• Clinical and Experimental Pediatrics
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• 제52권4호
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• pp.446-452
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• 2009

목 적 : 소아 부식식도염 환자에서 후기 합병증 예측을 위한 조기내시경 검사의 유용성에 대해서 분석하고자 하였다. 방 법 : 1989년 1월부터 2007년 12월까지 빙초산과 가성소오다 등의 부식성물질 섭취 후 급성기에 서울대학교 어린이병원과 분당서울대학교병원에 내원하여 내시경을 시행한 34명의 환자를 대상으로 내시경 검사와 의무기록 조사 및 보호자 전화면담을 통하여 정보를 수집하였다. 결 과 : 식도의 내시경 소견을 보면 grade 0, grade 1, grade 2a, grade 2b, grade 3인 경우가 각각 8명, 2명, 7명, 13명, 4명이었다. 구토, 침흘림, 삼킴곤란 등의 증상의 유무는 내시경상 식도 점막 손상의 유무와 유의한 상관관계를 보이지 않았다. 구강 손상의 유무는 내시경상 식도 점막 손상의 유무와 유의한 상관관계를 보였다(P=0.014). 내시경 시행 후 점막째짐, 출혈, 천공 등의 합병증은 발생하지 않았다. 협착은 12명(36.3%)의 환아에서 발생하였고, 식도의 협착은 11명, 유문부의 협착은 1명이었다. 식도 점막 손상의 정도가 심해질수록 식도협착이 많이 발생하는 경향을 보였다(P=0.002). 식도협착이 있었던 11명 중 2명(18.1%)은 반복적인 식도확장술만으로 증상이 호전되었고, 나머지 7명(63.6 %)은 수술이 필요하였다. 결 론 : 부식성 물질을 실수로 섭취한 소아에서 내시경 검사는 안전하고 유용한 검사이며, 점막 손상의 정도와 부위를 확인함으로써 후기 합병증 발생 예측에 도움이 되기 때문에 조기에 식도내시경을 시행하는 것이 필요하다.

• Journal of Chest Surgery
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• 제11권1호
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• pp.85-91
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• 1978

H.S. Lee, M.D., H.S. Yu, M.D. Esophageal perforation occurred rarely but often lead to a high mortality and morbidity. In the past, the main cause of esophageal perforation in Korea were instrumental perforation in patient with lye stricture of the esophagus. We experienced 9 cases of other forms of esophageal perforation from 1972 through 1977 and obtained the following results. 1. These 9 patients ranged from 10 months to 40 years in age at the time of admission. Six were women. 2. Causes of perforation are instrumental perforation in 3, foreign body perforation in 3, spontaneous perforation in 3 and one pneumatic esophageal perforation. 3. Perforation developed in a variety of locations in the esophagus. Three occurred in cervical part, two in the upper thoracic part, two in the lower thoracic part. 4. The main clinical symptoms and signs were dyspnea, subcutaneous emphysema, chest pain and fever. 5. Thoracic rentgenogram disclosed subcutaneous and mediastinal emphysema, widening of mediastinum and pleural effusion at the time of admission. 6. Complications of esophageal perforation were mediastinitis [7 cases], empyema [4 case], respiratory distress [4 cases] and sepsis [3 cases]. 7. In 3 deaths of the nine patients who sustained perforation of the esophagus, one was due to transfusion of infected blood and two of them were due to sepsis following empyema and mediastinitis. Early treatment [less than 24 hr] gave no hospital death, and good results obtained in the perforations of cervical and upper thoracic esophagus.

• Advances in pediatric surgery
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• 제14권1호
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• pp.88-93
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• 2008

Esophageal atresia with double tracheoesophageal fistula is a very rare anomaly and is difficulty to diagnose preoperatively. We treated a full term baby with esophageal atresia with double tracheoesophageal fistula. At the first operation, only the distal tracheoesophageal fistula was identified and ligated. When the upper esophageal pouch was opened, intermittent air leakages in sequence with positive bagging were noticed. However, intraoperative bronchoscopy did not identify a fistula in the proximal pouch, and the operation was completed with end to end anastomosis of the esophagus. On the $7^{th}$ postoperative day, esophagography showed another tracheoesophageal fistula proximal to the esophageal anastomosis. A wire was placed in the fistula preoperatively under bronchoscopy. At the 2nd operation through the same thoracotomy incision the proximal fistula was identified and ligated. On the $12^{th}$ postoperative day, esophagography showed neither stricture nor leakage.

• Journal of Chest Surgery
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• 제35권6호
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• pp.495-499
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• 2002

Plummer-Vinson(Paterson-Kelly) 증후군은 임상적으로 상부식도 혹은 하인두의 막양구조(web)와 이로 인한 연하곤란, 철분결핍성 빈혈, 그리고 구강점막의 위축성 변화를 동반하는 질환으로, 식도암을 유발하는 전암성 병변으로, 일반적으로 경구 철분 투여만으로 증상을 호전시키거나 내시경을 이용한 풍선확장술이나 전기소작술 치료가 주로 시행되고 있다. 본 병원에서는 63 세 여자환자에게서 나타난 상부식도의 협착을 유발한 병변에 대하여 공장 이식편을 이용한 유리이식술 치료한 후, 병리조직학적인 검사에서 상피내암종으로 진행한 Plummer-Vinson 증후군으로 판명되었기에 이를 보고하고자 한다.

• Archives of Plastic Surgery
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• 제33권2호
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• pp.245-248
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• 2006

Besides gastric pull-up or colonic interposition, microvascular technique in esophageal reconstruction has been approved reliable methods. When free intestinal transfer is considered, jejunal free flap is commonly used. We treated the patient who had undergone reconstruction with a right colon interposition and suffered from inability of swallowing because of stricture and necrosis of the interposed flap. Although we have planned jejunal free transfer, we couldn't use jejunum due to adhesion by previous gastrojejunostomy and colon interposition. Salvage procedure with microvascualr free left colon flap was executed successfully. After 9 month follow-up, the patient was able to consume a normal diet.

• Journal of Chest Surgery
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• 제23권3호
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• pp.600-604
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• 1990

A fistulous communication between an esophageal traction diverticulum and the tracheobronchial tree appears to be of rare occurrence. This report reviews the feature of benign esophagobronchial fistula due to esophageal traction diverticulum. This 36-year-old female patient suffered from substernal pain, interscapular pain and severe paroxysmal coughing after ingestion of fluids. This patient was taken a diverticulectomy and partial resection of superior segment of right lower lobe. After the operation, there was no subjective symptoms, esophagobronchial fistula, leakage, stricture and diverticulum. The postoperative result was excellent.

• Journal of Chest Surgery
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• 제41권5호
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• pp.671-674
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• 2008

이론적으로는 공장이나 근막피부판 혹은 근육피판이 여러 차례 실패한 식도재건의 재시도에 사용할 수 있는 장기지만, 다른 장기들도 식도의 대체 장기로 이용이 가능한지 고려해 보아야 한다. 우리는 21년 전 선천성 식도 폐쇄증의 식도 교정술 후 식도협착이 발생되어 식도재건술과 수 차례의 복부 및 경, 흉부 수술을 시행받은 24세의 여자 환자에게 2차 식도재건술을 성공적으로 시행하였다 식도의 재건은 남아 있는 변형된 위를 재단하여 피하경로를 통해 좌측 경부로 올렸으며, 상부 식도에 측 단문합하였다. 환자는 수술 후 일반 식사를 할 수 있는 상태로 호전되어 퇴원하였다.

• Journal of Chest Surgery
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• 제32권10호
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• pp.924-929
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• 1999

Background: The use of the stapler n esophageal reconstruction after esophageal resection for benign or malignant esophageal diseases has become popular because it has less leakage at the anastomotic site and shorter operation time than manual sutures. However, the use of classic circular stapler has some complications such as stenosis and dysphagia that requires additional treatment. Such complications are closely related to the inner diameter of the anastomotic sites. In this study, the diameter of anastomotic site was compared after the use of circular stapler(EEA) and straight endoscopic stapler(endo GIA). Material and Method: The patients who received esophageal reconstruction by stapler from August 1995 to September 1997 were reviewed. The patients were divided into 2 groups. One group need the circular stapler, and the other group the straight endo GIA(14 cases with endo GIA 30mm, 24 with endo GIA 45mm). After a cervical esophago-enteric anastomosis, the stricture of anastomotic site and the incidence of dysphagia were compared between the 2 groups using an esophagography and the patient's symptoms. The follow-up period was 12months in average. Result: In the former group in which the circular stapler was used, 2 cases of anastomotic stenosis were reported. In comparison, none were reported in the latter group. Dysphagia were reported in 8 cases of the former group, and in 3 cases of the latter group(1 case in endo GIA 30 mm, 2 cases in endo GIA 45 mm). Conclusion: The use of endo GIA in esophago-enteric anastomosis resulted in a wider diameter of the anastomotic site, lesser stricture, and lesser incidence of dysphagia compared to the use of former circular stapler. Therefore, it is thought to be a better method in esophageal reconstructions.

• 대한임상독성학회지
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• 제16권2호
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• pp.157-160
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• 2018

Chronic silica nephropathy has been associated with tubulointerstitial disease, immune-mediated multisystem disease, chronic kidney disease, and end-stage renal disease. On the other hand, acute intentional exposure is extremely rare. The authors' experienced a 44-year-old man who took rapid cement hardener (sodium silicate) in a suicide attempt whilst in a drunken state. He visited the emergency department approximately 1 hour after ingestion. Information on the material was obtained after 3 L gastric lavage. The patient complained of a sore throat, epigastric pain, and swollen to blood tinged vomitus. Proton pump inhibitors, hemostats, steroid, and fluids were administered. Nine hours after ingestion, he was administered 200 mL hematochezia. Immediately after, a gas-troenterologist performed an endoscopic procedure that revealed diffuse hyperemic mucosa with a color change and variable sized ulceration in the esophagus, whole stomach, and duodenal $2^{nd}$ portion. Approximately 35 hours later, persistent oligouria and progressive worsening of the renal function parameters (BUN/Cr from 12.2/1.2 to 67.5/6.6 mg/dL) occurred requiring hemodialysis. The patient underwent 8 sessions of hemodialysis for 1 month and the BUN/Cr level increased to 143.2/11.2 mg/dL and decreased to 7.6/1.5 mg/dL. He was discharged safely from the hospital. Follow up endoscopy revealed a severe esophageal stricture and he underwent endoscopic bougie dilatation. Acute cement hardener (sodium silicate) intoxication can cause renal failure and strong caustic mucosal injury. Therefore, it is important to consider early hemodialysis and treatment to prevent gastrointestinal injury and remote esophageal stricture.

• Journal of Chest Surgery
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• 제19권4호
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• pp.744-749
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• 1986

Even in the hands of the expert endoscopists, an occasional instrumental perforation of the esophagus occurs. But instrumental perforation of the esophagus should not be difficult to diagnose if the possibility is borne in mind. Occasionally patient with esophageal perforations show little reaction at first, but usually they develop systemic manifestation if surgical management is delayed. Early surgical drainage of esophageal perforation is very important & effective therapeutic method. The delayed surgical treatment of esophageal perforation would have increased the morbidity & mortality by allowing mediastinitis & empyema thoracis. We have experienced 6 cases of delayed surgical management of instrumental perforation of esophagus from May 1974 to April 1986 in the department of thoracic and cardiovascular surgery, Yonsei University, college of the medicine. The ages ranged from 4 years to 57 years. The underlying esophageal diseases consisted of esophageal stricture in 3 cases, foreign bodies in the esophagus in 2 cases and esophageal ca. in one case. Most clinical manifestations on admission were high fever, chest discomfort, chest pain, dysphagia and subcutaneous emphysema. Most complications due to esophageal rupture were acute mediastinitis with or without empyema thoracis. Failure to diagnose promptly and failure to promptly institute adequate treatment undoubtedly were largely responsible for this patients death. All 6 patients had been taken delayed surgical drainage more than 24 hours following esophageal perforation. One patient had been in the open drainage state for long time and the another patient has been in the tracheostomy with postintubation vocal cord ulceration. The third patient died due to respiratory failure and sepsis due to fulminant mediastinitis & empyema thoracis. Even if the patients with esophageal perforation have been taken delayed surgical management, the patients should be survived with aggressive & effective surgical drainage with intensive post-operative care.