• Journal of Chest Surgery
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• 제35권8호
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• pp.630-633
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• 2002

Although the incidence of descending necrotizing mediastinitis(DNM) is low, this is a serious disease because it"s mortality have been reported to be as high as 40∼50%. Currently, many authors have emphasized aggressive surgical approaches rather than medical treatment alone. We report good results in 2 DNM patients treated by less invasive approach with video-assisted thoracoscopic surgery, Less invasive methods with video-assisted thoracoscopic surgery can reduce hospital stay and morbidity if effective drainage can be achieved in selected DNM patients.

• Journal of Chest Surgery
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• 제18권2호
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• pp.320-326
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• 1985

Pulmonary sequestration occurs when some disturbance produces a cystic mass of nonfunctioning lung tissue which lacks normal communication with the tracheobronchial tree. Between 1971 and 1985, pulmonary sequestration was diagnosed in 11 patients, ranging age from 3 to 29 years. All sequestration were intralobar type. Definitive diagnosis can only be obtained by aortography and/or surgical exploration in 10 cases. The other one was confirmed by pathologic examination postoperatively. The presenting complaints were mostly recurrent local pulmonary infection, but in 2 cases mediastinal mass with respiratory symptoms was presented, and cardiac murmur was only finding in one case. Preoperative diagnostic procedure revealed 3 associated anomalies which were funnel chest, right aortic arch, and pulmonic stenosis with vascular ring. Operative treatment for sequestration was lobectomy in 10 cases, and a segmentectomy in one. There was no operative mortality, but 3 complications [empyema, B-P fistula, post-op bleeding] which were controlled by subsequent operations or conservative measure. Aortography is strongly advocated not only for its diagnostic value, but for its preoperative localization of the aberrant vessels that are the major concern to the surgeon.

• Journal of Chest Surgery
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• 제34권2호
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• pp.167-172
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• 2001

배경: 누두흉은 앞가슴 기형 중 가장 흔하며 Meyer 등이 1911년 수술적 교정을 시행한 이래로 많은 술식들이 개발되어 왔다. 이들의 대부분은 전흉벽에 상처를 내고 늑연골을 자르는 과정이 필요하였다. 그러나 Nuss 등에 의해서 상기 과정없이 작은 옆가슴의 상처와 stainless steel bar로 흉골의 기형을 교정하는 국소침습적 방법이 개발되었다. 대상 및 방법: 1999년 11월부터 2000년 7월까지 누두흉의 교정을 원하는 환자 14예를 대상으로 하였다. 수술은 15세미만에서는 pectus bar를 1개를 사용하였고 그 이상에서는 2개를 사용하여 교정하였다. 결과: 남자는 11예, 여자는 3예 였으며 나이는 2세에서 52세 사이였다. 누두흉 지표는 5.3$\pm$1.84였고 비대칭지표는 1.06$\pm$0.03이였다. 수술 후 2일째 모두 일반병실로 올라갔다. 평균 재원기간은 4.2일이였다. 술후 합병증으로 성인에서 기흉 1예, 혈흉 1예, 그리고 나중에 발생한 흉막액 1예가 있었다. 결론: 누두흉에서 Nuss 술식으로 좋은 결과를 얻었다. 성인에서도 bar 2개를 이용하여 교정이 가능하였으나 소아에 비하여 합병증이 많이 발생하였는데 이는 성인에서 근육이 발달되어 있고, 뼈의 골화가 다 진행되었기 때문이다.

• Journal of Chest Surgery
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• 제45권6호
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• pp.418-420
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• 2012

Pectus excavatum is rare, but it is the most common type of sternal congenital disorder. There are many surgical methods to correct pectus excavatum such as the Ravitch method, Wada method, Silastic mold method, and the Nuss operation. We report a case of minimal invasive surgery for pectus excavatum using a polyvinyl alcohol sponge.

• Journal of Chest Surgery
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• 제34권10호
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• pp.784-786
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• 2001

계명대학교 의과대학 동산의료원에서는 심방중격결손증을 동반한 누두흉 환자를 동시 교정하였다. 수술은 앙와위에서 정중피부절개후 흉근판을 만들고 변형된 늑연골을 절제한후 흉골을 90$^{\circ}$로 세움으로써 개심술을 위한 시야를 확보하여 심방중격결손을 동시에 교정하였다. 술 후 2시간 뒤 인공호흡기를 제거하였으며, 환아는 합병증없이 회복되어 술 후 6일째 퇴원하였다.

• Journal of Chest Surgery
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• 제25권6호
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• pp.621-629
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• 1992

Thirteen sternocosal elevations for pectus excavatum were performed on twelve patients between Jan 1989 and Sep. 1991. Eleven among the twleve patients were male. The subjects ranged in age from 2 years to 20 years, with a mean age of 8.33 years[SD=4.80 years], Eleven patients were below 15 years. The early postoperative evaluation by Humphreys` criteria except keloid formation was excellent in all the patients. The lower vertebral index[LVI], configuration index[CI], and upper vertebral index[UVI] were measured on the lateral chest roentgenogram. The LVI and CI improved significantly from 0.31$\pm$0.06 and 1.14$\pm$0.06 preoperatively to 0.25$\pm$0.03 and 0.78$\pm$1.10 postoperatively. The degrees of depression, flatness, and asymmetry and funnel index were measured at the most deformed portion on the computed tomgram performed pre- and postoperatively. The degrees of depression and funnel index improved significantly from 3.32$\pm$0.73 and 5.77$\pm$1. 54 preoperatively to 1.85$\pm$0.14 and 2.96$\pm$0.43 postoperatively, There was no significant change in the degree of flatness however, Six postoperative morbidities occurred in five patients Three were superficial wound infection, two hemopneumothorax, and one reoeration, Reoperation was performed due to forward displacement of the distal sternum below the posterior sternotomy, The findings of this study suggest that the sternocostal elevation is an excellent primary method for the pectus excavatum of children and young adolescents.

• Journal of Chest Surgery
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• 제51권6호
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• pp.390-394
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• 2018

Background: The nonsurgical treatment of chest wall deformity by a vacuum bell or external brace is gradual, with correction taking place over months. Monitoring the progress of nonsurgical treatment of chest wall deformity has relied on the ancient methods of measuring the depth of the excavatum and the protrusion of the carinatum. Patients, who are often adolescent, may become discouraged and abandon treatment. Methods: Optical scanning was utilized before and after the intervention to assess the effectiveness of treatment. The device measured the change in chest shape at each visit. In this pilot study, patients were included if they were willing to undergo scanning before and after treatment. Both surgical and nonsurgical treatment results were assessed. Results: Scanning was successful in 7 patients. Optical scanning allowed a visually clear, precise assessment of treatment, whether by operation, vacuum bell (for pectus excavatum), or external compression brace (for pectus carinatum). Millimeter-scale differences were identified and presented graphically to patients and families. Conclusion: Optical scanning with the digital subtraction of images obtained months apart allows a comparison of chest shape before and after treatment. For nonsurgical, gradual methods, this allows the patient to more easily appreciate progress. We speculate that this will increase adherence to these methods in adolescent patients.

• Journal of Chest Surgery
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• 제32권10호
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• pp.930-934
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• 1999

Background: The purpose of this study is to analyze the clinical results ad operative compatability by Ravitch methods with pectus excavatum. Material and Method: From 1984 to 1997, were performed Ravitch operations in 40 patients of pectus excavatum and analyzed the effects of correction and postoperative complication according to time of operation retrospectively. The group comprised 35 mem and women whose mean age was 8.9$\pm$7.9 years(between 2 to 35 years). All patients had corrected with Ravitch operation or its modified operation. Modified fixations were accomplished with K-wire in 15 patients and internal plate in 2 and the materials were removed 3 months after operation. The result of correction was estimated with the degree of changed distance between inner surface of sternal body and vertebral in 3 months after correction. Result: Postoperative complications were wound disruption in 14 patients. Estimated distances after correction ranged 0.4 cm to 4 cm. The acceptability for chest wall correction was high(6 excellent, 29 good in criteria of Humphreys). Conclusion: We concluded that the benefits of Ravitch operation were a high acceptability of patients and their family, and sufficient correction with no specific complications related operation.

• Journal of Chest Surgery
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• 제30권12호
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• pp.1247-1250
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• 1997

7년전 누두흉으로 Ravitch수술을 받은 13세 남아가 이차성 전흉벽기형과 운동시 호흡곤란(NYHA II)을 주소로 내원하였다. 술전 심초음파상 이차성 심방중격결손이 진단되었고, 폐기능검사상 WC가 2.03 L(72%), FEVI이 1.82 L(71%)로 감소된 것외에는 술전 검사상 이상소견은 없었다. 수술은 앙와위에서 흉골을 보존한 채 정 중흉절개를 통해 흉근판을 만든후 기형늑연골 잔유물과 섬유조직을 제거하여 이차성 전흉벽기형을 교정한 후 흉골을 90$^{\circ}$로 세움으로써 개심술을 위한 시야를 확보하여 심방중격결손을 동시에 교정하였다. 술후 1일째 급성호흡부전이 있어 기관내 재삽관 및 기계호흡을 시행하였고 술후 6일째 인공호흡기를 제거하였다. 환아는 합병증없이 회복되어 술후 19일째 퇴원하였다.

• Journal of Chest Surgery
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• 제30권2호
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• pp.231-235
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• 1997

선천성 낭종성 선종양기 형은 말초 기관지가 심하게 분화하여 선종(adenomatoid)의 형태를 취하는 질환으로 발생 빈도는 매우 낮으나 신생아에서 급성 호흡부전을 일으키는 선천성 폐기 형중 가장 빈도가 높다. 대부분적 선천성 낭종성 선종양기 형은 단일 폐염을 침범하며 다른 선천성 질환을 동반하는 경우는 드물다. 저자들은 빈번한 호흡기 감염을 주소로 내원하여 치료를 받던중 누두흉을 동반한 선천성 낭종성 선종양기 형으로 진단된 3세의 여아를 양폐엽절제술과 변형 흉골거상술을 동시에 시행하여 양호한 성적을 얻었기에 문헌고찰과 더불어 보고하고저 한다.