• Journal of Chest Surgery
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• v.29 no.1
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• pp.63-66
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• 1996

Postoperative empyema thoracis with bronchopleural fistula (BPF) Is uncommon but serious complication. The management remains troublesome area in the field of the general thoracic surgery During the period of October 1993 to December 1994, four patients with postresectional empyema thoracic with BPF were treated consecutively in Ewha Womans University Mokdong Hosp tal. The treatment procedures include irrigation and debridement of the empyema cavity and muscle flap transposition. Follow-up periods after surgery were 4-12 months. Three patients were thought successful, one patient failed. We think that the cause of failure is muscle necrosis of rectos abdominis muscle flap due to vascular injury and infection of muscle due to residual infected debridement of empyema cavity.

• Journal of Chest Surgery
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• v.20 no.2
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• pp.261-269
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• 1987

From 1976 through 1986, authors have experienced 127 cases of peripheral vascular surgery which had been done in this department. There were 29 cases of atherosclerosis obliterances including 7 Leriche syndrome, 32 Buerger`s diseases, 25 arterial thromboembolisms, 21 vascular injuries, 2 peripheral arterial aneurysms, 2 renovascular hypertensions, 1 congenital A-V malformation, 13 varicose vein of lower extremities, and 2 Jugular venous ectasia. Cases with vena caval disease and aortic disease were excluded. The mean age of ASO and Buerger`s disease was 56.1 yrs, 33.8 yrs respectively. The male to female ratio showed marked male preponderance [27:2, and 30:2], and almost every male patient was smoker. The indication of operation was similar in both disease entities. The method of operation for ASO were bypass procedure [17], thromboendarterectomy [6], and lumbar sympathectomy [5], and for Buerger`s disease were mainly sympathectomy and few bypass procedures and amputations. Seventeen patients with ASO were followed from 3 to 75 month and overall patency rate for bypass or endarterectomy in one and two months and 2 1/2 yr were 93%, 87%, and 31% respectively. Post operatively patient`s symptoms was relieved or alleviated in almost ASO patients, and about 60% of Buerger`s disease. We concluded that in patient with ischemic limb, we must revascularized aggressively for symptomatic relief. And choice of graft for bypass procedure was to be evaluated further.

• Journal of Chest Surgery
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• v.27 no.7
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• pp.603-609
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• 1994

Esophageal atresia is a rare congenital anomaly and it usually associated with tracheo-esophgeal fistula and other congenital anomalies. The first report of esophageal atresia with tracheo-esophageal fistula was done by Thomas Gibson in 1696. In 1941, Haight performed the first successful primary anastomosis for esophageal atresia. These accomplishments opened the gateway for clinical studies that have resulted in reinforcements and improvement in the care of infants born with this anomaly. From January 1986 to April 1994, 14 cases of esophgeal atresia with tracheo-esophgeal fistula were diagnosed in Kyung Hee Uinv. Hospital. There were 9 male and 5 female infants. 12 infants were Gross classification type C and 2 infants were type A. The average body weight was 2.7$\pm$0.4kg and Waterson Category A contained 4 infants, B contained 3 infants and C contained 7 infants. Among these infants, 9 infants were underwent anastomosis procedures. We performed retropleural approach in 6 infants, transpleural approach in 2 infants and 1 infant was performed colon interposition through substernal space.By the method of anastomosis, end-to-side anastomosis was performed in 5 infants, end-to-end anastomosis in 3 infants and esophagocologastrostomy in 1 infant.The former 8 infants were Gross classification type C and the latter was type A. Among the type C infants, 6 infants were anastomosed with one layer interrupted suture and 2 infants with 2 layer interrupted suture. Post- operative death was in 1 infant and 8 infants were discharged with good result and have been in good condition.

• Journal of Chest Surgery
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• v.25 no.6
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• pp.630-636
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• 1992

From August 1990 through December 1991, 14 patients[all males] underwent int-rathoracic muscle transposition of extrathoracic skeletal muscles to treat empyemas, 6 patients had tuberculous empyemas, 4 had chronic empyemas of unknown etiology, 3 had pos-tpneumonectomy empyemas, and 1 had postlobectomy empyema. 9 patients had associated bronchopleural fistulas, Their ages ranged from 22 to 67 years, with mean age of 45.1$\pm$17. 6[$\pm$S.D] years. The serratus anterior was transposed in 13 patients, the latissimus dorsi in 12. In 11 patients, both the serratus anterior and the latissimus dorsi were transposed. The omental flap also transposed in 3 patients. To reduce the dead space in the thoracic cavity, thr-oacoplasty was also carried out in 10 patients. The number of the partially resected ribs was 3.0$\pm$0.8[$\pm$S.D.]. All operations were single stage procedures, and all wounds were closed primarily, with no permanent tubes or chest wall openings. There was no hospital mortality, and so no subsequent operation has been required. Follow-up of the patients ranged from 5 to 16 months with a mean of 9.2$\pm$3.1[$\pm$S.D] months, All the patints had no further signs or symptoms of the original infection after discharge. We conclude that intrathoracic transposition of extrathoracic skeletal muscle is an excellent method of treatment for persistent, life-threatening intrathoracic infections.

• Journal of Chest Surgery
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• v.39 no.7 s.264
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• pp.561-564
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• 2006

Postoperative chylothorax is a rare but serious complication of thoracic surgical procedures. We report two cases of chylothorax after lobectomy and mediastinal Iymph node dissection for lung cancer. The patients were successfully treated with subcutaneous octreotide injection as an adjunct to conservative treatment.

• Journal of Chest Surgery
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• v.26 no.7
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• pp.521-525
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• 1993

Sixty-three patients who underwent open mitral commissurotomy at Sejong General Hospital during last 10 years from the August, 1983 to June, 1993 were reviewed There were fifty-one women and twelve men, and the mean age was 34.2 years. According to the NYHA classification, the distribution of patient preoperatively was as follows: class I, 5 patients ; class II, 26 patients ; class III, 30 patients ; class IV, 2 patients, and mean duration of symptome was 4.5 years. The mean mitral valvular area measured with echocardiogram preoperatively was 0.92cm2. All patients underwent open mitral commissurotomy and 41 patients required additional procedures for relief of subvalvular stenosis or other valvular disease. There were no operative death. 63 patients had three different types of mitral stenosis : type I, mobile cusps without subvalvular change [21 patients] ; typeII, thickened cusps with subvalvular change [34 patients] ; type III, rigid cusps with severe subvalvular change [8 patients]. The valvular calcification was seen in 11 patients [17%] and 15 patients [24%] had left atrial thrombus. The duration of follow-up was from 1 month to 168 months [mean, 39.6 months] and there were no late death. Six patients required reoperation and one patient had embolic episode. Conclusively,the open mitral commissurotomy represents a safe surgical precedure for treating mitral stenosis, allowing a complete removal of atrial thrombosis if present, and even when associated with subvalvular changes.

• Journal of Chest Surgery
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• v.19 no.4
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• pp.563-568
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• 1986

Tissue 02 tension is an important guide in detection of the general condition in critical patients. The tissue 0, is more difficult to measure with 0, sensor in skeletal muscle and subcutaneous tissues to present. But it is much easier to measure 0, tension in bladder urine with Censini catheter in Foley catheter than in tissue. We have measured 0, tension in bladder urine, main pulmonary artery and radial artery in 16 patients in chest surgical department of Yonsei University. College of Medicine from September 26 to December 22, 1981. Six patients were male and ten patients were female. Their ages ranged from 8 to 43 years. The correlation equation between the simultaneously measured PuO2 and PvO2 was found to be Ypvo2=4.04 + 0.88 Xpuo2 [r=0.88, p<0.0001] in regression curve with computer [HP/3,000, Program: SPSS] in the Yonsei University. Measurement of 0, tension in bladder urine and MPA will be rather simple, rapid and reproducible method than that of the 0, tension in tissues. But the speed of 0, consumption in urine is fast and so the 0, tensions in bladder urine were measured as soon as possible after they were collected. They were no complications or morbidity during measurement of 0, tension in these procedures except spontaneous removal of radial arterial cannulas in 2 patients.

• Journal of Chest Surgery
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• v.25 no.12
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• pp.1502-1507
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• 1992

Between February and July 1992, videothoracoscopic bullectomy was performed in nineteen patients with primary spontaneous pneumothorax. The indications of this surgery are recurrent in 12, persistent airleakage in 4 and previous contralateral pneumothorax in 3 patients. For the good operative field, we used double lumen endotracheal tube and put the CO2 gas into the thoracic cavity to make the lung collapse. We usually apply the endoGIA or electric cauterization for handling the bleb or bullae and there were 9 cases with of endoGIA only, 4 electric cauterization only and 6 both procedures. To evaluate the advantage of the Videothoracoscopic surgery, we compared surgical results with that of the tho-racotomy group[19 patients]. There were significant differences in operative time[93.8$\pm$41.9 min and 17.1$\pm$53.9 min, p< 0.01] and postoperative airleakage duration[35.6$\pm$113.3 hours and 117.9$\pm$214.4 hours, p<0.05] between the Videothoracoscopy and thoracotomy group. Tube indwelling time was shortened in Videothoracoscopy group[p<0.05]. The hospital stay was very short[p<0.01] and the patients needed analgesic injection less frequentley in videthoracoscopic group[p<0.05] In conclusion, we prefer the Videothoracoscopic procedure to the thoracotomy in uncomplicateed patients with pneumothorax because of simple procedure and good results.

• Journal of Trauma and Injury
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• v.29 no.2
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• pp.37-42
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• 2016

Purpose: Arterial injury in children is a challenging problem for its special characteristics. It is rare even during warfare. This review described a personal experience in the management and outcome of acute pediatric arterial injuries of extremities. Methods: Thirty-six children below age of 13 years were studied during period from 2004 through 2014 in Iraq. Results: Male patients were 27 (75%) and female were 9 (25%). Seven to twelve years old was the most affected age group. The incidence of iatrogenic injuries was greater in infants and toddlers while penetrating injuries were the most common in older children. Upper limbs arteries were affected in 17 (47.2%) and lower limb in 19 (52.8%) patients. Hard signs were the commonest mode of presentation (83.3%). Lateral wall tear and complete transection were the most frequent types of arterial injury (36.1% and 27.8% respectively). The most frequent procedures performed were end-to-end anastomosis and lateral arteriorrhaphy. Surgical outcome was good. In 27 cases distal pulsations were regained. Seven cases had impalpable distal pulses but still viable limbs. Limb length discrepancy was detected in one case. One case was complicated with limb loss. No death was recorded. Conclusion: Arterial injuries in children are age related. The proper treatment of arterial injuries in children requires high index of suspicion, early operative intervention and continuous postoperative follow-up throughout years of active growth. Angiogram has a limited role as a diagnostic tool in acute arterial injuries.

• Journal of Chest Surgery
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• v.1 no.1
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• pp.11-18
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• 1968

Author studied the possible pathogenesis of spontaneous pneumothorax and its effective treatment in 33 cases, and the results obtained as follows:1) Of the 33 cases, 15 cases were originated from pulmonary tuberculosis, 11 cases were non-tuberculous natures and 7 cases were followed by traumatic chest injuries which were not associated with a laceration of the lung or rib fractures.2) So called "Idiopathic spontaneous pneumothorax" seemed mostly to be caused by rupture of the emphy- sematous blebs.3) Spontaneous pneumothorax, in process of the pulmonary tuberculosis, seemed to be caused by the rupture of blebs which was formed with a pathological process of chronic pulmonary tuberculosis.4) Author experienced interesting cases of giant blebs which had been fully occupied the right thoracic cavity. At first, it was misdiagnosed as extensive spontaneous pneumothorax on X-ray which was revealed extensive pleural air shadow with total atelectasis of the right lung. A pneumonectomy was performed together with the giant multiple blebs.5] Generally, closed thoracotomy with water-sealed drainage is the treatment of choice in spontaneous pneumothorax. However, open thoracotomy and adequate surgical procedures should be undertaken in patients with continuous air leakage or recurrent attack of spontaneous pneumothorax.aneous pneumothorax.