• Childhood Kidney Diseases
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• 제23권2호
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• pp.128-133
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• 2019

Henoch-$Sch{\ddot{o}}nlein$ purpura (HSP) is a systemic vasculitis characterized by purpura, arthritis, abdominal pain, and nephritis. Gastrointestinal involvement can manifest as pain, intussusception, intestinal bleeding, and intestinal perforation. We report a case of fulminant HSP at an age of eight in 1994, with multiple complications of intra-thoracic bleeding, massive intestinal perforation, nephritis, and various skin rashes. The brisk bleeding findings of intestinal on Technetium-99m-labeled red blood cell scan ($^{99m}Tc$ RBC scan) were well matched to those of the emergency laparotomy and the resected intestine. The patient's abdominal conditions improved gradually but nodular skin eruptions developed newly apart from improving preexisting lower limb rashes and the urine findings continued abnormal, so skin and kidney biopsy were done for the diagnosis. After cyclosporine therapy, skin eruptions and urine findings returned to normal gradually. On a follow-up after 25 years in 2019, the patient is 33-year-old, healthy without any abnormality on blood chemistries and urine examination.

• Journal of Chest Surgery
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• 제31권11호
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• pp.1076-1080
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• 1998

연구배경 : 자연성 기흉은 흉부외과 영역에서 흔히 접하게 되는 질환 중의 하나로서 주로 젊은 연령층의 키 크고 마른 남자의 경우 호발하며 뚜렷한 유발 인자 없이 기포의 파열로 인해 발생하나, 흉강 내 혈액이 같이 축적되는 자연성 혈기흉은 드문 질환 으로 알려져 있다. 재료 및 방법 : 인제대학교 부산백병원 흉부외과학 교실에서는 1990년부터 1997년까지 최근 8년간 자연성 혈기흉 15례를 경험하여 다음과 같은 결과를 얻었다. 결과 : 남녀 비는 14:1로 남자가 대부분이었으며 30대 이하가 14례로 전체의 93.3%를 차지하였다. 발생부위는 우측이 10례 좌측이 5례였으며 내원시 흉통 및 흉부 불쾌감, 호흡곤란 등을 호소하는 경우가 대부분 이였고 과다 출혈로 인한 쇼크 현상을 나타낸 경우가 1례 있었다. 원인으로는 유착 파열이 14례였으며 내인성 폐질환인 결핵이 1례였다. 전례에서 폐쇄식 흉강삽관술을 시행하여 대부분 특별한 문제없이 치유되었으나 전원되었던 1례에서 지속적인 출혈로 발병 3일 후 개흉술을 시행하였다. 그 외 폐쇄식 흉강삽관술로 치료한 30일 및 50일 후에 발생한 섬유흉과 동측의 기흉으로 늑막박피술과 폐쇄기절제술을 시행한 경우가 각 1례씩 있었다. 결론 : 자연성 혈기흉의 치료에는 흉강천자, 폐쇄식 흉강삽관술, 비디오 흉강경 수술, 개흉술 등이 있으며 발병 후 환자의 내원이 빠른 시간 내에 이루어지고 지속적 출혈이 없다면 단순한 폐쇄식 흉강삽관술 만으로도 대부분 특별한 합병증 없이 치료가 가능할 것으로 사료된다.

• Journal of Chest Surgery
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• 제23권6호
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• pp.1180-1190
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• 1990

96 patients underwent cardiac valve replacement for valvular heart diseases consecutively between February 1986 to February 1990 in the Department of Thoracic and Cardiovascular Surgery of Yeungnam University Hospital. The follow up period was between 6 months and 4.5 years postoperatively[mean 23.4$\pm$13.1 months]. 75 cases got mitral valve replacement, 6 cases, aortic valve replacement, 15 cases, double valve replacement. 30[31.2%] patients were male and 66[68.8%] were female and the age ranged from 14 to 66 years old. Early hospital death within 30 days postoperation were 5 patients[5.2%], consisting of by low cardiac output in 2, infective endocarditis in 1, multiple organ failure with sepsis in 1 patient. There was no late postoperative death. Most common early postoperative complication was wound disruption [8.7%] and then low cardiac output, pneumothorax, pleural effusion in order. Most common late postoperative complications were minor bleeding episodes[8.7%] related to anticoagulant therapy which were consisted of frequent epistaxis in 3, gum bleeding in 2, hemorrhagic gastritis in 1, hypermenorrhea in 1, hematoma in right arm in 1 patient. Valve-related complications included valve thrombosis [1.6%/ patient-year], valve failure due to pannus formation[1.1% /patient-year], prosthetic valve endocarditis[1, 1%o/patient-year] and minor anticoagulant hemorrhage[4.4% /patient-year]. 5 cases of reoperations were performed in 4 patients due to valve failure and all of them were in the mitral positions[2.7% /patient-year]. Cardiothoracic ratios in the chest X-ray decreased at the 6th month and 1st year postoperation in all patients. But in New York Heart Association[NYHA] functional class IV, no change in cardiothoracic ratio was found between 6 months and 1 year postoperation. In the echocardiogram, the size of the cardiac chambers decreased, but ejection fraction increased postoperatively in each functional class. In the electrocardiogram, decreases were found in the incidence of atrial fibrillation, left atrial enlargement, left ventricular hypertrophy with right bundle branch block increasing postoperatively in each functional class. The actuarial survival rate was 98.4% for all patients, 98.7% for mitral valve replacement, 83.8% for aortic valve replacement, and 80% for double valve replacement at the end of a 4.5 year follow up period. Meanwhile the actuarial freedom rate was 91.5% for prosthetic valve endocarditis, 91.6% for thromboembolism, 89.0% for prosthetic valve failure and 83.7% for minor anticoagulant hemorrhage. Preoperative NYHA class III and IV were 75% of all patients, but 95% of all patients were up graded to NYHA class I and II postoperatively.

• Journal of Chest Surgery
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• 제8권1호
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• pp.37-44
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• 1975

Authors have reviewed the records of seven patients of multiple rib fractures with severe flail chest who were admitted to Hanyang University Hospital during the 3 years period from 1972 through 1975. Of the seven patients studied, automobile accidents led to the injuries in 4 cases, two patients were injured in fall from a tree and on the ox-heading. All who had a blunt trauma without any open wound on the chest. The numbers of the fractured ribs accounted for 6 to 9 of the ribs including double fractures from 3 to 5 ribs. The left side fractures occurred in the 6 patients and in the right only one patient. Thus the flail segment was more often located in the left antero-lateral position than in the right lateral position [the ratio was 6:1].. All cases had associated injuries. The injuries and multiple fractures were the most common associated injuries occurring in four and five of the patients respectively. The patients were classified as having associated head injuries when they were admitted in comatose or semicomatose state. When a major degree of instability of the thoracic cage exists, adequate respiratory change is not possible. For this reason the tracheostomy was performed in five patients in an acutely injured patient with flail chest only after an endotracheal tube has been inserted or after an endotracheal suction. All patients had secondary complications in the pleural cavity, such as hemothorax or hemopneumothorax with or without intrapulmonary hemorrhage and subcutaneous emphysema. Therefore, closed thoracostomy was performed in five patients in the emergency room. The thoracotomy was required in four patients: immediate operation without closed thoracostomy was performed in two patients and the thoracotomy was indicated in two patients after closed thoracostomy, because of increasing intrathoracic hemorrhage. As to the fixation of the flail segments, authors employed two techniques; one was towel clip traction of the flail segments and the other was intramedullary insertion of Kirschner`s wire in to the double fractured rib fragments for the fixation of the flail segments [Kirschner`s wire fixation]. Because` of an different results in the course of treatment between two techniques, data from patients with towel clip traction was compared with those from patients with thoracotomy and Kirschner`s wire fixation of the flail segments. Of the three patients with towel clip traction, two patients required bronchoscopic toilet due to lung atelectasis which developed because of inadequate motion of thoracic cage and poor expectoration. This was in contrast to the four patients with thoracotomy and Kirschner`s wire fixation, who didn`t these complication because of adequate motion of the thoracic cage and subsequent good expectoration.

• Clinical and Experimental Pediatrics
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• 제50권12호
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• pp.1180-1187
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• 2007

Systemic lupus erythematosus (SLE) is an episodic, multi-system, autoimmune disease characterized by widespread inflammation of blood vessels and connective tissues and by the presence of antinuclear antibodies (ANAs), especially antibodies to native (double-stranded) DNA (dsDNA). Its clinical manifestations are extremely variable, and its natural history is unpredictable. Untreated, SLE is often progressive and has a significant fatality rate. The most widely used criteria for the classification of SLE are those of the American College of Rheumatology (ACR), which were revised in 1982 and modified in 1997. The presence of four criteria have been diagnosed as a SLE. Rashes are common at onset and during active disease. The oral mucosa is the site of ulceration with SLE. Arthralgia and arthritis affect most children and these symptoms are short in duration and can be migratory. Lupus nephritis may be more frequent and of greater severity in children than in adults. The initial manifestation of nephritis is microscopic hematuria, followed by proteinuria. The most common neuropsychiatric symptoms are depression, psychosis(hallucination and paranoia) and headache. CNS disease is a major cause of morbidity and mortality. Pericarditis is the most common cardiac manifestation. Libman-Sacks endocarditis is less common in children. The most frequently described pleuropulmonary manifestations are pleural effusions, pleuritis, pneunonitis and pulmonary hemorrhage. During the active phase ESR, CRP, gamma globulin, ferritin and anti-dsDNA are elevated. Antibodies to dsDNA occur in children with active nephritis. Antibodies to the extractable nuclear antigens (Sm, Ro/SS-A, La/SS-B) are strongly associated with SLE. Specific treatment should be individualized and based on the severity of the disease. Sepsis has replaced renal failure as the most common cause of death.

• Journal of Chest Surgery
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• 제25권3호
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• pp.220-231
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• 1992

We have performed 28 single lung transplantation in mongrel dogs transplanting the left lung exclusively from November 1989 to September 1991, in the department of thoracic surgery of Seoul National University Hospital. In the donor dogs, the main pulmonary artery was divided proximal to its bifurcation, and the left atrium was incised freeing the left veins with a generous atrial cuff. We used cold saline in the first 7 transplantations and Euro-Collins or modified Euro-Collins solution in the remaining 17 transplantations as a lung preservatives. The bronchus was divided at two cartilage rings proximal to the upper lobe bronchus take off. In the recipient procedure, we used a Fogarty catheter as a bronchus block. Left atrial anastomosis was performed first using 5-O prolene and the pulmonary artery was anastomosed using 6-O prolene. The bronchus was anastomosed next with 4-O vicryl interruptedly and covered with a greater omentum which had been prepared previously. All dogs received cyclosporin A and azathioprine as immunosuppressants and were divided into two group. In the 10 Group I dogs, they survived within 6 days, mean survival time was 66.8$\pm$53.4 hours. In remainder 14 Group lI dogs, they survived above 6 days, mean survival time was 9. 5$\pm$5.6 days. The cause of death were as follows: 2 cases of sacrifice, 2 cases of respiratory insufficiency during operation, 2 cases of arrhythmia immediate postoperatively, 2 cases of bleeding, others in Group I, and 6 cases of sacrifice, 4 cases of sepsis, 3 cases of bleeding, others in Group lI. Results of bronchoscopic findings were obstruction above 50% in 12 cases of 16 performance cases within 5th day. Early chest radiologic haziness were showed, and total lung perfusion defect was frequently showed in both group within 7th day. Main autopsy findings were left atrial and pulmonary arterial thrombi and bronchial obstruction The major histologic findings of Group I were pleural exudate, hemorrhagic infarct, pulmonary congestion, and interesting histologic findings of Group II were 3 cases of perivascular or peribronchial lymphocyte infiltration, 3 cases of hemorrhage infarct, 2 cases of interstitial pneumonitis. The structual change of bronchioles, suggesting bronchiolitis obliterans was not observed due to improper preparation of proximal pulmonary tissue and short term survival times.

• Tuberculosis and Respiratory Diseases
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• 제47권4호
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• pp.538-542
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• 1999

von Recklinghausen 병을 진단 받았거나 임상적으로 의심되는 환자에서 외상력없이 갑자기 시작된 흉통을 주소로 내원하여 흉부 X-선 소견상 흉수 소견이 관찰될 때 동맥파열에 의한 자발성 혈흉의 가능성을 의심할 수 있다. 저자들은 von Recklinghausen 병에 드물게 동반되는 늑간동맥류 파열에 의한 자발성 혈흉 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

• Journal of Chest Surgery
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• 제42권6호
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• pp.813-820
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• 2009

1909년 12월 22일 당시 23세의 애국청년 이재명에 의해 이루어진 이완용 암살 기도 사건은 비록 그 결과는 실패로 끝났지만 지금까지도 민족정기를 크게 고취시켰던 사건으로 높이 평가받고 있다. 그런데 이 사건에 연관되어 이재명의 재판을 위해 당시 작성된 이완용의 상해감정서에는 여러 부분에서 의미있는 흉부외과적 기술이 포함되어 있다. 즉 늑골하연 자상, 늑간동맥 출혈, 폐손상, 좌흉부타박상, 외상성 늑막염 등의 전문적인 흉부외과 병명이 언급되고 있으며 그리고 기흉과 혈흉을 의미하는 기술(폐를 손상하여 창공으로부터 출혈 및 호흡에 수반된 공기 출입이 있었다)도 포함되어 있다. 또한 흉부천자술에 의한 혈성 삼출액 배출이라는 외과적 시술에 관해서도 기록되어 있다. 이 기록은 여러 정황 분석 상 한국사 최초의 흉부외과 관련 의학기록으로 판단된다. 따라서 본 연구논문은 우리나라 근대사에서 중요한 의미를 지닌 한 사건을 통하여 한국사 최초의 흉부외과 관련 기록을 발굴, 분석하였다는데 그 의미가 크다고 할 것이다.

• 대한영상의학회지
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• 제82권3호
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• pp.682-687
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• 2021

체-폐동맥루는 주로 외상, 감염, 종양 등에 의해 유발될 수 있으나 위험 인자가 없는 환자에서 생기는 체-폐동맥루는 매우 드물다. 이들은 감염이나 출혈 혹은 폐 고혈압 등을 유발할 수 있어 치료가 필요하다. 호흡곤란을 주소로 내원한 67세 여자 환자에서 늑간동맥-폐동맥루가 발견되었다. 먼저 배출혈관인 확장된 폐동맥으로 역행성으로 접근하여 코일 색전술로 치료하였으나 5개월 후 인접폐동맥의 확장이 관찰되어 공급동맥인 늑간동맥을 N-butyl cyanoacrylate를 이용하여 색전하였다. 10개월 추적검사에서 환자의 증상과 확장된 폐동맥은 호전되었다. 체-폐동맥루를 치료에서 순차적 혹은 동시에 역방향과 순방향 접근으로 혈관 내 치료하는 것이 효과적일 수 있겠다.

• Tuberculosis and Respiratory Diseases
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• 제51권2호
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• pp.155-160
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• 2001

한냉글로불린혈증에 의한 급성호흡곤란증후군은 극히 드문 것으로 보고되었다. 저자 등은 B형 간염을 가진 환자에서, 한냉글로불린혈증과 그에 인한 급성호흡곤란 증후군이 발생한 1예를 경험하였기에 보고하는 바이다.