Showing papers in "The Korean Journal of Thoracic and Cardiovascular Surgery in 2010"

Gastrointestinal Complications after Lung Transplantation.

Abstract: 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.

Thoracoscopic Diaphragmatic Plication Using Three 5 mm Ports.

Abstract: Background: Diaphragmatic plication through a thoracoscopic approach has been an effective modality to treat diaphragmatic enventration. However, the conventional technique for thoracoscopic plication has some disadvantages. We have developed an improved and simplified technique with utilizing the head up position, CO₂ insufflation and figure-of-eight sutures. Material and Method: Between October 2005 and September 2009, 9 patients with diaphragmatic paralysis underwent repair using our modified technique. The mean patient age was 38.5±53.0 years (range: 2~76 years). Result: The mean operation time was 46.7±15.9 min (range: 30~85 min). None of the patients died due to this procedure, but there was one case of prolonged air leakage, and a case of re-expansion pulmonary edema, which required 3 days of ventilator support after the procedure. The mean hospital stay was 6.22±2.04 days (range: 4~11 days). The mean follow-up duration was 27.2±11.6 months (range: 2~43 months). All the patients had their symptoms relieved and there was no recurrence of eventration except for one patient who developed more than 2 ㎝ elevation of the diaphragm compared to the immediate post-operation status. Conclusion: With our technique, thoracoscopic diaphragmatic plication was feasible via using only three 5 ㎜ ports and without a working window and the midterm results were favorable. Therefore, we advocate thoracoscopic diaphragmatic plication as a preferred technique to the conventional open plication technique.

Effects on Tensile Strength and Elasticity after Treatment with Glutaraldehyde, Solvent, Decellularization and Detoxification in Fresh Bovine Pericardium

Abstract: Background: Bioprosthetic materials have been made using glutaraldehyde fixation of porcine or bovine pericardium during cardiovascular surgery. But these bioprostheses have the problems of calcification and mechanical failure. We determined changes in tensile strength and elasticity of pericardium after glutaraldehyde, solvent, decellularization and detoxification. Material and Method: Tissues were allocated to four groups: glutaraldehyde with and without solvent, decellularization, and detoxification. We studied tensile strength and strain on tissues. We measured the tensile strength of fresh pericardium stretched in six directions (with 5 mm width), and % strain, which we calculated from the breaking point when we pulled the pericardium in two directions. Result: Tensile strength was reduced when we used the usual concentrated glutaraldehyde fixation (n=83, MPa=11.47±5.40, p=0.006), but there was no change when we used solvent. Elasticity was increased after glutaraldehyde fixation (n=83, strain (%)= 24.55±9.81, p=0.00), but there was no change after solvent. After decellularization of pericardium, the tensile strength was generally reduced. The decrease in tensile strength after concentrated glutaraldehyde fixation for a long time was significantly greater less than after concentrated solvent (p=0.01, p=0.00). After detoxification, the differences in strength and strain were not significant. Conclusion: After glutaraldehyde treatment of pericardium there is no loss in tensile strength (even though we did the glutaraldehyde, solvent and detoxification treatments LOGIC IS UNCLEAR). Also, these treatments had a tendency to increase elasticity. Although post-treatment decellularization led to a significant loss in strength, this effect could be attenuated using a low concentration of solvent or hypertonic solution.

Management of Patients with Rib Fractures: Analysis of the Risk Factors Affecting the Outcome

Abstract: Background: Thoracic trauma is one of the leading causes of morbidity and mortality in developing countries. A rib fracture that is secondary to blunt thoracic trauma is an important indicator of the severity of the trauma. The purpose of study was to determine the morbidity and mortality rates and the management of rib fractures. Material and Method: We performed a retrospective study that involved all the blunt trauma patients with rib fractures, excluding those that were transferred to other hospital within 3 days, that were seen at our hospital between May 2002 and December 2008. Of the 474 admitted patients, 454 met the inclusion criteria. There were 356 male and 98 females, and their overall mean age was 53 years (range: 5∼90 years). The outcome parameters included the mechanism of injury, the number of fractured ribs, the length of stay in the ICU, the Injury Severity Score (ISS), the length of the hospital stay, the pulmonary complications and the mortality. Result: The mechanism of trauma included traffic accidents in 189 (41.7%) cases, slipping down in 103 (22.7%) cases, falls in 85 (18.7%) cases, cultivator accidents in 30 (6.6%) cases, industrial accidents in 32 (7.0%) cases and assault in 15 (3.3%) cases. Intrathoracic injury was noted such as hemothorax in 269 (59.3%) cases, pneumothorax in 144 (31.7%) cases, pulmonary contusion in 95 (20.9%) cases, subcutaneous emphysema in 29 (6.4%) cases and great vessel injury in 5 (0.1%) cases. Conservative treatment was administered to most of the patients. Tube thoracostomy was administered in 234 (51.5%) cases, whereas thoracotomy was performed in 18 (4.0%) cases. The mean duration of thoracostomy was 5.2±6.2 days. Most of the cases with rib fracture were treated in wards and their mean duration of hospital stay was 22.5±20 days. The mean Injury Severity Score (ISS) was 14.8±10.9 (range: 3∼75). The mortality rate was calculated to be 4.8% (n=22). The main factors correlated with an adverse outcome were the number of ribs fractured, the duration of thoracostomy and pulmonary disease. Industrial insurance affected the length of hospitalization. Pulmonary contusion and the Injury Severity Score (ISS) affected the mortality. Conclusion: Rib fractures are a indicator of severe injury. Because of the complication and associated injuries, we believe these patients should be admitted for evaluation and treatment. Recent studies on the impact of rib fractures after blunt trauma have shown that patients as young as 40 years of age demonstrate increased morbidity and mortality with similar injuries as compared to that of older patients. The ISS and pulmonary contusion influenced the mortality rate. Patients with isolated rib fractures should be hospitalized if the number of fractured ribs is one or more.

Spontaneous Pneumomediastinum: Clinical Experience of 24 Patients in Two Medical Center

Abstract: Background: Spontaneous pneumomediastinum is an uncommon disorder with few cases reported It usually occurs in young males and has benign self-limiting course without any apparent concomitant factor It is seen after intrathoracic pressure changes leading to alveolar rupture The clinical experiences of two medical centers were reviewed to aid in optimal management Material and Method: Retrospective review between March 2003 and August 2010 with spontaneous pneumomediastinum patients was performed Result: 24 patients were identified with a diagnosis of spontaneous pneumomediastinum These 24 patients were comprised of 18 men and 6 women with mean age 189 years (range 10~33) The major initial complaints were chest pain (792%), throat pain (625%), and subcutaneous emphysema (417%) The triggering events were exercise (167%), coughing (125%) and vomiting (125%) No apparent triggering event was noted in 542% of patients In all cases, chest radiograph and computed tomography was done Diagnostic computed tomography was required in 25% White blood cell counts and C-reactive protein (CRP) were checked, and their initial mean values were 9,790±3,240/μL and 131±171 ㎎/dL, final mean values were 5,440±1,665/μL and 072±073 ㎎/dL, respectively 23 patients were admitted (average 50±18) and the symptoms were self-limiting in all cases without complications Conclusion: Spontaneous pneumomediastinum is a benign condition with mild inflammatory signs that often presents with chest or throat pain Secondary causes must be ruled out to avoid an unfavorable outcome with less invasive study Because of very rare complications and recurrence, outpatient basis and shortened hospitalization may be feasible

기흉 수술시 흉강경하 첨부 늑막 절제술과 기계적 흉막 유착술의 후향적 비교

Abstract: Background: Pleural symphysis is regarded as an important treatment option in reducing recurrence rates after surgical treatment of spontaneous pneumothorax. However, there is much debate over the best method for achieving pleural symphysis. We retrospectively compared apical pleurectomy (AP) with mechanical pleural abrasion (MPA). Material and Method: Between January 2000 and December 2007, 83 patients underwent video-assisted thoracoscopic surgery (VATS) for spontaneous pneumothorax. In addition to wedge resection of bullae, MPA was performed in 21 patients (group A) and AP in 62 patients (group B). Result: There were no significant differences in age, gender and site of pneumothorax between the two groups. Operative time was 97±44 minutes in group A and 77±18 minutes in group B (p＞0.05). The mean amount of pleural drainage through the chest tube on the first postoperative day was 156±87 cc in group A and 147±87 cc in group B (p＞0.05). There was no mortality or significant morbidity in all patients with the exception of reoperation for bleeding in two patients in group B. In the postoperative course, there were no statistical differences between the two groups in the rate of residual air space, air leak and indwelling time of chest tube, and hospital stay. Mean follow up time was 31.7±25.3 months, and the recurrence rate of pneumothorax was 9.5% (2/21) in group A and 6.5% (4/62) in group B, without statistical significance. Conclusion: AP was no more advantageous than MPA in terms of operative time, postoperative course and prevention of recurrent pneumothorax. Therefore, complete resection of bullae and existence of residual bullae are more important factors in reducing the incidence of recurrent pneumothorax than pleural symphysis.

Retroperitoneal Bronchogenic Cyst -A case report-

Abstract: sult from aberrant budding from the ventral diverticulum, and are usually discovered in the posterior part of the mediastinum, along the right paratracheal wall (1, 2). Cysts that develop below the diaphragm, especially in the retroperitoneal region, are extremely rare (3, 4), and fewer than 50 cases have been reported in English language clinical literature to date. To the best of our knowledge, there has been no report in a Korean radiological journal. We have recently experienced a case of a retroperitoneal bronchogenic cyst that was located between the stomach and pancreas. We report the case with a review of the literature.

A Study of the Effect of a Mixture of Hyaluronic Acid and Sodium Carboxymethyl Cellulose (Guardix-solⓇ) on the Prevention of Pericardial Adhesion

Abstract: Background: This study was designed to evaluate the efficacy of a mixture of hyaluronic acid and sodium carboxymethyl cellulose (Guardix-sol ⓡ ) on experimental pericardial adhesion. Material and Method: Thirty rats were divided into 2 groups of 15 rats each and pericardial mesothelial injury was induced during surgery by abrasion. In the control group, blood and normal saline were administered into pericardium; in the test group, blood and HA-CMC solution were administered. Pericardial adhesions were evaluated at 2 weeks (n=5), 4 weeks (n=5), and 6 weeks (n=5) after surgery. The severity of adhesions was graded by macroscopic examination, and the adhesion tissue thickness was analyzed microscopically with Masson trichrome stain and an image processing program. Result: The test group had significantly lower macroscopic adhesion scores (2.9±0.6 : 3.9±0.4, p＜0.000) compared with the control group. For microscopic adhesion tissue thickness, the test group had lower scores compared with the control group, but this difference was not statistically significant (91.73±49.91 : 117.67±46.4, p=0.106). Conclusion: We conclude that an HA-CMC solution (Guardix-sol ⓡ ) reduces the formation of pericardial adhesions in this animal model.

소심낭 절편의 무세포화와 알코올 전처치를 포함한 여러 고정 처리법 시행 후 석회화 경감 효과 관찰 연구

Abstract: Background: Our goal was to evaluate anti-calcification effects of decellularization and diverse fixing methods including preincubation of the bovine pericardium with ethanol. We also assessed changes in mechanical properties. Material and Method: Harvested bovine pericardium was decellularized with 0.25% sodim dodecysulfate and then treated with 5 methods of fixation: ① 0.5% glutaraldehyde (GA) for 14 days, ② 0.5% GA for 5 days, 2% GA for 2 days and 0.25% GA for 7 days, ③ 0.5% GA for 5 days, 2% GA for 2 days, 0.25% GA for 7 days, and then 70% ethanol for 2 days, ④ 0.5% GA for 5 days, a mixture of 2% GA and 70% ethanol for 2 days, and 0.25% GA for 7 days, ⑤ 0.5% GA for 5 days, a mixture of 2% GA, 65% ethanol, and 5% octanediol for 2 days and then 0.25% GA for 7 days. All treated bovine pericardia were tested for histological variables, lipid content, and mechanical properties including tensile strength and thermal stability. A total 10 kinds of differently treated bovine pericardia were implanted into rat subdermis and harvested 8 weeks later. Harvested pericardia were evaluated for calcium content. Result: No protein denaturation was observed microscopically after decellularization. There was a 32% mean decrease in tensile strength index after decellularization in the bovine pericardium group fixed. Octanediol preincubation attenuated the decrease in tensile strength and maintained thermal stability. TG and cholesterol were not affected by decellularization but were decreased by organic solvent. Calcium content was decreased after decellularization, and organic solvent preincubation decreased calcification in the non-decellularized bovine pericardium group. Conclusion: Decellularization and organic solvent preincubation have anti-calcification effects but decellularization may cause mechanical instability. A method of decellularization and fixation that does not cause damage to matrices will be needed for evaluation of the next step in using tissue-engineering for replacement of cardiac valves.

Orthotopic Cardiac Transplantation after Inter-caval Anastomosis in a Patient with Hypertrophic Cardiomyopathy and Persistent Left Superior Vena Cava

Abstract: − 522 − *울산대학교 의과대학 서울아산병원 흉부외과학교실 Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine **울산대학교 의과대학 서울아산병원 심장내과학교실 Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine 논문접수일:2010년 4월 7일, 논문수정일:2010년 5월 14일, 심사통과일:2010년 7월 30일 책임저자:윤태진 (138-736) 서울시 송파구 풍납 2동 388-1, 서울아산병원 흉부외과 (Tel) 02-3010-3580, (Fax) 02-3010-6966, E-mail: tjyun@amc.seoul.kr 본 논문의 저작권 및 전자매체의 지적소유권은 대한흉부외과학회에 있다. CC This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 지속성 좌상대정맥을 가진 비후성 심근증 환자에서의 양측상대정맥 문합술 후 심장이식술

동물 실험 모델에서 적용한 이종대동맥판막도관의 조직보존방법 비교

Abstract: Background: The commercially used vascular xenografts have some problems such as calcification, fibrosis and tissue degeneration that are associated with inflammatory and immunologic reactions. We compared two methods of xenograft preservation (fresh cryopreservation versus acellularized cryopreservation) of goat aorta. Material and Method: Aortic valved xenografts were harvested from adult pigs, and these were preserved using fresh cryopreservation (FC group, n=4) or acellularized crypreservation (AC group, n=4). These xenografts were implanted into adult goats. There were 2 short-term survivors (less than 100 days) and 2 long-term survivors in each group. These xenografts were explanted and they underwent microscopic examination. Result: The goats survived 31, 40, 107 and 411 days in the FC group and the other goats survived 5, 40, 363 and 636 days in the AC group. All the short-term survivors in each group expired because of rupture at the proximal anastomosis site. Marked neutrophil infiltration was observed in the FC group FC and lymphocytes were observed in the AC group. There were no differences in the occurrence of calcification, fibrosis and thrombosis among the groups. Conclusion: Some goats survived more than 100 days after the xenograft implantation irrespective of the methods of preservation. Because severe tissue degeneration developed in both groups, we think these methods are not appropriate for xenograft preservation of aorta. It was worth a preliminary trial for improving the preservation method or to modify the processing of xenografts.

Effect of Trypsin on Physico-dynamic and Histological Changes after Decellularization of Bovine Pericardium

Abstract: Background: Various decellularization methods have been studied in order to develop tissue graft which is less immunogenic and more durable. This study was performed to investigate the physico-dynamic and histological effect of trypsin pretreatment on decellularization protocols. Material and Method: Two groups of bovine pericardium specimen each underwent decellularization process based on SDS and Triton X-100 or N-lauroylsarcosinate and Triton X-100. Two more groups additionally underwent pretreatment with 0.1% Trypsin/0.1% EDTA. After decellularization process, mechanical tensile strength was tested, then biomechanical test of permeability and compliance was tested before and after fatigue test. Light microscopy and electron microscopy was performed to observe histological findings. Result: There was no difference in mechanical tensile strength between groups, but permeability and compliance was decreased in trypsin pretreated groups. Light microscopic and electron microscopic findings revealed damage of the extracellular matrix in trypsin pretreated groups and in groups which underwent the fatigue test also. Conclusion: Trypsin pretreatment in decellularizing process of bovine pericardium damages extracellular matrix and increases permeability and compliance of the bovine pericardium, but did not decrease tensile strength. Further studies are needed to use enzymatic treatments in decellularization protocols. (Korean J Thorac Cardiovasc Surg 2010;43:565-575)

Measurement of Porcine Aortic and Pulmonary Valve Geometry and Design for Implantable Tissue Valve

Abstract: 배경: 사람의 수명이 연장되면서 판막 질환이 점차 증가하는 가운데, 과거에는 심장 판막 이식에 기계 판막을 많이 사용하였으나, 혈액 응고 장애로 인한 출혈, 임신 시 태아의 기형 가능성, 판막의 급성 기계적 작용 부전, 평생 약을 복용해야 하는 불편함 등의 여러 합병증이 동반되는 단점이 있어, 조직 판막 사용이 증가하고 있고, 그 내구성을 높이기 위한 연구와 관심이 점차 증가하고 있다. 현재 사용하는 조직 판막은 외국계 회사의 수입된 제품으로서 그 구조나 도안에 이론적인 제안 등이 부족한 실정이다. 이에 본 연구는 돼지의 대동맥 및 폐동맥 판막의 구조에 대한 기하학적 분석을 시행하고, 각 수치를 계량화, 분석하여 그 3차원적 구조를 이해하여 대동맥 판막과 폐동맥 판막을 만들 수 있는 이론적 배경을 제시하고자 하였다. 대상 및 방법: 도축한 25마리의 돼지에서 채취한 대동맥 판막과 폐동맥 판막을 신선한 상태에서, 그리고 글루타알데하이드(GA) 용액으로 고정한 상태에서 판막의 각구조물 수치를 2차원적으로 측정하여 그 배율을 계량화하고 분석하였다. 신선한 상태와 글루타알데 하이드(GA) 용액으로 고정한 상태에서 판막엽 간 길이, 접합면 간 길이, 판막엽의 높이, 접합면 높이를 각각 측정하였다. 또한 이식 가능한 판막을 제작하기 위하여 스텐트의 도안으로 모양, 유순도에 따른 스텐트의 두께, 높이, 간격 및 판막 크기에 따른 심낭 판막엽의 크기, 모양, 두께 등을 도안하였다. 결과: 돼지 대동맥과 폐동맥 판막의 수치 및 각 구조물들의 배율을 구하였다. 대동맥 판막 및 폐동맥 판막은 각각 우측 관상동맥 첨판 및 우향 관상동맥 첨판의 크기가 상대적으로 제일 컸다. 무접합 관상동맥 첨판이 가장 작았으며(우향 관상동맥 첨판 : 무접합 관상동맥 첨판 : 좌향 관상동맥 첨판=1.00:0.88:1.00), 판막의 높이는 첨판의 크기에 비례하였다. 스텐트를 사용한 돼지 대동맥 판막은 외측 직경 크기를 19 ㎜부터 33 ㎜까지 정하였고, 이전에 정한 비율 및 스텐트 두께, 그리고 실제 판막 제작에 필요한 봉합 두께와 판막 주변 벽의 두께 등을 고려하여 스텐트의 높이(R×1.4, R:radius, 직경), 폭, 간격 수치를 정하였으며, 심낭을 이용한 판엽은 판막의 직경, 각 첨판 길이(2×R), 높이(R×1.4)와 첨판의 최소 접합면을 고려하여 스텐트 크기와 함께 모양을 도안하였다. 결론: 25개의 돼지 대동맥 판막과 폐동맥 판막의 구조물에 대한 수치를 측정하여 판막들의 기하학적 비율을 계산하고, 여러 크기의 이식형 돼지 대동맥 판막을 만들어 볼 수 있었으며, 또한 소의 심낭을 이용하여 다양한 크기의 판막을 만들어 볼 수 있는 이론적 근거를 만들 수 있었다. 향후 이러한 도안의 판막제작 후 충분한 생체 내외의 실험 및 추가 연구가 필요할 것으로 생각된다.

늑골 골절 후 발생한 늑간 신경병증의 임상적 연구

Abstract: 배경: 이 연구는 늑골 수상 후 발생하는 늑간 신경병증에 대한 평가를 위하여 숫자통증등급, 통증 기간 및 체질량 지수에 따른 늑간 신경병증에 대한 심한 정도를 알고자 하였다. 대상 및 방법: 늑골 골절 수상 후 3개월 이상 동안 보존적인 치료에도 불구하고 심한 통증을 호소하는 환자 47명을 대상으로 근전도 검사를 시...

경동맥 내중막 두께가 정상 c-반응성 단백질 농도를 가진 안정형 협심증 환자에서 가지는 임상적 의의

Abstract: Background: The purpose of this study was to determine whether hand-measured carotid intima-media thickness (IMT) was a reliable and simple tool that could be used to evaluate the severity of stable coronary artery disease (CAD) with normal high-sensitivity C-reactive protein (CRP). Material and Method: We examined left carotid IMTs in 688 patients with stable CAD and excluded 121 patients with abnormally elevated hs-CRP (≥0.5 ㎎/dL). We sought to determine the association between risk factors and the severity of stable CAD and carotid IMT in 567 patients who were divided into lower and higher groups based on the median value. Patients underwent a coronary artery angiogram and had at least significant stenosis (＞50% of the original luminal diameter involving one or more major coronary artery). Result: Of the 567 patients, 300 (52.9%) were in the lower IMT group and 267 (47.1%) were in the higher IMT group; the median value was 0.76 mm. By multivariable logistic regression analysis, the following groups were different: older age (~49 vs. 70~ years, respectively; OR=6.552), high FBS (~99 vs. 120~ ㎎/dL; OR=1.713) and severity of CAD (1 vessel vs. 2 vessel disease; OR=1.711, 1 vessel vs. 3 vessel disease; OR=1.714). Conclusion: We conclude that there are correlations between increased carotid IMT and severity of CAD in stable angina patients with normal CRP levels.

양전자단층촬영/전산화단층촬영(integrated PET/CT)을 이용한 비소세포폐암의 림프절 병기판정

Abstract: Background: For staging primary lung cancer, integrated positron emission tomography/computed tomography (PET/CT) imaging is popular. The purpose of this study was to evaluate the accuracy of PET/CT scanning in lymph nodal staging of lung cancer. Material and Method: We studied 48 patients who had received CT, PET/CT and pulmonary resections due to primary non-small cell lung cancer in our hospital between January 2006 and August 2009. Mediastinal lymph nodes were classified as superior mediastinal nodes, aortic nodes, inferior mediastinal nodes, or N1 nodes. We compared the power of CT and PET/CT for diagnosing pulmonary lymph nodes for each of the four types of nodes. Result: PET/CT was more sensitive than CT for all groups except inferior mediastinal nodes. However, the differences were not significant (McNemar’s test: superior mediastinal nodes, p=0.109; aortic nodes, p=1.000; inferior mediastinal nodes, p=0.625, N1 nodes, p=0.424). Conclusion: The accuracy of PET/CT is similar to that of CT alone for staging lymph nodes. The two imaging modalities might be used as complementary, cooperative tools. We expect that integrated PET/CT will be found to be significantly mmore sensitive after more trials are done and more data is accumulated.

Surgical Treatment for Empyema after Lung Transplantation.

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.

Spontaneous Pneumothorax due to Pulmonary Invasion in Multisystemic Langerhans Cell Histiocytosis: A case report.

Abstract: Langerhans cell Histiocytosis can present as a single or multiple lesion and can affect one or several organ systems. A 41-year-old woman with a history of multisystemic Langerhans cell Histiocytosis invading lung and thyroid was admitted with left-sided spontaneous pneumothorax. Here we report a case of uncommon pulmonary Langerhans-cell Histiocytosis presenting with spontaneous pneumothorax as a multisystemic Langerhans cell Histiocytosis. (Korean J Thorac Cardiovasc Surg 2010;43:447-449)

자연기흉의 비디오흉강경수술 후 재발에 대한 분석

Abstract: Background: Video-assisted thoracic surgery (VATS) became common in the treatment of spontaneous pneumothorax (SP). Therefor we"ve reviewed the recurrence rate after VATS and analysed the factors affecting recurrent pneumothorax after VATS on this study. Material and Method: This retrospective analysis was performed on 321 patients of SP who had undergone VATS from Jan. 2001 to Dec. 2008. The two goups were divided as follow: group A, non-recurrent group (298 patients: 93%); and group B, recurrent group (26 patients: 7%); the two groups were analysed retrospectively. Result: The average age of the study groups were 20.9±4.3 years old in recurrent group vs. 25.9±11.7 years old in non-recurrent group with statistical significance (p＜0.05). There were no statistical significance in male to female ratio, height/weight ratio, location of pneumothorax, smoking history, operative time, duration of drain, hospital stay, indication of opertion and incidence rate. Average length of duration in recurrence was 12.9 months. There was 22 (95.7%) recurrent patients after VATS within 4 year period among recurrent group. Treatment methods in 23 of recurrent patients were, 8 (VATS), 2 (Axillary thoracotomy) with 15% or more in amount of pneumothorax and 7 (7 Fr. chest tube), 6 (nasal O2) with 15% or less in amount of pneumothorax. Among 10 cases of reoperation, there were 3 cases of over looking type and 7 cases of new growing type. There was no additional recurrence after these procedures were given. Conclusion: There was higher recurrence rate in younger age after VATS thus for those under 20 yrs old, detailed and possible preoperative warning for recurrence is warranted. Most recurrence occured within 4 year period, thus for this reason, regular interval based follow up with chest x-ray study is suggested during this period.

Flcn 유전자의 삼염기 결손 돌연변이를 동반한 일차성 자발성 기흉 1예

Abstract: The cause of primary spontaneous pneumothorax (PSP) is obvious. Recently, the FLCN mutation was suggested to be a causal factor in PSP. A 47-year-old Korean male patient with chief complaint of repetitive PSP had numerous emphysematous bullae and multiple large cysts based upon high resolution computer tomography. Here we report a case of PSP with an FLCN c.468_470delTTC mutation.

일차 자연 기흉의 치료를 위한 흉강경하 폐기포 결찰술

Abstract: Background: Video assisted thoracic surgery has been widely accepted for the treatment of primary spontaneous pneumothorax. Material and Method: We retrospectively reviewed the medical records of 89 primary pneumothorax patients who had undergone thoracoscopic bleb ligation from February 2002 to June 2006, and we assessed the patients for recurrence. The mean follow-up period was 65 months. Result: Pneumothorax recurred in 7 patients (8%) during the follow-up period. Conclusion: Thoracoscpic bleb ligation might be an acceptable alternative technique for treating primary spontaneous pneumothorax.

Repair of Ruptured Papillary Muscle of the Tricuspid Valve as a Cause of Tricuspid Insufficiency Following Blunt Chest Trauma

Abstract: A 47-year-old man presented with complaints of chest pain and dyspnea caused by deceleration injury due to an automobile accident. Systolic cardiac murmur was audible at the right sternal border. An electrocardiogram showed sinus tachycardia. Transthoracic echocardiography revealed a flailing anterior leaflet of the tricuspid valve, papillary muscle rupture, and severe valve insufficiency. Rupture of papillary muscle of the anterior leaflet and chordae tendineae of the posterior leaflet were confirmed by right atrial incision under routine cardiopulmonary bypass. Artificial chordae tendineaes were implanted between the anterior and posterior leaflet and papillary muscles in the right ventricles. De-Vega annuloplasty was also added. This is a very rare case in which a surgery was done for tricuspid valve regurgitation caused by post-traumatic papillary muscle rupture.

Vacuum-assisted Closure for the Treatment of Lymphorrhea Following Surgery of the Femoral Artery

Abstract: Lymphorrhea is a common complication after inguinal dissection for exposure of the femoral artery. Injury of the lymphatics occurs frequently because they are anatomically close to blood vessels. Uncontrolled lymph drainage increases postoperative morbidity, and wound infection may follow. Despite current treatment options, lymphorrhea after inguinal dissection is still difficult to manage and results in a prolonged hospital stay. A vacuum-assisted closure device was used in a 72-year-old woman who had lymphorrhea after vascular surgery by groin incision. Vacuum-assisted control for lymphorrhea resulted in earlier closure of the wound and reduced the length of hospital stay. (Korean J Thorac Cardiovasc Surg 2010;43:562-564)

후종격동 종괴로 발견된 골수외 조혈 종괴의 비디오 흉강경 수술을 이용한 절제 1예

Abstract: Extramedullary hematopoiesis is a common compensatory mechanism of chronic anemia, but an asymptomatic posterior mediastinal mass is rarely diagnosed as an extramedullary hematopoiesis after surgical resection. The differential from neurogenic tumors is important, but fine needle aspiration biopsy is not recommended because of the difficulty of approach and risk of bleeding. Although diagnosis and treatment can involve resection via thoracotomy, video-assisted thoracic surgery may also be a useful strategy. We performed video-assisted thoracic surgery on a 59-year-old man for posterior mediastinal extramedullary hematopoiesis, with no evidence of recurrence or related hematologic diseases.

Completely Port-Accessed Atrial Septal Defect Patch Closure Using the da Vinci System

Abstract: We have experienced five cases of atrial septal defect closure under complete port access using the da Vinci system. We used only six 8∼12 ㎜ ports without thoracotomy or sternotomy for operation.

Early and Midterm Results of Hybrid Endovascular Repair for Thoracic Aortic Disease.

Abstract: Background: A hybrid procedure using an open surgical extra-anatomic bypass of aortic arch vessels and thoracic endovascular aortic repair (TEVAR) is less invasive than open surgery, and provides a suitable proximal landing zone. Here we report our experience with a hybrid TEVAR procedure at a single center. Material and Method: We retrospectively reviewed consecutive patients with thoracic aortic disease who received a hybrid TEVAR procedure between August 2008 and January 2010. Patients’ data were prospectively collected and mean follow-up was 10.8±5.5 months (range 3~20). Result: Nine patients (7 males and 2 females) with a mean age of 63.8±15.8 years (range 38~84) underwent a hybrid procedure. Five patients had an arch or a proximal descending aortic aneurysm, two had a dissecting aneurysm of the descending aorta, and two had an aneurysm of the ascending arch and descending aorta. Mean expected mortality calculated by logistic EuroSCORE was 21%. Six patients underwent debranching and rerouting from ascending aorta to arch vessels, 2 had carotid-carotid bypass grafting, and 1 underwent carotid-axillary bypass grafting. Mean operation time was 221.4±84.0 min (range 94~364). Deployment success of endovascular stent grafting was 100% with no endoleak on completion angiography. There was no mortality, and a small embolism in the branch of the right opthalmic artery in one patient. During follow-up, one intervention was required for the endoleak. Actuarial survival at 20 months was 100%. Conclusion: Early and mid-term results are encouraging and suggest that hybrid TEVAR procedures are less invasive and safer and represent an effective technique for treating thoracic aortic disease.

유전자 검사에서 양성 반응을 보인 가족성 점액종

Abstract: Ten percent of all myxomas are the familial form. Familial myxomas appear to have autosomal dominant transmission. We experienced two siblings with familial myxomas. A left atrial myxoma was surgically removed in a 21-year-old woman. Six years later, other myxomas were found in the right atrium and the left atrium and these were also surgically removed. Right ventricular and right atrial myxomas were surgically excised in her brother. The two siblings were found to have frame-shift mutations in the PRKAR1A gene (c.537delA; p.Gly180GlufsX26), which is the causative gene for Carney complex. Obtaining the genetic diagnosis makes it possible to prepare more effective therapeutic strategies for these patients and the gene carriers. Complete excision, ruling out multicentricity and proper postoperative follow up are all necessary to avoid recurrence of myxoma.

Surgical Experience with Killian-Jamieson Diverticulum

Abstract: Killian-Jamieson diverticulum is a rare disease that is seen at the cervical esophagus. It has quite a different pathogenesis and anatomical location compared with that of Zenker’s diverticulum. The pathophysiology and strategy for treating Killian-Jamieson diverticulum are not fully understood. We performed surgery using one incision for treating a case of Killian-Jamieson diverticulum and we review the medical literature that’s related to this unusual diverticulum. (Korean J Thorac Cardiovasc Surg 2010;43:324-327)