BACKGROUNDS: Carbon Dioxide (CO2) insufflation during thoracoscopy may result in adverse hemodynamic consequences such as increase in central venous pressure, decrease in cardiac output and increase in arterial carbon dioxide pressure. But the cerebral effects of CO2 insufflation during thoracoscopy are not known yet. To evaluate the cerebral effect of CO2 insufflation during thoracoscopy, jugular bulb venous blood oxygen saturation and pressure were measured. METHODS: Nine patients were underwent thoracic surgery by thoracoscopy and one lung ventilation. After operation, CO2 was insufflated and hemodynamic parameters, arterial blood pressure, heart rate, central venous pressure, jugular bulb pressure, arterial blood gases and jugular bulb venous blood gases were measured at intrathoracic pressure 5 mmHg, 10 mmHg and 15 mmHg respectively. RESULTS: Central venous pressure was increased with insufflation of CO2 of 10 mmHg and 15 mmHg. Jugular bulb pressure was increased with insufflationof of CO2 of 5mmHg, 10 mmHg and 15 mmHg. Arterial PCO2, jugular bulb venous PO2 and jugular bulb venous blood oxygen saturation were increased with insufflation of CO2 of 5 mmHg, 10 mmHg and 15 mmHg. CONCLUSION: CO2 insufflation pressure of 5 mmHg or greater resulted in significant increase in jugular bulb venous blood oxygen saturation and pressure.
Arterial Pressure ; Carbon Dioxide ; Cardiac Output ; Central Venous Pressure ; Gases ; Heart Rate ; Hemodynamics ; Humans ; Insufflation* ; Jugular Veins ; One-Lung Ventilation ; Oxygen* ; Thoracic Surgery ; Thoracoscopy*

The management of malignant pleural effusion is a difficult problem. Tetracycline was probably the most commonly used sclerosing agent, but parenteral tetracycline is no longer available. This prospective study was designed to determine the efficacy of insufflated talc in producing plerodesisin patients with malignant pleural effusions. Fifteen patients managed between March 1995 and March 1997 underwent thoracoscopy and had 4 gm sterile asbestos-free talc insufflation throughout the pleural space. The mean interval between the procedure and last follow-up was 101 days (range: 25-233 days). The results of treatment were clinically and radiologically compared with pre-operative status. The results were as follows: 1. The patients were 6 men and 9 women with a mean age of 55.1 years (range: 31-74 years). The primary tumors were lung cancer in 10 patients, breast cancer in two, hepatoma in one, stomach cancer in one, and adenocarcinoma of unkown origin in one. 2. Cancer cell positive ratio was 36% in sputum cytology study and 100% in thoracoscopic biopsy. 3. Symptoms improved in 94% of patients treated by talc pleurodesis. 4. After 30 days of the procedure, there was radiologically no recurrence of plural fluid in 94% patients. 5. There were wound infection in one, respiratory failure in one. In conclusion, the insufflation of 4 gm sterile asbestos-free talc in the pleural space is an effective method to control malignant pleural effusions and patients selection is important factor for reexpansion the lung.
Adenocarcinoma ; Biopsy ; Breast Neoplasms ; Carcinoma, Hepatocellular ; Female ; Follow-Up Studies ; Humans ; Insufflation ; Lung ; Lung Neoplasms ; Male ; Pleural Effusion ; Pleural Effusion, Malignant* ; Pleurodesis* ; Prospective Studies ; Recurrence ; Respiratory Insufficiency ; Sputum ; Stomach Neoplasms ; Talc* ; Tetracycline ; Thoracoscopy ; Wound Infection

BACKGROUND: We analysed simple chest PA and high-resolution CT findings in patients with spontaneous pneumothorax in order to help selecting the kind of treatment, provide a guidline during surgical treatment, and to recognize the bulla which may not be detected by simple radiographs or may be a potential cause of recurrence. MATERIAL AND METHOD: We retrospectively analysed the presence and number of bulla in each side, combined pulmonary disease on simple chest films and high-resolution CT, and methods and frequency of the treatment in 70 patients with spontaneous pneumothorax excluing traumatic origin. RESULT: 45 patients were revealed primary spontaneous pneumothorax, and the remaining 25 patients were revealed secondary spontaneous pneumothorax. All secondary spontaneous pneumothorax were from the longstanding sequelle of pulmonary tuberculosis. The patients with primary spontaneous pneumothorax group was younger(mean:26.0 years old) than secondary group (mean: 44.1 years old). On simple radiography, bulla was detected in 16 patients(30.2%). On HRCT, the bulla was detected in 53 patients(75.7%) of the total 70 patients. In 48 patients(68.6%), the bulla or bleb was noted in ipsilateral side to the pneumothorax, and 34 patients(48.6%) of them showed bulla or bleb bilaterally. 39 patients(55.7%) showed bulla or bleb in contralateral side. The number of bulla or bleb was variable. In secondary spontaneous pneumothorax group, the incidence of multiple(more than 10) bulla or bleb was higher than primary type. Most of the patients were treated by thoracostomy(36 patients) or bullectomy( 7 patients). CONCLUSION: HRCT was superior to detect bulla and analyse the combined pulmonary disease than simple radiography. Therefore, HRCT can help to determine the mothod of treatment, provide a guidline during surgical treatment, and notify the bulla as a possible cause of recurrent pneumothorax.
Blister ; Humans ; Incidence ; Lung Diseases ; Pneumothorax* ; Radiography ; Recurrence ; Retrospective Studies ; Thorax ; Tomography, X-Ray Computed ; Tuberculosis, Pulmonary

Diffuse lung disease is amenable to diagnosis by means of clinical evaluation, bronchoalveolar lavage, transbronchial biopsy, and lung biopsy. The recently introduced technique of thoracoscopic wedge biopsy provides the potential advantages of greater selection of biopsy sites and reduced postoperative pain compared with those associated with standard open lung biopsy. Video assisted thoracoscopic lung biopsy was performed in 22 patients for the diagnosis of diffuse lung disease during the period from August 1994 to December 1996, and the following results were obtained: 1. The patients were 14 men and 8 women. The average age was 54.6 years. 2. 13 lung biopsy specimens were obtained from the right lower lobe, 4 from the right upper lobe, 3 from the right middle lobe, 3 from the left upper lobe, and 3 from the left lower lobe. 3. A comparison of pulmonary function tests between preoperative and postoperative values showed no significant differences in FVC, FEV1, and FEV1/FVC(p>0.05). 4. All patients were pathologically diagnosed and the most common disease was usual interstitial pneumonia(8/22). In conclusion, thoracoscopic lung biopsy was a safe and effective diagnostic method of diffuse lung disease.
Biopsy* ; Bronchoalveolar Lavage ; Diagnosis ; Female ; Humans ; Lung Diseases ; Lung Diseases, Interstitial* ; Lung* ; Male ; Pain, Postoperative ; Respiratory Function Tests ; Thoracoscopy

BACKGROUND: In the studies of the distribution of time to death in trauma patients, the early deaths within several hours after injury were a large component of total trauma deaths. Due to the development of trauma system, overall mortality of trauma was decreased, but trauma is still the major cause of deaths. MATERIAL AND METHOD: From January 1994 to December 2003, trauma patients who had been admitted and had expired at tertiary hospital were enrolled. There was a total of 400 cases, a retrospective study was done to determine the distribution of trauma mortality according to the part of the body that were severely injured part and compared the difference between early deaths within 6 hours and late deaths after 6 hours. We also analysed the risk factors of early deaths due to trauma. RESULT: In severe injury to the head and abdomen, the distribution of mortality was bimodal. But, in severe chest injuries, the distribution was log-shape and most early deaths were almost of trauma related. The average of GCS were 5.86+/-4.15 for the early deaths and 8.24+/-5.02 for the late deaths (p <0.05). The AIS of thorax were 2.66+/-1.87 for the early deaths and 1.55+/-1.76 for late deaths. The risk factors for early mortality were non-EMS transportation (odds ratio 3.474), high AIS (odds ratio 1.491) and GCS (odds ratio 0.859). CONCLUSION: In trauma patients, the causes of early mortality were severe brain injury and massive hemorrhage. Also severe chest injuries were the major cause of the early deaths in truama. Early diagnosis of chest injury can frequently be missed in the acute trauma setting. Therefore, high index of suspicion, a careful examination, and aggressive surgical treatment are important in multiple trauma patients.
Abdomen ; Brain Injuries ; Cause of Death ; Early Diagnosis ; Head ; Hemorrhage ; Humans ; Mortality ; Multiple Trauma ; Retrospective Studies ; Risk Factors ; Tertiary Care Centers ; Thoracic Injuries* ; Thorax* ; Transportation

BACKGROUND: The macrophages activated by lipopolisaccharide produce numerous molecules and proteins, such as tumor necrotic factor-alpha (TNF-alpha), interleukin-6 (IL-6), IL-1beta, inducible nitric oxide synthase (iNOS), cyclooxygenase-2 (COX-2), and free radicals, associated with inflammation. The response was occurred by intracellular cascaded, NF-kappaB pathway. So, the regulation of this pathway is very important in control of inflammation. OBJECTIVE: In this study, the anti-inflammatory and anti-oxidant effects of Sophora flavescens that is used empirically in oriental medicine and folk remedy were evaluated and the mechanism of the effects was studied. METHODS: By using the root extracts of Sophora flavescens, we performed experiment in LPS and interferon-gamma (IFN-gamma)-activated Raw 264.7 cells. We measured the production of NO, PGE2 and expression of iNOS and COX-2 in activated Raw 264.7 cells with Sophora flavescens root extract. Also, we tested anti-oxidant effect of Sophora flavescens root extracts by ELISA kit in activated Raw 264.7 cells, and the free radical scavenging effect of material itself by DPPH assay. RESULTS: The Sophora flavescens root extracts decreased the production of NO (p<0.001) and PGE2 (p<0.01) in Raw 264.7 cells activated by LPS and IFN-gamma. The expression of proteins, iNOS and COX-2, suppressed along with the elevated concentration of Sophora flavescens root extracts. The result of DPPH assay was that the test material itself had scavenging effect for free radical (p<0.001). And the antioxidant activity in activated Raw 264.7 cells was increased with the level of the Sophora flavescens root extracts (p<0.05). CONCLUSION: The Sophora flavescens root extracts suppressed the production of NO and PGE2 through the decreased expression of iNOS and COX-2. And the Sophora flavescens root extracts had the scavenging effect about free radicals itself and increased the antioxidant activity in activated macrophages.
Antioxidants ; Cyclooxygenase 2 ; Dinoprostone ; Enzyme-Linked Immunosorbent Assay ; Free Radicals ; Inflammation ; Interferon-gamma ; Interleukin-6 ; Macrophages ; Medicine, East Asian Traditional ; Medicine, Traditional ; NF-kappa B ; Nitric Oxide Synthase Type II ; Proteins ; Sophora

No abstract available.
Thoracotomy*

A twenty six year old man was admitted to our clinic for bleeding from a venous ulcer of the left leg. His left femoral vein had been ligated for bleeding control after a traffic accident that happened when he was 5 years old. He had a varicose vein, stasis dermatitis, and a venous ulcer on his left leg. To shunt left femoral venous return to the right femoral vein, we did a crossover bypass with arteriovenous fistula using the right greater saphenous vein. To get good patency of the arteriovenous fistula, the bypass graft was closed 6 weeks after the initial operation. He maintained his left leg circumference relatively well for 6 months after the operation. We report the case of a patient who had a vein crossover bypass for a chronic femoral vein ligation.
Accidents, Traffic ; Arteriovenous Fistula ; Dermatitis ; Femoral Vein ; Hemorrhage ; Humans ; Leg ; Ligation ; Saphenous Vein ; Transplants ; Varicose Ulcer ; Varicose Veins ; Veins

Congenital interruption of the inferior vena cava (IVC) can lead to secondary hepatic congestion, portal hypertension, and liver cirrhosis. A 49-year-old woman was admitted to the gynecology department with symptoms of menorrhalgia, known uterine myoma, and anemia. Abdominal computed tomography (CT) and venography performed at our hospital revealed congenital interruption of the IVC. The patient underwent retrohepatic cavoatrial bypass surgery with a polytetrafluoroethylene (PTFE) 16-mm ringed graft via posterolateral thoracotomy, and recovered without major complications. A retroperitoneal approach via posterolateral thoracotomy provides appropriate visualization during dorsal cavoatrial bypass in treating patients with congenital interruption of IVC.
Anemia ; Budd-Chiari Syndrome ; Estrogens, Conjugated (USP) ; Female ; Gynecology ; Humans ; Hypertension, Portal ; Liver Cirrhosis ; Middle Aged ; Myoma ; Phlebography ; Polytetrafluoroethylene ; Thoracotomy ; Transplants ; Vena Cava, Inferior

No abstract available.
Esophageal Perforation*