A Case of Synchronous Presentation of Primary Non-Small Cell Lung Carcinoma and Pheochromocytoma / 결핵및호흡기질환

We report a rare synchronous presentation of primary lung cancer and adrenal pheochromocytoma. A 59-year-old woman was diagnosed with right upper lobe non-small cell lung carcinoma measuring 2.8 cm and a right adrenal gland mass measuring 3.5 cm, which displayed increased metabolic activity on 18F-fluorodeoxyglucose positron emission tomography-computed tomography. The adrenal lesion was revealed to be asymptomatic. The patient underwent right adrenalectomy and histological examination revealed a pheochromocytoma. Ten days later, right upper lobectomy was performed for lung cancer. This case indicates that incidental adrenal lesions found in cases of resectable primary lung cancer should be investigated.

An Elderly Man with Fatal Respiratory Failure after Eating a Poisonous Mushroom Podostroma cornu-damae / 결핵및호흡기질환

A 73-year-old, previously healthy man presented with nausea, vomiting, diarrhea, dry mouth and febrile sensation 3 hours after eating boiled wild mushrooms. After admission, he showed progressive severe respiratory distress, pancytopenia, azotemia, hypotension, hypoxemia and consolidation of the entire left lung on chest radiography. With a preliminary diagnosis of necrotizing pneumonia, he underwent left pneumonectomy in order to remove all necrotic lung tissue. Lung histology showed extensive hemorrhagic necrosis, massive inflammatory cell infiltration, prominent proliferation of young fibroblasts and the formation of an early-stage hyaline membrane along the alveolar wall. Despite aggressive treatment, including mechanical ventilation, continuous renal replacement therapy and administration of granulocyte colony stimulating factor and broad spectrum antibiotics, he died on hospitalization day 13. Subsequently, the mushroom was identified as Podostroma cornu-damae. This is the first case of a histological evidence of lung involvement by Podostroma cornu-damae poisoning in Korea.

Bronchoscopic Ethanolamine Injection Therapy in Patients with Persistent Air Leak from Chest Tube Drainage / 결핵및호흡기질환

BACKGROUND: Chest tube drainage (CTD) is an indication for the treatment of pneumothorax, hemothroax and is used after a thoracic surgery. But, in the case of incomplete lung expansion, and/or persistent air leak from CTD, medical or surgical thoracoscopy or, if that is unavailable, limited thoracotomy, should be considered. We evaluate the efficacy of bronchoscopic injection of ethanolamine to control the persistent air leak in patients with CTD. METHODS: Patients who had persistent or prolonged air leak from CTD were included, consecutively. We directly injected 1.0 mL solution of 5% ethanolamine oleate into a subsegmental or its distal bronchus, where it is a probable air leakage site, 1 to 21 times using an injection needle through a fiberoptic bronchoscope. RESULTS: A total of 15 patients were enrolled; 14 cases of spontaneous pneumothorax [idiopathic 9, chronic obstructive pulmonary disease (COPD) 3, post-tuberculosis 2] and one case of empyema associated with broncho-pleural fistula. Of these, five were patients with persistent air leak from CTD, just after a surgical therapy, wedge resection with plication for blebs or bullae. With an ethanolamine injection therapy, 12 were successful but three (idiopathic, COPD and post-tuberculosis) failed, and were followed by a surgery (2 cases) or pleurodesis (1 case). Some adverse reactions, such as fever, chest pain and increased radiographic opacities occurred transiently, but resolved without any further events. With success, the time from the procedure to discharge was about 3 days (median). CONCLUSION: Bronchoscopic ethanolamine injection therapy may be partially useful in controlling air leakage, and reducing the hospital stay in patients with persistent air leak from CTD.

Carinal Reconstruction and Sleeve Right Upper Lobectomy Assisted with Extracorporeal Membrane Oxygenator for Non-small Cell Lung Cancer: A case report

Bronchogenic carcinoma involving the carina has remained a challenging problem for thoracic surgeons. Carinal resection and reconstruction is limitedly indicated because this aggressive surgical approach has been reported to be associated with significant morbidity and mortality while long-term outcome has not been determined. Wesuccessfully performed carinal reconstruction and sleeve right upper lobectomy assisted with ECMO for a 60-year-old male with squamous cell carcinoma in the right upper lobe extending to the carina.

Outcomes of Sleeve Lobectomy versus Pneumonectomy for Lung Cancer

BACKGROUND: Sleeve lobectomy for lung cancer in close proximity to or involving the carina is widely accepted. Operative morbidity and mortality rates, recurrence, and survival rates have varied considerably across studies. MATERIALS AND METHODS: From March of 2005 to July of 2010, sleeve lobectomy was performed in 19 patients and pneumonectomy was performed in 20 patients. In this paper, the results of sleeve lobectomy and pneumonectomy for patients with lung cancer will be compared and evaluated. RESULTS: There were no postoperative complications in either group, but there was one mortality in the pneumonectomy group. There was better preservation of pulmonary function in the sleeve lobectomy group than the pneumonectomy group (p=0.066 in FVC, p=0.019 in FEV1). The 3-year survival rates were 46.7% in the sleeve lobectomy group and 54.5% in the pneumonectomy group (p=0.505). The 3-year disease-free survival rates were 38% in the sleeve lobectomy group and 45.8% in the pneumonectomy group (p=0.200). CONCLUSION: Sleeve lobectomy for lung cancer showed low mortality, low bronchial anastomotic complication rates, and good preservation of pulmonary function.

Outcome of Video-assisted Thoracoscopic Surgery for Spontaneous Secondary Pneumothorax

BACKGROUND: Conventional treatment (i.e. chest tube insertion and chemical pleurodesis) still remains standard for patients with secondary spontaneous pneumothorax because the risk of surgical bullectomy is deemed high in this subset. However, it has been suggested that surgical treatment using thoracoscopy may expedite postoperative recovery and, thus, may reduce hospital stay. MATERIALS AND METHODS: Retrospective review of 61 patients with secondary spontaneous pneumothorax, who underwent conventional treatment (n=39) or video-assisted thoracoscopic surgery (VATS) (n=22) between January 2007 and December 2009, was performed. Talc was used for chemical pleurodesis in both groups. RESULTS: Hospital stay of conventional treatment group and VATS group was 14.2+/-14.2 days (4~58 days) and 10.6+/-5.8 days (5~32 days), respectively, with statistically significant difference (p=0.033). Recurrence rate of conventional treatment group was also significantly higher (12/39, 30%) compared to VATS group (1/22, 4.5%) (p=0.016). CONCLUSION: In selected patients with secondary spontaneous pneumothorax with continuous air leak or inadequate lung expansion, thoracoscopic surgery with chemical pleurodesis using talc results in shorter hospital stay and lower recurrence rate compared to conventional approach.

The Clinical Results of Surgical Treatment for Sternoclavicualr Septic Arthritis / 대한흉부외과학회지

BACKGROUND: Sternoclavicular septic arthritis manifests serious complications such as abscess, osteomyelitis, mediastinitis and empyema; therefore, a prompt diagnosis and appropriate treatment are necessary. MATERIAL AND METHOD: The treatment results of eight patients with sternoclavicular septic arthritis and who had been surgically treated at our institutions between September 2005 and July 2008 were retrospectively reviewed. The surgical treatment they underwent was en bloc resection, including partial resection of the sternum, the clavicular head and the 1st rib. RESULT: The patients ranged in age from 40 to 74 years with an average of 55.1+/-10.3 years. Five were men and three were women. There were 6 patients with spontaneous sternoclavicular septic arthritis and 2 patients had their condition induced by central venous catheters. The pathogens isolated from the patients' blood and wounds were MRSA (3), Streptococcus intermedius (1), Streptococcus agalactiae (1) and Pseudomonas luteola (1). One patient expired from aggravation of preoperative sepsis on POD 31. CONCLUSION: The life-threatening complications from sternoclavicular septic arthritis can progress and lead to death unless appropriate treatment is administered. A prompt diagnosis, appropriate antibiotics therapy and effective surgical treatment such as radical en bloc resection can reduce the morbidity and mortality of this malady.

Delayed Diagnosis of a Traumatic Diaphragmatic Injury / 결핵및호흡기질환

Traumatic diaphragmatic rupture is uncommon, but requires a prompt diagnosis and repair. Diaphragmatic injury is most commonly associated with automobile accidents. The diagnosis is difficult and may be delayed because there are no specific symptoms, signs, or radiographic studies that are pathognomic for diaphragmatic injury. The most important factor in the diagnosis is a high suspicion and the use of proper diagnostic studies. We report a case involving the delayed presentation of diaphragmatic rupture in a 54 year old man, requiring surgical repair 12 days following multiple blunt trauma. It should be noted that early recognition for diaphragmatic injury is important in patients with multiple trauma to avoid the potential fatal complications.

Video-Assisted Thoracic Surgery Lobectomy: Experience with 36 Cases / 대한흉부외과학회지

BACKGROUND: Many video-assisted thoracic surgery (VATS) lobectomies are performed as a potential alternative to thoracotomy despite the controversy about the safety and the associated morbidity/mortality rates. MATERIAL AND METHOD: Between November 2006 and August 2008, we performed 87 lobectomies (VATS 36, Thoracotomy 51) and we retrospectively reviewed the surgical treatment results. A VATS lobectomy was performed by a 4~5 cm thoracotomy without rib spreading and this included anatomic hilar dissection, individual vessel and bronchus stapling and lymph node dissection. RESULT: We studied 52 male and 35 female patients whose age ranged from 6 to 79 (average age: 59.8+/-15.0 years). The cases were diagnosed with lung cancer (66) (SQC 24, ADC 38, others 4), pulmonary metastasis (2), carcinoid (2) and benign diseases (17). There was no intraoperative death. Postoperative complications were seen in 5 (15.6%) VATS and 33 (64.7%) thoracotomies, and perioperative death caused by adult respiratory distress syndrome occurred in 1 (2.8%) VATS and 3 (5.9%) thoracotomies. Three patients underwent conversion to thoracotomy (8.3%). The mean time to chest tube removal was 6 days for VATS and 9.4 days for thoracotomy (p<0.001), and the mean length of the hospital stay was 8 days for VATS and 12.8 days for thoracotomy (p<0.001). CONCLUSION: VATS lobectomy can be performed safely with low morbidity/mortality rates. Furthermore, all the patients benefited from earlier postoperative rehabilitation and less pain and they were candidates for an earlier return to normal activities.

Clinical Results and Risk Factor Analysis of Surgical Treatment for Esophageal Perforation / 대한흉부외과학회지

BACKGROUND: Esophageal perforation is an emergency that requires early diagnosis and effective treatment. A delay in diagnosis and treatment significantly increases morbidity and mortality. MATERIAL AND METHOD: Thirty-seven patients with esophageal perforation were surgically treated at our institutions between January 1990 and December 2006. We retrospectively reviewed the results of surgical treatment for esophageal perforation to understand the risk factors affecting survival in patients. RESULT: Patients ranged in age from 21 to 87 years, with an average age of 52.7+/-16.98 years. Thirty-one of the patients were men and six were women. There were 23 patients (62%) with spontaneous perforations, 10 patients (27%) with a traumatic perforation, and 4 patients (11%) with an iatrogenic perforation. The site of esophageal perforation was the cervical esophagus in 5 patients, the thoracic esophagus in 31 patients, and the abdominal esophagus in one patient. Twenty-nine patients underwent primary closure of the perforation and five patients had T-tube drainage. Exclusion-diversion procedures were performed in two patients and an esophagectomy was performed in one patient. There were six cases of mortality (16.22%) and 25 cases of postoperative complications in 15 patients (40.5%). Patients that were treated later than 24 hours after detection of the perforation showed a statistically significant high morbidity and mortality rate (p<0.05). CONCLUSION: The most important risk factor of esophageal perforation was the time interval between detection of the perforation and the initiation of treatment. A prompt diagnosis and effective treatment are necessary to decrease morbidity and mortality.

A Case of Idiopathic Interstitial Pneumonia in Childhood / 소아과

Interstitial lung disease refers to a group of pulmonary disorders characterized by inflammation of the interstitium, derangements and loss of alveolar capillary units leading to disruption of alveolar gas exchange, which induces symptoms of restrictive lung disease. Cases of interstitial pneumonia in children are uncommon and mostly have unknown causes. We have experienced an 8-year old boy who had symptoms of cyanosis, dry cough, dyspnea and abrupt weight loss. He had not been exposed to organic dusts, allergens or any other systemic disease infections. Chest radiology showed diffuse ground glass opacity in both lung fields. High resolution computed tomography(HRCT) showed multiple small patchy areas of consolidation with an underlying ground glass appearance in both lungs. The pathologic findings of lung biopsy tissue showed patchy areas of interstitial fibrosis, alveolar obliteration and nodular fibrotic areas, strongly suggesting interstitial pneumonia. No specific finding of viral inclusion or any other evidence of infection was found under electromicroscopy. We used peak flow meters to compare functional improvement. Forced expiratory volume in one second (FEV1) was decreased to 25 percent of predicted value. The boy was given treatment with prednisone and showed improvements in HRCT findings after two months. He was able to tolerate easy exercise in school and showed clinical improvements after one year of follow up.

Cavernous Hemangioma of the Esophagus: One Case Report / 대한흉부외과학회지

Hemangioma in the esophagus is an uncommon tumor. There have only been about 30 cases reported in the world literatures. It occurs predominantly in men and although majority are asymptomatic, may cause bleeding and dysphagia. Hemangioma in the esophagus was diagnosed with a barium swallowed esophagography and endoscopy. The main treatment modes recommended are surgery and endoscopic resection. We experienced one case of cav ernous hemangioma occurring at the distal esophagus. The patient was a forty-six year old male with dysphagia and indigestion. Barium esophagogram showed a filling defect at the distal portion. Esophagoscopy showed a bluish polypoid mass. Surgical resection was per formed and the pathologic diagnosis was confirmed as cavernous hemangioma. Postoperative course was uneventful and the patient had been followed up without any problems.

Clinical Comparison of Complications Between Esophagogastrostomy and Jejunal Free Transfer After Resection of Thoracic Esophageal Cancer / 대한흉부외과학회지

BACKGROUND: Replacement of the esophagus remains a challenge for surgeons involved in esophageal disease. From 1996 to 1999, a total of 27 patients with esophageal cancer underwent free jejunal transfer(12cases) or esophagogastrostomy(15cases). To determine the results such as leakage of anastomosis site, stenosis, reflux esophagitis and operation time, respiratory complications, etc. we reviewed the 4 years experiences. MATERIAL AND METHOD: Palliative bypass surgery or esophageal prosthesis and cancers of the pharyngoesophageal or esophagogastric junction were excluded in this study. Resection was usually peformed through right thoracotomy and anastomosis was made with EEA staplers in esophagogastrstomy. In cases of jejunal free transfer, 6cases of proximal esophagojejunostomy were stapled anastomosed and remaining 6 cases and all distal site were hand-sewn anastomosed. All reconstruction was done through posteromediastinal route. RESULT: There were two mortalities from thoracic esophagogastrostomy and one from jeunal free transfer. Major and minor complications(anastomosis site leakage: 3 cases, graft failure: 2cases etc) occurred in 27 cases. In 15 thoracic esophagogastrostomy cases, 11 patients had mild to moderate reflux esophagitis and 5 patients incurred stricture of the anastomosis. Operation time was about 550 280 minutes in jejunal free transfer, and about 300 160 minutes in esophagogastromy patients. CONCLUSION: Post operative reflux esophagitis and dysphagia were more frequent in Ivor-Lewis operation group than jejunal free transfer group; however, respiratory complications and operation time were significantly longer in jejunal free transfer group(p<0.05). To minimize the incidence of postoperative reflux esophagitis and dysphagia,patient evaluation focused on jejunal free transfer surgery is better than esophagogastrostomy followed by adequate post operative care.

The Surgical Correction for Pectus Carinatum: One Case Report / 대한흉부외과학회지

The pectus carinatum or anterior protrusion of the sternum is a less common than pectus excavatum. It occurs more frequently in boys than girls and associated musculoskeletal abnormalities, spinal scoliosis is most common. Ravitch first reported correction of chondromanubrial prominence in 1952, resecting the multiple deformed costal cartilages and performing a double osteotomy on sternum. We have experienced one case of pectus carinatum and obtained satisfactory postoperative results. The deformity was corrected by the subchondral resection of multiple deformed costal cartilage, bilaterally, with single osteotomy on sternum and fracture of the posterior cortex to correct anterior angulation. Postoperative course was uneventful. We report this case with brief review of the literature.

Selective Bronchial Occlusion for Treatment of Intractable Pneumothorax with Emphysematous Lung / 대한흉부외과학회지

The intractable pneumothorax with continuous air leakage, emphysematous lung and high operative risk treated by selective bronchial occlusion has been seldomly reported abroad. The bronchus responsible for air leakage was occluded with such materials as fibrin glue, gelatin sponge and oxidized regenerated cellulose(surgicel). We performed selective bronchial occlusion by flexible fiberoptic bronchoscopy with gelfoam in two cases. There was no complication after the procedure; therefore, we report the treatment for intractable pneumothorax by bronchoscopy with gelfoam packing.

Mediastinal lipoma: one case report / 대한흉부외과학회지

No abstract available.

Median sternotomy for bilateral resection or plication of bullae / 대한흉부외과학회지

No abstract available.

T-cell non-Hodgkim lymphoma associated with chronic tuberculous empyema: case report

Malignant neoplasm associated with long-standing pleuritis or empyema is rare but a critical complication. Among 67 cases which were reported in English and Japanese literatures the cause of empyema was considered tobe tuberculosis in 51 cases. The most common malignant disease associated with the long-standing pleural disease was non-Hodgkin lymphoma (NHL), and the majority of the malignant lymphomas were B-cell type. Detection of the malignancy combined with an empyema is difficult, however, chest radiograph or CT may show the evidence of malignant pleural disease. We report a case of pathologically proven T-cell type malignant NHL associated with chronic tuberculous empyema in a 66-year-old male patient.

T-cell non-Hodgkim lymphoma associated with chronic tuberculous empyema: case report

Malignant neoplasm associated with long-standing pleuritis or empyema is rare but a critical complication. Among 67 cases which were reported in English and Japanese literatures the cause of empyema was considered tobe tuberculosis in 51 cases. The most common malignant disease associated with the long-standing pleural disease was non-Hodgkin lymphoma (NHL), and the majority of the malignant lymphomas were B-cell type. Detection of the malignancy combined with an empyema is difficult, however, chest radiograph or CT may show the evidence of malignant pleural disease. We report a case of pathologically proven T-cell type malignant NHL associated with chronic tuberculous empyema in a 66-year-old male patient.

The surgical correction for pectus excavatum / 대한흉부외과학회지

No abstract available.