OBJECTIVES: The causes of benign esophageal stricture were postoperative, corrosive, peptic and after esophageal sclerotheraphy, etc. The patients mainly suffered from dysphagia and insufficient nutrition. Recently, balloon and bougie dilatation were introduced to these patients. This study was performed to evaluate the effectiveness and safety of both procedures in different types of strictures METHODS: 32 patients who presented dysphagia enrolled from March 1996 to August 1997 who visited Pusan National University Hospital. Balloon dilatation was performed on 22 patients and bougie on 10 patients. RESULTS: 1) The causes of stricture were postoperative (18 cases), corrosive (10 cases), hypertensive LES (2 cases), peptic (1 case) and web (1 case). 2) Overall cure rate was 59% in bougie dilatation and 40% in balloon dilatation 3) The cure rate of postopertive stricture was 59% which is significantly higher than that of corrosive stricture (27%), and cure rate of hypertensive LES, peptic stricture and web was 100%. 4) The cure rate of corrosive stricture was significantly higher on bougie dilatation than balloon dilatation. 5) The cure rate of postoperative stricture was similiar between balloon and bougie dilatation 6) The length of stricture was inversly affected on cure rate of both dilatation procedures. 7) Overall complication was 5.6% and similiar between balloon and bougie dilatation. CONCLUSIONS: These results suggested that bougie dilatation was recommended on corrosive stricture and balloon dilatation on postopertive stricture
Busan ; Constriction, Pathologic ; Deglutition Disorders ; Dilatation* ; Esophageal Stenosis* ; Humans

Acute respiratory distress syndrome (ARDS) is difficult to treat and it is often fatal. If the medical treatment for ARDS is not effective, then extracorporeal membrane oxygenation (ECMO) can be applied to the patient. A 22-year-old female who suffered multiple traumatic injuries due to a car accident presented with acute respiratory distress syndrome. Veinarterial extracorporeal membrane oxygenation (VA ECMO) was started to treat her respiratory failure. With the VA ECMO, the systemic oxygen saturation remained at only 84%, and so the ECMO system was switched to V-VA ECMO via an additional venous outflow through the right jugular vein to increase both the systemic and pulmonary oxygen saturation. After conversion to the V-VA type ECMO, the systemic oxygen saturation increased to 94% and the partial pressure of oxygen (PaO2) increased to 65 mmHg. We report here on a successful case of ECMO conversion from the VA type to the V-VA type in a patient with severely hypoxic respiratory failure.
Extracorporeal Membrane Oxygenation ; Female ; Humans ; Jugular Veins ; Multiple Trauma ; Oxygen ; Partial Pressure ; Respiratory Distress Syndrome, Adult ; Respiratory Insufficiency ; Young Adult

The purpose of this paper is to review the colonoscopic fingings of twenty two patients with colonic tuberculosis which were diagnosed by colonoscopic finding, histopathology, and follow-up observation after antituberculosis chemotherapy at Pusan National University Hospital from January 1992 to December 1994. The results were as follows: 1) The male to female ratio was 1: 1.2, and the average age of the patients was 39.4 years with a slight predominance in women. The age of peak incidence was the 4th decade 40.9%). 2) Abdominal pain(95%), diarrhea(63%), and weight loss(50%) were the most common clinical findings. Others were constipation, melena, and palpable abdominal mass. The location of the pain was right lower abdomen, epigastrium, central abdomen, and left lower abdomen in decreasing order. 3) Hematologic findings showed decrease in hemoglobin level, increase in ESR, and positive CRP(61.5%). The white blood cell counts were mostly normal. 4) The stool examination showed positive occult blood in 7 cases among 18 cases (38.9%). Acid-fast bacteria was observed in stool of one case. 5) On colonoscopy, the lesion sites were ileoeecal valve(75%), ascending colon(72.7 %), terminal ileum(52.6%), cecum(42.9%), transverse colon(31.8%), descending colon (27.3%), sigmoid colon(9%), and rectum(9%) in decreasing order of frequency. Most of them involved ileocecal area. 6) On colonoscopy, the shape of ulcer revealed circular(41%), fusion(36%), and irregular pattern(18%). It found skipped area in 9 cases, pseudopolyp in 8 cases, patency of ileocecal valve in 5 cases, and severe deformity of ileocecal valve in 6 cases. 7) Microscopic finding of biopsy specimens revealed noncaseating granulomatous inflammation in 12 cases, and nonspecific ulcerative inflammation in 10 cases. In conclusion the diagnostic yield may be greatly enhanced by obtaining multiple target biopsies frorn tbe deep portion of the ulcer bed and margins. Judged from the colonoscopic finding and clinical improvement after antituberculosis chemotherapy, more accurate diagnosis can be acquired.
Abdomen ; Bacteria ; Biopsy ; Busan ; Colon* ; Colon, Descending ; Colon, Sigmoid ; Colonoscopy ; Congenital Abnormalities ; Constipation ; Diagnosis ; Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Ileocecal Valve ; Incidence ; Inflammation ; Leukocyte Count ; Male ; Melena ; Occult Blood ; Tuberculosis* ; Ulcer

BACKGROUND: Spontaneous pneumothorax patients with blebs or bullae are considered to be good candidates for operation, and various objective diagnostic modalities have been performed for detection of blebs and bullae. This study was performed to compare the efficacy of thoracoscopic examination with using a minimally invasive 2 mm thoracoscope with high-resolution computed tomography (HRCT) for treating primary spontaneous pneumothorax. MATERIAL AND METHOD: From June 2001 to March 2002, 34 patients with spontaneous pneumothorax underwent study with 2 mm video-thoracoscopic examination and HRCT. We regarded a bleb larger than 5 mm in diameter as significant. Standard thoracoscopic wedge resection was performed in 18 patients with significant bleb via a 2 mm video-thoracoscopic examination. 1 patient incurred bleeding, and the remaining 15 patients were treated with pleural drainage. RESULT: Multiple or single bleb lesions were detected by 2 mm video-thoracoscope in 52.9% (18/34) of the patients with primary pneumothorax. For a total of 19 patients who were operated on, the diagnostic accuracy of the 2 mm video-thoracoscopic examination for bullae and bleb was 94.7% (18/19), which was superior to that of HRCT (73.7%, 14/19). At a mean follow-up of 30+/-3 months, no recurrence occurred in both the operative group and the non-operative group. CONCLUSION: 2 mm video-thoracoscopic examination under local anesthesia has higher diagnostic accuracy than HRCT, and it is a useful alternative for determining the operative indications for spontaneous pneumothorax.
Anesthesia, Local ; Blister ; Drainage ; Follow-Up Studies ; Hemorrhage ; Humans ; Pneumothorax ; Recurrence ; Thoracoscopes ; Thoracoscopy

Background: The superficial veins are commonly used in conventional autogenous arteriovenous fistulas and the placement of prosthetic grafts. When they are unsuitable, however, the use of the deep veins (venae comitantes) is generally considered to be a reasonable alternative. This study conducted a comparative analysis of clinical outcomes for arteriovenous grafts between 2 groups based on the type of venous outflow: superficial veins or venae comitantes. Methods: In total, 151 patients who underwent arteriovenous grafts from November 2005 to March 2022 were retrospectively analyzed. The patients were divided into 2 groups: group A (superficial veins, n=89) and group B (venae comitantes, n=62). The primary, secondary patency, and complication rates were analyzed in each group. A propensity score-matched analysis was performed. Results: In total, 55 well-balanced pairs were matched. Kaplan-Meier analysis revealed no significant differences in the primary patency rate between the 2 groups at 1-year, 3-year and 5-year intervals (group A, 54.7%, 35.9%, 25.4% vs. group B, 47.9%, 16.8%, 12.6%; p=0.14), but there was a difference in the secondary patency rate (group A, 98.2%, 95.3%, 86.5% vs.group B, 87.3%, 76.8%, 67.6%; p=0.0095). The rates of complications, simple percutaneous transluminal angioplasty, and stent insertion were comparable between the groups. Conclusion Although this study demonstrated not particularly favorable secondary patency rates in the venae comitantes group, the venae comitantes may still be a viable option for patients with unsuitable superficial veins because there were no significant differences in the primary patency and complication rates between the 2 groups.

Background: The superficial veins are commonly used in conventional autogenous arteriovenous fistulas and the placement of prosthetic grafts. When they are unsuitable, however, the use of the deep veins (venae comitantes) is generally considered to be a reasonable alternative. This study conducted a comparative analysis of clinical outcomes for arteriovenous grafts between 2 groups based on the type of venous outflow: superficial veins or venae comitantes. Methods: In total, 151 patients who underwent arteriovenous grafts from November 2005 to March 2022 were retrospectively analyzed. The patients were divided into 2 groups: group A (superficial veins, n=89) and group B (venae comitantes, n=62). The primary, secondary patency, and complication rates were analyzed in each group. A propensity score-matched analysis was performed. Results: In total, 55 well-balanced pairs were matched. Kaplan-Meier analysis revealed no significant differences in the primary patency rate between the 2 groups at 1-year, 3-year and 5-year intervals (group A, 54.7%, 35.9%, 25.4% vs. group B, 47.9%, 16.8%, 12.6%; p=0.14), but there was a difference in the secondary patency rate (group A, 98.2%, 95.3%, 86.5% vs.group B, 87.3%, 76.8%, 67.6%; p=0.0095). The rates of complications, simple percutaneous transluminal angioplasty, and stent insertion were comparable between the groups. Conclusion Although this study demonstrated not particularly favorable secondary patency rates in the venae comitantes group, the venae comitantes may still be a viable option for patients with unsuitable superficial veins because there were no significant differences in the primary patency and complication rates between the 2 groups.

Background: The superficial veins are commonly used in conventional autogenous arteriovenous fistulas and the placement of prosthetic grafts. When they are unsuitable, however, the use of the deep veins (venae comitantes) is generally considered to be a reasonable alternative. This study conducted a comparative analysis of clinical outcomes for arteriovenous grafts between 2 groups based on the type of venous outflow: superficial veins or venae comitantes. Methods: In total, 151 patients who underwent arteriovenous grafts from November 2005 to March 2022 were retrospectively analyzed. The patients were divided into 2 groups: group A (superficial veins, n=89) and group B (venae comitantes, n=62). The primary, secondary patency, and complication rates were analyzed in each group. A propensity score-matched analysis was performed. Results: In total, 55 well-balanced pairs were matched. Kaplan-Meier analysis revealed no significant differences in the primary patency rate between the 2 groups at 1-year, 3-year and 5-year intervals (group A, 54.7%, 35.9%, 25.4% vs. group B, 47.9%, 16.8%, 12.6%; p=0.14), but there was a difference in the secondary patency rate (group A, 98.2%, 95.3%, 86.5% vs.group B, 87.3%, 76.8%, 67.6%; p=0.0095). The rates of complications, simple percutaneous transluminal angioplasty, and stent insertion were comparable between the groups. Conclusion Although this study demonstrated not particularly favorable secondary patency rates in the venae comitantes group, the venae comitantes may still be a viable option for patients with unsuitable superficial veins because there were no significant differences in the primary patency and complication rates between the 2 groups.

Background: The superficial veins are commonly used in conventional autogenous arteriovenous fistulas and the placement of prosthetic grafts. When they are unsuitable, however, the use of the deep veins (venae comitantes) is generally considered to be a reasonable alternative. This study conducted a comparative analysis of clinical outcomes for arteriovenous grafts between 2 groups based on the type of venous outflow: superficial veins or venae comitantes. Methods: In total, 151 patients who underwent arteriovenous grafts from November 2005 to March 2022 were retrospectively analyzed. The patients were divided into 2 groups: group A (superficial veins, n=89) and group B (venae comitantes, n=62). The primary, secondary patency, and complication rates were analyzed in each group. A propensity score-matched analysis was performed. Results: In total, 55 well-balanced pairs were matched. Kaplan-Meier analysis revealed no significant differences in the primary patency rate between the 2 groups at 1-year, 3-year and 5-year intervals (group A, 54.7%, 35.9%, 25.4% vs. group B, 47.9%, 16.8%, 12.6%; p=0.14), but there was a difference in the secondary patency rate (group A, 98.2%, 95.3%, 86.5% vs.group B, 87.3%, 76.8%, 67.6%; p=0.0095). The rates of complications, simple percutaneous transluminal angioplasty, and stent insertion were comparable between the groups. Conclusion Although this study demonstrated not particularly favorable secondary patency rates in the venae comitantes group, the venae comitantes may still be a viable option for patients with unsuitable superficial veins because there were no significant differences in the primary patency and complication rates between the 2 groups.

Fibrovascular polyps are rare benign intraluminal tumors that usually arise from the cervical esophagus. These often present as very large sized pedunculated polyps and cause symptoms including dysphagia and respiratory distress. Generally, large polyps are surgically excised, while endoscopic resection is limited to smaller polyps. Herein, we present a giant fibrovascular polyp of the esophagus treated successfully by endoscopic resection.
Deglutition Disorders ; Esophagus* ; Polyps*

BACKGROUND: Reoperation of cardiac surgery via median sternotomy can be associated with significant complications. Thoracotomy is expected to reduce the risk of reoperation and to enhance the surgical outcomes. We retrospectively analyzed two operative approaches (thoracotomy vs. sternotomy) in cardiac reoperation. MATERIALS AND METHODS: From September 2007 to December 2010, 35 patients who required reoperation of the mitral valvular disease following previous median sternotomy were included. Average age of patients was 45.8+/-15.4 years (range, 14 to 76 years) and male-to-female was 23:12. Interval period between primary operation and reoperation was 135.8+/-105.6 months (range, 3.3 to 384.9 months). RESULTS: Comparative analysis was done dividing the patient group into two groups that are thoracotomy group (22 patients) and sternotomy group (13 patients). Thoracotomy group was significantly lower in operative time (415.2+/-90.3 vs. 497.5+/-148.0, p<0.05), bleeding control time (108.0+/-29.5 vs. 146.4+/-66.8, p<0.05) and chest tube drainage (287.5+/-211.5 mL vs. 557.3+/-365.5 mL, p<0.05) compared to sternotomy group. CONCLUSION: The thoracotomy approach is superior to sternotomy in some variables, and it is considered as a valid alternative to repeat median sternotomy in patients who underwent a previous median sternotomy.
Chest Tubes ; Drainage ; Hemorrhage ; Humans ; Operative Time ; Reoperation ; Retrospective Studies ; Sternotomy ; Thoracic Surgery ; Thoracotomy