• Journal of Chest Surgery
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• 제22권2호
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• pp.308-314
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• 1989

Pulmonary sequestration is a congenital malformation characterized by an area of embryonic lung tissue that derives its blood supply from an anomalous systemic artery. Two forms recognized: extralobar and intralobar. Extralobar form is a very rare congenital malformation, usually located in the lower chest, and may be found in newborn infants at the time a congenital diaphragmatic hernia is repaired. Large sequestrated segments may be cause acute respiratory distress in the neonate. The condition is asymptomatic in 15 per cent of patients. This report presents two cases of pulmonary sequestration which misdiagnosed a superior mediastinal tumor and a benign lung tumor. First case was 30-year-old male patient and chief complaints were dyspnea, dry cough and right chest pain. Chest X-ray showed a homogenous increased density of smooth margin at the right superior mediastinal area and suggested a benign mediastinal tumor. And so explothoracotomy was made without other special studies. Second case was 28-year-old male patient. One month ago, he had tracheostomy and right closed thoracostomy due to massive hemoptysis and spontaneous hemothorax. Chest X-ray showed a benign cystic lesion at RLL area. At the time of operation, in first case, a mass of adult fist size was placed medial to the right upper lobe and densely adhesive to trachea, SVC and esophagus. Blood supply of the mass was bronchial arteries of trachea and RUL bronchus and drained to SVC and azygos vein through anomalous systemic veins. There was no bronchial communication on Frozen biopsy. In 2nd case, large cystic lesion contained old blood hematoma was located in RLL and anomalous blood vessel from thoracic aorta was drained to posterior segment of RLL. In operation field, intralobar pulmonary sequestration was diagnosed, and RLL lobectomy was carried out.

• Journal of Chest Surgery
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• 제22권2호
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• pp.179-190
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• 1989

The experimental study for extracorporeal preservation of the heart-lung preparation by autoperfusion system was performed in 10 dogs. Under intravenous Pentothal endotracheal anesthesia bilateral thoracotomies were performed. A 24F cannula connected to a plastic reservoir bag located 100 cm above the level of the heart was introduced into the aortic arch. Left subclavian, innominate artery, and descending aorta were ligated and divided. Both vena cavae were ligated and divided after the bag was half filled with blood. A 24F catheter inserted into right atrium and connected to the plastic bag in order to keep constant the preload. The thoracic trachea was intubated and the lungs were ventilated. The heart-lung preparations were removed en bloc and floated in a $34^{\circ}C$ bath of Hartmann solution. The preparations were observed for from 2 hours to 8 hours, with the average of 5.2 hours. Hemodynamic and hematologic variables were measured during preharvest and autoperfusion. The pH revealed severe respiratory alkalosis due to very low $PaCO_2$ during autoperfusion ; $PaO_2$ remained constant for 130-140 mmHg; $A-aDO_2$ increased markedly. The static inspiratory pressure [SIP] at late autoperfusion [6hr] increased significantly as compared with at early autoperfusion [2hr]. There was no difference between white blood cell counts from right atrium and those of left atrium. Heart rates remained constant for 110-120/min; cardiac outputs maintained to approximately 0.6L/min; mean aortic pressures, 75 mmHg; mean pulmonary arterial pressures, 15-18 mmHg; mean right atrial pressures, 9-13 mmHg; mean left atrial pressures, 12 mmHg lower than those of right atrium. Serum Na maintained with normal range during autoperfusion; K increased significantly; Ca decreased progressively. Hemoglobin and hematocrit decreased significantly during autoperfusion. The study demonstrated that stable hemodynamics could be maintained throughout the experiment and the preparation of the lung seemed to be inadequate, especially after 3-4 hours, such as high $A-aDO_2$, increased SIP, and scattered atelectasis and edema in their gross appearances.

• Journal of Chest Surgery
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• 제16권2호
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• pp.170-174
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• 1983

Aortic arch syndrome is an unusual disease entity characterized by the narrowing or obliteration of major branches of the arch of the aorta regardless of etiology. We have experienced 2 cases. One of them was 22 years old office girl with 3 months history of headache, intermittent syncope and weakness and claudication on left arm especially during her physical exercise. On physical examination, pulseless on left antecubital and radial artery and blood pressure on left arm was inable to check and coldness with weakness were noted on the same side. Aortic angiography reealed 34% narrowing of left subclavian artery as that of right. But both common carotid artery and both axillary arterial patency were relatively good. Through right supraclavicular and left axillary incision, bypass graft with Gore-tex prosthesis (I.D. 6mm, Length 25 cm) was implanted from right subclavian artery on 2cm distal to origin of right common carotid arery to left axillary artery distal to axillary fossa. End to side anastomosis with preservation of left subclavian artery was done. Postoperative state was stable with blood pressure of 110/70 mmHg on left arm and palpable antecubital and radial pulsation. Another one was 41 year old male patient with 8 months history of pain and numbness on right upper arm and shoulder. On admission, right arm blood pressure was 110/80 mmHg, left arm was 160/110 mmHg, but other physical findings had no abnormalities. Angiography revealed segmental narrowing of right axillary artery on the beginning with 2 cm in length. Operative treatment with right wupraclavicular and right axillary incision, bypass graft with great saphenous vein (Length; 15 cm) from right subclavian artery between scalenus anticus and medius to axillary artery at distal end of axillary fossa was done. The authors report two cases of Aortic arch syndrome treated with bypass graft using Autograft or Gore-tex with good result.

• Journal of Chest Surgery
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• 제36권5호
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• pp.371-374
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• 2003

동맥혈관 폐쇄 질환의 원인 중 동맥경화증에 의한 경우가 60% 이상을 차지하고 있다. 부위별로는 복부대동맥 및 하지동맥의 폐쇄가 가장 많은 것으로 알려져 있다. 본 2예의 증례는 양측 하지의 간헐적 파행이 지속되어 혈관조영술 시행 후 양측 대동맥-장골동맥 및 대퇴동맥-슬와동맥의 동반 폐색을 진단받고 각각 내과적 치료 및 혈관성형술을 시행하였으나 실효성을 거두지 못하여 본과에서 수술적 방법으로 근치술을 시행한 경우이다. 수술은 Hemashield Y graft를 이용한 복부대동맥-양측 대퇴동맥간 우회술과 자가복재대정맥을 이용한 양측 대퇴동맥-슬와동맥 우회술을 동시에 시행하였다. 수술후 환자의 증상은 소실되었으며 복부창상결손 외에는 특별한 합병증이 없었고 수술 후 시행한 혈관 조영술상 이식혈관의 유통성이 양호하였다. 환자들은 증상의 재발 없이 외래에서 관찰 중이다.

• Journal of Chest Surgery
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• 제29권2호
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• pp.223-226
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• 1996

선천성 낭종양 선종양 기형과 외엽형 폐격리증은 각각드문 질환으로 이 두가지 질환이 퐁반되는 경우는 매우 드물다 본원에서는 출생 후 호흡시 흥벽 함몰과 빈호흡을 보인 생후 3주된 남아에서 컴퓨터 단층촬영을 통해 우폐하엽의 선천성 낭종성 선종양기형을의심하여 개흥술을시행하였다. 수술소견상 우폐하엽의 낭종성 병변 이외에 독립된 늑막에 둘러싸인채 비정상적인 혈류 공급을 받고 있는 종괴를 발견하여 하행 흉부 대동맥으로 부터 공급되는 2개의 동맥 가지와기정맥으로 유입되는 정맥분지를 결찰한 후 우하엽절제술과 더불어 격리폐를 절제하였다. 병리검사로 상기 두질환의 동반례로확진 하였고 환자는 건강한 모습으로 퇴원할 수 있었다.

• 한국임상수의학회지
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• 제25권1호
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• pp.23-26
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• 2008

2일간의 구토와 침울을 동반한 후지마비를 주증상으로 내원한 2년령의 암칫 터키 앙고라 고양이에서 약한 대퇴 동맥 맥박, 후지의 청색증이 관찰되었으나 흉부 청진, 흉부 방사선, 심초음파 상에서 이상소견을 보이지 않았으며 복부 초음파상에서 복부 대동맥내의 색전으로 판단되는 고에코성 물질이 확인되었다. 대동맥 혈전의 원인이 될 수 있는 다양한 진단 검사를 시행한 결과, 특발성 안장 색전혈전증으로 진단하였다. Heparin sodium, aspirin 및 diltiazem으로 4주간 치료하였으나 양쪽 후지의 병변은 진행적이고 비가역적으로 괴사되어 대퇴부를 절단한 결과, 30개월 이상 임상적으로 건강한 생활을 하고 있다.

• Journal of Chest Surgery
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• 제18권4호
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• pp.537-541
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• 1985

Recently, we met a 12 year old female patient who suffered from bacterial endocarditis and pericarditis which were complicated by patent ductus arteriosus. She was admitted to our hospital because of dyspnea, fever, headache, and generalized ache for 10 days. The initial diagnosis was bacterial endocarditis and pericarditis complicated by patent ductus arteriosus and congestive heart failure. At first, we tried to treat the patient medically with digitalis, diuretics, and massive antibiotics. On echocardiography large amount of pericardial fluid was accumulated mainly right anterior aspect and also noted a large vegetation at pulmonary valve area. With vigorous medical treatment including repeated pericardiocentesis, the patient showed no improvement. So we decided to perform pericardiectomy for elimination of the most probable septic focus. On operation, we encountered an unpredicted event, the pericardium was thickened, distended, and its surface showed pulsating which meant connecting to systemic circulation. We decided to close the operative wound and reoperate her under cardiopulmonary bypass later. On the next day, we operated her under cardiopulmonary bypass later. On the next day we operated her under cardiopulmonary bypass. The operative findings were ruptured main pulmonary artery about 1.5cm in diameter on its ventral portion, the blood from the ruptured main pulmonary artery was filled up the localized pericardial sac due to previous pericarditis. Through the ruptured main pulmonary artery, we also found 0.5cm diametered patent ductus arteriosus. With the aid of partial cardiopulmonary bypass and inserting 24F ballooned Foley catheter at aorta, pericardiectomy was performed first. After completion of the pericardiectomy, total cardiopulmonary bypass was established. With minimum pump flow [0.3L/min/m2] the PDA was closed with two Teflon-felted 4-0 Prolene interrupted sutures. The ruptured main pulmonary artery was also closed using thickened pericardium with three Teflon-felted 4-0 Prolene interrupted sutures. The operation was successful and postoperative course was uneventful. She was discharged on the 16th POD. We report this case as a very rare secondary complication of bacterial endocarditis complicated by patent ductus arteriosus.

• Journal of Chest Surgery
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• 제23권3호
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• pp.474-481
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• 1990

We have experienced 44 cases of coarctation of aorta in the age of infancy and children from April 1986 to September 1989 at Seoul National University Children`s hospital. Patients were thirty males and fourteen females, and their age ranged from one month to ten years[mean 23.84 $\pm$33.06 months] with thirty-two infant cases. In the infantile age, congestive heart failure was the most common chief complaint[18/32], and above that age, frequent upper respiratory infection was most common[8/12]. We experienced thirteen cases of isolated COA, twenty-two cases of COA with VSD, eight cases of COA with VSD, eight cases of COA with intracardiac complex anomalies and one case of COA with atrial septal defect. The associated intracardiac complex anomalies were three Taussig-Bing type double outlet right ventricle, one single ventricle, one transposition of great arteries, one atrioventricular septal defect, one hypoplastic aortic arch with left heart hypoplasia, and one Tetralogy of Fallot. Operative techniques of COA were twenty-three subclavian flap arterioplasty, 12 resection and end to end anastomosis, eight onlay patch angioplasty, and I direct angioplasty after resection of web. Among the cases with other cardiac anomalies, staged operation was done in twenty-nine patients, and single stage total correction was performed only in three patients. There were seven operative mortality[15.9%], all being in infantile age group, and among fourteen cases associated with large VSD[Qp/Qs>2.0, mean pulmonary arterial pressure>50mmHg], four patients were died, but there was no mortality in patients with small VSD. With above results, we are intended to discuss about the interval between staged operation, the fate of VSD after coarctoplasty in case of COA with VSD, causes of death, complications etc.

• Journal of Chest Surgery
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• 제30권6호
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• pp.625-630
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• 1997

56세 남자 환자가 신경과에 내원하였는데, 그는 최근에 심해지는 우측 세번째에서 다섯번째 수지의 반복 적인 저린 통증과 파악력의 약화를 주소로 하였다. 이와 함께 보행시 하지 동통을 호소하였다. 경동맥 조영술상 우내경동맥이 완전히 막혀 있었고 좌우총경동맥과 외경동맥, 좌내 경동맥은 심각한 협착이 있었다. 함께 시행한 대동맥 조영술상 신동맥이하는 완전한 폐색을 보였고 양측 대퇴 동맥은 지연 조영 을 보였다. 두개의 동맥 병변에 대해 단계별로 수술 계획을 세웠다. 양측 경동맥 병변은 경동맥 내막절제술을 시행 하였다. 이 때 좌측은·경동맥 션트를 사용하였다. 복부대동맥 병변은 2주후에 시행되었으며 복강동맥하방의 대동맥을 결찰하고 허혈시 신장을 보존하기위 해 신보존액을 주입하였다. 역 Y 회로 이식술과 신보존을 시행하여 린분간의 허혈동안에도 성공적으로 시술되었으며 별다른 문제없이 술 후 보름만에 퇴원하였다.

• 한국임상수의학회지
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• 제39권4호
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• pp.168-172
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• 2022

A 10-year-old female Pomeranian weighing 2.25 kg with a history of gradual weight loss and an intraabdominal mass confirmed with ultrasonography at a local hospital was referred to the Veterinary Medical Teaching Hospital, Jeju National University. Physical examination revealed abdominal distention. Blood analysis revealed hypoglycemia (57 mg/dL; reference range, 60-110 mg/dL). On abdominal ultrasonography, a heterogeneously hyperechoic mass measuring 7.51 × 10.6 cm was found at the level of the left kidney. Computed tomographic findings showed a unilateral left kidney mass with a 10-cm diameter and vessel contrast enhancement in the corticomedullary phase. Unilateral nephrectomy and ovariohysterectomy were performed because left ovary enlargement was observed during surgery. The renal mass was adjacent to the aorta and vena cava and attached to a portion of the small intestine, greater omentum, and left ovary. The mass was huge (12.5 × 10 × 7 cm) and was 16.5% of the body weight. Histopathological examination revealed renal cell carcinoma (RCC) and ovarian metastasis. After surgery, clinical signs improved remarkably, and serum glucose level returned to normal. As RCC is resistant to radiation and chemotherapy, the owner decided not to proceed with postoperative adjunctive therapies. To the best of our knowledge, this is the first case report of ovarian metastasis with huge RCC in a dog.