• 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.

• Journal of Chest Surgery
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• v.10 no.2
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• pp.195-204
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• 1977

Dynamic lung compliance was measured in healthy ten young[mean age, 26 years] male and five young[mean age, 25 years] female. Lung volume was integrated of the rate of flow signal which was obtained by using pneumotachograph and differential pressure transducer[PM 5, Statham]. Intrapleural pressure was measured as that of intraesophagel pressure. Esophageal ballon, 15. 5cm in length, 4ml of luminal capacity and made of thin latex, was connected to the polyethylene tube that had 12-14 side holes and was of 1.5mm of ID. Transpulmonary pressure was traced by means of differential pressure transducer[PM 131, Statham] to which connected the esophageal balloon catheter and connection tube from mouth piece. Lung volume and transpulmonary pressure were photographed by cathode ray oscilloscope camera while the subjects were breathing spontaneously. Dynamic lung compliance loop was displayed on single trace monitor and subtraction was performed for the quasi-static hysteresis. Dynamic lung compliance was measured, 1. by plotting the pressure-volume relationship 2. from the subtracted pressure-volume loop. Results were as follows. 1. Dynamic lung compliances measured by plotting of healthy young male and female were $0.202{\pm}0.06$ and $0.190{\pm}0.023L/cm$ $H_2O$ respectively. 2. When measured from subtraction loop, dynamic lung compliance for male and female were $0.327{\pm}0.107$, and $0.27{\pm}0.06L/cm$ $H_2O$ respectively. 3. Dynamic chest wall and total respiratory system compliance were also measured. 4. Dynamic lung compliance by plotting appeared to be essentially same when compared to that of static compliance reported previously from our laboratory, however, that obtained from subtraction loop revealed higher values than the compliances obtained by plotting and that of static compliance.

• Journal of Chest Surgery
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• v.32 no.11
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• pp.1009-1016
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• 1999

Background: Minimally invasive direct coronary artery bypass surgery(MIDCAB) has been increasing in interest along with the new techniques in myocardial immobilization for easier and safer procedures. Until the opening of the era of new techniques, adequate accuracy and good patency of grafts were debatable. Our experiences of MIDCAB were studied according to the stages of technical developments. Material and Methods: Since March 1996, 55 patients have undergone MIDCAB procedures. The patients of off-pump CABG(no cardiopulmonary bypass under full sternotomy) were excluded from the study. In the early experience(Stage I), a left anterior small thoracotomy through the left parasternal incision was performed(n=6); then an approach through the lower partial sternotomy was used(Stage II, n=33); and recently, a chest wall elevator for harvesting the internal thoracic artery and the foot plate for myocardial immobilization have been used(USSC, Norwalk, CT)(Stage III, n=16). Result: The surgical procedures of four patients in the Stage II group have been converted to conventional bypass because of the deeply seated left anterior descending coronary artery in two patients, fracture of the calcific lesion in the right coronary artery in one patient, and a cardiogenic shock during hypothermia in the other patient with ventricular dysfunction. Two patients in stage II experienced symptomatic recurrences after surgery and restenosis was verified on angiocardiography. They were managed by interventional procedures. All the other patients were doing well without symptoms, except one patients in Stage II who underwent PTCA procedure for a lesion in the circumflex artery during the follow up period. Conclusion: The new and specialized devices are essential to the development of MIDCAB surgery. MIDCAB and the hybrid procedures in multi-vessel disease are on the way to further development. So far, our experience is limited only to a single device among the many new devices for the purpose.

• Journal of Chest Surgery
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• v.30 no.9
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• pp.936-940
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• 1997

Pulmonary aspergilloma is potentially a life threatening disease resulting from the colonization of lung cavities by Aspergillus fumigatus. A case is reported: a 43-year-old man with symtomatic cavitary aspergilloma presenting with severe productive coughing, hemopt sis, occasional fever, and chilling. On preoperative plain chest radiograph and CT scan, we could find a rounded irregular opacity in a large pulmonary cavity. He received 2 separate operations for therapeutic need. At the first opertion, we performed cavernostomy and thoracoplasty because of severe pleural adhesions, tearing of cavity wall, and high risk of respiratory insufficiency. At the second operation, we performed myoplasty and omentoplasty for closure of remaining air space and complete wrapping of the BPF site. All symptoms of dyspnea and hemoptysis have since resolved. We believed that in the high risk patients who have severe respiratory symptoms, such as in aspergilloma and open cavity with a risk of respiratory insufficiency, cavernostomy followed by myoplasty or omentoplasty should be recommended.

• Clinical and Experimental Pediatrics
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• v.58 no.1
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• pp.37-40
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• 2015

The presence of a single coronary artery is a rare congenital anomaly; such patients often present with severe myocardial ischemia. We experienced the case of a 13-year-old girl with the right coronary artery originating from the left circumflex artery. She visited our Emergency Department owing to severe chest pain; her cardiac enzyme levels were elevated, but her initial electrocardiogram (ECG) was normal. Echocardiography showed normal anatomy and normal regional wall motion. When she presented with recurrent chest pain on admission, the ECG showed significant ST-segment elevation in the left precordial leads and inferior leads with ST-segment depression in aVR lead, suggesting myocardial ischemia, and her cardiac enzyme levels were also elevated. We performed coronary angiography that showed a single right coronary artery originating from the left circumflex artery without stenosis. We confirmed the presence of a single coronary artery using coronary computed tomography. In addition, the treadmill test that was performed showed normal results. She was discharged from the hospital without any medications but with a recommendation of a regular followup.

• Journal of Chest Surgery
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• v.31 no.3
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• pp.286-290
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• 1998

The pectus excavatum is the most common deformity of chest wall. The most common cause of surgical correction is cosmetic problem. From January 1981 to July 1996, 24 patients had undergone surgery for pectus excavatum and they were corrected by Ravitch operation(n=4) or modified Wada operation(n=20) respectively. We analyzed each surgical cases according to age, sex, chief complaint, degree of deformity, EKG findings, complications and satisfaction degree of patient. In some cases, we measured Welch index preoperatively and postoperatively. The postoperative complications were wound infection in two, pneumothorax in two and reccurrence in one. The average value of Welch index was significantly improved from 5.86$\pm$0.51 preoperatively to 4.10$\pm$0.51 postoperatively(P<0.05). The results by Humphreys' criteria were satisfiable in 88%(excellent 71%, good 17%). The findings of this study suggest that surgical correction of pectus excavatum with modified Wada rocedure and submammary s in incision is effective method in physical and psychiatric aspect.

• Journal of Chest Surgery
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• v.46 no.2
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• pp.159-161
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• 2013

Synovial sarcoma is a malignant soft tissue tumor that most commonly occurs in the extremities of young and middle-aged adults, in the vicinity of large joints. Although synovial sarcoma is frequently associated with joints, it may arise in unexpected sites, such as the mediastinum, heart, lung, pleura, or chest wall. Primary synovial sarcoma of the pleura is rare. To date, nearly 36 cases of primary synovial sarcoma of the pleura have been reported since Gaertner et al. published the first case in 1996. The oncologic characteristics, treatment, and prognosis for pleural synovial sarcomas are not well defined because of a paucity of data. However, a multimodal approach, including surgical resection, chemotherapy, and radiotherapy, has generally been suggested. We report the outcome of one patient with primary pleural synovial sarcoma treated with radical resection and adjuvant treatment.

• Journal of Chest Surgery
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• v.23 no.5
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• pp.962-967
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• 1990

The anomalous pulmonary venous return of the entire left lung was an extremely rare congenital anomaly. The reported surgical experience with correction of this disorder was limited. The 3-year-old female patient underwent an operation upon the unilateral total anomalous pulmonary venous return from the left lung, in which the left superior pulmonary vein drained into innominate vein and the left inferior pulmonary vein into the coronary sinus, in Yeungnam University Hospital. The symptoms were nonspecific except frequent upper respiratory infection. Cyanosis was not seen. On auscultatory findings, a grade 2/6 systolic ejection murmur was audible over left second intercostal space of left sternal border and second heart sound had an increased pulmonary component which was widely splitted. The electrocardiogram demonstrated a right ventricular hypertrophy and right axis deviation and chest X-ray showed slightly increased pulmonary vascularity and bulged pulmonary conus. The echocardiogram demonstrated increased right atrial, ventricular, and pulmonary arterial dimension, and also secundum atrial septal defect and enlarged coronary sinus. The cardiac catheterization confirmed the left-to-right with a Qp/Qs of 2.0: 1 and oxygen step-up was seen in pulmonary artery, right ventricle, right atrium, and left innominate vein, and the catheter was not been introduced into the left pulmonary vein. A median sternotomy incision was done. Left superior pulmonary vein was drained to the innominate vein through anomalous vertical vein and the left inferior pulmonary vein drained to right atrium through the coronary sinus. The diversion of the left inferior pulmonary vein to posterior wall of left atrium was done after division in the proximity of coronary sinus. The anomalous vertical vein was diverted to base of left atrial auricle and then a atrial septal defect was sutured directly. The postoperative course was uneventful and she was discharged on the eleventh postoperative day. In the postoperative follow-up-2 months, she has been well without specific problems.

• Journal of Chest Surgery
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• v.29 no.3
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• pp.311-314
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• 1996

Eighteen patients (13 female and ave male) aged from 15 to 62 years (mean age 42.6 years) underwent excision of cardiac myxoma(17 left atrial, one right atrial) between 1985 and 1994 at Pusan National University hospital. All patients complained of exertional dyspnea and most had a few additional symtoms including palpitation, chest pain, syncope, general weakness, weight loss, fever, cough and epigastric disconyort. The diagnosis was made by echocardiography alone in left atrial myxomas but a myxoma in right atrium was diagnosed incidentally during mitral valve replacement for rheumatic valvular heart disease. The tumor attachment sites were fossa ovalis in 13, other interatrial septum in 4, mitral valve annulus in one and free wall of left atrium in two cases. The tumor was excised successfully via right atriotomy in 8 and biatriotomy in 10 cases. There was no hospital nor late death, and no recurrent case during the follow up period. Curative surgical excision of cardiac myxoma can be performed with low morbidity and very low r currence rate.

• 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.