No abstract available.
Thoracic Surgery, Video-Assisted

Postpneumonectomy empyema is a life-threatening complication, which is often related with a bronchopleural fistula. After surgical repair of fistula, sterilization of infected pleural cavity is important and usually carried out by long-term cyclic irrigation. We report a case in which vacuum-assisted closure device was successfully applied to sterilize the pleural cavity and obliterate bronchopleural fistula.
Bronchial Fistula ; Empyema ; Fistula ; Negative-Pressure Wound Therapy ; Pleural Cavity ; Pneumonectomy ; Sterilization

BACKGROUND: Treatment of pulmonary metastasis from urothelial cell carcinoma has been mostly palliative chemotherapy and the role of pulmonary metastasectomy has not been investigated much. MATERIALS AND METHODS: This study is a retrospective interim review of pulmonary metastasectomy from urothelial carcinoma at single institution between 1998 and 2010. Overall 16 patients underwent pulmonary metastasectomies. RESULTS: There was no postoperative complication or hospital mortality. Mean hospital stay was 6 days. Overall and disease-free 5-year survival were 65.3% and 37.5%, respectively. CONCLUSION: In selected patients with pulmonary metastasis from urothelial carcinoma, surgical treatment is feasible and could contribute to long-term survival in selected patients.
Hospital Mortality ; Humans ; Length of Stay ; Lung Neoplasms ; Metastasectomy ; Neoplasm Metastasis ; Postoperative Complications ; Retrospective Studies

Primary acinic cell carcinoma (ACC) of the lung is very rare and this tumor is thought to arise from pluripotent cells of the submucosal glands of the tracheobronchial tree. We report here on a case of primary ACC of the lung in a 68-year-old man who had a solitary pulmonary nodule in the left lower lobe. The patient was symptomless and the lesion was found on a chest X-ray taken during a regular health checkup. The video assisted thoracoscopic surgery wedge resection revealed an ovoid yellow tan solid mass that was 1.8 cm at the largest diameter. Microscopically, the neoplastic cells grew in solid sheets of round cells with eccentric nuclei and abundant basophilic granular cytoplasm. There were no mitotic figures or areas of pleomorphic or anaplastic cells. Immunohistochemical staining for cytokeratin (AE1/AE3) was positive, but the staining for chromogranin A and CD56 was negative. Ultrastructural examination revealed polyhedral cells with many zymogen granules of varying electron density. The patient is well 4 months postoperatively.
Acinar Cells ; Aged ; Basophils ; Carcinoma, Acinar Cell ; Chromogranin A ; Cytoplasm ; Electrons ; Humans ; Keratins ; Lung ; Lung Neoplasms ; Secretory Vesicles ; Solitary Pulmonary Nodule ; Thoracic Surgery, Video-Assisted ; Thorax ; Triacetoneamine-N-Oxyl

PURPOSE: Cancer gene therapeutic strategy using p53 tumor suppresser gene have been suggested to be effective in many solid tumors including non-small cell lung cancer (NSCLC). To test generalized applicability, we tested a number of non-small cell lung cancer cell lines for their sensitivity to adenoviral-mediated wild-type p53 gene transfer. MATERIALS AND METHOD: Replication-incompetent recombinant adenovirus encoding wild- type p53 (Avp53) under the control of the human cytomegalovirus (CMV) promoter was constructed and the cytotoxic effectiveness was evaluated in various NSCLC cell lines. Because 20 moi (multiplicity of infection; number of active virus particle/cell number) of Avp53 showed highly-effective cytotoxicity in p53-deleted cell lines (NCI-H1299, and NCI-H358), same amount was used for other cell lines. RESULTS: Variable degree of cytotoxicity were observed in cell line with p53 mutation, but almost no effect were observed in those with will-type p53. Neither the infectivity of adenovirus, which was observed by x-gal stain after adenoviral mediated lac Z gene, nor the expression of p53 protein in infected cell, which was observed by western blot, was not the useful marker to expect the cytotoxic effect of Avp53. However, in responsive cell lines with Avp53, prominent expression of p21 protein, which was observed by western blot, was noticed. CONCLUSION: In conclusion, adenoviral-mediated wild-type p53 transfer may not be applicable to every patient with non-small cell lung cancer, especially when the tumor has wild-type p53 gene. Better method to predict the effectiveness before application and strategy to widen the applicable extent is needed.
Adenoviridae ; Blotting, Western ; Carcinoma, Non-Small-Cell Lung* ; Cell Line* ; Cytomegalovirus ; Genes, Neoplasm ; Genes, p53* ; Humans

Metaplastic thymoma (MT), accepted in the World Health Organization 2004 scheme, is a circumscribed tumor of the thymus exhibiting biphasic morphology. We herein describe the clinicopathologic features of four MTs and the differential diagnoses of this unusual tumor. There were three women and one man with mean age of 49.5 years. The patients were found to have mediastinal masses, and underwent surgical excision. One exhibited symptoms of myasthenia gravis, and the serum titer for anti-acetylcholine receptor antibody was positive. Grossly, the tumors were encapsulated, and showed vaguely multinodular, solid, tan-white to yellow cut surfaces. Histologically, they comprised epithelial islands intertwining with bundles of delicate spindle cells. The patients remained well after surgical excision at 5-55 months. Because of the distinctive histological appearance and benign clinical course, MT should be distinguished from other more aggressive mediastinal neoplasms displaying biphasic feature.
Carcinosarcoma ; Diagnosis, Differential ; Female ; Humans ; Islands ; Mediastinal Neoplasms ; Metaplasia ; Myasthenia Gravis ; Thymoma ; Thymus Gland ; World Health Organization

Primary pulmonary liposarcoma is extremely rare disease. It has poor prognosis with early multiple metastases and frequent local recurrences. Surgery is the choice of treatment for liposarcoma. Incomplete resection would result in rapid and aggressive growing of the tumor. We report a case of primary pulmonary liposarcoma which was successfully treated with complete resection without local recurrence and distant metastasis for 10 months.
Liposarcoma* ; Lung Neoplasms ; Neoplasm Metastasis ; Neoplasm Recurrence, Local ; Prognosis ; Rare Diseases ; Recurrence

BACKGROUND: The aim of this study was to evaluate the feasibility of single-port video-assisted thoracic surgery (VATS) in the treatment of secondary spontaneous pneumothorax (SSP). METHODS: Twenty-four patients who were scheduled to undergo single-port VATS for SSP were studied. The medical records of the patients were retrospectively reviewed. The mean follow-up duration was 26.1+/-19.8 months. In order to evaluate the feasibility of single-port VATS for SSP, the postoperative results of single-port VATS (n=15) in patients with emphysema were compared with those of emphysematous patients who underwent three-port VATS (n=15) during the study period. RESULTS: Single-port VATS was feasible in 19 of 24 patients (79.2%), while an additional port was needed in five patients. In the single-port VATS patients, the median operation time, duration of chest tube drainage, and hospital stay were 84.0 minutes, one day, and two days, respectively. Postoperative complications included prolonged chest tube drainage for more than five days (n=1), wound infection (n=1), and vocal fold palsy (n=1). No recurrence of pneumothorax was observed during the follow-up period. The median operation time, duration of chest tube drainage, and hospital stay of the emphysematous patients who underwent single-port VATS were shorter than those who underwent three-port VATS group (p<0.05 for all parameters). CONCLUSION: Single-port VATS proved to be a feasible procedure in the treatment of patients with secondary spontaneous pneumothorax.
Chest Tubes ; Drainage ; Emphysema ; Follow-Up Studies ; Humans ; Length of Stay ; Medical Records ; Pneumothorax* ; Postoperative Complications ; Recurrence ; Retrospective Studies ; Thoracic Surgery, Video-Assisted* ; Vocal Cord Paralysis ; Wound Infection

BACKGROUND: Esophageal cancer is an aggressive disease with a poor prognosis. Recently, neoadjuvant therapy has been used in an attempt to increase the long term survival but has not been shown as a clear advantage. We reviewed the recurrence and survival after complete resection of esophageal cancer without neoadjuvant therapy. MATERIAL AND METHOD: From December 1994 to December 2001, 182 consecutive patients who underwent intrathoracic esophagectomy, transthoracic esophagogastrostomy and two-field lymph node dissection for esophageal cancer without neoadjuvant therapy were studied retrospectively. RESULT: There were 167 men and 15 women. The median age was 65 years (range, 40 to 90 years). The tumor was located in the upper third part of the esophagus in 7 patients (3.8%), middle third in 86 (47.3%), and lower third in 89 (48.9%). The postsurgical stage were as follows: stage 0 in 2 patients (1.1%), stage I in 32 (17.6%), stage IIA in 47 (25.8%), stage IIB in 25 (13.7%), stage III in 54 (29.7%), stage IVA in 10 (5.5%), and stage IVB in 12 (6.6%). The in-hospital mortality rate was 3.8% (7 patients) and complications occurred in 65 patients (35%). Follow-up was complete in 95.6%. The recurrence occurred in 56 patients (30.8%) and the overall 5-year disease free rate was 55%. The overall 5-year survival rate was 57%; it was 80% for patients in stage I, 65% in stage IIA, 58% in stage IIB, 48% in stage III, and 40% in stage IVB. The overall 5-year survival rate of patients with postoperative adjuvant therapy was 59% compared to 34% in patients without postoperative adjuvant therapy (p <0.05). CONCLUSION: The most effective therapy for esophageal cancer may be complete resection. More aggressive surgical therapy and adjuvant therapy may improve the long-term survival, even for advanced stage esophageal cancer.
Esophageal Neoplasms* ; Esophagectomy ; Esophagus ; Female ; Follow-Up Studies ; Hospital Mortality ; Humans ; Lymph Node Excision ; Male ; Neoadjuvant Therapy ; Prognosis ; Recurrence* ; Retrospective Studies ; Survival Rate

BACKGROUND: Pulmonary sclerosing hemangioma is a rare thoracic tumor, and pathophysiology or clinical course of this tumor is not yet fully described. Furthermore, there is no consensus on the standard operative procedure for this tumor. MATERIAL AND METHODS: Medical records of thirty-two patients, who underwent surgical resection of pulmonary sclerosing hemangioma from 1996 to 2007, were retrospectively reviewed. RESULTS: Nineteen patients underwent lobectomy and thirteen patients underwent limited resection. Video-assisted thoracoscopic surgery was performed in 9 patients in the latter group. Lymph node dissection was done in 21 patients, and one patient was found to have lymph node metastasis of the tumor. There was no postoperative complication, no early death and no tumor-related late mortality. The mean follow-up duration was 39.3 months (2 months~129 months), and all patients were free of local recurrence and distant metastasis during this period. There was no significant difference in patient's characteristics between the two groups, except that the mean hospital stay was shorter in limited resection group than in lobectomy group (p=0.0031). CONCLUSION: Pulmonary sclerosing hemangioma usually requires surgical resection for both diagnosis and treatment. Limited resection can decrease hospital stay with a surgical outcome comparable to lobectomy, and may be preferred to lobectomy if sufficient resection margin can be achieved.
Consensus ; Follow-Up Studies ; Hemangioma ; Humans ; Length of Stay ; Lung Neoplasms ; Lymph Node Excision ; Lymph Nodes ; Medical Records ; Neoplasm Metastasis ; Postoperative Complications ; Pulmonary Sclerosing Hemangioma ; Recurrence ; Retrospective Studies ; Surgical Procedures, Operative ; Thoracic Surgery, Video-Assisted