김재종, 원윤선, 양태일, 강웅철, 이상표, 이상민, 강성윤

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A case of cardiovocal syndrome (ortner's syndrome) caused by thoracic saccular aortic aneurysm

가천대 길병원 내과

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김재종, 원윤선, 양태일, 강웅철, 이상표, 이상민, 강성윤

Cardiovocal syndrome known as Ortner’s syndrome is a rare case caused by left recurrent laryngeal nerve paralysis from various cardiopulmonary conditions. Here, we report a case of cardiovocal syndrome associated with thoracic aortic aneurysm. A 74-years-old man, a former smoker, was referred to outpatient department complaining of cough, left sided chest pain and horarseness for more than 2 months. He had a past medical history of hypertension without asthma, chronic rhinitis and GERD. One months prior to referral, he was admitted to the other hospital for complaints as above. A chest radiog- raphy and lung function appeared normal but fractional exhaled nitric oxide level was elevated with 39 ppb. Thoracic computed tomography (CT) scan showed severe stenosis in the left proximal subclavian artery and 2.5 cm sized partially thrombosed saccular aneurysm in the aortic arch for which he un- derwent thoracic endovascular aortic repair (TEVAR). The initial physical examination was unremarkable except for mild generalized pallor. Laboratory data revealed mild leukocytosis, normocytic anemia and elevated CRP. Echocardiogram demonstrated basal septal hypertrophy and dilated ascending aorta of 38mm with normal systolic function. Troponin and BNP level were within normal limits. Investigation by an otolaryngologist revealed left vocal cord palsy without any mass lesion described as paralysis in paramedian position. Neck CT showed adduction of left vocal cord with dilatation of laryngeal ventricle. Taken together, Thoracic aortic aneurysm could present symptoms such as hoarseness due to vocal cord paralysis and chest pain due to com- pression of the intrathoracic structures. Chronic cough is presumed to be secondary to bronchial compression, vocal fold movement or eosinophilic airway inflammation. Management of patients includes injection laryngoplasty, pharmacologic treatment to limit aortic expansion and coughing. He gradually im- proved and he could be discharged. Our case demonstrates the importance of clinical suspicion and contrast-enhanced CT imaging for cardiovocal syn- drome in patients with coughing, hoarseness, and chest pain.

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Survival outcome depending on treatment in the NSCLC patients over 80 years of age

충남대학교병원 호흡기내과

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고정숙, 김주옥, 정성수, 박희선, 문재영, 정재욱, 박동일, 윤선영, 강다현, 이송이, 정선영, 이정은

Background/Aims: Patients with lung cancer over 80 years of age account for about 20% of the total lung cancer patients and are increasing gradually.

We should be approached to this population with caution because of various comorbid conditions. However, there are few studies that gives us substantial information. The aim of this study was to unfold their natural course with or without treatment and to find applicable prognostic factors. Methods: We ret- rospectively analyzed 183 patients diagnosed with NSCLC at Chungnam National University Hospital from January 2014 to February 2019. The disease stage was evaluated according to TNM 8th edition, and various clinicopathologic factors, treatment status and type, and overall survival (OS) were analyzed. Results: Of the 183 patients, 15 patients were excluded from the analysis due to insufficient data, and 168 patients were finally included. The mean age was 82.68 years, and male was 72.6%(122/168). 89 patients (53%) were treated with surgery, radiation therapy, or chemotherapy, and 79 patients (47%) received supportive care only. Stage and treatment status were found to be significant prognostic factors for overall survival. To determine treatment benefit in very elderly patients, we divided into stage I/II and stage III/IV and compared survival by treatment status. Stage I/II group did not get survival benefit by treatment including surgery or radiotherapy. But chemotherapy in patients with stage III/IV showed significant survival benefit (21.3months vs 8.7 months, p=0.001). We found that the following prognostic factors significantly influenced patients with overall survival of 24 months or more : - fe- male, p=0.049 (OR 2.326); - performance status 0 or 1, p=0.006; - active treatment, p=0.000 (OR 0.184); - early stage I/II, p=0.000; - adenocarcinoma, p=0.001 (OR 0.207) Conclusions: This study showed that active treatment was related with survival gain in advanced NSCLC patients over 80 years of age but survival benefit was not confirmed in early NSCLC patients with surgery or radiotherapy. Before making treatment decision, we should consider that survival expectations of patient with female, adenocarcinoma, early stage, or good PS might be long over 24 months.