Comparison of Different Thawing Methods on Cryopreserved Aorta / 대한흉부외과학회지

BACKGROUND: The studies on cryopreserved arterial allograft have been focused on cooling methods, pre-treatment, cryoprotectant agents, and preservation temperature. But recently, several studies have reported that thawing methods also play an important role in the occurrence of macroscopic and microscopic cracks. This study was designed to investigate the cell injury after thawing, using a rabbit model to clarify the effect of thawing methods on cryopreserved arteries. MATERIAL AND METHOD: Segments of the rabbit aorta were obtained and divided into 3 groups (n=60) according to whether the specimens were fresh (control, n=20), cryopreserved and rapidly thawed (RT) at 37oC (n=20), or cryopreserved and subjected to controlled, automated slow thawing (ST)(n=20). Cell damage was established using the TUNEL method and the morphological changes were also evaluated. RESULT: In the group that was rapidly thawed, the expression of TUNEL (+) cells increased significantly more than in the slowly thawed group. In addition, the endothelial denudation, microvesicles and edema were significant in the rapidly thawed group compared with those changes in the slowly thawed group. CONCLUSION: Our study suggests that the rapid thawing method may be one of the major causes of cellular damage and delayed rupture in cryopreserved arterial allografts. The expression of TUNEL (+) cells and structural changes were significantly low in the slowly thawed group, which might have contributed to the improvement of graft failure after transplantation.

Surgical Treatment of T4 Lung Cancer with the Use of Extracorporeal Circulation: A case report of long-term survival / 대한흉부외과학회지

We report a case of a patient with lung cancer, which invaded the left atrium and pericardium. Right middle and lower lobectomy was performed with the use of the extracorporeal circulation. Postoperative pathologic examination revealed the stage of IIIB (T4N1M0). Although the postoperative clinical course was complicated by acute localized right sided pulmonary edema and the bronchopleural fistula, the patient recovered smoothly after the procedure of omentopexy with pedicled graft of greater omentum in closing the BPF. As of August 2003, he has been followed up for 6 years and he is healthy without any evidence of recurrence. We could not find any report concerning lung cancer resection using cardiopulmonary bypass in Korean literature and believe this is the first report, especially with long-term survival.

Endoscopic Removal of Benign Endotracheal/Endobronchial Tumor / 대한흉부외과학회지

Endoscopic removal is acceptable for the treatment of endotracheal/endobronchial mass, because it is less invasive in high-risk patients and a conservative procedure for benign tumors. Two benign tumors in the lumen of the trachea (pure lipoma) and in the intermediate bronchus (hamartoma) were completely eradicated by our procedures, which involved diathermic snaring and residual mass removal with biopsy forceps under the guidance of fiberoptic bronchoscopy. No tumor recurrence was evident after extended follow-up (6 years for endotracheal lipoma and 2.5 years for endobroncheal hamartoma). Our method is safe and less invasive for the patient and provides the surgeon with better view during procedure.

New Paradigm for Patients with Pulmonary Nodule Expecting Thoracoscopic Resection / 대한흉부외과학회지

BACKGROUND: The pulmonary nodules (PN), when indicated, need thoracoscopic resection, especially in cases of non-diagnostic or technically infeasible PCNA (percutaneous needle aspiration). In the difficult situations of small or deeply seated PN, several techniques facilitating thoracoscopy have been used for detecting them. Our new protocol for managing PN was developed and prospectively reviewed. MATERIAL AND METHOD: In the procedure of PCNA, we firstly placed the tip of the needle in the center of, or just in contact with PN under CT guidance, and loaded one or two segments of platinum radiomarker inside the needle after removing the stylet. Then, we forced the radiomarker to move to the tip of the needle by pushing the stylet. Finally, if the tip of the needle was not within PN, it was reoriented to the their center to obtain the sample for PCNA. RESULT: Between May 1999 and May 2000, radiomarkers were successfully placed in 28 PN of 26 patients, with the exception of one. In 18 (85%) of 21 nodules needing throacoscopy, intraoperative fluoroscopy was used to detect them or guide stapling resection during thoracoscopy. CONCLUSION: The advantages of this technique are that there is that there is no need for further localization for thoracoscopy even in cases of unsuccessful PCNA, and it was more effective in respect to both cost and time. Therefore, this strategy for PN expecting thoracoscopy will be helpful to patients and medical staff alike.

Prognosis Factors of Tricuspid Regurgitation after the Operation for Left-sided Valvular Heart Disease / 대한흉부외과학회지

BACKGROUND: Tricuspid regurgitation has been considered as a secondary lesion when it is combined with left valvular heart diseases. However, there have been some reports which show that tricuspid regurgitation keeps going and results in congestive heart failure even after a successful operation for left valvular heart disease. So far, there are no definite operation indications and predictive factors for the tricuspid regurgitation which is resulted from the left sided valvular heart disease. We designed this study to evaluate the effects of pulmonary artery pressure and left ventricular ejection fraction on the prognosis of tricuspid regurgitation, and to make an operation indication for the patients with secondary tricuspid regurgitation. MATERIAL AND METHOD: We reviewed the medical records of patients who underwent surgery for the left sided valvular heart disease with tricuspid regurgitation and were followed for more than 1 year with echocardiograms. There was a total of 114 cases. We compared the grades of tricuspid regurgitations and pulmonary artery pressures and left ventricular ejection fractions on the basis of echocardiograms which were checked preoperatively and on the last follow up. RESULT: There were 43 cases of tricuspid annuloplasty. In these patients, the grades of tricuspid regurgitations were improved in 42 cases (97.7%). But in 71 cases without annuloplasty, 29 cases (41%) were improved, 32 cases (45%) had no change, and 10 cases (14%) were aggravated. This finding shows significant differences in the prognoses of tricuspid regurgitations between the two groups (p0.05). The improvements of tricuspid regurgitations are not statistically related to the changes of pulmonary artery pressures or left ventricular ejection fractions. CONCLUSION: This study shows that it is impossible to predict the prognoses of tricuspid regurgitations with preoperative pulmonary artery pressures or left ventricular ejection fractions. Also, the excellent results of tricuspid annuloplasty is proven in controlling the secondary tricuspid regurgitations. Therefore, when tricuspid regurgitation is detected preoperatively, the procedures to correct the tricuspid regurgitation at the time of the operation for the left-sided valvular heart disease must be considered positively, regardless of the grades of tricuspid regurgitations, to prevent significant tricuspid regurgitation that may develop later.

Experimental and Clinical Study of Staple-Line Reinforcement Using Expanded Polytetrafluoroethylene in Thoracoscopic Bullectomy for Spontaneous Pneumothorax / 대한흉부외과학회지

BACKGROUND: Thoracoscopic bullectomy (VATS-B) is now the preferred treatment for spontaneous pneumothorax despite of higher recurrence rate than open thoracotomy. Several methods have been used to prevent this problem. The effectiveness of staple line reinforcement (SLR) in VATA-B using endostaplers was assessed by clinical and experimental study. MATERIAL AND METHOD: In experimental study, canine lungs were harvested immediately (group I, N=5) and 48 hours (group II, N=5) after stapling. The pressures at which initial air leaks occurred were measured. In clinical study from February 1997 to March 1999, 106 procedures in 104 patients undergoing VATS-B for spontaneous pneumothorax were classified into two groups according to the presence of SLR and were compared. RESULT: The average pressure of the initial air leakage was significantly higher in SLR than that of staples alone (18+/-1.6 vs 48+/-3 mm Hg in group I; 23.8+/-1.9 vs 54+/-4.6 mm Hg in group II, p<0.001). In the clinical data, there were significant differences seen in the duration of drainage, the total length of endostaplers used, and the duration of the postoperative hospital stay between patients with staple alone and patients with SLR (4.4+/-1.4 vs 3.1+/-1.1 days in duration of drainage, 92.3+/-28.1 vs 71.1+/-30.6 mm in total length of endostaplers used, 5.9+/-1.9 vs 4.6+/-1.7 days in postoperative hospital stays, p<0.001). CONCLUSION: SLR was effective for preventing prolonged air leakage and responsible for shorter hospital stays after VATS-B for the treatment of spontaneous pneumothorax.

Intraoperative assessment of Native Coronary Artery and Bypass Graft Flow Using a 15 MHz Linear Array Transducer

BACKGROUNDS: The internal mammary artery graft (IMAG) showed a gradual transition in the phasic flow pattern from predominant systolic velocity proximally at the origin from the subclavian artery to the predominant diastolic velocity distal to the anastomosis with coronary artery. IMAG without significant stenosis showed a typical pulsed Doppler flow pattern similar to that of coronary artery characterized by a predominant diastolic component. On the other hand, patients with occluded IMAGs or IMAGs with severe stenosis, low velocity profiles were recorded during diastole with an increase in the systolic component. OBJECTIVES: Identifying abnormal graft flow intraoperatively could allow for immediate graft revision. The aim of this study was to test the feasibility of using a new ultrasound 15 MHz linear array transducer. METHODS: In six patients (M:F=4:2, mean age=69+/-11 yrs), a 15 MHz linear array probe with a sterile cover was placed directly on native coronary arteries and grafts after anatomosis. 2-dimensional image, color and pulsed Doppler signals of native coronary arteries, IMA, saphenous vein and penetrating intramyocardial coronary arteries (PICA) were observed. RESULTS: 1) 2-dimensional image and color flow signals of all grafts and native coronary arteries were visualized. 2) The flow pattern of pulsed Doppler signals of all native coronary arteries including PICA were diastolic dominant. 3) The diastolic dominant pattern typical of a patent grafts on pulsed Doppler were obtained at anastomosis site of graft vessels. 4) The intimal thickening of right coronary artery was also visualized on 2-dimensional images. CONCLUSION: A new echo Doppler probe can be useful for intraoperative assessment of graft flow during bypass surgery.

Corrective Surgery of Congenital Cardiac Anomalies in the Noonan syndrome: Report of two cases / 대한흉부외과학회지

Noonan syndrome is characterized by a Turner-like phenotype and a normal karyotype associated with congenital abnormalities, such as short stature, variable mental retardation, hypertelorism, webbed neck, low posterior hair line, skeletal malformation and congenital cardiovascular defect. Two third of Noonan syndrome have cardiac anormalies, half with pulmonary stenosis. We have experienced two cases of pulmonary stenosis associated with other cardiac anomalies in Noonan syndrome. The first 31-year-old male patient had characteristic appearance of Noonan syndrome with severe infundibular pulmonic stenosis and patent foramen ovale. The second 28-year-old male patient had valvular and subvalvular pulmonary stenosis with typical Noonan's face and stature. Pulmonary valvotomy and hypertrophied muscle bundles in the right ventricular cavity were resected in both cases. Patent foramen ovale was closed directly in the first case. Postoperative follow-up examinations revealed no symptoms and successful outcome.

The Effects of addition of Cyclic Adenosine Monophosphate and NItric Oxide in Low Potassium Dextran Solution for Lung Preservation in an Isolated Rabbit Lung Perfusion Model / 대한흉부외과학회지

BACKGROUND: During organ preservation and reperfusion, both cyclic adenosine monophos-phate(cAMP) and nitric oxide(NO) play a central role in maintaining pulmonary vascular homeostasis. However , both cAMP and NO levels decline markedly during pulmonary ischemia and reperfusion. In this study we prepared a new solution in which a cAMP analog(dibutyryl cAMP, db-cAMP) and a nitric oxide donor (nitroglycerin, NTG) were added to the conventional low potassium dextran(LPD) solution. We investigated the effects of addition of cAMP and/or NO in LPD solution for lung preservation and compared the effectiveness of the solutions. MATERIAL AND METHOD: Rabbit lung grafts(six per group) were studied in an isolated lung perfusion model. The heart-lung blocks were harvested after flushing in situ with only LPD solution(group I, n = 6), plus NTG(group II, n = 6), plus db-cAMP(group III, n = 6), or plus NTG and db-cAMP(group IV, n = 6), and were preserved at 10degreesC for 24 hours. The stored lungs were ventilated with 100% oxygen and reperfused with fresh venous blood at 38degreesC for 30 minutes. We assessed the lung functions and subsequent lung edema. Tumor necrosis factor alpha(TNF-alpha) and nitrite/nitrate(total NO production) levels were also measured. In addition, we evaluated histologic and ultrastructual changes of the reperfused lungs. RESULT: Although Group IV demonstrated the best lung preservation, the differences were not significant among group II, III and IV. Group Irevealed the worst lung functions and severe pulmonary edema(p<0.05 versus all other groups). Although group II showed better lung preservation than in group III, the differences were not significant. TNF-alpha release was significantly reduced in group IV than in group I after reperfusion(p<0.01). NO levels were significantly increased in groups II and IV than in groups I and III after reperfusion(p<0.001). However , there were no significant differences between groups I and III or between groups II and IV. NO levels decreased gradually in groups I and III(p<0.05). Histologic and ultrastructual studies showed better preservation of the alveolar-capillary barrier in groups II, III and IV than in group I. CONCLUSION: This study demonstrate that both of db-cAMP and NTG had beneficial effects on lung preservation with LPD solution, and there was no difference in the effect of each component. Especially, we expect that combined supplementation of db-cAMP and NTG will preserve better vascular homeostasis and minimize reperfusion inj ury after ischemic cold storage.

Surgical Evaluation of Traumatic Tracheo: Esophageal Rupture / 대한흉부외과학회지

Tracheobronchial rupture associated with esophageal rupture due to blunt chest trauma is very rare. However, increasing number of thoracic inj uries have been reported during the recent years; This trend could be attributed to an increase in high-speed traffic accidents, and also to the better care for patients suffering from trauma. We report two cases of long tracheal disruption associated with esophageal rupture as a result of a nonpenetrating thoracic trauma. One patient who was transferred from another hospital after failed tracheoesophageal reconstruction received secondary reconstructive surgery but expired, and the other patient survived without any serious complications with reconstructive surgery.

Clinical and Histo-Pathological Analysis for Recurrence after Curative Surgery of Esophageal Cancer / 대한흉부외과학회지

BACKGROUND: Surgical resection remains the mainstay of treatment for esophageal cancer. Despite recent advances in surgical therapy, i.e. en bloc resection and extended lymphadenectomy, the overall long-term prognosis of patients with esophageal carcinoma has not, however, improved during the last decades. One of the major reasons in its relatively high recurrence rate. MATERIAL AND METHOD: A retrospective review of recurrent patterns of cancer in 42 patients who underwent curative surgery for primary esophageal cancer was performed clinically and histo-phthologically. RESULT: Nineteen patients had developed recurrece during the 18 to 52 months(mean 34.2 nonths), 8 had local recurrences, 1 had both, and 11 had systemic recurrences. Twelve patients(63%) had developed recurrence within 1 year, 5 patients(26%) between 1 year to 2 patients(11%) after 2 years. The recurrence rate according to growth pattern of tumor or presence of microinvasive findings was not statistically significant, but it increased significantly in clinical tumor stage III than stage IIA, B and in patients with the number of metastatic lymph node over ten. CONCLUSION: Post-operative recurrences of esophageal cancer appear as a high rate even though curative wide resection was done. Several clinical and histo-pathological factors correlate with the recurrence.

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.

Partial Anormalous Pulmonary Venous Return with Scimitar Sign / 대한흉부외과학회지

We experienced a case of partial anomalous pulmonary venous return from righ lung to inferior vena cava, which combined with Scimitar sign in 18 years old female patient. Diagnostic procedures were simple chest x-ray chest CT, and cardiac catheterization. We redirected the anomalous venous flow from inferior vena cava to left atrium through the intracardiac tunnel which was made with autologous pericardium. Postoperative course was not eventful.

Williams Syndrome with Megacoronary Artery

Supravalvular aortic stenosis is a rare cause of left ventricular outflow obstruction in adults. It occurs as an isolated defect sporadically or as a hereditary basis with an autosomal dominant trait without further phenotypical anomalies, or as a part of the Williams syndrome with mental retardation and multiple anomalies. In this report, we present a case of williams syndome associated with megacoronary artery.

A Case of Cardiac Lymphoma Developed in Right Atrium / 대한흉부외과학회지

Primary cardiac lymphoma is an uncommon malignancy, accounting for 1.3% of primary cardiac tumors and 0.5% of extranodal lymphomas. However, secondary involvement of the heart is seen in 8.7-27.2% of the documented clinical cases of lymphoma. A 66-year-old man was referred to us for evaluation of dyspnea. A tumor mass was detected by transthoracic and transesophageal echocardiogram in the right atrium. The tumor was surgically resected. The pathologic diagnosis was a malignant lymphoma(diffuse large B cell type) had associated with intracavitary involvement of the right atrium. But acute mediastinitis was developed and then the patient was expired due to sepsis and bleeding at postoperative 9 days.

Malignant Mesothelioma with Hypoglycemia: A Case Report / 대한흉부외과학회지

Pleural mesothelioma is a rare neoplasm originating from pleural mesothelial cell. Hypoglycemia associated with tumor is knowen to be a rare consequence of non-islet cell tumors. A patient having severe, episodic hypoglycemia was found to have a large mass occupying the left hemithorax. The hypoglycemia was resolved immediately after the surgical removal of the tumor. Histologic examination of the tumor revealed localized fibrous mesothelioma.

Congenital Cystic Adenomatoid Malformation Associated with Extralobar Pulmonary Sequestration: A case report / 대한흉부외과학회지

Congenital cystic adenomatoid malformation and Extralobar Pulmonary sequestration are very rare congenital anomalies. We experienced a 4 year-old female patient who had Congenital cystic adenomatoid malformation in her lower lobe of left lung. We accidently found extralobar pulmonary sequestration associated with Congenital cystic adenomatoid malformation at operation field. The resection of the left lower lobe and the extralobar pulmonary sequestration were performed. The arterial supply of the extralobar pulmonary sequestration was one anomalous artery arised from the thoracic aorta. The Venous drainage of expralobar pulmonary sequestration was intercostal vein into the azygous vein. The patient was discharged without any problem.

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.

Two Cases of Traumatic Aortic Dissection Diagnosed Early by Transesophageal Echocardiography in the Emergency Department

Traumatic dissection of the aorta is a fatal injury that requires rapid diagnosis and treatment. In assessing acute thoracic aortic injury, transesophageal echocardiography (TEE) has recently compared favorably with standard diagnostic modalities such as computed tomography, magnetic resonance imaging and aortography. These latter include time-consuming, contrast injection and the transportation of the patient to another area, requiring the interruption of resuscitative efforts. But, TEE includes less invasive nature, shorter procedure time, no contrast injection, portability at bedside, ability to be done concurrently other procedures such as resuscitation or hemodynamic monitoring and has high sensitivity and specificity for the evaluation of trauma patients with suspected injuries of the thoracic aorta. TEE may be suggested as primary diagnostic modality in suspected traumatic aortic injury in emergency department. We report two cases of traumatic aortic dissection diagnosed early by transesophageal echocardiography in the emergency department.

Surgical Experience of Pulmonary Vascular Tumor: 2 cases / 대한흉부외과학회지

Tumors of vascular origin are subdivided into two groups: those composed of pericytes (hemangiopericytoma and glomus tumor), and those composed of endothelial cells(hemangioendothelioma). They are uncommon, potentially malignant tumors, and in the lung, the tumors may present as a small asymptomatic nodule or a large symptomatic lesion. Recently we experienced two cases of solitary pulmonary vascular tumors(epithelioid hemangioendothelioma and hemangiopericytoma), and reviewed them with references