Epithelial-Myoepithelial Carcinoma of the Lung: one case report / 대한흉부외과학회지

Epithelial-myoepithelial carcinoma is a rate low-grade malignant salivary neoplasm that usually occurs in the parotid gland but can also arise in minor salivary glands. We report a case of a primary epithelial-myoepithelial carcinoma of the lung neoplasm. The patient was 48-year-old women who presented with dry cough of 1 month duration. A right middle lobe endobronchial lesion was identified bronchoscopically. The bilobectomy of RML & RLL was performed, the pathologic result was epithelial-myoepithelial carcinoma.

Rapidly Grown Huge Mediastinal Benign Teratoma: one case report / 대한흉부외과학회지

The benign teratoma is usually slow growing tumor, but we expirienced a case of primary huge mediastinal benign teratoma that had grown very rapidly, maximally during 3 years. The 14-year-old female patient was admitted to our hospital because of abnormal chest X-ray that showed 10x10cm sized well definded mass with multiple calcificactions. but the mass was not present in chest X-ray perfomed on 3 years prior to admission. Under the diagnosis of teratoma, complete surgical resection was done by the left thoracotomy. The result of pathology was benign teratoma.

Carcinosarcoma of the Esophagus: 2 Case Report / 대한흉부외과학회지

Carcinosarcoma of the esophagus have an interesting pathologic feature of admixture of carcinomatous and sarcomatous lesion and accounts for 0.5~1.5% of all esophageal neoplasm. Generally, it has been reported that these have better prognosis than the squamous cell carcinoma. We have experienced two cases of carcinosarcoma occurring at the mid-esophagus. In both two cases, Ivor Lewis operation was performed and lymph node metastasis was absent. The pathologic diagnosis was confirmed as carcinosarcoma. Postoperative course was uneventful and the patients have been followed up for 3 months and 3 years, respectively, without any problems. We report these cases with a brief review of the literatures.

Early Results of Maze III Operation Without Cryoablation / 대한흉부외과학회지

BACKGROUND: Atrial fibrillation is one of the most prevalent of all arrhythmias and in up to 79% of the patients with mitral valve disease. This study examined whether the atrial fibrillation that occur in patients with mitral valve operation could be eliminated by a concommitant maze operation without cryoablation. MATERIAL AND METHOD: From May 1997 to April 1998, 14 patients with atrial fibrillation associated with mitral valve disease underwent Maze III operation without cryoablation. Preoperatively there were 6 men and 8 women with an average age of 46.2+/-10.7 years. Eleven patients had mitral stenosis, and three had mitral insufficiency. The associated heart diseases were aortic valve disease in 4, tricuspid valve regurgitation in 1 and ASD in 2. Using transthoracic echocardiography, the mean left atrial diameters was 54.7+/-5.3 mm and thrombi were found in the left atrium of 2 patients. Postoperatively the ratio between the peak speed of the early filling wave and that of the atrial contraction wave (A/E ratio) was determined from transmitral flow measurement. Operations were mitral valve replacement in 13 including 4 aortic valve replacements, 1 DeVega annuloplasty and 2 ASD closures. Maze III operation was performed in 1 patient. RESULT: Five patients (38%) had recurred atrial fibrillation, which was reversed with flecainide or amiodarone at the average time of postoperative 38.8+/-23.5 days. Postoperative complications were postoperative transient junctional rhythm in 6, transient atrial fibrillation in 5, reoperation for bleeding in 3, postpericardiotomy syndrome(1), unilateral vocal cord palsy(1), postoperative psychosis(1), and myocardial infarction(1). Postoperatively A/E ratio was 0.43+/-0.22 and A wave found in 9(64%) patients. 3 to 14 months postoperatively (average follow- up, 8.1 months), all of patients had normal sinus rhythm and 9(64%) patients had left atrial contraction and 11(79%) patients were not on a regimen of antiarrhythmic medication. CONCLUSION: We conclude that Maze III operation without cryoablation is an effective surgical treatment in atrial fibrillation associated with the mitral valve disease.

Open Heart Surgeries in Septuagenarians / 대한흉부외과학회지

BACKGROUND: An increasing number of elderly are referred for open heart surgeries(OHS). These patients are assumed to have significantly increased morbidity and mortality because of compromised functional reserves in their vital organs. We reviewed the results of OHS patients who were 70 years old or older. MATERIAL AND METHOD: Thirty six consecutive septuagenarians underwent OHS from 1995 to 1997. Operations were coronary artery bypass grafting(CABG) in 26 including 3 left main surgical angioplasty, valve replacement in 7, MVR+CABG in 2, and ASD closure+TAP in 1. Statistical tests were carried out to compare survivor group with nonsurvivor group in respect to risk factors including NYHA functional class, LVEF, emergent operation, IABP support, CPB/ACC time, ventilator time cardiac index, ICU stay and hospital stay for operative mortality. RESULT: Operative mortality rate and postoperative complication were 16%(6/36) and 50%(18/36). One-year and 3-year actuarial survival rates were 76%. Nine patients(25%) had major complications including third-degree A-V block(2), respiratory failure(1), stroke(3), renal failure requiring dialysis(3) and postoperative hemorrhage(2). The causes of death were pneumonia(1), bleeding(1), acute renal failure(1), low cardiac output(1), third-degree A-V block(1), and ventricular tachycardia(1). The univariate analysis of mortality shows that NYHA class IV, LVEF<40%, lesser values for C.I, and longer time for ventilatory support were associated with the risk factors(p value=0.03, 0.001, 0.007, and 0.014). The emergent operation, CPB/ACC time, IABP support, ICU stay and hospital stay were not significant. CONCLUSION: We conclude that cardiac operation can be performed in septuagenarians with acceptable outcomes when done in patients with normal to moderately depressed left ventricular function and adequate functional reserves in their vital organs.

Left Bronchial Rupture Following Endobronchial Intubation: One case report / 대한흉부외과학회지

Rupture of the bronchus following endotracheal intubation with a double-lumen tube is extremely rare in all complications of endotracheal intubation. We experienced a case of left main bronchial rupture following endotracheal intubation. This 58-year old female patient was diagnosed of well-differentiated adenocarcinoma of right lower lobe, stage II B, preoperatively. She was intubated with Robertshaw double-lumen tube (35 Fr.) for Rt. lower lobectomy. Intraoperatively, Lt. main bronchial rupture was suspected because of pneumomediastinum and ventilation insufficiency and immediately repaired with monofilament absorbable sutures (PDS) through left thoracotomy. Postoperative course was uneventful.

Primary Leiomyosarcoma of The Lung: One case report / 대한흉부외과학회지

Primary leiomyosarcoma is an extremely rare tumor. We exprienced a case of 46-year-old man with a mass located in the left upper lobe bronchus which was discovered on a chest CT. Cytology of the sputum and bronchoscopic biopses did not reveal any malignant cells. The patient underwent a left sleeve upper lobectomy. The tumor was growing from the left upper lobe bronchus and had partially destroyed the lung parenchyme. The pathologic feature of the tumor was composed of fascicular arrayed cellular spindle cells with blunt-ended nuclei revealed mild to moderate pleomorphism and frequent mitoses (15/10HPF). The immunohistochemical staining was revealed positive reaction for antibody to smooth muscle actin and desmin. We conclude that the tumor is leiomyosarcoma of the lung and then report with a review of the literatures.