The 10 Years Experience of Lung Transplantation / 대한흉부외과학회지

BACKGROUND: Lung transplantation is a definitive therapy for a variety of end stage lung diseases. Since 1996, we have performed thirteen cases of lung transplantation including two retransplantations, and we analyzed the outcomes, complications, and survivals of these patients. MATERIAL AND METHOD: We retrospectively analyzed the medical records of thirteen cases from July, 1996 to July, 2005. RESULT: During the period, 11 patients had undergone 13 lung and heart-lung transplantations, and two patients had retransplantation due to allograft failure. Mean age of recipients were 45.2+/-10.7 years (range, 25~59). Early complications were bleeding, reperfusion injury, and infection and late complications were mainly infection and post-transplantation lymphoproliferative disease. Excluding the operative mortality, the mean survival period was 16.5 months (2~60 months). Two retransplantations had been performed 2 weeks and 13 months after single lung transplantations. CONCLUSION: In order to achieve long term survival, early detection of complications and proper treatment in addition to surgical skills are necessary, and these efforts can promote better lung transplantation programs in the near future.

Contralateral Single Lung Re-transplantation in the Patient with Lymphangioleiomyomatosis due to Graft Failure / 대한흉부외과학회지

Lymphangioleiomyomatosis (LAM) is a rare disease in women of childbearing ages that eventually leads to respiratory failure. Lung transplantation is the only conclusive therapeutic modality in end-stage LAM. While single-lung transplantation is the preferred operation, the graft failure or recurrence of LAM was reported. We performed a single lung transplantation on a 36-year-old woman suffering from respiratory failure due to lymphangioleiomyomatosis. After a 1-year follow up, the patient was readmitted because of graft failure with collapsed transplanted lung. The lung volume reduction surgery (LVRS), tracheostomy and ventilator care were performed. However, neither the medical nor surgical treatment had any effect. Subsequently, we performed a contralateral single lung re-transplantation and had a good postoperative results.

Successful Bilateral Lung Retransplantation in a Patient with Primary Graft Failure Following a Single Lung Transplantation / 대한흉부외과학회지

Lung transplantation is the choice of treatment for selected patients with end-stage pulmonary disease. However, retransplantation of the lung due to primary graft failure carries a high risk of morbidity and mortality. This is a case of a 52 year old male with emphysema who continuously needed a ventilator care and a tracheostomy. He underwent a left single lung transplantation but were not able to wean from the ventilator due to primary graft failure, and therefore we decided to do a retransplantation. Bilateral sequential single lung transplantation was performed under the cardiopulmonary bypass. The patient recovered quite well and was discharged and fully active with his work. Retransplantation although it carries a high risk, is a very effective treatment in patients with primary graft failure.

The Surgical Outcome of Thoracic Outlet Syndrome / 대한흉부외과학회지

BACKGROUND: Thoracic outlet syndrome(TOS) is caused by the compression of neurovascular structures that supply to the upper extremities. Only a few reports have been published in Korea, and this study attempts to investigate the clinical aspects and results of the patients who underwent surgical treatment. MATERIAL AND METHOD: This study consist of 16 patients who underwent operations for thoracic outlet syndrome from May, 2002 to October, 2004. The surgical indications were confined to patients with: 1) symptoms too severe to perform ordinary daily life because of pain, paresthesia, edema of upper extremities, 2) no improvement after proper physical therapy, 3) definite findings of compression confined by radiologic examinations (MRI, angiography, etc), and 4) no other diseases such as cervical intervertebral herniation, myositis, neurologic diseases below the brachial plexus. The surgical approaches were by transaxillary approaches in 12 cases, supraclavicular approaches in 2 cases, and infraclavicular approaches in 2 cases. RESULT: There were 15 males and one female with an average age of 23.9 years (range: 19~39). Rib anomalies were observed in four cases (25.0%), but the others had no abnormal ribs. Right lesions were found in eight cases (50.0%), left lesions in five cases (31.3%), and bilateral lesions in three cases (18.7%). The follow-up period was 9~26 months and recurrence rate was 12.5% (2/16). Complications were one case of ulnar nerve palsy, one case of persistent pain despite radiologic improvement and three cases of wound dehiscence due to fat necrosis and hematoma. CONCLUSION: Although the choice of treatment in patients with TOS has been disputed, patients who have no response with proper physical therapies can benefit from the surgical treatment which may help patients to return to normal daily activity in shorter period of time.

Malignant Fibrous Histiocytoma of the Lung

Malignant fibrous histiocytoma (MFH) is a primitive sarcoma originating in the deep soft tissue and composed of fibrocytic and histiocytic cells in a storiform pattern. It is rare but the most common soft tissue sarcoma of adulthood. MFH occurred in various epithelial organs derived from the supportive mesenchymal elements. The lung represents an extremely rare primary site. We have experienced one case of MFH, arising in the lung parenchyme in 67 years old male patient with cough for 6 months. The patient was taken right upper lobe and right middle lobe lobectomy with good post-operative results. But another MFH was recurred in the left upper lobe 3 months after complete resection. So he had been treated with chemotherapy and radiofrequency ablation of tumor. Then he continued to be treated with chemotherapy

Surgical Treatment of Varicose Vein - TIPP(Transilluminated Powered Phlebectomy / 대한흉부외과학회지

The present study was done to determine the efficacy and safety of varicose vein removal using a minimally invasive, powered vein-extracting device with cutaneous transillumination and tumescent anesthesia techniques and then compared this to a retrospective group of conventional phlebectomy operations. There were 133 limbs in 104 patients(72 women, 32 men) treated with the use of the vein extractor aided by transcutaneous illumination. The hydrodissection was performed with TrivexTM Irrigated Illuminator(Smith and Nephew ) system using normal saline after the 2~3mm sized skin incision. Varicose clusters were extracted by the use of TrivexTM Resector(Smith and Nephew ) system under transillumination. After the varisoce vein extraction, the operation area was compressed with surgical pad for bleeding control. The complication rate was 3.84%. The mean number of incisions was 3.24 and mean operative time per limb was 65.9 minutes. The mean hospitalization was 1.86 days. The varicose vein extraction using transilluminated powered phlebectomy(TIPP) is a safe, efficacious and cosmetically satisfactory method. The procedure decreases the operating time and the number of incisions repuired to remove varicose clusters. Further evaluation and long term follow up will be necessary to determine the recurrence rate and long term complications.

Bilateral Sequential Single Lung Transplantation for Eisenmenger's Syndrome / 대한흉부외과학회지

Eisenmenger's syndrome is the disease of right to left shunt developing from the increased pulmonary vascular resistance caused by excessive pulmonary blood flow in patients with abnormal connections of systemic to pulmonary blood passage. The heart-lung transplantation was the only curative method in early transplantation period, but good results after bilateral lung transplantation have been reported as the fact that right heart function improved by only lung transplantation. We successfully carried out bilateral sequential single lung transplantation in a 34-year-old female patient with Eisenmenger's syndrome with large PDA. We report this case with a brief review of the literature.

Bilateral Sequential Single Lung Transplantation for Eisenmenger's Syndrome / 대한흉부외과학회지

Eisenmenger's syndrome is the disease of right to left shunt developing from the increased pulmonary vascular resistance caused by excessive pulmonary blood flow in patients with abnormal connections of systemic to pulmonary blood passage. The heart-lung transplantation was the only curative method in early transplantation period, but good results after bilateral lung transplantation have been reported as the fact that right heart function improved by only lung transplantation. We successfully carried out bilateral sequential single lung transplantation in a 34-year-old female patient with Eisenmenger's syndrome with large PDA. We report this case with a brief review of the literature.

Left Bronchoesophageal Fistula Misdiagnosed as Chronic Empyema Thoracis / 대한흉부외과학회지

Congenital bronchoesophageal fistula is a rare anomaly that may cause fatal complications if it goes unnoticed for many years. This anomaly may have various symptoms such as respiratory infections, coughing bouts when eating or drinking and even hemoptysis. Surgical resection is the treatment of choice and is definitive in almost cases. We report a case of type I congenital bronchoesophageal fistula misdiagnosed as chronic empyema thoracis with literature review.

Left Bronchoesophageal Fistula Misdiagnosed as Chronic Empyema Thoracis / 대한흉부외과학회지

Congenital bronchoesophageal fistula is a rare anomaly that may cause fatal complications if it goes unnoticed for many years. This anomaly may have various symptoms such as respiratory infections, coughing bouts when eating or drinking and even hemoptysis. Surgical resection is the treatment of choice and is definitive in almost cases. We report a case of type I congenital bronchoesophageal fistula misdiagnosed as chronic empyema thoracis with literature review.

Surgical Treatment of Multiple Lung Abscesses with Adenoid Cystic Carcinoma / 대한흉부외과학회지

Adenoid cystic carcinoma is a very slowly growing and directly invasive cancer. The treatment of choice is complete surgical resection but if major complications associated with remaining carcinoma occur, aggressive conservative treatment to prevent complication is able to gain long term survival even though remaining carcinoma metastases to other organs. We experienced a case of surgical treatment of uncontrollable fever that caused by multiple lung abscesses due to obstruction of left main bronchus with adenoid cystic carcinoma. The post operative course was uneventful for 4 months to now.

Surgical Treatment of Multiple Lung Abscesses with Adenoid Cystic Carcinoma / 대한흉부외과학회지

Adenoid cystic carcinoma is a very slowly growing and directly invasive cancer. The treatment of choice is complete surgical resection but if major complications associated with remaining carcinoma occur, aggressive conservative treatment to prevent complication is able to gain long term survival even though remaining carcinoma metastases to other organs. We experienced a case of surgical treatment of uncontrollable fever that caused by multiple lung abscesses due to obstruction of left main bronchus with adenoid cystic carcinoma. The post operative course was uneventful for 4 months to now.

Treatment of Vasodilatory Shock after Cardiac Surgery:Low Dose Arginine Vasopressin Therapy: Three cases report / 대한흉부외과학회지

The vasodilatory shock after cardiopulmonary bypass is defined as the condition involving severe and persistent form of hypotension, tachycardia, normal or increased cardiac output and decreased systemic vascular resistance. Because of the unsuccessful response to infusion of fluids or catecholamine vasopressors, a sustained systemic shock state occurs and results in a high morbidity and mortality. We successfully treated this syndrome of 3 patients after open heart surgery with low dose of arginine vasopressin(AVP). Therefore,we report these cases with a review of related articles.

Cardiac Rupture Combined with Massive Right Hemothorax by Blunt Chest Trauma: A report of two cases / 대한흉부외과학회지

Patients with cardiac rupture due to blunt trauma have more than 50% mortality rate and most of them expire before they arrive at the hospital emergency room. Since patients typically present with cardiac tamponade, the diagnosis can be easily confirmed with physical examination, echocardiography, and chest CT scan. However, in our case of the massive hemothorax on right side without evidence of cardiac tamponade, the diagnosis for cardiac rupture does not seems to be easy. Therefore, we must assume the probability of cardiac rupture if we plan an explo-thoracotomy in a patients with massive right hemothorax without rib fracture. We describe two cases of cardiac rupture combined with pericardial laceration and right massive hemothorax by blunt chest trauma. The ruptured hearts of the patients were successfully closed using cardio-pulmonary bypass or cell saver system without detrimental sequelae.

Angioplasty of Bilateral Coronary Ostial Stenosis in a Patient with Takayasu's Arteritis: A case report / 대한흉부외과학회지

Coronary artery involvement in Takayasu's arteritis is a relatively rare, and potentially lethal but surgically correctable disease. A 28-year-old female was admitted for the evaluation of headache associated with dizziness, palpitation and claudication of left arm. Her aortogram and coronary angiogram showed Takayasu's arteritis with bilateral coronary ostial stenosis. We performed bilateral coronary ostioplasty with saphenous vein patch graft. The patient was discharged in good condition. We report this case with literature review.