• Journal of Chest Surgery
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• 제40권7호
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• pp.499-502
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• 2007

좌측 상대정맥이 관상정맥동으로 유입되는 경우 늘어난 관상정맥동에 의한 좌심실 유입로 폐쇄가 드물게 나타날 수 있다. 이차공형 심방중격결손, 좌측 상대정맥에 동반된 심한 심부전증상을 보이는 31일된 남아에 대하여 수술을 시행하였다. 수술 전 초음파상 승모 판막의 크기는 정상이었으나 확장된 관상정맥동이 좌심실 유입로 위로 드리워져 기능적 협착을 유발하는 양상이었다. 수술은 확장된 관상정맥동을 절개하여 개방한 후 자가 심낭막을 이용하여 심방중격결손을 봉합하고, 좌측 상대정맥은 분리하여 우심방 돌기에 단단 문합하였다. 수술 후 환아의 좌측 흉강에 유미흉이 발생하여 술 후 31일째 흉관 결찰술을 시행하였으며, 이후 경과가 호전되어 술 후 39일째 퇴원하였다. 환아는 현재 수술 후 9개월째 관찰 중이며, 정상적인 성장을 보이고 있다.

• Journal of Yeungnam Medical Science
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• 제31권1호
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• pp.65-68
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• 2014

Pseudochylothorax is an uncommon pleural effusion disease characterized by the presence of cholesterol crystals or high lipid content not resulting from a disrupted thoracic duct. Most of the cases reported so far had been found in patients with long-standing pleural effusion due to a chronic inflammatory disease such as old tuberculous pleurisy or chronic rheumatoid pleurisy. Authors encountered a case of pseudochylothorax in a 45-year-old man who had been treated for tuberculous pleurisy 6 years before his visit to authors' hospital. After that, he had visited the emergency department many times for removal of pleural effusion. The patient's chest X-ray revealed dyspnea and large left-sided pleural effusion. Although a large amount of pleural fluid was removed with a drainage catheter, massive pleural effusion was likely to recur, and the underlying lung was able to fully re-expand. Accordingly, decortication was done, and the patient's symptom was improved without postoperative complications.

• Journal of Chest Surgery
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• 제54권6호
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• pp.466-472
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• 2021

Background: Major intraoperative hemorrhage reportedly predicts unfavorable survival outcomes following surgical resection for esophageal carcinoma (EC). However, the factors predicting the amount of blood lost during thoracoscopic esophagectomy have yet to be sufficiently studied. We sought to identify risk factors for excessive blood loss during video-assisted thoracoscopic surgery (VATS) for EC. Methods: Using simple and multiple linear regression models, we performed retrospective analyses of the associations between clinicopathological/surgical factors and estimated hemorrhagic volume in 168 consecutive patients who underwent VATS-type esophagectomy for EC. Results: The median blood loss amount was 225 mL (interquartile range, 126-380 mL). Abdominal laparotomy (p<0.001), thoracic duct resection (p=0.014), and division of the azygos arch (p<0.001) were significantly related to high volumes of blood loss. Body mass index and operative duration, as continuous variables, were also correlated positively with blood loss volume in simple linear regression. The multiple linear regression analysis identified prolonged operative duration (p<0.001), open laparotomy approach (p=0.003), azygos arch division (p=0.005), and high body mass index (p=0.014) as independent predictors of higher hemorrhage amounts during VATS esophagectomy. Conclusion: As well as body mass index, operation-related factors such as operative duration, open laparotomy, and division of the azygos arch were independently predictive of estimated blood loss during VATS esophagectomy for EC. Laparoscopic abdominal procedures and azygos arch preservation might be minimally invasive options that would potentially reduce intraoperative hemorrhage, although oncological radicality remains an important consideration.

• Journal of Pharmaceutical Investigation
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• 제23권3호spc1호
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• pp.19-30
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• 1993

The influence of emulsion type of tegafur, an oral anticancer agent, on lymphatic transport was studied in rats. The water-in-oil-type of emulsion and the oil-in-water-type emulsion of tegafur each in 50 mg, calculated in terms of tegafur, were prepared by adding tegafur aqueous solution to sesame oil containing hydrogenated castor oil following ultrasonic treatment, and then the prepared emulsions and aqueous solution as a comparative formulation were administered orally to rats (50 mg/5 ml/kg). The concentration levels of tegafur in plasma of femoral artery and lymph from thoracic duct cannula were measured simultaneously along a time course after administration and the pharmacokinetic parameters were investigated. At the same time, we examined the above described factors of 5-FU which is known as an active metabolite of tegafur. In comparison with tegafur solution, AUC and mean residence time of plasma tegafur were significantly increased in w/o-emulsion but significantly decreased in o/w-emulsion. Lymph flow rates were similar in both solution and w/o-emulsion but half in o/w-emulsion. Ratios between area under the lymph and plasma concentration time curves were always less than 1 reflecting the passive lymphatic delivery after oral administration of the prepared tegafur emulsions, but those to the 5-FU in the case of w/o-emulsion were more than 1. These results suggested that lymphatic delivery of tegafur by w/o-emulsion was more effective than that by o/w-emulsion due to its differences of formation ability of chylomicrons.

• Journal of Yeungnam Medical Science
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• 제34권2호
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• pp.265-269
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• 2017

Chylothorax or chylous ascites are rare manifestations of liver cirrhosis. We report a rare case of simultaneous chylothorax and chylous ascites in a patient with hepatitis B virus-related liver cirrhosis. A 76-year-old woman was referred to our hospital with a pleural effusion on her right side. She had no history of recent medical procedures, trauma or tumor. There was no evidence of mass or thoracic duct obstruction in a computed tomography scan. Pleural fluid and ascites were confirmed as chylothorax and chylous ascites by chemistry analysis. Despite thorough conservative care, there was no improvement. Pleurodesis was planned, but hepatic encephalopathy developed suddenly and she did not recover.

• Tuberculosis and Respiratory Diseases
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• 제78권4호
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• pp.428-431
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• 2015

Epithelial-myoepithelial carcinoma (EMC) of lung is a minor subset of salivary type carcinoma of lung of known low grade malignancy. Histologically, two-cell components forming duct-like structure with inner epithelial cell layer and outer myoepithelial cell layer are characteristics of EMC. In salivary gland, dedifferentiation of conventional low grade malignancy has been reported and is thought to be related with poor prognosis. However, precise histomorphology and prognostic factors of pulmonary EMC have not been clarified due to its rarity. Herein, we reported a rare case of EMC presented as endobronchial mass in a 53-year old woman, which showed predominant solid lobular growth pattern and lymph node metastases.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제22권6호
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• pp.594-600
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• 2019

With improving survival of children with complex congenital heart disease (CCHD), postoperative complications, like protein-losing enteropathy (PLE) are increasingly encountered. A 3-year-old girl with surgically corrected CCHD (ventricular inversion/L-transposition of the great arteries, ventricular septal defect, pulmonary atresia, postdouble switch procedure [Rastelli and Glenn]) developed chylothoraces. She was treated with pleurodesis, thoracic duct ligation and subsequently developed chylous ascites and PLE (serum albumin ${\leq}0.9g/dL$) and was malnourished, despite nutritional rehabilitation. Lymphangioscintigraphy/single-photon emission computed tomography showed lymphatic obstruction at the cisterna chyli level. A segmental chyle leak and chylous lymphangiectasia were confirmed by gastrointestinal endoscopy, magnetic resonance (MR) enterography, and MR lymphangiography. Selective glue embolization of leaking intestinal lymphatic trunks led to prompt reversal of PLE. Serum albumin level and weight gain markedly improved and have been maintained for over 3 years. Selective interventional embolization reversed this devastating lymphatic complication of surgically corrected CCHD.

• 대한유전성대사질환학회지
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• 제17권1호
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• pp.24-30
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• 2017

Gorham-Stout disease (GSD)는 골용해와 함께 혈관 및 림프조직의 비정상적인 증식으로 골조직 파괴가 유발되는 매우 드문 질환이다. 아직까지 GSD의 정확한 병인 및 기전은 밝혀지지 않았다. 악성종양이나 신경병증, 감염과의 연관성은 불명확하며, 골조직이 있는 신체 어디에서든 기형적 혈관-림프관 증식이 발생할 수 있다. GSD 중 약 20%에서 유미흉을 동반하는데, 림프관 형성이상이나 가슴 림프관 손상에 의해 이차적으로 발생한다. 급격한 호흡부전으로 이어질 수 있어 불량한 예후인자로 알려져 있지만, 질환 자체의 희귀성 때문에 현재까지 확립된 표준치료법은 없다. 본 증례는 유미흉을 동반한 생명을 위협하는 GSD 환자에서 적극적인 외과적 중재술 후 mTOR inhibitor 및 beat-blocker 복합요법을 적용하여 치료에 성공한 보고이다. 환자는 가슴림프관 결찰술 및 흉막유착술을 시행 받았으나, 일시적 증상호전 이후로 유미흉 및 호흡곤란의 재악화 반복되었다. 양측 흉막유착제거 및 폐쇄 흉강삽관술과 함께, beta-blocker와 mTOR inbititor 경구투약을 시작했다. 약물투약 1개월 후 유미흉 재발없이 호흡 안정적으로 유지되어 산소 보조치료 없이 퇴원하였다. 현재 11개월째 지속적으로 약물 투약 중으로, 약물 부작용 및 추가적인 입원치료 없이 정상적인 일상생활을 유지하고 있다. 추후 유미흉을 동반한 GSD 환자의 치료에서, 적극적인 외과적 중재술과 함께 경구 mTOR inhibitor 및 beta-blocker 복합요법을 고려해 볼 수 있겠다.

• Tuberculosis and Respiratory Diseases
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• 제62권2호
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• pp.119-124
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• 2007

Sarcoidosis is a multi-system granulomatous disorder of an unknown etiology and affects individuals worldwide. It is characterized pathologically by the presence of non-caseating granulomas in more than one involved organ. However, pleural involvement of sarcoidosis is rare and there are no reported cases in Korea. Traditionally, sarcoidosis has often been treated with systemic corticosteroids or cytotoxic agents. In particular, chylothorax with sarcoidosis is usually treated with corticosteroid for approximately 3~6 months, followed by repeated therapeutic thoracentesis, talc pleurodesis, dietary treatment, or thoracic duct ligation where needed. We encountered a 46 years old female patient presenting with cough, dyspnea and both hilar lymphadenopathy (stage I) on chest radiograph. The patient was diagnosed with a non-caseating granuloma, sarcoidosis by a mediastinoscopic biopsy. For one month, she had suffered from dyspnea due to right side pleural effusion, which was clearly identified as a chylothorax on thoracentesis. Corticosteroid therapy with dietary adjustment was ineffective. She was treated successfully with a subcutaneous injection of octreotide for 3 weeks and oral corticosteroid. We report a case of successful and rapid treatment of chylothorax associated with sarcoidosis using octreotide and oral corticosteroid.

• Clinical and Experimental Pediatrics
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• 제52권9호
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• pp.1035-1037
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• 2009

동맥관 개존증은 선천성 심질환 중 비교적 흔한 질환이며, 크기나 중등도에 상관없이 폐쇄가 필요한 질환이다. 경피적 동맥관 폐쇄술은 개흉술에 비하여 합병증의 위험이 적고 경제적으로도 바람직하며, 치료 성적도 우수하여 최근에는 표준적인 치료법으로 받아들여지고 있다. 하지만 원통형 모양의 동맥관 개존증은 흔히 사용하는 분리형 코일이나 ADO로 시술하기에는 여러 가지로 어려운 점이 많다. 저자들은 이러한 형태의 동맥관을 폐쇄하기 위하여 일반적으로 추천되는 것보다 큰 크기의 AVP를 이용하여 원통형 동맥관이 메워지도록 하는 방법을 이용함으로써, 성공적인 동맥관 개존증 폐쇄술을 시행하였기에 이를 보고하는 바이다.