• Journal of Chest Surgery
• /
• 제44권6호
• /
• pp.418-422
• /
• 2011

Background: It has recently become most general to use the small bore catheter to perform closed thoracostomy in treating iatrogenic pneumothorax. This study was performed for analysis of the efficacy of treatment methods by using small bore catheter such as 7 F (French) central venous catheter, 10 F trocar catheter, 12 F pigtail catheter and for analysis of the appropriateness of each procedure. Materials and Methods: From March 2007 to February 2010, Retrospective review of 105 patients with iatrogenic pneumothorax, who underwent closed thoracostomy by using small bore catheter, was performed. We analyzed the total success rate for all procedures as well as the individual success rate for each procedure, and analyzed the cause of failure, additional treatment method for failure, influential factors of treatment outcome, and complications. Results: The most common causes of iatrogenic pneumothorax were presented as percutaneous needle aspiration(PCNA) in 48 cases (45.7%), and central venous catheterization in 26 cases (24.8%). The mean interval to thoracostomy after the procedure was measured as 5.2 hours (1~34 hours). Total success rate of thoracostomy was 78.1%. The success rate was not significantly difference by tube type, with 7 F central venous catheter as 80%, 10 F trocar catheter as 81.6%, and 12 F pigtail catheter as 71%. Twenty one out of 23 patients that had failed with small bore catheter treatment added large bore conventional thoracostomy, and another 2 patients received surgery. The causes for treatment failure were presented as continuous air leakage in 12 cases (52.2%) and tube malfunction in 7 cases (30%). The causes for failure did not present significant differences by tube type. Statistically significant factors affecting treatment performance were not discovered. Conclusion: Closed thoracostomy with small bore catheter proved to be effective for iatrogenic pneumothorax. The success rate was not difference for each type. However, it is important to select the appropriate catheter by considering the patient status, pneumothorax aspect, and medical personnel in the cardiothoracic surgery department of the relevant hospital.

• Journal of Chest Surgery
• /
• 제48권4호
• /
• pp.277-280
• /
• 2015

We report the case of a 37-year-old man who suffered from biventricular failure due to left isomerism, inferior vena cava interruption with azygos vein continuation, bilateral superior vena cava, double outlet of right ventricle, complete atrioventricular septal defect, pulmonary stenosis, and isolated dextrocardia. Heart transplantation in patients with systemic venous anomalies often requires the correction and reconstruction of the upper & lower venous drainage. We present a case of heart transplantation in a patient with left isomerism, highlighting technical modifications to the procedure, including the unifocalization of the caval veins and reconstruction with patch augmentation.

• Journal of Chest Surgery
• /
• 제26권6호
• /
• pp.483-487
• /
• 1993

From July 1990 to August 1992,78 Hickman catheters and 22 chemoports were inserted in 98 patients for chemotherapy.We analyzed the clinical data of these patients. The results were as follows: 1]Mean age of patients was 42.8$\pm$1.6[SE] years 2]Male to female ratio was 1.09:1 3]The diseases of the cases were leukemia[66] ,lymphoma[8], stomach cancer[8],uterine cervix cancer[5],ovarian cancer[4],lung cancer[3],aplastic anemia[2],maxillary gland cancer[1],pancreas cancer[1],malignant mesothelioma[1] and multiple myeloma[1] 4]Mean values of preoperative WBC counts,platelet counts,PT and APTT were 31,500$\pm$ 8,132[SE]/mm,104,000$\pm$ 12,200 [SE]/mm,82$\pm$ 1.9[SE]% and 32$\pm$ 0.8[SE] sec,respectively. 5]The average duration of catheter uses was 121.7$\pm$ 17.3[SE]days. 6]The complications were subcutaneous tunnel bleeding or hematoma[2],exit site or subcutaneous tunnel infection[2] and catheter related septicemia[1]. 7]The causes of catheter removal were patient`s death or hopeless discharge[22],completion of treatment[6],subcutaneus hematoma or bleeding[2],exit site or subcutaneous tunnel infection[2] and catheter related septicemia[1].So,we concluded that Hickman catheter and chemoport were useful vascular access for chemotherapy in patients with malignant diseases, with low rate of complication and longterm duration.

• Journal of Chest Surgery
• /
• 제16권3호
• /
• pp.362-367
• /
• 1983

Pulmonary arteriovenous fistula is a congenital malformation resulting from errant capillary development, with incomplete formation or disintegration of the vascular septa that normally divide the primitive connections between the venous and arterial plexuses. It generally occurs as part of the disorder known as hereditary hemorrhagic telangiectasia [Rendu-Osler-Weber disease]. The hereditary lesion is transmitted as a simple non-sex-linked dominant trait. It may be single or multiple, too small to see on plain chest films or large and easily recognized. One third of the lesions are multiple on plain chest film. The pathogenesis of its symptoms is that unoxygenated, desaturated arterial blood enters into the pulmonary venous system, directly. Recently we have experienced a case of the pulmonary arteriovenous fistula in 26 years old male soldier, which was confirmed by pulmonary angiography preoperatively. 2 thumb-tip sized, well circumscribed cystic masses filled with bright red colored blood were seen in subpleural and anterolateral portion of the right upper lobe. Right upper Iobectomy was performed due to close approximation of the fistula with pulmonary vein. Microscopically, it shows angiomatous dilatation of the abnormal vessels embedding in the parenchyma. Postoperative physiologic studies show nearly normal arterial oxygen saturation, hemoglobin and RBC count. There was good, uneventful postoperative course.

• Journal of Genetic Medicine
• /
• 제3권1호
• /
• pp.1-4
• /
• 1999

Scimitar syndrome is a rare congenital anomaly that is characterized by hypoplasia of the right lung and the right pulmonary artery with anomalous pulmonary venous drainage to the inferior vena cava. The scimitar vein is usually visible on chest radiographs, but may be obscured by the heart. It is essential for surgical correction to establish the point of drainage of the anomalous vein and associated anomalies. There are recent reports of familial total anomalous pulmonary venous return suggesting heritable forms of this anomaly. Although genetic factors are believed to have important roles in congenital heart disease, few genes involved in heart development have been located. We report a case of familial chromosome 9 inversion with Scimitar syndrome in an offspring who presented with dextrocardia. Evaluation with magnetic resonance cineangiograph imaging demonstrated an anomalous pulmonary vein draining into the inferior vena cava above the diaphragm and hypoplasia of the right lung and the right pulmonary artery. Chromsome analysis showed pericentric inversion of chromosome 9, inv 9 (p13, q21), in the patient and his mother as well. A brief review of the related literature is also included.

• 대한약침학회지
• /
• 제13권1호
• /
• pp.103-120
• /
• 2010

Objective : To review the trend of the study related to Leech therapy and to establish the hereafter direction for the study on Leech therapy. Methods : I reviewed and analyzed all the theses published in Domestic and Foreign research institution from 1990 to 2009. Results : The following results were obtained in this study. 1. Analyzed number of theses published, there was no significance per year. 2. Classified by theme of journal, journals related to surgery were most(41 journals, 75.92%) among 54 kinds. 3. Classified by theses by research method and thesis types, case report accounted for nearly twothirds (52 pieces, 68.42%) of all theses and consideration of document was next(9 pieces, 11.84%). 4. With the most case of venous congestion after plastic and reconstructive surgery(33 pieces, 63.46%), leech therapy was effective on illnesses such as haematoma, macroglossia, purpura, varicous vein, avulsion injury, neurovascular compression, diabetic neuropathy, penoscrotal oedema, buerger's disease, rheumatoid arthritis. 5. Two most appeared adverse effects were anemia and infection. Immediate blood transfusion was done for recovering anemia and prophylactic 3rd generation antibiotics to infection were emphasized in more than half of case reports. 6. All of consideration of documents was retrospective study of cases related leech therapy and 3 pieces of them emphasized prophyratic antibiotic treatment for preventing infection. 7. The study of clinical trail type started first in 2002 and osteoarthritis of knee and carpometacarpal joint were main target. As see above result, Leech therapy was effective cure and could be used in disease induced by venous congestion. And I think that it is necessary to perform additional study related to solution of problems about leech therapy and protocol for using in clinical practice.

• Childhood Kidney Diseases
• /
• 제2권1호
• /
• pp.69-72
• /
• 1998

Thromboemolism is one of the severe complications of nephrotic syndrome. And arterial thromboembolism is rare than venous thromboembolism. Hypercoagulability is the main pathophysiologic factors of thromboembolism in nephrotic syndrome with severe hypoalbuminemia. We experienced one case of arterial thromboembolism which occured in right common iliac artery. It was seen in a 6 year-old male child that presented with generalized edema and rigth ankle joint pain. Emergency embolectomy and anticoagulant therapy (heparin and antithrombin III) was performed. He didn't have to be amputated and recovered to self ambulation. This is an uncommon case that successful recovery was possible by early diagnosis and invasive surgical management with proper anticoagulant therapy.

• Clinical and Experimental Pediatrics
• /
• 제54권5호
• /
• pp.183-191
• /
• 2011

Although antenatal diagnostic technique has considerably improved, precise detection and proper management of the neonate with congenital heart disease (CHD) is always a great concern to pediatricians. Congenital cardiac malformations vary from benign to serious conditions such as complete transposition of the great arteries (TGA), critical pulmonary and aortic valvular stenosis/atresia, hypoplastic left heart syndrome (HLHS), obstructed total anomalous pulmonary venous return (TAPVR), which the baby needs immediate diagnosis and management for survival. Unfortunately, these life threatening heart diseases may not have obvious evidence early after birth, most of the clinical and physical findings are nonspecific and vague, which makes the diagnosis difficult. High index of suspicion and astute acumen are essential to decision making. When patent ductus arteriosus (PDA) is opened Widely, many serious malformations may not be noticed easily in the early life, but would progress as severe acidosis/shock/cyanosis or even death as PDA constricts after few hours to days. Ductus dependent congenital cardiac lesions can be divided into the ductus dependent systemic or pulmonary disease, but physiologically quite different from each other and treatment strategy has to be tailored to the clinical status and cardiac malformations. Inevitably early presentation is often regarded as a medical emergency. Differential diagnosis with inborn error metabolic disorders, neonatal sepsis, persistent pulmonary hypertension of the newborn (PPHN) and other pulmonary conditions are necessary. Urgent identification of the newborn at such high risk requires timely referral to a pediatric cardiologist, and timely intervention is the key in reducing mortality and morbidity. This following review deals with the clinical presentations, investigative modalities and approach to management of congenital cardiac malformations presenting in the early life.

• Journal of Yeungnam Medical Science
• /
• 제25권1호
• /
• pp.50-57
• /
• 2008

Pulmonary hypertension is an increase in blood pressure in the pulmonary artery, pulmonary vein or pulmonary capillaries. Depending on the cause, pulmonary hypertension can be a severe disease with markedly decreased exercise tolerance and right-sided heart failure. Pulmonary hypertension can present as one of five different types: arterial, venous, hypoxic, thromboembolic, or miscellaneous. Chronic obstructive pulmonary disease with severe pulmonary hypertension is a rare disease. A 52-year-old man presented with a complaint of aggravating dyspnea. The mean pulmonary arterial pressure was 61.5 mmHg by Doppler echocardiogram. The patient was prescribed diuretics, digoxin, bronchodilator, sildenafil, bosentan and an oxygen supply. However, he ultimately died of cor pulmonale. Thus, diagnosis and early combination therapy are important.

• Journal of Chest Surgery
• /
• 제25권12호
• /
• pp.1570-1577
• /
• 1992

The vascular surgery is the field that has developed in early 20 century and is progressing nowadays. Recent advance in surgical technique accompanying with excellent medical diagnosis and treatment, prompt angiographic usage, development of variable prosthetic material, and concomitant use of anti-coagulant have made remarkable results of vascular surgery. 83 cases of vascular surgery have been performed at Thoracic and Cardiovascular Surgery Department of Pusan National Unversity Hosaital since 1971 till 1990, for 20 years and their results are followed. Patient ductus arteriosus and Buerger`s disease were omited in this study. 1. The age distribution shows that the fifth and sixth decades are most frequently affected and mean age was 56.1 years old. Male to female ratio is 1: 2.32. 2. Among the 83 cases of all, number of occlusive vascular disease is 46 and that of aneurysmal disease is 33. 3. In clinical manifestation, most common symptom of occlusive disease is pulselessness and pain was next. Mass sensation is most commonly complained by patients of aneurysmal disease. 4. CT scan was more important in diagnosis of aneurysmal diseases and angiogram was more commonly used in occlusive diseases. 5. The common site of arterial occlusion was common iliac artery, femoral artery, aortic bifurcation, and external iliac artery, as its frequency rate. The most commonly affecting portion of aortic aneurysm was abdminal aorta, and descending thoracic aorta and femoral artery were next 6. Preoperative associated diseases were atherosclerosis[41 cases], hypertension[21 cases], valvular heart disease[11 cases], and diabetes mellitus[9 cases], etc, 7. Operative methods in ocllusive diseases were thrombectomy[36.9%], endarterectomy [10.9%], and bypass graft insertion[52.7%]. Among the bypass graft, Y-graft was used in 7 case, straight graft was used in 17 cases, and saphenous venous graft was used in 2 cases. 8. Postoperative complications were developed in 17 cases, and morbidity rate was 36. 9. Eleven patient were died within 1 month after operation, so operative mortality rate was 13.3%. 10. Duration of patency was beteween 7 and 58 months[average 27.5 months] in occlusive diseases and their 5-year patency rate was 56.3%. Duration of patency of aneurysmal disease was 20 months in aveage and their 5-year patency rate was 51.3%. 11. Patients of eleven cases of occlusive disease and two cases of aneurysmal disease required reoperation for variable reason. 12. 35 cases of patient have used anticoagulants: coumadin, ticlid, and persanthin-ASA combination.