Clinical Review for the Some Patients of Lung Cancer in Pusan - Kyungnam Area / 대한암학회지

PURPOSE: This study was performed to find out the natural history of lung cancer in Pusan-Kyungnam area and changing of that in previous report. MATERIALS AND METHOD: We studied retrospectively 508 patients with pathologically proven lung cancer from January 1991 to December 1995. We analysed age and sex distribution, initial symptoms before diagnosis, first method yielding histologic diagnosis, cell types of lung cancer, initial stage of lung cancer, schema of overall patients, survivial of lung cancer patients, and prognostic factors affecting survival of lung cancer patients.. RESULTS: The overall male to female ratio was 4.5: 1 and the age distribution ranged from 20 to 86 years, and the median age of overall patients was 60 years. Histologic classification revealed that the most prevalent type was squamous cell carcinoma (251 cases, 49.4%), followed by adenocarcinoma (141 cases, 27.8%), small cell carcinoma (91 cases, 17.9%), and large cell carcinoma (3 cases, 0.6%). In non-smali cell lung cancer 56.8% were stage IIIb and IV, therefore curative operation was done in 18.7% of all cases, but in small cell lung cancer 65.6% were extended disease. Meidan survival of overall patients was 11.8 months. There was a quite difference in survival among the stages. In non-small cell lung cancer, median survival was 59.7 months, 27.3 months, 18.5 months, 12.7 months, 5.9 months in stage I, II, IIIa, IIIb, IV in each. In small cell lung cancer, median survival of limited disese was 12.2 months and median survival of extended disease was 6.7 months. The stage and the performance status were independent prognostic factors in both small cell and non-small cell lung cancer. CONCLUSION: The prognosis of patients with lung cancer was still grave, but the survival was better than that of a previous report. This may be accorded to increase in early diagnosis and operation and advance in supportive care.

Surgical Correction of Thoracic Aortic Aneurysm Associated with Coronary Artery Disease: A Case Report / 대한흉부외과학회지

We experienced a case of thoracic aortic aneurysm combined with coronary artery disease. A 68-year-old man complained of anginal pain in the left anterior chest and nonspecific pain in the posterior chest. The aneurysm was extending from left subclavian artery to the diaphragm and sign of impending rupture was noted in the chest CT. Coronary angiograms revealed significant obstruction of left circumflex coronary artery(>95%) and left anterior descending artery(>50%). Exposure was obtained through the left posterolateral thoracotomy incision in the 4th intercostal space and then partial femoro-femoral cardio- pulmonary bypass was established. After aortic cross clamping, the aneurysmal sac was opened and repaired with interposition of 26 mm Hemashield graft. Under the beating heart with femoro-femoral cardiopulmonary bypass, aorto-left circumflex coronary bypass with autogenous saphenous vein used as conduit was performed. Postoperatively multiple cerebral infarction ensued due to intraoperative hypovolemic shock and hypoxic brain damage during cardiopulmonary bypass. Currently, the patient's mental status is drowsy and in an improving state.

Clinical Analysis of Traumtic Diaphragmatic Injuries

Authors reviewed the records of sixteen patients with traumatic diaphragmatic injuries from May 1992 through December 1996. Thirteen patients were male and three were female(M:F=4.3:1). The age distribution ranged from 2 to 46 years with the mean age of 30.2 years. The sixteen patients included thirteen who had blunt trauma and three with penetrating trauma. Of those thirteen blunt trauma, twelve patients(92.3%) were left sided and one(7.7%) involved the right diaphragm. Three patients with penetrating trauma had left sided diaphragmatic injuries. The diagnosis was made preoperatively in thirteen patients(81.3%) and during surgery in three patients(18.8%). Thoracotomy was performed in eleven patients and thoracoabdominal incision in five. There was one death and the mortality rate was 6.3%.

Three Cases of Cardiac Injury due to Penetrationg and Blunt Trauma

Three cases who were successfully treated for cardiac injuries by open thoracotomy were reported. The range of the ages of the patients was 3rd decade. Two of the 3 were males with blunt injuries by motor vehicle accident and one was male with stab wound by knife. In the case of blunt injuries, the right atrium was involved in one case and the right and left atrium were involved in the other. The site of stab wound was the right atrium. There were two cases with the pre-operative diagnosis of cardiac injuries and they were blunt injuries. The case of stab wound was not diagnosed pre-operatively. All cases were treated with open thoracotomy-one posterolateral thoracotomy, one median sternotomy and one Clam shell incision. All of them had an uneventfull post-operative course.