Early Result of Proximal Anastomosis Methods of Radial Artery in Coronary Artery Bypass Surgery / 대한흉부외과학회지

BACKGROUND: There are many different opinions regarding the proximal anastomotic sites of radial artery in coronary artery bypass surgery. Therefore, we compared the clinical and angiographic findings according to anastomosis of radial artery to develop a guideline. MATERIAL AND METHOD: From January 2003 to December 2004, 48 patients who underwent coronary artery bypass surgery using radial artery in Kangdong Sacred Heart Hospital were studied for clinical and coronary angiographic findings and were divided into group I for radial artery that anastomsed to aorta independently and group II that anastomosed to left internal mammary artery. RESULT: Patients in group I were 33 (men 26, women 7; mean age 61.93+/-6.56) and group II were 15 (men 13, women 2; mean age 59.53+/-6.02) and there was no difference in preoperative characteristics. Patients in group I had longer cardiopulmonary bypass time (169.36+/-40.28 versus 139.40+/-20.45, p=0.026) and patients in group II had more sequential grafts with RA per patients (5/33 versus 11/15, p <0.05). Patients in group I used more vein graft for distal anatstomosis (47/117 (40%) versus 9/48 (18%), p=0.011) and there was no difference in perioperative outcome and overall survival. Mean follow-up time was 15.87+/-7.33 (1 to 28) months in patients of the group I and 21.40+/-2.85 (17 to 25) months in group II. Postoperative coronary angiography was performed 17/33 (51.5%) in group I and 14/15 (93.3%) in group II. Early perfect patency rate was not statistically different in left anterior descending artery (15/17 (88.2%) versus 2/14 (85.7%), p=1.00) and radial artery (17/20 (85%) versus 30/30 (100%), p=0.058). Late mortality was 1/33 (3.0%) in group I and 1/15 (6.7%) in group II. CONCLUSION: There was no difference in terms of clinical and postoperative angiographic findings except in cardiopulmonary bypass time, the number of sequential grafts with the RA per patients and the number of the used vein graft.

Coronary Artery Bypass Graft Surgery in Patients 70 Years of Age and Older / 대한흉부외과학회지

BACKGROUND: There has been an increase in the number of elderly patients considered for coronary artery bypass grafting (CABG). Recently, there were many satisfactory reports of coronary artery bypass grafting (CABG) in old age due to the development in operative technique and postoperative management. We evaluated operative and follow-up results of patients 70 years of age and older compared to 60 years old. MATERIAL AND METHOD: We retrospectively studied the cases of 74 consecutive patients 70 years or older (group A) who underwent a elective CABG from January 2000 to December 2003 and compared that of relatively young age group (group B, 60-69 years old). We compared preoperative characteristics, operation technique, postoperative results that effect outcome, also we investigated late mortality and cardiac events at follow-up periods. RESULT: Preoperative demographic and clinical characteristics of two groups were not different, except preoperative renal dysfunction(serum creatinine: > or= 1.4 mg/dl) (group A 17, 23% vs group B 14, 9%) (p=0.024). There was no difference of the mean number of distal anastomosis and the left ventricular ejection fraction in group A decreased significantly from 53.7+/-13% preoperatively to 49.9+/-12% postoperatively (p=0.02), but not changed in group B. There was no difference at operative mortality rate and postoperative major morbidity rate, but wound problem of saphenous vein harvest site was significantly higher in group A than group B (6.8% vs 0.7%, p=0.02). The mean follow up duration was 24.3+/-13 months and the cumulative survival were 95.4% at 2 year and 79.9% at 4 year in group A and 95.4% at 2 year and 90.1% at 4 year in group B (p=ns). CONCLUSION: We conclude that age is not a factor of determination when we decide about operation because coronary artery bypass grafting in elderly more than 70 years old can be performed with a low mortality rate and acceptable morbidity rate.

Conservative Management of Postoperative Chylothorax Using Octreotide: A case report / 대한흉부외과학회지

Chylothorax is a rare but serious and well-recognized complication of thoracic and cardiac procedures. A postoperative chylothorax developed in a 3-month-old male patient after ligation of patent ductus arteriosus and repair of coarctation of aorta. He was treated successfully with conservative management using a combination of parenteral octreotide and medium-chain triglyceride (MCT) -enriched fomula with pleural drainage. We report a case of successful conservative treatment using octreotide for postoperative chylothorax.

Combined Large Cell Neuroendocrine Carcinoma with Component of Adenocarcinoma: A case report / 대한흉부외과학회지

Combined large cell neuroendocrine carcinoma is an uncommon lung cancer that include large cell neuroendocrine carcinoma with components of adenocarcinoma, squamous cell carcinoma, giant cell carcinoma and/or spindle cell carcinoma histologically. We report a case that pathologically diagnosed as combined large cell neuroendocrine carcinoma with component of adenocarcinoma after right pneumonectomy and mediastinal lymph node dissection. A 44-year-old man with intermittent chest pain was referred to our hospital for lung mass on the right mid lung field.

Efficacy of 12 Fr. Closed Thoracostomy Drainage in Management of Primary Spontaneous Pneumothorax / 대한흉부외과학회지

BACKGROUND: The indications of closed thoracostomy drainage in management of primary spontaneous pneumothorax is well known, but there is no special specification for the size to be inserted. Recently, various minimally invasive operational techniques have been introduced and researched. According to the trend, we tried to ascertain the efficacy of 12 Fr. chest tubes instead of the existing 24 Fr. chest tubes. MATERIAL AND METHOD: Patients who were younger than 30 years old and diagnosed as primary spontaneous pneumothorax and treated with closed thoracostomy drainage were enrolled in this study. We retrospectively compared group A who were drained with 24 Fr. chest tubes from January to May 2003 with group B with 12 Fr. chest tubes from November 2003 to April 2004 on procedure time for closed thoracostomy drainage, duration of chest tube drain, duration of hospital stay, complication, and recurrence. RESULT: The male to female ratio was 16:3 in group A and 18:2 in group B. The mean age of patients of group A was 21.7+/-4.0 and group B was 20.0+/-3.7. The mean procedure time for closed thoracostomy drainage in group A (21.6+/-2.9 minutes) was significantly longer than group B (10.8+/-1.9 minutes)(p<0.05). The mean duration of chest tube drain was 3.8+/-1.7 days in group A and 4.3+/-2.2 in group B, and the mean duration of hospital stay was 5.6+/-1.9 days in group A and 5.2+/-1.5 days in group B. There was no complication in both groups and 6 cases in group A (35%) and 5 cases in group B (25%) were operated because of recurrence and persistent air leakage. In conclusion, there was no statistical difference except for the procedure time for closed thoracostomy drainage between two groups. CONCLUSION: We concluded that there were no significant differences in efficacy between 12 Fr. chest tube and 24 Fr. chest tube in closed thoracostomy drainage for primary spontaneous pneumothorax and we found advantages of 12 Fr. chest tube in shortening procedure time because of easy and simple techniques.

Efficacy of 12 Fr. Closed Thoracostomy Drainage in Management of Primary Spontaneous Pneumothorax / 대한흉부외과학회지

BACKGROUND: The indications of closed thoracostomy drainage in management of primary spontaneous pneumothorax is well known, but there is no special specification for the size to be inserted. Recently, various minimally invasive operational techniques have been introduced and researched. According to the trend, we tried to ascertain the efficacy of 12 Fr. chest tubes instead of the existing 24 Fr. chest tubes. MATERIAL AND METHOD: Patients who were younger than 30 years old and diagnosed as primary spontaneous pneumothorax and treated with closed thoracostomy drainage were enrolled in this study. We retrospectively compared group A who were drained with 24 Fr. chest tubes from January to May 2003 with group B with 12 Fr. chest tubes from November 2003 to April 2004 on procedure time for closed thoracostomy drainage, duration of chest tube drain, duration of hospital stay, complication, and recurrence. RESULT: The male to female ratio was 16:3 in group A and 18:2 in group B. The mean age of patients of group A was 21.7+/-4.0 and group B was 20.0+/-3.7. The mean procedure time for closed thoracostomy drainage in group A (21.6+/-2.9 minutes) was significantly longer than group B (10.8+/-1.9 minutes)(p<0.05). The mean duration of chest tube drain was 3.8+/-1.7 days in group A and 4.3+/-2.2 in group B, and the mean duration of hospital stay was 5.6+/-1.9 days in group A and 5.2+/-1.5 days in group B. There was no complication in both groups and 6 cases in group A (35%) and 5 cases in group B (25%) were operated because of recurrence and persistent air leakage. In conclusion, there was no statistical difference except for the procedure time for closed thoracostomy drainage between two groups. CONCLUSION: We concluded that there were no significant differences in efficacy between 12 Fr. chest tube and 24 Fr. chest tube in closed thoracostomy drainage for primary spontaneous pneumothorax and we found advantages of 12 Fr. chest tube in shortening procedure time because of easy and simple techniques.

The Effect of Calcium Chloride on Hemodynamic Responses to Protamine Sulfate in the Dog / 대한마취과학회지

BACKGROUND: Protamine sulfate (PS), used to neutralize the effect of heparin, is often associated with systemic hypotension. The present study was aimed to investigate the protective effects of CaCl2 on adverse hemodynamic reaction to PS. METHODS: Forty-six dogs of three groups were studied. Animals were randomly allocated to receive either; saline 10 ml (controls, n = 26), CaCl2 5 mg/kg (n = 10) or 10 mg/kg (n = 10), added to PS 3 mg/kg given intravenously 5 min after heparin (300 IU/kg, iv). Mean aortic pressure (MAP), mean pulmonary arterial pressure (MPAP), left ventricular end-diastolic pressure (LVEDP), LVdP/dtmax, and -LVdP/dtmin, and pulmonary artery (cardiac output) and left circumflex blood flow (LCX flow) were recorded up to 15 min after PS. RESULTS: PS caused significant reductions in MAP (-49%), cardiac index (CI, -66%), systemic vascular resistance index (SVRI, -22%), LVEDP (-67%), LVdP/dtmax (-36%), and LVdP/dtmin (-55%), but increased MPAP (39%) and PVRI (3.8 fold), which all increases and reductions peaked 1-3 min after PS injection in the control group. The addition of CaCl2 to PS significantly attenuated reductions of MAP (-35 and -26% in CaCl2 5 and 10 mg/kg treated dogs, respectively), CI (-34 and -37%), LVdP/dtmax (-14, -11% ), and -LVdP/dtmin (-34, -21%), and increases in PVRI (1.8 and 2.4 fold). However, both doses of CaCl2 increased MPAP (48, 82%), but not SVRI (-28, -21%) or LVEDP (-73, -75%). LCX flow increased similarly in all groups (75-137%). CaCl2 5 and 10 mg/kg iv increased plasma Ca2+ by 0.23 and 0.36 mM, respectively. CONCLUSIONS: These results suggest that the simultaneous administration of CaCl2 attenuates the adverse hemodynamic effects of PS, used to reverse heparin anticoagulation in the dog.