• 대한기관식도과학회:학술대회논문집
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• 대한기관식도과학회 1983년도 제17차 학술대회연제순서 및 초록
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• pp.5.1-5
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• 1983

식도이물은 식도질환 중에서 우리가 쉽게 경험할 수 있는 질환 중의 하나로써 대부분의 경우에 있어서는 식도경에 의한 이물의 적출로써 별다른 문제없이 치유된다. 허나 드물게 식도천공, 객도주위농양, 종격동염, 기흉, 농흉, 폐농양 및 피하기종 등과 같은 합병증이 병발하기도 하며 이 때 조기에 진단하여 신속한 처치를 하지 않으면 생명을 위협하여 불행한 결과를 초래하는 경우가 발생하기도 한다. 이물에 의한 식도천공은 그것이 날카로운 금속성 물질 혹은 골편이거나 장기간 체류함에 따라 식도점막에 괴사를 일으키는 경우에 발생한다. 최근에 저자들은 식도에서 예리한 생선뼈를 제거한 후에 식도주위 농양이 발생한 환자를 경부 종격절제술로 배농한 후에 지속적인 세척을 시행함으로써 좋은 결과를 얻었기에 이를 문헌고찰과 함께 보고하는 바이다.

• Journal of Chest Surgery
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• 제23권3호
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• pp.572-576
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• 1990

A complete transection of left main bronchus was repaired by end to end anastomosis 5 months after the chest trauma in the Yeungnam University Hospital. The patient was a 36 years old male who had been injured bluntly by a heavy package on the left chest. The initial symptoms and signs were dyspnea, chest pain and subcutaneous emphysema on the left neck, but on admission at our hospital his chief complaint was only mild left chest discomfort. The preoperative chest X-ray findings 5 months after the trauma revealed total collapse of the left lung, deviation of trachea to the left, elevation of left diaphragm, abrupt discontinuation in the course of an air-filled left main bronchus and bronchoscopy showed that the left main bronchus was completely occluded, without any signs of inflammation, approximately 4 cm from the carina. The operation was performed through standard posterolateral thoracotomy incision at the fifth intercostal space. There was not any suppuration within the transected lung but plenty of white mucus which was removed by forceful suction. The transected bronchial edges were debrided and anastomosed primarily by end to end with interrupted nonabsorbable sutures. The suture line was reinforced with a pleural flap. The postoperative course was uneventful and pulmonary function following operation improved progressively and proved the delayed repair to have a reasonable decision.

• Journal of Chest Surgery
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• 제5권2호
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• pp.113-124
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• 1972

Clinical observations were performed on 150 cases of chest trauma, those were admitted and treated at the Department of Surgery, Korea University Woosok Hospital, during the past 8 years period from August 1965 to August 1972. 1. The ratio of male to female patient of chest trauma was 3.4:1 in male predominence and age from 20 to 50 occupied 62% of the total cases. 2. The most common cause of chest trauma was traffic accident in this series. Eighty-one cases[54%] were injured by traffic accident and total cases due to blunt trauma [non-penetrating injury] were 113 cases[75.4%]including the cases with traffic accident, and remaining 37 cases[24.6%] were due to penetrating injury including 25[16.6%] cases of stab wounds. 3. Hemopneumothorax were observed in 645/[96 cases] of the total cases, and etiologic distribution revealed 78.1% due to non-penetrating trauma and 20.8% due to penetrating injury. 4. Rib fracture was found in 50% of cases. Common injuries associated with rib fracture were lung, brain and liver. 5. Most common symptom was chest pain and respiratory difficulty, and common sign associated with chest injury was decreased respiratory sound and subcutaneous emphysema. 6. Conservative non-operative treatment was performed in 94 cases[62.6%] and 56 cases [37.4%] were treated with operative treatment including 31 cases[20.6%] with open thoracotomy. 7. Overall mortality was 9.3%[14 cases] and most common causes of death were due to brain edema,asphyxia and shock.

• 한국임상수의학회지
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• 제33권2호
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• pp.124-128
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• 2016

A 7-year-old intact female Maltese dog presented with a history of bite wounds. Physical examination revealed labored breathing, four puncture wounds with subcutaneous emphysema of the thorax, and paradoxical respiratory movement of the right thoracic wall. On radiography, a segmental fracture of the right 7th rib and a single fracture of the 8th rib were evident on the dorsal thorax. An inward displacement of the fractured segment and contusion of the right caudal lung lobe were identified with computed tomography. A diagnosis of pseudo-flail chest was made. Exploratory thoracotomy revealed a full-thickness muscular defect, a marked discoloration of the right caudal lung lobe, a segmental fracture of the right 7th rib, and a single fracture of the right 8th rib. Necrotic tissues were removed using surgical debridement. The fractured 7th and 8th ribs were corrected using a single interfragmentary wiring technique. The thoracic wall was reconstructed using the latissimus dorsi muscle flap. Additional thoracic stabilization using a thermoplastic splint was applied to correct paradoxical respiratory movement. The external splint was removed 4 weeks postoperatively. There was no evidence of respiratory abnormalities 18 months postoperatively.

• 한국응급구조학회지
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• 제9권1호
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• pp.95-99
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• 2005

Penetrating neck trauma by gunshot injury involving tracheobronchial tree is rare in Korea. Extensive tissue damage by cavitation, tissue fragmentation and shock wave transmission of high-velocity projectile along with associated organ injury renders high rate of mortality and morbidity. A 28 year old man in military service with gunshot wound in left cervical area presented initial symptoms of severe dyspnea and subcutaneous emphysema. Computed tomography of chest and cervical region as well as bronchoscopic evaluation was performed to confirm highly suspected injury to cervical trachea. Surgical exposure was established through a low collar incision; the damaged segment of 3.5 cm length including 2-4th tracheal rings was resected out and end-to-end anastomosis was performed. Bleeding from lacerated anterior jugular vein was controlled by ligation of both ends and a K2 bulllet was found upon inner border of body of first rib, medial to right carotid sheath and removed out. Cervical esophagus, carotid artery, internal jugular vein and recurrent laryngeal nerve were spared. Extubation was done on the first postoperative day and postoperative course until discharge on nineth postoperative day remained uneventful.

• Journal of Chest Surgery
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• 제43권6호
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• pp.675-680
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• 2010

배경: 이 연구는 외상성 기관-기관지 손상의 특징적인 임상 증상 및 영상학적 소견 등에 대하여 알아보고자 하였다. 대상 및 방법: 2003년 1월부터 2009년 12월까지 본원 응급실을 통해서 내원한 외상 환자들 중에서 수술을 통해서 외상성 기관-기관지 손상으로 진단된 6명의 환자를 대상으로 하였다. 외상의 종류, 동반된 손상, 진단 방법 및 수술까지 걸린 시간, 수술 소견 및 수술 방법, 예후 등에 대해서 조사해 보고 후향적으로 진단에 중요한 인자 등을 알아 보았다. 결과: 손상의 원인으로는 교통사고가 1명, 낙상 및 흉부에 강한 압박을 받은 경우가 5명이었다. 주 증상으로 피하기종, 호흡 곤란, 통증 등이 있었으며 영상소견으로는 기흉, 종격동 기종, 혈흉, 늑골 골절, 폐좌상 등이 있었다. 기관지 내시경을 시행하지 않은 상태에서 2명에서는 흉부 CT 소견에서 기관-기관지 손상이 의심되었지만 나머지 4명에서는 의심하지 못했다. 수상 부위는 기관부위가 2예, 기관지가 4예 있었다. 수술은 개흉술을 통한 일차 문합을 시행하였고 수술 후 사망과 문합 부위 유출은 없었으며 1명에서 술 후 성대 마비가 있었다. 진단에 도움이 되는 특징적인 소견으로는 흉관 삽입 후 음압의 적용에도 불구하고 지속적인 심한 폐 허탈이 가장 중요한 소견이었으며, 흉부 CT에서의 기관-기관지의 주행 경로의 단절이 진단에 중요하였다. 결론: 외상성 기관-기관지 손상은 의심하지 않으면 진단이 쉽지 않으나, 특징적인 흉관 삽입 후의 임상 증상과 영상 소견은 진단에 큰 도움을 주었다.

• 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.

• Journal of Chest Surgery
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• 제12권4호
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• pp.411-417
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• 1979

During the period of 4 years from August 1, 1975 to August 1, 1979, authors have experienced 100 cases of multiple rib fractures by nonpenetrating injury at Department of Thoracic Surgery, Paik Foundation Hospital in Seoul, Korea. 1. The ratio of male to female patients with multiple rib fracture was 2.6:1 with male predominance and 84% of the total cases were between 20 and 50 years of age. 2. The most common cause of multiple rib fracture was traffic accident and falls accounted for the next largest group. 3. The most common site of rib fracture was 4th rib to 7th rib level on both hemithorax [52%]. 4. Associated injuries were cerebral contusion in 26%, clavicular fracture in 22%, long bone fracture in 22%, pelvic bone fracture in 10%, and scapular fracture in 8%. 5. Early complications and/or result of the multiple rib fractures were lung contusion in 23 cases, subcutaneous emphysema in 21 cases, hemothorax in 21 cases, hemopneumothorax in 6 cases, and flail chest in 12 cases. 6. The flail chests were managed by strapping the chest with adhesive plaster, external traction of flail segment with towel clip, ventilatory assistance for marginal clinical indications, and in cases of complicated with intrathoracic hemorrhage, wire fixation of flail segment through open thoraco-tomy. 7. The principles of therapy for hemothorax and/or pneumothorax were rapid reexpansion of the lungs by thoracentesis [11%] and closed thoracostomy [22%], but open thoracotomy had to be done on 3 cases because of massive bleeding or intrapleural hematoma and diaphragmatic rupture. 8. The over all mortality was 4% [4 among 100 cases] and the cause of all deaths was head injury.

• Tuberculosis and Respiratory Diseases
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• 제40권3호
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• pp.314-318
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• 1993

Chronic eosinophilic pneumonia is an idiopathic condition characterized by chronic infiltration of the lung with eosinophils, weight loss, dyspnea, and pulmonary infiltration. Recently, we have experienced one case of chronic eosinophilic pneumonia presenting as the acute respiratory failure. A 34-year-old man was admitted to the hospital with one month's history of coughing, dyspnea, mucoid sputum, weight loss and one day's history of subcutaneous emphysema. The radiographic lung lesion and dyspnea rapidly progressed to a critical condition of acute respiratory failure. The combination of blood eosinophilia, lung infiltration on the chest x-ray, sign of acute rapiratory failure, rapid response to steroid therapy, and the finding of the transbronchial lung biopsy permit the diagnosis of chronic eosinophilic pneumonia.

• 대한두경부종양학회지
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• 제18권1호
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• pp.71-75
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• 2002

Background and Objectives: The tracheotomy is one of the most essential surgical procedures performed in the intensive care unit (ICU). The tracheal stenosis, as a complication following endotracheal intubation or tracheotomy, has been the subject of considerable recent investigation. Many different methods have been developed to avoid the tracheal stenosis but there is still controversy about the tracheal incisions. We had performed tracheotomy using a vertical elliptical tracheal incision in the ICU to evaluate its efficiency and safety. Materials and Methods: 191 patients who underwent the tracheotomy in the ICU between 1995 and 2000 were reviewed retrospectively by chart records and interviews. Results: The complications were reported such as bleeding, infection, subcutaneous emphysema, pneumothorax, tracheoesophageal fistula and tracheal stenosis. The total numbers of complications were 35 cases (18.3%) and the tracheal stenosis was developed in 4 patients. The characteristics of tracheal stenosis are as follows. Conclusion: The vertical elliptical tracheal incision is the safe and reliable methods in ICU patients compared with other methods, but other factors are also important in preventing the complications.