BACKGROUND: Many recent results of clinical trials show that pre-operative concurrent chemoradiotherapy and surgical resection could increase the survival of N2 positive stage IIIA non-small cell lung cancer. This study was performed to assess the feasibility, toxicity, and affect rates of concurrent chemoradiotherapy and surgical resection in N2 positive stage IIIA non-small cell lung cancer. MATERIAL AND METHOD: Thirty-one patients who underwent preoperative concurrent chemoradiotherapy for N2 positive stage IIIA non-small-cell lung cancer from May 1997 to April 1999 were entered into the study. Mean age was 61 yrs (43-70 yrs), There were 24 men and 7 women. The confirmation of N2 disease were achieved through mediastinoscopic biopsy (24) and CT scans (7). Induction was achieved by two cycles of cisplatin and etoposide(EP) plus concurrent chest radiotherapy to 45 Gy. Resections were done at 3 weeks after the complection of preoperative concurrent chemoradiotherapy. Resections were performed in 23 patients, excluding 5 refusals and 3 distant metastasis. All patients were compled the thoracic radiotherapy except one who had distant metastasis. Twenty three patients were completed the planned 2 cycles of EP chemotherapy, and 8 patients were received only 1 cycle for severe side effects (6), refusal (1), and distant metastasis(1). There was one postoperative mortality, and the cause of death was ARDS. Three patients who had neutropenic fever and one patient who had radiation pneumonitis were required admission and treatment. Esophagitis was the most common acute side effect, but relatively well-tolerated in most patients. The complection rate of concurrent chemoradiotherapy was 74%, resection rate was 71%, pathologic complete remission rate was 13.6%, and pathologic down-staging rate was 68%. CONCLUSION: Morbidity related to each treatment was acceptable and many of the patients have benefited down staging of its disease. Further prospective, preferably randomized, clinical trials of larger scale may be warranted to confirm the actual benefit of preoperative concurrent chemoradiotherapy and surgical resection in N2-positive stage IIIA non-small cell lung cancer.
Biopsy ; Carcinoma, Non-Small-Cell Lung ; Cause of Death ; Chemoradiotherapy* ; Cisplatin ; Disulfiram ; Drug Therapy ; Esophagitis ; Female ; Fever ; Humans ; Lung Neoplasms ; Male ; Mortality ; Neoplasm Metastasis ; Radiation Pneumonitis ; Radiotherapy ; Thorax ; Tomography, X-Ray Computed

We evaluated the feasibility and safety of this method by reviewing the early outcome of the patients who underwent coronary artery bypass grafting(CABG) utilizing parallel sequential anastomoses with saphenous vein grafts, comparing with the outcome of the patients revascularized with grafts having only single distal anastomosis. During the one-year period of 1995, a total of 79 patients underwent isolated CABG, among whom 39 patients with sequential vein grafts(sequential group) and 40 patients without sequential grafts(non-sequential group). There was no difference between the two groups in terms of preoperative status, except in the extent of the coronary disease; 87.2% of the sequential group and 45.0% of the non-sequential group had left main and/or triple vessel involvement. 318 distal coronary anastomoses were done; 198 for the sequential group(5.1/patient) and 120 for the non-sequential group(3.0/patient). In the sequential group, the mean durations of cardiopulmonary bypass and aortic clamp per one distal anastomosis were 33.5 and 21.1 minutes, respectively. In the non-sequential group, these were 41.8 and 22.7 minutes. There were two operative deaths, both in the non-sequential group. There was no difference in the incidence of postoperative complications including myocardial infarction. During the follow-up period(2 to 15 months), 8 patients(3 in the sequential and 5 in the non- sequential group) complained of residual or recurrent angina. Comparison of preoperative and postoperative 201Thallium myocardial perfusion scans in 30 patients showed improved or normal perfusion reserve in 83.3% of segments bypassed with sequential grafts and 82.5% of segments bypassed with non-sequential graft(s). These results show that, utilizing parallel sequential anastomoses with saphenous vein grafts, we could achieve satisfactory short-term clinical results in patients with extensive coronary stenoses. So, we conclude that this technique is a safe, technically feasible strategy for CABG, which can achieve the aim of complete myocardial revascularization with a limited length of graft. These results show that, utilizing parallel sequential anastomoses with saphenous vein grafts, we could achieve satisfactory short-term clinical results in patients with extensive coronary stenoses. So, we conclude that this technique is a safe, technically feasible strategy for CABG, which can achieve the aim of complete myocardial revascularization with a limited length of graft.
Cardiopulmonary Bypass ; Coronary Artery Bypass ; Coronary Disease ; Coronary Stenosis ; Follow-Up Studies ; Humans ; Incidence ; Myocardial Infarction ; Myocardial Revascularization* ; Perfusion ; Postoperative Complications ; Saphenous Vein ; Transplants ; Veins

Localized fibrous tumor of the pleura is a rare condition. Most follow a benign course and they are found as an incidental finding during routine chest X-ray. A small proportion of these tumors are malignant and have characteristic clinical and histopathological features. In this paper, we report three cases of localized fibrous tumors of the pleura, one malignant associated with asymptomatic hypoglycemia, the others benign. In a malignant case, the tumor was resected through thoracotomy and the hypoglycemia was relieved immediately. In two benign cases, tumors on small pedicles were resected using video-assisted thoracic surgical technique.
Hypoglycemia ; Incidental Findings ; Pleura* ; Pleural Neoplasms ; Thoracic Surgery ; Thoracotomy ; Thorax

This is a report on the clinical outcome and hemodynamic profile of the ATS(R) cardiac valve prosthesis, which is a recently introduced pyrolytic carbon bileaflet prosthesis. We retrospectively reviewed the early outcome of 100 consecutive patients who underwent isolated cardiac valve replacement with the ATS(R) prosthesis from October 1994 through June 1996 at our hospital. All patients were evaluated with Doppler echocardiography before discharge from the hospital. The mean age of the patients was 48.6 years(range: 2 to 74). A total of 124 prosthesis were implanted; 71 mitral, 46 aortic, and 7 tricuspid. The two most frequently used sizes were 27 mm(40.8%) and 29 mm(35.2%) in the mitral position, and 23 mm(30.4%) and 21 mm(28.3%) in the aortic position. There was no early or late death. The total follow-up period was 950 patient-months with 99% follow-up rate. Serious late morbidity occurred in three patients; reoperation in two patients for late rupture of Sinus of Valsava in one and for endocarditis with prosthetic dehiscence in the other, and intracranial hemorrhage due to hypertension in one patient. There has been no thromboembolic complication or structural valve deterioration. In the mitral position, the average values of peak and mean transprosthetic pressure gradients and valve area calculated from pressure half time were 6.9+/-2.8 mmHg, 2.6+/-1.5 mmHg, and 2.7+/-0.8 cm2 respectively. In the aortic position, the peak and mean pressure gradients were 26.4+/-15.9 mmHg and 14.2+/-7.9 mmHg. For the mitral prostheses larger than 25-mm size, there was no significant difference among prosthetic sizes in terms of transprosthetic gradients, whereas there was a significant negative correlation between the prosthesis size and the transprosthetic gradients for the aortic valves. The peak and mean pressure gradients were 52.2+/-17.6 mmHg and 26.9+/-7.4 mmHg across the 19-mm aortic prostheses, and 27.1+/-11.9 mmHg and 13.3+/-6.6 mmHg across the 21-mm size. Above results can lead to the conclusion that the early clinical outcome of the ATS valve prosthesis is quite satisfactory. And the hemodynamic characteristics are comparable, if not better, with other bileaflet prostheses.
Aortic Valve ; Carbon ; Echocardiography* ; Echocardiography, Doppler ; Endocarditis ; Follow-Up Studies ; Heart Valve Prosthesis ; Heart Valves* ; Hemodynamics ; Humans ; Hypertension ; Intracranial Hemorrhages ; Prostheses and Implants* ; Reoperation ; Retrospective Studies ; Rupture

From March, 1992 to March, 1996, a total of 279 patients underwent coronary bypass surgery at the Sejong General Hospital, Puchon. We selected 22 patients with severe left ventricular(LV) dysfunction from them. The criteria were the presence of global or segmental abnormalities of left ventricular contraction and LV ejection fraction(EF) less than 35% based on biplane LV angiography by planimetry method. The mean age of 17 male and 5 female patients was 60+/-5.6years(range:47~73 years). All had the anginas, which were Canadian class II in 6, class III in 12 and class IV in 4. All patients except one had the history of previous myocardial infarction more than once. Seven of them had the symptoms and signs of congestive heart failure, such as dyspnea on excertion and increased pulmonary vascular markings. Their mean LVEF was 29.4+/-4 5%(range : 18~35%) and mean LV end-diastolic pressure was 18.7 +/-8. 2mmHg(range:10~42mmHg). 21 patients had 3 vessel-disease and 1 had 2 vessel-disease. Complete revascularization was tried with the use of 16 internal mammary arteries and 60 sapheuous veins and 3 radial arteries grafts. The mean number of distal anastomosis was 3.5+/-1.1. Concomitantly, one mitral valvuloplasty and annuloplasty was performed in the patient with moderate mitral regurtigation. The hospital mortality was 4.5%. During the follow-up, there were 3 late deaths. Of 18 survivors, 2 patients were lost in follow-up 24 and 27 month respectively after operation and the remaining 16 patients have bcen followed up with an average of 30.4 +/-13.4 months.15 patients had improvement with respect to angina but 8 patients still have the continuing or progressing heart failure. The 1-year, 2-year and 3-year actuarial survival rate was 85.2, 69.1, 46.1%, respectively. This study indicates that coronary artery bypass sur ery can be performed in the patients with severe LV dysfunction at acceptable risk but does not greatly contribute to the improvement of congestive heart failure.
Angiography ; Coronary Artery Bypass ; Dyspnea ; Female ; Follow-Up Studies ; Gyeonggi-do ; Heart Failure ; Hospital Mortality ; Hospitals, General ; Humans ; Male ; Mammary Arteries ; Myocardial Infarction ; Radial Artery ; Survival Rate ; Survivors ; Transplants ; Veins ; Ventricular Dysfunction, Left*

BACKGROUND: Sleeve lobectomy of the main bronchus has been proposed to spare lung tissue in patients who cannot tolerate pneumonectomy because of impaired lung function. The purpose of this study was to evaluate whether sleeve lobectomy can preserve lung function as expected from preoperative evaluation of lung function in patients with non-small cell lung cancer. METHOD: Between January 1995 and March 1998, 15 patients with non-small cell lung cancer who underwent sleeve resection were evaluated. Preoperative evaluations included spirometry and quantitative lung perfusion scan, from which predicted postoperative FEV1 was calculated. At least 3 months after operation follow up spirometry and bronchoscopy were performed. Predicted FEV1 was compared with measured postoperative FEV1. RESULT: Fourteen men and one woman, with median age of 58 years, were reviewed. The diagnosis was squamous cell carcinoma in 13 patients and adenocarcinoma of lung in 2 patients. Our results showed a excellent preservation of pulmonary function after sleeve lobectomy. Correlation between the predicted (mean, 2180 +/- 570mL) and measured FEV1 (mean, 2293 +/- 499mL) was good ( r = 0.67, P< 0.05 ). Furthermore, patient with low FEV1 (<2L) showed improved lung function after sleeve lobectomy. CONCLUSION: These findings indicated a complete recovery of the reimplanted lung lobes after sleeve lobectomy. Therefore, this technique could be safely used in lung cancer patients with impaired lung function.
Adenocarcinoma ; Bronchi ; Bronchoscopy ; Carcinoma, Non-Small-Cell Lung ; Carcinoma, Squamous Cell ; Diagnosis ; Female ; Follow-Up Studies ; Humans ; Lung Neoplasms* ; Lung* ; Male ; Perfusion ; Pneumonectomy ; Respiratory Function Tests ; Spirometry

Thromboelastography(TEG) is the unique measure that gives rapid information about the whole clotting process. Simplifying the diagnosis of coagulopathy during operations, TEG can provide an adequate therapy for postoperative bleeding. Remarkable improvement in hemostasis after cardiopulmonary bypass(CPB) has been achieved by the treatment with proteinase inhibitor aprotinin, but the hemostatic mechanism of aprotinin during CPB is still unclear. This study was designed to evaluate the effects of aprotinin on coagulation system during CPB by using TEG. Forty patients who underwent CPB were divided into two groups: aprotinin(2 X 10(6) kallikrein inhibition units, as a single dose into the cardiopulmonary bypass priming solution) treatment group(male 14, female 8, mean age=50.8years) and no aprotinin treatment(control) group(male 10, female 8, mean age=53.4 years). TEG, activated clotting time, prothrombin time, activated partial thromboplastin time, platelet counts, fibrinogen and fibrinogen degradation product(FDP) concentrations were checked before and after CPB(30 minutes after neutralization of heparin effect by protamine sulfate). There was no significant difference in other conventional coagulation tests of two groups except postcardiopulmonary bypass FDP concentration in control group, which was significantly increased compared to that in aprotinin group(p<0.05). In TEG variables of both groups, clot formation time(K) and alpha angle(alpha degree) were significantly increased and decreased, respectively, after CPB(p<0.05), but fibrinolytic index(LYS60) was not changed during CPB. In aprotinin group, reaction time(R) was decreased significantly after CPB(p<0.05) but maximum amplitude(MA) was not changed(p>0.05). On the contrary, R was not changed markedly but MA was decreased significantly in control group after CPB(p<0.05). This result shows that the main change in coagulation system during CPB is not hyperfibrinolysis but decrease in clot strength by platelet dysfunction, and the main effect of aprotinin during cardiopulmonary bypass is the maintenance of clot strength to the pre-CPB level by the preservation of platelet function.
Aprotinin* ; Blood Platelets ; Cardiopulmonary Bypass* ; Diagnosis ; Female ; Fibrinogen ; Hemorrhage ; Hemostasis ; Heparin ; Humans ; Kallikreins ; Partial Thromboplastin Time ; Platelet Count ; Prothrombin Time

This study aimed to determine factors that influence blood flow through coronary bypass grafts and to analyze relationship between the graft flow and postoperative outcome. Blood flow through 146 bypass grafts(GBF) was measured with transit-time ultrasound flowmeter during coronary artery bypass grafting operations in 50 patients. Single and multiple regression analyses were done for relationships between the GBF and four variables: internal diameter of recipient coronary artery, myocardial value of bypassed branch(es), type of graft, and finding of preoperative myocardial perfusion scan. The relationship between GBF and postoperative scan finding was also analyzed. 1. The mean GBF was significantly higher in sequential grafts than in single vein grafts or in internal thoracic artery grafts(61.5 vs. 46.9 and 42.5 ml/min). 2. Myocardial value and recipient artery diameter were found to be the factors determining GBF. There was no correlation between GBF and presence of perfusion defect in the preoperative scan. 3. Myocardial value was found to be more important than recipient artery diameter in determinintg GBF. 4. Reversible perfusion defects were more frequently found in the areas supplied by grafts with low GBF. But this fact had only mild statistical significance. These results suggest that blood flow through a bypass graft is more determined by the size of its supplying myocardium than by the size of recipient artery. So, we can expect effective improvement in myocardial flow reserve after grafting of small(1~1.5mm) coronary arteries, if they supply substantial area of myocardium.
Arteries ; Coronary Artery Bypass* ; Coronary Vessels* ; Flowmeters ; Humans ; Mammary Arteries ; Myocardium ; Perfusion ; Regional Blood Flow ; Transplants ; Ultrasonography ; Veins

Cardiopulmonary bypass in children is associated with capillary leak, which results in an increase in total body water after open heart surgery. The purpose of these studies was to assess the cardiopulmonary effects of modified ultrafiltration after pediatric open heart surgery. Study A: Twenty-six consecutive children aged 0.1~10 years(median 7 months) underwent cardiac operation incorporating modified ultrafiltration. After completion of cardiopulmonary bypass, modified ultrafiltration was commenced at the flow rate of 100~150l/min for 3~14 min. After modified ultrafiltration, elevation of hematocrit(28.3%+/-3.6% vs. 33.8%+/-4.0%, p<0.001), increased systolic blood pressure(66.7+/-11.2mmHg vs. 76.2+/-11.8mmHg, p<0.02), and decreased central venous pressure(7.8+/-3.7mmHg vs. 6.9+/-2.9mmHg, p<0.001) were observed. Study B: Twenty-six children who underwent cardiac operation with the diagnosis of VSD under 2 years were assigned to control(n=14) or modified ultrafiltration(n=12). Peak inspiratory pressure checked immediately after operation was significantly lower in modified ultrafiltration group than in control group(20.0+/-2.4 cmH2O vs. 22.4+/-2.3cmH2O, p< 0.03). Modified ultrafiltration after cardiopulmonary bypass in children improves early hemo- dynamics and pulmonary mechanics, and represents an excellent option for perioperative management of accumulation of fluid in the tissues. We will continually employ the modified ultrafiltration technique in pediatric cardiac operations.
Body Water ; Capillaries ; Cardiopulmonary Bypass ; Child ; Diagnosis ; Filtration ; Heart* ; Hemodynamics ; Humans ; Mechanics ; Thoracic Surgery* ; Ultrafiltration*

BACKGROUND: Lobectomy is the generally accepted standard treatment for early-stage non-small cell lung cancer (NSCLC). However, especially in elderly patients, it is often necessary to perform pneumonectomy in order to maximize the likelihood of curative treatment, although pneumonectomy is a challenging procedure. METHODS: We analysed patients who were clinically diagnosed with stage I NSCLC and underwent pneumonectomy with curative intent from 2004 to 2011. The patients were divided into an elderly group (> or =70 years) and a younger group (<70 years). We retrospectively analysed the outcomes of these groups of patients in order to characterize the role of pneumonectomy as a treatment for elderly patients with clinical stage I NSCLC. RESULTS: Thirty patients younger than 70 years of age (younger group) and fourteen patients 70 years of age or older (elderly group) who underwent pneumonectomy were enrolled in the present study. The median follow-up period was 35 months (range, 0 to 125 months). The perioperative mortality rate (within 90 days after the operation) was 7.1% in the elderly group and 6.7% in the younger group (p=0.73). No significant differences between the two groups were observed regarding the occurrence of pneumonia, acute respiratory distress syndrome, cardiac arrhythmia, bronchopleural fistula, and vocal cord paralysis. The overall five-year survival rate was 79.4% in the younger group and 35.7% in the elderly group, which was a significant difference (p=0.018). The five-year disease-free survival rate was 66.7% in the younger group and 35.7% in the elderly group, but this difference was not statistically significant (p=0.23). CONCLUSION: Although elderly patients with early stage lung cancer showed a worse long-term survival rate after pneumonectomy than younger patients, the outcomes of elderly patients were similar to those of younger patients in terms of perioperative mortality and postoperative complications. Patients should not be denied pneumonectomy solely due to old age.
Aged* ; Arrhythmias, Cardiac ; Carcinoma, Non-Small-Cell Lung* ; Disease-Free Survival ; Fistula ; Follow-Up Studies ; Geriatrics ; Humans ; Lung Neoplasms ; Mortality ; Pneumonectomy* ; Pneumonia ; Postoperative Complications ; Respiratory Distress Syndrome, Adult ; Retrospective Studies ; Survival Rate ; Vocal Cord Paralysis