Risk Factors for Local Recurrence in Patients With N1b Papillary Thyroid Carcinoma / 대한이비인후과학회지

Background and Objectives@#Papillary thyroid carcinoma (PTC) with lateral neck lymph node metastasis is known as a major risk factor for tumor recurrence after surgical treatment. The aim of this study is to identify risk factors for loco-regional recurrence in patients with PTC with lateral neck lymph node metastasis, which has a high risk of recurrence.Subjects and Method This study involved 319 patients who underwent total thyroidectomy, central lymph node (LN) and lateral LN dissection due to PTC. The patients’ demographics and pathological factors, including lymph node metastasis were retrospectively reviewed. Univariate, multivariate and C-index with variable selection analyses were performed to identify factors associated with recurrence-free survival (RFS). @*Results@#A mean follow-up of 101 months, 35 (10.9%) patients had a loco-regional recurrence. In multivariate analysis according to loco-regional recurrence, patients with a primary tumor of more than 4 cm, multifocality, vascular invasion, and bilateral lateral cervical metastasis were associated with worse RFS. In the variable selection analysis, lateral lymph node metastasis ratio was also statistically significant. @*Conclusion@#PTC with lateral neck lymph node metastasis included tumors larger than 4 cm. Multifocality, vascular invasion, high lateral lymph node metastasis ratio and bilateral neck lymph node metastasis are predictive factors of loco-regional recurrence, and these risk factors should be carefully followed-up after surgery.

Association of Neutrophil Gelatinase associated Lipocalin and Leukocyte Differential Count in Children with Febrile Urinary Tract Infections

Purpose@#To investigate the association between urinary neutrophil gelatinaseassociated lipocalin (uNGAL) and leukocyte differential count in children with urinary tract infections (UTIs). @*Methods@#A retrospective chart review was performed in children undergoing uNGAL measurements between June 2018 and September 2019. Patients with suspected or diagnosed UTIs were included. The relationship between uNGAL and blood leukocyte differential count was investigated in children. @*Results@#A total of 197 children were included in this study, 119 of whom (60%) had UTIs. The non-UTI patients (n=78) were diagnosed with pneumonia, acute gastroenteritis, viral upper respiratory infection, and others. After adjusting for age, gender, and fever duration, the leukocyte count, monocyte count, and uNGAL levels were higher in the UTI group than in the non-UTI group (P<0.05). uNGAL showed positive correlations with neutrophil counts, monocyte counts, the neutrophil-to-lymphocyte ratio, and the monocyte-to-lymphocyte ratio in the UTI group (P<0.05). uNGAL levels were only associated with the neutrophil-tolymphocyte ratio in the non-UTI group (P<0.05). In a multivariable logistic regression analysis, only uNGAL was associated with the presence of UTI (P<0.05). The area under the receiver operating characteristic curves for uNGAL and monocyte counts to identify UTI were 0.89 (95% confidence interval (CI): 0.824–0.939; P=0.025) and 0.7 (95% CI: 0.627–0.774; P=0.038), respectively. @*Conclusions@#In children with UTIs, uNGAL levels may be associated with blood leukocyte differential counts. uNGAL measurements and monocyte counts can be helpful in children with suspected UTIs.

Clinical Characteristics and Prognostic Impact of Bacterial Infection in Hospitalized Patients with Alcoholic Liver Disease

Bacterial infection is an important cause of death in patients with liver cirrhosis. The aim of this study was to investigate the clinical characteristics and prognostic impact of bacterial infection in hospitalized patients with alcoholic liver disease (ALD). We retrospectively analyzed data from 409 patients consecutively admitted to a tertiary referral center with ALD diagnosis. Of a total of 544 admissions, 133 (24.4%) cases presented with bacterial infection, of which 116 were community-acquired whereas 17 were hospital-acquired. The common types of infection were pneumonia (38%), biliary tract infection (17%), soft tissue infection (12%), and spontaneous bacterial peritonitis (9%). Diabetes, serum Na or =20 mg/L, systemic inflammatory response syndrome (SIRS) positivity were independently associated with bacterial infection in patients with ALD. Overall 30-day and 90-day mortalities in patients with bacterial infection were significantly (P or =32 (HR, 2.3; 95% CI, 1.036-5.222, P = 0.041), and hemoglobin <12 g/dL (HR, 2.4; 95% CI, 1.081-5.450, P = 0.032) were independent predictors of short-term mortality. In conclusion, bacterial infection and SIRS positivity predicted short-term prognosis in hospitalized patients with ALD. A thorough evaluation at admission or on clinical deterioration is required to detect possible infection with prompt management.

Imatinib mesylate-induced interstitial lung disease in a patient with prior history of Mycobacterium tuberculosis infection

No abstract available.

Clinical Features and Risk Factors for Severe Complications among Patients with Acute Hepatitis A Virus Infection in The Jeonbuk Province of Korea / 대한소화기학회지

BACKGROUND/AIMS: The frequency of symptomatic acute HAV infections in adulthood are increasing in Korea. This study analyzes the clinical severity in patients with acute HAV infection and investigates risk factors associated with three severe complications: prolonged cholestasis, acute kidney injury, and acute liver failure. METHODS: We performed a retrospective analysis of 726 patients diagnosed from January 2006 to December 2010 at three tertiary hospitals in Jeonbuk Province, Republic of Korea with acute HAV infection. RESULTS: In the group of 726 patients, the mean age was 30.3 years, 426 (58.6%) were male, and 34 (4.7%) were HBsAg positive. Severe complications from acute HAV infection occurred as follows: prolonged cholestasis in 33 (4.6%), acute kidney injury in 17 (2.3%), and acute liver failure in 16 (2.2%). Through multivariate analysis, age > or =40 years (OR 2.63, p=0.024) and peak PT (INR) > or =1.5 (OR 5.81, p=0.035) were found to be significant risk factors for prolonged cholestasis. Age > or =40 years (OR 5.24, p=0.002) and female gender (OR 3.11, p=0.036) were significant risk factors for acute kidney injury. Age > or =40 years (OR 6.91, p=0.002), HBsAg positivity (OR 5.02, p=0.049), and peak total bilirubin (OR 1.11, p=0.001) were significant risk factors for acute liver failure. CONCLUSIONS: Age > or =40 years, female gender, HBsAg positivity, peak PT (INR) > or =1.5, and peak total bilirubin were significant risk factors for severe complications in acute HAV infections.

A case of acute myocardial infarction caused by a septic coronary embolism and treated with embolectomy / 대한내과학회지

An acute myocardial infarction caused by a septic coronary embolism is a known complication of infective endocarditis and usually carries a fatal prognosis. We experienced a case of a 27-year-old man with an acute myocardial infarction caused by a coronary embolism due to bacterial endocarditis. An echocardiogram demonstrated mitral valve regurgitation with highly mobile multiple vegetations. Because of the high risk of systemic embolization and congestive heart failure, the patient underwent emergency surgery. Mitral valve replacement and an embolectomy were performed successfully without any surgical complications.

Deep Vein Thrombosis and Pulmonary Embolism in the 8th Week of Pregnancy

A 29-year-old woman in her 8th week of pregnancy was referred to our hospital for swelling in the lower extremities, rapid onset of dyspnea (1 hr) and pre-syncope. Severe right ventricular dysfunction and moderate pulmonary hypertension were detected using 2-dimentional Doppler echocardiography. In addition, left calf vein and proximal thromboses were detected by venous compression ultrasound imaging. After successful thrombolytic treatment, the patient quickly recovered and was discharged from hospital on subcutaneous low-molecular-weight heparin. She delivered a normal, healthy infant at full-term (40 weeks).

A case of dermatomyositis associated with tonsil cancer / 대한내과학회지

Dermatomyositis is a rare and idiopathic inflammatory myopathy with characteristic cutaneous manifestations. A 61-year-old female presented with the chief complaints of proximal muscle weakness, facial edema and erythema on the face, chest and back. The patient was diagnosed with dermatomyositis by the clinical manifestation, laboratory findings and an electromyogram. After a year following appropriate treatment, a tonsil cancer was found. The patient was treated with three rounds of neoadjuvant chemotherapy and wide excision of the left tonsil. In Korea, a few cases of dermatomyositis have been reported associated with stomach cancer, breast cancer, acute lymphoblastic leukemia and lung cancer, but no associated cases with tonsil cancer have yet been reported. We report a case of tonsil cancer that developed in a patient with dermatomyosits during therapy.

Prevention of Autologous Vein Graft Atherosclerosis Thru Cell Cycle Inhibition

PURPOSE: Autologous vein graft is the most commonly used conduit for surgical revascularization of the small and medium sized vessels of the coronary and lower extremity circulations. But, 30~50% of these grafts succumb eventually to occlusive failure, often with recurrent morbidity that necessitates reoperation. The cause of failure is the vein graft atherosclerosis from the neointimal hyperplasia, which is the arterial remodeling process through adaptive thickening of the vein wall in response to the increased wall stress. We try to use cis-platin, DNA binding cell cycle specific inhibitory agent, against neointimal hyperplasia in experimental model. METHOD: 5 korean dogs had a autologous vein graft interposition at femoral or carotid arteries using saphenous or jugular veins bilaterally. One side of pairs is treated with cis-platin for one hour (study), while the other is not (conrol). After 4 weeks, we explanted 6 pairs of vein graft (3 jugular veins and 3 saphenous veins), and measured intimal thickness, intimal area and luminal area using videomorphometry, and analysed intimal ratio and luminal ratio. RESULT: Treatment with cis-platin reduced intimal thickness by 44% (P=0.0118) and intimal area by 50% (P=0.0124). Intimal ratio was decreased in the study group when compared to the control group by 0.18 versus 0.66 (P=0.001). The luminal area of the treated grafts was significantly larger than controls, having increased by 823% (P=0.0307), and luminal ratio having increased by 0.82 versus 0.34 (P=0.001). CONCLUSION: These results suggest that cis-platin reduced the development of neointimal hyperplasia in experimental vein grafts. In order to prove the obtained results to a higher degree, an accumulation of further cases is necessary.

Influence of the Difference in Temperature and Duration of Storage on the Rejection of Cryopreserved Rat Tracheal Homograft / 대한흉부외과학회지

BACKGROUND: It has been known that cryopreservation can reduce the rejection in the tracheal homograft implantation with preserving its viability. However, the effect of difference in the temperature and duration of storage on the rejection has not been proven. Therefore we investigated the effects of storage temperature and duration on the rejection of cryopreserved rat tracheal homograft. MATERIAL AND METHOD: Twenty four rat's tracheas were harvested from rats and stored in -80degrees C deep freezer and -196degrees C nitrogen tank for 1, 3, and 6 months respectively. The forty eight tracheal segment(each trachea divided into two) were implanted in peritoneal cavity with omental wrapping. The 48 recipient rats were divided into six groups(8 rats/group). Group 1, 3, and 5 were rats implanted with trachea of preservation in -80degrees C for 1 month, 3 months and 6 months respectively. And Group 2, 4, and 6 were rats implanted with trachea of preservation in -196degrees C for 1 month, 3 months and 6 months, respectively. Group 7(n=8) was control group that fresh trachea without cryopreservation was implanted. After 14 days, the implanted tracheas were harvested and the degrees of rejection were investigated with moncellular infiltration and luminal obliteration of trachea by fibrous tissue. RESULT: Most of the tracheas in each group showed moderate or severe degree of moncellular infiltration and there was no statistically significant difference between the 7 groups. The luminal obliterations were less in groups 1,2,3,4,5, and 6 compared to group 7, however, there was no statistical difference. The cartilages were maintained their viability even in the severe perichondral moncellular infiltration in all groups. CONCLUSION: There was no difference in rejection between groups of different storage temperature and duration. It is supposed that proper use of immunosuppressants is required even after cryopreserved tracheal homograft implantation.

Comparison Between Ligation Through Thoractomy and Video-assisted Clipping / 대한흉부외과학회지

BACKGROUND: This study was aimed at analyzing the preoperative conditions post-operative results indication and methods of surgical closure of patent ducturs arteriosus in prematures low birth weight infants and neonates. PATIENTS AND METHODS: We retro-spectively studied two groups of patients (prematures group and neonates group) who underwent surgical closure of the patent ductus arteriosus between March 1995 and June 1998. RESULTS: The premature group consisted of 9 patients(3 males and 6 females) Their mean gestational period was 30.7 weeks(ranging from 26 weeks to 33 weeks) mean age 27.8 days(11 days to 55 days) and mean body weight 1.56 kg. Prominent preoperative symptoms were dependency on mechanical ventilation generalized edema and hepatomegaly. We performed PDA ligation via thoracotomy in all premature patients. The neonate group consisted of 16 patients and their mean body weight was 3.75 kg. Major symptoms of this group was tachypnea and intercostal retraction resistant to medical treatment. We performed video-assisted PDA clipping to them all. There were no postoperative complications or operation-related mortality in both groups. Comparing the ratio of size of PDA(mm)/body weight(kg) the ratio of premature group (ligation through thoracotomy) was higher than that of neonate group ( video-assisted clipping) that is 3,89:1.21(p=0.03) CONCLUSION: We conclude that the surgical closure of PDA can be a safe method of treatment for prematures low birth weight infants and neonates with compromised general conditions. Choice of surgical technique depends on the surgeon's preference but there was a tendency to choose the ligation method through thoracotomy for patients with small body weight and large PDA.

Anatomical Repair of Double-Outlet Left Ventricle with Ventricular Septal Defect and Pulmonary Stenosis by Reight Ventricular Outflow Patch Reconstruction / 대한흉부외과학회지

Double-outlet left ventricle with ventricular septal defect and pulmonary stenosis was conventionally repaired with extracardiac conduit or pulmonary artery translocation. Here, we report an anatomically repaired double-outlet left ventricle without extracardiac conduit or pulmonary artery translocation in an 11 month old patient who had undergone palliative systemic-pulmonary shunt at a nonatal period. The location of ventricular septal defect, both great arteries and coronary arteries made it possible to reconstruct the right ventricular outflow tract using on-lay patch after incision and undercutting the tissue between the ventriculotomy and the pulmonary arteriotomy.

Prevention of Calcification in Glutaraldehyde Treated Bovine Pericardium with Combined Treatment of Sodium Dodecyl Sulfate ( SDS ) and Glutamate / 대한흉부외과학회지

BACKGROUND: Bovine pericardium treated with glutaraldehyde(GA) is one of the most popular prosthetic materials. However, its late calcific degeneration after implantation results in early failure of the prosthesis. Therefore, we investigated the effects of combined treatment with sodium dodecyl sulfate(SDS) and glutamate on calcific degeneration of GA treated bovine pericardium. MATERIAL AND METHOD: Sixty square-shaped pieces of bovine pericardia were fixed in 0.625% GA solution with 4g/L MgCl2 6H2O as a control group (group 1). Sixty pieces pretreated with 1% SDS (group 2) and sixty pieces posttreated with 8% glutamate (group 3) were also fixed in the same GA solution. Sixty pieces pretreated with 1% SDS and posttrated with 8% glutamate were also fixed in the same GA solution (group 4). After 1 month of fixation, the pieces were implanted into the belly of sixty Sprague-Dawley rat subdermally and were extracted 1 month, 2 months and 3 months after the implantation. With an atomic absorption spectrophotometry, we measured the calcium amount deposited. RESULT: The calcium deposition in 1 month was 2.01+/-0.13 mg/g in group 1, 1.45+/-0.31 mg/g in group 2, 2.49+/-0.15 mg/g in group 3 and 0.75+/-0.27 mg/g in group 4. In 2 months, it was 3.57+/-0.15 mg/g in group 1, 0.98+/-0.30 mg/g in group 2, 3.46+/-0.12 mg/g in group 3, and 1.48+/-0.39 mg/g in group 4, and 5.45+/-0.42 mg/g in group 1, 2.43+/-0.53 mg/g in group 2, 4.20+/-0.55 mg/g in group 3, and 1.02+/-0.27 mg/g in group 4 in 3 months. The calcium depositions in group 2 and 4 were less than those of group 1 and 3 in 1 month 2, months, and 3 months(p<0.01). The calcium depositions in group 1, 2 and 3 increased with time. However, they remained unchanged in group 4, which was statistically significant(p<0.01). CONCLUSION: Pretreatment with SDS is effective in reducing calcification of GA treated bovine pericardium, and the combined method of pretreatment with SDS and posttreatment with glutamate was more effective than the other methods.

Diagnostic Value of Thoracography in Pneumothorax / 대한흉부외과학회지

BACKGROUND: It is important to know the location, number, size and shape of bullae before thoracotomy or VATS bullectomy. Chest X-ray and chest CT may be used but with some limitation. The purpose of this study was to compare the diagnostic value of thoracography with that of chest X-ray in preoperative detection of bullae. Meterial and Method: Thoracography was performed by injection of non-ionic water-soluble dye into pleural space in 22 primary spontaneous pneumothoraces, which underwent thoracotomy or VATS bullectomy. Chest X-ray and thoracography were compared through operative finding. RESULTS: Sensitivity and accuracy of thoracography (75% and 72.7%) were higher than those of chest X-ray (30% and 36.4%). However, specificity of thoracography (50%) was lower than that of chest X-ray (100%). There were no complications during or after thoracography. CONCLUSION: Thoracography is a safer and more useful method for preoperative detection of bullae when compared with chest X-ray.