• Journal of Chest Surgery
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• 제10권2호
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• pp.327-336
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• 1977

A chinical analysis was performed on 383 ases of hest injurjes eperienced at Department of thoraci Surgery, Seoul National University Hospital during 21 year period From 1957 to 1977. Of 383 patients o hest injuries, 209 cases were result from nonpenetrating injuries whereas 175 were from penetrating injuries, and there were 258 cases of hemothorax or/and pneumothorax, 162 of rib fracture, 33 of foreign body, 26 of clavicle frcture, 26 of lung contusion, 17 of diaphragmati laceration, 14 of hemoperiardium, 14 of flail chest and others. Stab wound was the most common in penetrating injuries and followed by gunshot and shell fragments. The majority of nonpenetrating chest injury paiens were traffi accident vitims and falls accounted for the next largest group of accidents. Chest injuries were frequently encountered in the age group between 16 and 50 years, and 321 patients were male comparing to 62 of female. In blunt hest injuries the patients with five or more rib fractures had a 85 per ent incidence of intrathoracic injury and 19 per cent had an intraabdominal organ damage, whereas those with four or less rib fractures had a 69 per cent and a 6 per cent incidence respectively. The principal associated injuries were cerebral contusion on 19 cases, renal contusion on 10, liver laceration on 7, peripheral vessel laceration on 5, spleen laceration on 3 and extremity fracture on 18 patients. The principles of therapy for early complications of chest trauma were rapid reexpansion of the lungs by thoracentesis (46 cases) and closed thoracotomy (125 cases) but open thoracotomy had to be done on 90 cases (23.5%) because of massive bleeding or intrapleural hematoma, foreign body, cardiac injury, diaphragmatic laceration and bronhial rupture. The over all mortality was 2.87 per cent (11 among 383 cases), 8 cases were from penetrating injuries and 3 from nonpenetrating injuries.

• Journal of Chest Surgery
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• 제10권2호
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• pp.337-342
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• 1977

A clinical analysis was performed on 383 cases of chest injurjes experienced at Department of Thoracic Surgery, Seoul National University Hospital during 21 year period from 1957 to 1977. Of 383 patients of chest injuries, 209 cases were result from nonpenetrating injuries whereas 175 were from penetrating injuries, and there were 258 cases of hemothorax or/and pneumothorax, 162 of rib fracture, 33 of foreign body, 26 of clavicle fracture, 26 of lung contusion, 17 of diaphragmatic laceration, 14 of hemopericardium, 14 of flail chest and others. Stab wound was the most common in penetrating injuries and followed by gunshot and shell fragments. The majority of nonpenetrating chest injury patients were traffic accident victims. and fails accounted for the next largest group of accidents. Chest injuries were frequently encountered in the age group between 16 and 50 years, and 321 patients were male comparing to 62 of female. In blunt chest injuries the patients with five or more rib fractures had a 85 per cent incidence-of intrathoracic injury and 19 per cent had an intraabdominal organ damage, whereas those with four or less rib fractures had a 69 per cent and a 6 per cent incidence respectively. The principal associated injuries were cerebral contusion on 19 cases, renal contusion on 10, liver laceration on 7, peripheral vessel laceration on 5, spleen laceration on 3 and extremity fracture on 18 patients. The principles of therapy for early complications of chest trauma were rapid reexpansion of the lungs by thoracentesis [46 cases] and closed thoracotomy [125 cases] but open thoracotomy .had to be done on 90 cases [23-5%] because of massive bleeding or intrapleural hematoma, foreign body, cardiac injury, diaphragmatic laceration and bronchial rupture. The over all mortality was 2.87 per cent [11 among 383 cases], 8 cases were from penetrating injuries and 3 from nonpenetrating injuries.

• Journal of Trauma and Injury
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• 제25권4호
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• pp.115-121
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• 2012

Purpose: Severe pancreaticoduodenal injuries are relatively uncommon, but may result in high morbidity and mortality, especially when management is not optimal, and determining the appropriate treatment is often difficult. The objective of this study was to review our experience and to evaluate the role of a pancreaticoduodenectomy (PD) in treatment of pancreaticoduodenal injuries. Methods: We performed a retrospective review of 16 patients who underwent an emergency PD at our hospital for severe pancreaticoduodenal injury from 1990 to 2011. Demographic data, clinical manifestations, mechanism and severity of the injury, associated injuries, postoperative complications and outcomes were reviewed. Results: The mean age of the 16 patients was $45{\pm}12years$ ($mean{\pm}standard$ deviation), and 15(93.8%) patients were male. All patients underwent an explorative laparotomy after a diagnosis using abdominal computed tomography. Almost all patients were classified as AAST grade higher than III. Thirteen(83.3%) of the 16 patients presented with blunt injuries; none presented with a penetrating injury. Only one(6.3%) patients had a combined major vascular injury. Fifteen patients underwent a standard Whipple's operation, and 1 patient underwent a pylorus-preserving pancreaticoduodenectomy. Two of the 16 patients required an initial damage-control procedure; then, a PD was performed. The most common associated injured organs were the small bowel mesentery(12, 75%) and the liver(7, 43.8%). Complications were intraabdominal abscess(50%), delayed gastric emptying(37.5%), postoperative pancreatic fistula(31.5%), and postoperative hemorrhage (12.5%). No mortalities occurred after the PD. Conclusion: Although the postoperative morbidity rate is relatively higher, an emergency PD can be perform safely without mortality for severe pancreaticoduodenal injuries. Therefore, an emergency PD should be considered as a life-saving procedure applicable to patients with unreconstructable pancreaticoduodenal injuries, provided that is performed by an experienced hepatobiliary surgeon and the patient is hemodynamically stable.

• Journal of Trauma and Injury
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• 제20권2호
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• pp.106-114
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• 2007

Purpose: There is little controversy that a classic indication such as hemodynamic instability or any sign of peritoneal irritation requires an immediate laparotomy in the management of abdominal stab wounds. However, omental herniation or bowel evisceration as an indication for an immediate laparotomy is controversial. The purpose of this study was to evaluate the significance of these factors as indications for an immediate laparotomy. Methods: The medical records of 98 consecutive abdominal stab wounds patients admitted to the Emergency Center of Masan Samsung Hospital from January 2000 to December 2006 were carefully examined retrospectively. Using multivariate logistic regression analysis, thirty-nine factors, including the classic indication and intraabdominal organ evisceration, were evaluated and were found to be associated with a need for a laparotomy. Also, the classic indication was compared with a new indication consisting of components of the classic indication and intra-abdominal organ evisceration by constructing a contingency table according to the need for a laparotomy. Results: Multivariate logistic regression analysis revealed any sign of peritoneal irritation, base deficit, and age to be significant factors associated with the need for a laparotomy (p<0.05). The sensitivity, specificity, and accuracy rates of the classic indication were 98.6%, 72.0%, and 91.8%, respectively, and those of the new indication were 93.2%, 84.0%, and 90.8%, respectively. The differences in those rates between the above two indications were not significant. Conclusion: Intra-abdominal organ evisceration was not a significant factor for an immediate laparotomy. Moreover, the new indication including intra-abdominal organ evisceration was not superior to the classic indication. Therefore, in the management of abdominal stab wounds, the authors suggest that an immediate laparotomy should be performed on patients with hemodynamic instability or with any sign of peritoneal irritation.

• Journal of Chest Surgery
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• 제37권5호
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• pp.444-447
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• 2004

불안정협심증으로 진단된 59세 남자 환자가 좌내흉동맥과 정위 우위대망동맥을 이용하여 심폐바이패스 없이 시행하는 관상동맥우회술을 받았다. 우위대망동맥의 박리 시 위, 간을 포함한 복강내 장기에 특별한 이상소견이 발견되지 않았으며 환자는 술 후 3일째에 합병증 없이 퇴원하였다. 본원에서는 정위 우위대망동맥을 사용한 환자에서 술 후 정기적으로 위내시경검사를 권유하는데, 술 후 3개월에 시행한 위내시경 소견에서 위기저부 후방벽에 진행성 위암이 진단되었다. 환자는 관상동맥우회 수술 후 5개월째에 외과에서 우위대망동맥의 손상 없이 위전절제술을 시행받았으며 수술 후 9일째에 합병증 없이 퇴원하였다. 관상동맥우회로술 후 1년째에 시행한 추적 심혈관조영술 소견에서 위대망동맥을 포함한 이식편들의 개존성은 잘 유지되었다.

• Journal of Yeungnam Medical Science
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• 제3권1호
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• pp.87-94
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• 1986

1983년 5월부터 1986년 11월까지 3년 6개월 동안 본 영남 의료원에서 입원 치료를 받았던 농흉 환자 48예를 대상으로 임상적 고찰을 실시한 바 다음과 같은 결과를 얻었다. 1. 호발 연령군은 15세 이하와 36세에서 65세 사이의 연령층이었고, 16세 이상의 성인에서는 남녀 비율이 6.4:1로서 남자가 월등히 많았다. 2. 농흉의 유발인자는 음주나 사고로 인한 의식장애가 36.4%로 가장 많았으며 이중 94.1%가 남자였다. 3. 농흉의 원인은 폐렴이 64.6%로 가장 많았으며 그외에 폐농양이 6.3%, 횡격막하 질환이 6.3%, 수술후 합병증이 6.3%였다. 4. 증상은 발열, 기침, 흉통, 호흡곤란, 객담, 체중감소, 식욕부진, 도한의 순서로 있었다. 5. 늑막액의 세균 배양율은 50%였으며 원인균은 그람음성 간균(33.3%), 포도상구균(25%), 연쇄상구균 (25%) 등의 순서였다. 6. 치료 방법으로는 항생제의 사용 및 원인 치료와 함께 삽관배농술(77.1%), 늑막천자(6.3%), 폐박피술(6.3%) 등이 응용되었고, 전체 사망율은 8.3%였다.