• Journal of Chest Surgery
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• v.39 no.8 s.265
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• pp.573-578
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• 2006

Background: Generally hernia is diagnosed with simple chest or gastrointestinal x-ray. Sometimes CT or MRI can give lots of information for the diagnosis. However, there was no study for the differentiation with using CT findings between Morgagni hernia and pleuropericardial fat. The aim of this study was to evaluate the useful CT findings for differentiating Morgagni hernia from pleuropericardial fat. Material and Method: We retrospectively analyzed CT scans of eight patients with Morgagni hernia and 20 patients with abundant pleuropericardial fat without peridiaphragmatic lesions. All CT scans were performed with coverage of the whole diaphragm in the inspiration state. We evaluated 1) the presence of the defect of the anterior diaphragm, 2) the interface between the lung and fat, 3) the angle between the chest wall and fat, 4) the continuity between the extrapleural fat and fat, 5) the presence of the vessels within fat, and 6) the presence of a thin line surrounding fat. Result: In all cases with Morgagni hernia, the defect of the anterior diaphragm was seen. The interface was well-defined, smooth, and convex to the lung. The angle with the chest wall was acute. The continuity with the extrapleural fat was not seen. In the cases with abundant pleuropericardial fat, the defect of the anterior diaphragm was seen in three (15%). The interface was usually irregular (n=10) and flat (n=17). The angle with the chest wall was variable. The continuity with the extrapleural fat, that was markedly increased in amount, was usually seen (n=16). The thin line surrounding fat was seen in four cases with Morgagni hernia, however, not seen in all cases with pleuropericardial fat. All of the above findings were statistically significant, however, vessels within fat was not significant to differentiate Morgagni hernia (n=8/8) from pleuropericardial fat (n=14/20). Conclusion: The useful CT findings of Morgagni hernia were fatty mass with sharp margin, convexity toward lung, acute angle with chest wall, and thin line surrounding hernia. Branching structure within fatty mass representing omental vessels that has been known as a characteristic finding of Morgagni hernia was not useful for differentiating Morgagni hernia from pleuropericardial fat.

• Journal of Chest Surgery
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• v.39 no.5 s.262
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• pp.359-365
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• 2006

Background: Arterial grafts have been used to achieve better long-term results for coronary revascularization. Bilateral internal thoracic artery (ITA) grafts have a better results, but it may be not used in some situations such as diabetes and chronic obstructive pulmonary disease (COPD). We evaluated the clinical and angiographic results of composite left internal thoracic artery-radial artery (LITA-RA) Y graft. Material and Method: Between April 2002 and September 2004, 119 patients were enrolled in composite Y graft for coronary bypass surgery. The mean age was $62.6{\pm}8.8$ years old and female was 34.5%. Preoperative cardiac risk factors were as follows: hypertension 43.7%, diabetes 33.6%, smoker 41.2%, and hyperlipidemia 22.7%, There were emergency operation (14), cardiogenic shock (6), left ventricle ejection fraction (LVEF) less than 40% (17), and 17 cases of left main disease. Coronary angiography was done in 35 patients before the hospital discharge. Result: The number of distal anastomoses was $3.1{\pm}0.91$ and three patients (2.52%) died during hospital stay. The off-pump coronary artery bypass (OPCAB) was applied to 79 patients (66.4%). The LITA was anastomosed to left anterior descending system except three cases which was to lateral wall. The radial Y grafts were anastomosed to diagonal branches (4), ramus intermedius (21), obtuse marginal branches (109), posterolateral branches (12), and posterior descending coronary artery (8). Postoperative coronary angiography in 35 patients showed excellent patency rates (LITA 100%, and RA 88.5%; 3 RA grafts which anastomosed to coronary arteries <70% stenosed showed string sign with competitive flow). Conclusion: The LITA-RA Y composite graft provided good early clinical and angiographic results in multivessel coronary revascularization. But it should be cautiously used in selected patients.

• Journal of Chest Surgery
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• v.43 no.4
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• pp.364-374
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• 2010

Background: We assessed the early and mid-term results of the modified Norwood procedure for first-stage palliation of hypoplastic left heart syndrome (HLHS) and its variants to identify the risk factors for hospital mortality. Material and Method: Between March, 2003, and December, 2009, 23 patients (18 males and 5 females) with HLHS or variants underwent the modified Norwood procedure. The age at operation ranged from 3 to 60 days (mean, $11.7{\pm}13.2days$) and weight at operation ranged from 2.2 to 4.8 kg (mean, $3.17{\pm}0.52kg$). We used a modified technique that spared the anterior wall of the main pulmonary artery in 20 patients. The sources of pulmonary blood flow were RV-PA conduit in 15 patients (group I) and RMBTS in 8 (group II). Follow-up was completed in 19 patients (19/20, 95%) in our hospital (mean $26.0{\pm}22.8months$). Result: Early death occurred in 3 patients (3/23, 13%), of whom 2 had TAPVC. Fourteen patients underwent subsequent bidirectional cavopulmonary connection (BCPC, stage 2) and seven underwent the Fontan operation (stage 3). Three patients died between stages, 2 before stage 2 and one before stage 3. The estimated 1-year and 5-year survival rates were 78% and 69%, respectively. On multivariate regression analysis, aberrant right subclavian artery (RSCA) and associated total anomalous pulmonary venous connection (TAPVC) were risk factors for hospital mortality after stage 1 Norwood procedure. Conclusion: HLHS and its variants can be palliated by the modified Norwood procedure with low operative mortality. Total anomalous pulmonary venous connection adversely affects the survival after a stage 1 Norwood procedure, and interstage mortality rates need to be improved.

• Journal of Chest Surgery
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• v.42 no.4
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• pp.502-508
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• 2009

Background: Rib fractures are the most common injuries that are caused by blunt chest trauma. However, fractures of the costal cartilage generally go unnoticed on chest X-rays unless they involve a calcified cartilage. For this reason, the sensitivity of conventional radiography for detecting rib fractures is low, and especially those involving the cartilaginous part of the rib. Thus, we have evaluated the usefulness of ultrasonography for detecting fractures of the costal cartilage that were overlooked on the conventional radiographs of patients who suffered minor blunt chest traumas. Material and Method: A total of 45 patients who suffered minor blunt chest trauma and who had no evidence of rib fractures or other major fractures on conventional radiographs were admitted for ultrasonography between April 2008 and March 2009. There were 24 women and 21 men, and the mean age of the patients was 50.4$\pm$15.91 years (range: 17$\sim$76 years). They were examined for the detection of fractures of the costal cartilage by performing ultrasonography with a 7.5-MHz linear transducer. Result: A total of 30 patients (67%) had fractures of the costal cartilage, whereas 15 patients (33%) had no evidence of chondral rib fractures. The mean number of fracture sites of the fractured costal cartilage was 1.6$\pm$0.81 (range: 1$\sim$4 sites) in 30 patients. Periosteal hematoma was the most common finding associated with fractures of the costal cartilage (n=7, 17%), followed by sternum fracture (n=5, 12%). However, periosteal hematoma was noticed in 1 patient (2%) who was without fracture of the costal cartilage, and sternum fracture was noticed in 1 patient (2%) who was without fractures of the costal cartilage. Conclusion: The results of this study suggest that ultrasonography may be a useful imaging modality for detecting fractures of the costal cartilage that are overlooked on the conventional radiographs of patients who suffer minor blunt chest trauma.

• Journal of Chest Surgery
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• v.36 no.11
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• pp.839-845
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• 2003

Background: Even today when chemotherapy has been established as a treatment for tuberculosis and the prevalence of tuberculosis is gradually decreasing, multi-drug resistance tuberculosis still results in poor treatment performance and lowered survival periods. This research sought to analyze the surgery of multi-drug resistance tuberculosis, and determine the usefulness and danger of surgery in connection with this disease. Material and Method: Starting from February 1990 to February 2002, retrospective surveys were conducted targeted at 21 cases involving 20 patients who underwent surgery due to multi-drug resistance tuberculosis. The survey included 14 males cases and 6 females cases with the age averaging 42.8$\pm$12.1 years. 10.3$\pm$7.6 years on average passed after patients were initially diagnosed with tuberculosis. 13 patients (65%) tested positive in the pre-operative sputum AFB test, and all showed resistance against an average of 3.5 anti-tuberculosis agents including INH and RFP. Pre-operative radiologic examinations revealed cavitary lesions in 15 patients (75%), and three patients had lesions in the both lung fields, with the major lesions existing in the unilateral area. 13 patients (75%) failed negative conversion with medical treatment, while two patients (10%) with recurrent hemoptysis and five patients (25%) with lesions involving high recurrence-rate received the operation. Operations included nine cases (40%) of pneumonectomy, nine cases (45%) of lobectomy, and three cases of lobectomy with segmentectomy. The average follow-up period of patients stood at 23 months. Result: There was no post-operative death, and found were a total of eleven cases involving complications were found: three cases of long-term air leakage, three cases of bleeding requiring re-operation, two cases of empyemas due to broncho-pleural fistula, and one case of atelectasis, wound infection and chest wall fistula each. Eleven cases (85%) of negative conversion were completed immediately after the operation, and two cases failed negative conversion. Eleven months after the operation, the disease recurred in one case of negative conversion patients, and the patient was cured by completion pneumonectomy. Conclusion: If patients' lung function was sufficient and appropriate resection was possible, multi-drug resistance tuberculosis could achieve high-rate negative conversion and cure using combination of surgical and medical treatment, and also there were not many serious complications.

• Journal of Chest Surgery
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• v.13 no.3
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• pp.212-218
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• 1980

A severe crushing injury of the chest produce a very striking syndrome referred to as traumatic asphyxia. This syndrome is characterized by bluish-red discoloration of the skin which is limited to the distribution of the valveless veins of the head and neck. And also if it is characterized by bilateral subconjunctival hemorrhages and neurological manifestations. But these clinical entities faded away progressively in a few weeks. Apporximately 90% of the patients who live for more than a few hours will recover from traumatic asphyxia when it occurs as a single entity. And so, death results from either severe associated injuries of from subsequent infection, rather than from pulmonary or cardiac insufficiency in traumatic asphyxia. We have experienced 4 cases of traumatic asphyxia with severe crushing thoracic injuries at department of the chest surgery, Captial Armed forces General Hospital during about 3 years from April 1977 to Aug. 1980. The 1st 22 year-old male was struct 2$\frac{1}{2}$ ton truck on the road and was transferred to this hospital immediately. He had taken tracheostomy due to severe dyspnea with contusion pneumonia and for removal of a large amount of bronchial secretion. The 2nd case was 23 year-old male who was got buried in a chasm. In this case, the heavy metal post tumbled over him back while at work. The 3rd case was 39 year-old male who leapt out of a window in 5th story while fire broke out in living room by oil stove heating. He had multiple rib fracture with right hemothor x and right colle's fracture and pelvic bone fracture. The last 22 year-old male was run over by a gun carriage. The wheel of this gun carriage passed over his thorax and right chin. He was brought to this hospital by helicopter. when he was first examined at emergency room, he was in semicomatose state and has pneurmomediastinum with multiple rib fracture and severe subcutaneous emphysema. As soon as he arrived, bilateral closed thoracostomy was performed and cardiopulmonary resuscitation was done. In hospital 8th weeks, chest series showed fibrothorax in right side even if chest wall stabilized. All 4 cases had multiple petechiae over their facees and chest and bilateral subconjunctival hemorrhages referred to as traumatic asphyxia. 3 cases except one case who received splenectomy, had been suffered from contusion pneumonia and had been treated with respiratory care. In these 3 cases, they had warning of impending injury before accident, and took a deep breath hold it and braces himself. And also, even if he had not impending fear in remaining one case, he had taken a deep breath and had got valsalva maneuver for pulling off the heavy metal post. Intrathoracic pressure rose suddenly and resulted to traumatic asphyxia in this situation. All these cases were recovered completely without sequelae except one fibrothorax, right.

• Journal of Veterinary Clinics
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• v.25 no.2
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• pp.96-101
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• 2008

This study was performed to quantify the pleural effusion in radiography, ultrasonography and computed tomography(CT) and to evaluate and compare the usefulness of these methods. Normal saline of 10 ml/kg was infused into the pleural space until a final loading volume of 60 ml/kg body weight was reached in six Beagle dogs. The radiographic examination was performed for the detection and quantification of pleural effusion. On the ultrasonographic study, the maximum perpendicular distance was measured between the surface of the lung and the thoracic wall to evaluate pleural effusion. On the CT image, pleural effusion was evaluated as the perpendicular distance to the thoracic surface in the maximum pleural effusion volume on any transverse images with soft tissue window. Statistical analysis was performed using linear regression test. The volume of pleural effusion and measurements of radiography and ultrasonography had no statistical relationship. However, a significant correlation was identified between the volume of pleural effusion and the depth at right ($r^2=0.715$), left ($r^2=0.745$), and mean right and left depth ($r^2=0.844$) on the CT images. All of the thoracic radiographs, ultrasonography, and CT are useful in recognition of pleural effusion. In quantification of pleural effusion, the CT measurement method is superior to radiographic and ultrasonographic measurements.

• Journal of Physiology & Pathology in Korean Medicine
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• v.28 no.6
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• pp.689-694
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• 2014

We report a female small cell lung cancer patient in the extensive stage(T3N3Mx). After 6 cycles of chemotherapy combined radiation therapy, she received inpatient Korean medical care including herbal medicine, acupuncture therapy and concurrent western oral medications of opioid analgesics and anti-anxiety agent. The chief complaint was right side thoracic wall pain which had started after chemotherapy and was not effectively controlled by analgesics. For this condition, we treated her with 2Hz of constant electrical stimulation on Jiaji (Ex-B2) points T5-T7 laterally (right) using three needles for 20 minutes once a day for 9 days. With every session of electrical acupuncture treatment, thoracic pain decreased acutely. Korean medicine treatments including Jiaji (Ex-B2) point stimulation might be tried for lung cancer patients with uncontrolled thoracic pain at least for the acute analgesic effect.

• Journal of Chest Surgery
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• v.40 no.1 s.270
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• pp.1-7
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• 2007

Backgound: It has been shown that the endothelium of cardiac valves and adjacent great vessels have a reduced immune reaction compared to other vessels. We investigated the clinical feasibility of using immunologically untreated xenogenic valves, in a pig-to-goat pulmonary valve conduit implantation model. Material and Method: Porcine pulmonary valve conduits were prepared without specific immunologic treatment and implanted into the right ventricular outflow tract of goats while undergoing cardiopulmonary bypass. Two goats each were assigned to the following observation time intervals: one day, one week, three months, six months and twelve months. Echo-cardiographic examinations were performed prior to sacrifice of the goat to evaluate pulmonary valve function. After the xenograft specimens were retrieved, histological changes were evaluated microscopically. Result: Ten of the twelve animals survived the predetermined observation time intervals. Aneurysmal dilatations, of the anterior wall of the implanted pulmonary artery, were observed at each of three and twelve month-survival animals. A variable degree of pulmonary valve regurgitation was observed on echocardiography. However, valve stenosis, thrombotic occlusion and vegetation were not seen. Microscopically, the nuclei of the donor tissue disappeared as a result of pyknosis and karyolysis; however the three components of the implanted xenografts (the pulmonary artery, the valve and the infundibulum) were gradually replaced by host cells over time, while maintaining their structural integrity. Conclusion: Immunologically untreated xenogenic pulmonary valve conduits were replaced by host cells with few observed clinical problems in a pig to goat pulmonary valve implantation model. Therefore, they might be an alternative bioprosthesis option.

• The Journal of Korean Society for Radiation Therapy
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• v.31 no.2
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• pp.43-49
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• 2019

Purpose: This study examined changes in the position of the heat and lungs depending on the patient's breathing method during left breast cancer radiotherapy and used treatment plans to compare the resulting radiation dose. Materials and methods: The participants consisted of 10 patients with left breast cancer. A CT simulator(SIMENS SOMATOM AS, Germany) was used to obtain images when using three different breathing methods: free breathing(FB), deep inspiration breath hold(DIBH with Abches, DIBH), inspiration breath hold(IBH with CPAP, CPAP). A Ray Station(5.0.2.35, Sweden) was used for treatment planning, the treatment method was volumetric modulated arc therapy (VMAT) with one partial arc of the same angle, and the prescribed dose to the planning target volume (PTV) was a total dose of 50Gy(2Gy/day). In treatment plan analysis, the 95% dose (D95) to the PTV, the conformity index(CI), and the homogeneity index (HI) were compared. The lungs, heart, and left anterior descending artery (LAD) were selected as the organs at risk(OARs). Results: The mean volume of the ipsilateral lung for FB, DIBH, and CPAP was 1245.58±301.31㎤, 1790.09±362.43 ㎤, 1775.44±476.71 ㎤. The mean D95 for the PTV was 46.67±1.89Gy, 46.85±1.72Gy, 46.97±23.4Gy, and the mean CI and HI were 0.95±0.02, 0.96±0.02, 0.95±0.02 and 0.91±0.01, 0.90±0.01, 0.92±0.02. The V20 of Whole Lung was 10.74±4.50%, 8.29±3.14%, 9.12±3.29% and The V20 of the ipsilateral lung was 20.45±8.65%, 17.18±7.04%, 18.85±7.85%, the Dmean of the heart was 7.82±1.27Gy, 6.10±1.27Gy, 5.67±1.56Gy, and the Dmax of the LAD was 20.41±7.56Gy, 14.88±3.57Gy, 14.96±2.81Gy. The distance from the thoracic wall to the LAD was measured to be 11.33±4.70mm, 22.40±6.01mm, 20.14±6.23mm. Conclusion: During left breast cancer radiotherapy, the lung volume was 46.24% larger for DIBH than for FB, and 43.11% larger for CPAP than FB. The larger lung volume increases the distance between the thoracic wall and the heart. In this way, the LAD, which is one of the nearby OARs, can be more effectively protected while still satisfying the treatment plan. The lung volume was largest for DIBH, and the distance between the LAD and thoracic wall was also the greatest. However, when performing treatment with DIBH, the intra-fraction error cannot be ignored. Moreover, communication between the patient and the radiotherapist is also an important factor in DIBH treatment. When communication is problematic, or if the patient has difficulty holding their breath, we believe that CPAP could be used as an alternative to DIBH. In order to verify the clinical efficacy of CPAP, it will be necessary to perform long-term follow-up of a greater number of patients.