A Case of Pleomorphic Liposarcoma in a Patient with Crohn's Disease Taking Azathioprine / 대한소화기학회지

Azathioprine is frequently used for the treatment of inflammatory bowel diseases (IBD) such as Crohn's disease and ulcerative colitis. Lymphomas, squamous cell carcinomas, and undifferentiated pleomorphic sarcomas have been reported among patients receiving azathioprine therapy. Herein, we report a case of pleomorphic liposarcoma of chest wall which occurred in a 44-year-old man with Crohn's disease taking azathioprine. He was diagnosed with Crohn's disease 3 years ago after suffering from abdominal pain and hematochezia for 12 years. He had been taking 50 mg of azathioprine per day for 23 months when he visited the thoracic and cardiovascular surgery clinic due to right chest palpable mass that had rapidly grown during the past 2 months. Excisional biopsy was performed and the mass was diagnosed as pleomorphic liposarcoma. Therefore, he underwent radical excision of the right chest wall mass, which measured 11.0x6.5 cm in size. He is scheduled to receive radiation therapy and chemotherapy.

Right Coronary Artery to Left Ventricular Fistula with a Giant Right Coronary Artery Aneurysm: A case report / 대한흉부외과학회지

A right coronary artery to left ventricular fistula with a giant right coronary artery aneurysm is a very rare condition. This requires surgical treatment because of the possibility of rupture of aneurysm, heart failure and infective endocarditis. A 47 years old male patient with dyspnea on exertion for 3 months was diagnosed as having a right coronary artery to left ventricular fistula with a giant right coronary artery aneurysm according to the CT and coronary artery angiography. We resected the aneurysm and performed a coronary artery bypass graft.

Cardiac Hemangioma of the Left Atrial Appendage Associated with Hepatic Hemangiomas: The CT and Coronary Angiographic Findings

Cardiac hemangioma is a rare benign tumor of the heart. We report here on a case of cardiac hemangioma that originated from the left atrial appendage; this was observed on the CT and coronary angiographic findings and the lesion was pathologically proved.

The Change of Arterial Blood Gas during Endoscopic Saphenous Vein Harvesting for Coronary Artery Bypass Grafting / 대한마취과학회지

BACKGROUND: Endoscopic surgical procedure has recently been applied to not only intraabdominal or intrathoracic surgery but also saphenous vein harvesting, because it is less invasive and more cosmetically advantageous. Carbon dioxide insufflation during an endoscopic saphenous vein harvesting may cause an adverse effects on arterial blood gas and hemodynamic variables. This study was conducted to evaluate the safety of carbon dioxide insufflation during endoscopic saphenous vein harvesting. METHODS: Patients in ASA physical status III or IV, scheduled for an endoscopic saphenous vein harvesting (n=30) were gathered for the evaluation. Until the end of the procedure, controlled mechanical ventilation (tidal volume: 10 ml/kg, respiratory rate: 10 rates/min) and ventilator mode was fixed in this tidal volume and respiratory rate. Arterial blood gas analysis, end-tidal carbon dioxide, blood pressure and heart rate were measured before and at 10, 20, 30, 40 minutes after carbon dioxide insufflation. RESULTS: Preinsufflation values of PaCO2 (partial pressure of arterial carbon dioxide) and PETCO2 (partial pressure of end-tidal carbon dioxide) were 33.4 +/- 3.6 mmHg and 24.1 +/- 4.1 mmHg, respectively. PaCO2 was significantly increased at 30 and 40 minutes after carbon dioxide insufflation (40.1 +/- 7.4 mmHg and 41.4 +/- 8.6 mmHg). PETCO2 was significantly increased at 20, 30 and 40 minutes after carbon dioxide insufflation(27.6 +/- 5.5 mmHg, 28.9 +/- 7.0 mmHg and 29.6 +/- 7.8 mmHg). But, the magnitude of difference between PaCO2 and PETCO2 was not significantly different. CONCLUSIONS: During endoscopic saphenous vein harvesting, PaCO2 was significantly increased compared with preinsufflation values. Careful monitoring of PaCO2 is mandatory during the procedure.

Minimally Invasive Repair of Pectus Excavatum Based on the Nuss Principle: An Evolution of Techniques and Early Results on 322 Patients / 대한흉부외과학회지

BACKGROUND: The Nuss procedure is a recently developed technique for minimally invasive repair of pectus excavatum using a metal bar. Although its technical simplicity and cosmetic advantages are remarkable, applications have been limited to children with standard pectus excavatum. We report a single center experience of the technique that has been evolving in order to correct asymmetric pectus configurations and adult patients. MATERIAL AND METHOD: Between August 1999 and June 2002, 322 consecutive patients underwent repair by the Nuss technique and its modifications. Among them, 71 (22%) were adults. For the precise correction, morphology of the pectus was classified as symmetric and asymmetric types. Asymmetric type was subdivided into eccentric and unbalanced types. In repair, differently shaped bars were applied to individual types of pectus to achieve symmetric correction. RESULT: Symmetric type was 57.5% (185/322) and asymmetric type was 42.5% (137/322). Eccentric, unbalanced, and combined types were 71, 47 and 19, respectively. Major modifications were bar shaping and fixation. In asymmetric group, different shapes of asymmetric bars were applied (n=125, 38.8%). For adult patients, double bar or compound bar technique was used (n=51, 15.8%). To prevent bar rotation, multipoint wire fixations to ribs were used. Major postoperative complications were pneumothorax (n=24, 7.5%) and bar displacement (n=11, 3.4%). 42 patient had bar removal 2 years after the initial procedure. CONCLUSION: The Nuss procedure is safe and effective.Modifications of the techniques in accordance with precise morphological classification enabled the correction of all variety of pectus excavatum including asymmetric types and adult patients.

Clinecal Investigation and Acute Complications of Remodelling Plasty of Costochondral Rib Cage For Pectus Excavatum / 대한흉부외과학회지

BACKGROUND: Acute Complications of Remodelling Plasty of Costochondral Rib Cage For Pectus Excavatum Recently, Remodelling Plasty of Costochondral Rib Cage has been introduced as an minimally invasive procedure and expanded its application for pectus excavatum. Outcomes and acute complications were reviewed MATERIAL AND METHOD: A retrospective survey of 55 patients who underwent Remodelling Plasty of Costochondral Rib Cage from September, 1999 to February, 2002 was conducted to review complications, postoperative treatments, and outcomes. RESULT: Age ranged from 1 to 27 years(mean 11.4+/-7.1). 35(64%) were less than 15-year old and 20(36%) were more than 15-year old. There were 44(80%) Male patients and 11(20%) female patients. Length of hospital stay was 7.8+/-2.1 days for less than 15-Y-old group, 10.6+/-6.2 days for more than 15-Y-old group(p = 0.042) One substernal bar was inserted in 52 patients and two substernal bars were inserted in 3 patients. As for stabilizer, one lateral side was fastened in 15 patients and both lateral sides were fastened in 6 patients. In the less than 15-Y-old group, 4 patients needed stabilizer, whereas in the more than 15-Y-old group, 18 patients needed stebilizer(s)(p = 0.000).Including all kinds of complications, 28(51%)patients had postoperative complications. Of them, only 7 patients were treated for complications(C-tube insertion was done in 7 patients and reoperation for bar refixation or removal was done in 3 patients of them). CONCLUSION: Most complications after Remodelling Plasty of Costochondral Rib Cage For Pectus Excavatum were trivial without treatment although C-tube drainage was needed in some patients. However bar displacement such as rotation and lateral sliding should be corrected as soon as detected in order not to remove the bar(the worst situation).

Pulmonary Large Cell Neuroendocrine Carcinoma: One Case Report / 대한흉부외과학회지

A 60-year-old male was admitted to our hospital complaining of general weakness. Chest radiography showed lung mass on left lower lobe. After left lower lobectomy and mediastinal lymph node dissection, The mass was pathologically diagnosed as large cell neuroendocrine carcinoma. Pulmonary large cell neuroendocrine carcinoma is rare. Herein we report a case of large cell neuroendocrine carcinoma in lung.

Transilluminated Powered Phlebectomy for Varicose Vein / 대한흉부외과학회지

BACKGROUND: To determine the efficacy and safety of endoscopic resection and ablation of superficial varicosities using a powered vein resector, irrigated illuminator. MATERIAL AND METHOD: 83 consecutive patients were involved in the study. 103 limbs in 83 patients were treated using a minimal invasive, powered, vein resecting device with cutaneous transillumination and tumescent anesthesia technique. There were 51 women and 32 men. All patients were operated under general anesthesia or regional anesthesia. Operative time and patient satisfaction scores were recorded along with the number of incisions made. RESULT: 83 patients(51/61.4% female, 32/38.6% male, aged 25-78 years) had varicose vein. Average age at the time of operation was 45 years(range, 25 to 78 years). There were 63 unilateral procedures and 20 bilateral operations. Operative time ranged from 24 to 46 minutes (average 35.3 minutes) in the unilateral procedure. The number of incisions per limb averaged 2.7(range, 2 to 5). Postoperative complications occurred in 7(8.4%) patients. Patients were asked to describe their pain on an analog scale ranging from 1 to 10 with 1 representing no pain and 10 worst imaginable pain. Immediately postoperative pain score was 2.4. Postoperative pain score at 72 hours had a mean score of 2.0. Postoperative pain score at 1 months were 1. CONCLUSION: Varicose vein removal using Transilluminated Powered Phlebectomy(TIPP) is a safe and efficient procedure. The procedure saves time, is easy to perform, and gives direct visualization and a distinct endpoint of the removal of veins. It is also less tedious to perform and gives good cosmetic results with significant pain relief.