Seok Whan Moon

Somatic mutations of the ERBB4 kinase domain in human cancers.

The EGFR family consists of 4 receptor tyrosine kinases, EGFR (ERBB1), ERBB2 (HER2), ERBB3 (HER3) and ERBB4 (HER4). Recent reports revealed that the kinase domains of both EGFR (ERBB1) and ERBB2 gene were somatically mutated in human cancers, raising the possibility that the other ERBB members possess somatic mutations in human cancers. Here, we performed mutational analysis of the ERBB4 kinase domain by polymerase chain reaction–single‐strand conformation polymorphism assay in 595 cancer tissues from stomach, lung, colon and breast. We detected the ERBB4 somatic mutations in 3 of 180 gastric carcinomas (1.7%), 3 of 104 colorectal carcinomas (2.9%), 5 of 217 nonsmall cell lung cancers (2.3%) and 1 of 94 breast carcinomas (1.1%). The 12 ERBB4 mutations consisted of 1 in‐frame duplication mutation and 8 missense mutations in the exons, and 3 mutations in the introns. We simultaneously analyzed the somatic mutations of EGFR, ERBB2, K‐RAS, PIK3CA and BRAF genes in the 12 samples with the ERBB4 mutations and found that 1 gastric carcinoma with ERBB4 mutation also harbored K‐RAS gene mutation. Our study demonstrated that in addition to EGFR and ERBB2, somatic mutation of the kinase domain of ERBB4 occurs in the common human cancers, and suggested that alterations of ERBB4‐mediated signaling pathway by ERBB4 mutations may contribute to the development of human cancers.

Short-term and intermediate-term results after unclipping: what happened to primary hyperhidrosis and truncal reflex sweating after unclipping in patients who underwent endoscopic thoracic sympathetic clamping?

Endoscopic thoracic sympathetic clamping (ETC) is used to treat patients with primary hyperhidrosis because it offers the potential of a reversal operation (unclipping) when severe reflex sweating (RS) occurs. Although unclipping has been reported to be effective, the short-term or intermediate-term results after unclipping are unclear. From March 2002 to October 2006, 15 (12.9%) out of 116 patients with primary hyperhidrosis, who underwent ETC, had the endoclip(s) removed as a result of RS. Fourteen patients could be followed up for more than 6 months. The patients answered a telephone interview on the severity of RS, the recurrence of the primary site, and their level of satisfaction. There was no mortality or significant morbidity encountered. On the follow-up, 9 (64%) of the 14 patients who underwent unclipping reported symptomatic recovery from RS. Of these 9 patients with early unclipping (within 4 wk after ETC), only 7 (78%) were satisfied with the outcomes. This suggests that early unclipping does not always guarantee satisfactory recovery from RS. Because early unclipping does not guarantee a full recovery in all patients, special consideration in ETC is needed to determine when to remove the clamp and how strongly to apply the clamp to achieve better results.

Anterolateral Papillary Muscle Rupture Complicated by the Obstruction of a Single Diagonal Branch

A 66-year-old woman presented with a sudden onset of anterior chest pain lasting 2 days and a 1-year history of atrial fibrillation. She had never taken medication for the atrial fibrillation, and this was her first episode of chest pain. The physical examination, including cardiac enzymes, ECG, and echocardiogram, showed that she had acute myocardial infarction with severe mitral regurgitation (Figure 1). There was no evidence of systemic embolism other …

Rotational pectoral musculocutaneous flap for the repair of gastric conduit necrosis in cervical esophagogastrostomy

We experienced a case of wide necrosis of the cervical gastric conduit during esophageal cancer surgery. We attempted to repair this defect with various methods including conservative care, stents two times, and sternocleidomastoid muscle flap without successful results. Finally, we were able to reconstruct the gastric conduit defect with rotational pectoralis major musculocutaneous (PMM) flap. PMM flap is thought to be a reconstruction method applicable to the intractable gastric conduit defect.

New protocol for a reversal operation in endoscopic thoracic sympathetic clamping: pulling back the suture sling linked to the clip under local anesthesia.

Endoscopic thoracic sympathetic clamping (ETC) has widely been used for treating the patients with primary hyperhidrosis, as it offers the potential of reversal operation (unclipping) under general anesthesia (GA) when severe reflex sweating would occur. However, we modified ETC to unclip under local anesthesia. From March 2002 to January 2005, we performed ETC in 87 patients with primary hyperhidrosis. From September 2002 on, the suture sling which was made with a 3-0 propylphylene suture was additionally placed between the endoclip and the subcutaneous tissue of the thoracoport. When unclipping was needed, the endoclip was removed by being pulled back under portable fluoroscopy. Four of 53 patients (7.5%) who underwent ETC alone underwent unclipping under GA. By contrast, unclipping was successfully performed under local anesthesia in 5 of 34 patients (14.7%) who underwent the modified ETC. ETC will be more effective operation if it is modified concomitantly with the suture sling; otherwise the reversal operation will need GA for the unclipping.

Fluoroscopy-assisted thoracoscopic resection for small intrapulmonary lesions after preoperative computed tomography-guided localization using fragmented platinum microcoils.

BACKGROUND Preoperative localization is frequently necessary to perform thoracoscopic resection of a small and/or deeply located intrapulmonary lesion. We developed a new method that uses a fragmented platinum microcoil, and retrospectively evaluated the efficacy of our technique. METHODS Between January 2006 and May 2010, self-made microcoils (Easimarker) were used to localize total 32 lesions (21 solid nodules, and 11 ground glass opacities) in 30 patients. Computed tomography-guided localization was performed into, or just around the lesions. Localized lesions were resected using fluoroscopy-assisted thoracoscopic surgery (FATS), and the histopathologic diagnosis was confirmed. The accuracy and complications of the localization procedure, and operative results of FATS were observed. RESULTS Mean size and depth of all lesions were 11.8 ± 5.1 mm (range: 3 to 22) and 12.2 ± 7.1 mm (range: 2 to 30). CT-guided localizations were successfully performed in all lesions. Four minimal pneumothorax and one parenchymal hematoma related with localization procedure occurred. There were three repeated procedures, which resulted from pleural rebounding of the microcoils. There were two microcoil detecting failures due to intrathoracic displacement during FATS. All 32 resected lesions were histopathologically diagnosed. CONCLUSION CT-guided localization using the fragmented microcoil combined with FATS of small intrapulmonary lesions is a safe, effective, and a diagnostically accurate procedure.

A cross-sectional study for the development of growth of patients with pectus excavatum.

OBJECTIVES Pectus excavatum is one of the most common congenital chest wall deformities, and is thought to be one of the musculoskeletal diseases. There have been few studies on the development of growth of patients with pectus excavatum. The objectives of the present study were to present the development of growth of patients with pectus excavatum and to investigate the effects of the Nuss procedure on the development of growth. METHODS Data from 1371 patients who were treated for pectus excavatum (411 patients for only the Nuss procedure, 316 patients for only bar removal and 322 patients for both the Nuss procedure and the bar removal) at the Department of Thoracic and Cardiovascular Surgery in a single tertiary Korean Hospitals from March 2011 to December 2014 were assessed with respect to body measurements [height, weight and body mass index (BMI)]. Anthropometric measurements and developmental data and deviations of a reference population were analysed by the Fifth Korea National Health and Nutrition Examination Survey (KNHANES V-3), 2011-2013, Korea Centers for Disease Control and Prevention. To analyse the development of growth in patients with pectus excavatum, we performed (i) comparisons of body measurements between patients with pectus excavatum and the normal population, (ii) analyses of postoperative changes in the body measurements and (iii) analyses of the body measurements with respect to age at surgery, morphology and severity. RESULTS (i) Body measurements of the preoperative group (PreG, patients for the Nuss procedure) were significantly smaller than those of the normal control group (NCG) (height 139.2 ± 0.4 vs 140.7 ± 0.0, weight 37.4 ± 0.3 vs 39.6 ± 0.0, BMI 17.5 ± 0.1 vs 18.6 ± 0.0, all P < 0.001). Weight and BMI of the postoperative group (PostG, patients for pectus bar removal) were also significantly smaller than those of NCG (weight 36.6 ± 0.4 vs 39.6 ± 0.0, BMI 17.4 ± 0.1 vs 18.6 ± 0.0, both P < 0.001). However, height of PostG was not significantly different from that of NCG. In addition, height and BMI of PostG were larger than those of PreG (height 131.2 ± 0.3 vs 130.4 ± 0.3, P < 0.001; BMI 16.7 ± 0.1 vs 16.6 ± 0.1, P = 0.143). However, weight of PostG was significantly smaller than that of PreG (30.4 ± 0.2 vs 30.9 ± 0.2, P = 0.005). (ii) The severity of pectus excavatum was defined by the Haller index and the patients were divided into two groups by the mean value of the Haller index (4.3 ± 1.53). Preoperatively, weight and BMI of the high severity group (HG) were significantly smaller than those of the low severity group (LG) (weight 28.2 ± 0.3 vs 29.1 ± 0.2, P = 0.029; BMI 16.2 ± 0.1 vs16.6 ± 0.1, P = 0.008); however, height of HG was not significantly different from that of LG. Postoperatively, body measurements of HG were not significantly different from those of LG. In addition, severity of pectus excavatum was not correlated to age. (iii) Preoperatively, body measurements of the symmetric group (SG) were not different from those of the asymmetric group (AG). However, asymmetric type was more common in the older group (10.8 ± 5.7 vs 6.7 ± 5.0 years, P < 0.001). In addition, body measurements of SG were not different from those of AG postoperatively. (iv) Body growth after the surgery was more prominent in the early (age <10 years: height 112.4 ± 0.3 vs113.1 ± 0.4, P = 0.016, weight 20.2 ± 0.1 vs 20.2 ± 0.3, P = 0.053, BMI 15.7 ± 0.2 vs 15.8 ± 0.1, P = 0.007) than the late operation group (age ≥10 years: height 167.7 ± 0.5 vs 167.0 ± 0.6, P < 0.001, weight 51.2 ± 0.5 vs 51.8 ± 0.5, P = 0.536, BMI 18.1 ± 0.1 vs 18.3 ± 0.1, P = 0.078). CONCLUSIONS Development of growth in patients with pectus excavatum is retarded and appears to be related to the severity of pectus excavatum. The development of growth can be recovered by early correction of the deformity.

Intractable hiccup accompanying pleural effusion: reversible clipping of an intrathoracic phrenic nerve.

Hiccup is usually a self-limiting condition, and can be treated with medications and physical maneuvers. However, hiccup episodes continuing for days or weeks can be incapacitating, and disturb work, sleep, and eating. Therefore, timely therapeutic intervention is needed to achieve early resolution of this treatable condition. We report on a successful phrenic nerve block for intractable hiccups, which consisted of thoracoscopic nerve clipping under general anesthesia and reversal under local anesthesia. This method has the advantage of assured diaphragmatic functional recovery while controlling intractable hiccups.

Risk factors for recurrence after sublobar resection in patients with small (2 cm or less) non-small cell lung cancer presenting as a solid-predominant tumor on chest computed tomography

BACKGROUND Sublobar resection is considered controversial for non-small cell lung cancer (NSCLC) presenting as a solid-predominant nodule. The aim of this study was to identify risk factors related to recurrence in small-sized NSCLC presenting as a solid-predominant nodule. METHODS We conducted a retrospective chart review of 118 patients who were treated for clinical N0 NSCLC sized ≤2 cm and who underwent sublobar resection with clear resection margins. We assigned them to two groups according to radiologic features: ground glass opacity (GGO)-predominant tumor and solid-predominant tumor. Clinicopathological characteristics and survival were analyzed in both groups. Risk factors for recurrence were analyzed in the solid-predominant tumor group. RESULTS Seventy-three patients had a GGO-predominant tumor, and 45 patients had a solid-predominant tumor. Five-year recurrence-free survival (RFS) in the solid-predominant tumor and GGO-predominant tumor groups was 64.9% and 95.5%, respectively. A multivariate analysis was performed to determine factors associated with recurrence after sublobar resection in the solid-predominant tumor group; it indicated that SUVmax [hazard ratio (HR) =1.482, 95% confidence interval (CI): 1.123-1.956, P=0.005] and histologic types other than adenocarcinoma (squamous cell carcinoma, HR =8.789, 95% CI: 1.572-49.134, P=0.013; other types, HR =53.569, 95% CI: 2.616-1096.849, P=0.010) were significant risk factors for recurrence. CONCLUSIONS Risk factors in solid-predominant tumors sized ≤2 cm after sublobar resection are a high SUVmax and histologic types other than adenocarcinoma. Thus, lobectomy should be considered for solid-predominant NSCLC sized ≤2 cm with a high SUVmax or non-adenocarcinoma types.

Usefulness of positron emission tomography-computed tomography in pre-operative evaluation of intra-thoracic esophageal cancer

The purpose of the study was to clarify the usefulness of positron emission tomography‐computed tomography (PET‐CT) for pre‐operative evaluation of intra‐thoracic esophageal cancer, especially in terms of regional lymph node status.