Pneumonectomy for Clinical Stage I Non-Small Cell Lung Cancer in Elderly Patients over 70 Years of Age

BACKGROUND: Lobectomy is the generally accepted standard treatment for early-stage non-small cell lung cancer (NSCLC). However, especially in elderly patients, it is often necessary to perform pneumonectomy in order to maximize the likelihood of curative treatment, although pneumonectomy is a challenging procedure. METHODS: We analysed patients who were clinically diagnosed with stage I NSCLC and underwent pneumonectomy with curative intent from 2004 to 2011. The patients were divided into an elderly group (> or =70 years) and a younger group (<70 years). We retrospectively analysed the outcomes of these groups of patients in order to characterize the role of pneumonectomy as a treatment for elderly patients with clinical stage I NSCLC. RESULTS: Thirty patients younger than 70 years of age (younger group) and fourteen patients 70 years of age or older (elderly group) who underwent pneumonectomy were enrolled in the present study. The median follow-up period was 35 months (range, 0 to 125 months). The perioperative mortality rate (within 90 days after the operation) was 7.1% in the elderly group and 6.7% in the younger group (p=0.73). No significant differences between the two groups were observed regarding the occurrence of pneumonia, acute respiratory distress syndrome, cardiac arrhythmia, bronchopleural fistula, and vocal cord paralysis. The overall five-year survival rate was 79.4% in the younger group and 35.7% in the elderly group, which was a significant difference (p=0.018). The five-year disease-free survival rate was 66.7% in the younger group and 35.7% in the elderly group, but this difference was not statistically significant (p=0.23). CONCLUSION: Although elderly patients with early stage lung cancer showed a worse long-term survival rate after pneumonectomy than younger patients, the outcomes of elderly patients were similar to those of younger patients in terms of perioperative mortality and postoperative complications. Patients should not be denied pneumonectomy solely due to old age.

Outcomes of the Initial Surgical Treatment without Neoadjuvant Therapy in Patients with Unexpected N2 Non-small Cell Lung Cancer / 대한흉부외과학회지

BACKGROUND: Preoperative chemotherapy has been adopted in our hospital as a standard treatment for non-small cell lung cancer patients with N2 disease. However, there have been cases of pathologic N2 disease that have been detected after curative-intent surgical resection. We retrospectively studied the outcomes of initial surgical treatment without neoadjuvant therapy in patients with unexpected N2 non-small cell lung cancer. MATERIAL AND METHOD: Between January 1995 and June 2007, 225 patients were diagnosed with pathologic N2 disease after they underwent initial pulmonary resection without neoadjuvant therapy. Among them, 170 patients were preoperatively diagnosed with lymph node stage N0 or N1. We retrospectively reviewed their medical record and analyzed the outcomes. RESULT: The overall 5-year survival rate was 35.4%. The prognostic factors that were significantly associated with survival were no adjuvant therapy, histologic cell types other than adenocarcinoma or squamous cell carcinoma, a pathologic T stage more than T1, old age (> or =70 years) and no mediastinoscopic biopsy. During the follow-up, 79 patients (46.5%) experienced tumor recurrence, including loco-regional recurrence in 20 patients (25.3%) and distant metastasis in 56 (70.9%). The 5-year recurrence-free survival rate was 33.7%. CONCLUSION: Based on our findings, the survival was good for patients with unexpected N2 non-small cell lung cancer and who underwent initial pulmonary resection without neoadjuvant therapy. A prospective comparative analysis is needed to obtain more conclusive and persuasive results.

Pulmonary Resection for Metastases from Colorectal Cancer: Prognostic Factors and Survival

PURPOSE: Pulmonary metastases occur in up to 10% of all patients who undergo a curative resection for colorectal cancer. Surgical resection is an important part in the treatment of pulmonary metastasis from colorectal cancer. We analyzed the treatment outcome and the prognostic factors affecting survival in this subset of patients. METHODS: Between October 1994 and December 2004, 59 patients underwent a curative resection for pulmonary metastases from colorectal cancer. Uncontrollable synchronous liver and lung metastasis or synchronous colorectal cancers with isolated lung metastasis were excluded from this study. A retrospective review of the patients' characteristics and of factors influencing survival was performed. Survival was analyzed by using the Kaplan-Meier method. Comparisons between the groups were performed by using a log-rank analysis and the Cox proportional hazard model. RESULTS: The 5-year overall survival rate of all patients who received a pulmonary resection was 50.3%. The number of pulmonary metastases was significantly related with survival (P=0.032). A pre-thoracotomy CEA level exceeding 5 ng/ml was related with poor survival (P=0.001). A disease- free interval of greater than 2 years did not correlate with survival after a thoracotomy (P=0.3). CONCLUSIONS: The pre-thoracotomy CEA level and the number of metastases were independent prognostic factors. Resection of a pulmonary metastasis from colorectal cancer may result in improved survival or even cure in selected patients. A pulmonary resection of colorectal cancer is regarded as a safe and effective treatment with low morbidity and mortality rates.

The Successful Application of Nuss Procedures with Modified Operative Technique / 대한흉부외과학회지

BACKGROUND: Nuss procedure is a minimally invasive technique for correcting the pectus excavatum. But there are some limitations of correcting the complex anomaly or grown-up patients. MATERIAL AND METHOD: we retrospectively reviewed 135 consecutive patients who underwent repair of pectus excavatum by the Nuss procedure and its modifications between November 1999 and December 2004. We analyzed the computed tomography, age on operation, operative technique, and complications. RESULT: We operated 135 patients of pectus excavatum during 62 months. Total number of operations about Nuss procedure is 216, including bar removal procedure of 64 cases, redo Nuss procedures of 17 cases. We modified the point of bar insertion to the hinge point, made a shoulder in the bar to prevent a displacement. And then we changed the fixation material from Vicryl to steel wire. If the patients are old, we retract the sternum during bar rotation and fixation. Until 2002, the number of redo Nuss operations were 17, complications were 23. but, after modifications, the number of redo Nuss operation were 0, complications were 2. CONCLUSION: This result indicates that our modifications of Nuss operation is effective, and could decrease the number of redo Nuss operation and complications.

Cavitating Adenocarcinoma and Squamous Cell Carcinoma in the Same Lobe of the Lung / 대한흉부외과학회지

Synchronous primary lung cancers in the same lobe are rare. Cavitating adenocarcinoma as single lung lesion is unusual. We experienced cavitating adenocarcinoma and squamous cell carcinoma in the same lobe of the lung. The patient was a 64-year-old male with chief complaints of hemoptysis. CT scan showd a central mass in right upper lobar bronchus, obstructive pneumonia, and lung abscess in the right upper lobe. Pathologically, the central mass was a 2.3x1x1 cm sized squamous cell carcinoma, and lung abscess was revealed as a 3x2x2 cm sized adenocarcinoma. The patient was discharged without any specific problem after right peumonectomy.

Thymic Neuroendocrine Tumor Associated with Cushing's Syndrome: case report / 대한흉부외과학회지

Neuroendocrine tumor in thymus is rare and has poor prognosis due to frequent recurrence and distant metastasis. Approximately half of thymic carcinoids are hormonally active and Cushing's syndrome is seen in 33% of affected patients. Treatment of choice is surgical excision of tumor and role of chemotherapy and radiotherapy is controversal. We report 2 cases of thymic neuroendocrine carcinoma associated with Cushing's syndrome.

Analysis of Risk and Benefit of Open Lung Biopsy in Severe Immunocompromised Patients with Pulmonary Complications / 대한흉부외과학회지

BACKGROUND: Pulmonary complications in immunocompromised patients are often fatal. Empirical treatment is usually applied based on the clinical and radiological findings because of the risk of the aggressive diagnostic procedures such as open lung biopsy. However, recent advancements in operative procedures and perioperative management has decreased the procedure-related risks. We have prospectively analyzed the risks and benefits of the early application of open lung biopsy in such patients. MATERIAL AND METHOD: Forty-two consecutive immunocompromised patients with critical pulmonary complications were included from June, 1996 to December, 1999. The definition of the immunocompromised is as those with chemotherapy and/or other modality for hematologic disorders, with usage of immunosuppressive drug after transplantation, with usage of steroid for more than 1 month, and with primary immunodeficiency disorders. The indication of open lung biopsy was those with no significant improvement after a week of aggressive application of empirical treatment or with rapidly aggressive process. The underlying disease included hematologic disorder(31 patients), post-transplantation(3 patients), chemotherapy for solid tumor(2 patients), and others(6 patients). Operations were done through thoracotomy(conventional or mini-) or VATS. RESULT: One patient died on the first postoperative day and seven patients died in the hospital after the operation but none was related to the operation. Preoperative usage of steroid and preoperative mechanical ventilator-dependency was significantly related to the in-hospital mortality but the other factors such as thrombocytopenia and neutropenia had no relation to the in-hospital mortality. There was no major or minor surgical complication except for prolonged air leak(1 patient). Postoperative diagnosis included infectious diseases (26 diagnoses; fungal, 20; pyogenic bacteria, 3; mycobacteria, 2; viral, 1), inflammatory disorders(6 diagnoses), malignancy(2 diagnoses), and nonspecifically-defined disorders(13 diagnoses). In 35 patients(81.4%) treatment plans were changed after open lung biopsy and 30 patients(69.8%) improved after change of treatment. CONCLUSION: Open lung biopsy in immunocompromised patients with pulmonary complications can be done with acceptable risk and significant benefit. For accurate diagnosis, adequate treatment, and better prognosis, the early application of open lung biopsy should be considered when the empirical treatment does not improve the patient's condition.

Giant Thymic Hyperplasia in Children: 1 case report / 대한흉부외과학회지

Giant thymic Hyperplasia is a rare lesion in children. We report a case of giant thymic hyperplasia in the right anterior mediastinum in a 2 year-old male patient. Presenting symptom was frequent cough and sputum, plain chest X-ray and computed tomography showed huge mass in the right anterior mediastinum. The tumor resection was done through a median sternotomy for the prevention of progression to atelectasis caused by mass effect and tissue diagnosis. An open biopsy specimen showed normal thymic architecture. The patient recovered without any problem and is doing well untill now. We report this rare case of giant thymic hyperplasia with review of the literature.

A Study on Pulmonary Toxic Effect of High-Dose Cisplatin Administered by Isolated Lung Perfusion in Dogs / 대한흉부외과학회지

BACKGROUND: Isolated lung perfusion (ILP) was developed as a new treatment approach to non-resectable primary or metastatic lung cancer, because of its ability to reduce systemic toxicity while delivering high-dose chemotherapeutic agents to the target organs. This research was planned to evaluate the direct toxic effect of high-dose cisplatin to the lung tissue during isolated lung perfusion. MATERIAL AND METHOD: Fifteen mongrel dogs were divided in the perfusate for 40 minutes. The second group was composed of 5 mongrel dogs which underwent ILP with cisplatin 2.5 mg/Kg added to the perfusate for 30 minutes and 10 minutes with washing solution without cisplatin. The third group underwent the same procedure as the second group except cisplatin 5.0 mg/Kg in the perfusate. Activities of serum angiotensin converting enzyme (ACE), tumor necrosis factor-alpha (TNF-alpha), and concentration of serum lactate dehydrogenase (LDH) and blood urea nitrogen/creatinine (BUN/Cr) were analyzed in each groups at the time of pre-perfusion, 1 hour, 1 day, 1 week, and 2 weeks after ILP. RESULT: Serum ACE activities before and 1 hour, 1 day, 1 week, and 2 weeks after ILP in control group were 45.1+/-6.3, 44.6+/-9.3, 46.7+/-9.5, 50.8+/-9.1, 46.1+/-4.3 U/L. Those in cisplatin 2.5 and 5.0 mg/Kg groups were 49.4+/-12.6, 39.0+/-8.6, 42.3+/-15.9, 50.0+/-2.6, 53.8+/-8.3 and 55.5+/-12.3, 47.0+/-6.3, 45.1+/-6.9, 74.8+/-19.5, 60.2+/-12.0 U/L, respectively. Serum TNF-alpha activities in each group before and after ILP were 5.0+/-1.5 / 7.7+/-2.2 / 6.6+/-2.5 / 4.3+/-1.3 / 5.2+/-1.1 (control), 8.7+/-1.6 / 9.9+/-2.2 / 7.9+/-1.5 / 6.3+/-2.2 / 7.4+/-2.4 (cisplatin 2.5 mg/Kg), and 6.9+/-0.7 / 8.9+/-3.4 / 7.9+/-4.0 / 3.3+/-0.9 / 5.8+/-1.3 pg/ml (cisplatin 5.0 mg/Kg). Mean LDH levels of each group were 225.7 / 271.3 / 328.9 / 350.8 / 255.7(control), 235.7 / 265.7 / 336.0 / 379.5 / 299.2 (cisplatin 2.5 mg/Kg), and 259.6 / 285.2 / 340.6 / 433.4 / 292.4 IU/L (cisplatin 5.0 mg/Kg). So there was no significant difference in serum ACE, TNF-alpha, and LDH activity changes after ILP between the 3 groups. And, there was no significant changes in BUN/Cr in each groups, which was independent of ILP and perfused concentration of cisplatin. In addition, all dogs survived the ILP and there was no significant evidence of pulmonary vascular injury after 2 weeks of ILP with cisplatin. CONCLUSION: There was no harmful effect of cisplatin to the lund tissue of the mongrel dog up to 5.0 mg/Kg in perfusate. Therefore, it is perceived to be safe and effective to deliver high-dose cisplatin to the lung without pulmonary toxicity and renal damage with ILP.

Clinical Characteristics of Recurred Patients with Stage I ,II Non-Small Cell Lung Cancer / 결핵

BACKGROUND: Five year survival rate of postoperative stage I non-small lung cancer(NSCLC) reaches to 66%. In the remaining one third of patients, however, cancer recurs and overall survival of NSCLC remains dismal. To evaluate clinical and pathologic characteristics of recurred NSCLC, we studied patterns and factors for postoperative recurrence in patients with staged I, II NSCLC. METHOD: A retrospective analysis was performed in 234 patients who underwent radical resection for pathologic stage I, II NSCLC. All patients followed for at least one year were included in this study. RESULTS: 1) There were 177 men and 57 women. The median age was 63. The median duration of follow up was 732 days (range 365~1,695 days). The overall recurrence rate was 26.5% and the recurrence occurred at 358.8 +/- 239.8 days after operation. 2) The age of recurred NSCLC patients were higher (63.2 +/- 8.8 years) than that of non-recurred patients (60.3 +/- 9.8 years)(p=0.043). The recurrence rate was higher in stage II (46.9%) than in stage I (18.8%, p<0.001) NSCLC. The size of primary lung mass was larger in recurred (5.45 +/- 3.22 cm) than that of non-recurred NSCLC (3.74 +/- 1.75 cm, p<0.001). Interestingly, there were no recurrent cases when the resected primary tumors were less than 2cm. 3) Distant recurrence was more frequent than locoregional recurrence (66.1% vs. 33.9%). Distant recurrence rate was more frequent in female and adenocarcinoma. Brain metastasis was more frequent in patients with adenocarcinoma than squamous cell carcinoma (p=0.024). CONCLUSION: The tumor size and stage were two important factors for recurrence. Considering that distant brain metastasis was more frequent in patients with adenocarinoma, prospective study should follow to evaluate the effectiveness of preoperative brain imaging.

Early Result of Surgical Resection after Pre-Operative Concurrent chemoradiotherapy for N2-Positive Stage IIIA NSCLC / 대한흉부외과학회지

BACKGROUND: Many recent results of clinical trials show that pre-operative concurrent chemoradiotherapy and surgical resection could increase the survival of N2 positive stage IIIA non-small cell lung cancer. This study was performed to assess the feasibility, toxicity, and affect rates of concurrent chemoradiotherapy and surgical resection in N2 positive stage IIIA non-small cell lung cancer. MATERIAL AND METHOD: Thirty-one patients who underwent preoperative concurrent chemoradiotherapy for N2 positive stage IIIA non-small-cell lung cancer from May 1997 to April 1999 were entered into the study. Mean age was 61 yrs (43-70 yrs), There were 24 men and 7 women. The confirmation of N2 disease were achieved through mediastinoscopic biopsy (24) and CT scans (7). Induction was achieved by two cycles of cisplatin and etoposide(EP) plus concurrent chest radiotherapy to 45 Gy. Resections were done at 3 weeks after the complection of preoperative concurrent chemoradiotherapy. Resections were performed in 23 patients, excluding 5 refusals and 3 distant metastasis. All patients were compled the thoracic radiotherapy except one who had distant metastasis. Twenty three patients were completed the planned 2 cycles of EP chemotherapy, and 8 patients were received only 1 cycle for severe side effects (6), refusal (1), and distant metastasis(1). There was one postoperative mortality, and the cause of death was ARDS. Three patients who had neutropenic fever and one patient who had radiation pneumonitis were required admission and treatment. Esophagitis was the most common acute side effect, but relatively well-tolerated in most patients. The complection rate of concurrent chemoradiotherapy was 74%, resection rate was 71%, pathologic complete remission rate was 13.6%, and pathologic down-staging rate was 68%. CONCLUSION: Morbidity related to each treatment was acceptable and many of the patients have benefited down staging of its disease. Further prospective, preferably randomized, clinical trials of larger scale may be warranted to confirm the actual benefit of preoperative concurrent chemoradiotherapy and surgical resection in N2-positive stage IIIA non-small cell lung cancer.

Pre-operative Concurrent Chemoradiotherapy for Stage IIIA (N2) Non-Small Cell Lung Cancer / 대한방사선종양학회지

PURPOSE: This is to evaluate the acute complication, resection rate, and tumor down-staging after pre-operative concurrent chemoradiotherapy for stage IIIA (N2) non-small cell lung cancer. MATERIALS AND METHODS: Fifteen patients with non-small cell lung cancer were enrolled in this study from May 1997 to June 1998 in Samsung Medical Center. The median age of the patients was 61 (range, 45~67) years and male to female ratio was 12:3. Pathologic types were squamous cell carcinoma (11) and adenocarcinoma (4). Pre-operative clinical tumor stages were cT1 in 2 patients, cT2 in 12, and cT3 in 1 and all were N2. Ten patients were proved to be N2 with mediastinoscopic biopsy and five had clinically evident mediastinal lymph node metastases on the chest CT scans. Pre-operative radiation therapy field included the primary tumor, the ipsilateral hilum, and the mediastinum. Total radiation dose was 45 Gy over 5 weeks with daily dose of 1.8 Gy. Pre-operative concurrent chemotherapy consisted of two cycles of intravenous cis-Platin (100 mg/m2) on day 1 and oral Etoposide (50 mg/m2/day) on days 1 through 14 with 4 weeks' interval. Surgery was followed after the pre-operative re-evaluation including chest CT scan in 3 weeks of the completion of the concurrent chemoradiotherapy if there was no evidence of disease progression. RESULTS: Full dose radiation therapy was administered to all the 15 patients. Planned two cycles of chemotherapy was completed in 11 patients and one cycle was given to four. One treatment related death of acute respiratory distress syndrome occurred in 15 days of surgery. Hospital admission was required in three patients including one with radiation pneumonitis and two with neutropenic fever. Hematologic complications and other acute complications including esophagitis were tolerable. Resection rate was 92.3% (12/13) in 13 patients excluding two patients who refused surgery. Pleural seeding was found in one patient after thoracotomy and tumor resection was not feasible. Post-operative tumor stagings were pT0 in 3 patients, pT1 in 6, and pT2 in 3. Lymph node status findings were pN0 in 8 patients, pN1 in 1, and pN2 in 3. Pathologic tumor down-staging was 61.5% (8/13) including complete response in three patients (23.7%). Tumor stage was unchanged in four patients (30.8%) and progression was in one (7.7%). CONCLUSION: Pre-operative concurrent chemoradiotherapy for Stage IIIA (N2) non-small cell lung cancer demonstrated satisfactory results with no increased severe acute complications. This treatment scheme deserves more patient accrual with long-term follow-up.

Preservation of Pulmonary Function after Sleeve Lobectomy in Patients with Lung Cancer / 결핵

BACKGROUND: Sleeve lobectomy of the main bronchus has been proposed to spare lung tissue in patients who cannot tolerate pneumonectomy because of impaired lung function. The purpose of this study was to evaluate whether sleeve lobectomy can preserve lung function as expected from preoperative evaluation of lung function in patients with non-small cell lung cancer. METHOD: Between January 1995 and March 1998, 15 patients with non-small cell lung cancer who underwent sleeve resection were evaluated. Preoperative evaluations included spirometry and quantitative lung perfusion scan, from which predicted postoperative FEV1 was calculated. At least 3 months after operation follow up spirometry and bronchoscopy were performed. Predicted FEV1 was compared with measured postoperative FEV1. RESULT: Fourteen men and one woman, with median age of 58 years, were reviewed. The diagnosis was squamous cell carcinoma in 13 patients and adenocarcinoma of lung in 2 patients. Our results showed a excellent preservation of pulmonary function after sleeve lobectomy. Correlation between the predicted (mean, 2180 +/- 570mL) and measured FEV1 (mean, 2293 +/- 499mL) was good ( r = 0.67, P< 0.05 ). Furthermore, patient with low FEV1 (<2L) showed improved lung function after sleeve lobectomy. CONCLUSION: These findings indicated a complete recovery of the reimplanted lung lobes after sleeve lobectomy. Therefore, this technique could be safely used in lung cancer patients with impaired lung function.

The Effect of Two-Lung Ventilation Time on PaO2 during the Sequential One-Lung Ventilation / 대한마취과학회지

BACKGROUND: During bilateral transthoracic endoscopic sympathicotomy (TES), we have noticed a tendency for hypoxemia during deflation of the second lung despite adequate reinflation of the first one. This study was designed to compare PaO2 during TES of the first side with that of TES of the second side and to investigate whether PaO2 during the sequential one-lung ventilation (OLV) was correlated with two-lung ventilation (TLV) time after reinflation of the collapsed first lung. METHODS: Forty patients were randomly allocated into two groups. After TES of the first side, OLV of the second side was immediately performed after reinflation of the collapsed first lung (group A), or after 10 minutes of TLV when switching between the operated sides (group B). Arterial blood gas samples were taken at TLV before surgery, at 2 minute intervals during OLV, and during the period of TLV when switching between the operated sides. RESULTS: In group A, the significantly decreased PaO2 was observed during TES of the second side compared with TES of the first side (P < 0.01). In group B, there was no significant difference in PaO2 except 2 minutes after OLV. PaO2 during TLV and 4 and 6 minutes after OLV of the second side TES in group A significantly decreased compared with those of group B (P < 0.05). The lowest PaO2 during OLV of the second side TES was significantly lower in group A (93.5 +/- 28.7 mmHg) than in group B (154.1+/- 48.3 mmHg). CONCLUSIONS: A significantly decreased PaO2 was observed during TES of the second side, compared with TES of the first side, and time was needed after lung collapse for its full oxygenation function to recover.

The Effect of Two-Lung Ventilation Time on PaO2 during the Sequential One-Lung Ventilation / 대한마취과학회지

BACKGROUND: During bilateral transthoracic endoscopic sympathicotomy (TES), we have noticed a tendency for hypoxemia during deflation of the second lung despite adequate reinflation of the first one. This study was designed to compare PaO2 during TES of the first side with that of TES of the second side and to investigate whether PaO2 during the sequential one-lung ventilation (OLV) was correlated with two-lung ventilation (TLV) time after reinflation of the collapsed first lung. METHODS: Forty patients were randomly allocated into two groups. After TES of the first side, OLV of the second side was immediately performed after reinflation of the collapsed first lung (group A), or after 10 minutes of TLV when switching between the operated sides (group B). Arterial blood gas samples were taken at TLV before surgery, at 2 minute intervals during OLV, and during the period of TLV when switching between the operated sides. RESULTS: In group A, the significantly decreased PaO2 was observed during TES of the second side compared with TES of the first side (P < 0.01). In group B, there was no significant difference in PaO2 except 2 minutes after OLV. PaO2 during TLV and 4 and 6 minutes after OLV of the second side TES in group A significantly decreased compared with those of group B (P < 0.05). The lowest PaO2 during OLV of the second side TES was significantly lower in group A (93.5 +/- 28.7 mmHg) than in group B (154.1+/- 48.3 mmHg). CONCLUSIONS: A significantly decreased PaO2 was observed during TES of the second side, compared with TES of the first side, and time was needed after lung collapse for its full oxygenation function to recover.

Talc Pleurodesis via Video-Assisted Thoracoscopic Surgery(VATS) in Malignant Pleural Effusions / 결핵

BACKGROUND: Chemical pleurodesis is a widely used method for the control of symptomatic and recurrent malignant pleural effusions. Tab has been accepted to k the most effective sclerosing agent for chemical pleurodesis. This study was undertaken to evaluate the usefulness of talc pleurodesis via video-assisted thoracoscopic surgery(VATS) in treatment of malignant pleural effusion& METHODS: A retrospective analysis of the medical records and radiographic findings was performed. The success of the procedure was defined as daily pleural fluid drainage below l00microliter within 1 week after pleurodesis and complete expansion of tie lung on simple chest radiograph. Recurrence was defined as reaccumulation of pleural fluid on follow-up chest radiographs, arid complete response as no fluid accumulation on follow-up chest radiographs. RESULTS: Between October 1994 and August 1996, talc pleurodesis via VATS was performed in 35 patient& Duration of follow-up ranged from 5 days to 828 days(median 79days). The initial success rate of procedure was 8S.6%(31 of 35 cases). Complete responses were observed in 92.8% at3O days, 75.7% at 90 days and 64.9% at 180 days. Postoperative complications were fever(54.3%), subcutaneous emphysema(11.4%), reexpansion pulmonary edema(2.9o%) and respiratory failure(5.7%). But procedure related mortality or respiratory failure was not found. CONCLUISON: Talc p1eurodesis via VATS is a safe and effective method F or the control of symptomatic malignant pleural effusions.

Optimal Management of Patent Ductus Arterisus in Premature / 대한흉부외과학회지

Between December 1994 and October 1996, 57 premature infants with evidence of a hemodynamically significant PDA associated with cardiopulmonary compromise underwent indomethcin therapy(Group I, n=48) or surgical ligation(Group II, n=9) because of indomethacin failure. The gestational age(29.6+/-3.1weeks vs. 28.1+/-1.6weeks) and birth weight(1,413+/-580gm, 1,098+/-235gm) showed no significant differences between the two groups. Medical management included fluid restriction, diuretics, and indomethacin therapy(one or two cycles). Surgical ligation was done at the neonatal intensive care unit(NICU) without moving the patient to the operation room. There was no complication associated with the operation. There were 9 deaths in Group I(19%, 9/48) and 2 deaths in Group II(22%, 2/9). The main causes of deaths were persistent bronchopulmonary dysplasia with sepsis(n=8) and intrapulmonary hemorrhage(n=3). The rate of medical treatment failure including death and complication in premature infants whose body weights were less than 1500gm was higher(41%, 15/38) than in premature infants whose body weights were more than 1500gm(16%, 3/19). Early surgical ligation of PDA may be applicable in the premature infant with a large size, low birth weight(<1500 gm), or associated intracardiac anomalies. Perfoming the operation in the NICU may be safe in stead of moving the patient to the operating room.

Effects of Modified Ultrafiltration in Pediatric Open Heart Surgery / 대한흉부외과학회지

Cardiopulmonary bypass in children is associated with capillary leak, which results in an increase in total body water after open heart surgery. The purpose of these studies was to assess the cardiopulmonary effects of modified ultrafiltration after pediatric open heart surgery. Study A: Twenty-six consecutive children aged 0.1~10 years(median 7 months) underwent cardiac operation incorporating modified ultrafiltration. After completion of cardiopulmonary bypass, modified ultrafiltration was commenced at the flow rate of 100~150l/min for 3~14 min. After modified ultrafiltration, elevation of hematocrit(28.3%+/-3.6% vs. 33.8%+/-4.0%, p<0.001), increased systolic blood pressure(66.7+/-11.2mmHg vs. 76.2+/-11.8mmHg, p<0.02), and decreased central venous pressure(7.8+/-3.7mmHg vs. 6.9+/-2.9mmHg, p<0.001) were observed. Study B: Twenty-six children who underwent cardiac operation with the diagnosis of VSD under 2 years were assigned to control(n=14) or modified ultrafiltration(n=12). Peak inspiratory pressure checked immediately after operation was significantly lower in modified ultrafiltration group than in control group(20.0+/-2.4 cmH2O vs. 22.4+/-2.3cmH2O, p< 0.03). Modified ultrafiltration after cardiopulmonary bypass in children improves early hemo- dynamics and pulmonary mechanics, and represents an excellent option for perioperative management of accumulation of fluid in the tissues. We will continually employ the modified ultrafiltration technique in pediatric cardiac operations.

Intraoperative Measurement and Analysis of Coronary Artery Bypass Graft Flow / 대한흉부외과학회지

This study aimed to determine factors that influence blood flow through coronary bypass grafts and to analyze relationship between the graft flow and postoperative outcome. Blood flow through 146 bypass grafts(GBF) was measured with transit-time ultrasound flowmeter during coronary artery bypass grafting operations in 50 patients. Single and multiple regression analyses were done for relationships between the GBF and four variables: internal diameter of recipient coronary artery, myocardial value of bypassed branch(es), type of graft, and finding of preoperative myocardial perfusion scan. The relationship between GBF and postoperative scan finding was also analyzed. 1. The mean GBF was significantly higher in sequential grafts than in single vein grafts or in internal thoracic artery grafts(61.5 vs. 46.9 and 42.5 ml/min). 2. Myocardial value and recipient artery diameter were found to be the factors determining GBF. There was no correlation between GBF and presence of perfusion defect in the preoperative scan. 3. Myocardial value was found to be more important than recipient artery diameter in determinintg GBF. 4. Reversible perfusion defects were more frequently found in the areas supplied by grafts with low GBF. But this fact had only mild statistical significance. These results suggest that blood flow through a bypass graft is more determined by the size of its supplying myocardium than by the size of recipient artery. So, we can expect effective improvement in myocardial flow reserve after grafting of small(1~1.5mm) coronary arteries, if they supply substantial area of myocardium.

Synovial Sarcoma of the Rib: Report of a Case / 대한흉부외과학회지

Synovial sarcoma is an uncommon malignant mesenchymal tumor that occurs in the vicinity of the joints, bursae, and tendon sheaths. Typically the lesions are located in the extremities, especially in the lower extremities. They also occur in the abdominal and thoracic walls, but rarely in the head and neck. We experienced a case of synovial sarcoma of the rib in 17-year -old woman. We performed en bloc chest wall resection including the right second rib tumor, first and third ribs. The postoperative course was uneventful. She received chemotherapy because of a relapse of the tumor in sternum and both lung during follow-up.