• Tuberculosis and Respiratory Diseases
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• v.49 no.2
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• pp.246-252
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• 2000

Lymphangioleiomyomatosis(LAM) is a rare disease of unknown etiology that occurs mainly in woman in her reproductive age. We recently experienced two cases of bilateral diffuse cystic lesion of the lung on chest X-ray and HRCT. The first case, a 26-year-old female, who had been diagnosed with tuberous sclerosis by the presence of clinical manifestation such as mental retardation, bilateral renal angiomyolipoma, adenoma sebaceum and generalized seizure, was admitted due to a recently developed hemoptysis. Chest PA showed diffuse ground-glass opacity with radiolucent cystic lesions of various sizes on both lung fields. HRCT showed innumerable small cystic lesions with suspicious diffuse ground-glass opacity on both lung fields The second case, a 30-year-old fema1e was admitted due to dyspnea and spewing of blood-tinged sputum for 2 weeks, shortly after delivery. Chest PA showed diffuse reticular and ground-glass opacities on both lung field. HRCT showed multiple well-defined and relatively uniform size air cysts with a uniform wall thickness on entire both lung fields, with small amount of right pleural effusion. By thoracoscopic lung biopsy she was diagnosed with pulmonary lymphangioleiomyomatosis. We report these cases with a brief review of the literatures.

• Tuberculosis and Respiratory Diseases
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• v.38 no.2
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• pp.135-142
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• 1991

We reviewed 15 cases of mesothelioma of the pleura, of which three cases were localized benign form and 12 cases were malignant diffuse form. The tumors were distributed equally in both sexes, and occured most commonly in fifth to seventh decades. The history of exposure to asbestos was present in only one case. The chief complaints were mainly chest pain and dyspnea. Associated symptoms were cough, sputum, hemoptysis, weight loss, anorexia, chill. On physical examination, unilateral, decreased breathing sound was main feature. The simple chest radiograph showed masses in all localized mesotheliomas (100%) and in 2 diffuse mesotheliomas (17%). 8 cases of diffuse mesotheliomas (67%) showed unilateral pleural effusions. Pleural effusions were mainly bloody (67%), and almost all were exudates. In all localized mesotheliomas, final diagnosis was made by open thoracotomy. In diffuse mesotheliomas, final diagnosis was made by open thoracotomy in 7 cases, chest wall mass biopsy in 2 cases, thoracoscopic biopsy in 1 case, pleural biopsy in 1 case, and pleural biopsy combined with axillary lymph node biopsy in 1 case. Localized mesotheliomas were treated by simple excision with good prognosis. In diffuse mesotheliomas, surgical treatment (pleuropneumonectomy, pleurectomy), chemotherapy, or radiotherapy, alone or in combination, were used with dismal prognosis. The prognostic factors were not found due to the small number of cases, incomplete follow up, and early drop out.

• Journal of Chest Surgery
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• v.31 no.5
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• pp.509-512
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• 1998

Although posterolateral thoracotomy(PLT) has been a standard thoracic incision in resection surgery of the lung for surgeons to achieve a good surgical field, there remains concern about severing a group of thoracic muscles remains. Muscle-sparing vertical thoracotomy (MVT) is an alternative to PLT, which gives cosmetic result and may preserve motion of the shoulder girdle as well as respiratory function of the patient in the early postoperative period. However, surgeons tend not to perfer it because of limited surgical field from the vertical wound made on the lateral thoracic wall. The purpose of this study is to compare the surgical outcomes of PLT versus MVT. We retrospectively reviewed 29 patients(15 who had PLT and 14 who had MVT, organized into those two groups) who had undergone lung resection surgery in our institute. There were no clinical differences between the two groups in terms of operation time, estimated amount of blood loss during the operation, amount of chest drainage on the first and the second postoperative day, duration of chest tube placement, incidence and amount of transfusion, and postoperative complications. We conclude that, from our limited experience, MVT can be applied to lung resection surgery as safely as PLT and that it may have a beneficial role for the patient with compromised lung function in addition to cosmetic effect.

• Journal of Chest Surgery
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• v.34 no.6
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• pp.441-446
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• 2001

Background: Electrical breathing pacing has many advantages over mechanical ventilation. However, clinically permanent diaphragmatic pacing has been applied to limited patients and few temporary pacing has been reported. Our purpose is to investigate the feasibility of temporary electrical diaphragm pacing in explothoracotomy canine cases. Methods: Five dogs were studied under the general anesthesia. Left 5th intercostal space was opened. Self designed temporary pacing leads were placed around the left phrenic nerve and connected to the myostimulator. Chest wall was closed after tube insertion with underwater drainage. Millar catheter was introduced to the aorta and right atrium. Swan-Ganz catheter was introduced to the pulmonary artery. When the self respiration was shallow with deep anesthesia, hemodynamic and tidal volume were measured with the stimulator on. Results: Tidal volume increased from 143.3$\pm$51.3 ml to 272.3$\pm$87.4 ml(p=0.004). Right atrial diastolic pressure decreased from 0.7$\pm$4.0 mmHg to -10.5$\pm$4.7 mmHg(p=0.005). Pulmonary arterial diastolic pressure decreased from 6.1+2.5 mmHg to 1.2$\pm$4.8 mmHg(p<0.001). The height of water level in chest tube to show intrathoracic pressure change was from 10.3$\pm$6.7cmH$_{2}$O to 20.0$\pm$5.3 cmH$_{2}$O. Conclusion: Temporary electrical diaphragmatic pacing is a simple method to assist respiration in explothoracotomy canine cases. Self designed pacing lead is implantable and removable. Negative pressure ventilation has favorable effects on the circulatory system. Therefore, clinical application of temporary breathing pacing is feasible in thoracotomy patients to assist cardiorespiratory function.

• Journal of Chest Surgery
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• v.49 no.1
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• pp.29-34
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• 2016

Background: Pectus excavatum (PE) and pectus carinatum (PC) are the most common chest wall deformities. In this study, we aimed to characterize how patients obtained information about these deformities, as well as patients' family history, associated medical problems, and postoperative satisfaction after the Nuss and Abramson procedures. Methods: This cross-sectional retrospective study included patients who were operated by a single surgeon between 2006 and 2013. Follow-up calls were made after approval of our institution's ethics committee. We reached 207 of the 336 PE patients (61.6%) and 73 of the 96 PC patients (76%). Results: The majority of the patients were male (85% of the PE patients and 91.8% of the PC patients). The age of diagnosis of PE was $14.52{\pm}0.51years$ and the age at the time of operation was $17.89{\pm}0.42years$; for PC patients, the corresponding ages were $15.23{\pm}0.55years$ and $16.77{\pm}0.55years$, respectively. A total of 70% of the PE patients and 63.8% of the PC patients obtained information about pectus deformities through the Internet. In 27.1% of the PE patients with an associated anomaly, 57.1% (n=13) had scoliosis, while 41.1% of the PC patients with an associated anomaly had kyphosis (n=5). Postoperative satisfaction, as evaluated on a scale from 0 to 10, was $8.17{\pm}0.15$ for PE patients and $8.37{\pm}0.26$ for PC patients. The postoperative pain duration was $51.93{\pm}5.18days$ for PE patients and $38.5{\pm}6.88days$ for PC patients. Conclusion: In this study, we found that most patients with pectus deformities were male. The Internet was an important resource for patients to learn about their deformities. Family history and associated anomalies were identified as important aspects for consideration in the clinical setting. The patients reported high levels of postoperative satisfaction, and pain management was found to be one of the most important elements of postoperative care.

• The Korean Journal of Nuclear Medicine Technology
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• v.20 no.1
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• pp.13-19
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• 2016

Purpose In order to calculate the left ventricular ejection fraction (LVEF) accurately, it is important to acquire the best septal view of left ventricle in the multi-gated cardiac blood pool scan (GBP). This study aims to acquire the best septal view by measuring angle of ventricular septal wall (${\theta}$) using enhanced CT scan and compare with conventional method using left anterior oblique (LAO) 45 view. Materials and Methods From March to July in 2015, we analyzed the 253 patients who underwent both enhanced chest CT and GBP scan in the department of nuclear medicine at National Cancer Center. Angle (${\theta}$) between ventricular septum and imaginary midline was measured in transverse image of enhanced chest CT scan, and the patients whose difference between the angle of ${\theta}$ and 45 degree was more than 10 degrees were included. GBP scan was acquired using both LAO 45 and LAO ${\theta}$ views, and LVEFs measured by automated and manual region of interest (Auto-ROI and Manual-ROI) modes respectively were analyzed. Results $Mean{\pm}SD$ of ${\theta}$ on total 253 patients was $37.0{\pm}8.5^{\circ}$. Among them, the patients whose difference between 45 and ${\theta}$ degrees were more than ${\pm}10$ degrees were 88 patients ($29.3{\pm}6.1^{\circ}$). In Auto-ROI mode, there was statistically significant difference between LAO 45 and LAO ${\theta}$ (LVEF $45=62.0{\pm}6.6%$ vs. LVEF ${\theta}=64.0{\pm}5.6%$; P = 0.001). In Manual-ROI mode, there was also statistically significant difference between LAO 45 and LAO ${\theta}$ (LVEF $45=66.7{\pm}7.2%$ vs. LVEF ${\theta}=69.0{\pm}6.4%$; P < 0.001). Intraclass correlation coefficients of both methods were more than 95%. In case of comparison between Auto-ROI and Manual ROI of each LAO 45 and LAO ${\theta}$, there was no significant difference statistically. Conclusion We could measure the angle of ventricular septal wall accurately by using transverse image of enhanced chest CT and applied to LAO acquisition in the GBP scan. It might be the alternative method to acquire the best septal view of LAO effectively. We could notify significant difference between conventional LAO 45 and LAO ${\theta}$ view.

• Journal of Chest Surgery
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• v.31 no.8
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• pp.776-780
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• 1998

Background: In patients with coronary artery disease, dysfunctional hypoperfused myocardium at rest may represent either nonviable or viable hibernating myocardium. Two-dimensional echocardiography can detect regional wall motion abnormalities resulting from myocardial ischemia by dobutamine infusion. The purpose of the present study was to identify the prediction of improvement of regional left ventricular(LV) function after surgical revascularization. Materials and methods: Sixteen patients with chronic regional LV dysfunction underwent dobutamine stress echocardiography(DSE) (dobutamine: baseline, 5, 10, 20$\mu$g/kg/min) before coronary artery bypass grafting(CABG) and underwent echocardiography at least 2 months after CABG. Results: All patients were male with mean age of 58 years ranging from 42 to 73 years. The mean LV ejection fraction was 41.8% with a range from 19% to 55%. During DSE, there were no complications, also, there were no operative morbidities or mortalities. Improvement of wall motion within the dysfunctional myocardium was found in 8(50%) of 16 patients in DSE. Among them, 6 patients(75%) showed functional recovery after CABG. Another 8 patients did not show improvement of wall motion in DSE. But among them, 3 patients(38%) showed functional recovery after CABG. 84 dysfunctional segments were found in 256 segments of 16 patients. Improvement of wall motion was found in 34 of 84 segments in DSE. Among them, 23 segments(74%) showed functional recovery after CABG. Another 53 segments did not show improvement of wall motion in DSE. But among them, 12 segments(23%) showed functional recovery after CABG. The sensitivity and specificity of DSE for the prediction of postoperative improvement of segmental wall motion were 66% and 84%, respectively. The positive and negative predictive value of DSE were 74% and 77%, respectively. In patients with chronic regional LV dysfunction, think that DSE is a good predictor of the improvement of dysfunctional segments after CABG.

• 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.

• Tuberculosis and Respiratory Diseases
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• v.79 no.2
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• pp.101-103
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• 2016

Nocardia species are aerobic, gram-positive pathogens found worldwide in soil. Nocardia is considered an opportunistic pathogen, and its infection mostly occurs in immunocompromised patients. We report a case of Nocardia farcinica induced mediastinitis and pneumonia that occurred in a 64-year-old male patient who had no significant medical history except for hypertension. He visited another hospital with a complaint of dyspnea and left chest wall pain. The symptoms arose 7 days ago without any trauma and they worsened. A mediastinal mass was found on computed tomography scan. After being transferred to our hospital for further evaluation, he was diagnosed with mediastinitis and pneumonia. As N. farcinica was found to be the causative organism by 16S rRNA sequencing, proper antibiotic therapy including trimethoprim/sulfamethoxazole was initiated immediately. After this, the patient improved and he was discharged. If an infection has a disseminating course, nocardiosis cannot be excluded even in immunocompetent patients. Once the diagnosis is established, prompt antibiotic therapy should be performed based on the severity.

• Journal of Chest Surgery
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• v.47 no.4
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• pp.434-436
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• 2014

Left ventricular thrombus is a common complication related to acute myocardial infarction. Removing this with an incision of the free wall of the left ventricle may cause fatal cardiac dysfunction or arrhythmias. Furthermore, performing incision and suture on the fragile myocardium of an acute myocardial infarction patient may cause serious bleeding complications. If there is a patient with left ventricular thrombus who needs thoracotomy for another reason, the case is attempted with the thought that if effective intraventricular visualization and manipulation can be done, fatalities caused by incision and suture may be reduced. For patients undergoing cardiopulmonary bypass, if intracardiac manipulation is required, an endoscope can be used, and given the potential complications after the incision and suturing of the infarcted tissue, the benefits are deemed sufficient.