We performed nerve resection and reconstruction of the phrenic nerve in a 63-year-old female patient who underwent complete resection of a malignant thymoma. The left phrenic nerve was completely encased by the tumor for 2 cm. Thus, a 3 cm long piece of phrenic nerve with 5 mm margins of safety on each end was resected and it was directly anastomosed in an end-to-end fashion. At 11 months after reconstruction, fluoroscopy demonstrated adequate and symmetric motion of both hemidiaphragms, which indicated the restoration of phrenic nerve function. The pulmonary function test results were comparable to those obtained preoperatively at 30 months. There has been no evidence of recurrence at the recent follow up visits.
Background: The Ivor-Lewis operation has been widely applied for treating thoracic esophageal cancer, but more acceptable results from three-field lymph node dissection have recently been reported. In this study the efficacy of the Ivor-Lewis operation was evaluated. Material and Method: Among the 273 patients, who underwent operation for esophageal cancer between September 1994 and August 2004, we retrospectively studied 172 patients with esophageal squamous cell carcinoma and who had no other primary cancer and who underwent complete resection with an Ivor-Lewis operation. The postoperative complications, the short and long-term survival and the recurrence patterns were analyzed. Result: The postoperative staging was as follows: stage I in 40 cases, IIA in 48 cases, IIB in 18 cases, III in 55 cases, IVA in 5 cases and IVB in 6 cases. The operative mortality rate was 4% (7 of 172 pts). Postoperative complication occurred in 32 patients (18%) and tumor recurred in 55 patients (32%). The overall 5-year survival rate was 48%; it was 85.6% in stage I patients, 47.6% in IIA patients, 65% in IIB patients, 22.8% in III patients and 0% for those in IV (p<0.05). The 5-year survival rate according to the location of esophageal cancer was 26.5% for patients with tumor in the upper 1/3 of the esophagus and 52.4% for patients with tumor in the mid and lower 1/3 (p>0.05). Conclusion: The Ivor-Lewis operation is an acceptable surgical procedure for thoracic esophageal squamous cell carcinoma. Yet it is necessary to consider other surgical procedures, and especially three-field lymph node dissection for treating upper 1/3 esophageal cancer.
A review of 50 patients with primary mediastinal tumors or cysts has been done to evaluate clinical and pathological behavior of this heterogeneous group of tumors proved by either excision or biopsy from January 1980 to August 1989 at the cardiovascular department of surgery in Kyungpook National University Hospital. There were 30 males and 20 females in this series. The ages of patients ranged from 4 months to 64 years. The mean age of subjects was 30.4 years. Neurogenic tumors [14 cases, 28%] and teratoma [14 cases, 28%] were most frequently encountered and followed by thymoma [10 cases, 20%] and benign cysts [4 cases, 8%]. The anatomic location of the primary mediastinal tumors or cysts was classified as anterior mediastinum and middle or visceral mediastinum and paravertebral or costovertebral mediastinum on the basis of the Shields’ proposition. In 32 patients[64%], the tumors or cysts were located in anterior mediastinum and in 13 patients[26%], the tumors or cysts were located in paravertebral or costovertebral mediastinum. And the rest 5 patients[10%] had middle or visceral mediastinal tumors or cysts. One of the characteristic features of primary mediastinal tumors or cysts is that some mediastinal tumors or cysts have their own preferred location in the mediastinum. In our series, all of the 14 patients with teratoma and 10 patients with thymoma had the anterior mediastinal location, while 13 of the 14 patients with neurogenic tumors had the paravertebral mediastinal location. 14 patients[28%] were asymptomatic and they all were discovered via so-called “Routine” chest x-ray examination. 39 of 50 patients[78%] were benign. 11 patients[22%] were malignant and they were all symptomatic. 40 patients[80%] were treated with complete resection. 5 patients[10%] were treated with partial resection : 2 of malignant thymoma, 3 of lipoma, neuroblastoma, primary squamous cell carcinoma. The rest 5 patients[10%] were only biopsied: 2 of undetermined malignancy and 3 of hemangioma, lymphoma, primary squamous cell carcinoma. 4 of the 10 patients were treated with combination of irradiation and chemotherapy. Postoperative complications were as followings: Horner’s syndrome [4cases, ado], respiratory failure [3 cases, 6%], pleural effusion[3 cases, 6%], Wound infection[2 cases, 4%] and bleeding, pneumothorax, empyema. There were 5 postoperative deaths [10%]. One patient with neuroblastoma died from intraoperative massive bleeding, 3 patients died early postoperatively from respiratory failure with undetermined malignancy died late postoperatively from congestive heart failure due to direct invasion of the tumor to the heart.
Background: Surgical resection is the standad therapy for the stage I lung cancer. We analysed the risk facturs of stage I lung cancer patent and tryed to establish more effective and aggressive treatment modality. Materials and methods: A detailed analysis was undertaken to evaluate the surgical results and to define the risk factors associated with the recurrence and the survival time in 146 consecutive patients with stage I lung cancer who were diagnosed, and resected at Yonsei Medical Center from January 1990 to December 1996. Results: There were 115 males and 31 females. Their ages ranged from 27 to 79 years(mean age:58.9$\pm$9.3 years). The histologic types were squamous carcinoma in 72 cases(49.3%) and adenocarcinoma in 45 cases(30.8%). A pulmonary resection and mediastinal lymph node dissection were done in all cases. A lobectomy was performed in 96 cases(65.7%) and a pneumonectomy in 48 cases(32.9%). There were 5 operative mortalities(3.4%) and complications occured in 24 cases(16.5%). The overall 5-year survival was 64.1%, and survival time did not depend on the type of operation or histologic type. Significant predictors of decreased survival were visceral pleural invasion(p=0.0079), T2 lesion(p=0.0462), and tumor size($\geq$5 cm) in adenocarcinoma(p=0.0472). The overall incidence of recurrence was 33.3%(47 cases; local or regional 6.4%, distant 26.9%). Almost all recurrences(44cases) occurred in T2 lesions. The distant organs that failed were the contralateral lung in 13 patients, the brain in 12, the bone in 10, and other organs in 3. Conclusions: even in stage I lung cancer, we suggest that postoperative adjuvant therapy is recommended in patients with poor prognostic factors such as visceral pleural invasion, T2 lesions, and a tumor size($\geq$5 cm) in the adenocarcinoma.
Cho Yang Hyun;Ryu Se Min;Kim Hyun Koo;Sim Jae Hoon;Kim Hark Jar;Choi Young Ho;Sohn Young-Sang
Journal of Chest Surgery
/
v.38
no.1
s.246
/
pp.67-71
/
2005
The major etiology of superior vena cava (SVC) syndrome is malignancy. Radiologic endovascular intervention is the treatment of choice for patients with SVC syndrome due to malignant disease, which is unresponsive to radiation therapy and chemotherapy. However, it is not clear whether endovascular intervention can replace open surgery as the primary method of management of benign SVC syndrome. We report two cases of benign SVC syndrome resulting from dialysis catheters placed in the central veins. One patient underwent bypass surgery between innominate vein and right atrium by expanded polytetrafluoroethylene. Another patient had large thrombi in SVC and other central veins. We removed them under cardiopulmonary bypass to prevent pulmonary embolism, and SVC was repaired and augmented by autologous pericardium. Prompt symptomatic relief and angiographic improvements of collateral flow were achieved in both patients.
Park, Kuhn;Cho, Deog-Gon;Park, Jae-Kill;Jo, Geon-Hyon;Wang, Young-Pil;Kwack, Moon-Sub;Kim, Se-Wha;Lee, Hong-Kyun
Journal of Chest Surgery
/
v.25
no.3
/
pp.258-270
/
1992
Benign lung tumors have been considered as relatively rare disease, which comprise approximately 8 to 15% of all solitary pulmonary lesions that are detected radiographically. We clinically analized 30 cases of benign lung tumors underwent the operation from Jan. 1970 to Aug.1991 in the department of thoracic and cardiovascular surgery, Catholic University Medical College. We adopted the classification presented by the World Health Organization[WHO], modified from Liebow, and added benign mesothelioma. There were 11 males & 19 females ranging in age from 2 years to 68 years old % the mean age was 38 years old. Of all 30 benign lung tumors, hamartomas [14 cases, 49%] were the most common & followed by hemangiomas [9 cases, 30%], 3 cases of benign mesotheliomas % a case of teratoma, papilloma, arteriovenous malformation and inflammatory pseudotumor. 14 cases of tumors were asymptomatic & were incidentally detected by plane chest x-ray In other cases, chief complaints at admission were coughing, chest discomfort, dyspnea, hemoptysis, and fever. Diagnosis were made by pathological examination; exploratory thoracotomy in 23 patients[76.7%], bronchoscopy in 4 patients and percutaneous needle aspiration biopsy in 3 patients. Precisely, preoperative diagnosis for confirmation of benign lung tumor was made only in 7 cases[23.6%]. Tumors were located on Rt.side[24 cases], especially Rt. middle lobe, and Lt.side[6 cases]. Operation methods were as follows: 21 cases [70%] of lobectomy, 2 cases of segmentectomy, 2 cases of wedge resection, 1 case of pneumonectomy, 1 case of bronchotomy, 2 cases of wedge resection, 1 case of pneumonectomy, 1 case of bronchotomy removal of the endobronchial hamartoma which located at the rt. main stem bronchus and 3 cases of complete resection in benign mesotheliomas. There were no operative death. The post operative complications were developed in 3 cases; post pneumonectomy empyema, wound infection and atelectasis. In conclusion, benign lung tumors must be histologically diagnosed to confirm of benignity and to provide limited resection for preservation of the lung tissue, whenever possible.
A retrospective analysis was performed on the 72 cases of peripheral artery occlusive disease treated at Yonsei Medical School Yongdong Severance Hospital, from March 1, 1990, through July 31, 1992, focusing on the operative procedures, surgical results and perioperative complications. The etiologic causes of vascular obstruction were atherosclerosis in 28 cases, Buerger's disease in 31, traumatic orgin in 7, operative complications in 4, and malignancy and arteritis in one case each. Treatment modalities, actually performed include bypass graft.(27), infusion of PGE1 (23), Embolectomy (16), Sympathectomy (4) and end-to-end anastomosis (2). There were 21 satisfactory cases and 9 unsatisfactory cases of atherosclerotive occlusive disease, defining the operative outcome as“satisfactory”if the obstructive symptoms disappeared completely and “unsatisfactory”if they did not. The patients of TAO induced Buerger's disease with preoperative Foutain class III or IV were surgically converted to class 0 in 14 cases, class I in 12 and class II in 3.
Kim, Mi-Jung;Song, Chang-Min;Jung, Sung-Chol;Kim, Woo-Shik;Shin, Yong-Chul;Kim, Byung-Yul
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.
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.
Background: Video-assisted thoracoscopic surgery has become a standard therapy for several diseases such as pneumothorax, hyperhidrosis, mediastinal mass, and so on. These methods usually required single-lung ventilation with double-lumen endobronchial tube to collapse the lung under general anesthesia. However, risks of general anesthesia itself and single-lung ventilation must be considered in high-risk patients. Material and method: Between December 1997 and July 1998, eight high-risk patients (6: empyema, 1: intractable pleural effusion, 1: idiopathic pulmonary fibrosis) with underlying pulmonary disease and poor general condition were treated by video-assisted thoracoscopic surgerys under epidural anesthesia and spontaneous breathing. Result: Video-assisted thoracoscopic surgerys were successfully per formed in 7 patients. Conversion to general anesthesia was required in 1 patient because of decrease in spontaneous breathing. But, conversion to open decortication was not required. In two patients with chronic empyema, one patient required thoracoplasty as a second procedure and one patient required re-video-assisted thoracoscopic procedure due to a recurrence. The mean operative time was 31.8$\pm$15.2 minutes. No significant postoperative respiratory com plication was encountered. Conclusion: Video-assisted thoracoscopic surgerys can be per formed safely under epidural anesthesia for the treatment of empyema and diagnosis of pulmonary abnormalities in high-risk patients.
본 웹사이트에 게시된 이메일 주소가 전자우편 수집 프로그램이나
그 밖의 기술적 장치를 이용하여 무단으로 수집되는 것을 거부하며,
이를 위반시 정보통신망법에 의해 형사 처벌됨을 유념하시기 바랍니다.
[게시일 2004년 10월 1일]
이용약관
제 1 장 총칙
제 1 조 (목적)
이 이용약관은 KoreaScience 홈페이지(이하 “당 사이트”)에서 제공하는 인터넷 서비스(이하 '서비스')의 가입조건 및 이용에 관한 제반 사항과 기타 필요한 사항을 구체적으로 규정함을 목적으로 합니다.
제 2 조 (용어의 정의)
① "이용자"라 함은 당 사이트에 접속하여 이 약관에 따라 당 사이트가 제공하는 서비스를 받는 회원 및 비회원을
말합니다.
② "회원"이라 함은 서비스를 이용하기 위하여 당 사이트에 개인정보를 제공하여 아이디(ID)와 비밀번호를 부여
받은 자를 말합니다.
③ "회원 아이디(ID)"라 함은 회원의 식별 및 서비스 이용을 위하여 자신이 선정한 문자 및 숫자의 조합을
말합니다.
④ "비밀번호(패스워드)"라 함은 회원이 자신의 비밀보호를 위하여 선정한 문자 및 숫자의 조합을 말합니다.
제 3 조 (이용약관의 효력 및 변경)
① 이 약관은 당 사이트에 게시하거나 기타의 방법으로 회원에게 공지함으로써 효력이 발생합니다.
② 당 사이트는 이 약관을 개정할 경우에 적용일자 및 개정사유를 명시하여 현행 약관과 함께 당 사이트의
초기화면에 그 적용일자 7일 이전부터 적용일자 전일까지 공지합니다. 다만, 회원에게 불리하게 약관내용을
변경하는 경우에는 최소한 30일 이상의 사전 유예기간을 두고 공지합니다. 이 경우 당 사이트는 개정 전
내용과 개정 후 내용을 명확하게 비교하여 이용자가 알기 쉽도록 표시합니다.
제 4 조(약관 외 준칙)
① 이 약관은 당 사이트가 제공하는 서비스에 관한 이용안내와 함께 적용됩니다.
② 이 약관에 명시되지 아니한 사항은 관계법령의 규정이 적용됩니다.
제 2 장 이용계약의 체결
제 5 조 (이용계약의 성립 등)
① 이용계약은 이용고객이 당 사이트가 정한 약관에 「동의합니다」를 선택하고, 당 사이트가 정한
온라인신청양식을 작성하여 서비스 이용을 신청한 후, 당 사이트가 이를 승낙함으로써 성립합니다.
② 제1항의 승낙은 당 사이트가 제공하는 과학기술정보검색, 맞춤정보, 서지정보 등 다른 서비스의 이용승낙을
포함합니다.
제 6 조 (회원가입)
서비스를 이용하고자 하는 고객은 당 사이트에서 정한 회원가입양식에 개인정보를 기재하여 가입을 하여야 합니다.
제 7 조 (개인정보의 보호 및 사용)
당 사이트는 관계법령이 정하는 바에 따라 회원 등록정보를 포함한 회원의 개인정보를 보호하기 위해 노력합니다. 회원 개인정보의 보호 및 사용에 대해서는 관련법령 및 당 사이트의 개인정보 보호정책이 적용됩니다.
제 8 조 (이용 신청의 승낙과 제한)
① 당 사이트는 제6조의 규정에 의한 이용신청고객에 대하여 서비스 이용을 승낙합니다.
② 당 사이트는 아래사항에 해당하는 경우에 대해서 승낙하지 아니 합니다.
- 이용계약 신청서의 내용을 허위로 기재한 경우
- 기타 규정한 제반사항을 위반하며 신청하는 경우
제 9 조 (회원 ID 부여 및 변경 등)
① 당 사이트는 이용고객에 대하여 약관에 정하는 바에 따라 자신이 선정한 회원 ID를 부여합니다.
② 회원 ID는 원칙적으로 변경이 불가하며 부득이한 사유로 인하여 변경 하고자 하는 경우에는 해당 ID를
해지하고 재가입해야 합니다.
③ 기타 회원 개인정보 관리 및 변경 등에 관한 사항은 서비스별 안내에 정하는 바에 의합니다.
제 3 장 계약 당사자의 의무
제 10 조 (KISTI의 의무)
① 당 사이트는 이용고객이 희망한 서비스 제공 개시일에 특별한 사정이 없는 한 서비스를 이용할 수 있도록
하여야 합니다.
② 당 사이트는 개인정보 보호를 위해 보안시스템을 구축하며 개인정보 보호정책을 공시하고 준수합니다.
③ 당 사이트는 회원으로부터 제기되는 의견이나 불만이 정당하다고 객관적으로 인정될 경우에는 적절한 절차를
거쳐 즉시 처리하여야 합니다. 다만, 즉시 처리가 곤란한 경우는 회원에게 그 사유와 처리일정을 통보하여야
합니다.
제 11 조 (회원의 의무)
① 이용자는 회원가입 신청 또는 회원정보 변경 시 실명으로 모든 사항을 사실에 근거하여 작성하여야 하며,
허위 또는 타인의 정보를 등록할 경우 일체의 권리를 주장할 수 없습니다.
② 당 사이트가 관계법령 및 개인정보 보호정책에 의거하여 그 책임을 지는 경우를 제외하고 회원에게 부여된
ID의 비밀번호 관리소홀, 부정사용에 의하여 발생하는 모든 결과에 대한 책임은 회원에게 있습니다.
③ 회원은 당 사이트 및 제 3자의 지적 재산권을 침해해서는 안 됩니다.
제 4 장 서비스의 이용
제 12 조 (서비스 이용 시간)
① 서비스 이용은 당 사이트의 업무상 또는 기술상 특별한 지장이 없는 한 연중무휴, 1일 24시간 운영을
원칙으로 합니다. 단, 당 사이트는 시스템 정기점검, 증설 및 교체를 위해 당 사이트가 정한 날이나 시간에
서비스를 일시 중단할 수 있으며, 예정되어 있는 작업으로 인한 서비스 일시중단은 당 사이트 홈페이지를
통해 사전에 공지합니다.
② 당 사이트는 서비스를 특정범위로 분할하여 각 범위별로 이용가능시간을 별도로 지정할 수 있습니다. 다만
이 경우 그 내용을 공지합니다.
제 13 조 (홈페이지 저작권)
① NDSL에서 제공하는 모든 저작물의 저작권은 원저작자에게 있으며, KISTI는 복제/배포/전송권을 확보하고
있습니다.
② NDSL에서 제공하는 콘텐츠를 상업적 및 기타 영리목적으로 복제/배포/전송할 경우 사전에 KISTI의 허락을
받아야 합니다.
③ NDSL에서 제공하는 콘텐츠를 보도, 비평, 교육, 연구 등을 위하여 정당한 범위 안에서 공정한 관행에
합치되게 인용할 수 있습니다.
④ NDSL에서 제공하는 콘텐츠를 무단 복제, 전송, 배포 기타 저작권법에 위반되는 방법으로 이용할 경우
저작권법 제136조에 따라 5년 이하의 징역 또는 5천만 원 이하의 벌금에 처해질 수 있습니다.
제 14 조 (유료서비스)
① 당 사이트 및 협력기관이 정한 유료서비스(원문복사 등)는 별도로 정해진 바에 따르며, 변경사항은 시행 전에
당 사이트 홈페이지를 통하여 회원에게 공지합니다.
② 유료서비스를 이용하려는 회원은 정해진 요금체계에 따라 요금을 납부해야 합니다.
제 5 장 계약 해지 및 이용 제한
제 15 조 (계약 해지)
회원이 이용계약을 해지하고자 하는 때에는 [가입해지] 메뉴를 이용해 직접 해지해야 합니다.
제 16 조 (서비스 이용제한)
① 당 사이트는 회원이 서비스 이용내용에 있어서 본 약관 제 11조 내용을 위반하거나, 다음 각 호에 해당하는
경우 서비스 이용을 제한할 수 있습니다.
- 2년 이상 서비스를 이용한 적이 없는 경우
- 기타 정상적인 서비스 운영에 방해가 될 경우
② 상기 이용제한 규정에 따라 서비스를 이용하는 회원에게 서비스 이용에 대하여 별도 공지 없이 서비스 이용의
일시정지, 이용계약 해지 할 수 있습니다.
제 17 조 (전자우편주소 수집 금지)
회원은 전자우편주소 추출기 등을 이용하여 전자우편주소를 수집 또는 제3자에게 제공할 수 없습니다.
제 6 장 손해배상 및 기타사항
제 18 조 (손해배상)
당 사이트는 무료로 제공되는 서비스와 관련하여 회원에게 어떠한 손해가 발생하더라도 당 사이트가 고의 또는 과실로 인한 손해발생을 제외하고는 이에 대하여 책임을 부담하지 아니합니다.
제 19 조 (관할 법원)
서비스 이용으로 발생한 분쟁에 대해 소송이 제기되는 경우 민사 소송법상의 관할 법원에 제기합니다.
[부 칙]
1. (시행일) 이 약관은 2016년 9월 5일부터 적용되며, 종전 약관은 본 약관으로 대체되며, 개정된 약관의 적용일 이전 가입자도 개정된 약관의 적용을 받습니다.