Rhabdomyolysis Induced by Microembolism with Intra-Aortic Balloon Pump (IABP) Use in a Patient after Coronary Artery Bypass Graft (CABG) - A Case Report - / 대한구급학회지

A fifty seven-year-old man visited the outpatient department with chest pain and claudication. Coronary angiogram showed coronary artery diseases (3-vessel diseases) and CABG was planned. However, lower extremity angiogram showed stenosis of both common iliac arteries and stent implantation of both iliac arteries were done before CABG. He underwent CABG and IABP was inserted for weaning from cardiopulmonary bypass. After CABG, ischemic change on ends of feet was noted with red-brown colored urine and hyperkalemia. Blood myoglobin level was over 3,000 ng/ml. Microembolism of his lower body was revealed by multiple uptakes on the whole body bone scan study. After management by massive hydration and alkalization of urine with sodium bicarbonate, he was recovered without renal replacement therapy and discharged in good condition.

Multimodal Treatment of Primary Extraskeletal Ewing's Sarcoma of the Chest Wall: Report of 2 Cases / Journal of the Korean Cancer Association, 대한암학회지

Extraskeletal Ewing's sarcoma (EES) is a type of Ewing's sarcoma that arises in soft tissue and is now regarded as a member of a family of small round cell neoplasms of bone and soft tissue, including primitive neuroectodermal tumors (PNETs). EES occurs predominantly in adolescents and young adults between the ages of 10 and 30 years. The disease follows an aggressive course with a high recurrence rate. The presence of a distant metastasis is also common. EES arises in the soft tissue of either the trunk or extremities. We recently experienced two cases of EES that occurred in the chest wall. The two patients underwent wide resection and combined radiochemotherapy. There was no evidence of disease 30 and 22 months, respectively, after surgery. Although extremely rare, EES should be considered in the differential diagnosis of chest wall tumors. We report two cases of EES with a brief review of the literature.

Surgical Treatment of a Right Common Carotid Artery Aneurysm / 대한흉부외과학회지

A 38-year old man was admitted to our hospital due to a 5x6 cm sized pulsating mass in the right neck. He suffered from intermittent neck pain and hoarseness for two months due to the rapidly growing mass. The radiological examinations revealed an aneurysm of the right common carotid artery near the bifurcation, and it was compressing the internal and external carotid arteries. Endarterectomy of the right internal carotid artery, aneurysmectomy of the right common carotid artery and graft interposition were done, while the cerebral circulation was maintained by an internal shunt. Intraoperative injury to the nerve tissue around the aneurysm was avoided. He was discharged on the postoperative 7th day without any complications.

A case of lung abscess caused by Burkholderia cepacia in healthy child / 소아과

Burkholderia cepacia is a Gram-negative aerobic bacillus known to cause opportunistic infections in the immune-compromised hosts. This microorganism is strongly virulent and causes a necrotising invasive infection that may lead to death. As B. cepacia is highly resistant to various antimicrobials, combination antimicrobial therapy must be used instead of monotherapy. We report a successful treatment of lung abscess that was naturally caused by B. cepacia in a healthy child, through combination antimicrobial therapy of meropenem and trimethoprim/sulfamethoxazole and operative management.

Endobronchial Chondroid Hamartoma : A case report / 대한흉부외과학회지

Pulmonary hamartoma is a common benign tumor of the lung, but endobronchial hamartoma is a rare tumor. Although bronchoscopic rcemoval or removal by bronchotomy or sleeve resection with preservation of the lung may be possible, when irreversible lung damage has occurred because of chronic obstruction and pneumonitis, pulmonary resection may be indicated. We herein report a case of endobronchial hamartoma which was treated by left upper lobectomy. A 42-year-old female with 3-week history of cough and left chest pain visited our hospital. Bronchoscopy showed total occlusion of the orifice of the left upper lobe bronchus by a lobulated endobronchial tumor and bronchoscopic biopsy was failed due to bleeding. A left upper lobectomy was performed because of severe consolidation of the left upper lobe by chronic obstruction. The patient was discharged on postoperative 14th day.

Surgical Treatment for Carotid Artery Stenosis / 대한흉부외과학회지

BACKGROUND: Carotid endarterectomy is an effective treatment modality in patients with severe carotid artery stenosis, but it may result in serious postoperative complications. We analyzed the results of the carotid endarterectomy performed in our institution to reduce the complications related to the carotid endarterectomy. MATERIAL AND METHOD: We analyzed retrospectively the medical records of 74 patients (76 cases) who underwent carotid endarterectomy for carotid artery stenosis by a single surgeon from February 1996 to July 2004. RESULT: There were 64 men and 10 women. The mean age of the patients was 63.6 years old. Carotid endarterectomy only was performed in 63 cases, carotid endarterectomy with patch angioplasty in 8 cases, and carotid endarterectomy with segmental resection of internal carotid artery and end to end anastomosis in 5 cases. Intra-arterial shunt was used in 29 cases. The mean back pressures of internal carotid arteries checked after clamping common carotid arteries and external carotid arteries were 23.48+/-10.04 mmHg in 25 cases with changes in electroencephalography (group A) and 47.16+/-16.04 mmHg in 51 cases without changes in electroencephalography (group B). There was no statistical difference in the mean back pressure of internal carotid arteries between two groups (p=0.095), but the back pressures of internal carotid arteries of all patients with changes in electroencephalography were under 40 mmHg. When there was no ischemic change of electroencephalography after clamping common carotid artery and external carotid artery, we did not make use of intra-arterial shunt regardless of the back pressure of internal carotid artery. Operative complications were transient hypoglossal nerve palsy in four cases, cerebral hemorrhage occurred at previous cerebral infarction site in two cases, mild cerebral infarction in one case, hematoma due to anastomosis site bleeding in one case, and upper airway obstruction due to laryngeal edema probably caused by excessive retraction during operation in two cases. One patient expired due to cerebral hemorrhage occurring at previous cerebral infarction site. CONCLUSION: Carotid endarterectomy is a safe operative procedure showing low operative mortality. We suggest that intra-arterial shunt usage should be decided according to the ischemic change of electroencephalography regardless of the back pressure of internal carotid artery. Excessive retraction during operation should be avoided to prevent upper airway obstruction due to laryngeal edema and if upper airway obstruction is suspected, prompt management is essential.

Risk factors of Pneumonectomy in Non-Small Cell Lung Cancer / 대한흉부외과학회지

BACKGROUND: In the resection of lung cancer, pneumonectomy occupied 20~35% of all resections, and significantly high operative mortality is reported in right pneumonectomy (10~25%). The aim of this study is to identify the characteristics of morbidity, operative mortality and factors affecting operative mortality after pneumonectomy. MATERIAL AND METHOD: This study recruited the database which performed pneumonectomy for lung cancer in Korea Cancer Center Hospital from Aug 1987 to Apr 2002. RESULT: Total of 386 pneumonectomies were performed in that period. Sidedness were left in 238, right in 148; and the procedures were standard resection in 207, and extended resection in 179. Morbidity occurred in 115 cases (29.8%, 115/386). Mortality occurred in 12 cases (3.1%, 12 in 386). This mortality rate was similar to that of lobectomy (2.1%, 13 in 613) during the same period. Morbidity consisted of 42 hoarseness, 17 (9) pneumonia and ARDS, 8 empyema, 5 (1) broncho-pleural fistula, 5 reoperation for bleeding, 5 (1) arrhythmia, 1 (1) pulmonary edema, and 25 others (The number in the parenthesis is the number of mortality case for that morbidity). Several factors affecting the operative mortality were evaluated. At first, extended procedure (3.3%, 6 in 179) affected the operative mortality similar to the standard procedure (2.9%, 6 in 207)(p=0.812). Second, the rate of operative mortality in an elderly group over 60 years (5.5%, 10 in 182) was significantly higher than the younger group under 60 years (1%, 2 in 204)(p=0.016). Third, sidedness of resection affects to operative mortality. Right pneumonectomy (6.8%, 10 in 148) showed higher operative mortality than that of left pneumonectomy (0.8%, 2 in 238)(p=0.002). The group over 60 years showed higher incidence of respiratory morbidity (11.0%, 20 in 182) than that of the group under 60 years (3.4%, 7 in 204)(p=0.005). Right pneumonectomy also showed significantly higher incidence (11.5%, 17 in 148) than that of left pneumonectomy (4.2%, 10 in 238)(p=0.008). CONCLUSION: Age and sidedness of pneumonectomy were the risk factors of operative mortality and respiratory complications. Therefore, careful selection of patients and more attention perioperatively were demanded in right pneumonectomy. However, because the operative mortality is acceptable, pneumonectomy could be done safely if the pneumonectomy is necessary for curative resection of lung cancer.

Surgical Treatment for T4 Non-small Cell Lung Cancer Invading Mediastinal Structures / 대한흉부외과학회지

BACKGROUND: Non-small cell lung cancer (NSCLC) with invasion of mediastinal structures is classified as stage IIIB, and has been considered surgically unresectable. However, in a selected group of these patients, better results after surgical resection compared to non-surgical group have been reported. The aim of this study is to evaluate the role of surgical resection in treatment of mediastinal T4 NSCLC. MATERIAL AND METHOD: Among 1067 patients who underwent surgical intervention for non-small cell lung cancer from Aug 1987 to Dec 2001 in Korea cancer center hospital, 82 patients had an invasion of T4 mediastinal structures (7.7%). Resection was possible in 63 patients (63/82 resectability 76.8%). Their medical records in Data Base were reviewed, and they were followed up completely until Jun 2002. Surgical results and prognostic factors of NSCLC invading mediastinal structures were evaluated retrospectively. RESULT: Lung cancer was resected completely in 52 patients (63.4%, 52/82). Lung resection was lobectomy (or more) in 14, pneumonectomy in 49. The mediastinal structures invaded by primary tumor were great vessel (61.9%), heart (19%), vagus nerve (9.5%), esophagus (7.9%), and vertebral body (7.9%). Nodal status was N0 in 11, N1 in 24, and N2 in 28 (44.4%). Neoadjuvant therapy was done in 6 (9.5%, 5 chemotherapy, 1 radiotherapy), and adjuvant therapy was added in 44 (69.8%, 15 chemotherapy, 29 radiotherapy) in resection group (n=63). Complication was occurred in 23 (31.7%), and operative mortality was 9.5% in resection group. Median and 5 year overall survival including operative mortality was 18.1 months and 21.7% in resection group (n=63), 6.2months and 0 % in exploration only group (n=19, p=.001), 39 months and 32.9% in N2 (-) resection group (n=35), and 8.8 months and 8.6% in N2 (+) resection group (n=28, p=.007). The difference of overall survival by mediastinal structure was not significant. CONCLUSION: The operative risk of NSCLC invading mediastinal structures was high but acceptable, and long-term result of resection was favorable in selected group. Aggressive resection is recommended in well selected pateints with good performace and especially N2 (-) NSCLC with mediastinal invasion.

Treatment of Sclerosing Hemangioma by Lobectomy : A case report

A sixty-eight year old female patient was transferred to our department for the resection of a solitary pulmonary nodule on the right lower lobe. An intraoperative frozen-section revealed a bronchioloalveolar carcinoma. Therefore, a right lower lobectomy and mediastinal lymph node dissection were performed. The permanent pathologic diagnosis of this patient was a sclerosing hemangioma. Herein, our experience of the treatment of a sclerosing hemagioma presenting with a solitary pulmonary nodule by a lobectomy is reported with a review of the literature

Clinical investigation about the result of surgically treated myasthenia gravis / 대한흉부외과학회지

BACKGROUND: Myasthenia gravis is a rare autoimmune disease involving acetylcholine receptor and its autoantibody on neuromuscular junction. The methods of treatment are medical treatment and surgical thymectomy. In this paper we analyzed the result of thymectomy and the factors affecting the postoperative symptom improvement. MATERIAL AND METHOD: This study obtained medical records of 37 patients who received the thymectomy for myasthenia gravis from March 1986 to December 1998. RESULT: Out of 37 cases, 21 cases(57%) showed improvement, of which 8 cases (50%) in the group of thymoma(n=16), and 13 cases (62%) in the group of thymic hyperplasia(n=21) showed the improvement of symptoms. Postoperative complications were respiratory insufficiency due to aggravation of symptoms after operation, including tracheal intubation for ventilator support in 9 cases, pneumonia in 3 cases, pneumothorax in 2 cases and left vocal cord palsy in 1 case. There was one postoperative mortality. The relation between postoperative improvement and sex(P=0.3222), age(P=0.7642), thymic pathologic variants,(P=0.4335) and classification of thymoma(P=0.20) showed no statistically significant correlation. However, the lower grade of preoperative symptoms can predict the lower grade of postoperative symptoms significantly(P=0.0032). Follow up study to 36 postoperative survivors was performed in October 2002 based on the out-patient records and call with patients. Out of 36 cases, 33 cases(91.7%) could be investigated and 3 cases could not. Mean follow up period was 83.2 months. Out of 33 cases, 25 cases(75.8%) showed symptomatic improvement, of which 8 cases(53.3%) in the group of thymoma(n=15) and 17 cases(94.4%) in the group of thymic hyperplasia(n=18) showed the improvement of symptoms. CONCLUSION: In myasthenia gravis, thymectomy showed the good improvement, and more important factor affecting the improvement of symptoms was the grdae of preoperative symptoms. Also midterm and long term follow up results showed good symptomatic improvement.

Extraskeletal Mesenchymal Chondrosarcoma of the Mediastinum: A Case Report / 대한흉부외과학회지

Mesenchymal chondrosarcoma arising in soft tissue of mediastinum is a very rare tumor. This paper reports an extraskeletal mesenchymal chondrosarcoma occuring in the posterior mediastinum.

Cadiac Herniation Following Intrapericadial Pneumonectomy: A Case Report / 대한흉부외과학회지

Cardiac herniation is a rare catastrophic complication of intrapericardial pneumonectomy. Untreated it is invariably fatal. Left pneumonectomy for removal of huge angiomatosis tumor in left lung was performed in a 44 year-old male patient. At the end of operation, the patient had cardiovascular collapse due to cardiac herniation. Repaired pericardial suture was teared and the heart was herniated in the left thorax. The hernated heart was edematous caused by compression and incarceration of the cardiac muscle by the edge of the pericardial rent. The heart was introduced into the pericardial sac and the defect was closed with large Goretex patch; however the patient ' s brain had sever hypoxic damage. This paper reports a case of cardiac herniation following left intrapericardial pneumonectomy.