• Journal of Chest Surgery
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• v.23 no.2
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• pp.325-332
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• 1990

Complications of the mediastinal tumors and cysts are malignant change, infection, bleeding, local invasion and mass effect to heart, lung and other mediastinal structures. But early surgical excision and proper treatments bring patients to good clinical course and results. Therefore mediastinal tumors and cysts are surgically interesting diseases We report the analysis of the 58 cases of mediastinal tumors and cysts, experienced in the Department of Cardiothoracic Surgery of the Kosin Medical College from July 1979 to June 1989. The results were as follows ; Sex ratio of male to female to female was 1.3: 1. Range of age was from 11 to 64 years and mean age was 34.3 years. The thymomas were 14 cases[24%], the teratomas were 19 cases[33%o], the neurogenic tumors were 10 cases[17%], the cysts were 9 cases[15%], the carcinomas were 3 cases[5%], the thyroid tumor was 1 case[2%], the Castleman’s disease was 1 case[2%] and unclassified tumor was 1 case[2%]. Malignant tumors were 12 cases [21%] of the 58 cases. Most frequent symptom was chest pain and discomfort and relationship of symptom and malignancy was significant. Complete removal of tumor was performed on the 47 cases[92%] and partial excision was 3 cases[6%]. Inoperable cases were treated with anticancer chemotherapy and radiotherapy. Postoperative complications were wound infection, Homer’s syndrome, phrenic nerve palsy, mediastinal hematoma and pleurisy. There was no case of postoperative mortality and good clinical course in surgically completely resected cases.

• Journal of Chest Surgery
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• v.35 no.7
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• pp.517-522
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• 2002

Background: Congenital heart surgery may lead to myocardial swelling and hemodynamic instability. Delayed sternal closure may be beneficial in this setting. The purpose of this study was to assess mortality and mediastinal infection rate associated with delayed sternal closure after congenital heart surgery and to evaluate the risk factors which affect mortality and mediastinal infection rate. Material and Method: We retrospectively reviewed 40 patients who underwent delayed sternal closure after repair of congenital heart disease at Yonsei Cardiovascular Hospital, from January 1994 to May 2001. In these patients, we assessed the mortality and mediastinal infection rate, and evaluated their risk factors including operation time, bypass time, aortic cross clamp time, duration to sternal closure and postoperative artificial ventilation time. Mediastinal infection was defined to have positive culture in mediastinum. Result: Hemodynamic instability was the most common indication for delayed sternal closure(n=36) and other indications included postoperative bleeding(n=2) and conduit compression(n=2). The median age at operation was $14.4{\pm}33.4$months old(range, 2days-12years). The patients with postoperative bleeding and conduit compression were much older than the others. The sternum was left open for $4.5{\pm}3.4$ days(range, 1-20days). Overall mortality was 25%(10/40) and mediastinal infection occured in 24.3%(9/37) (3 patients were excluded in mediastinal infection for early death). In risk factor analyses, only aortic cross clamp time had statistical significance for mortality in univariate analyses. However, multivariate analyses revealed that there were no significant predictors for risk of mortality and mediastinal infection. Conclusion: Delayed sternal closure after repair of congenital cardiac disease had relatively high mortality and mediastinal infection rate. But, in patients with hemodynamic instability, postoperative bleeding and conduit compression after repair of congenital cardiac disease, delayed sternal closure may be an effective life saving method.

• Journal of Chest Surgery
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• v.3 no.2
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• pp.121-126
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• 1970

This is a report on a total of 8 cases of benign mediastinal tumors and cysts in Department of Thoracic Surgery, Chonnam University Hospital during the period from 1961 to 1969. The patients age was distributed between 18 and 38 year old with the highest incidence in the age group of second decade. Sex ratio of male to female was 3: 5. The tumors were classificed as follow; 3 case:, of neurogenic tumors, 2 cases of teratomas, one case of pericardial cyst, one case of cystic hygroma, and one case of brochogenic cyst. The symptomatic patients were 5 cases(62. 6%) and asymptomatic patients were 3 cases(37.5%). The symptomatic patients had the symptoms not referable to their lesion and the mediastinal tumors of asymptomatic patients were incidently found by routine chest X-ray. The Symptoms occurred by compression to adjacent nerve system in 3 cases. by perforation into the lung with infection in one case and by infection of bronchial cyst in one case. The complications were Pancoast's syndrome including Horner's syndrome(2 cases), middle lobe syndrome (one case), bro:1chial infection(one case) and intercostal neuralgia(one case). All tbe tumors were surgicai[y resectable with good recovery postoperatively. In 5 cases of the symptomatic patents, their symptoms were disappeared dramatically after operation.

• Journal of Chest Surgery
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• v.26 no.5
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• pp.395-402
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• 1993

For the purpose of evaluation of clinical characteristics and histopathological properties in mediastinal tumor, and to provide the guidelines of surgical management of mediastinal tumor,238 patients with mediastinal tumors treated during the period from January 1983 to December 1991 were reviewed at Seoul National University Hospital. There were 106 males & 132 females, and their ages ranged from 3 months to 73 years, with average 33.6 years. The most frequently encountered tumor site was anterosuperior mediastinum followed by posterior, and middle mediastinum. In the pathological viewpoint, thymoma was the most frequent type followed by neurogenic tumor. 81% of the tumor were benign and 19% were malignant. Half of the malignant tumors were neurogenic tumors. Malignancy rate was high in pediatric patients compared to adults as 40% and 19% respectively. 65% of patients were asymptomatic at diagnosis.There was no operative mortality. Post operative complications were occurred in 35 cases. Most frequent complications were adjacent peripheral nerve injuries. But other usual operative complications, such as bleeding, chylothorax, infection, were relatively rare.

• Korean Journal of Bronchoesophagology
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• v.15 no.2
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• pp.64-70
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• 2009

Descending necrotizing mediastinitis(DNM) can occur as a complication of oropharyngeal and cervical infections that spread to the mediastinum via the cervical spaces. Delayed diagnosis and inadequate mediastinal drainage through a cervical or minor thoracic approach are the primary causes of a high mortality rate. Therefore, We emphasize that aggressive and emergent mediastinal drainage by surgical approach is most important method of DNM treatment. We studied 5cases diagnosed as DNM from 2005 through 2007. All patients underwent emergent surgical drainage of deep neck infection combined with mediastinal drainage through a thoracic approach. Primary oropharyngeal infection lead to DNM in four cases(80%) and odontogenic abscess in one case(20%). The outcomes were favorable 5patients. Overall mortality rate was 0%. The time interval from diagnosis based on manifestation of initial symptoms(oral or pharyngolaryngeal area) to surgical intervention was $7.4{\pm}4.2$days. One patient required reoperation due to remnant mediastinal abscess and pericardial effusion. Early diagnosis and emergent combined drainage with neck and chest incisions, together with broad spectrum intravenous antibiotics, should be considered standard care for this disease. And intensive postoperative care which it is continuous mediastinal irrigation and antibiotics use can significantly reduce the mortality rate.

• Journal of Chest Surgery
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• v.28 no.10
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• pp.917-923
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• 1995

For the purpose of analysis of clinical and pathological characteristics in mediastinal tumors and cysts, 82 patients with mediastinal tumors and cysts treated in the department of thoracic and cardiovascular surgery in Chosun University Hospital during the period from January 1978 to December 1994 were reviewed. There were 49 male and 33 female patients in the study. Age ranges from 10 months to 84 years, with the mean 37.2 years. Frequently encountered symptoms and signs were dyspnea[40.2% , abnormal breathing sound[37.8% , chest pain[35.7% , cough[26.8% , and 18.2% of patients were asymptomatic. The most frequent tumor was anterosuperior mediastinum [59.8% followed by middle[24.4% and posterior mediastinum[15.8% . The malignant tumors were found in 35 cases[42.7% . Successful removal of the mass was possible in all the benign mediastinal masses[57.3% . But in the malignant cases, the surgical removal was possible in 18 cases and other inoperable cases were treated by radiation and chemotherapy. The postoperative complications occurred in 9 cases. Usual complications were bleeding[4 cases , wound infection[3 cases , pneumothorax[1 case and vocal cord paralysis[1 case . In the pathologic viewpoint, teratodermoid tumors[22.0% were the most frequent tumor followed by thymomas[19.5 , benign cysts[15.8% , lymphomas[13.4% and neurogenic tumors[8.5% .

• Journal of Chest Surgery
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• v.21 no.3
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• pp.535-540
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• 1988

Many mediastinal masses seen radiologically are clinically asymptomatic. Only 55 to 65 percent of such lesions are asymptomatic, and of these many have only nonspecific symptoms by rupture, infection and pressure of surrounding organs. This report presents one case of a mediastinal teratoma which complicated an empyema. The patient was 7-year-old female and chief complaints were fever, left chest pain and general ache. In her past history, lung decortication and drainage procedure under the diagnosis of an empyema were carried out, 5 years ago, but she had not been improved, And so, explothoracotomy was done. At the time of operation, a mass of adult fist size was placed in the left anterior mediastinum and covered with the mediastinal pleura. Extirpation of the tumor and decortication were carried out and the left lung was remained.

• Archives of Plastic Surgery
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• v.32 no.4
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• pp.421-427
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• 2005

Although the incidence of mediastinal wound infection in patient undergoing median sternotomy for cardiovascular surgery is relatively low(less than 1%), it is not only a devastating and potentially life-threatening complication but also associated morbidity, mortality and cost are unacceptably high. During the past few decades various methods had been applied for the treatment of postoperative mediastinitis. Currently, chest wall reconstruction by using muscle flaps-especially pectoralis major muscle and rectus abdominis muscle are commonly selected for the reconstruction after wide debridement has become widely accepted. We performed bilateral pectoralis major-rectus abdominis muscles in-continuity bipedicle flap to overcome the limit of each flap for reconstruction of sternal defects in 17 patients. We analyzed the results of the surgery. Recurrent infection developed in 17.6% of cases and abdominal herniation was observed in one patient. There was no postoperative hematoma or death. We conclude that this flap is very valuable in reconstruction of the anterior chest wall defect caused by post-sternotomy infection because it provides sufficient volume to fill the entire mediastinum, and the complication rate compares favorably to that of other methods.

• Clinical and Experimental Pediatrics
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• v.48 no.3
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• pp.333-336
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• 2005

Bronchogenic cysts are rare congenital anomalies that arise early in gestation from abnormal budding of the developing respiratory system. Mediastinal bronchogenic cysts account for 10-15 percent of all primary mediastinal masses; 63.7 percent of patients are symptomatic. Common symptoms are fever, chest pain, cough, dyspnea, and dysphagia. Gastrointestinal symptoms except dysphagia are rare. It can be life threatening with compression, infection, hemorrhage, or rupture. Symptoms and signs of compression are more frequent in infants and children than in adults. It may be asymptomatic, or cough, infection, and hemoptysis may be observed. Complete excision is recommended. We report a case of bronchogenic cyst misdiagnosed as chronic gastritis with nausea and epigastric pain for a year.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1979.05a
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• pp.9.1-10
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• 1979

The authors have recently observed a case of Ludwig's angina with forming mediastinal fistula & pneumonia. The Ludwing's angina is the cellulitis of the mouth floor and neck, ie, of the sublingual space. The suppurative inflammation of this space develops from dental infection, and can also develop from ulceration or inflammation of the mouth floor and the tongue base, lingual tonsillitis or salivary calculi. The main causes are characterized as mixed infection which hemolytic streptococcus and staphylococcus are considered to be pathognomic organisms. It may be followed as complications of mediastinal extension, parapharyngeal extension and laryngeal edema. This is the report on this case with literature review.