Pulmonary Thromboembolectomy for Acute Pulmonary Thromboembolism

BACKGROUND: Acute pulmonary thromboembolism is fatal because of abruptly occurring hypoxemia and right ventricular failure. There are several treatment modalities, including anticoagulation, thrombolytics, ECMO (extracorporeal membrane oxygenator), and thromboembolectomy, for managing acute pulmonary thromboembolism. MATERIALS AND METHODS: Medical records from January 1999 to December 2004 at our institution were retrospectively reviewed for pulmonary thromboembolectomy. There were 7 patients (4 men and 3 women), who underwent a total of 8 operations because one patient had post-operative recurrent emboli and underwent reoperation. Surgery was indicatedfor mild hypoxemia and performed with CPB (cardiopulmonary bypass) in a beating heart state. RESULTS: The patients had several symptoms, such as dyspnea, chest discomfort, and palpitation. Four patients had deep vein thromboembolisms and 3 had psychotic problems, specifically schizophrenia. Post-operative complications included hemothorax, pleural effusion, and pericardial effusion. There were two hospital deaths, one each by brain death and right heart failure. CONCLUSION: Emergency operation should be performed when medical treatments are no longer effective.

Spontaneous Rupture of a Gastric Stromal Tumor Causing Hemoperitoneum

We describe a 39-year-old man with spontaneous rupture of a gastric stromal tumor causing hemoperitoneum. Ultrasonography showed a large mass broadly abutting the stomach and liver. Computed tomography demonstrated a heterogeneous enhanced mass arising from the stomach and focal perforation of the tumor with hemoperitoneum; endoscopic ultrasonography showed an exophytic heterogeneous mass originating from the gastric muscle layer. Angiography revealed that the right gastric artery was the main artery supplying the tumor. A gastric stromal tumor with bloody fluid in the peritoneal cavity was seen at the laparotomy. The tumor was excised completely, and subsequent histological and immunohistochemical studies indicated that it was a gastric stromal tumor. We report a relatively rare case of gastric stromal tumor causing hemoperitoneum due to spontaneous rupture of the tumor.

Hemothorax Without Injury of the Pleural Cavity due to Diaphragmatic and Liver Laceration Caused by a Right Upper Anterior Chest Stab Wound

A hemothorax usually occur, due to injuries to the intercostal and great vessels, pulmonary damage, and sometimes fractured ribs. We report a case in which the hemothorax that occurred, neither intrathoracic injury nor injury to internal thoracic vessels and organs, via lacerated diaphragmatic and liver laceration due to a right upper part of anterior chest stab injury caused by a sharp object. The patient's general conditions gradually worsened, so chest and abdominal computed tomogram were taken. The abdominal computed tomogram revealed diaphragmatic injuries and bleeding from the lacerated liver. We performed an exploratory laparotomy to control the bleeding from the lacerated liver with simple primary sutures. In addition exploration was performed in the right pleural space through the lacerated diaphragm with a thoracoscopic instrument. There were no bleeding foci in the right pleural space, the vessels, or the lung on the thoracoscopic video. Closure of the lacerated diaphragm was achieved with simple, primary sutures. The postoperative course of the patient was uneventful, and the patient was discharged.

Spontaneous Pneumothorax due to Pulmonary Invasion in Multisystemic Langerhans Cell Histiocytosis: A case report / 대한흉부외과학회지

Langerhans cell Histiocytosis can present as a single or multiple lesion and can affect one or several organ systems. A 41-year-old woman with a history of multisystemic Langerhans cell Histiocytosis invading lung and thyroid was admitted with left-sided spontaneous pneumothorax. Here we report a case of uncommon pulmonary Langerhans-cell Histiocytosis presenting with spontaneous pneumothorax as a multisystemic Langerhans cell Histiocytosis.

Mediastinal Lymphangioma: A case report / 대한흉부외과학회지

A 14-year-old male patient was admitted for an abnormal chest X-ray. A chest computed tomogram showed a cystic mass in the anterior mediastinum and spleen, 14X14 cm and 2X2 cm in size respectively. Complete removal of the mediastinal lesion was achieved by a median sternotomy. The final histologic diagnosis of the lesion was cystic lymphangioma. There was no evidence of tumor recurrence until a postoperative period of 14 months.

Results of Bronchial Sleeve Resection for Primary Lung Cancer / 대한흉부외과학회지

BACKGROUND: It is known that long-term survival rate in patients underwent bronchial sleeve lobectomy for primary lung cancer is at least equal to that in patients underwent pneumonectomy, and bronchial sleeve lobectomy is performed in patients with suitable tumor location even in patients have adequate pulmonary function. Sleeve pneumonectomy is performed when carina was invaded by tumor or tumor location was near to the carina. We performed this study to know our results of sleeve resection for primary lung cancer. MATERIAL AND METHOD: We analyzed retrospectively the medical records of 45 patients who underwent sleeve lobectomy or sleeve pneumonectomy for primary lung cancer by one thoracic surgeon from May 1990 to July 2003 in Department of Thoracic & Cardiovascular Surgery, College of Medicine, Kyung Hee University. Follow-up loss was absent and last follow-up was performed in April 5, 2005. Kaplan-Meyer method and log-lank test were used to know long-term survival rate and p-value. RESULT: Mean age was 60 years old and male to female ratio 41:1. Histologic types were squamous cell carcinoma were 39, adenocarcinoma were 4, and others were 2 patients. Pathologic stages were I 14, II 14, and III 17 patients. Nodal stages were N0 23, N1 13, and N2 9 patients. Types of operation were sleeve lobectomy 40 and sleeve pneumonectomy 5 patients. Operative mortality was 3 patients and its cause was respiratory complications. Early complications were pneumonia 4, atelectasis 8, air leakage more than 7 days 6, and atrial fibrillation 4 patients. In 19 patients tumor was recurred. Local recurrence was 10 and systemic metastasis was 9 patients. Overall 5, 10-year survival rate were 54.2%, 42.5%. The 5, 10-year survival rates according to the pathologic stage were 83.9%, 67.1% in stage I, 55%, 47.1% in II, 33.3%, 25% in III, and significance difference was present between stage I and III. The 5, 10-year survival rate according to the lymph node involvement were 63.9%, 54.6% in N0, 53.8%, 46.5% in N1, 28.5%, 14.2% in N2, and significance difference was present between N0 and N2. CONCLUSION: Because bronchial sleeve lobectomy for primary lung cancer could be performed safely and shows acceptable long-term survival rate, it could be considered primary in case of suitable tumor location if complete resection is possible. Although sleeve pneumonectomy for primary lung cancer shows somewhat high operative mortality rate, it could be considered in view of curative treatment.

Long Term Impact of Laparoscopic Assisted Distal Gastrectomy on Quality of Life

PURPOSE: Laparoscopy-assisted distal gastrectomy (LADG) is gaining wider acceptance for the treatment of early gastric cancer. However, firm evidence supporting the long-term outcome after LADG for gastric cancer is unknown. This study compared long-term quality of life after LADG versus an open distal gastrectomy (ODG) for early gastric cancer. METHODS: This study included 29 patients who underwent LADG and 57 patients who underwent ODG for the treatment of stage I gastric cancer. Quality of life was evaluated based on the Korean version of EORTC QLQ-C30 (version 3.0) and EORTC QLQ-STO22 one year after surgery. All patients underwent a Billroth II gastrectomy for stage I gastric cancer between January 2003 and December 2004. RESULTS: A total of 86 (58%) out of 154 patients responded to the questionnaire. Demographic features showed no difference between the two groups of patients for age, sex, depth of invasion, lymph node metastasis except for tumor size and the number of retrieved lymph nodes. The mean score for global health status was not statistically different (LADG, 60.3+/-20.4 vs ODG, 57+/-20.6; P=0.413). The total score of 21 items related to stomach cancer (EORTC QLQ-STO22) also was not statistically different (LADG, 68.9+/-64.9 vs ODG, 94.5+/-97.3; P=0.340). CONCLUSION: Based on the results of the Korean version of EORTC QLQ-C 30 (version 3.0) and EORTC QLQ-STO22, LADG does not seem to have any long-term benefit over ODG on 'quality of life'.

Primary Sternal Osteomyelitis: A case report / 대한흉부외과학회지

Primary sternal osteomyelitis is a rare disease. Primary sternal osteomyelitis occurring during childhood is extremely rare; therefore, only eleven cases have been reported in the English language literatures. The predisposing factors of primary sternal osteomyelitis are malnutrition, immune deficiency, intravenous injection, blunt chest trauma, and sickle cell anemia. Drainage of pus with antibiotic therapy is the treatment of choice. We report a case of primary sternal osteomyelitis occurred in a 16-year old boy, who had no predisposing factors, with review of literatures.

Surgical Treatment for Carotid Artery Stenosis / 대한흉부외과학회지

BACKGROUND: Carotid endarterectomy is an effective treatment modality in patients with severe carotid artery stenosis, but it may result in serious postoperative complications. We analyzed the results of the carotid endarterectomy performed in our institution to reduce the complications related to the carotid endarterectomy. MATERIAL AND METHOD: We analyzed retrospectively the medical records of 74 patients (76 cases) who underwent carotid endarterectomy for carotid artery stenosis by a single surgeon from February 1996 to July 2004. RESULT: There were 64 men and 10 women. The mean age of the patients was 63.6 years old. Carotid endarterectomy only was performed in 63 cases, carotid endarterectomy with patch angioplasty in 8 cases, and carotid endarterectomy with segmental resection of internal carotid artery and end to end anastomosis in 5 cases. Intra-arterial shunt was used in 29 cases. The mean back pressures of internal carotid arteries checked after clamping common carotid arteries and external carotid arteries were 23.48+/-10.04 mmHg in 25 cases with changes in electroencephalography (group A) and 47.16+/-16.04 mmHg in 51 cases without changes in electroencephalography (group B). There was no statistical difference in the mean back pressure of internal carotid arteries between two groups (p=0.095), but the back pressures of internal carotid arteries of all patients with changes in electroencephalography were under 40 mmHg. When there was no ischemic change of electroencephalography after clamping common carotid artery and external carotid artery, we did not make use of intra-arterial shunt regardless of the back pressure of internal carotid artery. Operative complications were transient hypoglossal nerve palsy in four cases, cerebral hemorrhage occurred at previous cerebral infarction site in two cases, mild cerebral infarction in one case, hematoma due to anastomosis site bleeding in one case, and upper airway obstruction due to laryngeal edema probably caused by excessive retraction during operation in two cases. One patient expired due to cerebral hemorrhage occurring at previous cerebral infarction site. CONCLUSION: Carotid endarterectomy is a safe operative procedure showing low operative mortality. We suggest that intra-arterial shunt usage should be decided according to the ischemic change of electroencephalography regardless of the back pressure of internal carotid artery. Excessive retraction during operation should be avoided to prevent upper airway obstruction due to laryngeal edema and if upper airway obstruction is suspected, prompt management is essential.

Pleural Sparganosis: A case report / 대한흉부외과학회지

The major cause of Sparganosis is ingestion of raw snake or frog. The most common clinical manifestation of Sparganosis is subcutaneous moving nodule in abdominal wall, chest wall, thigh, and scrotal area. The most accurate method of diagnosis and treatment for Sparganosis is surgical removal of the parasite. We experienced pleural sparganosis in a 70-years-old male patient, and report it with review of literatures.

Surgical Treatment of Tracheal Restenosis following Operation for Postintubation Tracheal Stenosis: Two cases report / 대한흉부외과학회지

The treatment of choice for post-intubation tracheal stenosis is partial tracheal resection and end-to-end anastomosis. The surgical treatment of tracheal restenosis that results from unsuccessful repair of post-intubation tracheal stenosis is not easy. Failed reoperation results in permanent tracheostomy and loss of voice. If the first operation fails, about 4~6 months of period for resolution of inflammatory reaction, edema, and fibrosis is needed. The exact evaluation of the patient's status is necessary and success rate of reoperation for the appropriate candidates is over 90%. We report the results of treatment in two cases of tracheal restenosis that resulted from unsuccessful repair of post-intubation tracheal stenosis with review of literatures.

Urinothorax following Blunt Renal Trauma: One case report / 대한흉부외과학회지

Urinothorax occurs when urine leakes into thoracic cavity and it was first reported by Correie in 1968. The mechanism of its occurrence is an accumulation of urine in thoracic cavity by retroperitoneal urinoma formed by urinary tract obstruction or trauma. Retroperitoneal inflammation, malignant neoplasm, kidney transplantation, and kidney biopsy can also induce urinothorax. The diagnosis of urinothorax may be delayed due to its rare incidence rate, but if diagnosis is confirmed the treatment is possible by urinary diversion. We report our experience of a case of urinothorax associated with retroperitoneal urinoma followed by blunt renal trauma with review of literatures.

A Case of Chromobacterium Infection after Car Accident in Korea

Chromobacterium violaceum is a gram negative straight rod, 0.8-1.2 by 2.5 to 6.0 m, which is motile by one polar flagella and one to four lateral flagella. The organism inhabits soil and water and is often found in semitropical and tropical climates. Infections in humans are rare. We report a case of infection caused by strains of C. violaceum. A 38-year-old male patient was admitted to KyungHee University Hospital, Seoul, Korea on July 28th, 2003, after a car accident. The patient had multiple trauma and lacerations. He had an open wound in the left tibial area from which C. violaceum was isolated. The strain was resistant to ampicillin, tobramycin, ampicillin/sulbactam, ceftriaxone and cefepime, but was susceptible to amikacin, gentamicin, ciprofloxacin, levofloxacin, trimethoprim/sulfamethoxazole and piperacillin/tazobactam. The patient was treated successfully by debridement, cephapirin sodium and astromicine sulfate.

RVOTO Caused by Pulmonary Artery Sarcoma Originating from Pulmonary Valve: One case report / 대한흉부외과학회지

Primary pulmonary arterial sarcomas, especially those originating from the pulmonary valve are extremely rare. A 35 year-old male patient was admitted for exertional dyspnea and fatigue. Large intraluminal mass in the main pulmonary artery and both pulmonary arteries was detected by chest computed tomogram, chest magnetic resonance imaging, echocardiogram, and pulmonary angiogram. We regarded the mass as a primary pulmonary arterial malignant tumor, and resected under cardiopulmonary bypass. The mass was appeared to originate from the posterior cusp of pulmonary valve, and extended from below pulmonary valve to main pulmonary artery and both pulmonary arteries. We resected the mass by pulmonary endarterectomy and replaced the pulmonary valve. The mass was diagnosed as a pulmonary arterial sarcoma in histopathologic examination.

Aorto-bicarotid-biaxillary Bypass in Takayasu's Arteritis: One case report / 대한흉부외과학회지

A 30 year-old female patient was admitted for dizziness and palpitation. Pulsation of the both upper extremities and both common carotid arteries were absent. Innominate artery and both common carotid arteries were severely narrowed, and both subclavian arteries were completely obstructed on aortogram. The patient was diagnosed as type I Takayasu's arteritis, and operation was performed to increase blood flow to the brain and both upper extremities. Ascending aorta, both carotid arteries, both subclavian arteries, and both axillary arteries were exposed by four separate incision, and we performed an aorto-bicarotid-biaxillary bypass with Hemashield graft. Previous dizziness and palpation were disappeared after the operation.

Synchronous Double Cancer of the Esophagus and Lung: Two case report / 대한흉부외과학회지

The synchronous double cancer of the esophagus and lung is rare. Right lower lobectomy and Ivor Lewis procedure were performed simultaneously in a 75 year-old male patient who had synchronous double primary squamous cell carcinoma of the thoracic esophagus and right lower lobe of the lung. Left upper lobectomy was performed in a 69 year-old male patient who had squamous cell carcinoma of the left upper lobe of the lung, and four months later we performed Ivor Lewis procedure for the squamous cell carcinoma that occurred in the thoracic esophagus. The above two patients were doing well 10 months and 24 months after the operation respectively without recurrence. We treated the two cases of synchronous double cancer of the esophagus and lung with complete resection, and report this with review of literature.

Clinical investigation about the result of surgically treated myasthenia gravis / 대한흉부외과학회지

BACKGROUND: Myasthenia gravis is a rare autoimmune disease involving acetylcholine receptor and its autoantibody on neuromuscular junction. The methods of treatment are medical treatment and surgical thymectomy. In this paper we analyzed the result of thymectomy and the factors affecting the postoperative symptom improvement. MATERIAL AND METHOD: This study obtained medical records of 37 patients who received the thymectomy for myasthenia gravis from March 1986 to December 1998. RESULT: Out of 37 cases, 21 cases(57%) showed improvement, of which 8 cases (50%) in the group of thymoma(n=16), and 13 cases (62%) in the group of thymic hyperplasia(n=21) showed the improvement of symptoms. Postoperative complications were respiratory insufficiency due to aggravation of symptoms after operation, including tracheal intubation for ventilator support in 9 cases, pneumonia in 3 cases, pneumothorax in 2 cases and left vocal cord palsy in 1 case. There was one postoperative mortality. The relation between postoperative improvement and sex(P=0.3222), age(P=0.7642), thymic pathologic variants,(P=0.4335) and classification of thymoma(P=0.20) showed no statistically significant correlation. However, the lower grade of preoperative symptoms can predict the lower grade of postoperative symptoms significantly(P=0.0032). Follow up study to 36 postoperative survivors was performed in October 2002 based on the out-patient records and call with patients. Out of 36 cases, 33 cases(91.7%) could be investigated and 3 cases could not. Mean follow up period was 83.2 months. Out of 33 cases, 25 cases(75.8%) showed symptomatic improvement, of which 8 cases(53.3%) in the group of thymoma(n=15) and 17 cases(94.4%) in the group of thymic hyperplasia(n=18) showed the improvement of symptoms. CONCLUSION: In myasthenia gravis, thymectomy showed the good improvement, and more important factor affecting the improvement of symptoms was the grdae of preoperative symptoms. Also midterm and long term follow up results showed good symptomatic improvement.

Primary Malignant Fibrous Histiocytoma of the Diaphragm: One Case Report / 대한흉부외과학회지

A 25-year-old female patient was adimitted due to discomfort in the right chest and left epigastric area. Chest X-ray and chest CT showed a round 4x4x4cm sized mass located in the right lower lobe and abutted on the right diaphragm and metastatic lesions in the right lower lobe and right middle lobe. In exploratory thoracotomy, we discovered a mass originating from the right diaphragm which directly invaded the right lower lobe and metastatic subpleural lesions in the right lower lobe and right middle lobe. The mass was diagnosed as sarcoma by frozen section biopsy and we removed the mass by en bloc resection of the right diaphragm and right lower lobe. Metastatic subpleural lesions in the right lower lobe and right middle lobe were removed by wedge resection. The mass was malignant fibrous histiocytoma of the diaphragm in permanent pathologic examination and chemotherapy was done as adjuvant measure. We report one extremely rare case of malignant fibrous histiocytoma of the diaphragm with literature.

Necrotizing Bronchial Aspergillosis: A case report / 대한흉부외과학회지

Necrotizing bronchial aspergillosis usually occurs in the immumocompromised host. Aspergillus invades bronchial epithelium and forms endobronchial mass or endobronchial stenosis. A 78-year-old male patient with diabetus mellitus complaining of dyspnea and cough was admitted to our hospital. Plain chest X-ray and chest computed tomogram showed a large endobronchial mass and total collapse of left upper lobe of the lung. Bronchoscopic biopsy of the endobronchial mass revealed chronic inflammation. To confirm the endobronchial mass, we performed sleeve lobectomy of left upper lobe of the lung. Histologically the mass was diagnosed as necrotizing bronchial aspergillosis. We report a case of necrotizing bronchial aspergillosis in an elderly man who has diabetus mellitus with review of the literature.

Trachea Replacement with Cryopreserved Tracheal Allograft: Experiment in Dogs / 대한이식학회지

PURPOSE: Tracheal transplantation is necessary in patients with extensive tracheal stenosis caused by trauma, congenital disease, benign or malignant tumor. Results with the cryopreserved vascular homograft have prompted us to evaluate cryopreserved trachea. When trachea is cryopreserved, it maintains viability of the cartilage and allogenicity decreased because epithelium of trachea whitch has major allogenicity (MHC class II Antigen) is exfoliated after some periods of cryopreservation. We assessed the proper duration of cryopreservation and probability of trachea allotransplantation. METHODS: The trachea were harvested from Mongrel dogs and frozen to 80degrees C for different length preservation (group 1: 1~10 week, group 2: 1 month, 2 months, 3 months, 6 months, 2 months). Ggoup 1 was thawed and tested epithelial viability, Group 2 was perfomed trachea transplantation with cryopreserved trachea allograft, after one months We checked gross appearance, viability of cartilage and grade of monocyte infiltration (rejection). RESULTS: In group 1, Exfoliation of epithelium was begun after four weeks cryopreservation, in group 2, when allograft was extracted, trachea of 4 dogs was stenosed, and six months preserved trachea was not seen due to total necrosis. Cartilage viability of 4 case of transplantation, three of 4 case were mild infiltration of monocyte. CONCLUSION: We conclude that more than 1 month cryopreservation for prevention of rejection and additional procedure (omentopexy) for graft vascular supply are needed for trachea transplatation. Although cryopreservation was performed, all case of transplantation happened some degree graft rejection. if trachea transplantation will be applied, immune suppress will be needed.