• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.27 no.2
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• pp.122-125
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• 2016

Although many factors associated with difficult intubation have been known, predictors of difficult mask ventilation are not well known. We experienced a case of nearly complete airway obstruction following usual anesthetic induction which needed various emergency treatments. The patient had a preoperative diagnosis of contact granuloma of right posterior vocal cord and bilateral vocal cord palsy but later was found out as invasive laryngeal cancer. Upon the surgical field of view, both vocal cords were showing significantly thickened and fixated appearance and was considered as in the critical narrowing state with the potential of complete obstruction. Using $C-MAC^{(R)}$ video laryngoscope we were able to see the narrowed vocal cord and choose proper size of endo-tracheal tube. Consequently, intubation was successfully done and operation was conducted. From this case, we have lessons that physicians should examine the patient's airway more carefully in case of laryngeal mass and prepare emergency measures.

• Korean Journal of Bronchoesophagology
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• v.6 no.2
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• pp.177-180
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• 2000

Backgrounds： Patients with respiratory failure may require prolonged mechanical ventilation. The purpose of this study was to determine the optimal time for tracheostomy and complications of tracheostomy. Methods : All medical records of 27 patients who underwent tracheostomy in department of thoracic & cardiovascular surgery at Yondong Severance hospital between January 1, 1990 and December 31, 1998, were reviewed. Variables analyzed include underlying disease, primary indication of tracheostomy, interval from 1st intubation to tracheostomy, duration from tracheostomy to weaning ventilator, duration of decannulation, and complication. There were 18 men and 9 women. Mean age at the time of the tracheostomy was 54 years (rage, 11 to 64 yeras). Results : Underlying diseases included lung cancer in 14 patients (51.9%), trauma in 8 patients (29.6%), and TE fistula in 2 patients. The indication for tracheostomy were as follows: prolonged mechanical ventilation in 13 patients, purpose of bronchial toilet in 9 patients, and tracheal stenosis in 5 patients. The mean interval between the first intubation and tracheostomy was 8.1 days. The mean duration from tracheostomy to weaning ventilator was 10.1 days. Conclusions : Timing of tracheostomy Is very important. Tracheostomy may benefit patients because it can accelerate the process of weaning and thus lead to a reduction in the duration of ventilation, length of hospitalization, and cost.

• Korean Journal of Bronchoesophagology
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• v.9 no.2
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• pp.60-64
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• 2003

Restenosis frequently develops with granulation and overgrowth of scar following surgical treatment for laryngotracheal stenosis. Various methods such as stenting or CO2 laser application have been used to prevent restenosis, but they were seldom unsatisfactory. Mitomycin is an antineoplastic antibiotics derived from Streptomyces caespitosus; it inhibits fibroblast proliferation and acts as an alkylating agent to inhibit DNA synthesis. This study was desinged to evaluate effectiveness and determine indications of usage of topical mitomycin for laryngotracheal stenosis as a nonsurgical means of reducing postoperative granulation and scar tissue formation. Patients and Method : A retrospective study was performed on eight cases of laryngotracheal stenosis with topical mitomycin application. The author analyzed clinical outcomes of operative treatment with topical mitomycin. Patients underwent laryngotracheal reconstruction, endoscopic granulation removal, or bronchoscopic bougienage followed by topical application of mitomycin (0.4 mg/$m{\ell}$, 4minuntes) on the lesion intraoperatively. Result : Overall success rate of decannulation was 38% ($\frac{3}{8}$). Successful decannulation was possible in 75% ($\frac{3}{4}$) of laryngeal stenosis patients, 75% ($\frac{3}{4}$) of children, 60% ($\frac{3}{5}$) of the patients without previous surgery, and 75% ($\frac{3}{4}$) of bronchoscopic bougienage. Conclusion : The topical application of mitomycin in laryngotracheal stenosis was effective in untreated pediatric laryngeal stenosis which underwent bronchoscopic bougienage. Our results show that the topical mitomycin application for laryngotracheal stenosis could be a effective adjuvant treatment.

• The Korean Journal of Emergency Medical Services
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• v.9 no.1
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• pp.95-99
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• 2005

Penetrating neck trauma by gunshot injury involving tracheobronchial tree is rare in Korea. Extensive tissue damage by cavitation, tissue fragmentation and shock wave transmission of high-velocity projectile along with associated organ injury renders high rate of mortality and morbidity. A 28 year old man in military service with gunshot wound in left cervical area presented initial symptoms of severe dyspnea and subcutaneous emphysema. Computed tomography of chest and cervical region as well as bronchoscopic evaluation was performed to confirm highly suspected injury to cervical trachea. Surgical exposure was established through a low collar incision; the damaged segment of 3.5 cm length including 2-4th tracheal rings was resected out and end-to-end anastomosis was performed. Bleeding from lacerated anterior jugular vein was controlled by ligation of both ends and a K2 bulllet was found upon inner border of body of first rib, medial to right carotid sheath and removed out. Cervical esophagus, carotid artery, internal jugular vein and recurrent laryngeal nerve were spared. Extubation was done on the first postoperative day and postoperative course until discharge on nineth postoperative day remained uneventful.

• Journal of Veterinary Clinics
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• v.38 no.5
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• pp.244-248
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• 2021

A 10-year-old Thoroughbred mare was referred to the Jeju National University Equine Hospital with roaring, dyspnea, and weight loss. On endoscopic examination, the horse was diagnosed with right arytenoid chondritis. Surgical treatment was selected due to the failure of a previous medical treatment. Permanent tracheostomy was performed in a standing position. The horse was restrained and tied in a proper position in the stock. The cranial parts of the 2nd to 5th tracheal cartilages were resected, as were the associated skin, mucosa, muscle, and cartilages. After the stoma was formed, external mucosa and skin were sutured using a simple interrupted method. The horse was hospitalized for 22 days receiving postoperative care including antibiotics, non-steroidal anti-inflammatory drugs, dressing as required, and was pregnant six months after the surgery. A permanent tracheostomy is thought to be effective in horses with diseases causing upper respiratory tract obstruction.

• Journal of Chest Surgery
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• v.31 no.3
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• pp.329-335
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• 1998

A 55-year-old male was admitted to our hospital complaining of chest discomfort, dysphagia and severe pain on swallowing. Esophageal manometry showed that there was no relaxation of lower esophageal sphincter to swallowing. There was double barrelled esophagus or mucosal stripe appearance on esophagogram. Endoscopy revealed an appearance as if an esophago-tracheal fistula had been made at the level of the upper thoracic esophagus. Also, two slit-like mucosal tears was seen on the lower esophagus. There after, fasting and total parenteral nutrition for several weeks failed to bring about any changes in his symptoms. So, as treatment, primary closure of the upper opening of the false lummen was performed under general anesthesia. Soon after the surgical procedure, the patient's symptoms were improved except for mild dysphagia. He was discharged after oral intake had been juduciously commenced with fluids and soft diet subsequently. During follow-up in out-patient department, he had no specific symptoms including fever or dysphagia and massive dissection of the esophagus was improved on esophagogram. We report the experience of a case of spontaneous submucosal dissection of the esophagus which required conservative and surgical management

• Journal of Chest Surgery
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• v.31 no.7
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• pp.725-729
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• 1998

Endobronchial leiomyoma is extremely rare and accounts for less than 2% of benign tumors of the lower respiratory tract. Leiomyomas are predominantly found in the young and the middle aged : of the average age being 35 years for bronchial and lung parenchymal lesions and 40.6 years for tracheal lesions. The symptom depends on the location of the tumor, its size, and changes in the lung distal to the lesion. A 37-year-old woman was admitted to our hospital complaining of coughing. Bronchoscopy revealed complete obstruction of the right main bonchus at the carina by an oval-shaped, nonulcerative, smooth, and pinkish-tan tumor with a broad margin and extended to the left main bronchus. A biopsy was performed and showed a benign spindle cell tumor. A right pneumonectomy was performed because of chronic infection, and the lung could not expanded during aeration. The histological diagnosis of the resected specimen was leiomyoma. The postoperative course was uneventful.

• Journal of Chest Surgery
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• v.30 no.12
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• pp.1219-1224
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• 1997

Although several reports were presented recently about bronchial arterial revascularization in clinical lung transplantation, one factor peculiar to the lung transplantation is the ischemia of the donor bronchus. Poor bronchial healing occurs frequently following clinical lung transplantation and this has been major cause of mortality and morbidity. There have been many attempts to solve bronchial anastomotic complications. Telescoping technique, one of those attempts, was advocated by San Antonio Group recently. This experiment was per(armed to evaluate the effect of telescoping anastomotic technique upon th healing of the tracheo-bronchial anastomosis. We used rabbits(weighing about 800 g) as experimental animal. Method: Resection of middle one third of cervical trachea and reanastomosis was performed by simple interrupted anastomotic technique in Group 1(n=15) and by telescoping anastomotic technique in Group 2(n= 15). Result: Anastomotic sites in the telescoping technique group showed significant increase of fibrosis in the early postoperative days(< Sdays) and remarkable band-like fibrous union compared to the simple interrupted group.

• Journal of Chest Surgery
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• v.27 no.2
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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.

• Journal of Chest Surgery
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• v.33 no.12
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• pp.929-934
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• 2000

배경: 기관의 동종이식편은 초냉동보관으로 생육성을 유지할 수 있으며 항원성이 줄어든다고 알려졌으나 냉동보관 온도 및 기간에 따른 항원성의 변화는 아직까지 명확히 밝혀져 있지 않다. 따라서 이번 연구에서는 냉동보관 온도의 차이 및 기간이 쥐 기관 동종이식편의 거부반응에 미치는 영향을 연구하였다. 대상 및 방법: 24개의 쥐 기관을 적출하여 12개씩 -8$0^{\circ}C$ 냉동고 및 -196$^{\circ}C$ 질소탱크에 각각 1, 3, 6개월씩 보관하였다. 냉동보관한 기관을 반으로 나누어 48마리의 쥐복강에 대망으로 감싼 다음 이식하였다. 1, 3, 5군은 -8$0^{\circ}C$ 냉동고에 각각 1, 3, 6개월씩 보관한 기관 동종이식편을 이식하였고 2, 4, 6군은 -196$^{\circ}C$ 질소탱크에 각각 1, 3, 6개월씩 보관한 기관 동종이식편을 이식하였다. 7군은 대조군으로 냉동보관하지 않은 동종이식편을 이식하였다. 이식후 14일째 이식된 동종이식편을 적출하여 간질조직의 단세포 침윤정도 및 내강 폐쇄 정도를 관찰하여 거부반응을 정도를 측정하였다. 결과: 7개 군 모두에서 중등도 이상의 심한 단세포 침윤을 보였으며 각군간의 통계학적인 차이를 보이지 않았다. 1, 2, 3, 4, 5, 6군에서 7군에서 보다 내강 폐쇄 정도가 적었으나 통계학적인 의의는 없었다. 모든 군에서 연골주위 단세포 침윤이 심한 경우에도 연골세포는 비교적 생육성을 잘 유지하고 있었다. 결론: 냉동보관 온도 및 보관 기간의 차이에 따른 동종이식편의 거부반응의 차이는 없었으며 모든 군에서 심한 거부반응을 보였다. 따라서 냉동 보관 쥐 동종이식편을 이용한 실험에서는 적절한 면역억제제의 사용이 필수적이라고 생각된다.