Thoracoscopic Bleb Ligation in Patients with Primary Spontaneous Pneumothorax / 대한흉부외과학회지

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.

Treatment of Esophageal Injury / 대한흉부외과학회지

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.

Hybrid Endovascular Repair of Thoracoabdominal Aortic Aneurysm Using Visceral Debranching Technique: 2 case reports / 대한흉부외과학회지

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.

Surgery for a Muscular Type Ventricular Septal Defect via Right Apical Ventriculotomy: A case report / 대한흉부외과학회지

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.

Broncho-Pleuro-Gastro-Colonic Fistula: A case report / 대한흉부외과학회지

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.

Acceptability of Low Intensity Anticoagulation Therapy after Mechanical Heart Valve Replacement / 대한흉부외과학회지

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.

Left Ventricular Outflow Tract Obstruction Caused by Accessory Mitral Valve Tissue in a Child: A case report / 대한흉부외과학회지

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.

Surgical Technique for the Removal of Deep Vein Thrombi of the Lower Extremities / 대한흉부외과학회지

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.

Surgical Treatent for Chylothorax Following Cardiac Surgery: 1 case report / 대한흉부외과학회지

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.

A Modified Technique for the Correction of Funnel Chest / 대한흉부외과학회지

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.

Surgical Treatment of Tracheal Stenosis / 대한흉부외과학회지

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.

Esophageal Perforation Due to Pneumatic Pressure of Carbonated Beverage: Report of two cases / 대한흉부외과학회지

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.

Clinical Experience of Mediastinal Tumors and Cysts / 대한흉부외과학회지

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.

Surgical Treatment For Primary Non-Small Cell Lung Cancer / 대한흉부외과학회지

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%.

Surgical Results for Myasthenia Gravis / 대한흉부외과학회지

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.

Clinical Study and Risk Factors of Surgical Mortality of Congenital Heart Defects / 대한흉부외과학회지

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.

Changes of plasma lipoproteins during and after cardiopulmonary bypass / 대한흉부외과학회지

No abstract available.

Open heart surgery:clinical analysis of 100cases / 대한흉부외과학회지

No abstract available.

Unroofed coronary sinus and its surgery:Associated with partial atrioventricular canal defect and common atrium / 대한흉부외과학회지

No abstract available.

Surgical thrombectomy in deep vein thrombosis / 대한흉부외과학회지

No abstract available.