We have experienced a case of pleural aspergillosis. A 50 year old female complained of malaise, anorexia, coughing with sputum, and right sided pleuritic chest pain of two weeks' duration. About ten years ago, she had been treated for pulmonary tuberculosis with medication. Chest radiography showed right pyopneumothorax with cavitation in the right upper lung and Chest computed tomography revealed right loculated pyopneumothorax with cavity formation suggesting bronchopleural fistula. Decortication and wedge resection with pleurectomy were performed. The postoperative course was satisfactory and has been in good condition up to now. Pleural aspergillosis is a very rare and potentially life-threatening disease, but we have had good results without significant complications by treatment with systemic antifungal drugs and surgical operation.
Anorexia ; Aspergillosis* ; Chest Pain ; Cough ; Female ; Fistula ; Humans ; Lung ; Middle Aged ; Radiography ; Sputum ; Thorax ; Tuberculosis, Pulmonary

BACKGROUND: Adaptive remodeling of the wall of diseased arterial segments occurs to compensate for the accumulation of atherosclerotic plaque. Histopathologic studies and intraoperative high-frequency epicardial coronary ultrasound imaging as well as intracoronary ultrasound imaging have shown that human coronary arteries enlarge in parallel with the formation of atherosclerotic plaque. Therefore, the lumen area is preserved until the progressive accumulation of plaque exceeds the compensatory mechanisms of the vessel. In 1995, however, Pastercamp et al. reported that arterial wall constriction (shrinkage) or inadequate enlargement may be a different mechanism associated with the development of severe arterial lumen narrowing in addition to plaque proliferation. The aim of this study is to examine what extent of de novo native coronary arterial stenosis is accompanied by compensatory enlargement and to find the predictors of inadequate remodeling with intravascualr ultrasound. METHODS: Fifty eight patients were enrolled from February 1997 through October 1997. Patients who had the lesion of more than 50% stenosis of minimal luminal diameter in coronary angiography were indicated. The lesion which was located in the ostium or was very tortuous or angulated was excluded. The lesion which had the history of balloon angioplasty or stent insertion was also excluded. We used 20 MHz endosonic intravascular ultrasound catheter. We measured EEM area (External Elastic Membrane area), lumen area and plaque plus media area and analysed plaque characteristics. RESULTS: 1) Fifty-eight consecutive patients (43 men, 15 women; mean age 55.4 years, range 33 to 78) who had not undergone previous catheter intervention were studied with a single intravascular ultrasound system. 2) Among 58 patients, 20 patients (35%) had acute myocardial infarction, 30 patients (52%) unstable angina, 6 patients (10%) stable angina and 2 patients (3%) old myocardial infarction. Lesions were located at the left anterior descending arteries in 29 patients (50%), right coronary arteries in 21 patients (36%) and left circumflex coronary artery in 8 patients (14%). 3) Compensatory enlargement was observed in 19 (32%) of 58 lesions and inadequate compensatory enlargement in 39 (68%). 4) EEM and plaque areas at lesion site of compensatory enlargement group were significantly larger than those of inadequate enlargement group (p<0.05). 5) Risk factors for coronary arterial disease including diabetes mellitus, hypertension, hypercholesterolemia (serum cholesterol<0A65B>240 mg/dl), smokings and plaque characteristics were not statistically related with inadequate enlargement. Although there was no statistical significance, there was a tendency of inadequate enlargement in patients with diabetes mellitus and calcified plaque. 6) The only predictor of inadequate remodeling was the postmenopausal female (p<0.05). CONCLUSION: Adaptive compensatory coronary arterial remodeling was occured less frequently in patients with acute coronary syndromes than in patients with stable angina. The only statistically significant predictor of adaptive compensatory coronary arterial remodeling was postmenopausal women. Inadequate compensatory coronary arterial remodeling was occured more frequently in patients with diabetes mellitus or calcified plaque but without statistical significance.
Acute Coronary Syndrome ; Angina, Stable ; Angina, Unstable ; Angioplasty, Balloon ; Arteries ; Catheters ; Constriction ; Constriction, Pathologic ; Coronary Angiography ; Coronary Vessels ; Diabetes Mellitus ; Female ; Humans ; Hypercholesterolemia ; Hypertension ; Male ; Membranes ; Myocardial Infarction ; Phenobarbital ; Plaque, Atherosclerotic ; Risk Factors ; Smoke ; Stents ; Ultrasonics* ; Ultrasonography

We experienced a case of partial anomalous pulmonary venous return from righ lung to inferior vena cava, which combined with Scimitar sign in 18 years old female patient. Diagnostic procedures were simple chest x-ray chest CT, and cardiac catheterization. We redirected the anomalous venous flow from inferior vena cava to left atrium through the intracardiac tunnel which was made with autologous pericardium. Postoperative course was not eventful.
Adolescent ; Cardiac Catheterization ; Cardiac Catheters ; Female ; Heart Atria ; Humans ; Lung ; Pericardium ; Scimitar Syndrome ; Thorax ; Tomography, X-Ray Computed ; Vena Cava, Inferior

BACKGROUND: The aim of the current study was to analyze the early and intermediate-term performance of aortic valve replacement. MATERIAL AND METHOD: Between January 1986 and January 1996, records of 61 consecutive patients who had received aortic valve replacement were reviewed. 38 were male and 23 were female patients, ranging from 10 to 71 years of age (mean: 40.5+/-11.2). RESULTS: The early death rate was 4.9% (3/61). A thorough follow-up rate of 93.1% was accomplished in these 58 patients who left the hospital (mean: 51.5+/-32.0 patient-months) under the assistance of the same operator. Three of these patients who left the hospital died. The late death rate was 5.2% (3/58). Five patients experienced anticoagulant-related hemorrhage (all were minor). Three patients had thromboembolic episodes. There was no clinical evidence of hemolysis and structural failure of valves used. Of those patients who survived, the NYHA functional class improved significantly. Linearized rate were 1.58%/patient-year and 2.0%/patient-year respectively for thromboembolism and anticoagulant-related hemorrhage. The 10 year actuarial survival rate was 83.6%. CONCLUSION: This early and intermediate-term follow-up suggests that the mechanical valve is a reliable and durable prosthesis with good hemodynamic function and low rate of prosthesis-related complication.
Aortic Valve* ; Female ; Follow-Up Studies ; Hemodynamics ; Hemolysis ; Hemorrhage ; Humans ; Male ; Mortality ; Postoperative Complications ; Prostheses and Implants ; Survival Rate ; Thromboembolism

BACKGROUND: Intravascular ultrasound(IVUS) provides high resolution cross-sectional images of the vessels and permits the quantiative and qualitative assessment of coronary artery disease. Stent is a figid endovascular lattice that effectively prevents elastic recoil at treated sites, but in-stent restenois is a major limitation. The purpose of thecurrent study is to assess the contribution of neointimal hyperplasia for in-stent restenosis and the distribution and morphological characteristics of neointimal hyperplasia in deployed stents. METHODS: Thirty patients(male 25 & female 5;31 leions) deployed with intracoronary stents underwent intravascular ultrasound imaging at follow-up at least 4 months after stenting ([mean+/-SD] 8.3+/-2.9 months). RESULTS: 1) In-stent restenosis occurered in 15 lesions out of 31 lesions at follow-up coronary angiography. There was no difference in clinical characteristics between the restenotic and the non-restenotic groups. 2) There was no difference in angiographic profiles between two groups. Deployed stents were as follows ; 16 Palmaz-Schatz(P-S) stents, 12 Gianturco-Roubin(G-R) stents, 2 Cordis stents, and I Microstent II. Average diameter of stents in the restenotic and the non-restenotic groups were 3.07+/-0.26mm and 3.16+/-0.30mm, respectively(p=0.38). 3) There was no difference of stent cross-sectional areas(CSA) between the non-restenotic and the restenotic groups(p=0.476), but luminal CSA of the restenotic group was significantly smaller than that of the non-restenotic group(p=0.006). 4) In the restenotic group, there were no differences of the maximal and the minimal diameters of stents, and the mean CSAs of stents smong proxiaml, mid and distal segments. But the mean CSA of neointimal hyperplasia at the mid segment was larger than that at the distal segment(p<0.05). There was a tendency thatthe mean CSA of neointimal hyperplasia at the mid segment was larger than that at the proximal segment(p=0.187). These findings were the same in the non-restenotic group. 5) In the restenotic group deployed with P-S stents, there were no differences of the maximal and the minimal diameters of stents, and the mean cross-sectional areas(CSA) of stents between each segment. But, the mean CSA of neointimal hyperplasia at the mid segment was larger than that at the distal segment(p<0.005) and there was a tendency that the mean CSA of neointimal hyperplasia at the mid segment was larger than that at the proximal segment(p=0.354). 6) In the morphology of neointimal hyperplasia of the restenotic group, eccentric form(77%) was more common than concentric form(22%). Neointimal hyperplasia occurred in focal or diffuse patterns(7 versus 8 cases). CONCLUSIONS: In-stent restenosis resulted from neointimal hyperplasia which almost mainly occurred eccentrically at the mid segment of stents and in focal or diffuse patterns. Intravascular ultrasound imaging was a useful method for recognition of distribution and morphological characteristics of neointimal hyperplasia at follow-up of deployed stents.
Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels* ; Female ; Follow-Up Studies ; Humans ; Hyperplasia* ; Phenobarbital ; Stents* ; Ultrasonography*

Aldosterone has been shown to stimulate renal TGF-beta1 expression. However, the mechanisms for aldosterone-induced TGF-beta1 expression have not been clearly determined in mesangial cells. We examined the role of extracellular-signal regulated kinase 1 and 2 (ERK1/2), c-Jun N-terminal kinase (JNK) and activator protein- 1 (AP-1) in the aldosterone-induced TGF-beta1 expression in rat mesangial cells. TGF-beta1 protein in the conditioned medium released from rat mesangial cells was measured by sandwich ELISA, TGF-beta1 mRNA expression was analyzed by Northern blotting, AP-1 DNA binding activity was measured by EMSA and the ERK1/2, JNK activity was analyzed by western blotting. Aldosterone significantly stimulated TGF-beta1 protein production and TGF-beta1 mRNA expression in mesangial cells in a dose-dependent manner. Aldosterone significantly increased AP-1 DNA binding activity in mesangial cells. Pre-treatment of cells with AP-1 inhibitor, curcumin, blocked aldosterone-induced AP-1 DNA binding activity as well as aldosterone-induced TGF-beta1 production. Aldosterone increased phosphorylation of ERK1/2 and JNK in mesangial cells. Pre-treatment of cells with ERK1/2 inhibitor, PD98059, or JNK inhibitor, SP600125 significantly inhibited aldosterone-induced ERK1/2 and JNK activity and subsequently TGF-beta1 production, respectively. We conclude that aldosteroneinduced TGF-beta1 expression in mesangial cells is regulated by the ERK1/ 2, JNK and AP-1 intracellular signaling pathways.
Aldosterone/*pharmacology ; Animals ; Culture Media, Conditioned/pharmacology ; DNA/metabolism ; Extracellular Signal-Regulated MAP Kinases/metabolism ; *Gene Expression Regulation, Enzymologic ; Humans ; *MAP Kinase Signaling System ; Mesangial Cells/*metabolism ; Models, Biological ; Phosphorylation ; Protein Binding ; Rats ; Transcription Factor AP-1/*metabolism ; Transforming Growth Factor beta1/*biosynthesis

PURPOSE: The importance of postoperative management of those who have undergone intracardiac repair for congenital heart diseases has increased in recent years. In this study, we investigated postoperative complications and their relations to preoperative age or duration of the intubation and artificial ventilation in infants with large symptomatic ventricular septal defect. METHODS: Between January, 1993 and December, 1996, sixty infants underwent primary closure of a ventricular septal defect (VSD). The patients were divided into two groups based on preoperative age : group 1, infants aged 6 month or less (n=40), and group 2, infants aged more than 6 month (n=20). And, another three groups were divided into 3 groups due to the duration of the intubation and artificial ventilation including < 24 hour and 24-48 hour, >48 hour, respectively. We compared the incidence of complications such as infection, respiratory or cardiovascular complications among each group. RESULTS: No specific differences between two age groups were found, but the incidence of right bundle branch block was high in age group of 6 month or less (P<0.05). The incidence of sepsis was high in group of >48 hour (P<0.05). And also, arrhythmias, atelectasis, toxic hepatitis were more frequently observed in the former group. CONCLUSION: These results indicate that early weaning of the artificial ventilation in infants with large symptomatic ventricular septal defect could protect them from development of severe life- threatening infection such as sepsis. We suggest 48 hours or less as the optimal duration of artificial ventilation. Additionally, earlier weaning could provide earlier oral feeding or earlier ambulation, which is improve respiratory homeostasis.
Arrhythmias, Cardiac ; Bundle-Branch Block ; Drug-Induced Liver Injury ; Heart Diseases ; Heart Septal Defects, Ventricular* ; Homeostasis ; Humans ; Incidence ; Infant* ; Intubation ; Postoperative Complications* ; Pulmonary Atelectasis ; Sepsis ; Ventilation* ; Walking ; Weaning

PURPOSE: This study was designed to review the results of 2nd and 3rd kidney transplantation at our center. METHODS: Total 1,500 patients who had undergone kidney transplantation from 1968 to Aug 2005 at the Catholic Medical Center were retrospectively analyzed. The graft and patient survival were determined using Kaplan-Meier actuarial survival curves, compared with those of first transplant and assessed for significance using the log rank test. RESULTS: The patient of 2nd transplantation was 77 cases (male 55, female 22, mean age: 48.9+/-2.4 years) and 3rd transplantation was 5 patients (male 4, female 1, mean age 46.8+/-6.0 years). The 82 kidneys included from living donors in 67 patients and from cadaveric donors in 15 patients. The most common cause of renal failure of retransplanted kidney was chronic GN (2nd: 62 cases (80.5%), 3rd: 5 cases (100%)). The immunosuppressive regimen was mainly based on cyclosporine (2nd: 61 cases (79.2%), 3rd: 3 cases (60%)). The mean duration of the second transplantation from the first was 89.0 months and the third transplantation from the second was 32.7 months. There were 16 cases of death patients and the main cause of death was infection and cardiovascular events. The graft survival of 2nd & 3rd transplantation in 1 year were over 80%. CONCLUSION: Renal retransplantation is safe, effective, and the treatment of choice in patients with failed previous kidney transplantation for patient's quality of life and not associated with increased mortality retransplantation. The results of graft survival for retransplantation seem to be excellent for primary transplantation under cyclosporine or tacrolimus-based immunosuppression. The use of the potent and appropriate immunosuppression and surgical technique for retransplantation could help to improve better results.
Cadaver ; Cause of Death ; Cyclosporine ; Female ; Graft Survival ; Humans ; Immunosuppression ; Kidney Transplantation* ; Kidney* ; Living Donors ; Mortality ; Organ Transplantation* ; Quality of Life ; Renal Insufficiency ; Retrospective Studies ; Tissue Donors ; Transplants*

BACKGROUND: The HLA system is known to be the most polymorphic gene cluster in the human genome. HLA allele and haplotype distribution varies widely among different ethnic groups. In this study, we examined the frequency of HLA class I alleles and haplotypes in 309 healthy Koreans. METHODS: We typed HLA-A, -B, and -C genes at the allelic level in 109 unrelated Korean individuals using a sequence-based typing. With the additional data of 200 healthy Koreans from dbMHC (http: //www.ncbi.nlm.nih.gov/mhc/), allele and haplotype frequencies were estimated by the maximum likelihood method. Serological typing results of 49 individuals were compared with the results highly resolved. RESULTS: A total of 22 HLA-A, 41 HLA-B, and 21 HLA-C alleles were found in this study. Alleles showing frequencies of more than 10% in each HLA locus were A*2402 (22.5%), A*0201 (15.7%), A*3303 (14.4%), A*1101 (11.0%), B*5101 (12.1%), Cw*0102 (18.8%), and Cw*1402 (10.2%). The most common A-B-C haplotypes at a frequency of more than 3% were A*3303-B*5801-Cw*0302 (5.2%), A*2402-B*5101-Cw*1402 (4.5%), A*1101-B*1501-Cw*0401 (4.3%), A*3303-B*4403-Cw*1403 (4.0%), A*3001-B*1302-Cw*0602 (3.7%), and A*0207-B*4601-Cw*0102 (3.2%). Misassignment of HLA-C antigen by serotyping was detected in 11 (22.4%) of 49 individuals. CONCLUSIONS: Our results will be useful as a basic data for studies on anthropology, disease association, and bone marrow transplantation. Misidentification of HLA-C by serotyping is so high that it would be desirable to perform a DNA typing especially in unrelated bone marrow transplantation.
Alleles* ; Anthropology ; Bone Marrow Transplantation ; DNA Fingerprinting ; Ethnic Groups ; Genome, Human ; Haplotypes* ; Histocompatibility Testing ; HLA-A Antigens* ; HLA-B Antigens ; HLA-C Antigens ; Humans ; Multigene Family ; Serotyping

BACKGROUND: Diaphragm is innervated by phrenic nerve and lower intercostal nerves. For patients with avulsion injury of brachial plexus, an in situ graft of phrenic nerve is frequently used to neurotize a branch of the brachial plexus. We studied short-term and mid-term changes of diaphragmatic level and movement in patients with dissection of phrenic nerve for neurotization. MATERIAL AND METHOD: Thirteen patients with division of either-side phrenic nerve for neurotization of musculocutaneous nerve were included in this study. With endoscopic surgical procedure, the intrathoracic phrenic nerve was entirely dissected and divided just above the diaphragm. The dissected phrenic nerve was taken out through thoracic inlet and neck wound and then anastomosed to the musculocutaneous nerve through a subcutaneous tunnel. With chest films and fluoroscopy, levels and movements of diaphragm were measured before and after operation. RESULT: There was no specific technical difficulty or even minor postoperative complications following endoscopic division of phrenic nerve. After division of phrenic nerve, diaphragm was soon elevated about 1.7 intercostal spaces compared with the preoperative level, but it did not show paradoxical motion in fluoroscopy. More than 1.5 months later, diaphragm returned downward close to the preoperative level (average level difference was 0.9 intercostal spaces; p=NS). Movement of diaphragm was not significantly decreased compared with the preoperative one. CONCLUSION: After division of phrenic nerve, the affected diaphragm did not show a significant decrease in movement, and the elevated diaphragm returned downward with time. However, the decreased lung volumes in the last spirometry suggest the decreased inspiratory force following partial paralysis of diaphragm.
Bays ; Brachial Plexus ; Diaphragm ; Diaphragmatic Eventration ; Endoscopy ; Fluoroscopy ; Humans ; Intercostal Nerves ; Lung ; Musculocutaneous Nerve ; Neck ; Nerve Transfer ; Paralysis ; Phrenic Nerve* ; Postoperative Complications ; Spirometry ; Thorax ; Transplants ; Wounds and Injuries