• Tuberculosis and Respiratory Diseases
• /
• 제64권4호
• /
• pp.298-302
• /
• 2008

결핵은 다양한 양상으로 나타나며 결핵성 대동맥 가성 동맥류는 아주 드문 질환으로 알려져 있고 급성호흡곤란 증후군 또한 드물지만 생명을 위협하는 결핵의 합병이다. 저자들은 결핵성 대동맥 가성동맥류와 급성호흡곤란증후군이 동시에 발현해서 항결핵화학요법과 혈관내 스텐트 삽입술로 성공적으로 치료한 환자를 경험하였다. 치명적인 결핵의 합병이 조기 진단과 빠른 항결핵제의 투여로 치료되었다고 생각된다. 따라서 결핵의 합병증을 치료하는 데 조기 진단이 중요하고 이를 위해 결핵에 대한 임상적인 의심을 높게 유지하는 것이 중요하다는 것을 보고하 참는 바이다.

• Advances in pediatric surgery
• /
• 제12권2호
• /
• pp.192-201
• /
• 2006

1989년 3월부터 2005년 5월까지 울산대학교 의과대학 서울아산병원 소아외과에서 치료받은 신생아 Bochdalek 탈장 67예를 대상으로 하였다. 1989년 3월부터 1999년 말까지 조기수술, 과호흡, 수술시 흉관의 삽입을 시행한 I기(33예)와, 2000년 1월부터 2005년 5월까지 지연 수술, 최소한의 호흡 요법과 고빈도 환기 요법, 일산화질소 흡입 요법을 병행하고, 수술시 흉관의 삽입을 제한한 II기(34예)로 나누어 생존율을 비교하였다. I기의 경우 33예 중 20예가 생존하여 60.6 %, II기의 경우 34예 중 25예가 생존하여 73.5 %의 신생아기 생존율을 보였으나 통계학적 유의성은 없었다. 하지만 II기에서 생존율이 향상된 경향을 보임으로, II기에 불필요한 수술은 피할 수 있었던 것으로 생각되며, 나쁜 예후 인자를 갖는 예에서 치료 원칙의 변화가 의미 있는 역할을 했을 것으로 생각된다. 지연수술, 호흡요법, 일산화질소 흡입요법 각각의 영향에 대한 조사를 할 수 없었던 것은 이번 연구의 한계이다. 그러나 수술 전에 충분하게 제반 상태가 안정된 후에 시행하는 지연 수술이 바람직하다고 생각되며, 수술시 흉관 삽입은 피하는 것이 좋겠다. 수술 전후의 고빈도 환기 요법과 에 대해서는 좀 더 연구가 필요할 것으로 보인다.

• Journal of Trauma and Injury
• /
• 제23권2호
• /
• pp.170-174
• /
• 2010

Purpose: As techniques and instruments for video-assisted thoracic surgery (VATS) have been evolving, attempts to perform VATS for chest trauma have been increasing. Several studies have demonstrated the feasibility and safety of VATS for thoracic trauma. We reviewed our experience to evaluate the clinical feasibility and safety of VATS for thoracic trauma. Methods: Fifty-two patients underwent thoracic surgery for chest trauma in Asan Medical Center from January 1990 to December 2009. VATS was performed in 21 patients who showed stable vital signs. We reviewed retrospectively the medical records of those patients to investigate the results of VATS for thoracic trauma. Results: Thoracic exploration for chest trauma was performed in 52 patients. There were 46 males (88.5%) and 6 females (11.5%). The median age was 46.0 years (range: 11~81 years). There were 39 blunt and 13 penetrating traumas. A standard posterolateral thoracotomy was performed in 31 patients, and VATS was tried in 21 patients. We performed successful VATS in 13 patients; 11 males (84.5%) and 2 females (15.5%) with a median age of 46.0 years (range: 24~75 years). The indication of VATS was persistent intrathoracic hemorrhage in 10 patients and clotted hemothorax in 3 patients. There were no complications, but there were two mortalities due to multiple organ failure after massive transfusion. In 8 patients, VATS was converted to a standard posterolateral thoracotomy for several reasons. The reason was inadequate visualization for bleeding control or evacuation of the hematoma in 5 patients. In 3 patients, VATS was performed to evaluate diaphragmatic injury. After the diaphragmatic injury had been confirmed, a standard posterolateral thoracotomy was performed to repair the diaphragm. Conclusion: VATS should be safe and efficient method for diagnostic evaluation and surgical management of stable patients with thoracic trauma.

• 대한두경부종양학회지
• /
• 제30권2호
• /
• pp.74-78
• /
• 2014

갑상선 암 진단과 치료기술이 발전하면서 최근 그 수술 건 수가 급격하게 증가하고 있다. 하지만이와 관련된 합병증과 부작용을 면밀하게 평가해야 할 필요 역시 점차 늘어나고 있다. 갑상선 암 수술 후 발생할 수 있는 드문 합병증의 하나로 횡격막 신경마비(phrenic nerve paralysis)가 있다. 이러한 횡격막신경마비는 대부분 증상이 경미하고 쉽게 호전되어 임상적으로 크게 중요하게 다루어지지 않았다. 하지만, 갑상선 수술 후 갑작스런 호흡곤란이 발생한다면 횡격막 신경마비에 의한 횡격막 마비(diaphragmatic paralysis)와 관련되었을 가능성을 놓치지 말아야 한다. 저자들은 최근 갑상선암 수술 후 발생한 호흡곤란으로 2년 동안 심각한 호흡곤란을 호소하던 73세 여자환자에서 투시촬영(fluoroscopy) 상 편측으로 상승되고 운동성이 저하된 횡격막을 확인하여 일측성 횡격막신경마비(Unilateral phrenic nerve paralysis)를 확진 하였다. 갑상선수술 후 발생하는 일측 횡경막 신경마비는 임상에서 드물게 관찰되는 수술 합병증이기에 환자는 상당기간 이에 대한 감별이 제대로 이루어지지 않았다. 우리는 횡격막 마비의 조기 진단과 적극적인 치료를 통하여 심한 호흡곤란을 호소하는 환자의 증상 및 병의 경과를 호전 시킬 수 있었다.

• 한국융합학회논문지
• /
• 제11권9호
• /
• pp.51-57
• /
• 2020

본 연구는 칼텐본을 접목한 흉추가동운동이 폐기능에 미치는 영향을 알아보기 위하여 20대 대학생 20명을 대상으로 4주간 실시하였다. 실험대상자 20명을 대상으로 실험군, 대조군으로 무작위 동공선택방식으로 그룹 배정을 하였다. 실험군은 횡격막 호흡운동 15분과 칼텐본을 적용한 흉추가동운동 15분으로 구성되고, 대조군은 횡격막 호흡운동으로 30분간 훈련하였으며, 두 군의 운동프로그램은 주 3회 4주간 실시하였다. 측정은 폐기능을 측정하여 자료를 분석하였다. 실험 전·후 폐기능을 분석해 보면, 실험군은 TV, IRV에서 유의하게 증가하였으며, 실험후에 두 집단간의 변화검증에서도 TV와 IRV에서 유의한 차이가 나타났다. 본 연구를 통해 칼텐본을 이용한 흉추가동운동이 폐 기능에 더 긍정적인 효과를 주는 것을 알 수 있었다. 앞으로 임상에서 호흡훈련 시 일반적인 호흡훈련에 흉추가동운동을 함께 접목하는 치료방법이 적극적으로 중재되기를 기대하며 다양한 추가운동프로그램의 개발이 필요할 것으로 사료된다.

• Journal of Chest Surgery
• /
• 제17권1호
• /
• pp.150-156
• /
• 1984

Paraesophageal hiatus hernia represents a rare hiatal hernia that are treated surgically. The completely asymptomatic paraesophageal hernia often does not reach the clinician or surgeon. But the presence of a symptomatic paraesophageal hernia is sufficient indication for surgery. The paraesophageal hernia may be approached either transthoracically or transabdominally. The general technique is essentially the same, whichever route is used. From either transthoracic or transabdominal approach, following reduction of the viscus and elimination of the sac, the diaphragmatic opening is then closed with interrupted heavy dacron or silk sutures in paraesophageal hiatus hernia. But if the phrenoesophageal membrane often is destroyed when the esophagogastric junction and the distal esophagus have been mobilized, it becomes important to fix the esophagogastric junction below the diaphragm, so that it does not slide through the hiatus and produce a sliding-type hiatus hernia in future. We have experienced one case of paraesophageal hiatus hernia which was accompanied with severe anemia in child. We preferred to approach through left thoracotomy incision and then pushed down the stomach into the abdominal cavity with complete excision of the hernial sac. We employed Belsey Mark V procedure using of Teflon felt pledgets with the mattress sutures against development of sliding-type hiatus hernia in postoperative period. postoperative course has been uneventful and good for about 3 months to this time.

• Journal of Chest Surgery
• /
• 제6권2호
• /
• pp.243-248
• /
• 1973

Eventration of the diaphragm is, by definition, abnormally high or elevated position of diaphragm as a result of paralysis, aplasia or atrophy of varing degrees of muscle fibers, and the cause of which may be congenital or acquired. The unbroken continuity of the diaphragm differentiates it from diaphragmatic hernia. The clinical manifestations of the condition, if present, are usually due to the interference of the ventilatory function of the lung and digesive dysfunction due to gastrointestinal distorsion. Treatment consists of surgical repair of the relaxed diaphragm to it`s normal position. A ease of left sided eventuration of the diaphragm, 31 year old officer, was found by chance after traffic accident with chief complaints of hemoptysis and multiple superficial contusions. Routine chest roentgenogram and barium study of the colon revealed moderately elevated left hemidiaphragm with displacement of the splenic flexure of the colon into the left chest. Past history revealed frequent attack of upper respiratory infection and some abnormal condition on his left chest announced by screen cheek of chest X-ray at the time of entrance for his army service 3 years before. Plication of the relaxed diaphragm through left thoracotomy was done and result was excellent as seen on Fig. 5. Cause of eventration of the left hemidiaphragm was due to paralysis of the left phrenic nerve which was tested during thoracotomy.

• Tuberculosis and Respiratory Diseases
• /
• 제69권3호
• /
• pp.191-195
• /
• 2010

Abnormally located liver tissue has been described in the vicinity of the liver proper, near anatomical structures such as the gallbladder, the umbilical fossa, the adrenal gland, the pancreas, and the spleen. Supradiaphragmatic ectopic liver is a rare finding, but has been reported to have been found in the intrathoracic cavity and in the pericardium. In the majority of supradiaphragmatic ectopic liver cases, there was an accompanying transdiaphragmatic pedicle of the main liver body into the abdominal cavity. In a minority of supradiaphramatic ectopic liver cases, the liver was completely separated from the abdominal cavity without a connection between the thorax and the abdomen, with accompanying diaphragmatic anomalies. We describe one case of intrathoracic ectopic liver in a patient with a previous history of lower chest wall trauma, and a brief review of the English-language medical literature on this topic.

• Journal of Chest Surgery
• /
• 제16권1호
• /
• pp.115-120
• /
• 1983

We implanted pacemakers using screw-in sutureless myocardial electrode in 40 patients between February, 1980 and November, 1982 at Seoul Nation University Hospital. Mean age of total patient who received the pacemaker implantation was 39.9 years, but excluding the patient who received the open heart surgery, mean age was 49.3 years. Cause of pacemaker implantation was complete A-V block in 13 patients, symptomatic sick sinus syndrome in 12 patients, complete A-V block after open heart surgery in 12 patients, second degree A-V block with dizziness in one patient, and atrial fibrillation with slow ventricular response in two patients. In thirty nine cases, electrodes were implanted by subxiphoid approach, on the diaphragmatic surface of right ventricle. I n one case, electrode was implanted through the left anterior thoracotomy. Acute stimulation threshold, measured in 35 patients, varied from 0.1 to 2.5 mA [mean 0.85 mA.], and R-wave amplitude [sensitivity], measured in 19 patients, varied from 2.9 mV to 11.5 mV [mean 7.6 mV]. There was no hospital death. The postoperative complications included wound seroma in two patients [5%], wound hematoma in three patients [7.5%], and pacing failure in one patient [2.5%]. The subxiphoid implantation of the pacemaker using sutureless myocardial lead was valuable in obtaining safe, reliable and long-term impulse generation.

• Journal of Chest Surgery
• /
• 제15권3호
• /
• pp.361-365
• /
• 1982

Coarctation of the aorta is a congenital constriction of the aorta of varying degree usually located slightly distal to the origin of the left subclavian artery. This congenital malformation is found at 5-9% of the congenital heart disease in Europe & North America, but in our country, it is reported as one of rare malformations. We present a case of coarctation of the aorta, which had double diaphragms as discrete form. This is 9 year-old boy, who has suffered from hypertensive symptoms since 6 years before. Coarctation of the aorta was confirmed by aortography, and there was no combined anomalies, and it was postductal type, and coarctations were consisted of two diaphragmatic webs at the both ends with a central aneurysmized. After resection of the coarctated segment completely, Woven Dacron graft was inserted with 18mm in diameter & 2.5cm in length successfully.