Surgical Repair of Retrograde Type A Aortic Dissection after Thoracic Endovascular Aortic Repair

It is expected that the stent graft will become an alternative method for treating aortic diseases or reducing the extent of surgery; therefore, thoracic endovascular aortic repair has widened its indications. However, it can have rare but serious complications such as paraplegia and retrograde type A aortic dissection. Here, we report a surgical repair of retrograde type A aortic dissection that was performed after thoracic endovascular aortic repair.

Clinical Analysis of Spontaneous Pneumomediastinum / 결핵및호흡기질환

BACKGROUND: Spontaneous pneumomediastinum is a rare and benign condition that generally occurs in young generations without any precipitating factor or underlying disease. The purpose of this study is to review our experience in dealing with this entity and detail a reasonable course of assessment and management. METHODS: From December 1999 to May 2012, 32 spontaneous pneumomediastinum patients were managed in our hospital. We retrospectively reviewed the result of management. RESULTS: Patients ranged in age from 10 to 38 years, with the mean age of 18.3+/-5.6 years. Twenty-five patients were men and seven were women. Initial WBC count was 10,039+/-2,993/microL and thirty-one patients underwent computed tomography. Twenty-two patients underwent esophagography and results were shown to be normal. Twenty-five patients were admitted in the hospital and the mean duration of admission was 3.4+/-2.0 days. All patients were managed conservatively and discharged without any complications. CONCLUSION: Spontaneous pneumomediastinum is a benign condition combined with mild inflammatory signs and secondary causes must to excluded to avoid unfavorable outcomes and select proper management modality.

Late-Onset Postpneumonectomy Empyema Presenting as Right-Sided Heart Failure: Extrinsic Right Atrial Compression

Although it is rare, the right atrium can be encroached on by abnormal mediastinal structures, including aortic aneurysms, carcinomas, hepatic cysts and diaphragmatic paralysis. Extrinsic compression of the right atrium causes significant hemodynamic compromise and can lead to fatal outcomes. We describe the case of a 66-year old man with a past history of pulmonary tuberculosis that had undergone right pneumonectomy 40 years previously. He then presented with signs and symptoms of right-sided heart failure. These new signs and symptoms were recognized to be secondary to extrinsic compression of the right atrium, which was due to late-onset postpneumonectomy empyema, and the signs and symptoms were successfully relieved by performing open drainage of the empyema.

One-Stage Management of Ascending Aorta Replacement and Percutaneous Endovascular Repair for Ascending and Descending Aortic Aneurysms : A case report / 대한흉부외과학회지

A stent graft has been accepted as an alternative method for treating aortic diseases or to reduce the extent of surgery. We report here on a one-stage Management of Ascending Aorta Replacement and Percutaneous Endovascular Repair for the seperate aneurysmal lesions on the ascending and descending aorta.

A Successful Direct Phrenic Nerve Reconstruction in the Course of Malignant Thymoma Resection / 대한흉부외과학회지

We performed nerve resection and reconstruction of the phrenic nerve in a 63-year-old female patient who underwent complete resection of a malignant thymoma. The left phrenic nerve was completely encased by the tumor for 2 cm. Thus, a 3 cm long piece of phrenic nerve with 5 mm margins of safety on each end was resected and it was directly anastomosed in an end-to-end fashion. At 11 months after reconstruction, fluoroscopy demonstrated adequate and symmetric motion of both hemidiaphragms, which indicated the restoration of phrenic nerve function. The pulmonary function test results were comparable to those obtained preoperatively at 30 months. There has been no evidence of recurrence at the recent follow up visits.

Low Grade Fibromyxoid Sarcoma of the Visceral Pleura: A case report / 대한흉부외과학회지

Low grade fibromyxoid sarcoma (LGFM) is a rare, deep soft-tissue malignant tumor. Although its histologic features are benign, the clinical course is malignant. The usual tumor locations are the lower extremity and chest wall. LGFM originating from the visceral pleura is extremely rare. We report here on a 37 year old man with a LGFM of the visceral pleura. Thirty three months after surgery, the patient is alive without any sign of local recurrence or distant metastasis.

Surgical Management of Multiple Coronary Artery Aneurysms: A case report / 대한흉부외과학회지

Multiple coronary aneurysms are rare in adults. The cause may be atherosclerosis, congenital malformations, post-traumatic or post-syphilitic vascular lesions, connective tissue diseases like Marfan and Ehler-Danlos syndromes or Kawasaki disease, all of which cause weakening of the media. Surgical intervention is indicated to prevent rupture, embolization or compression symptoms. The successful management of multiple coronary artery aneurysms, associated with previous rupture and arrhythmia, originating from proximal potions of ramus intermedius and left circumflex artery are reported.

Successful Resuscitation of Cardiac Arrest with Acute Massive Pulmonary Embolism during Operation Using Percutaneous Cardiopulmonary Support (PCPS): A case report / 대한흉부외과학회지

Since the introduction of extracorporeal cardiopulmonary support of cardiac arrest in 1983, emergent cardiopulmonary support has been used to treat cardiac arrest. Acute massive pulmonary embolism is associated with a high mortality rate and it poses a challenge for both the anesthesiologist and the surgeons especially during operations. This report describes the use of the emergent bypass system in the effective management of an intraoperative massive pulmonary embolism and cardiac arrest in a 56-year-old woman. The patient was discharged on warfarin and there was no recurrence of the pulmonary embolism at the follow-up visit.

Management of Complete Tracheal Disruption after a Fall

A complete tracheal rupture due to blunt trauma is rare, and a high proportion of patients with this injury die prior to arrival at medical centers. Early diagnosis and prompt management is essential in order to reduce morbidity and mortality. A 38-year-old woman visited the emergency department after a fall from the 4th floor of a building. We confirmed that a complete tracheal disruption 4 cm above the carina by chest CT. We could not insert an endotracheal tube because the distal stump of the trachea was separated by 4 cm from the proximal stump, so we used percutaneous cardiopulmonary bypass for the prevention of hypoxia during the initial operative procedures. We performed resections and reconstruction of the injured trachea. Fourteen days after the operation we confirmed normal healing of the trachea with bronchoscopy. One year after the operation, the patient is healthy with no tracheal problems.

Clinical Analysis of Video-assisted Thoracoscopic Spinal Surgery in the Thoracic or Thoracolumbar Spinal Pathologies

OBJECTIVE: Thoracoscopic spinal surgery provides minimally invasive approaches for effective vertebral decompression and reconstruction of the thoracic and thoracolumbar spine, while surgery related morbidity can be significantly lowered. This study analyzes clinical results of thoracoscopic spinal surgery performed at our institute. METHODS: Twenty consecutive patients underwent video-assisted thoracosopic surgery (VATS) to treat various thoracic and thoracolumbar pathologies from April 2000 to July 2006. The lesions consisted of spinal trauma (13 cases), thoracic disc herniation (4 cases), tuberculous spondylitis (1 case), post-operative thoracolumbar kyphosis (1 case) and thoracic tumor (1 case). The level of operation included upper thoracic lesions (3 cases), midthoracic lesions (6 cases) and thoracolumbar lesions (11 cases). We classified the procedure into three groups: stand-alone thoracoscopic discectomy (3 cases), thoracoscopic fusion (11 cases) and video assisted mini-thoracotomy (6 cases). RESULTS: Analysis on the Frankel performance scale in spinal trauma patients (13 cases), showed a total of 7 patients who had neurological impairment preoperatively : Grade D (2 cases), Grade C (2 cases), Grade B (1 case), and Grade A (2 cases). Four patients were neurologically improved postoperatively, two patients were improved from C to E, one improved from grade D to E and one improved from grade B to grade D. The preoperative Cobb's and kyphotic angle were measured in spinal trauma patients and were 18.9+/-4.4 degrees and 18.8+/-4.6 degrees, respectively. Postoperatively, the angles showed statistically significant improvement, 15.1+/-3.7 degrees and 11.3+/-2.4 degrees, respectively (P<0.001). CONCLUSION: Although VATS requires a steep learning curve, it is an effective and minimally invasive procedure which provides biomechanical stability in terms of anterior column decompression and reconstruction for anterior load bearing, and preservation of intercostal muscles and diaphragm.

Comparison of Hypotensive with Non-hypotensive Group in Severe Trauma Patients

PURPOSE: There have been many reports that point to the increasing death and emergency operation rate in traumatic hemorrhagic shock patients. The purpose of this study was to discover the clinical difference between the hypotensive traumatic patients and the non-hypotensive traumatic patients that had been managed in intensive care unit (ICU). METHODS: We retrospectively reviewed the medical records of 122 patients admitted to ICU for trauma from January 2001 to December 2002. We compared the hypotensive (systolic blood pressure (SBP) < 90 mmHg) group with the non-hypotensive group about age, diastolic blood pressure, initial hemoglobin, Injury Severity Score (ISS), Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), transfusion volume at emergency department, blood pH, blood base deficit, duration of admission, ICU stay, death rate, transfusion volume and others. RESULTS: There was no difference between two groups in age, causes of injury, situation whether or not the patient was directly transported from the scene and ISS. But there were differences between two groups in initial hemoglobins, GCS, RTS, blood pH, blood base deficit, duration of admission, ICU stay, and death rate. It was documented that the ICU stay correlated with systolic blood pressure, diastolic blood pressure, initial hemoglobin, blood base deficit, ISS, GCS, and RTS but not correlated with transfusion volume in emergency department. CONCLUSION: Systolic blood pressure is not the sensitive parameter of blood loss. Various kinds of indices of hypotensive group are more severe than non-hypotensive group. If traumatic patients are hypotensive blood pressure on arrival at emergency department, we should be careful of the state of these patients.

Good's Syndrome (Thymoma with Immunodeficiency) : A case report / 대한흉부외과학회지

Good's syndrome (thymoma with immunodeficiency) is a rare cause of combined B and T cell immunodeficiency in adults. The clinical characteristics are increased susceptibility to bacterial infection and opportunistic viral and fungal infections. The most consistent immunological abnormalities are hypogammaglobulinemia and reduced or absent B cells. This syndrome should be treated by resecting the thymoma and replacing the immunoglobulin to maintain adequate IgG values. The author experienced one case of Good's Syndrome. The patient was a 64-year-old female who had a history of frequent sinopulmonary infection. Chest CT showed Pneumonia and anterior mediastinal mass and PCNB was taken and biopsy result was thymoma. She received thymectomy and replacement of immunoglobulin to control hypogammaglobulinemia.

The Usefulness of Venous Color Doppler with Valsalva Maneuver for Varicose Vein

PURPOSE: We wanted to evaluate the usefulness of venous color Doppler with performing a Valsalva maneuver for chassifing primary varicose vein of the lower extremity. MATERIALS AND METHODS: From September 2002 to March 2005, 207 patients and 288 extremities that were clinically suggestive of primary varicose vein in the lower extremity underwent venous color Doppler with performing a Valsalva maneuver. The patients included 133 women and 74 men aged between 20-79 years (mean age: 51 year). Color Doppler study was performed in the great and small saphenous veins. We used a 5 point grading system, Grade (Gr.) 0 was no evidence of reflux, Gr. I was early reflux within 3 seconds after the Valsalva maneuver, Gr. II was continuous reflux without dilatation during the Valsalva maneuver, Gr. III was continuous reflux with dilatation during the Valsalva maneuver and Gr. IV was reflux at a resting state. To find a relationship between the rate of operation and the grading system, we retrospectively reviewed the patient's medical records and the grading system. RESULTS: In the great saphenous vein, Gr. 0 was noted in 42 cases, Gr. I was noted in 68 cases, Gr. II was noted in 23 cases, Gr. III was noted in 104 cases and Gr. IV was noted in 51 cases. In the small saphenous vein, Gr. 0 was noted in 98 cases, Gr. I was noted in 60 cases Gr. II was noted in 38 cases, Gr. III was noted in 36 cases and Gr. IV was noted 56 cases. Among these cases, 2 cases of Gr. 0, 9 cases of Gr. I, 3 cases of Gr. II, 85 cases of Gr. III and 44 cases of Gr. IV of the great saphenous vein were operated on. 3 cases of Gr. 0, 4 cases of Gr. I, 4 cases of Gr. II, 23 cases of Gr. III and 37 cases of Gr. IV of the small saphenous vein were also operated on. Consequently, the operation rate was 76.5% in the severe cases over Gr. III. CONCLUSION: Color Doppler with performing a Valsalva maneuver and our new grading system is a useful method to determine the rate of operation for the patients suffering with primary varicose vein.

Treatment of Tumor Involving Thoracic Inlet by Using Transmanubrial Osteomuscular Sparing Approach: One case report / 대한흉부외과학회지

The operative case of transmanubrial osteomuscular sparing approach for the tumor involving thoracic inlet is reported. A 69-year-old man visited the hospital due to right upper extremity weakness. Chest roentgenogram showed bronchiectasis, chronic pulmonary tuberculosis, and fungal ball in right upper lobe. On computed tomogram, tumor was located in epidural space of the 6th, the 7th cervical, and the 1st thoracic spine and extended to the apex of the right thorax. A neurosurgeon performed laminectomy and removed the tumor located in the spinal canal. A thoracic surgeon performed a transmanubrial osteomuscular sparing approach and removed the tumor involving thoracic inlet. The tumor was diagnosed as hemangiopericytoma. The patient recovered without complication.

Radiological Findings of Giant Pulmonary Chondromatous Hamartoma: Case Report

Among lung tumors, multiple hamartomas are uncommon and multiple chondromatous hamartomas are extremely rare. In this report, we describe a patient with an interval growth of a giant chondromatous hamartoma with accompanying multiple satellite nodules in the adjacent lung and the parietal pleura. We also present the follow up chest radiograph, computed tomograph, magnetic resonance images and photographs of the operating field of the tumor with pathologic correlation.

Laparoscopic Heller Myotomy with Dor Fundoplication in Achalasia: One case report / 대한흉부외과학회지

An 18-year old woman had dysphagia and frequent vomiting after meals for 6 years. She lost 15 kg in 6 months recently. After esophageal manometry, she was diagnosed with achalasia. We decided to use laparoscopic surgery because there was no symptomatic improvement after medication. We made small 5 incisions on her abdomen. We performed Heller myotomy and Dor fundoplication. We performed esophagogram one day after the operation. There was no leakage of the contrast media, and it passed well. She started to eat at the 2nd day after the operation and was discharged on the 9th day without other specific problem.

Thoracoscopic Surgery for Diaphragmatic Rupture: One case report / 대한흉부외과학회지

The conformation of traumatic diaphragmatic rupture is frequently difficult, even if radiologic evaluation has been performed. A 37-year old man with multiple trauma was suspicious with diaphragmatic rupture. The diaphragmatic rupture could not be confirmed with chest CT. We decided thoracoscopic operation for diagnosis. Diaphragm was ruptured about 8 cm length involving entering site of phrenic nerve into diaphragm and diaphragmatic paralysis was combined. We made 5 cm sized working window additionally. Ruptured diaphragm was repaired by continuous suture and plication of diaphragm was performed. Postoperative result was good at chest radiogram after three monthes.

Mucoepidermoid Carcinoma of the Right Lower Lobe Bronchus: A case report / 대한흉부외과학회지

Mucoepidermoid carcinoma is an uncommon lesion that accounts for approximately 1% of primary malignant bronchial gland tumors and less than 0.2% of all lung neoplasm. This tumor presents with symptoms of bronchial irritation or obstruction. Distant metastasis is uncommon, therefore complete surgical resection is the treatment of choice. The prognosis of tumor correlates with on the histologic grade of tumor. We experienced mucoepidermoid carcinoma in a 15 year-old girl with symptoms of cough and blood tinged sputum. The patient underwent successful removal of tumor by bilobectomy via explorothoracotomy after chest CT and bronchoscopic biopsy.

Treatment of Bilateral Diaphragmatic Paralysis after Resection of Thymic Carcinoma: One case report / 대한흉부외과학회지

Bilateral diaphragmatic paralysis is a rare disease. It is caused by trauma, cardiothoracic surgery, neuromuscular disorders, cervical spondylosis, and infection. A 60 year-old male patient developed bilateral diaphragmatic paralysis after an en-bloc resection of thymic carcinoma which invaded the right upper lobe, pericardium, superior vena cava and innominate vein. Severe respiratory difficulty developed and ventilator weaning was impossible. We performed bilateral diaphragmatic plication. After the operation, satisfactorily ventilator weaning and sleeping in supine position were possible; therefore, we report this case.

Large Cell Neuroendocrine Carcinoma of the Lung: A case report / 대한흉부외과학회지

The large cell neuroendocrine carcinoma is uncommon and its diagnostic criteria was recently established as pulmonary neuroendocrine carcinoma. A 74-year-old man who was a heavy smoker without symptoms was presented with a lung mass in right lower lobe. He was diagnosed as having large cell neuroendocrine carcinoma by needle biopsy. He was treated with right lower lobe lobectomy and mediastinal lymph node dissection. We experienced one case of large cell neuroendocrine carcinoma of lung and report it with reference.