Thoracicl Actinomycosis Associated with Broncholithiasis: Report on 2 cases / 대한흉부외과학회지

We report here on two cases of a 48-year old woman and a 46-year-old man who both presented with broncholithiasis and obstructive pneumonitis. Removal of the broncholithiasis failed with bronchofibroscopy, and so right middle lobectomy of the lung were done in the 2 patients. The histopathologic diagnosis was thoracic actinomycosis associated with broncholithiasis. Thoracic actinomycosis associated with broncholithiasis is a very rare condition, so we report here on these two cases of thoracic actinomycosis associated with broncholithiasis.

Mediastinal Bronchogenic Cyst Misdiagnosed as Asthma and Dysphagia in a Child: One Case Report

A 19-month-old boy suffered from stridor and dysphagia. He was taking asthma medication for a few months, but symptoms did not improve. After admission, a chest CT showed a posterior mediastinal mass, which compressed the trachea and esophagus. The removed mass via open thoracotomy was a bronchogenic cyst on histopathology. Postoperatively, stridor and dysphagia disappeared. In case of persistent and refractory stridor or dysphagia in children, congenital lesions including bronchogenic cyst need to be ruled out.

A Case of Infantile Lobar Emphysema

An 1-month old female newborn was admitted to our hospital because of jaundice which occurred at 2 days after birth. Plain chest X-ray and chest CT revealed a collapsed right middle lobe and lobar emphysema was suspected. Right upper lobectomy of the lung was done and pathologic findings showed an infantile lobar emphysema. After the operation, the newborn was discharged without complication and was followed up through the out patient clinic. Infantile lobar emphysema is rare and male dominant. Left upper lobe of the lung is the most prevalent site. Patients with infantile lobar emphysema complain of respiratory symptoms. We report one case of infantile lobar emphysema on right upper lobe of lung, in a female with no respiratory symptoms.

Thrombectomy of Superior Mesenteric Artery Occlusion: A case report / 대한흉부외과학회지

A 50-year old man was admitted to our hospital because he complained of sudden abdominal pain. Multidetector abdominal CT showed proximal occlusion of the superior mesenteric artery. Emergency open laparotomy and Fogarty thrombectomy were done on admission day and repeat Fogarty thrombectomy and partial resection of the small bowel were done the next day. We report here on a case of superior mesenteric artery occlusion.

Treatment of Pectus Carinatum with a Compressive Brace / 대한흉부외과학회지

BACKGROUND: Patients suffering with pectus carinatum complain of cosmetic problems when they stand and this in spite of wearing cloths. The standard surgical treatment of pectus carinatum is resection of the deformed cartilages, but the wide operative scar, post-operative pain and complications related with such an operation can occur. Therefore, we have performed compressive brace therapy as a non-operative treatment for pectus carinatum and we observed the effects and the efficiency of this treatment. MATERIAL AND METHOD: From January, 2001 to December, 2006, 109 patients wore the compressive brace for all day. The degree of satisfaction was evaluated after 6~9 months of wearing the compressive brace. The degree of satisfaction was evaluated by a score of from 1~4. A score of 1 was assigned when the status was worse, 2 when it was the same, 3 when there was partial improvement and 4 when remarkable improvement was observed. The degree of satisfaction was assessed subjectively by the parent if the patient was a child younger than middle school age, and the patients older than middle school age assessed the score themselves. RESULT: The mean score of the overall degree of satisfaction was 3.93+/-0.33. Recurrence of pectus carinatum after removal of compressive brace occurred in 6 patients (5.5%) of the total 109 patients. But 4 patients of the total 6 recurred patients stopped wearing of compressive brace against our advice. The 6 recurred patients were re-corrected by re-wearing the compressive brace within 3 months after they originally removed the compressive brace. The complications were discomfort with initially wearing the compressive brace, which occurred in all patients, skin rash due to the compressive brace for 76 patients (69.7%) and skin discolorization with excessive compression for 16 patients (5.5%). The skin rash and discolorization returned to normal within a few months after removal of the compressive brace. CONCLUSION: This study demonstrated that non-surgical treatment with using the compressive brace for patients with pectus carinatum was effective, and especially for children and teenagers. Non-surgical treatment with using a compressive brace would be helpful for the patients suffering with pectus carinatum and who dislike surgical operations because of their fear about general anesthesia and operation-related complications. Yet long-term follow up is necessary to accurately evaluate the effectiveness of this compressive brace and the recurrences after removal of the compressive brace.

Tricuspid Valve Repair for Tricuspid Valve Insufficiency Following a Cardiac Stab Injury / 대한흉부외과학회지

A 51-year-old male was admitted three month previously with a cardiac stab injury and he underwent direct cardiac repair. He had no problem after this event. He complained of dyspnea that started 2 months after the original injury. Echocardiography showed severe tricuspid regurgitation and so, chordac replacement and ring annuloplasty was performed. Herein we report on a case of tricuspid valve repair for treating tricuspid insufficiency following a cardiac stab injury.

Pulmonary Inflammatory Myofibroblastic Tumor with Bronchus Invasion: One case report / 대한흉부외과학회지

A 34-year old man was admitted our hospital because he wished to evaluate the pulmonary mass that was incidentally detected on healthy examination. Bronchoscopy and chest CT showed endobronchial and peribronchial mass of the left lower lobe of the lung. Open thoracotomy and left lower lobectomy of the lung was done. Pulmonary mass was confirmed as a pulmonary inflammatory myofibroblastic tumor with bronchus invasion pathologically. Pulmonary inflammatory myofibroblastic tumor with bronchus invasion is a vary rare. Herein we report a case of pulmonary inflammatory myofibroblastic tumor with bronchus invasion.

The Effects of Diluted Fibrin Glue about Continuous Air Leakage after Lung Surgery / 대한흉부외과학회지

BACKGROUNG: Continuous air leakage through chest tube after lung surgery may increase pt's hospital stay and lead to many complications including empyema etc. Chemical pleurodesis has frequently been used for prevention of air leakage. Therefore, we performed chemical pleurodesis using diluted fibrin glue in patients with continuous air leakage and observed the effects and efficiency of treatment. MATERIAL AND METHOD: From September, 2001 to August, 2005, 16 patients whose continuous air leakage lasted more than 7 days underwent chemical pleurodesis with diluted fibrin glue. The effects of treatment, complications and recurrences were reviewed. Dissolved fibrinogen 1.0 g and aprotinin 500,000 KIU were mixed in a 50 cc syringe (Mixed solution A). And dissolved thrombin 5,000 IU and Calcium chloride 600 mg were mixed in a 50 cc syringe (Mixed solution B). Cefazolin 1.0 g was mixed in a 50 cc syringe (Mixed solution C). Rubber tube was inserted between the chest tube and the collecting bottle. An inserted rubber tube was positioned 60cm above the patient and forming a loop appearance was done. Mixed solutions A, B and C were injected into the highest rubber tube. RESULTS Continuous air leakages disappeared in all 16 patients at next day. Chest tubes were removed after 3 days in all patients. Complications were chest pain in 12 patients (75%), leukocytosis in 14 patients (88%), fever and chill in 14 patients (88%). All complicaitons were transient and disappeared without specific treatment. CONCLUSION: Our findings demonstrated that diluted fibrin glue chemical pleurodesis was effective in patients with continuous air leakage lasting more than 7 days. Diluted fibrin glue chemical pleurodesis had good results with acceptable complications. Long term follow-up is necessary to evaluate the accurate effects of treatment and recurrence in a large number of patients.

Endobronchial Leiomyoma Combined with Pulmonary Sequestration: A case report / 대한흉부외과학회지

A 42-year-old female was admitted to our hospital complaining of a dyspnea. Chest X-ray showed left atelectasis. A mass was detected in left main bronchus by computed tomography and bronchoscopy. The mass was diagnosed as a endobronchial leiomyoma by biopsy exam. After open thoracotomy and bronchotomy, mass removal was done and middle lobe was ventilated normally. Aberrant arterial supply from descending aorta to left lower lobe of the lung was detected and left lower lobectomy was done. The lower lobe of the left lung was pathologically diagnosed as intralobar pulmonary sequestration. Herein we report a rare coexistent case of endobronchial leiomyoma and intralobar pulmonary sequestration.

Middle Lobe Syndrome Caused by Occult Foreign Body in the Bronchus Intermedius: A case report / 대한흉부외과학회지

Occult bronchial foreign body is that long-standing foreign body lodge in bronchial tree. A 63-year-old male was admitted our hospital complaining of a cough. Chest computerized tomography and bronchoscopy showed collapse of right middle lobe and foreign body in the bronchus intermedius. After open thoracotomy and bronchotomy, foreign body was removed and collapsed middle lobe was ventilated. Herein we report a case of middle lobe syndrome caused by occult foreign body in the bronchus intermedius.

Tracheal Compression by Esophageal Mucocele after Surgical Exclusion of the Esophagus: One case report / 대한흉부외과학회지

A 43-year-old male was admitted to our hospital complaining of dyspnea and wheezing sound at respiration. He had received esophageal exclusion and esophagogastrostomy due to spontanous esophageal rupture 1-year ago. Chest computed tomography revealed esophageal mucocele like that of mediastinal tumor. Trachea is compressed by esophageal mucocele. The operation was performed by resection of thoracic esophagus through right open thoracotomy. Herein we report a case of a tracheal compression by esophageal mucocele after surgical exclusion of the esophagus.

Short-Term Result of Endovenous 980-nm Diode Laser Treatment in Varicose Vein of Lower Extremities / 대한흉부외과학회지

BACKGROUND: Recently 980-nm diode laser endovenous treatment was introduced and used as a method of treatment for varicose vein in lower extremities. The advantages of endovenous laser treatment are good cosmetic effects without incision and avoidance of complications associated with surgery. Therefore, we performed an endovenous laser treatment using a 980-nm diode laser and observed the effects and the efficiency of treatment. MATERIAL AND METHOD: From October, 2003 to March, 2004, 56 patients (84 limbs) underwent endovenous laser treatment with a 980-nm diode laser. The effects of treatment, complications and recurrences were reviewed. RESULT: The mean age of patients was 47.2 years old and the number of men and women were 21 and 35. In a total of 84 limbs, postoperative complications were transient ecchymosis(84 cases), local paresthesia (24 cases), local skin discolorization (6 cases), minimal burn (3 cases), and post operative phlebitis (1 cases). Adjuvant sclerotherapy was performed in 27 limbs and it was performed in varicose veins missed at operation and varicose veins remaining after endovenous laser treatment. In a total of 56 patients, 2 patients (3.57%) had recurrences after endovenous laser treatment and were treated with phlebectomy. CONCLUSION: Our findings demonstrated that 980-nm endovenous laser treatment had good cosmetic results with acceptable complications. This study was based on short-term results and long term follow-up is necessary to evaluate the accurate effects of treatment and recurrence. We think that multimodality treatment with endovenous laser treatment including phlebectomy or transilluminated powered phlebectomy can help decreasing of recurrence especially in patients with tortuous varicose cluster.

Synovial Sarcoma of the Parietal Pleura: One case report / 대한흉부외과학회지

A 34-year-old male was admitted to our hospital complaining of chest pain. Chest computerized tomography showed pleural effusion and mass in left lower area. After open thoracotomy and mass removal originating from the parietal pleura were done. The mass was pathologically diagnosed as poorly differentiated synovial sarcoma. Synovial sarcoma of the pleura is rare. Herein we report a case of synovial sarcoma of the parietal pleura.

A Case of Congenital Diaphragmatic Eventration Requiring Emergency Operation

A one day old female infant was brought to the emergency room suffering from shortness of breath. An x-ray revealed the gastrointestinal tract in the right thoracic cavity. An emergency operation demonstrated eventration of the diaphragm, and a plication was performed. The baby was discharged without complication and has been followed up in the out patient clinic. Congenital diaphragmatic eventuation requiring emergency operation is rare.

Transilluminated Powered Phlebectomy Using Arthroscopic Equipment in Varicose Vein of Lower Extremities / 대한흉부외과학회지

BACKGROUND: Recently transilluminated powered phlebectomy was introduced and used as a method of surgical treatment for varicose vein in lower extremities. The advantages of transilluminated powered phlebectomy are minimal scar and good cosmetic effect. However, the disadvantages of transilluminated powered phlebectomy is that a high priced Trivex system must be used which increases the patient's expenses. Therefore, we performed a transilluminated powered phlebectomy using an existing arthroscopic equipment instead of Trivex system and observed the effect of treatment and efficiency of the treatment. MATERIAL AND METHOD: From March, 2000 to February, 2003, 78 patients (113 limbs) underwent transilluminated powered phlebectomy with an arthroscopic equipment. Patient's disease history, the number of operative scars and complications were reviewed. RESULT: The operation was performed in 133 limbs of the 78 patients (34 men, 44 women) and the age of patients were ranged from 16 to 72 years with mean age of 41.8 years. Operative time ranged from 20 to 65 minutes (average 48.7 minutes) per limb. The number of operative scar per limb from 2 to 7 (average 4.9). Postoperative complications are transient ecchymosis (78 cases) that disappeared spontaneously, edema persisting longer than 3 weeks (6 cases), remnant varicose vein (4 cases), skin perforation during operative procedure (2 cases), and contact dermatitis due to compression stocking (4 cases) The mean hospitalization day was 3.09 days. Subjective mean satisfaction degree of operation by the patients using a visual analogue scale was 92.6%. CONCLUSION: Our findings demonstrated that transilluminated powered phlebectomy using arthroscopic equipment was posssible and had good cosmetic results with acceptable complications.

The Effect of Benztropine in Gustatory Hyperhidrosis: Two case report / 대한흉부외과학회지

Two patients with gustatory hyperhidrosis complaining of discomfort during usual activities were relieved of sweating by using anticholinergic benztropine. Herein, we report two cases of gustatory hyperhidrosis treated with benztropine.

Loculated Empyema with Sternocostoclavicular Osteomyelitis and Neck Abscess: One case report / 대한흉부외과학회지

A 65-year-old male was admitted to our hospital complaining of painful swelling of right sternocostoclavicular area. In the past history, he had no specific disease including trauma. After admission, chest CT and neck CT showed right empyema and right cervical abscess. Empyemectomy was performed through open thoracotomy and fistulous tract was detected on right parietal pleura and right sternocostoclavicular area. Ostomyelitis was also detected on right sternocostoclavicular area and removal of right cervical abscess, partial resection of proximal clavicle, resection of chondral portion of 1st rib, and partial resection of manubrium were performed. Empyema that extends from sternocostoclavicular osteomyelits, as in this case, is rare. Herein we report a case of loculated empyema with sternocostoclavicular osteomyelitis and neck abscess.

Extended Extraanatomic Bypass: Subclavian Artery-Popliteo-Crossover-Femoral-PEFE-Bypass: One case report / 대한흉부외과학회지

A 62-year-old male was admitted to our hospital complaining of coldness in both legs and discolorization in the right toes. On angiogram, obstruction of right external iliac artery and left common iliac artery was shown. The patient underwent extended extraanatomic arterial reconstruction due to poor general conditions. From right subclavian artery to right popliteal artery, artery bypass was done with 8 mm PTFE and 6 mm PTFE. Suprapubic crossover bypass was done with another 8 mm PTFE from 8 mm PTFE in right inguinal area that was anastomosed with right subclavian artery and left common femoral artery. The patient was discharged from hospital and OPD follow up was done. Right leg pain and discolorization of entire toes disappeared and were normalized. We report a case of extended extraanatomic arterial reconstruction: subclavian artery-popliteo-crossover-femoral-PEFE-bypass.

Anterior Tracheoplasty Using Glutaraldehyde-Soaked Autologous Pericardium: One Case Report / 대한흉부외과학회지

A 60-year-old female was admitted to our hospital complaining of dyspnea.In the past history,she had received tracheal diversion due to recurrent aspiration after brain surgery and tracheostomy.Emergency three dimensional spiral tracheal computed tomograhpy revealed distal tracheal stenosis.The operation was performed by anterior tracheoplasty using glutaraldehyde-soaked autologous pericardium through median sternotomy.Herein we report a case of anterior tracheoplasty using glutaraldehyde-soaked autologous pericardium.

A Study of Preservation of Spinal Cord in Spinal Cord Ischemia of the Rabbit Comparison of Aprotinin and Pentoxifylline

PURPOSE: The complications of ischemic spinal cord injury on the descending and thoracoabdominal aorta remain a problem in spite of surgery and anesthesia advance. The protective effects of aprotinin and pentoxifylline was assessed from a rabbit spinal cord ischemia model in order to prevent ischemia reperfusion injury from the spinal cord. METHOD: In 36 rabbits, left vertical flank incision and retroperitoenal approach were done and ischemia was induced with clamping of the aorta just distal to left renal artery and proximal to aortic bifurcation for 20 min. In Group A, Aprotinin was given 30,000 KIU/kg was given as a intravenous injection after anesthesia, and was followed by 10,000 KIU/hr by continuous infusion in group A (n=12). Also in group B, Pentoxifylline 40mg/kg was given as a intravenous injection after anesthesia, and was followed by 30 mg/hr by continuous infusion in group B (n=12). Similar volume of saline solution was used in control group C (n=12). Physiological parameters were monitored in animals before aortic occlusion, during aortic occlusion, after aortic occlusion. Their neurological outcome was clinically evaluated up to 48 hour postischemia. After 48 hour of the operation, all rabbits' victim were induced and their spinal cord, abdominal aorta, and its branches were processed for histopathological examination. RESULT: Mean aortic pressure, heart rate and arterial blood gas analysis showed no statistical difference in 3 groups. Bladder function also revealed no statistical difference. The average motor function score was significantly higher in aprotinin group (group A) than control group (group C) at 24 (P=0.026) and 48 hour (P=0.018) after the ischemic insult. But the average motor function score was similar in pentoxifylline group (group B) and control group (group C) at 24 and 48 hour after the ischemic insult. Histological observations were revealed fewer ischemic damage in aprotinin group (group A) than control group (group C) but in pentoxifylline group (group B) and control group (group C), ischemic damages were more than moderate degree. CONCLUSION: The results suggest that aprotininreduces spinal cord injury and preserves neurologic function in transient spinal cord ischemia of rabbits but pentoxifylline is not effective.