Heart transplantation remains the definitive surgical solution for Stage D heart failure. There have been impressive developments in lung transplantation also. This review is focused on the recent advancements in the field of heart and lung transplantation and the current status of thoracic organ transplantation in Korea. Future directions of thoracic organ transplantation are discussed.
Heart ; Heart Failure ; Heart Transplantation ; Korea ; Lung ; Lung Transplantation ; Organ Transplantation ; Transplants

Manual or mechanical compression followed by 4 to 8 hours of bed rest is still the standard technique for accessing site management of the femoral arterial puncture site. But these methods are often uncomfortable and delay hospital discharge. Recently, a number of new devices to achieve hemostasis have been developed. These devices uses collagen to facilitate local hemostasis. But many complications associated with the use these devices have been reported internationally. We present a case of successful treatment of Rt. femoral and Rt. popliteal arteries thrombosis caused by Angioseal.
Bed Rest ; Collagen* ; Hemostasis ; Popliteal Artery* ; Punctures ; Thrombosis*

BACKGROUND: Autogenous vein is the preferred vascular graft for patients who require coronary artery bypass surgery or peripheral arterial bypass surgery. When an autogenous vein is not available, an allograft saphenous vein can be used as an alternative conduit. Although arterial homograft has been under investigation since the beginning of this century, the viability of endothelial cells and the optimum mode of storage for the venous and arterial allografts is controversial. In addition, with the recently gained knowledge of vascular endothelial functions, such as the production of nitric oxide or thrombomodulin, the viability and antigenicity of endothelial cells are being studied again. The purpose of this study was to evaluate the viability of endothelial cells in the preserved human saphenous veins. MATERIAL AND METHOD: The veins were stored in a 4 degrees C RPMI (Roswell Park Memorial Institute) 1640 solution including 10% fetal calf serum, for one, three, five, seven or fourteen days. After the completion of the storage period, the veins were divided into two groups: Group I: studied immediately at 4 degrees C (cold) storage (I-1, I-3, I-5, I-7, I-14), and Group II: studied after storage at -196 degrees C liquid nitrogen tank (cryopreservation) in an RPMI 1640 solution containing 10% DMSO for two weeks (II-1, II-3, II-5, II-7, II-14). Light microscopy and scanning electron microscopy (SEM), trypan blue exclusion testing, and thrombomodulin immunohistochemistry were performed. RESULT: In a morphometric study using SEM, there was statistically significant increase in Gundry Score in Groups I-7, I-14, II-5, II-7, and II-14 and showed cellular destruction (p<0.05). In the thrombomodulin immunohistochemistry study, there was reactivity in Groups I-1, I-3, and I-5, but the cryopreserved group revealed decreased reactivity (p<0.05). The trypan blue exclusion testing also showed superior viability in cold storage Group I. CONCLUSION: Venous allografts preserved in a 4 degrees C RPMI 1640 solution showed well preserved endothelial cellular integrity and thrombomodulin expression at up to seven days of preservation. Although cryopreservation of venous allografts stored in 10% DMSO -RPMI 1640 solution maintained the endothelial cellular structure on SEM, immunohistochemistry from the thrombomodulin and trypan blue exclusion testing showed decreased viability. It remains to be seen whether the decreased thrombomodulin reactivity could be restored, and what the nature to the relationship is between thrombomodulin and long-term patency of allografts.
Allografts* ; Cellular Structures ; Coronary Artery Bypass ; Cryopreservation ; Dimethyl Sulfoxide ; Endothelial Cells* ; Humans* ; Immunohistochemistry ; Microscopy ; Microscopy, Electron, Scanning ; Nitric Oxide ; Nitrogen ; Saphenous Vein* ; Thrombomodulin ; Transplants ; Trypan Blue ; Veins

no abstract available.

Pulmonary lymphangitic carcinomatosis is a common secondary neoplasm of the lung that may result from hematogenous dissemination to small pulmonary arteries and arterioles followed by invasion of the interstitial space and lymphatics, or from the retrograde spread of tumors from mediastinal or hilar lymph nodes. Radiologically, irregular interlobular septal thickening, bronchovascular interstitial thickening and/or lymph node enlargement are observed. In this report, we describe an atypical radiological manifestation of lymphan-gitic metastasis of stomach cancer in a 37-year-old woman admitted for dyspnea on exertion and a cough which had been present for one month. HRCT scanning revealed bilateral multifocal ground glass opacity or consolidation, mild diffuse axial interstitial thickening, and slight pleural effusion. These findings were thought to indicate the existence of an air-space disease rather than metastasis. Open lung and endoscopic biopsy, however, demonstrated the presence of lymphangitic metastasis from stomach cancer.
Adult ; Arterioles ; Biopsy ; Carcinoma ; Cough ; Dyspnea ; Female ; Glass ; Humans ; Lung ; Lymph Nodes ; Neoplasm Metastasis* ; Pleural Effusion ; Pulmonary Artery ; Stomach Neoplasms

Congenital bronchoesophageal fistula in the adult is rare, especially Braimbridge type III is very rare. We experienced congenital bronchoesophageal fistula associated intrapulmonary bronchogenic cyst. The patient was a 38-year-old male with chief complaints of coughing and abdominal pain 3 days before admission. Esophagogram revealed a fistulous tract between esophagus and cystic lesion in RLL. Fistulectomy and right lower and middle bilobectomy was performed. The postoperative course was uneventful.
Abdominal Pain ; Adult ; Bronchogenic Cyst* ; Cough ; Esophagus ; Fistula* ; Humans ; Male

It suggested that localized fibrous tumor of the pleura originated from a primitive submesothelial mesenchymal cell. The criteria used for a judgment of malignancy were high cellularity and mitotic activity(more than four mitotic figures per 10 high-power fields), pleomorphism, hemorrhage, and necrosis. This 62 years female was admitted with dyspnea and cough. Chest X-ray and CT scan showed a huge mass in right thorax. A 23X18X12 cm, 2 Kg sized mass was excised, and it was collase the right lower lobe and right middle lobe and was adhered to the diaphragm. Pathologically, the tumor was composed high cellularity, fascicle of the spindle cells, and high mitotic numbers(27 mitosis/10HPF). Immunohistochemically, it was positive for vimentin and CD34. This tumor was diagnosised to the malignancy localized fibrous tumor. We experience a case of pleural malignant fibrous tumor and report this case with the review of literature.
Cough ; Diagnosis ; Diaphragm ; Dyspnea ; Female ; Hemorrhage ; Humans ; Judgment ; Necrosis ; Pleura ; Pleural Neoplasms ; Solitary Fibrous Tumor, Pleural* ; Solitary Fibrous Tumors* ; Thorax ; Tomography, X-Ray Computed ; Vimentin

A 49-year-old male patient was admitted with chief complaint of hemoptysis. Preoperative chest PA and CT scan revealed air-filled large cavitary lesion at the right upper lobe with typical meniscus sign. Serum anti-fungus antibody for Aspergillus was positive and he was diagnosed as aspergilloma. We planned RULobectomy but it was impossible due to severe pleural adhesion in apex and mediastinal pleura. Therefore, we performed a cavernostomy and serratus anterior muscle flap transposition in one stage. The patient recovered without complication and was followed up for 8 months without recurrence of hemoptysis.
Aspergillus ; Hemoptysis ; Humans ; Male ; Middle Aged ; Pleura ; Recurrence ; Thorax ; Tomography, X-Ray Computed

Fulminant myocarditis has been defined as the clinical manifestation of cardiac inflammation with rapid-onset heart failure and cardiogenic shock. We report on the case of a 23-yr-old woman with pathology-proven fulminant lymphocytic myocarditis presenting shock with elevated cardiac troponin I and ST segments in V1-2, following sustained ventricular tachycardia and a complete atrioventricular block. About 55 min of intensive cardio-pulmonary resuscitation, with extracorporeal membrane oxygenation support, bridged the patient to orthotopic heart transplantation. The explanted heart revealed diffuse lymphocytic infiltration and myocyte necrosis in all four cardiac chamber walls. Aggressive mechanical circulatory support may be an essential bridge for recovery or even transplantation in patients with fulminant myocarditis with shock.
Combined Modality Therapy/methods ; Extracorporeal Membrane Oxygenation/*methods ; Female ; *Heart Transplantation ; Humans ; Myocarditis/complications/*diagnosis/*therapy ; Shock/*diagnosis/etiology/*prevention & control ; Treatment Outcome ; Young Adult

Between May, 1994 and December, 1995, 122 adult cardiac surgical procedures requiring cardiopulmonary bypass were performed at Kang Dong Sacred Heart Hospital, including 18 cases(14.8%) that were associated with preoperative(n=9), intraoperative(n=7), postoperative(n=2) use of an IABP(intra-aortic balloon pump). The reasons for IABP were low cardiac output and PTCA(percutaneous transluminal coronary angioplasty) failure in preoperative period, CPB(cardiopulmonary bypass) weaning difficulty in intraoperative period, and intractable arrhythmia in postoperative period. The mean age of the IABP patients was 61.8+/-6.9 years(range, 39 to 75years). The overall hospital mortalities in patients with preoperative and intraoperative IABP insertion were 33.3 and 42.9% respectively. Two patients with postoperative IABP insertion are alive. The rate of IABP weaning is 66.7% for preoperative group, 85.7% for intraoperative group and 100% for postoperative group. In conclusion, if there were no irreversible myocardial damages, IABP could be used safely and emergently at any perioperative period for hemodynamic stability, CPB weaning, and to overcome low cardiac output syndrome.
Adult ; Arrhythmias, Cardiac ; Cardiac Output, Low ; Cardiac Surgical Procedures ; Cardiopulmonary Bypass ; Heart ; Hemodynamics ; Hospital Mortality ; Humans ; Intraoperative Period ; Perioperative Period ; Postoperative Period ; Preoperative Period ; Thoracic Surgery* ; Weaning