PURPOSE: There are some complications such as pulmonary edema, soft tissue swelling, decreased tissue perfusion which is frequently occurred in isotonic fluid resuscitation like Parkland formula. Hypertonic fluid resuscitation has several effects in burn patients. It may reduce soft tissue swelling and induce fluid shift from interstitium to vascular system. This study aims to compare actual fluid demand after hypertonic fluid resuscitation (160 mEq Na/L) and calculated volume from Parkland formula in severe burn patients. METHODS: From March 2010 to June 2011, a retrospective study was done. 21 patients were selected who had admitted within 6 hours after injury by various mechanisms. Total body surface area was calculated by Lund-Browder diagram. All subjects were treated by hypertonic fluid (Hartmann's solution +30 mEq NaHCo3, 160 mEq/L of Na+). After first 24 hr of resuscitation, physiologic parameters and total infused fluid volume was calculated. Physiologic parameters were used for assessing the effect of fluid therapy, and total infused fluid volume was compared to theoretical volume in Parkland formula, using dependent t-test. RESULTS: Mean TBSA of subjects was 47+/-5%, and four cases were accompanied by inhalation injury. The actual fluid volume infused was about 3.12 ml/kg/% and base excess was -0.5+/-2.8. Pulmonary edema was identified in 4 cases. CONCLUSION: Using hypertonic fluid (160 mEq Na/L), total fluid volume was reduced about 22% compared to Parkland formula without considerable complications.
Body Surface Area ; Burns ; Fluid Therapy ; Humans ; Inhalation ; Perfusion ; Pulmonary Edema ; Resuscitation ; Retrospective Studies

BACKGROUND: Recently, many surgeons have chosen sublobar resection for the curative treatment of lung tumors with ground-glass opacity, which is a hallmark of lepidic lung cancer. The purpose of this study was to evaluate the oncological results of sublobar resection for non-lepidic lung cancer in comparison with lobectomy. METHODS: We conducted a retrospective chart review of 328 patients with clinical N0 non-small cell lung cancer sized ≤2 cm who underwent curative surgical resection from January 2009 to December 2014. The patients were classified on the basis of their lesions into non-lepidic and lepidic groups. The survival rates following lobectomy and sublobar resection were compared within each of these 2 groups. RESULTS: The non-lepidic group contained a total of 191 patients. The 5-year recurrence-free survival rate was not significantly different between patients who received sublobar resection or lobectomy in the non-lepidic group (80.1% vs. 79.2%, p=0.822) or in the lepidic group (100% vs. 97.4%, p=0.283). Multivariate analysis indicated that only lymphatic invasion was a significant risk factor for recurrence in the non-lepidic group. Sublobar resection was not a risk factor for recurrence in the non-lepidic group. CONCLUSION: The oncological outcomes of sublobar resection and lobectomy in small-sized non-small cell lung cancer did not significantly differ according to histological type.
Carcinoma, Non-Small-Cell Lung* ; Humans ; Lung ; Lung Neoplasms ; Multivariate Analysis ; Pathology ; Recurrence ; Retrospective Studies ; Risk Factors ; Surgeons ; Survival Rate ; Thoracic Surgery

BACKGROUND: We report our surgical technique for nonintubated uniportal video-assisted thoracoscopic surgery (VATS) pulmonary resection and early postoperative outcomes at a single center. METHODS: Between January and July 2017, 40 consecutive patients underwent nonintubated uniportal VATS pulmonary resection. Multilevel intercostal nerve block was performed using local anesthesia in all patients, and an intrathoracic vagal blockade was performed in 35 patients (87.5%). RESULTS: Twenty-nine procedures (72.5%) were performed in patients with lung cancer (21 lobectomies, 6 segmentectomies, and 2 wedge resections), and 11 (27.5%) in patients with pulmonary metastases, benign lung disease, or pleural disease. The mean anesthesia time was 166.8 minutes, and the mean operative duration was 125.9 minutes. The mean postoperative chest tube duration was 3.2 days, and the mean hospital stay was 5.8 days. There were 3 conversions (7.5%) to intubation due to intraoperative hypoxemia and 1 conversion (2.5%) to multiportal VATS due to injury of the segmental artery. There were 7 complications (17.5%), including 3 cases of prolonged air leak, 2 cases of chylothorax, 1 case of pleural effusion, and 1 case of pneumonia. There was no in-hospital mortality. CONCLUSION: Nonintubated uniportal VATS appears to be a feasible and valid surgical option, depending on the surgeon’s experience, for appropriately selected patients.
Anesthesia ; Anesthesia, Local ; Anoxia ; Arteries ; Chest Tubes ; Chylothorax ; Hospital Mortality ; Humans ; Intercostal Nerves ; Intubation ; Ion Transport* ; Length of Stay ; Lung Diseases ; Lung Neoplasms ; Mastectomy, Segmental ; Minimally Invasive Surgical Procedures ; Neoplasm Metastasis ; Pleural Diseases ; Pleural Effusion ; Pneumonia ; Thoracic Surgery ; Thoracic Surgery, Video-Assisted*

BACKGROUND: The purposes of this study were to evaluate the appropriateness of the stage migration of stage IIA non-small cell lung cancer (NSCLC) in the seventh edition of the tumor, node, and metastasis classification for lung cancer to stage IIB lung cancer in the eighth edition, and to identify prognostic factors in patients with eighth-edition stage IIB disease. METHODS: Patients with eighth-edition stage IIB disease were subclassified into those with seventh-edition stage IIA disease and those with seventh-edition stage IIB disease, and their recurrence-free survival and disease-specific survival rates were compared. Risk factors for recurrence after curative resection were identified in all included patients. RESULTS: Of 122 patients with eighth-edition stage IIB NSCLC, 101 (82.8%) had seventh-edition stage IIA disease and 21 (17.2%) had seventh-edition stage IIB disease. Nonsignificant differences were observed in the 5-year recurrence-free survival rate and the 5-year disease-specific survival rate between the patients with seventh-edition stage IIA disease and those with seventh-edition stage IIB disease. Visceral pleural invasion was a significant risk factor for recurrence in patients with eighth-edition stage IIB NSCLC. CONCLUSION: The stage migration from seventh-edition stage IIA NSCLC to eighth-edition stage IIB NSCLC was appropriate in terms of oncological outcomes. Visceral pleural invasion was the only prognostic factor in patients with eighth-edition stage IIB NSCLC.
Carcinoma, Non-Small-Cell Lung ; Classification ; Humans ; Lung Neoplasms ; Neoplasm Metastasis ; Neoplasm Staging ; Prognosis ; Recurrence ; Risk Factors ; Survival Rate

BACKGROUND: The purposes of this study were to evaluate the appropriateness of the stage migration of stage IIA non-small cell lung cancer (NSCLC) in the seventh edition of the tumor, node, and metastasis classification for lung cancer to stage IIB lung cancer in the eighth edition, and to identify prognostic factors in patients with eighth-edition stage IIB disease. METHODS: Patients with eighth-edition stage IIB disease were subclassified into those with seventh-edition stage IIA disease and those with seventh-edition stage IIB disease, and their recurrence-free survival and disease-specific survival rates were compared. Risk factors for recurrence after curative resection were identified in all included patients. RESULTS: Of 122 patients with eighth-edition stage IIB NSCLC, 101 (82.8%) had seventh-edition stage IIA disease and 21 (17.2%) had seventh-edition stage IIB disease. Nonsignificant differences were observed in the 5-year recurrence-free survival rate and the 5-year disease-specific survival rate between the patients with seventh-edition stage IIA disease and those with seventh-edition stage IIB disease. Visceral pleural invasion was a significant risk factor for recurrence in patients with eighth-edition stage IIB NSCLC. CONCLUSION The stage migration from seventh-edition stage IIA NSCLC to eighth-edition stage IIB NSCLC was appropriate in terms of oncological outcomes. Visceral pleural invasion was the only prognostic factor in patients with eighth-edition stage IIB NSCLC.