Surgical Treatment of Recurrent Lung Cancer / 대한흉부외과학회지

BACKGROUND: The resection of recurrent non-small cell lung cancer can be performed very rarely. There has been many arguments for longterm result and therapeutic role in surgical management of recurrent non-small cell lung cancer(NSCLC). We analyze our result of surgical re-resection of recurrent NSCLC for 10 years retrospectively. MATERIAL AND METHOD: In the period from 1987 to 1997, 702 patients who had been confirmed for NSCLC had undergone complete resection in Seoul National University Hospital. As December 1997, 22 of these patients have been operated on the diagnosis of recurrent lung cancer. In these patients one has revealed for benign nodule at postoperative pathologic pathologic was unresectable. and two had revealed other cell type on postoperative pathologic examination. Analysis about postoperative survival rate and the factors that influence postoperative survival rate - sex, age, pathologic stage, cell type, operation adjuvant therapy after first and second operation location of recurrence disease free survival-was 59.1+/-10.9 year. There were 14 men and 3 women. Four patients was received radiation therpy after first opration and two patients was received postoperative chemotherapy. At first operation 2 patients was stage Ia, 8 was stage Ib, 1 was stage IIa 6 was stage IIb. Eleven patients had squamous. cell carcinoma at postoperatrive pathologic examination five had adenocarcinoma and one had bronchioalveolar carcinoma. In second operation 8 patients were received limited resection. 9 were received lobectomy or pneumonectomy. One-year survival rate was 82.4% and five-year survival rate was 58.2% Non-adjuvant therapy group after initial operation was more survived than adjuvant therapy group statistically. CONCLUSION: operation was more survived than adjuvant therapy group statistically. CONCLUSION: Operation was feasible treatment modality for re-resectable non-small cell lung cancer. But we cannot rule out possibility of double primary lung cancer for them. Postoperative prognostic factor was adjuvant therapy or nor after first oepration but further study of large scale is needed for stastically more valuable result.

"Off-Pump" Coronary rtery bypass Grafting in Multi-vessel Coronary Disease: Two Cases / 대한흉부외과학회지

Coronary artery bypass grafting (CABG) technique has been much developed but CABG under cardiopulmonary bypass has the unavoidable deficits such as generalized inflammatory reaction from cardiopulmonary bypass and myocardial ischemia from aortic-cross clamp. There has been remarkable advancement of CABG without cadiopulmonary bypass. We performed CABG successfully without cardiopulmonary bypass. We performed CABG successfully without cardiopulmonary bypass in two patients with multivessel coronary disease who were failed to intervene with percutaneous transluminal coronary angioplasty. We herein report the two cases.

Combined Percutaneous Transluminal Coronary Angioplasty and Minimally Invasive Coronary Arterial Bypass Grafting ( Hybrid CABG ) / 대한흉부외과학회지

Percutaneous coronary intervention including intracoronary stenting is currently an accepted treatment modality in the treatment of coronary artery disease and is widely performed to treat the patient with multivessel disease with decreased morbidities and less cost compared with conventional coronary rtery bypass grafting(CABG), Repeated interventions due to restenosis even after successful angioplasty are the major disadvantage of the angioplsty especially when the lesion is located inthe left anterior descending artery(LAD) Recently CABG through left anterior small thoracotomy using the left internal thoracic artery to revascularize the LAD territory without cardiopulmonary bypass so called Minimally Invasive Direct Coronary Artery Bypass(MIDCAB) was intrduced and performed with comparable early outcomes. In this regard the integrated approach with percutaneous coronary intervention and minimally invasive direct coronary artery bypass surgery so called 'Hybrid CABG' was suggested to be an effective treatment in suitable patients with multivessel coronary artery disease. We report three cases of Hybrid CABG.

Two Cases of Severe Hemolytic Transfusion Reactions Caused by Anti-Jkb Antibody / 대한수혈학회지

We report two patients who suffered from hemolytic transfusion reactions due to anti-Jkb antibody: one showed acute- and the other showed delayed-type hemolysis. The first patient was a 40-year-old man who suffered from epilepsy after the operation for arteriovenous malformation 16 years ago. He received five units of red blood cells (RBC) after right temporal lobectomy. On the fifteenth postoperative day, fever and chill developed during transfusion of one unit of packed RBC, followed by dark urine and oliguria. The polyethylene glycol-Coombs test and enzyme test revealed anti-Jkb antibody which had not been detected on the pretransfusion specimen. The second patient was a 41-year-old man who was admitted for the reoperation of the prosthetic mitral valve. Because hemoglobin was 5.9g/dL at admission, he received five units of packed RBCs. Oliguria and laboratory findings consistent with hemolytic anemia were observed from the third day of transfusion. Anti-Jkb antibody was detected on antiglobulin phase. Both patients developed acute renal failure (ARF) and hemodialysis with conservative management were done. They finally recovered from ARF without any residual complications. Implementation of more sensitive pretransfusion tests should be considered to prevent rare, but serious hemolytic transfusion reactions.