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Emergency Reexploration for Bleeding after Open Heart Surgery wth Cardiopulmonary Bypass -A Report of 16 Cases- (개심술후 출혈로 인한 응급개흉술의 임상적 고찰)

  • 유재현
    • Journal of Chest Surgery
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    • v.24 no.11
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    • pp.1068-1073
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    • 1991
  • Bleeding after open heart surgery with cardiopulmonary bypass was a cause of concern. requiring reexploration of the chest in approximately 8 percent of patients who have had operations on the heart. From April., 1983 to October, 1991, 16 patients[2%] out of 777 patients who underwent open cardiac surgery had emergency reexploration with bleeding at the Department of Thoracic and Cardiovascular Surgery, Chungnam National University Hospital. In 12 cases[75%], reexploration was performed for continuous bleeding and the reminder[4 cases] were performed for suspected tamponade & hypotension. There were 9 cases[56%] of congenital heart disease and 7 cases of acquired heart disease. The mean blood loss were 997$\pm$472ml /sq. M in total cases and 1442$\pm$ 647ml /sq. M in cases repair of cyanotic heart disease. The mean interval till reoperation was 16.6hr [1hr~72hr] and 41 hr[12~72hr] in tamponade cases and 8.4hr[1hr~24hr] in continuous bleeding cases. The bleeding sites were identified in 7 cases: aortotomy site in 2 cases, ventriculotomy site, SVC, thymus, pleura and sternum wiring site in each other case. But no specific sites was found in the remaining 9 cases. The 8 cases had complications but all except 1 cases with hypoxic brain damage were recovered without sequale. We conclude that emergency thoractomy after open heart surgery may be lifesaving and-/or diminishing complications with bleeding if performed promptly with excessive bleeding, tamponade and unexpected hypotension.

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Analysis on the Structure of Defect Consulting Report in Apartment Building (공동주택 하자감정서의 구성체계 분석)

  • Park, Jun-Mo;Seo, Deok-Suk;Kim, Ok-Kyue;Park, Gil-Bum
    • Proceedings of the Korean Institute of Building Construction Conference
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    • 2013.05a
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    • pp.166-167
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    • 2013
  • There has been a defect dispute of apartment building in Korea. The defect dispute is complicated by main issues and details of dispute. It is yet to be solved. Meanwhile, a judge does not a inspection and analysis, but, related field expert who contracted professional engineer does. As a result, defect consulting report that an important judgment is used in a defect dispute. Therefore, this study does research on structure of defect consulting report. A defect consulting report has same items, irrespective of a defect consultant as a result that check 7 indexes about 10 cases. It has different structure's details depending on each defect consultants. And, it inserts new detail or deletes existing detail, does not show clear distinction.

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Esophageal Corrosion Carcinoma at the Site of Caustic Stricture - A Report of 14 Cases - (부식성 식도협착부위에 발생한 식도암 - 14례 보고 -)

  • 안욱수
    • Journal of Chest Surgery
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    • v.23 no.1
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    • pp.90-94
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    • 1990
  • Between Dec. 1958 and Oct. 1989, we had been experienced 14 cases of the esophageal corrosion carcinoma among 562 cases of corrosive esophageal stricture, which incidence was revealed 5.6 % of total esophageal carcinoma cases and 2.5 9o of total benign esophageal stricture cases. The age distribution was from 15 to 64 years, and the mean age was 45.6 years. Ten of the patients were women. The caustic agents were lye in 12 patients and hydrochloric acid in 2 patients. The latent time from injury to the development of carcinoma was from 12 years to 45 years, and the mean latent time was 29 years. In majority of cases, the developing site of carcinoma was just or just above the benign stricture portion of the esophagus. Corrective surgery were made in seven cases; three cases were made esophagectomy and esophagogastrostomy, and the other four cases were made esophagectomy and colon interposition. Palliative surgery including feeding gastrostomy were made in seven cases. All cases had a longstanding history of difficult oral swallowing especially at the site of stricture. We think chronic food irritations of stricture portion of the esophagus induced the development of corrosion carcinoma. In conclusion, we had to suspect possibility of carcinoma in patient with long standing history of benign esophageal stricture. So we recommended preoperative esophagoscopic biopsy in such cases.

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Surgical treatment of acute purulent pericarditis: report of 14 cases (급성 화농성 심낭염 14례 보)

  • Jo, Geon-Hyeon;Lee, Hong-Gyun
    • Journal of Chest Surgery
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    • v.17 no.2
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    • pp.257-262
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    • 1984
  • Acute purulent pericarditis, though not common in incidence after introduction of antibiotics, is still potentially life treating isease. Since 1971, we have experienced 14 cases of acute purulent pericarditis with successful treatment. Among these 14 cases, 9 cases were male and they had high occurrence on their third to fifth decades in age distribution. Isolation of causative organisms were obtained in 11 cases through the bacterial culture of infectious source which was mainly pericardial effusion or blood, and the most frequently recovered organism was the staphylococcus aureus. Pre-existing inflammatory disease preceding to pericarditis, named as antecedent disease, were proved in 12 cases, and among which contiguous extension from the intrathoracic infection such as pneumonia or empyema accounted for the majority of antecedent disease. Pericardiocentesis with administration of antibiotics were tried in all cases, but result in recovery in 1 patient only. Remaining 13 cases had persistent picture of pericarditis and necessitated surgical drainage procedure. Ten of these 13 cases were underwent the open pericardial window using a mode of anterior approach in 4 and subxiphoid approach in 6 cases respectively. Two cases of subxiphoid group were reoperated by the anterior interphrenic pericardiectomy, due to insufficient drain of too thick effusion. In remaining 3 cases, anterior interphrenic pericardiectomy was performed initially because of purulent effusion already changed into fibrinopurulent peel with thickened pericardium. Through the experience of this series, we recommended that pericardiectomy should not be reluctant in purulent pericarditis as a initial surgical procedure for advantage of complete removal of infected space and avoidance of late constrictive pericarditis.

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Clinical Review of Primary Mediastinal Tumors & Cysts (원발성 종격동 종양 및 낭종의 임상적 고찰)

  • 정종화
    • Journal of Chest Surgery
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    • v.23 no.2
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    • pp.325-332
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    • 1990
  • Complications of the mediastinal tumors and cysts are malignant change, infection, bleeding, local invasion and mass effect to heart, lung and other mediastinal structures. But early surgical excision and proper treatments bring patients to good clinical course and results. Therefore mediastinal tumors and cysts are surgically interesting diseases We report the analysis of the 58 cases of mediastinal tumors and cysts, experienced in the Department of Cardiothoracic Surgery of the Kosin Medical College from July 1979 to June 1989. The results were as follows ; Sex ratio of male to female to female was 1.3: 1. Range of age was from 11 to 64 years and mean age was 34.3 years. The thymomas were 14 cases[24%], the teratomas were 19 cases[33%o], the neurogenic tumors were 10 cases[17%], the cysts were 9 cases[15%], the carcinomas were 3 cases[5%], the thyroid tumor was 1 case[2%], the Castleman’s disease was 1 case[2%] and unclassified tumor was 1 case[2%]. Malignant tumors were 12 cases [21%] of the 58 cases. Most frequent symptom was chest pain and discomfort and relationship of symptom and malignancy was significant. Complete removal of tumor was performed on the 47 cases[92%] and partial excision was 3 cases[6%]. Inoperable cases were treated with anticancer chemotherapy and radiotherapy. Postoperative complications were wound infection, Homer’s syndrome, phrenic nerve palsy, mediastinal hematoma and pleurisy. There was no case of postoperative mortality and good clinical course in surgically completely resected cases.

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Report of 25 Cases of Mediastinal Tumors (종격동 종양 25례 에 대한 임상적 고찰)

  • 김광택
    • Journal of Chest Surgery
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    • v.12 no.4
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    • pp.424-428
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    • 1979
  • Clinical observation were performed on 25 cases of Mediastinal tumors or Cyst, those were admitted and treated at the Department of Thoracic and Cardiovascular Surgery, Korea University Hospital, during the 6 years period from March 1973 to March 1979. The following results are obtained. Of 25 cases, 19 patients were males and 6 patients were females. Range of age varied widely from 2 years to 72 years. Approximately 28% were younger than 15 years of age at the time of diagnosis. The common subjective symptoms of the patients were anterior chest pain [36%], coughing [27%], dyspnea and a few incidence of hemoptysis. Diagnostic procedures were posteroanterior and lateral chest roentgenorgrams, Chest tomograms, Brochograms, Esophagograms, Mediastinoscopy, Scalene and Axillary Lymph node biopsy, and Needle aspiration biopsy. In the histological distribution on Mediastinal tumors in order of frequency, Neurogenic tumor 6 cases [25%], Lymphoma 5 cases [21%], Bronchogenic cyst 4 cases [17%], Pericardial cyst 2 cases [8.3%], Teratodermoid tumor 2 cases [8.3%], and each one case of Rhabdomyosarcoma, Seminoma, Cavernous hemangioma, Anthracosis, Tuberculoma were noted respectively. Of 24 cases of the histologically confirmed Mediastinal tumors, 6 cases [24%] were malignant. Thoracotomy for removal of tumor or cyst was performed on 17 cases and offered cure of all benign tumors. In 6 cases of malignant tumors, Chemotherapy with Vincristine, Cyclophosphamide and Prednisolone was given to 1 case Lymphoma. There was no case of postoperative mortality.

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Surgical Treatment of Achalasia : A report of 13 cases (Achalasia 의 수술요법 -13례 보고-)

  • Jo, Dae-Yun;Yang, Gi-Min;Rho, Joon-Rhyang
    • Journal of Chest Surgery
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    • v.13 no.4
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    • pp.470-474
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    • 1980
  • Achalasia is a neurogenic esophageal disorder, characterized by incomplete relaxation of the gastroesophageal sphincter in response to deglutition and absence of peristalsis from the body of the esophaugs. Because there is no known method by which esophageal peristalsis can be restored, therapy is directed toward the relief of dital esophageal obstruction. During the period of June 1965 to September 1980, 13 cases of achalasia were operated at the Department of Thoracic SUrgery, Seoul Natonal University Hospital. 1. Among 13 cases, 5 were male and 8 were female. 2. Esophagomyotomy was performed in 12 cases, and 1 case was treated with transverse suture of lower esophagus after longitudinal incision. 3. There was no operative mortality, but 2 cases subsequently underwent esophagogastrostomy after esophagomyotomy. 4. One of 13 cases was combined with mongolism.

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Total anomalous pulmonary venous return -Report of 4 cases- (총폐정맥 환류이상증의 외과적 치험 4예)

  • 김승철
    • Journal of Chest Surgery
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    • v.19 no.2
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    • pp.273-279
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    • 1986
  • Total anomalous pulmonary venous return is a cardiac malformation in which there is no direct connection between any pulmonary vein and the left atrium but, rather all the pulmonary veins connect to the right atrium or one of its tributaries. TAPVC is a relatively uncommon anomaly, accounting for only about 1.5-3% of cases of congenital heart disease. Recently improvement in intraoperative techniques did eventually bring substantial improvements in the results in infants. 4 cases of TAPVC was successfully treated with one-stage operation, in the Dept. of Thoracic and Cardiovascular Surgery, National Medical Center in which 2 cases are supracardiac types and the other 2 cases are cardiac types. Sex ratio was 1:1, and the range of age was 2 years-18 years. The common pulmonary venous sinus was connected to the left vertical vein and innominate vein: in 2 supracardiac types and coronary sinus in 2 cardiac types. All cases are operated with standard cardiopulmonary bypass, and the hospital mortality was 0%.

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Esophageal Perforation; 6 cases report (식도 천공;6례 보고)

  • 김영진
    • Journal of Chest Surgery
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    • v.26 no.8
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    • pp.661-663
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    • 1993
  • We have experienced 6 cases of esophageal perforation from September, 1988 to June, 1993, in the department of Thoracic and Cardiovascular Surgery, Chungang Univesity Hospital and obtained the following results. The number of male patients was 5, and female 1.The causes of esophageal perforations were spontaneous, post-emetic in 2 cases, spur of cervical spine in 1 case, foreign body in 1 case, surgical trauma in 1 case and blunt trauma in 1 case. Perforation developed in cervical esophagus in I case,and others in distal third of the esophagus. One case needed only conservative treatment, and others needed surgical intervention minor or major. There were 2 mortality cases, and 2 cases healed satisfactorily without complication, 2 cases had complications that needed reoperations.

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Clinical Report for Piroxicam in Orthopedic Field (류마치양 관절염 및 퇴행성관절염에 대한 Piroxicam의 사용경험)

  • Youn Sung-Ho;Rhee Kwang-Zin;Ahn Sang-No
    • The Korean Journal of Pharmacology
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    • v.15 no.1_2 s.25
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    • pp.39-43
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    • 1979
  • Piroxicam is known to be a new nonsteroidal anti-inflammatory drug which has anti-inflammatory, antiedema, antigranuloma and analgesic activities through the mechanism of inhibition of prostaglandin synthetase. Clinical survey for piroxicam was carried cut on 40 cases of rheumatoid arthritis and 30 cases of degenerative arthritis who visited University Hospital from Feb. to June, 1979. Following results could be obtained: 1) In rheumatoid and degenerative arthritis, the effect of piroxicam was significant in decrease of joint pain, shortening of duration of morning stiffness, decrease in number of swollen joints, improvement of joint stiffness, decrease of E.S.R., increase of mean grip strength and decrease of articular index. 2) Side effects, almost all in G-I troubles were encountered in 6 cases in 40 cases of rheumatoid arthritis and 4 cases in 30 cases of degenerative arthritis.

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