• 제목/요약/키워드: thoracic

검색결과 10,034건 처리시간 0.026초

인공심폐기를 이용하지 않는 관상동맥우회술 시 요골동맥을 이용한 Cabrol 술식의 응용 (Cabrol Technique Application in Off-pump Coronary Artery Bypass Grafting Using Radial Artery)

  • 나찬영;오삼세;김수철;김재현;조원민;서홍주;이철;장윤희;강창현;임청;백만종;황성욱;최인석;김웅한;박윤옥;문현수;박영관;김종환
    • Journal of Chest Surgery
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    • 제36권8호
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    • pp.630-632
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    • 2003
  • 인공심폐기를 사용하지 않는 관상동맥우회술에서 이식편의 근위부 문합을 상행대동맥에 시행하는 경우 상행대동맥의 조작으로 인한 공기나 대동맥조직, 죽종(atheroma) 등으로 인한 색전증과 대동맥 손상으로 유발되는 대동맥박리, 가성동맥류 등의 합병증을 유발할 수 있다 대동맥근부치환술 시 양측관상동맥의 재이식 시 도관을 사용하는 Cabrol 술식을 관상동맥우회술 시 적용하였다. 요골동맥이식편은 복재정맥과 다르게 혈관 내 판막이 없다는 이점을 고려하여 근위부 문합을 상행대동맥에 평행하게(side to side) 문합하여 하나의 근위부 문합으로 요골동맥이식편의 양측으로 혈류를 공급하는 Cabrol 술식을 이용하여 근위부 문합 수를 줄일 수 있으며 상행대동맥의 조작 수를 줄여 대동맥의 외상을 줄일 수 있다고 생각한다.

Is There a Role for a Needle Thoracoscopic Pleural Biopsy under Local Anesthesia for Pleural Effusions?

  • Son, Ho Sung;Lee, Sung Ho;Darlong, Laleng Mawia;Jung, Jae Seong;Sun, Kyung;Kim, Kwang Taik;Kim, Hee Jung;Lee, Kanghoon;Lee, Seung Hun;Lee, Jong Tae
    • Journal of Chest Surgery
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    • 제47권2호
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    • pp.124-128
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    • 2014
  • Background: A closed pleural biopsy is commonly performed for diagnosing patients exhibiting pleural effusion if prior thoracentesis is not diagnostic. However, the diagnostic yield of such biopsies is unsatisfactory. Instead, a thoracoscopic pleural biopsy is more useful and less painful. Methods: We compared the diagnostic yield of needle thoracoscopic pleural biopsy performed under local anesthesia with that of closed pleural biopsy. Sixty-seven patients with pleural effusion were randomized into groups A and B. Group A patients were subjected to closed pleural biopsies, and group B patients were subjected to pleural biopsies performed using needle thoracoscopy under local anesthesia. Results: The diagnostic yields and complication rates of the two groups were compared. The diagnostic yield was 55.6% in group A and 93.5% in group B (p<0.05). Procedure-related complications developed in seven group A patients but not in any group B patients. Of the seven complications, five were pneumothorax and two were vasovagal syncope. Conclusion: Needle thoracoscopic pleural biopsy under local anesthesia is a simple and safe procedure that has a high diagnostic yield. This procedure is recommended as a useful diagnostic modality if prior thoracentesis is non-diagnostic.

흉추 관절가동술이 만성요통환자의 통증, 고유수용감각 및 균형수준에 미치는 효과 (The Effect of Thoracic Joint Mobilization on Pain, Proprioception and Static Balance in Patients With Chronic Low Back Pain)

  • 양진모;김선엽
    • 한국전문물리치료학회지
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    • 제22권3호
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    • pp.1-11
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    • 2015
  • The purpose of this study was to investigate the effect of lumbar stabilization training and additional thoracic mobilization on pain, proprioception and static balance in patients with chronic low back pain. The subjects of this study were 48 chronic low back pain patients who were randomly allocated to an experimental group 1 ($n_1=16$, lumbar stabilization and thoracic mobilization, thoracic hypomobility), experimental group 2 ($n_2=16$, lumbar stabilization and thoracic mobilization, thoracic normal mobility), and a control group ($n_3=16$, lumbar stabilization, thoracic hypomobility) after a thoracic mobility test. Both experimental groups underwent lumbar stabilization training and additional thoracic mobilization. The control group underwent only lumbar stabilization training. The intervention was performed 3 times per week, 30 minutes each time, for a total of 6 weeks. Thoraco-lumbar joint reposition error was measured using an electrogoniometer and static balance ability was measured using the Tetrax posture analysis system. Subjects' pain level was measured using a 100 mm visual analogue scale. Statistical analyses were performed using a one-way analysis of variance and a paired t-test. Post-hoc testing was carried out with a Bonferroni test. The pain level was significantly lower in both experimental groups compared to the control group. Both experimental groups showed significant reductions in joint reposition error angle (flexion, extension, and side bending) compared to the control group. The static balance level was significantly lower in both experimental groups than in the control group. In summary, lumbar stabilization exercises and additional thoracic mobilization significantly improved the pain level, proprioception, and static balance in patients with chronic low back pain.

Thoracic Epidural Anesthesia and Analgesia (TEA) in Patients with Rib Fractures

  • Kim, Young-Jin;Cho, Hyun-Min;Yoon, Chee-Soon;Lee, Chan-Kyu;Lee, Tae-Yeon;Seok, June-Pill
    • Journal of Chest Surgery
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    • 제44권2호
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    • pp.178-182
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    • 2011
  • Background: We analyzed the results of surgical reduction and fixation of ribs under thoracic epidural anesthesia and analgesia (TEA) in patients who had no more than 3 consecutive rib fractures with severe displacement to examine the clinical usefulness of this method. Materials and Methods: From May 2008 to March 2010, 35 patients underwent surgical reduction and fixation of ribs under TEA. We reviewed the indications for this technique, number of fixed ribs, combined surgical procedures for thoracic trauma, intraoperative cardiopulmonary events, postoperative complications, reestablishment of enteral nutrition, and ambulation. Results: The indications of TEA were malunion or nonunion of fractured ribs in 29 (82.9%; first operation) and incompletely ribs under previous general anesthesia in 6 (17.1%; second operation). The average number of fixed ribs per patient was 1.7 (range: 1~3). As a combined operation for thoracic trauma, 17 patients (48.6%) underwent removal of intrathoracic hematomas, and we performed repair of lung parenchyma (2), wedge resection of lung (1) for accompanying lung injury and pericardiostomy (1) for delayed hemopericardium. No patient had any intraoperative cardiopulmonary event nor did any need to switch to general anesthesia. We experienced 3 postoperative complications (8.6%): 2 extrapleural hematomas that spontaneously resolved without treatment and 1 wound infection treated with secondary closure of the wound. All patients reestablished oral feeding immediately after awakening and resumed walking ambulation the day after operation. Conclusion: Thoracic epidural anesthesia and analgesia (TEA) may positively affect cardiopulmonary function in the perioperative period. Moreover, this technique leads to an earlier return of gastrointestinal function and early ambulation without severe postoperative complications, resulting in a shortened hospital stay and lowered costs.

Aortic Valve Replacement and Concomitant Multi-Vessel Coronary Artery Bypass: The Impact of Using the Bilateral Internal Thoracic Arteries on Early and Late Clinical Outcomes

  • Muhyung Heo;Myoung Young Kim;Jun Ho Lee;Suryeun Chung;Kiick Sung;Wook Sung Kim;Yang Hyun Cho
    • Journal of Chest Surgery
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    • 제56권3호
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    • pp.197-203
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    • 2023
  • Background: The survival benefit of coronary artery bypass grafting (CABG) using the bilateral internal thoracic arteries (BITA) is well known; however, the role of BITA in concomitant aortic valve replacement (AVR) and CABG has not been studied. Methods: We retrospectively reviewed patients who underwent concomitant AVR and CABG. Cases not using an internal thoracic artery and less than 2 bypass grafts were excluded. We enrolled 114 patients in this study. The mean follow-up duration was 61.5±43.5 months. Results: Forty patients (35.1%) underwent CABG with a single internal thoracic artery (SITA) and 74 patients (64.9%) underwent CABG with BITA. The preoperative clinical characteristics were not significantly different between the 2 groups, with the exception of a higher prevalence of atrial fibrillation in the SITA group. Postoperative mortality and morbidity were not significantly higher in the BITA group than in the SITA group. In the univariable analysis, the survival of the BITA group was similar to that of the SITA group (p=0.157). Multivariable analysis showed that only mean age was a predictor of death (p=0.042), but using BITA was not an independent predictor (p=0.094). In low-risk patients whose preoperative ejection fraction was >45%, the survival of the BITA group was significantly better than that of the SITA group (p=0.043). Conclusion: BITA use in concomitant AVR and CABG showed no difference in mortality compared to using SITA. Although its impact on long-term survival was inconclusive, BITA use can be considered for low-risk patients.

척추 측만과 위장장애와의 관련성 (Relations between Scoliosis and Gastroenteric Disorder)

  • 홍상진;김은영
    • 보건교육건강증진학회지
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    • 제21권1호
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    • pp.319-328
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    • 2004
  • The purpose of this study was to examine the relation between thoracic scoliosis and gastroenteric disorder. In this article, We surveyed sixty two patients and investigated through a questionnaire the health and meal habits, digestive trouble levels, stress levels(BEPSI-K), and the stress response index(SRI). Participants were classified according to each group in over $10^{\circ}$(vertebral scoliosis), under $10^{\circ}$(functional scoliosis) and made a diagnosis of X-ray of scoliosis grade. The data was took statistics on two group by independent t-test, chi-square test with SPSS/PC+ 10.0 program. The statistically significance was a p<.05 and the following results were obtained; 1. In general characteristics, The thoracic scoliosis was as many as women, weight 50∼60kg, height 160∼170cm, married person. 2. Relations between health and meal habit with thoracic scoliosis was not statistically significant(p>.05). 3. Relations between thoracic scoliosis and digestive trouble level was statistically significance (p<.05). 4. Relations between thoracic scoliosis and incidence rate of internal disease was statistically significant(p<.05). 5. Relations between thoracic scoliosis and stress(BEPSI-K) was statistically significant(p<.05). 6. Relations between thoracic scoliosis and stress(SRI) was statistically significant(p<.05). These results lead us to the conclusion that thoracic scoliosis influences digestive trouble, incidence rate of internal disease and stress. However, there results are not easy to explain because of the limitations of a few subjects and a single comparison. Therefore, further research on this study thoroughgoing inspection would clarify the association of thoracic scoliosis and gastroenteric disorders.

흉부외상 환자중 개흉술이 필요했던 53례에 관한 임상적 고찰 (Clinical Study of 53 Patients Requiring open Thoracotomy After Thoracic Injuries)

  • 김규만
    • Journal of Chest Surgery
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    • 제24권11호
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    • pp.1115-1124
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    • 1991
  • Recently the thoracic injuries have been markedly increasing due to the vast increase of traffic accident, industrial disaster, and incidental accident as well as the frequent use of the murderous weapons including gun or rifle. Because the thoracic injuries could involve the heart, lung, and great vessels, and would influence the lives, prompt diagnosis and adequate treatment are essential. Most of thoracic injuries can be managed with the conservative treatment and simple surgical procedure such as closed thoracostomy, but certain cases require open thoracotomy to preserve lives and to return to their normal environment. The authors have analysed the result of 53 cases of open thoracotomy after thoracic injuries mainly according to the patient`s chart review. The mean age was 33.4 years old and male to female ratio was about 5: l. Injury mechanisms that elicited thoracic trauma indicated for open thoracotomy were penetrating[47%] and non-penetrating[53%] injuries. The Most common type of the thoracic lesion was hemothorax with or without pneumothorax and diaphragm rupture was the second. 58\ulcornero of thoracic injuries were accompanied by abdominal injuries and 47% by bone fractures. 34 patients were operated within 24 hours after injury and their average elapsed time was 13.6 hour. The remained patients were operated after 24 hours and their average elapsed time was 7.8 days. 71 cases of operative procedures containing some overlappings were performed: diaphragm repair[28], bleeding control[12], pulmonary and cardiac repair[4 cases] Postoperative complication rate was 32.1% and operative mortality rate was 9.4%[5/53].

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VATER 증후군에 동반된 선천성 심장기형 치험 1례 (Congenital Cardiac Anomaly Combined with the VATER Association - A case report -)

  • 반동규;김혁;지행옥;정원상;강정호;김영학;이철범;함시영;김남수
    • Journal of Chest Surgery
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    • 제34권11호
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    • pp.858-860
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    • 2001
  • VATER 증후군은 심장의 기형을 동반하기 쉬운 복합기형이지만 적절하고 적극적인 수술적 치료에 의해 완치에 이를 수 있는 기형이다. 저자들은 VATER 증후군에 심장기형이 동반된 여아에서 적극적인 수술적 치료로 만족할만한 성과를 얻어 이 증례를 고찰과 함께 보고하는바이다.

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