Pneumothorax was recognized as a potential hazard of mechanical ventilation after tracheal intubation. Excessive pressure the trachea during general anesthesia could produce lung rupture and pneumothorax. The incidence of pneumothorax has increased as a result of increased application of invasive diagnostic and therapeutic procedures. Emphysematous bleb rupture afterlaryngospasm, bronchospasm, or cough may be causes of pneumothorax. Tension pneumothorax during anesthesia is often difficult to diagnosis, but it needs prompt dignose and treatment. We experienced 3 cases of tension pneumothorax during and after general anesthesia.
Anesthesia ; Anesthesia, General* ; Blister ; Bronchial Spasm ; Cough ; Diagnosis ; Incidence ; Intubation ; Lung ; Pneumothorax ; Respiration, Artificial ; Rupture ; Trachea

Two distinct hantaviruses have been isolated from Apodemus agrarius in 1976 and Rattus norvegicus in 1980 in Korea. Since our serosurveys conducted in 1994, a genetically distinct hantavirus from Apodemus peninsulae has been investigated. To isolate hantavirus from A. peninsulae captured in Korea, the lung homogenate of seropositive A. peninsulae inoculted Vero E6 cells. Viral antigen was detected in a progressively higher percentage of cells with subsequent passage after 80 days postinoculation. The new isolate from seropositive Apodemus peninsulae was designated Suchong virus after Suchong valley located in northeastern region of South Korea. Comparing with hantaan virus 76-118 strain, Suchong virus-1, 2, 3 and 4 showed the similarity of 71.0~91.8% at nucleotide and 90.9~94.8% at amino acid sequences in 231 nucleotides region of M segment, and the similarity of 75.1~81.0% at nucleotide and 97.5~100% at amino acid sequences in 237 nucleotides of S segment.
Amino Acid Sequence ; Animals ; Hantaan virus ; Hantavirus* ; Korea ; Lung ; Murinae* ; Nucleotides ; Population Characteristics* ; Rats

The incidence of lung cancer and its mortality rate are increasing in Korea. At the time of diagnosis, 40% patients of lung cancer patients had metastatic lesions. The common metastatic sites are the contralateral lung, bone, liver, adrenal gland and the brain. Metastasis to oral mucosa is rarely encountered in lung cancer and metastasis to the gingiva is more uncommon. Approximately 1% of malignant carcinomas in the oral cavity are the result of metastases, and 10-25% of metastatic cancers originate from lung cancer. Clinically metastatic gingival lesions are benign including hemangioma, pyogenic granuloma, giant-cell granuloma or a peripheral fibroma. Often metastases to the gingiva are diagnosed too late and by the time they are detected, they have metastases to other organs. Here we report a case of small cell lung carcinoma that had metastased to the gingiva with review of relevant literature.
Adrenal Glands ; Brain ; Diagnosis ; Fibroma ; Gingiva* ; Granuloma ; Granuloma, Pyogenic ; Hemangioma ; Humans ; Incidence ; Korea ; Liver ; Lung ; Lung Neoplasms ; Mortality ; Mouth ; Mouth Mucosa ; Neoplasm Metastasis* ; Small Cell Lung Carcinoma*

Glucagon like peptide-1 (GLP-1) stimulates glucose-dependent insulin secretion. Dipeptidyl peptidase-4 (DPP-4) inhibitors, which block inactivation of GLP-1, are currently in clinical use for type 2 diabetes mellitus. Recently, GLP-1 has also been reported to have neuroprotective effects in cases of cerebral ischemia. We therefore investigated the neuroprotective effects of GLP-1 receptor (GLP-1R) agonist, exendin-4 (ex-4), after cerebral ischemia-reperfusion injury. Transient middle cerebral artery occlusion (tMCAO) was induced in rats by intracerebroventricular (i.c.v.) administration of ex-4 or ex9-39. Oxygen-glucose deprivation was also induced in primary neurons, bEnd.3 cells, and BV-2. Ischemia-reperfusion injury reduced expression of GLP-1R. Additionally, higher oxidative stress in SOD2 KO mice decreased expression of GLP-1R. Downregulation of GLP-1R by ischemic injury was 70% restored by GLP-1R agonist, ex-4, which resulted in significant reduction of infarct volume. Levels of intracellular cyclic AMP, a second messenger of GLP-1R, were also increased by 2.7-fold as a result of high GLP-1R expression. Moreover, our results showed that ex-4 attenuated pro-inflammatory cyclooxygenase-2 (COX-2) and prostaglandin E₂ after MCAO. C-Jun NH₂ terminal kinase (JNK) signaling, which stimulates activation of COX-2, was 36% inhibited by i.c.v. injection of ex-4 at 24 h. Islet-brain 1 (IB1), a scaffold regulator of JNK, was 1.7-fold increased by ex-4. GLP-1R activation by ex-4 resulted in reduction of COX-2 through increasing IB1 expression, resulting in anti-inflammatory neuroprotection during stroke. Our study suggests that the anti-inflammatory action of GLP-1 could be used as a new strategy for the treatment of neuroinflammation after stroke accompanied by hyperglycemia.
Animals ; Brain Ischemia ; Cyclic AMP ; Cyclooxygenase 2 ; Diabetes Mellitus, Type 2 ; Down-Regulation ; Glucagon* ; Glucagon-Like Peptide 1 ; Glucagon-Like Peptide-1 Receptor ; Hyperglycemia ; Infarction, Middle Cerebral Artery ; Insulin ; Mice ; Neurons ; Neuroprotection ; Neuroprotective Agents ; Oxidative Stress ; Phosphotransferases ; Rats ; Reperfusion Injury ; Second Messenger Systems ; Stroke*

BACKGROUND: Elastic recoil contributes to the residual lumen reduction immediately after PTCA. We evaluated the factors to influence on immediate elastic recoil after the successful PTCA. METHODS: 88 patients(96 lesions) were studied by quantitative angiography. Angiograms were obtained in two identical near orthogonal projection before PTCA and immediately after the last balloon deflation. RESULTS: Immediately after PTCA, minimal luminal diameter increased from 0.7+/-0.6mm to 1.9+/-0.6mm and percent diameter stenosis was reduced from 77+/-20 to 34+/-21%. The calculated mean elastic recoil was 0.5+/-0.7mm in diameter and % elastic recoils were lesser both in calcified(3+/-23 vs 23+/-24%, p=0.04) and thrombotic(9+/-20 vs 23+/-35%, p=0.02) lesions. The elastic recoil increased significantly according to the inflation diameter of balloon(r=0.32, p<0.01. No significant correlation between the immediate elastic recoil and age, sex, risk factors, eccentricity and lesion length was shown. CONCLUSION: The elastic recoil immediately after a successful PTCA was dependent on the existance of calcium and thrombus on the target lesion and on the balloon size at the maximal inflation.
Angiography ; Angioplasty, Balloon, Coronary* ; Calcium ; Constriction, Pathologic ; Inflation, Economic ; Phenobarbital ; Risk Factors ; Thrombosis

The mortality rate of the invasive pulmonary aspergillosis to be able to developed during chemotherapy induced myleosuppressionin is high in hematologic malignancy patients despite antifungal treatment. Effective antifungal treatment combined with operation can decrease the mortaligy rate of the invasive pulmonary aspergillosis. Recently, we experienced the successful management of the two cases of invasive pulmonary aspergillosis in acute lymphoblastic leukemia through effective antifungal treatment and surgical resection. We report this cases with review of literature.
Drug Therapy ; Hematologic Neoplasms ; Hematology ; Humans ; Invasive Pulmonary Aspergillosis* ; Mortality ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Pulmonary Aspergillosis

A 21-year-old woman found to be hypertensive was referred for hypertension. On examination, blood pressure was 170/110mmHg in the right arm, 160/100mmHg in left arm,and 120/70mmHg in legs. A grade 2/6 systolic ejection murmur was present at the left upper sternal border, and a chest x-ray revealed a rib notching on the inferior margin of 4th rib. Two-dimensional echocardiogram showed the coarctation of aorta beyound the origin of the left subclavian artery. Biplane TEE demonstrated a discrete narrowing of the descending aorta at the site of coarctation. The blood pressure was 169/86mmHg in ascending aorta and 118/84mmHg in descending aorta. Aortogram showed a localized coarcted aortic segment of 7mm in diameter and 5mm long just distal to the left subclavian artery. Balloon coarctation angioplasty was performed with 7F 30x15mm pediatric balloon dilatation catheter. Balloon position was confirmed on fluoroscopy by the hourglass appearance of the balloon inflation and thereafter, the balloon was inflated until the waist of the balloon disappeared. After procedure, a pull back pressure tracing across the coarctation of aorta revealed no pressure gradient between ascending and descending aorta with 141/90mmHg. Aortogram showed an increase in diameter of the coarctation of aorta to 18mm with aneurysmal formation. 3 months later, follow up aortogram showed no significant change in diameter of coarctation of aorts or aneurysmal formation. Nonsurgical balloon coarctation angioplasty appears to be an alternative therapy for the coarctation of aorta in adults.
Adult* ; Aneurysm ; Angioplasty* ; Angioplasty, Balloon ; Aorta ; Aorta, Thoracic ; Aortic Coarctation* ; Arm ; Blood Pressure ; Catheters ; Dilatation ; Female ; Fluoroscopy ; Follow-Up Studies ; Humans ; Hypertension ; Inflation, Economic ; Leg ; Ribs ; Subclavian Artery ; Systolic Murmurs ; Thorax ; Young Adult

We report here a case of pulmonary benign metastasizing leiomyoma from the uterus in a 45 year old woman. The patient presented for investigation of multiple pulmonary nodules on a routine chest roentgenogram. The patient had undergone uterine myomectomy due to uterine leiomyoma 10 years earlier. We performed thoracoscopic wedge resection for definitive diagnosis. Histologically, spindle shaped smooth muscle cells appeared between collagen stroma, histology similar to that seen in uterine myoma. The tumor tissue tested positive for estrogen and progesterone receptors. The pathological findings were consistent with benign metastasizing leiomyoma. The patient was in pre-menopause. She received no specific treatment for lung tumors, and we did not found any changes in the lesions after one year follow up without any medication.
Collagen ; Diagnosis ; Estrogens ; Female ; Follow-Up Studies ; Humans ; Leiomyoma* ; Lung ; Lung Neoplasms ; Middle Aged ; Multiple Pulmonary Nodules ; Myocytes, Smooth Muscle ; Neoplasm Metastasis ; Premenopause ; Receptors, Progesterone ; Thorax ; Uterine Myomectomy ; Uterus

BACKGROUND: The aim of this study was to investigate the health problems which women feel important and what they want to know from their doctors in the family practice clinics. METHODS: The subjects were all female patients who visited the family practice clinics at the four hospitals in which some members of the Study Group for Women's Health in Korean Academy of Family Medicine worked from December 10 to 15, 2001. We surveyed by self-administered questionnaire on important health topic, health care services they woud like to receive, what they expected from their doctors, what topics they have difficulty in discussing with, the doctors preference of physician's gender. We analyzed the results by age groups; 19~44, 45~64, and 65 years old and over. RESULTS: A total of 437 women answered the questionnaires, whose mean age was 49.4 year. Health topics that women felt important were osteoporosis, stress, cervical cancer, arthritis, and stroke, which varied with the age groups and recent health perception. The provision of health care services which they desired were in the order of treatment, prevention and health promotion, and diagnosis, which varied with the age groups and recent health perception. What they expected from their doctors were in the order of giving accurate diagnosis, explaining the treatment plan, and answering their questions. They had difficulty undergoing physical exam undressed, gynecological exam, and discussing on their sexual problems. CONCLUSION: Women who visited the family practice clinics felt differently on important health problems according to the age groups. Overall, they wanted to receive health services on the treatment, prevention and health promotion of osteoporosis, stress, cervical cancer, and arthritis.
Aged ; Arthritis ; Attitude to Health ; Delivery of Health Care ; Diagnosis ; Family Practice ; Female ; Gynecological Examination ; Health Promotion ; Health Services ; Humans ; Osteoporosis ; Patient Education as Topic ; Stroke ; Uterine Cervical Neoplasms ; Women's Health ; Surveys and Questionnaires

BACKGROUND: The presence of infiltrated mediastinal lymph nodes is a crucial factor for the prognosis of lung cancer. The aim of our study is to investigate the pattern of metastatic non-small cell lung cancer that spreads to the mediastinal lymph nodes, in relation to the primary tumor site, in patients who underwent major lung resection with complete mediastinal lymph node dissection. MATERIAL AND METHOD: We retrospectively studies 293 consecutive patients [mean age 63.0+/-8.3 years (range 37~88) and 220 males (75.1%)] who underwent major lung resection due to non-small cell lung cancer from January 1998 to December 2005. The primary tumor and lymph node status was classified according to the international TNM staging system reported by Mountain. The histologic type of the tumors was determined according to the WHO classification. Fisher's exact test was used; otherwise the chi-square test of independence was employed. A p-value <0.05 was considered significant. RESULT: Lobectomy was carried out in 180 patients, bilobectomy in 50, sleeve lobectomy in 10 and pnemonectomy in 53. The pathologic report revealed 124 adenocarcinomas, 138 squamous-cell tumors, 14 adenosquamous tumors, 1 carcinoid tumor, 8 large cell carcinomas, 1 carcinosarcoma, 2 mucoepidermoid carcinomas and 5 undifferentiated tumors. The TNM stage was IA in 51 patients, IB in 98, IIB in 41, IIIA in 71, IIIB in 61 and IV in 6. 25.9 % of the 79 patients had N2 tumor. Most common infiltrated mediastinal lymph node was level No.4 in the right upper lobe, level No. 4 and 5 in the left upper lobe and level No. 7 in the other lobes, but no statistically significant difference was observed. Thirty-six patients (12.3%) presented with skip metastasis to the mediastinum. CONCLUSION: Mediastinal lymph node dissection is necessary for accurately determining the pTNM stage. It seems that there is no definite way that non-small cell lung cancer spreads to the lymphatics, in relation to the location of the primary cancer. Further, skip metastasis to the mediastinal lymph nodes was present in 12.3% of our patients.
Adenocarcinoma ; Carcinoid Tumor ; Carcinoma, Large Cell ; Carcinoma, Mucoepidermoid ; Carcinoma, Non-Small-Cell Lung ; Carcinosarcoma ; Humans ; Lung ; Lung Neoplasms ; Lymph Node Excision ; Lymph Nodes ; Lymphatic Metastasis ; Male ; Mediastinum ; Neoplasm Metastasis ; Neoplasm Staging ; Prognosis ; Retrospective Studies