Efficacy of Positron Emission Tomography in Diagnosing Pulmonary Tumor and Staging of Lung Cancer: Comparing to Computed Tomography / 대한흉부외과학회지

BACKGROUND: Diagnosing and determining the stage of lung cancer by means of positron emission tomography (PET) has been proven valuable because of the limitations of diagnosis by computed tomography (CT). We compared the efficacy of PET with that of CT in diagnosing pulmonary tumor and staging of lung cancer. MATERIAL AND METHOD: We performed F-18 FDG PET to determine the malignancy and the staging on patients who have been suspicious or were diagnosed as lung cancer by chest X-ray and CT. The findings of PET and of CT of 41 patients (male, 29; female, 12; mean age, 59) were compared with pathologic findings obtained from a mediastinoscopy and thoracotomy. RESULT: Out of 41 patients, 35 patients had malignant lesions (squamous cell carcinoma 19 cases, adenocarcinoma 14 cases, adenosquamous cell carcinoma 2 cases) and 6 patients had benign lesions. Diagnosing of lung cancer, the sensitivity, specificity and accuracy of CT and PET were the same for two method and the numbers were 100 %, 50 %, and 92.7 % respectively. Eighteen LN groups out of 108 mediastinal LN groups who recieved histologic examination proved to be malignant. Pathologic lymph node (LN) stage was N0-N1 31 cases, N2 8 cases, N3 2 cases. The correct identification of the nodal staging with CT, PET scans were 31 cases (75.6%), 28 cases (68.3%) respectively. The LN group was underestimated in each 6 cases of CT and PET. In 4 cases of CT and 7 cases of PET, they were overestimated in compare to histologic diagnosis. In the detection of mediastinal LN groups invasion, the sensitivity, specificity and accuracy of CT were 39.8 %, 93.3 %, and 84.3 % respectively. For PET, they were 61.1 %, 90.0 %, and 85.2 %. When two methods considered together (CT+PET), they were increased to 77.8 %, 93.3 %, and 90.7 % respectively. Conclusion:PET appears to be similar to CT in the diagnosis and the nodal taging of pulmonary tumor. Two tests may stage patients with lung cancer more accurately than CT alone.

A Case of the Pneumopericardium Following Blunt Chest Trauma / 대한흉부외과학회지

The pneumopericardium following blunt chest trauma is exceedingly unusual. A patient was admitted to the emergency room after a motorcycle accident. Pneumopericardium and left pneumothorax were not detected on initial chest AP, but they were detected on chest computed tomograpy and resolved completely after chest tube insertion into the left pleural space.

Surgical Management of Giant Aneurysm of Intracranial Artery Under Circulatory Arrest: one case report / 대한흉부외과학회지

Complete circulatory arrest with profound hypothermia has been an indispensable adjunct to the safe management of selected giant intracranial aneurysms. For the conduct of cardiopulmonary bypass, there are usually two kinds of methods, open and closed chest methods. We could manage one case of huge intracranial aneurysm that was successfully operated under circulatory arrest using the closed chest method, especially with percutaneous insertion of arterial and venous cannulas for cardiopulmonary bypass.

The Sympathetic Skin Responses after Thoracic Sympathicotomy for Patients with Palmar Hyperhidrosis / 대한흉부외과학회지

BACKGROUND: Thoracic sympathicotomy has been used safely and successfully to manage palmar hyperhidrosis. The preoperative and postoperative recording of Sympathetic Skin Responses(SSR) was performed for objective evaluation and follow-up of thoracic sympathicotomy in hyperhidrosis patients, and also for ascertaining the clinical usefullness of SSR. MATERIAL AND METHOD: The recording of SSR was performed on 15 patients suffering from palmar hyperhidrosis with Medelec Sapphire Plus electromyogragh before and after thoracic sympathicotomy. Eletrical stimuli on the right median nerve was made in patients in supine position and results were recorded on right and left palms with soles at the same time by 4 channels. Skin temperatures were also monitored simultaneously. T2,3 sympathicotomy was performed with VATS in every patients. SSR was done in 2 patients one month later. RESULT: Clinically, all patients had symptomatic improvement with satisfaction. Postoperative complication was small amount of residual pneumothorax in 5 patients but it was absorbed sponteneously. There was no recurrence during follow-up period and ten patients(66%) complained compensatory hyperhidrosis. After operation, SSR change was shown in every 15 patients. Abolition of SSR on both palms was achieved in 12 patients(80%) and on both soles in 6 patients. In the other 3 patients, the latencies were significantly delayed and the amplitudes were significantly reduced at both palms and soles. In two patients who were examined at one month later after operation, similar results with postoperative SSRs were shown. The skin temperature on preoperative both palm and sole were lower than normal temperature, and those on postoperative both palm and sole were increased. Those had statistical significance(p<0.05), and the temperature on the palm was increased higher that than on the sole. CONCLUSION: After thoracic sympathicotomy was performed on palmar hyperhidrosis patients, an increment of skin temperatures and SSR changes were achieved at both palms and soles of all patients. Palmar SSRs were completely abolished in 12 patients(80%), and similar results of postoperative SSRs were achieved. The recording of SSR may be useful to easily and objectively assess the completeness of sympathicotomy and the follow-up of recurrence in hyperhidrosis patients.

Cardiac Metastasis of Malignant Melanoma: A Case Report / 대한흉부외과학회지

We report a case of a resection of very large intracavitary metastatic malanoma causing obstruction of the right ventricular inflow and outflow tract of the heart. A 49-year-old woman with dyspnea and generalized edema was seen. Echocardiography reveal an intra cavitary mass occupying the entire right ventricle and pericardial effusion. The lesion was palliatively resected using a cardiopulmonary bypass and was confirmed as a malignant melanoma. The patient is alive and improved symptomatically 30days after the operation.

Clinical Result of the Patent Ductus Arteriosus in the Premature Infants / 대한흉부외과학회지

BACKGROUND: This study is to suggest the optimal method as a treatment for the patent ductus arteriosus in the premature infants. MATERIAL AND METHOD: Between April 1994 and April 1997, 45 premature infants with evidence of a hemodynamically significant patent ductus arteriosus associated with cardiopulmonary compromise underwent indomethacin therapy, surgical treatment, or both. Thirty-nine infants received indomethacin and twelve infants among them were surgically ligated because of indomethacin failure(5) or complications(7). Six infants, who weighed less than 1,500 gm at birth, were referred for primary surgical ligation because of contraindication to indomethacin therapy. RESULT: The failure rate of indomethacin therapy was 43%(17/39) and the complications(13/39, 33%) to the indomethacin were associated with a high morbidity and mortality. Among the infants who underwent ligation, there were no failures and complications related to the operation. This data suggests that in the premature neonate with a hemodynamically significant PDA, (1) indomethacin therapy is associated with a high failure rate and significant complications, (2) surgical duct closure is associated with minimal morbidity. CONCLUSION: Although the results of this study cannot suggest the optimal management for PDA in premature infants, primary surgical ligation may be considered. However, long-term studies will be needed to confirm this later.

Changes of Plasma Creatinine Kinase-BB after Total Circulatory Arrest / 대한흉부외과학회지

BACKGROUND: Although profound hypothermia with total circulatory arrest (TCA) is a valuable maneuver in cardiac surgery, its applications have been limited due to serious complications, especially cerebral damage. In this study, the possible role of creatinine kinase-BB (CK-BB), an index enzyme of ischemic cerebral damage, was assayed as a parameter for the assessment of the cerebral complications after TCA. Hemoglobin (Hb), ionized calcium (Ca++), and blood glucose levels were also assessed as clinical parameters involved in cerebral damage. MATERIALS AND METHODS: Among patients with congenital heart disease, 18 patients who had been operated on with TCA were randomly selected and divided into two groups: 6 with acyanotic and 12 with cyanotic heart disease. Arterial blood from each patient was collected before and after TCA at scheduled times (15 min., 30 min, 1, 2, 4, 8, and 12hr). The levels of CK-BB, Hb, Ca++, and blood glucose were assessed in each sample. RESULTS: As a whole, correlation between CK-BB level and blood sampling time after TCA was not statistically significant. Also, the difference in the level of CK-BB after TCA was not significant between the acyanotic and cyanotic groups. The levels of Hb and CK-BB correlated significantly. CONCLUSIONS: The results, which showed no correlation between the alterations in CK-BB level and the TCA duration, suggest that the single assay of the CK-BB level is not a representative measurement for the assessment of cerebral damage after TCA. Also, the cyanotic congenital heart disease group is not more vulnerable to cerebral damage induced by TCA.

Malignant Thrombi of Inferior Vena Cava from Renal Cell Carcinoma: 4 cases reports / 대한흉부외과학회지

Renal cell carcinoma involves the inferior vena cava (IVC) in approximately 5-10% of the patients. Presently surgical extirpation is the only form of therapy that can result in cure. Circulatory arrest with cardiopulmonary bypass is an operative technique that recently has been used to assist in resection of tumors that extend into the vena cava above the level of hepatic veins. We performed removal of tumor thrombi of IVC in 4 patients. All of them who had the renal cell carcinormas with infrahepatic vena caval extension were performed by standard surgical technique without cardiopulmonary bypass. But in one patient, inferior vena caval thrombectomy was done using circulatory arrest because of the recurred extension of the tumor thrombi within the vena cava above the insertion of the hepatic vein. All patients were recovered without any significant problems.

Teratoma of the Pleura: A Case Report / 대한흉부외과학회지

Intrathoracic teratoma is mainly found on the anterior mediastinum. For teratoma of the pleura, one case was described. We have presented what we believe to be the first report of a teraroma of the pleura, which was mainly composed of neuroglial cells and was accompanied with lymph node metastasis.

Coronary Revascularization without Extracorporeal Circulation: Two Case Reports / 대한흉부외과학회지

We have experienced two cases of coronary revascularization without extracorporeal circulation in a 63 year old female patient and a 75 year old male patient. The first patient had the lesion which was the nearly total occulusion of mid-LAD, about 90% luminal narrowing of second diagonal branch and less than 50% stenosis of proximal RCA. The other male patient had a single vessel disease involving about 95% stenosis of proximal LAD and 1st diagonal branch. PTCA failed in the first patient because of relatively long sinus pause during procedure. In both of the patients, the coronary revascularizations were done at distal LAD and diagonal branch using left internal mammary artery and saphenous vein graft under the beating state, respectively. The postoperative courses were uneventful and the patients were discharged without any complications.