman. A computed tomographic scan revealed a pleural mass in the right anterior costophrenic angle. The excised mass was well circumscribed, nonencapsulated, solid, and firm. The tumor showed dense hyalinized collagenous tissue interspersed with spindle cells, psammomatous calcifications, and a predominantly lymphoplasmocytic infiltrate. Most spindle cells were diffusely positive for vimentin, focally positive for CD34, and negative for desmins, smooth muscle actin, S-100 protein, and anaplastic lymphoma kinase-1.

Telangiectatic pulmonary arteriovenous malformation.

Telangiectatic pulmonary arteriovenous malformation is defined as a pulmonary arteriovenous malformation involving every segmental artery of at least one lobe of the lung. The authors report a case of telangiectatic pulmonary arteriovenous malformation in the left lower lobe of the lung.