• Journal of Chest Surgery
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• v.31 no.3
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• pp.255-261
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• 1998

A clinical evaluation was performed on 11 cases of the cardiac rupture by blunt chest trauma at the department of thoracic and cardiovascular surgery, Yeungnam University Hospital during the period from July, 1993 to May, 1995. The results were as follows ; The sex distribution was 8 mem and one women, and mean age was 41 years old. The causes of accident was traffic accident in most cases. And then one case was cultivator accident and another one was fall down. The average times from trauma to admission was 139 minutes and the patients that transferred via other hospitals have relatively long average times to 227 minutes. The average times from admission to operation was 117 minutes and we consumed 25 minutes for the preoperative preparation. The sites of injury were 7 cases in the right heart and 3 cases in the left heart. There were symptoms and signs of the cardiac tamponade(dyspnea, chest pain, nausea/vomitus, neck vein distention & hypovolemic shock) at admission and in most of them typical symptoms and signs of a tamponade appeared. Surgical approach was performed with median sternotomy in 10 cases. Subxiphoid pericardial window was created in one case. Another case which was very difficult in surgical procedure was operated under cardiopulmonary bypass and the result was good.

• Tuberculosis and Respiratory Diseases
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• v.65 no.3
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• pp.222-224
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• 2008

Spontaneous pneumomediastinum is defined as a clinical syndrome that's characterized by the presence of air in the mediastinal space, which is not due to an old previous injury or surgery. The condition is caused by a sustained increase in the intraalveolar and intrabronchial pressure with extravasated air dissecting along the perivascular spaces of the mediastinum. This is an uncommon complication of sports activity. The most common symptom is chest pain. This diagnosis should be considered for younger people who present with pleuritic chest pain or dyspnea and a characteristic crackling feel (known as subcutaneous crepitation) when touching of the skin covering the chest wall or neck, and they look otherwise well with normal vital signs. Usually no treatment is required, but the mediastinal air will be absorbed faster if the patient inspires high concentrations of oxygen. We present here a case of spontaneous pneumomediastinum that occurred during a Taekwondo match, along with a review of the relevant literature.

• Journal of Chest Surgery
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• v.49 no.4
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• pp.287-291
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• 2016

Background: Spontaneous pneumomediastinum (SPM) is an uncommon disorder with only a few reported clinical studies. The goals of this study were to investigate the clinical manifestations and the natural course of S PM, as w ell as examine the current available treatment options for SPM. Methods: We retrospectively reviewed 91 patients diagnosed with SPM between January 2008 and June 2015. Results: The mean age of the patients was $22.7{\pm}13.2years$, and 67 (73.6%) were male. Chest pain (58, 37.2%) was the predominant symptom. The most frequent precipitating factor before developing SPM was a cough (15.4%), but the majority of patients (51, 56.0%) had no precipitating factors. Chest X-ray was diagnostic in 44 patients (48.4%), and chest computed tomography (CT) showed mediastinal air in all cases. Esophagography (10, 11.0%), esophagoduodenoscopy (1, 1.1%), and bronchoscopy (5, 5.5%) were performed selectively due to clinical suspicion, but no abnormal findings that implicated organ injury were documented. Twelve patients (13.2%) were discharged after a visit to the emergency room, and the others were admitted and received conservative treatment. The mean length of hospital stay was $3.0{\pm}1.6days$. There were no complications related to SPM except for recurrence in 2 patients (2.2%). Conclusion: SPM responds well to conservative treatment and follows a benign natural course. Hospitalization and aggressive treatment can be performed in selective cases.

• Journal of Chest Surgery
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• v.30 no.11
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• pp.1128-1131
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• 1997

Injuries to versa cave continue to be associated with a high mortality. Essentials to successful treatment are immediate recognition of the injury and prompt control of the hemorrhage. We have experienced one case of inferior versa java perforation by a chest rainage tube in the patient with post-operative chronic empyema thoracic. The patient was 38-year old male who was taken RLL lobectomy after 6 cycle of chemotherapy due to small cell carcinoma in the RLL & suffered from post-operative chronic empyema thoracis at D hospital. He moved to our hospital for further evaluation with accidental removal of chest drainge tube. We inserted closed drainage tube and dark blood gushed out abruptly just after insertion of the drainage tube. CTscan, MRI, and angiogram were performed and showed the perforation of IVC just below RA. The IVC was repaired using simple interrupted 4-0 Prolene suture through right posterolateral thoracotomy. The patient recovered without event and doing well until now.

• Tuberculosis and Respiratory Diseases
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• v.67 no.5
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• pp.467-470
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• 2009

A traumatic pulmonary pseudocyst is a rare complication of blunt thoracic trauma. The clinical symptoms and signs are similar to other respiratory diseases, such as pulmonary tuberculosis. Therefore, a trauma history with the resulting radiologic and clinical findings is important for making a diagnosis. A 26-year-old male was admitted to our hospital due to cough for 3 days. The chest x-ray revealed diffuse infiltrations and a cavitary lesion at the left lung. His left chest had hit a tree as a result of motorcycle accident one day before admission. Initially, it was assumed that his symptoms and chest X-ray might be due to a tuberculosis infection. However, bronchoscopy revealed old blood clots at both lungs, particularly in the left lower lobe bronchus. A transbronchial lung biopsy showed alveolar hemorrhage. A traumatic pulmonary pseudocyst was diagnosed from his trauma history and these findings. Computed tomography of the chest performed 4 months later showed regression of the cavitary lesion.

• Journal of Chest Surgery
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• v.40 no.7 s.276
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• pp.480-484
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• 2007

Background: Major vascular injuries can jeopardize a patient's life or imperil limb survival. We performed this study to establish an optimal management plan for vascular injuries. Material and Method: We retrospectively reviewed 26 cases of vascular injury that were treated at Pusan National University Hospital from May, 1999 to September, 2004. The age and sex distribution, the locations and causes of vascular injury, the diagnostic tools, the degree of injuries, clinical manifestations, the treatment modality and complications were reviewed. Result: The mean age was 39.5 years (range: $12{\sim}86$) and the male to female ratio was 22 : 4. The injuries were in 6 descending thoracic aortas, 4 femoral arteries, 4 popliteal veins and so on. The causes of injury were iatrogenic in 8 cases, traffic accident in 7, stab injury in 6 and industrial accident in 5. The most commonly used diagnostic tools were CT and angiography. The degrees of arterial injury were pseudoaneurysm in 10 cases, partial severance in 5, complete severance in 3 and thrombosis in 3. The degrees of venous injury were partial severance in 6 cases, complete severance in 2 and arteriovenous fistula in 2. The clinical manifestations were absence of pulse in 8 cases, coldness in 7, chest pain in 6, swelling in 5, bleeding in 5 and so on. The most frequently used type of revascularization was graft interposition in 11 cases. Two arteriovenous fistulae were repaired by endovascular procedure. There was one case of mortality due to multi-organ failure after hemorrhagic shock, There were three major amputations, and two of them were due to delayed diagnosis and treatment. Conclusion: A system for the early diagnosis and treatment is essential for improving limb salvage and patient mortality. As a consequence of the widespread application of endovascular procedures, the incidence of iatrogenic injuries has recently increased. Educating physicians is important for the prevention of iatrogenic injury. Easy communication and cooperation for earlier involvement of a vascular surgeon is also an important factor.

• Journal of Chest Surgery
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• v.43 no.6
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• pp.705-709
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• 2010

Background: Esophageal injury requires early and proper management. We want to determine the results of various esophageal injuries. Material and Method: We respectively analyzed 22 patients who were managed for esophageal injury between 1999 and 2009. Based on the medical records, we reviewed the causes of injury, the diagnoses, the treatment methods, the complications and the prognosis. Result: The main causes of esophageal injury were a foreign body in 9 cases (41%) and vomiting in 5 cases (23%). We treated the patients with esophageal primary repair in 12 cases (55%), abscess drainage in 4 cases (18%) and conservative management in 6 cases (27%). There was esophageal leakage in 7 cases (32%) and death occurred in 3 cases (14%). Conclusion: For minor esophageal injury, conservative management was sometimes possible to treat the esophagus, yet aggressive and urgent surgical treatment should be applied for cases of major esophageal injury, including mediastinal abscess.

• Journal of Trauma and Injury
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• v.31 no.1
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• pp.16-18
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• 2018

Delayed esophageal rupture due to blunt injury is not new. However, rupture due to suspected barotrauma is very rare. We describe a case of esophageal rupture in a male 24-year-old patient after diving in shallow waters. The patient was quadriplegic and could not experience the typical chest pain related to rupture and resulting mediastinitis. The rupture was discovered 4 days after emergency decompressive laminectomy and fusion for his cervical spine. The rupture was evidently caused by barotrauma and was discovered four days after admission. He underwent primary closure and pericardial flap as a life-saving procedure.

• Journal of Chest Surgery
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• v.24 no.11
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• pp.1115-1124
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• 1991

Recently the thoracic injuries have been markedly increasing due to the vast increase of traffic accident, industrial disaster, and incidental accident as well as the frequent use of the murderous weapons including gun or rifle. Because the thoracic injuries could involve the heart, lung, and great vessels, and would influence the lives, prompt diagnosis and adequate treatment are essential. Most of thoracic injuries can be managed with the conservative treatment and simple surgical procedure such as closed thoracostomy, but certain cases require open thoracotomy to preserve lives and to return to their normal environment. The authors have analysed the result of 53 cases of open thoracotomy after thoracic injuries mainly according to the patient`s chart review. The mean age was 33.4 years old and male to female ratio was about 5: l. Injury mechanisms that elicited thoracic trauma indicated for open thoracotomy were penetrating[47%] and non-penetrating[53%] injuries. The Most common type of the thoracic lesion was hemothorax with or without pneumothorax and diaphragm rupture was the second. 58\ulcornero of thoracic injuries were accompanied by abdominal injuries and 47% by bone fractures. 34 patients were operated within 24 hours after injury and their average elapsed time was 13.6 hour. The remained patients were operated after 24 hours and their average elapsed time was 7.8 days. 71 cases of operative procedures containing some overlappings were performed: diaphragm repair[28], bleeding control[12], pulmonary and cardiac repair[4 cases] Postoperative complication rate was 32.1% and operative mortality rate was 9.4%[5/53].

• Journal of Chest Surgery
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• v.22 no.4
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• pp.609-619
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• 1989

During aortic valve surgery, cardioplegic solution is delivered through direct cannulation of both coronary ostia. Since this approach may cause an intimal injury leading to acute dissection or late ostial stenosis, this study was undertaken to evaluate myocardial protective effect of retrograde perfusion of cardioplegia [RCSP <% RRAP] in 18 clinical cases, which were compared with antegrade perfusion of cardioplegia in 27 clinical cases. This study were investigated 1] cease and return of electromechanical activity after cardioplegia infusion 2] the myocardial temperature during operation 3] the aortic cross clamping time and total bypass time 4] frequency of DC shock for defibrillation 5] need for inotropic drugs after operation 6] electrocardiographic evidence of myocardial infarction or ventricular arrhythmia after operation 7] the enzymes activity during preoperative and postoperative period as an evaluation of myocardial ischemic injury and 8] operative mortality rate The combination of retrograde cardioplegia and topical cooling with ice slush yielded promptly hypothermia of myocardium and shorter aortic cross-clamping time compared with antegrade cardioplegia [P < 0.05]. The temperature of the interventricular septum was maintained below 20oC by continuous perfusion or intermittent perfusion of cold blood cardioplegia and other results were no statistically significant difference between the two methods [P >0.05]. This technique provides clear operative field and avoids some serious complications which are caused by coronary ostial cannulation. These results suggested that the retrograde perfusion of cardioplegia is a simple, safe, and effective means of myocardial protection during open heart surgery.