BACKGROUND: Empyema is the collection of purulent exudate within the pleural space. Overall, 36%–65% of patients with empyema cannot be treated by medical therapy alone and require surgery. Multiloculated empyema is particularly difficult to treat with percutaneous drainage. Therefore, we describe our experiences with early aggressive surgical treatment for rapid progressive multiloculated empyema. METHODS: From January 2001 to October 2015, we retrospectively reviewed 149 patients diagnosed with empyema who received surgery. The patients were divided into 2 groups according to whether they underwent emergency surgery or not. We then compared surgical outcomes between these groups. RESULTS: The patients in group A (emergency surgery, n=102) showed a more severe infectious state, but a lower complication rate and shorter length of hospital stay. The incidence of lung abscess was higher in group A, and abscesses were associated with diabetes and severe alcoholism. CONCLUSION: Early aggressive surgical treatment resulted in good surgical outcomes for patients with rapid progressive multiloculated empyema. Furthermore, we suspect that the most likely causes of multiloculated empyema are lung abscesses found in patients with diabetes mellitus as well as severe alcoholism.
Abscess ; Alcoholism ; Diabetes Mellitus ; Drainage ; Emergencies ; Empyema* ; Exudates and Transudates ; Humans ; Incidence ; Length of Stay ; Lung Abscess ; Pleural Diseases ; Retrospective Studies

A 51-year-old woman visited our hospital with massive hemoptysis. She had suffered from recurrent hemoptysis for five years and had undergone bronchial artery embolization many times. The patient had a history of pulmonary tuberculosis and bronchiectasis. Chest radiography showed consolidation around the nodule in the lateral basal segment of the right lower lobe. We successfully performed a right lower lobectomy. The histological study of the resected specimen showed a vegetable foreign body and clumps of Actinomyces, indicating actinomycosis, which was suggested to be the cause of the hemoptysis. This was a very rare case of hemoptysis caused by a vegetable foreign body and actinomycosis.
Actinomyces ; Actinomycosis* ; Bronchial Arteries ; Bronchiectasis ; Female ; Foreign Bodies* ; Hemoptysis ; Humans ; Middle Aged ; Radiography ; Thorax ; Tuberculosis, Pulmonary ; Vegetables*

BACKGROUND: Numerous statistical models have been developed to accurately predict outcomes in multiple trauma patients. However, such trauma scoring systems reflect the patient's physiological condition, which can only be determined to a limited extent, and are difficult to use when performing a rapid initial assessment. We studied the predictive ability of the systemic inflammatory response syndrome (SIRS) score compared to other scoring systems. METHODS: We retrospectively reviewed 229 patients with multiple trauma combined with chest injury from January 2006 to June 2011. A SIRS score was calculated for patients based on their presentation to the emergency room. The patients were divided into two groups: those with an SIRS score of two points or above and those with an SIRS score of one or zero. Then, the outcomes between the two groups were compared. Furthermore, the ability of the SIRS score and other injury severity scoring systems to predict mortality was compared. RESULTS: Hospital death occurred in 12 patients (5.2%). There were no significant differences in the general characteristics of patients, but the trauma severity scores were significantly different between the two groups. The SIRS scores, number of complications, and mortality rate were significantly higher in those with a SIRS score of two or above (p<0.001). In the multivariant analysis, the SIRS score was the only independent factor related to mortality. CONCLUSION: The SIRS score is easily calculated on admission and may accurately predict mortality in patients with multiple traumas.
Emergency Service, Hospital ; Humans ; Inflammation* ; Models, Statistical ; Mortality* ; Multiple Trauma* ; Retrospective Studies ; Systemic Inflammatory Response Syndrome ; Thoracic Injuries

We report here on a very rare case of granulocytic sarcoma of the pectoralis muscle on the left chest wall of a patient with chronic myelogenous leukemia, and this malady presented as a very rapidly growing hematoma-like mass.
Humans ; Leukemia ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Pectoralis Muscles ; Sarcoma ; Sarcoma, Myeloid ; Thoracic Wall

BACKGROUND: The pathophysiology of acute respiratory distress syndrome with sepsis is acute lung injury (ALI) that's' caused by endotoxin (LPS). We evaluate effects of moxifloxacin on LPS-induced ALI in a rat model. MATERIAL AND METHOD: The rats were divided into 3 groups as the control group (C), the LPS insult group (L), and the LPS+moxifloxacin treated group (L-M). ALI was induced by endotracheal instillation of E.coli LPS, then moxifloxacin was given in 30 minutes. Five hours later, we checked the lung weight/body weight ratio(the L/BW ratio), the protein & neutrophils in the bronchoalveolar lavage fluid (BALF), the myeloperoxidase (MPO) activity & the malondialdehyde (MDA) content, the expressions of cytosolic and secretory phospholipase A2 (c, sPLA2), and the morphology of the lung with using a light microscope. RESULT: The L/BW ratio, the protein content and the neutrophil count in the BALF, and the MPO activity and the MDA content in lung were significantly increased in group L compared to group C, and these factors were markedly decreased in group L-M compare to group L. The cPLA2 expression and the sPLA2 expression were increased in group L and the cPLA2 expression was decreased in group L-M. Yet the sPLA2 expression was not changed in group L-M. Morphologically, many inflammatory findings were observed in group L, but not in group L-M. CONCLUSION: Many of the inflammatory changes of ALI that were caused by LPS insult were ameliorated by moxifloxacin treatment.
Acute Lung Injury ; Animals ; Aza Compounds ; Bronchoalveolar Lavage Fluid ; Cytosol ; Light ; Lung ; Malondialdehyde ; Neutrophils ; Peroxidase ; Phospholipases A2, Secretory ; Quinolines ; Rats ; Respiratory Distress Syndrome, Adult ; Sepsis

A 20 year old woman had developed stenosis at the lower part of the trachea, right main bronchus, and right upper lobe bronchus as a complication of endobronchial tuberculosis. The patient had complained of severe dyspnea. Tracheobronchial stenosis was so extensive that we did reconstruction of the trachea and right bronchus with resection of the lower trachea and right main bronchus and right upper lobectomy. She has been doing well without any respiratory symptoms or complications.
Bronchi ; Constriction, Pathologic ; Dyspnea ; Female ; Humans ; Trachea ; Tracheal Stenosis ; Tuberculosis

After laparoscopic surgery, most cases of incisional hernia occur when a trocar greater than 10 mm is used and this rarely occurs when a 5 mm trocar is used. We recently experienced two cases of incisional herniation at a 5 mm port site in connection with withdrawal of the drain after laparoscopic procedure.
Hernia ; Laparoscopy ; Surgical Instruments

After laparoscopic surgery, most cases of incisional hernia occur when a trocar greater than 10 mm is used and this rarely occurs when a 5 mm trocar is used. We recently experienced two cases of incisional herniation at a 5 mm port site in connection with withdrawal of the drain after laparoscopic procedure.
Hernia ; Laparoscopy ; Surgical Instruments

BACKGROUND: Surgery for Stanford type A aortic dissection shows a high operative mortality rate and frequent postoperative brain injury. This study was designed to find out the risk factors leading to operative mortality and brain injury after surgical repair in patients with type A aortic dissection. MATERIAL AND METHOD: One hundred and eleven patients with type A aortic dissection who underwent surgical repair between February, 1995 and January, 2005 were reviewed retrospectively. There were 99 acute dissections and 12 chronic dissections. Univariate and multivariate analysis were performed to identify risk factors of operative mortality and brain injury. RESULT: Hospital mortality occurred in 6 patients (5.4%). Permanent neurologic deficit occurred in 8 patients (7.2%) and transient neurologic deficit in 4 (3.6%). Overall 1, 5, 7 year survival rate was 94.4, 86.3, and 81.5%, respectively. Univariate analysis revealed 4 risk factors to be statistically significant as predictors of mortality: previous chronic type III dissection, emergency operation, intimal tear in aortic arch, and deep hypothemic circulatory arrest (DHCA) for more than 45 minutes. Multivariate analysis revealed previous chronic type III aortic dissection (odds ratio (OR) 52.2), and DHCA for more than 45 minutes (OR 12.6) as risk factors of operative mortality. Pathological obesity (OR 12.9) and total arch replacement (OR 8.5) were statistically significant risk factors of brain injury in multivariate analysis. CONCLUSION: The result of surgical repair for Stanford type A aortic dissection was good when we took into account the mortality rate, the incidence of neurologic injury, and the long-term survival rate. Surgery of type A aortic dissection in patients with a history of chronic type III dissection may increase the risk of operative mortality. Special care should be taken and efforts to reduce the hypothermic circulatory arrest time should always be kept in mind. Surgeons who are planning to operate on patients with pathological obesity, or total arch replacement should be seriously consider for there is a higher risk of brain injury.
Aorta, Thoracic ; Brain Injuries* ; Brain* ; Emergencies ; Hospital Mortality ; Humans ; Incidence ; Mortality ; Multivariate Analysis ; Neurologic Manifestations ; Obesity ; Retrospective Studies ; Risk Factors* ; Survival Rate

BACKGROUND: Historically the Fontan operation in patients with single ventricle and heterotaxy syndrome has been associated with high mortality because of systemic or pulmonary anomalous venous drainage, incompetent common atrioventricular valve, right ventricle type univentricular heart, and arrhythmia. MATERIAL AND METHOD: A retrospective review of 62 patients (age: 54.79+/-33.97 months) with heterotaxy syndrome who underwent a extracardiac Fontan operation between 1996 and 2005 was performed. Twenty one patients had left atrial isomerism, and 41 had right isomerism. The Fontan procedure was staged in all but 2 patients, and a fenestration was less placed in left isomerism. RESULT: Left isomerism was associated more with interrupted inferior vena cava and pulmonary arteriovenous fistula, and right isomerism was associated more with anomalous pulmonary venous drainage, common atrioventricular valve and morphologic right ventricle. There were 3 hospital deaths (4.8%), and 3 late deaths (5.2%) with a follow-up duration of 48.8+/-31.0 months. Eight-year survivals were 90.5+/-6.4% in left isomerism and 88.6+/-5.4% in right isomerism (p=0.94). At 8 years, freedom from reoperation was 73.9+/-11.3% in left isomerism, and 82.3+/-6.7% in right isomerism (p=0.87). Atrioventricular valve regurgitation progressed after Fontan operation in heterotaxy syndrome, and reoperation for pulmonary arteriovenous fistula and permanent pacemaker implantation for sinus node dysfunction were required more in left isomerism. CONCLUSION: The extracardiac Fontan operation can now be performed in patients with heterotaxy syndrome with excellent survival. However, morbidity in terms of postoperative atrioventricular valve regurgitation, arrhythmia, and pulmonary arteriovenous fistula remains significant.
Arrhythmias, Cardiac ; Arteriovenous Fistula ; Drainage ; Follow-Up Studies ; Fontan Procedure* ; Freedom ; Heart ; Heart Defects, Congenital ; Heart Ventricles ; Heterotaxy Syndrome* ; Humans ; Isomerism ; Mortality ; Reoperation ; Retrospective Studies ; Sick Sinus Syndrome ; Vena Cava, Inferior