Clinical Significance of p53 Gene and nm23 Gene Expression in Esophageal Cancer / 대한흉부외과학회지

BACKGROUND: Although significant progress has been made in the surgical treatment of esophageal carcinoma as well as in the detection of early stage esophageal carcinoma by diagnostic techniques, the prognosis of the esophageal carcinoma patients remain poor. The p53 gene product is known to regulate cell growth and proliferation. And the nm23 gene was identified originally as an anti-metastatic influence whose expression was correlated inversely with tumor metastatic potential in murine melanoma cell lines. This experiment was intended to know the relationship among the p53 and nm23 gene expression versus clinicopahologic characteristics of the esophageal cancer. MATERIAL AND METHOD: Total 40 cases were collected from patients who had undergone esophagectomy at St. Mary's Hospital, Catholic university of Korea. Immunohistochemical stain for p53 mutant-type protein and nm23 proein was graded as 50% positive tumor cells: +++ . The tumor invasion was grades as none: - ; mild: + ; moderate: ++ ; severe: +++ . RESULT: Overexpression of p53 protein and nm23 was not associated with the survival and cliniocopathologic characteristics of the esophageal cancer. Moreover, the combination analysis of p53 and nm23 revealed that there was no relationship between the gene expression and the clinicopatholic characteristics of the esophageal cancer.

Complex Regional Pain Syndrome after Thoracoscopic Sympathectomy in a Patient with Hyperhidrosis: A case report / 대한흉부외과학회지

Thoracoscopic sympathectomy is a common technique used to treat plamar hyperhiodrosis. The complications of thoracoscopic sympathectomy are rare. Recently, we experienced a complex regional pain syndrome(CRPS) after thoracoscopic sympathecotomy in a patient with hyperhidrosis. The treatment of this complication was chemical epidural sympathetic block and conservative pain control. The result of this treatment was good. The patient was recovered after one month.

Microsatellite Instability and p53 , k-ras c-myc Oncoprotein Expression in Non-Small Cell Lung Carcinoma / 대한흉부외과학회지

BACKGROUND: Microsatellites are short-tandem repeated uncleotide sequences present throughout the human genome. Alterations of microsatellites have been termed microsatellite instability(MI). It has been generally known that microsatellite instability detected in hereditary non-polyposis colorectal cancer (HNPCC) reflects genetic instability that is caused by impairments of DNA mismatch repair system regarding as a novel tumorigenic mechanism. A number of studies reported that MI occurred at varying frequencies in non-small cell lung carcinoma (NSCLC). However It has been unproven whether MI could be a useful market of genetic instability and have a clinical significance in NSCLC. MATERIAL AND METHOD: We have examined whether MI can be observed in thirty NCSLC using polymerase chain reaction whether such alterations are associated with other molecular changes such as p53, K-ras and c-myc oncoproteins expression detected by immunohistochemical stain,. RESULT: MI(+) was observed in 16.6%(5/30) and MI(-) was 83.3% (25/30) Average age was 50+/-7.5 year-old in MI(+) group and 57+/-6.6 year-old in MI(-) group. Two year survival rate in MI(=) group (20% 1/5) was worse than MI(-) group (64% 16/25) with a statistic difference. (P=0.04) The positive rate of K-ras oncoprotein expression and simultaneous expression of 2 or 3 oncoproteins expression were higher in MI(+) group than MI(-) group with a statistic difference(P=0.05, P=0.01) CONCLUSIONS: From, these results the authors can conclude that MI is found in some NSCLC and it may be a novel tumorigenic mechanism in some NSCLC. We also conclude that MI could be used as another poor prognostic factor in NSCLS.

Chylothorax after Endoscopic Thoracic Sympathicotomy: A Case Report / 대한흉부외과학회지

Endoscopic sympathicotomy is the choice of the treatment for hyperhidrosis. There are some recognized risks such as Honer's syndrome and Hemopneumothorax; however, Chylothorax has very rarely been reported after thoracic sympathicotomy. We recently encountered a case of chylothorax. Early diagnosis and prompt treatment is noteworthy.

The Effect of Platelet Derived Growth Factor on the Myocardial Revascularization in Implantation of Rabbit Internal Mammary Artery / 대한흉부외과학회지

BACKGROUND: Coronary artery bypases grafting in the old aged is associated with high mortality and morbidity, and it is difficult to perform if the coronary artery is diffusely disease. Recently it has been known that platelet derived growth factor(PDGF), especially PDGF-BB, stimulates angiogenesis. MATERIAL AND METHOD: New Zealand white rabbit were used. In an attempt to achieve effevtive cardiac revasculatrization without vascular anastmosis, we divided into three groups(group I : Left anterior descending artery(LAD) was occluded by ligature, group II : Bilateral internal mammary vascular pedicles were dissected and implanted into myocardium, group III : The vascular pedicles were implanted into myocardium and PDGF-BB was injected into the myocardial tissue). Two weeks after IMA implantation, the proximal region of implanted LAD was ligated. Four days after LAD ligation angiogram, triphenyl tetrazolium chloride(TTD) staining and hematoxylin eosin staining were performed. RESULT: 1. Survival rate in group II was significantly higher than that in group I (P<0.05), and survival rate in group III was signficantly higher than that in group II(53% vs 93%, P<0.01). 2. There were significant differences in the ratio of area of necrosis to area at risk between group I and group II, and between group II and group III (P<0.01). 3. Microangiogram for angiogenic response revealed wide area of extensive revascularization with patent vessels in group III. 4. Histologic findings of three groups showed that polymorphonuclear leukocyte infiltration was minimal in group II and none in group III. CONCLUSIONS: PDGF-BB can establish functinal cardiac revasculatization through systemic vessels implanted directly into the myocardium.

Lung Volume Reduction Surgery in Patients with Severe Emphysema , 7 cases / 대한흉부외과학회지

BACKGROUND: These days, lung volume reduction surgery (LVRS) is used as an alternative or a bridge operation to lung transplantation in treating patients with severe emphysema. The procedure can be used in patients with pulmonary nodules combined with severe emphysema. We report the results of 21 months follow up after lung volume reduction surgery in 7 cases including 2 cases of concurrent resection of pulmonary nodules. MATERIAL AND METHOD: Seven patients with emphysema, including 2 cases of preoperatively suspected lung cancer were operated with LVRS technique between July 1996 and June 1997. RESULT: Postoperative mortality was observed in a case of squamous cell carcinoma in LUL with brain metastasis, detected at postoperative 13months. Average of 21months(19-25months) follow up was done for other cases without specific events. CONCLUSION: LVRS is a useful operation in the treatment of patients with severe emphysema, but further evaluation should be done about the long term results and precise criteria for patient selection. Simultaneous LVRS and tumor resection could be done in patients with emphysema with marginal reserve in the hope of maximizing postoperative lung functions.

Valve Replacement in an Anuric Patient with Chronic Renal Failure: 1 Case Report / 대한흉부외과학회지

It is now generalized to perform cardiac surgery in the patients with end-stage renal disease. The growing number of patients with chronic renal failure wake us up to the need to prepare for proper management. There are not only the prevalence of coronary artery disease, but also a great amount of valve dysfunction exist in this group. Peritoneal dialysis may be one of the obstacles for cardiopulmonary bypass but it is not a great hindrance in cardiac surgery with careful preparation and well organized perioperative care. The author has performed mitral valve replacement in a 33-year-old anuric female patient with chronic renal failure and severe mitral insufficiency. Preoperatively, the patient was kept in adequate fluid and electrolyte balance using peritoneal dialysis. Peritoneal dialysis continued and regulated according to the laboratory data in this patient during and after the surgery. She recovered well showing an uneventful course and was discharged on postoperative 1 th day.

The Changes of Sweating Area, Temperature and Blood Flow in the Upper and Lower Extremity after Hyperhidrosis Operations / 대한흉부외과학회지

BACKGROUND: Thoracic sympathectomy for hyperhidrosis has been recognized as an effective treatment using thoracoscopic devices and operative techniques, but the satisfaction has decreased due to a compensatory hyperhidrosis. Therefore, the postoperative results and compensatory hyperhidrosis were analyzed. We also measured the temperature differences in the hand and foot during the preoperative and postoperative periods and measured the blood flow of upper and lower extremities. MATERIAL AND METHOD: From December 1995 to July 1998, total of 47 patients with hyperhidrosis underwent sympathectomy via VATS at the Department of Thoracic and Cardiovascular Surgery, Kangnam St. Mary's Hospital. The patients were evaluated for preoperative and postoperative temperature changes on the finger and toe, and preoperative and postoperative blood flows were measured by the Doppler examination on the digital artery, radial artery and dorsalis pedis artery. RESULT: There were no operative deaths but some complications existed: 7 pneumothorax, 3 recurrence and 1 Honor syndrome. Ninety-five percent of the patients also had compensatory sweating especially in the trunk. There were 5 patients who regretted recurring the operation because of the compensatory sweating. Sweating decreased in 46% of the sole hyperhidrosis patients. The temperature difference between preoperation and postoperation was 1degree C on the right hand side and 1.9degree C on the left hand side(p<0.05). There was no significant temperature difference on the sole. Blood flow increased significantly in the palm, but no difference in the sole. CONCLUSION: In conclusion, thoracic sympathectomy for hyperhidrosis is a safe and effective treatment but satisfaction has been decreased by the compensatory sweating; therefore, it is important to thoroughly explain the compensatory sweating prior to surgery. Improvement of the plantar hyperhidrosis is not due to a physiological change, but to a psychological stability.

Primary Malignant Melanoma of the Esophagus: A Case Report / 대한흉부외과학회지

Primary malignant melanoma of the esophagus (PMME) is an uncommon neoplasm. And the world literature reports only about 200 cases. A case of primary malignant melanoma of the esophagus is presented, and followed by review of the literature. In our patient, the walnut-sized melanoma was located at the midportion of esophagus and there were two small satellite lesions at the esophagogastric junction. The main mass was diagnosed as primary malignant melanoma histologically and immunohistologically. The tumor was curatively resected by the transthoracic subtotal esophagectomy and the 2 fields node dissection. Post-operative immunotherapy was performed but the tumor recurred 7 months later at the stomach.

Surgical Treatment of Primary Cardiac Tumor: Report of 27 cases / 대한흉부외과학회지

MATERIALS AND METHODS: Between 1979 and 1996, 27 patients with primary cardiac tumor underwent surgery at Catholic University Medical College. Mean age of patient was 45.1+/-3.03 ranging from 21 to 67 years old. Twenty-four cases were myxomas, 2 cases were chondrosarcoma, and remained case was angiosarcoma. Diagnosis was confirmed by echocardiography, cardiac angiography, CT scan, and MRI. The most common site of tumor origin was fossa ovalis limbus area (17cases:63%). A biatrial operative approach was commonly used in 15 cases and the tumor was removed through left atriotomy site. Complete excision of the tumor with a cuff of normal tissue was performed. All heart chambers were carefully explored for evidence of multicentric myxomas or other tumor debris. Most of the patients were improved on postoperative period compared to preoperative NYHA functional class. RESULTS: There was one operative death due to low cardiac output syndrome. Follow up period was 3 months to 17 years. There was 2 late deaths due to local recurrences. CONCLUSION: complete surgical excion is important for increasing cure rate. Malignancy cannot be ruled out even though preoperative echocardiography suggests benign nature. Chest CT or MRI is effective for further evalution in addition to echocardiography. In suspicious of malignancy, more extensive resection is essential and postoperative chemotheraphy or radiotherapy is useful.

Primary Tracheal Tumor C / 대한흉부외과학회지

BACKGROUND: Tumors of the trachea are rare despite their histologic similarity to tumors of the main stem bronchus and lung. MATERIALS AND METHODS: Fourteen patients with tracheal tumor underwent surgical, radiational, or laser photocoagulation therapy from March 1981 to July 1996. Nine patients were malignant and five patients were benign. The most common malignant tumor was adenoid cystic carcinoma. RESULTS: Age ranged from 10 to 65 years with mean age of 45.9 years. Most tumors were located middle and lower one-third of trachea. Surgery was done through collar incision, or collar incision with vertical partial sternal division, or left posterolateral thoracotomy, or sternal division with laryngeal release. Two patients died after operation, because of the disruption of anastomosis and airway obstruction,and laryngeal edema after suprahyoid release. Only one patient died after 8 month of diagnosis. The other patients were doing well during the follow-up period.

Esophageal Reconstruction by Hypopharyngointestinal Anastomosis in Corrosive Upper Esophageal Stricture / 대한흉부외과학회지

MATERIAL AND METHOD: Esophageal reconstruction by the hypopharyngointestinal anastomosis was done in 7 patients of corrosive upper esophageal stricture at St. Mary's Hospital from August 1995 to January 1997. RESULT: There were one male and six female patients ranging from 20 to 63 years of age. The causative agents were acid in 6 patients and alkali in 1 patient. The esophageal reconstruction was made by hypopharyngcolojejunostomy in 4 patients and hypopharyngocologastrostomy in 3 patients. There were no operative mortalities. One patient developed anastomotic stenosis but others were free from dysphagia. All gained 4 kg to 13 kg of body weight during the follow-up period. CONCLUSION: In this experience right colon and terminal ileum including ileocecal valve was revealed as a good substitute for the esophagus and the esophageal reconstruction by hypopharyngocologastro (jejuno)stomy seems to be a satisfactory method with acceptable morbidity and mortality in corrosive upper esophageal stricture patient.

Thoracoscopic Sympathectomy for Facial Hyperhidrosis: Three Cases Report / 대한흉부외과학회지

Facial hyperhidrosis has a symptom of excessive sweating on the face with or without underlying disease. It can be surgically treated by video-assisted thoracic surgery (VATS). We encountered three cases of facial hyperhidrosis which we treated by VATS, which was performed by resection of the lower third of stellate ganglion and T2-T3 sympathetic ganglia with chains. Postoperative symptom was improved in all cases. There were no postoperative complications such as Horner's syndrome or postsympathectomy neuralgia.

Unidirectional Valve Patch Closure for Ventricular Septal Defect with Severe Pulmonary Hypertension: A Case Report / 대한흉부외과학회지

The surgical closure of VSD in patient with severe pulmonary hypertension has been considered a difficult problem for surgeons, because sudden hemodynamic change after closure of the defect could bring on high perioperative mortality. Recently, it was reported that UVP (unidirectional valve patch), which allows some blood to flow from right to left in case of acute right heart failure, is effective in improving the postoperative hemodynamics after closing septal defects. This 42-year old woman had suffered from VSD for 20 years and recently complained of worsening exertional dyspnea for three months, and was diagnosed of a large VSD (2.0 cm in diameter) with severe pulmonary hypertension (116/38 mm Hg), equal to systemic arterial pressure. We could successfully close VSD with severe pulmonary hypertension using one UVP and the other UVP for the creative ASD to be prepared against possible acute right heart failure. She was discharged on the fourteenth postoperative day and has been well for twelve months with spontanenous closure of UVP patch at the ninth postopeative month.

Treatment of Esophagojejunostomy Leakage with Expanding Stent / 대한흉부외과학회지

It would be possible to manage the intestinal anastomotic failure with intraluminal stenting, but its reports are very rare. We experienced a effective and dramatic improvement of esophago-jejunal anastomotic leak in a esophageal and gastric double cancer patient with intraluminal stenting. The intraluminal stenting was tried at the 28th postoperative day and the anastomotic leak and inflammatory signs were disappeared about 3 weeks later. Postoperative 11th months now, the stent was moved about 1 cm downward but not changed further, and he enjoys regular diet without any problems. And we think the stenting would be helful with some limitations in the intestinal anastomotic leak patient.

Thoracoscopic Esophagectomy for Esophageal Cancer: One Case Report / 대한흉부외과학회지

Thoracoscopic esophagectomy can be performed in esophageal diseases to reduce the postoperative complications. Recently, We encountered a case of esophageal cancer and successfully treated it by thoracoscopic esophagectomy with gastric pull-up. A 59-year-old male was presented with swallowing difficulty and an esophagogram, esophagoscopy, and chest CT showed an ulcerating tumor on the lower esophagus. The operation was performed in three stages: mobilization of the esophagus by thoracoscopic surgery, construction of a gastric tube through a laparotomy, and cervical anastomosis between the esophagus and the gastric pull-through. Hoarseness developed postoperatively, and the postoperative esophagogram showed leakage at the esophagogastric anastomotic site. The anastomotic leakage was healed following surgical drainage and the patient was discharged in good health. Hoarseness subsided spontaneously two months after surgery.

Reoperation for Dysfunction of Cardiac Valve Prosthesis / 대한흉부외과학회지

From January 1988 to December 1995, 27 patients, 11 men and 16 women, underwent surgical intervention at our institution for prosthetic valve dysfunctions. The mean age was 43.5+/-12.2 years. Seventeen (63.0%) patients had the mitral valve replacement, 8 (29.6%) the aortic valve, 1 (3.7%) the aortic composite graft, and 1 (3.7%) the tricuspid valve. Mean follow-up period was 49.5+/-30.9 months. In 12 bioprostheses, mean interval between the previous valve replacement and the reoperation was 104.9+/-34.9 months. The causes of redo surgery were structural deterioration of the prosthetic valve (12/12, 100%), paravalvular leak (2/12, 16.7%), and prosthetic valve endocarditis (1/12, 8.3%). In 15 mechanical prostheses, the mean interval was 55.2+/-43.7 months. The causes of redo surgery were pannus formation (8/15, 53.3%), paravalvular leak (4/15, 26.7%), and valve thrombosis (3/15, 20.0%). Posto-perative complications occurred in 7 patients (25.9%). There was no intraoperative death. But one patient, who received mechanical aortic valve replacement died on the 3rd postoperative day due to low cardiac output and multiorgan failure.

Chest Wall Implantation of Lung Cancer After Percutaneous Fine Needle Biopsy: A Case Report / 대한흉부외과학회지

Percutaneous transthoracic fine needle biopsy has been widely used In the diagnosis of pulmonary lesions especially lung cancer. Onc of the rarest complication's is that malignant cells are implanted within the needle tract and developed a chest wall mass subsequently. Wc expcrlenccd a case of chest wall implantatio of lung cancer after percutaneous transthoracic floe needle biopsy. A 65-ycar old man had undergone bilobectomy (right upper lobe and right middle lobe)for squamous cell carcinoma (T2N0M0) of the lung. 60 days after percutaneous biopsy (48 days after operation), a tiny nodule (1 mm sized) was notcd at the right anterior chcst wall where the diagnostic fine needle biopsy had been performed before operation. This tiny mass was rapidly growing to 1.5 cm sized mass for 20 days. We carried out wide excision of chest wall mass and skin grafting, and confirmed squamous cell carcinoma histopathologically as same as the lung cancer.

A Case of Noonan Syndrome Combined with Infundibular Pulmonic Stenosis

The Noonan syndrome is a rate clinical syndrome associated with similar congenital abnormalities, that is characteristics of Turner syndrome, such as short stature, webbed neck, low posterior hairline, cubitus valgus, shield chest or funnel chest, congenital features similar to Turner syndrome but with a normal karyotype, and Opitz et al. proposed the name "Noonan syndrome" for this condition in 1965. We experienced a 31-year old man with Noonan syndrome combined with valvular and infundibular pulmonic stenosis who had short stature, webbed neck and normal karyotype. So we report a case Noonan syndrome with a review of literature.

A Case of Single Coronary Artery with Bicuspid Aortic Valve

Single coronary artery is one of coronary artery anomalies, which originates from single aortic ostium and distributes blood to whole myocardium and is reported to occur in about 0.02 percent of general population. Although this condition does not produce severe clinical complications, it is often combined with other congenital cardiac anomaly and may produce angina pectoris, arrythmia, and sudden cardiac death syndrome rarely. Bicuspid aortic valve is anomalous aortic valve which consists of two commisure and two cusps and is said to occur in about 2 percent of the population. In some cases, the valve may function normally for many decades, but in others, it may produce aortic stenosis and/or aortic regurgitation frequently. We report here a case of single coronary artery combined with bicuspid aortic valve.