• Tuberculosis and Respiratory Diseases
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• v.78 no.4
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• pp.455-458
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• 2015

Excessive dynamic airway collapse (EDAC) is a disease entity of excessive reduction of the central airway diameter during exhalation, without cartilage collapse. An 80-year-old female presented with generalized edema and dyspnea at our hospital. The patient was in a state of acute decompensated heart failure due to pneumonia with respiratory failure. We accordingly managed the patient with renal replacement therapy, mechanical ventilation and antibiotics. Bronchoscopy confirmed the diagnosis of EDAC. We scheduled extubation after the improvement of pneumonia and heart condition. However, extubation failure occurred due to hypercapnic respiratory failure with poor expectoration. Her EDAC was improved in response to high flow nasal oxygen therapy (HFNOT). Subsequently, the patient was stabilized and transferred to the general ward. HFNOT, which generates physiologic positive end expiratory pressure (PEEP) effects, could be an alternative and effective management of EDAC. Further research and clinical trials are needed to demonstrate the therapeutic effect of HFNOT on EDAC.

• Tuberculosis and Respiratory Diseases
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• v.48 no.1
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• pp.78-83
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• 2000

Endobronchial chondroma is a cartilaginous benign tumor, which arises from bronchial cartilage. As a rare benign tumor, endobronchial chondroma differs from cartilaginous hamartoma in that it includes cartilage components only, but hamartoma contains lipomatous and lymphoid tissue. The clinical manifestations of endobronchial chondroma are associated with the extent of mechanical obstruction of bronchus. Symptoms of endobronchial chondroma are nonspecific, such as cough, sputum, fever, or dyspnea on exertion. Endobronchial chondroma is often misdiagnosed as other diseases, such as asthma, chronic obstructive pulmonary disease, or pulmonary tuberculosis. The treatment is usually surgical procedures, such as resection of lung segment or lobe by thoracostomy, or resection of tumor by bronchoscopy. We report a case of the patient who was diagnosed to have endobronchial chondroma treated by bronchial resection and end to end anastomosis.

• Journal of Chest Surgery
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• v.38 no.6 s.251
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• pp.441-444
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• 2005

Abdominal tumors that can grow through vascular lumen and spread to the right heart are rare. Intravenous leiomyomatosis is a rare tumor that originates from the uterus and spreads through the vessels. Although histologically benign, tumor extension with mechanical obstruction of the inferior vena cava, right cardiac cavities, or even the pulmonary artery, may occasionally result in fatal outcome. The best treatment is complete surgical resection of the entire tumor using cardiopulmonary bypass and total circulation arrest, We report a case of intravenous leiomyomatosis of the uterus that showed intravascular growth up to the right atrium. The patient underwent successful resection of the tumor by one-stage cardiotomy with laparotomy.

• Journal of Chest Surgery
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• v.23 no.3
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• pp.438-451
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• 1990

Pneumatic total artificial heart[TAH] has been clinically applied for the purpose of permanent or temporary use followed by cardiac transplantation in the patients with end stage heart diseases. In spite of the good durability of the pneumatic TAH, thrombus formation, bleeding and infection resulted in death. The Tomasu heart, which is a type of pneumatic TAH, was used in this study. This model is a modified Jarvik heart and consists of atrial cuffs, outflow vascular grafts and thin-layer seamless diaphragm type of ventricles. Cardiac outputs of the left artificial heart were measured by Donovan`s mock circulation under variable conditions of driving parameters, and an experimental artificial heart implantation was performed in 4 calves to observe the changes of hemodynamic parameters in early postoperative period and hematologic and bio-chemical changes in a long-term survival case. In the mock circulation test, cardiac output of the heart was increased with the increase of the left atrial pressure and left driving pressure. Maximum cardiac output was obtained at the heart rate of 120 to 130/min and percent systole of 40 to 45Zo under the condition of a constant left driving pressure of 180mmHg and left atrial pressure of 10mmHg. During the first 24 hours of TAH pumping, driving pressure ranged from 178$\pm$5mmHg to 187$\pm$8mmHg for the left heart and from 58$\pm$6mmHg to 78$\pm$28mmHg for the right heart. The Mean arterial pressure significantly increased between 2 and 8 hours after the start of pumping. The survival time ranged from 27 hours to 46 days. The causes of death were respiratory failure in 2 cases, mechanical valve failure in one, and left ventricular outflow obstruction due to thrombus in a 46-day survival case. This study demonstrated that Tomasu artificial heart operated effectively during the first 24 hours of artificial heart pumping, but thrombus formation around the valve holding area was the main problem in long-term survival case.

• Journal of Chest Surgery
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• v.40 no.6 s.275
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• pp.445-447
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• 2007

Occlusion of a coronary artery ostium and especially occlusion of the right by an aortic cusp is a rare condition. We experienced an adult patient with occlusion of the right coronary ostium that was due to fusion of the right coronary cusp to the aortic wall along with underlying rheumatic aortic valve stenosis. During the operation, the adherent right coronary cusp was excised. After confirming that the right coronary ostium was patent, the other cusps were removed, and this followed by replacement of the aortic valve with a mechanical valve. The postoperative course was uneventful.

• Journal of Biomedical Engineering Research
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• v.25 no.5
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• pp.421-430
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• 2004

Clinically, it is almost impossible for a physician to distinguish subtle changes of frequency spectrum by using a stethoscope alone especially in the early stage of thrombus formation. Considering that reliability of mechanical valve is paramount because the failure might end up with patient death, early detection of valve thrombus using noninvasive technique is important. Thus the study was designed to provide a tool for early noninvasive detection of valve thrombus by observing shift of frequency spectrum of acoustic signals with computer aid diagnosis system. A thrombus model was constructed on commercialized mechanical valves using polyurethane or silicon. Polyurethane coating was made on the valve surface, and silicon coating on the sewing ring of the valve. To simulate pannus formation, which is fibrous tissue overgrowth obstructing the valve orifice, the degree of silicone coating on the sewing ring varied from 20％, 40％, 60％ of orifice obstruction. In experiment system, acoustic signals from the valve were measured using microphone and amplifier. The microphone was attached to a coupler to remove environmental noise. Acoustic signals were sampled by an AID converter, frequency spectrum was obtained by the algorithm of spectral analysis. To quantitatively distinguish the frequency peak of the normal valve from that of the thrombosed valves, analysis using a neural network was employed. A return map was applied to evaluate continuous monitoring of valve motion cycle. The in-vivo data also obtained from animals with mechanical valves in circulatory devices as well as patients with mechanical valve replacement for 1 year or longer before. Each spectrum wave showed a primary and secondary peak. The secondary peak showed changes according to the thrombus model. In the mock as well as the animal study, both spectral analysis and 3-layer neural network could differentiate the normal valves from thrombosed valves. In the human study, one of 10 patients showed shift of frequency spectrum, however the presence of valve thrombus was yet to be determined. Conclusively, acoustic signal measurement can be of suggestive as a noninvasive diagnostic tool in early detection of mechanical valve thrombosis.

• Journal of Veterinary Clinics
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• v.31 no.4
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• pp.307-312
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• 2014

A 16-year-old female Shih-Tzu, weighing 5 kg, presented with clinical symptoms of abdominal distension and urinary and fecal incontinence. Abdominal palpation detected a large mass. According to the radiographic findings, the bladder had been moved to the umbilicus by the mass and a large abdominal mass was confirmed in the lower abdominal area. Ultrasonography indentified a large heterogeneous mass with heterogeneous parenchyma and a focal anechoic area in the lower abdominal area. The complete blood count abnormalities suggested thrombocytosis and mild neutrophilia, and the serum chemistry indicated an elevated alkaline phosphatase value. During laparotomy, a firm mass that measured $10.5{\times}9.6cm$ was found between the uterine cervix and urinary bladder. The urethra was embedded in the mass. A diagnosis of leiomyosarcoma was established based on histopathology and histochemistry. One week after surgery, urinary retention symptoms that did not appear to be related to mechanical obstruction presented suddenly, but they did not respond to several drug treatments, thus long-term conservative therapy was adopted. The urinary symptoms disappeared on day 27 and the patient started to void large quantities of urine in a smooth and frequent manner. This case report describes the serial changes in the patient's status and the response after surgical remove of the urethra embedding leiomyosarcoma.

• Journal of Chest Surgery
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• v.29 no.10
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• pp.1111-1117
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• 1996

Structural deterioration of the bioprosthetic xenograft valves due to primary tissue failure occurs in two modes: from fatigue lesions with tear and wear with or without calcification and from calcification with obstruction. Two groups of consecutive 56 patients with the Hancock porcine ortic valve(HM) and of 1 13 patients with the standard-profile onescu-Shiley bovine pericardial valve(ISM) explanted from mitral position at the time of re-replacement surgery for primary tissue failure at Seoul national University Hospital until 1994, were studied for clinical and pathological features. Their ages at primary implant were 31.9 $\pm$9.2 years In HM and 30.4$\pm$ 12.5 years in ISM. Hemodrnamic dysfunction of the failed mitral bloprostheses were predominantly insufficiency in HM(64.3%) and stenosis in ISM(51.3%)(p<0.001). Pathologic findings of the explanted mitral valves reflected these hemodynamic changes, revealing failure more often from tissue damage(tears and wears) in HM and more often from calcification in ISM(p< 0.001). Explant period(from primary implant to explant) was relatively short in ISM(8.7$\pm$2.6years), compared with the one in HM(10.4 $\pm$2.6 years)(p<0.001). In conclusion, both the Hancock and the lonescu-shiley valves would fail from calcification as well as issue damage. However, while the Hancock porcine valves in mitral position failed more frequently from tissue failure and insufficiency, the standard-profile lonescu-Shiley pericardial valves did from calcification and stenosis, especially in young pAtients . Although the possibility of less occurrence of valve failure from mechanical reasons may be expected with newer generation bloprostheses, it does not seem to Improve durability significantly unless further refinement in antimineralization is achieved. Therefore, clinical use of the glutaraldehyde-treated bioprosthetic valves is, at present, limited to the patients of advanced age groups.

• The Journal of Internal Korean Medicine
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• v.26 no.1
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• pp.265-274
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• 2005

Diabetic gastroparesis is a disorder in a diabetic of delayed gastric emptying in the absence of mechanical obstruction. It is estimated that about 20%-50% of diabetics suffer from gastroparesis. Clinical Sympoms include early satiety, bloating, nausea, anorexia, vomiting, abdominal pain, and weight loss. Severe gastroparesis might result in recurrent hospitalization, malnutrition, and even death, but, no exact treatment has yet been established. Electrogastrography has been known to be a simple, non-invasive, and effective method in assessing gastric motility and EGG has been used to diagnosis diabetic gastroparesis and to estimate its prognosis. Recently, two cases of diabetic gastroparesis were observed. For this cases, manual acupucture, electroacupucture, lumbar skin warming and herb medicine were applied. After application of these therapies, gastrointestinal symptoms improved and these therapeutic effects were confirmed in EGG. Moreover, blood glucose control improved, so patients were able to discontinue insulin injection and change to p.o.medication. In light of this encouraging application of oriental medicine, this is reported along with investigation of the literature.

• Journal of Chest Surgery
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• v.40 no.8
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• pp.558-563
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• 2007

Background: Traumatic aortic rupture is a highly fatal condition in which a patient's outcome is strongly affected by other associated injuries. Selection of the appropriate surgical timing and the management plan is important. Material and Method: The medical records of the 15 traumatic descending thoracic aortic rupture patients who underwent the clamp & sew technique were retrospectively reviewed and checked for the presence of associated injuries and the postoperative course. Result: The hospital mortality was 6.07% (one patient). This patient died intra-operatively and the cause of the death was delayed hemoperitoneum. The mean operative time and aortic clamp time were $231{\pm}53.1$ and $13.1{\pm}5.3$ minutes, respectively. One patient complained the bowel obstructive symptoms at postoperative 10 days. We found the mechanical bowel obstruction on computed tomography of the abdomen, and segmental bowel resection was done. Conclusion: Although several surgical strategies may be appropriate for managing traumatic aortic rupture, the clamp & sew technique is a safe and effective method for the treatment of traumatic aortic injury.