• Journal of Chest Surgery
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• v.43 no.6
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• pp.753-757
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• 2010

We report hereon a case of double bypass of the esophagus and descending thoracic aorta for the treatment of esophagopleural fistula and aortopleural fistula due to an infected aortic aneurysm after esophageal rupture. A 48 year old man was diagnosed as having esophageal rupture after an accidental explosion. Although he had been treated by esophageal repair and drainage at another hospital, the esophageal leakage could not be controlled and subsequent empyema developed in the left pleura. Further, bleeding from the descending thoracic aorta had developed and he was managed with endovascular stent insertion to the descending thoracic aorta. He was transferred to our hospital for corrective surgery. We performed esophago - gastrostomy via the substernal route, without exploring posterior mediastinum and we let the empyema resolve spontaneously. While he was being managed postoperatively Without any signs and symptoms of infection, sudden bleeding developed from the left pleural cavity. After evaluation for the bleeding focus, we discovered an Infected aortic aneurysm and an aortospleural fistula at the stent insertion site. We performed a second bypass procedure for the infected descending thoracic aorta from the ascending aorta to the descending abdominal aorta via the right pleural cavity. We found leakage at the distalligation site during the immediate postoperative period, and we occluded the leakage using a vascular plug. He discharged without complications and he is currently doing well without any more bleeding or other complications.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1995.04a
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• pp.90.1-90
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• 1995

저자들은 최근 4년간 11례에서 기관절제 및 단단문합술을 사용하였기에 그 치료 결과를 살펴보고 치료적용의 범위를 넓혀보고자 한다. 대상은 후두-기관협착증 2례, 기관협착증 8례, 갑상선암 1례로 총 11례였으며 이중 3례에서 기관-식도누공이 동반되어 있었다. 술후 발거가 가능했던 경우는 8례였으며 발거가 불가능했던 경우는 술전에 이미 양측성대마비가 있던 경우 l례, 문합부위 아래에 새로운 협착 부위가 생겼던 1례, 기관 연골의 과도한 결손이 있었던 경우가 1례 있었다. 합병증으로 창상감염 1례, 육아조직 3례의 경우는 치료되었으며 양측성대마비가 있던 경우는 편측성대절제를 하여 관찰 중이다. 이상의 결과를 볼 때 기관절제 및 단단문합술이 실패한 경우는 2례로 술전 동반질환의 정확한 검사 및 절제부위의 국소화, 수술시 문합부위의 장력을 최소화하여 시행한다면 합병증은 비교적 받아들일만 하며 비교적 성공율도 기대할 만한 술식으로 여겨졌다.

• Proceedings of the Korean Society for Quality Management Conference
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• 2006.11a
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• pp.51-56
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• 2006

이 연구에서는 의료서비스 품질 향상을 위하여 제안된 뇌 전위적 영상안내에 의한 개두술 방법과 옥틸 시안화 아크렬산염 (2-octylcyanoacrylate: 2-0CA)을 드레싱 재료로 사용한 조사군과, 전통적 개두술 방법과 봉합사 및 아이오다인을 사용했던 대조군과 비교를 실시하여 의료품질 향상 효과를 분석하였다. 연구방법으로는 특정 의료기관에서 26 례 조사군과, 38례 대조군을 대상으로, 임상적 특성, 감염균, 두피접착의 열개(裂開)성 및 기타 위험 인자를 조사하였다. 연구결과 새롭게 제안된 의료용 재료인 2옥틸시안화 아크릴산염은 피부조직 속으로 외부 액체가 유입되는 것을 억제하거나 제한하였으며, 외피 접착기능으로 창상보호 특히, 평균감염률과 감염빈도에 있어서 상대적으로 대조군보다 우수하였다. 한편 뇌 전위적 영상 안내에 의한 개두술 방법으로 수술시간의 단축과 수술 복잡성의 경감 및 위험성이 감소되었으며, 상처 부위 흔적이 적게 남는 등 미용적인 측면에서도 우수한 것으로 나타났다.

• Journal of Rhinology
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• v.25 no.2
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• pp.63-68
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• 2018

Olfactory dysfunction is one of the most common complaints of patients with chronic rhinosinusitis. Patients who suffer from olfactory dysfunction report a negative effect on their overall quality of life. Chronic rhinosinusitis-related olfactory impairment is the most treatable form of olfactory disorder; however, outcomes after endoscopic sinus surgery (ESS) are challenging to predict. Previous studies have documented a wide range in overall improvement after ESS. The purpose of this study is to review the factors that predict changes in olfaction after ESS.

• Journal of Chest Surgery
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• v.43 no.3
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• pp.312-315
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• 2010

Infection of both native and prosthetic vessels in the groin is a very serious disease because of recurrent arterial rupture and sepsis, which can cause death. The successful treatment of groin infection, including infection of the femoral artery, requires extensive excision of the infected tissues and restoration of the circulation where the infected area is isolated. Here we describe a case of obturator bypass in a patient with infected femoral artery rupture that occurred after extracorporeal membrane oxygenation for myocarditis and severe heart failure.

• Journal of Veterinary Clinics
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• v.22 no.4
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• pp.309-313
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• 2005

This study was performed to assess the efficacy of surgical treatment with flexible alligator forceps (FAF) on heartworm infected dogs. Twenty dogs (10 males and 10 females) with heartworm infection, age $5.3\pm3.0\;(mean{\pm}S.D.)$ years and weight $9.3\pm6.5(mean{\pm}S.D.)kg$ were treated with FAF. Adult heartworms were removed by fluoroguided technique with FAF under inhalation anesthesia with isoflurane. For evaluation of the efficacy, removal rate and surgical time were measured, and removal sites were found. Antigen ELISA kit test and autopsy were performed to examine remained adult heartworms. Removal rate of total heartworms was $91.4\%$ including 15 complete retrieval cases and surgical time was $30.0\pm7.6(mean{\pm}S.E.)$ minutes. Heartworms were removed from the right ventricle, main pulmonary artery, and right and left pulmonary artery. Surgical treatment with FAF is an effective method with high removal rate, short surgical time, and various removal sites and it could be considered for the removal of adult heartworms in a dog.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1991.06a
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• pp.31-31
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• 1991

후두격막은 1822년 Fleichman이 호흡곤란과 발성장애를 야기한 례를 최초로 보고하였으며 선천성으로나 후천성으로 발생할 수 있다. 선천성후두격막은 태생 10주경의 후두발생장애로 발생한다고 알려져 있으며 성문부위에서 가장 많이 발견되며 후천성후두격막은 감염, 외상, 수술 및 방사선조사 후 발생한다. 저자들은 최근 1례의 선천성후두격막과 4례의 후천성후두격막환자를 치험하였기에 문헌고찰과 함께 보고하는 바이다.

• Journal of Chest Surgery
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• v.34 no.11
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• pp.848-853
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• 2001

Background: Sternal infection or dehiscence after cardiac surgery through median sternotomy is rare. If suitable treatment is not performed for the complication, however, the mortality is high. For 12 patients with sternal dehiscence or infection, we performed wide excision of the infected and necrotic tissue and covered with muscle flap(s) to obliterate the mediastinal dead space. Material and method: Sternal infection or dehiscence occurred in 13 of patients who underwent cardiac surgery One patient, who died of cerebral infarction before the sternal complication was treated, was excluded in this study. The sternal wound complication occurred in 6 of patients with valve replacement and 6 of patients with coronary bypass surgery, respectively. Since 1991, 9 patients underwent definite surgical debridement and muscle transposition as soon as fever was controlled with closed irrigation and drainage. The necrotic tissue and bone was widely excised and the sternal dead space was eradicated with the single flap or the combined flaps of right pectoralis flap(turnover flap), left pectoralis flap(turnover flap or rotation-advancement flap), and right rectus muscle flap. Result : There was no mortality in 12 patients with coverage of muscle flap(s) for sternal infection or dehiscence The mean interval between the diagnosis of sternal complication and the myoplasty was 6.6$\pm$3.9 days. In 4 patients, one pectoralis muscle flap was used, and in 8 patients both pectoralis muscle flaps were used. For each 1 patient and 2 patients in each group, right rectus muscle flap was added. For the last 3 patients, a single pectoralis flap was used to eradicate the mediastinal dead space and the longer placement of the mediastinal drain catheter was needed. One patient, who had suffered from necrosis of left pectoralis flap(rotation-advancement flap) with subsequent chest wall abscess after coverage of both pectoralis flaps, was managed with reoperation using right rectum flap. Conclusion : Sternal dehiscence or infection after cardiac operation can be readily managed with wide excision of necrotic infected tissue(including bone) and muscle flap coverage after short-term irrigation of sternal wound. The sternal(mediastinal) dead space may be completely eradicated with right pectoralis major muscle flap alone.

• Korean Journal of Adult Nursing
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• v.13 no.1
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• pp.171-181
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• 2001

본 연구는 수술에 사용하는 생리식염수가 수술의 종류와 수술진행단계에 따른 오염수준을 파악하여 생리식염수의 적절한 교환시점과 교환방법을 제시하기 위하여 시도되었다. 1500 병상 규모의 대학병원에서 1명의 일반외과 의사가 집도한 37건의 수술을 대상으로 하였다. 37개의 수술 각각에서 피부 절개전, 장기절제 후, 그리고 피부 봉합시의 3 시점에서 수술에 사용된 생리식염수와 공기에 노출시킨 생리식염수에서 각각 50 mL의 생리식염수를 채취하여 얻은 균주의 수를 비교하였다. 공기에 노출시킨 생리식염수에 비해 수술에 사용된 생리식염수에서 균주가 보다 많이 검출된 것으로 나타났다. 특히 수술의 종류에 관계없이 수술 마지막 단계 즉 피부봉합 단계에서 수술에 사용된 생리식염수의 오염수준이 급격히 증가한 반면 공기에 노출시킨 생리식염수의 오염수준 변화는 미미했다. 수술에 사용한 생리식염수에서는 Enterococcus(9.5%), Enterobacter species(4.6%), E. col i(2.8%), Alcaligenes species(1.2%), Klebsiella species(0.9%) and Pasteurella multocida(0.8%) 등의 균주가 검출되었으나 공기에 노출시킨 생리식염수에서는 이러한 균종이 검출되지 않았다. 수술실의 공기가 수술에 사용하는 생리식염수의 오염요인으로 작용하기보다는 수술조직이 생리식염수의 오염요인으로 작용하는 것으로 사료된다. 특히 수술에 사용하는 생리식염수의 오염가능성을 최소화시키기 위해 수술소요 시간이 길어지거나 또는 오염 수술의 경우 절제부위가 봉합된 후에 수술에 사용하는 생리식염수, 생리식염수를 담는 용기 및 봉합에 이용되는 봉합감자 등을 새로이 준비하여 피부 봉합에 이용해야 할 것으로 사료된다.

• Journal of Chest Surgery
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• v.43 no.2
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• pp.199-203
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• 2010

Infected aortic aneurysms are rare, but the mortality of patients with infected aortic aneurysms remains high. Open surgical procedures are the standard of care for infected aneurysms of aorta, but the surgical results are often disappointing. The risk factors related to the high mortality include aneurysm rupture and a suprarenal aneurysm location. The classic method for treating infected aneurysms has been aneurysm resection, soft tissue debridement, remote arterial reconstruction out of the field of infection and antibiotics. Infected anuerysms located in the suprarenal aorta are highly lethal because of the need to reimplant the visceral or renal arteries and the graft related complications. We reported here on a case of suprarenal infected aortic aneurysm in a 55-years-old man. We also include a review of the relevant medical literature.