Surgical Treatment of Pulmonary Metastases / 대한흉부외과학회지

BACKGROUND: Surgical resection is an important modality in the treatment of pulmonary metastases from various solid tumors. We analyzed 37 patients who underwent surgical treatments of pulmonary metastases in our hospital from 1996 to 2005. MATERIAL AND METHOD: Age, sex, disease free interval, operative procedure, the number of pulmonary metastases, and lymphatic metastasis were investigated with admission and operative records, and pathologic reports. Actuarial survival and comparisons between each survival rate were calculated according to Kaplan- Meier method and log-rank test, respectively. RESULT: Complete resections were carried out in 34 of 37 patients. The primary tumor was carcinoma in 25 cases, sarcoma in 10, and others in 2. The number of pulmonary metastases was 1 in 25 cases and 2 or more in 12 cases. 3-year and 5-year survival rates after complete resection were 50.5% and 35.9%, respectively. 3-year and 5-year survival rates for carcinoma were 64.5% and 45.6%, respectively, and 3-year survival rate for sarcoma was 17.5%. Otherwise, none of the operative procedures, the number of pulmonary metastases, lymphatic metastasis, adjunctive therapy and the disease free interval in the case of carcinoma significantly affected the survival rates. CONCLUSION: Complete resection of pulmonary metastasis in well selected patients allows high long term survival rate with low mortality and morbidity. Long-term follow up and randomized prospective studies were necessary to determine the prognostic factors of pulmonary metastases after surgical resection.

Aortoenteric Fistula: one case report / 대한흉부외과학회지

Secondary aortoenteric fistula is a rare but fatal complication of reconstructive aortoiliac surgery. This disease entity could be divided into true aortoenteric fistula and paraprosthetic enteric fistula. The prevention, diagnosis and treatment of this complication remains a challenging problem. We report a 39 year old man who was diagnosed as paraprosthetic enteric fistula in endoscopy and operated 41 months after reconstructive aortoiliac surgery due to the infected pseudoaneurysm.

Thromboendarterectomy of Chronic Pulmonary Thromboembolism: A Case Report / 대한흉부외과학회지

Chronic pulmonary artery thromboembolism is a relatively rare phenomenon causing hypoxia and pulmonary hypertension that eventually leads to respiratory failure and right heart failure. Patients with acute pulmonary artery thromboembolism are generally treated with antithrombotics and thrombolytics. However, in cases with chronic pulmonary artery thromboembolism the fibrinized thrombus is so strongly adhered to the pulmonary artery wall that medical treatment becomes ineffective and surgical treatment must then be considered. We report a 47year old patient, with a history of repeated admission due to unresolved chronic obstructive pulmonary disease and chronic pulmonary artery thromboembolism at a local hospital, who underwent a successful endarterectomy of pulmonary artery thromboemboli using intermittent total circulatory arrest.

Congenital Cardiac Anomaly Combined with the VATER Association: A case report / 대한흉부외과학회지

VATER is a complex anomaly of multiple organs and often combined with cardiac anomalies. However, it can be cured with active surgical intervention. We achieved successful result with aggressive surgery in the patient with VATER and report it with references.

Primary Pulmonary Leiomyosarcoma: A Case Report / 대한흉부외과학회지

The incidence of pulmonary leiomyosarcoma as primary lung tumor is very rare. Most of the primary leiomyosarcomas originate in the hilar region in relation to the main bronchus or pulmonary vessels and only a few originate more peripherally. This rare tumor can mimic bronchial carcinoma and present with local or systemic symptoms, or it may be discovered as an incidental finding on a routine chest X-ray. We report with review of literature, a case of incidental primary pulmonary leiomyosarcoma which originated peripherally. Huge mass was found on the left lung of a 61-year-old man on the chest X-ray peripherally. He underwent the surgical resection of the left pneumonectomy and the postoperative course was uneventful.

Surgical Management of Critical Pulmonary Stenosis: A case report / 대한흉부외과학회지

Although pulmonary valvular stenosis with intact ventricular septum is a common congenital abnormality, critical pulmonary stenosis of its severe form in the neonate is rare and highly fatal. With the development of percutaneous balloon valvuloplasty, surgical treatment is even more rare. This report is on a 2 day old male neonate with a critical pulmonary stenosis with intact ventricular septum who suffered from severe cyanosis and hypoxemia. Oxygen was inhalated and Prostaglandin E1 was infused initially and then arterial PO2 was increased from 19 mmHg to 54 mmHg. Percutaneous balloon valvuloplasty was attemped; however, the guidewire could not pass through the stenotic pulmonary valve, and during the procedure right ventricular perforation was suspected due to the presence of dye in the pericardial space. Emergency transarterial pulmonary valvotomy was performed using normothermic cardiopulmonary bypass. Postoperatively, the patient was in fair condition in the ICU and presently is in good condition at 6 months postoperative follow up.