Radial Probe Endobronchial Ultrasound Using Guide Sheath-Guided Transbronchial Lung Biopsy in Peripheral Pulmonary Lesions without Fluoroscopy / 결핵및호흡기질환

Background@#Radial probe endobronchial ultrasound-guided transbronchial lung biopsy (RP-EBUS-TBLB) has improved the diagnostic yield of bronchoscopic biopsy of peripheral pulmonary lesions (PPLs). The diagnostic yield and complications of RP-EBUS-TBLB for PPLs vary depending on the technique, such as using a guide sheath (GS) or fluoroscopy. In this study, we investigated the utility of RP-EBUS-TBLB using a GS without fluoroscopy for diagnosing PPLs. @*Methods@#We retrospectively reviewed data from 607 patients who underwent RP-EBUS of PPLs from January 2019 to July 2020. TBLB was performed using RP-EBUS with a GS without fluoroscopy. The diagnostic yield and complications were assessed. Multivariable logistic regression analyses were used to identify factors affecting the diagnostic yields. @*Results@#The overall diagnostic accuracy was 76.1% (462/607). In multivariable analyses, the size of the lesion (≥20 mm; odds ratio [OR], 2.06; 95% confidence interval [CI], 1.27–3.33; p=0.003), positive bronchus sign in chest computed tomography (OR, 2.30; 95% CI, 1.40–3.78; p=0.001), a solid lesion (OR, 2.40; 95% CI, 1.31–4.41; p=0.005), and an EBUS image with the probe within the lesion (OR, 6.98; 95% CI, 4.38–11.12; p<0.001) were associated with diagnostic success. Pneumothorax occurred in 2.0% (12/607) of cases and chest tube insertion was required in 0.5% (3/607) of patients. @*Conclusion@#RP-EBUS-TBLB using a GS without fluoroscopy is a highly accurate diagnostic method in diagnosing PPLs that does not involve radiation exposure and has acceptable complication rates.

Radial Probe Endobronchial Ultrasound Using Guide Sheath-Guided Transbronchial Lung Biopsy in Peripheral Pulmonary Lesions without Fluoroscopy / 결핵및호흡기질환

Background@#Radial probe endobronchial ultrasound-guided transbronchial lung biopsy (RP-EBUS-TBLB) has improved the diagnostic yield of bronchoscopic biopsy of peripheral pulmonary lesions (PPLs). The diagnostic yield and complications of RP-EBUS-TBLB for PPLs vary depending on the technique, such as using a guide sheath (GS) or fluoroscopy. In this study, we investigated the utility of RP-EBUS-TBLB using a GS without fluoroscopy for diagnosing PPLs. @*Methods@#We retrospectively reviewed data from 607 patients who underwent RP-EBUS of PPLs from January 2019 to July 2020. TBLB was performed using RP-EBUS with a GS without fluoroscopy. The diagnostic yield and complications were assessed. Multivariable logistic regression analyses were used to identify factors affecting the diagnostic yields. @*Results@#The overall diagnostic accuracy was 76.1% (462/607). In multivariable analyses, the size of the lesion (≥20 mm; odds ratio [OR], 2.06; 95% confidence interval [CI], 1.27–3.33; p=0.003), positive bronchus sign in chest computed tomography (OR, 2.30; 95% CI, 1.40–3.78; p=0.001), a solid lesion (OR, 2.40; 95% CI, 1.31–4.41; p=0.005), and an EBUS image with the probe within the lesion (OR, 6.98; 95% CI, 4.38–11.12; p<0.001) were associated with diagnostic success. Pneumothorax occurred in 2.0% (12/607) of cases and chest tube insertion was required in 0.5% (3/607) of patients. @*Conclusion@#RP-EBUS-TBLB using a GS without fluoroscopy is a highly accurate diagnostic method in diagnosing PPLs that does not involve radiation exposure and has acceptable complication rates.

Rectus abdominis muscle atrophy after thoracotomy / 영남의대학술지

Intercostal nerve injury is known to occur during thoracotomy; however, rectus abdominis muscle atrophy has rarely been reported. We describe a 52-year-old man who underwent primary closure of esophageal perforation and lung decortication via left thoracotomy. He was discharged 40 days postoperatively without any complications. He noticed an abdominal bulge 2 months later, and computed tomography revealed left rectus abdominis muscle atrophy. We report thoracotomy induced denervation causing rectus abdominis muscle atrophy.

Accidental cut of esophageal temperature probe during lobectomy for lung cancer: A case report

Adequate maintenance of body temperature during general anesthesia is necessary for safety. Generally, esophageal temperature probe is commonly used in practice for measuring core temperature because of its reliability and feasibility. Proper placement of esophageal temperature probe is important to avoid complications. In this case report, we describe our experience with a patient undergoing lobectomy of the lung in whom the esophageal temperature probe that was misplaced into the right intermediate bronchus was accidentally cut. This case highlights the need to carefully assess correct position of the temperature probe, especially in patients undergoing one-lung ventilation.

Comparison of the Long-Term Results of R3 and R4 Sympathicotomy for Palmar Hyperhidrosis

BACKGROUND: Video-assisted thoracoscopic sympathicotomy has been determined to be the best way to treat palmar hyperhidrosis. However, satisfaction with the surgical outcomes decreases with the onset of compensatory hyperhidrosis (CH) over time. The ideal level of sympathicotomy is controversial. Therefore, we compared the long-term results of R3 and R4 sympathicotomy. METHODS: We retrospectively reviewed 186 patients who underwent video-assisted thoracoscopic sympathicotomy between September 2001 and September 2015. We analyzed the long-term results with respect to hand sweating and CH, and the overall satisfaction in 186 patients. RESULTS: With respect to hand sweating, significantly more patients complained of overly dry hands in the R3 group (25% versus 3.7%, p<0.001) and of mildly wet hands in the R4 group (2.9% versus 13.4%, p=0.007). There was a significantly increased occurrence rate of CH in the R3 group (97.1% versus 65.9%, p< 0.001). The most frequent site of CH was the trunk area. The overall satisfaction was higher in the R4 group, but without significance (75% versus 85.4%, p=0.082). Significantly more patients reported being very satisfied in the R4 group (5.8% versus 22.0%, p=0.001). CONCLUSION: The R4 group had a higher rate of satisfaction than the R3 group with respect to hand sweating. CH and hand dryness were significantly less common in the R4 group than in the R3 group. The lower occurrence of hand dryness and CH resulted in a higher satisfaction rate in the R4 group.

Early Aggressive Surgical Treatment of Multiloculated Empyema

BACKGROUND: Empyema is the collection of purulent exudate within the pleural space. Overall, 36%–65% of patients with empyema cannot be treated by medical therapy alone and require surgery. Multiloculated empyema is particularly difficult to treat with percutaneous drainage. Therefore, we describe our experiences with early aggressive surgical treatment for rapid progressive multiloculated empyema. METHODS: From January 2001 to October 2015, we retrospectively reviewed 149 patients diagnosed with empyema who received surgery. The patients were divided into 2 groups according to whether they underwent emergency surgery or not. We then compared surgical outcomes between these groups. RESULTS: The patients in group A (emergency surgery, n=102) showed a more severe infectious state, but a lower complication rate and shorter length of hospital stay. The incidence of lung abscess was higher in group A, and abscesses were associated with diabetes and severe alcoholism. CONCLUSION: Early aggressive surgical treatment resulted in good surgical outcomes for patients with rapid progressive multiloculated empyema. Furthermore, we suspect that the most likely causes of multiloculated empyema are lung abscesses found in patients with diabetes mellitus as well as severe alcoholism.

Functional Mediastinal Pheochromocytoma

A 36-year-old man visited Yeungnam University Hospital with a sudden onset of palpitation, headache, and was found to be hypertensive. Chest radiography showed a 6 cm sized mass lesion on the posterior mediastinum. A biochemical study showed elevated levels of catecholamines. An I-123 metaiodobenzylguanidine scan revealed a hot uptake lesion on the posterior mediastinum. The patient was prepared for surgery with alpha and beta blocking agents. Two months later, we removed the tumor successfully. A histological study proved that the resected tumor was mediastinal pheochromocytoma. Functional mediastinal pheochromocytomas are rare. Therefore, we reported the case with a literature review.

Acute Type II Aortic Dissection with Severe Aortic Regurgitation and Chronic Descending Aortic Dissection in Pregnant Patient with Marfan Syndrome

Aortic dilatation and dissection are severe complications during pregnancy that can be fatal to both the mother and the fetus. The risks of these complications are especially high in pregnant patients with Marfan syndrome; however, incidents of descending aortic dissection are very rare. This case report involves a successful Bentall procedure for and recovery from a rare aortic dissection in a pregnant Marfan patient who developed acute type II aortic dissection with severe aortic regurgitation and chronic descending aortic dissection immediately after Cesarean section. Regular follow-up will be needed to monitor the descending aortic dissection.

Regression of Left Ventricular Mass after Aortic Valve Replacement in Isolated Aortic Regurgitation / 대한흉부외과학회지

BACKGROUND: The aim of our study was to assess the extent of regression of left ventricular mass after aortic valve replacement in isolated aortic regurgitation. MATERIAL AND METHOD: Retrospective analysis of echocardiographic data was collected preoperative and postoperative 1 year. There were 20 patients (12 males, 8 females, mean age 55.8+/-11.8 years, mean body surface area 1.64+/-0.19 m2) with aortic regurgitation from 2002 through 2007. We studied the change of left ventricular ejection fraction, ventricular septum and left ventricular posterior wall thickness, and left vemtricular muscle index (LVMI). The control group was age matched with normal echocardiographic study results. Patients with combined surgery or infective endocarditis were excluded. RESULT: Seven cases of tissue valves and thirteen cases of mechanical valve were used. The valve sizes were 21 mm (3 cases), 23 mm (13 cases) and 25 mm (4 cases). The postoperative (125.5+/-42 g/m2) LVMI has decreased than preoperative LVMI (212.3+/-80 g/m2, p=0.000) but higher than that of control group (80.5+/-15.9 g/m2, p=0.000). Postoperative septal wall (systolic/diastolic: 13.5+/-3.4 mm/17.1+/-4.1 mm) and left ventricular posterior wall (systolic/diastolic: 12.9+/-3.4 mm/16.7+/-3.4 mm) thickness were slightly decreased after the valve replacement but was not significantly different than preoperative levels. And postoperative interventricular septal wall and left ventricular posterior wall thickness (systolic/diastolic: 8.6+/-1.4 mm/12.1+/-1.7 mm, systolic/diastolic: 8.4+/-1.4/13.2+/-1.9) were higher than that of the control group (p<0.001). CONCLUSION: The significant regression of LVMI after aortic valve replacement developed at postoperative one year but the level was higher than control group. The main cause of decreased LVMI is decreased in left ventricular dimension.

Total Laparoscopic Hysterectomy using Modified Bae's Uterine Elevator / 대한산부인과학회잡지

OBJECTIVE: Hysterectomy is one of the most common gynecological operations. The objective of this study was to introduce a new uterine elevator for total laparoscopic hysterectomy. METHODS: Bae's uterine elevator was modified for laparoscopic hysterectomy. Modified Bae's uterine elevator was 5 cm longer than original one and handle was modified to vertical position and stopper, silicon tube and silicon adapter for colpotomizer was installed on the shaft. Three hundred and fifty seven cases of total laparoscopic hysterectomies using modified Bae's uterine elevator were performed from Jan 1999 to Jun 2000. RESULTS: Mean age of the patients was 41.8, operation time was 48.3 minutes and uterine weight was 245.5 gm. Leiomyoma was the most common cause of hysterectomies (70.9%), and followed by adenomyosis (16.2%), endometriosis (7.6%). There were no major operative complications such as vascular, bladder, ureter or intestinal injuries. CONCLUSIONS: Three hundred and fifty seven cases of total laparoscopic hysterectomies using modified Bae's uterine elevator were performed successfully without any major complications. Modified Bae's uterine elevator was very convenient for uterine manipulation during total laparoscopic hysterectomy.