Surgical Treatment for Atherosclerosis of Aaortoiliac Artery / 대한흉부외과학회지

BACKGROUND: Atherosclerosis obliterans affecting lower extremities may involve the abdominal aorta and its major branches to the lower extremities, especially the common iliac arteries. It may affect focal segment or multiple segments. MATERIAL AND METHOD: A retrosp ective study was performed on 23 cases of aortoiliac arterial atherosclerotic pa tients who were treated with bypass graft surgery at Eulji University Hospital f rom January, 1995 through December, 1999. RESULT: All the patients were male and the mean age was 60.15+/-8.7. All had history of smoking and the associa ted diseases were diabetes mellitus in 8, hypertension in 7, ischemic heart dise ase in 6, and valvular heart disease in 1. Operative methods of aortoiliac athro sclerotic disease were aortobifemoral bypass graft only(7), aortobifemoral bypas s graft and concomitant femoropopliteal bypass graft(8), aortofemoral bypass gra ft(2), axillofemoral and femorofemoral bypass graft(3), and femorofemoral bypass graft(3). Postoperative complications were retroperitoneal hematoma or bleeding (3), paralytic ileus(3), pneumonia(3), cerebrovascular accident(1), acute renal failure(2), wound infection(2). Three perioperative mortality occurred among ana tomical bypass patients. CONCLUSION: We concluded that anatomical bypass treament has been a standard procedure for treatment of aortoi liac occlusive disease, but extraanatomical bypass surgery colud be a good alter natives for compromised patients with lower morbidity and mortality.

Giant Bulla with Pulmonary Fibrosis Caused by Gramoxon Toxicity: A case report / 대한흉부외과학회지

Accidental or suicidal fatalities of paraquat (Gramoxon) poisong are occasionally seen in the emergency room or intensive care unit in this country. In most cases, respiratory symptoms and eventual death by respiratory distress occur within several days. The most striking pathologic change is fibrosis of the lung due to widespread proliferation of fibroblastic cell. We experience a 21-year-old woman with huge bulla on left lung and diffuse fibrosis in other site, who ingested paraquat 10 months ago. After thoracoscopic removal of bulla, the patient survive without progression of pulmonary complication till now.

Surgical Treatment of Spontaneous Pneumothorax by Thoracoscopic Wedge Resection with Fibrin Glue / 대한흉부외과학회지

BACKGROUND: To evaluate the efficacy of Fibrin glue to decrease recurrence in video-assisted thoracoscopic surgery(VATS) for a treatment of spontaneous penumothorax. MATERIAL AND METHOD: All medical records of 17 patients who underwent a thoracoscopic wedge resections of bullae with stapling device with Fibrin glue in our institute between May 1998 and December 1999 were reviewed. variables analyzed include affected sites primary indication of VATS. duration from admission to discharge duration of postoperative stay duration of chest tube drainage recurrence and complication. There were 16 men and 1 woman. RESULT: There was no evidence of hemodynamic instability or arterial blood gas abnormalities encountered during the procedure. Mean age at the time of the VATS was 26.9 years (range 15 to 61 years) The mean duration from admission to discharge was 7.8 days and mean postoperative stay was 5.1days mean chest tube indwelling period was 4..0 days. There was no recurrence of pneumothorx. CONCLUSION: Thoracoscopic wedge resections with introduction of fibrin glue are safe and effective and requires only a short hospital stay. We believe that this thoracoscopic technique will further simplify the surgical treatment of pneumothorax.

A Clinical Analysis of 24 cases of Cardiac Contusion and Cardiac Concussion / 대한흉부외과학회지

BACKGROUND: In the patients with thoracic injury, we suspect simultaneous cardiac contusion or concussion. We analyzed the patients with possible cardiac injury by electrocardiography, serum creatine kinase (CK), creatine kinase isoenzyme fraction (CK-MB) screening, followed by two dimentional echocardiogram (2-DE) to access the severity of injury. MATERIAL AND METHOD: From January 1997 to April 1998, 15-month retrospective study of suspicious myocardial injury was undertaken in including 24 patients admitted for suspected cardiac injury. All patients with history or signs of blunt chest injury were checked serially and the serial CK, CK-MB fraction, electrocardiography (EKG) analysis screening were followed by 2-DE. RESULT: The age range was between 20-40 years and were predominant male patients in(M:F=3:1). Most common causes of injury were traffic accidents, 15 patients(62.5%). Associated injuries involved multiple rib fractures, sternal fracture and such. EKG findings on the cardiac concussion were within normal limits, EKG findings on the cardiac contusion were nonspecific ST and T wave abnormality. In cardiac contusion patients, CK-MB fraction did not increase significantly on admission but on 2nd, 3rd, 4th hospital days, it increased significantly (p=0.0080, 0.0130, 0.0130). The average admission days were 9.22 in concussion and 26.18 in contusion patients(p=0.0075). Most common complication was the adult respiratory distress syndrome(7 cases), 5 out of the patients with ARDS were mechanically ventilated. There were no deaths. CONCLUSION: We believe the serial checks of CK-MB, EKG and subsquent two-dementional echocardiographic sector scanning are presently the most sensitive indicators available for structural and functional cardiac injury.

Surgical Treatment of Lipoid Pneumonia: A Case Report / 대한흉부외과학회지

We experienced an extremely rare case of lipoid pneumonia combined with empyema. A 53-year-old patient was admitted because of chilling sensation and blood tinged sputum. Simple X-ray and computered tomography(CT) showed a huge homogeneous opacification in the left lower lung field. This patient was diagnosed as endogenous type lipoid pneumonia by a computed tomography guided needle biopsy; decortication and left lower lobectomy are performed. We diagnosed it as endogenous type lipoid pneumonia because it revealed a foreign body reaction and lipid laden macrophage on the pathologic examination.

A Clinical Analysis of 20 cases of Diaphragmic Rupture / 대한흉부외과학회지

BACKGROUND: According to the changes in the Environmental factors, traumatic diaphragmic rupture is seen in increasing frequency. Many reports described the early diagnostic methods and treatment modalities. In our institution, a study was retrospectively performed to obtain the early diagnostic and treatment methods of diaphragmic ruptures. MATERIAL AND METHOD: From January 1994 to April 1998, 20 patients with traumatic rupture of the diaphragm were treated in our institution and We analyzed the patients in preoperative clinical presentations, diagnostic accuracies, associated injuries and postoperative complications. RESULT: Socially active male patients were affected most. 75% of patients had blunt trauma and 25% had penetrating injury. There were 16 cases of ruptured right diaphragm, 3 cases of left diaphragm and 1 case on both. Preoperative diagnosis were possible in 10 patients (50%) and 6 patients(30%) were diagnosed intraoperatively, but 4 patients (20%) were diagnosed in the late stages. Most common postoperative complication was wound infection, and two died of associated injuries. CONCLUSION: We conclude that if there is suspicion of diaphragmic rupture after a trauma, careful study and examination is essential and interdepartmental collaboration is very important.

Clinical Analysis of Spontaneous Pneumothorax: Comparison of VATS Versus Limited Thoracotomy / 대한흉부외과학회지

The bullectomy through the limited transaxillary thoracotomy and video-assisted thoracic surgery (VATS) had been used in operative management of spontaneous pneumothorax from Jan. 1994 to July 1997. The study comprised a retrospective review of 42 cases which were treated by limited thoracotomy, and 61 cases treated by video-assisted thoracoscopic sugery. We retrospectively reviewed annual incidnce of bullectomy. Analysis of video-assised thoracoscopic surgery and open bullectomy including age, sex, operative sites, surgical indications, associated diseases, operative time, posoperatve complications and hospital courses. There was no significant difference for operation time in two groups, 98.3+/-38.4 minutes in thoracotomy and 95.7+/-31.5 minutes in VATS. Prolonged air leakage over 7 days was observed in 8 cases from thoracotomy group, 4 cases from VATS group. 3 cases of recurrent pneumothorax were found from VATS group, but no recurrence was occurred from open bullectomy group. There were significant differences in postoperative hospital stay (8.0+/-3.9 day in thoracotomy vs 5.9+/-2.4day in VATS (P=0.001)), and indwelling period of chest tube after operation ( 5.8+/-3.0day in thoracotomy vs 4.0+/-2.0day in VATS (P=0.0006)).