Alternative Surgical Methods in Patients with Recurrent Palmar Hyperhidrosis and Compensatory Hyperhidrosis

Recurrent hyperhidrosis after thoracic sympathectomy is an uncomfortable condition, and compensatory hyperhidrosis (CH) is one of the most troublesome side effects. Here, we describe two patients with recurrent palmar hyperhidrosis (PH) and CH over the whole body simultaneously. They were treated with bilateral T4 sympathetic clipping and reconstruction of the sympathetic nerve from a T5 to T8 sympathetic nerve graft, which was transferred to the resected T3 sympathetic bed site. They reported improvements in sweating and were fully satisfied with the results. Our method can be considered as an alternative approach for patients with recurrent PH and CH.

Acute Respiratory Distress Syndrome after Viscum album Pleurodesis for Primary Spontaneous Pneumothorax

A 52-year-old male patient who underwent multiple wedge resections experienced postoperative acute respiratory distress syndrome in both lungs after Viscum album pleurodesis. Despite initial rapid deterioration in clinical condition and rapid progression of bilateral lung infiltration, he exhibited a relatively smooth clinical recovery with marked response to glucocorticoid treatment. Our case report suggests that care must be taken to guard against the development of acute respiratory complications in the use of Viscum album for pleurodesis. However, in view of the clinically benign course, initial aggressive management of complications can prevent suffering and sequelae.

Late Respiratory Infection after Lung Transplantation / 결핵및호흡기질환

BACKGROUND: Aiming to improve outcome of lung transplantation (LTx) patients, we reviewed risk factors and treatment practices for the LTx recipients who experienced respiratory infection in the late post-LTx period (>1 month after LTx). METHODS: We analyzed the clinical data of 48 recipients and donors from 61 LTx, who experienced late respiratory infections. Late respiratory infections were classified according to the etiology, time of occurrence, and frequency of donor-to-host transmission or colonization of the recipient prior to transplantation. RESULTS: During the period of observation, 42 episodes of respiratory infections occurred. The organisms most frequently involved were gram (-) bacteria: Acinetobacter baumannii (n=13, 31.0%), Pseudomonas aeruginosa (n=7, 16.7%), and Klebsiella pneumoniae (n=4, 10.0%). Among the 42 episodes recorded, 14 occurred in the late post-LTx period. These were bacterial (n=6, 42.9%), fungal (n=2, 14.3%), viral (n=4, 28.5%), and mycobacterial (n=2, 14.3%) infections. Of 6 bacterial infections, 2 were from multidrug-resistant (MDR) A. baumannii and one from each of MDR P. aeruginosa, extended spectrum beta-lactamase (+) K. pneumoniae, methicillin-resistant Staphylococcus aureus and Streptococcus pneumoniae. Infection-related death occurred in 6 of the 14 episodes (43%). CONCLUSION: Although the frequency of respiratory infection decreased sharply in the late post-LTx period, respiratory infection was still a major cause of mortality. Gram (-) MDR bacteria were the agents most commonly identified in these infections.

Ex vivo Lung Perfusion Model in Lung Transplantation / 대한이식학회지

BACKGROUND: Lung transplantation (LTx) is an effective treatment for end stage lung disease. However, the shortage of donor lungs has been a major limiting factor to increase the number of LTx. Ex vivo lung perfusion (EVLP) is a currently approved method to evaluate lung function and to repair donor lung with poor function. The purpose of this study was to develop EVLP system in pig model and to maintain lung function during 4 hours of EVLP. METHODS: Bilateral lung blocks were harvested from five 40 kg pigs. These blocks were applied in EVLP perfused with 37degrees C Steen solution. We performed arterial blood gas (ABG) analyses before death and also every 1 hour for 4 hours after application of EVLP and calculated oxygen capacities (OC) using the results of ABG. We also calculated pulmonary vascular resistance (PVR) and peak airway pressure (PAP) every 1 hour for 4 hours. After EVLP procedure, we excised specimens for pathologic review. RESULTS: We found that OC gradually decreased during the 4 hour period of EVLP; however, no statistically significant difference was obtained. PVR declined sharply after 1 hour of EVLP (P=0.031) and then remained constant for 3 hours. PAP significantly increased after 3 hours (P<0.0001). Pathologic investigations revealed various findings from normal lung to severe pulmonary edema. CONCLUSIONS: On the results of this study, we could preserve the lung function for 4 hours using EVLP. We conclude that application of EVLP in clinical setting can make more donor lungs available for LTx. However, we also understand that more studies and training are needed in clinical practice.

Treatment of Intractable Pneumothorax with Emphysema Using Endobronchial Watanabe Spigots

Prolonged air leakage is a major cause of morbidity in pneumothorax. When conservative management is not effective, surgery should be performed. However, surgery is not appropriate in patients with low pulmonary function. In these patients, occlusion of the airway with endobronchial blockers may be attempted under bronchoscopy. We treated two patients with prolonged air leakage using endobronchial Watanabe spigots under fibrobronchoscopy.

Paraneoplastic Encephalitis Associated with Thymoma: A Case Report

A 42-year-old woman with short-term memory loss visited Gangnam Severance Hospital, and her chest X-ray and computed tomography revealed a right anterior mediastinal mass. On hospital day two, she suddenly presented personality changes and a drowsy mental status, so she required ventilator care in the intensive care unit. She underwent thymectomy, and was pathologically diagnosed with thymoma, type B1. Her mental status eventually recovered by postoperative day 90. Paraneoplastic encephalopathy associated with thymoma is very rare, and symptoms can be improved by thymectomy. We report a case of paraneoplastic encephalopathy associated with a thymoma.

Treatment of Intractable Pneumothorax with Emphysema Using Endobronchial Watanabe Spigots

Prolonged air leakage is a major cause of morbidity in pneumothorax. When conservative management is not effective, surgery should be performed. However, surgery is not appropriate in patients with low pulmonary function. In these patients, occlusion of the airway with endobronchial blockers may be attempted under bronchoscopy. We treated two patients with prolonged air leakage using endobronchial Watanabe spigots under fibrobronchoscopy.

Paraneoplastic Encephalitis Associated with Thymoma: A Case Report

A 42-year-old woman with short-term memory loss visited Gangnam Severance Hospital, and her chest X-ray and computed tomography revealed a right anterior mediastinal mass. On hospital day two, she suddenly presented personality changes and a drowsy mental status, so she required ventilator care in the intensive care unit. She underwent thymectomy, and was pathologically diagnosed with thymoma, type B1. Her mental status eventually recovered by postoperative day 90. Paraneoplastic encephalopathy associated with thymoma is very rare, and symptoms can be improved by thymectomy. We report a case of paraneoplastic encephalopathy associated with a thymoma.

Gastrointestinal Complications after Lung Transplantation / 대한흉부외과학회지

BACKGROUND: The postoperative management following lung transplantation has dramatically improved in the recent decade. However, some complications still remain as troublesome problems. We retrospectively reviewed the gastrointestinal complications and their management after lung transplantation. MATERIAL AND METHOD: We performed a retrospective review of the medical records of 25 cases in 23 patients who underwent lung and heart-lung transplantations from July 1996 to March 2009. The definition of gastrointestinal complication was the gastrointestinal tract-related disease that occurred after lung transplantation. There were eight postoperative deaths (within postoperative 30 days) that were excluded from the analysis. RESULT: Twenty three gastrointestinal complications occurred in 11 (64.7%) of the 17 cases. The median follow-up period was 6.9 months (range: 2 months to 111 months), and chronic gastritis (23.5%, 4 of 17 cases) was the most common complication. Severe, prolonged (more than 2 weeks) diarrhea occurred in 3 cases. Three patients had gastric ulcer with one case requiring gastric primary closure for gastric ulcer perforation. This patient had gastric bleeding due to recurrent gastric ulcer 2 months after laparotomy. Cytomegalovirus gastritis and esophagitis occurred in 2 cases and 1 case, respectively, and esophageal ulcer occurred in 2 cases. There were esophageal strictures in 2 patients who underwent esophageal stent insertion. Other complications were one case each of ileus, early gastric cancer requiring endoscopic mucosal resection, gall bladder stone accompanied with jaundice, and pseudomembranous colitis. CONCLUSION: The incidence of gastrointestinal complication is relatively high in patients after they undergo lung transplantation. Since gastrointestinal complications can induce malnutrition, which might be related to considerable morbidity and mortality, close follow-up is necessary for the early detection and proper management of gastrointestinal complications.

Noninvasive Respiratory Management for Patients with Cervical Spinal Cord Injury

OBJECTIVE: To verify the safety and clinical utility of noninvasive respiratory management as an alternative method of invasive respiratory management for the patients with cervical spinal cord injury (CSCI) who often present with ventilatory insufficiency (due to inspiratory muscle paralysis) or difficulty in removing airway secretions (because of expiratory muscle weakness). METHOD: Nineteen patients with CSCI (male: 15, female: 4, mean age: 45.6) were recruited. All of the patients were in need of mechanical ventilation due to ventilatory failure or indwelling tracheostomy tube for secretion management. In order to switch from invasive to noninvasive means of respiratory management, expiratory muscle aids such as manual assist or CoughAassist(R) and inspiratory muscle aids such as noninvasive ventilatory support were applied to all candidates. RESULTS: Fifteen out of the 19 patients had indwelling tracheostomy tubes, and the remaining 4 patients were intubated via endotracheal tubes at admission. Through the noninvasive respiratory management, we were able to remove intubation or traheostomy tubes for all of the patients. Eleven patients were able to maintain normal ventilation status without ventilatory support, as time went on. The rest 8 patients were continuously in need of ventilatory support, but they could maintain normal ventilation status by noninvasive method. CONCLUSION: Noninvasive respiratory management is safe and equally effective in treating ventilatory insufficiency or removing airway secretions for patients with CSCI. In cases of long-term ventilator dependency or chronic tracheostomy state, it can be replaced as a creditable alternative to invasive respiratory management.

Pneumomediastinum and Subcutaneous Emphysema after Dental Treatment / 대한흉부외과학회지

The pneumomediastinum after a dental treatment occurs rarely and shows almost good prognosis, however it is potentially life-threatening complication. Here we report a case of pneumomediastinum, occurred by air bubbles originated from dental high speed equipment, via head and neck fascial space with literatures review.

Pneumothorax due to Metastasis of Angiosarcoma to the Lung / 대한흉부외과학회지

An 80 year-old male with a medical history of angiosarcoma of the scalp visited the Emergency Department complaining of dyspnea, and the chest X-ray revealed pneumothorax. He has undergone scalp resection and radiotherapy three years ago due to angiosarcoma. Due to a persistent air leak, he underwent wedge resection of the lung and was pathologically diagnosed with metastatic angiosarcoma to the lung. He underwent radiotherapy following the lung resection, but he died from his disease at 15 month following surgery due to further aggravation of the lung metastasis. Angiosarcoma is a highly malignant tumor and it frequently occurs on the scalp and face in elderly patients. Angiosarcoma frequently metastasizes to the lung and it may cause pneumothorax as a consequence of a ruptured cavitary lesion. We report here on a case of pneumothorax that was caused by lung metastasis in an elderly patient with a history of angiosarcoma of the scalp.

Clinical Features and Treatment of Cervical Tuberculous Lymphadenitis / 대한흉부외과학회지

BACKGROUND: Cervical tuberculous lymphadenitis is the most common form of peripheral tuberculous lymphadenitis. The American Thoracic Society recommends 6 months of isoniazid, rifampin, ethambutol and pyrazinamide for treatment of peripheral tuberculous lymphadenitis, but even with this recommended treatment, frequent relapse occurs in actual clinical situations. MATERIAL AND METHOD: The medical records of 38 patients diagnosed and treated for cervical tuberculous lymphadenitis between February 1997 and February 2007 were retrospectively reviewed. RESULT: The study included 14 males (36.8%) and 24 females (63.2%), with a mean age of 36.9+/-16.3 years. The most frequent symptom was palpable neck mass in 24 patients (63.2%); 10 patients (26.3%) complained of fever or chills. Only nine patients (23.7%) had radiologic abnormalities. All patients received anti-tuberculous medications for at least 7 months, with isoniazid, rifampin, ethambutol and pyrazinamide for the first 2 months, and then isoniazid, rifampin and ethambutol given for more than 5 months. Relapse occurred in 7 patients (21.2%). CONCLUSION: Since many patients with cervical tuberculous lymphadenitis have no symptoms and show no radiologic abnormalities, diagnosis and treatment tend to be delayed. Considering the high relapse rate, the anti-tuberculous medication period should be longer than 6 months and this is recommended by the American Thoracic Society.

A Case Report on Redo Lung Transplantation for Treating Chronic Pulmonary Graft Rejection / 대한흉부외과학회지

A 43 year-old female, who underwent bilateral lung transplantation for Eisenmenger syndrome 10 years previously, visited our hospital complaining of progressive severe dyspnea. She was diagnosed as having bronchiolitis obliterans syndrome, which was presumably caused by chronic graft rejection following lung transplantation. Due to the aggravated dyspnea despite medical treatment, she required ventilator care and then she underwent lung retransplantation. We report here on a case of lung retransplantation for treating chronic graft rejection following the previous lung transplantation for the first time in Korea.

Surgical Treatment for Empyema after Lung Transplantation / 대한흉부외과학회지

Empyema after lung transplantation causes dysfunction of the allograft, and it has the potential to cause mortality and morbidity, but the technical difficulty of surgically treating this empyema makes this type of treatment unfavorable. We report here on two cases of decortication for empyema after lung transplantation.

Sympathetic Nerve Reconstruction for Compensatory Hyperhidrosis after Sympathetic Surgery for Primary Hyperhidrosis

We performed sympathetic nerve reconstruction using intercostal nerve in patients with severe compensatory hyperhidrosis after sympathetic surgery for primary hyperhidrosis, and analyzed the surgical results. From February 2004 to August 2007, sympathetic nerve reconstruction using intercostal nerve was performed in 19 patients. The subjected patients presented severe compensatory hyperhidrosis after thoracoscopic sympathetic surgery for primary hyperhidrosis. Reconstruction of sympathetic nerve was performed by thoracoscopic surgery except in 1 patient with severe pleural adhesion. The median interval between the initial sympathetic surgery and sympathetic nerve reconstruction was 47.2 (range: 3.5-110.7) months. Compensatory sweating after the reconstruction surgery improved in 9 patients, and 3 out of them had markedly improved symptoms. Sympathetic nerve reconstruction using intercostal nerve may be one of the useful surgical options for severe compensatory hyperhidrosis following sympathetic surgery for primary hyperhidrosis.

Metastasis to the Skeletal Muscle from a Malignant Phyllodes Tumor of the Breast: A Case Report

We report radiological findings of ultrasonography (US), 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) computed tomography (CT), and magnetic resonance (MR) imaging for a rare case of skeletal muscle metastasis from an underlying known malignant phyllodes tumor. To our knowledge, there has been no previous published report of imaging findings of skeletal muscle metastasis from a sarcoma such as malignant phyllodes tumor.

Thoracoscopic Sympathetic Nerve Reconstruction with using an Intercostal Nerve Graft after Thoracoscopic Sympathetic Clipping for Facial Hyperhidrosis / 대한흉부외과학회지

From October 2005 to August 2006, sympathetic nerve reconstruction with using the intercostal nerve was performed in 4 patients with severe compensatory hyperhidrosis following thoracoscopic sympathetic surgery for facial hyperhidrosis. The interval between the initial sympathetic clipping and the sympathetic nerve reconstruction was a median of 23.1 months. The compensatory sweating after sympathetic nerve reconstruction was improved for 2 patients, but it was not improved for 2 patients. Thoracoscopic sympathetic nerve reconstruction may be one of the useful treatment methods for the patients with severe compensatory hyperhidrosis after they under go sympathetic nerve surgery for hyperhidrosis.

Da Vinci Robot-Assisted Pulmonary Lobectomy in Early Stage Lung Cancer: 3 cases report / 대한흉부외과학회지

Video-assisted pulmonary lobectomy was introduced in the early 1990's by several authors, and the frequency of video-assisted thoracic surgery (VATS) lobectomy for lung cancer has been slowly increasing because of its safety and oncologic acceptability in patients with early stage lung cancer. However, VATS is limited by 2D imaging, an unsteady camera platform, and limited maneuverability of its instruments. The da Vinci Surgical System was recently introduced to overcome these limitations. It has a 3D endoscopic system with high resolution and magnified binocular views and EndoWrist instruments. We report three cases of da Vinci robot system-assisted pulmonary lobectomy in patients with early stage lung cancer.

Surgical Treatment of Catamenial Pneumothorax: A report of two cases / 대한흉부외과학회지

Recurrent pneumothorax was associated with the menstrual cycle in two women 20 to 30 years age; this is referred to as catamenial pneumothorax. This form of pneumothorax occurs within 72 hours before or after the onset of menstruation. The pathophysiology underlying this condition is unknown. We report here on two cases of catamenial pneumothorax that were successfully treated by partial resection of the diaphragm.