Bleeding resulting from spontaneous rupture of the liver is an infrequent but potentially life threatening complication that may be associated with an underlying liver disease. A hepatocellular carcinoma or hepatic adenoma is frequently reported is such cases. However, hemoperitoneum resulting from a hepatic metastatic thymoma is extremely rare. Here, we present a case of a 62-year-old man with hypovolemic shock induced by ruptured hepatic metastasis from a thymoma. At the first hospital admission, the patient had a 45-mm anterior mediastinal mass that was eventually diagnosed as a type A thymoma. The mass was excised, and the patient was disease-free for 6 years. He experienced sudden-onset right upper quadrant pain and was again admitted to our hospital. We noted large hemoperitoneum with a 10-cm encapsulated mass in S5/8 and a 2.3-cm nodular lesion in the right upper quadrant of the abdomen. He was diagnosed with hepatic metastasis from the thymoma, and he underwent chemotherapy and surgical excision.
Background: Bronchial stenosis (BS) after lung transplantation is a major posttransplant airway complication, and bronchoscopic balloon dilatation is widely used for the management of bronchial stenosis because of its safety and ease of procedure. There are few studies on posttransplant bronchial stenosis and balloon dilatation in Asian lung transplant recipients. Methods: Medical records of lung transplant recipients from January 2013 to March 2020 at a university hospital in Seoul were reviewed retrospectively. Results: In this lung transplant cohort, 42 (15.7%) out of 267 transplant recipients were identified as bronchial stenosis patients who underwent balloon dilatation. The mean age and sex distribution of patients with bronchial stenosis did not show a statistically significant difference compared to patients without bronchial stenosis. There was no statistical difference between the two groups in the presence or absence of major comorbidities. The most common underlying lung disease in both groups was interstitial lung disease, and almost all patients in both groups underwent bilateral lung transplantation. When comparing the incidence of postoperative complications after transplantation, there were no statistically significant difference between the two groups. Also, no statistical difference was observed between the two groups in the overall mortality (without BS vs. with BS, 48.9% vs. 40.5%; P=0.404). On average, balloon dilatation for bronchial stenosis was performed 6 months after lung transplantation in patients with bronchial stenosis. Bronchoscopic balloon dilatation was performed at multiple sites in more than half of patients with bronchial stenosis. Patients with bronchial stenosis underwent an average of five or more balloon dilatations, and 21.4% of them underwent bronchial stent placement via rigid bronchoscopy (Table ). Conclusions: In this lung transplant recipient cohort, the clinical characteristics of patients with bronchial stenosis were similar to those without bronchial stenosis. In many of these, balloon dilatation was repeatedly performed at multiple sites.
Background: Low vitamin D levels have been associated with the prognosis of lung transplant recipients, perhaps reflecting the patient's poor health condition. However, the clinical significance of vitamin D changes before and after transplantation was unknown. Methods: We retrospectively reviewed the medical records of patients who underwent lung transplantation at Severance Hospital in Seoul, Korea from January 2013 to March 2020. Among a total of 267 transplant recipients, the clinical outcomes of 171 patients with both pre-and posttransplant vitamin D measurements (serum 25(OH)D level) were investigated. Results: Before and after transplantation, the 25(OH)D levels increased in 101 patients (59.1%) and decreased in 70 patients (40.9%). Their mean changes were +8.2 and -7.5 ng/mL, respectively. Compared with the 25(OH)D-increase group, the 25(OH) D-decrease group had a longer transplant waiting time and showed a higher rate of retransplantation. In addition, there were no significant differences in the baseline characteristics between the two groups. In the comparison of postoperative complications, the incidence of BPF (bronchopleural fistula) was higher in the 25(OH)D decrease group than in the 25(OH)D-increase group, and the total hospital stay was longer in the 25(OH)D-decrease group. There were no significant differences between the two groups in terms of overall mortality and variables related to prognosis. In the correlation analysis of 25(OH)D changes, there was a positive correlation between survival time and posttransplant FEV1, and a negative correlation with total hospital stay. Survival analysis according to the changes in 25(OH)D levels did not show significant differences between the survival curves. Conclusions: Patients with decreased vitamin D levels before and after transplantation had increased transplant waiting time, increased retransplantation, increased BPF, and increased length of hospital stay compared to patients with increased vitamin D levels, but there was no statistical difference between the two groups in overall mortality and survival curves.
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