Enterobacter cloacae Sacroiliitis with Acute Respiratory Distress Syndrome in an Adolescent / 감염과화학요법

Enterobacter cloacae has emerged as an important nosocomial pathogen, but is rarely a cause of sacroiliitis. Herein, we present the first reported case of Enterobacter cloacae sacroiliitis associated with sepsis and acute respiratory distress syndrome (ARDS). A previously healthy 14-year-old boy presented with low-grade fever and pain in the left side of the hip that was aggravated by walking. Pelvic computed tomography (CT) showed normal findings, and the patient received supportive care for transient synovitis with no antibiotics. However, there was no clinical improvement. On the third day of hospitalization, magnetic resonance imaging of the hip revealed findings compatible with sacroiliitis, for which vancomycin and ceftriaxone were administered. The patient suddenly developed high fever with dyspnea. Chest radiography and CT findings and a PaO2/FiO2 ratio <200 mmHg were suggestive of ARDS; the patient subsequently received ventilatory support and low-dose methylprednisolone infusions. Within one week, defervescence occurred, and the patient was able to breathe on his own. Following the timely recognition of, and therapeutic challenge to, ARDS, and after 6 weeks of parenteral antimicrobial therapy, the patient was discharged in good health with no complications.

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.

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.

A Hypervascular Inflammatory Myofibroblastic Tumor in the Mediastinum Resected Completely Following Embolization of the Feeding Vessels / 임상소아혈액종양

Inflammatory myofibroblastic tumors (IMTs) are rare tumors of intermediate malignant potential that can occur anywhere in the body. We describe an interesting case of a hypervascular IMT in the mediastinum that could be resected completely following embolization of the feeding vessels. A 17-month-old girl with complaints of cough and fever for 3 months was referred to our hospital. Computed tomography (CT) scan showed a large mass in the right hemithorax that shifted the mediastinum to the left. Primary excision was considered but not performed because there was very active capsule wall bleeding due to the hypervascular tumor. After embolization of the feeding vessels, successful complete resection was carried out. Approximately 6 weeks after the operation, follow-up CT scan showed no evidence of recurrent disease. Preoperative embolization is a good option for performing complete resection of hypervascular IMTs that could reduce the recurrence rate.

A Hypervascular Inflammatory Myofibroblastic Tumor in the Mediastinum Resected Completely Following Embolization of the Feeding Vessels / 임상소아혈액종양

Inflammatory myofibroblastic tumors (IMTs) are rare tumors of intermediate malignant potential that can occur anywhere in the body. We describe an interesting case of a hypervascular IMT in the mediastinum that could be resected completely following embolization of the feeding vessels. A 17-month-old girl with complaints of cough and fever for 3 months was referred to our hospital. Computed tomography (CT) scan showed a large mass in the right hemithorax that shifted the mediastinum to the left. Primary excision was considered but not performed because there was very active capsule wall bleeding due to the hypervascular tumor. After embolization of the feeding vessels, successful complete resection was carried out. Approximately 6 weeks after the operation, follow-up CT scan showed no evidence of recurrent disease. Preoperative embolization is a good option for performing complete resection of hypervascular IMTs that could reduce the recurrence rate.

Upper thoracic vertebral abnormalities in a patient with rheumatoid arthritis

No abstract available.

Accuracy of Nodal Staging with Integrated PET/CT Scanning in Non-small Cell Lung Cancer / 대한흉부외과학회지

BACKGROUND: For staging primary lung cancer, integrated positron emission tomography/computed tomography (PET/CT) imaging is popular. The purpose of this study was to evaluate the accuracy of PET/CT scanning in lymph nodal staging of lung cancer. MATERIAL AND METHOD: We studied 48 patients who had received CT, PET/CT and pulmonary resections due to primary non-small cell lung cancer in our hospital between January 2006 and August 2009. Mediastinal lymph nodes were classified as superior mediastinal nodes, aortic nodes, inferior mediastinal nodes, or N1 nodes. We compared the power of CT and PET/CT for diagnosing pulmonary lymph nodes for each of the four types of nodes. RESULT: PET/CT was more sensitive than CT for all groups except inferior mediastinal nodes. However, the differences were not significant (McNemar's test: superior mediastinal nodes, p=0.109; aortic nodes, p=1.000; inferior mediastinal nodes, p=0.625, N1 nodes, p=0.424). CONCLUSION: The accuracy of PET/CT is similar to that of CT alone for staging lymph nodes. The two imaging modalities might be used as complementary, cooperative tools. We expect that integrated PET/CT will be found to be significantly mmore sensitive after more trials are done and more data is accumulated.

Recurrent Bronchoesophageal Fistula after Endoscopic Treatment: A case report / 대한흉부외과학회지

Acquired bronchoesophageal fistula rare. Conservative treatment such as endoscopy is widely used. The recurrence rate after endoscopic treatment, however, is not well known. We report here on a case of a 54-year-old female who presented with recurrent bronchoesophageal fistula after endoscopic treatment that filled the fistula tract with Histoacryl(R).

Retroperitoneal Bronchogenic Cyst: A case report / 대한흉부외과학회지

Bronchogenic cysts are usually located in the pulmonary parenchyma or in the mediastinum. When bronchogenic cysts are located in the mediastinum, they are usually near the bronchus or esophagus, and rarely located in the retroperitoneal space. It is difficult to differentiate between bronchogenic cysts and benign cysts prior to surgert. We report here on a patient for who had a mass in the retroperitoneum, with the preoperative diagnosis being a benign neurogenic tumor. Via left open thoracotomy, pathologic reports revealed that the mass was a bronchogenic cyst. We report here on the case of a bronchogenic cyst that was located in the retroperitoneal space of the diaphragm.

Multiple Congenital Anomalies in a Neonate of a Diabetic Mother

Maternal diabetes is known to have teratogenic effects which increase the risk for congenital anomalies, such as caudal dysplasia, cardiac defects, hydronephrosis, and small left colon syndrome. Infants of diabetic mothers have a 10-fold higher frequency of anomalies in the central nervous system and a 5-fold higher frequency of congenital heart defects. However, jejunal atresia combined with multiple anomalies of the face, ears, and hands has rarely been reported. Herein we report a neonate born to a diabetic mother, who had hemifacial microsomia, displacement of the lacrimal ducts, polydactyly of the right hand, microtia of the right ear and proximal jejunal atresia presenting as bile regurgitation on the 1st day of life.

A Case Report of Amiodarone-induced Multiple Toxicity after a Long Course of a Low Dose Therapy

Amiodarone is a potent antiarrhythmic agent that is used to treat ventricular arrhythmias and atrial fibrillation. But it has a wide range of adverse effects, including pulmonary toxicity, thyroid dysfunction, liver toxicity, gastrointestinal events, corneal deposits, peripheral neuropathy and so on. Patients treated with amiodarone should be followed regularly to assess ongoing need for amiodarone, efficacy of the drug, appropriateness of dosage, adverse effects, and potential drug interactions. We experienced a case of severe weight loss due to amiodarone-induced multiple toxicity after a long course of a low dose therapy. So we report this unusual case with literature review.

Posterior Diaphragmatic Defect Detected on Chest CT: the Incidence according to Age and the Lateral Chest Radiographic Appearances

PURPOSE: We wanted to investigate the incidence of posterior diaphragmatic defect on chest CT in various age gropus and its lateral chest radiographic appearances. MATERIALS AND METHODS: The chest CT scans of 78 patients of various ages with posterior diaphragmatic defect were selected among 1,991 patients, and they were analyzed for the incidence of defect in various age groups, the defect location and the herniated contents. Their lateral chest radiographs were analyzed for the shape of the posterior diaphragm and the posterior costophrenic sulcus. RESULTS: The patients' ages ranged from 34 to 87 with the tendency of a higher incidence in the older patients. The defect most frequently involved the medial two thirds (n= 49, 50.4%) and middle one third (n=36, 37%) of the posterior diaphragm. The retroperitoneal fat was herniated into the thorax through the defect in all patients, and sometimes with the kidney (n=8). Lateral chest radiography showed a normal diaphragmatic contour (n=51, 49.5%), blunting of the posterior costophrenic sulcus (n=41, 39.8%), focal humping of the posterior diaphragm (n=7, 6.8%), or upward convexity (n=4, 3.9%) of the posterior costophrenic sulcus on the affected side. CONCLUSION: The posterior diaphragmatic defect discovered in asymptomatic patients who are without a history of peridiaphragmatic disease is most likely acquired, and this malady increases in incidence according to age. An abnormal contour of the posterior diaphragm or the costophrenic sulcus on a lateral chest radiograph may be a finding of posterior diaphragmatic defect.

Multilocular Thymic Cyst Associated with Mediastinal Teratoma: A Case Report

Multilocular thymic cyst (MTC) has been reported to develop in concert with various mediastinal neoplasms that have intrinsic inflammatory components, such as thymoma, thymic carcinoma, Hodgkin's disease, and seminoma. However, development of mediastinal teratoma without intrinsic inflammation in association with MTC has rarely been reported. Here, we report the findings of a case of MTC associated with mediastinal mature cystic teratoma on computed tomography (CT) with CT-histopathologic correlation.

Multilocular Thymic Cyst Associated with Mediastinal Teratoma: A Case Report

Multilocular thymic cyst (MTC) has been reported to develop in concert with various mediastinal neoplasms that have intrinsic inflammatory components, such as thymoma, thymic carcinoma, Hodgkin's disease, and seminoma. However, development of mediastinal teratoma without intrinsic inflammation in association with MTC has rarely been reported. Here, we report the findings of a case of MTC associated with mediastinal mature cystic teratoma on computed tomography (CT) with CT-histopathologic correlation.

Pulmonary Nocardiosis in a Patient with Lupus Nephritis / 대한류마티스학회지

Nocardiosis is uncommon in healthy people, but occurs as an opportunistic infection in patients with connective tissue disease, solid organ transplantation, lung disease, malignancies, and the acquired immune deficiency syndrome (AIDS). Nocardia is a gram positive, variably acid-fast aerobic bacterium of the family Nocardiaceae characterized by branching and filamentous growth, with distinctive aerial hyphae. In systemic lupus erythematosus (SLE) patients, immunosuppressiion with cytotoxic drugs or corticosteroids, proteinuria, renal insufficiency, and active SLE itself are known as risk factors for serious bacterial infections and opportunistic infections. We report a case of pulmonary Nocardiosis in patient with lupus nephritis treated with cyclophosphamide and high dose corticosteroid.

An experimental study on renal arterial and parenchymal change caused by selective renal infusion of epinephrine

Selective infusion of the epinephrine into the renal artery has been used in the field fo the diagnostic andthe therapeutic radiology for correct diagnosis and effective treatment, respectively. However, administration ofoverdose of epinephrine may cause serious complication, renal infarction. The study was undertaken to evaluate thesequential change of renal arterial constrictive effect of selective infusion of epinephrine into renal artery andto determine the critical doses of epinephrine producing irreversible renal infarct. A total of 25 rabbits areused, which are devided into 5 groups. Under the general anesthesia is made the selective infusion of variousdoses of epinephrine into the right renal arter of the rabbits. At the various time interval during and after theepinephrine infusion, renal angiography was doen, and 24 hrs. later, gross and microscopic findings of the kidneywere observed. The results are as follows; 1. Vasoconstriction of renal artery occurred within 2 mins. infusion,and maximum effect within 5 mins. 2. It seems that there is correlation between the amount of infused epinephrineand the time taken to recover from constiction of renal artery. 3. When epinephrine is infused into the renalartery in the rate of 1ug/min., renal infarct is not noticed below the level of 10 mins., but correlation betweenthe amount of infused epinephrine and the frequency of renal infarct occures above 20 mins. infusion.

Two cases of Empyema(pyothorax) caused by Mycoplasma pneumoniae Pneumonia in Children / 소아알레르기및호흡기학회지

Mycoplasma pneumoniae is the only known human pathogen among the Mycoplasma species isolated from the human respiratory tract. This pathogen causes respiratory infections most commonly in school-aged children and young adults. It may causes a variety of pulmonary manifestations and a few complication. empyema(pyothorax) as a complication of mycoplasma infection in children has been rarely reported. We report these two cases of empyema(pyothorax) preceded by Mycoplasma pneumoniae pneumonia in 5-year-old boy and 6-year-old girl. They were successfully managed by administration of antibiotics as well as surgical drainage.

CT findings and pathologic correlation atypical meningioma

13 cases of atypical meningioma were analysed, which were proven surgically S.N.U.H. for 3 years since Marach,1979. CT findings of atypical meningioma were central low density in 8 cases, large cyst in 4 cases, calcifiedmass in 1 case and non-specific scalp mass in 1 case. All the CT findings of atypical meningioma werepathologically proven as follows. Central low density was tissue necrosis in 5 cases, multiple cyts in 2 cases andhemorrhage in a case. Large cyst was arachnoid cyst in all 4 cases. Calcified mass was massive calcium depositionon tumor. Non-specific scalp mass on temporal area was meningioma involving soft tissue, bone and dura.

Treatment of Tracheobronchial Stenosis with a Self-Expandable Metallic Stents

PURPOSE: We analysed the role of modified Gianturco self-expandable stents in the treatment of tracheobronchial stenosis in 13 patients. MATERIALS AND METHODS: We inserted modified Gianturco self-expandable stents under the fluoroscopic and bronchoscopic guidance. There were stenosis in the trachea(n--2), the right main bronchus(n=2), and the left main bronchus(n=9). The causes of the stenosis were endobronchial tuberculosis(n=10), intubation granuloma (n=l), restenosis after surgical reconstruction(n=2). RESULTS: Dyspnea or wheezing was improved within 1 or 2 days following the procedure. There were 32% and 22% respective increase in average FEV1 and FVC. Lung perfusion scan showed 9.6% increase of perfusion in the involved lung. No complications related to the procedure were encountered. During follow-up period of up to 31 months, 2 patients showed tracheal or bronchial restenosis, at 3 and 6 months, retrospectively. There was a distal migration of the stents in one case. CONCLUSION: During the follow up period after stent insertion, improvement of the obstructive changes and dyspnea persisted in 10 out of 13 patients. The modified Gianturco self-expandable metallic stents may be a good choice for the treatment of tracheobronchial stenosis, either as a primary treatment, or when the reconstruction failed.

Fine Needle Aspiration Biopsy of the Lung in Children with Diffuse Pulmonary Lesions Suggesting Pneurnocystis carinii Pneumonia

PURPOSE: The purpose of this study was to determine the following:the safety of fine needle aspiration biopsy in immunocompromized children with radiographic features of Pneumocystis car/nil pneumonia, its diagnostic rate in those groups and the appropriate radiographic stage for fine needle aspiration biopsy to prove the etiologic agent. METHODS AND MATERIALS: We retrospectively reviewed the patient records of 16 children with immune compromizing diseases who had undergone fine needle aspiration biopsy of the lung. They showed the infectious sign of the lung along with the radiographic pattern of diffuse pulmonary disease, suggesting Pneumocystis carlnil pneumonia. All patients had underlying lymphoreticular malignancies including 14 acute lymphocytic leukemia and 2 non Hodgkin's lymphoma. According to the radiographic pattern of biopsy site, parenchymal disease was categorized as fine reticulonodular density(n=4), ground-glass opacity(n=9) and compact consolidation(n=3). We assessed the diagnostic rate of Pneumocystis carinii pneumonia and complications in each of the three groups. RESULTS: A diagnosis of Pneumocystis carinii pneumonia was established by fine needle aspiration biopsy in 9 patients(56%) including 2 of 4 patients with fine reticulonodular density, 4 of 9 patients with ground-glass opacity, and all 3 patients with compact consolidation. Four patients(25%) developed pneumothorax, and three of them required tube insertion. There was no patient who developed hemoptysis. CONCLUSION: Fine needle aspiration biopsy is a safe and easy method that can yield Pneumocystis carinii organism at a relatively high rate in immunocompromized children with diffuse pulmonary lesions suopicions of Pneumocystis carinii pneumonia. We recommend performing fine needle aspiration biopsy regardlesss of radiographic patterns when Pneumocystis carinii pneumonia is suggested.