• Proceedings of the KTCVS Conference
• /
• 1995.10a
• /
• pp.130-130
• /
• 1995

• Proceedings of the KTCVS Conference
• /
• 1995.10a
• /
• pp.138-138
• /
• 1995

• Proceedings of the KTCVS Conference
• /
• 1998.10a
• /
• pp.121-121
• /
• 1998

• Proceedings of the KTCVS Conference
• /
• 1993.06a
• /
• pp.62-62
• /
• 1993

• Journal of Chest Surgery
• /
• v.35 no.8
• /
• pp.584-589
• /
• 2002

Background : The thoracic and thoracoabdominal aortic surgery is a complicated procedure that has various method of approach and protection. The authors have performed several methods to treat these diseases. Therefore, we attempt to analyze their results and risks. Material and Method: From June of 1992 to August of 2001, we performed 26 cases of thoracic aortic surgery and 10 cases of thoracoabdominal aortic surgery. There were 17 aortic dissections, 17 aortic aneurysms, one coarctation of aorta and one traumatic aortic aneurysm. The thoracic aortic replacement was performed under a femorofemoral bypass, an LA to femoral bypass, or a deep hypothermic circulatory arrest. The thoracoabdominal aortic replacement was performed under a femorofemoral bypass or a pump assisted rapid infusion. Result: There were 7 renal failures, 11 hepatopathies, 7 cerebral vascular accidents, 2 heart failures, 5 respiratory insufficiencies, and 2 sepsis in postoperative period. There were 9 hospital mortalities which were from 2 bleedings, 2 heart failures, 2 renal failures, a sepsis, a respiratory failure, and a cerebral infarction. There were 3 late deaths which were from ruptured distal anastomosis, cerebral infarction, and pneumonia. Conclusion: Deep hypothermic circulatory arrest was not good supportive methods for thoracic aortic replacement. Total thoracoabdominal aortic replacement was a high risk operation.

• Journal of Chest Surgery
• /
• v.31 no.7
• /
• pp.730-734
• /
• 1998

Background: It is important to know the location, number, size and shape of bullae before thoracotomy or VATS bullectomy. Chest X-ray and chest CT may be used but with some limitation. The purpose of this study was to compare the diagnostic value of thoracography with that of chest X-ray in preoperative detection of bullae. Meterial and Method: Thoracography was performed by injection of non-ionic water-soluble dye into pleural space in 22 primary spontaneous pneumothoraces, which underwent thoracotomy or VATS bullectomy. Chest X-ray and thoracography were compared through operative finding. Results: Sensitivity and accuracy of thoracography(75% and 72.7%) were higher than those of chest X-ray(30% and 36.4%). However, specificity of thoracography(50%) was lower than that of chest X-ray (100%). There were no complications during or after thoracography. Conclusion: Thoracography is a safer and more useful method for preoperative detection of bullae when compared with chest X-ray.

• Journal of Chest Surgery
• /
• v.37 no.9
• /
• pp.774-780
• /
• 2004

Although traumatic thoracic aortic rupture is potentially a fatal condition requiring surgical attention, the presence of concomitant injury involving other parts of the body may greatly increase the risk of cardio-pulmonary bypass. We report our experience of treating associated injuries prior to the thoracic aortic rupture in these patients. Material and Method: From 1997 to 2003, the medical records of 24 traumatic aortic rupture patients were retrospectively reviewed and checked for the presence of associated injury, surgical method, postoperative course, and complications. Surgical technique comprised thoracotomy with proximal anastomosis under deep hypothermic circulatory arrest followed by side arm perfusion to reestablish cerebral circulation. CSF drainage was performed to prevent lower extremity paraplegia. Result： Major concomitant injuries (n=83) were noted in all of the reviewed patients, Of these, there were 49 thoracic injuries, 18 musculoskeletal injuries, and 13 abdominal injuries, Operations for associated injuries (n=16) were performed in 12 patients on mean 7.6$\pm$12.6 days following the injury. The diagnosis of aortic rupture at the time of injury was detected in only 18 patients. Delayed surgery of the thoracic aorta was performed on average 695$\pm$1350 days after injury and there were no deaths or progression of rupture in any of these patients during the observation period. There were no operative deaths and no major postoperative complications. Conclusion: Treating concomitant major injuries prior to the aortic injury in traumatic aortic rupture may reduce surgical mortality and morbidity.

• Journal of Chest Surgery
• /
• v.36 no.3
• /
• pp.182-188
• /
• 2003

Background: Although ramicotomy (division of the rami communicantes of the thoracic sympathetic ganglia) is a selective and physiological surgical method for essential hyperhidrosis, it has some problems such as higher recurrence rates and the different surgical results among the patients and between left and right sides in the same individual. As one of the factors that are related to the differences in surgical result and recurrences, we investigated the anatomical variations of the rami communicantes. The purpose of this study is to help develop new surgical methods to decrease surgical differences among the patients or between the left and right sides of the same individual and recurrence rates in the clinical application of ramicotomy. Material and Method: We dissected 118 thoracic sympathetic chains in 59 adult Korean cadavers (male: 33, female: 26) to examine the anatomical variations of the rami communicantes from the second to the fourth thoracic sympathetic ganglia that have major components innervating to the hands. After the dissection of bilateral thoracic sympathetic chains, we compared the anatomy of left and right sides and examined the anatomical variations of rami communicantes. Result: The number and variation of communicating rami connecting the spinal nerves and the second sympathetic thoracic ganglion were much larger than lower levels. There was considerably less variability in the anatomy of the rami communicantes at successive levels. Among the 59 cadavers dissected, only 14.3% (9/59) had similar anatomy of thoracic sympathetic chains at both sides. As the components related to the essential palmar hyperhidrosis, intrathoracic nerve of Kuntz from the second thoracic sympathetic ganglion to the first intercostal nerve or brachial plexus were observed in 55.9% (66/118). The incidence of descending rami communicates from the second thoracic sympathetic ganglion to the third intercostal nerve and from the third thoracic sympathetic ganglion to the fourth intercostal nerve were 49.2% (58/118) and 28.0% (33/118). And the incidence of ascending rami communicates from the third thoracic sympathetic ganglion to the second intercostal nerve and from the fourth thoracic sympathetic ganglion to the third intercostal nerve were 6.8% (8/118) and 3.4% (4/118), respectively. Conclusion: Based on the various anatomical evidences of the rami communicantes from this study, only the ramicotomy at the third sympathetic ganglion level is insufficient for the treatment of the essential palmar hyperhidrosis to decrease the difference of surgical results and recurrences. When one is planning to perform the ramicotomy for the essential palmar hyperhidrosis, it is advantageous to divide the intrathoracic nerve of Kuntz on the second rib and the descending or ascending rami communicantes on the third and the fourth ribs as well as all the communicating rami from the third sympathetic ganglion.

• Journal of Chest Surgery
• /
• v.32 no.9
• /
• pp.813-817
• /
• 1999

Background: Conventional thoracoscopic thoracic sympathectomy or sympathicotomy is an effective method in treating localized hyperhidrosis; however, this may result in a postoperatively embarrassing compensatory hyperhidrosis or facial anhidrosis in the treatment of palmar hyperhidrosis. We modified the conventional sympathicotomy by limiting the extent of nerve transection. The purpose of this study was to assess the result of the limited thoracoscopic sympathetic nerve transection in hyperhidrosis. Material and Method: From May to August 1998, 17 patients underwent limited transection of the sympathetic nerve. For 9 patients with facial hyperhidrosis, we transected only the interganglionic fiber between the first and the second ganglion, whereas the conventional method cuts two interganglionic fibers. Eight patients with palmar hyperhidrosis underwent limited transection of the interganglionic fiber between the second and third ganglion. Result: Sixteen patients had improved symptom postoperatively. There was a recurred facial sweating in 1 patient 1 month after the operation. Among the 9 facial hyperhidrosis patients, postoperative compensatory hyperhidrosis was severe in 4, moderate in 4 and minimal in 1. But in 8 cases of palmar hyperhidrosis compensatory hyperhidrosis was moderate in 3, and minimal in 1, none in 4. Facial sweating was not disturbed postoperatively in all of the palmar hyperhidrosis patients. Conclusion: Limited sympathetic nerve transection is a practical and less invasive method for the treatment of localized hyperhidrosis and may reduce the incidence of compensatory truncal hyperhidrosis and facial anhidrosis in case of palmar hyperhidrosis.

• Proceedings of the KTCVS Conference
• /
• 1995.10a
• /
• pp.122-122
• /
• 1995