Surgical Technique for the Removal of Deep Vein Thrombi of the Lower Extremities / 대한흉부외과학회지

The conventional surgery method of thrombectomy of venous thrombi from the deep veins of the lower extremity was the use of Forgarty balloon catheter. The catheter is inconvenient due to the presence of the balloon and prohibiting venous valves within the venous trees. With the use of a stone-forceps(Fig. 1), thrombi within iliofemoral vein could be easily removed without the obstacle of the valves because the instrument keeps valves open. This instrument is also useful in monitoring the back-flow from the iliac vein. Thrombi within the veins below the level of inguinal incision are removed successfully only by effective manual compression of the calf and thigh muscles. I recommend operating on the iliac vein first rather than the lower venous tree.

Polymorphism of CTLA-4 Gene in Major Depressive Disorder / 신경정신의학

OBJECTIVES: This study was carried out to explore the relationship between major depressive disorder and CTLA-4 which is related to the immunologic function such as T cell regulation. METHODS: Among the Korean patients diagnosed as major depressive disorder according to DSM-IV, 77 patients without neurological illness, hormonal disorder, or comorbid mental illness were selected. The stored data of 149 normal Koreans from the Catholic Hemopoietic Stem Cell Bank of Korea, were used as a normal control group. The data of Korean control group were compared with those of the studies of different ethnics. DNA was extracted from whole blood and the exon 1 region of CTLA-4 gene was amplified by polymerase chain reaction. Gene typing was performed by using SSCP and then, the results were assessed. RESULTS: There were no significant differences in genotype frequencies of CTLA-4*G/G, CTLA-4*G/A, and CTLA-4*A/A between the patients with major depressive disorder and the control group in Korean population(48.1% vs 46.3%, 41.6% vs 39.6%, 10.3% vs 14.1%, respectively).There were no significant differences in allelic frequencies of CTLA-4*G and CTLA-4*A between the patients with major depressive disorder and the control group in Korean population(68.8% vs 66.1%, 31.2% vs 33.9%, respectively). CONCLUSION: Considering negative result for the association of the exon 1 polymorphism of CTLA-4 gene with major depressive disorder in this study, the exon 1 polymorphism does not appear to be possible candidate gene for major depressive disorder. Moreover, further systematic researches including diverse clinical variables would be required.

A Modified Technique for the Correction of Funnel Chest / 대한흉부외과학회지

BACKGROUND: The authors have modified the method of Ravitch technique. MATERIAL AND METHOD: This technique was applied to 6 patients out of 18 patients who underwent corrective surgery from May 1987 to July 1999. The technique is quite different from that of Ravitch. We did not divide the intercostal muscle bundles from the laterals of sternum and the Akin's struts were placed retrosternally crossing the chest horizontally to prevent flail motion during immediate post-operative period and retraction of the sternum afterwards. Anterior sternal osteotomy instead of the posterior one was performed for the latest 3 cases which made operative procedure more simple and easy. The struts were removed one year later. RESULT: Compared to the hospital stay of the patients who received standard Ravitch method that of the six cases who received our modification was definitely shortened from 13.1 days to 8.3 days(p<0.0000). Flail motion was not noted in any patient and chest wall stability was obtained more easily with this technique. CONCLUSION: Our modification is recommendable for correction of funnel chest in regards to shorter operation time better chest wall stability shorter hospital stay and less complication.

Surgical Treatment of Tracheal Stenosis / 대한흉부외과학회지

BACKGROUND: Post-intubation injury is known to be the most common cause of tracheal stenosis. Treatment strategy for tracheal stenosis varies accoring to the extent of pathologic lesion. Focal mucosal lesion can be treated with laser photoablation, but full thickness tracheal lesion should be treated with resection and anastomosis. MATERIAL AND METHOD: From Aptil 1998 to May 1999, twelve patients suffering from tracheal stenosis as a complication of endotracheal intubation were managed by resection and end-to-end anastomosis in the Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Hospital. RESULT: There was no operative mortality. Five temporary vocal cord paralysis and one wound infection occurred as early complications. During 18 months of follow-up, re-stenosis was not found. CONCLUSION: Tracheal resection and anastomosis can be considered as an excellent surgical treatment for tracheal stenosis which developed as a complication of endotracheal intubation.

Bronchial Atresia with Collapse of the Right Upper Lobe: A Case Report / 대한흉부외과학회지

Congenital bronchial atresia is one of the rare bronchopulmonary anomalies which is thought to be caused by a vascular insult of uncertain timing during fefal development. It is defined as an anomaly which does not have communication between a segmental or lobar bronchus and the main airway. Because of the collateral ventilation, almost all of these cases show hyperlucency of the involved segment or lobe in chest roentgenogram. We report an extremely rare case of congenital bronchial atresia with collapse of the right upper lobe which was treated by surgical resection.

Surgical Treatment For Primary Non-Small Cell Lung Cancer / 대한흉부외과학회지

From May 1988 to December 1995, 77 patients underwent surgical resection for primary non-small cell lung cancer at GNUH, and were evaluated clinically. There were 65 males and 12 females(M:F=5.4:1), and the peak incidence of age was 6th decade of life(44.5%). The major symptoms were cough, hemoptysis and chest pain due to anatomical effects of the mass. Histopathologically, squamous cell carcinoma was 81.8%, adenocarcinoma 14.3%, and adenosquamous carcinoma 3.9%. There was no significant difference in survival among three groups. The pneumonectomy was performed in 26 cases(33.8%), lobectomy 30 cases(38.9%), bilobectomy 9 cases(11.7%), and overall resectability was 84.4%. The postoperative official stagings were as follows ; 26 patients of stage I(34%), 14 patients of stage II(18%), 22 patients of stage IIIa(29%), 14 patients of stage IIIb(18%), and one patients of stage IV(1%). In all cases, 3 year survival rate are showed stage I 83%, stage II 26%, stage IIIa 17%, and stage IIIb 0%.

Clinical Study and Risk Factors of Surgical Mortality of Congenital Heart Defects / 대한흉부외과학회지

OBJECTIVES: The surgical mortality of congenital heart defects has been reduced for the very young age group. Especially, young age at repair is an important risk factor for mortality after repair of tetralogy of Fallot. Some risk factors were analyzed. METHODS: Three hundred and sixty six patients underwent surgical intervention. Ages ranged from 5 days to 64 years, and 80 patients were adults(over 15 years of age). The defects consisted of 313(84.2%) acyanotic and 53(15.8%) cy anotic anomalies. The surgical mortalities were evaluated by univariate and multivariate analysis. RESULTS: The overall surgical mortality was 10.4%. Most deaths occurred in the infant group younger than 6 months(20/38 deaths) and in cyanotic group(21/38 deaths). Surgical infant mortality younger than 12 months was 24.8%(25/10 1). Risk factors of mortality in open heart surgery were age(p<0.0001), body weight(p<0.0001), pump time(p<0.0001), aortic cross clamp time(p<0.0001), use of total circulatory arrest(p<0.0001) and cyanotic disease(p<0.0001) by univariate analysis. But by multivariate analysis, the risk factor of mortality in open heart surgery was disease entity(p=0.002) only. A disease group with the highest risk was a cyanotic group(odds ratio was 15.3 relative to ventricular septal defect) excluding t etralogy of Fallot(odds ratio=0.27). CONCLUSIONS: Even though the most important risk factor was disease entity, technically feasible factors influencing mortality indicated by univariate analysis should be improved.

Surgical Results for Myasthenia Gravis / 대한흉부외과학회지

Myasthenia gravis is relatively rare disease which is related autoimmune response. There are various methods of management for myasthenia gravis, but nowaday radical thymectomy is the treatment of choice in the aspect of bringing out complete remission and clinical improvement. Sixteen patient of myasthenia gravis underwent radical thymectomy during last eight years, and its result was analyed. Complete remission was achieved in five patients(31 %) and pharmacological or symptomatic improvement in seven patients(44 %), thus giving a total remission in 12 patients(75 %). Postoperative result was not correlated with age, sex, degree of preoperative symptom, surgical approach, pathologic diagnosis.