Surgical Treatment with Extracorporeal Circulation for Acute Dissection of Descending Thoracic Aorta / 대한흉부외과학회지

The surgical management of acute type B dissection is controversial. The complexity of the repair usually requires a period of aortic cross-clamping exceeding 30 minutes, which can cause ischemic injury of the spinal cord. Several forms of distal perfusion have been considered for use to prevent this injury. To determine the safety and efficacy of a graft replacement with cardiopulmonary bypass in reparing acute dissection of descending thoracic aorta, we retrospectively reviewed our surgical experience treating 8 patients who had aortic dissection secondary to atherosclerosis, trauma, and carcinoma invasion. Cardiopulmonary bypass was performed with two aortic cannulas for simultaneous perfusion of the upper and lower body and one venous cannula for draining venous blood from the right atrium or inferior vena cava. Although aortic cross-clamp time was relatively long (average, 117.8 minutes; range, 47 to 180 minutes) in all cases, there was no neurologic deficit immediately after graft replacement for the aortic lesion. Two patients (25%) of relatively old age died on the postoperative 31st and 41st days, respectively, because of delayed postoperative complications, such as pulmonary abscess and adult respiratory distress syndrome. Although any of several maneuvers may be appropriate in managing dissection of the descending aorta, graft replacement with cardiopulmonary bypass during aortic cross-clamping may be a safe and effective method for the treatment of acute dissection of the descending thoracic aorta.

Cardiac Surgery for the Patient with VVI Unipolar Pacing System: One Case / 대한흉부외과학회지

A 56-year-old female with a permanent unipolar pacing (VVI) system underwent elective coronary bypass surgery and mitral valve replacement. Because the unipolar sensing is subject to considerable nonmyocardial electrical noise, the pacing function may be disturbed by the use of electrocautery. Temporary atrial and ventricular bipolar epicardial leads and external generator were used for maintaining A-V sequential pacing during the use of electrocautery. Before aortic cross-clamp was released after cardiac operation, regular cardiac rhythm could spontaneously be resumed with an integrated cardioplegic strategy, avoiding the use of defibrillator.

Videothoracoscopic Surgery for Secondary Spontaneous Pneumothorax / 대한흉부외과학회지

For the management of a secondary spontaneous pneumothorax, videothoracoscopic surgery may offer the potential therapeutic benefits of a minimally invasive approach. We report on a series of 36 patients (33 men and 3 women) with a mean age of 56.3 years (range, 31 to 80 years) who underwent thoracoscopic surgical procedures for the treatment of secondary spontaneous pneumothorax. Twenty-one patients had emphysema and 20 patients had old pulmonary tuberculosis. Nineteen patients presented a persistent severe air leak more than 3 days preoperatively and 15 patients had more than one recurrence. Bullectomy or exclusion of the lesion was performed in 33 patients. Mechanical pleurodesis was performed in the entire patients, talc was sprayed in 22 and vibramycin in 14. Mild pleural adhesion at the upper lobe was shown in 10 patients and severe pleural adhesion in 7 patients. One patient with persistent air leak died of persistent air leak and respiratory failure. The mean postoperative stay was 7.0 days (range, 2 to 17 days). At a mean follow-up of 15.8 months (range, 5 to 45 months), no pneumothorax had recurred. In comparison with the result of the treatment for 112 patients with primary spontaneous pneumothorax, the operating time was not significantly longer and there were no more primary treatment failures, but the duration of postoperative chest drainage and hospital stay was longer. Videothoracoscopic surgery has proved to be an effective treatment for secondary spontaneous pneumothorax in elderly patients who represent high-risk candidates for thoracotomy.

A Clinical Evaluation of Tuberculous Pleurisy: Report of 52 Cases / 대한흉부외과학회지

A clinical analysis was performed on 52 cases of tuberculous pleurisy experienced in the department of thoracic and cardiovascular surgery and department of medicine, Chosun University Hospital during a period from Jan. 1994 to Dec. 1995. Among them, male was 39 cases, female was 13 cases, with age ranged from 7 to 73 years. The common symptoms were chest pain 75%, dyspnea 59.6%, cough 55.8%. The most common diagnostic tool was pleural biopsy. The protein levels in the tuberculous pleural effusion were 0.9~6.5 gm%, and ratios of effusion protein to serum protein were 0.48~1.06. The glucose levels in the tuberculous pleural effusion were 37~112 mg%. The LDH levels in the tuberculous pleural effusion were 80~2440 unit/ml, and ratios of tuberculous pleural effusion LDH to serum LDH were 0.48~1.03. The ADA levels in the tuberculous pleural effusion were 24-63 IU/L. The common surgical methods of treatment in the tuberculous pleurisy were closed thoracostomy in 18 cases(66.7%), and thoracentesis in 5 cases(18.5%). his study compares the clinical results of group A and group B. There were no significant differences for age and sex, lag period from initial symptoms to admission, diagnostic method, and protein, pH, LDH, glucose, ADA levels in tuberculous pleural effusion. Authors noted that the discharge after admission on the tuberculous pleurisy was more faster in patients with surgical treatment than in patients with only medical treatment.