Blastomyces dermatitidis is a dimorphic fungus that causes the systemic pyogranulomatous disease known as blastomycosis. Blastomycosis most often involves the lungs, skin, and may involve nearly every organ in the body. It is difficult, however, to diagnose blastomycosis in the early stage of pulmonary disease because clinical manifestations are varied from subclinical infection to acute respiratory distress syndrome. Since blastomycosis is often accompanied by granulomatous inflammation in histopathologic findings, differentiation from other etiologic diseases is important. We report a case of a 45-year-old male with pulmonary blastomycosis who had been misdiagnosed with tuberculosis for 3 months.
Asymptomatic Infections ; Blastomyces ; Blastomycosis ; Fungi ; Granuloma ; Humans ; Inflammation ; Lung ; Lung Diseases ; Male ; Middle Aged ; Respiratory Distress Syndrome, Adult ; Skin ; Tuberculosis ; Tuberculosis, Pulmonary

BACKGROUND: Preoperative chemotherapy has been adopted in our hospital as a standard treatment for non-small cell lung cancer patients with N2 disease. However, there have been cases of pathologic N2 disease that have been detected after curative-intent surgical resection. We retrospectively studied the outcomes of initial surgical treatment without neoadjuvant therapy in patients with unexpected N2 non-small cell lung cancer. MATERIAL AND METHOD: Between January 1995 and June 2007, 225 patients were diagnosed with pathologic N2 disease after they underwent initial pulmonary resection without neoadjuvant therapy. Among them, 170 patients were preoperatively diagnosed with lymph node stage N0 or N1. We retrospectively reviewed their medical record and analyzed the outcomes. RESULT: The overall 5-year survival rate was 35.4%. The prognostic factors that were significantly associated with survival were no adjuvant therapy, histologic cell types other than adenocarcinoma or squamous cell carcinoma, a pathologic T stage more than T1, old age (> or =70 years) and no mediastinoscopic biopsy. During the follow-up, 79 patients (46.5%) experienced tumor recurrence, including loco-regional recurrence in 20 patients (25.3%) and distant metastasis in 56 (70.9%). The 5-year recurrence-free survival rate was 33.7%. CONCLUSION: Based on our findings, the survival was good for patients with unexpected N2 non-small cell lung cancer and who underwent initial pulmonary resection without neoadjuvant therapy. A prospective comparative analysis is needed to obtain more conclusive and persuasive results.
Adenocarcinoma ; Biopsy ; Carcinoma, Non-Small-Cell Lung ; Carcinoma, Squamous Cell ; Follow-Up Studies ; Humans ; Lung Neoplasms ; Lymph Nodes ; Mediastinoscopy ; Medical Records ; Neoadjuvant Therapy ; Neoplasm Metastasis ; Neoplasm Staging ; Recurrence ; Retrospective Studies ; Survival Rate ; Treatment Outcome

BACKGROUND: The treatment of acute pulmonary embolism is difficult, and it can be lethal when cardiogenic shock is involved with major pulmonary embolism. In the past, pulmonary embolectomy was considered as the last choice for patients with pulmonary embolism. Accordingly, we analyzed our experience with seven cases of pulmonary embolectomy as an alternative option for the early treatment of pulmonary embolism. MATERIAL AND METHOD: A retrospective analysis of medical charts of all patients who underwent pulmonary embolectomy at our hospital over the past eight years was performed. The patients were observed during their hospital stay and followed until their last visit to the outpatient department. RESULT: Among 7 patients (4 men and 3 women), 4 had massive pulmonary embolism, and 3 had submassive pulmonary embolism. An extracorporeal membrane oxygenator was inserted in 3 patients before surgery. There was no mortality, and postoperative echocardiography showed no pulmonary hypertension in 6 patients. CONCLUSION: Pulmonary embolectomy can be performed with minimal mortality. We think that the use of an extracorporeal membrane oxygenator in patients with cardiogenic shock before surgery improves survival.
Echocardiography ; Embolectomy ; Extracorporeal Membrane Oxygenation ; Humans ; Hypertension, Pulmonary ; Length of Stay ; Male ; Outpatients ; Oxygenators, Membrane ; Pulmonary Embolism ; Retrospective Studies ; Shock, Cardiogenic

BACKGROUND: Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are the leading causes of death after lungresection. Neutrophil elastase is thought to be an important mediator in the pathogenesis of ALI. Sivelestat is a new neutrophil elastase inhibitor which may improve the outcome in patients with ALI/ARDS after lung resection. The objective of this study was to determine whether or not sivelestat can reduce mortality in patients with ALI after pulmonary resection for lung cancer. METHODS: This study was a retrospective case-control study of twenty three patients who developed ALI/ARDS within seven days of lung resection for lung cancer. The control group (n = 12) received standard care, while the sivelestat group (n = 11) received a continuous infusion of sivelestat (0.2 mg/kg/hr) for seven days in addition to standard care. RESULTS: There was no significant difference in the baseline characteristics between the control and sivelestat groups, except for heart rate. Six of twelve patients (50%) in the control group survived, while seven of twelve patients (64%) survived in the sivelestat group (p = 0.34). There was also no significant difference between the two groups in the progression to ARDS. In the sivelelestat group, survivors had lower APACHE II and SOFA scores than the patients in the control group. CONCLUSIONS: There was no additional effect of a neutrophil elastase inhibitor in the treatment of ALI after pulmonary resection for lung cancer.
Acute Lung Injury ; APACHE ; Case-Control Studies ; Cause of Death ; Glycine ; Heart Rate ; Humans ; Leukocyte Elastase ; Lung ; Lung Neoplasms ; Neutrophils ; Respiratory Distress Syndrome, Adult ; Retrospective Studies ; Sulfonamides ; Survivors

PURPOSE: Pulmonary metastases occur in up to 10% of all patients who undergo a curative resection for colorectal cancer. Surgical resection is an important part in the treatment of pulmonary metastasis from colorectal cancer. We analyzed the treatment outcome and the prognostic factors affecting survival in this subset of patients. METHODS: Between October 1994 and December 2004, 59 patients underwent a curative resection for pulmonary metastases from colorectal cancer. Uncontrollable synchronous liver and lung metastasis or synchronous colorectal cancers with isolated lung metastasis were excluded from this study. A retrospective review of the patients' characteristics and of factors influencing survival was performed. Survival was analyzed by using the Kaplan-Meier method. Comparisons between the groups were performed by using a log-rank analysis and the Cox proportional hazard model. RESULTS: The 5-year overall survival rate of all patients who received a pulmonary resection was 50.3%. The number of pulmonary metastases was significantly related with survival (P=0.032). A pre-thoracotomy CEA level exceeding 5 ng/ml was related with poor survival (P=0.001). A disease- free interval of greater than 2 years did not correlate with survival after a thoracotomy (P=0.3). CONCLUSIONS: The pre-thoracotomy CEA level and the number of metastases were independent prognostic factors. Resection of a pulmonary metastasis from colorectal cancer may result in improved survival or even cure in selected patients. A pulmonary resection of colorectal cancer is regarded as a safe and effective treatment with low morbidity and mortality rates.
Colorectal Neoplasms* ; Humans ; Liver ; Lung ; Mortality ; Neoplasm Metastasis* ; Proportional Hazards Models ; Recurrence ; Retrospective Studies ; Survival Rate ; Thoracotomy ; Treatment Outcome

The clinical outcome and prognostic factors of patients with synchronous brain metastases from non-small cell lung cancer (NSCLC) who were treated with gamma knife radiosurgery (GKS) were analyzed. A total of 35 patients with NSCLC underwent GKS as an initial treatment for metastatic brain lesions of synchronous onset. The period of survival and various prognostic factors such as age, gender, performance status, multiplicity of the brain lesions, intracranial tumor volume, and extent of the primary tumor were analyzed. The overall median survival time for this series was 12 months (range 0.75 to 43 months) from the diagnosis. Of the 21 patients who were no longer alive at the conclusion of this study, only 7 (33.3%) died of neurological causes. Multivariate analysis of these data revealed that N stage, whole-brain radiotherapy (WBRT), and chemotherapy were significant predictors for survival (p<0.05). Survival of patients with NSCLC and synchronous brain metastases is mainly dependent upon the progression of the systemic disease, provided that the cerebral lesions are treated adequately with local treatment modalities including radiosurgery. Application of radiosurgery as an initial treatment option and aggressive local and systemic modalities to control extracranial disease may improve survival.
Treatment Outcome ; Time Factors ; Radiosurgery/*methods ; Prognosis ; Neoplasm Metastasis ; Middle Aged ; Male ; Lung Neoplasms/*diagnosis/pathology/*surgery ; Humans ; Female ; Carcinoma, Non-Small-Cell Lung/*diagnosis/pathology/*surgery ; Brain Neoplasms/*diagnosis/pathology/*surgery ; Aged, 80 and over ; Aged ; Adult

BACKGROUND: Nuss procedure is a minimally invasive technique for correcting the pectus excavatum. But there are some limitations of correcting the complex anomaly or grown-up patients. MATERIAL AND METHOD: we retrospectively reviewed 135 consecutive patients who underwent repair of pectus excavatum by the Nuss procedure and its modifications between November 1999 and December 2004. We analyzed the computed tomography, age on operation, operative technique, and complications. RESULT: We operated 135 patients of pectus excavatum during 62 months. Total number of operations about Nuss procedure is 216, including bar removal procedure of 64 cases, redo Nuss procedures of 17 cases. We modified the point of bar insertion to the hinge point, made a shoulder in the bar to prevent a displacement. And then we changed the fixation material from Vicryl to steel wire. If the patients are old, we retract the sternum during bar rotation and fixation. Until 2002, the number of redo Nuss operations were 17, complications were 23. but, after modifications, the number of redo Nuss operation were 0, complications were 2. CONCLUSION: This result indicates that our modifications of Nuss operation is effective, and could decrease the number of redo Nuss operation and complications.
Funnel Chest ; Humans ; Polyglactin 910 ; Retrospective Studies ; Shoulder ; Steel ; Sternum ; Surgical Procedures, Minimally Invasive ; Thoracic Wall

The mediastinal parathyroid cyst is a very rare cause of space occupying lesions in the mediastinum.We report a case of a non-functioning mediastinal parathyroid cyst that occurred ina 42 year-old male. He suffered from foreign body sensation of the throat whenever he wasin the supine position. A chest computed tomography showed a round cyst with a narrowbase attached to trachea. It was white and tan, thin-walled semi-transparent cyst containingyellow and tan serous fluid. Microscopically it was characterized by a thin fibrous wall linedwith a single or double layer of uniform cells with clear cytoplasm and small nuclei. The liningcells were immunopositive for chromogranin A.
Adult ; Chromogranin A ; Cytoplasm ; Foreign Bodies ; Humans ; Male ; Mediastinum ; Parathyroid Glands ; Pharynx ; Sensation ; Supine Position ; Thorax ; Trachea ; Triacetoneamine-N-Oxyl

Rounded atelectasis is a focal, pleural-based lesion that is the result of pleural and subpleural scarring and atelectasis of the adjacent lung tissue. We experienced a case of asbestosassociated rounded atelectasis that had developed in a 50-year-old male. When examined with routine chest radiography, the patient was shown to have an asymptomatic chest mass.Computed tomography showed a pleural-based mass with a curvilinear shape about 4.2 cmin greatest diameter in the medial basal segment of the right lower lobe. To exclude the possibilityof malignancy the mass was excised by video-assisted thoracotomy. The mass wasround and firm, and was gray and yellow in color. Microscopically, marked pleural fibrosisextended into the underlying lung parenchyme and then resulted in atelectasis. There areferruginous bodies in dense fibrous pleura.
Asbestos ; Cicatrix ; Humans ; Lung ; Lung Diseases ; Male ; Middle Aged ; Pleura ; Pulmonary Atelectasis* ; Radiography ; Thoracotomy ; Thorax

PURPOSE: No general consensus has been reached regarding the necessity of postoperative radiation therapy (PORT) and the optimal techniques of its application for patients with chest wall invasion (pT3cw) and node negative (N0) non-small cell lung cancer (NSCLC). We retrospectively analyzed the pT3cwN0 NSCLC patients who received PORT because of presumed inadequate resection margin on surgical findings. MATERIALS AND METHODS: From Aug. 1994 till June 2000, 21 pT3cwN0 NSCLC patients received PORT at Samsung Medical Center; all of whom underwent curative en-bloc resection of the primary tumor plus the chest wall and regional lymph node dissection. PORT was typically started 3 to 4 weeks after operation using 6 or 10 MV X-rays from a linear accelerator. The radiation target volume was confined to the tumor bed plus the immediate adjacent tissue, and no regional lymphatics were included. The planned radiation dose was 54 Gy by conventional fractionation schedule. The survival rates were calculated and the failure patterns analyzed. RESULTS: Overall survival, disease-free survival, loco-regional recurrence-free survival, and distant metastases-free survival rates at 5 years were 38.8%, 45.5%, 90.2%, and 48.1%, respectively. Eleven patients experienced treatment failure: six with distant metastases, three with intra-thoracic failures, and two with combined distant and intra-thoracic failures. Among the five patients with intra-thoracic failures, two had pleural seeding, two had in-field local failures, and only one had regional lymphatic failure in the mediastinum. No patients suffered from acute and late radiation side effects of RTOG grade 3 or higher. CONCLUSION: The strategy of adding PORT to surgery to improve the probability, not only of local control but also of survival, was justified, considering that local control was the most important component in the successful treatment of pT3cw NSCLC patients, especially when the resection margin was not adequate. The incidence and the severity of the acute and late side effects of PORT were markedly reduced, which contributed to improving the patients' quality of life both during and after PORT, without increasing the risk of regional failures by eliminating the regional lymphatics from the radiation target volume.
Appointments and Schedules ; Carcinoma, Non-Small-Cell Lung* ; Consensus ; Disease-Free Survival ; Humans ; Incidence ; Lymph Node Excision ; Lymphatic Irradiation* ; Mediastinum ; Neoplasm Metastasis ; Particle Accelerators ; Quality of Life ; Retrospective Studies ; Survival Rate ; Thoracic Wall* ; Thorax* ; Treatment Failure