Intestinal malrotation with volvulus is generally presented as a bilious vomiting and acute intestinal obstruction in the newborn period. It could compromise vascular supply of the small bowel secondary to torsion of superior mesenteric artery (SMA) and without urgent surgical management, it could lead to detrimental outcomes such as transmural bowel infarction and sepsis. However, in chronic cases, it is rarely obstructs the vascular supply and propagates to an acute bowel infarction. Rarely, chronic malrotation with midgut volvulus may not reduce the mesenteric blood supply because of collateral vessels, and the chronically stagnated blood flow of the superior mesenteric vein (SMV) favors thrombus formation within the lumen. The recommended treatment is Ladd's procedure and anticoagulation therapy. The authors present an unusual case of intestinal malrotation with chronic volvulus resulting in superior mesenteric vein and portal vein thrombosis in a 28-year-old patient.
Adult ; Humans ; Infant, Newborn ; Infarction ; Intestinal Obstruction ; Intestinal Volvulus ; Mesenteric Artery, Superior ; Mesenteric Veins ; Portal Vein ; Sepsis ; Thrombosis ; Vomiting

PURPOSE: Retrospective analyses of patients with stage I-II thymic epithelial tumors (TET) who were treated with either surgery alone (S) or surgery plus postoperative radiation therapy (SRT) were conducted to evaluate the role of adjuvant radiation therapy (RT). MATERIALS AND METHODS: A total of 110 stage I-II TET patients following complete resection were included in this study. Postoperative radiation therapy was recommended for those with aggressive histologic type and/or invasive features according to the surgeons' judgment during the operation. A median dose of 54.0 Gy (range, 44 to 60 Gy) focused on the primary tumor bed was administered to 57 patients (51.8%). RESULTS: In all patients, the rates of overall survival, disease-specific survival, and disease-free survival at 10 years were 91.7%, 97.1%, and 95.8%, respectively. No significant differences in disease-specific survival (100% in the S group and 93.5% in the SRT group at 10 years, p=0.12) and disease-free survival (98.1% in the S group and 94.5% in the SRT group at 10 years, p=0.41) were observed between the treatment groups, although a significantly larger number of World Health Organization (WHO)-type B2-C (p<0.001) and Masaoka stage II (p=0.03) tumors were observed in the SRT group than in the S group. No local recurrence was observed in the SRT group. No grade 2 or greater RT-related toxicities were observed in the SRT group. CONCLUSION: Excellent outcomes were achieved in patients with stage I-II TET who underwent complete resection. Considering excellent local control and low morbidity, adjuvant RT may be considered in high risk patients with WHO-type B2-C histology and Masaoka stage II.
Disease-Free Survival ; Humans ; Judgment ; Radiotherapy, Adjuvant ; Recurrence ; Retrospective Studies ; Thymus Neoplasms ; World Health Organization

PURPOSE: This research was designed to evaluate the chronic effect of isolated lung perfusion (ILP) with cisplatin on dogs. MATERIALS AND METHODS: Fifteen dogs were divided into three groups. Group I was in ILP without cisplatin, group II with 2.5 mg/kg and group III with 5.0 mg/kg of cisplatin for 30 minutes respectively. Serial blood samples were taken before and after ILP for quantitative analysis of serum lactate dehydrogenase (LDH) and blood urea nitrogen/creatinine (BUN/Cr). The specimens from the lung were obtained 2 weeks after ILP. RESULTS: There were no statistic significant differences in LDH concentration according to the time interval among the groups. The LDH concentration peaked at 1 week after ILP and declined thereafter to the pre-ILP concentration. The concentration of BUN/Cr was in normal range. Histologic examination showed no pathologic change. No significant histopathologic differences were found in the pulmonary parenchyme and vasculature among the groups. All of the dogs survived without complication 2 weeks after ILP. CONCLUSION: In ILP with cisplatin of 5.0 mg/kg in normal dog, the toxicity of cisplatin itself was not observed. With further study about the technique of ILP with cisplatin it would be effective to deliver high concentration of cisplatin into the target tissue minimizing lung damage.
Animals ; Cisplatin* ; Dogs* ; Drug-Related Side Effects and Adverse Reactions ; L-Lactate Dehydrogenase ; Lung* ; Perfusion* ; Reference Values ; Urea

PURPOSE: To evaluate the role of mediastinoscopy and CT in the preoperative nodal evaluation in patients with T1 lung cancer. MATERIALS AND METHODS: Between November 1994 and July 1996, 125 patients underwent thoracotomy and/or mediastinoscopy for surgical treatment of lung cancer. Among them, 35 patients had T1 lung cancer(peripheral lung cancer less than 3cm in diameter) on CT. One patient finally proved to have T4 lung cancer with pleural seeding at thoracotomy. In the remaining 34 patients, pathologic evaluation of mediastinal lymph nodemetastasis was feasible and the results were correlated with CT findings. On CT, nodes larger than 10mm in short-axis diameter were regarded as abnormal. RESULTS: The patients had adenocarcinoma in 12, squamous cellcarcinoma in 11, bronchioloalveolar carcinoma (BAC) in 10, and large cell carcinoma in one. Fifteen among total 478 sampled lymph nodes contained malignant tumor. Six (three with adenocarcinoma, two with squamous cell carcinoma, and one with large cell carcinoma) of 34 patients (18%) had nodal metastasis. With 112 sampled nodes, BAC did not show any nodal metastasis. Sensitivity and specificity of CT for nodal detection were 0% and 100% for2R, 0% and 100% for 4R, 100% and 97 % for 5, 50% and 100% for 7 and 0% and 100% for 10R, respectively. CONCLUSION: T1 lung cancer shows relatively high (18%) prevalence of mediastinal lymph node metastasis. Because small nodesless than 10mm in diameter contain malignancy and CT is insensitive in detection of metastatic nodes,mediastinoscopy is still needed for preoperative nodal evaluation except BAC.
Adenocarcinoma ; Adenocarcinoma, Bronchiolo-Alveolar ; Carcinoma, Large Cell ; Carcinoma, Squamous Cell ; Diagnosis* ; Humans ; Lung Neoplasms* ; Lung* ; Lymph Nodes ; Mediastinoscopy* ; Neoplasm Metastasis ; Prevalence ; Sensitivity and Specificity ; Thoracotomy

METHOD: 34 patients with a solitary pulmonary nodule less than 6 cm of its diameter who visited Samsung Medical Center from Semptember, 1994 to Semptember, 1995 were evaluated prospectively. Simple chest roentgenography, chest computer tomography, FDG-PET scan were performed for all patients. The results of FDG-PET were evaluated comparing with the results of final diagnosis confirmed by sputum study, PCNA, fiberoptic bronchoscopy, or thoracotomy. Results: (1) There was no significant difference in nodule size between malignant (3.1 1.5cm) and benign nodule(2.81.0cm)(P>0.05). (2) Peak SUV (standardized uptake value) of malignant nodules (6.93.7) was significantly higher than peak SUV of benign nodules(2.71.7) and time-activity curves showed continuous increase in malignant nodules. (3) Three false negative cases were found among eighteen malignant nodule by the FDG-PET imaging study and all three cases were nonmucinous bronchioloalveolar carcinoma less than 2 cm diameter. (4) FDG-PET imaging resulted in 83% sensitivity, 100% specificity, 100% positive predictive value and 84% negative predictive value. Conclusion: FDG-PET imaging is a new noninvasive diagnostic method of solitary pulmonary nodule that has a high accuracy of differential diagnosis between malignant and benign nodule. FDG-PET imaging could be used for the differential diagnosis of SPN which is not properly diagnosed with conventional methods before thoracotomy. Considering the high accuracy of FDG-PET imaging, this procedure may play an important role in making the dicision to perform thoracotomy in diffcult cases.
Adenocarcinoma, Bronchiolo-Alveolar ; Bronchoscopy ; Diagnosis ; Diagnosis, Differential ; Humans ; Proliferating Cell Nuclear Antigen ; Prospective Studies ; Radiography ; Sensitivity and Specificity ; Solitary Pulmonary Nodule* ; Sputum ; Thoracotomy ; Thorax

PURPOSE: This is to evaluate the acute complication, resection rate, and tumor down-staging after pre-operative concurrent chemoradiotherapy for stage IIIA (N2) non-small cell lung cancer. MATERIALS AND METHODS: Fifteen patients with non-small cell lung cancer were enrolled in this study from May 1997 to June 1998 in Samsung Medical Center. The median age of the patients was 61 (range, 45~67) years and male to female ratio was 12:3. Pathologic types were squamous cell carcinoma (11) and adenocarcinoma (4). Pre-operative clinical tumor stages were cT1 in 2 patients, cT2 in 12, and cT3 in 1 and all were N2. Ten patients were proved to be N2 with mediastinoscopic biopsy and five had clinically evident mediastinal lymph node metastases on the chest CT scans. Pre-operative radiation therapy field included the primary tumor, the ipsilateral hilum, and the mediastinum. Total radiation dose was 45 Gy over 5 weeks with daily dose of 1.8 Gy. Pre-operative concurrent chemotherapy consisted of two cycles of intravenous cis-Platin (100 mg/m2) on day 1 and oral Etoposide (50 mg/m2/day) on days 1 through 14 with 4 weeks' interval. Surgery was followed after the pre-operative re-evaluation including chest CT scan in 3 weeks of the completion of the concurrent chemoradiotherapy if there was no evidence of disease progression. RESULTS: Full dose radiation therapy was administered to all the 15 patients. Planned two cycles of chemotherapy was completed in 11 patients and one cycle was given to four. One treatment related death of acute respiratory distress syndrome occurred in 15 days of surgery. Hospital admission was required in three patients including one with radiation pneumonitis and two with neutropenic fever. Hematologic complications and other acute complications including esophagitis were tolerable. Resection rate was 92.3% (12/13) in 13 patients excluding two patients who refused surgery. Pleural seeding was found in one patient after thoracotomy and tumor resection was not feasible. Post-operative tumor stagings were pT0 in 3 patients, pT1 in 6, and pT2 in 3. Lymph node status findings were pN0 in 8 patients, pN1 in 1, and pN2 in 3. Pathologic tumor down-staging was 61.5% (8/13) including complete response in three patients (23.7%). Tumor stage was unchanged in four patients (30.8%) and progression was in one (7.7%). CONCLUSION: Pre-operative concurrent chemoradiotherapy for Stage IIIA (N2) non-small cell lung cancer demonstrated satisfactory results with no increased severe acute complications. This treatment scheme deserves more patient accrual with long-term follow-up.
Adenocarcinoma ; Biopsy ; Carcinoma, Non-Small-Cell Lung* ; Carcinoma, Squamous Cell ; Chemoradiotherapy* ; Disease Progression ; Drug Therapy ; Esophagitis ; Etoposide ; Female ; Fever ; Follow-Up Studies ; Humans ; Lymph Nodes ; Male ; Mediastinum ; Neoplasm Metastasis ; Radiation Pneumonitis ; Respiratory Distress Syndrome, Adult ; Thoracotomy ; Tomography, X-Ray Computed

PURPOSE: To determine the accuracy of CT in the evaluation of mediastinal nodal metastases of non-small celllung cancer. MATERIALS AND METHODS: Between November 1994 and June 1997, 178 patients with non-small cell lung cancer underwent thoracotomy and full nodal sampling. The results of preoperative CT scanning and of pathologicexamination of regional lymph node metastases were compared. Each scan was prospectively interpreted by one chestradiologist. Mediastinal lymph nodes were localized according to the lymph node mapping scheme of the AmericanThoracic Society and were considered abnormal if they exceeded 10mm in short-axis diameter. All accessible nodeswere either removed or sampled during thoracotomy. RESULTS: Of the 178 non-small cell lung cancers, 90 weresquamous cell carcinoma, 60 were adenocarcinoma, 13 were brochioloalveolar carcinoma, ten were large cellcarcinoma, and five were others (basaloid, 1; sarcomatoid, 1; spindle cell, 1; adenosquamous cell, 2). A total of615 mediastinal nodal stations were obtained. The sensitivity of CT for the diagnosis of mediastinal nodemetastasis on a station-by-station basis was 21%, with a specificity of 93% (squamous cell carcinoma: 21% and 91%;adenocarcinoma: 20% and 95%, respectively). Sensitivities were higher for groups 7 and 5. In 13 bronchioloalveolarcarcinomas, no lymph node metastasis was found on either CT or pathologic examination. The sensitivity of CT forthe diagnosis of mediastinal node metastasis on a per-patient basis was 43%, with a specificity of 83%. CONCLUSION: Because of the relative insensitivity of CT for the detection of mediastinal lymph node metastasis, nodalsampling with mediastinoscopy or thoracotomy is essential in the staging work-up of non-small cell lung cancerother than bronchioloalveolar carcinoma.
Adenocarcinoma ; Adenocarcinoma, Bronchiolo-Alveolar ; Carcinoma, Non-Small-Cell Lung ; Diagnosis ; Humans ; Lung Neoplasms* ; Lung* ; Lymph Nodes* ; Mediastinoscopy ; Neoplasm Metastasis* ; Prospective Studies ; Sensitivity and Specificity ; Thoracotomy ; Tomography, X-Ray Computed