• Journal of Chest Surgery
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• v.50 no.6
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• pp.424-429
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• 2017

Background: The surgical treatment of secondary spontaneous pneumothorax (SSP) can be complicated by fragile lung parenchyma. The preoperative prediction of air leakage could help prevent intraoperative lung injury during manipulation of the lung. Common sites of bulla development and ruptured bullae were investigated based on computed tomography (CT) and intraoperative findings. Methods: The study enrolled 208 patients with SSP who underwent air leak control through video-assisted thoracoscopic surgery (VATS). We retrospectively reviewed the sites of bulla development on preoperative CT and the rupture sites during VATS. Results: Of the 135 cases of right-sided SSP, the most common rupture site was the apical segment (31.9%), followed by the azygoesophageal recess (27.4%). Of the 75 cases on the left side, the most common rupture site was the apical segment (24.0%), followed by the anterior basal segment (17.3%). Conclusion: The azygoesophageal recess and parenchyma along the cardiac border were common sites of bulla development and rupture. Studies of respiratory lung motion to measure the pleural pressure at the lung surface could help to determine the relationship between cardiogenic and diaphragmatic movement and bulla formation or rupture.

• Journal of Chest Surgery
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• v.20 no.4
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• pp.839-846
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• 1987

The records of 10 patients with traumatic diaphragmatic hernia seen from November 1977 through July 1987 were reviewed. All the patients had a transdiaphragmatic evisceration of abdominal contents into the thorax. We treated 7 male and 3 female patients ranging in age from 3 to 62 years. In 8 patients, diaphragmatic hernia followed blunt trauma and in 2 patients, stab wounds to the chest. The herniation occurred on the right side in 3 patients and on the left side in 7. All the patients sustained additional injuries: rib fractures [7 patients], additional limb, pelvic and vertebral fractures [6], closed head injury [2], lung laceration [1], liver laceration [1], renal contusion [1], ureteral rupture [1], and splenic rupture [1]. Organs herniated through the diaphragmatic rent included the omentum [6 patients], stomach [4], liver [4], colon [3], small intestine [1], and spleen [1]. For right-sided injuries, the liver was herniated in all 3 patients and the colon, in 1. in the initial or latent phase, dyspnea, diminished breath sounds, bowel sounds in the chest were noted in 4 patients, and in the obstructive phase, nausea, vomiting, and abdominal pain were found in all 3 patients. Two patients had a diagnostic chest radiograph with findings of bowel gas patterns, and an additional 8 had abnormal but nondiagnostic studies. Hemothorax, pleural effusion or abnormal diaphragmatic contour were common abnormal findings. Three patients were operated on during the initial or acute phase [immediately after injury], 4 patients were operated on during the latent or intermediate phase [3 to 210 days], and 3 patients were operated on during the obstructive phase [10 to 290 days]. Six patients underwent thoracotomy, 2 required thoracoabdominal incision, and 2 had combined thoracotomy and laparotomy. Primary suture was used to repair the diaphragmatic hernia in 9 cases. One patient required plastic repair by a Teflon felt. Empyema was the main complication in 2 patients. In 1 patient, the empyema was treated by closed thoracostomy and in 1, by decortication and open drainage. There were no deaths.

• Journal of Chest Surgery
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• v.29 no.4
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• pp.440-443
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• 1996

Some tricuspid valve endocarditis can be controlled effectively with specific antibiotic treatment. However, surgical intervention Is necessary when there are continuing sepsis, moderate or severe heart failure, multiple pulmonary emboli, and echocardiographycally demonstrated vegitations. We are repoting a 19 year-old male patient who was admitted for the treatment of infective endocarditis. He previously had an operation for ventriculer septal defect (perimembranous type) about 9 years ago . An echocardiogram showed a large vegetation on the anterior cusp area and a left to right shunt through VSD, which was previously closed with dacron patch. A valve replacement in addition to antibiotic therapy was recommended for the patient. The patient underwent on operation : tricuspid valve replacement was done with 51. Jude medical valve prosthesis (33 mm), and in addition to above procedure, removal of vegetation and direct closure of VSD were done Postoperative echocardiogram showed that replaced tricuspid valve functioned well and vegeta ion and shunt flow were not observed. The patient recovered without complication and discharged at Postoperative day 25. Early aggressive surgical intervention is indicated to optimize surgical results, and this case seems to be a typical right sided bacterial endocarditis, which is caused by residual VSD. We are reporting a case of tricuspid valve endocarditis with a review of the literature. (Korean J Thorax Cardiovasc Surg 1996 ; 29: 440-3)

• Journal of Korean Neurosurgical Society
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• v.55 no.1
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• pp.43-47
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• 2014

Patients with neurofibromatosis 1 (NF1) are predisposed to develop central nervous system tumors, due to the loss of neurofibromin, an inactivator of proto-oncogene Ras. However, to our knowledge, only three cases of ependymomas with NF1 have been reported in the literature. The authors present a case of NF1 patient with a spinal cord ependymoma. She was referred for about half a year history of increasing numbness that progressed from her fingers to her entire body above the bellybutton. Magnetic resonance imaging revealed a relative-demarcated, heterogeneously enhanced mass lesion accompanied by perifocal edema in C5-7 level, a left-sided T11 spinous process heterogeneously enhanced mass in soft tissue, intervertebral disk hernia in L2-5 level, and widespread punctum enhancing lesion in her scalp and in T11-L5 level. The patient underwent C5-7 laminectomies and total excision of the tumor under operative microscope, and intraoperative ultrasonography and physiological monitoring were used during the surgery. Histopathologically, her tumor was found to be a ependymoma without malignant features (grade II in the World Health Organization classification). Therefore, no adjuvant therapy was applied. Following the operation, the patient showed an uneventful clinical recovery with no evidence of tumor recurrence after one year of follow-up.

• Journal of Veterinary Clinics
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• v.26 no.1
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• pp.58-61
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• 2009

A 10-year-old spayed female Shih-tzu dog with a left-sided caudal abdominal swelling of 2-month clinical duration was referred to the Konkuk University Teaching Hospital (KUVTH). We confirmed the presence of an abdominal mass by radiography and ultrasongraphy. A gossypiboma was identified between bladder and small intestines at surgery and removed. The resulting peritoneal adhesion was severe. But, the peritoneal defect did not allow easy repair of the abdominal wall. Therefore, polypropylene mesh (PPM) was used in repair. The patient was good condition after surgery with no caudal abdominal swelling. We followed the patient for the next 6 months with no complication.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.28 no.2
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• pp.143-153
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• 2006

Temporomandibular joint(TMJ) ankylosis is characterized by the formation of bony or fibrous mass, which replaces the normal articulation. Ankylotic block formation causes reduction of mandibular mobility, particularly hindering mouth opening, due to a mechanical block of the condylar head in its roto-transfatory motion. Surgery in TMJ ankylosis treatment entails complete ankylotic block removal and subsequent arthroplasty, possibly with autologous tissue between articular surfaces or heterologous material to restore the anatomic structure and normal function. Temporalis myofascial flap holds great promise for the reconstruction of various maxillofacial defects. In more recent years, a pedicled temporalis myofascial flap has been advocated in TMJ ankylosis surgery. Advantages of the temporalis myofascial flap in TMJ reconstruction include close proximity to the TMJ, adequate blood supply from the internal maxillary artery, and its attachment to the coronoid process, which provides movement of the flap during function, simulating physiologic action of the disc. This study evaluated 8 patients(11 TMJs) affected by TMJ ankylosis. All patients underwent surgical treatment of the removal of the ankylotic block and subsequent interpositional arthroplasty with temporalis myofascial flap. Bilateral TMJ ankylosis was observed in 3 patients(6 TMJs), right-sides in 3 patients, left-sided in 2 patients. Epipathogenesis was traumatic in 6 patients(8 TMJs), ankylosing spondylitis in 2 patients(3 TMJs). In 3 patients coronoidotomy was underwent. Average follow-up was 16.8 months after surgery, with a range of 7 to 28 months. No patients underwent additional TMJ procedures after the temporalis myofascial flap. All patients showed a distinctive improvement both in articular functionality and symptoms. We found that temporalis myofascial flap is very valuable in reconstruction of TMJ ankylosis.

• The korean journal of orthodontics
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• v.46 no.6
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• pp.395-408
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• 2016

We report a case involving a young female patient with severe mandibular retrognathism accompanied by mandibular condylar deformity that was effectively treated with Le Fort I osteotomy and two genioplasty procedures. At 9 years and 9 months of age, she was diagnosed with Angle Class III malocclusion, a skeletal Class II jaw relationship, an anterior crossbite, congenital absence of some teeth, and a left-sided cleft lip and palate. Although the anterior crossbite and narrow maxillary arch were corrected by interceptive orthodontic treatment, severe mandibular hypogrowth resulted in unexpectedly severe mandibular retrognathism after growth completion. Moreover, bilateral condylar deformities were observed, and we suspected progressive condylar resorption (PCR). There was a high risk of further condylar resorption with mandibular advancement surgery; therefore, Le Fort I osteotomy with two genioplasty procedures was performed to achieve counterclockwise rotation of the mandible and avoid ingravescence of the condylar deformities. The total duration of active treatment was 42 months. The maxilla was impacted by 7.0 mm and 5.0 mm in the incisor and molar regions, respectively, while the pogonion was advanced by 18.0 mm. This significantly resolved both skeletal disharmony and malocclusion. Furthermore, the hyoid bone was advanced, the pharyngeal airway space was increased, and the morphology of the mandibular condyle was maintained. At the 30-month follow-up examination, the patient exhibited a satisfactory facial profile. The findings from our case suggest that severe mandibular retrognathism with condylar deformities can be effectively treated without surgical mandibular advancement, thus decreasing the risk of PCR.

• The korean journal of orthodontics
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• v.43 no.5
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• pp.209-217
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• 2013

Objective: This study investigated whether temporomandibular joint (TMJ) condyle-fossa relationships are bilaterally symmetric in class III malocclusion patients with and without asymmetry and compared to those with normal occlusion. The hypothesis was a difference in condyle-fossa relationships exists in asymmetric patients. Methods: Group 1 comprised 40 Korean normal occlusion subjects. Groups 2 and 3 comprised patients diagnosed with skeletal class III malocclusion, who were grouped according to the presence of mandibular asymmetry: Group 2 included symmetric mandibles, while group 3 included asymmetric mandibles. Pretreatment three-dimensional cone-beam computed tomography (3D CBCT) images were obtained. Right- and left-sided TMJ spaces in groups 1 and 2 or deviated and non-deviated sides in group 3 were evaluated, and the axial condylar angle was compared. Results: The TMJ spaces demonstrated no significant bilateral differences in any group. Only group 3 had slightly narrower superior spaces (p < 0.001). The axial condylar angles between group 1 and 2 were not significant. However, group 3 showed a statistically significant bilateral difference (p < 0.001); toward the deviated side, the axial condylar angle was steeper. Conclusions: Even in the asymmetric group, the TMJ spaces were similar between deviated and non-deviated sides, indicating a bilateral condyle-fossa relationship in patients with asymmetry that may be as symmetrical as that in patients with symmetry. However, the axial condylar angle had bilateral differences only in asymmetric groups. The mean TMJ space value and the bilateral difference may be used for evaluating condyle-fossa relationships with CBCT.

• Tuberculosis and Respiratory Diseases
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• v.73 no.6
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• pp.336-341
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• 2012

Primary effusion lymphoma (PEL) is a rare type of lymphoma that arises in the body cavity without detectable masses. It is associated with human herpes virus-8 (HHV-8), Epstein-Barr virus (EBV), and human immunodeficiency virus (HIV). Recently, PEL unrelated to viral infection has been reported and it has been termed HHV-8 unrelated primary effusion lymphoma-like lymphoma (HHV-8 unrelated PEL-like lymphoma). Here, we report a case of HHV-8 unrelated PEL-like lymphoma in an 80-year-old woman. Chest X-ray and computed tomography revealed left-sided pleural effusion. Pleural effusion analysis and mediastinoscopic biopsy showed atypical cells that had originated from the B cells. The cells were positive for CD20 and bcl-2, but negative for CD3, CD5, CD21, CD30, CD138, epithelial membrane antigen, and HHV-8. Serological tests for HIV and EBV were negative. Considering the patient's age, further treatments were not performed. She has shown good prognosis without chemotherapy for more than 18 months.

• Tuberculosis and Respiratory Diseases
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• v.64 no.4
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• pp.314-317
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• 2008

We report the patient presented with a left-sided pleural effusion. Pleural fluid analysis revealed lymphocyte-dominant exudates with lower level of adenosine deaminase and negative cytologic malignancy. Thoracoscopic examination and histologic examination revealed metastatic nodules on pleurae, proven to be from the papillary thyroid cancer. There were no other sites of distant metastases. Though papillary thyroid cancer is characterized with slow progression and relatively good prognosis, metastatic pleural effusion as an initial manifestation of undiagnosed papillary thyroid cancer can be considered.