• Journal of Chest Surgery
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• 제55권6호
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• pp.482-484
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• 2022

Spontaneous hemothorax is rare, with limited data available on its etiology and treatment. We report a case of massive spontaneous hemothorax with a ruptured variceal phrenic vein during pregnancy, likely a complication of the Kasai procedure. Despite closed thoracostomy, the patient's symptoms and imaging findings did not improve. Emergent open thoracotomy and bleeding control were performed.

• Journal of Dental Anesthesia and Pain Medicine
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• 제22권6호
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• pp.457-464
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• 2022

Tracheostomy is a surgical procedure that is commonly used to treat upper airway obstruction. In particular, patients with head and neck cancer may require elective or emergency tracheostomy because of airway obstruction due to massive bleeding of the intraoral tumor mass and rapid growth of the tumor mass in the neck area. Here, we report four cases of tracheostomy in patients with head and neck cancer with narrowed airway space and difficulty in breathing. Based on these cases and a literature review, we recommend that oral and maxillofacial surgeons and dental anesthesiologists should cooperate closely and determine the appropriate timing to perform definitive airway management for such patients during palliative treatment, along with continuous evaluation of tumor location, risk of recurrence, and airway involvement.

• Journal of Chest Surgery
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• 제55권1호
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• pp.88-90
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• 2022

Tracheo-innominate artery fistula (TIF) is a rare, life-threatening complication of tracheostomy that makes it difficult to secure the airway due to massive bleeding, constituting a medical emergency. Therefore, most successful surgical treatments include innominate artery debridement and tracheal fistula repair. Herein, we report a case of successful surgical treatment of a TIF while maintaining cerebral blood flow through an artificial vascular graft.

• Tuberculosis and Respiratory Diseases
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• 제46권1호
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• pp.53-64
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• 1999

연구배경: 대량객혈을 치료하지 않는 경우 사망률이 50% 이상으로 매우 높은 것으로 알려져 있다. 대부분의 경우 출혈이 기관지 동맥에서 발생하고, 기관지 동맥색전술은 75-90% 의 환자에서 즉각적인 지혈효과를 가져오므로 대량객혈의 효과적인 치료방법으로 받아들여 지고 있다. 저자들은 대량 객혈환자에서 기관지 동맥 색전술의 유용성과 효과를 알아 보고자 하였고 또한, 성공적인 색전술후 재출혈에 관여 하는 인자를 알아보고자하였다. 방 법: 1990년 2월부터 1996년 7월 까지 가톨릭 의과대학 소속 7개 부속병원에 객혈을 주소로 내원하여 2 회 이상 객혈을 보이거나, 1 일 400-600cc 이상 대량 객혈을 보이는 환자에서 동맥색전술을 시행한 환자중에서 1년이상 경과관찰이 가능한 146명을 대상으로 하였다. 결 과: 기관지 동맥색전술을 시행한 환자는 남자 98예(67.1%), 여자48예(32.9%)였고, 객혈의 원인 질환으로는 폐결핵 및 이와 동반된 병변이 106예(72.6%)로 가장 많았다. 지혈에 사용된 색전물질로는 Ivalon을 단독으로 사용한 예가 58예(39.7%)로 가장 많았고, Gelfoam만 사용한 예는 52예(35.6%), 코일과 Gelfoam을 병용한 예는 24예(16.4%), Ivalon과 Gelfoam을 병용한 예는 9예(6.2%), 코일만 사용한 예는 3예(2.1%)이었다. 기관지 동맥색전술을 이용한 24시간 이내의 지혈의 성공률은 95%였으며, 추적관찰 중 객혈의 재발은 36예(24.7%)였고, 2 회이상 재발한 환자는 6예(4.1%)였다. 기관지 동맥색전술의 합병증은 40명(27.4%)의 환자에서 총 58 건수가 발생하였는데, 발열이 22 건(37.9%)으로 가장 많았고, 흉통 9건(32.8%), 두통 4건(6.9%), 오심 및 구토 3건(5.2%), 부정맥 2건(3.4%)순으로 나타났고, 기타 기침, 요통, 마비성장폐색, 배뇨장애, 하지감각 소실, 견갑골 통증, 저혈압, 두드러기등이 각각 1건씩 발생하였다. 초기 기관지동맥 조영술 소견상 색전의 대상이 양측성인 경우, 체측부동맥-폐동맥간 단락이 있는 경우, 신생혈관 형성, 동맥류, 출혈의 직접적인 소견인 조영제외 누출, 체측부동맥이 영양동맥으로 관여한 경우 등 이들 모두에서 재발군과 비재발군 사이에서 유의한 차이를 보이지 않았다(P>0.05). 원인 질환별, 지혈에 사용한 색전물질, 공동이 있는 경우, 국균종이 동반된 경우, 기관지 확장증이 동반된 경우, 폐기종이 동반된 경우 모두 재발군과 비재발군 사이에서 유의한 차이를 보이지 않았으나(P>0.05), 늑막에 병변이 있는 경우 양군 사이에 유의한 차이가 있었다(P<0.05). 결 론: 기관지 동맥색전술은 대량 객혈시 안전하고, 심각한 합병증의 빈도가 적은 시술로서 특히 초기 지혈효과가 뛰어난 시술방법으로 사료된다. 초기 기관지 동맥조영술 소견에서 출혈의 재발을 예견할 수 있는 의미있는 지표는 없었으나, 늑막에 병변이 있는 경우 재발의 빈도가 높은 것으로 보아 향후 이에 대한 재검토가 필요할 것으로 사료된다.

• Tuberculosis and Respiratory Diseases
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• 제73권2호
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• pp.107-114
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• 2012

Background: This study attempted to investigate the main causes of hemoptysis, the type of examinations used for diagnosis, the treatment modalities and outcomes. Methods: A retrospective study was conducted on the medical records of 221 patients admitted to the Chonnam National University Hospital, between January 2005 and February 2010, with hemoptysis. Results: Bronchiectasis (32.6%), active pulmonary tuberculosis (18.5%), fungus ball (10.8%), and lung cancer (5.9%) accounted for most causes of hemoptysis. Computed tomography scan was the most sensitive diagnostic test when employed alone, with positive yield of 93.2%. There were 161 cases of conservative treatment (72.9%), 42 cases of bronchial artery embolization (BAE) (19.0%), and 18 cases of surgery (8.1%). Regarding the amount of hemoptysis, 70 cases, out of 221 cases, were mild (31.5%), 36 cases moderate (16.2%), and 115 cases massive hemoptysis (52.0%). Most of the patients were treated conservatively, but if there was more bleeding present, BAE or surgery was more commonly performed than the conservative treatment ($p{\leq}0.0001$). In the multivariate model, severe hemoptysis and lung cancer were independently associated with short-term recurrence. BAE was independently associated with long-term recurrence, and lung cancer was associated with in-hospital mortality. The overall in-hospital mortality rate was 11.3%. Conclusion: Hemoptysis is a common symptom with a good prognosis in most cases. However, patients exhibiting massive bleeding or those with malignancy had a poorer prognosis. In-hospital mortality was strongly related to the cause, especially in lung cancer.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제29권1호
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• pp.56-59
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• 2003

구강악안면 영역에서의 외상에 의한 내악 동맥의 가성 동맥류는 극히 드문 병변으로 저자들은 서울 대학교 치과병원 구강악안면외과에서 1례를 치험하였다. 그 원인은 외상에 의한 하악 과두 골절, 관혈적 정복술시의 의원적 외상 또는 둘 다를 고려해 볼 수 있었으며 임상적으로 박동성 잡음,촉진 가능한 맥동이 있었고 술중 과다 출혈의 양상을 보였다. 병소는 혈관 조영술에 의해 확진되었으며, 색전술로 치료하였다. 가성 동맥류는 생명을 위협할 정도의 과다 출혈을 일으킬 수 있으므로 그 진단과 치료는 중요하다. 혈관 조영술은 임상적 증상에 대한 확실한 진단을 가능케 해 주며 이를 이용한 색전술은 관혈적 결찰법에 비해 장점을 가지므로 좋은 치료법이 될 수 있다.

• Journal of Trauma and Injury
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• 제31권1호
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• pp.6-11
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• 2018

Purpose: The diagnosis of pelvic fractures pattern has become to be essential in the decision making of treatment modality and reducing morbidity and mortality in multiple trauma patients. Sacroiliac joint (SIJ) disruption can cause life-threatening massive arterial bleeding. This study aimed to determine a method of predicting the prognosis and treatment direction with pelvis X-ray alone in the emergency room. We investigated whether SIJ disruption can be used alone as a poor prognostic factor. Methods: We analyzed the medical records and radiologic examination results of 167 patients with pelvic fractures from January 1, 2015 to December 31, 2016 retrospectively. Patients with pathologic fractures, thoraco-abdominal bleeding, and acetabulum fractures and pediatric patients (n=63) were excluded. Factors related to the clinical manifestations and treatments, such as transfusion and surgery, were statistically compared. Results: The cross-sectional analysis showed that there was no correlation between SIJ injury and sex; there were statistically significant relationships between occurrences of shock, conjoined fractures, transfusion, and surgeries. The hospitalization period and partial thromboplastin time and prothrombin time values increased. The logistic regression analysis showed that when an SIJ injury occurred, blood transfusion and hypotension possibilities increased. Conclusions: When pelvic fractures occur near the SIJ, blood transfusion and shock possibilities increase. Physicians must be aware of the high severity and poor prognosis of such fractures when these are diagnosed in the emergency room. And furthermore, the physician has to predict and prepare the intensive care and multidisciplinary approaches.

• Journal of Chest Surgery
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• 제23권5호
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• pp.844-853
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• 1990

We have performed 27 cases of orthotopic homologous cardiac transplantation using Korean mongrel dogs and one case of sham operation for the evaluation of harmful effect of cardiopulmonary bypass itself on the dog from April, 1989 to June, 1990. Our previous reports have already demonstrated basal hemodynamic and hematologic data on the canine homologous heart transplantation and the fundamental principles of transplantation of the heart. The mean body weight of recipients was 13.2$\pm$1.2kg with a rage of 11 ~ 15kg, and the hemodynamic and hematologic pictures were almost same as the result of previous reports from our hospital, except marked decrease in postoperative platelet count[from 3.18 $\pm$0.80x106/mm3 to 1.41$\pm$0 37x 106/mm3]. Mean survival time was 24.82$\pm$49.40 hours with the longest survival of 264 hours. Donor cardiectomy included coronary vasodilatation with diltiazem, potassium arrest, and the rapid cooling of the heart suspending in the specially designed ice-bath. Median sternotomy provided excellent exposure of the surgical field. 6 \ulcorner0 prolene suture was used for the anastomosis of both atrial cuffs and the great arteries, and we found the fact that stenosis, bleeding, thrombus formation around the anastomotic site could be decreased with the use of everted horizontal mattress suture techniques. Immunosuppression was done with a combination of lower dose Cyclosporin-A, Azathioprine, methyl-prednisolone, but our cases still showed too short survival to worry about graft rejection. Still poor was our quality control of experimental animal, we had much difficulties in postmortem evaluation of the dogs. Low cardiac output due to biventricular failure, intractable supraventricular or ventricular tachyarrhythmia, postoperative massive bleeding, sepsis were most frequent findings that could be thought as a cause of death. A few cases showed subendocardial patch hemorrhage in both ventricular cavity or atrial septum at autopsy, suggesting acute subendocardial infarction. Although our team overcome most of the technical problems of orthotopic heart transplantation, we should pile up further knowledges about donor heart preservation, quality control of animal, infection, rejection, the effect of the cardiopulmonary bypass to improve the results.

• Journal of Chest Surgery
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• 제21권1호
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• pp.87-100
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• 1988

The authors evaluated 200 cases of primary carcinoma of lung in terms of the cell type, operability, resectability and survival rate, that proved by histopathologic examination at the Dept. of Thoracic and Cardiovascular Surgery, Catholic Medical College during the period of 11 years from Jan., 1977 to Dec., 1987. The results are as follows; 1] The peak incidence was observed in the 7th decade of life [34%] and followed by 6th [30%] 8 5th decade [25%]. Male to female ratio was 3.4:1. 2] Histopathologic classifications were squamous cell carcinoma 48% [96 cases], adenocarcinoma 27% [34 cases], small cell carcinoma 13%[26 cases], ;bronchioloalveolar cell carcinoma 5% [10 cases], large cell carcinoma 4.5% [9 cases], adenosquamous cell carcinoma 1.5% [3 cases] and adenoalveolar cell carcinoma 0.5% [1 case]. 3] Among 200 cases of primary lung cancer, the operability was 47.5% [95 cases], refusal of operation 6.0% [12 cases] and inoperability 46.5% [93 cases]. 4] Ninety five cases [47.5%] were operated. Of these, post-surgical stage I was 18.9% [18 cases], stage II 24.2% [23 cases] and stage III 56.8% [54 cases]. Among 54 cases of stage III, 32 cases were unresectable, while 22 cases were resectable. Consequently, the resectability was 31.5% [63 cases] from the total numbers of 200 cases, and the resectability for the operable 95 cases was 66.3% [63 cases]. 5] Surgical complications were empyema with bronchopleural fistula [4 cases], G-I bleeding [1 case], tedious pleural effusion [1 case] and acute respiratory insufficiency [1 case]. Operative mortality was 3.2% [2 cases], which caused by massive G-I bleeding [1 case] and respiratory insufficiency [1 case]. 6] On the long term follow-up of resectable 63 cases, overall 3 year survival rate was 35%, 5 year 22% and 9 year 2%. Five year survival rate was 39% in stage l, 30% in stage II and 0% in stage III. As for the cell types, the higher 5 year survival rate was observed in resectable squamous cell carcinoma [35%] as compared to adenocarcinoma [15%], alveolar cell carcinoma [14%], small cell carcinoma [0%] and large cell carcinoma [0%].

• Advances in pediatric surgery
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• 제6권2호
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• pp.143-148
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• 2000

Pseudoaneurysm of the splenic artery may arise from a vascular erosion by a surrounding inflammatory processes in acute and chronic pancreatitis. Rupture of the pseudoaneurysm may threaten the patient's life. Conservative management for massive hemorrhage may cause 100 percent mortality and even with prompt therapy there is a high mortality. Preoperative detection of bleeding source is desirable because of the difficult identification of the bleeding site at laparotomy. Angiographic identification and embolization of the hemorrhagic vessels in selected cases may obviate the risk of urgent surgery. The authors have recently managed a case of ruptured splenic artery pseudoaneurysm combined with a pancreatic pseudocyst in a 6 years old boy. A bolus enhanced CT scan and angiography confirmed the diagnosis. We managed this child successfully with the urgent transcatheter arterial embolization followed by elective surgery.