• Journal of Chest Surgery
• /
• 제41권1호
• /
• pp.133-136
• /
• 2008

흉부둔상에 의한 내유동맥의 손상은 매우 드문 경우이다. 또한, 그로 인한 흉막외혈종과 종격동혈종의 발생도 매우 드물며 빠른 진단과 적극적인 치료가 요구된다. 교통사고에 의한 흉부둔상으로 앞가슴통증을 주소로 내원한 59세 남자에서 발생한 내유동맥의 손상으로 인한 흉막외혈종과 종격동혈종 1예를 진단하여 수술치험하였기에 문헌고찰과 함께 보고하는 바이다.

• Journal of Trauma and Injury
• /
• 제28권3호
• /
• pp.219-221
• /
• 2015

Subclavian injuries in blunt trauma are reported in less than 1% of all arterial injuries or chest related injuries. We report a female 68 yr-old patient whom has visited our emergency center due to a motorcycle traffic accident with complaints of right chest wall and shoulder pain. Her injury severity score was 22 and she was found with a comminuted clavicle fracture and subclavian artery injury. She developed delayed symptoms of pallor, pain and motor weakness with loss of pulse in her right arm. Attempts at intervention failed and thus, she underwent emergency artificial graft bypass from her subclavian artery to her brachial artery. Her postoperative course was uneventful and she is happy with the results. Although rare, a high index of suspicion for the injury must be noted and the inevitable surgical option must always be considered.

• Journal of Chest Surgery
• /
• 제41권5호
• /
• pp.675-678
• /
• 2008

42세 남자 환자가 건축 현장에서 작업 도중 네일 건(nail gun)의 못이 목의 앞면에 발사되는 사고로 내원하였다. 처음 시행한 흉부 방사선 사진에서 못은 전경부에 있었고, 점차 흉부에서 복부로 이동하였다. 전경부 기도 손상은 보였으나 식도 손상은 관찰되지 않았고, 못은 장내에 위치하여 내시경을 이용하여 제거하였다. 금식 및 항생제 투여 등 보존적 치료를 시행하였으며, 특별한 합병증 없이 치유되었기에 문헌 고찰과 함께 보고하는 바이다.

• Journal of Chest Surgery
• /
• 제49권1호
• /
• pp.15-21
• /
• 2016

Background: We aimed to evaluate the incidence, predictive factors, and impact of acute kidney injury (AKI) after thoracic endovascular aortic repair (TEVAR). Methods: A total of 53 patients who underwent 57 TEVAR operations between 2008 and 2015 were reviewed for the incidence of AKI as defined by the RIFLE (risk, injury, failure, loss, and end-stage kidney disease risk) consensus criteria. The estimated glomerular filtration rate was determined in the perioperative period. Comorbidities and postoperative outcomes were retrospectively reviewed. Results: Underlying aortic pathologies included 21 degenerative aortic aneurysms, 20 blunt traumatic aortic injuries, six type B aortic dissections, five type B intramural hematomas, three endoleaks and two miscellaneous diseases. The mean age of the patients was $61.2{\pm}17.5years$ (range, 15 to 85 years). AKI was identified in 13 (22.8%) of 57 patients. There was an association of preoperative stroke and postoperative paraparesis and paraplegia with AKI. The average intensive care unit (ICU) stay in patients with AKI was significantly longer than in patients without AKI (5.3 vs. 12.7 days, p=0.017). The 30-day mortality rate in patients with AKI was significantly higher than patients without AKI (23.1% vs. 4.5%, p=0.038); however, AKI did not impact long-term survival. Conclusion: Preoperative stroke and postoperative paraparesis and paraplegia were identified as predictors for AKI. Patients with AKI experienced longer average ICU stays and greater 30-day mortality than those without AKI. Perioperative identification of high-risk patients, as well as nephroprotective strategies to reduce the incidence of AKI, should be considered as important aspects of a successful TEVAR procedure.

• Korean Journal of Radiology
• /
• 제22권4호
• /
• pp.577-583
• /
• 2021

Objective: To report the authors' experience in performing thoracic endovascular aortic repair (TEVAR) for zone 2 lesions after traumatic aortic injury (TAI). Materials and Methods: This retrospective review included 10 patients who underwent zone 2 TEVAR after identification of aortic isthmus injury by CT angiography (CTA) upon arrival at the emergency room of a regional trauma center from 2016 to 2019. Patients were classified into two groups: those who underwent left subclavian artery (LSA) embolization concurrently with the main TEVAR procedure, and those in whom LSA embolization was not performed during the main procedure, but was planned as a bailout treatment if type II endoleak was noted on follow-up CTA images. Pre-procedural and procedure-related factors and post-procedure prognosis were compared between the groups. Results: There were no differences in pre-procedural factors, occurrence of endoleaks, and post-procedure prognosis (including mortality) between patients in the two groups. The duration of the procedure was shorter in the non-LSA embolization group (61 minutes vs. 27 minutes, p = 0.012). During follow-up, type II endoleak did not occur in either group. Conclusion: Delaying preventative LSA embolization until stabilization of the patient would be desirable when performing zone 2 TEVAR for TAI, in the absence of endoleak on the completion aortography image taken after complete deployment of the stent graft.

• Journal of Chest Surgery
• /
• 제42권1호
• /
• pp.100-103
• /
• 2009

흉부 대동맥의 외상성 파열은 두부 손상 다음으로 흔한 교통사고의 사망원인으로 약 85%의 환자가 병원 도착 전에 사망한다. 가장 흔한 기전은 고속의 차량이 충돌 등으로 인한 급작스런 감속에 의해 발생되며 대동맥 협부가 전체 대동맥 손상의 95%에 해당된다. 또 다른 기전으로는 흉부 압박 손상에 의해 골절되어 전위된 흉골병과 흉부 척추 사이에 대동맥이 끼이면서 나타날 수 있는데 이로 인해 흔하지 않은 위치의 대동맥벽의 내막이 파열된다. 저자들은 감속사고가 아닌 흉부 압박에 의해 대동맥궁이 파열되어 박리된 증례에 대해 집중적인 내과 치료 후에 지연 수술로 완전 순환정지 하에 뇌보호를 시행하면서 상행 대동맥의 일부와 대동맥궁을 인조혈관으로 치환하였기에 보고하는 바이다.

• Journal of Chest Surgery
• /
• 제41권1호
• /
• pp.124-127
• /
• 2008

외상에 의한 하대정맥의 손상은 사망률이 매우 높으며, 1970년대 이후로 사망률의 개선이 거의 없는 실정이다. 특히 간 후부 하대정맥의 손상은 사망률이 대개 75% 이상이며, 이는 시야확보와 지혈 등의 수술적 어려움에 기인한다. 하대정맥 손상 환자의 생존은 손상의 심한 정도와 해부학적 접근가능성 등과 연관이 있다. 총상에 의한 간 후부 하대정맥 손상환자의 수술을 경험하였기에 문헌 고찰과 함께 보고한다.

• 한국전문물리치료학회지
• /
• 제12권1호
• /
• pp.54-62
• /
• 2005

The purpose of this study was to find the effects of using aid in enhancing walking ability inpatients with spinal cord injury who have received rehabilitative care. The study population consisted of 24 spinal cord injury patients referred to the Department of Rehabilitation Medicine in the National Rehabilitation Center (NRC). All subjects were ambulatory with or without an assistive devices. All of the participants were assessed on SCIM II, WISCI II, FIM, MBI, gait speed (m/s), and walking endurance (120 min/m). The data were analyzed using a paired t-test, a one-way ANOVA, and a Duncan test. The results revealed that TSCIM II and all of the items of SCIM II of the cervical ASIA D group patients were higher than those of the Thoracic ASIA A and C group patients (p<.05). The FIM, MBI, and WISCI II of the cervical ASIA D group patients were higher than those of the Thoracic ASIA C group patients (p>.05). The walking velocities of the lumbar ASIA C group patients were higher than those of Thoracic ASIA A group patients (p<.05). The walking endurance of the lumbar ASIA C group patients was higher than that of the thoracic ASIA C group patients (p<.05). The ASIA D group patients used bilateral standard canes or crutches, but none used AFO. The ASIA A and C group patients used bilateral standard walkers with KAFO for standing and walking. The findings suggest that injury level as well as the functionality of walking aids should be considered when formulating a rehabilitative plan for patients with spinal cord injury.

• Journal of Chest Surgery
• /
• 제39권5호
• /
• pp.407-410
• /
• 2006

경동맥과 경정맥 사이의 외상성 동정맥루는 매우 드문 질환이고 경부의 해부학적 복잡성으로 인해 외상 후 진단을 놓치는 경우가 있으므로 혈관 손상이 있는 경우에는 동정맥루의 발견을 위해 적극적인 검사가 필요하다. 44년 전에 경부에 총상을 입은 57세 남자에서 늦게 발견된 경동맥-경정맥간의 동정맥루를 치험하였기에 보고하는 바이다.

• Journal of Chest Surgery
• /
• 제24권11호
• /
• pp.1115-1124
• /
• 1991

Recently the thoracic injuries have been markedly increasing due to the vast increase of traffic accident, industrial disaster, and incidental accident as well as the frequent use of the murderous weapons including gun or rifle. Because the thoracic injuries could involve the heart, lung, and great vessels, and would influence the lives, prompt diagnosis and adequate treatment are essential. Most of thoracic injuries can be managed with the conservative treatment and simple surgical procedure such as closed thoracostomy, but certain cases require open thoracotomy to preserve lives and to return to their normal environment. The authors have analysed the result of 53 cases of open thoracotomy after thoracic injuries mainly according to the patient`s chart review. The mean age was 33.4 years old and male to female ratio was about 5: l. Injury mechanisms that elicited thoracic trauma indicated for open thoracotomy were penetrating[47%] and non-penetrating[53%] injuries. The Most common type of the thoracic lesion was hemothorax with or without pneumothorax and diaphragm rupture was the second. 58\ulcornero of thoracic injuries were accompanied by abdominal injuries and 47% by bone fractures. 34 patients were operated within 24 hours after injury and their average elapsed time was 13.6 hour. The remained patients were operated after 24 hours and their average elapsed time was 7.8 days. 71 cases of operative procedures containing some overlappings were performed: diaphragm repair[28], bleeding control[12], pulmonary and cardiac repair[4 cases] Postoperative complication rate was 32.1% and operative mortality rate was 9.4%[5/53].