• Journal of Chest Surgery
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• v.51 no.3
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• pp.216-219
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• 2018

We report the case of a 16-year-old male patient who was involved in a traffic accident and transferred to the emergency department with mild chest pain. We initially did not find evidence of tracheal injury on computed tomography (CT). Within an hour after presentation, the patient developed severe dyspnea and newly developed subcutaneous emphysema and pneumoperitoneum were discovered. Abdominal CT showed no intra-abdominal injury. However, destruction of the right main bronchus was identified on coronal images of the initially performed CT scan. Emergency exploratory surgery was performed. The amputated right main bronchus was identified. End-to-end tracheobronchial anastomosis was performed, and the patient recovered without any complications.

• Journal of Chest Surgery
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• v.25 no.5
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• pp.458-468
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• 1992

With the aid of extracorporeal circulation, nine dogs underwent orthotopic cardiopulmonary transplantation after preservation of the donor heart in a hypothermic amino acid[glutamate, aspartate] enriched high potassium extracellular solution, and preservation of the donor lung with hypothermic low potassium dextran solution from June 1990 to May 1991. The mean body weights of dogs were 20kg and the recipients` preoperative hematologic and hemodynamic pictures were within normal range except slightly decreased level of albumin and total protein, which was supposed to be due to malnutrition. The following modifications of the original Stanford technique were emphasized: [1] the posterior mediastinum is dissected as little as possible with meticulous hemostasis; [2] the surgical procedure is kept away from the phrenic and vagus nerves; [3] the tracheal anastomosis may be wrapped with recipient`s pulmonary artery flap or surrouding soft tissues. A combination of Cyclosporine, Azathioprine, corticosteroid was used as perioperative immunosuppressive therapy. Postoperatively all recipients could be weaned from extracorporeal circulation, showing favorable vital signs, but within 24 hours, irreversible congetive heart failure, ascites, arrhythmias developed with a mean survival time 13.6$\pm$6.6[n=9, range=6~26] hours. Hemoglobin and platelet counts were significantly[p<0.05] decreased postoperatively, which is thought to be attributed to blood damage by cardiopulmonary bypass and hemodilution. Postmortem finding included multiple subendocardial patch hemorrhage in both atrial and ventricular cavities, pulmonary and liver congestion, and all tracheal anastomoses were intact. Further consideration about quality control of the animal, infection, rejection, the effect of cardiopulmonary bypass on the experimental animal is required to improve the results.

• Korean Journal of Bronchoesophagology
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• v.7 no.1
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• pp.40-45
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• 2001

Management of laryngotracheal stenosis remains one of the most challenging problems facing the otolaryngologist. The key to success is to obtain adequate rigid circular support with normal mucosal lining. Four Patients with laryngotracheal stenosis were surgically treated in our institution in 2000. All the patients were male adults. The cause of stenosis were longterm or repeated endotracheal intubation and tracheostomy in our patients. All patients were successfully decannulated following segmental resection of the stenotic portion including the anterior arch of the cricoid cartilage and end-to-end anastomosis after suprahyoid laryngeal release. The time between treatment and decannulation was just one day in three patients. These results suggest the Possibility of early decannulation even if the cricoid cartilage was partially resected. It is better to prevent laryngotracheal stenosis rather than to treat it once it has occurred.

• Journal of Chest Surgery
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• v.31 no.8
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• pp.799-803
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• 1998

Background: Tumors of the trachea are rare despite their histologic similarity to tumors of the main stem bronchus and lung. Materials and methods: Fourteen patients with tracheal tumor underwent surgical, radiational, or laser photocoagulation therapy from March 1981 to July 1996. Nine patients were malignant and five patients were benign. The most common malignant tumor was adenoid cystic carcinoma. Results: Age ranged from 10 to 65 years with mean age of 45.9 years. Most tumors were located middle and lower one-third of trachea. Surgery was done through collar incision, or collar incision with vertical partial sternal division, or left posterolateral thoracotomy, or sternal division with laryngeal release. Two patients died after operation, because of the disruption of anastomosis and airway obstruction,and laryngeal edema after suprahyoid release. Only one patient died after 8 month of diagnosis. The other patients were doing well during the follow-up period.

• Journal of Chest Surgery
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• v.27 no.2
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• pp.140-147
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• 1994

Reconstruction of the pharynx and cervical esophagus presents a tremendous challenges to surgeons. Over the past 2 years[1990, Dec.-1993, Jun], the free jejunal graft has been performed in 17 cases in Korea Cancer Center Hospital.The indications of this procedures were almost malignant neoplasms involving neck and upper aero-digestive tract; Hypopharyngeal cancer[12 cases, including 2 recurrent cases], laryngeal cancer[2 cases], thyroid cancer[2 cases, including 1 recurrent case], cervical esophageal cancer[1 case]. There were fifteen men and two women, and the mean age was 59.6 years. The anastomosis site of jejunal artery were common carotid artery[16 cases] or external carotid artery[1 case] and that of jejunal vein were internal jegular [15 cases] or facial[1 case] and superior thyroid vein[1 case]. The length of jejunal graft was from 9 cm to 17 cm[mean 13 cm] and the mean ischemic time was 68 minutes. There was one hospital mortality which was irrelevant to procedures[variceal bleeding] and one graft failure[1/16]. Other postoperative complications were neck bleeding or hematoma[3 cases], abdominal wound infection or disruption[5 cases], anastomosis site leakage[1 case], pneumonia[2 cases], graft vein thrombosis[1 case], and food aspiration[1 case]. The function of conduit was excellent and ingestion of food was possible in nearly all cases. Postoperative adjuvant radiation therapy was also applicable without problem in 7 cases. During follow-up periods, the anastomosis site stenosis developed in four patients, and the tracheal stoma was narrowed in one case but easily overcome with dilation. In conclusion, we think that the free jejunal graft is one of the excellent reconstruction methods of upper digestive tract, especially after radical resection of malignant neoplasm in neck with a high success rate and low mortality and morbidity rate.

• Journal of Chest Surgery
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• v.38 no.8 s.253
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• pp.583-588
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• 2005

Congenital tracheal stenosis can be a life-threatening disease, especially in cases involving the long-segment of the trachea. When patients are symptomatic immediately after birth or develop an accompanying complex cardiac anomaly, surgical repair can be a considerable challenge. We experienced a tracheoplasty in one early infant weighing 2.6 kg and one neonate who had ventilator dependency from long-segment congenital tracheal stenosis and congenital cardiac anomaly. One early infant, who had diffuse stenosis of distal trachea after ventricular septal defect closure, underwent resection and extended end to end anastomosis. One neonate who had diffuse stenosis of proximal trachea with tetralogy of Fallot (TOF), underwent slide tracheoplasty with total correction for TOF Postoperative chest computed tomography showed widely patent trachea. Both infants are now well without symptoms.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1982.05a
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• pp.9.2-9
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• 1982

The incidence of decannulation difficulty included tracheal stenosis has markedly increased in recent years because of translaryngeal intubation and tracheostomy although advancing antibiotics and new treatment for these problems. Treatment has always been difficult but in mild cases, a new soft, flexible tracheal T-tube that designed to maintain an adequate tracheal airway as well as to provide support in the reconstructed trachea and in severe cases, transverse resection with subsquent end to end anastomosis has been used in recent years. Authors experienced 2 cases of tracheal stenosis and decannulation difficulty which developed after tracheostomy that was performed due to automobile accident and fall down respectively and using a silicone tracheal T-tube for 3 months good results were obtained. So authors reported with brief review of literatures.

• Journal of Chest Surgery
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• v.29 no.11
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• pp.1182-1190
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• 1996

The best treatment of congenital or acquired tracheal stenosis is resection and end to end anastomosis. Various prosthetic material and tissue graft replacement can be considered when the stenotic segment is too long, but their uses are still limited due to many serious complications. The present study examined the effect of immunosuppression and cryopreserved allograft trachea after intraperitoneal omental implantation for evaluation of the possibility of tracheal transplantation. Thirty tracheal segments were harvested from fifteen donor Wistar rats. Among them eighteen segments were implanted immediately(group I, II, III) and twelve segments were used for cryopreservation(group IV, V). Heterotopical intraperitoneal implantation was performed in five groups of rats(n=6); Group I was Wistar syngeneic controls and received no immunosuppression. Group II and III were those of Sprague-Dawley recipients, the former receiving no immunosuppression and the latter receiving immunosuppression(Cyclosporin A 15mg/kg/day, Methylprednisolone 2mg/kg/day). Group IV and V were groups of Sprague-Dawley recipients, the former receiving immunosuppression and the latter receiving no Immunosuppression. After 28 days, rats were sacrificed and the tracheal segments were histologically evaluated. Epithelial thickness was significantly decreased in group II, IV. Epithelial regeneration score was also significantly decreased in II. All rats maintained well their round tracheal contour. In conclusion; I) trachea could be preserved for a long time with cryo method, 2) epithelium could regenerate fully with omentopexy in cryopreserved trachea, 3) immunosuppresion was not necessary with cryopreserved trachea.

• Journal of Chest Surgery
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• v.23 no.2
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• pp.362-365
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• 1990

Adenoid cystic carcinoma is a rare primary tracheal tumor, and this tumor behave slow growth, low grade malignancy with local invasion. Although many patient die within 2 to 3 years of the onset of symptoms without appropriate treatment, adequate therapy should lead to survival of 10 years or more. We had a case of adenoid cystic carcinoma in 47 year old female patient who was treated with resection and end-to-end anastomosis of the invaded trachea. Postoperative course was uneventful and discharged without any complications. Radiotherapy of total 6,600 cGy is scheduled 4 weeks after the resective surgery to prevent recurrence.

• Journal of Chest Surgery
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• v.29 no.10
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• pp.1166-1169
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• 1996

Neurllemomas of the tracheobroncheal tree are extremely rare. Most are located in the lower trachea, and cause chronic cough and wheezing. They usually have a very long natural history, causing symptoms only after they have attained a considerable size. Current treatment of primary intratracheal tumor is sugical removal. Recently, we experienced a case of primary intratracheal neurilemoma which was successfully treated by tracheal resection and anastomosis. We report this case with a brief review of literature.