Clinical Outcomes of Atypical Inflammatory Variants of Abdominal Aortic Aneurysm.

BACKGROUND: Most abdominal aortic aneurysms are degenerative atherosclerotic aneurysms. Inflammatory or infected abdominal aortic aneurysms, which show a slightly different clinical course, are rarely encountered in clinical settings. Therefore, we aimed to investigate the clinical course of these variants of abdominal aortic aneurysms. METHODS: This retrospective study included 32 patients with atypical inflammatory or infected abdominal aortic aneurysms who underwent emergent graft replacement between November 1997 and December 2017. Patients were followed up at the outpatient clinic for a mean period of 4.9±6.9 years. We analyzed the patients' clinical course and compared it with that of patients with atherosclerotic abdominal aortic aneurysms. RESULTS: There was 1 surgical mortality (3.0%) in a case complicated by aneurysmal free rupture. In 2 cases of infected abdominal aortic aneurysms, anastomotic complications developed immediately postoperatively. During the follow-up period, 10 patients (30%) developed graft complications, and 9 of them underwent reoperations; of these, 2 patients (22.2%) died of postoperative complications after the second operation, whereas 2 patients survived despite graft occlusion. CONCLUSION: Patients with inflammatory abdominal aneurysms frequently develop postoperative graft complications requiring secondary surgical treatment, so they require close mandatory postoperative follow-up.

Prognostic Significance of Cigarette Smoking in Association with Histologic Subtypes of Resected Lung Adenocarcinoma.

BACKGROUND: Smokers with lung adenocarcinoma have a worse prognosis than those who have never smoked; the reasons for this are unclear. We aimed to elucidate the impact of smoking on patients' prognosis and the association between smoking and clinicopathologic factors, particularly histologic subtypes. METHODS: We reviewed the records of 233 patients with pathologic stage T1-4N0-2M0 lung adenocarcinomas who underwent surgery between January 2004 and July 2015. The histologic subtypes of tumors were reassessed according to the 2015 World Health Organization classification. RESULTS: In total, 114 patients had a history of smoking. The overall survival probabilities differed between never-smokers and ever-smokers (80.8% and 65.1%, respectively; p=0.003). In multivariate analyses, the predominant histologic subtype was an independent poor prognostic factor. Smoking history and tumor size >3 cm were independent predictors of solid or micropapillary (SOL/MIP)-predominance in the logistic regression analysis. Smoking quantity (pack-years) in patients with SOL/MIP-predominant tumors was greater than in those with lepidic-predominant tumors (p=0.000). However, there was no significant difference in smoking quantity between patients with SOL/MIP-predominant tumors and those whose tumors had non-predominant SOL/MIP components (p=0.150). CONCLUSION: Smoking was found to be closely associated with SOL/MIP-predominance in lung adenocarcinoma. Greater smoking quantity was related to the presence of a SOL/MIP component.

Lymph Node Metastasis after Spontaneous Regression of Non-Small Cell Lung Cancer.

Spontaneous regression of lung cancer is a very rare and poorly understood phenomenon. A 64-year-old man presented to Dong-A University Hospital with a shrunken nodule in the right lower lobe. Although the nodule showed a high likelihood of malignancy on needle aspiration biopsy, the patient refused surgery. The nodule spontaneously regressed completely in the next 17 months. However, the subcarinal lymph node was found to be enlarged 16 months after complete regression was observed. We pathologically confirmed metastasis of squamous cell carcinoma and performed neoadjuvant chemotherapy, surgery, and adjuvant chemoradiation. Regardless of tumor size reduction, it is preferable to perform surgery aggressively in cases of operable lung cancer.

Systemic air embolism after computed tomography-guided hook wire localization: two case reports and literature review.

Computed tomography (CT)-guided hook wire localization is often used to identify small nodules prior to video-assisted thoracoscopic surgery (VATS). Pneumothorax, intrapulmonary hemorrhage, and wire dislodgement are well-known complications associated with the former procedure, but systemic air embolism (SAE) is an extremely rare and potentially fatal complication. We encountered two cases of SAE; one patient showed neurologic symptoms, whereas the other did not. With the patient in the supine position, 100% oxygen was inhaled via a face mask. Subsequently, symptoms were resolved, and we performed planned surgeries on that day. Operative and postoperative courses were uneventful, and both patients were discharged without any sequelae. In this case report, we describe our experience with the two patients and review related literature.

Risk Factors of On-Pump Conversion during Off-Pump Coronary Artery Bypass Graft.

BACKGROUND: Off-pump coronary artery bypass grafting (OPCABG) procedures can avoid the complications of an on-pump bypass. However, some cases unexpectedly require conversion to cardiopulmonary bypass during OPCABG. The risk factors associated with a sudden need for cardiopulmonary bypass were analyzed. METHODS: This retrospective study included 283 subjects scheduled for OPCABG from 2001 to 2010. These were divided into an OPCABG group and an on-pump conversion group. Preoperative, operative, and postoperative variables were compared between the 2 groups. RESULTS: Of the 283 patients scheduled for OPCABG, 47 (16%) were switched to on-pump coronary artery bypass grafting (CABG). The mortality of the both the OPCABG and on-pump conversion groups was not significantly different. The major risk factors for conversion to on-pump CABG were congestive heart failure (CHF) (odds ratio [OR], 3.5; p=0.029), ejection fraction (EF) <35% (OR, 4.4; p=0.012), and preoperative beta-blocker (BB) administration (OR, 0.3; p=0.007). The use of intraoperative (p=0.007) and postoperative (p=0.021) inotropics was significantly higher in the conversion group. The amount of postoperative drainage (p<0.001) and transfusion (p<0.001) also was significantly higher in the conversion group. There were no significant differences in stroke or cardiovascular complications between the groups over the course of short-term and long-term follow-up. CONCLUSION: Patients who undergo OPCABG and have CHF or a lower EF (<35%) are more likely to undergo on-pump conversion, while preoperative BB administration could help prevent conversions from OPCABG to on-pump CABG.

Pericardial-esophageal Fistula Complicating Atrial Fibrillation Ablation Successfully Resolved after Pericardial Drainage with Conservative Management.

A 40-year-old male patient underwent radiofrequency catheter ablation for symptomatic paroxysmal atrial fibrillation (AF). Although pulmonary vein (PV) isolation was successfully completed without acute complications, the patient began complaining of sustained retrosternal pain. Seventeen days after ablation, the patient visited the emergency room with fever and severe chest pain with pericarditis-like features. Chest computed tomography (CT) revealed clustered air bubbles in the pericardial space. Esophagography confirmed leakage of contrast agent into the pericardial space but not into the left atrium. While performing pericardiostomy, the operator confirmed the absence of active bleeding from the left atrium. Because there were no signs of left atrial-esophageal fistula, such as systemic embolization, conservative management based on strict fasting with fluids and antibiotic therapy was undertaken. Follow-up esophagography performed 2 weeks later showed no more contrast agent leakage, and the patient was discharged without further incident.

Impact of Lifestyle Diseases on Postoperative Complications and Survival in Elderly Patients with Stage I Non-Small Cell Lung Cancer.

BACKGROUND: The influence of lifestyle diseases on postoperative complications and long-term survival in patients with non-small cell lung cancer (NSCLC) is unclear. The aim of this study was to determine whether lifestyle diseases were significant risk factors of perioperative and long-term surgical outcomes in elderly patients with stage I NSCLC. METHODS: Between December 1995 and November 2013, 110 patients aged 65 years or older who underwent surgical resection of stage I NSCLC at Dong-A University Hospital were retrospectively studied. We assessed the presence of the following lifestyle diseases as risk factors for postoperative complications and long-term mortality: diabetes, hypertension, chronic obstructive pulmonary disease, stroke, and ischemic heart disease. RESULTS: The mean age of the patients was 71 years (range, 65 to 82 years). Forty-six patients (41.8%) had hypertension, making it the most common lifestyle disease, followed by diabetes (n=23, 20.9%). The in-hospital mortality rate was 0.9% (n=1). The 3-year and 5-year survival rates were 78% and 64%, respectively. Postoperative complications developed in 32 patients (29.1%), including 7 (6.4%) with prolonged air leakage, 6 (5.5%) with atrial fibrillation, 5 (4.5%) with delirium and atelectasis, and 3 (2.7%) with acute kidney injury and pneumonia. Univariate and multivariate analyses showed that the presence of a lifestyle disease was the only independent risk factor for postoperative complications. In survival analysis, univariate analysis showed that age, smoking, body mass index, extent of resection, and pathologic stage were associated with impaired survival. Multivariate analysis revealed that resection type (hazard ratio [HR], 2.20; 95% confidence interval [CI], 1.08 to 4.49; p=0.030) and pathologic stage (HR, 1.89; 95% CI, 1.02 to 3.49; p=0.043) had independent adverse impacts on survival. CONCLUSION: This study demonstrated that the presence of a lifestyle disease was a significant prognostic factor for postoperative complications, but not of survival, in elderly patients with stage I NSCLC. Therefore, postoperative complications may be influenced by the presence of a lifestyle disease.

Prediction and prognostic factors of post-recurrence survival in recurred patients with early-stage NSCLC who underwent complete resection.

BACKGROUND: This study aimed to evaluate prognostic factors of post-recurrence survival (PRS) and to improve survival in recurred patients with early-stage non-small cell lung cancer (NSCLC). METHODS: The 141 patients with recurrence after complete resection of stage I and II NSCLC between 1995 and 2012 was retrospectively reviewed. Overall PRS and PRS of the patient groups stratified according to the sum of their own risk scores were analyzed. RESULTS: The patterns of recurrence of 141 patients included local only in 40(28.4%), distant only in 86 (61%) and both in 15 (10.6%) patients. Of 141 patients, 110 patients received post-recurrence therapy. The overall 1- and 3-year PRS rates were 50.7% and 28.4%, respectively. Extensive pulmonary resection (P=0.001), poor histologic differentiation (P=0.009), symptom at initial recurrence (P=0.000), no pulmonary metastasis (P=0.006), no post-recurrence therapy (P=0.001) were significant risk factors in univariate analysis. Multivariate analysis revealed that extent of pulmonary resection [hazard ratio (HR), 2.039; 95% confidence interval (CI), 1.281 to 3.244; P=0.003; risk score 1.0], histologic differentiation HR, 3.125; 95% CI, 1.976 to 4.941; P=0.000; risk score 1.5), symptom (HR, 3.154; 95% CI, 2.000 to 4.972; P=0.000; risk score 1.5) and post-recurrence therapy (HR, 2.330; 95% CI, 1.393 to 3.899; P=0.001; risk score 1.1) were significant prognostic factors. The recurred patients whose risk score sums were 1.1 or less were assigned to Group I; between 1.5 and 2.1, to Group II; and more than 2.5, to Group III. Significant differences in their PRS rates were confirmed (P=0.000). CONCLUSIONS: Extent of pulmonary resection, histologic differentiation, symptom and post-recurrence therapy are a prognostic factor for PRS. Based on the hazard ratios of each factors, the risk scores were yielded. And the recurred patients were stratified according to the sum of their risk scores based on their PRS rates. Therefore, these results may help advancements in making predictions for their prognosis and the improvement of PRS.

Prognosis of recurrence after complete resection in early-stage non-small cell lung cancer.

BACKGROUND: Tumor recurrence is the most common cause of treatment failure, even after complete resection of early-stage non-small cell lung cancer (NSCLC). In this study, we investigated the prognosis of patients with early recurrence in order to identify independent risk factors related to early recurrence. METHODS: Between February 1995 and December 2012, 242 patients who underwent surgical resection for stage I NSCLC at Dong-A University Hospital were reviewed. The factors predicting overall survival (OS) and early recurrence were investigated. We also investigated the relationship between the patterns and period of recurrence and clinicopathological factors. RESULTS: For patients with stage IA and IB NSCLC, the 5-year OS rate was 75.7% and 57.3% (p=0.006), respectively. A multivariate Cox proportional hazards model demonstrated that gender (p=0.004), comorbidity number (p=0.038), resection type (p=0.002), and tumor size (p=0.022) were the statistically significant predictors of OS. Moreover, the multivariate analysis revealed that smoking history (p=0.023) and histologic grade (p=0.012) were the independent predictors of early recurrence. Additionally, only histologic grade (poor differentiation) was found to be significantly associated with a higher frequency of distant metastasis; there was no relationship between the patterns and period of recurrence and clinicopathological factors. CONCLUSION: The present study demonstrated that smoking history and histologic grade were independent prognostic factors for early recurrence within two years in patients with early-stage NSCLC. Patients with these predictive factors may be good candidates for adjuvant therapy.

Continuous "over and over" suture for tricuspid ring annuloplasty.

BACKGROUND: A ring implantation in the tricuspid annulus requires many interrupted mattress sutures for correction of tricuspid regurgitation (TR). In this study, tricuspid ring annuloplasty was performed by 2-0 polypropylene continuous suture instead of multiple interrupted 2-0 polyester mattress sutures, and the efficacy of the method was evaluated. MATERIALS AND METHODS: This study included 20 patients who underwent tricuspid ring annuloplasty by continuous suture between May 2009 and July 2010. Four of the patients had an isolated TR, and the rest had a left-sided cardiac lesion. The concomitant tricuspid annuloplasty was performed after the left-sided heart surgery was completed and a Duran flexible ring prosthesis was used. RESULTS: There was no perioperative mortality or conduction problem. More than a moderate degree of TR was improved to less than a mild degree after the procedure. After the ring annuloplasty, the right atrial volume decreased from 123.7±69.2 mL to 74.5±37.4 mL, and the mean right atrial pressure was lowered from 18.7±12.2 mmHg to 8.9±5.5 mmHg. CONCLUSION: The continuous "over and over" suture may be a useful procedure for fixing the ring to the annulus and making an intentional annular placation in performing tricuspid ring annuloplasty.