Primary hemangiopericytoma of chest wall is very rate and only a few cases have ever been reported. The tumor aries from the capillary pericyte of Zimmerman. It is a highly vascular slow growing tumor which can be calssified as both malignant and benign varieties. We report a case of a 66 year-old man in whom recurrent hemangiopericytoma was treated by complete surgical excision. In October 1993 he had received surgical excision of hemangiopericytoma on posterior chest wall. For more than 6 years after the operation he was in good condition until a recurrent mass was found on the chest X-ray. The patient was discharged 9 days after the operation and is receiving radiotherapy.
Aged ; Capillaries ; Hemangiopericytoma* ; Humans ; Pericytes ; Radiotherapy ; Thoracic Wall* ; Thorax*

Pulmonary endomertiosis is a rare disorder with the typical symptom of hemoptysis during menstruation (catamenial hemoptysis). We report a case of a 19-year-old woman, gravida 0, with 3-month history of catamenial hemoptysis which was confirmed with chest computed tomography. She was treated by means of thoracoscopic wedge resection for the right lesion and fuperior segmental resection through the left thoracotomy, successively. Preoperative fluoroscopy-guided hooking for thoracosopic target lwsion was helpful in circumstances with one lung anesthesia. Four months of follow-up after an uneventful discharge revealed out no recurrence of catamenial hemoptysis in symptoms and images.
Anesthesia ; Female ; Follow-Up Studies ; Hemoptysis* ; Humans ; Lung ; Menstruation ; Recurrence ; Thoracotomy ; Thorax ; Young Adult

Direct anterior approach for lesions located anterior to the thecal sac is definitely superior to lateral or posterior approach in many respects. However, various anatomical obstacles and technical difficulties often hinder direct anterior approach. Thanks to ripe experience of retroperitoneal approach to the lumbar spine for anterior lumbar interbody fusion and total disc replacement, the authors could perform lumbar corpectomy and reconstruction by using midline retroperitoneal approach recently. During this approach, we repaired anterior longitudinal ligament also to reduce the risk of graft extrusion and to prevent erosion of vascular wall due to direct contact between metallic hardware, which was used for reconstruction of vertebral body, and major vessels.
Longitudinal Ligaments ; Spine ; Total Disc Replacement ; Transplants

BACKGROUND: Congenital cystic diseases of the lung are uncommon but they share similar embryogenic and clinical characteristics. MATERIAL AND METHOD: From 1972 to 1999, 46 patients were operated on in the Dept. of Thoracic Surgery at the YUMC. And we analysed the patients' charts for clinical presentations, managements and pathologic findings with chart of patients. RESULT: There were 17 males and 29 females, and mean age was 16.2 years. The main symptoms were 11 fevers due to recurrent infection, 10 dyspneas, and chest pain and sputum production etc. Thirteen patients were asymptomatic. There were 13 pulmonary sequestrations(PS), 12 congenital cystic adenomatoid malformations(CCAM), 12 bronchogenic cysts(BC), 5 cystic bronchiectasis(CB) and 4 congenital lobar emphysemas(CLE). Simple excision(resection) was performed in 8 patients, segmentectomy in 6 patients, lobectomy (with 1 operative mortality) in 31 patients, and pneumonectomy in one patient. The compli-cations were 4 pneumonias, one persistent air leakage and one empyema. CONCLUSION: We experienced surgical treatment of congenital cystic lung disease and reported them with literature review.
Chest Pain ; Dyspnea ; Empyema ; Female ; Fever ; Humans ; Lung Diseases* ; Lung* ; Male ; Mastectomy, Segmental ; Pneumonectomy ; Pneumonia ; Sputum ; Thoracic Surgery

BACKGROUND: With mitral valvular heart disease, chronic atrial fibrillation(AF) is not likely to return to sinus rhythm after the operation. We evaluate the long term results and factors in recurrence of AF after modified Maze operation with mitral valve surgery. MATERIAL AND METHOD: From 1990 to 1996, 35 patients with chronic AF underwent modified Maze operation with mitral valve procedure in patients with chronic AF. The mean duration of AF was 7.7 +/-4.5 years. The concomitant operations were 34 mitral valve replacement(with 4 tricuspid annuloplasty and 3 tricuspid valve replacement)and 1 mitral valve repair. We analyzed the long term results and factors in recurrence of AF. RESULT: At immediate postoperatively, 33 of the 35 patients(93.9%) were converted to sinus rhythm. There was one operative death. However, AF recurred in 12 out of 35 patients during hospitalization and AF in these 12 patients were treated with antiarrhythmic drugs and electrical defibrillation 2-3 months later. Two out of twelve patients were failed in conversion to sinus rhythm after cessation of medication with side effects. During follow-up(71.1 +/-17.5 months, range 3-9 years), AF recurred in 9 patients and overall conversion rate to sinus rhythm was 73.5%. Predictors of postoperative AF included: duration of preoperative AF(maintenance group: recurrence group=6.3 years VS. 10.3 years, p=0.008) and cardiothoracic ratio on preoperative chest X-ray(0.58 VS. 0.72, p=0.009). CONCLUSION: AF surgery with mitral valve procedure increase the chance of recovery into sinus rhythm, reduce the incidence of atrial arrhythmia, and reduce the left atrial size with decreasing wall stress simultaneously. In order to decrease the incidence of postoperative arrhythmia, proper modification of the surgery with medical therapy should be considered.
Anti-Arrhythmia Agents ; Arrhythmias, Cardiac ; Atrial Fibrillation* ; Heart Valve Diseases ; Hospitalization ; Humans ; Incidence ; Mitral Valve ; Recurrence ; Thorax ; Tricuspid Valve

The primary mediastinal liposarcoma is very rare and only a few cases have been reported. We report a 25 year-old man who have had coughing and mild fever for a month. The simple chest X-ray and computed tomography of the chest revealed a huge mass in the right thoracic cavity that originated in the anterior mediastinum. Cytologic examination of the needle aspiration biopsy confirmed the diagnosis of a primary mediastinal liposarcoma. Through an exploratory right thoracotomy and a median sternotomy, the huge mass, lobulated and about 2,500 gm in weight, was extirpated. Mass was attached to a portion of the pericardium and diaphragm, but there was no invasion or metastasis to pleura and lung. The patient was discharged on the 12th postoperative day. He is continuously receiving radiotherapy.
Adult ; Biopsy, Needle ; Cough ; Diagnosis ; Diaphragm ; Fever ; Humans ; Liposarcoma* ; Lung ; Mediastinum* ; Needles ; Neoplasm Metastasis ; Pericardium ; Pleura ; Radiotherapy ; Sternotomy ; Thoracic Cavity ; Thoracotomy ; Thorax

The incidence of tuberculosis (Tbc) infection is high in some parts of the world and tuberculous cold abscess of the chest wall (CACW) often fails to respond to medical treatment. Medical records of 178 patients who underwent surgical treatment of chest wall abscesses from July 1970 to Sept. 2000 were reviewed and 89 patients who were pathologically confirmed as Tbc cold abscess cases were included in this study. Their ages ranged from 9 to 71 years (mean 33.3 years) and the male to female ratio was 1.2:1 (49 male, 40 female). The symptoms were palpable chest wall mass, pain and pus discharge, and three patients had multiple lesions. Twenty-five patients (28%) underwent excision of chest wall abscesses and 64 patients (72%) underwent chest wall and rib resection. Tbc medication was given preoperatively in 39 patients for an average of 6.3 months and all patients were given Tbc medication postoperatively for an average of 12 months. Postoperative complications were bleeding, pus discharge, empyema, pleural effusion, wound dehiscence, subcutaneous emphysema and activation of pulmonary Tbc. The disease recurred in 7 patients (7.8%) and these 7 patients all underwent a second operation. We recommend preoperative Tbc medication and complete resection of chest wall abscesses including any suspicious ribs. Postoperative Tbc medication for a minimum of 12 months is essential to decrease the risk of a relapse.
Abscess/drug therapy/*surgery ; Adolescent ; Adult ; Aged ; Antitubercular Agents/therapeutic use ; Child ; Female ; Human ; Male ; Middle Age ; Retrospective Studies ; Thoracic Diseases/drug therapy/*surgery ; *Thoracic Surgical Procedures ; Thoracic Vertebrae/surgery ; Tuberculosis/drug therapy/*surgery

The common cause of tracheoesophageal fistula(T-E fistula) after tracheal intubation is ulceration and necrosis of the posterior wall of trachea by compression pressure generated by cuff. We experienced a young woman sustaining a T-E fistula which was found on the 12th day of intubation for cardiopulmonary resuscitation. Because spontaneous closure of the fistula is far uncommon, operative closure should be aimed for and should be done as soon as diagnosis is conformed. We delayed operative closure because of poor general condition of the patient. In spite of delayed reconstruction, the tracheal reconstruction itself was successful, but the patient died of peritonitis induced sepsis on the postoperative 41th day.
Cardiopulmonary Resuscitation ; Diagnosis ; Female ; Fistula ; Humans ; Intubation ; Intubation, Intratracheal* ; Necrosis ; Peritonitis ; Sepsis ; Trachea ; Tracheoesophageal Fistula* ; Ulcer

OBJECTIVES: The aim of this study was to evaluate the morphometric changes in neuroforamen in grade I isthmic spondylolisthesis by anterior lumbar interbody fusion (ALIF). METHODS: Fourteen patients with grade I isthmic spondylolisthesis who underwent single level ALIF with percutaneous pedicle screw fixation were enrolled. All patients underwent standing lateral radiography and magnetic resonance imaging (MRI) before surgery and at 1 week after surgery. For quantitative analysis, the foraminal height, foraminal width, epidural foraminal height, epidural foraminal width, and epidural foraminal area were evaluated at the mid-portion of 28 foramens using T2-weighted sagittal MRI. For qualitative analysis, degree of neural compression in mid-portion of 28 foramens was classified into 4 grades using T2-weighted sagittal MRI. Clinical outcomes were assessed using Visual Analogue Sale (VAS) scores for leg pain and Oswestry disability index before surgery and at 1 year after surgery. RESULTS: The affected levels were L4-5 in 10 cases and L5-S1 in 4. The mean foraminal height was increased (p<0.001), and the mean foraminal width was decreased (p=0.014) significantly after surgery. The mean epidural foraminal height (p<0.001), epidural foraminal width (p<0.001), and epidural foraminal area (p<0.001) showed a significant increase after surgery. The mean grade for neural compression was decreased significantly after surgery (p<0.001). VAS scores for leg pain (p=0.001) and Oswestry disability index (p=0.001) was decreased significantly at one year after surgery. CONCLUSION: Foraminal stenosis in grade I isthmic spondylolisthesis may effectively decompressed by ALIF with percutaneous pedicle screw fixation.
Commerce ; Constriction, Pathologic ; Humans ; Leg ; Magnetic Resonance Imaging ; Radiography ; Spondylolisthesis*

PURPOSE: The liver and lung are the most common site of metastases after curative resection of colorectal carcinoma, and only 10 months of median survival is achieved once metastases has occurred in the lung. About 10% of patients have a solitary pulmonary metastasis and surgical resection leads to a 5 year survival rate of 21~43%. We have tried to define ideal candidates for pulmonary resection in a patient with pulmonary metastases from colorectal carcinoma. METHODS: Between March 1990 to Feb. 2001, 25 patients underwent pulmonary resection for metastatic colorectal carcinoma. 15 patients were male, and 10 were female with mean age of 60.0 (range, 36~73) years. The primary sites were colon in 7 patients and rectum in 18 patients. RESULTS: The mean disease free interval was 30.04 19.79 (range, 1~84) months and 19 patients had single metastasis and 6 patients had multiple metastatic lesions. Twenty- one patients had unilateral lesion. Wedge resection was done in 10 patients, lobectomy in 7, pneumonectomy in 2, wedge resection with bilobectomy in 2, segmentectomy and wedge resection in 1, and segmentectomy and lobectomy in 1 patient. Six patients recurred mean 13.7 months after the first operation (range, 1~33 months) and they underwent wedge resection in 4 and one case each of lobectomy and segmentectomy. Seven patients died during follow up with 3 year survival rate of 70.8% and 5 year survival rate of 43.4%. CONCLUSIONS: The disease free interval, number of metastases, type and location of pulmonary resection, level of carcinoembryonic antigen had no correlation with the survival rate. We conclude that surgical resection of colorectal lung metastases is safe and effective, and every patients should be evaluated as a surgical candidate.
Carcinoembryonic Antigen ; Colon ; Colorectal Neoplasms* ; Female ; Follow-Up Studies ; Humans ; Liver ; Lung* ; Male ; Mastectomy, Segmental ; Neoplasm Metastasis* ; Pneumonectomy ; Rectum ; Survival Rate