• Proceedings of the KOR-BRONCHOESO Conference
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• 1981.05a
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• pp.8.5-9
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• 1981

Foreign body in the esophagus is not uncommon in the otolaryngological field and esophageal perforation followed by mediastinitis is one of the most serious complications. Authors had experienced such case developed in 69 year old female patient. This woman swallowed a piece of sharp glass accidentally. Severe pain and swelling around the neck developed after ingestion. Marked subcutaneous emphysema was noted on first examination. By esophagoscopy, longitudinal laceration at right lateral wall of the cervical esophagus was noted and a lot of food debries were removed through this perforation, but foreign body could not be found. On third hospital day, patient complained chest pain and dyspnea. Mediastinal widening was noted on chest P-A. Tracheostomy was performed on next day and neck swelling decreased much. In spite of massive antibiotics, mediastinal abscess was developed and external drainage was performed on 15th hospital day. She was discharged on 38th hospital day with marked improvement and recovered completely on follow-up study. Still, we do not know where the foreign body is located.

• Clinical and Experimental Otorhinolaryngology
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• v.11 no.4
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• pp.293-300
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• 2018

Objectives. The current study aims to determine the correlation between nutritional status upon presentation and disease severity, as well as treatment and survival outcomes. Methods. Patients who were diagnosed with deep neck infection, underwent at least one surgical drainage/debridement, and had more than 1 week of hospitalization at a tertiary medical center from 2007 to 2015 were retrospectively included. Thereafter, initial serum albumin, C-reactive protein (CRP), and body mass index (BMI) were reviewed. Results. A total of 135 patients were included in the final analysis. Accordingly, the proportion of patients with simultaneous mediastinitis (21.0%), necrotizing fasciitis (12.9%), disease extent >1 cervical level (72.6%), mean CRP (22.4 mg/dL), mean length of hospitalization (25.0 days), and mean 1-week follow-up CRP (7.2 mg/dL) was significantly higher in the hypoalbuminemia group (initial serum albumin <3.0 g/dL) than in the normoalbuminemia group (all P<0.05). No significant correlations had been observed according to BMI status. After adjusting for age and Charlson comorbidity index, odds ratios for the following outcomes were calculated in patients initially presenting with hypoalbuminemia: simultaneous mediastinitis (3.07), necrotizing fasciitis (7.89), disease extent >1 cervical level (2.12), initial serum CRP over 20 mg/dL (3.79), hospitalization of more than 14 days (4.10), 1-week follow-up CRP over 5 mg/dL (3.78), and increased duration for an over 50% decrease in initial CRP (2.70) (all P<0.05). Although intravascular albumin replenishment decreased the proportion of patients with hypoalbuminemia after 2 weeks (P<0.05), it did not significantly predict better treatment outcomes. Conclusion. Among the markers reflecting an individual's nutritional state, an initial serum albumin of less than 3.0 g/dL was an independent serologic marker predicting increased disease severity and complications in patients with deep neck infection.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.32 no.6
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• pp.597-599
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• 2010

Subcutaneous emphysema and pneumomediastium is a relatively uncommon phenomenon. Most case of pneumomediastium are caused by iatrogenic injury on the cervical region and chest during tracheostomy. It is also well known that emphysema may occur secondary to dental treatment using high-speed air turbine handpiece, but there have been few cases of emphysema extended to involving the mediastinum. These complications are reported to occur mainly in patients after dental procedures, in particular during mandibular third molar extraction. Early recognition and conservative treatment of these problems is essential in preventing life-threatening complications such as airway obstruction, mediastinitis, pneumothorax and cardiac failure. As we report a case of 25-year-old woman with subcutaneous emphysema and pneumomediastium after mandibular third molar extraction using high-speed air turbine handpiece.

• Journal of Trauma and Injury
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• v.31 no.1
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• pp.16-18
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• 2018

Delayed esophageal rupture due to blunt injury is not new. However, rupture due to suspected barotrauma is very rare. We describe a case of esophageal rupture in a male 24-year-old patient after diving in shallow waters. The patient was quadriplegic and could not experience the typical chest pain related to rupture and resulting mediastinitis. The rupture was discovered 4 days after emergency decompressive laminectomy and fusion for his cervical spine. The rupture was evidently caused by barotrauma and was discovered four days after admission. He underwent primary closure and pericardial flap as a life-saving procedure.

• Journal of Chest Surgery
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• v.23 no.1
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• pp.115-121
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• 1990

We have experienced twenty-eight patients of esophageal perforation at the department of thoracic and cardiovascular surgery, Seoul National University Hospital during the period from Jan. 1957 to Jun. 1989. The ratio between male and female patients was 17:11, and their age ranged from 2 years to 61 years old. [average: 30.4 years old] The cause of esophageal perforation were instrumental trauma in 9 cases, caustic perforation in 6 cases, spontaneous perforation in 6 cases, surgical trauma in 2 cases, and others in 5 cases. The most frequent location of perforation was in the lower third portion of the esophagus [13 case, 46 %]. Patients complained of chest pain [86 %], dyspnea [57 %], fever [57 %], subcutaneous emphysema [43 %], and others. The frequent complications of esophageal perforation were empyema [13 cases, 46 %] and mediastinitis [11 cases, 39 %]. The first treatment was supportive care in 3 cases, primary closure and reinforced procedures in 13 cases with 3 deaths, open drainage in 5 cases with 2 deaths, diversion in 4 cases with 2 deaths and closed thoracostomy drainage in 3 cases. After the first treatment, 6 patients received multi-staged operations for several months. Overall mortality was 25 %, and the most frequent cause of death was sepsis[57 %]. We thought that factors affecting the outcome of esophageal perforation are;[1] early diagnosis and adequacy in the first treatment, [2] intensive perioperative management including multi-stage surgical approach, [3] patient`s condition at the diagnosis

• Journal of Chest Surgery
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• v.35 no.12
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• pp.898-901
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• 2002

It is now widely accepted that the complete arterial coronary revascularization has better short and long term results compared to coronary bypass surgery using arterial graft mixed with vein graft mainly due to its superior patency rate. However, sometimes the internal thoracic artery and other conventionally used grafts might be unavailable or it may require caution in using bilateral internal thoracic artery especially in diabetic patient because of the possible risk of the mediastinitis or other associated morbidities. Moreover, there could also be a shortage for arterial graft in case of coronary reoperation. We report our first three cases using thoracodorsal artery(TDA) as an alternative graft in complete arterial coronary revascularization.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.8 no.1
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• pp.75-81
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• 1997

The clinical investigation was done in the 42 patients with bilateral vocal cord palsy who visited the otorhinolaryngologic department of the Yongdong Severance Hospital during the 10-year period between August 1986 to August 1996. On the sex and age distribution, the ratio of male to female patients was 2.8 : 1 and the age was evenly distributed and average was 46 years old. Of their chief complaints, dyspnea was the most common symptom. Among the position of the paralyzed vocal cords, paramedian position was most common. The most common causes of the bilateral vocal cord palsy was idiopathic Other causes include iatrogenic, prolonged intubation, head ＆ neck trauma, brain tumor, Myasthenia Gravis, and mediastinitis. Our treament results were as follows. Recovery rate of idiopathic bilateral vocal cord palsy was 77.7% and recovery period after bilateral vocal cord palsy was shortened remarkedly after use with steroid. We performed laser arytenoidectomy in patients with irreversible idiopathic vocal cord palsy, neural injury, and cricoarytenoid joint fixation. Decannualtion was possible to be carried out in 86% of the patients and none of complication except for 1 case of aspiration developed. Thus we concluded that it was meaningful surgical treatment of bilateral vocal cord palsy.

• Journal of Chest Surgery
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• v.23 no.2
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• pp.285-298
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• 1990

The records of 67 patients who had been operated as an esophageal cancer during the period from 1973 to 1989 at the Department of Thoracic and Cardiovascular Surgery, Hanyang University Hospital were reviewed retrospectively. The results were summarized as follows ; The age ranged from 28 years old to 80 years old. The highest incidence was 5th decades, then 6th decades, and the incidence of male was 10 times as the incidence of female[M:F= 10.16: 1]. The locations were lower esophagus 44%, middle esophagus 38.8%, upper esophagus 11.9% and cervical esophagus 4.4% The frequent symptoms were dysphagia [88%], epigastric or substernal pain and discomfort [29.8%], weight loss [20.8%], and laryngeal dryness [1.4%]. The most common interval between the onset of dysphagia and admission was 2-3 months; 82% of patients was within 6 months, The cancer consisted of stage I [3%], stage II [11.9%], stage III[47.6%], and stage IV [33.7%] The resectability of cancer was 67%. The organs of substitute were stomach in 21 cases, right colon 6 cases, and jejunum in 8 CRSCS. The relation between invasion of tumor and lymph node metastasis was analyzed: mucosal involvement: 1 case/2case, muscle invasion; 0/2 full thickness; 4/6, adjacent structure 7/12. Postoperative complications were pneumonia, pleural effusion, hoarseness, mediastinitis, anastomosis site leakage, reoperation due to stenosis, chylothorax, empyema, mechanical ileus, wound infection, meat impaction at anastomosis site, and repair of gastrostomy site leakage. Adjuvant therapies were irradiation [15cases], chemotherapy [14cases], and Bougie dilatation [4 cases],

• Journal of Chest Surgery
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• v.28 no.10
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• pp.906-911
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• 1995

From January 1991 to January 1995, 11 patients with aortic diseases underwent various surgical repairs. The age at operation ranged from 26 years to 63 years[ mean=50.9 years . The disease entities included 8 aortic dissections[ type I in 4, type II in 2 and type III in 2 cases , 2 Marfan`s syndrome with annuloaortic ectasia and 1 desecending thoracic aortic aneurysm The operative procedures we tried were 3 Bentall`s operation, 5 graft replacement of ascending aorta, and 3 graft interposition in descending thoracic aorta.Overall hospital mortality rate is 36.3%[4/11 . And causes of death are pump weaning failure in 2 cases and multiorgan failure in 2 cases. It was that 2 sternal dehiscence & mediastinitis, 1 acute renal failure, 2 hypoxic brain damages and 2 postoperative psychosis were complicated. Recently we tried surgical repair of aortic dissection five out of 6 cases using total circulatory arrest with deep hypothermia at 14$^{\circ}C$. Total circulatory arrest time ranged from 18 to 26 minutes[ mean 22.2 minutes , and mean aortic cross-clamping time was 48.2 minutes. One of 5 patient died on the 7th postoperative day due to multiorgan failure. Mortality of patients with TCA was 20%[1/5 , and it of remainders was 50%[3/6 . Our result for surgical repair using total circulatory arrest with deep hypothermia is satisfactory on the basis of our clinical data.

• Journal of Chest Surgery
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• v.28 no.2
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• pp.170-176
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• 1995

Fourty nine patients out of 127 esophageal cancer were managed surgically from January 1986 to December 1991, at the Department of Thoracic and Cardiovascular Surgery, Jeonbuk National University Hospital. Most frequent preoperative symptom was dysphagia and its mean duration was 3.1 months. In histopathologic examination, squamous cell carcinomas were 44 cases [89.8% , and adenocarcinomas 5 [10.2% . The tumor location were the upper esophagus in 6.1%, middle esophagus in 57.2%, lower and cardiac portion of stomach in 36.7%. Involved and metastatic organs, which were detected perioperatively, were celiac lymph nodes in 6 cases, aorta 2, stomach 2, pericardium 2, cervical lymph node 1. The esophagus was resected radically, and the procedures for esophageal replacement were performed with esophagogastrostomy in 45 cases, esophagocologastrostomy 3, and esophagojejunostomy 1. Postoperative complications occurred in 16 cases [hospital morbidity = 32.6% ,anastomotic leak 3, anastomotic stricture 2, respiratory insufficiency 2, hemoperitoneum 1, chylothorax 1, intussusception 1, empyema 1, non-A,non-B hepatitis 1, and mediastinitis 1. Hospital deaths were experienced 3 cases [ hospital mortality = 6.1% . The 6 month, one, two, and five year actuarial survival rates were 85.7%, 71.4%, 57.1%, and 27.9%, respectively. One year survival rates of stages were 100% in stage I, 90.9% in stage IIa, 63.6% in stage IIb, 25.0% in stage III, and 7.2% in stage IV.