• Journal of Chest Surgery
• /
• v.39 no.12 s.269
• /
• pp.949-952
• /
• 2006

Spontaneous pneumothorax is rarely occurred as an initial sign of primary lung cancer. As a lot of these cases have already advanced, even then surgical resection is performed, the prognosis is often undesirable, We happened to find a ruptured cavity on a 65-year-old male patient who had suffered from pulmonary tuberculosis in the past, while performing VATS bullectomy for simple spontaneous pneumothorax, Then, as a result of frozen biopsy, it was diagnosed as squamous cell cancer Because the tumor was infiltrated from the upper lobe into the lower lobe passing by fissure, we should remove by pneumonectomy and the pathologic stage was found stage I(T2N0M0). When we made an follow-up observation for one year and a half, there was neither relapse nor complication. When there appears spontaneous pneumothorax to the high risk group for lung cancer who were smokers over forty-year old, with chronic bronchitis or pulmonary emphysema, it needs to have a closer observation on a base lung disease such as lung cancer through chest CT, and it is also necessary to make more active approach by performing the surgical operation through a thoracoscopy when there is a continued air release.

• Journal of Chest Surgery
• /
• v.31 no.3
• /
• pp.266-270
• /
• 1998

The management of malignant pleural effusion is a difficult problem. Tetracycline was probably the most commonly used sclerosing agent, but parenteral tetracycline is no longer available. This prospective study was designed to determine the efficacy of insufflated talc in producing plerodesisin patients with malignant pleural effusions. Fifteen patients managed between March 1995 and March 1997 underwent thoracoscopy and had 4 gm sterile asbestos-free talc insufflation throughout the pleural space. The mean interval between the procedure and last follow-up was 101 days(range: 25-233 days). The results of treatment were clinically and radiologically compared with pre-operative status. The results were as follows: 1. The patients were 6 men and 9 women with a mean age of 55.1 years(range: 31-74 years). The primary tumors were lung cancer in 10 patients, breast cancer in two, hepatoma in one, stomach cancer in one, and adenocarcinoma of unkown origin in one. 2. Cancer cell positive ratio was 36% in sputum cytology study and 100% in thoracoscopic biopsy. 3. Symptoms improved in 94% of patients treated by talc pleurodesis. 4. After 30 days of the procedure, there was radiologically no recurrence of plural fluid in 94% patients. 5. There were wound infection in one, respiratory failure in one. In conclusion, the insufflation of 4 gm sterile asbestos-free talc in the pleural space is an effective method to control malignant pleural effusions and patients selection is important factor for reexpansion the lung.

• Journal of Chest Surgery
• /
• v.40 no.11
• /
• pp.802-804
• /
• 2007

Although intrathoracic liver in association with a congenital diaphragmatic hernia has been well documented, the finding of intrathoracic ectopic liver tissue in the presence of an intact diaphragm is an extremely rare congenital anomaly. We have experienced a case of intrathoracic ectopic liver without any diaphragmatic hernia. A 37-year-old woman was admitted for the treatment of an incidentally detected right lung mass, A chest computed tomography scan revealed a right lower lobe lung mass close to the diaphragm, and this was suspicious for bronchial carcinoid tumor. Upon surgery, 2 round solid masses $3.5{\times}3.5 cm$ and a $2.0{\times}2.0 cm$ in size were noted, with their bottoms attached to the diaphragm dome. The masses were completely resected. Histologically, they were confirmed to be intrathoracic ectopic livers. The patient had an uncomplicated postoperative course.

• Journal of Chest Surgery
• /
• v.43 no.4
• /
• pp.437-440
• /
• 2010

Cardiac mesotheliomas are rare. It is difficult to diagnose them at an early stage because the symptoms are nonspecific. Here we report two cases that had been initially diagnosed as constrictive pericarditis but later were definitively diagnosed, after pericardiectomy, as mesothelioma. The two patients complained of dyspnea that lasted 4 months and 10 years. Chest CT showed mild pericardial effusion and thickened pericardium, which was found enveloping the heart without any lumps. Median sternotomy showed that the overall pericardium was thickened by more than 10 mm. Pericardiectomy (phrenic nerve to phrenic nerve) was performed and post-operative histology confirmed malignant mesothelioma. In one patient the disease recurred near the pericardium post-operatively at 7 months and the patient died at 11 months. The other patient received chemotherapy and was still alive at post-operative month 16. Pericardial mesothelioma is an extremely rare disease exhibiting clinical signs similar to those of constrictive pericarditis, and should be diagnosed at an early stage of onset.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.31 no.4
• /
• pp.343-348
• /
• 2009

Kaposi's sarcoma was first descrided by Kaposi in 1872 as an idiopathic multiple hemorrhagic sarcoma. Its clinical features revealed to be erythematous red or purple macule started out, and developing into palpable dome-shaped nodules. Etiology is not defined to detail at present. Kaposi's sarcoma is classified to 4 categories; Classical, African, Epidemic and Immunosuppressive type. Epidemic categories is found approximately 20% of all AIDS patients and has strong predilection for head and neck region. The first case of immunosuppresive type Kaposi's sarcoma in patients with kidney transplants was reported in 1969. Kaposi's sarcoma accounts for 5% of all tumors associated with transplanted patients. The most common site of Kaposi's sarcoma in immunosuppressed patients are extremities, but rare in head and neck area. A 42 years old woman who had systemic lupus erythematosus visited to our clinic because of gingival hyperplasia, and excisional biopsy revealed Kaposi's sarcoma. We experienced a case of favorable results using excision and chemotherapy, so we report with review of literatures.

• Journal of Chest Surgery
• /
• v.29 no.3
• /
• pp.331-336
• /
• 1996

Four operative cases of aortic valvuloplasty with leaflet extension technique using glutaraldehyde preserved tautologous pericardium are described. All patients had severe aortic regurgitation on preoperative echocardiogram, and Grade W AR on oath-angiogram. The causes of aortic regurgitation were rheumatic fever in 2 cases, degenerative change in 1 case, and 1 case of unknown cause. The autologous pericardium was fixed In a 0.625% glutaraldehyde solution for 15 minutes and rinsed in saline for an additional 15 minutes. Leaflet extension technique varied in 4 patients depending on the site and the extent of the leaflet size and lesion. There was no hospital mortality and no thromboembolic episode without anticoagulation. Post-operative cardiac size was reduced on simple chest film in all cases, and LVESD and LVEDD were reduced on folio w- up echo cardi o gram . This experience permits us to conclude that leaflet extension technique is simple and safe in valve r construction, allowing repair of aortic valves that need to be replaced.

• Journal of Chest Surgery
• /
• v.37 no.4
• /
• pp.376-381
• /
• 2004

Primary cardiac lymphoma is an extranodal malignant lymphoma of any cell type involving only heart and pericardium without dissemination. Patients usually present symptoms of heart failure, arrhythmias, pericardial effusion and cardiac tamponade. Diagnosis of primary cardiac lymphoma can be performed by echocardiogram, CT and MRI and cytologic examination of pericardial effusion or transvenously biopsied cardiac tissue. Prognosis of primary cardiac lymphoma is poor. Because of poor prognosis, early diagnosis and complete surgical excision is essential and postoperative systemic chemotherapy or radiotherapy is useful. In this case extensive tumor infiltration on the right ventricle and atrioventricular groove preclude surgical excision. Tissue biopsy revealed primary cardiac lymphoma. After postoperative chemotherapy and radiotherapy, the size of intracardiac mass is decreased in follow up chest CT scan and echocardiogram and symptoms of patient are relieved. Therefore, we report a case of primary cardiac lymphoma with review of literatures.

• Tuberculosis and Respiratory Diseases
• /
• v.59 no.6
• /
• pp.690-695
• /
• 2005

Nitric acid is an oxidizing agent used in metal refining and cleaning, electroplating, and other industrial applications. Its accidental spillage generates oxides of nitrogen, including nitric oxide (NO) and nitrogen dioxide ($NO_2$), which cause chemical pneumonitis when inhaled. The clinical presentation of a nitric acid inhalation injury depends on the duration and intensity of exposure. In mild cases, there may be no symptoms during the first few hours after exposure, or the typical symptoms of pulmonary edema can appear within 3-24 hours. However, in cases of prolonged exposure, progressive pulmonary edema develops instantaneously and patients may not survive for more than 24 hours. We report a case of a 44-year-old male who was presented with acute respiratory distress syndrome after nitric acid inhalation. He complained of cough and dyspnea of a sudden onset after inhaling nitric acid fumes at his workplace over a four-hour period. He required endotracheal intubation and mechanical ventilation due to fulminant respiratory failure. He was managed successfully with mechanical ventilation using positive end expiratory pressure and systemic corticosteroids, and recovered fully without any deterioration in his pulmonary function.

• Journal of Chest Surgery
• /
• v.31 no.2
• /
• pp.212-215
• /
• 1998

Pulmonary mucinous cystic tumor of borderline malignancy is very rare and distinguished from bronchogenic cyst or adenocarcinoma of bronchoalveolar type. We present the case of a 63-year-old woman with a right lower lobe mass, found by chest radiographs. The preoperative diagnosis was made as bronchoalveolar cancer by percutaneous needle aspiration of mass. Right lower lobectomy and lymph node dissections were performed. The lobectomy specimen contained variable sized multilocular cystic mucous masses, filled with mucus. Microscopically, the cystic masses are lined with tall columnar mucinous epithelium but some area contains focal cellular atypism and bronchoalveolar cancer like foci. This foci are lack of cellular atypism consistent with bronchoalveolar cancer cell. After lobectomy the patient has remained free from recurrence and distant metastasis for following 12 months period. Pulmonary mucinous cystic tumor of borderline malignancy appears to have a favorable prognosis and should be distinguished from other lung neoplasms.

• Journal of Chest Surgery
• /
• v.35 no.5
• /
• pp.392-396
• /
• 2002

Background: Video-thoracoscopy is known to be an useful method to provide accurate pre-resectional staging in patients with lung cancer in addition to the conventional radiologic studies and mediastinoscopy, for the pleural cavity is inspected directly and biopsy specimens call be obtained. This study is undertaken to evaluate how video-thoracoscopy can be used in deciding pre-resectional stage Material and Method: Video-thoracoscopy was performed in patients with lung cancer who were scheduled for surgical resection based on the radiologic staging and mediastinoscopic biopsy. 37 patients were included in this study. Pre-thoracoscopically 18 cases were in TNM stage 1, 7 in stage 2, and 12 in stage 3. Result: In 15 of 37 cases, video-thoracoscopy could not be performed effectively due to heavy adhesions in the pleural cavity, diaphragmatic and chest wall invasion of tumor and bulky tumor mass es. Mediastinal lymph nodes were positive postresectionally in 6 of these 15 cases. In 22 cases, video-thoracoscopy was performed as usual. Positive mediastinal lymph nodes were identified in 2 cases and exploratory thoracotomy was prevented. Surgical resection were carried out in remaining 20 cases and 5 cases among them had positive mediastinal lymph nodes. Conclusion: We believe that it is difficult to perform pre-thoracotorny video-thoracoscopy for all lung cancer patients for there were many cases that thoracoscory could not be undertaken doe to heavy adhesions in the pleural cavity, tumor involvement of the chest wall and/or diaphragm and bulky tumor mass. However we think it is helpful in preventing unnecessary exploratory thoracotomy for some patients with lung cancer whom pre-thoracotomy video-thoracoscopy was carried out.