• Journal of Trauma and Injury
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• 제36권3호
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• pp.180-186
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• 2023

Purpose: The purpose of this study was to report the treatment results of patients with traumatic cardiac tamponade after the opening of Jeju Regional Trauma Center. Methods: We analyzed the treatment outcomes of patients with traumatic cardiac tamponade who were treated at Jeju Regional Trauma Center from January 2018 to August 2022. Results: Seven patients with traumatic cardiac tamponade were treated. The male to female ratio was 1.33:1 (four male and three female patients) and the average age was 60.3±7.2 years. The mechanism of injury was blunt trauma in six cases and penetrating injury in one case. Upon arrival at the emergency department, pericardiostomy was performed in four cases, and an emergency operation was performed in six cases. Pericardiostomy alone was performed in one patient, who had cardiac tamponade due to extrapericardial suprahepatic inferior vena cava rupture. The causes of cardiac tamponade were right atrium appendage rupture in one case, right ventricle rupture in one case, inferior vena cava rupture in two cases, right atrium and left atrium rupture in one case, both atria and left ventricle rupture in one case, and intercostal artery rupture in one case. In three cases, intraoperative cardiopulmonary bypass was required. Two of the seven patients died (mortality rate, 28.5%). Conclusions: Relatively favorable treatment results were observed for traumatic cardiac tamponade patients after Jeju Regional Trauma Center was established.

• Tuberculosis and Respiratory Diseases
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• 제44권2호
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• pp.401-408
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• 1997

연구배경 : 폐격리증은 드문 선천성 폐질환으로 진단이 지연되거나 오진되는 경우가 많은 것으로 알려져 있으며, 수술전에 진단이 되지 않은 경우에는 수술시 이상동맥으로부터의 출혈로 인하여 어려움을 겪게 되는 경우가 있다. 저자 등은 수술적 치험을 한 폐격리증의 진단과 치료 등에 관한 전반적인 임상적 고찰을 시행하고자 한다. 방 법 : 1991년부터 1996년 5월까지 수술로써 확인된 15예의 폐격리증 환자를 대상으로 임상소견, 수술전 진단, 방사선 및 수술소견, 예후 등에 관하여 조사하였다. 결 과 : 평균연령은 22.5세(범위 5~57세)였고, 남녀비는 9 : 6이었다. 증상은 주로 재발성의 발열, 기침, 흉통, 객담 등의 감염증세를 나타내었으며, 내엽형 3예는 증상 없이 우연히 발견되었다. 단순 흉부 방사선 소견상 10예에서 다낭성 음영으로 나타났고, 5예에서 종괴양 음영이 관찰되었다. 흉부 전산화 단층촬영은 12예에서 시행되었는데, 8예에서 다낭성 음영이, 4예에서 종괴양 음영이 관찰되었다. 흉부 자기공명영상은 3예에서 시행되었는데, 2예에서 하행대동맥에서 기시하는 이상동맥을 확인할 수 있었다. 대동맥 조영술은 4예에서 시행되었고, 이상동맥은 2예에서는 하행 흉부대동맥, 1예는 복부대동맥, 1예는 늑간동맥에서 기시하였고, 모두 폐정맥으로 환류 되었다. 수술전 진단에 있어서는 폐격리증으로 진단한 경우는 내엽형 6예였고, 폐종양이 3예, 폐종양이 2예, 기관지 확장증이 2예 그리고 종격동 종양이 2예였다. 수술소견상으로는 내엽형이 12예중 8예는 좌하엽, 2예는 우하엽, 1예는 좌상엽, 1예는 우중엽에 위치하였고, 외엽형 3예중 2예는 좌우 횡격막 상부, 1예는 심낭내에 위치하였다. 수술시 이상동맥은 6예는 하행 흉부대동맥, 1예는 복부 대동맥, 2예는 내흉동맥, 1예는 늑간동맥, 1예는 심낭횡격막동맥에서 기시한 것으로 확인되었고, 4예에서는 정확한 기시부를 확인하지 못 하였다. 수술사망 및 이환률은 없었고, 추적관찰상 모두 특별한 문제없이 지내고 있다. 결 론 : 폐격리증 환자의 임상 양상은 다른 보고들과 유사한 소견을 보였고, 수술전 진단률은 비교적 낮았으며, 특히 외엽형의 경우에 더 낮은 경향을 보였다. 본 연구에서는 전 예에서 합병증 없이 양호한 경과를 보였으나, 향후 더 적극적인 수술전 진단적 접근을 하는 것이 수술시 출혈 등의 합병증 방지 및 적절한 수술방법의 적용에 도움이 될 것으로 사료된다.

• Journal of Chest Surgery
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• 제51권5호
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• pp.344-349
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• 2018

Background: We report our surgical technique for nonintubated uniportal video-assisted thoracoscopic surgery (VATS) pulmonary resection and early postoperative outcomes at a single center. Methods: Between January and July 2017, 40 consecutive patients underwent nonintubated uniportal VATS pulmonary resection. Multilevel intercostal nerve block was performed using local anesthesia in all patients, and an intrathoracic vagal blockade was performed in 35 patients (87.5%). Results: Twenty-nine procedures (72.5%) were performed in patients with lung cancer (21 lobectomies, 6 segmentectomies, and 2 wedge resections), and 11 (27.5%) in patients with pulmonary metastases, benign lung disease, or pleural disease. The mean anesthesia time was 166.8 minutes, and the mean operative duration was 125.9 minutes. The mean postoperative chest tube duration was 3.2 days, and the mean hospital stay was 5.8 days. There were 3 conversions (7.5%) to intubation due to intraoperative hypoxemia and 1 conversion (2.5%) to multiportal VATS due to injury of the segmental artery. There were 7 complications (17.5%), including 3 cases of prolonged air leak, 2 cases of chylothorax, 1 case of pleural effusion, and 1 case of pneumonia. There was no in-hospital mortality. Conclusion: Nonintubated uniportal VATS appears to be a feasible and valid surgical option, depending on the surgeon's experience, for appropriately selected patients.

• Journal of Chest Surgery
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• 제30권3호
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• pp.336-339
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• 1997

최근 흉부 대동맥의 수술적 치료가 과거에 비해 좋은 성적을 얻고 있다. 전 흉부 대동맥을 포함하는 대동맥류나 대동맥 박리증의 경우대개 두단계나세단계로나누어 수술하였다. 본원에서는 숲 대동맥을 포함한 드베키 타입 I 만성 대동맥 박리증 환자에 있어서 한번에 출 대동맥을 치환하는 수술을 시행하였다. 환자는 호흡 부전과 Marfan 환자의 특징적 외모를 갖고있는 25세 남자로 심한 대동맥 부전증과 만성 드베키 타입 I대동맥 박리증 진단하에 수술시행하였다. 수술소견상상행 대동맥이 매우 커져 있었으며 상행대동맥에 두 개의 내막 파열이 관찰되 었고 가혈관으로 부터 늑간 동맥들과 우측 신동맥이 혈공급을 받고있었다. 벤탈 술식과 함께 술 대동맥 치환술을 성공적으로 시행하였으며, 환자는 현재까지 큰 합병증없이 외래를 통해 추적 관찰중이다.

• Journal of Chest Surgery
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• 제10권1호
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• pp.148-155
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• 1977

The clinical findings with cardioangiography and successful surgical treatment of a 10 year old girl with double-outlet right ventricle is reported at The Dept. of Thoracic and Cardiovascular Surgery, Korea University Hospital, College of Medicine. The patient has been suffered from intermittent cyanosis, palpitation, and exertional dyspnea since 1 year after NFSD, and a holosystolic ejection murmur of grade 4 at the left 3rd intercostal space with mild cyanosis of the lips was the only physical findings at the time of this admission. Cardiac catheterization revealed ventricular septal defect with left to right shunt of 43% and right to left shunt of 10.2%. On cardioangiography from the left ventricle revealed all of the left ventricular outflow shunted into the right ventricle through the large ventricular septal defect, and the aorta originated from the infundibular chamber of the right ventricle with left, anterior sided pulmonary artery. The atria, viscera, and ventricles were normally located, and right ventricular out-flow was narrowed with infundibular hypertrophy and pulmonary valvular stenosis. Surgical correction was accomplished by closure of the ventricular septal defect in such a way that left ventricular outflow was routed via a Teflon felt prosthetic tunnel to the aorta, and pulmonary valvulotomy with infundibulectomy Was done to pass Hegar`s dilator No. 15 for reconstruction of the right ventricular outflow tract. The patient tolerated complete repair and has continued to improve over a period of three months after operation with normal school life. Details of the disease and method of repair are presented with related references.

• Journal of Chest Surgery
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• 제23권5호
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• pp.962-967
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• 1990

The anomalous pulmonary venous return of the entire left lung was an extremely rare congenital anomaly. The reported surgical experience with correction of this disorder was limited. The 3-year-old female patient underwent an operation upon the unilateral total anomalous pulmonary venous return from the left lung, in which the left superior pulmonary vein drained into innominate vein and the left inferior pulmonary vein into the coronary sinus, in Yeungnam University Hospital. The symptoms were nonspecific except frequent upper respiratory infection. Cyanosis was not seen. On auscultatory findings, a grade 2/6 systolic ejection murmur was audible over left second intercostal space of left sternal border and second heart sound had an increased pulmonary component which was widely splitted. The electrocardiogram demonstrated a right ventricular hypertrophy and right axis deviation and chest X-ray showed slightly increased pulmonary vascularity and bulged pulmonary conus. The echocardiogram demonstrated increased right atrial, ventricular, and pulmonary arterial dimension, and also secundum atrial septal defect and enlarged coronary sinus. The cardiac catheterization confirmed the left-to-right with a Qp/Qs of 2.0: 1 and oxygen step-up was seen in pulmonary artery, right ventricle, right atrium, and left innominate vein, and the catheter was not been introduced into the left pulmonary vein. A median sternotomy incision was done. Left superior pulmonary vein was drained to the innominate vein through anomalous vertical vein and the left inferior pulmonary vein drained to right atrium through the coronary sinus. The diversion of the left inferior pulmonary vein to posterior wall of left atrium was done after division in the proximity of coronary sinus. The anomalous vertical vein was diverted to base of left atrial auricle and then a atrial septal defect was sutured directly. The postoperative course was uneventful and she was discharged on the eleventh postoperative day. In the postoperative follow-up-2 months, she has been well without specific problems.

• Journal of Chest Surgery
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• 제33권7호
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• pp.594-596
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• 2000

선천성 낭종성 선종양 기형과 외엽형 폐격리증은 아주 드문 질환이다. 본원에서는 4세 된 여자환자에서 좌폐화엽의 선천성 낭종성 선종양 기형을 수술하던 중 우연히 외엽형 폐격리증이 동반된 것을 알고 좌폐하엽 절제술과 외엽형 폐격리증 절제술을 시행하였는데, 외엽형 폐격리증은 흉부대동맥에서 비정상적으로 직접 1개의 동맥으로 유입되고, 늑간정맥을 통하여 기정맥으로 유출되었다. 환자는 수술 후 건강하게 퇴원하였다.

• Archives of Plastic Surgery
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• 제36권4호
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• pp.503-506
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• 2009

Purpose: Unilateral breast reconstruction after mastectomy confront the challenges of recreating a natural appearing breast mound and achieving symmetricalness of the breasts. If the patient's remaining breast is large compared to reconstructed breast, the most common procedure is reduction mammoplasty of the large breast side. The authors experienced a new method of breast reconstruction using the excess breast tissue from the contralateral breast after breast reduction. Methods: The excess tissue from the contralateral breast after vertical reduction mammoplasty with superior pedicle and remaining lower breast tissue were transferred to the mastectomy site breast through the subcutaneous tunnel on the chest wall. The main blood supplies of the flap are perforator branches of the 4th, 5th and 6th anterior intercostal artery. After elevating and detaching the flap on the lower lateral area of the breast, the turn overed flap is fixed on the upper portion of the chest wall of the mastectomy site. Results: On two cases of the breast reconstructions, remaining excess breast tissue from reduction mammoplasty was transferred to the contralateral breast side as pedicles. Both patient and operator were satisfied with the outcome of the reconstruction as the breasts were symmetrical and natural shape. Conclusion: We have performed unilateral breast reconstruction using the excess breast tissue after reduction mammoplasty of the contralateral breast. As Oriental women's breasts are relatively smaller than that of Caucasian women, delayed breast reconstruction cases of Oriental women with large breasts(macromastia) seem to be ideal for this procedure.

• Journal of Chest Surgery
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• 제17권4호
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• pp.593-606
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• 1984

With the ligation of patent ductus arteriosus by Gross in 1938, surgeons first entered the field of congenital heart disease. Interruption of a ductus is one of the most satisfactory and curative operations in the field of surgery for congenital heart disease. 27 cases of isolated patent ductus arteriosus were operated from Jan. 1978 to July 1984 at the Department of Thoracic & Cardiovascular Surgery in Kyung-Hee University Hospital. Retrospective clinical analysis of these patients were: 1. Sex ratio, female: male, was 2:1. 2. Mean age at operation was 9.85\ulcorner.58 years. The youngest patient was a 23 month-old girl and the oldest one was a 24 year-old male. 3. More than half of the patients had less than 50 percentile of growth retardation. 4. Chief complaints of the patients were frequent URI [52%], dyspnea on exertion [33%], generalized weakness [22%], palpitation [7%], but 7 patients [26%] had no subjective symptoms. 5. Continuous machinery murmur could be heard at the 2nd or 3rd intercostal space on the left sternal border in 22 patients [81%]. The other S patients made systolic murmur with accentuation of the second heart sound and those were associated with pulmonary hypertension. 6. Radiologic findings of Chest P-A were cardiac enlargement in 15 patients [55%], enlargement of pulmonary conus and/or increasing density of pulmonary vascularity in 20 patients [74%]. 7. Electrocardiographic findings of the patients were within normal limit in 13 patients [48%], LVH in 4 patients [15%], biventricular hypertrophy in 3 patients [11%]. 8; echocardiogram was obtained from 11 patients. Ductus was directly visualized in 7 patients. Left atrial enlargement is the secondary change of left to right shunt, 10 patients had LA/Ao ratio more than 1.2. 9. Cardiac catheterization performed in 25 patients. The mean value of the results were:SO2[PA-RV]= 14.72\ulcorner6.01%, Qp/Qs=2.22\ulcorner.80, peak systolic pulmonary arterial pressure=48.28\ulcorner1.60 mmHg. 10. 26 patients were operated through the left posterolateral thoracotomy: closure of ductus by double ligation in 14 cases, triple ligation in 5 cases, and division with suture in 8 cases. One patient suffer from aneurysmal rupture of main pulmonary artery, endocarditis, hemopericardium was treated with cardiopulmonary bypass via median sternotomy and closure of ductus through the ruptured main pulmonary artery. 11.There was no death associated with the operation, but 3 cases were experienced with intraoperative rupture around the ductus resulting in massive bleeding. The other complications were transient hoarseness in one patient, atelectasis in left lower lobe in 3 patients, and postoperative systemic hypertension in 4 patients with unknown etiology. 12. Pulse pressure was reduced, 11.47+5.92 mmHg, postoperatively, as compare to preoperative status. 13. Intraoperative wedge lung biopsy from lingular segment for the evaluation of the pulmonary vascular disease was taken in S patients with severe pulmonary hypertension. The result was Heath-Edward grade I in one case, grade II in two cases, and grade III in two cases.

• 한국임상수의학회지
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• 제21권1호
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• pp.72-75
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• 2004

A ten months old, female Yorkshire terrier weighing 2.88 kg referred to veterinary leaching hospital of college of veterinary medicine, Konkuk University because of syncope, cough and dyspnea. First hematological and serum chemical test revealed thrombocytopenia, mild anemia, and increase of concentration of ALP (195 U/L). On 57 days later, second hematological and serum chemical test revealed polycythemia, increase of concentration of ALP (211 UR.), and Tchol (387 mg/dl). Right atrium enlargement, main pulmonary artery bulge and cardiomegaly (VHS = 11.5) were observed in radiographic findings. Ultrasohographic images showed both right and left ventricular dilation and turbulent flow between the descending aorta and the main pulmonary artery in color Doppler imaging. ECG showed left ventricular enlargement, SA block, and electrical alternant. Thoracotomy was performed through left fourth intercostal incision under isoflurane anesthesia. Patent ductus arteriosus was double ligated with 1-0 silk. Cough and dyspnea disappeared on 5 days after operation. Turbulent flow was not found in color doppler imaging of ultrasonography on 10 days after operation. Ten months later after the operation, syncope could not exist any more.