ABSTRACT
A fistula between the respiratory and gastrointestinal systems is generally caused by infection and trauma. We experienced a 51-year old man with a broncho-pleuro-gastro-colonic fistula. He complained of chronic foul odor during respiration. He had suffered a traumatic diaphragmatic rupture 30 years ago. The infection of the diaphragm caused necrosis of the right lower lobe of the lung. It also caused a broncho-pleural fistula. The infection also created adhesion and a perforation of the gastric cardiac portion and the colonic splenic flexus portion of the gastro-intestinal track. We performed left lower lobectomy of the lung, reconstruction of the diaphragm and gastro-intestinal reanastomosis.
Subject(s)
Colon , Diaphragm , Fistula , Lung , Necrosis , Odorants , Respiration , Rupture , Track and FieldABSTRACT
BACKGROUND: Esophageal injury requires early and proper management. We want to determine the results of various esophageal injuries. MATERIAL AND METHOD: We respectively analyzed 22 patients who were managed for esophageal injury between 1999 and 2009. Based on the medical records, we reviewed the causes of injury, the diagnoses, the treatment methods, the complications and the prognosis. RESULT: The main causes of esophageal injury were a foreign body in 9 cases (41%) and vomiting in 5 cases (23%). We treated the patients with esophageal primary repair in 12 cases (55%), abscess drainage in 4 cases (18%) and conservative management in 6 cases (27%). There was esophageal leakage in 7 cases (32%) and death occurred in 3 cases (14%). CONCLUSION: For minor esophageal injury, conservative management was sometimes possible to treat the esophagus, yet aggressive and urgent surgical treatment should be applied for cases of major esophageal injury, including mediastinal abscess.
Subject(s)
Humans , Abscess , Drainage , Esophageal Perforation , Esophagus , Foreign Bodies , Medical Records , VomitingABSTRACT
Surgical repair of thoracoabdominal aortic aneurysm (TAAA) remains a formidable challenge associated with significant rates of mortality and morbidity, especially in patients with high risk. Use of endovascular stent graft in aortic aneurysm disease is now accepted as an alternative treatment to surgery. But the saving of visceral arteries is the chief obstacle to endovascular repair of TAAA. We successfully treated two patients of TAAA with high risk by hybrid procedure including open visceral debranching and concomitant endovascular aneurysm exclusion.
Subject(s)
Humans , Aneurysm , Aortic Aneurysm , Aortic Aneurysm, Thoracic , Arteries , Chimera , Stents , TransplantsABSTRACT
BACKGROUND: Video assisted thoracic surgery has been widely accepted for the treatment of primary spontaneous pneumothorax. MATERIAL AND METHOD: We retrospectively reviewed the medical records of 89 primary pneumothorax patients who had undergone thoracoscopic bleb ligation from February 2002 to June 2006, and we assessed the patients for recurrence. The mean follow-up period was 65 months. RESULT: Pneumothorax recurred in 7 patients (8%) during the follow-up period. CONCLUSION: Thoracoscpic bleb ligation might be an acceptable alternative technique for treating primary spontaneous pneumothorax.
Subject(s)
Humans , Blister , Follow-Up Studies , Ligation , Medical Records , Pneumothorax , Recurrence , Retrospective Studies , Thoracic Surgery, Video-Assisted , ThoracoscopyABSTRACT
Apical muscular ventricular septal defects (VSDs) are relatively rare conditions among all the different types of VSDs. Apical VSDs are difficult to treat because of they are difficult to visualize through a trans-atrioventricular approach, and especially in infants. Treatment by left ventriculotomy is associated with long-term ventricular dysfunction. Catheter-based intervention still shows less than satisfactory results and this type of intervention may not be possible in small infants. This report describes the benefits of right apical ventriculotomy in terms of successful closure of the lesion without harming the ventricular function.
Subject(s)
Humans , Infant , Heart Septal Defects, Ventricular , Ventricular Dysfunction , Ventricular FunctionABSTRACT
BACKGROUND: The long-term administration of oral anticoagulant to the patients with a mechanical heart valve prosthesis is mandatory. However, the appropriate intensity of oral anticoagulant therapy to prevent thromboembolic or hemorrhagic complications is still controversial. We tried to apply low intensity anticoagulant therapy for which the International Normalized Ratios ranged between 1.5 and 2.5, and we analyzed the anticoagulation-related long term outcomes. MATERIAL AND METHOD: From January 1992 to December 2002, 144 patients who underwent a single cardiac valve replacement were included in the study, and their ages ranged from 15 to 72 years (mean age: 47.4+/-15.1): there were 49 aortic valve replacements (AVR) and 95 mitral valve replacements (MVR). The patients were followed up monthly or bi-monthly at the outpatient clinic with clinical examinations and measuring the prothrombin time to adjust the International Normalized Ratios (INRs) within the low-intensity target range between 1.5 and 2.5. RESULT: The follow-up period was 835.3 patient-years (mean: 5.9+/-3.5) and the INRs of 7,706 measurements were available for evaluation. The mean INRs of the aortic and the mitral valve replacement groups were significantly different (p<0.01). All the patients' INRs were within the target range in 61.9% of the measurements. The mean INRs (2.16+/-0.23) of the patients with atrial fibrillation, which was found in 30.3% of the patients, were definitely higher than those (2.03+/-0.27) measured in the patients with regular rhythm (p<0.01). Thromboembolic episodes occurred in 9 patients with an incidence of 1.08%/patient-year. Major bleeding occurred in 2 patients (MVR) with an incidence of 0.24%/patient-year. The patients who displayed better compliance showed a lower incidence of complications (p=0.000). CONCLUSION: The anticoagulation therapy with a low-intensity target range after MVR or AVR seems to be effective and feasible, and increasing the patients' compliance should be done for achieving more effective anticoagulation therapy.
Subject(s)
Humans , Ambulatory Care Facilities , Aortic Valve , Atrial Fibrillation , Compliance , Follow-Up Studies , Heart , Heart Valve Prosthesis , Heart Valves , Hemorrhage , Incidence , International Normalized Ratio , Mitral Valve , Prothrombin Time , ThromboembolismABSTRACT
Accessory mitral valve tissue is a very rare congenital cardiac malformation and it is an uncommon cause of left Ventricular outflow tract obstruction (LVOTO). The pathogenetic mechanism of subaortic obstruction is thought to be systolic ballooning of the abnormal valve tissue into LVOT. We are reporting a case of an accessory mitral valve tissue that was associated with LVOTO, and this was completely relieved after trans-aortic surgical excision of the accessory tissue.
Subject(s)
Mitral ValveABSTRACT
The conventional surgery method of thrombectomy of venous thrombi from the deep veins of the lower extremity was the use of Forgarty balloon catheter. The catheter is inconvenient due to the presence of the balloon and prohibiting venous valves within the venous trees. With the use of a stone-forceps(Fig. 1), thrombi within iliofemoral vein could be easily removed without the obstacle of the valves because the instrument keeps valves open. This instrument is also useful in monitoring the back-flow from the iliac vein. Thrombi within the veins below the level of inguinal incision are removed successfully only by effective manual compression of the calf and thigh muscles. I recommend operating on the iliac vein first rather than the lower venous tree.
Subject(s)
Catheters , Iliac Vein , Lower Extremity , Muscles , Thigh , Thrombectomy , Veins , Venous Thrombosis , Venous ValvesABSTRACT
BACKGROUND: Post-intubation injury is known to be the most common cause of tracheal stenosis. Treatment strategy for tracheal stenosis varies accoring to the extent of pathologic lesion. Focal mucosal lesion can be treated with laser photoablation, but full thickness tracheal lesion should be treated with resection and anastomosis. MATERIAL AND METHOD: From Aptil 1998 to May 1999, twelve patients suffering from tracheal stenosis as a complication of endotracheal intubation were managed by resection and end-to-end anastomosis in the Department of Thoracic and Cardiovascular Surgery, Gyeongsang National University Hospital. RESULT: There was no operative mortality. Five temporary vocal cord paralysis and one wound infection occurred as early complications. During 18 months of follow-up, re-stenosis was not found. CONCLUSION: Tracheal resection and anastomosis can be considered as an excellent surgical treatment for tracheal stenosis which developed as a complication of endotracheal intubation.
Subject(s)
Humans , Follow-Up Studies , Intubation, Intratracheal , Mortality , Tracheal Stenosis , Vocal Cord Paralysis , Wound InfectionABSTRACT
BACKGROUND: The authors have modified the method of Ravitch technique. MATERIAL AND METHOD: This technique was applied to 6 patients out of 18 patients who underwent corrective surgery from May 1987 to July 1999. The technique is quite different from that of Ravitch. We did not divide the intercostal muscle bundles from the laterals of sternum and the Akin's struts were placed retrosternally crossing the chest horizontally to prevent flail motion during immediate post-operative period and retraction of the sternum afterwards. Anterior sternal osteotomy instead of the posterior one was performed for the latest 3 cases which made operative procedure more simple and easy. The struts were removed one year later. RESULT: Compared to the hospital stay of the patients who received standard Ravitch method that of the six cases who received our modification was definitely shortened from 13.1 days to 8.3 days(p<0.0000). Flail motion was not noted in any patient and chest wall stability was obtained more easily with this technique. CONCLUSION: Our modification is recommendable for correction of funnel chest in regards to shorter operation time better chest wall stability shorter hospital stay and less complication.
Subject(s)
Humans , Funnel Chest , Intercostal Muscles , Length of Stay , Osteotomy , Sternum , Surgical Procedures, Operative , Thoracic Wall , ThoraxABSTRACT
A 45-year-old woman was diagnosed as having chylothorax after a mitral valve replacement for mitral stenosis. direct injury of lymphatics in thymus a ramification of thoracic duct was presumed to be responsibe for this complication. Four weeks of conservative treatment failed and surgical treatment was performed, We report a case of surgical treatment for chlyothorax after and open heart surgery.
Subject(s)
Female , Humans , Middle Aged , Chylothorax , Mitral Valve , Mitral Valve Stenosis , Thoracic Duct , Thoracic Surgery , Thymus GlandABSTRACT
Esophageal perforation due to the air pressure generated by forcefully evaporating gas is seldomly reported. If the diagnosis is confined to the injury of the oral cavity and the pharynx, missing the injury of the esophagus, the result may be fatal. Cases like this must be managed by early diagnosis and appropriate surgical intervention. The most important thing for early diagnosis is suspicion of esophageal injury from history and physical examination. We report two cases of esophageal pneumatic perforation caused by an explosive gas from the carbonated beverage bottle.
Subject(s)
Air Pressure , Carbon , Carbonated Beverages , Diagnosis , Early Diagnosis , Esophageal Perforation , Esophagus , Mouth , Pharynx , Physical ExaminationABSTRACT
From May 1988 to December 1995, 77 patients underwent surgical resection for primary non-small cell lung cancer at GNUH, and were evaluated clinically. There were 65 males and 12 females(M:F=5.4:1), and the peak incidence of age was 6th decade of life(44.5%). The major symptoms were cough, hemoptysis and chest pain due to anatomical effects of the mass. Histopathologically, squamous cell carcinoma was 81.8%, adenocarcinoma 14.3%, and adenosquamous carcinoma 3.9%. There was no significant difference in survival among three groups. The pneumonectomy was performed in 26 cases(33.8%), lobectomy 30 cases(38.9%), bilobectomy 9 cases(11.7%), and overall resectability was 84.4%. The postoperative official stagings were as follows ; 26 patients of stage I(34%), 14 patients of stage II(18%), 22 patients of stage IIIa(29%), 14 patients of stage IIIb(18%), and one patients of stage IV(1%). In all cases, 3 year survival rate are showed stage I 83%, stage II 26%, stage IIIa 17%, and stage IIIb 0%.
Subject(s)
Humans , Male , Adenocarcinoma , Carcinoma, Adenosquamous , Carcinoma, Non-Small-Cell Lung , Carcinoma, Squamous Cell , Chest Pain , Cough , Hemoptysis , Incidence , Lung Neoplasms , Pneumonectomy , Survival RateABSTRACT
OBJECTIVES: The surgical mortality of congenital heart defects has been reduced for the very young age group. Especially, young age at repair is an important risk factor for mortality after repair of tetralogy of Fallot. Some risk factors were analyzed. METHODS: Three hundred and sixty six patients underwent surgical intervention. Ages ranged from 5 days to 64 years, and 80 patients were adults(over 15 years of age). The defects consisted of 313(84.2%) acyanotic and 53(15.8%) cy anotic anomalies. The surgical mortalities were evaluated by univariate and multivariate analysis. RESULTS: The overall surgical mortality was 10.4%. Most deaths occurred in the infant group younger than 6 months(20/38 deaths) and in cyanotic group(21/38 deaths). Surgical infant mortality younger than 12 months was 24.8%(25/10 1). Risk factors of mortality in open heart surgery were age(p<0.0001), body weight(p<0.0001), pump time(p<0.0001), aortic cross clamp time(p<0.0001), use of total circulatory arrest(p<0.0001) and cyanotic disease(p<0.0001) by univariate analysis. But by multivariate analysis, the risk factor of mortality in open heart surgery was disease entity(p=0.002) only. A disease group with the highest risk was a cyanotic group(odds ratio was 15.3 relative to ventricular septal defect) excluding t etralogy of Fallot(odds ratio=0.27). CONCLUSIONS: Even though the most important risk factor was disease entity, technically feasible factors influencing mortality indicated by univariate analysis should be improved.
Subject(s)
Humans , Infant , Heart Defects, Congenital , Infant Mortality , Mortality , Multivariate Analysis , Risk Factors , Tetralogy of Fallot , Thoracic SurgeryABSTRACT
Myasthenia gravis is relatively rare disease which is related autoimmune response. There are various methods of management for myasthenia gravis, but nowaday radical thymectomy is the treatment of choice in the aspect of bringing out complete remission and clinical improvement. Sixteen patient of myasthenia gravis underwent radical thymectomy during last eight years, and its result was analyed. Complete remission was achieved in five patients(31 %) and pharmacological or symptomatic improvement in seven patients(44 %), thus giving a total remission in 12 patients(75 %). Postoperative result was not correlated with age, sex, degree of preoperative symptom, surgical approach, pathologic diagnosis.
Subject(s)
Humans , Autoimmunity , Diagnosis , Myasthenia Gravis , Rare Diseases , ThymectomyABSTRACT
We report on nine years experience of surgical treatment of mediastinal tumors in 47 patients. Their ages ranged from 5 to 67 years with an average of 36.4 years and the sex ratio of male and female was 1:1.5. The most frequent symptom was chest pain(27.7%), followed by ptosis(14.9%), general weakness(12.8%) and eight patients(17.0%) were asymptomatic. The most prevalent location of the tumor was anterosuperior mediastinum(63.8%). Pathologically, thymoma(32.9%) was the most common tumor, followed by cyst(21.3%), neurogenic tumor(17.0%), germ cell tumor(12.8%), and mesenchymal tumor(6.4%). Complete removal was achieved in 41 cases of all benign tumors and 3 cases of malignant tumors. All the malignant tumor patients were treated with chemotherapy, radiotherapy or both after surgery. Postoperative complications developed in 4 cases and there was no operative death.