In the spring of 2011, a cluster of lung injuries caused by humidifier disinfectant (HD) usage were reported in Korea. Many patients required mechanical ventilation, extracorporeal membrane oxygenation, and even lung transplantation (LTPL). However, the long-term course of HD-associated lung injury remains unclear because the majority of survivors recovered normal lung function. Here we report a 33-year-old woman who underwent LTPL approximately four years after severe HD-associated lung injury. The patient was initially admitted to the intensive care unit and was supported by a high-flow nasal cannula. Although she had been discharged, she was recurrently admitted to our hospital due to progressive lung fibrosis and a persistent decline in lung function. Finally, sequential double LTPL was successfully performed, and the patient's clinical and radiological findings showed significant improvement. Therefore, we conclude that LTPL can be a therapeutic option for patients with chronic inhalation injury.
Adult ; Catheters ; Disinfectants ; Extracorporeal Membrane Oxygenation ; Female ; Fibrosis ; Humans ; Humidifiers* ; Inhalation ; Inhalation Exposure ; Intensive Care Units ; Korea ; Lung Injury* ; Lung Transplantation* ; Lung* ; Oxygen Inhalation Therapy ; Respiration, Artificial ; Survivors

Severe acute respiratory distress syndrome (ARDS) is a life-threatening disease with a high mortality rate. Although many therapeutic trials have been performed for improving the mortality of severe ARDS, limited strategies have demonstrated better outcomes. Recently, advanced rescue therapies such as extracorporeal membrane oxygenation (ECMO) made it possible to consider lung transplantation (LTPL) in patients with ARDS, but data is insufficient. We report a 62-year-old man who underwent LTPL due to ARDS with no underlying lung disease. He was admitted to the hospital due to influenza A pneumonia-induced ARDS. Although he was supported by ECMO, he progressively deteriorated. We judged that his lungs were irreversibly damaged and decided he needed to undergo LTPL. Finally, bilateral sequential double-lung transplantation was successfully performed. He has since been alive for three years. Conclusively, we demonstrate that LTPL can be a therapeutic option in patients with severe ARDS refractory to conventional therapies.
Extracorporeal Membrane Oxygenation ; Humans ; Influenza, Human* ; Lung Diseases ; Lung Transplantation* ; Lung* ; Middle Aged ; Mortality ; Pneumonia* ; Respiratory Distress Syndrome, Adult*

No abstract available.
Cell Proliferation* ; Female ; Humans ; Trophoblasts*

No abstract available.
Factor VIII* ; Polymorphism, Restriction Fragment Length*

Portal vein thrombosis is a rare condition occuring in association with a wide varitey of precipitation factors. Among these, advanced hepatoma constitute the major etiology of portal vein thrombosis. Noncancerous intrahepatic portal vein occlusion was reported in some cases of repeated cholangitis. Generally, Intrahepatic stones occures in Lt. lobe of liver and repeated inflammatory precesses occlude peripheral branch of Lt. portal vein. So, noncancerous Rt. portal vein occlusion is extremly rare condition. Two Patients visited our hospital with Rt. upper quadrant abdominal pain and fever. Preoperative abdominal ultrasonography, computerlized tomography, endoscopic retrograde cholagiopancreaticography revealed multiple Rt. intrahepatic stones and Rt. portal vein 1st branch occlusion. Rt. lobectomy of liver were performed. Pathologic reports were portal vein occlusion due to inflammatory thrombi, not tumor thrombi. Thus authors experienced 2 cases of Rt. portal vein 1st branch occlusion due to noncancerous benign condition, such as multiple intrahepatic stones, we report these cases with brief review of literature.
Abdominal Pain ; Carcinoma, Hepatocellular ; Cholangitis ; Fever ; Humans ; Liver ; Portal Vein* ; Ultrasonography ; Venous Thrombosis

Anaplastic large cell lymphoma (ALCL) is a subtype of non-Hodgkin lymphoma, that was first described by Stein et al. in 1985. In most cases, ALCL invades the lymph nodes, but primary extranodal lymphoma can occur in the gastrointestinal tract, skin, bone, central nervous system, and lungs. Moreover, the occurrence of primary ALCL in the skeletal muscle is extremely rare. This paper reports a case of primary ALCL involving the iliopsoas, adductor, pectineus, and obturator muscles around the left hip in a nine-year-old girl with a review of the relevant literature.

The major complications of Meckel's diverticulum(MD) are bleeding, intestinal obstruction, infection, umbilical fistula and perforation. Although the relative incidences vary between authors, bleeding is the most common complication in children. The aim of our study is to show the symptomatic guideline for the diagnosis of the bleeding MD. Eight cases with bleeding MD which were operated upon at the department of Pediatric Surgery, Yeungnam University Hospital from April 1985 to April 2001 were reviewed. Half of the patients were under 2 years of age and all patients were male. All patients were preoperatively diagnosed by previous history of intestinal bleeding (melena, hematochezia) and 99mTc pertechnetate MD scan. Segmental resection and end-to-end anastomosis was performed in 6 patients and diverticulectomy in 2 patients. Heterotropic gastric mucosa was found in 6 patients. Postoperative complication was not observed in any cases. In conclusion, in any male children with obscure intestinal bleeding, especially less than 2 years of age, bleeding MD must be suspected. It seems to us that 99mTc pertechnetate MD scan is a useful tool to diagnose bleeding MD.
Child ; Diagnosis* ; Fistula ; Gastric Mucosa ; Hemorrhage* ; Humans ; Incidence ; Intestinal Obstruction ; Male ; Meckel Diverticulum* ; Postoperative Complications ; Sodium Pertechnetate Tc 99m

BACKGROUND: The experience of a single-institution regarding surgery for small cell lung cancer (SCLC) was reviewed to evaluate the surgical outcomes and prognoses. MATERIALS AND METHODS: From July 1990 to December 2009, thirty-four patients (28 male) underwent major pulmonary resection and lymph node dissection for SCLC. Lobectomy was performed in 24 patients, pneumonectomy in eight, bilobectomy in one, and segmentectomy in one. Surgical complications, mortality, the disease-free survival (DFS) rate, and the overall survival rate were analyzed retrospectively. RESULTS: The median follow-up period was 26 months (range, 4 to 241 months), and there was one surgical mortality (2.9%). Six patients (17.6%) experienced recurrence, all of which were systemic. Eight patients died during follow-up; four died of disease progression and the other four died of pneumonia or of another non-cancerous cause. The three-year DFS rate was 79.2+/-2.6% and the overall survival rate was 66.4+/-10.5%. Recurrence or death was significantly prevalent in the patients with lymph node metastasis (p=0.001) as well as in those who did not undergo adjuvant chemotherapy (p=0.008). The three-year survival rate was significantly greater in the patients with pathologic stage I/II cancer than in those with stage III cancer (84% vs. 13%, p=0.001). CONCLUSION: Major pulmonary resection for small cell lung cancer is feasible in selected patients. Patients with pathologic stage I or II disease showed an excellent survival rate after surgery and adjuvant treatment. Prospective randomized studies will be needed to define the role of surgery in early-stage small cell lung cancer.
Carcinoma, Small Cell ; Chemotherapy, Adjuvant ; Disease Progression ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Lung Neoplasms ; Lymph Node Excision ; Lymph Nodes ; Mastectomy, Segmental ; Neoplasm Metastasis ; Pneumonectomy ; Pneumonia ; Recurrence ; Small Cell Lung Carcinoma ; Survival Rate

OBJECTIVES: We studied the circadian rhythm of nonlinear heart rate dynamics in healthy subjects. BACKGROUND: The frequency of sudden cardiac death increases in the morning. The relationship between decreased complexity of heart rate dynamics and sudden cardiac death has been documented. An understanding of the circadian variation in the complexity of cardiac dynamics may be important and to predict and prevent this sudden cardiac death. METHODS: Dynamic 24-hour electrocardiographic recordings were obtained from 30 healthy ambulant subjects aged 41 to 50 years and the digitized data was partitioned into sections of 30 minutes' duration. For each section, four indexes obtained from separate algorithms of nonlinear dynamics of RR interval - correlation dimension, Lyapunov exponent, approximate entropy, and fractal dimension - were calculated. Normalized low- (0.04-0.1 hertz) and high-frequency (>0.15 hertz) components were also calculated. RESULTS: All the four indexes of nonlinear dynamics showed a remarkably similar circadian rhythm: a prominent morning dip preceded by a steep decline during the late night, a recovery during the evening and a peak around midnight. In the morning, the low frequency component rose rapidly with concomitant withdrawal of the high frequency component. CONCLUSION: The complexity of cardiac dynamics decreases significantly in the morning, and this may contribute to the ominously increased rate of cardiac death in the morning hours.
Circadian Rhythm* ; Death ; Death, Sudden, Cardiac ; Electrocardiography ; Entropy ; Fractals ; Heart Rate ; Nonlinear Dynamics

PURPOSE: We wanted to evaluate the relating factors for deformities of the foot after tibial fracture and the outcome of respective surgical treatment. MATERIALS AND METHODS: We studied thirty-two patients (thirty-five feet) who had foot deformities after tibia fracture. The age, gender, shape, location, concurrent soft tissue injury and operative treatment of tibial fracture were analysed and outcome of the surgical treatment was investigated. RESULTS: Deformities of the foot mostly occurred in open fractures of Gustilo type 3 or closed fracture with severe soft tissue injury. Variable surgical treatments such as simple release, lengthening, Z-plasty and osteotomy were performed. The AOFAS ankle-hind foot scale was improved from average of 37.3 points preoperatively to an average of 77.2 points at the last follow up. The Maryland foot score was from 42.9 to 90.2 and AOFAS Lesser Toe Metatarso-phalangeal interphalangeal scale was from 42.9 to 90.5. Radiological correction was also improved from 21.9 degrees to 7.9 degrees (Meary angle), from 112.2 to 138.5 (Hibb's angle) and from 33.8 to 25.9 (Calcaneal pitch). CONCLUSION: We proposed that great care should be taken of treatment for the tibial fracture and early detection and proper management of the foot deformities are crucial.
Congenital Abnormalities ; Follow-Up Studies ; Foot ; Foot Deformities ; Fractures, Closed ; Fractures, Open ; Humans ; Maryland ; Osteotomy ; Soft Tissue Injuries ; Tibia ; Tibial Fractures ; Toes