BACKGROUND: The presence of infiltrated mediastinal lymph nodes is a crucial factor for the prognosis of lung cancer. The aim of our study is to investigate the pattern of metastatic non-small cell lung cancer that spreads to the mediastinal lymph nodes, in relation to the primary tumor site, in patients who underwent major lung resection with complete mediastinal lymph node dissection. MATERIAL AND METHOD: We retrospectively studies 293 consecutive patients [mean age 63.0+/-8.3 years (range 37~88) and 220 males (75.1%)] who underwent major lung resection due to non-small cell lung cancer from January 1998 to December 2005. The primary tumor and lymph node status was classified according to the international TNM staging system reported by Mountain. The histologic type of the tumors was determined according to the WHO classification. Fisher's exact test was used; otherwise the chi-square test of independence was employed. A p-value <0.05 was considered significant. RESULT: Lobectomy was carried out in 180 patients, bilobectomy in 50, sleeve lobectomy in 10 and pnemonectomy in 53. The pathologic report revealed 124 adenocarcinomas, 138 squamous-cell tumors, 14 adenosquamous tumors, 1 carcinoid tumor, 8 large cell carcinomas, 1 carcinosarcoma, 2 mucoepidermoid carcinomas and 5 undifferentiated tumors. The TNM stage was IA in 51 patients, IB in 98, IIB in 41, IIIA in 71, IIIB in 61 and IV in 6. 25.9 % of the 79 patients had N2 tumor. Most common infiltrated mediastinal lymph node was level No.4 in the right upper lobe, level No. 4 and 5 in the left upper lobe and level No. 7 in the other lobes, but no statistically significant difference was observed. Thirty-six patients (12.3%) presented with skip metastasis to the mediastinum. CONCLUSION: Mediastinal lymph node dissection is necessary for accurately determining the pTNM stage. It seems that there is no definite way that non-small cell lung cancer spreads to the lymphatics, in relation to the location of the primary cancer. Further, skip metastasis to the mediastinal lymph nodes was present in 12.3% of our patients.
Adenocarcinoma ; Carcinoid Tumor ; Carcinoma, Large Cell ; Carcinoma, Mucoepidermoid ; Carcinoma, Non-Small-Cell Lung ; Carcinosarcoma ; Humans ; Lung ; Lung Neoplasms ; Lymph Node Excision ; Lymph Nodes ; Lymphatic Metastasis ; Male ; Mediastinum ; Neoplasm Metastasis ; Neoplasm Staging ; Prognosis ; Retrospective Studies

We report here a case of pulmonary benign metastasizing leiomyoma from the uterus in a 45 year old woman. The patient presented for investigation of multiple pulmonary nodules on a routine chest roentgenogram. The patient had undergone uterine myomectomy due to uterine leiomyoma 10 years earlier. We performed thoracoscopic wedge resection for definitive diagnosis. Histologically, spindle shaped smooth muscle cells appeared between collagen stroma, histology similar to that seen in uterine myoma. The tumor tissue tested positive for estrogen and progesterone receptors. The pathological findings were consistent with benign metastasizing leiomyoma. The patient was in pre-menopause. She received no specific treatment for lung tumors, and we did not found any changes in the lesions after one year follow up without any medication.
Collagen ; Diagnosis ; Estrogens ; Female ; Follow-Up Studies ; Humans ; Leiomyoma* ; Lung ; Lung Neoplasms ; Middle Aged ; Multiple Pulmonary Nodules ; Myocytes, Smooth Muscle ; Neoplasm Metastasis ; Premenopause ; Receptors, Progesterone ; Thorax ; Uterine Myomectomy ; Uterus

Anomalous systemic arterial supply to the normal basal segments with normal bronchial connection of the lung without sequestration is a rare anomaly. It was classified as a type of sequestration according to Pryce's terminology, but whether the term - one of the sequestration is appropriate or not, is controversial because of normal bronchial connection. We describe our experience with surgical treatments for anomalous arterial supply to the normal basal segments of the left lower lobe.
Lung ; Pulmonary Artery

PURPOSE: Fanconi anemia(FA) is a rare autosomal recessive disorder characterized by progressive bone marrow failure and congenital malformations. Patients with FA have aplastic anemia(> 90%), leukemia(10~15%), myelodysplasia(5%) and liver(5%) and other tumors(5%). In the International FA Registry study myelodysplasia in FA patients was detected at a median of 13 years. Presentation of FA with myelodysplasia in an infant should be extremely rare. CASE: A 3-month-old infant presented with anemia and poor feeding. The initial hemogram showed: hemoglobin, 4.6 g/dL; MCV, 104.1 fL/pg; white cell count, 4,300/microL; neutrophils, 450/microL; platelets, 23,000/microL. The bone marrow was normocellular, with findings of macrocytic anemia and dyserythropoiesis, and less than 5% of myeloid blasts, compatible with myelodysplastic syndrome(refractory anemia). The patient had multiple cafe-au-lait spots, hypopigmented nevi, broad nasal bridge, micrognathia, and thumb and toe anomalies. FA was confirmed by chromosomal hypersensitivity to diepoxybutane and mitomicin C. Supportive treatment with oxymetholone and prednisolone failed to improve hematologic and clinical findings. The patient succumbed to sepsis, pneumonia and meningitis due to Pseudomonas aeruginosa at 20 month of age. Clonal cytogenetic anomalies were not found. CONCLUSION: We reported here a rare case of FA presenting with myelodysplasia at the age of 3 month.
Anemia ; Anemia, Macrocytic ; Bone Marrow ; Cafe-au-Lait Spots ; Cell Count ; Cytogenetics ; Fanconi Anemia* ; Humans ; Hypersensitivity ; Infant* ; Meningitis ; Myelodysplastic Syndromes* ; Neutrophils ; Nevus ; Oxymetholone ; Pneumonia ; Prednisolone ; Pseudomonas aeruginosa ; Sepsis ; Thumb ; Toes

The prevalence of gastroesophageal reflux disease has been increased recently in Korea. The use of minimally invasive laparoscopic and thoracoscopic surgery has become popular in the operation of esophageal disease such as esophageal cancer or gastroesophageal reflux disorder. We experienced three cases of laparoscopic Nissen fundoplications and one case of laparoscopic Collis gastroplasty, and we will describe the technical aspect of these surgeries.
Esophageal Diseases ; Esophageal Neoplasms ; Fundoplication* ; Gastroesophageal Reflux ; Gastroplasty* ; Korea ; Laparoscopes ; Prevalence ; Thoracoscopy

Cardiac rhabdomyomas are the most common primary tumor in infancy and childhood and are frequently associated with tuberous sclerosis. Although spontaneous regression of cardiac rhabdomyoma has been reported , prognosis of this tumor associated with subaortic stenosis is still considered to be poor and surgery continues to be indicated. A 4-day-old female was admitted due to tachypnea and cyanosis. Single rhabdomyoma arising from the interventricular septum associated with severe subaortic stenosis was partially removed under cardiopulmonary bypass. Excised tumor size was 0.7 X 0.9 X 0.4 cm in dimension. The postoperative course was uneventful and the infant discharged on the 14th postoperative day.
Cardiopulmonary Bypass ; Constriction, Pathologic ; Cyanosis ; Echocardiography ; Female ; Heart Neoplasms ; Humans ; Infant ; Infant, Newborn* ; Prognosis ; Rhabdomyoma* ; Tachypnea ; Tuberous Sclerosis ; Ventricular Outflow Obstruction*

Cardiac rhabdomyomas are the most common primary tumor in infancy and childhood and are frequently associated with tuberous sclerosis. Although spontaneous regression of cardiac rhabdomyoma has been reported , prognosis of this tumor associated with subaortic stenosis is still considered to be poor and surgery continues to be indicated. A 4-day-old female was admitted due to tachypnea and cyanosis. Single rhabdomyoma arising from the interventricular septum associated with severe subaortic stenosis was partially removed under cardiopulmonary bypass. Excised tumor size was 0.7 X 0.9 X 0.4 cm in dimension. The postoperative course was uneventful and the infant discharged on the 14th postoperative day.
Cardiopulmonary Bypass ; Constriction, Pathologic ; Cyanosis ; Echocardiography ; Female ; Heart Neoplasms ; Humans ; Infant ; Infant, Newborn* ; Prognosis ; Rhabdomyoma* ; Tachypnea ; Tuberous Sclerosis ; Ventricular Outflow Obstruction*

PURPOSE: Myelodysplastic syndrome (MDS) in children needs to be elucidated in terms of clinical characteristics, natural history, the most effective treatment and prognostic factors, as the disease is very rare and its definition and classification has not reached a consensus by many physician. This study was aimed to describe the characteristics and the disease courses of Korean children with MDS, and to analyze the usefulness of prognostic scoring systems in the prediction of transformation to acute myelogenous leukemia (AML) and overall survival among subgroups. MATERIALS AND METHODS: Fourteen children with MDS seen at Chonnam University Hospital and additional 59 patients identified by the review of Korean literature were evaluated to define clinical characteristics and disease courses. Kaplan-Meier (K-M) probability of leukemic transformation and overall survival were plotted. FAB subtypes, subgroups by Boumemouth Scoring System (BSS), and International Prognostic Scoring System (IPSS) risk groups were compared to predict transformation to AML and overall survival. RESULTS: The median age of 14 patients was 36.5 months. The sex ratio was 3.7:1 (M: F). The frequency of FAB subtypes in Korea was similar to that of other countries except for higher proportion of RA (37%). K-M 3-yr probability of AML transformation and survival for Korean patients were 54.7%, and 49.8%, respectively. Although FAB system, BMS and IPSS were all capable of discriminating subgroups in the prediction of AML transformation and survival, they did not reach the significant level possibly due to small number of patients assigned to each subgroup. CONCLUSION: The clinical characteristics of Korean children with MDS were not different from those of other countries. This study showed the high rate of AML transformation and poor survival in children with MDS.
Child ; Classification ; Consensus ; Humans ; Jeollanam-do ; Korea ; Leukemia, Myeloid, Acute ; Myelodysplastic Syndromes* ; Natural History ; Prognosis ; Sex Ratio

BACKGROUND: Post-Herpetic Neuralgia(PHN) is the most common and serious complication of herpes zoster(H-Z). Especially in the elderly, intractable chronic pain is caused by PHN and it affects the quality of life severely. The study examined the predictive factors of PHN for its prevention and treatment. METHODS: 691 cases of patients with herpes zoster who visited department of dermatology were studied of Kwang Ju Christian Hospital during the five years from Jan. 1991 to Dec. 1995 Retrospective chart review was used to compare occurrence of PHN according to age, sex, residential area of patients, inpatients or outpatients status, nerve dermatome, interval of treatment, methods of treatment associated conditions and duration of PHN. The authors compared the incidence of patients with PHN and patients with H-Z according to above variables. For statistical analysis, we used Chi-square and t-test through SPSS/PC+ (P<0.05). RESULTS: The incidence of PHN was 22.9% (159/691) and increased with age. The incidence of patients under 60 years of age was 16.5%, more than 60 was 30.7% (P<0.05). There was no statistical significance concerning sex, residential area of patients, dermatome, method of treatment, associated conditions in the incidence of PHN compared to patients with H-Z. The significant difference In the incidence of PHN was shown between inpatients and outpatients status(20.5%, 27.3% respectively) (P<0.05). Anatomical site of PHN of the highest incidence was the opthalmic branch of trigeminal nerve(27.1%), followed by cervical(26.0%), thoracic(24.4%) and sacral(22.2%) in order of sequence. Associated conditions or diseases of PHN were observed in 80 patients(24.7%) including hypertension(39.5%), tuberculosis(39.3%), malignancy (34.5%), COPD(33.3%), Chronic hepatitis(22.7%), DM(15.4%). The interval between the onset of H-Z and the initiation of treatment showed that significant difference in the incidence of PHN was on the fourth day with less than and more than 4 days showing 18.5% : 25.1% respectively(P<0.05). CONCLUSIONS: The important factors affecting the incidence of PHN were interval between the onset of H-Z and the initiation of treatment age and inpatients or outpatients status. The methods of treatment(acyclovir or steroid), sex, residential area of patients, associated conditions and nerve distribution were not significant factors.
Aged ; Chronic Pain ; Dermatology ; Gwangju ; Herpes Zoster* ; Humans ; Incidence ; Inpatients ; Neuralgia* ; Outpatients ; Quality of Life ; Retrospective Studies

The aim of this study was to assess the potential of a prone chest CT for the evaluation of esophageal cancer, as compared with a routine supine chest CT. 69 patients (67±18 years old) with pathologically confirmed esophageal cancers underwent MDCT in the supine and prone positions. The supine CT was performed first, followed by the prone position. Localization and staging of individual esophageal lesions on both the prone and supine CTs were assessed by two thoracic radiologists, using a scoring system that consisted of three confidence scales, and the results were correlated with the endoscopic and surgical findings. The mean confidence score for the detection of esophageal cancer was higher in the prone position (2.58±0.74) than that in the supine position (2.42±0.83) with statistical significance (p=0.002). The mean confidence score for predicting local invasion in the selected patients (n=18) who underwent esophagectomy was also higher in the prone position (2.39±0.85) than that in the supine position (2.06±0.73) with statistical significance (p=0.01). In 10 of 11 cases that showed definitive determination for periesophageal infiltration or adjacent organ invasion on the prone CT (score 3), the corresponding findings were also observed in the post-operative evaluations. In conclusion, prone chest CT for evaluating esophageal cancer could have advantages in regards to the localization of esophageal cancer and predicting local invasion compared to that of routine supine CT and can improve the diagnostic accuracy of chest CTs.