• Proceedings of the KOR-BRONCHOESO Conference
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• 1982.05a
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• pp.10.3-11
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• 1982

Recently through the advancement of medical and surgical managements and the development of low pressure cuffed endotracheal tube, incidence of tracheal stenosis was decreased significantly. Though its incidence was decreased markedly, stenosis was developted unfortunately in the situations such as long term use of respirator, heavy infection, trauma of the trachea and long term intubation etc. Tracheal stenosis had been handled with various methods such as mechanical dilatation, tissue graft techniques, luminal augumentation and end to end anastomosis due to their individual advantages but their effects were not satisfactory. In 1959 Lester had been found the regenerated cartilage from the perichondrium of the rib incidentaly. Since then Skoog, Sohn and Ohlsen were reported chondrogenic potential of perichondrium through the animal experiments. Though many different materials have been tried to rebuild stenosis and gaping defect of trachea, tracheal reconstruction has been a perplexing clinical problems. We choose the perichondrium as the graft material because cartilage is the normal supporting matrix of that structure and it will be an obvious advantage to be able to position perichondrium over a defect and obtain new cartilage there. The young rabbits, which were selected as our experimental animals, were sacrified from two to eight weeks after surgery. The results of our experiment were as follows; 1) In control group, the defect site of trachea was covered with fibrosis and vessels but graft site was covered with hypertrophied perichondrium and vessels. 2) Respiratory mucosa was completely regenerated in defect sites both control and grafted groups. 3) The histologic changes of the grafted sites were as follows: 2 weeks- microvessel dilatation, inflammatory reaction, initiation of fibrosis 4 weeks- decreased microvessel engorgement, submucosal fibrosis, decreased inflammatory reaction immatured cartilage island was noted in the grafted perichondrium (one specimen) 6 weeks- mild degree vascular engorgement submucosal fibrosis. chronic inflamatory reaction cartilage island and endochondrial ossification was noted in the grafted perichondrium (Two specimens) 8 weeks- minute vascular engorgement dense submucosal fibrosis. loss of inflammatory reaction. cartilage island was noted in the grafted perichondrium (two specimens) 4) There was no significant differences in regeneration between active surface in and out groups. 5) We observed immatured cartilage islands and endochondrial ossification in the perichondrial grafted groups where as such findings were not noted in control groups except fibrosis. We concluded that perichondrium was the adequate material for the reconstruction of defected trachea but our results was not sufficient in the aspect of chondrogenic potential of perichondrium. So further research has indicated possibility of chondrogenic potential of perichondrium.

• Korean Journal of Head & Neck Oncology
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• v.37 no.1
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• pp.63-66
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• 2021

Supracricoid partial laryngectomy (SCPL) with cricohyoidoepiglottopexy (CHEP) or cricohyoidopexy (CHP) involves the removal of the whole thyroid cartilage, both true and false vocal cords, the ventricles, and the paraglottic spaces, sparing the cricoid cartilage, hyoid bone, and at least one functional and mobile cricoarytenoid unit. Reconstruction is performed by suturing of the cricoid cartilage up tightly to the hyoid bone, so trachea-releasing procedures are needed to prevent leakage at anastomosis site. In case of advanced tranglottic cancer invading tracheal tracheal wall, we need to perform additional circumferentrial circumferential tracheal wall resection. However, when we perform SCPL, circumferential resection of tracheal wall is limited because SCPL procedure itself needs releasing of tracheal length. We report a case of advanced transglottic cancer involving tracheal wall treated with induction chemotherapy and SCPL including tracheal wall resection with reconstruction of tracheal defect by sternocleidomastoid muscle flap covered with skin graft.

• Proceedings of the KOR-BRONCHOESO Conference
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• 2003.09a
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• pp.107-107
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• 2003

Purpose; Tracheal transplantation is necessary in patients with extensive tracheal stenosis, congenital lesions and many oncologic conditions but bears many critical problems compared with other organ transplantations. The purpose of this study was to make an intestine-cartilage composite graft for potential application for tracheal reconstruction by free intestinal graft. Methods; Hyaline cartilage was harvested from trachea of 2 weeks old New Zealand White Rabbits. Chondrocytes were isolated and cultured for 8 weeks. Cultured chodrocytes were seeded in the PLGA scaffolds and mixed in pluronic gel. Chondrocyte bearing scaffolds and gel mixture were embedded in submucosal area of stomach and colon of 3kg weighted New Zealand White Rabbits under general anesthesia. 10 weeks after implantation, bowels were harvested for evaluation. Results; We could identify implantation site by gross examination and palpation. Developed cartilage made a good frame for shape memory Microscopic examinations include special stain showed absorption of scaffold and cartilage formation even though not fully matured Conclusion; Intestine-cartilage composite graft could be applicable to future tracheal substitute and needs further Investigations.

• Tuberculosis and Respiratory Diseases
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• v.79 no.2
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• pp.98-100
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• 2016

We present a rare case of critically compromised airway secondary to a massively dilated sequestered colon conduit after several revision surgeries. A 71-year-old male patient had several operations after the diagnosis of gastric cancer. After initial treatment of pneumonia in the pulmonology department, he was transferred to the surgery department for feeding jejunostomy because of recurrent aspiration. However, he had respiratory failure requiring mechanical ventilation. The chest computed tomography (CT) scan showed pneumonic consolidation at both lower lungs and massive dilatation of the substernal interposed colon compressing the trachea. The dilated interposed colon was originated from the right colon, which was sequestered after the recent esophageal reconstruction with left colon interposition resulting blind pouch at both ends. It was treated with CT-guided pigtail catheter drainage via right supraclavicular route, which was left in place for 2 weeks, and then removed. The patient remained well clinically, and was discharged home.

• Journal of Chest Surgery
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• v.25 no.6
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• pp.581-587
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• 1992

Tracheoesophageal fistula[TEF] is a rare but life-threatening lesion that may occur from ventilation with a cuffed tube. It occurs most frequently when an inlying esophageal tube is also being used-usually for feeding purposes. The mechanism of injury appears to be pressure experted on the tracheal wall by the cuff, which then compresses the "party wall" of the trachea and esophagus against the foreign body that lies in the esophagus. The patient was 32 years old female who had been receiving a treatment of respiratory failure induced by postoperative sepsis with assist ventilator and nasogastric tubal feeding. Sudden attack of abdominal gas distention and massive drainage of gas through N-G tube were developed during assist ventilation in that patient, so we diagnosed as tracheal stenosis with a tracheoesophageal fistula induced by prolonged endotracheal intubation We performed tracheal reconstruction and primary closure of perforated esophagus after weaning ventilator. The postoperative course was uneventiful.eventiful.

• Korean Journal of Bronchoesophagology
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• v.1 no.1
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• pp.101-108
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• 1995

From 1988 to 1995, 59 patients with laryngotracheal stenosis were operated with resection of stenotic segment and end to end anastomosis in Seoul national university. Among these patients, 36 were tracheal stenosis, 17 were combined lesion of subglottis and trachea and 5 were subglottic stenosis. The success of procedure was determined by stoma closure or decannulation and an overall 89.8% success rate was achieved following 165 procedures. The success rate showed correlation with severity of stenosis and the number of procedures done was related to the site of stenosis. There was no mortality and granulation formation, unilateral vocal cord palsy were the common complication of end to end procedures.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.33 no.3
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• pp.123-129
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• 2022

Pediatric laryngotracheal stenosis occurs by either congenital or acquired causes and usually indicates subglottic stenosis. The main goals of treatment are decannulation, preserving phonation, and normal swallowing function. Various types and degrees of stenosis and combined anomalies would be the main barriers to reaching successful treatment results unless comprehensive understanding of stenosis. Multidisciplinary team approaches encompassing initial assessment, treatment, and postoperative care, are also necessary to achieve the best treatment outcome. Therapeutic approaches are divided into conservative, endoscopic, and open surgical approaches at length, which are not exclusive to each other. Here, an adequate selection of each therapeutic option and postoperative management will be introduced to achieve decannulation without leaving phonatory or swallowing complications.

• Journal of Korean Neurosurgical Society
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• v.49 no.2
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• pp.107-111
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• 2011

Objective : The aim of this study was to evaluate the utility of volume-rendered helical computerized tomography (CT) angiography focusing tracheostomy tube and innominate artery for prevention of tracheoinnominate artery fistula. Methods : The authors retrospectively analyzed 22 patients with tracheostomy who had checked CT angiography. To evaluate the relationship between tracheostomy tube and innominate artery, we divided into three categories. First proximal tube position based on cervical vertebra, named "tracheostomy tube departure level (TTDL)". Second, distal tube position and course of innominate artery, named "tracheostomy tube-innominate artery configuration (TTIC)". Third, the gap between the tube and innominate artery, named "tracheostomy tube to innominate artery gap (TTIG)". The TTDL/TTIC and TTIG are based on 3-dimensional (3D) reconstruction around tracheostomy and enhanced axial slices of upper chest, respectively. Results : First, mean TTDL was $6.8{\pm}0.6$. Five cases (23%) were lower than C7 vertebra. Second, TTIC were remote to innominate artery (2 cases; 9.1 %), matched with it (14 cases; 63.6%) or crossed it (6 cases; 27.3%). Only 9% of cases were definitely free from innominate artery injury. Third, average TTIG was $4.3{\pm}4.6$ mm. Surprisingly, in 6 cases (27.3%), innominate artery, trachea wall and tracheostomy tube were tightly attached all together, thus have much higher probability of erosion. Conclusion : If low TTDL, match or crossing type TTIC with reverse-L shaped innominate artery, small trachea and thin TTIG are accompanied all together, we may seriously consider early plugging and tube removal.

• Korean Journal of Head & Neck Oncology
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• v.13 no.1
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• pp.62-68
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• 1997

The papillary carcinoma is the most common malignant neoplasm of thyroid gland and the prognosis is better than anyother type of thyroid carcinoma. However, the thyroid is closed to the important organs such as esophagus, trachea and larynx, there are some possibilities to invade these organs. In case of advanced disease, not only surrounding structures but also mediastinum and cervical lymphatic chain can be involved or distant metastasis develops frequently. Therefore in these cases the prognosis is worse and the rate of inoperable case is more than those of non-metastatic group. Generally, the treatment modality for papillary thyroid carcinoma consists of surgery, postoperative thyroid hormone and radioiodine therapy. If the tumor invades surrounding structures, cervical lymph node or mediastinum, total thyroidectomy and wide excision of tumor invaded area including mediastinal dissection and neck dissection is necessary. Recently, the authors have experienced a case of locally invasive and recurred papillary thyroid carcinoma without treatment for 7 years. The patient was performed previously thyroid lobectomy and isthmusectomy 13 years ago. We had determinded surgical therapy for this patient and performed mass excision with overlying skin, completion total thyroidectomy, right type I modified radical neck dissection, left lateral neck dissection, thoracotomy with supramediastinal dissection, shaving of diffusely involved trachea and skin defect reconstruction with pectoralis major myocutaneous flap. After operation 2 cycles of radioiodine therapy were taken. Now the patient is following up at the outpatient base and no evidence of disease state for postoperative 16 months. So we report on this case with a brief review of literature.

• Korean Journal of Radiology
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• v.22 no.1
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• pp.131-138
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• 2021

Objective: Iterative reconstruction degrades image quality. Thus, further advances in image reconstruction are necessary to overcome some limitations of this technique in low-dose computed tomography (LDCT) scan of the chest. Deep-learning image reconstruction (DLIR) is a new method used to reduce dose while maintaining image quality. The purposes of this study was to evaluate image quality and noise of LDCT scan images reconstructed with DLIR and compare with those of images reconstructed with the adaptive statistical iterative reconstruction-Veo at a level of 30% (ASiR-V 30%). Materials and Methods: This retrospective study included 58 patients who underwent LDCT scan for lung cancer screening. Datasets were reconstructed with ASiR-V 30% and DLIR at medium and high levels (DLIR-M and DLIR-H, respectively). The objective image signal and noise, which represented mean attenuation value and standard deviation in Hounsfield units for the lungs, mediastinum, liver, and background air, and subjective image contrast, image noise, and conspicuity of structures were evaluated. The differences between CT scan images subjected to ASiR-V 30%, DLIR-M, and DLIR-H were evaluated. Results: Based on the objective analysis, the image signals did not significantly differ among ASiR-V 30%, DLIR-M, and DLIR-H (p = 0.949, 0.737, 0.366, and 0.358 in the lungs, mediastinum, liver, and background air, respectively). However, the noise was significantly lower in DLIR-M and DLIR-H than in ASiR-V 30% (all p < 0.001). DLIR had higher signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) than ASiR-V 30% (p = 0.027, < 0.001, and < 0.001 in the SNR of the lungs, mediastinum, and liver, respectively; all p < 0.001 in the CNR). According to the subjective analysis, DLIR had higher image contrast and lower image noise than ASiR-V 30% (all p < 0.001). DLIR was superior to ASiR-V 30% in identifying the pulmonary arteries and veins, trachea and bronchi, lymph nodes, and pleura and pericardium (all p < 0.001). Conclusion: DLIR significantly reduced the image noise in chest LDCT scan images compared with ASiR-V 30% while maintaining superior image quality.