Tzu-Ti Hung

Hand-grip strength is a simple and effective outcome predictor in esophageal cancer following esophagectomy with reconstruction A prospective study

BackgroundSurgery for esophageal cancer usually carries considerable complication and mortality rate. Adequate preoperative evaluation is mandatory to decrease complication rate. Hand-grip strength is a useful measure to assess the extent of aging, nutrition and patients overall condition. Because preoperative nutrition state and physiologic aging process play important roles in postoperative recovery, we would like to know if hand-grip strength is an adequate tool for such evaluation.Material and methodsFrom January 1st, 2007 to December 31, 2008, there was 68 cases underwent esophagectomy with reconstruction due to esophageal cancer in our hospital. After excluding 7 patients of incomplete data and loss of follow-up, there were 61 patients included in the study.ResultsThere were 54 men and 7 women. The mean age is 60.7. Most of patients had squamous cell carcinoma. Patient with weak hand-grip strength prior to operation had exceedingly high rates of complication and mortality within 6 months after operation. Compared to other risk factors, low grip strength has highest relative risks for both mortality and morbidity.ConclusionBecause test for hand-grip strength is cheap, not time-consuming and has high predictive value, it may be included in routine preoperative evaluation.

Possible roles of Epstein-Barr virus in Castleman disease

BackgroundComplete resection seemed to be curative in patients with Castleman disease of any location but the disease is likely to be reactive in its pathogenesis. The relation between Epstein-Barr virus and Castleman disease has not been elucidated. We tried to define the role of Epstein-Barr virus in the pathogenesis of Castleman disease.Methods20 cases of Castleman disease were retrospectively reviewed from 1993 to 2006. At least 2 to 4 representative sections of formalin-fixed, paraffin-embedded specimens from each patient were obtained to examine the presence of EBV and its localization by hematoxylin-eosin stain, immunohistochemistry, polymerase chain reaction and In-situ hybridizationResultsHyaline-vascular type was diagnosed in 18 cases, plasma cell type in 1 and mixed type in 1 case. All of them were positive for Epstein-Barr virus confirmed by PCR. For tumors that EBER(Epstein-Barr early region) signals mainly localized in the germinal centers have increased vascularity than cases with EBER detected in inter-follicular areas.ConclusionThere is a strong association between Castleman disease and Epstein-Barr virus. EBV may have a potential role in angiogenesis of Castleman disease. For smaller lesion with high activity of angiogenesis but not amenable for curative resection, anti-angiogenesis medications may have a potential role to control the disease.

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.

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.

A preliminary report of a disposable electrical non-fiberoptic endoscope in thoracoscopic surgery.

PURPOSE Conventional thoracoscopic surgery requires a camera connected to optic fibers and rigid rod lens to ensure the provision of adequate light and quality of real-time images in the operative field. However, the camera, the connected optic fibers and rigid rod lens are not disposable due to cost, which is a concern as regards potential contamination of patients. To decrease such contamination, we designed a disposable device of extremely low cost which we tested in thoracoscopic surgery in animals. DESCRIPTION A complementary metal-oxide-semiconductor is used for obtaining real-time image at a refresh rate of 30 frames per second. A circumferential light was added by a light emitting diode. We connected wires to a universal serial bus adapter, with which the device can negotiate with a computer so as to control signal retrieval and adjustment of the light as well as focus. The device was designed to be as compact as possible. The contour resembled a conventional thoracoscope, but with no optic fibers and rigid rod lens included. EVALUATION We used the devices to perform routine thoracoscopic surgical procedures, including wedge resection of the lung, lobectomy, esophagectomy, pericardiotomy and pleural biopsy in two 40-kg pigs under general anesthesia. The operating techniques were not altered while using this device. CONCLUSION This disposable, electrical non-fiberoptic endoscope has the potential to be easily and safely used in routine thoracoscopic surgery at a minimal cost. Further clinical evaluation will be required to demonstrate the utility in human patients.

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.

Spontaneous empyema necessitatis caused by Aspergillus fumigatus in an immunocompetent patient.

We present a rare case of spontaneous empyema necessitatis caused by Aspergillus fumigatus infection.