• Journal of Chest Surgery
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• v.34 no.6
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• pp.447-453
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• 2001

Background: Although pulmonary resection is the standard approach for the management of pulmonary metastases from soft tissue sarcoma, most of them are unresectable and chemotherapy remains the only option. The effectiveness of the cytotoxic drugs may be limited by the toxicities that occur before the therapeutic dose is reached. The regional administration of doxorubicin using pulmonary arterial perfusion in a rodent model can produce 10 to 25 times higher concentrations in the lung than systemic administration with minimal systemic toxicities. However, it is unclear whether a high concentration of doxorubicin has beneficial effects for killing cancer cells. Material and Method: We studied this to evaluate the dose-dependent cytotoxic and apoptotic effects of doxorubicin on methylcholanthrene-induced rat fibrosarcoma(MCA) cells. This study examined the cytotoxicity and apoptosis-related gene expressions(Fas, FasL, Bax, caspase 1, caspase 2, caspase 8, Bcl-2, Bcl-xL, Bcl-xS) in MCA cells after 24 hours exposure to various concentrations of doxorubicin such as 1, 5, 10, 50, and 100 $\mu$M. Result: Dose-dependent cytotoxicity was observed after 24 hours exposure to doxorubicin. However, peak apoptosis after 24 hours exposure was observed at 5 $\mu$M of doxorubicin. Above 5 $\mu$M, apoptotic activity was decreased with dose-increment. All mRNA levels of apoptosis-related genes after 24 hours exposure were up-regulated above the control level at 1 $\mu$M of doxorubicin and then decreased by doxorubicin dose-increment except caspase 8, which showed higher levels than the control level at 5 $\mu$M. Apoptosis-related protein levels were highest at 1 $\mu$M of doxorubicin and then decreased by doxorubicin dose-increment. However, Bax and Bcl-xL proteins steadily showed higher levels than the control throughout the different concentrations of doxorubicin. Conclusion: These results suggest that apoptosis is the main cytotoxic mechanism in low concentrations of doxorubicin in MCA cells and apoptosis-related genes, such as Bax, caspase 8, and Bcl-xL, are involved. At high concentrations, doxorubicin still can kill MCA cells, even when apoptosis is inhibited, and have its propriety for achieving much cytotoxicity against MCA cells.

• Journal of Chest Surgery
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• v.40 no.1 s.270
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• pp.37-44
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• 2007

Background: It is known that long-term survival rate in patients underwent bronchial sleeve lobectomy for primary lung cancer is at least equal to that in patients underwent pneumonectomy, and bronchial sleeve lobectomy is performed in patients with suitable tumor location even in patients have adequate pulmonary function. Sleeve pneumonectomy is performed when carina was invaded by tumor or tumor location was near to the carina. We performed this study to know our results of sleeve resection for primary lung cancer. Material and Method: We analyzed retrospectively the medical records of 45 patients who underwent sleeve lobectomy or sleeve pneumonectomy for primary lung cancer by one thoracic surgeon from May 1990 to July 2003 in Department of Thoracic & Cardiovascular Surgery, College of Medicine, Kyung Hee University. Follow-up loss was absent and last follow-up was performed in April 5, 2005. Kaplan-Meyer method and log-lank test were used to know long-term survival rate and p-value. Result: Mean age was 60 years old and male to female ratio 41:1. Histologic types were squamous cell carcinoma were 39, adenocarcinoma were 4, and others were 2 patients. Pathologic stages were I 14, II 14, and III 17 patients. Nodal stages were N0 23, N1 13, and N2 9 patients. Types of operation were sleeve lobectomy 40 and sleeve pneumonectomy 5 patients. Operative mortality was 3 patients and its cause was respiratory complications. Early complications were pneumonia 4, atelectasis 8, air leakage more than 7 days 6, and atrial fibrillation 4 patients. In 19 patients tumor was recurred. Local recurrence was 10 and systemic metastasis was 9 patients. Overall 5, 10-year survival rate were 54.2%, 42.5%. The 5, 10-year survival rates according to the pathologic stage were 83.9%, 67.1% in stage I, 55%, 47.1% in II, 33.3%, 25% in III, and significance difference was present between stage I and III. The 5, 10-year survival rate according to the lymph node involvement were 63.9%, 54.6% in N0, 53,8%, 46.5% in N1, 28.5%, 14.2% in N2, and significance difference was present between N0 and N2. Conclusion: Because bronchial sleeve lobectomy for primary lung cancer could be performed safely and shows acceptable long-term survival rate, it could be considered primary in case of suitable tumor location if complete resection is possible. Although sleeve pneumonectomy for primary lung cancer shows somewhat high operative mortality rate, it could be considered in view of curative treatment.

• Tuberculosis and Respiratory Diseases
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• v.44 no.2
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• pp.280-289
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• 1997

Background : Bronchioloalveolar carcinoma (BAC) has been reported to diveres spectrum of chinical presentations and radiologic patterns. The three representative radiologic patterns are followings ; 1) a solitary nodule or mass, 2) a localized consolidation, and 3) multicentric or diffuse disease. While, the localized consolidation and solitary nodular patterns has favorable prognosis, the multicentric of diffuse pattern has worse prognosis regardless of treatment. BAC presenting as a solitary pulmonary nodule is often misdiagnosed as other benign disease such as tuberculoma. Therefore it is very important to make proper diagnosis of BAC with solitary nodular pattern, since this pattern of BAC is usually curable with a surgical resection. Methods : We reviewed the clinical and radiologic features of patients with pathologically-proven BAC with solitary nodular pattern from January 1995 to September 1996 at Samsung Medical Center. Results : Total 11 patients were identified. 6 were men and 5 were women. Age ranged from 37 to 69. Median age was 60. Most patients with BAC with solitary nodular pattern were asymptomatic and were detected by incidental radiologic abnormality. The chest radiograph showed poorly defined opacity or nodule and computed tomography showed consolidation, ground glass appearance, internal bubble-like lucencies, air bronchogram, open bronchus sign, spiculated margin or pleural tag in most patients. The initial diagnosis on chest X-ray were pulmonary tuberculosis in 4 patients, benign nodule in 2 patients and malignant nodule in 5 patients. The FDG-positron emission tomogram was performed in eight patients. The FDG-PET revealed suggestive findings of malignancy in only 3 patients. The pathologic diagnosis was obtained by transbronchial lung biopsy in 1 patient, by CT guided percutaneous needle aspiration in 2 patients, and by lung biopsy via video-assited thoracocopy in 8 patients. Lobectomy was performed in all patients and postoperative pathologic staging were $T_1N_0N_0$ in 8 patients and $T_2N_0M_0$ in 3 patients. Conclusion : Patients of BAC presenting with solitary nodular pattern were most often asymptomatic and incidentally detected by radiologic abnormality. The chest X-ray showed poorly defined nodule or opacity and these findings were often regarded as benign lesion. If poorly nodule or opacity does not disappear on follow up chest X-ray, computed tomography should be performed. If consolidation, ground glass appearance, open bronchus sign, air bronchogram, internal bubble like lucency, pleural tag or spiculated margin are found on computed tomography, further diagnostic procedures, including open thoracotomy, should be performed to exclude the possiblity of BAC with solitary nodular pattern.

• Tuberculosis and Respiratory Diseases
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• v.43 no.4
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• pp.623-629
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• 1996

Bronchial carcinoid tumors are uncommon, constituting approximately 5% of all primary lung cancers. Carcinoid tumors belong to the calss of neuroendocrine tumors that consist of cells that can store and secrete neuramines and neuropeptides. Neuroendocrine tumors of the lung include three pathologic types : a low-grade malignancy, the so-called 'typical carcinoid', a more aggressive tumor, the "atypical carcinoid", and the most aggressive malignant neoplasm, the small-cell carcinoma. Atypical carcinoid tumor have a higher malignant potential, is more commonly peripheral than is the typical carcinoid tumor. Histologic features would characterize a carcinoid as hitologically atypical : increased mitotic activity, pleomorphism and irregularity of neuclei with promonent nucleoli, hyperchromatin, and abnormal nuclear-cytoplasmic ratio, areas of increased cellularity with disorganization of architecture, and areas of tumor necrosis. Metastatic involvement of regional lymph nodes and distant organ is common. The prognosis is related to size of the tumor, typical of atypical appearance, endoluminal of extraluminal growth, vascular invasion, node metastasis, Pulmonary resection is the treatement of choice for bronchial carcinoid. We experienced one case of bronchopulmonary atypical carcinoid tumor. In the case, radiologic study showed solitary lung mass with liver metastasis and the level of 5-HIAA was elevated. There was no history of cutaneous flushing, diarrhea, valvular heart disease. The authors reported a case of bronchopulmonary atypical carcinoid tumor with review of literatures.

• Archives of Plastic Surgery
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• v.38 no.6
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• pp.791-797
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• 2011

Purpose: Angiosarcoma is a rare and aggressive malignant soft tissue tumor. Due to a lack of the established optimal treatment modalities, however, an extensive resection followed by an early detection has been reported to be the best treatment of choice. We analyzed the clinical course of six patients, hence attempted to contribute to making a treatment plan for patients with angiosarcoma. Methods: Six patients who have been surgically treated between 2005 and 2010 are included. Through a retrospective analysis of the medical records, we evaluated the pattern of disease detection, a past history, time span between the detection and the primary surgery, surgical treatment modalities, time span between the primary surgery and the recurrence/metastasis, the sites of metastasis and the secondary treatment modalities. Results: The mean age of patients was 70.5 years; all male; and the sites were the scalp. Four patients underwent the reconstruction using a local flap with a skin graft and two patients using a free flap. The mean period elapsed until the primary operation since the identification was 7.3 months and until a recurrence or a metastasis occurred following the primary operation was 12 months. Four patients had pulmonary metastasis. As a secondary therapy, four patients underwent the radiotherapy and one was treated with the chemotherapy. At the present, five patients died and one undergoes a monitoring of the clinical course. Conclusion: It would be mandatory to shorten the length of hospital stay and to return patients to their daily lives as the earliest as possible using relatively simpler surgical methods, thus attempting to give them opportunity to resume their previous normal life.

• Journal of Chest Surgery
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• v.17 no.4
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• pp.762-774
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• 1984

A clinical analysis was performed on 49 cases of the benign esophageal diseases experienced at Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital during 7 year period from 1977 to 1983. Of 49 cases Of the benign esophageal diseases, there were 19 patients of esophageal stricture, 11 of achalasia, 6 of perforation, 3 of bronchoesophageal fistula, 3 of esophageal perforation, 3 of esophageal leiomyoma and one of esophageal foreign body. Twenty three patients were male and 26 were female. Ages ranged from 4 years to 74 years with the average age of 34.7 years. Of 19 patients of esophageal strictures, 7 patients were male and 12 were female and ages ranged from 6 years to 74 years with the average being 33.8 years. Causes of esophageal strictures were corrosive of esophageal strictures were dysphagia, vomiting, general weakness, weight loss and pain that order and developed on several different parts of esophagus. Operations were performed in 18 cases, of whom 7 patients were performed by esophagocologastrostomy, 4 gastrostomy, 4 esophagogastrostomy, 1 esophageal resection and esophagoesophagostomy, 1 esophagotomy and dilatation and 1 scar revision. Five patients had one or two complications; 2 anastomotic leakage, 1 wound infection, 1 localized empyema, 1 bilateral pneumothorax and 1 respiratory failure. One patient expired due to respiratory failure arising from aspiration pneumonia. The average age of achalasia patients was 33.1 years and symptom durations were from 2 months to 10 years with the average of 3.3 years. Main symptoms were dysphagia, vomiting, weight loss, pain and cough in that order. Modified Hellers myotomy was performed in 11 patients with one complication of restenosis. One patient was operated on by using longitudinal incision and transverse sutures with good result. Of 6 patient of esophageal diverticulum, 2 patients were traction diverticulum on the midesophagus, 2 were pulsion diverticulum on the midesophagus and 2 were pulsion diverticulum on the lower esophagus. Diverticulectomy was performed on 2 cases of traction diverticulum and esophagocardiomyotomy with or without diverticulectomy was erformed on 4 cases of pulsion diverticulum with good results. Of 5 patients of congenital bronchoesophageal fistula, the chief complaints were productive cough in 4 patients and hematemesis without respiratory symptoms in one patient. Two patients were operated on by using fistulectomy only and 3 by fistulectomy with pulmonary lobectomy. Of 3 patients of esophageal perforation, causes were foreign body ingestion, esophageal stricture after ECG and corrosive esophagitis. Two patient were operated on by using drainage and gastrostomy with symptomatic improvement but one patient died due to septic shock after thoracotomy. Three patients of esophageal leiomyoma were all male and 2 patients were operated on by using enucleation and one by distal esophagectomy with esophagogastrostomy. In one patient of esophageal foreign body, it was removed by esophagotomy through the right thoracotomy.

• Journal of Chest Surgery
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• v.29 no.4
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• pp.408-413
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• 1996

In most cases of diffuse bullous emphysema and chronic obstructive lung disease, t e risk of surgical treatment is very high. But surgical treatment in selected cases of bullous emphysema with localized involvement of only one side of the lung has suggested safe and good management. So patient selection of surgical treatment Is one of the most important things in management of bullous emphysema. From 1987 to 1992, 11 patients were operated for bullous emphysema with giant bullae at the Department of Thoracic and Cardiovascular Surgery of Chonbuk National University Hospital. Author selected surgical candidates who had progressive dyspnea and symptomatic bullae occupying more than one third of the hemithorax and shifting the trachea and mediastinum to the opposite side of the lung. There were 7 males and 4 females ranged from 19 to 61 years of age. Operative procedures were bullectomy and/or wedge resection in 7 cases, segmentectomy in 2 cases and lobectomy in 2 cases. Symptoms and pulmonary function of all patients were improved six months to three years postoperat vely. There were no postoperative death. We conclude that surgical treatment of bullous emphysema with giant bullae is safe and a good treatment of modality in indicated patients.

• Journal of Chest Surgery
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• v.31 no.3
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• pp.279-285
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• 1998

Exessive sweating of the palms and soles, is a psychologically and occupationally distressing and sometimes disabling condition. Hyperhidrosis is one of the common abnormalities in autonomic nervous system. There were no specific treatment on hyperhidrosis, so invasive thoracic sympathectomy via axillary thoracotomy or cervical approach had been used. Video-assisted thoracic surgery(VATS) is now mostly performed for treating of the palmar and axillary hyperhidrosis. From March 1996 to March 1997, 15 patients with bilateral palmar hyperhidrosis had been treated by the bilateral thoracic sympathectomy(T2, T3, T4) with thoracoscopic resection. The patient were evaluated preoperative and postoperative Digital Infrared Thermographic Imaging (DITI) at Kyung-Hee University Hospital. There were no case of the thoracotomy conversion. There were 3 complications ; pulmonary edema in 1 case, Horner's syndrome in 1 case, and gustatory hyperhidrosis in 1 case. More than half of the patients also had compensatory sweating in the lower abdomen, the buttocks, the back and the thighs. In conclusion, most of the patients were satisfied with the postoperative results of the thoracoscopic sympathectomy, including no more palmar and axillary sweating, less pain, better cosmetic appearances, decreased sweating of the face and soles. In addition, intraoperative temperature monitoring of the hands could estimate the successful thoracoscopic sympathectomy and the preoperative and postoperative Digital infrared thermographic imaging(DITI) could especially be the technique for the objective manifestation of the successful results of the thoracoscopic sympathectomy.

• Journal of Chest Surgery
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• v.29 no.10
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• pp.1118-1122
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• 1996

From January 1990 through December 1995, 43 patients underwent diaphragmatic plication for the management of phrenic nerve palsy .complicating various pediatric cardiovascular surgery. Their mean age at plication was 11.1 months and sex ratio was 31 males to 12 females. In order of decreasing incidence, the primary cardiovascular procedures included modified Blalock-Taussig shunt (7), total correction for the Tetralogy of Falloff (7), arterial switch operation (6), unifocalization for the pulmonary atresia with VSD (3), modified Fontan operation (3), VSD patch closure (3) and others. The involved sides of diaphragm were right in 17, left in 2) and bilateral in 3. Extensive pericardial resection with electocauterization of resected margin was thought to be the most common cause of phrenic nerve palsy (20). The interval between primary operation and plication ranged from the day of operation to 98 days (median 11 days). The methods of plication were central pleating technique(plication with phrenic nerve branch preservation) in 41, and other technique In 2. 10 patients died after plication (7: early, 3; late), and the causes of death were thought to be unrelated to plication itself. Among the 36 early survivors, extubation or cessation of positive pressure ventilation could be accomplished between 1 and 24 days postoperatively(mean : 4.5). Cumulative follow-up was 92 patient years without major complications. Postoperative follow-up fluoroscopy was performed in 6 patients, and the location and movement of plicated diaphragms were satisfactory in 5 patients. We concluded that diaphragmatic plication with preservation of phrenic n rve branch could lead to cessation of positive pressure ventilation and complete recovery of diaphragmatic function in the long term, unless the phrenic nerve was irreversibly damaged.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.21
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• pp.9505-9509
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• 2014

Objective: To investigate the effects of stellate ganglion block (SGB) on the peri-operative vasomotor cytokine content and intrapulmonary shunt in patients with esophagus cancer who underwent thoracotomy. Materials and Methods: Forty patients undergoing elective resection of esophageal cancer patients who had I~II American Society of Anesthesiologist (ASA) were randomly divided into total intravenous anesthesia group (group N, n=20) and total intravenous anesthesia combined with SGB group (group S, n=20, 0.12 mL/kg 1% lidocaine was used for SGB 10 min before induction). Heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), mean pulmonary arterial pressure (MPAP) and continuous cardiac output (CCO) were continuously monitored. The blood from internal jugular vein was drawn respectively before induction ($T_0$), and 30 min ($T_1$), 60 min ($T_2$) and 120 min ($T_3$) after one-lung ventilation (OLV), and 30 min (T4) after two-lung ventilation. The contents of plasma endothelin (ET), nitric oxide (NO) and calcitonin gene-related peptide (CGRP) were detected with enzyme linked immunosorbent assay (ELISA). Meanwhile, arterial and mixed venous blood samples were collected for determination of blood gas and calculation of intrapulmonary shunt fraction (Qs/Qt). Results: During OLV, ET contents were increased significantly in two groups (P<0.05), and no significant difference was presented (P>0.05). NO content in group S was obviously higher than in group N at T3 (P<0.05), whereas CGRP content in group N was markedly lower than in group S at each time point (P<0.05). Qs/Qt was significantly increased in both groups after OLV, but there was no statistical significant regarding the Qs/Qt at each time point between two groups. Conclusions: Total intravenous anesthesia combined with SGB is conducive to regulation of perioperative vasomotor cytokines in thoracotomy, and has little effect on intrapulmonary shunt at the time of OLV.