• Journal of Chest Surgery
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• 제50권2호
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• pp.86-93
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• 2017

Background: The influence of lifestyle diseases on postoperative complications and long-term survival in patients with non-small cell lung cancer (NSCLC) is unclear. The aim of this study was to determine whether lifestyle diseases were significant risk factors of perioperative and long-term surgical outcomes in elderly patients with stage I NSCLC. Methods: Between December 1995 and November 2013, 110 patients aged 65 years or older who underwent surgical resection of stage I NSCLC at Dong-A University Hospital were retrospectively studied. We assessed the presence of the following lifestyle diseases as risk factors for postoperative complications and long-term mortality: diabetes, hypertension, chronic obstructive pulmonary disease, stroke, and ischemic heart disease. Results: The mean age of the patients was 71 years (range, 65 to 82 years). Forty-six patients (41.8%) had hypertension, making it the most common lifestyle disease, followed by diabetes (n=23, 20.9%). The in-hospital mortality rate was 0.9% (n=1). The 3-year and 5-year survival rates were 78% and 64%, respectively. Postoperative complications developed in 32 patients (29.1%), including 7 (6.4%) with prolonged air leakage, 6 (5.5%) with atrial fibrillation, 5 (4.5%) with delirium and atelectasis, and 3 (2.7%) with acute kidney injury and pneumonia. Univariate and multivariate analyses showed that the presence of a lifestyle disease was the only independent risk factor for postoperative complications. In survival analysis, univariate analysis showed that age, smoking, body mass index, extent of resection, and pathologic stage were associated with impaired survival. Multivariate analysis revealed that resection type (hazard ratio [HR], 2.20; 95% confidence interval [CI], 1.08 to 4.49; p=0.030) and pathologic stage (HR, 1.89; 95% CI, 1.02 to 3.49; p=0.043) had independent adverse impacts on survival. Conclusion: This study demonstrated that the presence of a lifestyle disease was a significant prognostic factor for postoperative complications, but not of survival, in elderly patients with stage I NSCLC. Therefore, postoperative complications may be influenced by the presence of a lifestyle disease.

• Tuberculosis and Respiratory Diseases
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• 제71권5호
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• pp.368-372
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• 2011

Acute fibrinous and organizing pneumonia is a newly recognized pattern of acute lung injury. A 49-year-old female presented with a cough and worsening dyspnea on exertion. She had no history of smoking and no specific past medical history except exposure of home humidifier containing sterilizer. A chest computed tomography scan showed patchy consolidation with fibrosis in the right lower lobe and ill-defined centrilobular ground glass opacity in both lungs. The pathological findings were patchy areas of lung parenchyma with fibrin deposits in the alveolar ducts and alveoli, and fibrin balls with hemosiderin deposition in the alveolar spaces. The histological pattern of our case is differentiated from diffuse alveolar damage by the absence of hyaline membranes, and from eosinophilic pneumonia by the lack of eosinophils. In our case, the patient was treated with corticosteroid pulse therapy. However, the clinical course became aggravated and she died within two weeks.

• Journal of Chest Surgery
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• 제39권2호
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• pp.111-116
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• 2006

배경: 식도천공은 즉시 진단되어 치료하지 않으면 높은 이병률과 사망률을 보인다. 수술 방법의 진보에도 불구하고 식도천공의 치료의 시기와 방법은 아직 논쟁의 여지가 많은 상태이다. 대상 및 방법: 1990년 1월에서 2004년 6월까지 계명대학교 동산의료원에서 식도 천공을 진단받은 38명의 환자에서 차트를 이용하여 후향적 조사를 하였다. 결과: 환자는 남자가 28명, 여자가 10명이었고 평균 연령은 43.84$\pm$18.89세($1{\~}73$세)였다. 천공은 경부에서 8예, 흉부가 28예 그리고 복부가 1예 발생하였고 자연성 식도 천공이 $34\%$, 의인성이 $32\%$ 그리고 외상성이 $34\%$로 조사되었다. 치료는 경부식도 천공에서는 일차봉합 6예, 배농만 시행한 경우가 2예였으며, 흥부식도 천공에서는 일차봉합 14예, 식도 절제술 3예 그리고 보존적 치료가 12예였다. 사망률은 경부 식도 파열이 $25\%$, 흉부식도 파열이 $34\%$였다. 환자의 생존에 유의한 위험인자는 술 전의 패혈증 여부로 나타났다. 결론: 식도파열에서 가장 중요한 위험인자가 술 전의 패혈증 상태로 나타났다 술 전에 상태를 호전시킬 수 있는 적극적인 치료가 예후를 향상시킬 수 있을 것이다.

• Journal of Chest Surgery
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• 제36권8호
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• pp.630-632
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• 2003

인공심폐기를 사용하지 않는 관상동맥우회술에서 이식편의 근위부 문합을 상행대동맥에 시행하는 경우 상행대동맥의 조작으로 인한 공기나 대동맥조직, 죽종(atheroma) 등으로 인한 색전증과 대동맥 손상으로 유발되는 대동맥박리, 가성동맥류 등의 합병증을 유발할 수 있다 대동맥근부치환술 시 양측관상동맥의 재이식 시 도관을 사용하는 Cabrol 술식을 관상동맥우회술 시 적용하였다. 요골동맥이식편은 복재정맥과 다르게 혈관 내 판막이 없다는 이점을 고려하여 근위부 문합을 상행대동맥에 평행하게(side to side) 문합하여 하나의 근위부 문합으로 요골동맥이식편의 양측으로 혈류를 공급하는 Cabrol 술식을 이용하여 근위부 문합 수를 줄일 수 있으며 상행대동맥의 조작 수를 줄여 대동맥의 외상을 줄일 수 있다고 생각한다.

• Journal of Chest Surgery
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• 제30권1호
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• pp.48-54
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• 1997

본 인제대학교 의과대학 흉부외과학교실 서울백병 원에서는 1986년 10월부터 1995년 12월까지 부식제 의 음용으로 하인두와 식도 입구부터 심한 협착이 발생한 1 1례의 환자에서 하인두의 양배꼴동에 대용식 도를 문합하는 식도재건술을 시행하였다. 환자는 남자 7례, 여자 4례로 모두가 성인으로 연령은 21세 에서 47세까지로 평균 34세였다. 식도협착의 원인이 된 부식제는 산성이 6례: 알칼리성이 5례였다. 이들의 부식제 음용 동기는 자살 목적이 9례였 고, 사고로 인한 경우가 2례였다. 부식제의 음용후 최종적으로 식도재건술까지의 기간은 4개월에서 부 터 21년까지 였다. 식도재 건술시 이용한 대용식도는 9례에서는 우측 결장을 사용하였고, 2례는 이 전에 우측 결장을 이용한 식도재건술이 실패한 상태여서 좌측 결장을 사용하였다. 모든 환자에서 식도 절제술은 하지 않았고 결장은 흉골하로 거상하였다. 경부 문합은 환자의 머리를 똑바로 놓은 상태에서 경부에 J형태로 피부를 절개하고 흉골설골, 갑상설 골근을 절단하고 갑상연골의 연골막을 박리하여 감상연골을 역삼각형모양으로 부분절제하고 양배꼴동을 열고 결장과 단단문합하였다. 수술 직후 類觀隙\ulcorner환자는 음식물을 삼킬 때 연하곤란과 기도내로 음식물이 넘어가 고형 음식물로 삼키는 훈련이 필요하였다. 수술 후 발생한 합병증은 대용식도의 괴사가 3례가 발생하여 유리공장을 이식하였다. 3례에서는 경부 문합부위에 협착이 있어 2례에서 상부문합부위를 확장하였고 1례에서는 유착띠제거술을 시행하였으며 모두 협착이 해소되었다. 수술 후 외래 추적관찰에서 10례에서는 정상적으 로 음식물을 삼킬 수 있었고 유리공장을 사용하여 2차수술을 시행한 1례는 유리공장의 괴사로 3차수술 을 기다리고 있다.

• Journal of Chest Surgery
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• 제53권1호
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• pp.8-15
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• 2020

Background: We aimed to investigate the associations of critical care provided in a cardiac surgical intensive care unit (CSICU) staffed by an attending intensivist with improvements in intensive care unit (ICU) quality and reductions in postoperative complications. Methods: Patients who underwent elective isolated coronary artery bypass grafting (CABG) between January 2007 and December 2012 (the control group) were propensity-matched (1:1) to CABG patients between January 2013 and June 2018 (the intensivist group). Results: Using propensity score matching, 302 patients were extracted from each group. The proportion of patients with at least 1 postoperative complication was significantly lower in the intensivist group than in the control group (17.2% vs. 28.5%, p=0.001). In the intensivist group, the duration of mechanical ventilation (6.4±13.7 hours vs. 13.7±49.3 hours, p=0.013) and length of ICU stay (28.7±33.9 hours vs. 41.7±90.4 hours, p=0.018) were significantly shorter than in the control group. The proportions of patients with prolonged mechanical ventilation (2.3% vs. 7.6%, p=0.006), delirium (1.3% vs. 6.3%, p=0.003) and acute kidney injury (1.3% vs. 5.3%, p=0.012) were significantly lower in the intensivist group than in the control group. Conclusion: A transition from an open ICU model with trainee coverage to a closed ICU model with attending intensivist coverage can be expected to yield improvements in CSICU quality and reductions in postoperative complications.

• 대한후두음성언어의학회지
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• 제22권2호
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• pp.119-125
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• 2011

Background and Objectives : Temporary or permanent vocal paralysis can be occurred after head and neck surgery such as thyroid cancer, esophageal resection, and chest operation including lung parenchymal resection, due to a vagus or recurrent laryngeal nerve injury. The authors aimed to determine the clinical efficacy of using Calcium-Hydroxyapatite (CaHA) for permanent unilateral vocal cord palsy patients. Materials and Method : Between July 2008 to July 2010, among patients with chief complain of hoarseness and aspiration, only who were diagnosed as unilateral vocal cord palsy under laryngoscopy, were selected. The patients included 3 females and 13 males age range between 29 to 79 and average age was 60 years old. Results : The hoarseness range were $8.94{\pm}0.77$, $4.63{\pm}1.02$, $4.31{\pm}1.30$ statistically showing significant postoperative improve at preoperative, 1 week and 3 months. Also aspiration were $7.44{\pm}2.48$, $3.63{\pm}1.82$, $3.19{\pm}1.91$ statistically improved during the same period. The result of voice analysis showed that the frequency range shows decrease at 1 week and 3 months after the injection compared to that of the preoperative result in both male and female group (Male: $161.63{\pm}32.78$ Hz, $139.13{\pm}30.63$ Hz, $146.67{\pm}34.20$ Hz ; Female: $244.62{\pm}26.62$ Hz, $244.91{\pm}42.03$ Hz, $237.50{\pm}38.95$ Hz). The Maximal phonation time were $2.75{\pm}1.06$ (sec), $8.88{\pm}3.46$ (sec), $8.44{\pm}3.71$ (sec) statistically showing significant postoperative improve at preoperative, 1 week and 3 months. Conclusion : Injection laryngoplasty with CaHA in unilateral vocal cord paralysis is very safe and efficient procedure to improve a voice disorder, a swallowing difficulty, and a quality of life for those patients with a sacrificed RLN, a cancer invasion of the nerve, and a prolonged vocal cord paralysis which is more than six to twelve months.

• Journal of Chest Surgery
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• 제33권8호
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• pp.605-612
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• 2000

Background: Ischemic preconditioning enhances the tolerance of myocardium against ischemia/reperfusion injury, with the enhancement of the recovery of post-ischemic myocardial function. This study was disigned to assess whether the protective effect of ischemic preconditioning could provide one additional hour of myocardial preservation in four hour myocardial ischemia in a rate heart. Material and method: Fourty four Spargue-Dawley rats, weighing 300~450gm, were divided into four groups. Group 1(n=7) and group 3(n=12) were subjected to 30 minutes of aerobic Langendorff perfusion without ischemic preconditioning and then preserved in saline solution at 2~4$^{\circ}C$ for 4 hours and 5 respectively. Group 2(n=7) and group 4(n=18) were perfused in the same way for 20 minutes, followed by 3 minutes of global mormothermic ischemia and 10 minutes of perfusion and then preserved in the same cold saline solution for 4 hours and 5 hours respectively. Heart rate, left ventricular developed pressure(LVDP), and coronary flow were measured at 15 minutes during perfusion as baseline. Spontaneous defibrillation time was measured after reperfusion. Heart rate, LVDP, and coronary flow were also recorded at 15 minutes, 30 minutes, and 45 minutes during reperfusion. Samples of the apical left ventricular wall were studied using a transmission electron microscope. Result: Time of spontaneous defibrillation(TSD) was significantly longer in group 4 than in group 1(p<0.001), and TSD in group 1 was significantly longer in comparision to that of group 2(p<0.05). Heart rate at 45 minutes was significantly higher in group 1 than in group 4(p<0.05). Heart rate at 15 min was significantly higher in group 2 than in group 1(p<0.001) and in group 4 than in group 3(p<0.05). Left ventricular developed pressure(LVDP) at 30 minutes and 45 minutes was higher in group 1 than in group 4(p<0.01), LVDP at 45 minutes was higher in group 4 than in group 3(p<0.05). Rate-pressure product(RPP) at 30 minutes and 45 minutes was higher in group 1 than in group 4(p<0.05). RPP at 15 minutes was higher in group 2 than in group 1(p<0.01). RPP at 30 minutes and 45 minutes was higher in group 4 than in group 3(p<0.05). Group 2 showed relatively less sarcoplasmic edema and less nuclear chromatin clearance than group 1. Group 4 showed less myocardial cell damage than group 3, group 4 showed less myocardial cell damage than group 3, group 4 showed more myocardial cell edema than group 1. Conclusion: Ischemic preconditioning enhanced the recovery of postischemic myocardial function after 4 hours and 5 hours preservation. However, it was not demonstrated that ischemic preconditioning could definitely provide one additional hour of myocardial preservation in four hour myocardial ischemia in a rat heart.

• Journal of Chest Surgery
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• 제40권8호
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• pp.558-563
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• 2007

배경: 외상성 대동맥 파열은 사망률이 매우 높은 치명적인 손상이며, 환자의 경과는 동반된 손상과 밀접한 관계가 있다. 따라서 적절한 수술 시기와 치료 방침을 결정하는 것이 중요하다. 대상 및 방법: 겸자 봉합술로 수술한 15명의 외상성 흉부 하행 대동맥 파열 환자를 대상으로 동반 손상 여부, 수술 후 경과 등을 후향적으로 분석하였다. 결과: 사망률은 6.68% (1예)로 환자는 수술 중 사망하였으며, 지연 혈복강으로 인한 것으로 생각한다. 평균 수술 시간 및 대동맥 겸자 시간은 $231{\pm}53.1$분, $13.1{\pm}5.3$분이었다. 1예에서 수술 후 10일째, 장 폐쇄 증상을 호소하여 시행한 복부 전산화 단층 촬영에서 기계적 장 폐쇄가 발견되어 구획 절제술을 시행하였다. 결론: 외상성 대동맥 파열은 여러 방법으로 수술할 수 있지만, 그중 겸자 봉합술은 비교적 안전하고 효과적인 방법이라고 생각한다.

• 혜화의학회지
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• 제9권1호
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• pp.725-743
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• 2000

This study was intended to investigate the contents associated with the neuropsychosis in the medical books published in the times of Chinese dynasty of Jin and Yuan. As a result, the following findings were drawn. 1. As for palpitation from fright and severe palpitation, the medical schools in the times of Chinese Jin and Yuan dynasties viewed their causes as heart-fire, shuiqichengxin, blood vacuity, phlegm and so on and presented a prescription for each cause for them. 2. As for psychosis, medical books published in the times of Chinese Jin and Yuan dynasties accurately divided and discussed epilepsy and viewed their causes largely as Yangming heat, phlegm of chest and heart-fire. And a number of medical schools made use of such therapeutics as sweating, vomiting and diarrhea therapies. 3. As for headache, medical books published in the times of Chinese Jin and Yuan dynasties presented their causes as fire and heat, phlegm heat, phlegm and so on and classified the aspect of headache in detail. As for vacuity rexation and dysphoria, medical books at that time saw their causes as fire and heat, heart-fire, blood vacuity and so forth and presented a prescription for them accordingly. 4. Liu Wan Su was the Hanliang school. He viewed the etiological cause for psychopathy as fire and heat and prescribed largely the medication of cold nature for it. 5. Zhang Cong Zheng belonged to the Gongxia School. He viewed the etiological cause for psychopathy as fire, phlegm and so forth and made use of sweating, vomiting and diarrhea therapies. Especially, he used the 'Jingzhepingzhe' therapy as a method to treat the symptom of fright. 6. Li Gao did not any specific mention of psychopathy and divided headache due to internal injury and headache due to external contraction. 7. Zhu Zhen Heng viewed most of the etiological causes for psychopathy as phlegm, fire and deficiency of blood and attached importance to such its therapeutics as resolving phlegm, cleaning away fire and nourishing Yin. 8. Wang Hao Gu did not present the specifically common etiological cause and prescription for psychopathy but described the cause and prescription for headache, dysphoria, maniac speech, palpitation and so forth. Luo Tian Yi presented the process of psychosis due to abnormal therapy for cold demage and prescription of it. 9. Wang Lu made a detailed explanation about the therapeutics of five types of stagnated syndrome and said that stagnated syndrome became the major cause for them in the occurrence of such psychopathy. Wei Yi Lin presented the prescription and medication for comparatively diverse mental diseases such zhong-qi, severe palpitation, palpitation for fright, impaired memory, vacuity rexation, headache, psychosis.