Bong Soo Son

Association between Sarcopenia and Metabolic Syndrome in Chronic Obstructive Pulmonary Disease: The Korea National Health and Nutrition Examination Survey (KNHANES) from 2008 to 2011

Abstract Aim: It is not clear whether the restrictive or obstructive pattern of spirometry is associated with metabolic syndrome. We investigated the associations between restrictive and obstructive spirometric patterns and metabolic risk factors using data from the Korea National Health and Nutrition Examination Survey (KNHANES). Additionally, we investigated whether sarcopenia is associated with metabolic syndrome in patients with chronic obstructive pulmonary disease (COPD). Methods: Using data from KNHANES between 2008 and 2011, we enrolled 8,145 subjects (normal lung function: 6,077, obstructive spirometric pattern: 1,039, restrictive pattern: 1,029) aged ≥40 years who underwent anthropometric measurement, laboratory tests, spirometry and estimation of appendicular muscle mass. Sarcopenia was defined as an appendicular skeletal muscle mass divided by body weight squared <2 SD below the sex-specific mean for the young reference group. Results: Sarcopenia was found in 32.8% of male and 12.2% of female patients with COPD. The odds ratio (OR) of metabolic syndrome for the restrictive spirometric pattern in male was 1.29 (95% confidence interval [CI], 1.02–1.65), and that for obstructive pattern in males was 0.99 (95% CI, 0.79–1.26) after adjustments for covariables (female restrictive pattern (ORs, 1,45; 95% CI, 1.09–1.91) and female obstructive pattern (ORs 0.73; 95% CI, 0.49–1.09). After adjustment for other confounding factors, the risk of metabolic syndrome was higher in sarcopenic male (OR, 1.88; 95% CI, 1.27–2.77) with COPD than in those without sarcopenia. Conclusions: The restrictive spirometric pattern is associated with metabolic syndrome, and sarcopenia may contribute to the risk of metabolic syndrome in male patients with COPD.

Life-threatening cardiac tamponade: a rare complication of acupuncture

Acupuncture as an ancient Chinese treatment has proven effective and is utilized worldwide. Although it is generally believed to be a safe clinical procedure, serious lethal complications including death have been reported. We present a rare case of life-threatening cardiac tamponade due to penetration of an acupuncture needle directly into the right ventricle.

Modified Incision and Closure Techniques for Single-Incision Thoracoscopic Lobectomy

Single-incision video-assisted thoracoscopic surgery (VATS) lobectomy has recently gained attention due to its various advantages. However, this technique requires direct insertion of the chest tube into the thoracic cage; thus, leakage of intrathoracic fluid or air around the tube frequently occurs. Additionally, cosmetic problems may develop due to direct fixation of the chest tube at the site of the skin incision. To solve these problems we designed new incision and closure techniques for VATS lobectomy. In our technique the skin is incised lower than an intercostal muscle incision, and the chest tube transpierces the chest wall muscle about 1 cm below the incision. Finally, nylon is used for tube fixation and is anchored through the subcutaneous suture.

Single-incision thoracoscopic surgery using an anchoring suture of the lung parenchyma for two-directional traction.

Single-incision thoracoscopic surgery (SITS) is difficult to perform because of an increased likelihood of collision between surgical instruments; moreover, the use of all the instruments through a single incision requires the creation of a relatively large incision. Therefore, a new SITS technique needs to be developed to reduce the likelihood of collision between surgical instruments and the incision size to a cosmetically acceptable one. In the present study, we aimed to perform SITS to easily avoid collisions between instruments through small-incision sites by means of a novel two-directional traction method using anchoring lung sutures.

Castleman's Disease with Myasthenia Gravis

Castlemans disease is a rare disorder characterized by benign tumors that may develop in the lymph node tissue throughout the body. Castlemans disease associated with myasthenia gravis is an especially rare disease. Only less than 10 cases have been reported in the world literature. The cause of Castlemans disease is associated with immune mediated reaction, and myasthenia gravis also develops due to an antibody-mediated process. The cause of myasthenia gravis is the immune activity of Castlemans disease, which may be the promoter of the antibody-mediated process. We report here a case of Castlemans disease, which was incidentally found in a patient diagnosed with myasthenia gravis.

Conservative extracorporeal membrane oxygenation treatment in a tracheal injury: a case report

In patients with tracheal injuries, conservative treatment is an alternative approach when surgical treatment is difficult. However, the success rate of conservative treatment is low when a ventilator is used constantly because of underlying lung disease, and successful conservative treatment requires the maintenance of as much self-respiration as possible without a ventilator. Here, we report a case of lower tracheal injury in which both surgical and conservative treatments were difficult, but conservative treatment with extracorporeal membrane oxygenation was successful while maintaining self-respiration without a ventilator.

The Feasibility of Extracorporeal Membrane Oxygenation in the Variant Airway Problems

INTRODUCTION Extracorporeal membrane oxygenation (ECMO) is widely used to treat respiratory distress during cardiac or respiratory arrest; moreover, its use is being extended to a wide variety of clinical fields. In this study we assess the utility of ECMO in the management of airway obstruction. PATIENTS AND METHODS 15 patients underwent ECMO for airway obstruction. We retrospectively analyzed and evaluated the feasibility of ECMO in the treatment of airway problems. RESULTS Seven patients received ECMO to facilitate respiration and promote stability during trachea surgery. In six cases ECMO ceased immediately following the operation; in the remaining case ECMO cessation was delayed due to post-operative ARDS. In three cases emergency ECMO was used in response to respiratory arrest; two patients died. In five cases ECMO was emergently inserted to prevent death, following airway blockade by massive hemoptysis. One patient was not discharged from the intensive care unit. Another patient was transferred to a general ward but died from other causes. CONCLUSION ECMO is useful during anesthesia in patients at high risk of airway blockade, for example due to endobronchial bleeding, and during complex thoracic surgery. ECMO confers a safer environment during airway surgery, and its complication rate is acceptable.

Validity of Outcome Prediction Scoring Systems in Korean Patients with Severe Adult Respiratory Distress Syndrome Receiving Extracorporeal Membrane Oxygenation Therapy

Recently, several prognostic scoring systems for patients with severe acute respiratory distress syndrome (ARDS) requiring extracorporeal membrane oxygenation (ECMO) have been published. The aim of this study was to validate the established scoring systems for outcome prediction in Korean patients. We retrospectively reviewed the data of 50 patients on ECMO therapy in our center from 2012 to 2014. A calculation of outcome prediction scoring tools was performed and the comparison across various models was conducted. In our study, the overall hospital survival was 46% and successful weaning rate was 58%. The Predicting Death for Severe ARDS on V-V ECMO (PRESERVE) score showed good discrimination of mortality prediction for patients on ECMO with AUC of 0.80 (95% CI 0.66-0.90). The respiratory extracorporeal membrane oxygenation survival prediction (RESP) score and simplified acute physiology score (SAPS) II score also showed fair prediction ability with AUC of 0.79 (95% CI 0.65-0.89) and AUC of 0.78 (95% CI 0.64-0.88), respectively. However, the ECMOnet score failed to predict mortality with AUC of 0.51 (95% CI 0.37-0.66). When evaluating the predictive accuracy according to optimal cut-off point of each scoring system, RESP score had a best specificity of 91.3% and 66.7% of sensitivity, respectively. This study supports the clinical usefulness of the prognostic scoring tools for severe ARDS with ECMO therapy when applying to the Korean patients receiving ECMO.

Cardiac Perforation due to Intracardiac Bone Cement After Percutaneous Vertebroplasty

A 68-year-old female presented with progressive dyspnea 28 days following a percutaneous vertebroplasty of the third lumbar vertebrae for chronic back pain. A chest radiograph, which was obtained on admission, showed a massive pleural effusion in the left lung field andmultiple high-density tubular opacities corresponding to the course of the pulmonary vessels (Fig. 1). Chest computed tomography (CT) revealed radio-opaque linear deposits in the right ventricle and distal branches of both pulmonary arteries. Thus, it was suspected that themetal-densitymaterials, found in the right ventricle, had perforated the right ventricular-free wall and caused hemopericardium and hemothorax (Fig. 2).

Small Single-Incision Thoracoscopic Surgery Using an Anchoring Suture in Patients With Primary Spontaneous Pneumothorax: A Safe and Feasible Procedure

BACKGROUND Single-incision thoracoscopic surgery is an alternative procedure used to treat primary spontaneous pneumothorax, although conventional three- or four-port video-assisted thoracoscopic surgery is the recognized standard procedure. Single-incision thoracoscopic surgery is not yet popular when a wedge resection is required during general thoracic surgery, including pneumothorax surgery and lung biopsy, because of the danger of collision between instruments during surgery. In addition, introducing all of the instruments through a single incision means that a relatively large incision is required, leading to less than satisfactory cosmetic outcomes. The purpose of this study was to show that our in-house surgical method is a safe, alternative procedure for treating a primary spontaneous pneumothorax. METHODS A total of 104 patients underwent our in-house surgical procedure to treat primary spontaneous pneumothorax from October 2012 to October 2014. Mean patient age was 22.7 ± 8.8 years; 91 patients were male and 13 were female. We used a wound protector intraoperatively, and placed an anchoring suture at the point of the bleb lesion, permitting us to retract the lung, which enabled us to create a small skin incision (<2 cm). We only inserted a stapler and the scope through this small incision when we performed the wedge resection; no lung manipulation (normally requiring instrumentation) was necessary. A total of 107 surgeries were performed (3 patients experienced contralateral recurrences). All clinical data were analyzed retrospectively. RESULTS Mean operative time (107 surgeries) was 49.7 ± 13.9 minutes, and the mean duration of thoracic catheter insertion was 4.1 ± 1.0 days. Three cases were converted to two- or three-port video-assisted thoracoscopic surgery during the operation. Three patients experienced prolonged air leakage (>5 days). No other complication was recorded. The Wong-Baker pain scores on postoperative days 0, 1, and 2 were 2.4 ± 1.0, 2.3 ± 1.3, and 1.7 ± 0.83, respectively. The mean duration of postoperative hospital stay was 4.8 ± 1.7 days. The mean follow-up period was 11 ± 6 months. Twelve patients experienced chest wall paresthesia (11.2%). One ipsilateral pneumothorax recurrence was encountered during follow-up. CONCLUSIONS Small (<2 cm) single-incision thoracoscopic surgery using a wound protector and a bidirectional anchoring suture was safe and feasible and yielded acceptable outcomes for treating primary spontaneous pneumothorax.