• Tuberculosis and Respiratory Diseases
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• 제40권2호
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• pp.165-170
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• 1993

연구배경 : 대량 객혈은 기도폐색의 위험이 높은 응급 상황이므로, 지혈을 위한 방법이 즉시 동원되어야 한다. 기관지동맥등의 폐순환동맥 색전술은 대량 객혈의 출혈부위 확인과 함께 신속히 지혈시킬 수 있는 방법이다. 저자들은 대량 객혈 환자에서 동맥 색전술을 시행하여 지혈의 효과와 출혈의 재발에 대하여 경과 관찰하였다. 방법 : 1990년 6월부터 1992년 7월까지 동맥 색전술을 시행하고나서 최소 6개월이상의 경과 관찰이 가능한 23명의 환자를 대상으로 하였다. 대퇴 동맥을 통한 경피적 삽관으로, 기관지동맥외에 비기관지 체측부동맥을 전부 혈관 조영하여 출혈 부위를 확인하고, 출혈부위 동맥에 gelfoam으로 색전하고, 출혈이 큰 경우에는 금속 제재인 coil을 함께 색전시켰다. 결과 : 23예 전예에서 즉각적인 지혈 효과를 볼 수 있었고, 7예(30%) 에서 재발하였다. 비기관지동맥 출혈군과 기관지동맥 단독출혈군의 재발률은 46% (6/13)와, 10% (1/10)로서 서로 비교되었다. 재발의 원인 질환은 비활동성 폐결핵 4예, 활동성 폐결핵 1예, 기관지 확장증 1예, 국균종 1예였으며, 조치로서 1예는 경과 관찰, 2예는 재색전, 2예는 재색전후 수술, 2예는 대량 객혈로 사망하였으며, coil로 색전한 경우는 아직 재발이 없었다. 결론 : 폐순환 동맥색전술은 대량 객혈 환자에서 장기간의 지혈 효과는 확실치 않으나, 응급적 조치로서는 확실한 지혈 효과가 있으며, 응급적 지혈후에는 원인 질환에 대한 대책을 즉시 수렵해야한다.

• Tuberculosis and Respiratory Diseases
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• 제60권6호
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• pp.678-683
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• 2006

기관지 평활근종과 폐 격리증은 두 질환 모두 희귀한 질환으로 같이 동반된 증례는 현재까지 보고된 적은 없다. 저자들은 호흡곤란, 기침, 화농성 객담을 주소로 개인의원에서 폐렴 치료 후 호전 없어 본원으로 전원 후, 흉부 CT 촬영과 기관지내시경에서 좌폐하엽의 허탈을 동반한 좌측 주기관지의 말단부위에 1.5 cm크기의 종괴와 대동맥에서 나오는 이상 동맥을 발견하여 이상 동맥 결찰과 좌하엽 절제술을 시행하여 호전되었던 폐 격리증을 동반한 기관지 평활근종 1 예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

• Journal of Chest Surgery
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• 제22권3호
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• pp.416-424
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• 1989

We have performed eight, single transplantations of right lung in dogs from September, 1988 to March 1989 at the Thoracic & Cardiovascular Surgical department, Yonsei University, College of Medicine, Seoul, Korea. We wrapped bronchial anastomosis site with great omentum and used cyclosporin in preoperative and postoperative periods in seven cases except one. The one without wrapping the bronchial anastomotic site with omentum and using cyclosporin died due to bronchial anastomotic site rupture in postoperative fourth day. If there is no reason to choose one side over the other, we would generally choose to do left-sided transplant as this is technically somewhat easier because of the long length of recipient bronchus and the ease of clamping the left atrium proximal to the pulmonary veins. The right atrium limits the amount of left atrium that can have incorporated into the clamp proximal to the pulmonary veins on the right side. But we had chosen to do right-sided transplant of lung because we must take variable technical experiences on right sided lung transplant in dogs. We have to anastomose one of pulmonary vein and left atrial wall on right-sided transplant easily only with double ligation of one pulmonary vein because right atrium limited the clamp of left atrium proximal to pulmonary veins with decreased venous return and cardiac output in some dogs. All seven dogs with right-sided lung transplant had survived more than one day with good condition except one. The one dog have to be sacrificed to evaluate the difference between the gas analysis in pulmonary venous and arterial blood in post-operative eight hours. We found hemorrhagic pulmonary edematous changes of contralateral left lung in this dog. And also all dogs have to be sacrificed for the evaluation of surgical problems, anytime in post-operative periods without any cardiopulmonary resuscitative efforts when the general condition would be worse progressively. We found no any surgical technical errors in seven dogs except one with thrombi in suture site of left atrium. There were hemorrhagic pulmonary edematous changes of transplanted right lung in one, of contralateral left lung in one, of contralateral left lung with double ligation of its pulmonary artery in one, thrombi around left atrial sutures sites in one, multiple air leakage in one bronchial rupture in one due to rejection or infection. There were accidental extubation and delayed intubation in one and unknown cause of death in one.

• Journal of Chest Surgery
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• 제27권11호
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• pp.961-964
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• 1994

The pulmonary sequestration is an uncommon congenital anomaly characterized by the presence of nonfunctioning lung tissue supplied by aberrant artery from the aorta or its branches and usually has no communication with the normal bronchial tree. The patient was 35 year old female and had no specific complaints. The lung mass was found incidentally and was continned to be intralobar pulmonary sequestration by aotography whitch showed aberrant blood supply from thoracic aorta at the T. vertebra level. The right lower lobectomy was done.

• Journal of Chest Surgery
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• 제27권5호
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• pp.374-378
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• 1994

Bronchoplastic and angioplastic operation in lung surgery is appropriate treatment for a wide range of benign endobronchial lesions and low grade malignancies. Between March 1990 to February 1994, four patients underwent bronchial sleeve resection and one patient received left upper lobe lobectomy with pulmonary artery angioplasty. Types of disease includes two cases of endobronchial tuberculosis and three cases of lung cancer. The main operation performed are one pneumonectomy, two right upper lobectomy and one each of left upper lobectomy and left lower lobectomy. All cases received sleeve resection not due to decreased respiratory reserve but due to anatomic suitability. One patient who received pneumonectomy had postoperative complication of empyema thoracis.

• Journal of Chest Surgery
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• 제27권9호
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• pp.804-807
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• 1994

Pulmonary sequestration is an unusual congenital malformation characterized by the presence of nonfunctioning lung tissue which usually has no communication with the normal bronchial tree and receives its blood supply from an anomalous systemic artery. Extralobar form is a very rare congenital malformation. We have experienced a 54 year old female patient with a mass in the upper lobe complaining of cough and blood tinged sputum. A triangular shaped mass was located in the left upper lobe, medially. The arterial blood supply were from the thoracic aorta and the pulmonary artery but there was no the tracheobronchial communication. The venous drainage was through the pulmonary vein. The mass was confirmed as extralobar pulmonary sequestration associated with a pericardial defect.

• Journal of Chest Surgery
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• 제48권2호
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• pp.139-141
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• 2015

The aetiology, incidence and management of type II endoleaks in standard infrarenal endovascular aortic aneurysm repair is well described. Far less data is available for thoracic stent grafting. We present a rare and interesting case of a type II endoleak post thoracic aortic stenting and highlight the aberrant anatomy that can cause this phenomenon in such cases.

• Journal of Chest Surgery
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• 제15권1호
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• pp.27-34
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• 1982

Pulmonary sequestration Is an unusual congenital malformation characterized by the presence of nonfunctioning lung tissue which usually has no communication with the normal bronchial tree and which receives its blood supply from an anomalous systemic artery instead of a pulmonary arterial branch. Two forms of pulmonary sequestration occur: Intralobar sequestration, in which the abnormal pulmonary tissue is incorporated within the normal lung and shares a common covering of visceral pleura, and extralobar sequestration, in which the abnormal pulmonary tissue is separated from the normal lung and has its own pleural investment. Since 1970, five cases of pulmonary sequestration were operated at the Department of Thoracic and Cardiovascular Surgery, College of Medicine, Seoul National University. 1. Among five cues, one was male and the others were female. 2. All were intralobar type and involved left lower lobe. 3. There was no operative mortality following left lower lobectomy and ligation of the aberrant artery.

• Journal of Chest Surgery
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• 제9권1호
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• pp.20-26
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• 1976

Author has performed experimental study on hemodynamic changes of lung following radical hilar stripping and contralateral pulmonary artery ligation. In view of hemodynamic changes in group 1 (right pulmonary artery ligation only) and group 2(left hilar stripping+right pulmonary artery ligation). group 2 showed remarkable decrease rate in oxygen uptake (P<0.001) and total pulmonary blood flow(P<0.001), and the more increase rate in mean pulmonary artery pressure(P<0.02) and total pulmonary vascular resistance (P<0.001). Meanwhile, the decrease percent of left lung vascular resistance was lower than group 1(P<0.001). The hemodynamic changes in group 1 returned to control range two weeks later. In the group 2, two dogs were expired as a result of atelectasis and pulmonary hypertension. Among allying 8 dogs, five months after operation, follow up studies performed in two dogs, which showed normal pulmonary hemodynamics similar to preoperative data. The altered blood gas values and decreased oxygen uptake are more remarkable in denervated lung, which may due to pulmonary hypertension and partly retained more secretion in bronchial trees than usual. Important factors of raising pulmonary vascular resistance and pulmonary artery pressure are considered as the increased blood flow to remaining left lung and dysfunction of pulmonary vascular bed to accept the increased blood flow after denervation. Loss of nerve innervation had a influence, to some extent, to the decrease of oxygen uptake and the increase of pulmonary vascular resistance and pulmonary artery pressure. There can be little question that denervation does impair the pulmonary hemodynamics, however, intact pulmonary nerve innervation is not absolutely essential for survival of the animal.

• Tuberculosis and Respiratory Diseases
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• 제42권5호
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• pp.752-759
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• 1995

연구배경: 심부전 환자에서 기관지 과민성의 여부를 확인하고 이러한 기관지 과민성과 혈역학적 지표사이의 상관관계를 알기위해 메타콜린을 이용하여 기관지 유발검사를 실시하였다. 방법: 1994년 3월부터 8월까지 본원에 내원하여 흉부 X선 촬영, 심에코도 검사, 심도자술로 승모판 심장질환이 진단되고 호흡곤란의 정도가 NYHA 기능적 분류 2인 11명의 환자를 대상으로 PARI nebulizer I을 이용하여 메타콜린 용액의 농도를 올리면서 기관지 유발검사를 시행하여 최대호기 유속이 20%이상 감소를 보이면 양성반응으로 간주하였다. 또한 각각의 환자는 심도자술을 통해서 혈역학적인 지표와 기관지 과민반응과의 상관 관계를 알아보고저 하였다. 결과: 1) 11명의 환자중 남자 2명 여자 9명이였으며 평균연령은 38.0세이였고 흡연력은 1명이외에는 없었다. 2) 각 환자의 호흡곤란 정도는 NYHA 기능적 분류 2였고 승모판 협착증만 있는 환자는 5명이였고 이외는 승모판 질환과 대동맥 판막질환이 동반되어있었다. 3) 환자들의 평균폐동맥압과 평균폐모세혈관 쐐기압은 각각 21.72mmHg(${\pm}8.55$), 15.45mmHg(${\pm}8.69$)로 정상보다 높았고 심장지수와 좌심실분획률은 각각 2.64L/min/m2(${\pm}0.41$), 61.81%(${\pm}7.21$)로 정상범위이였다. 4) 11명의 환자중 1명만 메타콜린 기관지 유발검사에 양성이었다. 결론: NYHA 기능적 분류 2인 승모판 심장질환이 있는 심부전환자 11명중 1명만 기관지 과민반응이 관찰되었으며 그 이유로 지속적인 심부전의 치료에 의한 간질성 폐부종의 소설로 인해 기관지의 반응성이 증가되지 않았다고 사료되며 NYHA 기능적 분류 3 또는 4인 승모판 심장질환 환자를 대상으로 기관지 과민 반응에 대한 추후의 검사가 필요할 것으로 생각된다.