The occurrence of lung cancer in patients suffering with pneumothorax is very rare, especially in the absence of any radiological changes that would suggest neoplasia after the pulmonary reexpansion. We have experienced a case of a 60-year-old male who presented with lung cancer that was discovered by chance after an operation for his pneumothorax. The resected lung tissue showed a 0.3 cm-sized, peripheral squamous cell carcinoma associated with a bulla. The tumor was not macroscopically detected on the first thoracotomy that was performed for the treatment of the pneumothorax. The micronodular cancer was diagnosed after the histological examination of the resected bulla. The patient has been doing well with no evidence of tumor recurrence during the fifteen months follow-up. This case shows that we should always be vigilant for associated lung cancer when we examine the lung tissue after the operation for pneumotherax.
Carcinoma, Squamous Cell* ; Follow-Up Studies ; Humans ; Lung Neoplasms ; Lung* ; Male ; Middle Aged ; Pneumothorax* ; Recurrence ; Thoracotomy

BACKGROUND: This study was performed to examine the significance of the circumferential resection margin (CRM) involvement by a tumor on the postoperative survival after esophageal cancer surgery. METHODS: Fifty nine resected cases of esophageal cancers were retrospectively reviewed. The presence of a tumor either at, or within 1 mm of, the CRM was recorded. By an immunohistochemical study for Ki-67, the Ki-67 differential grades (Ki-67 DG) were defined according to the differences between the Ki-67 labeling indices of the central and of peripheral areas of the tumor nearest to the CRM: Ki-67 DG 0 (< or =10%) and Ki-67 DG 1 (>10%). The CRM involvement was correlated with the clinicopathological factors, Ki-67 DG and survival data. RESULTS: CRM involvement was found in 26 (44.1%) of the 59 cases. There were significant differences in the cases, both with and without CRM involvement of tumor cells, in relation to lymph node metastasis, lymphovascular, perineural invasions and tumor stage (p<0.05). Ten (38.3%) of the 26 with, and 3 (9.1%) of 33 cases without, CRM involvement, showed Ki-67 DG 1 (p=0.007). The 3-year survivals of patients with and without CRM involvement were 26.8 and 61.8%, respectively (p=0.003). CONCLUSIONS: These results show that the CRM involvement status may be used as a predictor of survival after esophageal cancer surgery, and CRM involvement is more an indicator of an advanced disease than of an incomplete resection.
Esophageal Neoplasms* ; Esophagectomy* ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Prognosis ; Retrospective Studies

PURPOSE: This study was performed to evaluate the relation between nodal micrometastasis and tumor angiogenesis, and to assess potential molecular markers pertaining to the development of nodal micrometastasis. MATERIALS AND METHODS: Immunohistochemical studies were performed to evaluate the expression patterns of Phosphatase, and its Tensin homolog, deleted from chromosome TEN (PTEN), and the vascular endothelial growth factor (VEGF) and microvessel density (MVD) in 41 stage I non-small cell lung cancer (NSCLC), using anti-PTEN monoclonal, anti-VEGF polyclonal and anti-CD34 monoclonal antibodies, respectively. The occult micrometastasis in 503 dissected regional lymph nodes were also evaluated using anti-cytokeratin (CK) monoclonal antibody. RESULTS: CK positive cells were identified in 13 (31.7%) of the 41 cases and in 23 (4.6%) of the 503 lymph nodes. There were 19 and 22 cases with positive and negative VEGF expressions, respectively, and 10 (52.7%) and 3 (13.6%) of these, respectively, showed nodal micrometastasis (p<0.05). There were 9 cases with loss of PTEN expression, and 4 of these showed nodal micrometastasis, whereas 9 (21.8%) of 32 positive PTEN expression cases showed nodal micrometastasis (p<0.05). The MVD in the tumors with nodal micrometastasis was 60.4+/-22.6, whereas that in the tumors without nodal micrometastasis was 52.0+/-18.2. The loss of PTEN expression, an increased VEGF expression and a high MVD, within primary tumors, were significantly associated with nodal micrometastasis. CONCLUSION: The results indicate a possible value in using these biological markers, associated with tumor angiogenesis, for predicting the risk of nodal micrometastasis in NSCLC.
Antibodies, Monoclonal ; Biomarkers ; Carcinoma, Non-Small-Cell Lung* ; Humans ; Lymph Nodes* ; Microvessels ; Neoplasm Micrometastasis* ; Vascular Endothelial Growth Factor A

We have reviewed 1211 burn patients who had visited our emergency department of Keimyung University Dongsan medical center between April 1995 to March 1997. The following results were obtained; 1) On age and sex distribution, the highest incidence of age group was under 10 year and old in 321 cases(26.5%). Male was affected more frequently than female, the incidence being 847 cases(70.1%) and 364 cases(29.9%). The ratio of male to female was 2.3:1. 2) No monthly and seasonal differences could be recognized. We found winter season having the highest 319 cases(26.3%), followed by autumn, spring and summer. 3) An analysis of causes in burns showed that flame burns were 527 cases(43.1%), scalding burns, 486 cases(40.2%), electrical burns, 96 cases(8.1%) and chemical burns, 48 cases(4.1%). 4) Domestic accidents accounted for 639 cases(52.7%), occupational for 286 cases(23.6%), traffic accidents for 160 cases(13.2%), suicides for 122 cases(10.1%), formentation for 4 cases(0.4%). 5) Most of patients 699 cases(57.7%) were affected with 2nd degree burn in depth, 1st degree for 413 cases(34.1%) and 3rd degree for 99 cases(8.2%). 6) The trunk was the anatomical region most commonly affected followed by upper and lower limbs. 7) 243 cases(20.5%) of all were accompanied by some complications. The main complications were would infection noted in 212 cases(17.5%), pneumonia in 179 cases(14.8%), acute renal failure in 160 cases(13.2), contracture in 155 cases(13.0), urinary tract infection in 24 cases(2.0%), Curling ulcer in 20 cases(1.6%) in order. 8) The over-all mortality rate was 73 cases(6.1%). The mortality rate of the patients with inhalation injury were 33 cases(45.3%). Causes of death were due to sepsis in 54 cases(4.5%), ARDS in 11 cases(0.9%), acute renal failure in 5 cases(0.4%), upper GI bleeding in 2 cases(0.2%), purmonary edema in 1 cases(0.1%).
Accidents, Traffic ; Acute Kidney Injury ; Burns* ; Burns, Chemical ; Cause of Death ; Contracture ; Duodenal Ulcer ; Edema ; Emergency Service, Hospital ; Female ; Hemorrhage ; Humans ; Incidence ; Inhalation ; Lower Extremity ; Male ; Mortality ; Pneumonia ; Seasons ; Sepsis ; Sex Distribution ; Suicide ; Urinary Tract Infections

This study was designed retrospectively to evaluate Ranson's criteria and APACHE II scores as a predictor of mortality in patients with acute pancreatitis. Acute pancreatitis is a common disorder. From mild disease to multiorgan failure, it is a disorder that has numerous causes, an obscure pathogenesis. An accurate history and through physical examination will often raise clinical suspicion of acute pancreatitis in the differential diagnosis of a patient with acute abdominal pain. The retrospective analysis by chart review of 86 cases of acute pancreatitis who visited emergency department of Dongsan hospital from Jan to Dec 1996. The results were as follows. The majority of the patients with acute pancreatitis presented with chief complaints of abdominal pain. The male patient outnumbered female by the ratio of 2.9:1. The highest incidence of age group was between 40 and 50. The majority of our patients had past histories of either chronic alcoholic or gallbladder problems e.g.. the number being 53 cases(61.6%) and 31 cases(36%) respectively. Among 7 patients who had changes in consciousness, 5 were expired. Of those expired, 3 patients had less than 90 mmHg of systolic blood pressure. The overall mortality rate was 10.5%(9 cases). It has been known that acute pancreatitis would be the results of traumatic and non-traumatic causes. The exact mechanism of its pathophysiolgy has not been known yet, but it has been well known that the majority of patients who in forties and fifties had history of alcoholic abuse, the rest being mainly gallbladder problem and, some other diseases implicated too. The relationship of acute pancreatitis with familiar Ranson's criteria was such that 3 patients of the Ranson's out of 9 death were noted to have more than 3 of the criteria, but another 3 had less than 3. Among the 60 patients in whom the required physiologic variables were available out of total 86 patients studied, 9 were expired and 51 survived, average APACHE II scores for the survival and the expired being 6.92+/-3.99 & 18.11+/-5.68 respectively (P<0.05). We concluded that the APACHE II score could be used to better than Ranson's criteria to predict hospital mortality in patients with acute pancreatitis.
Abdominal Pain ; Alcoholics ; APACHE ; Blood Pressure ; Consciousness ; Diagnosis, Differential ; Emergency Service, Hospital ; Female ; Gallbladder ; Hospital Mortality ; Humans ; Incidence ; Male ; Mortality ; Pancreatitis* ; Physical Examination ; Retrospective Studies

Complications of tracheal intubation are well documented. However, iatrogenic aspiration of a broken metallic stylet following tracheal intubation has been infrequently reported. A 60-year-old woman, 10 days after shoulder arthroscopic surgery under endotracheal general anesthesia, was admitted to our hospital because of right chest pain. Chest radiographs showed a 8 cm length of metallic foreign body in the lower lobe of the right lung. Attempts at retrieval, including thoracoscopy, were unsuccessful. Open thoracostomy was performed. The removed foreign body was a part of metallic stylet. We report a case of iatrogenic aspiration of a broken metallic stylet.
Anesthesia, General ; Arthroscopy ; Chest Pain ; Female ; Foreign Bodies ; Humans ; Intubation ; Lung ; Middle Aged ; Radiography, Thoracic ; Shoulder ; Thoracoscopy ; Thoracostomy

Primary liposarcoma of the lung is an extremely rare disease. To date, only 14 cases have been reported in the literature. We experienced a case of myxoid liposarcoma of the lung treated by surgery. The tumor was well-defined, solid, lobulated mass measuring 3.5x2 cm, involving the bronchus of the left lower lobe. Microscopically, myxoid liposarcoma was identified. The fluorescence in situ hybridization confirmed the presence of a reciprocal translocation involving DNA damage-inducible transcript 3 (DDIT3) and fused in sarcoma (FUS) genes. The patient is still alive with no recurrence or metastasis at the time of writing this report (on 20 months postoperatively). To our knowledge, this is the first cytogenetic case report of pulmonary myxoid liposarcoma.
Bronchi ; Cytogenetics ; DNA ; Female ; Fluorescence ; Humans ; In Situ Hybridization ; In Situ Hybridization, Fluorescence ; Liposarcoma ; Liposarcoma, Myxoid ; Lung ; Neoplasm Metastasis ; Rare Diseases ; Recurrence ; Sarcoma ; Writing

PURPOSE: We conducted a comparative evaluation in the ease of endotracheal intubation when using the Macintosh laryngoscope (ML) versus the new Disposcope endoscope(R) (DE) (Disposcope Taiwan, Hsinchuang city, Taiwan), a video-laryngoscope, during simulated normal airway and manual in-line stabilization of suspected cervical spine injury patients. METHODS: Forty-three medical interns participating in an endotracheal intubation training program used both the DE and the ML as part of their lessons. In each of the two simulated patient scenarios, endotracheal intubation was performed using each endoscope, in random order. The rate of successful intubation, time required for visualizing the glottis, time to complete endotracheal intubation, results of a modified Cormack & Lehane classification (CL grade), and a measure of dental injury were all recorded and analyzed. RESULTS: In the normal airway scenario, there was no difference in the rate of successful completion of intubation (both 100%) between the two endoscopes. Time to complete endotracheal intubation using the DE was shorter than that with the ML (10.7 versus 12.6 sec; p=0 010). In the trauma scenario, despite similar success rates (95.3% in ML versus 100% in DE), the time required to complete endotracheal intubation using the DE was shorter than that with the ML (17.6 versus 24.1 sec; p=0.010). Rate of dental injury using the DE was significantly less than that observed with the ML (0.0% versus 30.2%; p<0.0001). In both scenarios, the DE provided higher achievement of CL grade 1 (93% versus 67.4% in normal airway; p=0.006 and 55.8% versus 0% in trauma airway; p<0.0001). CONCLUSION: Compared to the ML, the DE provided a better view of the glottis, provided decreased dental trauma, and offered faster completion time for endotracheal intubation.
Achievement ; Endoscopes ; Glottis ; Humans ; Intubation ; Intubation, Intratracheal ; Laryngoscopes ; Manikins ; Spine ; Taiwan

We describe the case of primary pulmonary paraganglioma in a 37-year-old woman who presented recurrent, severe cough. Computed tomography revealed a lobulated inhomogeneous enhanced mass with endobronchial protruding lesion suspected to be lung neoplasm, located in the upper lobe of the left lung. Bronchoscopic biopsy showed chronic inflammation with granulation tissue which was not in accord with the radiologic findings. Subsequently, a left lower sleeve lobectomy was performed. Histological analysis of the resected tumor proved to be compatible with pulmonary paraganglioma. Primary pulmonary paragangliomas are very uncommon tumors. So we report this case with literature review.
Adult ; Biopsy ; Cough ; Female ; Granulation Tissue ; Humans ; Inflammation ; Lung ; Lung Neoplasms ; Paraganglioma*

PURPOSE: The melanoma differentiation-associated gene-7 (MDA-7) protein, also known as interleukin 24 (IL-24), is a novel candidate of tumor suppressor that has been found to experimentally induce apoptosis and growth inhibition in a variety of human malignant cells. However, there have been few studies about its role in lung adenocarcinoma. Even at the same stage and with similar pathologic characteristics, lung adenocarcinomas with a diameter of 3 cm or less can have a variable prognosis depending on their biologic characteristics. The purpose of this study is to define the relationship between MDA-7/IL-24 expression and the progression of small-sized lung adenocarcinomas. MATERIALS AND METHODS: We performed immunohistochemical detection of MDA-7/IL-24 in forty-seven tissue samples from primary lung adenocarcinomas of < or =3 cm in diameter by using tissue microarray. RESULTS: MDA-7/IL-24 immunoreactivity was observed in 20 (42.6%) of the 47 adenocarcinoma cases. MDA-7/IL-24 expression was positive in 66.7% of the adenocarcinomas < or =2 cm, and in 31.3% of the adenocarcinomas >2 cm or < or =3 cm in diameter. A statistically significant association was found between MDA-7/IL-24 expression and tumor size (p=0.03). Although this difference did not reach statistical significance, tumors with a negative MDA-7/IL-24 expression tended to more frequently show lymph node metastasis (p=0.07). There were no significant associations for other clinicopathologic characteristics. CONCLUSION: These results suggest the possible involvement of MDA-7/IL-24 in the growth and progression of small-sized lung adenocarcinoma. MDA-7/IL-24 immunoreactivity could be used to identify a subset of adenocarcinomas of the lung of 3 cm or less in diameter that have different biologic behavior.
Adenocarcinoma ; Apoptosis ; Humans ; Immunohistochemistry ; Interleukins ; Lung ; Lung Neoplasms ; Lymph Nodes ; Melanoma ; Neoplasm Metastasis ; Population Characteristics ; Prognosis