Purpose: Clamshell incision offers excellent exposure and access to the pleural spaces and is a standard incision for lung transplantation. However, due to its high sternal complication rate, the clamshell incision is considered a procedure that requires improvement. In this study, we aimed to investigate the outcomes of transverse sternotomy with clamshell incision in comparison to sternum-sparing bilateral anterolateral thoracotomy (BAT). Materials and Methods: In total, 134 bilateral sequential lung transplants were performed from May 2013 to June 2022. The clamshell incision was used between May 2013 and December 2017, and the BAT was introduced in January 2018. Thirty-four patients underwent clamshell surgery, and 100 patients underwent BAT. We retrospectively compared patient characteristics and perioperative and postoperative outcomes between the two groups. Results: The clamshell group required an operation time of 745.18±101.76 min, which was significantly longer than that of the BAT group at 669.90±134.09 min (p=0.003). The mechanical ventilation period after surgery was 17.26±16.04 days in the clamshell group, significantly longer than the 11.35±12.42 days in the BAT group (p=0.028). Intensive care unit stay was also significantly longer in the clamshell group (21.54±15.23 days vs. 15.03±14.28 days; p=0.033). In-hospital mortality rates were 26.5% in the clamshell group and 22.0% in the BAT group. Conclusion Less-invasive lung transplantation via sternum-sparing BAT is a safe procedure with low morbidity and favorable outcomes. Preventing sternal instability enables more stable breathing after surgery, earlier weaning from mechanical ventilation, and faster recovery to routine activities.

Castleman's disease is a rare disorder characterized by benign tumors that may develop in the lymph node tissue throughout the body. Castleman's disease associated with myasthenia gravis is an especially rare disease. Only less than 10 cases have been reported in the world literature. The cause of Castleman's disease is associated with immune mediated reaction, and myasthenia gravis also develops due to an antibody-mediated process. The cause of myasthenia gravis is the immune activity of Castleman's disease, which may be the promoter of the antibody-mediated process. We report here a case of Castleman's disease, which was incidentally found in a patient diagnosed with myasthenia gravis.
Giant Lymph Node Hyperplasia ; Humans ; Lymph Nodes ; Myasthenia Gravis ; Rare Diseases ; Retroperitoneal Neoplasms ; Thymectomy

PURPOSE: Imaging studies for the diagnosis of breast cancer such as ultrasonography or mammography, play an essential role; however, it is well known that they have some limitations; the low specificity of ultrasonography and the low sensitivity of mammography, especially in the dense breasts of Korean women. Recently, 99mTc-MIBI scintimammography was introduced for the detection of breast cancer, and showed acceptable results in its diagnostic accuracy. In this study, the clinical usefulness of 99mTc-MIBI scintimammography was evaluated for the determination of a better imaging study for the diagnosis of breast cancer. METHODS: This study included 75 patients with breast masses, and 3 imaging studies were performed; mammography, ultrasonography and 99mTc-MIBI scintimammography and the results compared on the basis of the pathological reports from core needle or excisional biopsies of the patients. RESULTS: From the pathological reports of 75 patients, 45 cases were confirmed as malignant and 30 as benign diseases. Based on the pathological reports, the sensitivities of mammography, ultrasonography and 99mTc-MIBI scintimammiography were 62.2, 88.9, and 86.7%, and the specificites of 3 imaging studies were 90.0, 76.7, and 90.3% respectively. The positive predictive values were 90.3, 85.1, and 92.9% and the negative predictive values were 61.4, 82.1, and 81.8%, respectively. 99mTc-MIBI mammoscintigraphy showed a comparable sensitivity to ultra-sonography, and a similar specificity to mammography, in the diagnosis of breast cancer. CONCLUSION: Clinically, as a primary imaging tool, 99mTc-MIBI mammoscintigraphy showed acceptable results in the diagnosis of breast cancer. Considering the weak points of ultrasonography and mammography, 99mTc-MIBI mammoscintigraphy would be a very useful tool in the diagnosis of breast cancer.
Biopsy ; Breast Neoplasms* ; Breast* ; Diagnosis* ; Female ; Humans ; Mammography ; Needles ; Sensitivity and Specificity ; Ultrasonography

PURPOSE: The purpose of this study was to establish optimal imaging acquisition conditions for the GE Advance(TM) PET imaging system by performing the acceptance tests designed by National Electrical Manufacturers Association (NEMA) protocol and General Electric Medical Systems (GEMS) test procedures. MATERIALS AND METHODS: Performance tests were carried out with 18FDG radioactivity source and phantoms by using a standard acquisition mode. Transaxial resolution and scatter fraction tests were performed with a line source and axial resolution with a point source, respectively. A cylindrical phantom made of polymethylmethacrylate (PMMA) was used to measure sensitivity, count rate losses and randoms, uniformity correction, and attenuation inserts were added to measure remaining tests. The test results were acquired in a diagnostic acquisition mode and analyzed mainly on high sensitivity mode. RESULTS: Transaxial resolution and axial resolution were measured as average of 4.65 mm and 3.98 mm at 0 cm, and 6.02 mm and 6.71 mm at 20 cm on high sensitivity mode, respectively. Average scatter fraction was 9.87%, and sensitivity was 225.8 kcps/micronCi/cc of trues. Activity at 50% deadtime was 4.6 Ci/cc, and the error of count rate correction at that activity was from 1.49% to 3.83%. Average nonuniformity for total slice was 8.37%. The accuracy of scatter correction was -0.95%. The accuracies of attenuation correction were 5.68% for air, 0.04% for water and -6.51% for polytetrafluoroethylene (PTFE). CONCLUSION: The results satisfied most acceptance criteria, indicating that the GE AdvanceTM PET system can be optimally used for clinical applications.
Electrons* ; Fluorodeoxyglucose F18 ; Polymethyl Methacrylate ; Polytetrafluoroethylene ; Positron-Emission Tomography* ; Radioactivity ; Water

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) strategy is proposed to reduce the ventilator-induced lung injury in acute respiratory distress syndrome (ARDS). As ECMO use has increased, a number of studies on prognostic factors have been published. Age is estimated to be an important prognostic factor. However, clinical evidences about ECMO use in elderly patients are limited. Therefore, we investigated clinical courses and outcomes of ECMO in elderly patients with ARDS. METHODS: We reviewed medical records of patients with severe ARDS who required ECMO support. Study patients were classified into an elderly group (> or = 65 years) and a non-elderly group (< 65 years). Baseline characteristics, ECMO related outcomes and associated factors were retrospectively analyzed according to group. RESULTS: From February 2011 to June 2013, a total of 31 patients with severe ARDS were treated with ECMO. Overall, 14 (45.2%) were weaned from ECMO, 9 (29.0%) survived to the general ward and 7 (22.6%) survived to discharge. Among the 18 elderly group patients, 7 (38.9%) were weaned from ECMO, 4 (22.2%) were survived to the general ward and 2 (11.1%) were survived to discharge. Overall intensive care unit survival was inversely correlated with concomitant acute kidney injury or septic shock. CONCLUSIONS: In this study, ECMO outcome was poor in severe ARDS patients aged over 65 years. Therefore, the routine use of ECMO in elderly patients with severe ARDS is not warranted except in highly selective cases.
Acute Kidney Injury ; Aged* ; Extracorporeal Membrane Oxygenation ; Humans ; Intensive Care Units ; Medical Records ; Patients' Rooms ; Respiratory Distress Syndrome, Adult* ; Retrospective Studies ; Shock, Septic ; Ventilator-Induced Lung Injury

Acute mesenteric infarction is a catastrophic illness representing a diverse spectrum of pathologic conditions which ultimately lead to necrosis of the intestine and which is uniformly fatal if left untreated. Despite better understanding of the disease process, acute mesenteric infarction continues to be a lethal disorder with high mortality rate. We experienced two cases of acute mesenteric infarction due to superior mesenteric arterial and venous branch occlusion, respectively, in recent years: One case was focal segmental ischemia with normal radiologic finding including angiography, successfully treated with segmental resection of the necrotized ileum, another case was mesenteric venous thrombosis, also treated with resection of necrotized small intestine followed by second look operation.
Angiography ; Catastrophic Illness ; Ileum ; Infarction* ; Intestine, Small ; Intestines ; Ischemia ; Mortality ; Necrosis ; Venous Thrombosis

BACKGROUND: Adequate exposure of skull base lesion and intraoral lesion occupying the posterior oral cavity, base of tongue, tonsil, superior hypopharynx, anterior skull base, and infratemporal space for wide-field primary surgical resection is critical to tumor ablation. The division of mandible for resection of tumor was first undertaken by Roux in 1836, and many studies renewed the interest of mandible sparing procedure for surgical treatment of oropharyngeal carcinoma. OBJECTIVES: Mandibular swing approach for gaining access to oral cavity, oropharynx, and skull base for excision of tumor, provides excellent exposure with low complication rate when there is intervening grossly normal tissue between the tumor and bone. We studied mandibular swing approach with our surgical experience, with special emphasis on its subtypes related to osteotomy sites and forms. MATERIALS AND METHOD: The records of 20 patients underwent mandibular swing approach at Hanyang University Hospital, were studied by chart review. The patients were retrospectively reviewed to assess age, sex, tumor site origin, stage of disease, types of neck dissection and methods of the reconstruction, types of the mandibular osteotomies, and difference of complication rates between symphyseal and parasymphyseal osteotomy. RESULTS: Post-operative complications occured in 6 patients(30%). But osteotomy related complication rate was 15%. Complications of osteotomy site occurred at a rate of 20% in the symphyseal osteotomy group, but no complications arose in parasymphyseal osteotomy group. CONCLUSIONS: We believe that, if the mandible is clinically and radiologically clear of malignant involvement, midline mandibulotomy is more feasible surgical approach method for treatment of oral cavity, oropharyngeal, skull base lesion.
Humans ; Hypopharynx ; Mandible ; Mandibular Osteotomy ; Mouth* ; Neck Dissection ; Oropharynx* ; Osteotomy ; Palatine Tonsil ; Retrospective Studies ; Skull Base* ; Skull* ; Tongue

The aim of this paper is to report a salvage treatment for malpositioned stent graft due to mislabeled product during thoracic endovascular aortic repair (TEVAR) in descending thoracic aneurysm (DTA). A 78-year-old male presented with 6.7×4.1 cm sized saccular DTA and 7.1×7.3 cm sized abdominal aortic aneurysm (AAA). DTA was initially treated by TEVAR and 2 months later AAA was treated by open aortic repair. Unfortunately, although the stent graft was correctly labeled for DTA, the actual size of product wrapped in a box was different contrary to our expectations. On completion angiography, proximal sealing zone showed no endoleak, however, celiac trunk and superior mesenteric artery (SMA) was found to be accidentally occluded. Through an emergent thoracotomy, distal part of stent graft was removed by cutting distal segment of stent graft and pulling out maneuver to restore blood flow. The completion angiography presented no endoleak, and celiac trunk and SMA were secured. Cutting distal segment of stent graft and pulling out maneuver is one of feasible rescue technique to maintain blood flow of occluded celiac trunk during TEVAR.
Aged ; Aneurysm ; Angiography ; Aortic Aneurysm, Abdominal ; Blood Vessel Prosthesis ; Endoleak ; Humans ; Male ; Mesenteric Artery, Superior ; Salvage Therapy ; Stents ; Thoracotomy

We present a patient with primary hyperparathyroidism in whom preoperative Tc-99m sestarnibi scanning cleary demonstrated mediastinal parathyroid adenoma. After resectian of tumor through median sternotomy, he was restored to the normocalcemia. This case suggests that Tc-99m sestamibi scanning may be a useful method in the preoperative localization of mediastinal parathyroid adenoma.
Humans ; Hyperparathyroidism, Primary ; Methods ; Parathyroid Neoplasms ; Sternotomy

No abstract available.
Cellulitis ; Humans ; Lymphedema