Biomedical subjects
Hyun-Sung Lee
Publications and source records attributed to Hyun-Sung Lee.
Preoperative serum fibrinogen level predicts postoperative pulmonary complications after lung cancer resection.
BACKGROUND: Patients undergoing pulmonary resection are thought to be at high risk for the development of postoperative pulmonary complications (PPCs), and these complications may lead to serious morbidity. The purpose of this study was to identify the factors associated with postoperative pulmonary complications in patients undergoing lung cancer resection and to determine the effect of PPCs on survival. METHODS: The study involved a retrospective review of 635 patients who had undergone curative resection for lung cancer. The patient group included 504 males (79.4%), and the overall mean age was 61.3 years. Patients were classified as those who had experienced PPCs (PPCs group, n = 105, 16.5%) or those who had not (no-PPCs group, n = 530, 83.5%). RESULTS: The surgical procedures performed were 101 pneumonectomies (15.9%), 505 lobectomies (79.5%), and 29 lesser resections (4.6%). Cancer types comprised 330 squamous cell carcinomas (52.0%), 255 adenocarcinomas (40.2%) and 50 others (7.8%). Univariate analysis showed that the following factors were predictors for PPCs: male sex, erythrocyte sedimentation rate, preoperative serum fibrinogen level, pulmonary function, chronic obstructive pulmonary disease, smoking, double primary cancer, and surgical duration. Multivariate logistic regression showed that preoperative serum fibrinogen level (p < 0.001), surgical duration (p < 0.0001) and being male (p = 0.02) were significant predictors of PPCs. Overall survival 3 years after surgery was 68.2% in no-PPCs group and 38.8% in PPCs group (p < 0.0001). Regardless of tumor staging, overall survival differed significantly between PPCs and no-PPCs groups, whereas disease-free survival did not. CONCLUSIONS: Higher preoperative serum fibrinogen levels, longer surgical duration, and being male were the predictive factors for PPCs in surgical candidates. The development of PPCs was linked to a shortened overall survival.
Repair of gastrotracheal fistula with a pedicled pericardial flap after Ivor Lewis esophagogastrectomy for esophageal cancer.
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Low-dose steroid therapy at an early phase of postoperative acute respiratory distress syndrome.
BACKGROUND: The acute respiratory distress syndrome (ARDS) that develops after thoracic surgery is usually lethal. The use of corticosteroids to treat ARDS has been the subject of great controversy. METHODS: Therefore we compared conventional therapy with early low-dose steroid therapy in the treatment of postoperative ARDS. Methylprednisolone was given daily as an intravenous push every 6 hours and was changed to a single oral dose or discontinued, with a loading dose of 2 mg/kg followed by 2 mg/kg per day. RESULTS: Over 2.5 years, 523 major thoracic operations were performed with postoperative ARDS developing in 20 patients (3.8%), of which 8 were treated with conventional therapy and 12 with early low-dose steroid therapy. Early low-dose steroid therapy significantly reduced postoperative mortality, with 7 patients (58.3%) recovering without mechanical ventilation. CONCLUSIONS: We believe this is the first clinical study of low-dose methylprednisolone at an early phase of postoperative ARDS. The beneficial effects of the use of early low-dose steroids in ARDS are consistent with the hypothesis that fibroproliferation is an early response to lung injury, which is inhibited by early low-dose steroid therapy without disturbing operative wound healing.
Intrathoracic gastric emptying of solid food after esophagectomy for esophageal cancer.
BACKGROUND: Information on the function of the intrathoracic stomach after esophageal resection for esophageal cancer is limited. This study evaluated the factors affecting intrathoracic gastric emptying of solid food in patients who had undergone this surgery. METHODS: Between February 2003 and August 2003, intrathoracic gastric emptying of solid food was evaluated by radioisotope in 56 of the patients who underwent esophageal replacement surgery with the stomach for esophageal cancer. The 50% gastric emptying time was categorized into three ranges: over 180 minutes was defined as delayed, within 180 minutes as intermediate, and when all the radioisotopes were dumped into the jejunum as rapid. The factors affecting the gastric emptying were analyzed. RESULTS: In 6 out of 56 (10.7%) patients the radioisotope removal was too rapid to check the gastric-emptying time, and hence the analysis was performed in 50 patients. Twenty-one (37.5%) patients showed significantly delayed gastric emptying. The 50% gastric emptying time calculated by an exponential fitting method was 422 and 109 minutes in the delayed and intermediate groups, respectively. Age, the method of gastric drainage, and the stomach shape used did not affect the intrathoracic gastric emptying. Only the follow-up interval after surgery was a significant factor on gastric emptying (p = 0.024). The intrathoracic gastric emptying of solid food was more and more increased over time after surgery by regression analysis (p = 0.03). CONCLUSIONS: The use of the intrathoracic stomach as an esophageal substitute had a significant effect on gastric emptying, with intrathoracic gastric emptying of solid foods immediately after esophagectomy being markedly prolonged in about 50% of patients. However, the intrathoracic gastric emptying significantly increased over time. Research is required into improving intrathoracic gastric emptying in the early period after esophagectomy.
Long-term digital blood flow after radial artery harvesting for coronary artery bypass grafting.
OBJECTIVE: The radial artery is widely used as a bypass conduit in coronary artery bypass surgery, but the long-term flow readjustment in the hands and fingers induced by the removal of the radial artery is poorly understood. METHODS: Using pulse-volume-recording plethysmography, digital blood flow was measured semiquantitatively in 24 patients immediately after harvesting of the radial artery for coronary artery bypass grafting (short-term group) and reassessed in 15 of these patients 3 years later (long-term group). Measurements taken from the fingers of the operated arms were evaluated and compared to those taken from the opposite or control arms. The short- and long-term changes in digital blood flow were also compared. RESULTS: Postoperatively, there was an overall decrease in blood flow to all the fingers of the operated arms. There was also evidence of redistribution of digital blood flow favoring the thumb and index finger over the fourth and fifth fingers, with the same distribution pattern seen in the fingers of control arms. Over time, the digital blood flow in operated arms recovered to levels similar to those in control arms. CONCLUSION: The study showed that there was an overall decrease in digital blood flow following radial artery harvesting. The resulting blood supply in the remaining ulnar artery still provided more flow to the thumb and index fingers than to the fourth and fifth fingers, indicating the existence of an autoregulatory mechanism operating to satisfy the physiologic needs of the fingers. The long-term results showed that the overall decrease in distal blood flow immediately after radial artery harvesting was significantly recovered by physiologic adaptation.
Digital blood flow after radial artery harvest for coronary artery bypass grafting.
BACKGROUND: Despite widespread use of radial artery as a bypass conduit in coronary artery bypass surgery, flow readjustment that takes place in the hands and fingers after the removal of the radial artery is poorly understood. METHODS: Using pulse volume recording plethysmography, a semiquantitative measurement of digital blood flow was carried out in 24 patients 7 days after harvesting of radial artery for coronary artery bypass grafting. Measurements taken from the fingers of the operated arms were evaluated and compared with those taken from the opposite or the control arms. RESULTS: Postoperatively, there was an overall decrease in blood flow to all the fingers of the operated arms. At the same time, there was evidence of redistribution of digital blood flow favoring the first two fingers over the last two, the same distribution pattern as seen in the fingers of the control arms. The pulse amplitude studies, likewise, showed a significant drop in all fingers of the operated arms, with the decrease most pronounced in the fourth and fifth fingers. None of the patients showed signs of digital ischemia postoperatively. CONCLUSIONS: The study showed that there was an overall decrease in digital blood flow after radial artery harvesting. The resulting blood supply by way of the remaining ulnar artery still provided more flow to the first two fingers over the last two fingers, indicating the existence of an autoregulatory mechanism operating to satisfy the physiologic needs of the fingers.
Chronic cerebral paragonimiasis combined with aneurysmal subarachnoid hemorrhage.
A 67-year-old Korean woman attended our hospital complaining of a severe headache. A brain computed tomography scan showed conglomerated, high-density, calcified nodules in the left temporo-occipito-parietal area and high-density subarachnoid hemorrhage in the basal cisterns. Magnetic resonance imaging of the brain shows multiple conglomerated iso- or low-signal intensity round nodules with peripheral rim enhancement. She underwent craniotomies to clip the aneurysm and remove the calcified masses. Paragonimus westermani eggs were identified in the calcified necrotic lesions. Results of parasitic examinations on the sputum and an enzyme-linked immunosorbent assay for P. westermani were all negative. The patient presented with headache and dizziness that had occurred for more than 30 years. She had not eaten freshwater crayfish or crabs. However, she had sometimes prepared raw crabs for several decades. Overall, this case was diagnosed as chronic cerebral paragonimiasis, in which she may have been infected through the contamination of utensils during the preparation of the second intermediate hosts, combined with a cerebral hemorrhage.