No abstract available.

Unilateral reexpansion pulmonary edema(RPE) is generally considered a rare complication, occurring when a chronically atelectatic lung is rapidly reexpanded by tube thoracostomy or thoracentesis. It can also take place when the lung collapse is of short duration or when the lung is reexpanded without intrapleural suction. We experienced a case of RPE following surgical resection in mediastinal thymic cyst. A 26 year old female patient suffered from long-standing atelectasis of the right lung due to a huge mediastinal cyst that was misrecognized as tuberculous pleural effusion. Empyema developed after iatrogenic rupture of mediastinal cyst by pig-tailed tube thoracostomy. We successfully managed the ruptured mediastinal thymic cyst, empyema and postoperatively developed RPE following reexpansion of the collapsed lung. The patient was treated with drugs and mechanical ventilation with positive end-expiratory pressure for RPE. The remainder of her hospital course was uneventful.
Adult ; Empyema ; Female ; Humans ; Lung ; Mediastinal Cyst* ; Mediastinal Neoplasms ; Pleural Effusion ; Positive-Pressure Respiration ; Pulmonary Atelectasis ; Pulmonary Edema* ; Respiration, Artificial ; Rupture ; Suction ; Thoracostomy

STUDY DESIGN: A retrospective study. OBJECTIVES: To introduce an endoscopic anterior release and posterior total spondylectomy, and the evaluation of its clinical efficacy. SUMMARY OF LITERATURE REVIEW: A total spondylectomy was introduced for the treatment of primary and metastatic tumors of the spine, with many authors having reported favorable clinical results with its use. Endoscopic surgery has been used for various spinal disorders, including disc diseases or scoliosis, and has been widely used as it offers a minimally invasive technique, with a small surgical incision and very few complications. MATERIAL AND METHODS: Three primary spinal tumor cases were reviewed. The first case was a patient with a Ewing's sarcoma of the sacrum; the second was a giant cell tumor of the sacrum and the last was a giant cell tumor of the T10 vertebra. An endoscopic anterior release was initially performed, including the ligation and release of blood vessels, and soft tissue release, using laparoscopies for the 2 sacral tumors and a thoracoscopy for the thoracic tumor. The total spondylectomy were performed via a posterior approach. In two cases, the one with the Ewing's sarcoma of sacrum and the other with the giant cell tumor of the T10 vertebra, the reconstructions were performed using strut allografts and instrumentations. The average follow-up period was 19 months. RESULTS: Intraoperatively, the endoscopic anterior release made it possible to successful finish the anterior releases, with minimal incisions and blood losses. It also allowed a safer and faster posterior total spondylectomy, without significant complication. At the last follow-up, all patients had favorable clinical results, with no local recurrence in any case or fusions in the two cases that had to undergo reconstruction. CONCLUSION: Endoscopic anterior release and a posterior total spondylectomy was a favorable surgical procedure for primary tumors of spine. It made possible the safe and efficient finish the anterior release and posterior total excision of the affected vertebrae, using small incisions and with no complications.
Allografts ; Blood Vessels ; Follow-Up Studies ; Giant Cell Tumors ; Humans ; Laparoscopy ; Ligation ; Recurrence ; Retrospective Studies ; Sacrum ; Sarcoma, Ewing ; Scoliosis ; Spine* ; Thoracoscopy

STUDY DESIGN: A retrospective study. OBJECTIVES: To introduce an endoscopic anterior release and posterior total spondylectomy, and the evaluation of its clinical efficacy. SUMMARY OF LITERATURE REVIEW: A total spondylectomy was introduced for the treatment of primary and metastatic tumors of the spine, with many authors having reported favorable clinical results with its use. Endoscopic surgery has been used for various spinal disorders, including disc diseases or scoliosis, and has been widely used as it offers a minimally invasive technique, with a small surgical incision and very few complications. MATERIAL AND METHODS: Three primary spinal tumor cases were reviewed. The first case was a patient with a Ewing's sarcoma of the sacrum; the second was a giant cell tumor of the sacrum and the last was a giant cell tumor of the T10 vertebra. An endoscopic anterior release was initially performed, including the ligation and release of blood vessels, and soft tissue release, using laparoscopies for the 2 sacral tumors and a thoracoscopy for the thoracic tumor. The total spondylectomy were performed via a posterior approach. In two cases, the one with the Ewing's sarcoma of sacrum and the other with the giant cell tumor of the T10 vertebra, the reconstructions were performed using strut allografts and instrumentations. The average follow-up period was 19 months. RESULTS: Intraoperatively, the endoscopic anterior release made it possible to successful finish the anterior releases, with minimal incisions and blood losses. It also allowed a safer and faster posterior total spondylectomy, without significant complication. At the last follow-up, all patients had favorable clinical results, with no local recurrence in any case or fusions in the two cases that had to undergo reconstruction. CONCLUSION: Endoscopic anterior release and a posterior total spondylectomy was a favorable surgical procedure for primary tumors of spine. It made possible the safe and efficient finish the anterior release and posterior total excision of the affected vertebrae, using small incisions and with no complications.
Allografts ; Blood Vessels ; Follow-Up Studies ; Giant Cell Tumors ; Humans ; Laparoscopy ; Ligation ; Recurrence ; Retrospective Studies ; Sacrum ; Sarcoma, Ewing ; Scoliosis ; Spine* ; Thoracoscopy

Minimally invasive thoracic surgery has been one of the most important surgical advances recently. Congenital cystic adenomatoid malformation of the lung is a relatively rare anomaly and is clearly associated with various congenital anomalies such as pectus excavatum, cardiac and pulmonary vascular lesions. We have experienced a case that was treated with minimal invasive methods for congenital cystic adenomatoid malformation involving in the right lower lobe and pectus excavatum in a 5-year-old boy. We simultaneously performed thoracoscopic right lower lobectomy and Nuss procedure of pectus excavatum using a substernal steel bar. Therefore, a minimally invasive surgical treatment for this diseases is feasible and cosmetically excellent.
Child, Preschool ; Cystic Adenomatoid Malformation of Lung, Congenital* ; Funnel Chest* ; Humans ; Lung ; Male ; Steel ; Surgical Procedures, Minimally Invasive ; Thoracic Surgery ; Thoracoscopy

No abstract available.
Lung*

BACKGROUND: During organ preservation and reperfusion, both cyclic adenosine monophos-phate(cAMP) and nitric oxide(NO) play a central role in maintaining pulmonary vascular homeostasis. However , both cAMP and NO levels decline markedly during pulmonary ischemia and reperfusion. In this study we prepared a new solution in which a cAMP analog(dibutyryl cAMP, db-cAMP) and a nitric oxide donor (nitroglycerin, NTG) were added to the conventional low potassium dextran(LPD) solution. We investigated the effects of addition of cAMP and/or NO in LPD solution for lung preservation and compared the effectiveness of the solutions. MATERIAL AND METHOD: Rabbit lung grafts(six per group) were studied in an isolated lung perfusion model. The heart-lung blocks were harvested after flushing in situ with only LPD solution(group I, n = 6), plus NTG(group II, n = 6), plus db-cAMP(group III, n = 6), or plus NTG and db-cAMP(group IV, n = 6), and were preserved at 10degreesC for 24 hours. The stored lungs were ventilated with 100% oxygen and reperfused with fresh venous blood at 38degreesC for 30 minutes. We assessed the lung functions and subsequent lung edema. Tumor necrosis factor alpha(TNF-alpha) and nitrite/nitrate(total NO production) levels were also measured. In addition, we evaluated histologic and ultrastructual changes of the reperfused lungs. RESULT: Although Group IV demonstrated the best lung preservation, the differences were not significant among group II, III and IV. Group Irevealed the worst lung functions and severe pulmonary edema(p<0.05 versus all other groups). Although group II showed better lung preservation than in group III, the differences were not significant. TNF-alpha release was significantly reduced in group IV than in group I after reperfusion(p<0.01). NO levels were significantly increased in groups II and IV than in groups I and III after reperfusion(p<0.001). However , there were no significant differences between groups I and III or between groups II and IV. NO levels decreased gradually in groups I and III(p<0.05). Histologic and ultrastructual studies showed better preservation of the alveolar-capillary barrier in groups II, III and IV than in group I. CONCLUSION: This study demonstrate that both of db-cAMP and NTG had beneficial effects on lung preservation with LPD solution, and there was no difference in the effect of each component. Especially, we expect that combined supplementation of db-cAMP and NTG will preserve better vascular homeostasis and minimize reperfusion inj ury after ischemic cold storage.
Adenosine Monophosphate* ; Adenosine* ; Dextrans* ; Edema ; Flushing ; Homeostasis ; Humans ; Ischemia ; Lung* ; Nitric Oxide* ; Organ Preservation ; Oxygen ; Perfusion* ; Potassium* ; Reperfusion ; Reperfusion Injury ; Tissue Donors ; Tumor Necrosis Factor-alpha

Talc pleurodesis is a safe and effective treatment for a recurrent malignant pleural effusion. However, acute hypoxemia, pulmonary edema or acute respiratory failure can develop in a small number of patients. We report 2 patients who developed fatal hypoxemia after talc pleurodesis which was necessary the control recurrent pleural effusion. The first case was an 18-year old male diagnosed with Ewing's sarcoma with bilateral lung metastases and pleural effusion. The performance status was ECOG (Eastern Cooperative Foncology Group) grade 3. Fever along with hypoxemia and leukocytosis developed 10 hours after the second talc pleurodesis on the right side for an uncontrolled pleural effusion, The patient died from respiratory failure after 13 days. The second case was a 66-year old female diagnosed with non-small cell lung cancer with a bone metastasis. Two weeks after systemic chemotherapy, she complained of dyspnea, and a pleural effusion was observed on the right side. Her performance status was ECOG grade 3. Talc pleurodesis was performed for recurrent pleural effusion, but hypoxemia developed 6 days after pleurodesis and she died from respiratory failure 10 days after pleurodesis. In conclusion, talc pleurodesis should be performed very carefully in patients with a poor performance status, in cases with repeated pleurodesis, bilateral pleural effusion, recent chemotherapy, radiotherapy and when there are parenchymal metastatic lesions present.
Adolescent ; Aged ; Anoxia* ; Carcinoma, Non-Small-Cell Lung ; Drug Therapy ; Dyspnea ; Female ; Fever ; Humans ; Leukocytosis ; Lung ; Male ; Neoplasm Metastasis ; Pleural Effusion ; Pleural Effusion, Malignant* ; Pleurodesis* ; Pulmonary Edema ; Radiotherapy ; Respiratory Insufficiency ; Sarcoma, Ewing ; Talc*

BACKGROUND: Primary focal hyperhidrosis is characterized by overactivity of the sympathetic nervous function, and this has been effectively treated with endoscopic thoracic sympathetic denervation (ESD). The imbalance of sympathetic and parasympathetic nervous system that's created by ESD may affect the heart, lung and other thoracic organs. We analyzed the heart rate and ECG changes after performing ESD at our hospital, and this is the first such study that has been conducted on this. MATERIAL AND METHOD: Of the 263 patients who underwent ESD between October 1996 and October 2006, 130 had ECG before and after ESD, and they were classified into 3 groups according to the level of ESD: Group I (n=40) patients underwent ESD at the 2nd rib (T2ESD), Group II (n=80) at the 3rd rib (T3ESD) and Group III (n=10) at the 4th rib (T4ESD). RESULT: There was no mortality or major morbidity. Heart rate (HR) was significantly decreased from 71.6+/-10.6/min to 66.8+/-10.2/min after ESD (p<0.01); however, the PR (from 148.6+/-21.2 msec to 152.8+/-20.5 msec) and QTc (from 399.2+/-15.4 msec to 404.0+/-15.1 msec) intervals were significantly increased after ESD in the patients who suffered with primary hyperhidrosis (p<0.01). According to the level of ESD, there were significant changes in the HR and QTc interval in group I (T2ESD), the HR and PR interval in group II and the QTc interval in Group III. CONCLUSION: There were significant changes in the heart rate and ECG findings after ESD. The thoracic sympathetic denervation of T2, T3 and T4 affected the electrical activity of the heart at the resting state.
Electrocardiography ; Heart ; Heart Rate ; Humans ; Hyperhidrosis ; Lung ; Parasympathetic Nervous System ; Ribs ; Sympathectomy

BACKGROUND/AIMS: The clinical outcomes of some patients with pleural infection may be favorable with medical treatment alone, but in others, the disease progresses and requires additional surgical treatment. However, little is known about the factors affecting this difference. The aim of this study was to investigate the factors predictive of failure of medical treatment in patients with pleural infection. METHODS: A cohort of 127 consecutive patients who were admitted to the hospital with pleural infection was studied. Clinical manifestations and laboratory findings in patients in whom medical treatment succeeded or failed were reviewed. RESULTS: In univariate analysis, the significant factors associated with medical treatment outcome were age, smoking history, duration of chief complaint, serum albumin level, and pleural fluid glucose and lactate dehydrogenase levels (p < 0.05). Multivariate logistic regression analysis identified age and duration of chief complaint as independent predictive factors for failure of medical treatment, with odds ratios of 0.871 (p = 0.013) and 0.797 (p = 0.026), respectively. Receiver operating characteristic curve analysis determined cutoff values of 50.5 years for age and 4.5 days for duration of chief complaint. CONCLUSIONS: We demonstrated that a younger age < 50.5 years and shorter duration of chief complaint < 4.5 days were independent predictive factors for the failure of medical treatment in patients with pleural infection. This suggests their role as evaluative criteria in setting indications for the optimal treatment in patients with pleural infection. A larger, prospective study is required to confirm these findings.
Adult ; Aged ; Anti-Bacterial Agents/therapeutic use ; Cohort Studies ; Drainage ; Empyema, Pleural/metabolism/*therapy ; Female ; Glucose/metabolism ; Humans ; L-Lactate Dehydrogenase/metabolism ; Male ; Pleural Effusion/metabolism/*therapy ; Serum Albumin/metabolism ; Thoracic Surgery, Video-Assisted ; Treatment Failure