Surgical Treatment of a Submitral Left Ventricular Aneurysm and the Patient Present with Recurrent Ventricular Tachycardia / 대한흉부외과학회지

Submitral left ventricular aneurysm (SMLVA) is a rare disease entity that exclusively occurs in the black population. We herewith report on a surgical case of SMLVA in a 68-year-old male who presented with ventricular tachycardia. He underwent surgical repair under standard hypothermic cardiopulmonary bypass. In the state of apical elevation, a vertical ventriculotomy was made directly over the aneurysm, which was located at the posterobasal aspect of the left ventricle. Radiofrequency ablation was performed on the endocardium all around the neck of the aneurysm and then patch endoaneurysmorrhaphy was carried out with particular care not to injure the mitral valve and subvalvular structure. His postoperative recovery was uneventful. There has been no dysfunction of the mitral valve or recurrence of the ventricular tachycardia at 2 years' follow-up.

Pharmaco-mechanical Thrombectomy and Stent Placement in Patients with May-Thurner Syndrome and Lower Extremity Deep Venous Thrombosis / 대한흉부외과학회지

BACKGROUND: Compression of the left common iliac vein by the overriding common iliac artery is frequently combined with acute deep vein thrombosis in patients with May-Thurner Syndrome. We evaluate the results of treatment with thrombolysis and thrombectomy followed by stenting in 34 patients with May-Thurner Syndrome combined with lower extremity deep venous thrombosis. MATERIAL AND METHOD: The authors retrospectively reviewed the records of 34 patients (mean age: 65+/-14 year old) who had undergone stent insertion for acute deep vein thrombosis that was caused by May-Thurner syndrome. After thrombectomy and thrombolysis, insertion of a wall stent and balloon angioplasty were performed to relieve the compression of the left common iliac vein. Urokinase at a rate of 80,000 to 120,000 U/hour was infused into the thrombosed vein via a multi-side hole thrombolysis catheter. A retrieval inferior vena cava (IVC) filter was placed to protect against pulmonary embolism in 30 patients (88%). Oral anticoagulation with warfarin was maintained for 3 months, and follow-up Multi Detector Computerized Tomography (MDCT) angiography was done at the date of the patients' hospital discharge and at the 6 months follow-up. RESULT: The symptoms of deep venous thrombosis disappeared in two patients (4%), and there was clinical improvement within 48 hours in twenty eight patients (82%), but there was no improvement in four patients (8%). The MDCT angiography at discharge showed no thrombus in 9 patients (26%) and partial thrombus in 21 (62%), whereas the follow-up MDCT at 6.4+/-5.5 months (32 patients) revealed no thrombus in 23 patients (72%), and partial thrombus in 9 patients (26%). Two patients (6%) had recurrence of DVT, so they underwent retreatment. CONCLUSION: Stent insertion with catheter-directed thrombolysis and thrombectomy is an effective treatment for May-Thurner syndrome combined with acute deep vein thrombosis in the lower extremity.

Pleomorphic Hyalinizing Angiectatic Tumor of the Chest Wall: A case report / 대한흉부외과학회지

Pleomorphic hyalinizing angiectatic tumor (PHAT) is a rare, low grade soft tissue neoplasm of an unknown histogenesis. It is characterized by sheets of mitotically inactive oval and pleomorphic cells, mono- and multi-nucleated giant cells, intranuclear cytoplasmic inclusions and prominent clusters of thin-walled ectatic vessels with perivascular hyalinization. We have experienced a 50 years old male patient who had a palpable mass in his right anterior lower chest wall. The mass was excised and it was confirmed as PHAT. He has been well 2 years postoperatively without recurrence.

Lipoblastoma of Mediastinum: A case report / 대한흉부외과학회지

Lipoblastoma is a rare benign tumor that usually originates in children from the embryonic lipid cells of the extremities. This condition shows an early childhood occurrence, a benign nature without metastasis, a cellular composition of mainly mature lipid cells and an ability to differentiate into a simple lipoma. We have experienced a 15 month old girl who had developed a lipoblastoma in the right anterior mediastinum. Surgical resection was carried out without complications. Her postoperative course was uneventful. She has been well 6 months after the operation.

Surgical Closure of the Patent Ductus Arteriosus in Premature Infants by Axillary Minithoracotomy / 대한흉부외과학회지

BACKGROUND: Closure of the ductus arteriosus is often delayed in premature infants, which creates a hemodynamically significant left to right shunt that exerts an adverse effect on the normal development and growth of these babies. We reviewed our experience on surgical closure of patent ductus arteriosus via axillary minithoracotomy in premature infants. MATERIAL AND METHOD: From April 2002 to October 2006, 20 premature infants whose gestation was under 37 weeks underwent surgical closure of patent ductus arteriosus as a result of complications or contraindications for the use of indomethacin. Their mean gestational age was 28.8+3.4 weeks, ranging from 25+3 to 34+6 weeks, and the average age at operation was 15.6+/-6.3 days. The mean body weight at operation was 1,174+/-416 g, ranging from 680 to 2,100 g; 16 infants were under 1,500 and 9 infants were under 1,000 g. The procedures were performed in the newborn intensive care unit via 2~3 cm long axillary minithoracotomy with the infant in the lateral position with left arm abduction. The mean size of the patent ductus arteriosus was 3.8+/-0.3 mm. For the most part, the ductus was closed with clips; 2 infants in whom the ductus was ruptured while dissection was being performed underwent ductal division. RESULT: Ten of twelve infants who had been ventilator dependent preoperatively could be successfully weaned from the ventilator at a mean duration of 9.7 days after the operation. There was no procedure-related complication or death. Two infants eventually died of the conditions not related to the operation; one from sepsis at postoperative 131 days and the other from pneumonia at postoperative 41 days, respectively. CONCLUSION: Surgical closure of the patent ductus arteriosus improved the hemodynamic instability and so promoted the successful growth and normal development of premature infants. Considering the low surgical risk along with the reduced invasiveness, early and aggressive surgical intervention is highly recommended.

Recurrent Massive Subcutaneous Hemorrhage in Neurofibromatosis Type 1: A Case Report

Neurofibromatosis type 1 (NF-1) is an autosomal dominant disorder that has three major features: multiple neural tumors, cafe-au-lait spots, and pigmented iris hamartomas (Lisch nodules). The purpose of this case report is to advise physicians of the danger associated with the progression of fast-onset massive hemorrhage to hemodynamic instability, which mandates rapid treatment to prevent the development of a life-threatening condition. A 64-yr-old woman with NF-1 was admitted to the Emergency Department (ED) because of a rapidly growing, 10x5x3 cm-sized mass on the left back area. She had previously undergone surgery for a large subcutaneous hematoma, which had developed on her right back area 30 yr before. She became hemodynamically unstable with hypotension during the next 3 hr after admission to ED. Resuscitation and blood transfusion were done, and the hematoma was surgically removed. The mass presented as a subcutaneous, massive hematoma with pathologic findings of neurofibroma. We report a case of NF-1 that presented as recurrent, massive, subcutaneous hemorrhage on the back region combined with hypovolemic shock.

TGF-beta1 Protein Expression in Bullae of Patients with Spontaneous Pneumothorax / 대한흉부외과학회지

BACKGROUND: In our previous study, we demonstrated that transforming growth factor-beta 1 receptor II (TGF-beta1RII) may have a role in the formation of bullae. In this study, we investigated if expression of transforming growth factor-beta 1 (TGF-beta1) ligand was altered in a bullous lung tissue by immunohistochemical staining of bullous tissues from patients with primary spontaneous pneumothorax. MATERIAL AND METHOD: Bullous lung tissues were obtained from 36 patients with primary spontaneous pneumothorax, including 34 males and 2 females aged 14 to 38 years old. RESULT: Of the 36 patients, 19 were TGF-beta1 positive and 24 were transforming growth factor-beta 1 receptor II (TGF-beta1RII) positive. Among the 19 TGF-beta1 positives, 15 were also TGF-beta1RII positive, observation at high magnification showed that strong immunohistochemical stain was detected in the boundary region between the bullous and normal lung tissues. CONCLUSION: These results suggest that overexpression of TGF-beta1 may be involved in the formation of a bulla as well as the alteration of TGF-beta1RII expression. Further molecular studies are needed to elucidate the more detailed molecular mechanisms of the bulla formation.

Pulmonary Cystic Lymphangioma: A case report / 대한흉부외과학회지

Although pulmonary lymphangioma is very rare, it is usually discovered as cystic or cavitary or solitary pulmonary nodular shadow on radiological studies. The final diagnosis is usually made pathologically after surgical intervention. We report an unusual case of pulmonary cystic lymphangioma developed in the lingular segment of the left upper lobe which was diagnosed and treated by surgical resection.

Spontaneous Pneumothorax associated with Thoracic Endometriosis: Report of a case / 대한흉부외과학회지

Pneumothorax associated with thoracic endometriosis is a rare clinical entity and it is called catamenial pneumothorax if the recurrence of pneumothorax is related to the period of menstruation. Several hypotheses about its pathogenesis are suggested including spontaneous rupture of the bulla, endometrial implants of the visceral pleura, and passage of air from the genital tract through endometrial fenestration of the diaphragm. Pneumothorax is associated with chest pain and dyspnea within 72 hours of the onset of menses in young women and developed usually at right side. We report a case of 32-year-old woman who had bilateral pneumothorax and thoracic endometriosis confirmed histopathologically in the visceral pleura by thoracotomy.

Malignant Fibrous Histiocytoma of the Lung

Malignant fibrous histiocytoma (MFH) is a primitive sarcoma originating in the deep soft tissue and composed of fibrocytic and histiocytic cells in a storiform pattern. It is rare but the most common soft tissue sarcoma of adulthood. MFH occurred in various epithelial organs derived from the supportive mesenchymal elements. The lung represents an extremely rare primary site. We have experienced one case of MFH, arising in the lung parenchyme in 67 years old male patient with cough for 6 months. The patient was taken right upper lobe and right middle lobe lobectomy with good post-operative results. But another MFH was recurred in the left upper lobe 3 months after complete resection. So he had been treated with chemotherapy and radiofrequency ablation of tumor. Then he continued to be treated with chemotherapy