• 대한수의학회지
• /
• 제48권2호
• /
• pp.209-213
• /
• 2008

A four-month-old intact femlae Abyssinian cat was present for routine health evaluation, because her littermate was recently died of ventricular septal defect. Diagnostic imaging studies showed a large caudal paracardiac mass in thoracic radiography and homogenous mass adjacent to heart in the echocardiography. Further echographic study revealed that the mass was liver and the diaphragmatic line was intact. The positive contrast celiogram revealed that no extravasation of the contrast media across the diaphragm and the prolapse of diaphragm into the pleural cavity. Based on our diagnostic imaging studies, the case was diagnosed as diaphragmatic deformity in a cat mimicking a cardiac mass.

• Advances in pediatric surgery
• /
• 제16권2호
• /
• pp.143-153
• /
• 2010

Congenital diaphragmatic disease is one of the common major congenital anomalies, and its mortality remained still high despite recent medical advances. The aim of this study is to examine the clinical characteristics of congenital diaphragmatic diseases. A total of 39 patients with congenital diaphragmatic disease that underwent surgery from January, 1997 to December, 2009 at Pusan National University Hospital were included in this study. Medical records were retrospectively reviewed. The male to female ratio was 30:9. Six out of 39 cases died (NS) before surgery, 17 patients had Bochdalek's hernia (BH), 11 patients hiatus hernia (HH), 4 diaphragmatic eventration (DE), and 1 Morgagni hernia (MH). There were no differences in mean birth weight and mean gestational age. NS (83.3 %). BH (35.3 %) was diagnosed more frequently than other diseases in the prenatal period. Three patients (17.6 %) of BH expired due to pulmonary hypoplasia and 1 patient had co-existing congenital heart disease. BH was diagnosed more frequently in the prenatal stage and had a higher motality rate than other conditions. Therefore, BH needs to be concentrated more than other anomalies.

• 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.

• Journal of Chest Surgery
• /
• 제49권6호
• /
• pp.456-460
• /
• 2016

Background: Surgical correction needs to be considered when diaphragm eventration leads to impaired ventilation and respiratory muscle fatigue. Plication to sufficiently tense the diaphragm by VATS is not as easy to achieve as plication by open surgery. We used pneumatic compression with carbon dioxide ($CO_2$) gas in thoracoscopic diaphragmatic plication and evaluated feasibility and efficacy. Methods: Eleven patients underwent thoracoscopic diaphragmatic plication between January 2008 and December 2013 in Pusan National University Hospital. Medical records were retrospectively reviewed, and compared between the group using $CO_2$ gas and group without using $CO_2$ gas, for operative time, plication technique, duration of hospital stay, postoperative chest tube drainage, pulmonary spirometry, dyspnea score pre- and postoperation, and postoperative recurrence. Results: The improvement of forced expiratory volume at 1 second in the group using $CO_2$ gas and the group not using $CO_2$ gas was $22.46{\pm}11.27$ and $21.08{\pm}5.39$ (p=0.84). The improvement of forced vital capacity 3 months after surgery was $16.74{\pm}10.18$ (with $CO_2$) and $15.6{\pm}0.89$ (without $CO_2$) (p=0.03). During follow-up ($17{\pm}17$ months), there was no dehiscence in plication site and relapse. No complications or hospital mortalities occurred. Conclusion: Thoracoscopic plication under single lung ventilation using $CO_2$ insufflation could be an effective, safe option to flatten the diaphragm.

• Journal of Chest Surgery
• /
• 제35권10호
• /
• pp.730-735
• /
• 2002

횡격막은 횡격막 신경과 동측의 하 흉벽 늑간신경의 지배를 받는다. 상완신경총의 적출 손상을 가진 환자에서 신경총의 일부 신경의 신경이식술에 횡경막 신경의 신경 이식편이 종종 이용된다. 이와 같이 횡격막 신경이 신경이식편으로 사용된 환자에서 횡격막 신경의 탈신경으로 인하여 발생하는 횡격막의 위치 및 운동의 변화를 연구하였다. 대상 및 방법 : 어께의 둔상으로 상완신경총의 적출 손상 때문에 동측의 횡격막 신경으로 근피부신경에 신경이식술을 시행한 13예를 대상으로 하였다. 흉강경 수술방법으로 흉강 내 횡격막 신경을 박리하고 횡격막 바로 위에서 횡격막 신경을 절단하여 경부 절개창을 통해서 외부로 끌어낸 다음 피하 터널을 통해서 동측의 근피부신경에 이식하였다. 엑스선 투시검사와 흉부 엑스선 촬영으로 수술 전후의 횡격막 위치 및 운동 상태를 조사하였다. 결과 : 흉강경을 이용하여 횡격막 신경을 박리 절단하는데 기술적 어려움이나 경미한 합병증도 없었다. 횡격막 신경의 절단 직후에는 횡격막이 평균 1.7 늑간 정도 올라가 있었으나, 엑스선 투시검사에서 흡기시 횡격막의 역행성 운동은 보이지 않았다. 1.5개월 이후의 엑스선 검사에서 횡격막의 위치는 수술 전에 비해 유의한 차이 없을 정도(평균 0.9 늑간 차이; p＝NS로 복원되었다. 횡격막 신경의 절단으로 횡격막의 운동 범위는 탈신경 전에 비해 유의한 차이가 없었다. 결론 : 횡격막 신경의 차단으로 인한 탈신경 후 횡격막의 운동기능은 남아 있었으며 횡격막의 위치는 시간이 경과함에 따라 어느 정도 회복되는 현상을 보였다. 그러나 폐활량이 계속 감소된 소견은 횡격막의 흡기력이 완전히 회복되지 않았음을 추정할 수 있다.

• Pediatric Gastroenterology, Hepatology & Nutrition
• /
• 제22권6호
• /
• pp.608-612
• /
• 2019

Gastric volvulus (GV) is an uncommon pathology, with 10-20% of cases occurring in children, typically before one year of age. It often occurs in people with congenital diaphragmatic hernias, intestinal malrotation, eventration of the diaphragm, paraesophageal hernias, wandering spleens, asplenism, or intra-abdominal adhesions. We report a rare case of chronic GV after left hemihepatectomy for hepatoblastoma in a child. The patient was a 9-year-old boy who complained of upper abdominal pain and postprandial upper abdominal distension for one year. At the age of 4 months, he was diagnosed with hepatoblastoma and had undergone left hemihepatectomy. The upper gastrointestinal contrast study revealed chronic organoaxial gastric volvulus. After a surgical procedure involving adhesiolysis and an anterior wall gastropexy, the patient improved and the symptoms resolved. Although GV is a rare disease, it should be suspected in a patient with a previous abdominal surgical history who is complaining of abdominal distension and pain.

• Journal of Chest Surgery
• /
• 제43권5호
• /
• pp.513-517
• /
• 2010

배경: 횡경막 내장전위증의 치료를 위해 흉강경을 이용한 횡격막 주를 성형술은 효과적인 방법이다. 그러나, 기존 흉강경을 이용한 횡경막 주름 성형술은 여러 가지 문제점을 가지고 있다. 본 저자들은 Head up position, $CO_2$ 삽입 및 Figure of eight 봉합법을 이용하여 수술 술기를 단순화하여 기존 흉강경의 단점을 개선하고자 하였다. 대상 및 방법: 2005년 3월부터 2009년 9월까지 횡경막 내장전위증으로 수술을 받은 9명의 환자를 대상으로 후향적 연구를 시행하였다. 평균 연령은 $38.5{\pm}53.0$세(범위, 2~76세)였으며 남자 4명, 여자 5명이었다. 결과: 평균 수술 시간은 $46.7{\pm}15.9$분(범위, 30~85분)이었다. 수술 중 사망은 없었다. 합병증으로는 7일 이상의 지속적 공기 누출 1예, 폐부종(Re-expansion pulmonary edema)으로 3일간 호흡기 사용 1예가 있었다. 평균 재원일 수는 $6.22{\pm}2.04$일(범위, 4~11일)이었다. 수술 후 추적 관찰 기간(평균 $27.2{\pm}11.6$개월, 범위 2~43개월) 동안 1예에서만 수술 직후 횡경막 위치에 비해 2.5 cm 이상 상승을 보였다. 호흡 곤란 증상을 보이는 환자는 없었다. 결론: 저자들의 변형 술식에 의해 횡격막 내장전위증 환자에서 단지 수술창의 사용없이 3개의 5 mm 포트를 이용하여 횡격막 주름 성형술이 가능하였다. 횡경막 내장 전위증 환자에서 흉강경을 이용한 방법이 현재 널리 사용되고 있는 개흉을 이용한 방법보다 유용한 수술 방법으로 생각된다.