Recurrent fetal postpartum stress induced cardiomyopathy after normal vaginal delivery / 고신대학교의과대학학술지

Stress induced cardiomyopathy is a disease that shows a dysfunction of the ventricle, but it can be rapidly reversible. It often occurs in older women primarily who suffers from emotional or physical stress. There are some case reports about postpartum stress induced cardiomyopathy. Most of the patients are recovered naturally within days to weeks. We report a case of a 37 years-old woman, who had experienced postpartum stress induced cardiomyopathy 8 years ago, revisited hospital because of cardiomyopathy after secondary delivery. Herein we report a rare case of recurrent stress induced cardiomyopathy after secondary normal vaginal delivery.

A Case of Three Consecutive Events of Acute Myocardial Infarctions in Three Different Vessels

A 51-year-old man was being admitted to the emergency department with chest pains. He had a history of acute myocardial infarction (MI) on two prior occasions and was successfully treated with drug eluting stents. He was diagnosed with 3 consecutive events of acute MI in 3 different vessels. The consecutive events of acute MI in different vessels are a very rare case. He did not have risk factors, such as coagulation abnormality, clopidogrel resistance, patient's compliance and vessel abnormality, except for his cigarette smoking. We reported the first case with 3 consecutive events of acute MI in each 3 vessels during a long-term interval.

A Case of Patent Ductus Arteriosus with Congestive Heart Failure in a 80-Year-Old Man

Patent ductus arteriosus (PDA) is a rare clinical finding in adult patients. Considering the increase in cases of PDA discovered incidentally on echocardiograms at young ages, and the life-shortening effect of PDA, it is rare to diagnose PDA in old patients. We report a case of an 80-year-old patient who experienced symptoms of congestive heart failure showed findings suggestive of PDA in echocardiogram and confirmed the diagnosis through a cardiac catheterization and a coronary angiography. After percutaneous occlusion of PDA with an Amplatzer duct occlusion device, symptoms related to congestive heart failure improved.

Identification of Genomic Aberrations by Array Comparative Genomic Hybridization in Patients with Aortic Dissections

BACKGROUND: The aim of the present study was to identify chromosomal loci that contribute to the pathogenesis of aortic dissection (AD) in a Korean population using array comparative genomic hybridization (CGH) and to confirm the results using real-time polymerase chain reaction (PCR). MATERIALS AND METHODS: Eighteen patients with ADs were enrolled in this study. Genomic DNA was extracted from individual blood samples, and array CGH analyses were performed. Four corresponding genes with obvious genomic changes were analyzed using real-time PCR in order to assess the level of genomic imbalance identified by array CGH. RESULTS: Genomic gains were most frequently detected at 8q24.3 (56%), followed by regions 7q35, 11q12.2, and 15q25.2 (50%). Genomic losses were most frequently observed at 4q35.2 (56%). Real-time PCR confirmed the results of the array CGH studies of the COL6A2, DGCR14, PCSK6, and SDHA genes. CONCLUSION: This is the first study to identify candidate regions by array CGH in patients with ADs. The identification of genes that may predispose an individual to AD may lead to a better understanding of the mechanism of AD formation. Further multicenter studies comparing cohorts of patients of different ethnicities are warranted.

Effects of Percutaneous Coronary Intervention on Depressive Mood in Elderly Patients

BACKGROUND: Depression is a common comorbid condition in patients with coronary artery disease and a well-documented risk factor for recurrent cardiac events and mortality. We examined the impact of percutaneous coronary intervention (PCI) on depressive mood in elderly patients with chronic stable angina. METHODS: Consecutive patients with chronic stable angina (n=171) who had undergone elective PCI from January 2010 to May 2010 were included in this study. Patients were divided into elderly (> or =65 years) and non-elderly groups (<65 years) and then completed the 21-item Beck Depression Inventory I (BDI-I) at baseline and prior to discharge to assess for depressive symptoms. RESULTS: Seventy-three (43%) patients were assigned to the elderly group and 98 (57%) to the non-elderly group. Using multivariate regression analysis, we found that the elderly group had a higher prevalence of joint, lung, and gastrointestinal diseases; were less religious and less likely to be employed; had lower rates of private health insurance; and were, less frequently, users of regular alcohol, current smokers, and regular exercisers compared to the non-elderly patients. The mean difference in BDI-I scores at baseline and pre-discharge was higher in elderly patients. CONCLUSION: Our study showed a correlation between the extent of depression and elective PCI, especially in elderly patients. This population should be assessed routinely for depressive symptoms and managed accordingly.

Upregulation of Connexin43 Expression in Mitral Valves in a Rabbit Model of Hypercholesterolemia / 대한흉부외과학회지

BACKGROUND: Connexin 43-mediated gap junctional communication plays an important role in atherosclerosis. Numerous studies have demonstrated a correlation between mitral valve annular calcification and atherosclerotic disease. However, the relevance of connexin 43 to mitral valve disease remains unclear. We hypothesized that the mechanism contributing to mitral valve disease is associated with alterations in cell-to-cell communication mediated by changes in Connexin 43 expression. MATERIAL AND METHOD: Twenty male New Zealand rabbits were divided into two groups: animals in group 1 (n=10) were fed a normal chow diet, whilst those in group 2 (n=10) received a diet containing 1% cholesterol for 12 weeks. After sacrificing the animals, the mitral valves were excised and analyzed with immunohistochemical staining and Real-time Reverse Transcriptase polymerase chain reaction (real time RT-PCR). RESULT: Myofibroblasts and macrophages were found concentrated within the endothelial layer on the ventricular side of the leaflet in the cholesterol diet group. Immunohistochemial staining showed elevated expression of connexin43 in the cholesterol diet group. Real-time RT-PCR revealed increased connexin43 mRNA levels in mitral valves from hypercholesterolemic animals. CONCLUSION: Our finding that connexin43 expression is increased in mitral valves of hypercholesterolemic rabbits suggests that alterations in cell-to-cell communication via connexin43 containing gap junctions play a role in the development of mitral valve disease in hypercholesterolemia.

The Clinical Value of Intima-media Thickness in Patients with Stable Coronary Artery Disease and C-reactive Protein within Normal Limits / 대한흉부외과학회지

BACKGROUND: The purpose of this study was to determine whether hand-measured carotid intima-media thickness (IMT) was a reliable and simple tool that could be used to evaluate the severity of stable coronary artery disease (CAD) with normal high-sensitivity C-reactive protein (CRP). MATERIAL AND METHOD: We examined left carotid IMTs in 688 patients with stable CAD and excluded 121 patients with abnormally elevated hs-CRP (> or =0.5 mg/dL). We sought to determine the association between risk factors and the severity of stable CAD and carotid IMT in 567 patients who were divided into lower and higher groups based on the median value. Patients underwent a coronary artery angiogram and had at least significant stenosis (>50% of the original luminal diameter involving one or more major coronary artery). RESULT: Of the 567 patients, 300 (52.9%) were in the lower IMT group and 267 (47.1%) were in the higher IMT group; the median value was 0.76 mm. By multivariable logistic regression analysis, the following groups were different: older age (~49 vs. 70~ years, respectively; OR=6.552), high FBS (~99 vs. 120~ mg/dL; OR=1.713) and severity of CAD (1 vessel vs. 2 vessel disease; OR=1.711, 1 vessel vs. 3 vessel disease; OR=1.714). CONCLUSION: We conclude that there are correlations between increased carotid IMT and severity of CAD in stable angina patients with normal CRP levels.

Congenital Sternal Foramen: A case report / 대한흉부외과학회지

A 43-year-old male patient visited our hospital because of intermittent chest pain and exertional dyspnea. This patient was diagnosed as suffering with pulmonary stenosis that was caused by muscle hypertrophy of the subpulmonic area, and the diagnosis was made by performing echocardiography and cardiac catheterization. A sternal foramen of the chest wall was found on the operation field. We report here on this case and we also review the relevant literature.

Clinical Analysis of Iatrogenic Pneumothorax / 대한흉부외과학회지

BACKGROUND: This study was designed to determine etiologic factors for iatrogenic pneumothorax in an era of increased use of invasive procedures and to evaluate its impact on morbidity. MATERIAL AND METHOD: Subjects were 112 patients (65 men and 47 women ranging in age from 20 to 90 years) who were diagnosed with an iatrogenic pneumothorax between January 2005 and December 2008. We reviewed medical records retrospectively. RESULT: The leading causes of iatrogenic pneumothorax were percutaneous needle aspiration (50), central venous catheterization (29), acupuncture (14), thoracentesis (8) and positive pressure ventilation (7). The majority of the patients (60 of 114) were treated with chest tubes. The mean duration of hospital treatment was 5.8 (+/-4.0) days. Hospitalization was prolonged in 24 patients (21.1%). No patient died from iatrogenic pneumothorax. CONCLUSION: In our study, the most common cause of iatrogenic pneumothorax was percutaneous needle aspiration. The mortality and morbidity from iatrogenic pneumothorax is not significant. The recognition of pneumothorax, depends on careful examination after completion of an invasive procedure, and should be followed by prompt and definitive therapy.

The Relationship of the LV Systolic Function, the LV Dimension and the LV Mass to QT Dispersion in Stable Angina Patients who are with or without Significant Coronary Stenosis / 대한흉부외과학회지

BACKGROUND: The aim of this study was to investigate the relationship of the left ventricular (LV) systolic function, the LV dimension and the LV mass with the QT dispersion in patients with stable angina, and we also wanted to compare this relationship between patients with and without significant coronary stenosis on coronary angiography. MATERIAL AND METHOD: 174 patients complained of typical angina and they had no associated ST segment or cardiac enzyme abnormalities. The patients were divided into 2 groups based on the results of coronary angiography: the patients with angiographic coronary stenosis > or =50% made up group I (n=101), and the patients with angiographic coronary stenosis <50% made up group II (n=73). An echocardiogram for assessing the LV ejection fraction (EF), the LV dimension and the LV mass and a 12-lead electrocardiogram for assessing the QT dispersion were performed before the coronary angiography. RESULT: The QT dispersion was significantly greater in group I than that in group II (39.8 ms vs. 33.3 ms; p<0.05). For all the patients, all the parameters of LV dimension and LV mass had statistically positive correlation to the QT dispersion, but the LV mass was the only independently significant parameter that was correlated with the increased QT dispersion (p<0.05). For group I, none of the echocardiographic parameters had significant correlation with the QT dispersion. However, the LV dimension and LV mass had significantly positive correlation with the QT dispersion, and the LV mass was also the only independently significant parameter that was correlated with increased QT dispersion in group II (p<0.05). CONCLUSION: Our study demonstrated a significantly positive correlation of the QT dispersion to the LV dimension and the LV mass in patients with stable angina. These findings are present only in patients without significant coronary stenosis.

Chest Pain due to Coronary Artery Vasospasm after Aortic Valve Replacement Surgery: A case report / 대한흉부외과학회지

Coronary artery vasospasm results in transient, abrupt chest pain that's due to the increased vasomotor tone of the coronary artery, and this can cause myocardial ischemia. We report here on one case of the right coronary artery vasospasm after aortic valve replacement surgery, and this was due to severe aortic regurgitation.

Mediastinal Neurofibroma in a the Patient with Type 1 Neurofibromatosis: A case report / 대한흉부외과학회지

Neurogenic tumors are the most common posterior mediastinal tumors and accounting for 19~39% of all mediastinal tumors and 75% of all posterior mediastinal tumors. Neurofibromatosis is an autosomal dominant disorder with variable expression of tumors, including neurologic tumors of the peripheral nerves, nerve roots, and plexi. A posterior mediastinal neufibroma in neurofibromatosis patients is rare. We report here a case of posterior mediastinal neurofibroma in a patient with type 1 neurofibromatosis.

Chest Wall Lipoblastoma in a Nineteen-months-old Boy: A case report / 대한흉부외과학회지

Lipoblastoma is a rare benign mesenchymal tumor that occurs primarily in infancy and childhood. There are two types of lipoblastoma: focal or diffuse (lipoblastomatosis). This is typically located in the extremities, and less frequently in the trunk, head and neck, and the retroperitoneum. Lipoblastoma is a tumor with a good prognosis with no reported metastasis, despite of its potential for local invasion, local recurrence and rapid growth. Complete surgical resection is essential for treatment, and long term follow up is needed.

Thoracic Actinomycosis / 대한흉부외과학회지

BACKGROUND: Thoracic actinomycosis is a rare, chronic debilitating disease and it is difficult to diagnose and treat. MATERIAL AND METHOD: Between March 1990 to December 2003, 17 patients were diagnosed and treated for actinomycosis in our center. Except 4 patients (involving cervicofacial, and abdominopelvic area), we reviewed the clinical characteristics, diagnosis method, and treatment in 13 patients. RESULT: In 8 patients, the operation was required for diagnosis and treatment. 7 of 8 patients had tumor-like lesions in radiological findings and they were not distinguished as lung cancer, and 1 of 8 patients was non-responsive to the antibiotics therapy. Among the 5 medically treated patients, 4 of 5 patients were diagnosed by bronchoscopic biopsy and one by CT-guided biopsy. All of them was well-responsive by the antibiotic treatment. CONCLUSION: Thoracic actinomycosis is a chronic inflammatory disease that respond well to antibiotics (penicillin therapy). It should be diagnosed by the repeated biopsy (CT-guided or bronchoscopic) before starting treatment. However, if the lesion is not distinguished as the lung cancer, non-responsive to the medical treatment, and the patients experience the recurrent hemoptysis, we can consider the operation for the diagnosis and treatment.

The Effects of Leukocyte Depleted Priming Solution on the Gastric Mucosal CO2 Partial Pressure and Serum IL-8 Level during Cardiopulmonary Bypass in Korean Mongrel Dogs / 대한흉부외과학회지

BACKGROUND: Cardiopulmonary bypass is an essential process to maintain circulation for saving life during the cardiac surgery. But it is a process in which systemic inflammation was evoked inevitably because of the exposure of blood to foreign surface. The injuries to distal organs during the cardiopulmonary bypass were resulted from systemic inflammation and the disturbances of micro-circulations in the organs. We designed this study to research the effects of leukocyte depletion from pump-oxygenator priming solution on the systemic inflammation, and the micro-circulation of gastric mucosa that is suggested by the gastric mucosal CO2 partial pressure and acidity. MATERIAL AND METHOD: The dogs were divided into three groups according to the different pump-oxygenator priming solutions; non-hemic crystalloid solution; leukocyte-depleted homologous blood; and non leukocyte-depleted homologous blood. Each priming solution group contained five dogs. In all three groups, 2 hours of cardiopulmonary bypass, and 4 consecutive hours of general anesthesia was maintained on the mechanical ventilation. Each dog was evaluated for the gastric mucosal pH, CO2 partial pressure, arterial pH, CO2 partial pressure, the exhaled air CO2 partial pressure and the level of IL-8 on before the cardiopulmonary bypass, 1 hour after the cardiopulmonary bypass, 2 hours after the cardiopulmonary bypass, 2 hours after the restoration of normal circulation, and 4 hours after the restoration of normal circulation after the cardiopulmonary bypass. The levels of IL-8 were measured with ELISA (enzyme linked immunosorbent assay) technique. RESULT: 1. There were significant differences of gastric mucosal CO2 partial pressure between the leukocyte-depleted homologous blood group and other two groups(vs non leukocyte-depleted homologous blood group; p=0.02, vs non-hemic crystalloid solution group; p=0.01). 2. The gastric mucosal pH of leukocyte-depleted homologous blood group was significantly different from non leukocyte-depleted homologous blood group (p=0.01). 3. The levels of IL-8, which examine the systemic inflammation, showed significantly better results in leukocyte-depleted homologous blood group and non-hemic crystalloid solution group than non leukocyte-depleted homologous blood group (p=0.01, 0.01). CONCLUSION: Based upon these results, we concluded that the leukocyte depletion from the pump-oxygenator priming solution has a beneficial effects in reducing systemic inflammation and the preserving of gastric mucosal micro-circulation.

Clinical Significance of p53 Gene and nm23 Gene Expression in Esophageal Cancer / 대한흉부외과학회지

BACKGROUND: Although significant progress has been made in the surgical treatment of esophageal carcinoma as well as in the detection of early stage esophageal carcinoma by diagnostic techniques, the prognosis of the esophageal carcinoma patients remain poor. The p53 gene product is known to regulate cell growth and proliferation. And the nm23 gene was identified originally as an anti-metastatic influence whose expression was correlated inversely with tumor metastatic potential in murine melanoma cell lines. This experiment was intended to know the relationship among the p53 and nm23 gene expression versus clinicopahologic characteristics of the esophageal cancer. MATERIAL AND METHOD: Total 40 cases were collected from patients who had undergone esophagectomy at St. Mary's Hospital, Catholic university of Korea. Immunohistochemical stain for p53 mutant-type protein and nm23 proein was graded as 50% positive tumor cells: +++ . The tumor invasion was grades as none: - ; mild: + ; moderate: ++ ; severe: +++ . RESULT: Overexpression of p53 protein and nm23 was not associated with the survival and cliniocopathologic characteristics of the esophageal cancer. Moreover, the combination analysis of p53 and nm23 revealed that there was no relationship between the gene expression and the clinicopatholic characteristics of the esophageal cancer.

Surgical Treatment of Pulmonary Artery Sarcoma: One case report / 대한흉부외과학회지

We report a rare case of pulmonary artery sarcoma mimicking pulmonary artery thromboembolism in a 57-year-old man who suffered with 2-month dyspnea and exacerbated for 1 week. He was transferred from private clinic and he was diagnosed as acute pulmonary artery thromboembolism on the basis of chest CT. Chest CT, pulmonary artery angiogram, and perfusion scan were examined. We performed surgical excision with aid of CPB. The final pathologic report was that the mass was a pulmonary artery sarcoma. We experienced one case of pulmonary artery sarcoma and reported it with reference.

Modified Thoracoscopic Bullectomy / 대한흉부외과학회지

BACKGROUND: Morbidity, the use of analgesics, the amount of postoperative drainage and the postoperative hospital stay were reduced in VATS for pneumothorax. However, some authors preferred minithoracotomy to VATS because the rate of recurrence after VATS were between 5% and 10%. Therefore, we present a modified thoracoscopic bullectomy (MTB) which we believe has the advantages of conventional VATS and minithoracotomy. MATERIAL AND METHOD: Sixty-six patients who received the operation from January 2002 to December 2002 were divided into 3 groups. Twenty-six patients were treated by axillary minithoracotomy and thirteen by conventional VATS and 18 by modified thoracoscopic bullectomy. The mean age was 21.9 years (range, 16~35 years) for minithoracotomy group, 20.6 years (range, 17~28 years) for conventional VATS group and 22.6 years (range, 16~39 years) for MTB group. The mean follow-ups were 11.4months for minithoracotomy group, 9.5 months for conventional VATS group and 4.7 months for MTB group. RESULT: The mean duration of operation was 55.79+/-23.35 minutes in MTB and 44.23+/-19.24 minutes in conventional VATS (p=0.333). The number of staplers being used was 1.63+/-0.76 in MTB, 1.41+/-0.64 in minithoracotomy (p=0.663), and 2.92+/-1.19 in conventional VATS (p<0.001). The duration of indwelling chest tube was 1.63+/-0.76 day in MTB, 4.07+/-1.41 day in minithoracotomy (p<0.001) and 4.46+/-2.33 day in conventional VATS (p<0.001). Hospital length of stay was 3.26+/-0.81 day in MTB, 6.04+/-2.21 day in minithoracotomy (p<0.001) and 6.69+/-3.33 day in conventional VATS (p<0.001). The number of postoperative complication and recurrence were 2 in minithoracotomy (7.4%), 5 in conventional VATS (38.5%) and 1 in MTB (5.6%). CONCLUSION: Modified thoracoscopic bullectomy is an effective procedure in the treatment of spontaneous pneumothorax.

Video-Assisted Thoracoscopic Surgery for Patent Ductus Arteriosus: 6 cases report / 대한흉부외과학회지

Surgical interruption through a left posterolateral thoracotomy and percutaneous transcatheter closure of ductus arteriosus were popular procedures of treatment. However, concerns over postthoracotomy syndrome and postoperative pain and complications such as persistent shun-ting, hemolysis, possible migration, and problem of prophylaxis against bacterial endocarditis in residual shunt were reported. Therefore, we present our procedure using video-assisted thoracoscopy for PDA clipping. 6 patients underwent video assisted-thoracoscopic clipping of PDA, but one case was converted into minithoracotomy. Postoperative examination showed the absence of murmur and decreased pulmonary vascularities progressively in all patients. In our series, we had no cases of ductal rupture during operation, incomplete ductal closure, pneumothorax, or hoarseness. Mean hospital stay was 3.4days. Postoperative echocardiography revealed no cases of ductal patency or residual shunt. We concluded that the technique described here is an effective procedure in view of the prevention of postthoracotomy syndrome, successful closure of ductus, cosmetic effect, and a short hospital stay.

Coronary Artery Bypass Grafting with Cardiopulmonary Bypass Versus Without Cardiopulmonary Bypass / 대한흉부외과학회지

BACKGROUND: Coronary artery bypass graft with cardiopulmonary bypass is a conventional method of operative revascularization of coronary artery disease. Because of many troubles of cardiopulmonary bypass such as systemic inflammatory reaction, mechanical trauma of blood components and coagulopathy, coronary artery bypass graft without cardiopulmonary bypass has been popularized. MATERIAL AND METHOD: From March 1999 to September 2000, 35 patients underwent CABG at our institution. Among them, 14 patients received CABG without the use of CPB and 21 patients underwent CABG with the use of CPB. Mean operative time, mean postoperative tracheal intubation time, mean ICU stay, mean hospital stay, the amount of transfusion, postoperative use of inotropic agents, and postoperative changes of cardiac enzymes were compared in both groups. RESULT: There were differences between the CABG without CPB group and CABG with CPB group with regard to mean tracheal intubation time, the amount of transfusion and the elevation of postoperative cardiac enzymes(p<0.05). CONCLUSION: While CABG without CPB provided satisfactory results, more long term follow-up is required.