• Journal of Chest Surgery
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• v.42 no.5
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• pp.649-652
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• 2009

A 75-year-old man presented with worsening dyspnea and intermittent dysphagia of one month's duration. A plain chest X-ray showed severe tracheal indentation by the right superior mediastinal mass. A chest CT established the diagnosis of a saccular aneurysm arising from the right proximal subclavian artery. Resection of the aneurysm and arterial revascularization was done through a median sternotomy with supraclavicular extension. Aneurysm wall and thrombus culture results were negative and pathology showed an atherosclerotic aneurysm. After the operation, dyspnea and dysphagia were reduced, but he died of advanced stomach cancer 8 months later.

• Journal of Chest Surgery
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• v.24 no.1
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• pp.72-82
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• 1991

From May 1978 to Sep. 1990, 106 patients who had been diagnosed as primary lung cancer and operated on at the Department of Thoracic & Cardiovascular Surgery, Han Yang University, were clinically evaluated. 1. The peak incidence of age was 5th decade of life[37.7%] and 6th decade[29.2%]. Male to female ratio was 3.8: l. 2. Most of symptoms were respiratory, which were cough, chest pain, hemoptysis, and asymptomatic cases were 2.9%. 3. Histopathologic classifications were squamous cell carcinoma[53.7%], adenocarcinoma [23.8%], bronchioloalveolar cell carcinoma[6.6%], undifferentiated large cell carcinoma[6.6%], small cell carcinoma[3.8%], adenosquamous carcinoma[3.8%] and others[1.8%]. 4. Methods of operation were pneumonectomy 49.1%[52cases], lobectomy 21%[22cases] bilobectomy[6cases], lobectomy with wedge resection[3cases], exploration 21.9%[23cases], and resectability was 78.3%. 5. Staging classifications were Stage I [22.6%], Stage II [11.3%], Stage IIIa[42.6%], Stage IIIb[21.7%] and Stage lV[1.6%]. Resectability by Stage; Stage I was 100%, II 100%, IIIa 84.4% and IIIb 30.4%. 6. Causes of most of inoperable cases were invasion of mediastinal structures and diffuse chest wall, and others were contralateral lymph node invasion and malignant pleural effusion. 7. Operative mortality was 6.7% which caused by arrhythmia, sepsis, pulmonary edema, and radiation pneumonitis. 8. On the long term follow up of the resectable cases, overall 1 year survival rate was 58.5 %, 2 year 39%, and 5 year 19.5%. Five year survival rate was 40% in Stage I, 25% in Stage II and 11.7% in Stage Illa. As for the method of operation, the higher 5 year survival rate was observed in lobectomies[33.3%] than in pneumonectomies[10.3%].

• Radiation Oncology Journal
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• v.21 no.4
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• pp.253-260
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• 2003

Purpose: No general consensus has been reached regarding the necessity of postoperative radiation therapy (PORT) and the optimal techniques of its application for patients with chest wall invasion (pT3cw) and node negative (NO) non-small cell lung cancer (NSCLC). We retrospectively analyzed the PT3cwN0 NSCLC patients who received PORT because of presumed inadequate resection margin on surgical findings. Materials and Methods: From Aug. 1994 till June 2000, 21 pT3cwN0 NSCLC patients received PORT at Samsung Medical Center; all of whom underwent curative on-bloc resection of the primary tumor plus the chest wall and regional lymph node dissection. PORT was typically stalled 3 to 4 weeks after operation using 6 or 10 MV X-rays from a linear accelerator. The radiation target volume was confined to the tumor bed plus the immediate adjacent tissue, and no regional lymphatics were included. The planned radiation dose was 54 Gy by conventional fractionation schedule. The survival rates were calculated and the failure patterns analyzed. Results: Overall survival, disease-free survival, loco-regional recurrence-free survival, and distant metastases-free survival rates at 5 years were 38.8$\%$, 45.5$\%$, 90.2$\%$, and 48.1$\%$, respectively. Eleven patients experienced treatment failure: six with distant metastases, three with intra-thoracic failures, and two with combined distant and intra-thoracic failures. Among the five patients with intra-thoracic failures, two had pleural seeding, two had in-field local failures, and only one had regional lymphatic failure in the mediastinum. No patients suffered from acute and late radiation side effects of RTOG grade 3 or higher. Conclusion: The strategy of adding PORT to surgery to improve the probability, not only of local control but also of survival, was justified, considering that local control was the most important component in the successful treatment of pT3cw NSCLC patients, especially when the resection margin was not adequate. The incidence and the severity of the acute and late side effects of PORT were markedly reduced, which contributed to improving the patients' qualify of life both during and after PORT, without increasing the risk of regional failures by eliminating the regional lymphatics from the radiation target volume.

• Journal of Chest Surgery
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• v.37 no.3
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• pp.272-274
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• 2004

We report an unusual case of left atrial auricular abscess which was successfully treated by surgical resection, treatment with antibiotics and mediastinal irrigation. A 9-year-old female patient with previous history of urinary tract infection was admitted because of persistent fever. Echocardiography and magnetic resonance imaging revealed massive pericardial effusion and a mass lesion at the left upper cardiac border. Pericardiocentesis isolated Staphylococcus aureus on culture. The patient underwent mass removal under cardiopulmonary bypass. The mass was located within the left atrial auricular wall with fibropurulent abscess formation inside. Postoperative mediastinal irrigation was performed. Pathologic examination of the mass showed organized thrombi with chronic fibrosing mural endocarditis. She discharged on the 21st postoperative day without complication.

• Korean Journal of Bronchoesophagology
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• v.15 no.2
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• pp.81-86
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• 2009

A 57 year old human immune virus(HIV)-positive male presented with a progressive dyspnea for 6 months. Chest CT showed multiple polypoid masses arising from upper tracheal wall. Bronchoscopic examination revealed that multiple large cauliflower-like polypoid tumors was obstructing tracheal lumen. They were diagnosed as multiple squamous papillomas and were removed by Nd:YAG laser photocoagulation and rigid bronchoscopic treatment. The tumors were histologically diagnosed as squamous papilloma infected with human papilloma virus(HPV) type 6 and 11 in in-situ hybridization. Rigid bronchoscopy might be safer and more efficient than flexible bronchoscopy for the treatment of multiple tracheal papillomatosis obstructing tracheal lumen because of easy establishment of airway patency and direct use of rigid bronchoscope itself for tumor resection.

• Journal of Chest Surgery
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• v.47 no.2
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• pp.111-116
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• 2014

Background: We aimed to investigate the epidemiological, clinical, paraclinical, and treatment aspects of elastofibroma dorsi through a retrospective study of 76 patients who underwent surgery between January 2008 and December 2012 in our department. Methods: Our study is retrospective between January 2008 and December 2012. We admitted 79 patients with a subscapular mass, and only 76 patients had ED. The others (n=2) had high associated risk of anesthesia and were managed by a medical treatment and one patient had a subscapular sclerotic hemangioma. Results: The average age of the patients was 49 years (range, 38 to 70 years), with a female predominance (54 females and 22 males). Subscapular location was constant. The right, left, and bilateral form was noted in 41, 15 and 20 cases, respectively. The diagnosis was clinical in 60 cases. Ultrasound and computerized tomography scans confirmed the diagnosis of an ill-defined mass in a subscapular location in all cases. Surgical treatment consisted of complete resection of the mass. The clinical diameter of the mass remained significantly lower than that of the surgical specimen (7 cm versus 12 cm) because the major hidden part of the mass in the subscapular area was inaccessible to palpation. Complications were noted in 9 cases (11.8%), seroma in 8 cases (10.5%), infection of wound site in 4 cases (5%), and parietal textilome in one case (1%). No case of recurrence was noted. Conclusion: Surgery of elastofibroma is unique because of the subscapular location of the parietal tumor, whose histological fibrous nature makes it very adherent to the chest wall.

• Tuberculosis and Respiratory Diseases
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• v.52 no.6
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• pp.645-650
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• 2002

Extraosseous pulmonary chondrosarcoma is rare neoplasm, which is characterized into two groups. One is termed a primary chondrosarcoma, and arise de novo (bronchial cartilage), the other is termed a secondary chondrosarcoma, and is superimposed on preexisting benign cartilagenous neoplasms, such as a chondroma or hamartoma. The preferred treatment is surgical resection. We recently experienced a secondary chondrosarcoma changed from a hamartoma. A 54-year-old woman was referred to our hospital because of an abnormal chest X-ray with mild dyspnea. We performed a percutaneous transthoracic needle biopsy and sputum examination. The abnormal mass had been diagnosed as a chondromatous hamartoma with active pulmonary tuberculosis, which had been treated with anti-tuberculosis regimens. Despite her medication, an abnormal mass had grown. Therefore, we undertook a pneumonectomy with chest wall reconstruction. Histopathologically, the mass was a grade II, dedifferenciated chondrosarcoma, with chronic granulomatous inflammation and necrosis. We suggest this case had changed from a chondromatous hamartoma to a dedifferentiated chondrosarcoma, with associated pulmonary tuberculosis. We report this case with a brief literature review.

• Journal of Chest Surgery
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• v.35 no.3
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• pp.235-238
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• 2002

Among the causes of SVC syndrome, intraluminal tumor, especially the leiomyosarcoma is very rare. We report a 39 year old female patient who had been suffering from headache and facial edema for 6 weeks before admission. On physical examination, facial edema and venous engorgement on upper extermities and upper chast wall were showed. The chest CT scan and SVC cavogram showed a long intraluminal mass lesion resulting in a near total obstruction of the SVC Surgery was performed through median sternotomy. For complete resection of the tumor and thrombus, we used partial and total CPB. The follow up SVC cavogram revealed no abnormality 14 months after the operation.

• Journal of Chest Surgery
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• v.30 no.6
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• pp.613-616
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• 1997

We present a case of 58-year-old (tamale with dilated cardiomyopathy(DCMP) in whom we performed left ventricular(LV) remodeling surgery(Batista operation) to reduce the left ventricle diameter and improve left ventricular unction. The patient was admitted September 1996 with heart failure NYHA class IV. There was severe orthopnea and peripheral edema. 2-D echocardiography(Echo) showed DCMP with the ejection fraction(EF) I5%, LV end diastolic dimension(LVEDD) 80mm, mitral regurgitation(MR) grade IV, tricuspid regurgitation ('m) grade ll. Preoperative cardiac output(CO) was 1.5/L/min and cardiac index(Cl) was 1.0 L/min/m2. We proceeded with LV remodeling surgery by resection a part of LV lateral wall between both papillary muscle, from the mitral annulus to the LV apex. Size of resected LV wall was 90 $\times$ 100 $\times$ 15 mm. At the mean time, mitral valve and tricuspid valve were repaired. Postoperative 2-D Echo showed the EF 37%, LVEDD 50 mna, trivial MR, no TR. CO was 3.SL/min and Cl was 2.3 L/min/m2. Her fuctional NYHA class was 1.

• Journal of Chest Surgery
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• v.42 no.3
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• pp.355-360
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• 2009

Background: Benign teratoma is mostly asymptomatic, but this tumor rarely ruptures into the adjacent structure such as the pleural space, pericardium, lung parenchyma or tracheobronchial tree. Thus, it is important to differentiate ruptured teratoma from unruptured teratoma. This study evaluated the difference between ruptured and unruptured benign teratoma. Material and Method: Twenty-four cases of surgically resected benign teratomas were reviewed retrospectively. The clinical symptoms, chest CT findings and operative findings of the ruptured teratoma were compared with those of the unruptured teratoma. Especially, the tumor size, wall thickness, location of the mass, internal septation, homogeneity, calcification and ancillary findings were evaluated on CT. Result: Of the 24 patients, 7 patients were diagnosed with ruptured teratoma. Severe symptoms were more commonly found for ruptured teratoma than for unruptured teratoma. The ruptured teratoma had a tendency to display calcification and such ancillary findings as collapse or consolidation of the lung parenchyma. For the ruptured teratoma, the resection was performed by sternotomy or thoracotomy, and more lung resection was included. Conclusion: Calcification within the mass and changes in the lung parenchyma on the preoperative CT findings can be diagnostic signs of a ruptured teratoma. The demonstration of ruptured teratoma is important not only for making the early diagnosis, but also for the surgical planning.