• Proceedings of the KOR-BRONCHOESO Conference
• /
• 1977.06a
• /
• pp.7.1-7
• /
• 1977

According to Bryce and Cranston, prolapse of the laryngeal ventricle is a protrusion of the ventricular mucosa into the laryngeal cavity from inflammatory hyperplasia or edema. This 53 year old female patient was admitted to our hospital March 11, 1977 with the chief complaints of dyspnea and hoarseness. On admission, evaluation of the larynx revealed smooth surfaced round pink-reddish mass protruding bilaterally beneath the false cord. The airway was almost completely obstructed by the tumor mass, but neither ulceration nor infiltration was seen, also no lymphnode was palpable in the neck. Tracheotomy was performed for the relief of dyspnea and biopsy was done endoscopically. Histologic study showed chronic inflammation. On April 2, 1977 laryngofissure was performed under general anesthesia. Laryngeal examination revealed smooth surfaced, plate like, pinkreddish mass protruding bilaterally from both laryngeal ventricles into the laryngeal cavity and extending the whole length of the ventricle antero-posteriorly and touching each other. Biopsy was taken of the mass and the result was non-specific inflammatory hyperplasia of the larynx. Postoperatively, the air way is completely clear of obstruction but mild hoarseness still remains. No recurrent mass is visible in the larynx. In view of the symptoms, operative findings and histological findings, this case is diagnosed as "Prolapse of the laryngeal ventricle". The prolapse of the laryngeal ventricle is a very rare lesion and is reported with review of the literature.

• Journal of Chest Surgery
• /
• v.31 no.10
• /
• pp.1004-1008
• /
• 1998

We report a case of heart-lung transplantation in a 32 year-old female with Eisenmenger syndrome secondary to patent ductus arteriosus. She has been suffered from congestive heart failure since June 1996 and repeatedly treated at Intensive Care Unit with intravenous inotropic support since July 1997. Preoperative echocardiography showed a patent ductus arteriosus with right to left shunt, severe regurgitation of tricuspid valve and estimated right ventricular systolic pressure of 100mmHg. The brain-dead donor was an 18 year-old male with head trauma from traffic accident 3 days ago. Heart-lung block procurement was performed at another general hospital and was transported to the Seoul National University Hospital by ambulance. Total ischemic time of the transplanted heart and lung were 249 minutes and 270 minutes, respectively. The immunosuppressive therapy was commenced preoperatively with cyclosporine and azathioprine. Corticosteroid was not used until postoperative 3 weeks in order to avoid infection and delayed healing at the tracheal anastomotic site. The patient was discharged at 31st postoperative day, and has been regularly followed up at outpatient clinic without specific complication. The follow-up bronchoscopy, performed 2 weeks and 4 months after surgery, revealed no evidence of cellular rejection.

• Journal of Chest Surgery
• /
• v.39 no.8 s.265
• /
• pp.598-603
• /
• 2006

Background: High thoracic epidural anesthesia allows awake coronary artery bypass grafting, avoiding the drawbacks of mechanical ventilation and general anesthesia. Materian and Method: From April, 2005 to September, 2005, 12 patients were underwent awake coronary artery bypass grafting using high thoracic epidural anesthesia. There were 1 female and 11 male patients, with a mean age of $66{\pm}6$ years. Off pump coronary artery. bypass grafting was performed through a median sternotomy using arterial grafts. Result: There were no mortality. Pneumothorax was developed during surgery in 8 patients. Five patients required secondary intubation because of pneumothorax (n=3), bowel herniation (n=1), and hemothorax after chest tube insertion (n=1). Postoperative coronary angiography was performed before discharge in all patients and all the grafts were patent. Conclusion: Our intial experience demonstrated the feasibility of awake off-pump coronary artery bypass grafting. Further study is required to define the indications, advantages and limitations of this strategy.

• Journal of Chest Surgery
• /
• v.34 no.3
• /
• pp.224-230
• /
• 2001

배경: 지속적인 온혈 심성지액을 이용한 심금 보호술이 소개된 이수, 이를 토대로 많은 임상결과가 발표되고 있다. 그러나 지속적 심정지액 주입에 따른 적정한 수술시야 확보와 역행성 관류법에 따른 우심실 보호에 대한 문제들이 제기 되고 있다. 이에 Antonio 등은 포타슘만을 이용한 간헐적 온혈액 심정지술을 이용하여 만족할 만한 임상결과를 보고 하였다. 본 임상연구는 포타슘만을 이용한 간헐적 온혈액 심정지술을 이용하여, 개심술을 시행 받은 70례의 환잔의 임상결과를 분석하여 그 유용성을 알아보고자 하였다. 대상 및 방법: 1998년 5월부터 1999년 1월까지 포타슘만을 이용한 간헐적 온혈액 심정지술을 이용하여 관상동맥 우회술 및 판막수술을 시행한 70명의 환자와 같은 기간 간헐적 냉혈액 심성지술을 이용하여 동일 술자에 의해 수술을 시행한 70명의 임상결과를 비교 분석하였다. 결과: 총 심폐기 사동 시간(98.7$\pm$6.0분, 114.3$\pm$7.5분, p=0.018),수술중 심정지를 위해 필요한 심정지액의 양(1463.0$\pm$68.0cc, 3584.0$\pm$179.0cc, p<0.001), 의식이 회복될 때까지의 시간(3.5$\pm$0.4시간, 4.9$\pm$0.8시간, p=0.044), 기관 삽관의 제거까지의 시간(10.8$\pm$0.8시간, 13.2$\pm$0.6시간, p=0.017), 부정액으로 리도케인(Lidocaine)의 도움이 필요한 경우(75.2$\pm$6.8mg, 114.5$\pm$7.2mg, p=0.006)등에 있어서는 포타슘만을 이용한 간헐적 온혈액 심정지술이 유의성의 있었고, 술수 심근효소의 상승, 사망률과 이환율에 있어서는 두군간의 유의성은 없었다. 결론: 관상동맥 우회술 및 판막수술에 있어 포타슘만을 이용한 간헐적 온혈액 심정지술은 적어도 간헐적 냉혈액 심정지술과 같은 정도의 심근 보호를 할 수 있었으며, 기존의 warm heart surgery의 장점인 심폐기 가동시간이 짧고, 의식회복이 빠른 점과 함께 용적과부학(volume loading)를 줄일 수 있는 장점이 있어 유용한 심근 보호술의 하나로 사료된다.

• Journal of Chest Surgery
• /
• v.39 no.12 s.269
• /
• pp.949-952
• /
• 2006

Spontaneous pneumothorax is rarely occurred as an initial sign of primary lung cancer. As a lot of these cases have already advanced, even then surgical resection is performed, the prognosis is often undesirable, We happened to find a ruptured cavity on a 65-year-old male patient who had suffered from pulmonary tuberculosis in the past, while performing VATS bullectomy for simple spontaneous pneumothorax, Then, as a result of frozen biopsy, it was diagnosed as squamous cell cancer Because the tumor was infiltrated from the upper lobe into the lower lobe passing by fissure, we should remove by pneumonectomy and the pathologic stage was found stage I(T2N0M0). When we made an follow-up observation for one year and a half, there was neither relapse nor complication. When there appears spontaneous pneumothorax to the high risk group for lung cancer who were smokers over forty-year old, with chronic bronchitis or pulmonary emphysema, it needs to have a closer observation on a base lung disease such as lung cancer through chest CT, and it is also necessary to make more active approach by performing the surgical operation through a thoracoscopy when there is a continued air release.

• Journal of the Korea Academia-Industrial cooperation Society
• /
• v.11 no.6
• /
• pp.2078-2087
• /
• 2010

This study conducted a chi-square test and a logistic regression analysis by not only using a investigation data of discharged patients with damages from 2004 to 2006, but also using a census and a research data on the actual condition from health care system. The result follows; First, the centralization of medical utilization of operation patients is becoming apparent, centrally the capital area. To improve this, a policy that can not only provide medical centers and sickbed, but also improve the quality of local medical treatments for the localization of medical treatments. Second, propelling localization policy of certain diseases for the localization of medical utilization is needed as the rate of non-residential of operation patients that have diseases of the eye and adnexa, or cancers is high. Third, a localization policy for patients with damages is needed as the rate of treatments in other regions of operation patients with industrial accidents is increasing day by day.

• Korean Journal of Adult Nursing
• /
• v.21 no.5
• /
• pp.538-546
• /
• 2009

Purpose: The purpose of this study was to identify the effects of cuff pressure on postoperative sore throat. Methods: Data were collected from January 4 through May 15, 2008. Among the 60 patients, 30 patients were randomly assigned to the control group and the rest to the experimental group. Initial cuff pressure of both groups was set at 20 $cmH_2O$. The experimental group was maintained at 20 $cmH_2O$ throughout the anesthesia, while the control group was not regulated further. Sore throat was assessed at postoperative 1, 24 and 72 hours. Data were analyzed using Mann-Whitney test and Spearman's rho coefficients. Results: Cuff pressure in control group increased from 20 to 43 $cmH_2O$ within 3 hours after induction. However, the experimental group showed that there was apparently a reduced rate of sore throat at postoperative 24 hours (p = .048), and 72 hours (p = .002) than in the control group. However, no outstanding differences between both groups at postoperative 1 hour (p = .081) were detected. The correlation between cuff pressure and sore throat was statistically significant ($r_s$ = .590, p < .001). Conclusion: We conclude that maintaining cuff pressure at 20 $cmH_2O$ could be an effective means to reduce sore throat in surgical patients with inhalation anesthesia.

• Proceedings of the KAIS Fall Conference
• /
• 2010.11b
• /
• pp.755-758
• /
• 2010

본 연구의 목적은 지방 환자의 서울 지역 입원진료의 추이를 파악하고 그 요인을 규명하는 데 있다. 이를 위해 2005년 및 2008년 환자조사 입원자료를 이용하였으며, 서울지역 거주 환자를 제외하고 2005년 333,280명, 2008년 419,873명을 연구대상으로 하였다. 자료분석은 기술통계, 카이제곱 검정, 로지스틱 회귀분석을 실시하였다. 2005년 대비 2008년 성별, 연령별, 의료기관 유형 등 일반적 특성의 분포는 유사한 것으로 나타났다. 지방 환자의 서울지역 이용은 다소 증가한 것으로 나타났으며, 서울 지역 입원진료는 남자, 중장년층 건강보험환자가 타기관에서 의뢰되어 외래를 통해 입원하며, 주 거주지가 경기, 강원, 충북, 충남, 제주지역 순으로, 광역시는 상대적으로 낮았다. 질병군별로는 선천성 기형, 신생물, 종양이나 수술후 추후치료, 눈 질환, 혈액 조혈 면역기 질환, 근골격계 질환 순으로 지방환자의 서울지역 의료기관 입원 이용률이 높았다. 그러나 상대적으로 지방 입원진료 확률이 높은 노년층, 의료급여, 응급경유, 질병군별로 중증도가 높은 환자가 혼재되어 있어 있을 가능성이 있어 향후 중증도 보정에 대한 심층 연구가 필요한 것으로 판단된다.

• Korean Journal of Bronchoesophagology
• /
• v.2 no.2
• /
• pp.182-193
• /
• 1996

식도내 이물은 종종 어린이나 식도질환을 가진 환자, 죄수들, 정신박약자 및 정신질환자등의 위험성이 높은 성인에서 흔히 발생한다. 그러나 대부분의 이물은 저절로 위장관을 통과하나 날카롭고 뾰족하며 긴 이물은 위장관의 천공이나 혈관과 누공형성 및 다른 합병증을 초래할 수도 있다. 이물의 섭취는 대개 환자나 다른 목격자에 의하여 복용한 병력으로 진단할 수 있다. 그러나 어린이나 정신박약자는 병력을 얻을 수 없기 때문에 우선 의심하는 것이 중요한 진단방법이 될 수밖에 없다. 연하곤란과 연하통은 식도이물의 통상적인 증상이다. 주변기도의 압박으로 인한 호흡기 증상은 어린이에 흔하며 종종 성인에서도 관찰된다. 식도내 이물을 제거하는데 많이 사용되는 방법은 굴곡형내시경을 사용하여 제거하는 것이다. 이방법은 성인이나 어린이에서 전신마취없이 기존의 진정제 투여방법으로 시술할 수 있다. 이물제거에 사용되는 파지겸자와 올가미는 내시경이물제거술을 가능하게 하였고 굴곡형내시경에 사용되는 overtube는 기존의 강직 형내시경의 장점을 얻을 수 있어 뽀족하거나 날카로운 이물을 제거하는데 사용하게 되었다. 이런 내시경적이물제거 원칙을 잘 지키고 적절한 준비가 된다면 합병증이 거의 없이 98% 정도의 이물을 제거할 수 있다. 내시경을 사용하지 않는 여러 가지 방법은 천공의 위험성이 높고 흡인성폐렴을 유발할 수 있기 때문에 사용하지 않는 것이 낫다. 수술적인 처치는 천공이 되었거나 다른 이물로 인한 합병증이 있는 경우에만 드물게 적용된다.

• Korean Journal of Bronchoesophagology
• /
• v.14 no.1
• /
• pp.46-49
• /
• 2008

Neurofibroma is a neurogenic tumor arising from schwann cells or peripheral tissues of nerve sheaths. Neurofibroma rarely occurs as a solitary lesion but mostly occurs as part of neurofibromatosis and reports of neurofibromas developed in the nasal cavity or paranasal sinus are very rare. We report on a case of neurofibroma of the nasal cavity treated by endoscopic surgery. Preoperative computed tomography(CT), and punch biopsy suggested that the tumor was benign neurogenic tumor cofined to right nasal cavity. The tumor was removed with endoscopic surgery completely, and confirmed as neurofibroma by histological and immunohistochemical examination. We discuss the clinical and pathological characters of neurofibroma arising in the nasal septum.