• Journal of Chest Surgery
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• v.24 no.3
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• pp.245-252
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• 1991

For the purpose of evaluation of clinical characteristics and histopathological properties in mediastinal tumors and cysts, 50 patients with mediastinal tumors and cysts treated at the department of thoracic and cardiovascular surgery in Chosun University Hospital during the period from January, 1978 to Mach, 1990 were reviewed. The results of this cases analysis were as follows; 1. of all 50 mediastinal tumors and cysts, 27 patients were male and 23 patients were female. There was no sex preference. The age distribution was from 10 months to 84 years, and mean age was 37 years old, and no age preference. 2. Subjective symptoms were as follows : Dyspnea[54%], Chest pain[44%], Coughing [34%] Fever[16%] and General malaise[12%]. Objective signs were as follows: Decreased breathing sound[46%], Pleural effusion and hemothorax[32%], Palpable neck mass[24%] and SVC syndrome[14%]. But, there were no definitive symptoms in 5 cases[10%]. 3. The most frequently encountered tumors were teratodermoid tumors[26%] followed by lymphomas[22%], thymomas[12%] and benign cysts[8%] in decreasing order of frequency. 4. Based on the subdivision of the mediastinum, 44% of the tumors were in the anterior mediastinum, 24% in the middle mediastinum, 18% in the superior mediastinum and 14% in the posterior mediastinum. 5. The malignant tumors were 25 cases[50%]. 6. The successful removal was possible in all the benign mediastinal tumors and cysts. In malignant cases, the surgical removal had been 12 cases and inoperable cases were treated to radiation and chemotherapy. 7. Postoperative complications were bleeding, wound infection, pneumothorax and vocal cord paralysis. The recurrence was 3 cases. 8. The most frequent mediastinal tumor in the west is neurogenic tumor but is teratoma in Korea.

• Journal of Chest Surgery
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• v.9 no.1
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• pp.83-89
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• 1976

This is a report on the cases of benign mediastinal tumors in the Department of Thoracic and Cardiovascular Surgery, Chonnam University Hospital during the period from 1961 to 1975. Age distribution was from 18 to 62 years old with the highest incidence in the 3rd decade, and sex ratio of male to female was 7 : 8. The tumor were classified as follows; 6 cases of teratoma 5 cases of neurogenic tumor one case of pericardial cyst one case of cystic hygroma one case of dermoid cyst one case of bronchogenic cyst. The symptomatic patients were 10 cases (66.7%) and asymptomatic patients were 5 cases (33.3%), who were found incidentally by routine chest n-ray. The symptoms occurred by compression to the adjacent nerve system in 7 cases, by perforation into the lung with infection in one case of teratoma and by infection of bronchogenic cyst in one case and of teratoma in one case. Complications were Pancoast's syndrome including Horner's syndrome 2 cases, middle lobe syndrome 2 cases, intercostal neuralgia 1 case and bronchitis 1 case. All tumors were surgically resectable with good recovery. In all 10 cases of symptomatic patients, their symptoms disappeared dramatically after operation.

• Journal of Chest Surgery
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• v.56 no.3
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• pp.206-212
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• 2023

Background: Delayed sternal closure (DSC) is a useful option for patients with intractable bleeding and hemodynamic instability due to prolonged cardiopulmonary bypass and a preoperative bleeding tendency. Vacuum-assisted closure (VAC) has been widely used for sternal wound problems, but only rarely for DSC, and its efficacy for mediastinal drainage immediately after cardiac surgery has not been well established. Therefore, we evaluated the usefulness of DSC using VAC in adult cardiac surgery. Methods: We analyzed 33 patients who underwent DSC using VAC from January 2017 to July 2022. After packing sterile gauze around the heart surface and great vessels, VAC was applied directly without sternal self-retaining retractors and mediastinal drain tubes. Results: Twenty-one patients (63.6%) underwent emergency surgery for conditions including type A acute aortic dissection (n=13), and 8 patients (24.2%) received postoperative extracorporeal membrane oxygenation support. Intractable bleeding (n=25) was the most common reason for an open sternum. The median duration of open sternum was 2 days (interquartile range [25th-75th pertentiles], 2-3.25 days) and 9 patients underwent VAC application more than once. The overall in-hospital mortality rate was 27.3%. Superficial wound problems occurred in 10 patients (30.3%), and there were no deep sternal wound infections. Conclusion: For patients with an open sternum, VAC alone, which is effective for mediastinal drainage and cardiac decompression, had an acceptable superficial wound infection rate and no deep sternal wound infections. In adult cardiac surgery, DSC using VAC may be useful in patients with intractable bleeding or unstable hemodynamics with myocardial edema.

• Korean Journal of Bronchoesophagology
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• v.12 no.2
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• pp.42-46
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• 2006

Descending necrotizing mediastinitis (DNM) is defined as mediastinal infection that begins at the cervical region and spread through deep fascial planes into the mediastinum. This is a rare and life-threatening complication of deep neck space infection. As infection reaches the mediastinum, widespread cellulitis, necrosis, abscess formation and sepsis may occur. So, early diagnosis and immediate antibiotics and surgical treatment are required to improve the poor prognosis of DNM. We present four cases of deep neck infection causing a virulent mediastinitis with a literature review.

• Journal of Chest Surgery
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• v.37 no.4
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• pp.386-389
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• 2004

Descending nectorizing mediastinitis (DNM). represents a virulent form of mediastinal infection requiring prompt diagnosis and treatment to reduce the high morbidity mortality associated with this disease. Intr. avenous broad-spectrum antibiotic therapy alone is not efficient without adequate surgical drainage of the cervical and mediastinal collections, extensive debridement and excision of necrotic tissue, and wide mediastino-pleural irrigation. A 38-year-old man admitted via emergency room with painful left neck swelling and uncontrolled high fever. Chest computed tomogram showed left paratracheal abscess descending into the superior and anterior mediastinum. Transcervical mediastinal drainage was performed with 26 Fr. chest tube and left paratracheal drainage was performed with Penrose drain in urgency. Culture and sensitivity test grew Yeast. The drains removed via gradually shortening on day 39 after surgery.

• Journal of Chest Surgery
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• v.24 no.12
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• pp.1228-1231
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• 1991

One of the most lethal forms of mediastinitis is descending necrotizing mediastinitis, in which infection arising from the oropharynx spreads to the mediastinum. Despite the development of computed tomographic scanning to aid in the early diagnosis of mediastinitis, the past 30 years, in large part because of continued dependence on transcervical mediastinal drainage, Although transcervical drainage is usually effective in the treatment of acute mediastinitis due to a cervical esophageal perforation, these approach in the patient with descending necrotizing mediastinitis fails to provide adequate drainage and pre-disposes to sepsis and a poor outcome. In addition to cervical drainage, aggressive, early mediastinal exploration - debridement and drainage through a subxiphoid incision or thoracotomy - is advocated to salvage the patient with descending necrotizing mediastinitis.

• Journal of Veterinary Clinics
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• v.40 no.5
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• pp.349-353
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• 2023

A 2-year-old outdoor, spayed, female Korean Jindo dog was referred for thoracic and abdominal masses. Diagnostic imaging revealed generalized lymphadenopathy and a significant amount of pleural effusion. The cytological evaluation of the pleural effusion and fine-needle aspiration of the mediastinal lymph nodes confirmed the presence of fungal hyphae. The histopathological examination of the mediastinal lymph nodes stained with Grocott's methenamine silver revealed fungal mycelia, and Aspergillus terreus was identified based on fungal DNA sequencing. Thus, the dog was diagnosed with disseminated canine aspergillosis caused by A. terreus. This case report describes a rare case of disseminated canine aspergillosis caused by A. terreus in a Korean Jindo dog.

• Journal of Chest Surgery
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• v.23 no.2
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• pp.299-308
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• 1990

A review of 50 patients with primary mediastinal tumors or cysts has been done to evaluate clinical and pathological behavior of this heterogeneous group of tumors proved by either excision or biopsy from January 1980 to August 1989 at the cardiovascular department of surgery in Kyungpook National University Hospital. There were 30 males and 20 females in this series. The ages of patients ranged from 4 months to 64 years. The mean age of subjects was 30.4 years. Neurogenic tumors [14 cases, 28%] and teratoma [14 cases, 28%] were most frequently encountered and followed by thymoma [10 cases, 20%] and benign cysts [4 cases, 8%]. The anatomic location of the primary mediastinal tumors or cysts was classified as anterior mediastinum and middle or visceral mediastinum and paravertebral or costovertebral mediastinum on the basis of the Shields’ proposition. In 32 patients[64%], the tumors or cysts were located in anterior mediastinum and in 13 patients[26%], the tumors or cysts were located in paravertebral or costovertebral mediastinum. And the rest 5 patients[10%] had middle or visceral mediastinal tumors or cysts. One of the characteristic features of primary mediastinal tumors or cysts is that some mediastinal tumors or cysts have their own preferred location in the mediastinum. In our series, all of the 14 patients with teratoma and 10 patients with thymoma had the anterior mediastinal location, while 13 of the 14 patients with neurogenic tumors had the paravertebral mediastinal location. 14 patients[28%] were asymptomatic and they all were discovered via so-called “Routine” chest x-ray examination. 39 of 50 patients[78%] were benign. 11 patients[22%] were malignant and they were all symptomatic. 40 patients[80%] were treated with complete resection. 5 patients[10%] were treated with partial resection : 2 of malignant thymoma, 3 of lipoma, neuroblastoma, primary squamous cell carcinoma. The rest 5 patients[10%] were only biopsied: 2 of undetermined malignancy and 3 of hemangioma, lymphoma, primary squamous cell carcinoma. 4 of the 10 patients were treated with combination of irradiation and chemotherapy. Postoperative complications were as followings: Horner’s syndrome [4cases, ado], respiratory failure [3 cases, 6%], pleural effusion[3 cases, 6%], Wound infection[2 cases, 4%] and bleeding, pneumothorax, empyema. There were 5 postoperative deaths [10%]. One patient with neuroblastoma died from intraoperative massive bleeding, 3 patients died early postoperatively from respiratory failure with undetermined malignancy died late postoperatively from congestive heart failure due to direct invasion of the tumor to the heart.

• Journal of Chest Surgery
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• v.34 no.11
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• pp.848-853
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• 2001

Background: Sternal infection or dehiscence after cardiac surgery through median sternotomy is rare. If suitable treatment is not performed for the complication, however, the mortality is high. For 12 patients with sternal dehiscence or infection, we performed wide excision of the infected and necrotic tissue and covered with muscle flap(s) to obliterate the mediastinal dead space. Material and method: Sternal infection or dehiscence occurred in 13 of patients who underwent cardiac surgery One patient, who died of cerebral infarction before the sternal complication was treated, was excluded in this study. The sternal wound complication occurred in 6 of patients with valve replacement and 6 of patients with coronary bypass surgery, respectively. Since 1991, 9 patients underwent definite surgical debridement and muscle transposition as soon as fever was controlled with closed irrigation and drainage. The necrotic tissue and bone was widely excised and the sternal dead space was eradicated with the single flap or the combined flaps of right pectoralis flap(turnover flap), left pectoralis flap(turnover flap or rotation-advancement flap), and right rectus muscle flap. Result : There was no mortality in 12 patients with coverage of muscle flap(s) for sternal infection or dehiscence The mean interval between the diagnosis of sternal complication and the myoplasty was 6.6$\pm$3.9 days. In 4 patients, one pectoralis muscle flap was used, and in 8 patients both pectoralis muscle flaps were used. For each 1 patient and 2 patients in each group, right rectus muscle flap was added. For the last 3 patients, a single pectoralis flap was used to eradicate the mediastinal dead space and the longer placement of the mediastinal drain catheter was needed. One patient, who had suffered from necrosis of left pectoralis flap(rotation-advancement flap) with subsequent chest wall abscess after coverage of both pectoralis flaps, was managed with reoperation using right rectum flap. Conclusion : Sternal dehiscence or infection after cardiac operation can be readily managed with wide excision of necrotic infected tissue(including bone) and muscle flap coverage after short-term irrigation of sternal wound. The sternal(mediastinal) dead space may be completely eradicated with right pectoralis major muscle flap alone.

• Korean Journal of Bronchoesophagology
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• v.14 no.1
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• pp.42-45
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• 2008

Tracheal injury associated with esophageal injury due to fish bone is very rare. Also, treatment of mediastinitis due to esophageal perforation when it is diagnosed late remains controversial. We report the case that we have successfully experienced treatment of mediastinitis due to tracheal and esophageal injury by fish bone.