A Totally Thoracoscopic Ablation for Persistent Atrial Fibrillation

We report the case of a 72-year-old female with persistent atrial fibrillation who underwent a totally thoracoscopic ablation. A successful normal sinus conversion was achieved.

Prognostic Factors for Mortality in Emergency Department Patients with Hypotension / 대한구급학회지

BACKGROUND: This study was performed to analyze the effects of differences between initial and follow up amounts of central venous oxygen saturation (Scvo2), lactate, anion gap (AG), and corrected anion gap (CAG). METHODS: Patients with systolic blood pressure that was lower than 90 mmHg participated in this study. Along with Arterial Blood Gas Analysis (ABGA), the amounts of electrolytes, albumin, and Scvo2 were initially checked and then re-checked four hours later. The patients were divided into two groups, which were survived and expired, and the differences in initial and final values were compared in both groups. RESULTS: Out of a total of 36 patients, 29 patients survived and 7 patients died. The data showed almost no difference in mean age, mean arterial pressure, heart rate, respiratory rate, and body temperature between two groups. Comparing the initial amount, there was a statistically significant variation in lactate. Comparing the final values, lactate, AG, and CAG varied significantly. However, for both groups, the differences between the initial and final values were not significant. The area under curve (AUC) of follow up lactate and follow up CAG was 0.89 and 0.88. AUC of ED-APACHEII and original ICU APACHEII was 0.74 and 0.96. CONCLUSIONS: There was no prognostic effect of Scvo2, lactate, AG, and CAG in hypotensive patients. The initial and final values of lactate and CAG were good prognostic factors for the expired group.

A Case of Pulmonary Sparganosis in a Patient with a History of Recurrent Sparganum Infections / 결핵및호흡기질환

Sparganosis is a zoonosis caused by the migrating larvae of cestode genus Spirometra. We report a rare form of sparganosis that invades the lung. A 44-year-old man presented with newly appeared pulmonary nodules that were found accidentally on regular medical checkup, and on sequential chest CT, which we checked at an interval of every 2 months, revealed that the pulmonary lesion had migrated. The patient had a medical history of having undergone surgical excisions for sparganosis in muscles and in subcutaneous tissues of the lower abdomen, perianus, thigh, right axilla, and scapula area, several times over 7 years. A right middle lobectomy was performed and the lesion was diagnosed as sparganosis based on the characteristic histological findings.

Change in Pulmonary Function Following Empyemectomy and Decortication in Tuberculous and Non-Tuberculous Chronic Empyema Thoracis

Chronic empyema thoracis results from various etiologies. Improvement in pulmonary function after empyemectomy and decortication has proved difficult to predict when the etiology of chronic empyema thoracis is tuberculosis. The purpose of this study was to confirm the changes in pulmonary function according to the etiology after an operation. Sixty-five patients were classified into two groups according to their etiology: Group A (tuberculous) and Group B (non-tuberculous), and they were retrospectively evaluated with regard to their forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), percentage of predicted normal value of FEV1 (% FEV1) and FVC (%FVC). Empyemectomy and decortication was performed for all the patients and the two groups were similar in age, gender and preoperative spirometric parameters. In Group A (n=41), the pre- and postoperative mean values were 2.31L and 2.88L in FEV1, 65.8% and 80.5% in %FEV1, 2.62L and 2.55 L in VC, 61.9% and 71.8% in %VC, respectively. In Group B (n=24), the pre- and postoperative mean values were 2.13L and 2.49L in FEV1, 66.4% and 73.8% in %FEV1, 2.55L and 2.95 L in FVC, 64.9% and 71.8% in %FVC, respectively. All the spirometric parameters improved significantly in both groups compared to their preoperative values. However, no significance was shown in the rate of increase of the spirometric parameters between the two groups. In conclusion, improvement of lung function is expected after empyemectomy and decortication, regardless of the etiology of the chronic empyema thoracis.

Clinical Review of Primary Chest Wall Tumors / 대한흉부외과학회지

BACKGROUND: Primary chest wall tumors originate from soft tissue, bone or cartilage of the chest wall and it comprises 1~2% of all primary tumors. Resection of tumor is often indicated for chronic ulceration or pain, and long-term survival might be achieved after surgery depending on the histology and the surgical procedure. MATERIAL AND METHOD: Retrospective study of 125 primary chest wall tumors (86 benign, 39 malignant) operated between Sep. 1976 to Mar. 2001 were reviewed and their clinical outcomes were analyzed. Follow-up data were collected at the outpatient clinic. RESULT: All patients with benign tumors were treated by excision without recurrence or death, and most malignancies were treated by wide resection. Malignant fibrous histiocytoma and chondrosarcoma constituted 46.2% of the malignant neoplasm. There was no operative death. The overall 3-year survival for patients with primary malignant neoplasm was 76.0%, and the 10-year survival was 60.5%. All deaths were disease-related and the tumor recurred in 11 patients. There was no significant difference in survival between patients with resection margins less than 4 cm and those with resection margins greater than 4 cm. CONCLUSION: Chest wall resection offers excellent results for benign chest wall tumors and substantial long-term survival for malignant diseases. Safe resection margin of 4 cm or more did not correlate with the survival rate although the tumor recurrence correlated with poor survival.

The Effect of Visceral Pleura Invasion in the Resected Stage IB Non-Small Cell Lung Cancer Patients

PURPOSE: The purpose of this study was to clarify the prognostic significance of visceral pleura invasion in T2N0M0 non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: Between Jan. 1990 and Dec. 2001, 213 consecutive patients with T2N0M0 NSCLC underwent complete surgical resection. The patients were divided into two groups according to the existence of visceral pleural invasion. P1 and P2 defined by Hammar's definition were included in visceral pleural invasion group. The follow-up was carried out completely without missing case. The median follow-up period was 34.4 months, ranging from 0.13 to 156.2 months. RESULTS: Patient ages ranged from 10 to 79 years (mean: 60.1 years, median : 62 years). Visceral invasion was identified in 55 patients (25.8%). The operation included lobectomy in 110, pneumonectomy in 67, bi-lobectomy in 36 patients. Histology was squamous cell carcinoma in 110, adenocarcinoma in 72, large cell carcinoma in 13, others in 18. There were 5 hospital mortality (2.3%) and 71 late mortality (33.3%). 27 (50.94%) and 44 (28.4%) of late mortality were in visceral pleural invasion group (Group I) and visceral pleural non-invasion group (Group II) respectively (p=0.002). Overall 5-year survival rate was 44.8% in Group I and 63.5% in group II (p=0.0017). There were 55 (25.8%) postoperative recurrences, 24(43.6%) in group I, 21 (13.3%) in group II (p<0.0001). There were 60 recurrence sites, 58 (96.7%) of them were distant metastases, 2 (3.3%) were local recurrences. CONCLUSION: Visceral pleural invasion is a significant prognostic factor in stage IB NSCLC in survival time and recurrence. The postoperative adjuvant systemic therapy can be thought in stage IB NSCLC with visceral pleural invasion

Early and Late Surgical Result of Post MI-VSD / 대한흉부외과학회지

BACKGROUND: Despite early aggressive treatment, post myocardial infarction(MI) ventricular septal defect(VSD) revealed high surgical mortality. We reviewed the 10-year experiences of surgically treated post-MI VSD in Yonsei University. MATERIAL AND METHOD: From Jan. 1991 to May 2001, 17 patients underwent surgical repair of post-MI VSD. Ages ranged between 47 and 77 years (mean age=63.2+/-9.1). There were 10 males and 7 females. VSD was located at anterior in 16 patients and at posterior in one. IABP was inserted preoperatively in 12 patients due to cardiogenic shock. Mean interval from MI to occurrence of VSD was 5.6 days. Among patients undergoing early surgical correction(n=13), mean interval from occurrence of VSD to operation was 2.5 days. In 11 patients, concomitant CABG was performed during repair of VSD. RESULT: Four patients died within 30 days after the operation (30 day mortality=23.5%). Among 12 patients with preoperative cardiogenic shock, 4 patients died within 30 days (30-day mortality=33.3%). During mean follow up period of 52 months, one patient died of unknown cause and 10-year survival of discharged patients was 66.7%. All follow-up patients were in NYHA functional class I or II when their last OPD visit. CONCLUSION: In the treatment of post-MI VSD, aggressive medical treatment with early surgical correction seems to be very important in terms early and long-term survival of patients.

Endobronchial Inflammatory Myofibroblastic Tumor of Right Lower Lobar Bronchus / 대한흉부외과학회지

Inflammatory myofibroblastic tumor was widely known as inflammatory pseudotumor, commonly developed as a solid mass in lung.The endobronchial inflammatory myofibroblastic tumor is a very rare case where only a few cases have been reported.We report a 13-year-old girl who had coughing for 5 months.The simple chest X-ray and computued tomography of the chest revealed a mass which obstructed the right lower lobe bronchus and pneumonic consolidation.The fiberoptic bronchoscopic finding was mostly gelatinous,gray-yellowish mass that obstructed the airway of right lower lobe bronchus nearly,and was considered as a chondroid hamartoma pathologically.Right lower lobectomy of lung was performed.The mass was confirmed as a endobronchial inflammatory myofibroblastic tumor.The patient was discharged without complication and with outpatient followup.

Surgical Management and Long-Term Outcome of Bronchial Carcinoids / 대한흉부외과학회지

BACKGROUND: Bronchial carcinoids account for approximately 2% of all pulmonary tumor and consist of typical carcinoids and atypical carcinoids. An atypical carcinoid is considered to be an intermediate form of tumor between a low-grade malignant typical carcinoid and a high-grade malignant small cell lung carcinoma. There is still controversy with regard to the extent of resection and the value of systemic adjuvant therapy in atypical carcinoids. We performed a retrospective review of our experiences at Severance Hospital. MATERIAL AND METHOD: Between 1990 and 2000, 15 patients with bronchial carcinoids were operated, and 5 of these had atypical carcinoids. Histologic diagnosis was established on the criteria of WHO/IASLC(1999). RESULT: There were 3 pneumonectomies, 11 lobectomies, and 1 segmentectomy. In typical carcinoids, one patient had regional lymph node metastasis, and 3 patients in atypical carcinoids had mediastinal lymph node metastases. Distant metastases developed in one patient of typical carcinoid, but developed in 4 patients of atypical carcinoids(p=0.0017). The 5-year survival rate in patients with atypical carcinoids was 20%, versus the 100% 5-year survival rate observed in patients with typical carcinoids(p=0.0039). CONCLUSION: In atypical carcinoids, because of many lymph node metastases on diagnosis and a low long-term survival rate, lobectomy constitutes a mininal procedure. Adjuvant systemic therapy is recommended for patients with lymph node and distant metastasis.

Pleuropneumonectomy in a Patient With Acquired Immune / 대한흉부외과학회지

A 54-year-old homosexual man was diagnosed as human immunodeficiency virus-1-positive in 1992. He was admitted to a tertiary hospital in March, 2000 because of right flank pain, fever and intermittent cough. A chest roentgenogram showed right-sided pleural effusion, and closed thoracostomy was performed for drainage. Salmonella species and Escherichia coli were isolated from the pleural fluid. In spite of 6 weeks of antibiotic treatment, fever did not subside and the general condition gradually deteriorated, and under the diagnosis of lung abscess with empyema thoracis, right pleuropneumonectomy was performed. The general condition improved postoperatively until day 10 when he showed sudden change in mental status to stuporous and developed focal seizure. Brain CT showed multiple abscesses in right frontal and left frontotemporal lobes and he expired on postoperative day 14.

Postinfarction Left Ventricular Free Wall Rupture / 대한흉부외과학회지

Left ventricular free wall rupture following acute myocardial infarction (AMI) is the second most common cause of death and has been reported to be responsible for 4 to 24% of all infarction deaths. The rupture occurs anywhere from a few hours to several days after AMI. The common findings of ventricular rupture are persistent chest pain bradycardia and shock. This may be often mistaken for the ruptured dissection of the ascending aorta. The different points from dissection are 1) persistent chest pain 2)persistent ST segment elevation and 3) only intramural hematoma in ascending aorta. We have sucessfully managed two patients with postinfarction myocardial rupture. Surgical management consisted of infarctectomy repairi of the ventricular rupture and coronay artery bypass grafting. We conclude that successful surgical management of ventricular free wall rupture should require prompt diagnosis and emergency operation.