• Journal of Chest Surgery
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• v.49 no.6
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• pp.435-442
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• 2016

Background: Blunt traumatic cardiac rupture is rare. However, such cardiac ruptures carry a high mortality rate. This study reviews our experience treating blunt traumatic cardiac rupture. Methods: This retrospective study included 21 patients who experienced blunt traumatic cardiac rupture from 1999 to 2015. Every patient underwent surgery. Several variables were compared between survivors and fatalities. Results: Sixteen of the 21 patients survived, and 5 (24%) died. No instances of intraoperative mortality occurred. The most common cause of injury was a traffic accident (81%). The right atrium was the most common location of injury (43%). Ten of the 21 patients were suspected to have cardiac tamponade. Significant differences were found in preoperative creatine kinase-myocardial band (CK-MB) levels (p=0.042) and platelet counts (p=0.004) between the survivors and fatalities. The patients who died had higher preoperative Glasgow Coma Scale scores (p=0.007), worse Trauma and Injury Severity Scores (p=0.007), and higher Injury Severity Scores (p=0.004) than those who survived. Conclusion: We found that elevated CK-MB levels, a low platelet count, and multi-organ traumatic injury were prognostic factors predicting poor outcomes of blunt cardiac rupture. If a patient with blunt traumatic cardiac rupture has these factors, clinicians should be especially attentive and respond promptly in order to save the patient's life.

• Journal of Chest Surgery
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• v.41 no.4
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• pp.489-491
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• 2008

A 52-year-old man was taken to the emergency room following a motor vehicle accident. An echocardiogram showed moderate to severe tricuspid regurgitation due to rupture of the anterior chordae. An operation to repair the tarumatic tricuspid regurgitation was recommended; however, the patient refused because he was asymptomatic. Two years later, he developed mild generalized edema and dyspnea. The echocardiogram revealed progressive severe tricuspid regurgitation and annular dilatation. We treated the tricuspid regurgitation successfully using artificial chordae and ring annuloplasty.

• Journal of Chest Surgery
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• v.9 no.2
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• pp.117-124
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• 1976

Hemorrhage into the biliary system as a consequence of injury to the liver has been called "traumatic hemobilia," a term introduced by Sandblom in 1948. The source of gastrointestinal hemorrhage has been frequently misinterpreted, resulting in inadequate or inappropriate treatment, often with catastrophic results and needless fatalities. It is now being diagnosed with increasing frequency, due to more widespread knowledge of the syndrome and improved diagnostic means. we experienced 2 cases of hemobilia following blunt chest trauma, One patient had! multiple rib fractures on right chest by car traffic accident and 13 days later, suddenly massive melena was developed with nausea, vomiting, jaundice and severe pain on right upper quadrant. And so, he had operated on the ligation of Rt. hepatic artery and partial right hepatectomy for a traumatic hemobilia. The other one also revealed similar symptoms 20 days later following blunt chest injury by falling down accident. However, uneventful recovery was seen without any of surgical intervention in this case.

• Journal of Chest Surgery
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• v.21 no.3
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• pp.547-552
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• 1988

Rupture of the main bronchus followed by blunt chest trauma is comparatively very rare. Early recognition of bronchial rupture and emergency thoracostomy and management is essential for reducing of morbidity and mortality and late complications. This case was 11 years old female who was a primary school student. The patient was sustained a crushing injury to her right hemithorax by traffic accident and had been taken emergency closed thoracostomy at her second intercostal space, midclavicular line at emergency room. In the course of the next 2 hours, the girl`s condition remained critical with tension pneumothorax and abnormal arterial blood gas analysis. Induction of anesthesia started 3 hours after the accident. During the general anesthesia, cardiac arrest was occurred and cardiac resuscitation was performed. Right upper lobectomy and end-to-end anastomosis of ruptured right main bronchus was performed. Postoperative course was satisfactory.

• Journal of Chest Surgery
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• v.27 no.10
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• pp.888-892
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• 1994

Acquired, traumatic tracheoesophageal fistula [TEF] is rare and difficult problem to manage. This 55 years old man met with a roller accident of a tractor. During accident, he received a penetrating injury on the left upper sternal border. At local clinic, he received closed thoracotomy drainage [CTD]for relief of pneumothorax[left]. Three days after CTD, he complained abdominal pain and hematemesis. The endoscopy revealed large ulcer at the stomach, so he received subtotal gastrectomy. On 10th day post subtotal gastrectomy, he developed aspiration and coughing from a TEF. The esophagogram showed large TEF at the mid-trachea level. So he transfered to our hospital for operation. This patient was operated on for late TEF three weeks after injury. We have used absorble 4-0 Vicryl sutures to repair trachea. We repair all esophageal injuries with two layers of nonabsorbable silk suture. Where suture line on the esophagus, the strap muscle was interposed for reinforcement. And for feeding, the feeding jejunostomy was performed. Postoperatively the osteomyelitis of the manubrium site was developed, so on the 30th postoperative day, an ostectomy of manubrium, both clavicle and fight 1st, 2nd ribs, and the pectoralis major musculo-cutaneous flap coverage were performed.

• Journal of Chest Surgery
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• v.13 no.3
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• pp.198-205
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• 1980

Clinical observations were performed on 373 cases of chest trauma, those were admitted and treated at the Department of surrgery, Korea University Hospital, during the past 15 years period from August 1965 to June 1980. 1. The ratio of male to female patient of chest trauma was 4:1 in male predominence and age from 10 to 50 occupied 87.4 % of the total cases. 2. The most common cause of chest trauma was traffic accident in this series. One hundred and eight one cases (48.5%) were injuried by traffic accident and total cases due to blunt trauma (non-penetrating injury) were 282 cases (75.6%) including the cases with traffic accident, and remaining 91 cases (24.4%) were due to penetrating injury including 73 cases (19.6%) of stab wounds. 3. hemopneumothorax were observed in 49% (182 cases) of the total cases, and etiologic distribution revealed 72% due to non-penetrating trauma and 28% due to penetrating injury. 4. Rib fracture was found in 44.8% of cases. common injuries associated with rib fracture were lung, brain and liver. 5. Most common symptom was chest pain and respiratory difficulty, and common sign associated with chest injury was decreased respiratory sound and subcutaneous sound. 6. conservative non-operative treatment was performed in 281 cases (75.4%) and 92 cases (24.6%) were treated with operative treatment including 33 cases (8.9%) with open thoracotomy. 7. Overall mortality was 5.6% (21 cases) and most common cause of death were due to brain edema, cardiogenic shock, asphyxia.

• Journal of Chest Surgery
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• v.5 no.2
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• pp.113-124
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• 1972

Clinical observations were performed on 150 cases of chest trauma, those were admitted and treated at the Department of Surgery, Korea University Woosok Hospital, during the past 8 years period from August 1965 to August 1972. 1. The ratio of male to female patient of chest trauma was 3.4:1 in male predominence and age from 20 to 50 occupied 62% of the total cases. 2. The most common cause of chest trauma was traffic accident in this series. Eighty-one cases[54%] were injured by traffic accident and total cases due to blunt trauma [non-penetrating injury] were 113 cases[75.4%]including the cases with traffic accident, and remaining 37 cases[24.6%] were due to penetrating injury including 25[16.6%] cases of stab wounds. 3. Hemopneumothorax were observed in 645/[96 cases] of the total cases, and etiologic distribution revealed 78.1% due to non-penetrating trauma and 20.8% due to penetrating injury. 4. Rib fracture was found in 50% of cases. Common injuries associated with rib fracture were lung, brain and liver. 5. Most common symptom was chest pain and respiratory difficulty, and common sign associated with chest injury was decreased respiratory sound and subcutaneous emphysema. 6. Conservative non-operative treatment was performed in 94 cases[62.6%] and 56 cases [37.4%] were treated with operative treatment including 31 cases[20.6%] with open thoracotomy. 7. Overall mortality was 9.3%[14 cases] and most common causes of death were due to brain edema,asphyxia and shock.

• Annals of Occupational and Environmental Medicine
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• v.34
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• pp.40.1-40.9
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• 2022

Background: According to the occupational accident status analysis in 2020, of 1,180 occupational deaths, 463 were caused by cardiovascular disease (CVD). Workers should be assessed for CVD risk at regular intervals to prevent work-related CVD in accordance with the rules on occupational safety and health standards. However, no previous study has addressed risk and mortality. Therefore, this longitudinal study was conducted to evaluate the relationship between 10-year cardiovascular risk of the general health checkup and mortality. Methods: The study included 545,859 participants who visited Kangbuk Samsung Total Healthcare Centers from January 1, 2002, to December 31, 2017. We performed 10-year cardiovascular risk assessment for the participants and the risk was divided into 4 groups (low, moderate, high, and very high). The study used death data from the Korea National Statistical Office for survival status as an outcome variable by December 31, 2019, and the cause of death based on the International Classification of Diseases, 10^th Revision (ICD-10) was identified. Statistical analysis was performed using Cox proportional hazards regression analysis, and the sum of the periods from the first visit to the date of death or December 31, 2019, was used as a time scale. We also performed a stratified analysis for age at baseline and sex. Results: During 5,253,627.9 person-years, 4,738 overall deaths and 654 cardiovascular deaths occurred. When the low-risk group was set as a reference, in the multivariable-adjusted model, the hazard ratios (HRs) (95% confidence interval [CI]) for overall mortality were 3.36 (2.87-3.95) in the moderate-risk group, 11.08 (9.27-13.25) in the high-risk group, and 21.20 (17.42-25.79) in the very-high-risk group, all of which were statistically significant. In cardiovascular deaths, the difference according to the risk classification was more pronounced. The HRs (95% CI) were 8.57 (4.95-14.83), 38.95 (21.77-69.69), and 78.81 (42.62-145.71) in each group. As a result of a subgroup analysis by age and sex, the HRs of all-cause mortality and cardiovascular mortality tended to be higher in the high-risk group. Conclusions: This large-scale longitudinal study confirmed that the risk of death increases with the 10-year cardiovascular risk of general health checkup.

• Journal of Chest Surgery
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• v.25 no.4
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• pp.356-363
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• 1992

We have performed left lung transplantations in 15 dogs for one year and six months from June, 1990 to December, 1991 at the Repartment of Thoracic and Cardiovascular Surgery Yonsei University College of medicine, Seoul, Korea. These dogs were sacrificed at from operative day to post-operative 15 days when their general conditions were deteriorated. The gross findings of the transplanted lungs were thrombi in left atrium in three cases, partial occlusion of pulmonary artery or pulmonary veins in three cases, hemorrhage at pulmonary arterial anastomotic site in one case and bronchial anastomotic stenosis in two cases, bronchial anastomotic rupture in one case % no abnormal gross findings in four cases. The microscopic findings of the transplanted lungs were hemorrhagic infarction in one case, perivascular hemorrhage or pulmonary edema in two cases, peribronchial inflammatory cell infiltration & pneumonia in three cases, and alveolar type rejection with infiltration of type II pneumocytes and septal thickening in 3 cases. And also there were no abnormal findings including rejection or inflammatory evidences in six cases. The one among these six dogs survived to 15 days without evidence of rejection or inflammatory reaction & died due to postoperative care accident.

• Journal of Chest Surgery
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• v.23 no.1
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• pp.128-136
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• 1990

A Clinical analysis was performed on 717 cases of the chest trauma experienced at department of thoracic and cardiovascular surgery, Soonchunhyang Chunan Hospital from Mar. 1985 to Jun. 1989. 1. The sex ratio was 2.89:1 with male predominance. The patients in 75 % of total cases was between 3rd to 5th decade. 2. The most common causes were traffic accident in non-penetrating thoracic injury and stab wound by knife in penetrating injury. 3. The hemothorax, pneumothorax and hemopneumothorax were observed in 306 cases[42.7 %]. 4. The left thorax was the preferred site of penetrating and non-penetrating thoracic injury. The rib fracture was prevalent between 4th to 8th rib. 5. The open thoracotomy was performed in 55 cases[7.7 %] 6. The overall mortality was 3.07 %[22 cases] and causes of death were hypovolemic shock, adult respiratory distress syndrome, sepsis, disseminated intravascular coagulation, renal failure and pneumonia.