A 74-year-old woman presented at our hospital with hemoptysis. Three months ago, she had endovascular stent-grafting done by a general surgeon for a saccular thoracic aneurysm that was found accidentally following an episode of fever and chills. Despite a lasting fever after the procedure, she was discharged without further treatment and follow-up. She was subsequently admitted to the hospital for evaluation and several exams were performed. Chest CT scans and an esophagoscopy identified an aorto-esophageal fistula at the level of the aorta that was covered by a previous stent-graft. After extensive administration of antibiotics, surgery was done - esophagectomy, cervical esophago-gastrostomy and replacement of the thoracic aorta. She was later discharged uneventfully.
Aged ; Aneurysm ; Aneurysm, Infected ; Anti-Bacterial Agents ; Aorta ; Aorta, Thoracic ; Chills ; Esophageal Fistula ; Esophagectomy ; Esophagoscopy ; Female ; Fever ; Fistula ; Follow-Up Studies ; Hemoptysis ; Humans ; Thorax

Suitability rate of endovascular aneurysm repair (EVAR) and the anatomic features causing unsuitability have not been well determined in Asian patients who have abdominal aortic aneurysm (AAA). In a single Korean center, a total of 191 patients with abdominal aortic aneurysm (maximal diameter > or = 4 cm) were identified. Aortoiliac morphologic characteristics in contrast-enhanced computed tomography images were retrospectively reviewed to determine suitability for EVAR with four FDA-approved stent-grafts. AAA was considered ideally suitable for EVAR in 46.6% of patients. The most frequent causes for unsuitability were common iliac artery (CIA) aneurysm (61.8%) and excessive neck angulation (52.9%). Problems such as small and/or short neck and small access were found in minor incidences. If CIA aneurysm is dealt by overstenting with sacrifice of internal iliac artery, suitability rate can increase to 65%. Larger aneurysms were more frequently unsuitable for EVAR and had more chance of having multiple unfavorable features. In conclusion, the overall feasibility rate for EVAR in Korean patients was not different from that in Western patients. However, considering the difference in the major causes of unsuitability, more attention has to be paid to neck angulation and CIA aneurysm to provide EVAR for more Korean patients especially who have large aneurysm.
Aged ; Aged, 80 and over ; Aortic Aneurysm, Abdominal/*surgery ; *Blood Vessel Prosthesis ; Blood Vessel Prosthesis Implantation/*instrumentation ; Female ; Humans ; Iliac Aneurysm/surgery ; Iliac Artery ; Male ; Middle Aged ; Republic of Korea ; Retrospective Studies ; *Stents ; Tomography, Spiral Computed

An application of the multi-detector computed tomography (MDCT) for cardiac imaging is the non-invasive CT angiographic assessment of the cardiac morphology and the coronary arteries. The most important application is for the non-invasive diagnosis of coronary artery disease, and this includes assessment of coronary artery anomaly and stenosis, the evaluation of non-calcified atherosclerotic plaque and the follow-up examinations after stent deployment and bypass surgery. In the study, we have illustrated a variety of diseases of the coronay artery by using MDCT. These may facilitate the understanding of MDCT features of coronary artery lesions.
Arteries ; Constriction, Pathologic ; Coronary Angiography* ; Coronary Artery Disease ; Coronary Vessels ; Diagnosis ; Follow-Up Studies ; Multidetector Computed Tomography* ; Plaque, Atherosclerotic ; Stents

BACKGROUND: The associations between hepatitis B virus (HBV) infection and natural killer cell activity (NKA) have been studied. However, there have been no studies on detection of NKA in HBV patients using NK Vue Gold kit (ATGen Co., Korea), which has been developed in Korea and can easily detect NKA in whole blood. METHODS: A patient group of 40 patients diagnosed with hepatitis B antigen-positive chronic hepatitis B and a control group of 40 people eligible for blood donation were selected for this study. Whole blood (1 mL) was collected in special tubes for analysis with NK Vue Gold kit. The concentration of interferon-γ (IFN-γ) was measured and considered to represent NKA. RESULTS: There was no significant difference in the median (value, range) of concentration of IFN-γ between the patient (2,000, 89–2,000 pg/mL) and control groups (1,786, 333–2,000 pg/mL). The concentration of IFN-γ was inversely correlated with leukocyte count in both patient (r=–0.390, P=0.022) and control (r=–0.339, P=0.032) groups. The concentration of IFN-γ in the patient group was inversely correlated with concentrations of alanine aminotransferase (r=–0.363, P=0.021), aspartate aminotransferase (r=–0.336, P=0.037), and bilirubin (r=–0.376, P=0.020). CONCLUSIONS: There was no significant difference in NKA between the patient and control group. Caution should be practiced when interpreting results of NKA, because leukocyte count can affect concentration of IFN-γ.
Alanine Transaminase ; Aspartate Aminotransferases ; Bilirubin ; Blood Donors ; Hepatitis B ; Hepatitis B virus ; Hepatitis B, Chronic* ; Hepatitis, Chronic* ; Humans ; Interferon-gamma ; Killer Cells, Natural ; Korea ; Leukocyte Count

BACKGROUND: Valvular heart disease is still the most common health problem i n Korea.By the end of the year 1999,there has been 94,586 cases of open heart surgery since the first case in 1958.Among them,36,247 cases were acquired heart diseases and 20,704 of those had valvular heart disease.But there was no database system and every surgeon and physician had great difficulties in analysing and utilizing those tremendous medical resources. Therefore,we developed a valve registry database program and utilize it for risk factor analysis and so on. MATERIAL AND METHOD: Personal computer-based multiuser database program was created using Microsoft AccessTM.That consisted of relational database structure with fine-tuned compact field variables and server-client architecture.Simple graphic user interface showed easy-to-use accessability and comprehensibility.User-oriented modular structure enabled easier modification through native AccessTM functions.Infinite application of query function aided users to extract, summarize,analyse and report the study result promptly. RESULT: About three-thousand cases of valve replacement procedure were performed in our hospital from 1968 to 1999.Total number of prosthesis replaced was 3,700.The numbers of cases for mitral,aortic and tricuspid valve replacement were 1600,584,76, respectively. Among them,700 patients received prosthesis in more than two positions. Bioprosthesis or mechanical prosthesis were used in 1,280 and 1,500 patients respectively. Redo valve replacements were performed in 460 patients totally and 40 patients annually. CONCLUSION: Database program for registry of valvular heart disease was successfully developed and used in personal computer-based multiuser environment.This revealed promising results and perspectives in database management and utilization system.
Bioprosthesis ; Heart ; Heart Diseases ; Heart Valve Diseases ; Humans ; Prostheses and Implants ; Risk Factors* ; Thoracic Surgery ; Tricuspid Valve

BACKGROUND: Epidemiological studies have shown correlation between low incidence of coronary heart disease and high consumption of fish products. It has been suggested that this may be due to the high content of polyunsaturated fatty acids of the n-3 fatty acid group in fish oil. In animal studies eicosapentaenoic acid (EPA) inhibited attachment of monocytes to the arterial endothelium. METHOD: Adhesion assay was performed on the endothelial cells of the human umbilical vein with 25, 50, 100, 200 micrometer EPA-treated U937 cells. The endothelial cells were activated with lipopoysaccharide (LPS). The adhesion assay was repeated with oxidized EPA. EPA was oxidized with CuSO4 and ascorbic acid. RESULT:Viability of U937 cells were not affected by concentrations up to 200 micrometer of EPA and oxidized EPA. LPS treatment of endothelium notably increased the number of U937 cells attached to endothelial cells on the adhesion assay. However, treatment of EPA, native or oxidized, to U937 cells did not affect the number of U937 cells attached to LPS activated endothelial cells. CONCLUSION: EPA treatment, native or oxidized, of U937 cells did not affect U937 cell-endothelial cell adhesion. This suggests that inhibition of monocyte-endothelial cells attachment by EPA is not due to the effects of EPA on monocytes.
Animals ; Ascorbic Acid ; Cell Adhesion* ; Coronary Disease ; Eicosapentaenoic Acid* ; Endothelial Cells ; Endothelium ; Fatty Acids, Unsaturated ; Fish Products ; Humans ; Incidence ; Monocytes ; U937 Cells ; Umbilical Veins

PURPOSE: We wanted to analyze the efficacy of hydroxyapatite as a bone graft extender and we wanted to compare the bone fusion rate between hydroxyapatite and allogenous bone as an adjunct to autogenous iliac bone graft in posterolateral spinal fusion. MATERIALS AND METHODS: Our study included 19 patients who were treated with decompression and posterolateral spinal fusion using hydroxyapatite on right side and frozen allogenous bone on left side as an adjunct to autogenous iliac bone graft, and all the procedures were performed between May 2003 and August 2004. Fusion was determined by the final radiographic findings with using Christiansen's classification. RESULTS: There were 3 male and 16 female patients. Their average age was 65.5 years (range: 48-81) and the average follow-up period was 21.5 months (range: 12-36). Fusion was performed in 3.4 segments (range: 2-6) on average per patient. Of all the 65 segments that underwent fusion, 63 segments (96.9%) in group using hydroxyapatite and 54 segments (83.1%) in group using allogenous bone were determined to be fused, and the difference was not statistically significant (p=0.074). CONCLUSION: Hydroxyapatite as adjunct to autogenous iliac bone for use in posterolateral spinal fusion showed a high fusion rate and it seemed to be useful as a bone graft extender for reducing the volume of the autogenous iliac bone.
Bone Transplantation ; Decompression ; Durapatite ; Female ; Follow-Up Studies ; Humans ; Male ; Spinal Fusion ; Transplants

The complement is a part of the immune system that plays several roles in removing pathogens. Despite the importance of the complement system, the exact role of each component has been overlooked because the complement system was thought to be a nonspecific humoral immune mechanism that worked against pathogens. Decay-accelerating factor (DAF or CD55) is a known inhibitor of the complement system and has recently attracted substantial attention due to its role in various diseases, such as cancer, protein-losing enteropathy, and malaria. Some protein-losing enteropathy cases are caused by CD55 deficiency, which leads to complement hyperactivation, malabsorption, and angiopathic thrombosis. In addition, CD55 has been reported to be an essential host receptor for infection by the malaria parasite. Moreover, CD55 is a ligand of the seven-span transmembrane receptor CD97. Since CD55 is present in various cells, the functional role of CD55 has been expanded by showing that CD55 is associated with a variety of diseases, including cancer, malaria, protein-losing enteropathy, paroxysmal nocturnal hemoglobinuria, and autoimmune diseases. This review summarizes the current understanding of CD55 and the role of CD55 in these diseases. It also provides insight into the development of novel drugs for the diagnosis and treatment of diseases associated with CD55.
Antigens, CD55 ; Autoimmune Diseases ; Complement System Proteins ; Diagnosis ; Hemoglobinuria, Paroxysmal ; Immune System ; Immunotherapy ; Malaria ; Parasites ; Protein-Losing Enteropathies ; Thrombosis

OBJECTIVE: To define the mechanism associated with abnormal septal motion (ASM) after coronary artery bypass graft surgery (CABG) using comprehensive MR imaging techniques. MATERIALS AND METHODS: Eighteen patients (mean age, 58 +/- 12 years; 15 males) were studied with comprehensive MR imaging using rest/stress perfusion, rest cine, and delayed enhancement (DE)-MR techniques before and after CABG. Myocardial tagging was also performed following CABG. Septal wall motion was compared in the ASM and non-ASM groups. Preoperative and postoperative results with regard to septal wall motion in the ASM group were also compared. We then analyzed circumferential strain after CABG in both the septal and lateral walls in the ASM group. RESULTS: All patients had normal septal wall motion and perfusion without evidence of non-viable myocardium prior to surgery. Postoperatively, ASM at rest and/or stress state was documented in 10 patients (56%). However, all of these had normal rest/stress perfusion and DE findings at the septum. Septal wall motion after CABG in the ASM group was significantly lower than that in the non-ASM group (2.1+/-5.3 mm vs. 14.9+/-4.7 mm in the non-ASM group; p < 0.001). In the ASM group, the degree of septal wall motion showed a significant decrease after CABG (preoperative vs. postoperative = 15.8+/-4.5 mm vs. 2.1+/-5.3 mm; p = 0.007). In the ASM group after CABG, circumferential shortening of the septum was even larger than that of the lateral wall (-20.89+/-5.41 vs. -15.41+/-3.7, p < 0.05) CONCLUSION: Abnormal septal motion might not be caused by ischemic insult. We suggest that ASM might occur due to an increase in anterior cardiac mobility after incision of the pericardium.
Contrast Media/diagnostic use ; *Coronary Artery Bypass ; Coronary Disease/*surgery ; Female ; Gadolinium DTPA/diagnostic use ; Humans ; Image Interpretation, Computer-Assisted ; Magnetic Resonance Imaging/*methods ; Male ; Middle Aged ; Pericardium/surgery ; Retrospective Studies ; Statistics, Nonparametric ; Ventricular Septum/*physiopathology

BACKGROUND: Rapid and accurate diagnosis is essential for successful management of acute aortic dissection. As transesophageal echocardiography(TEE) provides excellent imaging of thoracic aorta conveniently, TEE is widely indicated as a effective diagnostic method of aortic disease. To evaluate clinical usefulness of TEE in patients with suspected aortic dissection, we assessed diagnostic accuracy and feasibility of TEE. METHODS: Ninety-one consecutive patients with clinically suspected aortic dissection were examined by TEE, computerized tomography(CT), magnetic resonance imagion(MRI) and aortic angiography between August 1991 and September 1994. The diagnosis was confirmend by these techniques and surgery. RESULTS: 1) We diagnosed 27 proximal aortic dissection, 22 distal aortic dissection, 8 aortic intramural hematioma, 12 thoracic aortic aneurysm, 2 penetration ulcer, 1 necrotizing aortitis, 1 traumatioc aortic rupture and 18 normal findings in 91 study patients. 2) The sensitivity and specificity of TEE for aortic dissection were 98% and 97%, respecitively. The sensitivity and specificity of TEE to detect ascending aorta involvement were 94% and 100%. 3) CT was chosen in 62 cases as primary diagnostic method of aortic dissection, whereas TEE was performed in 21 cases. TEE was chosen as confirmative diagnostic method following CT in 45 cases, in one-third of whom TEE played a great role in diagnosis or decision of treatment modality. CONCLUSION: As TEE is and accurate and practical method in diagnosis of aortic dissection, TEE may be suggested as primary diagnostic method in suspected aortic dissection. TEE was also useful as confirmative diagnostic method complemention CT.
Angiography ; Aorta ; Aorta, Thoracic ; Aortic Aneurysm, Thoracic ; Aortic Diseases ; Aortic Rupture ; Aortitis ; Complement System Proteins ; Diagnosis* ; Echocardiography, Transesophageal* ; Humans ; Sensitivity and Specificity ; Ulcer