ABSTRACT
The pulmonary giant cell carcinoma is classified as a variant of a large cell carcinoma and is diagnosed by the minimum component of 10% huge, pleomorphic and multinucleated giant tumor cell and emperipolesis of the neutrophils into the tumor cells. This tumor is characterized by local recurrences and early metastasis with extremely short patient survival. However, there are some reports that state that the survival time was extended by the operative resection and postoperative adjuvant chemotherapy and radiotherapy. A 46-year old male was admitted with complaint of hemoptysis for 2 months. Through chest X-ray and chest CT, a 5cm sized mass was found in the apical segment of the right upper lobe. During the preoperative evaluation, stenotic lesion in the left anterior descending coronary artery was found and treated by percutaneous transarterial coronary angioplasty. Four weeks later, right upper lobectomy was performed and the mass was proven to be a giant cell carcinoma. The patient received adjuvant chemotherapy and radiotherapy.
Subject(s)
Humans , Male , Middle Aged , Angioplasty , Carcinoma, Bronchogenic , Carcinoma, Giant Cell , Carcinoma, Large Cell , Carcinoma, Non-Small-Cell Lung , Chemotherapy, Adjuvant , Coronary Vessels , Emperipolesis , Giant Cells , Hemoptysis , Lung Neoplasms , Neoplasm Metastasis , Neutrophils , Radiotherapy , Recurrence , Thorax , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: Among the various techniques for the adequate exposure of the mitral valve, the extended transseptal approach is the essential prerequisite for accurate repair or replacement of the mitral apparatus. But the efficacy and safty of the extended transseptal approach has not determined in Korea yet. MATERIALS AND METHODS: Retrospective data of 80 consecutive patients, operated from September 1992 to July 1997 were reviewed. Seventy- eight patients underwent mitral valve replacement and 2 patients underwent excision of left atrial myxoma. Thirty-eight of 78 patients had other concomitant procedures such as aortic valve replacement (n=22), tricuspid annulopasty (n=14), coronary artery bypass graft (n=1) and closure of ventricular septal defect (n=1). Mean follow up was 23.3+/-15.0 months and total follow up was 1792 patient-months. RESULTS: The hospital mortality rate was 3.8% (3 patients). Two deaths were due to low cardiac output and one due to postoperative bleeding of coagulopathy. Among the 46 patients who had atrial fibrillation preoperatively, 45 had atrial fibrillation postoperatively and 1 converted to sinus rhythm. All 34 patients who were in normal sinus rhythm preoperatively remained in sinus rhythm after the operation. Mean aortic cross clamping time was 62 minutes for isolated mitral procedure and 90 minutes for concomitant procedures. There were no specific complications related to this approach. CONCLUSIONS: We suggest that the extended transseptal approach is an easy and good method for mitral valve surgery, especially in patients with small sized left atrium.
Subject(s)
Humans , Aortic Valve , Atrial Fibrillation , Cardiac Output, Low , Constriction , Coronary Artery Bypass , Follow-Up Studies , Heart Atria , Heart Septal Defects, Ventricular , Hemorrhage , Hospital Mortality , Korea , Mitral Valve , Myxoma , Retrospective Studies , TransplantsABSTRACT
Aortic aneurysm has poor prognosis and high mortality, but the incidence of aortic aneurysm is in increasing state. From July, 1986 to July, 1996, we operated on 25 patients with aortic aneurysm and analysed the clinical results and relations between the duration from symptoms onset to operation (Sx-Op), the duration from admission to operation (Adm-Op), preoperative blood pressure, preoperative heart rate and postoperative mortality, retrospectively. The patients were classified as dissecting aneurysm (10 cases), abdominal aortic aneurysm (9 cases), Marfan's syndrome (3 cases), descending thoracic aortic aneurysm (3 cases). The operative technique were graft interposition in 17 cases, Bentall's operation in 4 cases, aneurysm bypass in 2 cases, and wrapping of aorta in 2 cases. Seven patients died of several causes, bleeding in 5 cases, acute renal failure in 1 case and respiratory failure in another one case. Before 1992, the early stage of operation, 6 mortality among 14 operated patients occurred, and after then 1 mortality among 11 operated patients occurred. Eighteen survivors were followed up from 1 to 118 months (mean 50.6 months), and total follow up was 911 patient-months. During the follow up period one patient died of melena 30 months after operation. The other patients did not complain chest pain or dyspnea. The surgical mortality was improved in the late period, and the major cause of death was intraoperative or postoperative bleeding. The Sx-Op duration, the Adm-Op duration, preoperative blood pressure and preoperative heart rate were proven to have no statistical relations with postoperative mortality.
Subject(s)
Humans , Acute Kidney Injury , Aneurysm , Aortic Dissection , Aorta , Aortic Aneurysm , Aortic Aneurysm, Abdominal , Aortic Aneurysm, Thoracic , Blood Pressure , Cause of Death , Chest Pain , Dyspnea , Follow-Up Studies , Heart Rate , Hemorrhage , Incidence , Marfan Syndrome , Melena , Mortality , Prognosis , Respiratory Insufficiency , Retrospective Studies , Survivors , TransplantsABSTRACT
Primary malignant melanoma of the esophagus (PMME) is an extremely rare tumor with only scattered case reports. The treatment of choice is surgical resection. However, the prognosis is poor. Recently we experienced one case of primary malignant melanoma of the esophagus in a 60-year-old male patient. Esophagectomy and intrathoracic esophagogastrostomy were perfomed. The patient was discharged without specific complications.
Subject(s)
Humans , Male , Middle Aged , Esophageal Neoplasms , Esophagectomy , Esophagus , Melanoma , PrognosisABSTRACT
Proinflammatory cytokines such as tumor necrosis factor-alpha (TNF-alpha) have been implicated in myocardial and organ dysfunction associated with postperfusion syndrome. We tested the hypothesis that cytokine productions are depressed by preoperative cortiosteroid injection for cardiopulmonary bypass (CPB) and the postoperative courses will be better than without steriod pretreated cases. Cardiac surgery was performed in randomized blind fashion for 20 patients from June 1996 to September 1996. In the steroid group (n=10), corticosteroid (dexamethasone 1 mg/kg) was injected 1 hour before anesthetic induction, but in the control group (n=10), nothing was injected. Each of groups were sampled 11 times as scheduled for TNF-alpha bioassays. We have checked EKG, cardiac enzymes (CPK, LDH with isoenzyme), WBC count preoperative day, one day and three days after operation. Viatal signs were continuously monitored for three postoperaive days. In the postoperative period three patients in the control group had elevated body temperature and four patients had hypotension that required considerable intravenous fluid administration. But steroid injected patients showed normal body temperture and acceptable blood pressures without supportive treatment. CPK enzymes rose in control group higher than steroid group at postoperative 1st and 3rd day (CPK; 1122+/-465 vs 567+/-271, 864+/-42 vs 325+/-87), and CPK-MB enzymes rose in control group higher than steroid group at postoperative 1st day (106.4+/-115.1 vs 29.5+/-22.4) (P=0.02). Arterial tumor necrosis factor-alpha rose during cardiopulmonary bypass, peaking at 5 minutes before the end of aortic cross clamping (ACC-5min) in steroid group (11.9+/-4.7 pg/ml), and 5 minutes before the end of cardiopulmonary bypass (CPB-5min) in control group (22.3+/-6.8 pg/ml). The steroid pretreated patients had a shorter period of time in respirator suport time, ICU stay day, hospital admission day. We conclude that corticosteroid suppress cytokine production during and after cardiopulmonary bypass, and may improve the postoperative course through inhibition of reperfusion injury such as myocardial stunning and hemodynamic instability.
Subject(s)
Humans , Biological Assay , Body Temperature , Cardiopulmonary Bypass , Constriction , Cytokines , Electrocardiography , Hemodynamics , Hypotension , Myocardial Stunning , Postoperative Period , Reperfusion Injury , Thoracic Surgery , Tumor Necrosis Factor-alpha , Ventilators, MechanicalABSTRACT
No abstract available.
ABSTRACT
No abstract available.