Accidental or suicidal fatalities of paraquat (Gramoxon) poisong are occasionally seen in the emergency room or intensive care unit in this country. In most cases, respiratory symptoms and eventual death by respiratory distress occur within several days. The most striking pathologic change is fibrosis of the lung due to widespread proliferation of fibroblastic cell. We experience a 21-year-old woman with huge bulla on left lung and diffuse fibrosis in other site, who ingested paraquat 10 months ago. After thoracoscopic removal of bulla, the patient survive without progression of pulmonary complication till now.
Emergency Service, Hospital ; Female ; Fibroblasts ; Fibrosis ; Humans ; Intensive Care Units ; Lung ; Paraquat ; Pulmonary Fibrosis* ; Strikes, Employee ; Young Adult

BACKGROUND: Pleura, diaphragm, pericardial fat pad, intercostal muscles and omentum can be used to protect and revascularize the bronchial suture line of tracheal transplantation, lung transplantation and pulmonary resection. The purpose of the present study is to compare the influence of the pleura, diaphragm and omentum in survival of isolated tracheal segments in the experimental animals. MATERIAL AND METHOD: Sprague-Dawley rats weighing 250~350 g were used. The animals were divided in three groups; the pleura, omentum and diaphragm. Following intraperitoneal anesthesia, endotracheal intubation was performed. Then the trachea was exposed. A three-ring section of cervical trachea was excised. The resected trachea was implanted at each sites. After 2 weeks, rats were sacrificed. Histopathological examination of the tracheal segments was performed. For comparison of each groups, histopathological viability of resected tracheal segment was scored by three tissue layers; epithelium, submucosa, and cartilage. The results were presented as average score. RESULT: In histopathological examination, submucosa and cartilage using tracheal segment necrosis scoring system. The pleural group showed well preserved tissue. There was minimal necrosis and inflammation compared with other groups. In the pleural group, tracheal necrosis scores were 2.17+/-0.983 at epithelium, 1.67+/-0.516 at submucosa and 2.17+/-0.753 at cartilage. At the omental group, scores were 1.00+/-0.00, 1.60+/-0.548 and 1.80+/-0.447. In the diaphragmatic group, scores were 1.40+/-0.894, 2.40+/-0.547 and 2.20+/-0.447. Total necrosis score were 6.00+/-1.789 in the pleural group, 4.40+/-0.894 in the omental group and 6.00+/-1.414 in the diaphragmatic group. CONCLUSION: There were no significant viability differences in terms of total necrosis score for the viability of resected tracheal segment. But the best result was achieved in the omental group. Therefore, omental wrapping on tracheal graft site will be beneficial for the prevention of graft necrosis.
Adipose Tissue ; Anesthesia ; Animals ; Autografts* ; Cartilage ; Diaphragm* ; Epithelium ; Graft Survival ; Inflammation ; Intercostal Muscles ; Intubation, Intratracheal ; Lung Transplantation ; Necrosis ; Omentum* ; Pleura* ; Rats ; Rats, Sprague-Dawley ; Sutures ; Trachea ; Transplants

PURPOSE: Canine left single lung allotransplantation has become a frequently used model, but has some limitation. The purpose of this study is to verify and compare canine sequential bilateral allotrasplant model with canine left single lung transplant model. We prepared LPDG (low potassium dextran glucose)solution for lung preservation study. In this study we examined the efficacy of LPDG solution in 24-hour lung preservation by using a sequential bilateral canine lung allotransplant model. METHODS: Seven bilateral lung transplant procedures were performed using adult mongrel dogs. Comparative group was 9 cases of left single lung. The donor lungs were flushed with LPDG solution and maintained hyperinflated with 100% oxygen at 10oC for a planned ischemic time of 24 hours. After sequential bilateral lung transplantation, dogs were maintained on ventilators for 3 hours: arterial resistance were determined and compared with donor values which were used as controls. After 2 hours of reperfusion, the chest X-ray, computed tomogram and lung perfusion scan were checked. Pathological examinations for ultrastructural findings of alveolar structure and endothelial structure of pulmonary artery were performed. RESULTS: Five of seven experiments successfully finished the whole assessments after bilateral reperfusion for 3 hours. Arterial oxygen tension in the recipients was markedly decreased in immediate reperfusion period but gradually recovered after reperfusion for 3 hours. The pulmonary arterial pressure and pul-monary vascular resistance showed significant elevation (P<0.05 vs. control values) but also recovered after reperfusion for three hours (P<0.05 vs. immediate period value). The ultrastructural findings of alveolar structure and endothelial structure of pulmonary artery showed reversible mild injury in 24 hours of lung perservation and reperfusion on both groups. CONCLUSION: The present study suggests that LPDG solution provide excellent preservation in a canine sequential bilateral lung transplant model in which the dog is completely dependent on the function of the transplanted lung and under physiologic condition. Sequential bilateral lung transplant model was more appropriate and accurate experimental model compared to single lung transplant model.
Adult ; Animals ; Arterial Pressure ; Dextrans ; Dogs ; Humans ; Lung Transplantation ; Lung* ; Models, Theoretical ; Oxygen ; Perfusion ; Potassium ; Pulmonary Artery ; Reperfusion ; Thorax ; Tissue Donors ; Vascular Resistance ; Ventilators, Mechanical

We report here on an uncommon case of mediastinitis that occurred after central venous catheterization. A patient with colon and jejunal cancer complained high fever, right shoulder pain, chest pain, and limited motion of the affected shoulder just 6 days after central venous catheterization. Bacterial culture of the blood, shoulder abscess, and catheter puncture site revealed methicillin-resistent staphylococcus aureus. Right upper mediastinal widening on chest film also suggested mediatinitis. Mediastiotomy and pus drainage was performed along with adequate antibiotics therapy. In this case, it seems that initially formed bacteria from the puncture site migrated to the mediastinum through the tissue plane to start the mediastinitis. Careful dressing of puncture site and correct handling of catheter is important to prevent this serious complication.
Abscess ; Anti-Bacterial Agents ; Bacteria ; Bandages ; Catheterization ; Catheterization, Central Venous* ; Catheters ; Central Venous Catheters* ; Chest Pain ; Colon ; Drainage ; Fever ; Humans ; Jejunal Neoplasms ; Mediastinitis* ; Mediastinum ; Punctures ; Shoulder ; Shoulder Pain ; Staphylococcus aureus ; Suppuration ; Thorax

BACKGROUND/AIMS: Spontaneous esophageal rupture is a life-threatening injury because of delay in diagnosis and rapid progression to septic condition. But acceptable standard treatment strategy has not been established yet. This may be due to its low incidence and lack of published literature. In this study, we evaluated the proper treatment strategy as to decide when and how to manage spontaneous esophageal rupture by analyzing our experiences. METHODS: Eleven patients who were diagnosed as spontaneous esophageal perforation in Dongsan Medical Center from 1993 to 2003 were analyzed. Patients were divided into survival and death group. Clinical manifestations, rupture site and size, treatment methods and complications were compared. RESULTS: All patients were male and alcoholics. Six patients had survived and five patients died. Age, sites and sizes of ruptures, operation methods were not different in both groups. Before operation, septic condition was present in all patients of death group and more common than survival group (p=0.015). Survival group showed shorter time interval from rupture to initial treatment (p=0.021) and to operation (p=0.019). CONCLUSIONS: Early diagnosis and initial aggressive treatments such as nothing per oral, pleural and mediastinal drainage are important factor for better prognosis. If possible, early operation such as primary repair must be done. Although any difference according to types of operation method was not found in this study, further study with larger groups seems to be necessary.
Adult ; Alcoholism/complications ; English Abstract ; Esophageal Diseases/complications/diagnosis/*surgery ; Humans ; Male ; Middle Aged ; Prognosis ; Rupture, Spontaneous

BACKGROUND: The treatment strategy for primary spontaneous pneumothorax has progressively changed with the introduction of video-assisted thoracic surgery (VATS). Recently, we modified the strategy of primary spontaneous pneumothorax. If the patient had mild dyspnea and the lung was minimally collapsed, 2 mm thoracoscopic examination was performed. If no bleb or bullae was inspected, the intrathoracic air was evacuated through the 2 mm thoracoscopic troca without closed thoracostomy. and if the bleb and bullae was noted, the 10 mm thoracoscopic bullecotomy was carried out immediately and also application of fibrin glue was substituted for pleural abrasion. We compared the clinical outcomes of modified treatment strategy with conventional strategy in primary spontaneous pneumothorax. MATERIAL ANDMETHOD: Patients were divided into four groups. Group I (n=21) underwenet 2 mm thoracoscopic examination. Group II (n=68) underwent closed thoracostomy. Group III (n=56) underwent VATS and application of fibrin glue. Group IV (n=87) underwent VATS and pleural abrasion. The duration of chest tube drainage, the duration of hospitalization and the recurrence rate were compared between group I and group II and between group III and group IV. RESULT: Mean age, sex, location of pneumothorax were not different in all groups. In group I, the bleb or bullae were existed in 12 patients. In remaining 9 patients, the bleb or bullae was not inspected. The mean duration of hospitalization in 9 patients were 2.1+/-1.0 day and in group II were 3.9+/-2.1 day (p=0.014). There was 1 case of recurrence among the 9 patients in group I and 26 recurrences in group II (p=0.149). The mean duration of chest tube drainage were not difference in group III and IV (group III: 2.8+/-1.8 day, group IV: 3.0+/-2.5 day). The mean duration of hospitalization was shorter in group III than group IV (group III: 5.6+/-2.7 day, group IV: 7.3+/-3.3 day)(p=0.002). There was no recurrence in group III and 7 recurrences in group IV (p=0.043). CONCLUSION: Our modified treatmen strategy of primary spnontaneuous peumothorax was effective in short hospital course and low recurrence rate.
Blister ; Chest Tubes ; Drainage ; Dyspnea ; Fibrin Tissue Adhesive* ; Fibrin* ; Hospitalization ; Humans ; Lung ; Pneumothorax* ; Recurrence ; Thoracic Surgery, Video-Assisted ; Thoracoscopy ; Thoracostomy

PURPOSE: Interleukin(IL)-10 is an antiinflammatory cytokine produced by monocytes/macrophages. Granulocyte colony-stimulating factor(G-CSF) plays an important role, not only as a hemopoietic factor but also as a regulating factor for a biologic defense system by neutrophils, in the foci of infection. We studied G-CSF and IL-10 levels in the serum and cerebrospinal fluid(CSF) of patients with aseptic meningitis and investigated the relationship of G-CSF and IL-10 with other inflammatory cells. METHODS: We measured IL-10 and G-CSF levels in the serum and CSF of children with or without aseptic meningitis using ELISA and compared them with other inflammatory cells in the CSF. RESULTS: CSF levels of IL-10 & G-CSF on admission were significantly higher in the aseptic meningitis group than in the control group. IL-10 and G-CSF levels in the CSF were higher than those in the serum(P<0.001). Mean CSF IL-10 & G-CSF levels during the recovery stage decreased significantly compared to those of the symptomatic stage(P<0.001). Significant correlations were found between CSF IL-10 levels and mononuclear cell counts(r=0.26, P<0.05), and between G-CSF levels and neutrophil counts in the CSF(r=0.44, P<0.005). CSF levels of G-CSF were highest on the 1st day of the illness, although CSF IL-10 levels reached its peak on the 3rd day of the illness. CONCLUSION: IL-10 and G-CSF are produced in the CSF of patients with aseptic meningitis and may play an immunoregulatory role by recruiting inflammatory cells from the peripheral blood at the initial stage of aseptic meningitis.
Cerebrospinal Fluid* ; Child* ; Enzyme-Linked Immunosorbent Assay ; Granulocyte Colony-Stimulating Factor* ; Granulocytes* ; Humans ; Interleukin-10* ; Meningitis, Aseptic* ; Neutrophils

PURPOSE: Interleukin(IL)-10 is an antiinflammatory cytokine produced by monocytes/macrophages. Granulocyte colony-stimulating factor(G-CSF) plays an important role, not only as a hemopoietic factor but also as a regulating factor for a biologic defense system by neutrophils, in the foci of infection. We studied G-CSF and IL-10 levels in the serum and cerebrospinal fluid(CSF) of patients with aseptic meningitis and investigated the relationship of G-CSF and IL-10 with other inflammatory cells. METHODS: We measured IL-10 and G-CSF levels in the serum and CSF of children with or without aseptic meningitis using ELISA and compared them with other inflammatory cells in the CSF. RESULTS: CSF levels of IL-10 & G-CSF on admission were significantly higher in the aseptic meningitis group than in the control group. IL-10 and G-CSF levels in the CSF were higher than those in the serum(P<0.001). Mean CSF IL-10 & G-CSF levels during the recovery stage decreased significantly compared to those of the symptomatic stage(P<0.001). Significant correlations were found between CSF IL-10 levels and mononuclear cell counts(r=0.26, P<0.05), and between G-CSF levels and neutrophil counts in the CSF(r=0.44, P<0.005). CSF levels of G-CSF were highest on the 1st day of the illness, although CSF IL-10 levels reached its peak on the 3rd day of the illness. CONCLUSION: IL-10 and G-CSF are produced in the CSF of patients with aseptic meningitis and may play an immunoregulatory role by recruiting inflammatory cells from the peripheral blood at the initial stage of aseptic meningitis.
Cerebrospinal Fluid* ; Child* ; Enzyme-Linked Immunosorbent Assay ; Granulocyte Colony-Stimulating Factor* ; Granulocytes* ; Humans ; Interleukin-10* ; Meningitis, Aseptic* ; Neutrophils

The pectus excavatum is the most common deformity of chest wall. The most common cause of surgical correction is cosmetic problem. From January 1981 to July 1996, 24 patients had undergone surgery for pectus excavatum and they were corrected by Ravitch operation (n=4) or modified Wada operation (n=20) respectively. We analyzed each surgical cases according to age, sex, chief complaint, degree of deformity, EKG findings, complications and satisfaction degree of patient. In some cases, we measured Welch index preoperatively and postoperatively. The postoperative complications were wound infection in two, pneumothorax in two and reccurrence in one. The average value of Welch index was significantly improved from 5.86+/-0.51 preoperatively to 4.10+/-0.51 postoperatively (p<0.05). The results by Humphreys' criteria were satisfiable in 88% (excellent 71%, good 17%). The findings of this study suggest that surgical correction of pectus excavatum with modified Wada rocedure and submammary s in incision is effective method in physical and psychiatric aspect.
Congenital Abnormalities ; Electrocardiography ; Funnel Chest* ; Humans ; Pneumothorax ; Postoperative Complications ; Thoracic Wall ; Wound Infection

BACKGROUND: Even today when chemotherapy has been established as a treatment for tuberculosis and the prevalence of tuberculosis is gradually decreasing, multi-drug resistance tuberculosis still results in poor treatment performance and lowered survival periods. This research sought to analyze the surgery of multi-drug resistance tuberculosis, and determine the usefulness and danger of surgery in connection with this disease. MATERIAL AND METHOD: Starting from February 1990 to February 2002, retrospective surveys were conducted targeted at 21 cases involving 20 patients who underwent surgery due to multi-drug resistance tuberculosis. The survey included 14 males cases and 6 females cases with the age averaging 42.8+/-12.1 years. 10.3S7.6 years on average passed after patients were initially diagnosed with tuberculosis. 13 patients (65%) tested positive in the pre-operative sputum AFB test, and all showed resistance against an average of 3.5 anti-tuberculosis agents including INH and RFP. Pre-operative radiologic examinations revealed cavitary lesions in 15 patients (75%), and three patients had lesions in the both lung fields, with the major lesions existing in the unilateral area. 13 patients (75%) failed negative conversion with medical treatment, while two patients (10%) with recurrent hemoptysis and five patients (25%) with lesions involving high recurrence-rate received the operation. Operations included nine cases (40%) of pneumonectomy, nine cases (45%) of lobectomy, and three cases of lobectomy with segmentectomy. The average follow-up period of patients stood at 23 months. RESULT: There was no post-operative death, and found were a total of eleven cases involving complications were found: three cases of long-term air leakage, three cases of bleeding requiring re-operation, two cases of empyemas due to broncho-pleural fistula, and one case of atelectasis, wound infection and chest wall fistula each. Eleven cases (85%) of negative conversion were completed immediately after the operation, and two cases failed negative conversion. Eleven months after the operation, the disease recurred in one case of negative conversion patients, and the patient was cured by completion pneumonectomy. CONCLUSION: If patients' lung function was sufficient and appropriate resection was possible, multi-drug resistance tuberculosis could achieve high-rate negative conversion and cure using combination of surgical and medical treatment, and also there were not many serious complications.
Drug Resistance, Multiple ; Drug Therapy ; Empyema ; Female ; Fistula ; Follow-Up Studies ; Hemoptysis ; Hemorrhage ; Humans ; Lung ; Male ; Mastectomy, Segmental ; Pneumonectomy ; Prevalence ; Pulmonary Atelectasis ; Retrospective Studies ; Sputum ; Thoracic Wall ; Tuberculosis ; Tuberculosis, Pulmonary* ; Wound Infection