• Journal of Chest Surgery
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• 제42권3호
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• pp.368-370
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• 2009

전체 인구 연령이 증가함에 따라 심장수술을 시행 받는 고령의 환자들이 많아지고 있다. 80세 이상의 고령의 환자들에게서 시행한 대동맥 판막 치환술이 훌륭한 결과와 좋은 만기 생존율을 보이고 있지만, 몇몇 내과의사들은 고령의 환자들에게 수술적 치료를 고려하는 것을 주저하고 있다. 95세 여자 환자가 심인성 쇼크를 주소로 내원하였고 응급 수술이 필요한 상태였으며 응급으로 대동맥 판막 치환술을 성공적으로 시행 받았다. 95세의 고령환자에게 성공적으로 응급 대동맥 판막 치환술을 시행 하였기에 이를 보고하는 바이다.

• Journal of Chest Surgery
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• 제32권11호
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• pp.1009-1016
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• 1999

Background: Minimally invasive direct coronary artery bypass surgery(MIDCAB) has been increasing in interest along with the new techniques in myocardial immobilization for easier and safer procedures. Until the opening of the era of new techniques, adequate accuracy and good patency of grafts were debatable. Our experiences of MIDCAB were studied according to the stages of technical developments. Material and Methods: Since March 1996, 55 patients have undergone MIDCAB procedures. The patients of off-pump CABG(no cardiopulmonary bypass under full sternotomy) were excluded from the study. In the early experience(Stage I), a left anterior small thoracotomy through the left parasternal incision was performed(n=6); then an approach through the lower partial sternotomy was used(Stage II, n=33); and recently, a chest wall elevator for harvesting the internal thoracic artery and the foot plate for myocardial immobilization have been used(USSC, Norwalk, CT)(Stage III, n=16). Result: The surgical procedures of four patients in the Stage II group have been converted to conventional bypass because of the deeply seated left anterior descending coronary artery in two patients, fracture of the calcific lesion in the right coronary artery in one patient, and a cardiogenic shock during hypothermia in the other patient with ventricular dysfunction. Two patients in stage II experienced symptomatic recurrences after surgery and restenosis was verified on angiocardiography. They were managed by interventional procedures. All the other patients were doing well without symptoms, except one patients in Stage II who underwent PTCA procedure for a lesion in the circumflex artery during the follow up period. Conclusion: The new and specialized devices are essential to the development of MIDCAB surgery. MIDCAB and the hybrid procedures in multi-vessel disease are on the way to further development. So far, our experience is limited only to a single device among the many new devices for the purpose.

• Journal of Chest Surgery
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• 제31권3호
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• pp.304-307
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• 1998

Valsalva동 동맥류는 발생빈도가 낮은 질환으로 대부분이 선천성이며 동양인에서 보다 빈번하게 발생하는 것으로 보고되고 있다. Valsalva동 동맥류는 심장내로 진행되어 우심실이나 심방으로 파열되는 경우가 대부분이고 심외성 Valsalva동 동맥류는 발생빈도가 매우 낮다. 심외성 Valsalva동 동맥류는 대부분 대동맥판폐쇄부전을 야기하고 동맥류에 의한 압박으로 우심실 유출로 협착, 심근 허혈 및 심근 경색 등을 일으킬 수 있으며 심낭내로 파열된 경우 심인성 쇼크나 돌연사를 일으키므로 매우 주의를 요하며 확진되면 외과적으로 교정하는 것이 바람직하다. 저자들은 좌관상동맥동 및 무관상동맥동에 발생한 동맥류에 의해 심근허혈 및 대동맥판폐쇄부전이 발생하였던 예를 외과적으로 치료하여 양호한 성적을 얻었기에 문헌고찰과 더불어 보고하고저 한다.

• Journal of Chest Surgery
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• 제53권6호
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• pp.368-374
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• 2020

Background: The extracorporeal ventricular assist device (e-VAD) system is designed for left ventricular support using a permanent life support console. This study aimed to determine the impact of temporary e-VAD implantation bridging on posttransplant outcomes. Methods: We reviewed the clinical records of 6 patients with the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile 1, awaiting heart transplantation, who were provided with temporary e-VAD from 2018 to 2019. The circuit comprised a single centrifugal pump without an oxygenator. The e-VAD inflow cannula was inserted into the apex of the left ventricle, and the outflow cannula was positioned in the ascending aorta. The median follow-up duration was 8.4±6.9 months. Results: After e-VAD implantation, lactate dehydrogenase levels significantly decreased, and Sequential Organ Failure Assessment scores significantly improved. Bedside rehabilitation was possible in 5 patients. After a mean e-VAD support duration of 14.5±17.3 days, all patients were successfully bridged to transplantation. After transplantation, 5 patients survived for at least 6 months. Conclusion: e-VAD may reverse end-organ dysfunction and improve outcomes in INTERMACS I heart transplant patients.

• Journal of Chest Surgery
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• 제48권6호
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• pp.381-386
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• 2015

Background: Postinfarction ventricular septal defects (pVSDs) are a serious complication of acute myocardial infarctions. The aim of this study was to analyze the clinical outcomes of the surgical treatment of pVSDs. Methods: The medical records of 23 patients who underwent operations (infarct exclusion in 21 patients and patch closure in two patients) to treat acute pVSDs from 2001 to 2011 were analyzed. Intra-aortic balloon counterpulsation was performed in 19 patients (82.6%), one of whom required extracorporeal membrane support due to cardiogenic shock. The mean follow-up duration was $26.2{\pm}18.6months$. Results: The in-hospital mortality rate was 4.3% (1/23). Residual shunts were found in seven patients and three patients required reoperation. One patient needed reoperation due to the transformation of an intracardiac hematoma into an abscess. No patients required reoperation due to recurrence of a ventricular septal defect during the follow-up period. The cumulative survival rate was 95.5% at one year, 82.0% at five years, and 65.6% at seven years. Conclusion: The use of a multiple-patch technique with sealants appears to be a reliable method of reducing early mortality and the risk of significant residual shunting in patients with pVSDs.

• 대한임상독성학회지
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• 제9권2호
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• pp.49-55
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• 2011

Purpose: Acetanilide has been in widespread use as an amide herbicide compound. However, available data regarding acute human poisoning is scarce. The aim of this study was to analyze the clinical characteristics of acetanilide poisoning in order to identify the risk factors associated with severity. Methods: We conducted a retrospective observational study encompassing the period January 2005 to December 2010, including adult ED patients suffering from acetanilide intoxication. Toxicological history, symptoms observed, clinical signs of toxicity, and laboratory test results were collected for each patient. The patients were classified into two groups for analysis, according their poisoning severity score (PSS). Resulting clinical data and prognostic variables were compared between mild-to-moderate poisoning (PSS 1/2 grades), and severe poisonings and fatalities (PSS 3/4 grades). Results: There were a total of 37 patients, including 26 alachlor, 6 s-metolachlor, 4 mefenacet, and 1 butachlor cases. The majority of patients (81.1%) were assigned PSS 1/2 grades. Changes in mental status and observation of adverse neurologic symptoms were more common in the PSS 3/4 group. The median ingested volume of amide herbicide compound was 250 ml (IQR 200-300 ml) in the PSS 3/4 group, and 80 ml (IQR 50-138 ml) in the PSS 1/2 group. Also, the median GCS observed in the PSS 3/4 group was 13 (IQR 10-14), which was markedly low as compared to a median GCS of 15 in the PSS 1/2 group. Overall mortality rate was 5.4%, and profound cardiogenic shock was observed prior to death in all fatalities. Conclusion: When compared to previous reports, acute acetanilide poisoning resulted in relatively moderate severity. The presence of neurologic manifestations, hypotension, lower GCS score, and larger ingested volumes was associated with more serious effects and mortalities.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제28권2호
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• pp.178-182
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• 2006

폐부종은 구강악안면외과 영역의 수술 도중에 발생할 가능성이 있다. 따라서 전신마취하에 수술중인 외과의와 마취의는 환자의 상태를 주의깊게 관찰하여야 하며 수술 중 폐부종이 발생할 가능성에 항상 대비하여야 한다. 폐부종 증세가 발견되는 즉시, 즉각적이고도 적절한 처치를 시행한 경우 예후가 좋으며, 근본적인 원인치료 및 타장기의 합병증 및 후유증에 대하여 검사가 필요하다.

• Archives of Plastic Surgery
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• 제38권1호
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• pp.85-88
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• 2011

Purpose: Takotsubo cardiomyopathy is a relatively uncommon type of stress-induced cardiomyopathy characterized by transient left ventricular regional wall motion abnormalities. Emotional and physical stresses play a key role in this type of cardiomyopathy in postmenopausal women. The current hypothesis is that the syndrome represents a form of catecholamine surge due to stress or epinephrine-mediated acute myocardial stunning. Methods: A 44-year-old woman had suffered premature ventricular contraction following a cardiogenic shock during a breast augmentation surgery under enflurane anesthesia and tumescent solution infiltration. She was treated with cardiopulmonary resuscitation at a local clinic. Then she was brought to the Emergency Department of the authors' hospital. Results: The woman's echocardiogram showed an ejection fraction of 20~25% with associated basal hyperkinesis and left ventricular apical ballooning. The patient was admitted to the ICU and required inotropic support for two weeks. The patient's condition dramatically improved, and her ejection fraction returned to 70%. Conclusion: It is believed that there were multiple triggering factors of the onset of Takotsubo cardiomyopathy in the woman's social and family history, including infiltration of a large volume of the tumescent solution and VPCs induced by enflurane anesthesia without premedication. The importance of careful history-taking, careful pre-operative consultation on psychological suffering especially for breast surgery, premedication before surgery, patient reassurance, and post-operative psychosocial and emotional assistance was again seen in this case.

• Journal of Chest Surgery
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• 제27권12호
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• pp.989-994
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• 1994

Between January 1986 and August 1993, 11 patients underwent surgical repair of ventricular septal defect [VSD] complicated with myocardial infarction. The ages of patients were ranged from 22 years to 83 years with a mean of 64 years. There were 8 male and 3 female patients. The preoperative cineangiograms of all patients were reviewed to measure both ventricular function and to evaluate coronary artery disease. The mean time interval between occurance of VSD and operation was 13 days. The operations were performed as soon as possible if there were hemodynamic derangement. Postmyocardial infarction VSD were repaired simultaneuously with coronary artery bypass graft in 3 patients, repaired with left ventricular aneurysmectomy in 6 patients, with left ventricular thrombectomy in 1 patient and with mitral valve chordae repair in 1 patient. There was no early death [within 30 days]. There were 6 postoperative complications; one with perioperative myocardial infarction, two with recurred VSD on postoperative 1 and 6 days respectively, two with lower leg embolism associated with intraaortic balloon pump insertion, one with wound infection. Of the complicated patients, 1 patient with lower leg embolism performed left above ankle amputation. Among two patients with recurred ventricular septal defect, one patient is doing well without problem. On follow up echocardiogram, the residual VSD was occluded completely. However another patient was with recurred VSD died 3 months after the operation because of congestive heart failure. Of the long term survivors, all patients are in NEW YORK Heart Association functional Class I or II. Although number of patients were small, our results of surgical closure of postmyocardial infarction VSD were favored to the others. Moreover, seven patients with preoperative cardiogenic shock among 11 were performed early operation after diagnosis of ventricular septal rupture. All of the patients were survived and doing well during the follow up period. Therefore early diagnosis with aggressive preoperative care with intraaortic balloon pumping and early operation seems to be very important for prevention of deterioration of vital organ.

• Journal of Digestive Cancer Research
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• 제5권1호
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• pp.62-65
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• 2017

2013년 실제 임상에 Gemcitabine과 nab-paclitaxel 병용요법이 적용된 후 NCCN Guideline에서 절제 불가능한 췌장암 환자에서 일차적으로 선택할 수 있는 약제로 제시하고 있다. 이 병용요법으로 인한 가장 흔한 Grade 3 부작용으로는 호중구감소증, 피로, 말초신경병증이 보고되었으며, 심장독성은 흔하지 않다. 본 증례에서는 심장표지자의 상승 및 심초음파에서의 우측관상동맥의 허혈 손상이 확인되어 병용요법으로 인한 심장 허혈 손상 및 심낭삼출물이 발생하여, 심장성 쇼크로 사망하였을 것으로 추정해 볼 수 있다. Gemcitabine과 nab-paclitaxel에 의한 심장 허혈 손상의 더 많은 증례 보고 및 연구가 필요하며, 병용요법을 투여 받는 환자들에 대한 심장독성에 대하여 주의 깊은 관찰이 필요할 것으로 생각된다.