A case of endothelial cyst of the adrenal gland / 대한내과학회지

Adrenal cysts are rare lesions usually discovered incidentally during surgery, or at the time of autopsy. Most adrenal cysts are generally asymptomatic and small, less than 10 cm in diameter. When adrenal cysts enlarge sufficiently, they cause pain and gastrointestinal disturbances or become palpable. When cystic lesions in upper abdomen are found, many cystic lesions such as hepatic, splenic, renal and pancreatic cysts should be considered. It's difficult to differentiate between benign and malignant lesions. Usually these cystic lesions have been excised to rule out malignancy. Herein we report a case of adrenal endothelial cyst which was detected in a 63-year-old female patient during a routine health examination by ultrasonography.

Corrective Surgery of Congenital Cardiac Anomalies in the Noonan syndrome: Report of two cases / 대한흉부외과학회지

Noonan syndrome is characterized by a Turner-like phenotype and a normal karyotype associated with congenital abnormalities, such as short stature, variable mental retardation, hypertelorism, webbed neck, low posterior hair line, skeletal malformation and congenital cardiovascular defect. Two third of Noonan syndrome have cardiac anormalies, half with pulmonary stenosis. We have experienced two cases of pulmonary stenosis associated with other cardiac anomalies in Noonan syndrome. The first 31-year-old male patient had characteristic appearance of Noonan syndrome with severe infundibular pulmonic stenosis and patent foramen ovale. The second 28-year-old male patient had valvular and subvalvular pulmonary stenosis with typical Noonan's face and stature. Pulmonary valvotomy and hypertrophied muscle bundles in the right ventricular cavity were resected in both cases. Patent foramen ovale was closed directly in the first case. Postoperative follow-up examinations revealed no symptoms and successful outcome.

Benign Metastasizing Leiomyoma of Lung: A case report / 대한흉부외과학회지

We performed thoracoscopic resection for diagnosis in a 41 year-old-female presenting with multiple pulmonary nodules in both lung fields, which was detected incidentally on routine chest x-ray and followed by additional exmaminations including chest CT scan and percutaneous needle aspiration biopsy under the presumptive diagnosis of metastatic cancer. During thoracoscopy, the result of the frozen section analysis of multiple masses revealed strong evidence of leiomyoma. In her past medical history, she had undergone myomectomy, and hysterectomy, 7 years ago and 10 years ago, respectively. Based on permanent, special staining of specimen, estrogen receptor assay and review of past specimen of uterine myoma, the final diagnosis was benign metastasizing leiomyomata from uterine myoma, the report was very uncommon in Korean and English literatures. The patient has been followed up for 2 years without special therapy, such as hormonal therapy.

Tuberculoma in a 3-year-old child / 대한흉부외과학회지

Tuberculomas of the lung are rare in children and one of the more common lesions presenting a solitary pulmonary nodule roetgenorgraphically. We are reporting of a 3-year-old child with a tuberculoma in left upper lobe. The patient was initially diagnosed as the benign mediastinal tumor but in the end as tuberculoma in left uper lobe. Wedge resection including the mass was done. The tumor had brown smooth external surfaces on sectioning including the mass was done. The tumor had brown smooth external surfaces on sectioning show pale gray and soft cut surface was shown. In light electromicroscopy chronic granulomas with multinucleated giant cells and central caseous necrosis were observed which are the characteristics of tuberculoma. The postopeative course was smooth and uneventful and patient has been well for 4 months postoperatively.

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.

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.

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.

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.

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.

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.

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.

A case Report of Tracheal Lipoma / 대한흉부외과학회지

Pure lipoma, originating from the trachea is a very rara disease entity A-37-ycar-old-male patient had suf'leered from intermittent episodes of dyspnea and has been treated under the diagnosis of bronchial asthma for 6 months. On chest CT scan and bronchofiberscopic examination, a round mass with the pedunculated neck was found in the mid-portion of the membranous portion of the intrathoracic trachea. Under the guide of fiberoptic bronchoscope, the mass was extirpated using polypectomy w re loop and eletrocauterization. He was discharged without any events on third postoperative day of operation and has been well without recurrence for 6 months.

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.

Surgical Treatment for Metastatic Pulmonary Sarcoma / 대한흉부외과학회지

The therapeutic results of pulmonary resection for metastatic bone and soft tissue sarcomas were analyzed. From 1986 to 1996, 14 patients(11 male and 3 female) underwent 15 pulmonary resections for metastatic sarcomas. One(7.1%) patient had 2 thoracotomies for recurrences. The number of metastatic tumors were from one to five. The primary malignant tumors were from bone in 4 and from soft tissues in 10. Mean survival time after thoracotomy was 29.2 months, and Kaplan-Meier's 5-year survival rate from the first metastasectomy was 33.2%. Three patients who had the tumor free interval period over 3 years were alive(mean survival period 52.6 months), whereas eleven patients of the less than 3 years were dead with disease(mean survival period 17.3 months). These results suggested that pulmonary metastasectomy in bone and soft tissue sarcoma may prolong the survival rate.

Re-Expansion Pulmonary Edema Associated with Resection of Ruptured Mediastinal Thymic Cyst: A Case Report / 대한흉부외과학회지

Unilateral reexpansion pulmonary edema(RPE) is generally considered a rare complication, occurring when a chronically atelectatic lung is rapidly reexpanded by tube thoracostomy or thoracentesis. It can also take place when the lung collapse is of short duration or when the lung is reexpanded without intrapleural suction. We experienced a case of RPE following surgical resection in mediastinal thymic cyst. A 26 year old female patient suffered from long-standing atelectasis of the right lung due to a huge mediastinal cyst that was misrecognized as tuberculous pleural effusion. Empyema developed after iatrogenic rupture of mediastinal cyst by pig-tailed tube thoracostomy. We successfully managed the ruptured mediastinal thymic cyst, empyema and postoperatively developed RPE following reexpansion of the collapsed lung. The patient was treated with drugs and mechanical ventilation with positive end-expiratory pressure for RPE. The remainder of her hospital course was uneventful.

Surgical Treatment for Carcinoma of Esophagus / 대한흉부외과학회지

From January 1990 to March 1994, 61 patients with thoracic esophageal cancer were treated at our institute. We analyzed the medical records retrospectively to find any prognostic factors of esophageal cancer surgery. The age ranged from 36 years to 74 years and the mean age was 58.3 years. The sex ratio of men to women was 14:1. The mean duration of dysphagia was 3.8 months and they mostly suffered from the dysphagia of grade IV. Tumors were staged postoperatively; 2 stage I, 23 Stage II, 27 stage III, 9 stage IV, and the resectability was 78.7%. Fortynine patients underwent curative esophageal resection and 5 patients permitted palliative esophagogastrostomy with incomplete tumor resection. Five patients underwent feeding gastrostomy and 2 patients were managed with Celestin tube. The most common complication was atelectasis and pneumonia, and early mortality rate was 5.6%. There were 9 cases of identified local recurrence or distant metastasis. Estimated overall actuarial survival rate d uring the follow-up was 73.4% in 1 year, 54.7% in 2 years, and 23.1% in 4 years. The tumor stage higher than II(p = 0.02) was confirmed as a poor prognostic factor.

Experimental study of retorgrade cerebral perfusion during hypothermic circulatory arrest / 대한흉부외과학회지

No abstract available.