• Tuberculosis and Respiratory Diseases
• /
• v.72 no.2
• /
• pp.228-231
• /
• 2012

Bronchobiliary fistula (BBF), defined as an abnormal communication between the biliary duct and bronchial trees, is a very rare condition. Bilioptysis is a pathognomonic finding for BBF. We studied a 58-year-old man, who had a BBF complicated by liver biloma that occurred after radiofrequency ablation. The diagnosis was confirmed by the presence of bile-stained sputum and an Endoscopic Retrograde Cholangio-Pancreatography. BBF was treated successfully by endoscopic sphincterotomy and biliary drainage with insertion of a double pig-tail plastic stent into the biloma. We suggest that the optimal choice of treatment modality for BBF depends on the natural course of the underlying disease, and the status of the biliary stricture.

• Journal of Chest Surgery
• /
• v.21 no.6
• /
• pp.1060-1070
• /
• 1988

Since Jan. 1957, 142 cases of benign esophageal stricture, 55 males and 87 females, were managed in our hospital, and their ages ranged from 3 to 77 years. old[mean 31.2yrs]. The most common cause was caustic burns and they all complained dysphagia and some loss of weight, general malaise and substernal pain, which usually appeared in 1 month to 1 year after ingestion of corrosive agents. The mid 1/3 of the thoracic esophagus was the most prevalent portion[29%] but rather evenly distributed along the entire esophagus. Operations were done on 129 patients, of whom 50 patients had ECG[esophagocologastrostomy], 5 PCG[pharyn-gocologastrostomy], 34 EG[esophagogastrostomy], 4 EJG[esophagojejunogastrostomy], 3 PG[pharyngogastrostomy], 2 esophageal end to end anastomosis and 31 Gastrostomy. There were 6 deaths in the postoperative period, so its operative mortality was 4.7%, among them 3 were ECG cases, 2 EG and 1 EJG. And 34 complications occurred so it recorded 24% complication rate. and in details in ECG 46%, PCG 60%, EG 17.6%, EJG 25%, and PG 33%. When we reviewed periodic variations, the mortality rate of the first 20 yrs. period was 6.9%, next 10yrs. 2.6% and now for last 2yrs non.

• Journal of Chest Surgery
• /
• v.31 no.11
• /
• pp.1110-1115
• /
• 1998

Esophagectomy has a high morbidity rate, mainly related to pulmonary complications. The respiratory morbidity of open esophagectomy is high, ranging from 6% to 10%. This high morbidity is partially responsible for the 6∼15% mortality rate of esophagectomy. Many techniques of esophagectomy without thoracotomy have been described since the initial report of Orringer and Sloan. Endoscopic microsurgical dissection of the esophagus was clinically introduced in 1989. Endoscopic microsurgical dissection of the esophagus was developed as a minimally invasive procedure that avoids thoracotomy and provides precise vision during the operation in order to reduce mediastinal trauma and to improve the peri- and post-operative situation. A 20 year-old women who accidentally swallowed about 150 cc of glacial acetic acid underwent an esophagectomy using the operating mediastinoscopy, cervical esophagogastric anastomosis, pyloromyotomy, and feeding jejunostomy tube placement for esophageal stricture. The postoperative course was uneventful and the patient was discharged on the 17th postoperative day. Our clinical experience shows that endoscopic microsurgical dissection of esophagus is a safe and feasible method because it offers excellent optical control and enables the surgeon to operate in a minimally invasive manner.

• Archives of Reconstructive Microsurgery
• /
• v.5 no.1
• /
• pp.99-105
• /
• 1996

The reconstruction of esophageal defect after ablative surgery have more difficult than other digestive tract tumor because the restoration of anatomical and physiologic function is difficult, the risk of tumor invasion into the adjacent tissue is large. The reconstruction of cervical esophus was depended on the degree of resection of the esophagus, various reconstruction method was developed to minimize functional deficiency and deformity of cervical region. Recently, the free jejunal transfer or free radial forearm flap was commonly utilized for esophageal reconstruction due to development of technique of the microvascular anastomosis. After the esophageal reconstruction used by free jejunal transfer was reported by Seidenberg in 1951, jejunum is most commonly used for reconstruction of esophgus. Becaue of, it have been tubed anatomical similarity with muscular layer, relative small risk of complication, possible of oral intake within 10 days after operation, and early rehabilitaion. Authors have been treated esophageal defect with free jejunal transfer in 7 patients after resection of lesion in 6 eshageal cancer and 1 esophageal stricture from December 1994 to January 1996. We were transferred jejunum used by intercostal artery as recipient artery in 3 cases, it was satisfied with results. If intercostal artery was utilized as recipient artery for free jejunal transfer, we believe that any site of intrathoracic or intraabdominal esophageal defect is possible to recontruction.

• Journal of Chest Surgery
• /
• v.41 no.5
• /
• pp.671-674
• /
• 2008

Jejunum and fasciocutaneous and myocutaneous flaps are theoretically recommended as esophageal substitutes in reconstruction of the esophagus after several occurrences of failed reconstruction. However, other esophageal substitutes should also be considered. Secondary esophageal reconstruction was successfully performed on a 24-year-old woman who had a history of cervical, thoracic, and abdominal operations and esophageal stricture secondary to several failed reconstructions for esophageal atresia and tracheo-esophageal fistula 21 years prior. The esophageal reconstruction was done subcutaneously by end-to-side anastomosis at the left cervical area using a deformed stomach graft. The patient was discharged with the ability to consume a regular diet after the operation.

• Journal of Yeungnam Medical Science
• /
• v.9 no.1
• /
• pp.167-174
• /
• 1992

Microvascular tissue transfers have facilitated primary closure of various complex defects after radical ablation of head and neck cancers. From Oct 1991 to Feb 1992, we used forearm free flap in two patients and delto-pectoral flap in one patient who had preoperative irradiation for pharyngoesophageal reconstruction. The stricture and fistular formation were most troublesome complication in forearm free flap, so we designed as lazy S shape in distal flap margin to prevent circular contraction and longitudinal margin was deepithelized(5mm) and sutured double layer to withstand fistular formation and this can be considered useful in place of a free jejunal transfer.

• Journal of Yeungnam Medical Science
• /
• v.33 no.1
• /
• pp.29-32
• /
• 2016

Most ingested foreign bodies pass readily throughout intestinal tract if they reach the stomach. In some cases, foreign bodies may be impacted behind a luminal constriction but are rare in colon. Here, we report the case of a 59-year-old man who did laparoscopic anterior resection due to sigmoid colon cancer 2 years ago and ischemic colitis was repeated on the anastomosis site. He initially presented with symptoms of abdominal pain 3 months before and melena 1 day before admission. Abdomen computerized tomography showed a 3.2 cm segment of luminal narrowing of the proximal colon involving upstream foreign material stasis. Sigmoidoscopic approaches revealed near complete obstruction on the anal verge of 20 cm and scope passing failed. Balloon dilatations were done on the obstruction site four times all and a foreign body impacted above the obstruction site was removed by an alligator without any complications. The foreign body removed looks like plastic or a shell, about 20 mm in size.

• Journal of Conservation Science
• /
• v.5 no.2 s.6
• /
• pp.51-56
• /
• 1996

This paper deals with the restoration of ancient wooden bridge foundation which excavated in Seta river Shiga Prefecture, Japan. Shiga Archeological Research started a marine archeological investigation of the bridge foundation in 1987. The bridge foundation stricture excavated and have since then recovered about a lots of woods and another materials. The bridge foundation structure constructed log, timbers and stones. The species of those waterlogged wood were identified as two types, hardwood and softwood. Hardwood(log : Cyclobalanopsis) was used for below foundation and softwood (timber' Chamaecyparis obtusa Endl. Cupreessaceae) was used for base structure. One of those timber sample dated by dendrochronology, we asked Dr. Misutani*. The softwood gave a felling date of 567 A.D. In result, the ancient Seta bridge foundation structure had constructed between Asuka and Nara period. We healed the news that ancient bridge foundation excavated at Woljyongyo site in Kyongju, Korea 1987. The bridge foundation Setakarahashi is similar in plane and structure to Woljyongyo structures. The Woljyongyo site report had be of value for reference. We had planning to restore those woods. Hardwood log was got serious damage. The water content varies from 400 to $600\%$. The other timbers water content varies about $200\%$. In the Shiga Center for Archaeological Operations and the Azuchi Castle Archaeological Museum, we set up the PEG impregnation tank. Those wooden objects treated by PEG method. PEG with a molecular weight of 4000. The treatment results may be considered satisfactory. The ancient wooden Seta bridge was reconstructed in Biwako Museum which established in Oct. 1996. We must take care of indoor exhibition environments. (*Nara National Cultual Properties Research Institute).

• Journal of Chest Surgery
• /
• v.49 no.2
• /
• pp.99-106
• /
• 2016

Background: Barium swallow is performed following esophagectomy to evaluate the anastomosis for detection of leaks and to assess the emptying of the gastric conduit. The aim of this study was to evaluate the reliability of the barium swallow study in diagnosing anastomotic leaks following esophagectomy. Methods: Patients who underwent esophagectomy from January 2000 to December 2013 at our institution were investigated. Barium swallow was routinely done between days 5-7 to detect a leak. These results were compared to clinically determined leaks (defined by neck wound infection requiring jejunal feeds and or parenteral nutrition) during the postoperative period. The sensitivity and specificity of barium swallow in diagnosing clinically significant anastomotic leaks was determined. Results: A total of 395 esophagectomies were performed (mean age, 62.2 years). The indications for the esophagectomy were as follows: malignancy (n=320), high-grade dysplasia (n=14), perforation (n=27), benign stricture (n=7), achalasia (n=16), and other (n=11). A variety of techniques were used including transhiatal (n=351), McKeown (n=35), and Ivor Lewis (n=9) esophagectomies. Operative mortality was 2.8% (n=11). Three hundred and sixty-eight patients (93%) underwent barium swallow study after esophagectomy. Clinically significant anastomotic leak was identified in 36 patients (9.8%). Barium swallow was able to detect only 13/36 clinically significant leaks. The sensitivity of the swallow in diagnosing a leak was 36% and specificity was 97%. The positive and negative predictive values of barium swallow study in detecting leaks were 59% and 93%, respectively. Conclusion: Barium swallow is an insensitive but specific test for detecting leaks at the cervical anastomotic site after esophagectomy.

• Journal of The Korean Society of Clinical Toxicology
• /
• v.13 no.2
• /
• pp.87-94
• /
• 2015

Purpose: We investigated comparison of clinical characteristics and prognosis by initial endoscopic severity in caustic injury and then discussed predisposing factors which can be helpful in predicting the prognosis and determining the treatment. Methods: This study was a retrospective review of medical records from patients over the age of 15, who underwent initial endoscopy for caustic injury from April 2007 through November 2014. Patients were classified according to two groups based on the initial endoscopic finding by Zargar's classification: patients with grade 0, I, IIa at esophagus (low risk group) and patients with grade IIb, IIIa, IIIb at esophagus (high risk group). The two groups were then compared. Results: A total of 55 patients were included (low risk group [n=44] vs. high risk group [n=11]). Old age (p<0.001), large amount of ingestion (p<0.05), oropharyngeal symptoms (p<0.01), high SOFA score (p<0.001), high WBC count (p<0.05), low base excess (p<0.01), and HCO3 (p<0.05) were statistically significant factors in the high risk group. A poor prognosis was observed for hospital stay (p<0.001), ICU admission (p<0.001), mortality (p<0.01), and stricture (p<0.001) in the high risk group. Conclusion: Clinical characteristics including age, amount of ingestion, oropharyngeal symptoms, SOFA score, WBC count, base excess, and $HCO_3$ can be helpful in the decision to undergo initial endoscopy and risk assessment by initial endoscopic severity can be helpful in predicting prognosis and determining the treatment plan.