비디오흉강경을 이용한 자연기흉의 치료시 국소적 Fibrin Glue 도포

신화균 대한흉부심장혈관외과학회 2000 Journal of Chest Surgery (J Chest Surg) Vol.33 No.10

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.

후종격동에 발생한 위식도 낭종

신화균 대한흉부심장혈관외과학회 1993 Journal of Chest Surgery (J Chest Surg) Vol.26 No.9

The gastroesophageal cyst is rare variety of benign developmental cysts in the mediastinum and it arises from sequestrations of nodules of forgut in the developing embryo.The patient was 23 year old man with complaint of right chest pain. Simple chest X-ray and chest CT scan showed a huge homogeneous cystic mass in the posterior mediastinum. The resected cystic mass showed combining of portion of esophagus and stomach. The cyst was confirmed as gastroesophageal cyst.

식도 벽내에 발생한 식도 낭종

신화균 대한흉부심장혈관외과학회 1994 Journal of Chest Surgery (J Chest Surg) Vol.27 No.9

The esophageal cyst result from a wrong cleavage of the primitive gut in the 4 weeks embryo. In embryo and after seperation of the tracheal diverticulum, the esophagus is lined with ciliated cells which are able cover a "cystic duplication". It is often difficult to distinguish between the bronchogenic and the esophageal cyst. Pathological findings showed the presence of a ciliated epithelium without cartilage which was diagnosed as an esophageal cyst. The patient was 21 year old man for evaluation of the cyst in the posterior mediastinum. The cyst was located the intramural esophagus. Microscopically, the cyst was lined with ciliated columnar epithelium and there was no evidence of cartilage. The cyst was confirmed as the intramural esophageal cyst.geal cyst.

기계판막치환술 후 골반강내 대량출혈

신화균,김남혁,이용재,강창희,권오춘,이길노 대한흉부심장혈관외과학회 1993 Journal of Chest Surgery (J Chest Surg) Vol.26 No.2

The hemorragic episode is the major problem of mechanical prosthesis, because of the necessity for anticoagulant therapy to prevent complication of thromboembolism. Double valve replacement was performed to 42 year old male due to aortic stenoinsufficiency and mitral stenosis. For anticoagulant therapy, the patient has been given wafarin under the control of prothrombin time 0.5-2 times of normal) in the our hospital. The patient was injuried the right pelvic area by waves in the beach 4 years after double valve replacement. Pelvic MRI scan showed huge hematoma in the right pelvic cavity. The patient was operated removal of intrapelvic hematoma.

폐기종환자에서의 우측 폐이식술 -1 례보고 -

신화균,김해균,이두연,백효채,홍윤주,황정주,김부연,류송현 대한흉부심장혈관외과학회 2000 Journal of Chest Surgery (J Chest Surg) Vol.33 No.7

밀기 폐쇄성 패질환의 치료로 페이식이 성공적으로 수행되고 있으며, 현재 일측 폐이식이 성행되고 있다. 영ㄴ세의대 영동세브란스 병원 흉부외과에서는 심한 호흡곤란을 호소하는 57세의 말기 폐기종환자에게 1999년 4월 7일 우측 폐이식을 성공적으로 시행하였으며 3제 면역억제제를 사용하였다. 그러므로 일측 폐이식은 말기의 폐기종환자에 있어 실행할 수 있으며 좋은 결과를 얻을 수 있으리라 생각한다. Lung transplantation has been successfully employed for variety of obstructive lung disease. Single lung transplantation has become a therapeutic option for end-stage obstructive lung disease. The patient, a 57 year old man with emphysema, suffered from severe dyspnea, which progressively aggravated him for the last three years. A single lung transplantation was performed from a young brain-dead donor on April 7th, 1999 in the department of thoracic surgery, Respiratory Center, Yongdong Severance hospital, yonsei University. The immunosuppressive regimen was based on cyclosporine A and azathioprine from beginning, adding steroid. Single lung transplantation was feasible and beneficial in patients with end-stage emphysema.

위장을 이용한 식도재건술의 합병증

신화균,이두연,강정신,윤용한,김도형 대한흉부심장혈관외과학회 1999 Journal of Chest Surgery (J Chest Surg) Vol.32 No.6

배경: 식도절제술후 식도대용장기로 위장이 가장 흔히 사용되어지는데 위장은 다른 장기에 비해 다루기가 비교적 간편하며 합병증이 적게 발생된다고 한다. 위장을 이용한 식도재건술에서 발생한 합병증을 분석 조사하였다. 대상 및 방법: 연세의대 영동세브란스병원 흉부외과에서는 1990년부터 1998년까지 식도질환으로 식도절제술후 식도위 문합술을 시행 받은 환자를 대상으로 하였다. 결과: 술후 합병증이 70.5%이었고 수술 사망률이 6.8%이었다, 가장 흔히 발생되었된 합병증은 문합부협착이 13.6%, 폐렴 11.4%, 창상 감염이 9.1% 이었다. 술후 사망원인은 전부가 폐합병증과 패혈증이였다. 결론: 문합부 누출 및 협착 등의 기술적인 문제는 많은 발전을 보였으나 술후 충분한 영양공급, 폐감염 방지 , 적극적인 물리치료 등이 폐합병증 및 사망률을 감소시키는데 중요하다. Background: After an esophageal resection for an esophageal disease, the stomach becomes the most common organ for a substitute. The stomach has the advantages of being simple with fewer complications when used properly. The complications of an esophageal reconstruction using the stomach as the substitute are assessed and discussed. Material and Method: Between 1990 and 1998, 44 patients who underwent esophagogastric anastomosis were treated in the department of Thoracic and Cardiovascular Surgery of Yongdong Severance Hospital, Seoul, Korea. Result: The rate of postoperative complications and mortality in these 44 patients were 70.5% and 13.6%, respectively. The major complications in our series involved the stricture of anastomosis(13.6%), pneumonia(11.4%), and wound infection(9.1%). The most frequent causes of postoperative deaths were pulmonary complications and sepsis(6.8%). Conclusion: Anastomotic leakage is no longer a major complication of an esophagogastrostomy. Most postoperative stricture can be overcome with frequent esophageal dilations. Postoperative pulmonary infection, nutrition, and physiotherapy are very important in reducing the rate of pulmonary morbidity and mortality.

대동맥 침습이있었던 식도암의 절제수술

신화균,이두연,김상진,김부연,이성수,금기창 대한흉부심장혈관외과학회 2000 Journal of Chest Surgery (J Chest Surg) Vol.33 No.1

Advanced esophageal carcinoma which invades into adjacent organs are classified as T4 esophageal cancer,. Its complete resection without residual tumor would be difficult. Preoperative chemoradiotherapy and combined modality therapy are being tried to improve survival in patients with T4 esophageal carcinoma. In a 74-year-old man a 6cm squamous cell carcinoma of the esophagus with invasion of the thoracic aorta was detected (T4). After neoadjuvant chemoradiotherapy the patient was operated on using bio-pump with aorto-femoral cannulation. The invased segment of descending aorta was resected and reconstructed with a graft. The tumor was resected and EG anastomosis was done. The postoperative period was uneventful the patient was discharged after good condition and has been well to now.

이중 박동성 인공심폐기의 동물 실험

신화균,원용순,이재욱,허균,염욱,김승철,민병구 대한흉부외과학회 2004 Journal of Chest Surgery (J Chest Surg) Vol.37 No.1

늑골에 발생한 연골점액유사 섬유종 -1예 보고-

신화균,이재욱,임재웅,원용순,고은석 대한흉부외과학회 2005 Journal of Chest Surgery (J Chest Surg) Vol.38 No.11

Chondromyxoid fibroma (CMF) is a rare, benign tumor of the bone that represents fewer than 2% of all benign tumors of bone. CMF is most often found in the long tubular bones, especially the tibia and femur near the knee joint. Less common sites included the pelvis, fibula, calcaneus and rib. A 54-year-old male patient presented to us with history of swelling and mild, intermittent local pain without any rise in overlying skin temperature in lateral portion of left 7th rib for one-month duration, which was diagnosed as benign rib tumor by plain chest X-ray and CT scan, and treated successfully by excision of rib with good result. Pathologic diagnosis of this tumor was CMF. Without any medical therapy, there was no evidence of recurrence after operation. We report this case and follow- up of the patient. 연골점액유사 섬유종은 뼈에 발생하는 드문 양성 종양으로 양성 골 종양의 2% 미만을 차지한다. 연골점액유사 섬유종은 무릎부위의 경골 근위부와 대퇴골 원위부에 가장 호발하며 골반, 비골, 발꿈치뼈, 늑골에서는 드물게 발생한다. 내원 1달 전부터 시작된 좌측 7번째 늑골부위의 부종과 간헐적으로 지속된 경한 동통으로 내원한 54세 남자가 방사선 검사상 양성 늑골 종양 진단 하에 늑골 절제술을 시행 받았으며 조직 검사상 늑골에 발생한 연골점액유사 섬유종으로 최종 진단되었고 현재까지 재발이나 별다른 증상 없이 외래 추적 중으로 이에 보고하는 바이다.

외상성 질식 증후군 -1례 보고-

신화균 대한흉부심장혈관외과학회 1994 Journal of Chest Surgery (J Chest Surg) Vol.27 No.4

Traumatic asphyxia is a distinctive clinical syndrome characterized by cervicofacial cyanosis and edema, bilateral subconjuctival hemorrhage, and multiple petechiae of the face, neck, and upper part of the chest after a severe compressive crush injury of the thorax or of the upper part of the abdomen.The pathophysiologic mechanism of traumatic asphyxia is reflux of blood from the heart retrograde through the valveless superior vena cava and the great veins of the head and neck by severe compression of the thorax or the abdomen.We experienced one case of the traumatic asphyxia, and its clinical features are discussed.