• 대한기관식도과학회지
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• 제17권2호
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• pp.98-103
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• 2011

Purpose Pulmonary complications continue to be the major cause of morbidity and mortality after esophageal resection. The aim of this study was to compare and analyze retrospectively the factors which effect for postoperative pulmonary complications in patients who underwent curative resection for esophageal cancer. Material and Method A total of 118 patients were enrolled in the study from January 1994 to March 2009, and patients with previous neoadjuvant chemotherapy or radiotherapy were excluded. Of the total 118 patients, 27 patients developed pulmonary complications within 30 days of their operation. the factors which effect for postoperative pulmonary complications were compared and analyzed. Results There were 7 patients in-hospital deaths. 51 patients (43.2%) developed complications, and of them, the most common complication was pulmonary complication and occurred in 27 patients (22.9%). In univariate analysis, diabetes mellitus, cervical anastomosis through the retrosternal route, old age and poor lung function were risk factors contributing to postoperative pulmonary complications (p<0.05). In multivariate analysis, statistically significant factor was old age (65 years or older). Conclusion Clinical factor for the pulmonary complications after esophagectomy of esophageal cancer was significantly associated with diabetes mellitus, cervical anastomosis through the retrosternal route, old age (65 years or older) and poor lung function (FEV1<80%). Of these, old age was the most significant factor.

• Asian Pacific Journal of Cancer Prevention
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• 제13권9호
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• pp.4413-4416
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• 2012

Aim: Individual differences in chemosensitivity and clinical outcome in non-small cell lung cancer (NSCLC) patients treatment with platinum-based chemotherapy may be due to genetic factors. Our study aimed to investigate the prognostic role of GSTP1, XRCC1 and XRCC3 in NSCLC patients treated with chemotherapy. Methods: A total of 460 cases were consecutively selected from The Affiliated Hospital of Nantong University between Jan. 2003 to Nov. 2006, and all were followed-up until Nov. 2011. Genotyping of GSTP1 Ile105Val, XRCC1 Arg194Trp, XRCC1 Arg399Gln and XRCC3 Thr241Met was conducted by duplex polymerase-chain-reaction with confronting-two-pair primer methods. Results: Patients with GSTP Val/Val exhibited a shorter survival time, and had a 1.89 fold greater risk of death than did those with the IIe/IIe genotype. For XRCC1 Arg194Trp, the variant genotype Trp/Trp was significantly associated with a decreased risk of death from NSCLC when compared with the Arg/Arg. Individuals carrying XRCC1 399Gln/Gln genotype had a longer survival time, with a lowered risk of death from NSCLC. Conclusion: This study indicated that GSTP1 Ile105Val, XRCC1 Arg194Trp and XRCC1Arg399Gln genes have a role in modifying the effect of platinum-based chemotherapy for NSCLC patients in a Chinese population. Our findings provide information for therapeutic decisions for individualized therapy in NSCLC cases.

• Journal of Chest Surgery
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• 제55권4호
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• pp.325-331
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• 2022

Postoperative critical care management for lung transplant recipients in the intensive care unit (ICU) has expanded in recent years due to its complexity and impact on clinical outcomes. The practical aspects of post-transplant critical care management, especially regarding ventilation and hemodynamic management during the early postoperative period in the ICU, are discussed in this brief review. Monitoring in the ICU provides information on the patient's clinical status, diagnostic assessment of complications, and future management plans since lung transplantation involves unique pathophysiological conditions and risk factors for complications. After lung transplantation, the grafts should be appropriately ventilated with lung protective strategies to prevent ventilator-induced lung injury, as well as to promote graft function and maintain adequate gas exchange. Hypotension and varying degrees of pulmonary edema are common in the immediate postoperative lung transplantation setting. Ventricular dysfunction in lung transplant recipients should also be considered. Therefore, adequate volume and hemodynamic management with vasoactive agents based on their physiological effects and patient response are critical in the early postoperative lung transplantation period. Integrated management provided by a professional multidisciplinary team is essential for the critical care management of lung transplant recipients in the ICU.

• Journal of Chest Surgery
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• 제57권2호
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• pp.195-204
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• 2024

Background: Extracorporeal membrane oxygenation (ECMO) is an intervention for severe heart and lung failure; however, it poses the risk of complications, including gastrointestinal bleeding (GIB). Comprehensive analyses of GIB in patients undergoing ECMO are limited, and its impact on clinical outcomes remains unclear. Methods: This retrospective study included 484 patients who received venovenous and venoarterial ECMO between January 2015 and December 2022. Data collected included patient characteristics, laboratory results, GIB details, and interventions. Statistical analyses were performed to identify risk factors and assess the outcomes. Results: GIB occurred in 44 of 484 patients (9.1%) who received ECMO. Multivariable analysis revealed that older age (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.01-1.06; p=0.0130) and need to change the ECMO mode (OR, 3.74; 95% CI, 1.75-7.96; p=0.0006) were significant risk factors for GIB, whereas no association was found with antiplatelet or systemic anticoagulation therapies during ECMO management. Half of the patients with GIB (22/44, 50%) underwent intervention, with endoscopy as the primary modality (19/22, 86.4%). Patients who underwent ECMO and developed GIB had higher rates of mortality (40/44 [90.9%] vs. 262/440 [59.5%]) and ECMO weaning failure (38/44 [86.4%] vs. 208/440 [47.3%]). Conclusion: GIB in patients undergoing ECMO is associated with adverse outcomes, including increased risks of mortality and weaning failure. Even in seemingly uncomplicated cases, it is crucial to avoid underestimating the significance of GIB.

• Journal of Chest Surgery
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• 제39권6호
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• pp.462-469
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• 2006

배경: 염증성 폐질환을 위한 전폐절제술은 동반된 합병증률과 사망률로 인해 흉부외과의에게는 난제이며 늑막외전폐절제술의 경우는 더욱 그러하다. 이 연구의 목적은 늑막외전폐절제술을 시행 받은 환자에서의 수술 성적과 합병증 등을 단순 전폐절제술을 받은 환자와 비교분석하고 이들 환자에서의 합병증 발생에 영향을 미치는 요인에 대해 알아보고자 보고자 하였다. 대상 및 방법: 1992년 1월부터 2004년 12월까지 만성염증성폐질환으로 전폐절제술을 시행 받은 98명을 대상으로 후향적 분석을 시행하였다. 늑막외전폐적출술(A군)은 48명에서, 단순 전폐절제술(B군)은 50명에서 시행되었다. 두 군 환자의 임상적 특징, 수술 후 성적 및 합병증 등을 비교 분석하고 늑막외전폐절제술(A군)을 받은 환자에서 수술 후 합병증 발생에 영향을 미치는 인자를 수술 전, 수술 중 요인으로 나누고 이들의 유의성을 단변량 및 다변량 분석을 통하여 평가하였다. 결과: 수술로 인한 조기 사망은 1명으로 수술 후 성인성 호흡곤란증후군(adult respiratory distress syndrome, ARDS)으로 인한 경우였다. 21명(21.4%)의 환자에서 23예의 주요 수술 후 합병증을 나타내었다. 가장 흔한 합병증으로는 수술 후 출혈로 인해 재개흉이 필요했던 경우 8예, 농흉(기관지-흉막루 포함)의 발생 8예였다. A군 48명 중 14명(29.2%)의 환자에서, B군 50명 중 7명(14.0%)에서 각각 합병증을 보였다. 높은 합병증을 보인 A군의 경우, 농흉(기관지-흉막루 포함)의 발생 6예, 수술 후 출혈로 인해 재개흉이 필요했던 경우 6예로 가장 흔한 합병증이었고, 수술 후 합병증 발생의 위험인자를 알기 위해 단변량 분석을 시행한 결과, 우측 전폐절제술(p=0.0022), 완성전폐절제술(p=0.023), 1,000 mL 이상의 출혈(p=0.005), 수술 중 흉강 내 오염(p=0.035) 등이 위험인자로 판명되었고, 다변량 분석에서는 수술 중 흉막강 내 오염이 되었던 경우가 통계적 유의성을 보였다(p=0.028). 결론: 만성 염증성 폐질환의 치료를 위한 전폐절제술은 만족할 만한 사망률과 합병증률을 보였다. 그러나 늑막외전폐절제술은 수술 술기상 고난도이며 고위험군의 수술임을 확인할 수 있었다. 특히 수술 중 세심한 박리 조작으로 폐병소부위의 파열로 인한 흉막강 내의 오염의 발생을 최소화하기 위한 수술 중의 특별한 노력이 필요함을 알 수 있었다.

• Journal of Chest Surgery
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• 제55권1호
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• pp.30-36
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• 2022

Background: No consensus exists regarding whether volatile anesthetics are superior to intravenous anesthetics for reducing postoperative pulmonary complications (PPCs) in patients undergoing general anesthesia for surgery. Studies of this issue focused on anatomic pulmonary resection are lacking. This study compared the effects of total intravenous anesthesia (TIVA) versus volatile anesthesia on PPCs after anatomic pulmonary resection in patients with lung cancer. Methods: This retrospective study examined the medical records of patients with lung cancer who underwent lung resection at our center between January 2018 and October 2020. The primary outcome was the incidence of PPCs, which included prolonged air leak, pneumonia, acute respiratory distress syndrome, empyema, atelectasis requiring bronchofiberscopy (BFS), acute lung injury (ALI), bronchopleural fistula (BPF), pulmonary embolism, and pulmonary edema. Propensity score matching (PSM) was used to balance the 2 groups. In total, 579 anatomic pulmonary resection cases were included in the final analysis. Results: The analysis showed no statistically significant difference between the volatile anesthesia and TIVA groups in terms of PPCs, except for prolonged air leak. Neither of the groups showed atelectasis requiring BFS, ALI, BPF, pulmonary embolism, or pulmonary edema after PSM. However, the length of hospitalization, intensive care unit stay, and duration of chest tube indwelling were shorter in the TIVA group. Conclusion: Volatile anesthetics showed no superiority compared to TIVA in terms of PPCs after anatomical pulmonary resection in patients with lung cancer. Considering the advantages of each anesthetic modality, appropriate anesthetic modalities should be used in patients with different risk factors and situations.

• Parasites, Hosts and Diseases
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• 제53권6호
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• pp.785-788
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• 2015

Cystic echinococcosis (CE) caused by Echinococcus granulosus is a major public health problem worldwide, including Turkey. The aim of the current study was to identify the strains and to estimate the potential risk factors of E. granulosus in operated pediatric cases in eastern Turkey. Ten pediatric patients (7 boys and 3 girls) living in rural areas, with ages ranging from 3 to 15 years old and various clinical histories, were included in this study. Eight patients had only liver hydatid cyst, while 1 patient had liver and lung hydatid cyst and the other liver, lung, and spleen, together. There were 2 ruptured liver cysts. After surgery, during follow-up, no increase was observed in hemagglutination levels, there were no mortalities, and there was no evidence of recurrence at 2 years post operation in all patients. Molecular analysis was performed on hydatid cyst samples obtained from the 10 pediatric cases. According to mt-12S rRNA PCR results, all cases were found to be G1/G3 cluster of E. granulosus sensu stricto.

• Archives of Plastic Surgery
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• 제33권2호
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• pp.193-197
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• 2006

Pulmonary thromboembolism is often clinically silent and difficult to diagnose, and can be fatal to patients with belated treatment. This complication is seen in patients who underwent TRAM breast reconstruction. Multiple factors are involved in this disease such as the presence of malignancy itself, major surgery and therapy-related interventions. TRAM surgery is a lengthy procedure involving mastectomy, flap surgery and abdominoplasty. The purpose of this study is to evaluate the incidence and the correlation between presurgical risk factors(BMI and age) of symptomatic pulmonary thromboembolism after TRAM surgery and the incidence. From July 2001 to March 2005 a total of 384 pedicled TRAM reconstruction of breast was performed in 382 patients at Asan Medical Center. The average of Body mass index was $21.9kg/m^2$ and mean age of the patients was 37.9 years old. We diagnosed symptomatic pulmonary thromboembolism using ventilation/perfusion lung scan and pulmonary embolism computed tomography. Incidence of in-hospital symptomatic pulmonary thromboembolism was 1.3%. BMI and age showed no significant statistical relationship to pulmonary thromboembolism. But the incidence of symptomatic pulmonary thromboembolism in obese patients (BMI > 25) was 3.75%. According to the guideline of the 7th American College of Chest Physicians Consensus Conference on Antithrombotic and Thrombolytic Therapy, the incidence of 3.75% was classified as high risk group. The prevention of pulmonary thromboembolism should be considered in cases of obese patients with low molecular weight heparin(BMI > 25).

• Journal of Chest Surgery
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• 제38권6호
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• pp.421-427
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• 2005

완전절제는 pT1/2N1 비소세포폐암의 가장 효과적인 치료 방법이지만 수술 후 5년 생존율은$40\%$정도이며 많은 환자가 암의 재발로 사망하게 된다. 완전 절제된 pT1/2Nl 비소세포폐암에서 재발에 영향을 주는 인자를 규명하고자 하였다. 대상 및 방법: 1990년 1월부터 2003년 7월까지 연세대학교 의과대학 세브란스병원 흉부외과에서 pT1/2N1 비소세포폐암으로 수술받은 환자 117명을 대상으로 환자의 특성, 조직병리학적 소견, 수술방법, 림프절 전이 양상, 술 후 보조요법 등과 재발과의 관계를 후향적으로 연구하였다. 결과: 전체 환자의 평균 연령은 $59.3\pm9.1$세였으며 T1N1이 14명, T2N1이 103명이었다. 추적관찰기간은 27.5개월이었으며 5년 생존율은 $41.3\%$였다. 수술 후 재발은 44명$(37.6\%)$에서 관찰되었으며 원격전이가 40명이었다. 재발한 환자의 5년 생존율은 $3.3\%$로 재발이 없는 환자$(61.3\%)$에 비해 유의하게 낮았으며(p=0.000), 전체 환자의 5년 무재발률(freedom-from recurrence rate)은 $54.1\%$였다. 무재발률에 영향을 미치는 요인에 대한 다변량 분석 결과 다림프절군 N1 (multi-station N1)이 단일림프절군 N1 (single station N1)에 비해 재발의 위험도가 1.997배 높았다(p=0.047). 걸론: 완전 절제된 pT1/2N1 비소세포폐암 환자들에서 다림프절군 N1이 수술 후 재발의 위험인자였다.

• Yonsei Medical Journal
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• 제59권9호
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• pp.1088-1095
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• 2018

Purpose: Post-operative pulmonary function is an important prognostic factor for lung transplantation. The purpose of this study was to identify factors affecting recovery of forced expiratory volume in 1 second (FEV1) at the first year after lung transplantation. Materials and Methods: We retrospectively reviewed the medical records of lung transplantation patients between October 2012 and June 2016. Patients who survived for longer than one year and who underwent pulmonary function test at the first year of lung transplantation were enrolled. Patients were divided into two groups according to whether they recovered to a normal range of FEV1 (FEV1 ${\geq}80%$ of predicted value vs. <80%). We compared the two groups and analyzed factors associated with lung function recovery. Results: Fifty-eight patients were enrolled in this study: 28 patients (48%) recovered to a FEV1 ${\geq}80%$ of the predicted value, whereas 30 patients (52%) did not. Younger recipients [odds ratio (OR), 0.92; 95% confidence interval (CI), 0.87-0.98; p=0.010], longer duration of mechanical ventilator use after surgery (OR, 1.14; 95% CI, 1.03-1.26; p=0.015), and high-grade primary graft dysfunction (OR, 8.08; 95% CI, 1.67-39.18; p=0.009) were identified as independent risk factors associated with a lack of full recovery of lung function at 1 year after lung transplantation. Conclusion: Immediate postoperative status may be associated with recovery of lung function after lung transplantation.