• Journal of Chest Surgery
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• 제26권8호
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• pp.613-619
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• 1993

As developing surgical techniques and postoperative cares, a pneumonectomy is a relatively popular surgical method in disease which is not treated completely with other type of pulmonary resection, but a postpneumonectomy complication is a life-threatening serious problem if it occurred. We performed one hundred twenty-five cases of pneumonectomy for treatment of various causes of pulmonary diseases in Kosin Medical College during about ten years, and we experienced 41 cases of postoperative complications in 29 patients, so we analyzed them. The most common complication is an empyema thoracis in 13 cases[10.4%], of which one case combined with bronchopleural fistula died on early postoperative day. Of them except one case, the early postoperative empyema thoracis[within 30 days] were 6 cases, and the late postoperative empyema thoracis[above 30 days] were 6 cases. The main etiologic pathogens were a staphylococcus in early postoperative empyema and a streptococcus in late postoperative empyema, but the most cases were mixed infections with pseudomonas, klebsiella, acinectobacter, and candida. The treatment of postoperative empyema thoracis were that 4 cases were treated with open drainage using chest tube, 7 cases with Clagett`s operation, and 1 case with thoracoplasty. The next common complication was a postoperative serious respiratory insufficiency in 7 cases. And the other complications were massive postoperative bleeding in 5 cases, of which 2 cases advanced to occurrence of postoperative empyema thoracis, and wound disruption in 4 cases, cardiac arrhythmia in 3 cases, contralateral pneumothorax and pneumonia in each of 2 cases, esophagopleural fistula in 1 case. The postoperative deaths were 9 cases[7.2%] of 125 cases, the causes of death were respiratory insufficiency in 6 cases, sepsis in 2 cases, and cardiac arrhythmia in 1 case.

• Journal of Trauma and Injury
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• 제27권2호
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• pp.33-37
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• 2014

Central venous catheterization through a subclavian approach is indicated for some special purposes but it may cause many complications such as infection, bleeding, pneumothorax, thrombosis, air embolization, arrhythmia, myocardial perforation, and nerve injury. A case involving a mistaken central venous catheterization into the right vertebral artery through the subclavian artery is presented. A 33-year-old man who had deteriorated mentality after head injury underwent an emergency craniotomy for acute epidural hematomas on the right frontal and temporal convexities. His mentality improved rapidly, but he complained of continuous severe pain in the right posterior neck even though he had no previous symptom or past medical history of such pain. Three-dimensional cervical spine computed tomography (3D-CT) was performed first to rule out unconfirmed cervical injuries and it revealed a linear radiopaque material intrathoracically from the level of the 1st rib up to the level of C6 in the right vertebral foramen. An additional neck CT was performed, and the subclavian catheter was indwelling in the right vertebral artery through right subclavian artery. For the purpose of proper fluid infusion and central venous pressure monitoring, the subclavian vein catheterization had been performed in the operation room after general anesthesia induction before the craniotomy. Sufficient anatomical consideration and prudence is essential because inadvertent arterial cannulation at a non-compressible site is a highly risky iatrogenic complication of central venous line placement.

• Journal of Chest Surgery
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• 제25권4호
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• pp.418-423
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• 1992

Tracheo-innominate artery fistula[TIF] is the uncommon delayed fatal complication of tracheostomy. The mortality rate of the lesion, if not treated surgically, approaches 100%. A 64-year-old man presenting with a TIF after tracheostomy was treated by lateral repair and muscle interposition between the innominate artery and trachea. Preoperatively, bleeding was controlled by gauze packing around the tude under manual compression and hyperinflation of the balloon cuff of the tracheostomy tube. No abnormality was found by angiographic evaluation. The patient failed to regain consciousness and died 4 days later from sepsis.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제13권1호
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• pp.1-6
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• 2010

The small bowel is the most difficult intestinal segment to examine. Radiologic tests are mostly insensitive and double-balloon enteroscopy is unsuitable for the younger child. Capsule endoscopy is a novel wireless method of investigation of the small bowel. The primary indications for capsule endoscopy include evaluation of obscure gastrointestinal bleeding, small bowel Crohn's disease, and polyposis syndromes. Capsule endoscopy offers an accurate and effective means of investigating the small bowel in children. Capsule retention is a potential complication of capsule endoscopy. This review provides the indications, safety, and limitations of wireless capsule endoscopy in children.

• Journal of Chest Surgery
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• 제54권4호
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• pp.263-265
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• 2021

Intraoperative events can occur during video-assisted thoracoscopic surgery (VATS) lobectomy due to unfavorable surgical anatomy, such as dense adhesions or calcifications around the pulmonary arteries. Troubleshooting intraoperative complications is essential for performing safe and successful VATS pulmonary resection and lymph node dissection. If continuous bleeding occurs or VATS does not proceed despite all measures, conversion to open thoracotomy should not be delayed.

• Advances in pediatric surgery
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• 제19권2호
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• pp.81-89
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• 2013

The purposes of this study was to describe the clinical correlation of mass size and gestational age, prognostic factors in sacrococcygeal teratoma (SCT) at a tertiary pediatric surgery, University of Ulsan College of Medicine and Asan Medical Center (AMC), Seoul, Korea. Fifty five patients admitted to the AMC with a SCT between May 1989 and April 2013 were included in this retrospective review. Mean follow up was 861 days. Mean maternal age at delivery was $30{\pm}2.7$ year, mean gestational age (GA) was $36.9{\pm}3.6$ wks, and preterm delivery was 21.8%. Birth body weight was $3182{\pm}644$ g and male vs. female ratio was 1:2.05. We can't find significant difference between Caesarean section and maternal age at delivery (p =0.817). But, caesarean section was favored by gestational age (p = 0.002), larger tumor size (p =0.029) or higher tumor weight fraction rate to birth body weight (p =0.024). Type I was 13, II 21, III 17, and IV 3 according to Altman et al. classification. The tumor component was predominantly cystic(> 50%) in 73.1 %. And the majority histological classification of tumors were mature teratoma (70.3%). The motality rate was 5.5%. Three patients expired because of postpartum bleeding, post-op bleeding related complication such as DIC. SCT recurred in four patients. The interval between first and second operation was $206.2{\pm}111.0$ d (range 53~325 d). In two patients, serum AFP levels were elevated at a regular checkup without any symptom, and subsequent imaging studies revealed SCT. The most common cause of death was bleeding and bleeding related complication. So Caesarean section and active peripartum and perioperative management will be needed for huge solid SCT. In the case of Yolk sac tumor or huge immature teratoma, possibility of recurrence have to be always considered, so follow up by serial AFP and MRI is important for SCT management.

• 대한영상의학회지
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• 제82권1호
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• pp.237-243
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• 2021

본 증례는 73세 남자 환자가 십이지장 3부에서 발생한 상부위장관 출혈로 인해 경동맥 색전술로 치료한 드문 증례이다. 환자는 혈변을 주소로 내원하여 시행한 초기 상부 및 하부 위장관 내시경과 전산화단층촬영에서 출혈 부위를 발견하지 못하였다. 입원 3일째에 혈색소 수치가 지속적으로 감소하여 테크네슘-적혈구 스캔을 시행하였고 십이지장 3부의 게실 내에 출혈이 의심되어 혈관조영술을 시행하였다. 상장간동맥 혈관조영술에서 십이지장 게실에 혈류를 공급하는 하췌십이지장동맥의 활동성 출혈이 관찰되어 색전술을 시행하였다. 이후 7일 동안 재출혈이나 합병증이 없어 퇴원하였다. 이에 발생빈도가 매우 낮고 초기 진단이 어려웠던 십이지장 게실 출혈의 보고와 관련된 문헌고찰을 하고자 한다.

• Radiation Oncology Journal
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• 제21권4호
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• pp.276-282
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• 2003

목적: 자궁경부암의 고선량률 근접치료는 근치적 치료에서 중요한 역할을 차지하나 만성합병증 특히 직장합병증의 위험도 증가하게 된다. 이에 저자들은 직장합병증과 직장 방사선선량을 비교하여 합병증과 관련된 인자를 알아보고자 하였다. 대상 및 방법: 1995년 7월부터 2001년 12월까지 자궁경부암으로 진단받고 근치적 방사선치료로 외부방사선치료와 고선량률 강내치료를 모두 받은 환자 222명을 대상으로 하였다. 외부방사선치료의 총방사선량 중앙값은 50.4 Gy(30.6$\~$56.4 Gy)이고 고선량률 강내치료는 이리듐(Ir)-192를 이용하여 point A에 3$\~$5.5 Gy (중앙값 4 Gy), 조사횟수는 5$\~$8회(중앙값 6회)로 주 2회 조사하여 총 15$\~$32.5 Gy (중앙값 24 Gy)를 조사하였다. 환자의 중앙 추적기간은 39개월(6$\~$90개월)이었다 결과: 만성 직장합병증은 21명(9.5$\%$)에서 관찰되었다. 이들은 모두 직장출혈을 보였으며 다른 합병증은 나타나지 않았다. 직장합병증이 발생하기까지의 시간은 방사선치료 종료 후 3$\~$44개월(중앙값 13개월)이었다. 이전의 결과와 마찬가지로 직장합병증을 보인 군의 계산직장선량은 합병증을 보이지 않았던 군과 비슷하고 그 차이가 통계적으로 유의하지 않았다. 그러나 직장합병증을 보인 군의 측정직장선량의 평균값과 BED는 합병증을 보이지 않았던 군에 비해 높았으며 통계적으로 유의한 차이를 보였다. 측정 직장선량이 16 Gy를 넘거나 측정 직장선량과 A point 선량과의 비가 70$\%$를 넘는 경우 또는 측정 직장선량의 BED가 120 Gy$_{3}$을 넘는 경우는 직장 합병증의 가능성이 유의하게 증가하였다. 결론: 자궁경부암에서 고선량률 강내치료시 TLD를 이용한 생체 내 선량측정을 하고 이를 조정함으로써 만성 직장합병증을 예측하고 그 가능성을 줄일 수 있을 것으로 생각된다.

• Journal of Gastric Cancer
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• 제4권2호
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• pp.121-125
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• 2004

Purpose: Esophagojejunal anastomotic complications after a total gastrectomy include leakage, stenosis, bleeding, and abscess formation. Especially, the mortality rate for esophagojejunal anastomotic leakage is $80\%$. Although these complications hare been reduced by the usage of the EEA stapler, they are still serious and depend on various factors: the surgeon's experience, the stage of disease, the extent of surgical intervention, the method of operation, and the patient. Some local factors, such as vascularization of the graft, traction on the anastomosis suture line, and local infections, have been implicated as contributing to these complications. Materials and Methods: During the period $1995\∼2003$, of the 850 gastrectomies for gastric carcinomas, 171 were intra-abdominal total gastrectomies. All of these 171 operations were performed by one surgeon using a routine D2 lymph-node dissection and a 25-mm EEA stapler on an antecolic end-to-side esophagojejunostomy. In the 77 cases a seromuscular reinforced suture at the esophagojejunostomy site was performed, and in 94 cases, a whole layer reinforced suture with absorbible materials was used. We evaluated the incidence of complications according to age, sex, stage of patients, and combined resection. Also, we compared the incidences of complications for seromuscular and whole layer reinforced sutures. Results: The complications are major leaks ($2.9\%$), minor leaks ($3.5\%$), stenosis, bleeding ($1.8\%$), and abscess formation formation ($1.8\%$). In the five cases of major leaks, there were four mortalities with operative methods. The other patients with stenosis, bleeding, and abscess formation were treated conservatively with success. The incidences of complications were not related with age, sex, stages, and combined resection. The incidences of complications for the whole layer reinforced suture group ($2.9\%$) were less than those for the seromuscular reinforced group ($8.8\%$, P=0.04). Conclusion: The most serious complication of esophagojejunal anastomosis is major leakage with an $80\%$ mortality. The other complications are stenosis, bleeding, and abscess formation, for which no mortalities occurred during this study. Whole layer suture of the esophagojejunal anastomotic site is an important method for preventing leakage.

• Journal of Korean Neurosurgical Society
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• 제60권1호
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• pp.75-81
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• 2017

Objective : Spinal deformity surgery has the potential risk of massive blood loss. To reduce surgical bleeding, the use of tranexamic acid (TXA) became popular in spinal surgery, recently. The purpose of this study was to determine the effectiveness of intra-operative TXA use to reduce surgical bleeding and transfusion requirements in spinal deformity surgery. Methods : A total of 132 consecutive patients undergoing multi-level posterior spinal segmental instrumented fusion (${\geq}5$ levels) were analyzed retrospectively. Primary outcome measures included intraoperative estimated blood loss (EBL), transfusion amount and rate of transfusion. Secondary outcome measures included postoperative transfusion amount, rate of transfusion, and complications associated with TXA or allogeneic blood transfusions. Results : The number of patients was 89 in TXA group and 43 in non-TXA group. There were no significant differences in demographic or surgical traits between the groups except hypertension. The EBL was significantly lower in TXA group than non-TXA group (841 vs. 1336 mL, p=0.002). TXA group also showed less intra-operative and postoperative transfusion requirements (544 vs. 812 mL, p=0.012; 193 vs. 359 mL, p=0.034). Based on multiple regression analysis, TXA use could reduce surgical bleeding by 371 mL (37 % of mean EBL). Complication rate was not different between the groups. Conclusion : TXA use can effectively reduce the amount of intra-operative bleeding and transfusion requirements in spinal deformity surgery. Future randomized controlled study could confirm the routine use of TXA in major spinal surgery.