• Title/Summary/Keyword: Pulmonary Surgical Procedures

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Surgical Treatment of Obstructive Lobar Emphysema. A Report of Four Cases. (폐쇄성 엽성 폐기종의 외과적치료 - 4례 보고 -)

  • 김근호
    • Journal of Chest Surgery
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    • v.8 no.2
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    • pp.109-118
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    • 1975
  • This is a report on four cases of the lobar emphysema due to proximal bronchial obstruction in the Department of Thoracic Surgery, Hanyang University Hospital, during the period of three and half years from 1972 to 1975. First case, a two years old male child was referred to our Department with the lobar emphysema of the lower lobe of the right lung with pneumonia. This emphysema was developed after aspiration of a piece of peanut. Bronchoscopy revealed that the bronchus of the right lower lobe was obstructed with the foreign body, however removal of the peanut through bronchoscope was not attempted because of corruption and softening of the peanut. The removal of the peanut by bronchotomy was performed after subsiding of acute phase of pulmonary infection. Postoperative course was uneventful and the emphysema was disappeared. Second case, a twenty months old female baby was referred to our Department with lobar emphysema of the lower lobe of the left lung. The emphysema was suddenly developed with coughing and dyspneic symptoms and the diagnosis was made roentgenologically. She gave a history of reccurrent infections of the respiratory tract after birth. Bronchoscopy showed an obstruction of the left main bronchus with the growing of fibrinous tissue on the bronchial mucosa. The protruded tissue in the left main bronchus taken out about O.8ml with biopsy forceps for histological examination. After this procedure, the emphysema of the left lung was disappeared. Histological finding was reported to be a chronic inflammatory granulation tissue. Third case, a two and half years old male child was referred to our Department with roentgenological lobar emphysema. Two weeks prior to admission he had an episode of sudden onset of coughing attack with dyspnea. Bronchoscopy revealed that the bronchus of the left lower lobe was obstructed with a mass which was strongly suspected of a neoplastic tissue. At operation, there was found a perforation of enlarged tuberculous lymph node in the bronchus of the left lower lobe and protrusion of granulation tissue into the bronchus. Ruptured orifice on themembranous wall of the left lower lobe bronchus was closed with interrupted suture after the" removal of a perforated tuberculous lymph node. Postoperative course was uneventful and antituberculous chemotherapy was given. Fourth case, a 47 years old man was admitted to our Department with the complaint of severe dyspnea of few months duration. Twenty years ago, he had a history of lung tuberculosis and was treated for many years. X-ray examination including tomography and bronchography revealed that the upper lobe of the right lung was destroyed with cavities, the lower lobe was completely shrunk, and the right middle lobe was strongly overdistended with narrowing bronchial trees. Differential bronchospirometry and lung scanning confirmed that the respiratory function of the affected lung was impaired almost totally. The value of the right lung was calculated on 6% of oxygen uptake, 1% of Minute volume, and 32% of vital capacity. The right pneumonectomy was performed under the careful consideration of anesthetic and surgical procedures. Postoperative course was uneventful and the respiratory function was improved nearly to the normal level.evel.

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Early Results in Surgical Treatment of Thoracic Aortic Aneurysm (흉부 대동맥류의 외과적 치료)

  • An, Byeong-Hui;Sin, Seong-Hyeon;Na, Guk-Ju
    • Journal of Chest Surgery
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    • v.30 no.7
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    • pp.686-692
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    • 1997
  • This study represents an attempt to present an analysis of early surgical results in 15 cases of aortic surgery conducted at Chonnam University Hospital between February 1994 to August 1995. The subject, 9 males and 6 females, ranged in age from 32 to 73 years with a mean age of 55.07$\pm$ 1176 years. The patients were treated for dissecting aortic aneurysm in nine, atherosclerotic aneurysm in 4, and traumatic aortic aneurysm in two. There were 9 cases of median stemotomy, 4 cases of posterolateral thoracotomy, and 2 cases of thoracoabdominal incision. Graft replacement of ascending aorta andfor partial or total aortic arch were performed in 9 patients, descending aorta andfor t oracoabdominal aorta in 3 and total aorta in 1, Two traumatic aortic aneurysms were closed directly. Associate procedures were resuspension of aortic valve in three patients and elephant trunk procedure, coronary reimplantation and aortic valve replacement in one patient. Nine patients underwent operation for ascending aorta andfor aortic arch with retrograde cerebral perfusion during deep hypothermia and circulatory arrest. Perfusion pressure was maintained below 25 mmHg and the mean duration of circulatory arrest was 56.67 $\pm$ 29.25 minutes. Three patients underwent graft replacement of desending thoracic and thoracoabdominal aorta during deep hypothermia and circulatory arrest. Three patients died of traumatic bile peritonitis, multioragn failure, and rupture of residual dissecting aortic aneurysm by malignant hypertension. Postoperative complications included reoperation for bleeding in 4 patients, temporary confusion in 3, pulmonary complication in 3, and pericardial effusion in .

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Recurred Thyroid Carcinoma (재발성 갑상선 암)

  • Park Kyue-Il;Yoon Jung-Han;JeGal Young-Jong
    • Korean Journal of Head & Neck Oncology
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    • v.8 no.2
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    • pp.72-81
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    • 1992
  • Thyroid cancer, the most common cancer of endocrine neoplasms, has tremendous variation in tumor biologic behavior. There is no consensus about treatment mode to prevent recurrences despite of recent advance in understanding characteristics of thyroid cancer. So, we have made a clinical analysis and follow-up study of recurred 27 cases among 189 cases treated under the diagnosis of thyroid carcinoma in the department of surgery, Chonnam University Hospital from February, 1982 to February, 1992 to clarify our experience about the characteristics of recurred thyroid cancer. The results were as follow: According to the pathological classification of recurred thyroid cancer, recurrence rate was 11.6% in papillary carcinoma, 15.6% in follicular carcinoma, 37.5% in medullary carcinoma, 66.7% in undifferentiated carcinoma, respectively, and the mean recurrence rate of thyroid cancer was 14.3%. The recurrence rate according to age was 28.6% in 8th decade and 17.9% in 4th decade. The recurrence rate according to sex was not singificant(15.6% in male: 14% in female). The mean period to relapse was 4 years 6 months in papillary carcinoma, 2 years 5 months in follicular carcinoma, 2 years 1 months in medullary carcinoma, 2 years 6 months in undifferentiated carcinoma. The recurrence rate according to previous operating methods, such as performing lymph node dissection or not, mode of thyridectomy, type of lymph node dissection was statisfically non-specific. Common recurrent sites of papillary and follicular carcinoma was cervical lymph node and remained thyroid tissue. Medullary and undifferentiated carcinoma was noted in multiregional or systemic involvement Reoperation was performed with complete resection of recurred or metastatic mass, such as radical neck dissection or mass extirpation from involved organs as possible. The postoperative complications were 2 cases of horseness, and 1 case with hematoma, transient hypocalcemia, wound infection, and pulmonary insufficency, respectively. 5-year survival rate was 85.5% in papillary carcinoma, 66.7% in follicular carcinoma. 50% in medullary carcinoma, and 50% in undifferentiated carcinoma. We concluded that recurrence in thyroid cancer give a reconsideration to previous conservative therapy and more extensive surgical procedures for thyroid cancer including lymphatic dissection are recommanded to prevent recurrences in selected cases if possible.

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Clinical features and results of recent neonatal cardiac surgery - A review of 82 cases in one hospital (최근 신생아 심장 수술의 특징과 결과 - 단일 병원에서의 82례 고찰)

  • Oh, Ki Won;Kim, Jung Ok;Cho, Joon Yong;Hyun, Myung Chul;Lee, Sang Bum
    • Clinical and Experimental Pediatrics
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    • v.50 no.7
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    • pp.665-671
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    • 2007
  • Purpose : The purpose of this study was to investigate the clinical features and outcome in newborns undergoing cardiac surgery. Methods : Eighty two neonates underwent heart surgery for congenital heart defect at Kyungpook National University Hospital between March 2000 and February 2006. Patient characteristics (sex, age, diagnosis), pre-operative conditions, operation type, postoperative complications and mortality were reviewed retrospectively. Results : In 82 patients, 41 (50%) were male. The mean age and weight at operation were 12 days and 3.2 kg, respectively. The common cardiac anomalies were complete transposition of the great arteries (TGA), Tetralogy of Fallot (TOF), pulmonary atresia with intact ventricular septum, and single ventricle variants. Fifty seven operations were performed with cardiopulmonary bypass and corrective surgery was done on 54 patients. Arterial switch operation and modified Blalock-Taussig shunt were most frequently performed as corrective and palliative operations, respectively. The early hospital mortality rate was 7%; the late mortality was 3.9%. Complications were acute renal insufficiency, delayed sternal closure, wound infection, arrhythmia, and brain hemorrhage. Conclusion : During the last 6 years, the outcomes of cardiac surgery for congenital heart defects in neonates improved by progress in perioperative, anaesthetic, surgical, and postoperative care.

Surgical Technique for Korean Artificial Heart(AnyHeart) Implantation Using a Right Thoracotomy Approach (우측 개흉술을 이용한 한국형 인공심장(AnyHeart)의 이식기법)

  • Son. Ho-Sung;Sun, Kyung;Shin, Jae-Seung;Lee, Sung-Ho;Jung, Jae-Seung;Lee, Hye-Won;Kim, Kwang-Taik;Kim, Seung-Chul;Won, Yong-Soon;Min, Byoung-Goo;Kim, Hyoung-Mook
    • Journal of Chest Surgery
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    • v.35 no.5
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    • pp.329-335
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    • 2002
  • Background: The surgical technique for biventricular assist device(BVAD) implantation has mainly consisted of cannulation procedures. A median sternotomy has been the technique of choice as it gives a surgeon an excellent exposure of the heart. However, considering that most patients require a future sternotomy or already have a previous sternotomy, sternotomy-related complication remains a major concern in BVAD implantation. Based on this consideration as well as the clinical experiences of conventional heart surgery, the authors have hypothesized that the cardiac chambers for BVAD cannulation can be approached from the right side of the heart. The purpose of this studs to develop a novel surgical technique of right thoracotomy for BVAD implantation in an animals study. Material and Method: For last two years, 16 (11 calves, 3 canines, and 2 sheep) out of 30 experimental animals with AnyHeart implantation underwent a right thoracotomy. The device was used as an implantable BVAD in 14 animals, a wearable BVAD in 1, and an implantable LVAD in 1. The chest cavity was entered through the 4th intercostal space or the 5th periosteal bed. As for the BVAD use, a right inflow cannula was inserted into the right atrial free wall and a right outflow cannula was grafted onto the main pulmonary artery. A left inflow cannula was inserted into the interatrial groove and a left outflow cannula was grafted on the innominate artery of the ascending aorta. The connecting tubes were brought out through the thoracotomy wound and connected to the pump located in the subcutaneous pocket at the right flank. Result: Except for the 5 animals for a lilting test or during the early learning curve, all recovered smoothly from the procedures. The inflow drainage allowed the pump output 6.5 L/min at the maximum with 3-3.5 L/min in an average. Of the survivors, there noted no procedure-related mortality or morbidity. Necropsy findings demonstrated the well-positioned cannula tips in the each cardiac chamber

Surgical Evaluation of Squamous Cell Carcinoma of the Lung (편평상피세포 폐암의 외과적 고찰)

  • An, Byeong-Hui;Mun, Hyeong-Seon;Na, Guk-Ju;Kim, Sang-Hyeong
    • Journal of Chest Surgery
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    • v.30 no.2
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    • pp.179-186
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    • 1997
  • The frequency of primary lung cancer is increasing compared to other cancer. Complete surgical resection is the most effective method of treatment, but it is limited to only 25 to 30 percent of patients after initial clinical presentation. The survival rate is different by the subtypes of carcinoma, stages, and general condition of patients. The author investigated the survival rate of 87 patients with squamous cell carcinoma of the lung after surgery. Age ranged from 31 to 73 years, with Lean 57.1) $\pm$ 7.15 and 80.5% (70 cases) was initially diagnosed at sixth and seventh decades. Male to female ratio was 8.9'1. Initial complaints were cough with sputum in 78.1%, weight loss in 31.0%, chest pain and discomfort in 29.9%, and hemoptysis in 24.1%. The location of the tumor was right side in 44.8% and left slde in 55.2% ; LUL in 39.1%, RLL in 20.7%, LLL in'16. 1%, RUL in 14.9% and RML in 9.2%. Stage I was 19.5%, stage II 25.3%, stage olla 54.1% and stage lIIb 1.1%. Operative procedures were as follow : pneumonectomy in 52.9%, lobectomy in 47.1%, sleeve upper lobectomy in 4 cases. Single mediastinal Iymph node involvement was observed in 17 cases, and multi-level mediastinal Iymph node involvement in 23 cases. Lower paratracheal Iymph node and subcarinal Lymph node were more frequently involved in right side lung cancer, with 8 and 10 cases, respectively and subaortic Iymph node was most frequently involved in left side lung cancer with 9 cases. Operative complications were hoarseness, wound infection and chylothorax in 7, 5 and 4 cases, respectively. The operative mortality was 2.2% and the cause of death was pulmonary edema. Postoperative follow-up period ranged from 1 month to 99 months with a mean of 29.95 $\pm$ 17.21 months. Overall one-year survival rate was 75.1 % and five-year survival rate was 29.8%. One-year and five-year survival rates were 93.7% and 52.4% for stage 1, 92.2% and 30.5% for st ge ll, and 61.2% and 17.4% for stage llla, respectively. These findings correlate survival rate with tumor size, mediastinal Iymph node metastasis and surgical resectability, and long-term survival can be expected with small sized tumor, absent mediastinal Iymph node metastasis and complete surgical resection.

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Long-Term Outcomes and Risk factor Analysis after Pneumonectomy for the Sequelae of Pulmonary Tuberculosis (폐결핵의 후유증에 대한 전폐절제술의 장기 성적 및 위험인자 분석)

  • 김영태;김홍관;성숙환;김주현
    • Journal of Chest Surgery
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    • v.35 no.7
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    • pp.535-541
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    • 2002
  • Background: The prevalence of pulmonary tuberculosis remains high in several areas of the world, and pneumonectomy is often necessary to treat the sequelae of the disease. We retrospectively analyzed the morbidities, mortalities, and long-term outcomes after pneumonectomy for the treatment of tuberculous sequelae. Material and Method: Between 1981 and 2001, 94 patients underwent either pneumonectomy or extrapleural pneumonectomy for the treatment of tuberculous sequelae. There were 44 males and 50 females. The mean age was 40(16~68) years. The pathology included destroyed lung in 80, main bronchus stenosis in 10, and both lesions in 4. Surgical procedures were pneumonectomy in 47, extrapleural pneumonectomy in 43, and completion pneumonectomy in 4. Results: One patient died postoperatively due to empyema. Twenty-three complications occurred in 20 patients; empyema in 15(including 7 bronchopleural fistulas), wound infection in 5, and others in 3. Univariate analysis revealed presence of empyema, extrapleural pneumonectomy, prolonged operation time, and old age as risk factors of postpneumonectomy empyema. In multivariate analysis, old age and low preoperative FEV1 were risk factors of empyema. Low preoperative FEV1 was the risk factor of bronchopleural fistula(BPF) in univariate analysis. Low preoperative FEV1, positive sputum AFB, and presence of aspergilloma were risk factors of BPF in multivariate analysis. There were twelve late deaths. Actuarial 5-and 10-year survival rates were 94$\pm$3% and 87$\pm$4%, respectively. Conclusion: Pneumonectomy could be performed with acceptable mortality and morbidity, and could achieve good long-term survival for the treatment of tuberculous sequelae. In patients with risk factors, special care is recommended to prevent postoperative empyema or bronchopleural fistula.

The Safety of Microsurgical Head and Neck Reconstruction in the Elderly Patients (고령 환자군에 있어서 유리피판술을 이용한 두경부재건의 안전성)

  • Choi, Bong Kyoon;Kim, Young Seok;Lee, Won Jai;Lew, Dae Hyun;Tark, Kwan Chul
    • Archives of Plastic Surgery
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    • v.33 no.3
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    • pp.289-293
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    • 2006
  • By means of microsurgical free-tissue transfer providing a large amount of required tissue, the surgeon can resect tumoral tissue more safely, which allows tumor-free margins and enhances the reliability of the ablative surgery that otherwise could not be performed radically. The morbidity of elective free-tissue transfer seems to be quite low, carrying acceptable risks for most patients. But the elderly patients are at risk for cardiac and respiratory problems, deep vein thrombosis, pulmonary emboli and infection merely as a function of age. This study was undertaken to define further risks of the elderly population with regards to free-tissue transfer. We retrospectively reviewed our experience with 110 microsurgical free-tissue transfers for head and neck reconstruction in patients greater than 60 years of age. Microsurgical procedures in all cases were preformed by the plastic and reconstructive department at Yonsei medical center. The investigated parameters were patient demographics, past medical history, American Society of Anesthesiologists(ASA) status, site and cause of defect, the free tissue transferred and postoperative complication including free-flap success or failure. There were 46 patients in the age group from 60 to 64 years, 34 patients from 65 to 70 years, and 30 patients 70 years or older. There happened 3 flap losses, resulting in a flap viability rate of 97%. Patients with a higher ASA designation experienced more medical complication(p=0.05, 0.01, 0.03 in each age group I, II, III) but not surgical complication p=0.17, 0.11, 0.54 in each age group I, II, III). And the relationship between postoperative complication and age groups was not significant. These observations suggest that major determinant for postoperative medical complication be the patient's American Society of Anesthesiologists score, and chronologic age alone should not be an exclusion criterion when selecting patients for free-tissue transfer

Videothoracoscopic Surgery for Secondary Spontaneous Pneumothorax (비디오 흉강경을 이용한 이차성 자연기흉의 치료)

  • 양현웅;정해동;최종범;최순호
    • Journal of Chest Surgery
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    • v.31 no.7
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    • pp.692-696
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    • 1998
  • For the management of a secondary spontaneous pneumothorax, videothoracoscopic surgery may offer the potential therapeutic benefits of a minimally invasive approach. We report on a series of 36 patients(33 men and 3 women) with a mean age of 56.3 years(range, 31 to 80 years) who underwent thoracoscopic surgical procedures for the treatment of secondary spontaneous pneumothorax. Twenty-one patients had emphysema and 20 patients had old pulmonary tuberculosis. Nineteen patients presented a persistent severe air leak more than 3 days preoperatively and 15 patients had more than one recurrence. Bullectomy or exclusion of the lesion was performed in 33 patients. Mechanical pleurodesis was performed in the entire patients, talc was sprayed in 22 and vibramycin in 14. Mild pleural adhesion at the upper lobe was shown in 10 patients and severe pleural adhesion in 7 patients. One patient with persistent air leak died of persistent air leak and respiratory failure. The mean postoperative stay was 7.0 days(range, 2 to 17 days). At a mean follow-up of 15.8 months (range, 5 to 45 months), no pneumothorax had recurred. In comparison with the result of the treatment for 112 patients with primary spontaneous pneumothorax, the operating time was not significantly longer and there were no more primary treatment failures, but the duration of postoperative chest drainage and hospital stay was longer. Videothoracoscopic surgery has proved to be an effective treatment for secondary spontaneous pneumothorax in elderly patients who represent high-risk candidates for thoracotomy.

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Transbronchial Lung Cryobiopsy for Diagnosing Interstitial Lung Disease: A Retrospective Single-Center Experience

  • Park, Jin Han;Jang, Ji Hoon;Kim, Hyun Kuk;Jang, Hang-Jea;Lee, Sunggun;Kim, SeongHo;Kim, Ji Yeon;Choi, Hee Eun;Han, Ji-yeon;Kim, Da Som;Kang, Min Kyun;Kang, Eunsu;Kim, Il Hwan;Lee, Jae Ha
    • Tuberculosis and Respiratory Diseases
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    • v.85 no.4
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    • pp.341-348
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    • 2022
  • Background: An accurate diagnosis in patients with interstitial lung diseases (ILDs) by multidisciplinary discussion (MDD) based on histopathologic information is essential for optimal treatment. Transbronchial lung cryobiopsy (TBLC) has increasingly been used as a diagnostic alternative to surgical lung biopsy. This study aimed to evaluate the appropriate methods of TBLC in patients with ILD in Korea. Methods: A total of 27 patients who underwent TBLC were included. TBLC procedure details and clinical MDD diagnosis using TBLC histopathologic information were retrospectively analyzed. Results: All procedures were performed under general anesthesia with the fluoroscopic guidance in the operation room using flexible bronchoscopy and endobronchial balloon blocker. The median procedure duration was less than 30 minutes, and the median number of biopsies per participant was 2. Most of the bleeding after TBLC was not severe, and the rate of pneumothorax was 25.9%. The most common histopathologic pattern was alternative (48.2%), followed by indeterminate (33.3%) and usual interstitial pneumonia (UIP)/probable UIP (18.5%). In the MDD after TBLC, the most common diagnosis was idiopathic pulmonary fibrosis (33.3%), followed by smoking-related ILD (25.9%), nonspecific interstitial pneumonia (18.6%), unclassifiable-ILD (14.8%), and others (7.4%). Conclusion: This first single-center experience showed that TBLC using a flexible bronchoscopy and endobronchial balloon blocker with the fluoroscopic guidance under general anesthesia may be a safe and adequate diagnostic method for ILD patients in Korea. The diagnostic yield of MDD was 85.2%. Further studies are needed to evaluate the diagnostic yield and confidence of TBLC.