Acute Peripheral Arterial Tumorous Embolism after Lung Cancer Surgery

Yoohwa Hwang,Hyun Joo Lee,Young Tae Kim 대한중환자의학회 2015 Acute and Critical Care Vol.30 No.3

Systemic tumor embolisms after pulmonary resections for malignancy are rare, but usually severe and sometimes fatal. Here, we report a case of a 70-year-old woman who underwent pulmonary resection for lung cancer and subsequently developed acute arterial occlusion of the lower extremities caused by a tumorous embolus.

의료보험 상태가 식도암 수술 환자의 예후에 미치는 영향

황유화 ( Yoohwa Hwang ),오세진 ( Se-jin Oh ),최재성 ( Jae-sung Choi ),김지원 ( Ji Won Kim ),이정상 ( Jeong Sang Lee ),문현종 ( Hyun Jong Moon ) 대한소화기학회 2018 대한소화기학회지 Vol.72 No.1

목적: 환자의 사회 경제적 지표는 식도암의 발생 및 치료에 주요한 영향을 미치는 요인이다. 본 연구에서는 수술적 치료가 가능한 병기의 식도암 환자에서 사회 경제적 지표로써 의료보험 상태가 식도암 환자의 수술 후 예후에 미치는 영향을 알아보고자 하였다. 대상 및 방법: 보라매병원에서 2006년에서 2017년 사이에 원발성 식도암을 진단받고 수술적 치료를 시행받은 66명의 환자를 의료보험 상태에 따라 의료보험군과 의료급여군으로 나누었으며, 의료급여군은 17명(25.8%)에 해당하였다. 두 군 사이의 환자의 임상적 데이터를 비교 분석하고, 수술적 및 종양학적 결과를 비교하였다. 결과: 본 연구에서 의료보험 상태에 따른 두 환자군 사이에서 성별(p=0.13), 나이(p=0.24), 수술 후 병기(p=0.61) 간에는 차이가 없었다. 의료급여군에서 수술 후 재원 기간이 25일로 의료보험군의 17일과 비교하여 통계적으로 유의하게 더 길었다(p=0.02). 의료급여군에서 수술 후 사망률, 수술 후 합병증 발생의 빈도에는 통계적 차이는 없었으나(11.8% vs. 6.1%, p=0.45, 64.7% vs. 46.7%, p=0.21), 폐렴, 급성호흡곤란 증후, 지속성 공기누출을 포함한 호흡기계 합병증은 의료급여군에서 더 높게 발생하였다(47.1% vs 18.4%, p=0.02). 의료급여군에서 두 군 간의 5년 무병생존율에는 통계적 차이가 없었으나, 5년 생존율의 경우에는 의료급여군에서 27.7%로 의료보험군과 비교하여 유의하게 더 낮은 것으로 확인되었다(p=0.03). 결론: 수술적 치료를 받은 식도암 환자 중 의료보험 상태가 의료급여인 경우, 수술 후 호흡기계 합병증의 발생률을 높여 장기 생존율을 낮추는 영향을 미친다. Background/Aims: Socioecomomic factor is an important determinant of access to healthcare and is one of the potential causes of disparities in esophageal cancer care outcomes. The aim of the study was to clarify the association between National health Insurance status (health insurance vs. medicare) as a socioeconomic factor and survival of patients with esophageal cancer who underwent surgical resection. Methods: Among the 66 patients who underwent surgical resection for esophageal cancer between January 2006 and December 2017, 17 patients (25.8%) were in the medicare group. The data were analyzed to identify clinical manifestations and to compare surgical and oncologic outcomes between the groups. Results: There was no significant difference in the distribution of sex (p=0.13), age (p=0.24), and pathologic stage (p=0.61) between the groups. The length of median hospital stay was significantly shorter in the healthy insurance group (18 days vs. 25 days, p=0.04). In the medicare group, postoperative mortality rates and incidence of postoperative complication were non-significantly higher (11.8% vs. 6.1%, p=0.45, 64.7% vs. 46.7%, p=0.21, respectively). However, pulmonary complication rates, including pneumonia, acute respiratory distress syndorme, and prolonged air leakage was significantly higher in the medicare group (47.1% vs. 18.4%, p=0.02). Five-year disease free survival rate was not different between the two groups (61.0% vs. 54.5%, p=0.68); the 5-year overall survival rate was significantly lower in the medicare group (27.7% vs. 53.7%, p=0.03). Conclusions: The medicare status of National health insurance could have a negative influence on the overall survival in patients with esophageal cancer who underwent surgery. (Korean J Gastroenterol 2018;72:15-20)

Immediate Postoperative Care in the General Thoracic Ward Is Safe for Low-risk Patients after Lobectomy for Lung Cancer

박성용,박인규,Yoohwa Hwang,변천성,배미경,이창영 대한흉부외과학회 2011 Journal of Chest Surgery (J Chest Surg) Vol.44 No.3

Background: Following major lung resection, patients have routinely been monitored in the intensive care unit (ICU). Recently, however, patients are increasingly being placed in a general thoracic ward (GTW). We investigated the safety and efficacy of the GTW care after lobectomy for lung cancer. Materials and Methods: 316 patients who had undergone lobectomy for lung cancer were reviewed. These patients were divided into two groups: 275patients were cared for in the ICU while 41 patients were care for in the GTW immediately post-operation. After propensity score matching, postoperative complications and hospital costs were analyzed. Risk factors for early complications were analyzed with the whole cohort. Results: Early complications (until the end of the first postoperative day) occurred in 11 (3.5%) patients. Late complications occurred in 42 patients (13.3%). After propensity score matching, the incidence of early complications, late complications, and mortality were not different between the two groups. The mean expense was higher in the ICU group. Risk factors for early complications were cardiac comorbidities and low expected forced expiratory volume in one second. The location of postoperative care had no influence on outcome. Conclusion: Immediate postoperative care after lobectomy for lung cancer in a GTW was safe and cost-effective without compromising outcomes in low-risk patients.

Impact of High-Dose Statin Pretreatment in Patients with Stable Angina during Off-Pump Coronary Artery Bypass

윤영남,Seong-Yong Park,Yoohwa Hwang,주현철,유경종 대한흉부외과학회 2011 Journal of Chest Surgery (J Chest Surg) Vol.44 No.3

Background: Periprocedural treatment with high-dose statins is known to have cardioprotective and pleiotropic effects,such as anti-thrombotic and anti-inflammatory actions. We aimed to assess the efficacy of high-dose rosuvastatin loading in patients with stable angina undergoing off-pump coronary artery bypass grafting (OPCAB). Materials and Methods: A total of 142 patients with stable angina who were scheduled to undergo surgical myocardial revascularization were randomized to receive either pre-treatment with 60-mg rosuvastatin (rosuvastatin group, n=71)or no pre-treatment (control group, n=71) before OPCAB. The primary endpoint was the 30-day incidence of major adverse cardiac events (MACEs). The secondary endpoint was the change in the degree of myocardial ischemia as evaluated with creatine kinase-myocardial band (CK-MB) and troponin T (TnT). Results: There were no significant intergroup differences in preoperative risk factors or operative strategy. MACEs within 30 days after OPCAB occurred in one patient (1.4%) in the rosuvastatin group and four patients (5.6%) in the control group, respectively (p=0.37). Preoperative CK-MB and TnT were not different between the groups. After OPCAB, the mean maximum CK-MB was significantly higher in the control group (rosuvastatin group 10.7±9.75 ng/mL, control group 14.6±12.9ng/mL, p=0.04). Furthermore, the mean levels of maximum TnT were significantly higher in the control group (rosuvastatin group 0.18±0.16 ng/mL, control group 0.39±0.70 ng/mL, p=0.02). Conclusion: Our findings suggest that high-dose rosuvastatin loading before OPCAB surgery did not result in a significant reduction of 30-day MACEs. However, high-dose rosuvastatin reduced myocardial ischemia after OPCAB.

Mediastinoscopic Bilateral Bronchial Release for Long Segmental Resection and Anastomosis of the Trachea

Jeong-Han Kang,박인규,배미경,Yoohwa Hwang 대한흉부외과학회 2011 Journal of Chest Surgery (J Chest Surg) Vol.44 No.3

The extent of resection and release of the trachea is important for successful anastomosis. Bilateral bronchial dissection is one of the release techniques for resection of the lower trachea. We present the experience of cervical video-assisted mediastinoscopic bilateral bronchial release for long segmental resection and anastomosis of the lower trachea.

A newly developed capture-based sequencing panel for genomic assay of lung cancer

Sun‑Wha Im,Jeesoo Chae,Se Song Jang,Jaeyong Choi,Jihui Yun,차수진,Nak‑Jung Kwon,Yoon Kyung Jeon,Yoohwa Hwang,Miso Kim,Tae Min Kim,Dong‑Wan Kim,Jong‑Il Kim,Young Tae Kim 한국유전학회 2020 Genes & Genomics Vol.42 No.7

Background The increase in genetic alterations targeted by specific chemotherapy in lung cancer has led to the need for universal use of more comprehensive genetic testing, which has highlighted the development of a lung cancer diagnostic panel using next-generation sequencing. Objective We developed a hybridization capture-based massively parallel sequencing assay named Friendly, Integrated, Research-based, Smart and Trustworthy (FIRST)-lung cancer panel (LCP), and evaluated its performance. Methods FIRST-LCP comprises 64 lung cancer-related genes to test for various kinds of genetic alterations including single nucleotide variations (SNVs), insertions and deletions (indels), copy number variations (CNVs), and structural variations. To assess the performance of FIRST-LCP, we compiled test sets using HapMap samples or tumor cell lines with disclosed genetic information, and also tested our clinical lung cancer samples whose genetic alterations were known by conventional methods. Results FIRST-LCP accomplished high sensitivity (99.4%) and specificity (100%) of the detection of SNVs. High precision was also achieved, with intra- or inter-run concordance rate of 0.99, respectively. FIRST-LCP detected indels and CNVs close to the expected allele frequency and magnitude, respectively. Tests with samples from lung cancer patients also identified all SNVs, indels and fusions. Conclusion Based on the current state of the art, continuous application of the panel design and analysis pipeline following up-to-date knowledge could ensure precision medicine for lung cancer patients.