Clinical Application for Video-Thoracoscopy in Lung Cancer Surgery Patients / 대한흉부외과학회지

BACKGROUND: Video-thoracoscopy is known to be an useful method to provide accurate pre-resectional staging in patients with lung cancer in addition to the conventional radiologic studies and mediastinoscopy, for the pleural cavity is inspected directly and biopsy specimens can be obtained. This study is undertaken to evaluate how video-thoracoscopy can be used in deciding pre-resectional stage. MATERIAL AND METHOD: Video-thoracoscopy was performed in patients with lung cancer who were scheduled for surgical resection based on the radiologic staging and mediastinoscopic biopsy. 37 patients were included in this study. Pre-thoracoscopically 18 cases were in TNM stage 1, 7 in stage 2, and 12 in stage 3. RESULT: In 15 of 37 cases, video-thoracoscopy could not be performed effectively due to heavy adhesions in the pleural cavity, diaphragmatic and chest wall invasion of tumor and bulky tumor mass es. Mediastinal lymph nodes were positive postresectionally in 6 of these 15 cases. In 22 cases, video-thoracoscopy was performed as usual. Positive mediastinal lymph nodes were identified in 2 cases and exploratory thoracotomy was prevented. Surgical resection were carried out in remaining 20 cases and 5 cases among them had positive mediastinal lymph nodes. CONCLUSION: We believe that it is difficult to perform pre-thoracotomy video-thoracoscopy for all lung cancer patients for there were many cases that thoracoscopy could not be undertaken due to heavy adhesions in the pleural cavity, tumor involvement of the chest wall and/or diaphragm and bulky tumor mass. However we think it is helpful in preventing unnecessary exploratory thoracotomy for some patients with lung cancer whom pre-thoracotomy video-thoracoscopy was carried out.

CT Measurement of Diameter and Dimension of the Trachea in Normal Korean Adults / 대한흉부외과학회지

BACKGROUND: Knowledge of size and morphology of the normal trachea is important for airway management and tracheal reconstruction. Conventional radiography is a simple method used to measure the tracheal diameter, but it is not accurate because of the artifacts related to image magnification and overlapping by the shoulder. The purpose of this study was to provide the normal values of the tracheal size and anatomy in Korean adults using Computerized Tomography. MATERIAL AND METHOD: There were 43 men and 34 women included in this study. They were divided into three age groups(group 1, 20-39 years ; group 2, 40-59 yeas ; groups 3,>or=60 years). The anteroposterior and transverse diameters and cross - sectional areas of the trachea were measured at the level of the thoracic inlet(Level 1) and the aortic arch(Level 2). These values obtained at each level were compared between age groups and sexes. RESULT: In 43 men, the anteroposterior / transverse diameters(mean SD in millimeters) of the trachea at levels 1 and 2 were 19.95+/-2.99 / 17.72+/-2.13 and 19.77+/-2.57 / 18.02+/-2.19, respectively. In 34 women, those values at levels 1 and 2 were 15.56+/-2.12 / 14.18+/-2.07 and 15.35+/-1.82 / 15.00+/-1.60, respectively. At both levels, the anteroposterior and transverse diameters were significantly greater in men than in women (p<0.05). The cross-sectional area of the trachea at levels 1 and 2 were 279.14+/-61.37 / 281.93+/-63.97 mm2 in men and 173.29+/-35.81 / 181.88+/-34.74 in women, respectively. They also showed significantly greater values in men than in women(P<0.05). There was no significant difference in diameters and cross-sectional areas of the trachea between age groups. CONCLUSION: There are significant differences in the internal diameter and cross- sectional area of the trachea between men and women in normal Korean adults, while the age difference was insignificant. We believed CT is a relatively accurate and safe way to measure the internal diameter and cross-sectional areas of the trachea.

Single Lung Transplantation in Pulmonary Fibrosis Patients / 대한이식학회지

A lung transplantation in the case of idiopathic pulmonary fibrosis was performed on July 7th, 1996 by the department of Thoracic Surgery, Yonsei University Medical College. The 52 year-old male patient (having a past history of cholecystectomy, 6 years ago) suffering from severe dyspnea, progressively aggravating for last five years. On physical examinations, two surgical scars were found in his left chest wall and upper abdominal area and wheezing was auscultated in both lung fields. The pulmonary function test performed in march, 1996, revealed FVC of 1940 ml (51%) and FEV1 of 1680 ml/min (58%) and the arterial blood gas study showed pH 7.4 PaO2 43.2 mmHg, PaCO2 35.0 mmHg (room air), pH 7.4 PaO2 89.8 mmHg, PaCO2 40.8 mmHg (mask 5l/min). Through the coronary angiography, moderate degree of pulmonary hypertension and 50% stenosis of left anterior descending branch of his coronary arteries were detected. The right lung from 17 year old male under brain death was removed through a median sternotomy incision and immersed in 70 ml/Kg of preservation solution (modified Euro-collins). Preparing the recipient, the pulmonary artery was dissected and temporally ligated for 15minutes, after then, an arterial blood gas study was taken to reveal pH 6.97, PaO2 221 mmHg, PaCO2 126 mmHg (FiO2 1.0 PEEP 5 cm) and his pulmonary arterial pressure was 85/26 mmHg (when the systemic arterial pressure was 140/80 mmHg) that indicates the necessity of the cardiopulmonary bypass; extracorporeal circulation was initiated through the femoral artery and right atrium. Placing the donor lung in the ipsilateral thoracic cavity of the recipient, the bronchus was first anastomosed in an telescopic fashion (the smaller bronchus into the lumen of the larger one) using the prolene 4-0. The pulmonary artery was anastomosed by prolene 5-0 and the LA by prolene 4-0. The total ischemic time was 70 minutes and the bypass time was 145 minutes. For the postoperative immunosuppression, cyclosporin and immuran was used and 2 weeks of induction therapy with OKT3 was followed by steroid. No evidence of rejection was shown in the transbronchial lung biopsy, performed a week after the transplantation. Fever developed 3 month after and aspergillosis and CMV infection was suspected through the transbronchial lung biopsy; vigorous treatment was followed but the patient had expired after 82 days postoperative survival.