A 56 year-old man complaining of dry cough, dyspnea, chest pain, fever, and chills was admitted to the emergency room. The patient had a history of esophagectomy and esophagogastrostomy and subsequent radiotherapy because of an esophageal cancer. After the emergency echocardiography revealed a small amount of pericardial effusion and pneumopericardium. Upper GI contrast study showed a fistulous tract between the stomach and the pericardium, and an emergency operation was done under the diagnosis of gastropericardial fistula. The patient expired postoperative seven days later. Gastropericardial fistula caused by a peptic ulcer perforation after the esophagectomy and esophagogastrostomy operation is a very rare complication and brings forth a disastrous result. Early detection using the chest radiography, electrocardiogram, upper GI study, echocardiography and a review of physical examination, and an immediate treatment are therefore mandatory.
Chest Pain ; Chills ; Cough ; Diagnosis ; Dyspnea ; Echocardiography ; Electrocardiography ; Emergencies ; Emergency Service, Hospital ; Esophageal Neoplasms ; Esophagectomy* ; Fever ; Fistula* ; Gastric Fistula ; Humans ; Middle Aged ; Peptic Ulcer ; Peptic Ulcer Perforation ; Pericardial Effusion ; Pericardium ; Physical Examination ; Pneumopericardium ; Radiography ; Radiotherapy ; Stomach ; Thorax

VATER is a complex anomaly of multiple organs and often combined with cardiac anomalies. However, it can be cured with active surgical intervention. We achieved successful result with aggressive surgery in the patient with VATER and report it with references.
Heart Defects, Congenital ; Humans

Langerhans' Cell Histiocytosis(LCH) is a disease of unknown origin, characterized by abnormal proliferation of Langerhans' cells. Previously, it has been called histiocytosis X, which included eosinophilic granuloma, Hand-Sch ller-Christian's disease, and Letterer-Siwe disease. Any organs or tissues such as skin, lymph nodes, bone and bone marrow can be involved. However, LCH of chest wall is rarely reported in our country. We experienced a 18 month old male child, who had osteolytic lesion involving the rib with axillary lymph node metastasis. The tumor was confirmed as LCH after surgery.
Bone Marrow ; Child ; Eosinophilic Granuloma ; Histiocytosis* ; Histiocytosis, Langerhans-Cell ; Humans ; Infant ; Lymph Nodes ; Male ; Neoplasm Metastasis ; Ribs ; Skin ; Thoracic Wall* ; Thorax*

BACKGROUND: Pneumonectomy carries the possibility of numerous dangerous complications as well as the vast effect the operation itself has on the cardiopulmonary function. Most of operations are done with the insertion of the chest tubes upon completion, but because of the high incidence of pyothorax as its complications, we have tried to analyze and compare the cases without inserting the chest tubes. MATERIAL AND METHOD: During a 5 year period from January, 1996 to December 2000, 100 cases, which were operated at the Hanyang University Hospital, were selected using the patient's charts. The age, gender, indication of operation, associated diseases, and operation site(left or right) were classified accordingly and the postoperative complications and mortality were statistically analyzed using the X2-test. After resecting the lung, the intrathoracic pressure was set at -15~-20cm H2O using the nelaton catheter, and the thoracotomy site was then closed. The gradual collection of the fluid and blood in the thorax of the operated side, as well as the mediastinum location, were observed carefully for 4~5 days postoperatively with the aid of the simple chest x-rays. RESULT: Of the 100 cases, 16 cases of pulmonary tuberculosis(16%), 81 cases of lung tumor(81%), 2 cases of bronchiectasis(2%), and 1 case of aspergilloma associated bronchiectasis were noted. There were 8 mortality cases(8%), and of the 34 cases(34%), 44 complications were noted. The age, sex, and operation site(left or right) were not statistically significant with the complications. 7 of the 16 cases of pulmonary tuberculosis(44%) and 27 of the 81 cases of lung tumor(33%) had complications, but they were found not to bestatistically significant. The increase of the complication rate in the pulmonary tuberculosis patients was 3.86. The evidence of postoperative bleeding was observed in 6 cases with the 3 cases being the pulmonary tuberculosis patients and the 3 cases were others. This shows that the increase in postoperative bleeding in the pulmonary tuberculosis is statistically significant(p=0.019). Of the 100 cases, there were 8 mortality cases(8%), with 5 cases from the 81 cases of the lung tumor group(6.1%), 3 cases from the 16 cases of pulmonary tuberculosis group(18.7%). CONCLUSION: The mortality and complication rates of the pneumonectomy operation with or without the insertion of the chest tube were similar to the previous reports, and we can conclude that the pneumonectomy without the insertion of the chest tube is also a good method, and We expect that this method will decrease the infection rate. The high risk group of mortality and complications was the pulmonary tuberculosis patients.
Bronchiectasis ; Catheters ; Chest Tubes ; Empyema, Pleural ; Hemorrhage ; Humans ; Incidence ; Lung ; Mediastinum ; Mortality ; Pneumonectomy ; Postoperative Complications ; Thoracotomy ; Thorax* ; Tuberculosis, Pulmonary