BACKGROUND: To evaluate the efficacy of Fibrin glue to decrease recurrence in video-assisted thoracoscopic surgery(VATS) for a treatment of spontaneous penumothorax. MATERIAL AND METHOD: All medical records of 17 patients who underwent a thoracoscopic wedge resections of bullae with stapling device with Fibrin glue in our institute between May 1998 and December 1999 were reviewed. variables analyzed include affected sites primary indication of VATS. duration from admission to discharge duration of postoperative stay duration of chest tube drainage recurrence and complication. There were 16 men and 1 woman. RESULT: There was no evidence of hemodynamic instability or arterial blood gas abnormalities encountered during the procedure. Mean age at the time of the VATS was 26.9 years (range 15 to 61 years) The mean duration from admission to discharge was 7.8 days and mean postoperative stay was 5.1days mean chest tube indwelling period was 4..0 days. There was no recurrence of pneumothorx. CONCLUSION: Thoracoscopic wedge resections with introduction of fibrin glue are safe and effective and requires only a short hospital stay. We believe that this thoracoscopic technique will further simplify the surgical treatment of pneumothorax.
Chest Tubes ; Drainage ; Female ; Fibrin Tissue Adhesive* ; Fibrin* ; Hemodynamics ; Humans ; Length of Stay ; Male ; Medical Records ; Pneumothorax* ; Recurrence ; Thoracic Surgery, Video-Assisted

No abstract available.
Mediastinum*

No abstract available.
Hematoma*

BACKGROUND: Pulsatile pumps for extracorporeal circulation have been known to be better for tissue perfusion than non-pulsatile pumps but be detrimental to blood corpuscles. This study is intended to examine the risks and benefits of T-PLS(TM) through the comparison of clinical effects of T-PLS(TM) (pulsatile pump) and Bio-pump(TM) (non-pulsatile pump) used for coronary bypass surgery. MATERIAL AND METHOD: The comparison was made on 40 patients who had coronary bypass using T-PLS(TM) and Bio-pump(TM) (20 patients for each) from April 2003 to June 2005. All of the surgeries were operated on pump beating coronary artery bypass graft using cardiopulmonary extra-corporeal circulation. Risk factors before surgery and the condition during surgery and the results were compared. RESULT: There was no significant difference in age, gender ratio, and risk factors before surgery such as history of diabetes, hypertension, smoking, obstructive pulmonary disease, coronary infarction, and renal failure between the two groups. Surgery duration, hours of heart-lung machine operation, used shunt and grafted coronary branch were little different between the two groups. The two groups had a similar level of systolic arterial pressure, diastolic arterial pressure and mean arterial pressure, but pulse pressure was measured higher in the group with T-PLS(TM) (46+/-15 mmHg in T-PLS(TM) vs 35+/-13 mmHg in Bio-pump(TM), p<0.05). The T-PLS(TM)-operated patients tended to produce more urine volume during surgery, but the difference was not statistically significant (9.7+/-3.9 cc/min in T-PLS(TM) vs 8.9+/-3.6 cc/min in Bio-pump(TM), p=0.20). There was no significant difference in mean duration of respirator usage and 24-hour blood loss after surgery between the two groups. Plasma free Hb was measured lower in the group with T-PLS(TM) (24.5+/-21.7 mg/dL in T-PLS(TM) versus 46.8+/-23.0 mg/dL in Bio-pump(TM), p<0.05). There was no significant difference in coronary infarction, arrhythmia, renal failure and morbidity rate of cerebrovascular disease. There was a case of death after surgery (death rate of 5%) in the group tested with T-PLS(TM), but the death rate was not statistically significant. CONCLUSION: Coronary bypass was operated with T-PLS(TM) (Pulsatile flow pump) using a heart-lung machine. There was no unexpected event caused by mechanical error during surgery, and the clinical process of the surgery was the same as the surgery for which Bio-pump(TM) was used. In addition, T-PLS(TM) used surgery was found to be less detrimental to blood corpuscles than the pulsatile flow has been known to be. Authors of this study could confirm the safety of T-PLS(TM).
Arrhythmias, Cardiac ; Arterial Pressure ; Blood Cells ; Blood Pressure ; Cardiopulmonary Bypass ; Coronary Artery Bypass ; Extracorporeal Circulation ; Heart-Lung Machine ; Humans ; Hypertension ; Infarction ; Lung Diseases, Obstructive ; Mortality ; Perfusion* ; Plasma ; Pulsatile Flow ; Renal Insufficiency ; Risk Assessment ; Risk Factors ; Smoke ; Smoking ; Transplants ; Ventilators, Mechanical

BACKGROUND: Prostacyclin administered intravenously has demonstrated intermediate pulmonary specificity and its aerosol form has an even greater pulmonary selectivity. There have been few systematic analyses of the difference in response according to the route of administration and the dose of administration of prostacyclin. So we have compared prostacyclin infusion versus inhalation in various concentrations in an animal model. METHODS: Pulmonary hypertension was induced by continuous intravenous infusion of the vasoconstrictor U46619 and prostacyclin solutions of 10, 50, 100, 200 mcg/ml were inhaled using a jet nebulizer. Prostacyclin infusion was done at a rate of 100, 200, 400 ng/kg/min. RESULTS: With inhalation of 10, 50, 100, 200 mcg/ml prostacyclin, PVR fell to values of 85%, 76%, 64%, 55% of the preinhalation value and SVR fell to values of 94%, 80%, 76%, 64% of the preinhalation value, respectively (p<0.05). PVR/SVR ratios decreased significantly in all inhalation doses (p<0.05). With infusion of prostacyclin at a rate of 100, 200, 400 ng/kg/min, PVR fell to values of 73%, 60%, 50% of the preinfusion value and SVR fell to values of 68%, 54%, 38% of the preinfusion value, respectively (p<0.05). PVR/SVR ratios increased at an infusion rate of 400 ng/kg/min. CONCLUSION: Prostacyclin inhalation did not result in selective pulmonary vasodilation without causing any efects on the systemic vascular bed (absolute pulmonary selectivity). But it did cause more predominant vasodilation on the pulmonary vascular bed (relative pulmonary selectivity). By contrast, prostacyclin infusion caused more predominant vasodilation on the systemic vascular bed, creating the risk of severe systemic hypotension.
15-Hydroxy-11 alpha,9 alpha-(epoxymethano)prosta-5,13-dienoic Acid ; Epoprostenol* ; Hypertension, Pulmonary* ; Hypotension ; Infusions, Intravenous ; Inhalation ; Models, Animal ; Nebulizers and Vaporizers ; Sensitivity and Specificity ; Vasodilation

Chondromyxoid fibroma (CMF) is a rare, benign tumor of the bone that represents fewer than 2% of all benign tumors of bone. CMF is most often found in the long tubular bones, especially the tibia and femur near the knee joint. Less common sites included the pelvis, fibula, calcaneus and rib. A 54-year-old male patient presented to us with history of swelling and mild, intermittent local pain without any rise in overlying skin temperature in lateral portion of left 7th rib for one-month duration, which was diagnosed as benign rib tumor by plain chest X-ray and CT scan, and treated successfully by excision of rib with good result. Pathologic diagnosis of this tumor was CMF. Without any medical therapy, there was no evidence of recurrence after operation. We report this case and follow-up of the patient.
Calcaneus ; Chondroma ; Diagnosis ; Femur ; Fibroma* ; Fibula ; Follow-Up Studies ; Humans ; Knee Joint ; Male ; Middle Aged ; Pelvis ; Recurrence ; Ribs* ; Skin Temperature ; Thorax ; Tibia ; Tomography, X-Ray Computed

An aortoesophageal fistula (AEF) is an extremely rare, potentially fatal condition, and aortic surgery is usually performed together with extracorporeal circulation. However, this surgical method has a high rate of surgical complications and mortality. This report describes an AEF caused by tuberculous esophagitis that was treated successfully using a two-stage operation. A 52-yr-old man was admitted to the hospital with severe hematemesis and syncope. Based on the computed tomography and diagnostic endoscopic findings, he was diagnosed with an AEF and initially underwent thoracic endovascular aortic repair. Esophageal reconstruction was performed after controlling the mediastinal inflammation. The patient suffered postoperative anastomotic leakage, which was treated by an endoscopic procedure, and the patient was discharged without any further problems. The patient received 9 months of anti-tuberculosis treatment after he was diagnosed with histologically confirmed tuberculous esophagitis; subsequently, he was followed as an outpatient and has had no recurrence of the tuberculosis or any further issues.
Aortic Diseases/etiology/*surgery ; Eosinophilic Esophagitis/*complications/*surgery ; Esophageal Fistula/etiology/*surgery ; Esophagoscopy/*methods ; Humans ; Male ; Middle Aged ; Treatment Outcome ; Tuberculosis/*complications/surgery ; Vascular Surgical Procedures/methods

Central venous stenosis or occlusion is a serious complication in end-stage renal disease patients undergoing maintenance hemodialysis. It is mostly secondary to trauma caused by temporary or permanent hemodialysis catheter placement. Venous hypertension may cause pain, edema of the ipsilateral arm and increased venous pressure prevents acceptable flow rates during dialysis. Venous bypass to the internal jugular vein, the external jugular vein, or axillary vein to saphenous vein bypass have been described as alternative options of surgical management. Our patients underwent internal jugular vein bypass. We think it is an effective and low risk surgical option.
Arm ; Axillary Vein ; Catheters ; Constriction, Pathologic ; Dialysis ; Edema ; Humans ; Hypertension ; Jugular Veins ; Kidney Failure, Chronic ; Renal Dialysis* ; Saphenous Vein ; Veins* ; Venous Pressure

Lung transplantation has been successfully employed for variety of obstructive lung disease. Single lung transplantation has become a therapeutic option for end-stage obstructive lung disease. The patient, a 57 year old man with emphysema, suffered from severe dyspnea, which progressively aggravated him for the last three years. A single lung transplantation was performed from a young brain-dead donor on April 7th, 1999 in the department of thoracic surgery, Respiratory Center, Yongdong Severance hospital, yonsei University. The immunosuppressive regimen was based on cyclosporine A and azathioprine from beginning, adding steroid. Single lung transplantation was feasible and beneficial in patients with end-stage emphysema.
Azathioprine ; Cyclosporine ; Dyspnea ; Emphysema ; Humans ; Lung Diseases, Obstructive ; Lung Transplantation* ; Lung* ; Middle Aged ; Pulmonary Emphysema* ; Respiratory Center ; Thoracic Surgery ; Tissue Donors

Resectional surgery of sympathetic nerves has been known to be the most effective treatment for essential hyperhidrosis and the application of thoracoscopic electrocauterization has provided a minimally-invasive procedure with the least morbidity and a resultant higher satisfaction rate. This paper describes our experience on the 1,167 cases of thoracoscopic sympathetic surgery for the treatment of essential hyperhidrosis. A total of 1,167 patients (674 males (58%) and 493 females (42%), mean age of 26.4 years with palmar (930), craniofacial (190) or axillary (47) hyperhidrosis underwent thoracoscopic sympathetic surgery from July 1992 to March 1999. Since the T2-4 sympathectomy, first performed in July 1992 for a patient of palmar hyperhidrosis, the operative methods have been altered to achieve a higher satisfaction level with the least complication by adopting less invasive procedures. Our current standard procedures being performed are T3 and T2 clipping for palmar and craniofacial hyperhidrosis and T3,4 sympathicotomy for axillary hyperhidrosis, all using a 2 mm needle thoracoscope. As the surgical procedures have been transited to a less invasive method with limited resection using the newest endoscopic devices, the average operation time and complications such as Horner's syndrome and compensatory hyperhidrosis have gradually decreased and thus the long-term satisfaction rate has been raised up to 98% for palmar hyperhidrosis, 92% for craniofacial hyperhidrosis and 89% for axillary hyperhidrosis. The recurrent cases (14/1167) were treated successfully with reoperations of thoracoscopic sympathetic surgery. The optimal goal of therapy could be achieved by complete elimination of the hyperhidrotic symptom, by decreasing the incidence and degree of compensatory hyperhidrosis through a selective and limited resection, and by adopting the least invasive procedures. Sympathicotomy has provided the advantages of a limited extent of denervation and the resultant decrease of compensatory hyperhidrosis compared to sympathectomy. The reversible method of clipping may be an effective, provisionary means for cases of severe, intractable compensatory sweating. For craniofacial hyperhidrosis, T2 sympathicotomy or clipping has been proven to be superior to the T1 sympathectomy due to the decreased occurrence of Horner's syndrome and T3,4 sympathicotomy providing a satisfactory outcome with less compensatory hyperhidrosis for axillary hyperhidrosis.
Adolescence ; Adult ; Aged ; Child ; Female ; Human ; Hyperhidrosis/surgery* ; Male ; Middle Age ; Sympathectomy* ; Thoracoscopy*