Multiple primary lung cancer is classified into a synchronous primary lung cancer or a metachronous primary lung cancer. Both are rarely encountered disease entities. We report our surgical experience of each one case of synchronous and metachronous primary lung cancer.
Lung Neoplasms* ; Lung*

Accessory mitral valve tissue is a very rare congenital cardiac malformation and it is an uncommon cause of left Ventricular outflow tract obstruction (LVOTO). The pathogenetic mechanism of subaortic obstruction is thought to be systolic ballooning of the abnormal valve tissue into LVOT. We are reporting a case of an accessory mitral valve tissue that was associated with LVOTO, and this was completely relieved after trans-aortic surgical excision of the accessory tissue.
Mitral Valve

BACKGROUND: Pathologic confirmation is needed to diagnose various forms of interstitial lung diseases. We wanted to find out how much the thoracic surgical lung biopsies will be needed for definite diagnosis of interstitial lung diseases. MATERIAL AND METHOD: 17 patients underwent surgical lung biopsy in the department of thoracic and cardiovascular surgery, Gyeongsang National University Hospital from June 1995 to November 2002. Chart review and telephone questionnaire were done for retrospective study. RESULT: Mean age was 49+/-22 years. Age ranged from 1 to 70 years. Dyspnea was the most common complaint. They were referred for definite differClinical Evaluation of Instrumental ential diagnosis from pediatrics and internal medicine. Biopsy methods were thoracotomy in 11 cases, and thoracoscopy in 6 cases. Pathologic confirmation was possible in 11 cases (65%). According to the pathologic reports, treatment plans were changed in 13 cases (76%). CONCLUSION: Surgical lung biopsy was effective method in differentiating diagnosis of the interstitial lung disease. There was no mortality during operation. It is important that undiagnosed fibrous lung disease should be recommanded the lung biopsy for planning patient's treatment.
Biopsy ; Diagnosis ; Diagnosis, Differential* ; Dyspnea ; Humans ; Internal Medicine ; Lung ; Lung Diseases ; Lung Diseases, Interstitial* ; Mortality ; Pediatrics ; Surveys and Questionnaires ; Retrospective Studies ; Telephone ; Thoracoscopy ; Thoracotomy

BACKGROUND: The treatment results of the advanced lung carcinoma is not satisfactory with the present therapeutic modalities: surgical resection, anti-cancer chemotherapy, and radiotherapy or combination therapy. To predict the prognosis of the non-small-cell lung carcinoma, TNM classification has been was as the basic categorization; however, it has been not satisfactory. It is necessary to consider the causes and the prognosis of the lung carcinoma from another points of view rather the conventional methods. We intended to find out the relationship between the major apoptotic factor, p53 gene and the prognosis of the patient with lung carcinoma. MATERIAL AND METHOD: Three hundreds and fifty-nine patients with lung carcinoma who underwent surgery were analysed. We observed p53 protein accumulated in the cellular nuclei. The p53 protein was detected by immuno-histo-chemical method. We collected information of the patient retrospectively. RESULT: p53 protein densities were observed in 40% in average as a whole. The protein density was 44 percent in man, 25 percent in woman, 49 percent in the squamous cell carcinoma, and 38 percent in the adenocarcinoma. There were significant correlations between the p53 protein density and the mortality in the squamous cell carcinoma (p=0.025), follow-up duration in TNM stage I group (p=0.010), and follow-up duration in the lobectomy patient group (p=0.043), and tumor cell differentiation (p=0.009). p53 protein densities were significantly different between the lobectomy and the pneumonectomy group (p=0.044). CONCLUSION: The authors found that p53 protein had some correlations with the prognosis of the lung cancer partially in some factors. We suggest the p53 protein density could be used as a marker of prognosis in the non-small-cell lung carcinoma.
Adenocarcinoma ; Apoptosis ; Carcinoma, Non-Small-Cell Lung ; Carcinoma, Squamous Cell ; Cell Differentiation ; Classification ; Drug Therapy ; Female ; Follow-Up Studies ; Genes, p53 ; Humans ; Lung Neoplasms ; Lung* ; Mortality ; Pneumonectomy ; Prognosis ; Radiotherapy ; Retrospective Studies

BACKGROUND: Vascular injury has been increased with popular outside activities. However there are only a few studies for vascular trauma. We intended to find out the relationships between the vascular trauma and its prognosis. MATERIAL AND METHOD: Forty-four patients were diagnosed and operated on for vascular injury in the Gyeongsang National University Hospital from 1992 to 1999. We reviewed their chart and analysed their data retrospectively. We studied te causes, treatments, and prognoses of traumatic vascular injury. RESULT: The transfer time between accident place and emergency department was mean 3.5 hour, and the operation preparing time was 8.8 hours. Five cases required amputation of extremity. All amputation cases were combined with communited bony fractures. Thirty-eight cases had combined other injuries, and almost combined injuries were muscular and neurological damages. CONCLUSION: The optimal treatment plan for vascular trauma was prompt diagnosis and quick management. It may decrease amputation rate and post-traumatic complications. Therefore we must be carefully evaluated the multiple traumatic patients for early diagnosis of vascular injury and operate quickly in emergency status.
Amputation ; Diagnosis ; Early Diagnosis ; Emergencies ; Emergency Service, Hospital ; Extremities ; Humans ; Prognosis ; Retrospective Studies ; Vascular System Injuries*

The conventional surgery method of thrombectomy of venous thrombi from the deep veins of the lower extremity was the use of Forgarty balloon catheter. The catheter is inconvenient due to the presence of the balloon and prohibiting venous valves within the venous trees. With the use of a stone-forceps(Fig. 1), thrombi within iliofemoral vein could be easily removed without the obstacle of the valves because the instrument keeps valves open. This instrument is also useful in monitoring the back-flow from the iliac vein. Thrombi within the veins below the level of inguinal incision are removed successfully only by effective manual compression of the calf and thigh muscles. I recommend operating on the iliac vein first rather than the lower venous tree.
Catheters ; Iliac Vein ; Lower Extremity* ; Muscles ; Thigh ; Thrombectomy ; Veins* ; Venous Thrombosis ; Venous Valves

Traumatic cardiac injury is an extremely serious medical condition. It is possible to overlook a cardiac injury where there is no chest wall trauma. We here report the 47-year-old woman who got a crach car accident and had a tear of the right atrium. The distortion force from a decelerating injury may cause cardiac rupture at a fixed point. The most common symptom that alerts the clinician to a potentially fatal cardiac injury is the change in vital signs. Therefore cardiac injury should be considered in any patient with unexplained hypotension who has experienced decelerating trauma, even without external injury to the chest wall.
Accidents, Traffic* ; Female ; Heart Atria* ; Heart Rupture ; Humans ; Hypotension ; Middle Aged ; Rupture* ; Thoracic Wall ; Vital Signs

Apical muscular ventricular septal defects (VSDs) are relatively rare conditions among all the different types of VSDs. Apical VSDs are difficult to treat because of they are difficult to visualize through a trans-atrioventricular approach, and especially in infants. Treatment by left ventriculotomy is associated with long-term ventricular dysfunction. Catheter-based intervention still shows less than satisfactory results and this type of intervention may not be possible in small infants. This report describes the benefits of right apical ventriculotomy in terms of successful closure of the lesion without harming the ventricular function.
Heart Septal Defects, Ventricular ; Humans ; Infant ; Ventricular Dysfunction ; Ventricular Function

BACKGROUND: The long-term administration of oral anticoagulant to the patients with a mechanical heart valve prosthesis is mandatory. However, the appropriate intensity of oral anticoagulant therapy to prevent thromboembolic or hemorrhagic complications is still controversial. We tried to apply low intensity anticoagulant therapy for which the International Normalized Ratios ranged between 1.5 and 2.5, and we analyzed the anticoagulation-related long term outcomes. MATERIAL AND METHOD: From January 1992 to December 2002, 144 patients who underwent a single cardiac valve replacement were included in the study, and their ages ranged from 15 to 72 years (mean age: 47.4+/-15.1): there were 49 aortic valve replacements (AVR) and 95 mitral valve replacements (MVR). The patients were followed up monthly or bi-monthly at the outpatient clinic with clinical examinations and measuring the prothrombin time to adjust the International Normalized Ratios (INRs) within the low-intensity target range between 1.5 and 2.5. RESULT: The follow-up period was 835.3 patient-years (mean: 5.9+/-3.5) and the INRs of 7,706 measurements were available for evaluation. The mean INRs of the aortic and the mitral valve replacement groups were significantly different (p<0.01). All the patients' INRs were within the target range in 61.9% of the measurements. The mean INRs (2.16+/-0.23) of the patients with atrial fibrillation, which was found in 30.3% of the patients, were definitely higher than those (2.03+/-0.27) measured in the patients with regular rhythm (p<0.01). Thromboembolic episodes occurred in 9 patients with an incidence of 1.08%/patient-year. Major bleeding occurred in 2 patients (MVR) with an incidence of 0.24%/patient-year. The patients who displayed better compliance showed a lower incidence of complications (p=0.000). CONCLUSION: The anticoagulation therapy with a low-intensity target range after MVR or AVR seems to be effective and feasible, and increasing the patients' compliance should be done for achieving more effective anticoagulation therapy.
Ambulatory Care Facilities ; Aortic Valve ; Atrial Fibrillation ; Compliance ; Follow-Up Studies ; Heart ; Heart Valve Prosthesis ; Heart Valves ; Hemorrhage ; Humans ; Incidence ; International Normalized Ratio ; Mitral Valve ; Prothrombin Time ; Thromboembolism

Lymphangioma is a developmental anomaly that is known to occur in the neck and axilla, and only rarely in the mediastinum, retroperitoneum, groin and pelvis. An isolated chest wall lymphangioma is a rare benign neoplasm. In case of large sized lymphangioma, surgical excision is preferably recommended as the treatment of choice. We operated on a three-year old female for excision of chest wall. In pathologic diagnosis, it diagnosed the mass as chest wall lymphangioma.
Axilla ; Child* ; Diagnosis ; Female ; Groin ; Humans ; Lymphangioma ; Lymphangioma, Cystic* ; Mediastinum ; Neck ; Pelvis ; Thoracic Wall* ; Thorax*