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류대웅 ( Dae Woong Ryu ),이미경 ( Mi Kyung Lee ),이삼윤 ( Sam Youn Lee ) 대한외상학회 2012 大韓外傷學會誌 Vol.25 No.4
Cardiac rupture after blunt trauma is very rare and caval injury is even rarer. However, cardiac rupture after blunt trauma is associated with very high mortality and can occur without a high speed collision or severe thoracic injury. Symptoms are not expressed in all patients in the early stage, so the condition is easily overlooked if patients have an associated injury, minimal thoracic injury or relatively stable vital signs. We report the successful management of two cases of vena caval injury after blunt trauma with slight thoracic injury. (J Trauma Inj 2012;25:287-290)
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신장종양이 동반된 Birt-Hogg-Dube Syndrome
오수진 ( Su-jin Oh ),황기은 ( Ki-eun Hwang ),정은택 ( Eun-taik Jeong ),김학렬 ( Hak-ryul Kim ),최금하 ( Keum-ha Choi ),류대웅 ( Dae Woong Ryu ) 대한내과학회 2019 대한내과학회지 Vol.94 No.4
Birt-Hogg-Dube syndrome (BHD) is a rare autosomal dominant disorder characterized by the formation of hair follicle tumors, kidney tumors, and pulmonary cysts with recurrent spontaneous pneumothorax. A 44-year-old woman visited Wonkwang University Hospital with mild dyspnea. A chest X-ray on admission revealed pneumothorax in both lung fields. Chest computed tomography (CT) revealed both pneumothorax and multiple, irregularly shaped, variable-sized cysts in both lung fields. Upon physical examination, white dome-shaped papules were observed on the face. Histological examination of the skin lesion confirmed fi-brofolliculoma, and genetic studies revealed a folliculin gene mutation. Abdominal CT revealed a 1-cm small solid renal mass at the lower pole of the right kidney. We surgically removed the renal tumor, and a histological diagnosis of oncocytoma was made. Here, we report a case of BHD that demonstrated all three clinical manifestations; this is the first case report of its kind in Korea. (Korean J Med 2019;94:379-382)
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최순호,류대웅,이미경,이삼윤 원광대학교 의과학연구소 2009 圓光醫科學 Vol.24 No.1
배경: 젊은 성인에서 자발성기흉의 치료는 논란이 많다. 흉관삽관술로 구성된 고식적인 치료는 흉관 삽관시기의 이환율, 장기간의 입원 그리고 일정기간 안에 수술을 요한다. 젊은 성인에서 기흉은 보통 폐 첨부의 기포를 동반한 것처럼, 저자는 첫 기흉의 발생 시기에 기포의 흉강경하 절제는 낮은 이환율과 짧은 입원 일을 동반하는 효과적인 치료이며 개흉술에 대한 훌륭한 대체수단이라고 가정하였다. 대상 및 방법:2005년 1월부터 2006년 12월까지 166명의 기흉환자에서 비디오흉강경수술을 시행하였다. 155명은 남자이었고 11명은 여자이었다. 평균 나이는 29.3±6.7세(15-75세)이었다. 환자는 특히 날씬하고 키가 컸으며 증상의 발현시기에 경도의 호흡곤란과 흉통을 보였다. 폐 첨부의 기포는 조직 검사로 확인을 하였다.130명의 환자는 5일이상의 지속적인 공기누출과 흉부 컴퓨터사진상 다발성 기포 때문에,15명은 반대편 기흉으로, 7명은 양측성 기흉, 그리고 5명은 흉관삽관술의 치료 후 재발한 경우로 수술을 받았다. 모든 환자에서 Endo-GIA stapler 에 의한 폐 쐐기절제수술과 탈크도포, 그리고 늑막찰과상이 수행되었다. 추적 동안에 환자의 재발 과 잔존 만성 흉통을 관찰하였다. 결과: 수술사망은 없었다. 수술 후 합병증은 1명에서 과도한 늑막찰과상에 기인한 출혈로 재수술,9명의 환자에서는 7일 이상의 지속적인 공기누출, 그리고 3명에서 재발을 보였다. 재발은 수술 후 1-3개월 동안에 발생하였다. 그리고 또한 16명에서 경도의 잔존 흉통을 호소하였지만 진통제는 필요하지 않았다. 입원 일은 원발성 기흉 환자에서는 5.2±2.4일 그리고 이차성 기흉환자는 7.5±3.2일 이었다. 결론: 늑막유착술을 동반한 폐 첨부의 쐐기절제수술은 낮은 이환율과 짧은 입원 일을 동반하고, 초기 흉관삽관술이나 개흉수술 같은 고식적인 수술에 대한 매력적인 대체수단이다. 흉강경수술은 자발성 기흉 환자를 위한 효과적으로 처음 시도하는 수술일 수 있다. 이 질환의 병태생리상 기흉 환자는 기흉의 재발 때문에 엄밀한 추적을 요한다. Background:The treatment of spontaneous pneumothorax in young adult has been controversial. Conventional treatment consisting of chest tube thoracostomy may be associated with morbidity at the time of tube insertion, prolonged hospitalization, and interval operation in many patients. As spontaneous pneumothorax in young adults is usually associated with apical blebs, we hypothesized that video-assisted thoracic surgery(VATS) resection of the blebs at the time the first pneumothorax may be effective treatment associated with low morbidity and short hospital stay, and also viable alternative to thoracotomy. Method & materials. From Jan.2005 to Dec.2006,a series of 165 patients with spontaneous pneumothorax were treated by video-assisted thoracic surgery, there were 135 men and 11 women. The mean age was 29.3±6.7 years old(range:15to 78 years).Patients were predominantly tall and thin and also mildly symptomatic at the time of presentation. Apical bullae was confirmed in the pathologic specimen.139 patients was treated for persistent air leak(>5days) and multiple blebs & bullae on Chest CT, 15 patients for contralateral pneumothorax. 7 patients for bilateral pneumothorax, and another 5 patients for recurrent pneumothotax after conservative treatment. Stalpling of blebs and bullae with Edo-GIA stapler and pleurodesis by Talc poudrage and pleural abrasion was performed in all cases. During follow-up patients were observed for recurrence and residual chronic chest pain. Results: There was no postoperative death. Postoperative complications were reoperation due to excessive pleural abrasion in one patient and continued air leaks more than 7 days in 9 patients, and recurrence in 3 patients.Recurrence were occurred during postoperative 1 to 2 months also mild chronic residual chest pain also noted in 16 patients, but no required analgesics. The hospital stay was mean 5.2±2.4 days in primary spontaneous pneumothorax and mean 7.5±3.2 days in secondary pneumothorax. Conclusions: VATS wedge resection of apical bullaes with pleurodesis is associated with low morbidity and short hospitalization, and provides an attractive alternative to the conventional treatment of initial tube thoracostomy and possible interval repeat thoracostomy or operations. VATS may be an effective first line treatment for spontaneous pneumothorax.Due to the pathophysiology of this disease, patients should be closely followed for the occurrence of the pneumothorax.
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이미경,류대웅,이삼윤,최순호 원광대학교 의과학연구소 2009 圓光醫科學 Vol.24 No.1
Intrathoracic goiter consist of two types, namely, the primary intrathoracic goiter and secondary intrathoracic goiter. Primary intrathoracic goiters are very rare. Fifteen to fifty percent of these patients are asymptomatic. Symptoms, when present, are usually the result of tracheal or esophageal compression. Standard chest roentgenograms are often diagnostic but computed tomographic or radioactive iodine scans may be helpful. In symptomatic patients or those in whom explorations are undertaken for diagnostic purpose or exclude carcinoma, surgical removal is indicated. We report here on a case that was completely removed with using the thoracoscopic assist technique. The postoperative courses were uneventful.
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