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: 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: 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: 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

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

OBJECTIVE: The aim of this study was to determine whether fetuses delivered prematurely because of pregnancy complications had a different neonatal outcomes than that of those bom after either spontaneous preterm labor or after premature rupture of membrane. METHODS: The study design was a retrospective analysis of 150 very low birthweight(<1500 grams) infants and their mothers who delivered preterm neonates at Samsung Medical Center. Only singleton infants without major congenital anomalies were included. The primary reason for delivery was categorized as preterm delivery because of pregnancy complications(indicated preterm delivery) or spontaneous preterm delivery. Selected neonatal outcomes were compared between infants born to women in each of these groups. RESULTS: There were some survival benefits in infants born to women who underwent indicated preterm delivery from univariate analyses. In the multiple logistic regression analysis, however, selected neonatal outcomes did not differ between the groups. CONCLUSION: We concluded that a "stressed" pregnancies confer negligible survival advantage to the very low birthweight infants.
Female ; Fetus ; Humans ; Infant ; Infant, Newborn ; Logistic Models ; Membranes ; Mothers ; Obstetric Labor, Premature ; Pregnancy Complications ; Pregnancy* ; Retrospective Studies ; Rupture

The surgical management of acute type B dissection is controversial. The complexity of the repair usually requires a period of aortic cross-clamping exceeding 30 minutes, which can cause ischemic injury of the spinal cord. Several forms of distal perfusion have been considered for use to prevent this injury. To determine the safety and efficacy of a graft replacement with cardiopulmonary bypass in reparing acute dissection of descending thoracic aorta, we retrospectively reviewed our surgical experience treating 8 patients who had aortic dissection secondary to atherosclerosis, trauma, and carcinoma invasion. Cardiopulmonary bypass was performed with two aortic cannulas for simultaneous perfusion of the upper and lower body and one venous cannula for draining venous blood from the right atrium or inferior vena cava. Although aortic cross-clamp time was relatively long (average, 117.8 minutes; range, 47 to 180 minutes) in all cases, there was no neurologic deficit immediately after graft replacement for the aortic lesion. Two patients (25%) of relatively old age died on the postoperative 31st and 41st days, respectively, because of delayed postoperative complications, such as pulmonary abscess and adult respiratory distress syndrome. Although any of several maneuvers may be appropriate in managing dissection of the descending aorta, graft replacement with cardiopulmonary bypass during aortic cross-clamping may be a safe and effective method for the treatment of acute dissection of the descending thoracic aorta.
Aorta ; Aorta, Thoracic* ; Atherosclerosis ; Cardiopulmonary Bypass ; Catheters ; Extracorporeal Circulation* ; Heart Atria ; Humans ; Lung Abscess ; Neurologic Manifestations ; Perfusion ; Postoperative Complications ; Respiratory Distress Syndrome, Adult ; Retrospective Studies ; Spinal Cord ; Transplants ; Vena Cava, Inferior

BACKGROUND: When internal thoracic artery (ITA) and saphenous vein graft are anastomosed to the same coronary artery, the patency rate of the internal thoracic artery graft with relatively narrow diameter may be decreased owing to competition of pressure and flow rate. We evaluate the clinical outcome and the patency of the ITA graft in patients undergoing dual grafting to the same coronary artery. MATERIAL AND METHOD: In 14 patients with the ITA graft having relatively low flow, the ITA and saphenous vein graft were anastomosed to the same coronary artery. During the mean follow-up period of 33.5 months, coronary angiography was performed in 6 patients who complained of recurrent angina, needed confirmation of graft flow, or showed postoperative Q wave. RESULT: In all 6 patients, the ITA and saphenous vein grafts were patent without stenosis or obstruction. Two patients showed good flow in both grafts, 2 showed competitive flow in the ITA graft, and the remaining 2 showed poor flow in the ITA graft. CONCLUSION: Early operative closure When saphenous vein grafting was added to the same coronary artery that the internal thoracic artery was anastomosed to, the perfusion to the coronary artery was satisfied and the dual grafting did not affect the short-term and mid-term patency rate of the ITA.
Arteries* ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Bypass ; Coronary Vessels ; Follow-Up Studies ; Humans ; Mammary Arteries* ; Perfusion ; Saphenous Vein* ; Transplants*

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*