[Show abstract][Hide abstract] ABSTRACT: Objectives:
Although better nutritional support has improved the growth rates in children, the occurrence of primary spontaneous pneumothorax has also been increasing in children. The current study attempts to investigate the occurrence and recurrence of primary spontaneous pneumothorax and the efficacy of surgery for primary spontaneous pneumothorax in young adults and children.
A total of 840 patients were treated for pneumothorax at our hospital from January 2006 to December 2010. Exclusion criteria for this study were age >25 or secondary, traumatic or iatrogenic pneumothorax, and a total of 517 patients were included. Patients were classified into three groups according to age at the first episode of primary spontaneous pneumothorax: Group A: ≤16 years; Group B: 17-18 years and Group C: ≥19 years.
The study group was composed of 470 male and 47 female patients. There were 234 right-sided, 279 left-sided and 4 bilateral primary spontaneous pneumothoraces. Wedge resection by video-assisted thoracic surgery was performed in 285 patients, while 232 were managed by observation or closed thoracostomy. In the wedge resection group, 51 patients experienced recurrence. The recurrence rates after wedge resection were 27.9% in Group A, 16.5% in Group B and 13.2% in Group C (P = 0.038). The recurrence rates after observation or closed thoracostomy were 45.7% in Group A, 51.9% in Group B and 47.7% in Group C (P = 0.764).
In the present study, postoperative recurrence rates were higher than those in the literature. Intense and long-term follow-up was probably one reason for the relatively high recurrence rate. The recurrence rate after wedge resection in patients aged ≤16 years was higher than that in older patients. There was no difference between the recurrence rates after observation or closed thoracostomy, regardless of age. These results suggest that wedge resection might be delayed in children.
Preview · Article · Apr 2015 · Interactive Cardiovascular and Thoracic Surgery
[Show abstract][Hide abstract] ABSTRACT: Small-cell lung cancer (SCLC) is one of the most aggressive and lethal forms of lung cancers. Chemotherapy and radiotherapy would be standard modality for SCLC with median survival being less than 4 months only. Complementary treatment to chemotherapy is desired. Oncothermia will be one of the candidates to this addition. We have made a study of 31 SCLC patients from April 2006 to March 2012. 23 cases were treated with combined chemotherapy and oncothermia, and 8 cases were treated with chemotherapy alone. Three patients from 14 patients (14/31) died in the study period; there were equal numbers in the two arms, including one long survival case of 28 months and one of 26 months, in the combination and chemo-group, respectively .16 patients (16/31) are alive: 4 patients with chemotherapy only, including one long survival case of 28.7 months, and 11 cases with combined therapy including three long survival cases of more than 3 years. We conclude that the combined use of chemotherapy and oncothermia has significantly enhanced the survival rate in comparison with the use of chemotherapy alone (log-rank test:
value < 0.02).
[Show abstract][Hide abstract] ABSTRACT: 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.
Preview · Article · Jun 2013 · Korean Journal of Thoracic and Cardiovascular Surgery
[Show abstract][Hide abstract] ABSTRACT: 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).
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.
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 β-lactamase (+) K. pneumoniae, methicillin-resistant Staphylococcus aureus and Streptococcus pneumoniae. Infection-related death occurred in 6 of the 14 episodes (43%).
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.
Full-text · Article · Feb 2013 · Tuberculosis and Respiratory Diseases
[Show abstract][Hide abstract] ABSTRACT: 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.
[Show abstract][Hide abstract] ABSTRACT: Purpose
Endoscopic thoracic sympathetic surgery is effective for treating palmar hyperhidrosis, although compensatory sweating (CS) is a significant and annoying side effect. The purpose of this study was to compare the results of limited resection at two different locations.
From May 2004 to June 2009, T3 sympathicotomy (group I) was performed in 46 patients and T3,4 ramicotomy (group II) was performed in 43 patients during the same period. T3 sympathicotomy (group I) and T3,4 ramicotomy (group II) were performed during the same period. Using questionnaires, completed by the patients, the satisfaction rates and grades of CS were analyzed.
No significant differences in age distribution or sex ratios were observed between the two groups. The satisfaction rate was 91.3 % in group I and 79.1 % in group II. The operation time was 19.8 (±6.6) min in group I, and 51.6 (±18.8) min in group II, showing a statistically significant difference (p < 0.002). The incidence of persistent hand sweating in group II (16.3 %) was higher than that observed in group I (2.2 %). The incidence of compensatory sweating on the lower extremities was higher in group II (37.2 %) than in group I (10.9 %).
Although ramicotomy is considered to be an effective method for treating hyperhidrosis and has a theoretical advantage of allowing greater anatomical resection, it requires longer operation time and induces more severe compensatory sweating in the lower limbs resulting in reduced satisfaction rates.
[Show abstract][Hide abstract] ABSTRACT: Non-small cell lung cancer (NSCLC) invading the visceral pleura is classified as T2 stage, and NSCLC invading the chest wall, diaphragm, phrenic nerve, mediastinal pleura or parietal pleura is classified as T3. But, there is no definition as to whether tumours directly invading an adjacent lobe beyond the fissure should be classified as T2 or T3. We assessed whether these tumours should be classified as T2 or T3.
We evaluated patients with NSCLC who, between 1992 and 2009, underwent complete resection and were pathologically diagnosed as T2 or T3 according to the 7th edition of the TNM classification. To evaluate the effect of the T-stage only, the patients with nodal- and distant metastasis were excluded.
Among 837 patients, 499 (59.6%) were pathologically staged as T2a, 91 (10.9%) as T2b and 201 as T3 (24.0%). Forty-six (5.5%) patients had NSCLC with a direct invasion of the adjacent lobe. The mean age (P = 0.102) and sex distribution (P = 0.084) were not statistically significant, but there were more adenocarcinomas in the T2 group than that in the T3 group. The overall survival of the patients with adjacent lobe invasion was statistically worse than that of T2 patients (P = 0.042), but was not statistically different from that of T3 (P = 0.368) patients. There was no difference between the disease-free survival of patients with adjacent lobe invasion and T3 patients (P = 0.306), but disease-free survival of the patients with adjacent lobe invasion was worse than that of T2 (P = 0.003) patients.
Considering that the overall survival and disease-free survival of patients with direct adjacent lobe invasion are similar to those of T3, NSCLC with direct invasion to the adjacent lobe should be classified as T3 rather than T2.
Preview · Article · Jun 2012 · European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery
[Show abstract][Hide abstract] ABSTRACT: 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.
Preview · Article · Apr 2010 · Journal of Korean medical science
[Show abstract][Hide abstract] ABSTRACT: 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.
Full-text · Article · Feb 2010 · Korean Journal of Thoracic and Cardiovascular Surgery
[Show abstract][Hide abstract] ABSTRACT: To determine the diagnostic efficacy of magnetic resonance imaging (MRI) in pulmonary hamartoma and observe the significant MRI features, other than fat or characteristic calcification revealed by computed tomography (CT).
Six hamartomas were included and surgically resected, and we prospectively studied MRI in cases showing suggestive findings of hamartoma or indeterminate nodule on CT. We analyzed the tumor on CT and MRI (available enhancement study in 4) focusing on cleftlike structure in comparison with specimen MRI (n = 3) and histopathologic findings: presence, shape, and distribution of the cleftlike structure and signal intensity and enhancement of the cleftlike structure and main portion.
Computed tomography revealed suggestive findings of pulmonary hamartoma (fat or popcorn calcification) in only 3. All MRI revealed cleftlike structures particularly evident on T2-weighted images with same detectability as its specimen MRI: peripheral linear or curvilinear inclusions with sometimes intratumoral cleftlike space (n = 3), variable signal intensity, and frequent enhancement (3 in 4) pathologically correlated with the variable mesenchymal tissue components and amount arrayed along respiratory epithelial cells lining the cleft and richer vascularity than main portion of pulmonary hamartoma.
Magnetic resonance imaging study is a useful diagnostic tool, when a discrete pulmonary nodule demonstrates neither fat nor calcification on CT, for detecting the quite typical cleftlike structure in a pulmonary hamartoma and could provide diagnostic confidence.
No preview · Article · Oct 2008 · Journal of computer assisted tomography
[Show abstract][Hide abstract] ABSTRACT: Anatomical variation of the sympathetic nervous system is known to be one of the main causes of failure and dissatisfaction after sympathetic surgery. However, there are only few reports on the descriptive analysis of sympathetic nerve variants. The purpose of this study is to investigate the anatomical variations of the sympathetic trunk at the levels of T3 and T4 ganglia considered in a topographic approach for sympathetic procedures and to further improve the postoperative outcome.
From June 2003 to January 2004, 44 patients with palmar hyperhidrosis underwent bilateral T3,4 ramicotomy via video-assisted thoracoscopic surgery. The anatomy of T3 and T4 sympathetic ganglia, pathway of sympathetic trunk, and rami-communicantes were recorded on video and still cut images for descriptive analysis.
The thoracic sympathetic trunks were mostly lying against the heads of the ribs, but there were variants of sympathetic trunk running along the medial side of the rib heads of 3rd, 4th and 5th ribs, respectively in 9.0%, 18.0% and 37.5% of the cases. There were also variants running along the lateral side of rib heads near the neck portion in 12.5%, 10.2% and 8.0% of the cases. The 3rd ganglion was located within the intercostal space (59.1%) or at the level of the upper border of the 4th rib (36.4%) or upon the 4th rib (4.5%). The location of the 4th ganglion was in the intercostal space (18.2%), the upper border of the 5th rib (44.3%) or upon the 5th rib (37.5%). The ascending rami were found at the level of the 3rd ganglion in 48.8% and the 4th ganglion in 45.5% of the cases. The descending rami were located at the level of 3rd and the 4th ganglion in 8.0% and 6.8%, respectively. And the middle rami were found in all cases except one.
It may be difficult to localize the sympathetic trunk in some cases of severe obesity; a careful inspection has to be performed from the medial side of the rib heads to the neck portion. The obvious 'downward shift of ganglion' in the position shown as the thoracic sympathetic trunk descends is to be deliberated in T4 sympathetic surgery. Many ascending and descending accessory pathways of sympathetic nerve were observed; therefore, a lateral extension of electrocoagulation at the level of upper and lower rib border is necessary to impose a complete blockage of sympathetic nerve stimulus.
Preview · Article · Jun 2008 · European Journal of Cardio-Thoracic Surgery
[Show abstract][Hide abstract] ABSTRACT: Recurrent lung cancer with endobronchial obstruction after surgical resection due to lung cancer may lead to severe dyspnea, respiratory insufficiency and sudden death. Many palliative modalities including partial excision of endobronchial tumor, insertion of stent, and evaporation with laser, have been used for endobronchial obstruction due to recurrent endobronchial lung cancer. In photodynamic therapy (PDT), photosensitizer named photofrin, is infused intravenously at 48 hours before PDT, and diode laser of an appropriate wavelength is applied to induce destruction of tumor mass with 200~250 J/cm2. We report 2 cases of treatment using PDT for endobronchial obstruction due to recurrent endobronchial lung cancer after surgical resection.
[Show abstract][Hide abstract] ABSTRACT: The purpose of this report is to describe our experience in the successful treatment of two patients with postpneumonectomy bronchopleural fistula (BPF). With use of computed tomography reformatting, the stent-graft occluders were tailored to precisely fit the fistula site and remnant bronchus stump. These were placed under fluoroscopic guidance via a preexisting chest tube tract in one case and via an open thoracostomy window site in the other. The BPFs were successfully occluded without complications, and the stent-graft occluders remained stable in position for 1 year and 6 months of follow-up, respectively.
No preview · Article · Oct 2006 · Journal of Vascular and Interventional Radiology
[Show abstract][Hide abstract] ABSTRACT: The applicability of tumor markers still remains controversial in non-small cell lung cancer (NSCLC) due to lower sensitivity & specificity. And, tumor markers actually have not been used determining treatment plans in NSCLC patients yet. So, we evaluated correlation between levels of serum tumor marker (CEA, NSE and Cyfra 21-1) and prognosis in NSCLC patients underwent complete surgical resection.
[Show abstract][Hide abstract] ABSTRACT: To evaluate the usefulness of computed tomography (CT) in the localization of parenchymal pulmonary endometriosis and to correlate the CT findings with fiberoptic bronchoscopic and pathologic findings.
A prospective study of 5 patients presenting with catamenial hemoptysis was conducted. The CT scans and fiberoptic bronchoscopy were performed twice during and 2 weeks after menstruation. After the localization of the presumed bleeding focus, surgical resection was performed.
The CT scans obtained during menstruation revealed a well-demarcated area of consolidation (n = 4) and ground-glass opacity (n = 5), whereas CT scans obtained after menstruation demonstrated ground-glass opacity (n = 4) or complete resolution of the previously noted lesion (n = 1). Fiberoptic bronchoscopy exhibited trails of blood clot at the orifice of the involved bronchi unilaterally (n = 4) or a thin bloody secretion in the bronchi bilaterally. Histopathologic examination of the resected specimens showed typical findings of pulmonary endometriosis.
Computed tomography scans during and after menstruation were useful for the precise preoperative localization of parenchymal pulmonary endometriosis.
No preview · Article · Nov 2005 · Journal of Computer Assisted Tomography
[Show abstract][Hide abstract] ABSTRACT: The Nuss procedure is a newly developed operative method for minimally invasive repair of pectus excavatum in pediatric patients. However, the surgical indication for this procedure has been extended into adult patients. The aim of this study was to assess the surgical outcome of the Nuss procedure in different age groups and to analyze its feasibility in the adult population.
From December 1999 to March 2003, 51 patients (40 males and 11 females) with pectus excavatum underwent the Nuss procedure. We classified patients into three groups based on age (pediatric, adolescent, and adult), retrospectively analyzed demographic, intraoperative and postoperative data, and compared outcomes among each group.
Mean operation time was 52.0 +/- 22.9 minutes, 80.4 +/- 27.4 minutes, and 127.3 +/- 44.9 minutes in the pediatric, adolescent, and adult groups, respectively (p < 0.001). Postoperative complications occurred in 3 of 27 patients (11.1%) in the pediatric group and in 7 of 12 patients (58.3%) in both the adolescent and adult groups (p = 0.002). Reoperations were performed due to complications in 1 of 27 patients (3.7%) in the pediatric group, 2 of 12 patients (16.6%) in the adolescent group, and 5 of 12 patients (41.7%) in the adult group (p = 0.001).
The Nuss procedure is highly recommended in pediatric patients with pectus excavatum. However, in adults it is necessary to select patients carefully because of the longer operation time and higher incidence of complications associated with the procedure in this population.
Preview · Article · Oct 2005 · The Annals of thoracic surgery
[Show abstract][Hide abstract] ABSTRACT: Excessive sweating, or hyperhidrosis, can have detrimental effects on the patient's quality of life, resulting in impairment of daily activities, social interactions and occupational activities. The symptoms of hyperhidrosis also may put the patients at risk of fear, avoidance and even social anxiety disorder. Hyperhidrosis is caused by an excessive, non-thermoregulatory sweat response to emotional stimuli in body regions influenced by the central preoptic-anterior hypothalamus. Treatment options are based on the severity of symptoms and the risks and benefits of therapy. In general, noninvasive topical agents and medications are initial treatment options. Endoscopic sympathetic surgery can be used for severe cases of palmar, axillary and facial hyperhidrosis. Compensatory sweating is an annoying complication after sympathetic surgery; however, various methods have been introduced to reduce or reverse it. Nonetheless, careful selection is needed for the patient to improve the quality of life after the treatment.
Preview · Article · Aug 2005 · Taehan Ŭihak Hyŏphoe chi. The Journal of the Korean Medical Association
[Show abstract][Hide abstract] ABSTRACT: The characteristics and causes of re-sweating after sympathetic surgery in hyperhidrosis patients have yet to be clearly documented due primarily to low incidence of re-sympathetic surgery. The purpose of this study is to identify the causes of re-sweating following sympathetic surgery, and to assess the outcomes of re-sympathetic surgery.
From February 1997 to July 2003, 36 patients underwent re-sympathetic surgery in order to treat re-sweating. Patients originally underwent sympathetic surgery due to facial (14 cases), palmar (21 cases), and axillary (1 case) hyperhidrosis.
Sympathectomy was performed as a primary surgical intervention in 7 cases (19.4%), sympathicotomy in 12 cases (33.3%), and sympathetic clipping in 17 cases (47.3%). Thirteen patients complained of re-sweating on both sides, and 23 patients exhibited unilateral re-sweating. The onset of re-sweating occurred after an average of 3.1+/-3.4 months (range, 1-12 months) after the operation. The causes of re-sweating after sympathetic surgery included an intact sympathetic chain in 4 cases (11.1%), incomplete resection in 6 cases (16.7%), partial reattachment in 6 cases (16.7%), improper ganglion location in 4 cases (11.1%), clip slipping out in 11 cases (30.5%), and unknown in 5 cases (13.9%). Twenty-seven patients (75.0%) exhibited re-sweating within 3 months, and 9 patients (25.0%) experienced re-sweating after 6 months. During the second operation, sympathicotomy was performed in 20 cases (55.6%) and sympathetic clipping in 16 cases (44.4%) in which 32 patients (88.9%) reported decreased sweating.
Surgical errors during the initial operation constituted the main cause of re-sweating following sympathetic surgery. Re-sympathetic surgery was necessary in order to treat re-sweating, and was associated with favorable outcomes.
Preview · Article · Jun 2005 · European Journal of Cardio-Thoracic Surgery