Early Aggressive Surgical Treatment of Multiloculated Empyema

BACKGROUND: Empyema is the collection of purulent exudate within the pleural space. Overall, 36%–65% of patients with empyema cannot be treated by medical therapy alone and require surgery. Multiloculated empyema is particularly difficult to treat with percutaneous drainage. Therefore, we describe our experiences with early aggressive surgical treatment for rapid progressive multiloculated empyema. METHODS: From January 2001 to October 2015, we retrospectively reviewed 149 patients diagnosed with empyema who received surgery. The patients were divided into 2 groups according to whether they underwent emergency surgery or not. We then compared surgical outcomes between these groups. RESULTS: The patients in group A (emergency surgery, n=102) showed a more severe infectious state, but a lower complication rate and shorter length of hospital stay. The incidence of lung abscess was higher in group A, and abscesses were associated with diabetes and severe alcoholism. CONCLUSION: Early aggressive surgical treatment resulted in good surgical outcomes for patients with rapid progressive multiloculated empyema. Furthermore, we suspect that the most likely causes of multiloculated empyema are lung abscesses found in patients with diabetes mellitus as well as severe alcoholism.

Prolonged Air Leakage Caused by Mesenchymal Cystic Hamartoma of the Lung

A 16-year-old girl was transferred to the department of thoracic and cardiovascular surgery because of a spontaneous pneumothorax with prolonged air leakage. Chest computed tomography demonstrated a cystic lesion measuring 2×3 cm and involving the left upper lobe. Left upper lobectomy was performed via video-assisted thoracoscopic surgery. A pathologic examination of the specimen revealed a mesenchymal cystic hamartoma. Despite the rarity of pulmonary mesenchymal cystic hamartoma, it should be considered a potential cause of pneumothorax for patients with a large pulmonary cyst. Further, surgical resection must be considered because serious complications such as hemothorax, hemoptysis, and malignant transformation have been reported.

Systemic Inflammation Response Syndrome Score Predicts the Mortality in Multiple Trauma Patients

BACKGROUND: Numerous statistical models have been developed to accurately predict outcomes in multiple trauma patients. However, such trauma scoring systems reflect the patient's physiological condition, which can only be determined to a limited extent, and are difficult to use when performing a rapid initial assessment. We studied the predictive ability of the systemic inflammatory response syndrome (SIRS) score compared to other scoring systems. METHODS: We retrospectively reviewed 229 patients with multiple trauma combined with chest injury from January 2006 to June 2011. A SIRS score was calculated for patients based on their presentation to the emergency room. The patients were divided into two groups: those with an SIRS score of two points or above and those with an SIRS score of one or zero. Then, the outcomes between the two groups were compared. Furthermore, the ability of the SIRS score and other injury severity scoring systems to predict mortality was compared. RESULTS: Hospital death occurred in 12 patients (5.2%). There were no significant differences in the general characteristics of patients, but the trauma severity scores were significantly different between the two groups. The SIRS scores, number of complications, and mortality rate were significantly higher in those with a SIRS score of two or above (p<0.001). In the multivariant analysis, the SIRS score was the only independent factor related to mortality. CONCLUSION: The SIRS score is easily calculated on admission and may accurately predict mortality in patients with multiple traumas.

Pulmonary Actinomycosis Associated with Endobronchial Vegetable Foreign Body

A 51-year-old woman visited our hospital with massive hemoptysis. She had suffered from recurrent hemoptysis for five years and had undergone bronchial artery embolization many times. The patient had a history of pulmonary tuberculosis and bronchiectasis. Chest radiography showed consolidation around the nodule in the lateral basal segment of the right lower lobe. We successfully performed a right lower lobectomy. The histological study of the resected specimen showed a vegetable foreign body and clumps of Actinomyces, indicating actinomycosis, which was suggested to be the cause of the hemoptysis. This was a very rare case of hemoptysis caused by a vegetable foreign body and actinomycosis.

Preoperative Extracorporeal Membrane Oxygenation for Severe Ischemic Mitral Regurgitation: 2 case reports

Indication for extracorporeal membrane oxygenation (ECMO) has been extended as the experience of ECMO in various clinical settings accumulates and the outcome after ECMO installation improves. We report two cases of successful mitral valve surgery for severe ischemic mitral regurgitation in patients on ECMO support for cardiogenic shock which developed upon coronary angiography.

Aortic Root and Ascending Aortic Aneurysm in an Adult with a Repaired Tetralogy of Fallot

Surgical repair of the tetralogy of Fallot is one of the most successful operations in the treatment of congenital heart diseases. We report the case of a 65-year-old man who had an aortic valve replacement at the time of complete repair of the tetralogy of Fallot at the age of forty-three. He subsequently had progressive aortic root and ascending aorta dilation to 9 cm. The aortic root and ascending aorta replacement was done using a composite valve-graft and was performed along with other procedures. Thus, meticulous follow-up of aortic root and ascending aorta after corrective surgery for tetralogy of Fallot is recommended following initial curative surgery.

Aortic Root and Ascending Aortic Aneurysm in an Adult with a Repaired Tetralogy of Fallot

Surgical repair of the tetralogy of Fallot is one of the most successful operations in the treatment of congenital heart diseases. We report the case of a 65-year-old man who had an aortic valve replacement at the time of complete repair of the tetralogy of Fallot at the age of forty-three. He subsequently had progressive aortic root and ascending aorta dilation to 9 cm. The aortic root and ascending aorta replacement was done using a composite valve-graft and was performed along with other procedures. Thus, meticulous follow-up of aortic root and ascending aorta after corrective surgery for tetralogy of Fallot is recommended following initial curative surgery.

Native Coronary Artery and Grafted Artery Spasm Just after Coronary Artery Bypass Grafting: A Case Report

Native coronary artery spasm after coronary artery bypass grafting (CABG) is scarce. It frequently causes disastrous circulatory collapse. We report a 72-yr-old male, who experienced native coronary artery spasm and grafted artery spasm following CABG, which was successfully treated with coronary angiography and intracoronary injection of nitroglycerine.

Granulocytic Sarcoma Involving the Pectoralis Muscle in a Patient with Chronic Myelogenous Leukemia / 대한흉부외과학회지

We report here on a very rare case of granulocytic sarcoma of the pectoralis muscle on the left chest wall of a patient with chronic myelogenous leukemia, and this malady presented as a very rapidly growing hematoma-like mass.

Analysis of Risk Factors and Effect of Vancomycin for Sternal Infection after Coronary Artery Bypass Graft / 대한흉부외과학회지

BACKGROUND: Sternal wound infection (SWI) is an important complication after cardiac surgery. The aim of this study was to investigate the predictors affecting sternal wound infection and preventive factors including short term Vancomycin therapy in patients who underwent coronary artery bypass grafting (CABG). MATERIAL AND METHOD: A retrospective study was done using data collected from January 2001 through December 2007. This included 219 patients who had isolated CABG. The definition of SWI was documentation from a microbiological study and a requirement for simple closure or other surgical revision. RESULT: The overall incidence of SWI was 7.8% (n=17). The causative organisms were methicillin resistant Staphylococcus aureus (MRSA, n=13), methicillin resistant Staphylococcus epidermidis (n=2), Pseudomonas aeruginosa (n=1), and Candida albicans (n=1). Ten cases had deep sternal wound infection with mediastinitis; 7 cases had a superficial wound infection. Infection-related mortality was low (1/17; 6%). Diabetes mellitus (p=0.006) and smoking history (p=0.020) were factors that predicted high risk. Short term use of vancomycin decreased the incidence of MRSA-associated SWI (p=0.009). For treatment, curettage and rewiring or flap were needed in most cases (88%, n=14). CONCLUSION: Patients who had diabetes mellitus and a smoking history need careful management. Short term use of vancomycin is effective for prevention of SWI with MRSA.

The Effects of Moxifloxacin in Endotoxin-induced Acute Lung Injury / 대한흉부외과학회지

BACKGROUND: The pathophysiology of acute respiratory distress syndrome with sepsis is acute lung injury (ALI) that's' caused by endotoxin (LPS). We evaluate effects of moxifloxacin on LPS-induced ALI in a rat model. MATERIAL AND METHOD: The rats were divided into 3 groups as the control group (C), the LPS insult group (L), and the LPS+moxifloxacin treated group (L-M). ALI was induced by endotracheal instillation of E.coli LPS, then moxifloxacin was given in 30 minutes. Five hours later, we checked the lung weight/body weight ratio(the L/BW ratio), the protein & neutrophils in the bronchoalveolar lavage fluid (BALF), the myeloperoxidase (MPO) activity & the malondialdehyde (MDA) content, the expressions of cytosolic and secretory phospholipase A2 (c, sPLA2), and the morphology of the lung with using a light microscope. RESULT: The L/BW ratio, the protein content and the neutrophil count in the BALF, and the MPO activity and the MDA content in lung were significantly increased in group L compared to group C, and these factors were markedly decreased in group L-M compare to group L. The cPLA2 expression and the sPLA2 expression were increased in group L and the cPLA2 expression was decreased in group L-M. Yet the sPLA2 expression was not changed in group L-M. Morphologically, many inflammatory findings were observed in group L, but not in group L-M. CONCLUSION: Many of the inflammatory changes of ALI that were caused by LPS insult were ameliorated by moxifloxacin treatment.

Reconstruction of Tracheobronchial Stenosis due to Endobronchial Tuberculosis : A case report / 대한흉부외과학회지

A 20 year old woman had developed stenosis at the lower part of the trachea, right main bronchus, and right upper lobe bronchus as a complication of endobronchial tuberculosis. The patient had complained of severe dyspnea. Tracheobronchial stenosis was so extensive that we did reconstruction of the trachea and right bronchus with resection of the lower trachea and right main bronchus and right upper lobectomy. She has been doing well without any respiratory symptoms or complications.

Protamine Induced Anaphylactic Reaction after Cardiopulmonary Bypass: A case report / 대한흉부외과학회지

Anaphylactic reaction to protamine sulfate, which is used widely to reverse the anticoagulative effect of heparin after cardiopulmonary bypass, is very rare. But the result of anaphylactic reaction can be very fatal and the mechanism of it is still not clear. We report a case of severe anaphylactic reaction to protamine sulfate following the replacement of the mitral valve and Maze procedure using microwave in a non-diabetic 57-year-old female patient.

Pulmonary Epithelioid Hemangioendothelioma Mimicking Hamartoma: A case report / 대한흉부외과학회지

Epithelioid hemangioendothelioma, originating from the vascular endothelium, is a very rare and low-grade malignancy. World-wide, about 50 cases of pulmonary epithelioid hemangioendothelioma have been reported. This is more common in female and is usually shown as multiple nodules in both lung fields. A 41-year-old male, who had suffered from right pleuritic chest pain for 3 months, was initially diagnosed as adenocarcinoma under bronchofiberscopic biopsy. At that time, the stage of tumor according to the TNM staging was IIIa. He received bronchoscopic biopsy again during follow-up period and it was diagnosed as hamartoma. After surgery, the final diagnosis was pulmonary epithelioid hemangioendothelioma.

Schwannoma of the Esophagus: A case report / 대한흉부외과학회지

A rare case of schwannoma involving lower thoracic esophagus is presented. A 64-year-old male was seen with slowly progressing dysphagia for 2 years. Large sized submucosal tumor was found by endoscopy and chest CT. On surgery, tumor was very solid and tightly adherent to the adjacent tissue. Esophagectomy and esophagogastrostomy was done.

Follow-Up of Residual Shunt after Repair of Ventricular Septal Defect / 대한흉부외과학회지

BACKGROUND: Obtaining precise hemodynamic and morphological information in the early postoperative period after surgical correction of congenital heart disease is important in determining the need for future medical or surgical intervention. We investigated the residual shunting after surgical repair of simple ventricular septal defect in order to know the incidence of residual shunting in the postoperative period and the natural history of small residual shunts located in the peripatch area. MATERIAL AND METHOD: Forty three consecutive patients under one year of age who underwent patch repair of a simple ventricular septal defect were evaluated for incidence of residual shunts by echocardiography. RESULT: Eleven patients had echocardiographic residual shunt in the peripatch area at immediate postoperative period, however, there were no patients who needed reoperation due to deteriorated hemodynamic effect of residual shunt. The incidence of residual shunts was not significantly different with type of ventricular septal defect and material used for closure. During follow up period, two patients were lost and remaining nine patients no longer showed evidence of residual shunt. The mean time of last evidence of shunt was 4.2+/-3.6 months after operation. CONCLUSION: Residual peripatch shunt flow was frequently noted in the immediate postoperative period following surgical repair of ventricular septal defect, however, most of them were disappeared within six months.

Effect of Surgical Closure of Ventricular Septal Defect on Ventricular Systolic Time Intervals / 대한흉부외과학회지

BACKGROUND: This study was undertaken in infant patients with isolated ventricular septal defect(VSD) to determine the effect of surgical closure on ventricular systolic time interval, as a parameter for ventricular performance, by echocardiography. MATERIAL AND METHOD: Thirty patients were enrolled. Mean age of patients at operation was 6.5+/-3.2 months and all patients had non-restrictive VSD. We checked the left atrium/aorta(LA/Ao) ratio, left ventricle ejection fraction(EF), left ventricular systolic time interval(LVSTI), and right ventricular systolic time interval(RVSTI). Echocardiographic studies were done before surgical correction and postoperative periods(postop1: within 2 weeks, postop2: between 4 and 6 months, postop3: between 1 and 2 years). RESULT: LA/Ao ratio decreased significantly at immediate postoperative period compared to preoperative period and sustained during further follow-up period(from 1.74+/-0.37 to 1.36+/-0.24*, 1.32+/-0.22*, and 1.27+/-0.19*, p<0.01 ). LV EF had not changed during follow-up periods(from 65.1+/-7.0 to 62.3+/-9.5, 62.8+/-5.7, and 64.1+/-6.9). LVSTI decreased significantly at postop2 and sustained during further follow-up period (from 0.46+/-0.13 to 0.46+/-0.11, 0.37+/-0.08*, and 0.34+/-0.07*, p<0.01 ). RVSTI decreased significantly at postop3(0.33+/-0.08 to 0.32+/-0.08, 0.31+/-0.07, and 0.27+/-0.05*, p<0.01). CONCLUSION: We found that right and left ventricular systolic time intervals had decreased over the period of 1 year after surgical correction of VSD. Therefore, it is necessary to observe the change of ventricular function during that period.

Health Concern Survey of Parents of School Children / 예방의학회지

Obtaining an available information on health concerns of parents of school-age children and furthermore developing the sound policy for the public on health education, this study was conducted during Nov.-Dec. 1985 in the four selected areas; Seoul, large, middle and small city, and farming and fishery villages for 3,337 parents of schoolchildren in Korea. In this study, parents complected a questionnaire containing 34 items related to health concerns(e.g. drinking alcohol, air pollution, cancer, etc. see Table 4 and Fig. 2). For each health items, respondents were asked to indicate a choice between three levels of concern; "Very high concern", "Moderate concern", "Little concern", and "No opinion". An analysis of responses indicated that most of the top ten health concerns identified by parents as cancer, abortions among high school students, medical malpractice, water pollution, traffic accidents, air pollution, suicide of parents and homicide of offspring, heart disease, venereal diseases, and high blood pressure in that order. Those health problems about which respondents were least concerned were more closely related to the individual, such as drinking alcohol, smoking, tooth decay, gum disease, underweight, overweight. Of greater concern were more such as water pollution, abortions among high school students, air pollution, accidents, medical malpractice. For cancer, heart disease, high blood pressure, various accidents, environmental pollution, parents showed high concern, however, for health issues which contributed as causative influences such as lung cancer from smoking and liver cirrhosis and traffic accidents from drinking alcohol showed less concern. Relationship between parent's residential areas, educational level and sex distribution and health concern showed little difference, however, for these issues parents identified as relatively high concern. Most parents showed more concern in sex-related of family-related health issues such as abortions among high school students, suicide of parents and homicide of offspring.