Chronic Expanding Hematoma of the Thorax

We report the first case in Korea of a chronic expanding hematoma, which presented as a huge mass in the pleural cavity. A 67-year-old woman exhibiting a slowly-expanding intrathoracic mass, as revealed by a chest radiograph, was admitted to our hospital. The patient had undergone a pneumonectomy 37 years earlier during treatment for pulmonary tuberculosis. Computed tomography revealed a huge mass in her right hemithorax. The differential diagnosis of this mass included chronic empyema combined with a malignancy, such as lymphoma or a soft tissue sarcoma. The tumor, which was classified as an encapsulated chronic hematoma, was removed surgically. Samples sent for histopathological and microbiological analysis revealed no evidence of neoplasia or infection. The patient was finally diagnosed with a chronic expanding hematoma of the thorax. This case is particularly rare due to the patient's development of a very large mass after undergoing treatment for tuberculosis more than 30 years earlier.

Two cases of Endobronchial Neurilemmoma and Review of the Literature in Korea / 결핵및호흡기질환

Neurilemmomas are benign tumors that originate from Schwann cells. These tumors rarely occur in the trachea or bronchus. Although small peripheral lesions cause no symptoms, they usually cause dyspnea, cough, wheeze, and atelectasis. We encountered two cases of endobronchial neurilemmoma, and reviewed 10 cases previously reported in Korea in order to clarify the characteristics of this disease, and to determine the appropriate treatment. The median age of the 12 patients reviewed were 36.5 (range 16-75). Cough and dyspnea were the most common initial symptoms (40%), and two cases had no symptoms. Regarding the diagnostic methods, bronchoscopic biopsy was found to be inadequate for diagnosis in two cases. A review of the cases revealed the following teatments: bronchoscopic removal in two cases, surgery in six cases, and combined bronchoscopic removal and surgery in one case.

Successful treatment of Mycobacterium abscessus lung disease with pneumonectomy combined with antibiotic therapy: A case report / 대한내과학회지

Mycobacterium abscessus is the most common respiratory pathogen in rapidly growing mycobacteria and is resistant to all of the first-line antituberculosis drugs. M. abscessus is extremely difficult to eradicate with antibiotic treatment. The only curative approach to therapy for M. abscessus lung disease is surgical resection of the involved lung. We describe a patient of M. abscessus lung disease who was successfully treated with surgical lung resection combined with antibiotic therapy. This is the first case report in Korea that the patient underwent successful surgical lung resection for the curative treatment of M. abscessus lung disease.

p 53 Expression in Non - Small Cell Lung Cancer: Its relationship to the clinical prognostic factor and smoking history / 대한암학회지

PURPOSE: p53 mutations are one of the most common genetic alterations in human lung cancer. Although the prognostic value of mutant p53 is still debated, it is widely accepted as a relatively early genetic event in the development and progression of lung cancer. Moreover, there are growing reports about an association between smoking and p53 mutation, suggesting that the p53 gene could be a target of the smoking associated carcino- genesis in the lung cancer. MATERIALS AND METHODS: Surgically resected 89 primary non-small cell lung cancers were obtained from May of 1995 to May of 1997. p53 expression and Ki-67 expression were measured by immunohistochemistry, and each p53 expression and smoking amount were compared with Ki-67 expression and other clinical prognostic factors. RESULTS: Positive p53 expressions were found in 52 (58%) specimens, including 38 (69%) squamous cell carcinomas, 11 (39%) adenocarcinomas, and 3 (50%) large cell carcinomas, and closely associated with male and squamous cell carcinoma. Also close correlation was observed between smoking amount and p53 expression by the regression analysis. But p53 and Ki-67 expression showed no associations in pathologic stage and survival, and there was no association between p53 expression and survival after adjuvant radiotherapy. CONCLUSION: Smoking seems to affect p53 mutations in non-small cell lung cancer, and additional efforts are needed to evaluate the carcinogesis of lung cancer.

Prospective Study on Preoperative Evaluation for the Prediction of Mortality and Morbidity after Lung Cancer Resection / 결핵

PURPOSE: This study was undertaken to determine the preoperative predictors of mortality and morbidity after lung cancer resection. METHOD: During the period from October 1, 1995 to August 31, 1996, a prospective study was conducted in 92 lung resection candidates diagnosed as lung cancer. For preoperative predictors of nonpulmonary factors, we considered age, sex, weight loss, hematocrit, serum albumin, EKG and concomitant illness, and f or those of pulmonary factors, smoking history, presence of pneumonia, dyspnea scale(1 to 4), arterial blood gas analysis with room air breathing, routine pulmonary function test. And predicted postoperative(ppo) pulmonary factors such as ppo-FEV1, ppo-diffusing capacity(DLco), predicted postoperative product(PPP) of ppo-FEV1 % x ppo-DLco% and ppo-maximal O2 uptake(VO2max) were also considered. RESULTS: There were 78 men and 14 women with a median age of 62 years(range 42 to 82) and a mean FEV1 of 2.37+/-0.06L. Twenty nine patients had a decreased FEV1 less than 2.0L. Pneumonectomy was performed in 26 patients, bilobectomy in 12, lobectomy in 54. Pulmonary complications developed in 10 patients, cardiac complications in 9, other complications(empyema, air leak, bleeding) in 11, and 16 patients were managed in intensive care unit for more than 48hours. Three patients died within 30 days after operation. The ppo-O2max was less than 10ml/kg/min in these three patients, but its statistical significance could not be determined due to small number of patients. In multivariate analysis, the predictor related to postoperative death was weight loss (p<0.05), and as for pulmonary complications, weight loss, dyspnea scale, ppo-DLco and extent of resection(p<0.05). CONCLUSIONS: Based on this study, preoperative nonpulmonary factors such as weight loss and dyspnea scale are more important than the pulmonary factors in the prediction of postoperative mortality and/or morbodity in lung resection candidates, but exercise pulmonary fuction test may be useful. Our study suggests that ppo-VO2max value less than 10ml/kg/min is associated with death after lung cancer resection but further studies are needed to validate this result.

Gastric pull-up vs. free jejunal graft for pharyngoesophagealreconstruction / 대한이비인후과학회지

No abstract available.

Chest CT findings of recurrent esophageal cancer after transthoracic esophagectomy with esophagogastrostomy

Surgical resection of esophageal cance has played a prominent role in both cure and palliation. The radiologic evaluation of postesophagectomy patients is directed at the detection of normal and pathological appearances after surgical resection. Since early detection of recurrent tumor is important in the management of patients who have undergone esophagectomy, we undertook a retrospective study to evaluate the findings of recurrence on CT in postesophagectomy patients. Between January 1988 and July 1991, 26 patients who had undergone transthoracic esophagectomy with esophagogastrostomy for epidermoid carcinoma of the esophagus with following reoccurance were examined by chest CT. The group included 25 male and one female patients were aged 45-71 years(mean, 53). All patients had studies done immediate post operative 7-10 days. The CT were performed with a CT 9800 scanner (GE Medical System, Milwaukee) after administration of oral contrast media and intravenous injection of contrast media. The findings seen on CT were cnfirmed by biopsy in five cases and by clinical, radiological follow-up manifestation in 21 cases. The abnormalities that were demonstrated on follow-up CT were adenopathy-mediastinal node(ten cases) or abdominal node(five cases), local recurrence-previous tumor site (five case), anastomotic siteI(two cases) or thoracases), peicardial effusion(two cases). Our results indicate that serial chest CT play an important role in the evaluation of the patients after transthoracic esophagectomy with esophagogastrotomy.