Preoperative Concurrent Radiochemotherapy for Locally Advanced Esophageal Cancer: Treatment Outcome and Prognostic Factors / 대한방사선종양학회지

PURPOSE: This study reports the results of the use of preoperative concurrent radiochemotherapy (CRCT) for the treatment of locoregionally advanced esophageal cancer. MATERIALS AND METHODS: From 1998 through 2005, 61 patients with intrathoracic esophageal cancer at stages II-IVB (without distant organ metastasis and presumed to be respectable) received preoperative CRCT. CRCT consisted of radiotherapy (45 Gy /25 fractions /5 weeks) and FP chemotherapy (5-FU 1 g/m2/day, days 1-4 and 29-32, Cisplatin 60 mg/m2/day, days 1 and 29). An esophagectomy was planned in 4~6 weeks after the completion of CRCT. RESULTS: There were two treatment-related deaths. Among the 61 patients, 53 patients underwent surgery and 17 patients achieved a pathological complete response (pCR). The overall survival (OS) rates of all 61 patients at 2 and 5 years were 59.0% and 38.0%, respectively. The rates of OS and disease-free survival (DFS) of the surgically resected patients at 2 and 5 years were 61.6%, 40.1% and 53.3%, 41.8%, respectively. By univariate analysis, achieviement of pCR and a clinically uninvolved distant lymph node (cM0) were favorable prognostic factors for OS and DFS. There were 27 patients that experienced a relapse-a locoregional relapse occurred in 5 patients, a distant metastasis occurred in 12 patients and combined failure occurred in 10 patients. CONCLUSION: The results of the current study are favorable. pCR and an uninvolved distant lymph node were found to be favorable prognostic factors.

Motor Unit Action Potentials of the Rectus Abdominis Muscle according to Changes of Abdominal Pressure

OBJECTIVE: In current urodynamic studies, rectal catheters can cause erroneous result affecting detrusor pressure, and the catheter itself is not comfortable to the patients. To reduce these problems we investigated the relationship between the motor unit action potentials (MUAP) of rectus abdominis muscle and the abdominal pressure measured by rectal catheter. METHOD: Healthy seven men and three women volunteers (mean age: 49 years) with no neurological abnormality were enrolled. Possible maximal abdominal pressure (Pmax) was attained by Valsalva maneuver for 5 seconds. The MUAPs of the rectus abdominis muscle were recorded with surface electrodes for analysis. These recordings were done on 100, 80, 60, 40, and 20% of Pmax. The parameters of MUAP such as mean frequency, median frequency, turns, mean amplitude, and RMS (root mean square) were measured. RESULTS: Turns, mean amplitude, and RMS were increased in a proportion to the increment of abdominal pressure in all subjects(R=0.840, 0.879, and 0.984, respectively). CONCLUSION: These findings suggested that the surface MUAP of rectus abdominis muscle might be used indirectly for more convenient measurement of the abdominal pressure.

Cross-Linked Hyaluronic Acid Gel Injection for the Patients with Unilateral Vocal Cord Paralysis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Hyaluronic acid (HA) is a natural polysaccharide, which resides in the extracellular space of all mammalian connective tissue and creates viscoelasticity, hydrating, lubricating and stabilizing matrix. The authors aimed to determine the clinical efficacy and safety of using HA derivative as an injection material to correct the glottal insufficiency of patients with unilateral vocal cold palsy (VCP). SUBJECTS AND METHOD: Twenty-eight consecutive patients with recent unilateral VCP received percutaneous HA derivative (Rofilan(R)) injections under local anesthesia. Acoustic, aerodynamic and stroboscopic analyses were prospectively provided for the 14 subjects prior to the injection, and 1 week and 3 months after the injection. Perceptual GRBAS grading by speech language pathologists and subjective ratings of the hoarseness and aspiration by the patients were also obtained. RESULTS: Acoustic (jitter and shimmer) and aerodynamic (maximal phonation time) parameters were significantly improved after the injection (p<0.05). Perceptual grading and subjective scaling also showed significant improvement. Those beneficial effects could be maintained for longer than 3 months but with a tendency of losing their effects with time. Early or delayed significant side effects were not observed. CONCLUSION: Vocal fold injection with HA derivative is a convenient, safe and useful method of correcting glottal insufficiency for more than 3 months. The patients with recently developed unilateral VCP with unknown possibility of recovery would be suitable candidates for HA injection. Further long-term follow-up studies will answer the durability of the HA injection effect.

Treatment Outcome of Thymic Epithelial Tumor: Prognostic Factors and Optimal Postoperative Radiation Therapy / 대한방사선종양학회지

PURPOSE: This study was conducted to analyze treatment outcome and prognostic significance of World Health Organization (WHO)-defined thymic epithelial tumor (TET) subtype and to assess optimal radiation target volume in patients receiving surgery and adjuvant radiation therapy with TET. MATERIALS AND METHODS: The record of 160 patients with TET, who received surgical resection at the Samsung medical Center, from December 1994 to June 2004, were reviewed. 99 patients were treated with postoperative radiation therapy (PORT). PORT was recommended when patients had more than one findings among suspicious incomplete resection or positive resection margin or Masaoka stage II~IV or WHO tumor type B2~C. PORT performed to primary tumor bed only with a mean dose of 54 Gy. The prognostic factor and pattern of failure were analyzed retrospectively. RESULTS: The overall survival rate at 5 years was 87.3%. Age (more than 60 years 77.8%, less than 60 years 91.1%; p=0.03), Masaoka stage (I 92.2%, II 95.4%, III 82.1%, IV 67.5%; p=0.001), WHO tumor type (A-B1 96.0%, B2-C 82.3%; p=0.001), Extent of resection (R0 resection 92.3%, R1 or 2 resection 72.6%; p=0.001) were the prognostic factors according to univariate analysis. But WHO tumor type was the only significant prognostic factor according to multivariate analysis. Recurrence was observed in 5 patients of 71 Masoka stage I-III patients who received grossly complete tumor removal (R0, R1 resection) and PORT to primary tumor bed. Mediastinal recurrence was observed in only one patients. There were no recurrence within irradiation field. CONCLUSION: WHO tumor type was the important prognostic factor to predict survival of patients with TET. This study suggest that PORT to only primary tumor bed was optimal. To avoid pleura- or pericardium-based recurrence, further study of effective chemotherapy should be investigated.

Changes of Voiding Methods in Patients with Spinal Cord Injury

PURPOSE: To investigate the changes of voiding methods according to the time after discharge and to clarify the reason of changing voiding method. MATERIALS AND METHODS: One hundred and seventeen patients with spinal cord injury were enrolled. We classified these patients into five groups such as normal voiding, reflex voiding, intermittent catheterization, Foley catheter, and suprapubic cystostomy group. We interviewed the patients for necessary information including current voiding method and reason of changing voiding method. RESULTS: 50% of intermittent catheterization patients changed to reflex voiding method. 66% of these patients changed the voiding method without consult with their physician. Higher percentage of the paraplegic patients with intermittent catheterization changed to reflex voiding than the quadriplegic patients. Moreover, female patients indwelt the catheters due to absence of external collecting device than males. CONCLUSION: It is necessary to follow up the voiding methods of patients with spinal cord injury more closely to avoid the following inadvertent complications.

Epidural Abscess and Pyogenic Arthritis of Knee Joint in One Family after Epidural Injection

A mother-in-law and a daughter-in-law suffered chronic low back pain and they were injected epidural steroid on same day. Eleven days after injection, the daughter-in-law showed weakness of right lower extremity and lost filling sensation of bladder. Radiologic findings of Magnetic Resonance Imaging for lumbar spine revealed epidural abscess encompassing from L1 to sacral spine. After emergency surgical procedure and antibiotics therapy, the symptoms and the signs disappeared. Seven days after injection, the mother-in-law was diagnosed as pyogenic arthritis of right knee joint and then epidural abscess. Although the surgical procedure for right knee joint and antibiotics therapy were done, the epidural abscess didn't disappear. Moreover, surgical procedure for the epidural abscess couldn't be done due to septic condition, which was the cause of death. We report two cases of epidural abscess showing the importance of early management and serious end result. Prevention of these complication through extreme caution is needed.

Postoperative Radiation Therapy for Chest Wall Invading pT3N0 Non-small Cell Lung Cancer: Elective Lymphatic Irradiation May Not Be Necessary / 대한방사선종양학회지

PURPOSE: No general consensus has been reached regarding the necessity of postoperative radiation therapy (PORT) and the optimal techniques of its application for patients with chest wall invasion (pT3cw) and node negative (N0) non-small cell lung cancer (NSCLC). We retrospectively analyzed the pT3cwN0 NSCLC patients who received PORT because of presumed inadequate resection margin on surgical findings. MATERIALS AND METHODS: From Aug. 1994 till June 2000, 21 pT3cwN0 NSCLC patients received PORT at Samsung Medical Center; all of whom underwent curative en-bloc resection of the primary tumor plus the chest wall and regional lymph node dissection. PORT was typically started 3 to 4 weeks after operation using 6 or 10 MV X-rays from a linear accelerator. The radiation target volume was confined to the tumor bed plus the immediate adjacent tissue, and no regional lymphatics were included. The planned radiation dose was 54 Gy by conventional fractionation schedule. The survival rates were calculated and the failure patterns analyzed. RESULTS: Overall survival, disease-free survival, loco-regional recurrence-free survival, and distant metastases-free survival rates at 5 years were 38.8%, 45.5%, 90.2%, and 48.1%, respectively. Eleven patients experienced treatment failure: six with distant metastases, three with intra-thoracic failures, and two with combined distant and intra-thoracic failures. Among the five patients with intra-thoracic failures, two had pleural seeding, two had in-field local failures, and only one had regional lymphatic failure in the mediastinum. No patients suffered from acute and late radiation side effects of RTOG grade 3 or higher. CONCLUSION: The strategy of adding PORT to surgery to improve the probability, not only of local control but also of survival, was justified, considering that local control was the most important component in the successful treatment of pT3cw NSCLC patients, especially when the resection margin was not adequate. The incidence and the severity of the acute and late side effects of PORT were markedly reduced, which contributed to improving the patients' quality of life both during and after PORT, without increasing the risk of regional failures by eliminating the regional lymphatics from the radiation target volume.

Isolated Pulmonary Cryptococcosis: Report of Six Cases and Review of the Korean Cases

BACKGROUND: Isolated pulmonary cryptococcosis is uncommon, and it can be seen in both immunocompetent and immunocompromised individuals. In Korea, twenty cases have been described thus far. METHODS: We report six additional cases of isolated pulmonary cryptococcosis, which were diagnosed by surgical biopsies or fine needle aspiration cytology. We also reviewed the clinicoradiologic and pathologic findings of all the previously published Korean cases of isolated pulmonary cryptococcosis. RESULTS: Only two patients out of six cases exhibited mild cough and/or fever. Radiologically, three cases presented with multiple subpleural nodules, two with a solitary pulmonary nodule, and one with patchy pneumonic infiltration. On systemic steroid therapy, one case was in severe immunocompromised status at the time of the diagnoses; but three cases had histories of gastric or uterine cervix carcinomas, raising the initial clinical impression of hematogeneous pulmonary metastatic nodules, and one case was accompanied by synchronous pulmonary adenocarcinoma. After reviewing all twenty-six cases of isolated pulmonary cryptococcosis (twenty reported in Korea and our six additional cases), the most common radiologic finding was solitary pulmonary nodule (50%), followed by subpleurally located, multiple nodules (26.9%), pneumonic infiltrates (19.2%), and pleural effusion with thickened pleura (3.8%). Two cases were also accompanied by hilar lymphadenopathy (7.7%). Clinically, presenting symptoms varied: 18 of 26 cases (69.2%) were accompanied by cough and mild fever, but 8 of 26 cases (30.8%) were entirely asymptomatic. CONCLUSIONS: Since isolated pulmonary cryptococcosis presents itself with nonspecific clinicoradiologic findings, early recognition and differentiation from malignant tumors and pulmonary tuberculosis -the most common causes of solitary pulmonary nodules in Korea- are important to avoiding unnecessary treatment.

The Relation between Histopathologic Findings on Surgical Specimen and Outcomes in Patients with N2 Positive Stage IIIA Non-Small Cell Lung Cancer Receiving Preoperative Concurrent Radiochemotherapy and Surgery / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: To evaluate the prognostic implication of histopathologic findings on the surgical specimens of N2 positive stage IIIA non-small cell lung cancer (NSCLC) patients who were treated with preoperative concurrent radiochemotherapy (CRCT) and surgery. MATERIALS AND METHODS: From May 1997 to April 2000, 48 patients with N2 positive stage IIIA NSCLC were treated with preoperative CRCT and surgery. Retrospective analyses were performed on 33 patients who underwent surgical resection. The thoracic radiation therapy (TRT) dose was 45 Gy over 5 weeks with a 1.8 Gy daily fraction using 10 MV X-rays. Chemotherapy consisted of two cycles of intravenous cisplatin (100 mg/m2, on days 1 and 29) and oral etoposide (50 mg/m2/day, on days 1~14 and 29~42), concurrently delivered with TRT. Surgery was performed around 4 weeks of the completion of CRCT. The median follow up was 18 months. The histopathologic findings, including the proportions of viable tumor cells, fibrosis, and necrosis, as well as the tumor and nodal statuses on the surgical specimens following the preoperative CRCT, were analyzed. RESULTS: The 3-year overall survival, disease-free survival, and local control rates were 46.1%, 49.5%, and 85.5%, respectively. Post-surgical stages decreased in 18 patients (54.5%), including 3 pathologic complete responses, were unchanged in 13 (39.4%), and increased in two (6.1%). On univariate analyses, the low proportion of the viable tumor cells was the only factor favorably affecting the overall survival rate (p=0.0386), and the histologic type of squamous cell carcinoma was a favorable factor affecting disease free survival rate (p=0.0452). On multivariate analyses, however, no factor affected the overall survival, disease free survival, or local control rates. CONCLUSION: The histopathologic findings of the proportion of viable tumor cells, fibrosis, and necrosis on the surgical specimens following preoperative CRCT had few prognostic implications on uni-and multi-variate analyses. Furthermore, the primary tumor and nodal responses to preoperative CRCT did not influence the outcomes. Longer-term follow-up with a larger number of patients, however, is awaited.

Severity of Disability and Serum Lipid Level according to the Genotype of Apolipoprotein E in Patients with Brain Injury

OBJECTIVE: This study was to investigate the relationship between genotype of Apolipoprotein E (Apo E) and severity of disability after brain injury as well as serum lipid profile. METHOD: One hundred thirty-five brain injured patients (mean age 54.6 16.7 years, 90 male and 45 female) were enrolled. There were 34 patients with ischemic Stroke, 61 hemorrhagic stroke, and 40 traumatic brain injury. Apo E genotype was determined by polymerase chain reaction and polyacrylamide gel electrophoresis. The serum concentra tions of total cholesterol, triglyceride, and HDL-cholesterol were measured. The outcome of brain injury was assessed by functional independence measure (FIM) scores. RESULTS: Most frequent Apo E genotype was E 3/3 (72%). In hemorrhagic stroke patients with Epsilon4 allele, FIM score at admission was significantly lower than that of the patients without Epsilon4 allele (p<0.05). In traumatic brain injury patients with Epsilon4 allele, FIM score change was significantly smaller than that of patients without Epsilon4 allele (p<0.05). The level of total serum cholesterol was lower in the ischemic stroke patients who have Epsilon2 allele in comparison with the patients without that allele. CONCLUSION: The presence of Epsilon4 allele is considered to have relationship with the severity of disability and functional outcome in the patients with brain injury.

Surgical Resection of Primary Sarcoma of Pulmonary Artery Clinically Suspected of Carcinoid / 대한흉부외과학회지

Primary sarcomas of the pulmonary arteries are and the clinical presentation closely resembles several more common conditions, Therefore they are seldomly diagnosed preoperatively without a pathologic esxamination of sufficient surgical specimen. Treatment of these tumors remains primarily surgical as possible and the role of the adjuvant chemotherapy and radiotherapy is not yet evident We report a case of primary sarcoma of pulmonary artery clinically suspected of carcinoid partially involving the pulmonary parechyme and the bronchus mainly in the left main pulmonary artery and the vein with left intrapericardial pneumonectomy.

Isolated Lung Perfusion with Cisplatin in Rabbit - evaluation of pharmacokinetics and long term pathologic changes of the lung / 대한흉부외과학회지

BACKGROUND: Recently, regional or isolated organ perfusion is being studied again as a drug administration modality which is able to reduce systemic toxicity while delivering high-dose chemotherapeutic agents. This research was planned to evaluate the pharmacokinetics and long-term pathologic changes of the lung in isolated lung perfusion (ILP) with cisplatin. MATERIAL AND METHOD: Twenty-five New Zealand white rabbits were divided into 2 groups (Group I: 10, Group II: 15). The groups were then subdivided into 2 and 3 subgroups of 5 rabbits. In group I, tissue samples of the lung and kidney, and systemic blood for platinum concentration measurement were taken 30 minutes after systemic intravenous infusion of cisplatin (5 mg/kg) and isolated lung perfusion in each 5 rabbits. In 2 subgroups of group II, lung tissues for pathologic exams were taken 30 minutes and 1 week after ILP in each 5 rabbits, which received 10% pentastarch solution only and cisplatin, respectively. In the other subgroups, lung biopsy was undertaken 4 weeks after ILP with cisplatin. RESULT: When cisplatin was infused via systemic vein, the platinum concentration in the lung, kidney and plasma were 1.50+/-0.43 microgram/g, 7.65+/-2.49 microgram/g, 1.19+/-0.03 microgram/ml, respectively. However, the platinum concentration in the lung was about 50 times higher (75.43+/-11.47 microgram/g) than that of intravenous infusion group, and those in the kidney and plasma were decreased (1.30+/- 0.35 microgram/g, 0.13+/-0.02 microgram/ml) when cisplatin was introduced through ILP. Pathologic change in the treated lung with ILP was characterized by the medial hypertrophy of the pulmonary arterioles and interstitial eosinophilic infiltration, which was not dependent on cisplatin.

Results of Pharyngocolostomy in Intractable Caustic Pharyngeal Stricture / 대한흉부외과학회지

BACKGROUND: It is not easy to surgically correct caustic pharyngeal strictures and a lot of effort is required to restore normal swallowing after the surgery. The authors reviewed the course in patients who underwent pharyngocolostomy. MATERIAL AND METHOD: From August 1995 to March 1998, 6 patients with caustic stricture underwent esophageal reconstruction surgery. The time of injury to the replacement of the esophagus was from 3 months to 2 years and 4 months. The left colon was used in all patients. The surgical route was used under the sternum in 5 patients and through the esophageal hiatus in 1 patient. In the cervical anastomoses, the cervical pharyngocolic anastomosis was performed on the left pyriform sinus after a partial resection of the thyroid cartilage in 3 patients and on the posterolateral aspect of the inferior pharyngeal constrictor in 3 patients. RESULT: Postoperative complications consisted of a dysphagia in 3 patients and left vocal cord palsy in 1 patient. There was no cervical anastomotic stricture. Revisional procedures consisted of an esophageal dilation and free jejunal graft in 1 patient, supraglottic scar band resection in 1 patient, and colonic mucosal resection in 1 patient. Swallowing training was required in the 3 patients with dysphagia. Restoration of normal swallowing was obtained in all patients between the 9th and the 303rd day. CONCLUSION: Pharyngocolostomy is a satisfactory method of treatment for patients with intractable caustic stricture. Pharyngocolojejunostomy is an effective alternative for esophagocologastrostomy in cases where gastric outlets are involved.

One-stage Replacement of the Total Thoracic Aorta / 대한흉부외과학회지

Some extensive thoracic aortic aneurysms are not amenable to staged repair, such as extremely large distal aortic aneurysms that are unsuitable for an elephant trunk anastomosis, or aneurysms that are accompanied by complications such as ruptured descending thoracic aneurysm. We report here a case of successful replacement of the aorta from the ascending to the descending aorta in one operation. The patient was 65-year-old man who had an aneurysm which involved the entire thoracic aorta and ruptured in the descending aorta. The operation was performed via transverse thoracosternotomy, and under the deep hypothermic circulatory arrest with retrograde cerebral perfusion. The patient recovered uneventfully and was discharged without any neurologic complications.

Comparision of Risk Factors in Lung Cancer Surgery of Above 70-Year Old Patients / 대한흉부외과학회지

BACKGROUND: Early detection and surgical resection offer the most advantage out of all cures for lung cancer. Elderly patients may fail to benefit maximally from these interventions because of their general condition and residual lung function. To study the impact of age on stages, histology, symptoms, and treatments of the patients with non-small cell lung cancer, we undertook a retrospective review. MATERIAL AND METHOD: Two hundred eleven patients with non-small cell lung cancer were operated on at Samsung Seoul hospital between October 1994 and June 1997. Patients were arbitrarily arbitrarily by age less than 70 years(176 patients) and 70 years or more(35 patients), and their medical records were reviewed. RESULT: There were no differences in pathologic staging and diagnosis. But there were differences in surgical methods, complications, and mortality rates between the two groups. There were much more complications in the 70 years or more group(p=0.02). We chose less invasive surgical methods in the 70 years or more group. CONCLUSION: More complications were experienced in the 70 years or more group. Although thoracic operation imparts the greatest survival advantage, this benefit is diminished in elderly patients because of their high complications and mortality rate. We recommend serious consideration of surgical indications and operative methods.

Gastro-Cavenous Fistula Developed after Esophagectomy ( Ivor Lewis Operation ) Due to Active Gastric Ulcer in Esophageal Cancer / 대한흉부외과학회지

A 58-year-old male patient visited our hospital for epigastric discomfort and dysphagia which had developed 5 months earlier. He was diagnosed with esophageal cancer at the mid-thoracic level based on radiologic, endoscopic, and histologic examinations. An esophagectomy(Ivor Lewis technique) was done to treat the esophageal cancer. He was doing well until the 20th postoperative day when he began to complain of cough, sputum, fever and chills, Subsequently, thereafter, abdominal pain and generalized abdominal tenderness developed on the 22nd postoperative day. Upon gastrofiberscopy and esophagographic examinations, he was diagnosed with gastrobronchial fistula and an emergency operation was performed. On operative findings, the gastric fundus was perforated and directly connected to the abscessed cavity of the right upper lobe due to a gastric ulcer. We, herewith, report this case after review of the literature.

A case of respiratory bronchiolitis-associated interstitial lung disease / 결핵

Respiratory bronchiolitis-associated interstitial lung disease has been described among current or former smokers and has features consistent with interstitial lung disease. Symptoms include cough, dyspnea on exertion. Lung pathology is characterized by the accumulation of pigmented macrophages within respiratory bronchioles and adjacent air spaces associated with mild thickening of the peribronchiolar interstitium. It must be separated from the other interstitial lung disease because of marked differences in treatment and prognosis. Recently we experienced a case of respiratory bronchiolitis -associated interstitial lung disease in a 48-year-old man. As far as we know, this is the first case in Korea.

Computerized Quantative Analysis of Cornary Angiogram in Patients without Coronary Pathology / 대한흉부외과학회지

In the preoperative evaluation before coronary artery bypass surgery, review of the coronary arteriogram is the most important step. Expected "normal" lumen diameter at a given coronary anatomic location is a basis for quantative estimation of coronary disease severity that could be more useful than the traditional "percent stenosis". The distribution and number of major coronary artery branches are determinants of number of bypass grafts needed. We reviewed the coronary artery anatomy in 174 adult patients who revealed no coronary pathology in angiographic studies done from September 1994 to June 1996. Quantative analysis was done in all cases by a single person using a Computerized System (Arripro 35(r)). The results were follows; 1) The mean diametre of left main coronary artery was 4.45 mm (range 2.74~6.72). The pattern of branching was bifurcation in 67.24%, trifurcation in 28.74% and quadrifurcation in 4.02% of the patients. 2) The mean diametre of left anterior descending artery was 3.17 mm (range 2.10~5.85), 2.79 (range 1.55~5.59) and 2.17 mm (range 1.37~3.81) in the proximal, mid, and the distal portions, respectively. The number of diagonal branches of left anterior artery was from one to four (mode=2). 3) The mean diametre of proximal and distal left circumflex artery were 3.17mm (range 1.74~4.89) and 2.19 mm (range 1.21~4.46). The number of obtuse marginal branches of left circumflex artery is from one to six (mode 2). 4) The mean diametre of proximal and distal right coronary artery, the posterior descending artery and the largest posterolateral branch were mean 3.51 mm (range 2.07~5.67), 2.09 mm (range 1.42~3.60), 2.09 mm (range 1.02~3.60) and 2.30 mm (range 1.39~4.39). 5) The right coronary artery dominant was 163 cases (93.68%) of the total 174 cases. 6) The large significant acute marginal artery was visualized in more than half of the people.

Prospective Study on Preoperative Evaluation for the Prediction of Mortality and Morbidity after Lung Cancer Resection / 결핵

PURPOSE: This study was undertaken to determine the preoperative predictors of mortality and morbidity after lung cancer resection. METHOD: During the period from October 1, 1995 to August 31, 1996, a prospective study was conducted in 92 lung resection candidates diagnosed as lung cancer. For preoperative predictors of nonpulmonary factors, we considered age, sex, weight loss, hematocrit, serum albumin, EKG and concomitant illness, and f or those of pulmonary factors, smoking history, presence of pneumonia, dyspnea scale(1 to 4), arterial blood gas analysis with room air breathing, routine pulmonary function test. And predicted postoperative(ppo) pulmonary factors such as ppo-FEV1, ppo-diffusing capacity(DLco), predicted postoperative product(PPP) of ppo-FEV1 % x ppo-DLco% and ppo-maximal O2 uptake(VO2max) were also considered. RESULTS: There were 78 men and 14 women with a median age of 62 years(range 42 to 82) and a mean FEV1 of 2.37+/-0.06L. Twenty nine patients had a decreased FEV1 less than 2.0L. Pneumonectomy was performed in 26 patients, bilobectomy in 12, lobectomy in 54. Pulmonary complications developed in 10 patients, cardiac complications in 9, other complications(empyema, air leak, bleeding) in 11, and 16 patients were managed in intensive care unit for more than 48hours. Three patients died within 30 days after operation. The ppo-O2max was less than 10ml/kg/min in these three patients, but its statistical significance could not be determined due to small number of patients. In multivariate analysis, the predictor related to postoperative death was weight loss (p<0.05), and as for pulmonary complications, weight loss, dyspnea scale, ppo-DLco and extent of resection(p<0.05). CONCLUSIONS: Based on this study, preoperative nonpulmonary factors such as weight loss and dyspnea scale are more important than the pulmonary factors in the prediction of postoperative mortality and/or morbodity in lung resection candidates, but exercise pulmonary fuction test may be useful. Our study suggests that ppo-VO2max value less than 10ml/kg/min is associated with death after lung cancer resection but further studies are needed to validate this result.

Tracheal Myoepithelioma / 대한흉부외과학회지

Myoepithelioma is a benign tumor composed of sheets and islands of various proportion of spindle, plasmacytoid, epitheloid, and clear cells. We are reporting of a 38-year-old woman with an extremely rare neoplasm of the trachea, myoepithelioma. The patient had an right neck mass and diagnosed presumptively as the thyroid tumor with tracheal invasion. Resection and anastomosis of the trachea with partial thyroidectomy was done. The tumor was a well circumscribed mass with solid growth pattern and composed of spindle and epitheloid cells, which were positive for S-100 protein and smooth muscle actin. In electron microscopy, a large amount of microfilaments in the cytoplasm and layers of basement membrane-like materials in the intercellular spaces were observed, which are characteristics of myoepithelioma. Patient has been well for 8 months postoperatively.