BACKGROUND AND PURPOSE: Upper respiratory infection (URI), including influenza, may exacerbate the symptoms of myasthenia gravis (MG), which is an autoimmune disease that causes muscle weakness. There is also concern that the influenza vaccine may trigger or worsen autoimmune diseases. The objective of this study was to determine the impacts of influenza infection and vaccination on symptom severity in MG patients. METHODS: Patients diagnosed with MG were enrolled from 10 university-affiliated hospitals between March and August 2015. Subjects completed a questionnaire at the first routine follow-up visit after enrolling in the study. The patient history was obtained to determine whether a URI had been experienced during the previous winter, if an influenza vaccination had been administered before the previous winter, and whether their MG symptoms were exacerbated during or following either a URI or vaccination. Influenza-like illness (ILI) was defined and differentiated from the common cold as a fever of ≥38℃ accompanied by a cough and/or a sore throat. RESULTS: Of the 258 enrolled patients [aged 54.1±15.2 years (mean±SD), 112 men, and 185 with generalized MG], 133 (51.6%) had received an influenza vaccination and 121 (46.9%) had experienced a common cold (96 patients) or ILI (25 patients) during the analysis period. MG symptoms were aggravated in 10 (40%) patients after ILI, whereas only 2 (1.5%) experienced aggravation following influenza vaccination. The rate of symptom aggravation was significantly higher in patients experiencing an ILI (10/25, 40%) than in those with the common cold (15/96, 15.6%, p=0.006). CONCLUSIONS: The results of this study suggest that the potential risk of aggravating autoimmune disease is higher for ILI than for influenza vaccination, which further suggests that influenza vaccination can be offered to patients with MG.
Autoimmune Diseases ; Common Cold ; Cough ; Fever ; Follow-Up Studies ; Humans ; Influenza Vaccines ; Influenza, Human* ; Male ; Muscle Weakness ; Myasthenia Gravis* ; Pharyngitis ; Vaccination*

Bronchiolitis obliterans (BO) or bronchiolitis obliterans organizing pneumonia (BOOP) is one of manifestations of graft-versus-host disease (GVHD), a complication of hematopoietic stem cell transplantation (HSCT). Recently there are reports about thoracic air-leakage syndrome (TALS), but real incidence, clinical course, and implications of TALS remain unclear. Retrospective review of 18 TALS patients among 2,177 patients who received allogeneic HSCT between January 2000 to July 2007 was done. Clinical manifestations, treatments, and outcomes of TALS were reviewed. The incidence of TALS was 0.83% (18/2,177). The onset of TALS was mean 425.9+/-417.8 days (60-1,825 days) after HSCT, and the duration was mean 16.3+/-21 days (2-90 days). The most common types of TALS were spontaneous pneumothroax (n=14), followed by subcutaneous emphysema (n=6), pneumomediastinum (n=5), interstitial emphysema (n=2), and pneumopericardium (n=1). TALS persisted in six patients, who died during the same hospitalization. The 12 patients recovered from TALS, but only 2 survived, while others died due to aggravation of GVHD. TALS may complicate BO/BOOP and be an initial manifestation of BO/BOOP. TALS is hard to be resolved, and even after the recovery, patients die because of aggravation of GVHD. We suggest specifically in HSCT patients, when once developed, TALS seems hard to be cured, and as a result, be related to high fatality.
Adolescent ; Adult ; Comorbidity ; Female ; Graft vs Host Disease/*mortality/*surgery ; Hematopoietic Stem Cell Transplantation/*mortality ; Hemothorax/*mortality ; Humans ; Incidence ; Korea ; Male ; Middle Aged ; Pneumothorax/*mortality ; Prognosis ; Risk Assessment ; Risk Factors ; Survival Analysis ; Survival Rate ; Syndrome ; Treatment Outcome ; Young Adult

OBJECTIVE: The purpose of this study was to determine the perinatal outcome in monoamniotic twin pregnancies and to review the recently published literature about the topic. METHODS: This retrospective study examined the records of prenatally diagnosed monoamniotic twin pregnancy casese in our institution between January 1997 and April 2010. RESULTS: Among 1,112 twin pregnancies, there were 15 (1.3%) monoamnionic twins, including 2 conjoined twin pregnancies. Twelve (80%), 9 (60%), 5 (33.3%), and 4 pregnancies (26.7%) delivered after 20, 30, 32, and 34 weeks, respectively. Among 12 pregnancies that continued after 20 weeks of gestation, three cases showed one-fetal death and one, both-fetal death. The perinatal mortality rate (from 20 weeks of gestation to 28 days after birth) was 37.5%. The incidence of lethal anomalies and congenital heart anomalies was 20% and 23.3%, respectively. The mean gestational age at delivery was 31.4+/-4.53 weeks; 16 of 18 neonates (84.2%) were admitted to the neonatal intensive care unit (NICU). Three neonates expired on the first day after birth. The mean duration of the NICU stays for 13 live neonates was 32.0+/-29.3 days (range, 3 to 114 days). The main causes of perinatal deaths were preterm birth, congenital anomalies, pregnancy loss before 20 weeks, and intrauterine fetal demise that might have resulted form cord entanglement. CONCLUSION: Perinatal mortality in monoamniotic twins was still very high and the survival rate after 32 weeks of gestation is approximately one-third. Further studies are needed to improve the perinatal mortality.
Gestational Age ; Heart ; Humans ; Incidence ; Infant, Newborn ; Intensive Care, Neonatal ; Parturition ; Perinatal Mortality ; Pregnancy ; Pregnancy, Twin ; Premature Birth ; Retrospective Studies ; Survival Rate ; Twins ; Twins, Conjoined

BACKGROUND: Tracheal reconstruction after extended tracheal resection still remains as a major surgical challenge because good clinical outcomes are usually correlated with limited tracheal resection. Recent investigations with a using cryopreserved trachea for the reconstruction of a trachea have been carried out to overcome this problem. In this study, we analyzed viability of tracheas, which is an important determining factor for the success of transplanting a cryopreserved trachea and the development of post-transplantation tracheal stenosis, according to three different experimental factors: 1) the warm-ischemic time, 2) the cryopreservation solution and 3) the preserving temperature, to determine a better cryopreservation protocol and a better composition of the cryopreservation solution. MATERIAL AND METHOD: Rats tracheas were harvested for different warm-ischemic times (0 hr, 12 hrs, 24 hrs). The tracheas were treated with recombinant insulin growth factor-1 (IGF-1) and they were stored at three different temperatures (4 degreesC, -80 degreesC, -196 degreesC) for two weeks. After two weeks, we thawed the stored trachea and isolated the cells of the tracheas with using type II collagenase. We cultured the cells for seven days and then we compared the cellular viability by the MTT reduction assay. RESULT: Though cryopreservation is required to preserve a trachea for a longer time period, the viability of the tracheas stored at -80 degreesC and -196 degreesC was significantly reduced compared to that of the tracheas stored at 4 degreesC. The viability of the tracheas with warm-ischemic times of 12 hrs and 24 hrs was also reduced in comparison to the tracheas with a warm-ischemic time of 0 hrs.Department of Thoracic and Cardiovascular Surgery, St. Mary's Hospital, The Catholic University of Korea College of Medicine Our data showed that the warm ischemic time and the parameters of cryopreservation negatively affect on trachea viability. However, a cryopresrvation solution containing IGF-1 improved the cellular viability better than the existing cryopreservation solution. For the warm ischemic time group of 0 hr, the addition of IGF-1 improved the viability of trachea at all the preserving temperatures. CONCLUSION: These experiments demonstrate that the viability of a cryopreserved trachea can be improved by modifying the components of the cryopreservation solution with the addition of IGF-1 and reducing the warm-ischemic time.
Animals ; Collagenases ; Cryopreservation ; Insulin ; Insulin-Like Growth Factor I ; Korea ; Rats ; Trachea ; Tracheal Stenosis ; Transplants ; Warm Ischemia

Jejunum and fasciocutaneous and myocutaneous flaps are theoretically recommended as esophageal substitutes in reconstruction of the esophagus after several occurrences of failed reconstruction. However, other esophageal substitutes should also be considered. Secondary esophageal reconstruction was successfully performed on a 24-year- old woman who had a history of cervical, thoracic, and abdominal operations and esophageal stricture secondary to several failed reconstructions for esophageal atresia and tracheo-esophageal fistula 21 years prior. The esophageal reconstruction was done subcutaneously by end-to-side anastomosis at the left cervical area using a deformed stomach graft. The patient was discharged with the ability to consume a regular diet after the operation.
Diet ; Esophageal Atresia ; Esophageal Stenosis ; Esophagus ; Female ; Fistula ; Humans ; Reoperation ; Stomach ; Transplants

Benign metastasizing leiomyoma is a rare disease that histologically shows features of a benign tumor; however it can metastasize to the lung or other organs. We report here on a case of a 53-year-old woman with benign metastasizing leiomyoma, and she was admitted to the hospital with symptoms of coughing for 2 months; she showed multiple diffuse nodular opacities of both lungs on a chest radiograph. She had undergone hysterectomy for leiomyoma of the uterus 13 years previously. Thoracoscopic lung biopsy was performed to rule out metastatic lung cancer. The pulmonary nodules appeared benign with a very low mitotic rate and they consisted of smooth muscle cells. The pathologic findings of the pulmonary nodules were consistent with benign metastasizing leiomyoma. The patient has been followed up closely without any specific therapy.
Biopsy ; Cough ; Female ; Humans ; Hysterectomy ; Leiomyoma ; Lung ; Lung Neoplasms ; Middle Aged ; Myocytes, Smooth Muscle ; Neoplasm Metastasis ; Rare Diseases ; Thorax ; Uterus

BACKGROUND: Cervical epidural injection, performed via the interlaminar approach, represents a useful interventional pain management procedure indicated in patients with a cervical herniated disk. Due to thedecreased epidural space in the cervical region, cervical epidural injections may result in potentially serious complications, especially during a large volume injection. METHODS: Thirty-four patients with neck pain due to a cervical herniated disk that were referred to the pain clinic for cervical epidural steroid injection were randomized into two groups. One group received a cervical epidural injection of 4 ml drug and the other group received 2 ml drug. The injected mixture included triamcinolon, ropivacaine and omnipaque. Spread levels of the drug after injection were estimated with the use of C-arm fluoroscopy. RESULTS: Spread levels to the cephalad for patients in the two groups were 4.88 +/- 0.78 segments and 4.53 +/- 0.49 segments, respectively. Spread levels to the caudad for patients in the two groups were 4.59 +/- 0.93 segments and 4.47 +/- 0.51 segments, respectively. The results showed no significant difference in the spread level between the two groups. CONCLUSIONS: Use of a small volume of drug (2 ml) can provide a sufficient spread level of the injected drug that is desirable for patients with a cervical herniated disk.
Epidural Space ; Fluoroscopy ; Humans ; Injections, Epidural ; Intervertebral Disc Displacement ; Iohexol ; Neck Pain ; Pain Clinics ; Pain Management

Pericardial cysts are uncommon benign congenital mediastinal lesions and they are most often found in either cardiophrenic angle. We present here one case of atypically located pericardial cyst that was located in the subpulmonary region. The clinicians should take into consideration this entity in the differential diagnosis of cystic lesion of the mediastinum. The diagnostic difficulties that are encountered and the utility of video-assisted thoracoscopy are described.
Diagnosis, Differential ; Mediastinal Cyst* ; Mediastinum ; Pericardium ; Thoracoscopy

BACKGROUND: Recent progress in the surgical therapy for lung cancer is one of the best examples of the successful evolution of clinical medicine. We reviewed our experience to evaluate the surgical outcomes in patients with non-small cell lung cancer. MATERIAL AND METHOD: We reviewed clinical records of 432 consecutive patients with proven non-small cell lung cancer who underwent complete removal of the primary tumor together with hilar and mediastinal lymph nodes from 1995 to 2005. The clinical characteristics, surgical methods, and recurrence patterns were analyzed. RESULT: Lobectomy was the most common procedure (66.7%) performed and sleeve lobectomy was the least (5.6%). In 179 patients (42.6%) the recurrence was noted and the regional recurrence (67 cases, 16.0%) was less than systemic recurrence (112 cases, 26.7%). The main sites of regional recurrence were hilum (25 cases, 37.3%) and ipsilateral mediastinum (17 cases, 25.4%). The hospital mortality rate was 2.8% (12/432 cases) and resection-morbidity rate was 12.5% (54/432 cases). CONCLUSION: The low recurrence rate, especially regional recurrence rate indicated that our surgical procedures with preoperative measures were considered useful and effective.
Carcinoma, Non-Small-Cell Lung* ; Clinical Medicine ; Hospital Mortality ; Humans ; Lung Neoplasms ; Lymph Nodes ; Mediastinum ; Recurrence

BACKGROUND: Invasive pulmonary aspergillosis, a frequent fungal infection in immunocompromised patients, is known to have a poor prognosis despite the use of antifungal therapy in leukemic patients. We studied the outcome of surgical resection of invasive pulmonary aspergillosis where bleeding tendency, localized recurrence of infection, and incidence could be reduced. MATERIAL AND METHOD: We retrospectively reviewed 14 patients with a hematological malignancy where invasive pulmonary aspergillosis was diagnosed during the 10 years between 1998 and 2007. From the medical records, we reviewed the type and treatment of the hematological malignancy, including the diagnostic methods of invasive pulmonary aspergillosis, the preoperative hematological conditions and their management, and the surgical methods and records. We also analyzed the development of postoperative complications and patient mortality, the recurrence of postoperative invasive pulmonary aspergillosis, and if the patients had a bone marrow transplant. RESULT: Fourteen patients with invasive pulmonary aspergillosis and a hematological malignancy underwent a pulmonary lobectomy. One patient had a complication of bronchopleural fistula, but there were no other serious complications such as bleeding or wound infection, and none of the patients died postoperatively. CONCLUSION: We have shown that pulmonary lobectomy is a safe and effective therapy for invasive pulmonary aspergillosis in patients with hematological malignancies that allow further treatment of the hematological malignancy.
Bone Marrow ; Fistula ; Hematologic Diseases ; Hematologic Neoplasms* ; Hemorrhage ; Humans ; Immunocompromised Host ; Incidence ; Invasive Pulmonary Aspergillosis* ; Medical Records ; Mortality ; Postoperative Complications ; Prognosis ; Pulmonary Aspergillosis ; Recurrence ; Retrospective Studies ; Wound Infection