• Journal of Chest Surgery
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• v.1 no.1
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• pp.37-44
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• 1968

This paper is a review of 29 cases of mediastinal tumors originating in the mediastinum or metastasized from other organs and classified on the basis of histopathological types and specific anatomic location in this depart-ment, during nine years period from January 1959 to December 1967. In twenty-three cases, diagnosis was confirmed by histological findings and the rest of the cases were considered to be mediastinal tumors by clinical and/or roentgenological findings. In this series, metastatic mediastinal carcinomas of unknown primary site were most frequent [30.4%] and lymphoma ranked second in frequency comprising 21.7% of total. Range of age was 5 to 61 years and average mean age was 39 years old. Sex ratio was 1.4 male to female. Subjective complaints in order of frequency were as follows: dyspnea [37%], cough [34%], chest pain[24%] and chest discomfort [21%]. Objective signs were as follows: hoarseness [17%], palpable cervical lymph node[17%], blood tinged sputum [10%], weight loss [10%] and superior vena cava syndrome [7%]. There was no operative mortality. There were histologically nine different kinds of mediasfinal tumors in this series.

• Radiation Oncology Journal
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• v.23 no.2
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• pp.78-84
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• 2005

Purpose: The studied the effect of such variables as the symptom improvement rate, survival and prognostic factors on the treatment results of radiation therapy for Superior Vena Cava Syndrome (SVCS). Materials and Methods: From 1988 to 2003, seventy two patients with SVCS were treated with radiation therapy at the Department of Radiation Oncology, Keimyung University Dongsan Medical Center. The patients' ages ranged from 10 to 83 years old with the median age being 61, and sixty four patients were male. For the causes of the SVCS, 64 patients had lung cancer, four had metastatic lung cancer, two had malignant lymphoma and two had thymoma. The radiotherapy was delivered with 6-MV X-rays and all patients received above 900 cGy up to 6,600 cGy, with the median dose being 4,000 cGy The follow-up periods were from 1 to 180 months with a median of 5.6 months. Results: The main clinical manifestations were dyspnea ($84.7\%$), facial edema ($81.9\%$), arm edema ($22.2\%$), neck vein distension ($25\%$), hoarseness ($12.5\%$) and facial plethora ($5.6\%$). Eighty percent of patients achieved excellent to good symptom improvement and $19.4\%$ experienced minimal improvement. The median survival period was 5.1 months, and overall survival rates were $17.7\%$ at 2 years (2YOS) and $14.8\%$ at five years (5YOS) for all the patients. The median survival period, the two and five year disease free survival rates were 4.3 months, $16.7\%$ and $13.4\%$ for the lung cancer patients, respectively. The total tumor dose was a statistically significant survival factor on the univariate analysis for the patients with lung cancer (2YSR; > 30 Gy, $25.6\%$, $\leq$ 30 Gy $6.7\%$, p<0.01). On the multivariated analysis, a higher total tumor dose (p<0.01) and younger age (p<0.05) were statistically significant factors of survival for the lung cancer patients. Patients with NSCLC showed better survival than did the patients with SCLC, but this was not statistically significant (p > 0.05), Conclusion: Radiation therapy for the patients with SVCS due to malignancy could be an effective treatment. We considered that radiation therapy above 30 Gy of the total tumor dose may improve survival for SVCS due to lung cancer.

• Journal of Chest Surgery
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• v.43 no.3
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• pp.273-279
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• 2010

Background: The benefit of superior vena cava (SVC) resection in thoracic malignancies remains controversial. We analyzed the results of extended resection in patients with thoracic malignancy involving the SVC. Material and Method: From March 2000 to March 2009, we performed surgical resection and reconstruction in 18 thoracic malignancies involving the SVC. Ten male and 8 female enrolled and their mean age was 56 years. Result: SVC reconstruction was performed in 9 patients with polytetrafluoroethylene (PTFE) graft. Primary closure was possible in 6 patients by partially clamping the SVC. Patch angioplasty was performed in 3 patients with PTFE or autologous pericardial patch. Three-year survival was 58.0% and median survival time was 24.5 months. Disease specific survival and recurrence free survival were not significantly different between lung cancer and mediastinal malignancy. Obstruction of graft was detected in 4 patients during follow-up; SVC graft obstruction in 1 patient, and accessory graft between the innominate vein and right atrium in 3 patients. Conclusion: Extended resection of thoracic malignancies involving the SVC was a feasible method in selected patients. Although the morbidity rate was relatively high, mid-term survival was acceptable when complete resection was possible.

• Journal of Chest Surgery
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• v.26 no.7
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• pp.513-520
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• 1993

Surgical treatment of aneurysm or dissection involving the ascending aorta and aortic arch still poses one of the most complicated technical and tactical challenges in surgery. The use of total circulatory arrest[TCA] with profound hypothermia in the surgical treatment of aneurysmal dissection involving the ascending aorta and aortic arch has been reported as popular surgical methods. However, the safe period of prolonged circulatory arrest with hypothermia remains controversial and ischemic damage to the central nervous system and uncontrollable perioperative bleeding have been the major problem. We have found profound hypothermic circulatory arrest with retrograde cerebral perfusion via the superior vena cava to achieve cerebral protection. We experiment the aortic anastomosis in 7 adult mongrel dogs, using profound hypothermic circulatory arrest with continuous retrograde cerebral perfusion[RGCP] via superior vena cava. We also studied the extent of cerebral protection using above surgical methods, by gas analysis of retrograde cerebral perfusion blood and returned blood of aortic arch, preoperative, intraoperative and postoperative electroencephalography and microscopic findings of brain tissue. The results were as follows: 1. The cooling time ranged from 15 minutes to 24 minutes[19.71$\pm$ 3.20 minutes] ; Aorta cross clamp time ranged from 70 minutes to 89 minutes[79.86 $\pm$ 7.54 minutes] ; Rewarming time ranged from 35 minutes to 47 minutes[42.86$\pm$ 4.30 minutes] ; The extracorporeal circulation time ranged from 118 minutes to 140 minutes[128.43$\pm$ 8.98 minutes] [Table 2]. 2. The oxygen content in the oxygenated blood after RGCP was 12.66$\pm$ 1.25 ml/dl. At 5 minutes after the initiation of RGCP, the oxygen content of returnedlood was 7.58$\pm$ 0.21 ml/dl, and at 15 minutes 7.35$\pm$ 0.17 ml/dl, at 30 minutes 7.20$\pm$ 0.19 ml/dl, at 60 minutes 6.63$\pm$ 0.14 ml/dl [Table 3]. 3. Intraoperative electroencephalographic finding revealed low amplitude potential during hypothermia, and no electrical impulse throughout the period of circulatory arrest and RGCP. Electrical activity appeared after reperfusion, and the electroencephalographic reading also recovered rapidly as body temperature returned to normal [Fig. 2]. 4. The microscopic finding of brain tissue showed widening of the interfibrillar spaces. But there was no evidence of tissue necrosis or hemorrhage [Fig. 3]. We concluded the retrograde cerebral perfusion during hypothermic circulatory arrest is a simplified technique that may have a excellent brain protection.

• Journal of Chest Surgery
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• v.55 no.3
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• pp.206-213
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• 2022

Background: Surgical repair of partial anomalous pulmonary venous return (PAPVR) to the superior vena cava (SVC) using the Warden procedure has favorable outcomes. However, there remain some concerns after the Warden procedure, such as sinoatrial nodal dysfunction and systemic or pulmonary venous stenosis. We investigated the outcomes of the Warden procedure for repair of PAPVR to the SVC. Methods: This retrospective study included 22 consecutive patients who underwent the Warden procedure for PAPVR between 2002 and 2018. The median age and body weight at operation were 27.5 months (interquartile range [IQR], 5.0-56.8 months) and 13.2 kg (IQR, 6.5-16.0 kg), respectively. The median follow-up duration was 6.2 years (IQR, 3.5-11.6 years). Results: There were no cases of early or late mortality. No patients had postoperative heart rhythm problems, except 1 patient who showed transient sinoatrial nodal dysfunction in the immediate postoperative period. Procedure-related complications requiring reintervention occurred in 5 patients, including 3 of 4 SVC stenosis cases and 2 pulmonary venous stenosis cases during follow-up. The rate of freedom from reintervention related to the Warden procedure was 75.9% at 10 years. Conclusion: In cases requiring extension or creation of an atrial septal defect to achieve a sufficient venous pathway, or interposition of an entire circumferential conduit between the SVC and right atrium due to the shortness of the SVC in the Warden procedure, stenotic complications of the venous pathway occurred. Careful observation of changes in the pressure gradient or anatomical stenosis is required in such patients.

• Journal of Chest Surgery
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• v.51 no.2
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• pp.130-132
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• 2018

Coronary sinus ostial atresia (CSOA) with persistent left superior vena cava (LSVC) in the absence of an unroofed coronary sinus is a benign and rare anomaly that may be taken lightly in most instances. However, if overlooked in patients undergoing univentricular heart repair such as bidirectional Glenn or Fontan-type surgery, fatal surgical outcomes may occur due to coronary venous drainage failure. We report a case of CSOA with a persistent LSVC that was managed through coronary sinus rerouting during a total cavopulmonary connection, and provide a review of the literature regarding this rare anomaly.

• Journal of Korean Clinical Health Science
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• v.2 no.2
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• pp.133-147
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• 2014

Purpose. Radiation therapy for oncologic emergencies is an important modality in the management of cancer patients. The aim of the present study was to review the roles of RT in oncologic emergencies based on literature review. Methods. The oncologic emergencies requiring rapid treatment include superior vena cava syndrome, spinal cord compression, brain metastasis, and bone metastasis. We reviewed the literatures on the pathophysiology, diagnosis, and treatment of oncologic emergencies. Results. In this literature review, radiation therapy among treatment modalities for oncologic emergencies has been shown to be fast and very effective treatment modality for oncologic emergencies. Conclusions. Based on this review, we conclude that the literature provides support for the role of radiation therapy in the situation of oncologic emergencies. As the number of cancer patients increase, the prevalence of oncologic emergencies will increase. In the future, the development of RT techniques will provide the improvement of not only patient's quality of life but also the survival.

• Journal of Chest Surgery
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• v.21 no.5
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• pp.877-881
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• 1988

A coronary arteriovenous fistula represents an abnormal communication from a coronary artery that may enter any cardiac chamber, a pulmonary artery, the coronary sinus, the superior vena cava or the pulmonary vein. We had a successful experience with 46 year-old male who complained exertional dyspnea[NYHA classification II] and anginal pain since 5 years ago. In intensive study of cardiac catheterization and coronary cineangiography, multiple bilateral coronary arteriovenous fistulas and mitral stenoinsufficiency with left atrial thrombi were recognized. The coronary arterio-venous fistula of left coronary artery was revealed large tortuous aberrant vessels that were connected between just distal portion of first diagonal branch of left anterior descending artery and main pulmonary artery. Other fistula was small tortuous vessel which was originated from left atrial branch of left circumflex artery, was drained into left atrium. The fistula of right coronary artery was communicated conal branch of right coronary artery to main pulmonary artery. But there was no 0y step-up in the right cardiac catheterization. The operative procedure were suture-ligation of draining orifice of coronary arteriovenous fistula in main pulmonary artery, mitral valve replacement[Ionescu-Shiley 25mm] with removal of left atrial thrombi and plication of left atrium under the extracorporeal circulation. The postoperative course was uneventful without any complication and discharged without problem at 17th postoperative days.

• Journal of Chest Surgery
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• v.25 no.4
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• pp.406-411
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• 1992

Thirty-four patients were received bidirectional cavopulmonary shunt[BCPS] from Aug. 1989 to Apr. 1991 at Sejong General Hospital, Puchon, Korea. Their ages were from 43 days to 21 years old with 19 cases of infant, 10 from 1 to 5 years old and 5 cases above 6 years old. Their diagnoses were as follows: 13 cases with uni-ventricular heart, 9 tricuspid atresia, 6 double outlet of right ventricle, 4 pulmonary atresia with intact ventricular septum, and 2 transposition of great arteries with pulmonary stenosis. Among them, 10 patients had received other palliative operations before. The BCPS operations were performed under the cardiopulmonary bypass and 10 patients who had bilateral superior vena cava received bilateral BCPS. Other associated procedures were 9 cases of takedown of Blalock-Taussig shunt, 3 pulmonary artery angioplasty, 1 unifocalization, 1 repair of total anomalous pulmonary venous return, 1 Damus procedure, 1 relief of sub-aortic stenosis, 1 right ventricular outflow tract reconstruction and one case of tricuspid valve obliteration. There were 3 operative deaths[8.8%] and two late deaths. The remainders show good postoperative state and their oxygen saturation was increased significantly. Conclusively, the bidirectional cavopulmonary shunt is very effective and safe palliative or pre-Fontan stage operation for the many complex congenital anomalies with low pulmonary blood flow especially for the patients who have the risk of Fontan repair.

• Journal of Chest Surgery
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• v.18 no.2
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• pp.258-264
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• 1985

The experience with operative treatment for total correction of Fallot at the department of Thoracic and Cardiovascular Surgery, Keimyung University Dong San Medical Center from July 1980 to July 1984 was reviewed. There were 37 males and 12 females and their ages ranged from 3 years to 30 years, with the average age of 12.2 years. Sixty nine point four percent of patients were younger than 15 years of age. The most frequent type of right ventricular outflow stenosis was the combined type [pulmonary valvular and infundibular stenosis] containing 41 patients [83.7%] and there were 9 deaths in this group. The major associated lesions included Patent foramen ovale in 20 patients [40.8%], Atrial septal defect in 7 patients [14.3%], Left superior vena cava in 4 patients [8.2%], Right sided aortic arch in 2 patients [4.1%] and Patent ductus arteriosus in 11 patient [2.0%]. The pulmonary valvotomy was performed in 41 patients and patch graft reconstruction of the right ventricular outflow tract was performed in 23 patients. In 11 patients the monocusp patches were used. Thirty-five patients [71.4%] had the right bundle branch block postoperatively. There were 11 postoperative deaths with hospital mortality rate of 22.4% and the leading causes of death were low output syndrome, bleeding, and cerebral embolism.