- Surgical Treatment of Renal Cell Carcinoma with Acute Pulmonary Embolism Using Deep Hypothermic Circulatory Arrest －A Case Report－
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Dong Hyup Lee, Dong Chun Park
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Yeungnam Univ J Med. 2007;24(2 Suppl):S731-736. Published online December 31, 2007
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DOI: https://doi.org/10.12701/yujm.2007.24.2S.S731
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- Renal cell carcinoma occasionally invades the inferior vena cava and rarely extends to the right atrium and occurred massive pulmonary embolism. A healthy 54-year-old man presented to the emergency room with anterior chest pain, dyspnea and hypotension from which he had been suffering for several hours. We diagnosed him as left renal cell carcinoma with acute both pulmonary arteries embolism. The patient underwent a complex surgical procedure in which left radical nephrectomy, inferior vena cava thrombectomy and both pulmonary arteries thromboembolectomy under deep hypothermic circulatory arrest. Total circulatory arrest time was 44 minutes. We should use many inotropic agents for weaning of cardiopulmonary bypass. The patient had many postoperative complications including of acute renal failure, respiratory distress and sepsis. He died from septic shock and multi organ failure at 36th postoperative day.
- Effect of Submucosal Formalin Injection on Bladder Wall in Rats.
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Dong Heon Lee, Dong Chun Park
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Yeungnam Univ J Med. 1987;4(2):113-120. Published online December 31, 1987
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DOI: https://doi.org/10.12701/yujm.1987.4.2.113
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Abstract
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- The effect of intravesical formalin instillation as a therapeutic modality for intractable bladder hemorrhage in well known. And despite clear evidence of therapeutic efficacy of intravesical cytotoxic drugs and / or BCG immunotherapy, there have been substantial recurrences during follow up after transurethral resection for superficial bladder tumor. If formalin injected at the bed of superficial bladder tumor is able to coagulate and necrotize the tumor, it will be greatly helpful to the patients with recurrent bladder tumor developed during follow up. Since this technique is applicable on outpatient basis, an economical as well as a psychological burden of the patients can be reduced considerably. The purpose of this study is to evaluate the effect of submucosal formalin injection on rat bladder wall. 36 healthy adult male Sprague-Dawley rats (weighing 350 gm in average) were divided into 3 groups: In Group I (control group), 0.01ml of normal saline was injected submucosally at the left posterolateral wall of the bladder opened under intraperitoneal Nembutal anesthesia; In Group II and III, 0.01 ml of 10% and 4% formalin, respectively, were administered at the same site as in the Group I, two rats in each group were sacrificed at day 1, 2, and 3, and week 1, 2, and 4 after injection, respectively. Gross and microscopic examination of the cystectomized specimen were done in each group. In the Group II, bladder stones were formed at week 1, and in both the Group I and III, stones were seen at week 2 post injection. There was no significant difference in histologic findings of the bladder between the group II and III. Mucosal ulcer and/or prominent mucosal disruption was observed at 24 hours after injection in both Group II and III. Epithelial regeneration began at day 2, and was marked at day 3, and epithelial lining was almost normalized one week after injection. Subepithelial edema, telangiectasia and inflammatory reaction were prominent at 24 hours post formalin injection. Subepithelial edema persisted in moderate degree for 1 week. Telangiectasia and inflammatory reaction were noted for 4 weeks. Mild degree of these findings also appeared in the control group. Fibroblastic proliferation appeared at day 2 and persisted in moderate degree for 4 weeks. There has been no mortality or bladder perforation. These results suggest that clinical application of this technique is feasible for the selected cases of recurrent, solitary superficial bladder tumor. However, optimal dosage of formalin in relation to the size of the lesion remains to be investigated.
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Yeungnam University College of Medicine
