Lung Cancer in the Explanted Lung of the Recipient in Lung Transplantation

Undetected lung cancer in the explanted lungs may significantly complicate the outcome of a patient following lung transplantation. The incidence and survival of undetected primary lung cancer in the explanted lungs have not been studied in a large cohort of patients. We have experienced a 63 year old male with a diagnosis of idiopathic pulmonary fibrosis who underwent bilateral sequential single lung transplantation in whom primary lung cancer was detected in the explanted lung of the recipient. A retrospective review of all radiological imaging study was correlated with the pathology of the explanted lung in order to localize the primary focus of the tumor. The patient was diagnosed as squamous cell carcinoma, stage IIIA (T1N2M0). This patient is currently under the close surveillance, and we recommend computerized tomograms of the chest immediately prior to lung transplantation in order to avoid the incidence of undetected primary lung cancer.ope

Two cases of post transplant lymphoproliferative disorder in lung transplant recipients

Post-transplant lymphoproliferative disease (PTLD) is a serious, often fatal complication after solid organ transplantation. The incidence of PTLD is greater among heart (2 approximately 13%), lung (12%) and heart/lung (5 approximately 9%) transplant recipients than among liver (2%), renal (1 approximately 3%) and bone marrow (1 approximately 2%) transplants recipients. The difference in the incidence of PTLD may be partly attributed to the higher dose of immunosuppressant therapy used for heart and lung transplantation. The Epstein-Barr virus (EBV) infection status of the donor and recipient before a transplant, and high dose of immunosuppressive drugs are considered major risk factors. Recently, 2 cases of PTLD in a single lung and a heart-lung transplantation recipient were encountered. Both patients presented with multiple pulmonary nodules in the transplanted lung, which developed 6 months and 2 years after the transplantation, respectively. Following a transthoracic lung biopsy for diagnostic confirmation, one patient underwent chemotherapy for PTLD and the other conservative care for an accompanying viral infection. Both patients showed rapid clinical deterioration, without response to treatment, and then rapidly succumbed. Herein, our experiences are reported, with a review of the literature.ope

Thoracoscopic Sympathetic Nerve Reconstruction with using an Intercostal Nerve Graft after Thoracoscopic Sympathetic Clipping for Facial Hyperhidrosis

From October 2005 to August 2006, sympathetic nerve reconstruction with using the intercostal nerve was per- formed in 4 patients with severe compensatory hyperhidrosis following thoracoscopic sympathetic surgery for facial hyperhidrosis. The interval between the initial sympathetic clipping and the sympathetic nerve reconstruction was a median of 23.1 months. The compensatory sweating after sympathetic nerve reconstruction was improved for 2 pa- tients, but it was not improved for 2 patients. Thoracoscopic sympathetic nerve reconstruction may be one of the useful treatment methods for the patients with severe compensatory hyperhidrosis after they under go sympathetic nerve surgery for hyperhidrosis. (ope

Da Vinci Robot-Assisted Pulmonary Lobectomy in Early Stage Lung Cancer - 3 cases report -

Video-assisted pulmonary lobectomy was introduced in the early 1990's by several authors, and the frequency of video-assisted thoracic surgery (VATS) lobectomy for lung cancer has been slowly increasing because of its safety and oncologic acceptability in patients with early stage lung cancer. However, VATS is limited by 2D imaging, an unsteady camera platform, and limited maneuverability of its instruments. The da Vinci Surgical System was re- cently introduced to overcome these limitations. It has a 3D endoscopic system with high resolution and magnified binocular views and EndoWrist instruments. We report three cases of da Vinci robot system-assisted pulmonary lo- bectomy in patients with early stage lung cancerope

Ex vivo Lung Perfusion Model in Lung Transplantation

Background Lung transplantation (LTx) is an effective treatment for end stage lung disease. However, the shortage of donor lungs has been a major limiting factor to increase the number of LTx. Ex vivo lung perfusion (EVLP) is a currently approved method to evaluate lung function and to repair donor lung with poor function. The purpose of this study was to develop EVLP system in pig model and to maintain lung function during 4 hours of EVLP. Methods Bilateral lung blocks were harvested from five 40 kg pigs. These blocks were applied in EVLP perfused with 37℃ Steen solution. We performed arterial blood gas (ABG) analyses before death and also every 1 hour for 4 hours after application of EVLP and calculated oxygen capacities (OC) using the results of ABG. We also calculated pulmonary vascular resistance (PVR) and peak airway pressure (PAP) every 1 hour for 4 hours. After EVLP procedure, we excised specimens for pathologic review. Results We found that OC gradually decreased during the 4 hour period of EVLP; however, no statistically significant difference was obtained. PVR declined sharply after 1 hour of EVLP (P=0.031) and then remained constant for 3 hours. PAP significantly increased after 3 hours (P<0.0001). Pathologic investigations revealed various findings from normal lung to severe pulmonary edema. Conclusions On the results of this study, we could preserve the lung function for 4 hours using EVLP. We conclude that application of EVLP in clinical setting can make more donor lungs available for LTx. However, we also understand that more studies and training are needed in clinical practice.ope

Surgical Treatment for Empyema after Lung Transplantation

Empyema after lung transplantation causes dysfunction of the allograft, and it has the potential to cause mortality and morbidity, but the technical difficulty of surgically treating this empyema makes this type of treatment unfavorable. We report here on two cases of decortication for empyema after lung transplantationope

Surgical Treatment of Catamenial Pneumothorax - A report of two cases

Recurrent pneumothorax was associated with the menstrual cycle in two women 20 to 30 years age; this is referred to as catamenial pneumothorax. This form of pneumothorax occurs within 72 hours before or after the onset of menstruation. The pathophysiology underlying this condition is unknown. We report here on two cases of catamenial pneumothorax that were successfully treated by partial resection of the diaphragmope

Photodynamic therapy for endobronchial obstruction due to recurrent lung cancer - 2 cases report -

Recurrent lung cancer with endobronchial obstruction after surgical resection due to lung cancer may lead to severe dyspnea, respiratory insufficiency and sudden death. Many palliative modalities including partial excision of endobronchial tumor, insertion of stent, and evaporation with laser, have been used for endobronchial obstruction due to recurrent endobronchial lung cancer. In photodynamic therapy (PDT), photosensitizer named photofrin, is infused intravenously at 48 hours before PDT, and diode laser of an appropriate wavelength is applied to induce destruction of tumor mass with 200~250 J/cm2. We report 2 cases of treatment using PDT for endobronchial obstruction due to recurrent endobronchial lung cancer after surgical resection.ope

Paraneoplastic Encephalitis Associated with Thymoma: A Case Report

A 42-year-old woman with short-term memory loss visited Gangnam Severance Hospital, and her chest X-ray and computed tomography revealed a right anterior mediastinal mass. On hospital day two, she suddenly presented personality changes and a drowsy mental status, so she required ventilator care in the intensive care unit. She underwent thymectomy, and was pathologically diagnosed with thymoma, type B1. Her mental status eventually recovered by postoperative day 90. Paraneoplastic encephalopathy associated with thymoma is very rare, and symptoms can be improved by thymectomy. We report a case of paraneoplastic encephalopathy associated with a thymoma.ope

Noninvasive Respiratory Management for Patients with Cervical Spinal Cord Injury

OBJECTIVE: To verify the safety and clinical utility of noninvasive respiratory management as an alternative method of invasive respiratory management for the patients with cervical spinal cord injury (CSCI) who often present with ventilatory insufficiency (due to inspiratory muscle paralysis) or difficulty in removing airway secretions (because of expiratory muscle weakness). METHOD: Nineteen patients with CSCI (male: 15, female: 4, mean age: 45.6) were recruited. All of the patients were in need of mechanical ventilation due to ventilatory failure or indwelling tracheostomy tube for secretion management. In order to switch from invasive to noninvasive means of respiratory management, expiratory muscle aids such as manual assist or CoughAassist(R) and inspiratory muscle aids such as noninvasive ventilatory support were applied to all candidates. RESULTS: Fifteen out of the 19 patients had indwelling tracheostomy tubes, and the remaining 4 patients were intubated via endotracheal tubes at admission. Through the noninvasive respiratory management, we were able to remove intubation or traheostomy tubes for all of the patients. Eleven patients were able to maintain normal ventilation status without ventilatory support, as time went on. The rest 8 patients were continuously in need of ventilatory support, but they could maintain normal ventilation status by noninvasive method. CONCLUSION: Noninvasive respiratory management is safe and equally effective in treating ventilatory insufficiency or removing airway secretions for patients with CSCI. In cases of long-term ventilator dependency or chronic tracheostomy state, it can be replaced as a creditable alternative to invasive respiratory managementope