Journal Detail Information

1

Cite

Share

Prognostic Relevance of WHO Classification and Masaoka Stage in Thymoma.

Seong Sik KANG ; Mi Sun CHUN ; Yong Hee KIM ; Seung Il PARK ; Dae W EOM ; Jae Y RO ; Dong Kwan KIM

The Korean Journal of Thoracic and Cardiovascular Surgery.2005;38(1):44-49.

BACKGROUND: Although thymomas are relatively common mediastinal tumors, to date not only has a universal system of pathologic classification not been established but neither has a clearly defined predictable relationship between treatment and prognosis been made. Recently, a new guideline for classification was reported by WHO, and efforts, based on this work, have been made to better define the relationship between treatment and prognostic outcome. In the present study a comparative analysis between the WHO classification and Masaoka stage system with the clinical disease pattern was conducted. MATERIAL AND METHOD: A total of 98 patients undergoing complete resection for mediastinal thymoma between Juanuary 1993 and June 2003 were included in the present study. The male female ratio was 48:50 and the mean age at operation was 49.6+/-13.9 years. A retrospective analytic comparison studying the relationship between the WHO classification and the Masaoka stage system with the clinical disease pattern of thymoma was conducted. Pathologic slide specimens were carefully examined, details of postoperative treatment were documented, and a relationship with the prognostic outcome and recurrence was studied. RESULT: There were 7 patients in type A according to the WHO system of classification, 14 in AB, 28 in B1, 23 in B2, 18 in B3, and 9 in type C. The study of the relationship between the Masaoka stage and WHO classification system showed 4 patients to be in WHO system type A, 7 in type AB, 22 in B1, 17 in B2, and 3 in type B3 among 53 (54%) patients shown to be in Masaoka stage I. Among 28 (28.5%) patients in Masaoka stage II system, there were 2 patients in type A, 7 in AB, 4 in B1, 2 in B2, 8 in B3, and 5 in type C. Among 15 (15.3%) in Masaoka stage III, there were 1 patient in type B1, 3 in B2, 7 in B3, and 4 in type C. Finally, among 2 (2%) patients found to be in Masaoka stage IV there was 1 patient in type B1, and 1 in type B2. The mean follow up duration was 28+/-6.8 months. There were 3 deaths in the entire series of which 2 were in type B2 (Masaoka stages III and IV), and 1 was in type C (Masaoka stage II). Of the patients that experienced relapse, 6 patients remain alive of which 2 were in type B2 (Masaoka III), 2 in type B3 (Masaoka I and III) and 2 in type C (Masaoka stage II). The 5 year survival rate by the Kaplan-Meier method was 90% for those in type B2 WHO classification system, 87.5% for type C. The 5 year freedom from recurrence rate was 80.7% for those in WHO type B2, 81.6% for those in type B3, and 50% for those in type C. By the Log-Rank method, a statistically significant correlation between survival and recurrence was found with the WHO system of classification (p<0.05). An analysis of the relationship between the WHO classification and Masaoka stage system using the Spearman correction method, showed a slope=0.401 (p=0.023), showing a close correlation. CONCLUSION: As type C of the WHO classification system is associated with a high postoperative mortality and recurrence rate, aggressive treatment postoperatively and meticulous follow up are warranted. The WHO classification and Masaoka stage system were found to have a close relationship with each other and either the WHO classification method or the Masaoka stage system may be used as a predict prognostic outcome of Thymoma.
Classification* ; Female ; Follow-Up Studies ; Freedom ; Humans ; Male ; Mortality ; Neoplasm Staging ; Prognosis ; Recurrence ; Retrospective Studies ; Survival Rate ; Thymoma*

2

Cite

Share

Activity of Matrix Metalloproteinase-2 and its Significance after Resection of Stage I Non-small Cell Lung Cancer.

Sang Hui KIM ; Young Sook HONG ; Jinseon LEE ; Dae Soon SON ; Yu Sung LIM ; In Seung SONG ; Hye Sook LEE ; Do Hun KIM ; Jhingook KIM ; Yong Soo CHOI

The Korean Journal of Thoracic and Cardiovascular Surgery.2005;38(1):38-43.

BACKGROUND: Matrix metalloproteinase-2 (MMP-2) is a class of proteolytic enzymes that digest collagen type IV and other components of the basement membrane. It plays a key role in the local invasion and the formation of distant metastases by various malignant tumors. The aim of this study was to evaluate the activity of MMP-2 and its significance as a prognostic marker in resected stage I non-small cell lung cancer (NSCLC). MATERIAL AND METHOD: In this study we obtained fresh-frozen samples of tumor and non-tumor tissues from 34 patients with stage I NSCLC who underwent resection without preoperative radiotherapy or chemotherapy. After the extraction of total protein from tissue samples, MMP-2 activities were assessed by gelatin-substrate-zymography. The activities were divided into the higher or lower groups. RESULT: The MMP-2 activities were higher in tumor tissues than in non-tumor tissues. The MMP-2 activity of non-tumor tissues in recurrent group was higher than in non-recurrent group (p<0.01). Also the patients with higher MMP-2 activity of non-tumor tissues showed poor 5 year survival (p<0.01). CONCLUSION: This result indicates that the higher level of MMP-2 activity in the non-tumor tissue is associated with the recurrence and survival after the resection of stage I NSCLC. Therefore, MMP-2 activity in the non-tumor tissue could be used as a potential prognostic marker for the resected stage I-NSCLC.
Basement Membrane ; Carcinoma, Non-Small-Cell Lung* ; Collagen Type IV ; Drug Therapy ; Humans ; Lung Neoplasms ; Matrix Metalloproteinase 2* ; Neoplasm Metastasis ; Neoplasm Proteins ; Peptide Hydrolases ; Radiotherapy ; Recurrence

3

Cite

Share

The Systemic Effects of Hypothermic and Normothermic Cardiopulmonary Bypass in Cardiac Surgery.

Jae Min PARK ; Yong Gil CHO ; Kwang Hyun CHO ; Yoon Ho HWANG ; Yang Haeng LEE ; Young Chul YOON ; Hee Jae JUN ; Il Yong HAN ; Seok Cheol CHOI

The Korean Journal of Thoracic and Cardiovascular Surgery.2005;38(1):29-37.

BACKGROUND: This study was prospectively designed to determine the physiologic effects of normothermic CPB and to compare its influences with hypothermic CPB. MATERIAL AND METHOD: Thirty-six adult patients scheduled for elective cardiac surgery were randomly assigned to moderate hypothermic (hypothermic group nasopharyngeal temperature 26~28 degreeC, n=18) or normothermic (normothermic group, nasopharyngeal temperature>35.5 degreeC, n=18) CPB. Arterial blood samples were taken before CPB (Pre-CPB), 10 minutes after the start of CPB (CPB-10), and immediately after CPB stop (CPB-off) for determining total leukocyte counts, neuron-specific enolase (NSE), interleukin-6 (IL-6), endothelin-1 (ET-1), cortisol, troponin I (TNI), aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatinine, blood urea nitrogen (BUN), and the pulmonary index (PI, PaO2/FiO2). Other parameters such as urine output, mechanical ventilating period, ICU-staying period, postoperative complications and hospitalized days were also evaluated. RESULT: Total leukocyte counts, increased rate in NSE, in IL-6 and in cortisol at CPB-10 and CPB-off were significantly higher in normothermic group than in hyphothermic group. Urine output during CPB was lower in normothermic group than in hyphothermic group. The duration of mechanical ventilation, ICU-stay, and hospitalization were longer in normothermic group than in hyphothermic group. CONCLUSION: These findings suggested that normothermic CPB caused higher inflammatory and stress responses than hypothermic CPB during cardiac surgery using cold crystalloid cardioplegia. However, further studies with large number of cases should be carried out to validate this hypothesis.
Adult ; Alanine Transaminase ; Aspartate Aminotransferases ; Blood Urea Nitrogen ; Cardiopulmonary Bypass* ; Creatinine ; Endothelin-1 ; Heart Arrest, Induced ; Hospitalization ; Humans ; Hydrocortisone ; Hypothermia ; Inflammation ; Interleukin-6 ; Leukocyte Count ; Phosphopyruvate Hydratase ; Postoperative Period ; Prospective Studies ; Respiration, Artificial ; Thoracic Surgery* ; Troponin I

4

Cite

Share

Mid-term Results of the Ross Procedure.

Seong Sik KANG ; Sung Ho JUNG ; Jae Won LEE ; Sang Gwon LEE ; Suk Jung JOO ; Hyun SONG ; Meong Gun SONG

The Korean Journal of Thoracic and Cardiovascular Surgery.2005;38(1):23-28.

BACKGROUND: Ross procedure is ideal aortic valve replacement method with several merits of hemodynamic superiority and durability without the need of anticoagulation. Based upon this presumption, we studied its procedure performed in our hospital and tried to get the mid-term results MATERIAL AND METHOD: From Jan 1999 to Oct 2001, 22 patients underwent the Ross procedure. The mean age of experimented (including 17 men and 5 women) was 30.9+/-8.1 (17~44). The diagnosis before the surgery had shown 20 as accompanied with AR and the rest 2 as with ASR. The follow-up period ranged from 0.6 to 40.6 months, mean of 38.9+/-1.6 months, and follow-up rate was 100%. RESULT: There was no operative death and two late deaths, one of whom was cardiac originated and the other, non-cardiac relate The survival rate was 94.1+/-5.7% (40.6 months). Postoperatively there were 2 exploration for bleeding, 3 low cardiac output patients. The pulmonary autograft technique was root replacement in 14 and inclusion technique in 8. Pulmonary homografts were used at the pulmonary position in all cases. There was no patient with significant aortic regurgitation. CONCLUSION: These showed that the mortality and morbidity of the Ross procedure were acceptable and postoperative AR was not significant. However, further long-term follow-up will be necessary for the improvement of the function of pulmonary autograft and homograft.
Allografts ; Aortic Valve ; Aortic Valve Insufficiency ; Autografts ; Cardiac Output, Low ; Diagnosis ; Follow-Up Studies ; Hemodynamics ; Hemorrhage ; Humans ; Male ; Mortality ; Survival Rate

5

Cite

Share

Effect of Pulsatile Versus Nonpulsatile Blood Flow on Renal Tissue Perfusion in Extracorporeal Circulation.

Hyun Koo KIM ; Ho Sung SON ; Yong Hu FANG ; Sung Young PARK ; Kwang Taik KIM ; Kyung SUN ; Hark Jei KIM

The Korean Journal of Thoracic and Cardiovascular Surgery.2005;38(1):13-22.

BACKGROUND: It has been known that pulsatile flow is physiologic and more favorable to tissue perfusion than nonpulsatile flow. The purpose of this study is to directly compare the effect of pulsatile versus nonpulsatile blood flow to renal tissue perfusion in extracorporeal circulation by using a tissue perfusion measurement system. MATERIAL AND METHOD: Total cardiopulmonary bypass circuit was constructed to twelve Yorkshire swines, weighing 20~30 kg. Animals were randomly assigned to group 1 (n=6, nonpulsatile centrifugal pump) or group 2 (n=6, pulsatile T-PLS pump). A probe of the tissue perfusion measurement system (QFlow(TM)-500) was inserted into the renal parenchymal tissue. Extracorporeal circulation was maintained for an hour at a pump flow of 2 L/min after aortic cross-clamping. Tissue perfusion flow of the kidney was measured at baseline (before bypass) and every 10 minutes after bypass. Serologic parameters were collected at baseline and 60 minutes after bypass. RESULT: Baseline parameters were not different between the groups. Renal tissue perfusion flow was substantially higher in the pulsatile group throughout the bypass (ranged 48.5~4 in group 1 vs. 65.8~8.3 mL/min/100 g in group 2, p=0.026~0.45). The difference was significant at 30 minutes bypass (47.5+/-18.3 in group 1 vs. 83.4+/-28.5 mL/min/100 g in group 2, p=0.026). Serologic parameters including plasma free hemoglobin, blood urea nitrogen, and creatinine showed no differences between the groups at 60 minutes after bypass (p=NS). CONCLUSION: Pulsatile flow is more beneficial to tissue perfusion of the kidney in short-term extracorporeal circulation. Further study is suggested to observe the effects to other vital organs or long-term significance.
Animals ; Blood Urea Nitrogen ; Cardiopulmonary Bypass ; Creatinine ; Extracorporeal Circulation* ; Kidney ; Perfusion* ; Plasma ; Pulsatile Flow ; Swine

6

Cite

Share

Current Status of Cardiopulmonary Perfusionists in the Republic of Korea.

Won Gon KIM

The Korean Journal of Thoracic and Cardiovascular Surgery.2005;38(1):1-12.

BACKGROUND: The primary responsibility of a perfusionist is to operate the heart-lung bypass machine during open heart surgery, which is vital for the successful operative outcome. However, despite the perfusionist's crucial role on the cardiac surgical team, no relevant studies have not yet been conducted in our country. In this regard, this study was performed about the current status of perfusionists in Korea with comparative analysis on the certification and education system of perfusionists in foreign countries. MATERIAL AND METHOD: We analyzed the demographic data on the Korean perfusionists conducted in 1994 and 2003, with comparison of recent data on the perfusionists of the nineteen foreign countries. RESULT AND CONCLUSION: Although all agree that professionalism and responsibility of the perfusionist are essential in conducting a cardiac procedure and bringing about successful outcome, the formally approved training and certification system for perfusionists have not yet been established in Korea. Adequate measures should be done as soon as possible in order to try to obtain the adequate recognition of the profession.
Cardiopulmonary Bypass ; Certification ; Education ; Korea ; Perfusion ; Republic of Korea* ; Thoracic Surgery

7

Cite

Share

Early Results of Coronary Bypass Surgery in Patients with Severe Left Ventricular Dysfunction.

Yoon Seop JEONG ; Wook Sung KIM ; Woong Han KIM ; Cheol Hyun CHUNG ; Chan Young RA ; Young Thak LEE ; Young Kwhan PARK ; Sung Nok HONG

The Korean Journal of Thoracic and Cardiovascular Surgery.1997;30(4):383-389.

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*

8

Cite

Share

Modified Blalock-Taussig Shunt in Neonates.

Kwang Jo JO ; Si Chan SUNG

The Korean Journal of Thoracic and Cardiovascular Surgery.1997;30(4):378-382.

To evaulate the effectiveness and risk factors for shunt failure of the Blalock-Taussig shunt in neonates, we analyzed the 21 neonates who were undergone Blalok-Taussig shunt operation at Dong-A University Hospital from December 1991 to Feburary 1996. We evaluated operative mortality, patency of the shunt. and distortion of pulmonary artery. We also determined the risk factors for the shunt failure. Age at operation was from 1 day to 30 days(mean 11.7 days). Weights were 2.4 to 4.5kg(mean 3.1 kg). The underlying lesions included severe tetralogy of Fallot with pulmonary stenosls or atresia(N=11) and single ventricle varieties with. pulmonary stenosis or atresia(N=10). Prostaglandin E1 was given in 13 neonates prior to operation. The mean preoperative(prior to prostaglandin El therapy) and postoperative arterial oxygen tension were 30.1 mmHg and 46.3 mmHg respectively(P<0.01). The shunt was performed through a left thoracotomy in 11 patients and through a right thoracotomy In 10. A 5 mm graft was used in 15 patients and a 4 mm graft in 6 patients. The incidence of early shunt occlusion was 9.5%(2 patients). The hospital mortality was 9.5%(2 patients with early shunt occlusion). Univariate analysis revealed that body weight of 2.6 kg or less(p=0.021), pulmonary artery size of 3mm or less(p=0.008), and 4 mm graft (p=0.021) were risk factors predictive of early shunt failure. The patency rate of the shunt in hospital survivors was 100% at mean ollow-up of ll.3 months(There was not death or reoperation related to shunt failure). 10 patients were catheterized during postoperative follow-up. There was no significant distorsion of pulmonary artery. So we concluded that the modified Blalock-Taussig shunt in neonates was excellent in the hospital survivors.
Alprostadil ; Blalock-Taussig Procedure* ; Body Weight ; Catheters ; Follow-Up Studies ; Hospital Mortality ; Humans ; Incidence ; Infant, Newborn* ; Mortality ; Oxygen ; Pulmonary Artery ; Pulmonary Valve Stenosis ; Reoperation ; Risk Factors ; Survivors ; Tetralogy of Fallot ; Thoracotomy ; Transplants ; Weights and Measures

9

Cite

Share

Surgical Result of Congenital Mitral Regurgitation in Children.

Yoo Sun HONG ; Young Hwan PARK ; Han Gy PARK ; Bum Koo CHO ; Hwan Kyu RHO

The Korean Journal of Thoracic and Cardiovascular Surgery.1997;30(4):373-377.

Between January, 1991 and May 1995, mitral valve repair was undertaken on 32 patients under 15 years for congenital mitral regurgitation. Mean age was 24.0+/-26.1 months(range 3 months to 15 years), 16 patients were male and 16 patients were female associated cardiac anomalies were found in 26 patients (81%), and ventricular septal defects were noted in 18 patients(56%). In regards to pathologic findings, there were annular dilatation(n:7), leaflet prolapse(n=18), cleft leaflet(n=5) and restricted valve motion (n=2). The method of repair consisted of annuloplasty(Modif ed Devega type) in 14, repair of redundunt leaflet in 6, closure of cleft in 5, triangular resection in 2 and splitting of papillary muscle in one. There was no operative mortality and two late deaths occurred as a result of heart failure and sepsis. Tro patients required replacement of the mitral valve after 3 months and 7 months respectivehy because of recurrent mitral regurgitation. Actuarial survival was 92.5% at 46 months and actuarial freedom from reoperation was 95% at 12 months and 92.5% at 46 months. Actuarial freedom from valve repair failure was 68% at 12 months and 61.8% at 46 months. Although valve repair failure rate was high, we believe that mitral valve repair should be of rcrred to children because of low mortality and low reoperation rate.
Child* ; Female ; Freedom ; Heart Failure ; Heart Septal Defects, Ventricular ; Humans ; Male ; Mitral Valve ; Mitral Valve Insufficiency* ; Mortality ; Papillary Muscles ; Reoperation ; Sepsis

10

Cite

Share

Influence of Anatomy, Associated Anomalies, Age, and Surgical Methods on the Surgical Results of Aortic Coarctation.

Jeong Ryul LEE ; Hye Soon KIM ; Hyun Jong MOON ; Gee Ik SUNG ; Sook Whan SUNG ; Yong Jin KIM ; Joon Rhyang RHO ; Kyung Phill SUH ; Jung Il NO ; Jung Youn CHUI ; Yong Soo YOON

The Korean Journal of Thoracic and Cardiovascular Surgery.1997;30(4):363-372.

One hundred forty-four patients underwent operation for coarctation of the aorta at Seoul National University Children's Hospital between June 1986 and Decembsr 1995. Age ranged 0.1 to 191 months. Of these 78.5%(113) were infants. We classified the patients in terms of the anatomic location of coarctatiln and the associatCd anomalies(I[40]= primary coarctation, II[74]=isthmic hypoplasia, lII[30]=tubular hypoplasia involving transverse arch, A[63]=with ventricular septal defect, B[28]=with other major cardiac defects). Subcalvian flap coarctoplasty(60), resection and anastomosis(44), extended aortoplasty(26), and onlay patch(14) were used as surgical methods. Overall operative mortality was 16.0(23/144)%. The hospital mortality was significantly higher in patheints with type III, subtype B, younger age(under 3 months), extended aortoplasty(p<0.01). However, one-stage total repair in patients with subtype A or B were not found to be a predictor of hospital death. Restenosis had occured in 18 patients among 121 survivals(14.9%). The mean follow-up period was 29.1+/-28.8(0~129.2) months. Preoperative, immediate postoperative(within 3 months after operation) and postoperative(later than 6 months after operation) echocardiographic data on the dimensions of ascending aorta(AA), transverse arch(TA), an4 aortic isthmus(Al) were available in 77 patients(I=20, II=42, III= 15). Preoperative and postoperative aortic isthmus(All) and tra sverse arch indices(TAI), defined as TA/AA and AI/AA respectively, were compared. Immediate postoperative All in type I, II and TAI in type III were significantly smaller in stenotic than non-stenotic group suggesting incomplete relieves of stenotic segment Younger age, subclavian coarctoplasty in patient under 3 months of age were round to be the risk factors for restenosis in this series. In conclusion, We found that aortic arch index and transverse arch index can be a useful tool to figure out the anatomic and clinical characteristics of the patients with aortic coarctation, and that anatomy, associated anomalies, age, and surgical methods may influence the surgical outcome of the coarctation repair.
Aorta, Thoracic ; Aortic Coarctation* ; Echocardiography ; Follow-Up Studies ; Heart Septal Defects, Ventricular ; Hospital Mortality ; Humans ; Infant ; Inlays ; Mortality ; Risk Factors ; Seoul

DISPLAY OPTIONS

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share