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Intercostal Lung Hernia after Pectus Bar Removal
계여곤,김영두 대한흉부외과학회 2012 Journal of Chest Surgery (J Chest Surg) Vol.45 No.2
A 27-year-old man presented with chest pain and shortness of breath. A chest radiograph revealed collapse of the right lung (Fig. 1); this was his third episode of ipsilateral pneumothorax during the past 3 years. He had a history of minimally invasive repair of pectus excavatum (MIRPE) at another hospital 11 years earlier, and he had undergone surgery for a bar removal 4 years earlier. The computed tomographic scan of the chest revealed deformed ribs, costal cartilages, herniation of both lungs through the chest walls (Fig. 2), and a huge bulla in the right upper lobe. During surgery, the right lung was densely adhered to the parietal pleura, and the medial segment of the right middle lobe was herniated through the chest wall (Fig. 3). We resected the bulla of the right upper lobe and the herniated portion of the right middle lobe with an endostapler after the adhered lung was dissected free due to air leakages from those lobes. Complications related to a pectus bar such as displacement, infection, and allergy make up most of the late postoperative complications [1]. However, intercostal lung hernia after pectus bar removal is rare, and it has not been previously reported on. The patient had had a pectus bar for 7 years, and it may have caused deformities of the ribs and costal cartilages, especially at the sites where it entered and exited the pleural cavity. As a result, intercostal defects were created on each side of the chest wall, and the lungs may have herniated through these defects. Although this type of herniation usually does not cause pulmonary problems such as a reduction of lung function, they can complicate entering the pleural cavity during surgery in the future.
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무심폐기하 관상동맥우회수술에서 아스피린과 Clopidogrel의 수술 전 병합투여가 수술 후 출혈에 미치는 영향
최강주,성후식,계여곤 대한흉부외과학회 2008 Journal of Chest Surgery (J Chest Surg) Vol.41 No.5
Background: It is well known that preoperative administration of combined antiplatelet agents can have an impact on the postoperative bleeding, the requirement for transfusion and the need for reexploration during on-pump coronary artery bypass surgery. Yet its effects have not been well evaluated in the case of off-pump coronary artery bypass surgery. Material and Method: We performed a retrospective study of nineteen patients who underwent OPCAB from March 2003 to December 2004. All the patients had taken antiplatelet agents until 12 hours before operation. The patients were divided into two groups as an aspirin group and a combined (aspirin+clopidogrel) group. The perioperative platelet count, the hemoglobin level, the hematocrit, the prothrombin time and the aPTT were compared between both groups. The amount of postoperative bleeding, the transfusion requirement and the need for re-exploration to control bleeding were also compared between both groups. Result: There was no difference of operation time and the intraoperative ACT between the aspirin group and the combined group. The amount of blood loss through the chest tube for 24 hours was not different between the aspirin group (697±271 mL) and the combined group (944±432 mL). The number of patients who received blood transfusion was also not different between both groups. There was no patient who required reexploration for bleeding control in both groups. The perioperative hemoglobin level and hematocrit were also not different between both groups, but the postoperative hemoglobin level and hematocrit were decreased significantly in the group. Conclusion: The preoperative combined antiplatelet (aspirin+clopidogrel) therapy group was not different from the aspirin group for the amount of postoperative bleeding, the amount of blood transfusion and the need for reexploration during off-pump coronary artery bypass grafting. This subject needs further evaluation because of small population in our study.
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김종인,조성래,계여곤 대한흉부외과학회 2009 Journal of Chest Surgery (J Chest Surg) Vol.42 No.1
Cryptococcosis is a subacute or chronic inflammation that’s caused by infection from cryptococcus neoformans in the soil or dust that’s contaminated by pigeon droppings. Pulmonary cryptococcosis occurs in immunocompromised patients, and particularly in HIV positive patients, but it rarely occurs in immunocompetent individuals. It is most often detected as asymptomatic single or multiple nodules that are found by chest X-ray examination. In these situations, the diagnosis for most cases is made by the histology of the resected lesion. We report here on a case of solitary nodular pulmonary cryptococcosis that occurred in a 32 years old female patient who underwent thyroidectomy for treating her thyroid cancer. 효모균증은 비둘기의 배설물에 의해 오염된 먼지나 토양에 주로 존재하는 cryptococcus neoformans에 의한 아급성 또는 만성 감염이다. 폐의 효모균증은 건강한 사람에게는 잘 발생하지 않으며 면역이 저하된 환자 특히 후천성 면역결핍증 환자에게서 호발 한다. 일반적으로 증상이 없이 단순 흉부 X-선 검사에서 고립성 또는 다발성 폐 결절이 관찰되며, 이런 경우에는 대부분 절제된 조직의 병리학적 소견으로 진단된다. 본 증례는 갑상선 암으로 수술 받은 32세 여자환자에서 추적관찰 중에 발견된 좌하엽폐의 종괴가 전이성 폐암으로 추정되어 좌하엽폐 절제술을 시행한 후 폐 효모균증으로 확인되었다.
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기관절개술 후 발생한 기관무명동맥루에서 연골막을 포함한 늑연골을 이용한 기관성형술 -수술치험 1예-
조성호,조성래,계여곤,김종인 대한흉부외과학회 2007 Journal of Chest Surgery (J Chest Surg) Vol.40 No.9
기관무명동맥루는 매우 드물지만 높은 사망률을 보이는 질환으로, 장기간의 기관절개술이나 기관내 삽관후 합병증으로 발생한다. 대량 출혈로 인해 기도폐쇄 및 출혈성 쇼크로 생명의 위협이 초래되기 때문에 조기 진단과 즉각적인 치료가 반드시 필요하다. 후두 협착에 대한 수술을 위해 가능한 한 기관의 보존이 필요한 환자에 발생한 기관무명동맥루 환자에서 연골막을 포함한 늑연골을 이용한 기관성형술을 시행하였기에 보고하는 바이다.
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