Early and Midterm Results of Hybrid Endovascular Repair for Thoracic Aortic Disease / 대한흉부외과학회지

BACKGROUND: A hybrid procedure using an open surgical extra-anatomic bypass of aortic arch vessels and thoracic endovascular aortic repair (TEVAR) is less invasive than open surgery, and provides a suitable proximal landing zone. Here we report our experience with a hybrid TEVAR procedure at a single center. MATERIAL AND METHOD: We retrospectively reviewed consecutive patients with thoracic aortic disease who received a hybrid TEVAR procedure between August 2008 and January 2010. Patients' data were prospectively collected and mean follow-up was 10.8+/-5.5 months (range 3~20). RESULT: Nine patients (7 males and 2 females) with a mean age of 63.8+/-15.8 years (range 38~84) underwent a hybrid procedure. Five patients had an arch or a proximal descending aortic aneurysm, two had a dissecting aneurysm of the descending aorta, and two had an aneurysm of the ascending arch and descending aorta. Mean expected mortality calculated by logistic EuroSCORE was 21%. Six patients underwent debranching and rerouting from ascending aorta to arch vessels, 2 had carotid-carotid bypass grafting, and 1 underwent carotid-axillary bypass grafting. Mean operation time was 221.4+/-84.0 min (range 94~364). Deployment success of endovascular stent grafting was 100% with no endoleak on completion angiography. There was no mortality, and a small embolism in the branch of the right opthalmic artery in one patient. During follow-up, one intervention was required for the endoleak. Actuarial survival at 20 months was 100%. CONCLUSION: Early and mid-term results are encouraging and suggest that hybrid TEVAR procedures are less invasive and safer and represent an effective technique for treating thoracic aortic disease.

The Clinical Efficacy of Bidirectional Cavopulmonray Shunt in Young Infants / 대한흉부외과학회지

BACKGROUND: The bidirectional cavopulmonary shunt (BCPS) is one of the primary palliative procedures for complex congenital heart disease. It has many advantages, but it is known to have high risks in young infants. MATERIAL AND METHOD: From 1995 to 2003, 48 infants under the age of one year underwent BCPS. All the patients were Fontan candidates due to functional univentricular heart physiology. There were no significant differences in preoperative variables, except in mean age (67.58+/-3.78 vs. 212.91+/-13.44 days), and mean body weight (4.51+/-0.29 vs. 6.62+/-0.27 kg), between group A ( or=3 months, n=36). RESULT: In group A, the arterial oxygen saturations serially measured were significantly lower. Hospital mortality was 25%, and 19%, respectively. During follow up, there were 2 late mortalities in group A, and 5 in group B. CONCLUSION: This study showed that operative risk in young infants was comparable to that of older patients, and BCPS could be a good option as a primary palliative procedure, and may eliminate other repeated palliative procedures which could be the risk factors for Fontan candidates. However, in high-risk patients accompanying pulmonary hypertension, or heterotaxia syndrome, other palliative procedures should be considered.

Primary Schwannoma of Bronchus: 2 case report / 대한흉부외과학회지

Most tumors of the tracheobronchial tree are malignant, and benign tumors are less than 10%. Especially, the incidence of primary neurogenic tumors of the lung has been estimated to be less than 2 percent of primary lung cancer, and majority of these tumors are originated from Schwann cells. These tumors can be presented either as a solitary benign neoplasm or as a malignant form, which is rare. We present two cases of bronchial Schwannoma managed by means of lobectomy.

Comparison of Clinical Outcomes of Off-pump versus On-pump Coronary Artery Bypass Grafting in Diabetes Patients / 대한흉부외과학회지

BACKGROUND: Avoiding cardiopulmonary bypass (CPB) in coronary artery bypass grafting (CABG) has been known to reduce early mortality and morbidity. Diabetes Mellitus is a significant risk factor for adverse early and late outcomes after CABG. We compared the clinical results of off-pump CABG versus on-pump CABG in diabetes patients. MATERIAL AND METHOD: 682 patients (424 off-pump CABG and 258 on-pump CABG) underwent isolated coronary artery bypass grafting between January 2001 and June 2003. Data were collected 242 patient who had diabetes. Among them, 154 patients underwent off-pump CABG and 90 patients underwent on-pump CABG. We analyzed the preoperative risk factors and postoperative results between 2 groups. RESULT: Two groups did not show statistical differences in age, sex, coronary and operative risk factors. Operative time was significantly shorter in off-pump CABG, however, number of grafts was fewer in off-pump CABG. Postoperative inotropic usage was lower in off-pump CABG. Postoperative CK-MB level was lower in off-pump CABG, and ICU stay and ventilation time was significantly shorter in off-pump CABG. However, there was no statistical difference between 2 groups in operative mortality, reoperation rate, perioperative myocardial infarction, wound infection, renal failure, neurological complications and hospital stay. CONCLUSION: Off-pump CABG group showed less myocardial damage and early recovery. We concluded that off-pump CABG is the more reasonable technique in diabetes patients although two techniques showed good results. The long-term follow up and prospective study may be warranted.

Fontan Procedure for Functional Single Ventricle with Major Aortopulmonary Collateral Arteries / 대한흉부외과학회지

Not only morphology of pulmonary artery or pulmonary artery resistance, but major aortopulmonary collateral arteries are risk factors of Fontan procedure. We report a successful Fontan procedure after rehabilitation of pulmonary arteries by unifocalization and systemic to pulmonary shunt in a high risk Fontan candidate with functional single ventricle combined with hypoplastic pulmonary arteries and major aortopulmonary collateral arteries supplying most of the bilateral lung field.

A Case Report of a Bronchogenic Cyst Misconceived to Lung Cancer / 결핵

Bronchogenic cysts are generally presented as a well defined mass that have thin and smooth wall in the intrapulmonary or mediastinal area by simple chest radiographs. We present the case of a 20-year-old man with a ill-defined left upper lobe mass, found by chest radiographs. At the preoperative examinations, chest computed tomography showed ill-defined mass with Hounsfield Number 26, and nonspecific findings were shown by the bronchoscopy and percutaneous needle aspiration. The patient was undertaken the left upper lobectomy. The surgical specimen contained a ill-defined mass, measuring 2x3 cm. On the section of the mass, a cyst containing dark brown thick materials was noted. The cyst was unilocular, and the wall showed a trabeculation. Microscopically, the cystic mass was lined with ciliated pseudostratified columnar epitheliums and surrounded by smooth muscle and cartilage.

A Case of Liddle's Syndrome in a Seventy One-year Old Woman / 대한신장학회잡지

Liddle's syndrome is a rare inherited disease with characteristic clinical manifestations of hypertension and hypokalemic metabolic alkalosis. Markedly suppressed serum aldosterone and renin levels are important laboratory findings to differentiate this disorder from primary hyperaldosteronism. When Liddle et al. reported the disorder in 1963, they proposed aggressive Na+ absorption and increased excretion of K+ as the pathogenesis of the syndrome. Since then, specific mutation in the epithelial Na+ channel located in the collecting duct of the kidney has been elucidated as a disease mechanism. Liddle's syndrome is inherited by an autosomal dominant trait and generally the onset of the syndrome is before the age of 20 with increased risk of premature death due to stroke or heart failure. Recently, however, a few cases of late onset and genetically proven nonfamilial cases with de novo mutation of beta or gamma Na+ channel have been reported. We report a case of seventy-one year old woman who had hypertension with hypokalemic metabolic alkalosis and was diagnosed as Liddle's syndrome. Further evaluation revealed low serum renin and aldosterone levels. Primary aldosteronism, Cushing's syndrome, glucocorticoid remediable aldosteronism and deficiency of 11beta-OHase and 17alpha-OHase were ruled out based on her laboratory data and history. Her hypertension and hypokalemia responded to amiloride treatment but not to spironolactone.

The Effect of Visceral Pleura Invasion in the Resected Stage IB Non-Small Cell Lung Cancer Patients

PURPOSE: The purpose of this study was to clarify the prognostic significance of visceral pleura invasion in T2N0M0 non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: Between Jan. 1990 and Dec. 2001, 213 consecutive patients with T2N0M0 NSCLC underwent complete surgical resection. The patients were divided into two groups according to the existence of visceral pleural invasion. P1 and P2 defined by Hammar's definition were included in visceral pleural invasion group. The follow-up was carried out completely without missing case. The median follow-up period was 34.4 months, ranging from 0.13 to 156.2 months. RESULTS: Patient ages ranged from 10 to 79 years (mean: 60.1 years, median : 62 years). Visceral invasion was identified in 55 patients (25.8%). The operation included lobectomy in 110, pneumonectomy in 67, bi-lobectomy in 36 patients. Histology was squamous cell carcinoma in 110, adenocarcinoma in 72, large cell carcinoma in 13, others in 18. There were 5 hospital mortality (2.3%) and 71 late mortality (33.3%). 27 (50.94%) and 44 (28.4%) of late mortality were in visceral pleural invasion group (Group I) and visceral pleural non-invasion group (Group II) respectively (p=0.002). Overall 5-year survival rate was 44.8% in Group I and 63.5% in group II (p=0.0017). There were 55 (25.8%) postoperative recurrences, 24(43.6%) in group I, 21 (13.3%) in group II (p<0.0001). There were 60 recurrence sites, 58 (96.7%) of them were distant metastases, 2 (3.3%) were local recurrences. CONCLUSION: Visceral pleural invasion is a significant prognostic factor in stage IB NSCLC in survival time and recurrence. The postoperative adjuvant systemic therapy can be thought in stage IB NSCLC with visceral pleural invasion

Comparison Study of the Pulmonary Function and Serum Carboxyhemoglobin Level Between the Traffic Policmen and Clerk Policemen / 결핵

BACKGROUND: A large number of pollutants such as sulfur dioxide, nitric oxide, carbon monoxide, particulate matter, and ozone influence on the body. These pollutants put a burden on the lung and the sequelae resulting from the oxidative stress are thought to contribute to the development of fibrotic lung disease, emphysema, chronic bronchitis and lung cancer. Also, carbon monoxide generated from the incomplete combustion of carbon-containing compounds is an important component of air pollution caused by traffic exhaust fumes and has the toxic effect of tissue hypoxia and produce various systemic and neurologic complications. The objective of this study is to compare the difference of pulmonary function and serum carboxyhemoglobin(CO-Hb) level between the traffic policemen and clerk policemen. METHODS: Three hundred and twenty-nine of traffic policemen, and one hundred and thirty clerk policemen were included between 2001 May and 2002 August. The policemen who took part in this study were asked to fill out a questionnaire which included questions on age, smoking, drinking, years of working, work-related symptoms and past medical history. The serum CO-Hb level was measured by using carboxyoximeter. Pulmonary function test was done by using automated spirometer. Additional tests, such as elecrocardiogram, urinalysis, chest radiography, blood chemistry, and CBC, were also done. RESULTS: FEV1(%) was 97.1+/-0.85%, and 105.7+/-1.21%(p<0.05). FVC(%) was 94.6+/-0.67%, and 102.1+/-1.09%, respectively(p<0.05). Serum CO-Hb level was 2.4+/-0.06%, and 1.8+/-0.08%(p<0.05). After correction of confounding factors (age, smoking), significant variables were FVC(%), FEV1(%) and serum CO-Hb level(%)(p<0.05). CONCLUSION: Long exposure to air pollution may influence the pulmonary function and serum CO-Hb level. But, further prospective cohort study will be needed to elucidate detailed influences of specific pollutants on pulmonary function and serum carboxyhemoglobin level.

Endobronchial Inflammatory Myofibroblastic Tumor of Right Lower Lobar Bronchus / 대한흉부외과학회지

Inflammatory myofibroblastic tumor was widely known as inflammatory pseudotumor, commonly developed as a solid mass in lung.The endobronchial inflammatory myofibroblastic tumor is a very rare case where only a few cases have been reported.We report a 13-year-old girl who had coughing for 5 months.The simple chest X-ray and computued tomography of the chest revealed a mass which obstructed the right lower lobe bronchus and pneumonic consolidation.The fiberoptic bronchoscopic finding was mostly gelatinous,gray-yellowish mass that obstructed the airway of right lower lobe bronchus nearly,and was considered as a chondroid hamartoma pathologically.Right lower lobectomy of lung was performed.The mass was confirmed as a endobronchial inflammatory myofibroblastic tumor.The patient was discharged without complication and with outpatient followup.

A study of the temporomandibular joint in malocclusion using TMJ tomogram and cephalogram / 대한치과교정학회지

The purpose of this study was to investigate the difference between normal and malocclusion subjects in Temporomandibular joint. This study was based on the 44 subjects with normal occlusion, 30 subjects with Class II malocclusion, 30 subjects with Class III malocclusion before treatment. After submental vertex view analysis, each subject was given the TMJ Tomogram in centric relation and centric occlusion and the Cephalogram was taken with Quint Sectograph. The TMJ spaces were measured and analyzed statistically. Following results were obtained. 1. When centric relation was compared to centric occlusion. The condyles were positioned more posteriorly and superiorly in centric relation position of the normal occlusion group and the class II malocclusion group. In the Class III malocclusion group. There was no significant difference in the condylar position between centric occlusion and centric relation. 2. The condyles of the Class III malocclusion group were positioned more superiorly than the normal occlusion group and the Class II malocclusion group. 3. In the correlation between articular eminence posterior slope angle and lingual slope angle of the upper anterior central incisor, there was significant correlation in the normal occlusion group. But no significant correlation was found in the malocclusion group. 4. The mean value of the horizontal angulation of condylar head to the transear rod axis plane was 20.32degrees +/- 8.12degrees in the normal occlusion group, 25.08degrees +/- 4.83degrees in the class II malocclusion group, 14.68degrees +/- 4.08degrees in the class III malocclusion group.

Third molar changes following lower second molar extractions / 대한치과교정학회지

The purpose of this study was to observe the changes of the lower 3rd molars following the extraction of the lower 2nd molars by Lateral Cephalograms and Orthopantomograms. The subjects consisted of twenty malocclusion, 7 males 13 females, were 19 year 5 month old at the removal of the lower 2nd molars, 19 year 1 month old at the end of the orthodontic supervision after the removal of the lower 2nd molars (mean age). The obtained results were as follows, 1. It is recommended to extract the lower 2nd molars when the lower 3rd molars are Nolla's Stage 4 or 5. 2. With the pre-extraction variables obtained by factor analysis, it was possible to predict the long axis of the lower 3rd molars after 2nd molar extraction. 3. There were no impacted 3rd molars.