• Clinical and Experimental Pediatrics
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• 제48권10호
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• pp.1143-1143
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• 2005

흉부 관통상에 의해 심실중격결손이 동반된 대부분의 환자들은 내원 시 활력징후가 불안정하여 심폐소생술 및 응급 개흉술을 시행받게 되는데, 이러한 경우 심장과 흉부 손상의 위치 및 정도에 대한 자세한 검사가 이루어지지 않은 상태이므로 발견되지 않았거나 잔존하는 이상 소견들이 수술 후 검사에서 발견될 수 있고 이에 대한 재수술을 필요로 하는 경우도 있다. 심실중격결손의 심도자술을 통한 폐쇄는 수술을 대처할 수 있는 방법으로서, 특히 수술 후 잔존하는 단락의 경우 이차 수술의 위험을 피할 수 있다. 저자들은 흉부 자상에 의한 심실벽의 열창 및 심실중격결손을 수술적 방법으로 봉합한 후 잔존하는 심실중격결손을 기구($Amplatzer^{(R)}$ VSD occluder)를 이용한 중재적 심도자술로 치료한 증례를 문헌 고찰과 함께 보고한다. 심도자술 6개월 후 시행한 심초음파검사에서 잔존하는 심실 좌우 단락은 없었고, 심실 크기와 기능도 정상이었고, 현재 상태는 양호하여 정상적으로 학교생활을 하고 있다.

• Journal of Chest Surgery
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• 제10권1호
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• pp.7-17
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• 1977

The increasing frequency of post-tracheostomy stenosis parallels the increase in the incidence of tracheostomy. The development of stenosis of trachea following the operation of tracheal tumor or tracheostomy is a very serious complication. The continuing need for an adequate tracheal substitute has not been answered, despite the necessities of excision and reconstruction of the trachea to keep for effective ventilation. Experimental tracheal reconstuction, with a prosthesis of heavy Marlex mesh and pericardium, _ vas performed in twelve dogs. Five to six tracheal ring circumferential defects were created and were bridged with heavy Marlex mesh fashioned into a tube of suitable diameter. Group A: A prepared cylinder of Marlex mesh was anastomosed outside the cut ends of the trachea. Group B: The external surface of the prepared cylinder of Marlex mesh was completely covered with suitably sized patch of pericardium and overlapped all margin of the Marlex mesh by 2 to 3 mm in each direction. Group C: The internal surface of the prepared cylinder of Marlex mesh was covered with suitably sized patch of pericardium and overlapped all margin of the Marlex mesh by 2 to 3 mm in each direction. The results of this exepriment were as follow: 1. In group A and B, the graft was well bridged with new granulation and fibrous tissue, and the lumen of trachea kept good patency for effective ventilation.. The interstices of Marlex became uniformly infiltrated with young well vasculated connective tissue. Epithelization has not yet occurred at 4 weeks in each group, but there were evidences of new growing mucosa at grafted site in 6 weeks. The remainder of the prosthesis was completely covered with glistening epithelium and the underlying fibrous tissue became more matured with little inflammation. These findings were more striking in group B than group A. 2. In group C, the covered pericardium was necrotized with stenosis of the lumen of grafted site due to poor blood supply.

• Tuberculosis and Respiratory Diseases
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• 제70권3호
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• pp.261-265
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• 2011

Cholethorax is a bilious pleural effusion caused by a pleurobiliary fistula or leakage of bile into the pleural space. Most cases of cholethorax arise from a complication of abdominal trauma, hepatobiliary infection, or invasive procedures or surgery of hepatobiliary system. However, we experienced a case of a patient with cholethorax of unknown origin. There was no evidence of pleurobiliary fistula or leakage of bile from the hepatobiliary system although we examined the patient with various diagnostic tools including chest and abdominal computed tomography, endoscopic retrograde cholangiopancreatography, tubography, bronchofiberscopy, hepatobiliary scintigraphy and video-assisted thoracoscopic surgery. Herein we report a case of cholethorax for which the specific cause was not identified. The patient was improved by percutaneous drainage of pleural bile.

• Tuberculosis and Respiratory Diseases
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• 제67권2호
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• pp.140-144
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• 2009

The majority of flexible bronchoscopies are performed under topical anesthesia with lidocaine being the most commonly used agent. Anaphylaxis rarely occurs after local administration of lidocaine, but can be a fatal complication. We experienced a case of unexpected anaphylaxis. A 66-year-old woman was scheduled for flexible bronchoscopy to evaluate a tracheal mass and stenosis. The oral and nasal mucosa were pretreated with lidocaine. About 2~3 minutes later, the patient developed hypotension and we treated for anaphylaxis in the emergency room. Then, we decided to perform rigid bronchoscopy in this patient, under conditions of general anesthesia. A rigid bronchoscopy was performed in this patient, safely and successfully. The tracheal mass was determined to be squamous cell carcinoma.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제32권3호
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• pp.246-250
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• 2010

Mediastinal emphysema, also referred to as pneumomediastinum or Hamman's syndrome, is defined as the presence of air or gas within the fascial planes of the mediastinum. Superior extension of air into the cervicofacial subcutaneous space via communications between the mediastinum and cervical fascial planes or spaces occurs occasionally. The mediastinal air may originate from the respiratory tract, the intrathoracic airway, the lung parenchyma, or the gastrointestinal tract. The presence of air in the mediastinum may be spontaneous, iatrogenic or due to penetrating trauma. Pneumothorax is defined as the presence of air or gas within the pleural cavity. A pneumothorax can occur spontaneously. It can also occur as the result of a disease or injury to the lung or due to a puncture to the chest wall. Pneumomediastinum and pneumothorax is a rare complication of head and neck surgery. Nevertheless, when it occurs, it is usually considered to result from direct dissection by the air at the time of injury or of surgery. Most of the cases of pneumomediastinum and pneumothorax that have been described in the oral and maxillofacial surgery literature result from air dissecting down the fascial planes of the neck. The authors report a case with subcutaneous emphysema, pneumomediastinum and pneumothorax after orthognathic surgery.

• Archives of Plastic Surgery
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• 제33권3호
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• pp.371-375
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• 2006

Frontometaphyseal dysplasia is a rare genetic syndrome first described by Gorlin and Cohen in 1969. This disease affects the skeletal system and connective tissue, and could be characterized by hyperostosis of the skull, prominence of supraorbital ridges, additional skeletal and extraskeletal abnormalities. It is believed that the condition is an X-linked dominant trait with severe manifextations in males and extreme variability in females.We described a case of 15-year-old boy manifested a pronounced supraorbital ridge associated with exorbitism. He also had bilateral progressive hearing deficit, thoracic spine scoliosis, chest wall deformity, bilateral maxillary sinusitis and both 5th finger arachnodactyly.The patient underwent a fronto-temporo-orbital cranioplasty through a coronal incision. The frontal bone including supraorbital region, orbital lateral rim and temporal bone were extensively contoured with burr. And then, burring of the medial aspect of lateral orbital wall was made to increase both orbital volume for correction of exorbitism. Postoperative results show well corrected prominent supraorbital ridge, hyperostosis of frontotemporal bone and exorbitism. The patient was satisfied with the improved appearance. No recurrence occurred during the 6 months of follow-up period. We report this case as it shows esthetically good result without any complication.

• 대한수의학회지
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• 제44권1호
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• pp.121-124
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• 2004

Horses that have been retired from racing or imported from abroad are retired as broodmares. Whether at private farms or government institutes they are bred to stallions with the aim of improving fertility and enhancing the breed. Accidental deaths as a result of surgical or obstetrical complications lead to decreased productivity and economic losses to the horse breeding industry. Intussusception of the uterine horn is a frequent complication of the equine and bovine species, but rarely seen in other species. The most common causes are thought to be tearing of the placenta which is suspended from the uterus and ovaries and the weight of the placenta. Expulsion of the embryonic membranes is also thought to be a contributing factor. If symptoms are minor and treatment affected quickly, the problem will likely resolve itself. In more severe cases the uterus will prolapse completely. This case study was observed in a Thoroughbred broodmare. After treatment of dystocia, the broodmare could not stand up. She became dehydrated, collapsed, suffered colic and was euthanised. In this case was observed serious swelling vulva and perineal region by morphology, and there was seldom ascites and unusual view in thoracic and abdominal cavity after opening abdomen. However, intussusception of uterine horn involuted left uterine horn into the uterine body was observed.

• Journal of Chest Surgery
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• 제25권6호
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• pp.598-604
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• 1992

Rhabdomyosarcoma is the most common soft tissue sarcoma in childhood and acounts for 6% to 15% of all cases of childhood cancer, Rhabdomyosarcoma in seventh most common form of childhood neoplasms, following acute leukemia, tumors of the central nervous system, lymphoma neuroblastoma, Wilm`s tumor, bone tumor. Rhabdomyosarcoma can arise anywhere in the body, but primary site in the thorax is relatively rare. We experienced a case of aveolar rhabdomyosarcoma arising from intercostal muscle, A 12 year-old woman was suffered from the intermittent left chest pain radiating to the scapular area and dyspnea, On physical examination, pulmonary friction rub was heard on the left upper lobe area. Qn adimission, the chest simple radiography revealed a 7 x 6, 5cm sized radio-opaque mass with pleural effusion in the superior mediastinum and the CT showed a well difined radio-opaque mass including the destructed 2nd rib and pleural effusion. The percutaneous tra-nsthoracic needle aspiration biopsy was likely to show blastoma. After the chemotherapy[vincristine, actinomycin-D, cyclophosphamde] was done to treat blastoma, the pleural effussion was subsided and the mass was slightly decreased by 4.5x 4. 5cm. For treatment and diagnosis, we performed en-bloc resection and the defected chest was reconstucted with Gortex patch. Grossly, the specimen was colored graysh-white and arised in between two ribs The microscopic findings showed that the tumor cells were small round with scant pinkish cytoplasm on the H-E stain and the tumor cell nests were grouped by reticulum fibers and showed alveolar pattern on the silver stain The electromicroscopic finding presented that the cytoplasm contained tangled fibrillar and flocculent materials. The histopathologic findings were compatable with laveolar rhabdomyosarcoma. She was discharged without any complication. After discharge, she has been treated with radiation theraphy and chemotheraphy, and not recurred untill last follow-up We report a case of alveolar rhabdomyosarcoma arising to intercostal muscle, developed in 12 year-old waman, with brief review of literatures.

• Journal of Chest Surgery
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• 제25권11호
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• pp.1327-1336
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• 1992

Between Jan. 1986 and Aug. 1992. 72 patients underwent Rastelli procedure. There were 43 male and 29 female, aged 46 days to 16 years [mean age, 5.2 years] with 18 patients less than 2 years of age. All patients had complex defect, 27 pulmonary atresia with ventricular septal defect, 18 corrected transposition of great arteries with pulmonary atresia or punmonary stenosis, 10 truncus arteriosus, 10 double outlet right ventricle with pulmonary atresia or stenosis, 7 complete transposition of great artersia with pulmonary atresia or pulmonary stenosis. The types of extracardiac valved conduit used were prosthetic valve[n=47, 24 car-bomedics, 19 Ionescu-Shiley, 4 Bjork-shiley] and hand-made trileaflet valve using pericardium. [n=23, 20 bovine pericardium, Z autologous pericardium, 1 equine pericardium] The mean size of valved cinduit was 5.25mm larger in diameter than the size of main pulmonary artery. [normalized to the patient`s body surface area] There were 17 hospital death[24%] and 4 late deaths[5.6%]. Postoperative complication rate was 38.9%a, none of which was conduit-related. All patients were followed pos-toperatively for 1 to 73 months. [mean 25.8 months] During follow-up period, reoperation was done in 6 patients due to stenosis of valved conduit. Mean interval between intial repair and reoperation was 20.3 months. In our experience, li recently extracardaic valved conduits between right ventricle [or pulmonary ventricle] and pulmonary artery were inserted with increasing frequency in infants less than 2 year, but hospital mortality was decreased, 2] Risk of reoperation due to conduit stenosis is low, so that the effect of graft failure on overall survival is minimized. 3] Nevertheless, because any type of extracardaic valved conduit is not ideal in children, we recommended that Lecompte should be done if cardiac anatomy is permitted.

• Journal of Chest Surgery
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• 제31권2호
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• pp.113-117
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• 1998

아산재단 서울중앙병원 흉부외과에서는 1993년 10월부터 1997년 4월 사이에 대동맥륜대동맥 확장환자에서 37례의 Bentall술식을 시행하였다. 환자군의 술전 호흡곤란 정도는 NYHA Class I이 4례, Class II가 10례, Class III가 20례, Class IV가 3례였다. 수술은 대동맥박리증이 동반된 경우 초저체온법(식도체온: 11.8$\pm$1.6!), 완전순환정지, 역행성 대뇌관류법을 시행하였다. 37례 모두 병변이 있는 대동맥벽을 대부분 제거하고 복합이식편이나 대동맥 인조혈관 및 인공판막을 이용하여 상행대동맥과 대동맥판막을 치환하였고, 관상동맥편을 인조혈관에 직접 연결하였다. 수술결과는 합병증은 7례 발생하였으며(18%), 수술사망은 없었으나 뇌혈관 발작으로 인한 1례의 만기 사망이 있었다(2.7%). 퇴원후 추적기간은 1개월에서 36개월까지였으며 평균 9.6개월였다. 결론적으로 대동맥륜대동맥 확장의 수술에 있어 Bentall술식은 안전하고 좋은 수술이라 할 수 있다.