• Journal of Chest Surgery
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• 제37권4호
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• pp.335-341
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• 2004

외상에 의한 심장 손상은 드물게 발생하지만 진단 및 치료가 지연되었을 경우 치사율이 매우 높다. 이에 본원에서는 외상성 심장 손상 환자를 대상으로 후향적 연구를 진행하였다. 대상 및 방법: 1995년 3월부터 2002년 7월까지 본원 응급실을 통하여 내원한 외상성 심장 손상 환자 대상으로 하였다. 총 17명의 환자 중 흉기 등에 의한 자상이 5예, 둔상 중에서 교통사고로 인한 손상이 7예, 작업장 등에서 추락한 경우가 4예, 원인을 알 수 없는 경우가 있었다. 모든 예에 있어서 응급 수술을 진행하였고, 6예의 경우 심폐기를 이용한 수술을 진행하였다. 결과: 수술 후 4예의 사망이 있었다. 수술 후 모든 환자는 중환자실로 이송하였고 평균 중환자실 재원기간은 3.86$\pm$3.35일, 평균 총재원기간은 18.27$\pm$14.99일이었다. 응급실에 도착하여 수술의 진행까지 생명 징후가 비교적 안정적이었던 경우 사망한 예는 없었다. 결론: 수술 전의 환자의 상태는 환자의 예후에 직접적인 영향을 주는 중요한 인자이기 때문에 흉부외상 환자에게 있어서 심장손상 여부의 판단은 매우 중요하다.

• Tuberculosis and Respiratory Diseases
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• 제46권4호
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• pp.586-590
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• 1999

비관통성 흉부손상에 의한 기관-기관지 파열의 높은 사망률과 이환율은 조기 진단과 수술로 이를 낮출 수 있으므로 초기 임상증상과 단순흉부방사선상 기관-기관지 파열이 의심되는 소견이 있으면 바로 기관지경검사로 기관-기관지 파열을 진단하고 적절한 치료를 해야한다. 저자들은 교통사고후 비관통성 흉부손상을 받고 호흡곤란을 주소로 내원한 환자에서 기관지경검사로 기관 파열을 조기 진단하여 수술적 치료로 회복시킨 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

• Journal of Trauma and Injury
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• 제34권3호
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• pp.162-169
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• 2021

Purpose: For severe lung injuries or acute respiratory distress syndrome that occurs during critical care due to trauma, extracorporeal membrane oxygenation (ECMO) may be used as a salvage treatment. This study aimed to describe the experiences at a single center with the use of ECMO in trauma patients. Methods: We enrolled a total of 25 trauma patients who were treated with ECMO between January 2015 and December 2019 at a regional trauma center. We analyzed and compared patients' characteristics between survivors and non-survivors through a medical chart review. We also compared the characteristics of patients between direct and indirect lung injury groups. Results: The mean age of the 25 patients was 45.9±19.5 years, and 19 patients (76.0%) were male. The mean Injury Severity Score was 26.1±10.1. Ten patients (40.0%) had an Abbreviated Injury Scale (AIS) 3 score of 4, and six patients (24.0%) had an AIS 3 score of 5. There were 19 cases (76.6%) of direct lung injury. The mortality rate was 60.0% (n=15). Sixteen patients (64.0%) received a loading dose of heparin for the initiation of ECMO. There was no significant difference in heparin use between the survivors and non-survivors (70% in survivors vs. 60% in non-survivors, p=0.691). When comparing the direct and indirect lung injury groups, there were no significant differences in variables other than age and ECMO onset time. Conclusions: If more evidence is gathered, risk factors and indications will be identified and we expect that more trauma patients will receive appropriate treatment with ECMO.

• Journal of Trauma and Injury
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• 제33권4호
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• pp.207-218
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• 2020

The following recommendations are presented herein: All trauma patients admitted to the resuscitation room should be constantly (or periodically) monitored for parameters such as blood pressure, heart rate, respiratory rate, oxygen saturation, body temperature, electrocardiography, Glasgow Coma Scale, and pupil reflex (1C). Chest AP and pelvic AP should be performed as the standard initial trauma series for severe trauma patients (1B). In patients with severe hemodynamically unstable trauma, it is recommended to perform extended focused assessment with sonography for trauma (eFAST) as an initial examination (1B). In hemodynamically stable trauma patients, eFAST can be considered as the initial examination (2B). For the diagnosis of suspected head trauma patients, brain computed tomography (CT) should be performed as an initial examination (1B). Cervical spine CT should be performed as an initial imaging test for patients with suspected cervical spine injury (1C). It is not necessary to perform chest CT as an initial examination in all patients with suspected chest injury, but in cases of suspected vascular injury in patients with thoracic or high-energy damage due to the mechanism of injury, chest CT can be considered for patients in a hemodynamically stable condition (2B). CT of the abdomen is recommended for patients suspected of abdominal trauma with stable vital signs (1B). CT of the abdomen should be considered for suspected pelvic trauma patients with stable vital signs (2B). Whole-body CT can be considered in patients with suspicion of severe trauma with stable vital signs (2B). Magnetic resonance imaging can be considered in hemodynamically stable trauma patients with suspected spinal cord injuries (2B).

• Journal of Chest Surgery
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• 제57권2호
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• pp.120-125
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• 2024

Background: This study aimed to assess the outcomes of patients with complex rib fractures undergoing operative or nonoperative management at our major trauma center. Methods: A retrospective review of all patients who were considered for surgical stabilization of rib fractures (SSRF) at a single major trauma center from May 2016 to September 2022 was performed. Results: In total, 352 patients with complex rib fractures were identified. Thirty-seven patients (11%) fulfilled the criteria for surgical management and underwent SSRF. The SSRF group had a significantly higher proportion of patients with flail chest (32 [86%] vs. 94 [27%], p<0.001) or Injury Severity Score (ISS) >15 (37 [100%] vs. 129 [41%], p<0.001). No significant differences were seen between groups for 1-year mortality. Patients who underwent SSRF within 72 hours were 6 times less likely to develop pneumonia than those in whom SSRF was delayed for over 72 hours (2 [18%] vs. 15 [58%]; odds ratio, 0.163; 95% confidence interval, 0.029-0.909; p=0.036). Prompt SSRF showed non-significant associations with shorter intensive care unit length of stay (6 days vs. 10 days, p=0.140) and duration of mechanical ventilation (5 days vs. 8 days, p=0.177). SSRF was associated with a longer hospital length of stay compared to nonoperative patients with flail chest and/or ISS >15 (19 days vs. 13 days, p=0.012), whilst SSRF within 72 hours was not. Conclusion: Surgical fixation of complex rib fractures improves outcomes in selected patient groups. Delayed surgical fixation was associated with increased rates of pneumonia and a longer hospital length of stay.

• Journal of Korean Neurosurgical Society
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• 제29권1호
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• pp.58-65
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• 2000

Objective : Thoracolumbar junction is second most common level of injury next to cervical spine. The object of this study is to study the usefulness of surgical titanium mesh instead of bone graft, as well as to evaluate the correction of spinal deformity and safety of early ambulation in patients with injury at thoracolumbar junction. Patients and Methods : This review included 51 patients who were operated from July 1994 to December 1997. The injured spine is considered to be unstable, if it shows involvement of two or more columns, translatory displacement more than 3.5mm, decrease more than 35% in height of vertebral body and progression of malalignment in serial X-ray. The decision to operate was determined by (1) compression of spinal cord or cauda eguina, (2) unstable fracture, (3) malalignment and (4) fracture dislocation. The procedure consisted of anterior decompression through corpectomy and internal fixation with anterior instrument and surgical titanium mesh which was impacted with gathered bone chip from corpectomy. Results : Fifty-one patients were followed up for at least 12 months. The main causes of injury were fall and vehicle accident. The twelfth thoracic and the first and the second lumbar vertebrae were frequently involved. Complete neural decompression was possible under direct vision in all cases. Kyphotic angulation occurred in a patient. Radiologic evaluation showed correction of deformity and no distortion or loosening of surgical titanium mesh with satisfactory fixation postoperatively. Conclusions : We could obtain neurological improvement, relief of pain, immediate stabilization and early return to normal activities postoperatively. Based on these results, authors recommend anterior decompression and internal fixation with surgical titanium mesh in thoracolumbar unstable spine injuries.

• Journal of Chest Surgery
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• 제38권12호
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• pp.807-814
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• 2005

배경: 체외순환은 심정지를 필요로 하는 모든 심장 수술에서 정지된 심장의 기능을 대신하여 환자의 말초 장기의 혈액순환을 유지하기 위한 필수적인 과정이다. 그러나 체외순환은 필연적으로 인공도관을 관류하는 특성상 신체의 혈관계를 흐르는 혈류와 달리 혈액손상에 따른 전신성 염증반응을 피할 수 없으며, 이러한 전신성 염증반응과 함께 말초혈관의 미세혈관 순환장애가 체외순환동안에 원발장기의 손상을 초래하는 것으로 생각된다. 저자들은 전신성 염증반응을 일으키는 주된 혈액성분인 백혈구를 제거한 충진액을 사용하여 전신성 염증반응을 줄일 수 있는가를 확인하고, 체외순환도중 위점막의 산도를 측정함으로써 위점막의 미세혈류에 대한 백혈구 제거 충진액의 효과를 확인하기 위하여 실험을 진행하였다. 대상 및 방법: 실험군은 15마리의 한국산 잡견을 충진액의 성분에 따라 비혈액성 충진액군, 백혈구 제거 혈액성 충진액군, 백혈구 비제거 혈액성 충진액군으로 각각 5마리씩 세 군으로 나누었다. 세 군 모두에서 2시간의 체외순환 및 연속된 4시간의 마취유지를 시행하였으며, 체외순환 전과 체외순환 후 1시간, 2시간, 체외순환 종료 후 2시간 4시간에 위점막 이산화탄소 농도와 산도, 동맥혈 이산화탄소 분압 과 호기말 이산화탄소 분압을 측정하고, 염증반응의 지표검사를 위하여 동맥혈을 채혈하였다. 전신성 염증반응의 정도는 채취한 동맥혈에서 ELISA (enzyme linked immunosorbent assay)법을 이용하여 IL-8의 수준을 검사하였다. 결과: 1, 위점막의 이산화탄소 농도는 백혈구 제거 혈액성 충진액군이 백혈구 비제거 혈액성 충진액군과 비혈액성 충진액군에 비하여 유의하게 낮았다(p=0.02, 0.01). 2. 위점막의 산도는 백혈구 제거 혈액성 충진액군과 백혈구 비제거 혈액성 충진액군간에 유의한 차이를 보였다(p=0.01). 3. 전신성 염증반응의 정도를 확인하기 위하여 측정한 IL-8의 수준은 백혈구 제거 혈액성 충진액군과 비혈액성 충진액군이 백혈구 비제거 혈액성 충진액군에 비하여 유의하게 낮았다(p=0.01, 0.01). 결론: 백혈구를 제거한 혈액성 충진액을 사용하는 것이 체외순환중 위점막의 미세순환 장애를 방지하고 전신성 염증반응을 감소시킬 수 있음을 확인하였다.

• Journal of Chest Surgery
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• 제13권3호
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• pp.198-205
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• 1980

Clinical observations were performed on 373 cases of chest trauma, those were admitted and treated at the Department of surrgery, Korea University Hospital, during the past 15 years period from August 1965 to June 1980. 1. The ratio of male to female patient of chest trauma was 4:1 in male predominence and age from 10 to 50 occupied 87.4 % of the total cases. 2. The most common cause of chest trauma was traffic accident in this series. One hundred and eight one cases (48.5%) were injuried by traffic accident and total cases due to blunt trauma (non-penetrating injury) were 282 cases (75.6%) including the cases with traffic accident, and remaining 91 cases (24.4%) were due to penetrating injury including 73 cases (19.6%) of stab wounds. 3. hemopneumothorax were observed in 49% (182 cases) of the total cases, and etiologic distribution revealed 72% due to non-penetrating trauma and 28% due to penetrating injury. 4. Rib fracture was found in 44.8% of cases. common injuries associated with rib fracture were lung, brain and liver. 5. Most common symptom was chest pain and respiratory difficulty, and common sign associated with chest injury was decreased respiratory sound and subcutaneous sound. 6. conservative non-operative treatment was performed in 281 cases (75.4%) and 92 cases (24.6%) were treated with operative treatment including 33 cases (8.9%) with open thoracotomy. 7. Overall mortality was 5.6% (21 cases) and most common cause of death were due to brain edema, cardiogenic shock, asphyxia.

• Journal of Chest Surgery
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• 제37권12호
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• pp.999-1002
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• 2004

흉부관통상 환자에서 심장손상이 의심될 때 신속한 이송, 조기 진단 및 체계적인 수술적 치료는 좋은 결과를 얻을 수 있다. 생명을 위협하는 응급상황에서 심장손상의 정도를 진단하는 것은 어려울 수도 있다. 13세 남아가 칼에 의한 흉부 관통상을 입고 흉관으로부터 과도한 출혈이 있어 본원 흉부 외과로 전원되었다. 단순 흉부촬영에서 좌측페야에 균일한 음영 증가가 관찰되었다. 그는 의식이 혼미했으며 생체의 징후는 불안정하여 신속히 수술실로 옮겼다. 소생술 후 정중 흉골절개술을 통해 좌심실 열상을 봉합하였다. 수술 중 시행한 경식도 심초음파에서 심실중격결손에 의한 단락이 발견되었고 좌심실절개하에 데크론 첨포(Dacron patch)를 이용하여 정복하였다. 수술 후 경과는 좋았으며 심실중 격결손을 통한 작은 단락이 있었으나 추적 관찰하기로 하고 퇴원하였다.

• Journal of Chest Surgery
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• 제20권2호
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• pp.261-269
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• 1987

From 1976 through 1986, authors have experienced 127 cases of peripheral vascular surgery which had been done in this department. There were 29 cases of atherosclerosis obliterances including 7 Leriche syndrome, 32 Buerger`s diseases, 25 arterial thromboembolisms, 21 vascular injuries, 2 peripheral arterial aneurysms, 2 renovascular hypertensions, 1 congenital A-V malformation, 13 varicose vein of lower extremities, and 2 Jugular venous ectasia. Cases with vena caval disease and aortic disease were excluded. The mean age of ASO and Buerger`s disease was 56.1 yrs, 33.8 yrs respectively. The male to female ratio showed marked male preponderance [27:2, and 30:2], and almost every male patient was smoker. The indication of operation was similar in both disease entities. The method of operation for ASO were bypass procedure [17], thromboendarterectomy [6], and lumbar sympathectomy [5], and for Buerger`s disease were mainly sympathectomy and few bypass procedures and amputations. Seventeen patients with ASO were followed from 3 to 75 month and overall patency rate for bypass or endarterectomy in one and two months and 2 1/2 yr were 93%, 87%, and 31% respectively. Post operatively patient`s symptoms was relieved or alleviated in almost ASO patients, and about 60% of Buerger`s disease. We concluded that in patient with ischemic limb, we must revascularized aggressively for symptomatic relief. And choice of graft for bypass procedure was to be evaluated further.