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A ventricular septal defect is, almost always, an integral part of double outlet right ventricle and has been classified into the subaortic, subpulmonary, doubly committed and non-committed varieties. This study was performed to correlate the cross-sectional imaging characteristics of such ventricular septal defect in double outlet right ventricles using pathological specimens. The extent and the orientation of the outlet septum were the most important in the differentiation of the four varieties of ventricular septal defect. In the subaortic variety, the outlet septum fused with the left anterior margin of the defect, this being marked by the anterior limb of the septomarginal trabeculation. In the subpulmonary variety, the outlet septum fused with the right posterior margin of the defect, this being the posterior limb of the septomarginal trabeculation. The outlet septum was vestigial in case with doubly committed defects. In those with non-committed defects, the defect was not shown in those images or sections which demonstrated the outlet septum.

Objective. The objective of this study was to present a case of trigger point injection-related pneumothorax treated by computed tomography (CT)-guided needle aspiration. Design. Case report. Setting. The study was set in a community hospital practice. Patient. The study consisted of a singlecase. Intervention. The intervention used for the study was CT-guided needle aspiration of the pneumothorax. Results. The result of the study was the successful evacuation of the pneumothorax and lung expansion. Conclusion. CT-guided needle aspiration is a viable management option for symptomatic patients with iatrogenic pneumothorax.

‘Putting Evidence-Based Practice into Action: EBP Journal Clubs’ was the theme of one of the workshops at the recent 10th International Congress on Medical Librarianship held in Brisbane, Australia. The workshop's focus was the role of librarians in providing a non-threatening environment that would encourage clinicians to make evidence-based practice (EBP) a core part …

To apply the Osteoarthritis Research Society International (OARSI) assessment system to an osteoarthritis model, 44 Wistar rats were randomized into treadmill-running exercise or control group. At 6, 8, and 10 weeks, medial knee joints were histopathologically evaluated, and aggrecan neoepitope and TUNEL staining were performed. Cartilage changes in exercise group were histopathologically and histochemically compatible with early OA. Total modified Mankin system (MMS) scores were significantly higher at all time points (each P ≤ 0.01) in exercise than in control group. However, only tibial OARSI scores of runners were higher at 10 weeks (P

In this paper we proposes an efficient feedback scheme using compressive sensing (CS) for MIMO broadcast channel(BC) with random beamforming(RBF). Feedback resources are opportunististically accessed by strong users whose SINR is larger than threshold. Strong users transmit same feedback information on feedback channel and they are indentified by BS using CS. There is reduction of the feedback overhead via CS. Besides, we can achieve sum-rate throughput as full feedback. To exploit CS, feedback signal must be sparse. However, because there exist a trade-off between the sparsity and multiplexing gain, we must know how to decide K-sparsity and threshold. Therefore, we drive relation between K-spasity and threshold. These are suitable to ‘actual’ BC feedback channel with CS.

The morphological variation in the recognized landmarks for the atrioventricular conduction system was studied grossly in 94 hearts with atrioventricular septal defect, assessing 20 hearts with normal atrioventricular septation as a control. In all the hearts with intact atrioventricular septal structures, the tendon of Todaro demarcated the superior boundary of the triangle of Koch. In hearts with atrioventricular septal defect, however, the landmarks for the conduction axis made up a separate nodal triangle. The tendon of Todaro, along with a bridging tendon not found in the normal heart, were variably developed in hearts with atrioventricular septal defect and formed a further triangle unrelated to the axis for atrioventricular conduction. The opening of the coronary sinus was also variable in its location and size. It was the location of the inferior bridging leaflet as it crossed the ventricular septum that was the best surgical landmark to the site of penetration of the atrioventricular conduction axis.

SummaryThe arterial supply to the lungs in cases with tetralogy of Fallot with pulmonary atresia or critical pulmonary stenosis is mostly via the arterial duct or else by collateral arteries arising directly or indirectly from the aorta. Nine anatomical specimens with collateral arteries were studied by blunt dissection to determine the arterial supply to each pulmonary segment. The precise supply varied from case to case but, overall, nearly two-thirds of the pulmonary segments were connected to the central pulmonary arteries. A quarter were supplied exclusively by systemic-to-pulmonary collateral arteries, with the remainder having a dual supply. Coexistence of ductal connections and systemic-to-pulmonary collateral arteries was seen in one case. Anastomoses between vessels of different origins were observed up to the segmental level in eight of the nine cases. In four cases, the anastomoses formed arterial rings. The extent of pulmonary parenchyma supplied by arteries from different sources and the presence of arterial anastomoses in these malformations have implications on the planning of surgical repair.

Diffuse panbronchiolitis (DPB), which is prevalent in Japan, is known to be rare outside Japan. Although a case of diffuse panbronchiolitis in a second generation Korean was reported in Japan in 1986, no case has been reported in Korea. Recently we found 5 cases of diffuse panbronchiolitis in Korea, two histologically proven and three clinically and radiologically suspected. All 5 cases had the typical respiratory symptoms and signs and a history of chronic sinusitis. In three clinically and radiologically suspected cases, high resolution computed tomography showed the typical findings of DPB and other diseases such as pulmonary emphysema, bronchial asthma, chronic bronchitis and bronchiectasis could be ruled out. More cases of DPB are expected to be found in Korea in the near future.(Internal Medicine 31 : 695-701, 1992)

This paper investigates the simulation performances of vehicle-to-anything (V2X) communications based on the IEEE 802.11p wireless access in vehicular environments (WAVE) system in practical small-scale fading models. The main contributions of this paper are as follows. First, we modify the experimental fading models reported by Georgia Institute of Technology to be applied to the computer simulation of V2X communications. Second, an enhanced linear minimum mean square error smoothing-aided decision directed (LSA-DD) channel estimator is proposed to track the time variation of fading channels and mitigate noise enhancement.

Fluorescence in situ hybridization (FISH) has been known to be the most representative and standardized test for assessing gene amplification. However, FISH requires a fluorescence microscope, the signals are labile and rapidly fade over time. Recently, chromogenic in situ hybridization (CISH) has emerged as a potential alternative to FISH. The aim of this study is to test the reliability of CISH technique for the detection of epidermal growth factor receptor (EGFR) gene amplification in non-small-cell lung carcinomas (NSCLC), to compare CISH results with FISH. A total of 277 formalin-fixed and paraffin embedded NSCLC tissue samples were retrieved from the surgical pathology archives at Seoul National University Bundang Hospital. CISH and FISH examinations were performed to test EGFR gene amplification status. There was high concordance in the assessment of EGFR gene copy number between CISH and FISH tests (Kappa coefficient = 0.83). Excellent concordance was shown between two observers on the interpretation of the CISH results (Kappa coefficient = 0.90). In conclusion, CISH result is highly reproducible, accurate and practical method to determine EGFR gene amplification in NSCLC. In addition, CISH allows a concurrent analysis of histological features of the tumors and gene copy numbers.

Impregnation of thermoplastic resin into continuous unidirectional fiber tows was investigated. A power-law was employed to describe the effect of the shear rate on the viscosity of the molten resin. The effect of the impregnation pressure on the permeability of the fiber tow was also taken into consideration. The degree of impregnation was defined as the ratio between the number of impregnated fibers and the total number of fibers of a tow. A model was developed to describe the degree of impregnation as a function of time, pressure, temperature and tow size. The radial inward flow of resin through the fiber tow was assumed to be a flow through porous media and thus governed by Darcy's law. Experiments were performed to evaluate the validity of the model for different impregnation conditions such as impregnation time, pressure, temperature and tow size. From microphotographs of the cross-sections of the samples obtained from the experiments, the degree of impregnation was measured. Good agreement was found between the model and the experimental data.

We studied the postmortem vascular anatomy of four patients with total anomalous pulmonary venous connection (TAPVC) with obstruction using a silicone rubber casting method. Two patients were studied clinically but died before therapeutic intervention, one died after corrective surgery, and another was not diagnosed before death. The morphologic types were supracardiac (2), infracardiac (1), and mixed (1). One of the supracardiac forms had a stenosis at the left vertical vein by a bronchoarterial vise, and a collateral channel to the right superior caval vein was also present. In the other supracardiac case, a left upper pulmonary vein was connected to the left vertical vein above the stenotic portion, resulting in postoperative pulmonary hemorrhage into the left upper lobe. The patient with infracardiac TAPVC had a tree-shaped descending vertical vein and small opening at the inferior caval vein. In the mixed type, a right upper pulmonary vein ran between the pulmonary artery and bronchus draining into the superior caval vein, and the rest of the drainage was to the portal vein.

Mucous gland adenoma of the bronchus is a truly benign, well defined, intraluminal mass that manifests on CT with air-meniscus sign or abutting the bronchus. We report the CT findings of mucous gland adenoma in two patients.

This paper proposes an linear minimum mean square error (LMMSE) channel estimator with maximum ratio combining-based decision directed (MRC-DD) technique to increase spectral efficiency in orthogonal frequency division multiplexing (OFDM) transmit diversity. For Alamouti's transmit diversity, pilot symbols are exclusively allocated in two OFDM symbols on different antennas. This results in serious degradation of spectral efficiency. The proposed subcarrier allocation scheme uses repetition-coded data symbols to reduce the number of pilot symbols. The proposed channel estimator consists of an MRC-DD channel estimator and an LMMSE channel estimator. The MRC-DD channel estimator performs a two-step estimation procedure to obtain more accurate CFR estimates at the repetition-coded data locations: the first coarse LMMSE step and the second fine DD step. Then, the final LMMSE channel estimator gives the CFR estimates at the Alamouti-coded data locations. Simulation results show that the proposed channel estimator provides as good bit error rate performance as the conventional LMMSE channel estimator using more pilot symbols, whereas it improves spectral efficiency more than the conventional one.

Diffuse alveolar septal involvement is a rare form of pulmonary amyloidosis. Ante-mortem diagnosis is unusual, and most of the reported cases were diagnosed at autopsy. It has recently been reported that transbronchial lung biopsy via a flexible fiberoptic bronchoscope was a relatively safe method to confirm diffuse alveolar septal amyloidosis. We report a case of pulmonary diffuse alveolar septal amyloidosis confirmed by transbronchial lung biopsy. The patient’s chief complaints were dyspnea on exertion and epigastric pain aggravated over a one-year period, while a chest roentgenogram showed bilateral diffuse interstitial infiltration. This case also showed nephrotic syndrome, cardiac arrhythmia, congestive heart failure, a tingling sensation in both hands and multiple nodules in the gastrointestinal tracts, suggesting involvement of the kidney, heart, peripheral nerves and gastrointestinal tracts. We propose that when diffuse interstitial lung disease is present with systemic signs such as nephrotic syndrome or cardiac arrhythmia, amyloidosis should be considered as a possible diagnosis. Also, transbronchial lung biopsy may be a useful confirmative diagnostic tool.

Summary Background Recently, the demand for intraoperative pathology consultation for small pulmonary nodules including ground-glass opacity (GGO) has been increasing. Evaluation of minute precancerous lesions of the lung by frozen section is very difficult for the pathologist as uninflated lung tissue usually shows severe atelectasis and frozen artifact. We tried to inflate lung tissue with the embedding medium used for frozen section and to determine the appropriate dilution ratio of the embedding medium for optimization of frozen section morphology. Methods The lung specimens were derived from 10 patients who underwent video-assisted thoracoscopic surgery (VATS) due to pneumothorax (four patients) and GGO (six patients) detected on high-resolution computed tomography (HRCT) at Seoul National University Bundang Hospital. The pneumothorax specimens were divided into six groups—uninflated, inflated with saline, and inflated with embedding medium (not diluted, 1:1, 2:1 and 2:3). The qualities of the frozen sections were compared with corresponding permanent paraffin sections. Lung specimens obtained from the six people with GGO detected on HRCT were submitted for intraoperative pathology consultation. Frozen sections were made after inflation with optimally diluted embedding medium determined by the above experiment with pneumothorax specimens, and the frozen section diagnoses (FSD) were compared with the final pathologic diagnoses of corresponding permanent paraffin sections. Results The frozen section quality of lung tissue was excellent after simple inflation with diluted embedding medium (2:3). Minute precancerous foci such as atypical adenomatous hyperplasia (AAH) and bronchioloalveolar carcinoma (BAC) could be readily identified in frozen sections using this method. Of the six patients with solitary GGO, four were diagnosed as BAC, nonmucinous type and two were as AAH on the frozen sections. Intraoperative FSD corresponded well with final diagnoses obtained with paraffin sections. Conclusions An inflation procedure using diluted embedding medium can make lung tissue expand well during frozen section. Minute and even nonpalpable GGO lesions could be detected more easily by this technique in frozen sections, which would be helpful in determining how extensive a surgical procedure needs to be. Application of this procedure appears to improve the accuracy of FSD of minute precancerous pulmonary nodules.

In this paper, an enhanced time-domain cancellation method is proposed for inter-carrier interference (ICI) reduction in OFDM systems. The conventional time-domain cancellation does not work well in deep fades. In order to supplement the conventional method, the simple repetition (de-)coding and the modulation order increasing are employed in the time-domain cancellation. The approximated repetition decoding provides reliable symbols in the regeneration operation, and the increased modulation order maintains the spectral efficiency. Simulation results indicate that the proposed method using 16QAM significantly improves the BER performance compared to the conventional method using QPSK, while maintains the spectral efficiency. Moreover, the proposed method using 64QAM concurrently improves both the BER performance and the spectral efficiency.

This study was performed to evaluate the clinical feasibility of use of immunologically nontreated xenogenic valves, using a porcine-to-goat pulmonary valved conduit implantation model. Porcine pulmonary valve conduits were prepared with no specific immunological treatment and implanted in the right ventricular outflow tract of goats under cardiopulmonary bypass. The goats were assigned at predetermined intervals (1 day, 1 week, and 3, 6, and 12 months) as two animals for each interval. Echocardiographic examinations of the valves were performed before sacrifice. Upon retrieving the xenograft specimens, they were inspected visually and microscopically. Ten of the 12 animals survived the predetermined observation periods. Variable degrees of pulmonary regurgitation were the main findings on echocardiographic evaluations. On gross examination of the explanted specimens, all leaflets, except in one animal that prematurely died, were fairly well preserved. They were slightly shortened but free of thrombosis or vegetation. Aneurysmal dilatations of the anterior wall of the implanted pulmonary artery were observed in one of 12-month-survival animals and in another one of 3-month-survival animals. Microscopically, the three components of implanted xenografts (the pulmonary artery, valve, and infundibulum) were shown to be gradually replaced with host cells in time, while maintaining structural integrity. The nuclei of the donor tissue disappeared through pyknosis and karyolysis. In conclusion, immnunologically untreated xenogenic pulmonary valved conduits can be an alternative potential as valve substitutes with distinctive advantages of providing self-healing potential, despite a few problems observed in the current study such as occurrences of pulmonary regurgitation and sporadic cases of aortic aneurysm.

The study was conducted to assess needs on the functionalities of an electronic health record (EHR) system and to determine the difference of needs among MR administrators' groups and expert groups in Korea.

Increased epidermal growth factor receptor (EGFR) gene copy numbers and mutations predict sensitivity to EGFR tyrosine kinase inhibitor in non-small cell lung cancer (NSCLC). However, the clinicopathologic features of EGFR gene copy status in NSCLC remain unclear. We retrospectively analyzed 262 cases of NSCLC, including 135 squamous cell carcinomas (SCC) and 112 adenocarcinomas (ADC), for which paraffin blocks of the resected primary lung mass were available. None had received EGFR-targeted therapy. EGFR gene copy number was evaluated using fluorescence in situ hybridization (FISH), and EGFR expression was determined immunohistochemically using a tissue microarray. A high EGFR gene copy (EGFR FISH-positive) was found in 30.2% of the cases (amplification in 11.1% and high polysomy in 19.1%). There was no significant difference in EGFR FISH status with respect to SCC and ADC histology. The EGFR FISH-positive rate was higher in non-smokers than in smokers in the multivariate analysis (p=0.012). EGFR expression was significantly associated with a high EGFR gene copy and SCC histology (p=0.000). In the univariate survival analysis, EGFR FISH-positivity predicted worse survival in SCC (p=0.059), especially stage I SCC (p=0.04). EGFR amplification was associated with a shorter survival in node-positive SCC (p=0.015). However, the EGFR gene copy number or protein expression had no influence on the prognosis of ADC. In conclusion, the EGFR FISH-positive rate in Korean patients with NSCLC was similar to rates in Western populations, unlike the higher frequencies of EGFR mutation in East Asians. A high EGFR gene copy number was significantly more common in non-smokers, as were EGFR mutations. A high EGFR gene copy number predicted worse survival in SCC; therefore, the prognostic implications of the EGFR gene and protein should be analyzed in the context of histology and staging in NSCLC.

This paper proposes an improved discrete Fourier transform-based and pilot-symbol-aided channel estimation (DFT-based PSA CE) for coherent orthogonal frequency division multiplexing (OFDM) systems. Conventional DFT-based PSA CE suffers from the dispersive distortion of an estimated channel impulse response (CIR) caused by virtual carriers. The proposed method estimates an equal-spaced channel frequency response (CFR) in a virtual carrier region by using forward and backward linear prediction (FBLP). Simulation results show that the proposed method outperforms the conventional one with slightly increased complexity and provides a performance similar to the frequency domain linear minimum mean square error (LMMSE) channel estimation with significantly reduced complexity.

A time-varying multipath channel causes co-channel interference (CCI) as well as inter-carrier interference (ICI) in a space-time block coded orthogonal frequency-division multiplexing (STBC-OFDM) system using two transmit antennas and an conventional simplified decoding scheme (SDS). In this paper, we derive the power of the CCI as a function of normalized channel variation rate. Also, we propose a successive interference cancellation (SIC) technique to improve the performance of the STBC-OFDM by considering the CCI mechanism. The proposed SIC technique can compensate the CCI to some extend with slightly increased complexity compared to the SDS.

In this paper, we present the results of Plasma Enhanced Chemical Vapor Deposition gate oxide (SiO2) integrity on ELC (excimer laser crystallized), MILC (metal induced lateral crystallized) and SPC (solid phase crystallized) polysilicon films. We observed that gate oxide strength of poly Si TFT strongly depends on the crystallization method for the active silicon layer. In the case of ELC films, asperities on the silicon surface reduce the SiO2 breakdown field significantly. The metallic contaminants in MILC films are responsible for a deleterious impact on gate oxide integrity. Among the three cases, the SiO2 breakdown field was the highest for the SPC silicon films. The breakdown fields at the 50% failure points in Weibull plots for the ELC, MILC and SPC cases were 5.1MV/cm, 6.2MV/cm, 8.1MV/cm, respectively. We conclude that the roughness and metallic contamination of the poly Si films are the main factors that cause en-hanced breakdown of SiO2 films.

Degradation of speech quality caused by packet loss of voice traffic is still one of critical technical barriers of the VoIP system. We propose a new VoIP system that can adapt transmission bit rate flexibly to network conditions to reduce packet loss. In order to determine the transmission bit rate depending upon the network conditions on a frame basis, we use the time-stamp parameter in the RTP of the H.323 protocol. Experimental results demonstrate that the proposed system is very promising to reduce packet loss that leads to improvement of speech quality.

Pituitary adenoma (PA) is a common benign neuroendocrine tumor; however, the incidence and proportion of hormone-producing PAs in Korean patients remain unknown. Authors analyzed 506 surgically resected and pathologically proven pituitary lesions of the Seoul National University Hospital from 2006 to 2011. The lesions were categorized as: PAs (n = 422, 83.4%), Rathke's cleft cysts (RCCs) (n = 54, 10.6%), inflammatory lesions (n = 8, 1.6%), meningiomas (n = 4), craniopharyngiomas (n = 4), granular cell tumors (n = 1), metastatic renal cell carcinomas (n = 2), germinomas (n = 1), ependymomas (n = 1), and unsatisfactory specimens (n = 9, 1.8%). PAs were slightly more prevalent in women (M: F = 1:1.17) with a mean age of 48.8 yr (9-80 yr). Immunohistochemical analysis revealed that prolactin-producing PAs (16.6%) and growth hormone-producing adenomas (9.2%) were the most common functional PAs. Plurihormonal PAs and nonfunctioning (null cell) adenomas were found in 14.9% and 42.4% of patients with PAs, respectively. The recurrence rate of PAs was 11.1%, but nearly 0% for the remaining benign lesions such as RCCs. 25.4% of patients with PAs were treated by gamma-knife after surgery due to residual tumors or regrowth of residual tumor. In conclusion, the pituitary lesions and the proportions of hormone-producing PAs in Korean patients are similar to those of previous reports except nonfunctioning (null cell) PAs, which are unusually frequent. Graphical Abstract

An experiment to study the role of contact-activation leukocyte sequestration in the formation of ischaemia-reperfusion injury (I-R injury) was carried out. The study was conducted using light and electron microscopic analyses in an ovine cardiopulmonary bypass (CPB) model using a membrane oxygenator. Five adult sheep were used in the study. The CPB circuitry consisted of a roller pump and a membrane oxygenator. During CPB, flow rates ranged from 50 to 60 ml/kg/min with mild hypothermia. The CPB time was fixed at 120 min. Ten minutes after the start of CPB, total CPB was established. Thereafter, total CPB was performed for 100 min, followed by another 10 min of partial CPB. Lung biopsy specimens for light and electron microscopy were obtained from the upper lobe of the right lung before CPB, 109 min after the start of CPB (just before reperfusion) and 30 min after weaning (after reperfusion). A portion of the lung biopsy specimen was taken for a water content measurement at the same time intervals. For measuring the left and right atrial leukocyte counts, blood samples were taken before thoracotomy, 5 and 109 min after the start of CPB, and 30 and 120 min after weaning. C3a was measured before thoracotomy, 109 min after the start of CPB, and 30 and 120 min after weaning. Plasma malondialdehyde (MDA) was checked before thoracotomy, 109 min after the start of CPB and 30 min after weaning. On both light and electron microscopic examination, mild to moderate acute lung change was observed after ischaemia-reperfusion. Interstitial oedema, leakage of erythrocytes into the alveolar space and endothelial cell swelling were the main findings. However, few neutrophils were seen. Water content of the lung showed a slight increase after the start of CPB, but there was no statistical significance. Neither significant differences in the transpulmonary gradients of leukocytes nor a significant complement activation, expressed by C3a levels, was observed. The MDA level did not display a significant change related to lung reperfusion despite an increase in MDA after the start of CPB. These findings indicate that I-R injury during CPB may not be from complement-activation leukocyte sequestration, but from another source of oxygen free radicals related to CPB.

Reperfusion injury involves leukocyte-endothelial interaction mediated by cell adhesion molecules. This study was designed to determine the time course of intercellular adhesion molecule-1 (ICAM-1) expression and the functional recovery of myocardium when reperfused with leukocyte depleted whole blood.Sixteen neonatal piglet hearts were harvested and stored with 4 degrees C cold University of Wisconsin Solution (UWS) for 12 hours. An ex vivo model consisting of an isolated working heart perfusion circuit, roller pumps, and a membrane oxygenator, was used for reperfusion. Atrial tissues were taken for staining ICAM-1. The stroke work index (SWI) was calculated during 4 hours of reperfusion. Two groups (group 1: reperfused with whole blood, group 2: with leukocyte depleted blood) were compared.The differences of ICAM-1 expression between group 1 and 2 were significant at 3 and 4 hours of reperfusion (p0.05). The differences of the mean stroke work indices were significant at 2, 3, and 4 hours after reperfusion (p0.05).Leukocyte-depleted reperfusion attenuates the expression of ICAM-1 and reduces the time-dependent functional deterioration of the myocardium. These results suggest that adhesion molecule like ICAM-1 plays a major role in deteriorating myocardial function during the reperfusion, possibly by leukocyte-mediated inflammatory process.

Castleman's disease represents an atypical lymphoproliferative disorder, infrequently associated with various immunologic abnormalities or subsequent development of malignancy such as Kaposi sarcoma, malignant lymphoma and plasmacytoma. Its clinicopathologic features depend on various etiologic factors such as Kaposi sarcoma herpesvirus (KSHV), oversecretion of IL-6, adhesion molecule and follicular dendritic cell dysplasia, etc. To investigate the relationship of Castleman's disease (CD) and the above factors, we reviewed 22 cases of CD. Four cases of KSHV positive CD were detected, all multicentric, plasma cell type, and these cases displayed prominent vascular proliferation, characteristic 'Kaposi-like lesion'. IL-6 and CD54 positive mononuclear cells were scattered in interfollicular areas of KSHV positive cases. Follicular dendritic cell hyperplasia, vascular proliferation, expression of IL-6 and CD54 did not show any significant difference between solitary vs multicentric type, and plasma cell type vs hyaline vascular type. Our study suggests that KSHV positive CD reveals unique pathologic features, and the probable relationship of KSHV and IL-6 and CD54 is discussed.

BackgroundThe morphological definition of atrial chambers, and the determination of atrial laterality, are based on analysis of the structure of the atrial appendages. The systemic and pulmonary venous connections to the heart, nonetheless, are important in the management of patients having isomeric appendages. In this study, therefore, we analysed the morphology of the postero-superior walls of the atrial chambers so as to provide evidence concerning the morphogenetic background of those hearts, and to improve operative management.MethodsWe reviewed 15 autopsied specimens with isomeric right appendages, and 10 with isomeric left appendages, paying particular attention to the morphology of the systemic and pulmonary venous connections. The postero-superior walls of the atrial chambers can be made up of the atrial body, the systemic venous components, or the pulmonary venous component. We analysed the contributions made by each of these components.ResultsThe postero-superior walls of the atrial chambers were markedly variable, but could be grouped into five patterns. Bilaterally well-developed systemic venous components and absence of the pulmonary venous component within the hypoplastic atrial body were present in 9 hearts with extracardiac pulmonary venous connections in the setting of right isomerism. Bilaterally well-developed systemic venous components, and a hypoplastic pulmonary venous component within the hypoplastic atrial body, were present in 5 hearts with intracardiac pulmonary venous connections in right isomerism. Bilaterally well-developed systemic venous components, and a hypoplastic pulmonary venous component within the sizable atrial body, were present in 1 heart with an intracardiac pulmonary venous connection in right isomerism. A well-developed pulmonary venous component within the atrial body, and hypoplasia of one systemic venous component, were present in 7 hearts with left isomerism. A well-developed pulmonary venous component within the atrial body, and hypoplasia of bilateral systemic venous components, were present in 3 hearts with left isomerism.ConclusionsThe postero-superior walls of the atrial chambers in hearts with isomeric atrial appendages can be analysed on the basis of a compound structure made of bilateral systemic venous components, a central pulmonary venous component, and the body of the atrium. Hearts with isomeric right appendages have absence or hypoplasia of the pulmonary venous component, while hearts with isomeric left appendages have hypoplastic systemic venous components.

Morphologic features and pathogenesis of arterial changes occurring in Buerger's disease (thromboangiitis obliterans) are still controversial. This study describes histopathologic features of medium sized arteries from patients with Buerger's disease, particularly of the internal elastic lamina in relation to the immunologic mechanism of the injury. Seventeen segments of occluded arteries (femoral or popliteal arteries) from 17 patients with Buerger's disease were analyzed by histopathological and immunohistochemical methods. The most characteristic features were total luminal obliteration, together with a varying degree of recanalization and deposition of hemosiderin pigments. Detailed analysis, however, showed marked undulation and multiplication of the internal elastic lamina (100%) associated with basophilic degeneration and delicate linear calcification (47%). Lymphocytic infiltration along the internal elastic lamina was seen in 71% and was associated with localized edema. Lymphocytes along the lamina were consistently positive for T cell marker. Mild to moderate fibrosis was present at the media in 24%. Adventitial changes included mild, nonspecific and irregular fibrosis seen in 53%. Immunologic injury to the internal elastic lamina associated with T-lymphocytic infiltration might be the initial morphogenetic mechanism of the thrombotic occlusion and organization of medium-sized arteries in Buerger's disease.

In this study of the inhibitory effects of angiopeptin and aspirin on the development of accelerated graft atherosclerosis (AGAS), 22 B10.BR mice received intra-abdominal heterotopic heart transplants from B10.A mice, without immunosuppression. Group 1 (n = 5) received no pharmacological intervention, Group 2 (n = 6) was treated with angiopeptin, Group 3 (n = 5) with aspirin, and Group 4 (n = 6) with both. There was no significant difference in the incidence of AGAS among these groups. The magnitude of intimal lesion development showed less narrowing of large vessels (> 100 microns in diameter) in groups 2 and 4--i.e. the groups received angiopeptin (Group 1 = 46.9 +/- 9.3%, Group 2 = 28.5 +/- 9.2%, Group 3 = 44.1 +/- 10.9%, Group 4 = 24.2 +/- 5.9%; p < 0.01). Comparison of the fraction of tropomyosin-positive staining cells in the intima revealed a lesser degree of staining in Group 2 (p < 0.01). No intervention was effective in preventing smooth muscle cell proliferation in the media or inflammatory cell infiltration in the adventitia. In conclusion, our data suggest that angiopeptin is effective in the direct inhibition of intimal smooth muscle cell proliferation in relatively large vessels, whereas aspirin exhibits no inhibitory role in the progression of AGAS. Angiopeptin appears to be a potential therapeutic agent for inhibiting the progression of postoperative AGAS in clinical heart transplantation.

SummaryAnatomic data are presented of a female abortus with the unusual combination of Ebstein's malformation and atrioventricular septal defect with right isomerism of the atrial appendages, left-hand ventricular topology and discordant ventriculoarterial connection. The common atrioventricular orifice was guarded by an effectively common valve, the right half being guarded by a well-formed three-leaflet valve, but the posterior and left lateral wall of the orifice being deficient of valvar leaflet tissue. The right ventricular inlet was a blind chamber, an imperforate dimple being seen which was surrounded by valvar remnants. The apical trabecular and outlet components of the right ventricle communicated with the left ventricle through an outlet ventricular septal defect in front of the anterosuperior leaflet of the atrioventricular valve, giving the potential clinically for the lesion to be misdiagnosed as double inlet left ventricle.

BACKGROUND Pulmonary lymphangioleiomyomatosis (LAM) is a rare disease occurring in women of reproductive age and leading to progressive respiratory failure in spite of treatment. In Korea the first case was reported in 1984 and by 1997 a total of 23 cases had been reported. The clinical findings of these Korean cases are reviewed. METHODS The details of 10 cases of LAM on file at Seoul National University Hospital were reviewed together with those of 13 cases previously reported from other Korean institutes. Two, including the only one to be reported in a man, were excluded after reviewing the clinical, radiological, and pathological findings, leaving a total of 21 cases in the present study. RESULTS All 21 patients were women and in all cases the disease was proven pathologically. The mean (SD) age at onset of symptoms was 32 (8.6) years. The most common symptoms were dyspnoea and pneumothorax which were seen in 19 (90%) and 13 (76%) patients, respectively. Pulmonary function tests showed decreased transfer factor (Tlco) (100%) and airflow limitation (67%). All the cases had characteristic cysts on high resolution computed tomographic (HRCT) scanning. The overall severity score based on HRCT scans correlated with the percentage predicted Tlco/Va (p = 0.03) and FEV 1 /FVC (p = 0.02). The patients were all treated with medroxyprogesterone and/or tamoxifen. Follow up was possible in 10 cases. Two of these patients appeared to stabilise with no appreciable change clinically or in lung function on medroxyprogesterone and/or tamoxifen, but the remaining patients all deteriorated with two dying of respiratory insufficiency and one of infection following lung transplantation. CONCLUSIONS As in other countries, in Korea LAM occurs exclusively in women and progresses despite hormonal treatment.

Woong-Han Kim*, Jeong-Wook Seo, Soo-Jin Kim, Jinyoung Song, Jaeyoung Lee, Chan-Young Na Department of Thoracic and Cardiovascular Surgery, Seoul National University Children’s Hospital, College of Medicine, Seoul National University, Seoul National University Medical Research Center, Seoul, South Korea Department of Pathology, Seoul National University Children’s Hospital, College of Medicine, Seoul National University, Seoul National University Medical Research Center, Seoul, South Korea Department of Pediatric Cardiology, Sejong General Hospital, Sejong Heart Institute, Pucheon-Shi, Kyonggi-Do, South Korea Department of Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, Pucheon-Shi, Kyonggi-Do, South Korea

Purpose: We sought to evaluate the feasibility and outcomes of laparoscopic resection of giant hepatic cysts and surgical success, focusing on cyst recurrence. Methods: From February 2004 to August 2011, 37 consecutive patients with symptomatic hepatic cysts were evaluated and treated at Dong-A University Hospital. Indications were simple cysts (n = 20), multiple cysts (n = 6), polycystic disease (n = 2), and cystadenoma (n = 9). Results: The median patient age was 64 years, with a mean lesion diameter of 11.4 cm. The coincidence between preoperative imaging and final pathologic diagnosis was 54% and half (n = 19) of the cysts were located in segments VII and VIII. Twenty-two patients had American Society of Anesthesiologists (ASA) classification I and II, and nine had ASA classification III. Surgical treatment of hepatic cysts were open liver resection (n = 3), laparoscopic deroofing (n = 24), laparoscopic cyst excision (n = 4), laparoscopic left lateral sectionectomy (n = 2), hand assisted laparoscopic procedure (n = 2), and single port laparoscopic deroofing (n = 2). The mean fellow-up was 21 months, and six patients (16%) experienced radiographicapparent recurrence. Reoperation due to recurrence was performed in two patients. Among the factors predicting recurrence, multivariate analysis revealed that interventional radiological procedures and pathologic diagnosis were statistically significant. Conclusion: Laparoscopic resection of giant hepatic cysts is a simple and effective method to relieve symptoms with minimal surgical trauma. Moreover, the recurrence is dependent on the type of pathology involved, and the sclerotherapy undertaken.

BACKGROUND--The location of the sinus node is known to be at best abnormal, or at worst unknown, in patients with isomerism of the morphologically left atrial appendage. In contrast, the sinus node is known to be an excellent histological marker of the morphologically right appendage, being duplicated in those with right isomerism. The aim of the study was to investigate this condition further in fetal human and mouse hearts. METHODS--Serial histological sections of the area anticipated to contain the sinus node were studied in hearts with isomerism of the atrial appendages taken from 14 human fetuses and 13 iv/iv mice, using 12 mouse hearts with normally arranged or mirror imaged atrial chambers for controls. RESULTS--All hearts with isomerism of the right appendages (two human and four mouse) had bilateral sinus nodes. The cases with isomerism of the left appendages (12 human and nine mouse) showed absence of a recognisable sinus node except in four cases (19%) in which a small remnant of the node was found. In three of these cases, it was related postero-inferiorly to the superior cavoatrial junction. CONCLUSIONS--The concept of isomerism of the atrial appendages is endorsed by findings on the morphology of the sinus node, this being the most reliable histological criterion for existence of a morphologically right atrium. A small proportion of hearts with left isomerism had a structure resembling the sinus node, but it was hypoplastic and displaced postero-inferiorly, distant from its expected position had the hearts possessed an incompletely formed morphologically right appendage.

A new method to study the developing heart was developed. Using this “section directed” cryosectioning method, appropriate fixed embryos can be trimmed optimally to obtain sectional planes that, if necessary, can be matched with histologically treated sections. As a result, the morphological information obtained with the scanning electron microscope can be compared in detail with the information on the molecular phenotypes of the subpopulations of cells as deducted from staining patterns of the sections. This method allows combination of the specific advantages of sophisticated histological techniques, such as immunohistochemistry and in situ hybridisation, with those of the scanning electron microscope. © 1995 Wiley-Liss, Inc.

Thirty-six pairs of conjoined twins are reviewed from the joint experience of the authors. The external forms of conjunctions were 18 thoracopagus (joined at chest), eight cephalothoracopagus (joined at head and chest), eight dicephalus (single trunk and two heads), one craniopagus (joined at head), and one omphalopagus (joined at abdomen). There was one case with a single conventional heart in association with isomerism of the left lungs and absence of the heart in the left-side twin. Six cases had two conventional hearts. All of them had associated lesions, which were more severe in three cases (50%) with abnormal laterality. All of the cephalothoracopagus (eight cases) had two shared hearts. Cardiac lesions were commonly seen in the posterior heart, but the arrangement of atrial appendages were normal in every heart. Twenty-one cases of either dicephalus or thoracopagus had a compound heart. Three cases (14%) had fusion only at the level of venous sinus; three others (14%) were fused at the atrial level only, but 15 cases (71%) had fusion at both atrial and ventricular levels. Abnormal laterality was an associated lesion in ten cases (48%) with a compound heart. The fusion at the atrial level always occurred between right atriums, but ventricular fusion was more commonly between two left ventricles. Four atrial or ventricular chambers, if fused, were arranged in a cruciate arrangement. Mode of conjunction was as important, in the formation of the cardiovascular system, as was the degree of fusion. Abnormal laterality, which is commonly associated in lateral or mixed lateral/facing conjunction, was the most important factor affecting the general morphology of the cardiovascular system.

BACKGROUND In the management of hearts with deranged laterality, it is essential that the left and right atrial chambers are correctly identified. There are two major approaches, which are based on venous connections or on the morphology of the atrial appendages, and there is no consensus as to which is the most useful. We used the iv/iv mouse mutant, which is known to be pertinent to this problem, to evaluate the relations of cardiac defects with atrial, venous, and other visceral morphologies. METHODS AND RESULTS The morphology of the heart and other organs was examined in 275 iv/iv mice using criteria based on abnormal laterality in humans. The arrangement of the atrial appendages was determined by morphological examination of the junction between the appendage and the venous component of the atrium. On this basis, 45.1% of cases were shown to have usual atrial arrangement, 50.2% had mirror imagery, 1.5% had right isomerism, and 3.3% had left isomerism. Every case of atrial isomerism had a cardiac lesion; the morphological types were similar to those seen in human cases. Of cases with either usual or mirror-image arrangement of the appendages, 33.2% had abnormal spleens, but only 3.1% had cardiac defects. Similarly, venous abnormalities were much more common (30.1%) than cardiac defects. CONCLUSIONS Study results endorse the importance of the morphology of atrial appendages in predicting cardiac abnormalities and point to the marked inconsistency of the arrangement of other organs, including the spleen and the connections of the systemic veins.