Chao-Hung Chen

Massive Necrotizing Pneumonia With Pulmonary Gangrene

Pulmonary gangrene is an extremely rare and severe complication of pneumonia. It is very rarely seen in community-acquired pneumonia. A 49-year-old immunocompetent man was admitted with community-acquired pneumonia caused by Klebsiella pneumonia. His condition rapidly deteriorated with ensuing pulmonary gangrene and septic shock. He was successfully managed by emergency pneumonectomy.

Technical aspects of single-port thoracoscopic surgery for lobectomy

Thoracoscopic Surgery is in common use in routine surgical practice. With the advancement of the various techniques and instruments required, mini wounds and fewer thoracoports become practical in recent years. Here, we report our experience of performing lobectomy with radical lymph node dissection in 3 patients using regular straight endoscopic instruments. We demonstrate the feasibility of such techniques and discuss the key points of effectively performing the procedures. Because of the favorable outcomes, we encourage such procedures to be widely applied in surgical operations of various types.

The adequacy of single-incisional thoracoscopic surgery as a first-line endoscopic approach for the management of recurrent primary spontaneous pneumothorax: a retrospective study

BackgroundThoracoscopic surgery is a commonly used endoscopic surgical treatment approach in patients with primary spontaneous pneumothorax. The conventional thoracoscopic approach utilizes three or more small wounds for surgery. Currently, a single port approach is a potential alternative procedure in general thoracoscopic surgery. We investigated whether a single-port approach is suitable as a first-line endoscopic approach for all patients with primary spontaneous pneumothorax requiring surgery.MethodsFrom July 1st, 2008 to Dec 31, 2009, a total of 62 patients was included in this study. All the patients were admitted to our ward because they had surgical indications for surgery. Twenty-six patients underwent conventional three-port thoracoscopic surgery and thirty-six underwent single-port thoracoscopic surgery. All of the clinical data were analyzed retrospectively. Variables were compared and analyzed to determine the outcomes of the different surgical approaches.ResultsThe mean age of the 62 patients was 27.2 years. Forty-nine patients were men and thirteen patients were women. The mean time required for the operation was 61.6 minutes. There was one patient who had a recurrence in single-port group and 2 patients had a recurrence in three-port group during the period of follow-up. The average pain scores at 24 and 48 hrs after the operation were similar, but the pain scores at 72 hrs in the single-port group were better than the three-port group. There was no case that required conversion from a single-port to multiple wound approach in this study. There was no immediate postoperative recurrence. The follow-up duration was greater than 12 months.ConclusionThis study showed that single-port thoracoscopic surgery is a feasible and reasonable first-line endoscopic approach in the surgical treatment of primary spontaneous pneumothorax.

Inflammatory Myofibroblastic Tumor Mimicking Anterior Mediastinal Malignancy

Inflammatory myofibroblastic tumor arising in the anterior mediastinum is rare. A 58-year-old woman had an anterior mediastinal mass invading the sternum, pericardium, and pleura. It was completely resected and found to be an inflammatory myofibroblastic tumor. The patient was well and had no recurrence 6 months after surgery.

Restrictive Chest Wall Deformity as a Complication of Surgical Repair for Pectus Excavatum

The Ravitch operation is frequently performed to correct pectus excavatum. However, extensive destruction of the perichondrium and rib growth centers may lead to failure of subsequent chest wall development. A 29-year-old man who underwent a Ravitch operation 26 years previously developed a restrictive chest wall deformity, which resulted in severe pulmonary hypertension and restrictive lung disease.

Single-port thoracoscopic surgery can be a first-line approach for elective thoracoscopic surgery

BACKGROUND Thoracoscopic surgery has become very popular in recent years. Conventional thoracoscopic surgery requires three or more port wounds for manipulations of endoscopic instruments. For complicated cancer surgery, more port wounds and a larger thoracotomy wound may be required due to technical reasons. We want to investigate the effectiveness of single-port thoracoscopic approach in elective thoracoscopic surgery for thoracic disease. MATERIALS AND METHODS From July 1st, 2010 to March 31, 2011, 90 consecutive patients underwent general thoracoscopic surgery performed by the same thoracic surgeon. Two patients with severe trauma and massive bleeding were excluded from the study. All patients included had thoracoscopic surgery with a single-port approach. The surgical outcomes, complications, mortality and conversion rates were recorded and analyzed. RESULTS A total of 88 patients were included in this study. All these patients were operated on by the same surgeon. For sixty-eight patients, the single-port thoracoscopic approach was used. Nineteen patients were changed to a two-port thoracoscopic approach and one patients was changed to mini-thoracotomy. Two patients died from terminal lung cancer and severe mitral regurgitation. Complications occurred in six cases. Eighty-seven patients (98.8%) were effectively managed with either single-port or a two-port approach. Only one patient was managed by mini-thoracotomy. CONCLUSION Elective thoracoscopic surgery performed through a single-port wound is feasible. Single-incisional thoracoscopic surgery can be safely applied as a first-line approach in most cases of elective thoracoscopic procedures.

A rare case of dysphagia and palpitation caused by the compression exerted by an enormous mediastinal lipoma

A 65-year-old woman presented with mild dysphagia, weight loss and intermittent palpitation. Chest radiograph revealed a large opacity in the right lower lung field. Subsequent CT scan showed a large posterior mediastinal lipoma extending from the level of the aortic arch to the thoracoabdominal junction. After thoracoscopic resection, the patients dysphagia and palpitation were resolved. After a follow-up of 2 years, the patient has had no evidence of recurrence.

Video-Guided Tube Thoracostomy With Use of an Electrical Nonfiberoptic Endoscope

PURPOSE Tube thoracostomy is a common and generally safe procedure. However, potential hazards can occur during placement of the chest tube. Inasmuch as unexpected injuries may arise from tube thoracostomy, we propose a novel video-guided method. DESCRIPTION We used an independent complementary metal oxide semiconductor image sensor with a processing chip to obtain a front view image of the chest cavity. The device is connected to an aluminum shaft with four small light-emitting diode crystals in the tip, and a detachable small monitor with a battery inside. The apparatus is small and can be used to direct vision-guided tools in tube thoracostomy. EVALUATION We performed video-guided tube thoracostomy in 6 patients with pleural adhesions. All patients experienced good tolerance to the procedure and had no immediate adverse events. The thoracostomies were performed by a single surgeon with good acceptability, and each procedure was completed in less than 10 minutes. CONCLUSIONS In some cases of pleural adhesion, the video-guided thoracostomy may be a safer alternative to non-image guided tube thoracostomy.

Bilateral pulmonary metastectomy through a unilateral single-port thoracoscopic approach

A 58-year-old woman underwent radical proctectomy 19 months prior to admission. The initial diagnosis was rectal adenocarcinoma of pathological stage T2N0M0. She was discharged five days after the operation. She was followed by abdominal computed tomographic (CT) scan at 3, 9 and 18 months after the operation. Eighteen months after the operation, follow-up abdominal CT scan revealed tiny nodules in the bilateral lower lobes. Subsequent CT scan of the chest showed two tiny nodules in the right lower lobe and a single tiny nodule in left lower lobe. She then underwent single port thoracoscopic surgery through the right side for resection of the nodules. Using a single port wound, we excised the two tiny nodules on the right side and the one tiny nodule in the left lower lobe across the mediastinum. She was discharged four days later. The final pathology report showed those three nodules were metastases from an adenocarcinoma in the colon.

Pneumothorax, pneumomediastinum and pneumopericardium complications arising from a case of wisdom tooth extraction

A 25-year-old woman underwent surgical tooth extraction. Several hours after the procedure, the woman complained of severe retrosternal pain and mild dyspnea. Subsequent imaging revealed subcutaneous emphysema from the mandibular region extending to the mediastinum and left side pneumothorax, as well as pneumopericardium. After treatment with antibiotics and analgesics, the patient recovered without any complications.