Treatment of Complete Persistent Sciatic Artery with Distal Thromboembolism by Thromboembolectomy Only

A persistent sciatic artery (PSA) is very rare congenital vascular anomaly which is present in 0.025% to 0.04% of the population by an angiographic study. A PSA is usually combined with aneurismal disease or thromboembolic events because of its arteriosclerosis and vessel wall degeneration. The treatments of symptomatic PSA are comprised of exclusion of PSA from circulation and bypass surgery for the lower limb. However, surgical treatment should be tailored to its anatomy and presentation. We report a successful treatment of PSA with distal thromboembolism by thromboembolectomy without bypass surgery.

An Adult Right-sided Bochdalek Hernia Accompanied with Hepatic Hypoplasia and Inguinal Hernia

We herein report a very rare case of adult right-sided Bochdalek hernia accompanied with hepatic hypoplasia and inguinal hernia. A 29-year-old man was admitted with right-sided pneumothorax. A computed tomography was performed and revealed large right sided Bochdalek hernia with hepatic hypoplasia. Under thoracolaparotomy, the defect was closed with Gore-Tex soft tissue patch. After the operation, left-sided inguinal hernia was found. However, it turned out that it had been present during infancy and spontaneously resolved during adolescence. This is the first report of right-sided Bochdalek hernia with hepatic hypoplasia and inguinal hernia in an adult.

A Case of Pulmonary Hemorrhage Associated with Henoch-Schonlein Purpura / 결핵및호흡기질환

Henoch-Schonlein purpura (HSP) is an immunologically mediated systemic vasculitis of small blood vessels that primarily involves the skin, gastrointestinal tract, joints and kidneys. HSP is a common vasculitic syndrome in children who, in most cases, achieve complete recovery. Pulmonary hemorrhage is a very rare manifestation of HSP. The authors present a case of a 46-year-old male presenting with pulmonary hemorrhage and renal involvement and the diagnosis of HSP. The patient responded to prednisolone therapy.

A Case of Non-Specific Interstitial Pneumonia Associated with Primary Lung Adenocarcinoma / 결핵및호흡기질환

Idiopathic pulmonary fibrosis (IPF) is strongly associated with lung cancer compared with the general population. However, other types of idiopathic interstitial pneumonia (IIP) are rarely associated with lung cancer. We describe a case of a primary lung cancer associated with IIP other than IPF, which was considered to be nonspecific interstitial pneumonia (NSIP), and NSIP disappeared spontaneously after treating the primary lung cancer.

Synchronous Double Primary Cancers of Lung and Liver / 결핵및호흡기질환

Although reports of multiple primary malignant tumors have increased recently, cases of synchronous double primary tumors of lung and liver are rare. A 73-year-old man suffered from chronic cough. His chest x-ray showed segmental atelectasis of the right upper lobe. Bronchoscopy revealed a mass occluding the orifice of the anterior segmental bronchus of the right upper lobe, and a biopsy showed a squamous cell carcinoma. A synchronous hepatic mass was found by ultrasonography. However, F18-FDG-PET showed no evidence of a distant metastasis. The liver biopsy revealed a hepatocellular carcinoma. A right upper lobe lobectomy and a sleeve resection were performed for the lung cancer, and radiofrequency ablation was performed for the hepatocellular carcinoma.

Mitigation of Calcification of Heterograft Tissue / 대한흉부외과학회지

BACKGROUND: With the development of cardiac surgical technique, we need more prosthetic materials for repairing the intra- and extracardiac defects. Although bovine pericardial bioprosthesis treated with glutaraldehyde (GA) solution is one of the most popular materials, it has a drawback of later calcific degeneration. The purpose of this study is to investigate the effectiveness of several materials and methods in reducing the calcific degeneration of bovine pericardium. MATERIAL AND METHOD: Forty square-shaped pieces of bovine pericardia were fixed in 0.625% GA solution with 4 g/L MgCl2.6H2O as a control group (group 1). Other 40 pieces pre-treated with 1% SDS (group 2) and 40 pieces post-treated with 8% glutamate (group 3) and 2% chitosan (group 4) were also fixed in the same GA solution. Other 40 pieces pre-treated with 1% SDS and post-treated with 8% glutamate and 40 pieces post-treated with 2% chitosan were also fixed in the same GA solution (group 5, 6). The pericardial pieces were implanted into the belly of 40 Fisher 344 rats subdermally and were extracted 1 month, 2 months, 3 months, and 6 months after the implantation. With an atomic absorption spectrophotometry, we measured the calcium amount deposited and examined the tissue with microscope. RESULT: The calcium deposition in 1 month was less in group 2, 5, 6 than that in group 1 (p<0.05). It was most prominent in group 5 (p<0.01). This finding continued in 2 month. In 3 month, the calcium deposition was less in group 3 and 4 as well as group 2, 5, and 6 than in group 1. In 6 month, the calcium deposition in group 2, 3, 4, 5, and 6 was less than that in group 1 and the difference was more than that of 1, 2, and 6 month. The microscopic calcium deposition was also less in group 2 and 5. Calcium deposition developed in the whole layer of pericardium, beginning with the surrounding the collagen fiber and progressing inwardly. CONCLUSION: Pre-treatment with SDS, post-treatment with glutamate or chitosan, and SDS pre-treatment and post-treatment with glutamate or chitosan were effective in reducing the calcium deposition in bovine pericardium. Moreover, the combined method of SDS pre-treatment and glutamate post-treatment was more effective than other methods.

Factors Influencing on Early Patency Rate of Autogenous Arteriovenous Fistula for Hemodialysis / 대한흉부외과학회지

BACKGROUND: It is very important for hemodialysis in patients with end stage renal disease to obtain vascular access that resists repeated punctures and maintains adequate blood flow. This study was designed to indentify factors that may influence early patency rate of autogenous arteriovenous fistula. MATERIAL AND METHOD: 49 cases in 47 patients who underwent radiocephalic fistula formation in our hospital from June 2002 through May 2003 were reviewed and analyzed. RESULT: The early patency rate was 79.6%. Age, sex, hypertension, and diabetes mellitus were not significant factors for patency. Body mass index and duration of hypertension and diabetes did not influence the early results either. Cephalic vein diameter measured preoperatively and blood flow at radiocephalic fistula were significantly positive correlative factors. Groups with the vein diameter less than 2.7 mm, or with the blood flow less than 100 mL/min had significantly lower early patency rate than the other groups. CONCLUSION: To improve early patency rate of radiocephalic fistula, large sized cephalic vein should be selected and if the intraoperative flow at radiocephalic fistula is less than 100 mL/min, another arteriovenous fistula formation should be considered.

Regulatory Mechanism of Vascular Contractility by Extracellular K+ : Effect on Endothelium-Dependent Relaxation and Vascular Smooth Muscle Contractility / 대한흉부외과학회지

BACKGROUND: Extracellular K+ concentration ([K+]o) can be increased within several mM by the efflux of intracellular K+. To investigate the effect of an increase in [K+]o on vascular contractility, we attempted to examine whether extracellular K+ might modulate vascular contractility, endothelium-dependent relaxation (EDR) and intracellular Ca2+ concentration ([Ca2+]i) in endothelial cells (EC). MATERIAL AND METHOD: We observed isometric contractions in rabbit carotid, superior mesentery, basilar arteries and mouse aorta. [Ca2+]i was recorded by microfluorimeter using Fura-2/AM in EC. RESULT: No change in contractility was recorded by the increase in [K+]o from 6 to 12 mM in conduit artery such as rabbit carotid artery. whereas resistant vessels, such as basilar and branches of superior mesenteric arteries (SMA), were relaxed by the increase. In basilar artery, the relaxation by the increase in [K+]o from 1 to 3 mM was bigger than that by the increase from 6 to 12 mM. In contrast, in branches of SMA, the relaxation by the increase in [K+]o from 6 to 12 mM is bigger than that by the increase from 1 to 3 mM. Ba2 (30microM) did not inhibit the relaxation by the increase in [K+]o from 1 to 3 mM but did inhibit the relaxation by the increase from 6 to 12 mM. In the mouse aorta without the endothelium or treated with NG-nitro-L-arginine (30microM), nitric oxide synthesis blocker, the increase in [K+]o from 6 to 12 mM did not change the magnitude of contraction induced either norepinephrine or prostaglandin F2alpha. The increase in [K+]o up to 12 mM did not induce contraction of mouse aorta but the increase more than 12 mM induced contraction. In the mouse aorta, EDR was completely inhibited on increasing [K+]o from 6 to 12 mM. In cultured mouse aorta EC, [Ca2+]i was increased by acetylcholine or ATP application and the increased [Ca2+]i was reduced by the increase in [K+]o reversibly and concentration-dependently. In human umbilical vein EC, similar effect of extracellular K+ was observed. Ouabain, a Na+-K+ pump blocker, and Ni2 , a Na+-Ca2+ exchanger blocker, reversed the inhibitory effect of extracellular K+. CONCLUSION: In resistant arteries, the increase in [K+]o relaxes vascular smooth muscle and the underlying mechanisms differ according to the kinds of the arteries; Ba2 -insensitive mechanism in basilar artery and Ba2 -sensitive one in branches of SMA. It also inhibits [Ca2+]i increase in EC and thereby EDR. The initial mechanism of the inhibition may be due to the activation of Na+-K+ pump.

A Giant Bronchial Artery Aneurysm in Brochiectatic Patient: One case report / 대한흉부외과학회지

Bronchial artery aneurysm is a rare but life-threatening disease when it ruptures, and it requires prompt treatment to prevent from catastrophic ruptures.A 78-year-old woman was referred to our hospital to evaluate mediastinal massfound on chest computed tomography. We did a selective bronchial artery angiography and diagnosed as bronchial artery aneurysm. Aneurysmectomy with division of afferent and efferent arteries was performed through standard thoracotomy without cardiopulmonary bypass. The patient recovered uneventfully and was discharged on postoperative 8th day without any complications.

Extracellular K+ Effects on the Mouse Aortic Endothelial Cell Contractility / 대한흉부외과학회지

BACKGROUND: External stimuli increases intracellular (IC) Ca2+, which increases extracellular (EC) K+. To verify K+ effects on the vascular contraction, we performed an experiment using mouse aortic endothelial cell. MATERIAL AND METHOD: We examined the mouse aortic contractility changes as we measured the IC Ca2+ change and ionic current by using the voltage clamp technique under different conditions such as; increasing EC K+, removing endothelial cell, giving L-NAME (N-nitro-L-arginine methyl ester) which suppress nitric oxide formation, Ouabain which control Na+-K+ pump and Ni2+ which repress Na+-Ca2+ exchanger. RESULT: When we increased EC K+ from 6 to 12 mM, there was no change in aortic contractility. Aorta contracted with more than 12 mM of EC K+. Acetylcholine (ACh) induced relaxation was inhibited with EC K+ from 6 to 12 mM, but was not found after de- endothelialization or L-NAME treatment. ATP or ACh increased IC Ca2+ in cultured endothelium. After maximal increase of IC Ca2+, increasing EC K+ from 6 to 12 mM made IC Ca2+ decrease and re-decreasing EC K+ to 6 mM made IC Ca2+ increase. Ouabain and Ni2+ masked the inhibitory effect of endothelium dependent relaxation by increased EC K+. CONCLUSION: These data indicate that increase in EC K+ relaxes vascular smooth muscle and reduces Ca2+ in the endothelial cells which inhibit endothelium dependent relaxation. This inhibitory mechanism may be due to the activation of Na+-K+ pump and Na+-Ca2+ exchanger.

Effect of Selective Cyclooxygenase-2 Inhibitor on Apoptosis of the Human Prostate Cancer Cell Xenografted in Nude Mice / 대한비뇨기과학회지

PURPOSE: Cyclooxygenase (COX)-2, an inducible enzyme that catalyzes the formation of prostaglandins from arachidonic acid, is overexpressed in various cancers, including prostate cancer, and cell lines. COX-2 has been reported to play an important role in carcinogenesis. The aim of this study was to evaluate the effects of a selective COX-2 inhibitor (meloxicam) on the cell proliferation, apoptosis, Bcl-2, and Bcl-xL expression in prostate cancer. MATERIALS AND METHODS: 20 male nude mice were subcutaneously inoculated with 1 million PC-3 cells expressing COX-2. After 1 week, the mice were divided into two groups of 10 mice. Group 1 was left untreated, which served as a control. Group 2 was treated with meloxicam (40mg/kg) four times a week for 3 weeks. After the 4 weeks experimental period, the tumors were immunohistochemically assayed for apoptosis (TUNEL) and proliferation (Ki-67). The COX-2, Bcl-2 and Bcl-xL mRNA expression levels in the tumors were evaluated by RT-PCR. RESULTS: The meloxicam had no effect on the tumor cell proliferation, but induced inhibition of PC-3 tumor cell growth and apoptosis. The Bcl-2 expression decreased in the meloxicam-treated group, but there was no significant difference between the two groups. The Bcl-xL expression was significantly down regulated in the meloxicam-treated group (p<0.01). CONCLUSIONS: Our results suggest that a selective COX-2 inhibitor suppresses PC-3 cell tumor growth in vivo. Tumor growth suppression was achieved by the induction of tumor cell apoptosis, and was associated with a decreased Bcl-xL expression, which is one of the Bcl-2 related genes.

The Role of beta-Adrenergic Receptor in the Seminal Vesicle Contraction / 대한비뇨기과학회지

PURPOSE: To investigate the role of beta-adrenergic receptors, and the relevance of NO-mediated & calcium channel-mediated signal transduction in seminal vesicle contractions. MATERIALS AND METHODS: Rabbit seminal vesicle strip preparations were applied to an organ bath system under standard condition. Smooth muscle contractions were induced by alpha and/or beta-adrenergic agonists (norepinephrine, phenylephrine, isoproterenol), and blocked by alpha (prazosin) and/or beta (propranolol)-blocker, an NO donor (sodium nitroprusside) and calcium channel blocker (verapamil). The contractility of the smooth muscle was measured by EC50. RESULTS: Norepinephrine, phenylephrine and isoproterenol produced a sudden increase in the contractions of the smooth muscle. The order of the adrenergic agonists in relation to increases in the contractility was norepinephrine>phenylephrine>isoproterenol. The contractions induced by norepinephrine and phenylephrine were partially blocked by prazosin, and those by isoproterenol were completely blocked by propranolol. The contraction induced by norepinephrine was partially blocked by sodium nitroprusside and verapamil, in dose dependant manners. CONCLUSIONS: Seminal vesicle contractions are mediated mostly by alpha-adrenergic receptors, and seem to be partly mediated by beta-adrenergic receptors. The contractility of seminal vesicle seems to be partly regulated by the NO-cGMP-cascade and calcium channel mediated signal transduction.

Mitigation of Calcification in Bovine Pericardial Bioprosthesis after Amino Acids Posttreatment / 대한흉부외과학회지

BACKGROUND: Bovine pericardium fixed in glutaraldehyde solution (GA) has been one of the most popular surgical bioprosthesis, however, late calcific degeneration after implantation remains to be solved. To mitigate calcific degeneration, we posttreated the bovine pericardium with amino acids after GA fixation. MATERIAL AND METHOD: 40 small pieces of bovine pericardia were fixed in 0.625% GA solution with 4 g/L MgCl2 6H2O as a control group (group 1). 40 pieces fixed in the same GA solution were posttreated with 2% chitosan solution (group 2) and the other 40 pieces posttreated with 8% glutamate (group 3). These were implanted into the belly of forty Fisher 344 rats subdermally and extracted at 1 month, 2 months, 3 months and 4 months after implantation. RESULT: With atomic absorption spectrophotometry we measured the deposited calcium amount and the results were as follows; 2.01+/-0.13 mg/g in group 1, 2.34+/-0.73 mg/g in group 2, 2.49+/-0.15 mg/g in group 3 at 1 month after implantation, and 3.57+/-0.15 mg/g in group 1, 3.52+/-0.92 mg/g in group 2, 3.46+/-0.12 mg/g in group 3 at the second month. But 5.45+/-0.42 mg/g in group 1, 3.22+/-1.31 mg/g in group 2 and 4.20+/-0.55 mg/g in group 3 at the 3rd month, which have statistical significance in group 2 (p<0.05). Finally at 4th month, 6.01+/-1.21 mg/g in group 1, 3.78+/-1.82 mg/g in group 2, 3.92+/-0.92 mg/g in group 3, which also have statistical significance (p<0.05). CONCLUSION: This means posttreatment with 2% chitosan shows meaningful calcium mitigation effects after 3rd month on subcutaneously implanted bovine pericardium in the rat models but 8% glutamate shows mitigation effect after 4months in this experiment.

Primary Giant Cell Tumor of Rib-Unusual Location / 대한흉부외과학회지

Giant cell tumor rarely occurs in ribs. Usually it is located in the posterior arc. We reported a very rare case of primary giant cell tumor of rib in the anterior arc with review of literatures.

Efficacy of Intra-Aortic Balloon Pump in Postcardiotomy Cardiogenic Shock / 대한흉부외과학회지

BACKGROUND: Intra-aortic balloon pump (IABP)is well known for its hemodynamic benefit but still has its own complications.Proper use of IABP is the best way t o obt ai n maximum benefit with low complication rate. MATERIALS AND METHOD: Twenty one(men 10,female 11) patients were included in this study among the 100 consecutive adult cardiac surgery patients in our hospital.Eighteen(85.7%)were ischemic heart disease patients.They all received IABP therapy due to postcardiotomy cardiogenic shock according to the well-known indications.Their preoperative conditions,intraoperative factors including hemodynamics, postoperative conditions and IABP-related complications were analyzed. RESULT: Nineteen patients(90.5%)were successfully weaned from IABP.There were 2 patients of operative death and the mortality rate was 9.5%.Duration of IABP use was 40.7+/-24.3 hours.There were 2 cases(9.5%)of IABP-related vascular complications that required surgical intervention. CONCLUSION: We concluded that IABP could be used effectively and safely for postcardiotomy cardiogenic shock patients with low complication rate.

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.

A Case of Myxoid Type of Malignant Fibrous Histiocytoma of the Heart

Malignant fibrous histiocytoma (MFH) of the heart is a very rare disease. It is difficult to distinguish from myxoma which is most common benign cardiac tumor. Prognosis of malignant fibrous histiocytoma (MFH) of the heart is known to be fatal despite of medical and surgical treatment in contrast to benign tumors. A primary myxoid malignant fibrous histiocytoma of the left atrium was diagnosed in a 58 years old woman. The mass was removed incompletely by operation. The patient did not receive either chemotherapy or radiotherapy. However, the patient is still alive for more than fifteen months after the initial presentation. We report a case of malignant fi brous histiocytoma (MFH) with reviewing the current references.

Reoperation of Postinfarction VSD / 대한흉부외과학회지

After early surgical repair of ventricular septal rupture complicated by myocardial infarction, newly developed ventricular septal defects were discovered on the 7th and the 40th postoperative day in 2 cases. We reoperated these patients for closure of newly developed ventricular septal defects with Dacron patch successfully on the 77th and the 10th day after discovery of those defects. From these results we conclude that early surgical repair for ruptured ventricular septum following myocardial infarction is an appropriate approach with low risk and that remnant or recurred ventricular septal defect can be corrected rather safely with proper myocardial preservation and unrestricted application of intraaortic balloon pump or other ventricular assist device.

Total Replacement of Aorta in Chronic Type I Aortic Dissection / 대한흉부외과학회지

The surgical treatment of diseases of thoracic aorta has had much better success rate in recent years compaired to the past. Aortic aneurysms or dissections that extend along the entire thoracic aorta are usually approached in two or three stages. Recently we successfully performed one-stage aortic replacement from the aortic root to the abdominal aorta in chronic DeBakey type I dissection. A 25 year-old man who had dyspnea on exertion (NYHA Fc II) and a Marfanoid feature was operated under the diagnosis of chronic type I dissection with severe aortic regurgitation. At operation, a huge ascending aorta with two intimal tearings was seen and the blood supply of intercostal arteries and right renal artery was done from the false lumen. Modified Bentall operation with total aortic replacement was done successfully, and the patient is being followed-up without major complications.

A Case of Left Ventricular Rupture and Complete Rupture of both Papillary Muscles Following Blunt Chest Trauma

Blunt chest trauma can cause various types of cardiac injuries such as myocardial contusion,cardiac ruptrue, valvular or papillary muscle injuries, and pericardial or coronary artery injuries. Complete rupture of both papillary muscles accompanied by left ventricular(LV) rupture following blunt chest trauma to our knowledge has not been previously reported. A 40-year-old female was referred because of severe dyspnea and anterior chest pain which occured immedicately after blunt chest trauma. Echocardiography demonstrated a moderate pericardial effusion as well as rupture of both papillary muscle with severe mitral regurgitation. Hemopericardium and a complets tear of the anterolateral papillary muscle at the mid portion were observed. The posteromedial papillary muscle was totally transected at the attachment site of LV wall and accompanied by external rupture of left ventricle at that site. Mitral valve replacement and primary repair of LV ruptrue was performed successfully. In the case we report, complete rupture of both papillary muscles developed after blunt chest trauma and LV rupture occurred as the papillary muscle was torn from the LV wall.