• Journal of Chest Surgery
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• 제18권1호
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• pp.111-121
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• 1985

A clinical analysis was performed on 312 cases of the chest trauma experienced at department of thoracic surgery, Chosun University Hospital during the past 6 years 10 months period from January 1978 to October 1984. 1. The ratio of male to female patient of the chest trauma was 3.1:1 in male predominance and age from 20 to 50 occupied 71.2% of the total cases. 2. The most common cause of the chest trauma was traffic accidents [45.5%] in this series. 244 cases [78.2%]were injured due to non-penetrating injuries and the remainders [68 cases, 21.8%] were injured due to penetrating injuries. 3. The frequently injured site of the chest trauma was left side of the chest [56.4%], the right side was 33% and the both side was 10.6%. 4. The most common symptoms were chest pain and dyspnea, and common signs were diminished breathing sound and subcutaneous emphysema. 5. The Hemothorax, Pneumothorax, Hemopneumothorax, and Hemopericardium were observed in 190 cases [60.9%] of the total cases, and etiologic distribution revealed 76.5% due to penetrating injuries and 56.6% due to non-penetrating injuries. 6. The rib fractures were observed in 210 cases [67.3%] of the total cases and the most common site of the rib fracture was 6th rib 140 cases [19.2%]. The common site of the rib fracture was from 4th rib to 7th rib [63.8%]. 7. The lung injuries were observed in 150 cases [48.1%] and the other organ injuries were observed in 260 cases [83.3%]. 8. Conservative treatment including thoracentesis were performed in 153 cases [49.1%], Closed thoracotomy with water seal drainage were performed in 112 cases [35.9%], and open thoracotomy were performed in 45 cases [14.4%]. 9. The complications of the chest trauma were developed in 63 cases [20.2%] and the common complications were atelectasis, wound infection and pneumonitis etc. 10. Overall mortality was 0.96% [3 cases] and the cause of death was bacteremia, hypovolemic shock, heart failure and pulmonary edema.

• Archives of Plastic Surgery
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• 제45권5호
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• pp.418-424
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• 2018

Background Complication rates after flap coverage for pressure ulcers have been high historically. These patients have multiple risk factors associated with poor wound healing and complications including marginal nutritional status, prolonged immobilization, and a high comorbidities index. This study utilizes the National Surgical Quality Improvement Program (NSQIP) to examine perioperative outcomes of flap coverage for pressure ulcers. Methods Data from the NSQIP database (2005-2015) for patient undergoing flap coverage for pressure ulcers was identified. Demographic, perioperative information, and complications were reviewed. One-way analysis of variance and Pearson chi-square were used to assess differences for continuous variables and nominal variables, respectively. Multivariate logistic regression was performed to identify independent risk factors for complications. Results There were 755 cases identified: 365 (48.3%) sacral ulcers, 321 (42.5%) ischial ulcers, and 69 (9.1%) trochanteric ulcers. Most patients were older male, with some degree of dependency, neurosensory impairment, high functional comorbidities score, and American Society of Anesthesiologists class 3 or above. The sacral ulcer group had the highest incidence of septic shock and bleeding, while the trochanteric ulcer group had the highest incidence of superficial surgical site infection. There was an overall complication rate of 25% at 30-day follow-up. There was no statistical difference in overall complication among groups. Total operating time, diabetes, and non-elective case were independent risk factors for overall complications. Conclusions Despite patients with poor baseline functional status, flap coverage for pressure ulcer patients is safe with acceptable postoperative complications. This type of treatment should be considered for properly selected patients.

• Pediatric Infection and Vaccine
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• 제20권2호
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• pp.98-104
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• 2013

뎅기열은 아시아, 남태평양 지역, 아프리카, 아메리카 대륙의 열대지방에 걸쳐 널리 발생하며, 이러한 유행지역으로부터 돌아온 여행자들에게 중요한 감염 질환의 하나로 부각되고 있다. 풍토지역을 방문하는 여행자의 점차적인 증가로 뎅기 바이러스에 대한 노출의 위험도가 증가하고 있으며, 이로 인해 해외에서 유입되는 뎅기 감염 사례가 증가하고 있다. 뎅기열은 다양한 임상 양상을 나타내며, 종종 예측할 수 없는 임상 증상과 결과를 초래하기도 한다. 대부분의 감염자들은 저절로 회복되거나 경한 증상을 보이지만, 일부에서는 뎅기 출혈열이나 뎅기 쇼크와 같은 심각한 경과를 보이기도 한다. 따라서 뎅기열 유행지역 방문자가 발열을 보이는 경우 뎅기열을 의심하는 것은 중요하며, 일단 의심이 되면 신속한 진단과 적절한 치료를 통해 합병증을 예방하는 것이 중요하다. 저자들은 뎅기열 유행지역을 여행한 소아에서 발열, 두통, 구역, 발진 등이 발생하여 시행한 혈청검사에서 뎅기열로 진단된 2례를 경험하였기에 보고하는 바이다.

• Journal of Trauma and Injury
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• 제18권1호
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• pp.1-16
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• 2005

An ideal trauma care system would include all the components identified with optimal trauma care, such as prevention, access, acute hospital care, rehabilitation, and research activities. Central to an ideal system is a large resource-rich trauma center. The need for resources is primarily based on the concept of being able to provide immediate medical care for unlimited numbers of injured patients at any time. Optimal resources at such a trauma center would include inhouse board-certified emergency medicine physicians, general surgeons, anesthesiologists, neurosurgeons, and orthopedic surgeons. Other board-certified specialists would be available, within a short time frame, to all patients who require their expertise. This center would require a certain volume of injured patients to be admitted each year, and these patients would include the most severely injured patients within the system. Additionally, certain injuries that are infrequently seen would be concentrated in this special center to ensure that these patients could be properly treated and studied, providing the opportunity to improve the care of these patients. These research activities are necessary to enhance our knowledge of the care of the injured. Basic science research in areas such as shock, brain edema, organ failure, and rehabilitation would also be present in the ideal center. This trauma center would have an integrated concurrent performance improvement program to ensure optimal care and continuous improvement in care. This center would not only be responsible for assessing care delivered within its trauma program, but for helping to organize the assessment of care within the entire trauma system. This ideal trauma center would serve as a total resource for all organizations dealing with the injured patient in the regional area.

• Journal of Chest Surgery
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• 제23권5호
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• pp.929-935
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• 1990

Violence in our society, combined with improving transport system, resulted in increased numbers of patients with cardiac wounds reaching the hospital alive. Most patients with penetrating cardiac injury, rather than blunt injury, present with a syndrome of either hemorrhagic shock or cardiac tamponade. And they should be operated upon as soon as possible. Often the atrioventricular valves and other important cardiac structures are also damaged by the penetrating instruments or missile. Both intracardiac communications and atrioventricular fistulas may result in significant left-to-right shunts accompanied by congestive heart failure, necessitating surgical correction. Usually, retained cardiac foreign bodies, which are almost always bullets or fragments of missiles, may lie within a cardiac chamber or in the myocardium. Emboli of bullets or other missiles from distant sites to the right side of the heart are numerous enough to require attention. Recently we experienced a case with intracardiac foreign body due to penetrating cardiac injury. A 19 year-old man was admitted to our hospital due to penetrating anterior chest wound by iron segment. The roentgenogram of the chest revealed a radio-opaque metallic shadow in left lower chest around the cardiac apex, mild blunting of left costophrenic space, but no cardiomegaly. During operation the foreign body was noted to be present in the cardiac chamber by the portable C-arm fluoroscopy. But during the manipulation it moved into left inferior pulmonary vein from left ventricle by way of left atrium. So we could manage to remove it from left inferior pulmonary vein by direct approach to the vein. It was iron segment, sized 0.lcm x0.6cmx0.5cm, with sharp margins. The patient had an uneventful postoperative recovery except for chylopericardium and was discharged.

• Journal of Chest Surgery
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• 제30권7호
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• pp.724-728
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• 1997

68세된 남자로 좌측과 후측 흉부에 통증을 주소로 내원하였다. 술전 시행한 흉복부 W scan에서 대동맥류는 좌측 쇄골하동맥에서 횡격막까지 연결되었고 긴박성 파열의 소견도 보였다. 또한 술전 관동맥조영술에서는 좌회선동맥에 95%, 좌전하행지에 50%의 협착소견을 보였다. 수술은 고동맥-고정맥 우회술을 하면서 좌측 제 4늑간을 통하여 측후방 개흉절개를 하여 수술시야를 확보하였고 대동맥을 차단한뒤 대동맥류를 절개하고 인조혈관으로 대치하였다. 그리고 심박동하에서 대복제정 맥을 이용하여 좌회선동맥의 두번째 둔각변연동맥과 좌측 쇄골하동맥 기시부에 관상동맥 우회술을 하였다. 술후 환자는 술중 저혈압성 쇼크와 저산소증으로 다발성 뇌경색의 합병증을 보였다.

• Journal of Chest Surgery
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• 제48권6호
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• pp.381-386
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• 2015

Background: Postinfarction ventricular septal defects (pVSDs) are a serious complication of acute myocardial infarctions. The aim of this study was to analyze the clinical outcomes of the surgical treatment of pVSDs. Methods: The medical records of 23 patients who underwent operations (infarct exclusion in 21 patients and patch closure in two patients) to treat acute pVSDs from 2001 to 2011 were analyzed. Intra-aortic balloon counterpulsation was performed in 19 patients (82.6%), one of whom required extracorporeal membrane support due to cardiogenic shock. The mean follow-up duration was $26.2{\pm}18.6months$. Results: The in-hospital mortality rate was 4.3% (1/23). Residual shunts were found in seven patients and three patients required reoperation. One patient needed reoperation due to the transformation of an intracardiac hematoma into an abscess. No patients required reoperation due to recurrence of a ventricular septal defect during the follow-up period. The cumulative survival rate was 95.5% at one year, 82.0% at five years, and 65.6% at seven years. Conclusion: The use of a multiple-patch technique with sealants appears to be a reliable method of reducing early mortality and the risk of significant residual shunting in patients with pVSDs.

• Journal of Chest Surgery
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• 제49권2호
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• pp.73-79
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• 2016

Background: The aim of this study was to report our early experiences with the endovascular repair of ruptured descending thoracic aortic aneurysms (rDTAAs), which are a rare and life-threatening condition. Methods: Among 42 patients who underwent thoracic endovascular aortic repair (TEVAR) between October 2010 and September 2015, five patients (11.9%) suffered an rDTAA. Results: The mean age was $72.4{\pm}5.1years$, and all patients were male. Hemoptysis and hemothorax were present in three (60%) and two (40%) patients, respectively. Hypovolemic shock was noted in three patients who underwent emergency operations. A hybrid operation was performed in three patients. The mean operative time was $269.8{\pm}72.3minutes$. The mean total length of aortic coverage was $186.0{\pm}49.2mm$. No 30-day mortality occurred. Stroke, delirium, and atrial fibrillation were observed in one patient each. Paraplegia did not occur. Endoleak was found in two patients (40%), one of whom underwent an early and successful reintervention. During the mean follow-up period of $16.8{\pm}14.8months$, two patients died; one cause of death was a persistent type 1 endoleak and the other cause was unknown. Conclusion: TEVAR for rDTAA was associated with favorable early mortality and morbidity outcomes. However, early reintervention should be considered if persistent endoleak occurs.

• Journal of Chest Surgery
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• 제49권3호
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• pp.151-156
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• 2016

Background: Survival of children experiencing cardiac arrest refractory to conventional cardiopulmonary resuscitation (CPR) is very poor. We sought to examine current era outcomes of extracorporeal CPR (ECPR) support for refractory arrest. Methods: Patients who were <18 years and underwent ECPR between November 2013 and January 2016 were including in this study. We retrospectively investigated patient medical records. Results: Twelve children, median age 6.6 months (range, 1 day to 11.7 years), required ECPR. patients' diseases spanned several categories: congenital heart disease (n=5), myocarditis (n=2), respiratory failure (n=2), septic shock (n=1), trauma (n=1), and post-cardiotomy arrest (n=1). Cannulation sites included the neck (n=8), chest (n=3), and neck to chest conversion (n=1). Median duration of extracorporeal membrane oxygenation was five days (range, 0 to 14 days). Extracorporeal membrane oxygenation was successfully discontinued in 10 (83.3%) patients. Nine patients (75%) survived more than seven days after support discontinuation and four patients (33.3%) survived and were discharged. Causes of death included ischemic brain injury (n=4), sepsis (n=3), and gastrointestinal bleeding (n=1). Conclusion: ECPR plays a valuable role in children experiencing refractory cardiac arrest. The weaning rate is acceptable; however, survival is related to other organ dysfunction and the severity of ischemic brain injury. ECPR prior to the emergence of end-organ injury and prevention of neurologic injury might enhance survival.

• 대한임상독성학회지
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• 제9권2호
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• pp.49-55
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• 2011

Purpose: Acetanilide has been in widespread use as an amide herbicide compound. However, available data regarding acute human poisoning is scarce. The aim of this study was to analyze the clinical characteristics of acetanilide poisoning in order to identify the risk factors associated with severity. Methods: We conducted a retrospective observational study encompassing the period January 2005 to December 2010, including adult ED patients suffering from acetanilide intoxication. Toxicological history, symptoms observed, clinical signs of toxicity, and laboratory test results were collected for each patient. The patients were classified into two groups for analysis, according their poisoning severity score (PSS). Resulting clinical data and prognostic variables were compared between mild-to-moderate poisoning (PSS 1/2 grades), and severe poisonings and fatalities (PSS 3/4 grades). Results: There were a total of 37 patients, including 26 alachlor, 6 s-metolachlor, 4 mefenacet, and 1 butachlor cases. The majority of patients (81.1%) were assigned PSS 1/2 grades. Changes in mental status and observation of adverse neurologic symptoms were more common in the PSS 3/4 group. The median ingested volume of amide herbicide compound was 250 ml (IQR 200-300 ml) in the PSS 3/4 group, and 80 ml (IQR 50-138 ml) in the PSS 1/2 group. Also, the median GCS observed in the PSS 3/4 group was 13 (IQR 10-14), which was markedly low as compared to a median GCS of 15 in the PSS 1/2 group. Overall mortality rate was 5.4%, and profound cardiogenic shock was observed prior to death in all fatalities. Conclusion: When compared to previous reports, acute acetanilide poisoning resulted in relatively moderate severity. The presence of neurologic manifestations, hypotension, lower GCS score, and larger ingested volumes was associated with more serious effects and mortalities.