BACKGROUND/AIMS: Cyclophosphamide (CP) is a promising treatment for severe cases of paraquat (PQ) poisoning. We investigated the effective dose of CP for mitigating PQ-induced lung injury. METHODS: Adult male Sprague-Dawley rats were allocated into five groups: control, PQ (35 mg/kg, intraperitoneal injection), and PQ + CP (1.5, 15, or 30 mg/kg). The dimensions of lung lesions were determined using X-ray microtomography (micro-CT), and histological changes and cytokine levels were recorded. RESULTS: The micro-CT results showed that 15 mg/kg CP was more effective than 1.5 mg/kg CP for treating PQ-induced lung injury. At a dose of 1.5 mg/kg, CP alleviated the histological evidence of inflammation and altered superoxide dismutase activity. Using 15 mg/kg CP reduced the elevated catalase activity and serum transforming growth factor (TGF)-beta1 level. CONCLUSIONS: A CP dose of > 15 mg/kg is effective for reducing the severity of PQ-induced lung injury as determined by histological and micro-CT tissue examination, possibly by modulating antioxidant enzyme and TGF-beta1 levels.
Animals ; Catalase/metabolism ; Cyclophosphamide/*pharmacology ; Cytokines/metabolism ; Disease Models, Animal ; Dose-Response Relationship, Drug ; Immunosuppressive Agents/*pharmacology ; Inflammation Mediators/metabolism ; Lung/*drug effects/metabolism/pathology/radiography ; Lung Injury/chemically induced/diagnosis/*drug therapy/metabolism ; Male ; Oxidative Stress/drug effects ; *Paraquat ; Pulmonary Edema/chemically induced/diagnosis/*drug therapy/metabolism ; Rats ; Rats, Sprague-Dawley ; Severity of Illness Index ; Superoxide Dismutase/metabolism ; Transforming Growth Factor beta1/metabolism ; X-Ray Microtomography

Pneumocystis jirovecii pneumonia (PCP) is a frequent manifestation of Acquired Immune Deficiency Syndrome (AIDS). The classic chest radiographic finding is perihilar ground glass opacities that may progress to more diffuse lung involvement. Atypical radiographic appearances include a normal chest film, lobar or segmental consolidation, cystic lesions, cavitation, pneumothorax, pleural effusion, and solitary or multiple pulmonary nodules. Although PCP is common in AIDS, presenting with nodular pulmonary densities is rare. We encountered the case of a 33-year-old man with AIDS whose chest radiography showed multiple bilateral nodular patterns suggestive of malignancy. We performed a transcutaneous lung biopsy and diagnosed him with PCP by Gomori methenamine-silver staining. Along with fungal and mycobacterial infections, intrathoracic Kaposi's sarcoma, and lymphoma, PCP should be considered in the differential diagnosis of nodular pulmonary disease in AIDS patients.
Acquired Immunodeficiency Syndrome ; Adult ; Biopsy ; Diagnosis, Differential ; Glass ; Humans ; Lung ; Lung Diseases ; Lymphoma ; Multiple Pulmonary Nodules ; Pleural Effusion ; Pneumocystis ; Pneumocystis jirovecii ; Pneumonia ; Pneumothorax ; Sarcoma, Kaposi ; Thorax

OBJECTIVES: In addition to the main symptoms of posttraumatic stress disorder (PTSD), which include reexperience, avoidance and hyperarousal, many patients complain of cognitive deficits and especially in attention and memory. This study was conducted to evaluate the cognitive deficits of survivors of a tragic shooting incident at a frontline guard post. All of the survivors experienced the same accident, and they were homogeneous in terms of age and education level, which are closely associated with cognitive performance. METHODS: We recruited 12 survivors who suffered from PTSD following the same traumatic incident and we also recruited 12 normal volunteers, and we assessed their neurocognitive functions with using a vigilance test, a continuous attention test, a reaction unit test and the Corsi block tapping test in the computerized Vienna Test System, as well as an auditory verbal learning test and complex figure test in the Rey-Kim Memory Test. Standardized clinical scales, including the Clinician-Administered PTSD Scale, the Hamilton Depression Rating Scale, the Hamilton Anxiety Scale and the State-Trait Anxiety Scale I and II, were used to assess the involved mental areas and the severity of the PTSD symptoms. RESULTS: The patient group showed significant impairments in continuous attention, and the visual and auditory information processing time on the Vienna test when compared to the control group. The patient group also showed significant impairments in the verbal memory, visual memory and visuospatial function on the Rey-Kim Memory Test. CONCLUSION: In this study, the author reports on the cognitive impairments in patients with PTSD as measured by computerized neurocognitive tests and memory tests. Future studies are needed to determine the changes in cognitive functioning that are related to symptom improvement, as well as the influence of the therapeutic effects on the cognitive improvement.
Anxiety ; Automatic Data Processing ; Cognition ; Depression ; Humans ; Memory ; Neuropsychological Tests ; Psychomotor Performance ; Stress Disorders, Post-Traumatic ; Survivors ; Verbal Learning ; Weights and Measures

BACKGROUND: There have been controversies whether mitral valvular surgery is necessary in the patients with moderate ischemic mitral regurgitation undergoing coronary artery bypass grafting. The purpose of this study is to evaluate the long term clinical results of patients with moderate ischemic mitral regurgitation. MATERIAL AND METHOD: Between January 1992 and February 2005, 44 patients with moderate ischemic mitral regurgitation underwent coronary artery bypass grafting. Concomitant mitral valvular procedure was performed in 20 patients (group 1) and isolated coronary artery bypass grafting was performed in 24 patients (group 2). There were no significant difference between groups except cardiopulmonary bypass time (p<0.01). Postoperative follow up duration was 30.1+/-29.6 months and last follow up echocardiographic examination was performed at 21.2+/-28.0 months. RESULT: There was no difference in operative mortality between groups (group 1 vs group 2, 15.0% vs 8.3%, p=0.493). Grade of mitral regurgitation (0.81+/- 0.91 vs 1.50+/- 0.05, p=0.046) and reduction in regurgitation grade (1.75 +/-0.93 vs 0.70 +/-1.26, p=0.009) were different between two groups. But there were no significant differences in left ventricular ejection fraction (34.1+/-11.4% vs 41.6+/-12.9%), left ventricular end systolic volume (118.2+/-63.9 mL vs 85.6+/-28.1 mL), New York Heart Association functional class (2.1+/-0.2 vs 2.4+/-1.2) and 5 year survival rate (85+/-8% vs 82+/-8%). There was no risk factor for operative mortality and the only risk factor for late death was preoperative atrial fibrillation (p=0.042). There was no significant correlation between mitral valvular surgery and late death. CONCLUSION: Concomitant mitral valvular procedure in patients with moderate ischemic mitral regurgitation undergoing coronary artery bypass grafting had no significant positive effect on survival and ventricular function compared with isolated coronary artery bypass grafting. Prospective randomized study may be needed to evaluate the necessity of concomitant mitral procedure and to find more effective method for the improvement of ventricular function.
Atrial Fibrillation ; Cardiopulmonary Bypass ; Coronary Artery Bypass* ; Coronary Vessels* ; Echocardiography ; Follow-Up Studies ; Heart ; Humans ; Mitral Valve Insufficiency* ; Mortality ; Risk Factors ; Stroke Volume ; Survival Rate ; Ventricular Function

BACKGROUND: There have been controversies whether mitral valvular surgery is necessary in the patients with moderate ischemic mitral regurgitation undergoing coronary artery bypass grafting. The purpose of this study is to evaluate the long term clinical results of patients with moderate ischemic mitral regurgitation. MATERIAL AND METHOD: Between January 1992 and February 2005, 44 patients with moderate ischemic mitral regurgitation underwent coronary artery bypass grafting. Concomitant mitral valvular procedure was performed in 20 patients (group 1) and isolated coronary artery bypass grafting was performed in 24 patients (group 2). There were no significant difference between groups except cardiopulmonary bypass time (p<0.01). Postoperative follow up duration was 30.1+/-29.6 months and last follow up echocardiographic examination was performed at 21.2+/-28.0 months. RESULT: There was no difference in operative mortality between groups (group 1 vs group 2, 15.0% vs 8.3%, p=0.493). Grade of mitral regurgitation (0.81+/- 0.91 vs 1.50+/- 0.05, p=0.046) and reduction in regurgitation grade (1.75 +/-0.93 vs 0.70 +/-1.26, p=0.009) were different between two groups. But there were no significant differences in left ventricular ejection fraction (34.1+/-11.4% vs 41.6+/-12.9%), left ventricular end systolic volume (118.2+/-63.9 mL vs 85.6+/-28.1 mL), New York Heart Association functional class (2.1+/-0.2 vs 2.4+/-1.2) and 5 year survival rate (85+/-8% vs 82+/-8%). There was no risk factor for operative mortality and the only risk factor for late death was preoperative atrial fibrillation (p=0.042). There was no significant correlation between mitral valvular surgery and late death. CONCLUSION: Concomitant mitral valvular procedure in patients with moderate ischemic mitral regurgitation undergoing coronary artery bypass grafting had no significant positive effect on survival and ventricular function compared with isolated coronary artery bypass grafting. Prospective randomized study may be needed to evaluate the necessity of concomitant mitral procedure and to find more effective method for the improvement of ventricular function.
Atrial Fibrillation ; Cardiopulmonary Bypass ; Coronary Artery Bypass* ; Coronary Vessels* ; Echocardiography ; Follow-Up Studies ; Heart ; Humans ; Mitral Valve Insufficiency* ; Mortality ; Risk Factors ; Stroke Volume ; Survival Rate ; Ventricular Function

Although cardiac myxoma is rare, it is the most common primary cardiac tumor. Seventy-four cases of cardiac myxoma that were surgically treated in our center between August 1980 and February 2005 were retrospectively reviewed. The mean patient age was 50.4+/-15.0 (range 7-80) years, and 53 patients (71.6%) were female. The most common preoperative symptom, occurring in 44 patients, was dyspnea. The interval from onset of symptoms to surgery was 9 months. Seventy cases were located in the left atrium, 3 in the right atrium and 1 in the right ventricle. The myxoma in the right ventricle could not be resected completely, due to severe infiltration. Cardiopulmonary bypass and aortic cross clamp times were 100.4+/-37.1 and 64.8+/-29.8 minutes, respectively. There were no hospital deaths, and 7 patients suffered from postoperative complications including atrial fibrillation in 2 cases. During the follow up period (mean 105.7+/-73.6 months), there was no tumor recurrence and 6 late deaths that were not related to the underlying tumor. There was no evidence of tumor growth in the cases with incomplete resection during the 14-month follow-up. In conclusion, in this study there was no recurrence of tumors after complete resection and surgical resection is considered to be the curative method of treatment for cardiac myxoma.
Treatment Outcome ; Postoperative Complications ; Myxoma/physiopathology/*surgery ; Middle Aged ; Male ; Humans ; Heart Neoplasms/physiopathology/*surgery ; Follow-Up Studies ; Female ; Child ; Aged, 80 and over ; Aged ; Adult ; Adolescent

Although cardiac myxoma is rare, it is the most common primary cardiac tumor. Seventy-four cases of cardiac myxoma that were surgically treated in our center between August 1980 and February 2005 were retrospectively reviewed. The mean patient age was 50.4+/-15.0 (range 7-80) years, and 53 patients (71.6%) were female. The most common preoperative symptom, occurring in 44 patients, was dyspnea. The interval from onset of symptoms to surgery was 9 months. Seventy cases were located in the left atrium, 3 in the right atrium and 1 in the right ventricle. The myxoma in the right ventricle could not be resected completely, due to severe infiltration. Cardiopulmonary bypass and aortic cross clamp times were 100.4+/-37.1 and 64.8+/-29.8 minutes, respectively. There were no hospital deaths, and 7 patients suffered from postoperative complications including atrial fibrillation in 2 cases. During the follow up period (mean 105.7+/-73.6 months), there was no tumor recurrence and 6 late deaths that were not related to the underlying tumor. There was no evidence of tumor growth in the cases with incomplete resection during the 14-month follow-up. In conclusion, in this study there was no recurrence of tumors after complete resection and surgical resection is considered to be the curative method of treatment for cardiac myxoma.
Treatment Outcome ; Postoperative Complications ; Myxoma/physiopathology/*surgery ; Middle Aged ; Male ; Humans ; Heart Neoplasms/physiopathology/*surgery ; Follow-Up Studies ; Female ; Child ; Aged, 80 and over ; Aged ; Adult ; Adolescent

BACKGROUND: Primary cardiac tumors are known to be rare. We studied the surgical results for primary cardiac tumors. MATERIAL AND METHOD: Between August 1980 and December 2003, we classified 86 patients who had operation for primary cardiac tumors in our center into 3 groups; myxoma, nonmyxoma benign tumors, and malignant tumors. The mean age was 44.3+/-20.8 years and 59 patients (66.3%) were female. In postoperative pathologic diagnosis, there were 81 cases (94.2%) of benign tumors in which myxoma was the most common tumor (70 cases, 78.7%); 5 fibroma (5.6%), 3 rhabdomyoma (3.4%), and 5 malignant tumors (5.8%). RESULT: 86.4% of benign tumor was myxoma and the mean age was 50.4+/-15.4 (range 7~80) years. Tumor was more common in females (49 cases) and most common preoperative symptom was dyspnea (62.9%). 57 cases were located at left atrial septum and only one case, which was located at right ventricular septum, was resected incompletely. There were no hospital deaths and one patient had mitral valve replacement on the first operative day due to newly developed postoperative mitral regurgitation. The mean follow up period was 109.3+/-71.8 months and there was no evidence of recurrence in this period. 11 cases (12.8%) were nonmyxoma benign tumors; 5 fibromas, 3 rhabdomyomas, etc. There were two hospital deaths and the causes of death were fungal endocarditis and hypoxia. There were no reoperations in nonmyxoma benign tumors. Malignant tumors were in 5 cases (5.8%); undifferentiated sarcoma in 2, rhabdomyosarcoma in 1, etc. Although there were no hospital mortalities, 3 patients who were followed up died from complications of tumors. CONCLUSION: Myxomas showed very excellent prognosis after complete resection and nonmyxoma benign tumors showed relatively good results for relief of symptoms. Surgery helped to relieve symptoms for malignant tumors, but the prognosis was poor.
Anoxia ; Atrial Septum ; Cause of Death ; Diagnosis ; Dyspnea ; Endocarditis ; Female ; Fibroma ; Follow-Up Studies ; Heart Neoplasms* ; Hospital Mortality ; Humans ; Mitral Valve ; Mitral Valve Insufficiency ; Myxoma ; Prognosis ; Recurrence ; Rhabdomyoma ; Rhabdomyosarcoma ; Sarcoma ; Ventricular Septum

BACKGROUND: Clinical reports on replacement of all three (AV+MV+TV) valves are rare. MATERIAL AND METHOD: From January 1992 to December 2003, 38 patients received triple valve replacement (aortic, mitral, tricuspid) at Yonsei Cardiovascular Center. Mean age of patients was 49.5+/-10.7 (28~69) years, and 24 patients (63.1%) were female. Rheumatic valve disease was the most common cause of operation (n=37). Preoperative New York Heart Association functional class were II in 4, III in 24 and IV in 10. Fifteen patients (group 1) received triple valve replacement at their first operation. Twenty three patients (group 2) received one or more operations before tricuspid valve replacement (TVR). Seven patients received tricuspid valve annuloplasty at first operation and received TVR later. RESULT: Six patients died at hospital after operation (15.8%) and all these patients were in group 2. All patients in group I survived and were discharged. Three patients (9.4%) died during follow up periods. Most of the survivors had improved functional class (I in 22, II in 8, III in 1, IV in 1). During follow up period, there were 4 valve related complications. The 10-year survival rate was 68.8% and survival rate for free from valve related event at 10 years was 85.5%. CONCLUSION: After triple valve replacement, most patients showed improvement of symptoms. And during follow up period, valve related complications and survival were acceptable. Therefore, if indicated, triple valve replacement is recommended before the patients' conditions get worse.
Female ; Follow-Up Studies ; Heart ; Heart Valves ; Humans ; Survival Rate ; Survivors ; Tricuspid Valve

BACKGROUND: Discrete subaortic stenosis is known to recur frequently even after surgical resection. We retrospectively reviewed the preoperative and postoperative changes in pressure gradient through left ventricular outflow tract, and the recurrence rate. MATERIAL AND METHOD: Between September 1984 and December 2004, 34 patients underwent surgical treatment. Mean age of patients was 17.1+/-15.2 years and 19 patients (55.9%) were male. 16 patients (47.1%) had previous operations and associated diseases were aortic regurgitation (11), coarctation of aorta (3), and others. RESULT: Immediate postoperative peak pressure gradient was significantly lower than preoperative peak pressure gradient (21.8 mmHg vs 75.8 mmHg, p<0.01). Peak pressure gradient measured after 50.3 months of follow up was 20.2 mmHg, which was also significantly lower than that of preoperative value but not significantly different from that of immediate postoperative value. There was no surgical mortality but one patient developed cerebral infarction. Mean follow up duration was 69.8+/-54.6 months. During this period, 5 patients (14.7%) had reoperation, 3 (8.8%) of whom were due to recurred subaortic stenosis. We found no risk factors for recurrence and survival for free from reoperation was 76.4%. CONCLUSION: Excision of subaortic membrane combined with or without myectomy in discrete subaortic stenosis showed sufficient relief of left ventricular outflow tract obstruction with low mortality and morbidity, but careful long term follow up is necessary for recurrence, since it is not predictable.
Aortic Coarctation ; Aortic Stenosis, Subvalvular ; Aortic Valve Insufficiency ; Cerebral Infarction ; Constriction, Pathologic ; Discrete Subaortic Stenosis* ; Follow-Up Studies ; Humans ; Male ; Membranes ; Mortality ; Recurrence ; Reoperation ; Retrospective Studies ; Risk Factors