Jae Jun Kim

How early can we repair pectus excavatum: the earlier the better?

OBJECTIVESnThe optimal age for the repair of pectus excavatum using minimally invasive technique has yet to be determined. We hypothesized that the early repair of pectus excavatum may contribute in preserving chest wall integrity and also in enhancing patients growth. The purpose of our present study was to verify a potential advantage of the early repair of pectus excavatum by using a minimally invasive technique.nnnMETHODSnFor our study on minimally invasive pectus excavatum repair, 1571 patients from the period 1999 to 2011 were enrolled. Our strategy was to carry out routine repairs in patients older than 3 years of age. To examine the age factor on the results of the repairs the patients were divided into different age groups: Group 1 (≤ 5 years, 618 (39.3%)), Group 2 (6-11 years, 322 (20.5%)), Group 3 (12-20 years, 401 (25.5%)) and Group 4 (>20 years, 230 (14.6%)). A comparative analysis was performed for factors such as complication rates; growth-percentile scores of height, weight and body mass index (BMI); incidence of asymmetry and costal flare score to determine the potential to resume the normal chest wall conformation by earlier repair.nnnRESULTSnThe mean age of the patients was 10.2 years (16 months to 51 years). The incidence of asymmetry was found to be lowest in Group 1 (24.3, 45.5, 58.7, 48.4%, respectively, P < 0.001). The complication rate after repair was also lowest in Group 1 (7.6, 11.5, 16.3, 19.1%, respectively, P < 0.001). The growth of body weight was significant in Groups 1 and 2 (0.53 ± 1.02, P < 0.001). The costal flare score was found to have decreased in Groups 1 and 2 (Group 1: from 1.6 to 0.12, P < 0.001; Group 2: from 1.44 to 0.14, P < 0.001). In Groups 3 and 4, there was no improvement in costal flare after repair.nnnCONCLUSIONSnOur results suggest that routine early repair of pectus excavatum in patients older than 3 years of age is safe and effective. We would recommend early repair to avoid asymmetry transformation of the deformity and to enhance the patients growth potential.

Total Gastrectomy in Gastric Conduit Cancer

We report a very rare case of surgery on gastric conduit cancer. A 67-year-old male patient underwent esophagectomy and intrathoracic esophagogastrostomy for squamous cell carcinoma of the lower thoracic esophagus 27 months ago. Upon follow-up, a gastric carcinoma at the intra-abdominal part of the gastric conduit was found on an esophagogastroduodenoscopy. We performed total gastrectomy and esophagocolonojejunostomy in the manner of Roux-en-Y anastomosis. The postoperative course was not eventful and an esophagogram on the 10th postoperative day showed no leakage or stenosis of the passage. The patient was discharged on the 17th day with no complications.

Surgical Resection of Pulmonary Metastasis from Renal Cell Carcinoma

Background Renal cell carcinoma has shown less response to systemic therapies including chemotherapy, radiation, and immunotherapy than other cancers. Surgery has therefore become an important treatment tool. The protocol for treatment is the same for pulmonary metastasis of renal cell carcinoma. We performed surgery for pulmonary metastatic renal cell carcinomas and analyzed the results. Materials and Methods We retrospectively analyzed 15 patients who had undergone pulmonary metastasectomy from renal cell carcinoma at our hospital from January 2005 to December 2009. Results No patients had extrathoracic metastatsis. The mean age was 60.2 years (range 35~73). There were 12 male and 3 female patients. The number of synchronous and metachronous patients were 8 and 7, respectively. The mean survival times of synchronous and metachronous patients were 32.6 and 42.9 months, respectively. 6 patients had single lesions and 9 patients had multiple (more than 3) lesions. The surgical procedures included wedge resection (10), lobectomy (2), wedge resection with segmentectomy (2), and segmentectomy (1). Median observation and survival time were 54.1 and 34.9 months. The 1-year and 3-year survival rates were 80% and 50%, respectively. Conclusion Pulmonary resection for pulmonary metastatic renal cell carcinoma was found to be a safe and effective treatment modality when complete resection was performed.

Lung Cancer Associated with Sarcoidosis - A case report -

Sarcoidosis is a somewhat common pulmonary disease, but the concurrence of lung cancer and sarcoidosis in the same patient is very rare. Because sarcoidosis usually presents as mediastinal lymphadenopathies, this concurrence in a lung cancer patient detected radiologically is apt to be misunderstood to be mediastinal metastases, and it is thus considered to be an unresectable disease. We report a case of lung cancer associated with sarcoidosis that developed in a 65-year-old woman who underwent surgery. Radiological studies revealed a 1.9×1.7 cm mass in the left upper lobe with multiple enlarged bilateral mediastinal lymph nodes (2R, 3a, 4R, 4L, 5, 6, 7, 8R). Pathologic findings showed that the mass was a well-differentiated adenocarcinoma and all of the enlarged mediastinal lymph nodes were granulomas without cancer metastasis. We report this case with a review of the literature.

Diffuse Alveolar Hemorrhage in a 39-year-old Woman: Unusual Initial Presentation of Microscopic Polyangiitis

Microscopic polyangiitis (MPA) is a necrotizing vasculitis involving the small vessels without granulomatous inflammation. Most MPA initially presents with renal involvement without pulmonary involvement. Isolated and initially presenting alveolar hemorrhage is very rare. The patient was a 39-year-old female with a progressive cough, dyspnea, and blood-tinged sputum for the previous 5 days. We determined that her condition was MPA though VATS lung biopsy and renal biopsy. After 2 months of steroid therapy, the chest lesions had improved. We report here a rare case of MPA with isolated and initial involvement of the lung with a review of the literature.

Complete Resection of Pulmonary Metastatic Melanoma

Background The prognosis of melanoma metastasized to other organs is very poor. There have been many studies on metastatic melanoma in Western society, but there have been few studies done in Korea because of the small number of cases. Materials and Methods A retrospective review of 7 patients who underwent complete resection of pulmonary metastases from melanoma from January 2005 to December 2009 was performed. When the primary lesion was controlled or simultaneously controllable and no other metastatic lesion was found, pulmonary resections were performed. We analyzed the clinical prognoses after the initial melanoma diagnosis. Results Of the seven patients, one was male and six were female. The mean age was 58.2 years (range 45~71). Six patients had a single pulmonary lesion and one patient had three lesions confined to the same lobe. The mean disease-free interval was 43.5 months (0~146 months). Before pulmonary resection, 4 patients had received systemic therapy. After pulmonary resection, 6 patients received systemic therapy. Complete resection was confirmed histologically. The metastasectomy was performed by wedge resection (6 patients) or lobectomy (1 patient). There were no mortalities or complications. After pulmonary resection, 1 patient had recurrent multiple lesions in the lung and 4 patients had metastases to other organs. The organs were the liver, brain, pleura, and lymph nodes. The mean observation time was 31.6 months and 3 patients died during observation. The mean survival was 27.7 months (14~60 months) and the 1-year and 3-year survival rates were 100% and 42%, respectively. Conclusion When patients were selected carefully, the complete resection of pulmonary metastatic lesions was considered a major therapeutic tool.

Implementation of Image-based Virtual Fence for Surveillance Area Setup

The existing CCTV has limitation such as problem on usage of the off-line type of recorded image for specific investigation, and requirement on interactive operator intervention for real-time surveillance. Therefore, it is required to develop the intelligent CCTV equipped with various functionalities in order to overcome drawbacks mentioned above. In this paper, implementation methods of image-based virtual fence were proposed by using the spline curves with supplied control for setup of surveillance area. In addition, pre-alarm region within the predefined distance was established with tangent and normal lines extracted from control points. The image-based virtual fence can be used for remote detection of intrusion and provision of real-time intrusion alarm, and can be expected to use in safety-related application areas including security and crime prevention.

Blunt cardiac trauma: right atrioventricular groove rupture

Seong Cheol Jeong, Si Young Choi, Jae Jun Kim and Yong Hwan Kim* Department of Thoracic and Cardiovascular Surgery, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, College of Medicine, Seoul, South Korea * Corresponding author. Uijeongbu St. Mary’s Hospital 65-1, Geumo-dong, Uijeongbu, Gyeonggi-do, 480-821, South Korea. Tel: +82-31-8203586; fax: +82-31-8472934; e-mail: cmccs@naver.com (Y.H. Kim). Received 11 December 2012; accepted 14 January 2013