합병증을 동반한 종격동 기형종 -2예 보고-

구자홍,김공수,Kuh, Ja-Hong,Kim, Gong-Su 대한흉부심장혈관외과학회 1982 Journal of Chest Surgery (J Chest Surg) Vol.15 No.2

We have experienced two cases of complicated teratoma in anterior mediastinum. One case, 1-year-old female, has a huge anterior mediastinal teratoma involving almost all of the left pleural cavity with atelectasis of the left lung. The other case, 12-year-old female, has a anterior mediastinal teratoma with fistula between the teratoma and the bronchus of anteromedial basal segment of left lung. The bronchus has a bronchiectatic change with cell infiltration. We performed exploratory thoracotomy with complete excision of tumor mass in both cases and with additional resection of anteromedial basal segment of the left lung due to inflammation and necrosis in latter case. The patients had uneventful postoperative courses and were discharged in good condition. Histopathologic diagnosis of these were benign teratoma consist of skin, skin appendages, cartilage, connective tissue, and gut.

심방중격결손과 동반된 선천성 관동정맥루 1예

이규호,최정기,구자홍,이양근,채제건,김원호,고재기 대한순환기학회 2000 Korean Circulation Journal Vol.30 No.6

비디오 흉강경을 이용한 흉부수술에 대한 고찰

김진,김민호,구자홍,김공수,Kim, Jin,Kim, Min-Ho,Kuh, Ja-Hong,Kim, Kong-Soo 대한흉부심장혈관외과학회 1996 Journal of Chest Surgery (J Chest Surg) Vol.29 No.10

최근들어 비디오 흉강경을 이용한 흉부수술은 다양한 흉부질환에 이용되고 있다. 전북대학교 의과대학 흉부외과학교실에서 1992년 8월부터 1995년 7훨까지 비디오 흉강경을 이용한 흉부수술을 46예 시행 하였다. 20명이 남자, 26명이 여자이었고 이들의 연령 분포는 14세에서 56세이었다. 대상질환은다한증 21예, 종격동 종양 12예, 기홍 10예, 식도의 평활근종 1예, 그리고 Raynaud's syndrome과 Burger's disease가 각각 1예씩이었다. 평균 수술시간은 89.7분이었고, 개흉술로 전환한 경우는 없었다. 사용한 트로카의 평균 숫자는 3개, 수술 후 흉관 거치 기간은 평균 1.8일, 그리고 수술 후 평균 입원 기간은 4.3일이 었다. 수술후 합병증은 5예(잔류기흉 1예, 횡격신경마비 1예, 지속적 공기 누출 2예, 대상성 과발한 1예)가 있었다. 지속적인 공기누출이 있었던 환자중 1예에서는 술후 3일째 개흉하여 폐부분절제술을 시행하였고 다른 1예에서는 술후 4일째 화학적 흉막유착술을 시행하여 공기 누출을 막을 수 있었다. 종격동 종양 절제술을 받은 환자중 1예에서는 조직검사상 흉선암으로 판명되어 6주간 5600cgy의 방사선 치료를 받 았다. 전체적으로 수술후 사망한 환자는 없었다. 흉강경을 이용한 흉부수술은 수술후 통증과 입원 기간을 감소시킬 수 있었고, 미용상의 이점이 있었다. Video-assisted thoracic surgery(VATS) is emerging as a potentially less invasive means of managing a wide variety of thoracic disorders. VATS was performed in 46 cases, in the Department of Thoracic & Cardiovascular Surgery of Chonbuk national University Hospital from August 1992 to July 1995. There were 20 men and 26 women, whose age ranged from 14 to 56 years. They were diagnosed hyperhidrosis in 21 cases, mediastinal tumor in 12 cases, pneumothorax in· 10 cases, and one case each of lelomyoma of the esophagus, Raynaud's syndrome, Burger's disease. Operation time averaged 89.7 minutes, and no patient was converted to d thoracotomy. The number of troche used, period of chest tube drainage, and postoperative hospitalization were 3, 1.8 days, and 4.B days, respectively. The postoperative complication ocurred in 5 cases (remnant pneumothorax 1 case, phrenic nerve aralysis 1 case, persistant air leakage 2 cases, compensatory hyperhidrosis 1 case). One patient with persistent air leak was managed by thoracotomy on postoperative) days, and the other patient by chemical pleurodesis. One patient diagnosed pathologically as thymic carcinoma, was managed by radiation therapy. There was no postoperative death. VATS has the benefits of reduced postoperative pain and postoperative hospitalization, and good cutsmetic effect.

수술중 Bupivacaine 으로 늑간신경차단후 갑자기 발생한 저혈압

송희선,이상귀,송정자,구자홍 대한마취과학회 1994 Korean Journal of Anesthesiology Vol.27 No.5

Postoperative pain may be associated with shallow breathing, inability to cough, and reduction in spirometric values which lead to restrictive pattern of ventilation with hypoxemia and/or hypercarbia. Therefore, postoperative pain should be managed with appropriate methods. The authors have usually performed intraoperative intercostal nerve block with 0.25% bupivacaine hydrochloride to alleviate postoperative thoracotomy pain. A 21 years old male patient developed sudden hypotension and severe bradycardia 1 minute following the intraoperative 4th, 5th, 6th intercostal nerve block with a total of 10 ml of 0.25% bupivacaine hydrochloride, who was treated by ephedrine with success. The authors discuss the possible causes of sudden hypotension and severe bradycardia in detail.

Self expandable Metallic Stent 합병증으로 인한 좌측 전폐 설상 절제술 -치험 1례-

김진,신형주,구자홍,김공수,Kim, Jin,Shin, Hyeong-Ju,Kuh, Ja-Hong,Kim, Kong-Soo 대한흉부심장혈관외과학회 1995 Journal of Chest Surgery (J Chest Surg) Vol.28 No.2

Most of the patient with endobronchial tuberculosis have some degree of bronchial stenosis. however, a part of bronchial stenosis need aggressive treatment for the patency because of severe symptoms. The self-expendable metallic stents provide palliative treatment for narrowed airways where surgical resection is inadvisable. We experienced a successful left wedge pneumonectomy on a 29-year-old woman with obstruction of left main bronchus due to complication of the bronchial stent. She had inserted self-expendable metallic stents on left main bronchus of the tuberculous bronchial stenosis two times. There was no specific postoperative complication.

Obstruction After Self-Expanding Metallic Stent Placement in Tuberculous Bronchial Stenosis

(Yang Keun Rhee),(Won Kim),(Yong Chul Lee),(Ja Hong Kuh) 전북대학교 의과학연구소 1996 全北醫大論文集 Vol.20 No.1

불완전 비틀림을 보인 줄기를 가진 가슴막밑 지방종 1예 보고

곽형종 ( Hyoung Jong Kwak ),차은정 ( Eun Jung Cha ),손경락 ( Kyung Rak Sohn ),구자홍 ( Ja Hong Kuh ),진공용 ( Gong Yong Jin ),정명자 ( Myoung Ja Chung ),장규윤 ( Kyu Yun Jang ) 대한내과학회 2008 대한내과학회지 Vol.74 No.6

지방종은 흔한 양성 연부조직 종양이지만 가슴막에서 기원하는 경우는 매우 드물다. 대부분의 가슴막 지방종은 증상이 없어서 흉부 방사선 사진에서 우연히 발견된다. 저자들은 갑자기 시작한 옆구리 통증을 호소하는 29세 여자에서 발생한 불완전한 뒤틀림을 보인 줄기를 가진 가슴막밑 지방종 한예를 경험하였기에 보고하는 바이다. 흉부 방사선 소견상 좌측 폐 하방에서 난원형의 경계가 분명하고 균일한 음영 증가가 있는 종괴가 관찰되었다. 가슴막공간 내종괴가 의심되어 확진을 하기 위해 비디오 흉강경술을 시행하였다. 절제된 종괴는 10×5 cm 크기의 줄기를 가진 잘 경계지워진 가슴막 종괴로 절단면 상 황색을 띠었고 부분적으로 출혈 부위가 관찰되었다. 조직학적 소견상 종양은 섬유성 격막에 의해 구획 지워져 있었으며 주로 섬유혈관간질을 가지는 성숙한 지방세포로 구성되어 있었다. 종양의 표면은 중피 세포로 피복되어 있었다. 부분적으로 세포밀도가 높은 부위가 관찰되고 소수의 유사분열이 관찰되었으나 전형적인 지방모세포나 비정상적인 유사분열은 관찰되지 않아 지방종으로 진단하였다. Lipoma is a common benign neoplasm, but lipoma arising from the pleura is rare. Most pleural lipomas are asymptomatic and are discovered incidentally on chest radiographs. Here we report an unusual case of a pedunculated subpleural lipoma with incomplete torsion in a 29-year-old woman who presented with flank pain. On chest radiography, there was a well-defined, ellipsoidal, homogeneous, radioopaque mass in the left lower lobe. An intrathoracic tumor was suspected, and video-assisted thoracic surgery was performed to establish the final diagnosis. The resected tumor was a 10×5 cm sized pedunculated pleural mass. The cut surface showed a yellow, well-circumscribed mass with areas of hemorrhage. Histologically, the tumor was composed of mature adipose tissue with fibrous septae composed of fibroblasts. The outer surface of the tumor was covered by mesothelial cells. Some areas were hypercellular, and occasional mitoses were found, but neither lipoblasts nor atypical mitoses were identified.(Korean J Med 74:676-679, 2008)

A Case Report of Fast Growing Mediastinal Desmoid Tumor

( Joon Hyung Lee ),( Jae Seok Jeong ),( So Ri Kim ),( Seung Yong Park ),( Yeong Hun Choe ),( Heung Bum Lee ),( Seoung Ju Park ),( Gong Yong Jin ),( Myoung Ja Chung ),( Ja Hong Kuh ),( Yong Chul Lee ) 대한결핵 및 호흡기학회 2015 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.120 No.-

Desmoid tumors (DTs) are rare and benign soft tissue tumors that result from monoclonal proliferation of well-differentiated fibroblasts. Since DTs tend to infiltrate and compress adjacent structures, the location of DTs is one of the most crucial factors in determining the severity of the disease. Furthermore, DTs can further complicate the clinical course of the patients whenthe growth is remarkably rapid, especially for DTs occurring in anatomically critical compartments including the thoracic cavity. We report a case of a 71-year-old man with a known mediastinal mass incidentally detected 4 months ago, presenting dyspnea with right-sided atelectasis and massive pleural effusion. Imaging studies revealed a fibrous, 16.4 cm×9.4 cm-sized anterior mediastinal mass with high glucose metabolism. The mass infiltrated into the chest wall and also shifted the mediastinum contralaterally. Interestingly, the tumor had an extremely rapid doubling time of 31.3 days. En bloc resection of the tumor was performed as a curative as well as a diagnostic measure. Histopathological examination showed spindle cells with low cellularity and high collagen deposit in the stroma. Immunohistochemical staining showed the positivity for nuclear β -catenin. Based on these pathologic findings, the mass was diagnosed as DT. After the surgery, there has been no evidence of recurrence of disease in this patient.

흉선지방종 1 예

이진희,이양근,이용철,한영민,이흥범,이동근,이경석,구자홍 대한내과학회 1996 대한내과학회지 Vol.51 No.1

Thymolipomas are unusual benign anterior mediastinal tumors. The tumor was first described by Lange as a lipoma of the thymus, and later, Hall named the lesion thymolipoma. There have been about 130 cases are reported in the world and one case in Korea. Despite its rarity, thmolipoma should be considered in the differential diagnosis of mediastinal tumors. We report a case of thymolipoma in asymptomatic 19 year old male patient with review.