• Journal of Chest Surgery
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• 제31권2호
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• pp.162-167
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• 1998

저자들은 1976년 1월 부터 1997년 3월 까지 21년간 외상성 횡격막 파열 52례 중 지연성 외상성 횡격막 탈장 6례를 치험 하였는데 이중 남자는 4례, 여자는 2례였으며 우측은 1례였다. 둔상에 의한 경우는 5례였고 자상은 1례였다. 수술은 모두 개흉술을 시행 하였고 복부로 절개를 연장한 경우가 1례 있었다. 외상성 흉부 손상을 입었을 때 횡격막 파열을 의심하는 것이 중요하며 흉강경을 이용하여 진단및 치료를 할 수 있다.

• 대한간호학회지
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• 제29권6호
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• pp.1304-1313
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• 1999

Breathing is essential for life and at the same time takes a role as a antidote for stress. In the Orient, it was recognized early that respiration, mind, and body have a relation that is inseparable and therefore proper breathing is so important. However, since the mechanism of therapeutic effect by breathing have not been verified, the treatment has been continued till recent years. From that which originated in the Orient, several techniques in the west have been developed to regulate breathing, and have been applying to the clinical situation and to studies, however scientific studies are still lacking. Recently, relaxed breathing has been used as an efficient strategy for breathing therapy as it has an effect on reducing physiological tension and arousal, and, therefore can be used as a basic technique to control or manage stress. In this study, in order to provide basic information and guidelines for clinical application, which will aid in the application of the theoretical basics of breathing therapy and its technique, a review of the literative was conducted. The findings are as follows: 1. Since proper breathing not only has, physically, the important function in supplying oxygen to the body but also gives a good emotional, or pleasant state of mind, it is the first step in controlling physical and mental health. 2. The basic types of breathing can be classified into two types; ‘diaphragmatic breathing(relaxed breathing)’ and ‘chest breathing(stress breathing)’. In yoga type breathing, there are four kinds of breathing, ‘upper breathing’, ‘mid breathing’, ‘down breathing’, and ‘complete breathing’. 3. The theoretical explanation of the positive thera peutic effect of breathing therapy techniques exemplifies good brain function, sufficient air flow through the nasal passages, diaphragmatic movement, light vagal stimulation, CO2 changes and cognitive diversion but in most studies, the hypothesis of CO2 is supported. 4. The technique of breathing is designated with many names according to the muscles and techniques used for breathing, and for control of stress, diaphragmatic breathing(relaxed breathing) is explained as a basic technique best used to manage of stress. 5. The relaxed-breathing includes slow diaphragmatic breathing, breath meditation, nasal breathing, yogic abdominal breathing, Benson's relaxed response, and quiet response.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제12권2호
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• pp.246-250
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• 2009

평소 건강하게 지내다가 갑자기 시작된 반복적인 구토와 보채는 증상으로 5개월 여아가 병원에 내원하였고, 단순 흉부 방사선 검사에서 비정상적 음영이 좌측 흉부에서 관찰되었다. 이어 시행된 흉부 전산화 단층촬영에서 선천성 횡경막 탈장으로 진단되어, 흉부외과에서 수술적 치료 시행하였으며 수술 결과 횡경막 좌측후외방의 Bochdalek 형식의 선천성 횡격막 탈장으로 확인되었고, 수술적 치료 후 증상의 호전을 경험하였기에 문헌고찰과 함께 보고하는 바이다.

• Tuberculosis and Respiratory Diseases
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• 제45권4호
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• pp.736-745
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• 1998

연구배경: 횡격막의 운동은 흉부 단순 촬영과 fluoroscopy로 관찰해 왔으나 근래 초음파에 의해서 횡격막의 운동거리와 두께를 측정하는 연구들이 있어왔다. 초음파 검사의 장점을 살펴보면 간편하고 비침습적이며 방사선조사가 없고 재현성과 정확성이 있다는 점을 들 수 있다. 본 연구에서는 이러한 횡격막 운동 측정에 대한 초음파의 장점을 이용하여 정상인과 만성폐쇄성 폐질환 환자에서 횡격막 운동을 조사하고 그 결과를 폐기능 지표들과 비교하였다. 연구방법: 정상 성인 28례(의과대학생 16례, 나이를 고려한 대조군 12례)와 만성폐쇄성 폐질환 환자 17례를 대상으로 각각에서 폐기능 검사, 최대 흡기압, 최대 호기압과 초음파상 횡격막의 이동 거리를 측정하여 비교하였다. 초음파는 Aloka 사의 KEC-620 모델을 이용하였으며 앙와위 상태에서 환자의 쇄골 중심선에 해당하는 부위의 우상복부에 횡으로 3.5MHz 탐촉자를 대고 간을 에코창으로 이용하여 M-mode 상에서 평상 호흡시와 폐활량 호흡 또는 최대 호흡시의 횡격막 이동 거리를 3회 측정하여 그 평균값을 얻었으며 최대 흡기압과 최대호기압은 Chest사의 Vitalopower KH-101을 이용하여 3회 측정하여 그 평균값을 얻었다. 결 과: 정상인에서의 횡격막 이동거리는 평상호흡에는 1.5cm-1.7cm를 보였고 최대호흡시에는 5.7cm-6.7cm를 보였다. 정상인에서의 최대호흡시에 횡격막 이동거리는 $FEV_1$ $FEV_1/FVC$, PEF, PIF, 신장과 유의한 상관관계를 보였으나 다중 희귀분석에서는 $FEV_1$ 만이 유용한 예측지표로 계산되었다. 만성폐쇄성 폐질환 환자에서의 횡격막 이용거리는 평상호흡시에는 $1.5{\pm}0.6cm$로 정상인과 유의한 차이가 없었으나 최대호흡시에는 $3.7{\pm}1.3cm$로 대조군에 비해 유의하게 감소되어 있었다. 만성폐쇄성 폐질환 환자군의 각 병기에 따라 횡격막 이동거리를 비교해 본 결과 최대호흡시 횡격막의 이동거리는 $FEV_1$이 감소할수록 짧은 경향을 보였으나 통계적 의의는 없었다. 만성폐쇄성 폐질환 환자에서의 최대호흡시에 횡격막 이동거리는 연령, PEmax, %FVC와 유의한 상관관계를 보였으나 다중 회귀분석에서는 최대호기압(PEmax)과 연령이 유의한 예측인자로 계산되었다. 결 론: 만성폐쇄성 폐질환 환자의 횡격막 이동거리는 정상인에 비해 유의하게 감소하였으며 최대호기압과 가장 좋은 상관관계를 보였다. 그러나 만성폐쇄성 폐질환 환자에서 횡격막 이동거리는 $FEV_1$과 유의한 상관관계를 발견할 수 없어서 초음파를 통한 횡격막 운동검사가 폐기능 평가의 또다른 생리적 지표로 이용될 수 있음을 시사하였다.

• Journal of Chest Surgery
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• 제17권4호
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• pp.729-734
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• 1984

Bochdalek hernia is a type of congenital diaphragmatic defect in the posterolateral portion of the diaphragm. The defect is usually Lt. sided due to protective effect of liver on right. Sex distribution is male preponderance [2:1] and it is diagnosed during neonate, mostly first 24 hours, due to severe respiratory distress. We experienced a rare case of old aged female patient with congenital Bochdalek hernia on Rt. side which was found incidentally during treatment of spontaneous pneumothorax of Rt. side. 17 year old female patient was admitted to CS department for chest discomfort on right and mild dyspnea with duration of 20 days. Under the diagnosis of spontaneous pneumothorax, Rt. closed thoracostomy and underwater sealed drainage with continuous suction was applied. On follow-up chest x-ray, poorly defined hazy increased density with multiple air-fluid levels in Rt. lower lung field and Lt. subphrenic free air were noted. So, Barium enema was done under the impression of Rt. diaphragmatic hernia, and nearly entire colon proximal to sigmoid was demonstrated in the Rt. hemithorax. Operation was done-for surgical repair of defected diaphragm through Rt. posterolateral thoracotomy. Operative findings were as follows; 1.Hypoplastic Rt. lung, esp. RML & RLL. 2.Nearly entirely intestines were herniated. 3.Diaphragmatic defect was located on posterolateral portion of the diaphragm, about 10x3cm in size with blunt smooth margin. 4.A large bleb on apex of RUL of lung. Herniated intestines were repaired into abdominal cavity manually and defect of diaphragm was repaired with No. I black silk interrupted sutures directly, and bleb was resected. Postoperative courses were uneventful and the patient was discharged with good condition on POD 14th.

• Journal of Chest Surgery
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• 제48권5호
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• pp.307-310
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• 2015

Background: To evaluate our experience of early surgical plication for diaphragmatic eventration (DE) in infancy and childhood. Methods: This study evaluated infants and children with symptomatic DE who underwent plication through an open transthoracic approach in our childhood development department between January 2005 and December 2012. Surgical plication was performed in several rows using polypropylene U-stitches with Teflon pledgets. Results: The study included 12 infants and children (7 boys and 5 girls) with symptomatic DE (9 congenital and 3 acquired). Reported symptoms included respiratory distress (91.7%), wheezing (75%), cough (66.7%), and recurrent pneumonia (50%). Preoperative mechanical ventilatory support was required in 41.7% of the patients. The mean length of hospital stay was $6.3{\pm}2.5days$. The mean follow-up period was $24.3{\pm}14.5months$. Preoperative symptoms were immediately relieved after surgery in 83.3% of patients and persisted in 16.7% of patients one year after surgery. All patients survived to the end of the two-year follow-up and none had recurrence of DE. Conclusion: Early diagnosis and surgical plication of the diaphragm for symptomatic congenital or acquired diaphragmatic eventration offers a good clinical outcome with no recurrence.

• Journal of Trauma and Injury
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• 제23권1호
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• pp.49-52
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• 2010

A hemothorax usually occur, due to injuries to the intercostal and great vessels, pulmonary damage, and sometimes fractured ribs. We report a case in which the hemothorax that occurred, neither intrathoracic injury nor injury to internal thoracic vessels and organs, via lacerated diaphragmatic and liver laceration due to a right upper part of anterior chest stab injury caused by a sharp object. The patient's general conditions gradually worsened, so chest and abdominal computed tomogram were taken. The abdominal computed tomogram revealed diaphragmatic injuries and bleeding from the lacerated liver. We performed an exploratory laparotomy to control the bleeding from the lacerated liver with simple primary sutures. In addition exploration was performed in the right pleural space through the lacerated diaphragm with a thoracoscopic instrument. There were no bleeding foci in the right pleural space, the vessels, or the lung on the thoracoscopic video. Closure of the lacerated diaphragm was achieved with simple, primary sutures. The postoperative course of the patient was uneventful, and the patient was discharged.

• Journal of Gastric Cancer
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• 제12권1호
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• pp.49-52
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• 2012

Through the advent of surgical techniques and the improvement of laparoscopic tools including the ultrasonic activated scissor, laparoscopic gastrectomy has been increasingly used in far more cases of benign or malignant gastric lesions for the benefit of patients without compromising therapeutic outcomes. Even though possible complications provoked by the ultrasonic activated scissor can be prevented during the procedure with increasing advanced laparoscopic experience and supervision, unexpected late complications after the operations rarely occur. An extremely rare case of left incarcerated diaphragmatic hernia of the transverse colon developed in an 81-year-old female patient as a late complication, 8 months after laparoscopy-assisted total gastrectomy for gastric cancer, with laparoscopy successfully resumed and without the need to sacrifice any portion of the bowel.

• Journal of Chest Surgery
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• 제25권12호
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• pp.1542-1549
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• 1992

From March 1986 to August 1992, 18 patients underwent diaphragmatic plication for the diaphragmatic paralyses complicating various pediatric cardiac procedures. Age at operation ranged from 16 day to 84 months with mean age of 11.8 months. In order of decreasing incidence, the primary cardiac procedures included modified Blalock-Taussig shunt [ 5 ], Arterial switch operation [ 4 ], modified Fontan operation [ 2 ], and others [ 7 ]. The suspicious causes of phrenic nerve injury included overzealous pericardial resection [ 7 ], direct trauma during the procedure [ 6 ], dissection of fibrous adhesion around the phrenic nerve [ 3 ] and unknown etiology [ 2 ]. The involved sides of diaphragm were right in 10, left in 7 and bilateral in one. The diagnosis was suspected by the elevation of hem-idiaphragm on chest x-ray and confirmed by fluoroscopy. The interval between primary operation and plication ranged from the day of operation to 38 postoperative days [mean : 14 days]. The method of plication were "Central pleating technique" described by Schwartz in 16 and other techniques in 2. Five patients expired after plication and the cause of death were not thought to be correlated directly with the plication itself. In the remaining 13 survivors, extubation or cessation of positive ventilation could be done between the periods of the day of plication and 14th postoperative days [mean; 3.8day]. We have made the following conclusions : 1] Phrenic nerve paralyses are relatively common complication after pediatric cardiac procedures and the causes of phrenic nerve injury are mostly preventable; 2] Phrenic nerve palsy is associated with corisiderable morbidity; 3] diaphragmatic plication is safe, reliable and can be applicable in patients who are younger age and require prolonged positive pressure ventilation.ntilation.

• 한국운동역학회지
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• 제23권3호
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• pp.279-284
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• 2013

The purpose of this study was to determine the effect of head posture and respiratory pattern on muscle activities of sternocleidomastoid (SCM) and scalene during maximal respiration. The seventeen subjects with upper-costal breathing pattern were participated in this study. Surface electromyography was used to measure the muscles activities of SCM and scalene. The volume and velocity of inspiration were monitored by using the spirometer in each subject. Each subject was performed the 3-cycle of respiration in each condition. The mean values of three peak muscle activity in each muscle were used in the data analysis. A2 (head posture: forward head posture: FHP vs. neutral posture) X 2 (breathing pattern: costal vs. diaphragmatic) repeated-measures analysis of variance (ANOVA) was used to compare the normalized muscle activities of the SCM and scalene. The results showed that the muscle activities of SCM and scalene in diaphragmatic breathing were significantly lower than those in costal breathing for each head posture (p<.0125). The muscle activities of SCM in neutral position were lower than those in forward head position during costal breathing (p<.0125). The diaphragmatic breathing in neutral position of head is recommended to decrease the tension of the accessory inspiratory muscles during respiration in neck-pain patients with FHP.