Long-Term Survival after Wide Resection of Malignant Fibrous Histiocytoma of the Chest Wall / 대한흉부외과학회지

Primary malignant fibrous histiocytoma (MFH) of the chest wall is extremely rare and is characterized by aggressive features, including a high incidence of local recurrence and distant metastasis. Surgical resection of the chest wall is the primary modality of management. However, surgical treatment is not generally recommended in patients with evidence of distant metastasis. Here, we present a case of chest wall MFH along with a schwannoma mimicking distant metastasis in the right upper arm. The patient was treated by radical en bloc resection and survived for more than 9 years without recurrence.

Prognostic Factors in Stage IIB Non-Small Cell Lung Cancer according to the 8th Edition of TNM Staging System / 대한흉부외과학회지

BACKGROUND: The purposes of this study were to evaluate the appropriateness of the stage migration of stage IIA non-small cell lung cancer (NSCLC) in the seventh edition of the tumor, node, and metastasis classification for lung cancer to stage IIB lung cancer in the eighth edition, and to identify prognostic factors in patients with eighth-edition stage IIB disease. METHODS: Patients with eighth-edition stage IIB disease were subclassified into those with seventh-edition stage IIA disease and those with seventh-edition stage IIB disease, and their recurrence-free survival and disease-specific survival rates were compared. Risk factors for recurrence after curative resection were identified in all included patients. RESULTS: Of 122 patients with eighth-edition stage IIB NSCLC, 101 (82.8%) had seventh-edition stage IIA disease and 21 (17.2%) had seventh-edition stage IIB disease. Nonsignificant differences were observed in the 5-year recurrence-free survival rate and the 5-year disease-specific survival rate between the patients with seventh-edition stage IIA disease and those with seventh-edition stage IIB disease. Visceral pleural invasion was a significant risk factor for recurrence in patients with eighth-edition stage IIB NSCLC. CONCLUSION: The stage migration from seventh-edition stage IIA NSCLC to eighth-edition stage IIB NSCLC was appropriate in terms of oncological outcomes. Visceral pleural invasion was the only prognostic factor in patients with eighth-edition stage IIB NSCLC.

Atypical Thymic Carcinoid in a Patient with Zollinger-Ellison Syndrome / 대한흉부외과학회지

Atypical thymic carcinoid is an extremely rare tumor with a poor prognosis. In addition to its known association with multiple endocrine neoplasia type 1, its hallmark characteristics include local invasion and early distant metastasis. In this report, we share our experience treating atypical thymic carcinoid in a patient with Zollinger-Ellison syndrome.

Prognostic Factors in Stage IIB Non-Small Cell Lung Cancer according to the 8th Edition of TNM Staging System

BACKGROUND@#The purposes of this study were to evaluate the appropriateness of the stage migration of stage IIA non-small cell lung cancer (NSCLC) in the seventh edition of the tumor, node, and metastasis classification for lung cancer to stage IIB lung cancer in the eighth edition, and to identify prognostic factors in patients with eighth-edition stage IIB disease.@*METHODS@#Patients with eighth-edition stage IIB disease were subclassified into those with seventh-edition stage IIA disease and those with seventh-edition stage IIB disease, and their recurrence-free survival and disease-specific survival rates were compared. Risk factors for recurrence after curative resection were identified in all included patients.@*RESULTS@#Of 122 patients with eighth-edition stage IIB NSCLC, 101 (82.8%) had seventh-edition stage IIA disease and 21 (17.2%) had seventh-edition stage IIB disease. Nonsignificant differences were observed in the 5-year recurrence-free survival rate and the 5-year disease-specific survival rate between the patients with seventh-edition stage IIA disease and those with seventh-edition stage IIB disease. Visceral pleural invasion was a significant risk factor for recurrence in patients with eighth-edition stage IIB NSCLC.@*CONCLUSION@#The stage migration from seventh-edition stage IIA NSCLC to eighth-edition stage IIB NSCLC was appropriate in terms of oncological outcomes. Visceral pleural invasion was the only prognostic factor in patients with eighth-edition stage IIB NSCLC.

Long-Term Survival after Wide Resection of Malignant Fibrous Histiocytoma of the Chest Wall

Primary malignant fibrous histiocytoma (MFH) of the chest wall is extremely rare and is characterized by aggressive features, including a high incidence of local recurrence and distant metastasis. Surgical resection of the chest wall is the primary modality of management. However, surgical treatment is not generally recommended in patients with evidence of distant metastasis. Here, we present a case of chest wall MFH along with a schwannoma mimicking distant metastasis in the right upper arm. The patient was treated by radical en bloc resection and survived for more than 9 years without recurrence.

Atypical Thymic Carcinoid in a Patient with Zollinger-Ellison Syndrome

Atypical thymic carcinoid is an extremely rare tumor with a poor prognosis. In addition to its known association with multiple endocrine neoplasia type 1, its hallmark characteristics include local invasion and early distant metastasis. In this report, we share our experience treating atypical thymic carcinoid in a patient with Zollinger-Ellison syndrome.

The Clinical Value of Intima-media Thickness in Patients with Stable Coronary Artery Disease and C-reactive Protein within Normal Limits / 대한흉부외과학회지

BACKGROUND: The purpose of this study was to determine whether hand-measured carotid intima-media thickness (IMT) was a reliable and simple tool that could be used to evaluate the severity of stable coronary artery disease (CAD) with normal high-sensitivity C-reactive protein (CRP). MATERIAL AND METHOD: We examined left carotid IMTs in 688 patients with stable CAD and excluded 121 patients with abnormally elevated hs-CRP (> or =0.5 mg/dL). We sought to determine the association between risk factors and the severity of stable CAD and carotid IMT in 567 patients who were divided into lower and higher groups based on the median value. Patients underwent a coronary artery angiogram and had at least significant stenosis (>50% of the original luminal diameter involving one or more major coronary artery). RESULT: Of the 567 patients, 300 (52.9%) were in the lower IMT group and 267 (47.1%) were in the higher IMT group; the median value was 0.76 mm. By multivariable logistic regression analysis, the following groups were different: older age (~49 vs. 70~ years, respectively; OR=6.552), high FBS (~99 vs. 120~ mg/dL; OR=1.713) and severity of CAD (1 vessel vs. 2 vessel disease; OR=1.711, 1 vessel vs. 3 vessel disease; OR=1.714). CONCLUSION: We conclude that there are correlations between increased carotid IMT and severity of CAD in stable angina patients with normal CRP levels.

Is Video-assisted Thoracoscopic Resection for Treating Apical Neurogenic Tumors Always Safe? / 대한흉부외과학회지

BACKGROUND: Mediastinal neurogenic tumors are generally benign lesions and they are ideal candidates for performing resection via video-assisted thoracoscopic surgery (VATS). However, benign neurogenic tumors at the thoracic apex present technical problems for the surgeon because of the limited exposure of the neurovascular structures, and the optimal way to surgically access these tumors is still a matter of debate. This study aims to clarify the feasibility and safety of the VATS approach for performing surgical resection of benign apical neurogenic tumors (ANT). MATERIAL AND METHOD: From January 1996 to September 2008, 31 patients with benign ANT (15 males/16 females, mean age: 45 years, range: 8~73), were operated on by various surgical methods: 14 VATS, 10 lateral thoracotomies, 6 cervical or cervicothoracic incisions and 1 median sternotomy. 3 patients had associated von Recklinhausen's disease. The perioperative variables and complications were retrospectively reviewed according to the surgical approaches, and the surgical results of VATS were compared with those of the other invasive surgeries. RESULT: In the VATS group, the histologic diagnosis was schwannoma in 9 cases, neurofibroma in 4 cases and ganglioneuroma in 1 case, and the median tumor size was 4.3 cm (range: 1.2~7.0 cm). The operation time, amount of chest tube drainage and the postoperative stay in the VATS group were significantly less than that in the other invasive surgical group (p<0.05). No conversion thoracotomy was required. There were 2 cases of Hornor's syndrome and 2 brachial plexus neuropathies in the VATS group; there was 1 case of Honor's syndrome, 1 brachial plexus neuropathy, 1 vocal cord palsy and 2 non-neurologic complications in the invasive surgical group, and all the complications developed postoperatively. The operative method was an independent predictor for postoperative neuropathies in the VATS group (that is, non-enucleation of the tumor) (p=0.029). CONCLUSION: The VATS approach for treating benign ANT is a less invasive, safe and feasible method. Enucleation of the tumor during the VATS procedure may be an important technique to decrease the postoperative neurological complications.

Clinical Analysis of Iatrogenic Pneumothorax / 대한흉부외과학회지

BACKGROUND: This study was designed to determine etiologic factors for iatrogenic pneumothorax in an era of increased use of invasive procedures and to evaluate its impact on morbidity. MATERIAL AND METHOD: Subjects were 112 patients (65 men and 47 women ranging in age from 20 to 90 years) who were diagnosed with an iatrogenic pneumothorax between January 2005 and December 2008. We reviewed medical records retrospectively. RESULT: The leading causes of iatrogenic pneumothorax were percutaneous needle aspiration (50), central venous catheterization (29), acupuncture (14), thoracentesis (8) and positive pressure ventilation (7). The majority of the patients (60 of 114) were treated with chest tubes. The mean duration of hospital treatment was 5.8 (+/-4.0) days. Hospitalization was prolonged in 24 patients (21.1%). No patient died from iatrogenic pneumothorax. CONCLUSION: In our study, the most common cause of iatrogenic pneumothorax was percutaneous needle aspiration. The mortality and morbidity from iatrogenic pneumothorax is not significant. The recognition of pneumothorax, depends on careful examination after completion of an invasive procedure, and should be followed by prompt and definitive therapy.

Surgical management of recurrent pneumothorax in the second trimester of pregnancy / 대한주산의학회잡지

Spontaneous pneumothorax in pregnancy is generally regarded as an unusual disorder, with only approximately 44 cases having been reported in the world literature. The most common cause is the rupture of a subpleural apical bulla or bleb, due to increased respiratory demand of the peripartum period. Pneumothorax should be considered in any pregnant woman with chest pain and/or dyspnea and must be confirmed radiographically. Treatment of simple pneumothorax during pregnancy is controversal. Admission and close observation of the patient is usually done with small pneumothorax. Other treatment options are needle aspiration, needle decompression (eg, intension pneumothorax), pleurodesis, tube thoracostomy, thoracotomy, and thoracoscopy. We report a recent experience of a 34 years-old pregnant woman with recurrent pneumothorax, who was treated with thoracotomy during the 28th weeks of pregnancy. She had previously been well during pregnancy and all antenatal investigations, including ultrasound scan, were normal. Cardiovascular examination did not reveal any abnormality. On chest auscultation, air entry was reduced on the left side of the chest. Chest X-ray revealed significantly expanded left lung with a large pneumothorax. After successfully treated with surgical approach, the patient had vaginal delivery of a healthy male infant, weighing 2.93 kg, safely during 39th weeks of pregnancy.

The Effect of Chlamydia pneumoniae on the Expression of Peroxisome Proliferator-Activated Receptor-gamma in Vascular Smooth Muscle Cells

PURPOSE: This study was designed to investigate the change of peroxisome proliferator-activated receptor gamma (PPARgamma) after the infection of the human coronary artery smooth muscle cells (HCSMCs) with Chlamydia pneumoniae (C. pneumoniae) and the effect of PPARgamma agonist on the expression of PPARgamma of C. pneumoniae-infected HCSMCs. MATERIALS AND METHODS: To determine the effect of PPARgamma agonist on the proliferation of C. pneumoniae-infected HCSMCs, rosiglitazone at various concentrations was applied 1 hour before inoculation of HCSMCs. RESULTS: The expression of PPARgamma mRNA in HCSMCs increased from 3 hours after C. pneumoniae infection and reached that of noninfected HCSMCs at 24 hours (p < 0.05). The expression of PPARgamma protein in HCSMCs also increased from 3 hours after C. pneumoniae and persisted until 24 hours as compared with that of noninfected HCSMCs (p < 0.05). The pretreatment of HCSMCs with rosiglitazone followed by the infection with C. pneumoniae augmented the expression of PPARgamma mRNA and protein (p < 0.05) and decreased cell proliferation. CONCLUSION: Our results showed that the expression of PPARgamma increases in response to C. pneumoniae infection and rosiglitazone further augmented the expression of PPARgamma. It is suggested that rosiglitazone could ameliorate the chronic inflammation in the vessel wall induced by C. pneumoniae by augmenting PPARgamma expression.

Coronary Artery Bypass Grafting in Patients with Acute Myocardial Infarction with an Abnormal Origin of the Right Coronary Artery / 대한흉부외과학회지

An abnormal origin of the right coronary artery can be responsible for sudden death, myocardial ischemia, arrhythmia and syncope, and it may be associated with the accelerated development of atherosclerotic disease. The mechanisms of ischemia in the case of an abnormal origin of the right coronary artery are currently unclear and several surgical methods have been proposed to treat this malady. Multidetector Computed Tomography shows the course of the abnormal coronary artery, it helps to clarify the mechanism of the ischemia and it aids in choosing the best surgical approach. We report here on a case of acute myocardial infarction with an abnormal origin of the right coronary artery. Coronary artery bypass grafting was subsequently carried out to treat this patient.

Magnetic Resonance Angiographic Evaluation as a Screening Test for Patients who are Scheduled for Cardiac Surgery / 대한흉부외과학회지

BACKGROUND: The advances in surgical techniques, anesthesia management, perfusion methodology and postoperative intensive care have markedly decreased the mortality and cardiac morbidity of patients who undergo heart surgery over the past 2 decades. Nevertheless, it is well recognized that cardiac surgery carries a substantial risk for central nervous system complications. This study was conducted to evaluate the prevalence of subclinical cerebrovascular lesions in the head and neck by performing magnetic resonance angiography (MRA), and we investigated the clinical course of patients who had abnormal lesion seen on head and neck MRA. MATERIAL AND METHOD: The subjects were 107 patients (71 men and 36 women ranging in age from 21 to 83 years) who were scheduled for cardiac surgery under nonemergency conditions between October 2005 and June 2008. Informed consent was obtained before the MRA. The carotid arteries, intracranial arteries and brain parenchyme were examined for subclinical cerebrovascular lesions by performing MRA. We reviewed the patients' medical records and MR findings to evaluate the prevalence of neurologically high risk patients and their clinical course. RESULT: The overall prevalence of neurologically high risk patients was 15.7% (17 patients). Among these patients, 11 patients had ischemic heart disease and 6 patients had valvular heart disease. Only 2 patients had a history of cerebrovascular disease. The clinical courses of 14 patients (13.1%) were changed according to their MRI findings. CONCLUSION: The prevalence of subclinical cerebrovascular disease in patients who were scheduled for cardiac surgery was higher than was expected. MR angiography was of value to identify these patients.

Clinical Analysis of Pulmonary Hamartoma: 37 Cases / 대한흉부외과학회지

BACKGROUND: Pulmonary hamartomas are the most common form of pulmonary benign tumors, and they occur in approximately 2~5% of all pulmonary neoplasm. However, only a few reports have been published on the clinical characteristics of pulmonary hamartoma in Korea. MATERIAL AND METHOD: The charts, X-rays and pathological specimens of 37 pulmonary hamartoma patients who were diagnosed by a pathological examination from January of 2000 to May of 2005 at the Catholic Medical Center were retrospectively reviewed. RESULT: The peak incidence of the tumor occurred in the seventh decade of life (32.4%). There were 23 men (62.6%) and 14 women (37.8%), with mean age of 55.6 years. Twenty-six patients (70.3%) were asymptomatic and 11 patients (29.7%) had symptoms. A total of 29 tumors (78.4%) were parenchymal, and 8 (21.6%) were endobronchial. Twenty cases (54.1%) were in the right lung and 17 cases (45.9%) were in the left lung. The right lower lobe was most commonly involved. Thirty-two (86.5%) hamartomas were diagnosed by surgical resection, 4 cases (10.8%) were diagnosed by bronchoscopic biopsy and 1 case (2.7%) was diagnosed by a fine needle aspiration biopsy. Thirty-four hamartomas (91.9%) were managed by surgical resection without complication. No recurrence or malignant changes were seen during the follow up period. CONCLUSION: Pulmonary hamartomas are most common in males during their fifth to seventh decade and they more commonly involve the right lung. No recurrence or malignant changes were seen during the follow up period.

Possible Implications of Placental Expressions for Heat Shock Protein 70 and Lectin-like Oxidized Low Density Lipoprotein Receptor-1 on Postnatal Blood Pressure in Their Newborns / 체질인류학회지

The 'fetal origin' hypothesis propose the alteration in fetal environment result in developmental adaptation, the permanently change in structure, physiology and metabolism, thereby predisposing to cardiovascular, metabolic and endocrine disease in adult life. Evidence is accumulating that the fetal environment affects newborn cardiac structure and function in humans, and blood pressure (BP) in newborn predicts the likelihood of developing hypertension in adult life. However, few studies have reported the influence of fetal factors on BP in neonates and an attempt to relate fetal factors to a neonate's BP seems to be important to identify individuals at risk of developing hypertension later in life. As the placenta is the regulator of nutrient composition and supply from mother to fetus and the source of hormonal signals that affect maternal and fetal metabolism, appropriate development of the placenta is crucial to normal fetal development. By virtue of these roles the placenta is in a key position to play a direct role in fetal programming. The aim of this study was to evaluate positive relationship between placental oxidative stress and BP in their healthy newborn offsprings, and propose to relate fetal factors to a neonatal BP. Systemic blood pressure was measured by automated device in 68 healthy term newborns who were born at Ewha Womans Medical Center, and their tissue samples of placentas were obtained from 40 cases which are 20 cases from high neonatal blood pressure group and 20 cases from low neonatal blood pressure group. We investigated placental expressions for heat shock protein (HSP) 70 and lectin-like oxidized low density lipoprotein receptor-1 (LOX-1), as markers for placental oxidative stress using immunohistochemistry and Western blot analysis, and evaluated their association with BP in healthy term newborn babies. The mean values of placental LOX-1 and HSP 70 were significantly higher in newborns with high BP group compared to those with low BP group. Increase in placental oxidative stress was associated with higher newborn systolic blood pressure. These findings suggest that newborn blood pressure may represent prenatal influence on cardiac structure and function.

Tracheostomy Assisted with Emergency Bypass System in Severe Tracheal Stenosis / 대한흉부외과학회지

Airway management is difficult problem in severe tracheal stenosis. A total airway obstruction during the procedure resulted in a fatal outcome. We suggest a tracheostomy assisted with an emergency bypass system as a possible method for avoiding this complication.

Preoperative Risk Factors for the Prognosis of Mitral Regurgitation in Patients with Coronary Artery Stenosis and Mitral Regurgitation Who Underwent Coronary Artery Bypass Surgery Alone / 대한흉부외과학회지

BACKGROUND: In the operation for coronary artery stenosis, the procedures for mitral regurgitation are restricted to cases of more than moderate mitral regurgitation or for the lesions in leaflets. This is based on the belief that the less than mild regurgitation are a form of reversible change results from ischemia with coronary artery stenosis. We studied the changes and prognostic factors of mitral regurgitation in patients with coronary artery stenosis and mitral regurgitation who underwent coronary artery bypass surgery alone. MATERIAL ANDMETHOD: We reviewed the medical records of 90 patients with coronary artery stenosis and mitral regurgitation who underwent coronary artery bypass surgery alone by a single surgeon from Jan. 1995 to Dec. 2002. We grouped the patients according to the postoperative changes of mitral regurgitation, and then we statistically compared the findings of echocardiogram between preoperative and last follow up. RESULT: There were 24 cases with progression of mitral regurgitation, 12 cases without changes, 54 cases with improvements of mitral regurgitation in total 90 patients. The bypass to LAD was proven as the significant prognostic factor of mitral regurgitation. The preoperative end diastolic left ventricular volume index were higher in aggravated group with 105.38+/-38.89 mL compared to 71.75+/-28.45 mL in improvement group, and 84.00+/-11.66 mL in no change group. The grade of preoperative mitral regurgitation did not show significant differences among the groups. CONCLUSION: The mitral regurgitation in patient with coronary artery stenosis can be improved after the coronary artery bypass surgery alone. However, the expectation of improvements based on the degree of preoperative mitral regurgitation can not be justified, therefore, the procedures for mitral regurgitation should be aggressively considered even in the cases of mild mitral regurgitation. Also, further study should be performed to identify the exact prognostic factors of mitral regurgitation including the left ventricular volume index, and whether the left anterior descending artery has been bypassed.

The Correlation between Radiologic Findings and Clinicopathological Prognostic Factors in Small Peripheral Adenocarcinoma of Lung / 대한흉부외과학회지

BACKGROUND: Tumor size in lung cancer is not as good a prognostic factor for adenocarcinoma as it is for other types of lung cancer; therefore it is difficult to estimate the prognosis preoperatively. However, there have recently been some reports on the radiologic findings correlating to the clinicopathologic prognostic factors in peripheral small adenocarcinoma of lung. We tried to evaluate the prognostic importance of High-Resolution CT (HRCT) findings of such adenocarcinoma. MATERIAL ANDMETHOD: One houndred and seventy-six surgically resected small peripheral adenocarcinoma measuring 3 cm or less in greatest dimension were reviewed radiologically and clinicopathologically. RESULT: The patients with greater extent of ground-glass attenuation (GGA) had better clinicopathological factors. The tumors with gross appearance of GGA or bubble-like shape showed better clinicopathological prognostic factors than scar-like or solid shape. CONCLUSION: HRCT findings of small peripheral adenocarcinomas of the lung correlated well with the histologic and clinical prognostic factors. We can predict the post- operative prognosis with the radiologic findings.

Experimental and Clinical Study of Staple-Line Reinforcement Using Expanded Polytetrafluoroethylene in Thoracoscopic Bullectomy for Spontaneous Pneumothorax / 대한흉부외과학회지

BACKGROUND: Thoracoscopic bullectomy (VATS-B) is now the preferred treatment for spontaneous pneumothorax despite of higher recurrence rate than open thoracotomy. Several methods have been used to prevent this problem. The effectiveness of staple line reinforcement (SLR) in VATA-B using endostaplers was assessed by clinical and experimental study. MATERIAL AND METHOD: In experimental study, canine lungs were harvested immediately (group I, N=5) and 48 hours (group II, N=5) after stapling. The pressures at which initial air leaks occurred were measured. In clinical study from February 1997 to March 1999, 106 procedures in 104 patients undergoing VATS-B for spontaneous pneumothorax were classified into two groups according to the presence of SLR and were compared. RESULT: The average pressure of the initial air leakage was significantly higher in SLR than that of staples alone (18+/-1.6 vs 48+/-3 mm Hg in group I; 23.8+/-1.9 vs 54+/-4.6 mm Hg in group II, p<0.001). In the clinical data, there were significant differences seen in the duration of drainage, the total length of endostaplers used, and the duration of the postoperative hospital stay between patients with staple alone and patients with SLR (4.4+/-1.4 vs 3.1+/-1.1 days in duration of drainage, 92.3+/-28.1 vs 71.1+/-30.6 mm in total length of endostaplers used, 5.9+/-1.9 vs 4.6+/-1.7 days in postoperative hospital stays, p<0.001). CONCLUSION: SLR was effective for preventing prolonged air leakage and responsible for shorter hospital stays after VATS-B for the treatment of spontaneous pneumothorax.

Thoracic Actinomycosis: A Case Report / 대한흉부외과학회지

Actinomycosis of the lung is a chronic, suppurative granulomatous infection which is caused by Actinomyces israelii. It is believed to enter the thorax by way of the bronchial tree, by aspiration of contaminated aerosol particles in the upper digestive tract. Symptoms of chronic cough, sputum, hemoptysis, low grade fever, chest pain, and weight loss are common. Chest X-ray shows mass like lesion, pulmonary infiltration, abscess, and tuberculosis like lesion, which makes differential diagnosis from lung cancer very difficult. Surgical intervention is needed for the diagnosis and treatment, and diagnosis of actinomycosis is achieved when histologic examination reveals sulfur granules containing filamentous organisms. Penicillin is the drug of choice. Two or three months of penicillin treatment is recommended to treat the oropharyngeal or dental abscess to avoid recurrences. We present a case of actinomycosis which is suspected to malignant with review of literatures.