• Journal of Medicine and Life Science
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• 제17권1호
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• pp.16-20
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• 2020

Spontaneous hemopneumothorax is a rare disease, and it can cause life threatening condition. It is characterized by the accumulation of more than 400 mL of blood and air in the pleural cavity without any other apparent causes. A previously healthy 22-year-old female patient presented with acute chest pain and dyspnea. Chest X-ray and computed tomography revealed a massive hemopneumothorax in the left hemithorax. The images showed a completely collapsed left lung with right-sided tracheal deviation, several pleural adhesion bands, and fluid collection with air-fluid level. We emergently performed a closed thoracostomy, and then 560 mL of fresh bloods were initially drained. We considered an emergent video-assisted thoracoscopic surgery for pulmonary wedge resection and bleeding control because of the massive hemothorax. However, the patient's vital signs were stabilized after blood transfusion and supportive cares for re-expansion pulmonary edema. The patient discharged from the hospital on 11^th in-hospital day after removal of the chest tube, and there had not been any recurrence of the pneumothorax for 10 months. We suggest that treatment strategy should be decided upon individually based on the patient's condition and clinical course of the disease.

• 대한기관식도과학회지
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• 제7권1호
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• pp.40-45
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• 2001

Management of laryngotracheal stenosis remains one of the most challenging problems facing the otolaryngologist. The key to success is to obtain adequate rigid circular support with normal mucosal lining. Four Patients with laryngotracheal stenosis were surgically treated in our institution in 2000. All the patients were male adults. The cause of stenosis were longterm or repeated endotracheal intubation and tracheostomy in our patients. All patients were successfully decannulated following segmental resection of the stenotic portion including the anterior arch of the cricoid cartilage and end-to-end anastomosis after suprahyoid laryngeal release. The time between treatment and decannulation was just one day in three patients. These results suggest the Possibility of early decannulation even if the cricoid cartilage was partially resected. It is better to prevent laryngotracheal stenosis rather than to treat it once it has occurred.

• 대한기관식도과학회지
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• 제10권2호
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• pp.28-34
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• 2004

Background : Esophageal perforation due to a traumatic endoscopy or intubation is exceedingly rare. If riot noticed immediately or treated promptly, however, the morbidity and mortality is significant. We performed a retrospective review of patients with iatrogenic hypopharyngo-esophageal perforation to assess the outcome of current management techniques. Material and Methods : We retrospectively analyzed all cases iatrogenic hypopharyngo-esophageal perforation diagnosed at our hospital from January, 1999, through April, 2004. The study group consisted of 11 patients (4 men) with a mean age of 47.6 years (range, 21-83 yr). We reviewed the 11 patients with perforated injuries of the hypopharynx or esophagus during the diagnostic or therapeutic procedures. Result: Perforations were due to diagnostic gastroscopy ($54.5\%$, 6/11), esophageal dilation ($27.3\%$, 3/11), endoscopic port insertion ($9.1\%$, l/11), and tracheal intrathoracic ($9.1\%$, 1/11). Seven patients had intrathoracic and 4 had cervical perforations. Treatment included incision and drainage (5), resection and reconstruction (4), drainage only (1), and observation (2). Nonfatal complications included transient pneumonia (1), and wound infection (1). They occurred in advanced mediastinal abscess ]patients. Mortality was $9.1\%$ (1/11) in old patient who managed medically in cervical esophageal perforation. Conclusions : Current mortality rates in iatrogenic esophageal perforation were improved compared to previous published rates of $19\%\;to\;66\%$ for all patients with this condition. We concluded that aggressive and definitive surgery for thoracic esophageal perforations improving the survival rate, whether diagnosed early or late.

• Journal of Chest Surgery
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• 제30권2호
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• pp.219-225
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• 1997

비록 대부분의 기관지내 결핵 환자들이 약간의 기관지 협착을동반하지만,항결핵제요법과스테로이 드 치료에 잘 반응하지 않는 환자들에서 기관 및 기관지내 개방성을 유지하기 위해서는 더욱 적극적인 치료가 필요하다. 저자가 치험한 첫 번째 경우에는, 기관지내 결핵에 의한 협착이 있는 42세 여자 환자 에게 Modified Gianturco스텐트를 삽입후 육아조직의 증식으로 재협착이 생겨 6cm의 기관절제 및 단단문합술을 시행하였고, 결핵에 의한 좌측 주기관지 협착 증세를 보이는 31세 남자에게 Strecker스텐트 삽입후 스텐트의 이동과 육아조직의 형성으로 재혐착된 예에서는 좌측 주기관지 전체와 하엽을 절제하고 주기관지와 상엽 기관지를 연결하여 주었다.

• Journal of Chest Surgery
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• 제42권5호
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• pp.649-652
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• 2009

75세 남자 환자가 한 달 동안 점점 심해지는 호흡곤란 및 간헐적인 연하곤란을 주소로 내원하였다. 단순 흉부 사진상 기관이 우측 종격동 종괴에 심하게 눌려 있는 소견이 보였으며, 흉부 컴퓨터 촬영상 우측 쇄골하동맥 근위부 낭성 동맥류로 확진되었다. 정중흉골절개 및 쇄골상부 절개하에 동맥류 절제술 및 혈관재건술을 시행하였다. 동맥류 벽과 혈전의 균 배양 검사는 음성이었고, 병리 검사는 동맥경화성 동맥류 소견이었다. 수술 후 호흡곤란과 연하곤란은 호전되었으나, 술 후 8개월에 진행된 위암에 의해 사망하였다.

• Radiation Oncology Journal
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• 제31권3호
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• pp.162-170
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• 2013

Purpose: To analyze the outcome of adjuvant postoperative external beam radiotherapy (EBRT) in well-differentiated thyroid cancer (WDTC). Materials and Methods: We identified 84 patients treated with EBRT for WDTC from February 1981 to December 2010. Among them, we analyzed 39 patients who received EBRT after initial radical surgery. Twenty-four females and 15 males were included. The median age was 49 years (range, 16 to 72 years). There were 34 papillary thyroid carcinomas and 5 follicular thyroid carcinomas. Most patients showed pathologic T3/T4 stage (54%/26%). Ten patients (25.6%) had gross residual tumors. Five patients (12.8%) had tumor cells at the margin. The median EBRT dose and fraction size were 62.6 Gy and 1.8 to 2.0 Gy, respectively. Results: The median follow-up was 73 months (range, 21 to 372 months). The five-year overall survival (OS) and locoregional recurrence free survival (LRFS) were 97.4% and 86.9%, respectively. Locoregional failures occurred in 5 and all failure sites were the neck node area. In univariate analysis, OS was significantly influenced by invasion of the trachea (p = 0.016) or esophagus (p = 0.006). LRFS was significantly decreased by male (p = 0.020), gross residuum after resection (p = 0.002), close or positive tumor at surgical margin involvement (p = 0.044), and tracheal invasion (p = 0.040). No significant prognostic factor was identified in the multivariate analysis. No patient experienced the Radiation Therapy Oncology Group grade 3 or more toxicity. Conclusion: Our locoregional control rate of 87.2% is comparable to historical controls with surgery alone, even though our study had a large proportion of advanced stage. Adjuvant EBRT may an effective and safe treatment option in patients with WDTC.

• Journal of Chest Surgery
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• 제30권12호
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• pp.1219-1224
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• 1997

1980년대 이후 임상 폐이식 예가 급속히 증가하고 그 성적도 날로 향상되어, 현재 폐이식술은 말기 폐질환 의 치료 방법으로 선택되어 지고 있으나, 아직도 거부 반응의 조기 발견 및 치료, 적출 폐장의 보존, 감염 관 리, 기관지 문합부 합병증 등 여러 면에서 해결해야 할 과제가 많이 남아 있다. 기관지 문합부 합병증은 다른 장기 이식과는 달리 폐이식에 특이한 것으로, 허혈, 거부 반응, 면역 억제제, 문합 부위의 기계적 손상, 감염 등의 여러 인자가 복합적으로 작용하여 일어난다고 생각되고 있다. 기관지 문합부 합병증을 감소시키기 위한 노력의 하나인 telescoping 기법은 Su Antonio Group에 의해 최근에 다시 소개되어 좋은 성적을 보이고 있다 이 실험은 허혈 상태의 기관 문합부 치유에 있어서 Telescoping 기법의 효과를 평가하기 위해 고안되었다. 방법 : 경부 기관을 주위 조직으로 부터 완전 박리하여 최대한의 허혈 상태를 만든 후 중간 1/3을 절제하여 절제된 기관 절편을 재문합하였는데, 그룹 I에서는 단순 단속 봉합하였고, 그룹 II에서는 telescoping 기법으로 문합하여 문합부에서의 섬유화 정도를 비교 관찰하였다. 결과 ; 양 군에서 평균 생존일, 사망 원인, 원인 불명 또는 혈종에 의한 질식으로 사망한 토끼의 술후 평균 생존 기간, 기관 합병증의 발생 빈도 등이 모두 통계적으로 유의한 차이가 없었음에도 불구하고 telescoping 기법으로 문합한 군에서 수술 조기의 문합부의 섬유화(fibroblast density, collagen formation)가 유의하게 증가 되었으며, 섬유아세포의 band-like fibrous union 현상이 문합부에서 현저하게 관찰되었다.

• Tuberculosis and Respiratory Diseases
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• 제48권1호
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• pp.91-95
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• 2000

성인의 기관에서 발생한 점액선 선종은 매우 드문 종양으로 대부분 양성이다. 저자 등은 객혈을 주소로 내원한 환지에서 발견된 기관의 점액선 선종 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

• Journal of Chest Surgery
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• 제27권2호
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• pp.140-147
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• 1994

Reconstruction of the pharynx and cervical esophagus presents a tremendous challenges to surgeons. Over the past 2 years[1990, Dec.-1993, Jun], the free jejunal graft has been performed in 17 cases in Korea Cancer Center Hospital.The indications of this procedures were almost malignant neoplasms involving neck and upper aero-digestive tract; Hypopharyngeal cancer[12 cases, including 2 recurrent cases], laryngeal cancer[2 cases], thyroid cancer[2 cases, including 1 recurrent case], cervical esophageal cancer[1 case]. There were fifteen men and two women, and the mean age was 59.6 years. The anastomosis site of jejunal artery were common carotid artery[16 cases] or external carotid artery[1 case] and that of jejunal vein were internal jegular [15 cases] or facial[1 case] and superior thyroid vein[1 case]. The length of jejunal graft was from 9 cm to 17 cm[mean 13 cm] and the mean ischemic time was 68 minutes. There was one hospital mortality which was irrelevant to procedures[variceal bleeding] and one graft failure[1/16]. Other postoperative complications were neck bleeding or hematoma[3 cases], abdominal wound infection or disruption[5 cases], anastomosis site leakage[1 case], pneumonia[2 cases], graft vein thrombosis[1 case], and food aspiration[1 case]. The function of conduit was excellent and ingestion of food was possible in nearly all cases. Postoperative adjuvant radiation therapy was also applicable without problem in 7 cases. During follow-up periods, the anastomosis site stenosis developed in four patients, and the tracheal stoma was narrowed in one case but easily overcome with dilation. In conclusion, we think that the free jejunal graft is one of the excellent reconstruction methods of upper digestive tract, especially after radical resection of malignant neoplasm in neck with a high success rate and low mortality and morbidity rate.

• Asian Pacific Journal of Cancer Prevention
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• 제14권8호
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• pp.4529-4532
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• 2013

Background: Acute normovolemic hemodilution (ANH) has been widely used to prevent the massive blood loss during hepatic carcinoma. The influences of ANH on coagulation function are still controversy, especially in elderly patients. The study observed ANH effects on coagulation function and fibrinolysis in elderly patients undergoing the disease. Materials and Methods: Thirty elderly patients (aged 60-70 yr) with liver cancer (ASA I or II) taken hepatic carcinectomy from February 2007 to February 2008 were randomly divided into ANH group (n=15) and control group (n=15). After tracheal intubation, patients in ANH group and control group were infused with 6% hydroxyethyl starch (130/0.4) and Ringer's solution, respectively. Blood samples were drawn from patients in both groups at five different time points: before anesthesia induction (T1), 30 min after ANH (T2), 1 h after start of operation (T3), immediately after operation (T4), and 24 h after operation (T5). Then coagulation function, soluble fibrin monomer complex (SFMC), prothrombin fragment (F1+2), and platelet membrane glycoprotein (CD62P and activated GP IIb/GP IIIa) were measured. Results: The perioperative blood loss and allogeneic blood transfusion were recorded during the surgery. The perioperative blood loss was not significantly different between two groups (p>0.05), but the volume of allogeneic blood transfusion in ANH group was significantly less than in control group ($350.0{\pm}70.7$) mL vs. ($457.0{\pm}181.3$) mL (p<0.01). Compared with the data of T1, the prothrombin time (PT) and activated partial thromboplastin time (APTT) measured after T3 were significantly longer (p<0.05) in both groups, but within normal range. There were no significant changes of thrombin time (TT) and D-dimer between two groups at different time points (p>0.05). SFMC and F1+2 increased in both groups, but were not statistically significant. PAC-1-positive cells and CD62P expressions in patients of ANH group were significantly lower than those at T1 (p<0.05) and T2-T5 (p>0.05). Conclusions: ANH has no obvious impact on fibrinolysis and coagulation function in elderly patients undergoing resection of liver cancer. The study suggested that ANH is safe to use in elderly patients and it could reduce allogeneic blood transfusion.