Cardiac herniation is a rare catastrophic complication of intrapericardial pneumonectomy. Untreated it is invariably fatal. Left pneumonectomy for removal of huge angiomatosis tumor in left lung was performed in a 44 year-old male patient. At the end of operation, the patient had cardiovascular collapse due to cardiac herniation. Repaired pericardial suture was teared and the heart was herniated in the left thorax. The hernated heart was edematous caused by compression and incarceration of the cardiac muscle by the edge of the pericardial rent. The heart was introduced into the pericardial sac and the defect was closed with large Goretex patch; however the patient ' s brain had sever hypoxic damage. This paper reports a case of cardiac herniation following left intrapericardial pneumonectomy.
Adult ; Angiomatosis ; Brain ; Heart ; Humans ; Lung ; Male ; Myocardium ; Pneumonectomy* ; Polytetrafluoroethylene ; Sutures ; Thorax

PURPOSE: To evaluate the chest radiographic findings of rickettsial disease including murine typhus and tsutsugamushi disease in Chunchon. MATERIALS & METHODS: Chest radiographic films of 81 cases diagnosed as rickettsial disease(55 cases of tsutsugamushi disease, 26 cases of murine typhus) by immunofluorescence test were retrospectively analyzed. RESULTS: Main serotypes of Rickettsia tsutsugamushi were Gilllain and Karp. Incidence rate of tsutsugamushi disease was 2.1 times greater than that of murine typhus. Chest radiographs were abnormal in 63.6% of tsutsugamushi disease, and in 30.8% of murine typhus. Radiographic findings were Kerly's B line, reticu-Ionodular densities, hilar enlargement, pleural effusion, and splenomegaly in both entities, but pulmonary consolidation was only found in tsutsugamushi disease. The patients with the abnormal radiographic findings were statistically well correlated with cardiomegaly(p<0.01) and azygos engorgement(p<0.05), as compared to the patients with normal radiographic findings. CONCLUSION: Radiographic findings of both murine typhus and tsutsugamushi disease were interstitial pattern. But the chest radiographs in patients with tsutsugamushi disease showed more severe pattern with higher rate of abnormality.
Fluorescent Antibody Technique ; Gangwon-do* ; Humans ; Incidence ; Orientia tsutsugamushi ; Pleural Effusion ; Radiography, Thoracic* ; Retrospective Studies ; Scrub Typhus* ; Splenomegaly ; Thorax* ; Typhus, Endemic Flea-Borne*

The treatment of choice for post-intubation tracheal stenosis is partial tracheal resection and end-to-end anastomosis. The surgical treatment of tracheal restenosis that results from unsuccessful repair of post-intubation tracheal stenosis is not easy. Failed reoperation results in permanent tracheostomy and loss of voice. If the first operation fails, about 4~6 months of period for resolution of inflammatory reaction, edema, and fibrosis is needed. The exact evaluation of the patient's status is necessary and success rate of reoperation for the appropriate candidates is over 90%. We report the results of treatment in two cases of tracheal restenosis that resulted from unsuccessful repair of post-intubation tracheal stenosis with review of literatures.
Edema ; Fibrosis ; Reoperation ; Tracheal Stenosis* ; Tracheostomy ; Voice

PURPOSE: To evaluate the long-term outcomes of anti-vascular endothelial growth factor (VEGF) therapy for polypoidal choroidal vasculopathy (PCV) with feeder vessels and to investigate fellow-eye findings. METHODS: This retrospective observational study included 14 eyes with treatment-naïve PCV accompanied by feeder vessels that were treated with anti-VEGF monotherapy. The best-corrected visual acuity (BCVA) at baseline was compared with that at the last follow-up. The fellow-eye indocyanine green angiography findings were also analyzed. RESULTS: The mean follow-up period was 28.1 ± 19.2 months (range, 12 to 60 months). During the follow-up period, 5.9 ± 2.5 anti-VEGF injections were administered. The logarithm of the minimal angle of resolution (logMAR) BCVAs at the time of diagnosis, at 3 months, and at the last follow-up were 0.81 ± 0.49, 0.55 ± 0.44, and 0.71 ± 0.54, respectively. Although the BCVA at the last follow-up was not different from the baseline value (p=0.809), an improvement of ≥0.2 logMAR BCVA was observed in seven eyes (50.0%). In 11 eyes that underwent bilateral indocyanine green angiography at diagnosis, PCV, branching vascular networks, and late geographic hyperfluorescence were noted in two (18.2%), five (45.4%), and three (27.3%) fellow eyes, respectively. During the follow-up period, the development of polypoidal lesions in the fellow eye was observed in three patients. CONCLUSIONS: In this study, long-term improvement in BCVA was noted in 50% of the included patients who received anti-VEGF monotherapy. A relatively high incidence of pathological findings in the fellow eye and bilateral involvement suggest the need for bilateral examinations.
Angiography ; Choroid* ; Choroidal Neovascularization ; Diagnosis ; Endothelial Growth Factors ; Follow-Up Studies ; Humans ; Incidence ; Indocyanine Green ; Macular Degeneration ; Observational Study ; Ranibizumab ; Retrospective Studies ; Visual Acuity

The majority of lung cancers associated with hyperamylasemia are adenocarcinomas. Here we report an unusual case of a 54-year-old male patient who complained of dyspnea, anterior chest wall discomfort and facial edema for one month, presenting with a huge mediastinal mass and hyperamylasemia complicated by pericardial effusion Histological evaluation of mediastinal mass revealed small cell carcinoma and pericardium showed nonspecific inflammation with fibrosis. The serum amylase had an electrophoretic mobility similar to that of salivary gland enzyme. There were no evidence of a salivary or pancreatic causes of hyperamylasemia. After chemotherapy, parenchymal lung lesions improved and hyperamylasemia disappeared. For the mannagement of peracardial effusion a pericardial window was forms(i. We concluded that the striking increase in serum amylase was due to the ectopic production of this enzyme by the tumor.
Adenocarcinoma ; Amylases* ; Carcinoma, Small Cell ; Drug Therapy ; Dyspnea ; Edema ; Fibrosis ; Humans ; Hyperamylasemia ; Inflammation ; Lung ; Lung Neoplasms ; Male ; Middle Aged ; Pericardial Effusion ; Pericardium ; Salivary Glands ; Small Cell Lung Carcinoma* ; Strikes, Employee ; Thoracic Wall

PURPOSE: Lung size mismatch is a major cause of poor lung function and worse survival after lung transplantation (LTx). We compared predicted total lung capacity (pTLC) and TLC measured by chest computed tomography (TLC(CT)) in LTx candidates. MATERIALS AND METHODS: We reviewed the medical records of patients on waiting lists for LTx. According to the results of pulmonary function tests, patients were divided into an obstructive disease group and restrictive disease group. The differences between pTLC calculated using the equation of the European Respiratory Society and TLC(CT) were analyzed in each group. RESULTS: Ninety two patients met the criteria. Thirty five patients were included in the obstructive disease group, and 57 patients were included in the restrictive disease group. pTLC in the obstructive disease group (5.50±1.07 L) and restrictive disease group (5.57±1.03 L) had no statistical significance (p=0.747), while TLC(CT) in the restrictive disease group (3.17±1.15 L) was smaller than that I the obstructive disease group (4.21±1.38 L) (p<0.0001). TLC(CT)/pTLC was 0.770 in the obstructive disease group and 0.571 in the restrictive disease group. CONCLUSION: Regardless of pulmonary disease pattern, TLC(CT) was smaller than pTLC, and it was more apparent in restrictive lung disease. Therefore, we should consider the difference between TLC(CT) and pTLC, as well as lung disease patterns of candidates, in lung size matching for LTx.
Adolescent ; Adult ; Aged ; Female ; Humans ; Lung/*diagnostic imaging/pathology/*physiopathology ; Lung Diseases/diagnostic imaging/pathology/physiopathology/therapy ; *Lung Transplantation ; Male ; Middle Aged ; Organ Size ; *Patient Selection ; Retrospective Studies ; *Tomography, X-Ray Computed ; *Total Lung Capacity ; Young Adult

BACKGROUND: Myasthenia gravis is a rare autoimmune disease involving acetylcholine receptor and its autoantibody on neuromuscular junction. The methods of treatment are medical treatment and surgical thymectomy. In this paper we analyzed the result of thymectomy and the factors affecting the postoperative symptom improvement. MATERIAL AND METHOD: This study obtained medical records of 37 patients who received the thymectomy for myasthenia gravis from March 1986 to December 1998. RESULT: Out of 37 cases, 21 cases(57%) showed improvement, of which 8 cases (50%) in the group of thymoma(n=16), and 13 cases (62%) in the group of thymic hyperplasia(n=21) showed the improvement of symptoms. Postoperative complications were respiratory insufficiency due to aggravation of symptoms after operation, including tracheal intubation for ventilator support in 9 cases, pneumonia in 3 cases, pneumothorax in 2 cases and left vocal cord palsy in 1 case. There was one postoperative mortality. The relation between postoperative improvement and sex(P=0.3222), age(P=0.7642), thymic pathologic variants,(P=0.4335) and classification of thymoma(P=0.20) showed no statistically significant correlation. However, the lower grade of preoperative symptoms can predict the lower grade of postoperative symptoms significantly(P=0.0032). Follow up study to 36 postoperative survivors was performed in October 2002 based on the out-patient records and call with patients. Out of 36 cases, 33 cases(91.7%) could be investigated and 3 cases could not. Mean follow up period was 83.2 months. Out of 33 cases, 25 cases(75.8%) showed symptomatic improvement, of which 8 cases(53.3%) in the group of thymoma(n=15) and 17 cases(94.4%) in the group of thymic hyperplasia(n=18) showed the improvement of symptoms. CONCLUSION: In myasthenia gravis, thymectomy showed the good improvement, and more important factor affecting the improvement of symptoms was the grdae of preoperative symptoms. Also midterm and long term follow up results showed good symptomatic improvement.
Acetylcholine ; Autoimmune Diseases ; Classification ; Follow-Up Studies ; Humans ; Intubation ; Medical Records ; Mortality ; Myasthenia Gravis* ; Neuromuscular Junction ; Outpatients ; Pneumonia ; Pneumothorax ; Postoperative Complications ; Respiratory Insufficiency ; Survivors ; Thymectomy ; Ventilators, Mechanical ; Vocal Cord Paralysis

This study was designed to develop and validate a computerized exercise intervention program using the transtheoretical model (TTM) for Korean patients with type 2 diabetes mellitus (DM). This computerized program was web-based and developed by designing a flow chart. An expert group (n=24), who validated the content of the computerized program, produced a mean score for the evaluation scale of 4.25 (SD .56). Of the patients (n=28) with type 2 DM who participated in clinical validity testing of the program, the mean score for the satisfaction scale was 4.82 (SD .12). In the validation of the program, significant differences between baseline and after-intervention were observed in the stage of readiness for exercise (Z=-3.78, p < 0.001), physical activity (Z=-2.33, p < 0.05), blood glucose profiles [FBS (Z=-2.84, p < 0.01), pc 2hr. glucose (Z=-2.33, p < 0.05), HbA1c (Z=-2.77, p < 0.01) ], and VO2max (Z=-2.52, p < 0.01). The study confirmed that the computerized program could be used to construct a database and continue to provide follow-up intervention for patients in all stages.
Diabetes Mellitus, Type II/physiopathology/*therapy ; *Exercise ; Human ; Intervention Studies ; Patient Education ; *Software ; Support, Non-U.S. Gov't

Objective: To understand the anatomic characteristics of the aortic arch (AA) and its major branches to build a foundation toward performing endovascular surgery safely. Methods: A total of 25 formalin fixed Korean adult cadavers were used. The authors investigated : anatomical variations of the AA and its major branches; curvature of the AA; distance from the mid-vertebrae line to the origin of the major branches; distances from the origin of the major branches of AA to the origin of its distal branches; and the angle of the three major branches, the brachiocephalic trunk (BCT), the left common carotid artery (LCCA) and the left subclavian artery (LSCA) arising from AA. Results: The three major branches directly originated from AA in 21 (84%) of the cadavers. In two (8%) of remaining four cadavers, orifice of LCCA was slightly above the stem of BCT. In remaining two (8%) cadavers, the left vertebral artery (LVA) was directly originated from AA. Average angle of AA curvature to the coronal plane was 62.2 degrees. BCT originated 0.92 mm on the right of the mid-vertebrae line. LCCA and LSCA originated from 12.3 mm and 22.8 mm on the left of the mid-vertebrae line. Mean distance from the origin of the BCT to the origin of the RCCA was 32.5 mm. Mean distance from the origin of the LSCA to the origin of the LVA was 33.8 mm. Average angles at which the major branches arise from the AA were 65.3, 46.9 and 63.8 degrees. Conclusion: This study may provides a basic anatomical information to catheterize AA and its branches for safely performing endovascular surgery.
Adult ; Aorta ; Aorta, Thoracic ; Atherectomy ; Brachiocephalic Trunk ; Cadaver ; Carotid Artery, Common ; Catheters ; Formaldehyde ; Humans ; Subclavian Artery ; Vertebral Artery

Mesenchymal chondrosarcoma arising in soft tissue of mediastinum is a very rare tumor. This paper reports an extraskeletal mesenchymal chondrosarcoma occuring in the posterior mediastinum.
Chondrosarcoma ; Chondrosarcoma, Mesenchymal* ; Mediastinum*