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.

The Effect of Vitamin E and N-acetyl-cysteine in Amiodarone-induced Pulmonary Fibrosis in Hamsters

PURPOSE: Amiodarone (AD) is a potent and effective anti-dysrhythmic drug, but some literature reports that it 's long-term use is associated with the development of potentially life-threatening amiodarone-induced pulmonary toxicity (AIPT). Until now, oxygen free radical theory has been the most probable hypothesis for the development of AIPT. We investigated the protective effect of two potent antioxidants, N-acetylcysteine(NAC) and vitamin E, against AIPT. METHODS: Twenty-six (26) Hamsters were divided into a sham-operation group(n=2) and the following 4 groups: AD-induced effects without antioxidants (group 1, n=6), with NAC (group 2, n=6), with vitamin E (group 3, n=6), and with both NAC and vitamin E (group 4, n=6). Vitamin E (100 mg/kg) was injected intramuscularly into the hind leg once a day. At day 21, amiodarone (1.83 umol) was administered by transoral intratracheal instillation. NAC (300 mg/kg) was injected intraperitoneally just after amiodarone instillation. At day 28, amiodarone and NAC were administered again. Twenty-one (21) days after instillation of the second dose of amiodarone, the hamsters were sacrificed, and the lung fibrosis index and the hydroxyproline content were assessed. RESULTS: In the NAC-treated group (group 2), there was no significant decrease in either the lung fibrosis index, as determined by microscopic evaluation, or the lung hydrox-yproline content (p > 0.05). But there were significant decreases in the fibrosis index and the lung hydroxyproline content in the vitamin E-treated groups (group 3 and 4 ) (p < 0.05). CONCLUSION: Although vitamin E and NAC are both potent antioxidants, we found that AD-induced lung fibrosis was significantly decreased by only vitamin E and that there was no synergistic effect between vitamin E and NAC. It is possible that AIPT is developed by some other mechanisms rather than oxygen free radical injury. Vitamin E may have some other path for decreasing lung fibrosis. Further studies are warranted.

Effect of Steroids on Interleukin-1beta and Tumor Necrosis Factor-alpha Expression due to High Tidal Volume in the Rat Ventilator-induced Lung Injury Model

PURPOSE: Although mechanical ventilation is used to improve oxygenation, this strategy can impose injurious mechanical stress on lung tissue. This is recognized as ventilator-induced lung injury (VILI). Recently, several studies have reported that inflammatory cells and mediators play an important role in the progression of VILI. This study was designed to investigate, in a rat model, the expression of interleukin (IL)-1beta and tumor necrosis factor (TNF)-alpha, as well as the anti-inflammatory activity of steroids in VILI. METHODS: Male Sprague-Dawley rats were divided into 3 groups. The control group received low tidal volume (6ml/kg) ventilation. The second group received high tidal volume (25 ml/kg) ventilation and the third group received high tidal volume (25 ml/kg) ventilation with methylprednisolone (30 mg/kg) treatment. After 60 minutes of mechanical ventilation, the animals in each group were sacrificed. Resected lungs were immunostained with antisera for IL-1beta and TNF-alpha. The stained areas were evaluated with an image analyzer. RESULTS: In the groups that received a high tidal volume, the number of positive pixels in IL-1 beta and TNF-alpha was significantly higher than it was in the low tidal volume group. The high tidal volume group showed greater expression of I L - 1beta and TNF-alpha,but this was significantly decreased by methylprednisolone. CONCLUSION: Our study suggests that an inflammatory response related with IL-1beta and TNF-alpha is involved in the development of VILI. The expression of IL-1beta and TNF-alpha was lessened by treatment with methylprednisolone, which might have contributed to improving lung dysfunction after mechanical ventilation.

Cytotoxicity and Apoptosis of Various Concentrations of Doxorubicin in Methylcholanthrene-induced Rat Fibrosarcoma(MCA) Cells / 대한흉부외과학회지

BACKGROUND: Although pulmonary resection is the standard approach for the management of pulmonary metastases from soft tissue sarcoma, most of them are unresectable and chemotherapy remains the only option. The effectiveness of the cytotoxic drugs may be limited by the toxicities that occur before the therapeutic dose is reached. The regional administration of doxorubicin using pulmonary arterial perfusion in a rodent model can produce 10 to 25 times higher concentrations in the lung than systemic administration with minimal systemic toxicities. However, it is unclear whether a high concentration of doxorubicin has beneficial effects for killing cancer cells. MATERIAL AND METHOD: We studied this to evaluate the dose-dependent cytotoxic and apoptotic effects of doxorubicin on methylcholanthrene-induced rat fibrosarcoma(MCA) cells. This study examined the cytotoxicity and apoptosis-related gene expressions(Fas, FasL, Bax, caspase 1, caspase 2, caspase 8, Bcl-2, Bcl-xL, Bcl-xS) in MCA cells after 24 hours exposure to various concentrations of doxorubicin such as 1, 5, 10, 50, and 100 micrometer. RESULT: Dose-dependent cytotoxicity was observed after 24 hours exposure to doxorubicin. However, peak apoptosis after 24 hours exposure was observed at 5 micrometer of doxorubicin. Above 5 micrometer, apoptotic activity was decreased with dose-increment. All mRNA levels of apoptosis-related genes after 24 hours exposure were up-regulated above the control level at 1 micrometer of doxorubicin and then decreased by doxorubicin dose-increment except caspase 8, which showed higher levels than the control level at 5 micrometer. Apoptosis-related protein levels were highest at 1 micrometer of doxorubicin and then decreased by doxorubicin dose-increment. However, Bax and Bcl-xL proteins steadily showed higher levels than the control throughout the different concentrations of doxorubicin. CONCLUSION: These results suggest that apoptosis is the main cytotoxic mechanism in low concentrations of doxorubicin in MCA cells and apoptosis-related genes, such as Bax, caspase 8, a can kill MCA cells, even when apoptosis is inhibited, and have its propriety for achieving much cytotoxicity against MCA cells.

Enhanced Expressions and Histological Characteristics of Intravenously Administered Plasmid DNA in Rat Lung

Cationic liposome-mediated gene transfection is a promising method for gene therapy. In this study, the transfection efficiency and histological patterns were evaluated in rat lung after intravenous administration via femoral vein of naked plasmid DNA, naked plasmid DNA with pretreatment of DOTAP, and DOTAP-cholesterol-plasmid DNA complex. Plasmid DNA encoding bacterial LacZ gene was used. For quantification of LacZ gene expression, -galactosidase assay was performed. For histologic examination, X-gal staining and immunohistochemical staining for transfected gene products were performed. Pretreatment of DOTAP prior to the infusion of naked plasmid DNA increased transfection efficiency up to a level comparable to DOTAP-cholesterol-plasmid DNA complex injection. Transfected genes were mainly expressed in type II pneumocytes and alveolar macrophages in all animals. We conclude that the high transfection efficiency is achievable by intravenous administration of naked plasmid DNA with pretreatment of DOTAP, to a level comparable to DOTAP-cholesterol-plasmid DNA complex. In this regard, naked plasmid DNA administration with pretreatment of DOTAP could be a more feasible option for intravenous gene transfer than DOTAP-cholesterol-plasmid DNA complex, in that the former is technically easier and more cost-effective than the latter with a comparable efficacy, in terms of intravenous gene delivery to the lung.

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.

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.

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.

A Case of Localized Fibrous Tumor of the Pleura / 결핵

Localized fibrous tumor of the pleura is very rare. Most of them are benign, some of them but some are malignant. Although some tumors are histologically malignant, (This clause does not relate with the rest of the sentence.) the The single best predictor of clinical benignity is whether the tumor can be totally resected. We experienced a case of localized fibrous tumor of the pleura in a 57 year old man with right chest pain and cough. He heard that he had He was informed of a 8X5cm mass in his right lower lung field, but the mass which was benign 3 years ago. Preoperative chest x-ray showed an increased hazy density at right lower lung field (,) and CT scan showed a 12X8cm huge mass (,) which was located in right lower thorax. Left thoracotomy was done and to excise a 12X8X5cm(1200gm) sized large mass was excised (delete). The patient was discharged without any complications postoperatively.

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.

Spontaneous Pneumomediastinum: Natural History and Clinical Significance

STUDY OBJECTIVE: We evaluate the clinical characteristics and natural history of patients presenting with spontaneous pneumomediastinum (SPNM) . DESIGN: A retrospective case series was conducted to identify patients diagnosed with SPNM. ICD-7(J98.2) discharge codes were used for Jan. 1993 to Aug. 1996 at four institutions , and emergency department(ED) records and admission charts were reviewed. Clinical features, interventions, complications, setting, etiology, symptoms, and length of hospital stay were recorded. PARTICIPANTS: All ED patients more than 12 years old with a diagnosis of SPNM. RESULTS: Thirteen cases were identified. Age range was 14 to 58 years(mean 24 years). Presenting symptoms were chest pain in eight(62%), dyspnea in six(46%), both symptoms in three(23%), no complaints in three(23%). Seven(54%) patients complained only of throat discomfort. Seven(54%) had subcutaneous emphysema, and two(15.3%) had a small pneumothorax. Two(15.3%) were smokers. Three(23%) had normal esophagograms and another three had normal chest CT findings. Two cases(15.3%) were associated with inhalational drug use and three cases were due to exercise. Nine cases(69%) had a history of "Valsalva-type" maneuver. Two patients(15%) had a history of antituberculous treatment and one(7.7.%) had suffered from bronchial asthma. Mean hospital days were 7.3 days(range 3 to 14), none of all needed any intervention. Specifically, no patient developed a subsequent pneumothorax or airway compromise. Seven cases(54%) were received prophylactic antibiotics. CONCLUSION: Most simple SPNM cases are benign disease and most of them(78%) had shown typical chest pain, dyspnea and subcutaneous emphysema. Inhalational drug use is not a main cause of SPNM yet, but increase in use of bronchoinhalers is a suspicous cause of SPNM.

Surgical resection of tracheal leiomyoma: A case Report / 대한흉부외과학회지

No abstract available.