• Journal of Chest Surgery
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• 제21권6호
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• pp.979-983
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• 1988

Calcium channel blockers may prevent myocardial injury during cardioplegia and reperfusion. This study was done to evaluate the effects of diltiazem cardioplegia on myocardial protection during ischemic arrest and recovery of myocardial function after reperfusion. Four formulations of crystalloid cardioplegic solutions, GIK solution[group I, n=12], diltiazem[lug/ml GIK] in GIK solution[group II, n=7], ],diltiazem[2ug/ml GIK] in GIK solution[group III, n=6] and diltiazem[4ug/ml GIK] in GIK solution[group IV, n=6] were compared in isolated working rat heart subjected to a long period [2 hours] of hypothermic arrest with multi-dose infusion. Diltiazem cardioplegia[group II, III and IV]was found to be superior in nearly all aspects. Diltiazem cardioplegia showed faster recovery of regular rhythm and lower incidence of ventricular fibrillation than group I did. In comparing mechanical function in all experimental hearts, the mean postischemic recoveries of aortic flow, cardiac output, peak aortic pressure, stroke volume and stroke work[expressed as a percentage of its preischemic control] were significantly greater in group II, III and IV[diltiazem cardioplegia] than in group I. The infused amount of cardioplegic solution was more increased by the addition of diltiazem to GI K solution. [p < 0.01] Creatine kinase leakage tended to be lower in hearts receiving diltiazem cardioplegia, especially in group III and IV[p<0.05] than in those receiving GIK solution only[group I]. Diltiazem cardioplegia results in the increased flow of cardioplegic solution and the decreased ischemic injury of myocardium during ischemic arrest and the improved recovery of myocardial function after reperfusion, and a dose-response relation must be established before clinical use.

• Journal of Chest Surgery
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• 제45권6호
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• pp.390-395
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• 2012

Background: Conventional open repair is a suboptimal therapy for blunt traumatic aortic injury (BTAI) due to the high postoperative mortality and morbidity rates. Recent advances in the thoracic endovascular repair technique may improve outcomes so that it becomes an attractive therapeutic option. Materials and Methods: From August 2003 to March 2012, 21 patients (mean age, 45.81 years) with BTAI were admitted to our institution. Of these, 18 cases (open repair in 11 patients and endovascular repair in 7 patients) were retrospectively reviewed and the early perioperative results of the two groups were compared. Results: Although not statistically significant, there was a trend toward the reduction of mortality in the endovascular repair group (18.2% vs. 0%). There were no cases of paraplegia or endoleak. Statistically significant reductions in heparin dosage, blood loss, and transfusion amounts during the operations and in procedure duration were observed. Conclusion: Compared with open repair, endovascular repair can be performed with favorable mortality and morbidity rates. However, relatively younger patients who have acute aortic arch angulation and a small aortic diameter may be a therapeutic challenge. Improvements in graft design, delivery sheaths, and graft durability are the cornerstone of successful endovascular repair.

• Journal of Chest Surgery
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• 제42권4호
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• pp.528-531
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• 2009

경식도 초음파는 심장수술에서 비교적 안전하게 수술 중 심장의 기능 및 수술 결과를 평가할 수 있어 그 이용이 일반화되고 있으며, 경식도 초음파 관련 합병증은 드물지만 하인두 손상이나 식도 천공 등 위험한 합병증이 생길 수 있다. 폐부종을 동반한 심근경색으로 진단받은 77세 남자환자에서 심폐 바이패스를 사용하 않는 관상동맥우회술 시행 후, 수술 중 경식도 초음파 시술과 관련되어 발생한 것으로 추정되는 pyriform sinus 천공 및 이에 동반된 경부 심부감염을 경험하여 보고하는 바이다.

• Tuberculosis and Respiratory Diseases
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• 제78권3호
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• pp.281-285
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• 2015

Statins lower the hyperlipidemia and reduce the incidence of cardiovascular events and related mortality. A 60-year-old man who was diagnosed with a transient ischemic attack was started on acetyl-L-carnitine, cilostazol, and rosuvastatin. After rosuvastatin treatment for 4 weeks, the patient presented with sudden onset fever, cough, and dyspnea. His symptoms were aggravated despite empirical antibiotic treatment. All infectious pathogens were excluded based on results of culture and polymerase chain reaction of the bronchoscopic wash specimens. Chest radiography showed diffuse ground-glass opacities in both lungs, along with several subpleural ground-glass opacity nodules; and a foamy alveolar macrophage appearance was confirmed on bronchoalveolar lavage. We suspected rosuvastatin-induced lung injury, discontinued rosuvastatin and initiated prednisolone 1 mg/kg tapered over 2weeks. After initiating steroid therapy, his symptoms and radiologic findings significantly improved. We suggest that clinicians should be aware of the potential for rosuvastatin-induced lung injury.

• Journal of Chest Surgery
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• 제11권4호
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• pp.378-384
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• 1978

Injuries to the major vessels in the thoracic inlet require early recognition and expedient operative approach. Delayed diagnosis difficulties encountered in the operative exposure of the region are the major factors limiting successful management. This report is a review of 13 patients with vascular injuries to the neck base who were managed at Busan National University Hospital from March 1975 to September 1978 about 3 years and 6 months. The important clinical problems are delineated with emphasis on the technical aspects of operative management. 1] Among 13 cases, 8 cases were male 5 cases were female. 2] Of 28 vascular injuries, subclavian axillary vascular injuries were 22 [78%]. Stab wound was the cause in 70% of these patients. 3] Without extension 7 cases[53.8%] were managed successfully with supraclavicular, and axillary incision. Posterolateral thoracotomy one of extending 4 cases, 2 cases were used right musculoskeletal flap for management of proximal part of the subclavian artery and innominate vessel, 2 cases were used left supraclavicular incision with anterolateral thoracotomy for management of left proximal subclavian artery. One Expired. 4] Repair of vascular injury was accomplished by lateral suture of debridement and end-to end anastomosis in 17[74%]. Autogenous vein was used one for interposition graft. Ligation was required 2 arterial, 6 venous injuries. Of 8 cases which were pulseless preoperatively, 5 cases were able to palpable distal pulse. 5] Post operative complications occurred 50%. Complication of vasular repair was rare. The majority was neurologic deficit (33.3%).

• Journal of Chest Surgery
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• 제28권12호
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• pp.1167-1173
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• 1995

We evaluated fifty three cases of traumatic diaphragmatic injuries that we have experienced from Jan.1973 to Oct.1994. The age distribution of the pateint was ranged from 1 to 74 years. Sex ratio is 39:14 with male dominence. The traumatic diaphragmatic injuries were due to blunt trauma in 37[Left 22, Right 15 cases and penetrating trauma in 16[Left 9, Right 7 cases. In blunt trauma, Preoperative diagnosis of the diaphragmatic injuries was possible in 27 patients[72% , and in penetrating trauma, 14 patients[88% . Among 37 in blunt traumas, 22[58% cases, and among 16 in penetrating traumas, 13[88% cases were operated within 24 hours. The most common herniated abdominal organ in the thorax was stomach[14/53 . The traumatic diaphragmatic repair of 50 cases were performed by thoracic approach in 23 cases, thoracoabdominal approach in 8 cases and abdominal approach in 19 cases, and in 3 cases, not operated. Hospital mortality [including not operated patients[3 was 17%[9/53 and the causes of death were intracranial hematoma[1 , hypertensive encephalopathy[1 and asphyxia[1 , and among operated patients[6 , combined head injury[2 , multiorgan failure[2 , hypovolemic shock[1 , and pulmonary edema & renal failure[1 . All deaths had related to the severity of associated injuries.

• Journal of Chest Surgery
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• 제32권10호
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• pp.897-902
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• 1999

Use of the left internal thoracic artery(ITA) to bypass the left anterior descending(LAD) coronary artery has become the standard of care based on its superior graft patency, reduced cardiac events, and enhanced survival. But rarely we encountered with injury to the artery during harvesting which leads to loss of the merits of surgery. We reconstructed inadequate ITAa with other arterial conduits so proximal stump to be a blood source if possible. Maternal and method: Between January 1996 and March 1999, 12 patients received bypass with the reconstructed left internal thoracic artery grafts to left anterior descending artery because of an injury(n=8), short or small(n=4). Right or left ITA was used to LAD as a free graft(n=2). And the other 10 left ITAs were extended with radial artery(n=6), right ITA(n=3), saphenous vein(n=1). Composite "T" graft was made with other arterial conduits in these extended graft(n=5). Result: There was only one morbidity of minor would problem, and no mortality. The patency of extended graft to LAD was complete in 5 patients who received angiography during the period of 2wks to 2 years postoperative, but one of side branch of "T" graft occluded. All of these patients were well. Conclusion: Reconstructive extension with the use of other arterial conduit for the injured proximal ITA is warranted in any patients with acceptable results. acceptable results.

• Journal of Chest Surgery
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• 제40권3호
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• pp.232-235
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• 2007

외상성 대동맥판막 손상 환자에게 대동맥 판막 성형술과 대동맥 판막 치환술로 각각 치료한 2예를 보고한다. 한 명은 18세 남자 환자로 대동맥 판막 성형술을 시행하였으나 수술 후 5년째 중등도의 잔존한 대동맥판막폐쇄부전증으로 추적관찰 중이며 다른 64세 남자 환자는 기계판막 치환술 후 관찰 중이다. 신중하게 선택된 일부의 환자를 제외한 외상성 대동맥판막폐쇄부전증에는 판막치환술을 우선적 수술 방법으로 귄유한다.

• Tuberculosis and Respiratory Diseases
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• 제72권4호
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• pp.386-389
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• 2012

Diffuse alveolar damage (DAD) is a histological change in lung tissue, and is generally caused by an acute lung injury, which is characterized by bilateral and widespread damages. Localized DAD occurs very rarely. The causes for DAD are numerous, but the chief cause is acute interstitial pneumonia or acute exacerbation of idiopathic interstitial pneumonia, in cases of idiopathic manifestation. The 82-year-old patient, in this case study, showed a DAD lesion in only 1 lobe. The patient was otherwise healthy, with no previous symptoms of DAD. He was admitted to our medical center owing to localized infiltration, observed on his chest radiograph. Laboratory studies showed no signs of infections. DAD was confirmed by a surgical lung biopsy. The patient received corticosteroid treatment and had gradually improved. We report the case of a patient with localized, idiopathic DAD that cannot be classified as acute interstitial pneumonia or acute exacerbation of idiopathic interstitial pneumonia.

• Tuberculosis and Respiratory Diseases
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• 제38권1호
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• pp.70-73
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• 1991

We have experienced a case of lung injury caused by accidental inhalation of ammonia gas in a 34 year-old-man. By the explosion of ammonia tank in a refrigerator boat he inhaled ammonia gas. Several minutes later, he suffered from severe dyspnea and visual loss. On arrival at emergency room, analysis of arterial blood gas revealed severe hypoxemia and his chest film showed bilateral pulmonary infiltrates. Under the impression of adult respiratory distress syndrome, mechanical ventilator was applied to the patient. After recovery from ARDS and tracheal edema, he complained of some hemoptysis and productive sputum during the admission. So we checked bronchoscopy and bronchograpy which showed tracheal bullae just above carina and tubular bronchiectatic change in the right lower lobe. We report a case of lung injuries-ARDS, tracheal bullae, and bronchiectasis-caused by inhalation of ammonia gas with the review of the relevant literatures.