Recently, increased traffic accident has resulted in a corresponding increase in incidences of blunt trauma. Tracheal and main bronchial injuries artier blunt chest trauma can be life-threatening, and hence early diagnosis and early management of patients with such injuries are essential. A 3-year-old boy was transferred to the Department of Emergency Medicine after a motor vehicle accident in which he sustained multiple blunt injuries consisting of tracheal rupture, left main bronchial rupture, liver laceration, vitreous hemorrhage, and fracture of the iliac wing. The tracheal rupture was managed nonoperatively with intensive respiratory care, while the left main bronchial rupture was managed surgically by bronchoplasty. Postoperative course was uneventful and the patient was discharged without respiratory problems.
Accidents, Traffic ; Bronchi* ; Child, Preschool ; Early Diagnosis ; Emergency Medicine ; Humans ; Incidence ; Lacerations ; Liver ; Male ; Motor Vehicles ; Rupture ; Thorax ; Trachea* ; Vitreous Hemorrhage ; Wounds, Nonpenetrating

No abstract available.
Bronchi* ; Rupture*

A 51-year-old woman was transferred from a private hospital for persistent massive left pleural effusion. Available examination methods did not reveal the cause of the disease. The pleural effusion was confirmed as chylothorax by thoracentesis and chest computed tomography. Previous tube drainage and pleurodesis had failed. Therefore we decided on an operative approach. A left thoracotomy revealed nothing abnormal except for the oozing lymph from the mediastinal pleura, which was sutured by 4-0 prolene. Decortication and pleurodesis were done at the same time. Postoperative course was uneventful and no recurrent pleural effusion was recognized for 3 months. Adult Idiopathic unilateral chylothorax with unknown etiology is rare, but this case was successfully treated with an operative method.
Adult ; Chylothorax* ; Drainage ; Female ; Hospitals, Private ; Humans ; Middle Aged ; Pleura ; Pleural Effusion ; Pleurodesis ; Polypropylenes ; Thoracotomy ; Thorax

BACKGROUND: Coronary artery bypass graft(CABG) in patients with advanced left ventricular dysfunction has often been regarded as having high mortality rate, despite the great improvement in operative result of CABG. With recent advances in surgical technique and myocardial protection, surgical revascularization improved the symptom and long-term survival of these high risk patients more than the medical conservative treatment. MATERIAL AND METHOD: Clinical data of 31(4.1%) patients with preoperative ejection fraction less than 30% among 864 CABGs performed between January 1995 and March 1999 were retrospectively analyzed and pre- and postoperative changes of the ejection fraction on echocardiography were analyzed. There were 26 men and 5 women. The mean age was 60.7 years(range 41 to 72 years). History of myocardial infarction(30 cases, 98%) was the most common preoperative risk factor. There were seven irreversible myocardial infarction on thallium scan. Most patients had triple vessel diseases(26 cases, 84%) and first degree of Rentrop classification(16 cases, 52%) on coronary angiography. The mean number of distal anastomosis during CABG was per patient was 4.9+/-0.8 sites in each patient. In addition to long saphenous veins, the internal mammary artery was used in 20 patients. Total bypass time was 244.7+/-3.7 minutes(range, 117 to 567 minutes), and mean aortic cross-clamp time was 77.9+/-1.6 minutes(range, 30 to 178 minutes). There were five other reparative procedures such as two left ventricular aneurysmectomy, two mitral repair, and one aortic valve replacement. There were twelve postoperative complications such as three cardiac arrhythmia, two bleeding(re-operation), one delayed sternal closure, eleven usage of intra-aortic balloon counterpulsation for low cardiac output. Two patients died, postoperative mortality was 6.5%. Twenty-nine patients were relieved of chest pain and left ventricular ejection fraction after operation was significantly higher(38.5+/-11.6%, P<0.001) as compared with preoperative left ventricular ejection fraction(25.3+/-2.3%). The follow up period of out patient was 25.3 months. CONCLUSION: In patients with coronary artery disease and advanced left ventricular dysfunction, coronary artery bypass grafting can be performed relatively safely with improvement in left ventricular function, but it will be necessary to study long term results.
Aortic Valve ; Arrhythmias, Cardiac ; Cardiac Output, Low ; Chest Pain ; Coronary Angiography ; Coronary Artery Bypass* ; Coronary Artery Disease ; Coronary Vessels* ; Counterpulsation ; Echocardiography ; Female ; Follow-Up Studies ; Humans ; Male ; Mammary Arteries ; Mortality ; Myocardial Infarction ; Postoperative Complications ; Retrospective Studies ; Risk Factors ; Saphenous Vein ; Stroke Volume ; Thallium ; Ventricular Dysfunction, Left* ; Ventricular Function, Left

Traumatic diaphragmatic injuries in infants and children are uncommon. Late presentation of such an injury is well recognised in adults but is exceptionally rare in children. Because of the increased compliance of the thoracic cage in children, rupture of the diaphragm can occur without signs of external injury. Morbidity and mortality can be minimized by a high index of suspicion, prompt recognition, and surgical repair of even the smallest diaphragmatic injury. We present a case of delayed presentation of traumatic diagphragmatic hernia in a boy of 10 months.
Adult ; Child* ; Compliance ; Diaphragm ; Hernia ; Hernia, Diaphragmatic, Traumatic* ; Humans ; Infant ; Male ; Mortality ; Rupture

The presense of pectus excavatum in Marfan's syndrome may complicate cardiac operation by making midline sternotomy technically more difficult and limiting the operative exposure of the heart. We operated on a 33 year old male patient with Marfan's syndrome and severe pectus excavatum who had severe mitral regurgitation and moderate aortic regurgitation with 52mm aortic root dilation. The operative field was adequately exposed through a midline sternal incision with two sternal retactors. The patient underwent Bentall operation and mitral valve replacement. The repair of pectus excavatum was performed after completion of CPB and the administration of protamin. Permanent internal stabilization achieved by overlapping of the ends of lower ribs and reinforced with sternal closure wire.
Adult ; Aortic Valve Insufficiency ; Funnel Chest* ; Heart* ; Humans ; Male ; Marfan Syndrome* ; Mitral Valve ; Mitral Valve Insufficiency ; Ribs ; Sternotomy ; Thoracic Surgery*

From Feb. 1985 to Aug. 1996, 450 patients underwent open heart surgery with hypothermic cardiopulmonary bypass. In 450 cases of open heart surgery, 222 cases(49.3%) were congenital heart diseases and 228 cases(50.7%) were acquired heart diseases. In 222 cases of congenital heart diseases, there were 201 cases of acyanotic heart disease and 21 cases of cyanotic heart diseases. Among the 228 cases of acquired heart diseases, most cases were valvular heart diseases in which 206 valves were implanted. There were 32 cases of ischemic heart disease and the average graft anastomoses were 2.37 sites per operation. The operative mortality of congenital and acquired disease was 9.0% and 10.1% respectively and then overall mortality rate was 9.6%.
Cardiopulmonary Bypass ; Heart Diseases ; Heart Valve Diseases ; Heart* ; Humans ; Mortality ; Myocardial Ischemia ; Thoracic Surgery* ; Transplants

A rare small cell carcinoma of the trachea was managed in a 59 year old female patient. The diagnosis was confirmed by histopathological and immunohistochemical studies. Surgical resection and adjuvant chemotherapy were done. The patient died 6 months later due to multiple metastasis.
Carcinoma, Small Cell* ; Chemotherapy, Adjuvant ; Diagnosis ; Female ; Humans ; Middle Aged ; Neoplasm Metastasis ; Trachea* ; Tracheal Neoplasms

Thrombosis at the left ventricular outflow tract occurs without any detectable heart disease or predisposing factors only extremely rarely. A 48-year-old male visited Konkuk University Medical Center with loss of consciousness one month prior to presentation. Before he visited our hospital, he had been diagnosed with a cardiac tumor, which was located between the left atrium and posterior aortic root, and which was adjacent to both the aortic and mitral valves. Cardiac transplantation was recommended at the other hospital because of the high risk of cardiac dysfunction induced by both aortic and mitral valvular dysfunction after surgical resection. Based on preoperative transthoracic echocardiography, cardiac computed tomography, cardiac magnetic resonance imaging, and intra-operative transesophageal echocardiography, we considered it to be a benign tumor. Complete resection was achieved and the pathology confirmed organizing thrombus. We report a case of organizing thrombus mimicking a cardiac tumor, which was located at the mitral-aortic intervalvular fibrosa of the left ventricular outflow tract without any heart disease.
Academic Medical Centers ; Aneurysm, False ; Causality ; Echocardiography ; Echocardiography, Transesophageal ; Heart Atria ; Heart Diseases ; Heart Neoplasms* ; Heart Transplantation ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Mitral Valve ; Pathology ; Thrombosis* ; Unconsciousness

The laryngeal mask airway (LMA) is new method for maintaining the airway and has many advantages such as easy insertion without muscle relaxant, decreasing cardiovascular change, decreasing damage of pharynx and larynx and useful in difficult intubation. It has being increasingly used in the management of difficult airway problems, but has not been widely used in tracheal surgery. A 59 year old woman with tracheal stenosis due to tracheal tumor was admitted for tracheal reconstruction. The stenotic lesion was 5 cm above the carina and the length of the stenotic segment was 2 cm. Anesthetic management should be focus on maintenance of the airway and adequate ventilation with the number 3 sized LMA during the tracheal resection. The tracheal segmental resection and primary end-to-end anastomosis were performed without serious hypoxia and hypercarbia. We discuss the advantages and limitations of the LMA in tracheal surgery.
Anoxia ; Female ; Humans ; Intubation ; Laryngeal Masks* ; Larynx ; Middle Aged ; Pharynx ; Trachea* ; Tracheal Stenosis ; Ventilation