• Tuberculosis and Respiratory Diseases
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• v.64 no.2
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• pp.133-137
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• 2008

Pulmonary paragonimiasis continues to be a diagnostically challenging parasitic disease, despite a drastically decreased prevalence in South Korea during the past decade. Pulmonary paragonimiasis is characterized by fever, chest pain, and chronic cough with hemoptysis. Numerous radiographic and computed tomographic findings including the presence of pneumothorax, pleural effusion, and parenchymal lesions such as nodular or infiltrative opacities have been reported. The clinical and radiological manifestations of paragonimiasis can resemble those of lung cancer, tuberculosis or a metastatic malignancy. Furthermore, this disease can mimic lung cancer as seen on $^{18}F$-fluorodeoxyglucose positron emission tomography (FDG-PET). We report a case of pulmonary paragonimiasis in a 48-year old man that presented with a solitary pulmonary nodule and was suspected as a lung cancer based on FDG-PET imaging.

• Pediatric Infection and Vaccine
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• v.19 no.3
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• pp.162-167
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• 2012

Respiratory syncytial virus (RSV) is the major cause of lower respiratory tract infection in infants. Life-threatening RSV infection is often reported in young children and immunocompromised hosts. Since there is no report on ribavirin therapy for RSV pneumonia in pediatric cancer patients in Korea, we report one case of RSV pneumonia that developed in an infant with acute lymphoblastic leukemia (ALL). Despite administration of oral ribavirin and intravenous immunoglobulin, the patient's respiratory distress worsened and admission to an intensive care unit was necessary. Chest x-ray showed multifocal consolidation, pneumothorax, and pneumomediastinum. Treatment with aerosolized ribavirin led to significant clinical improvement. The role of aerosolized ribavirin is still controversial, but it might have a therapeutic potential for severe RSV pneumonia in children with leukemia.

• Journal of Chest Surgery
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• v.24 no.5
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• pp.451-458
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• 1991

We have observed 101 cases of recurrent spontaneous pneumothorax from Sep. 1979 to Dec. 1989 at the Department of Thoracic & Cardiovascular Surgery, College of Medicine, Inje University, Pusan Paik Hospital and the result obtained as follows. 1] Age range of patients was the first decade to seventh decade. Males outnumbered females by 6.7: l. One or two episodes of recurrent attack were noted in majority cases. 2] In distribution of the lesion sites, right side was 55 cases[55.4%], left 42 cases[41.9%], and bilateral 4 cases[3.0%]. 3] In clinical manifestations, abrupt onset of dyspnea was 78 cases[77.2%], chest pain 48 cases[47.5%], cough 9 cases[8.9%] and chest discomfort 8 cases[7.9%]. 4] Of 101 cases, 48 cases were associated with pulmonary tuberculosis and other cases were associated with subpleural bullae and blebs[26 cases], emphysema[7 cases], bronchiectasis[2 cases], lung cancer[1 case], and silicosis[1 case], 5] In 88 cases[87.2%] of patients, the magnitude of collapse was above 50% in plain chest film. 6] The interval of recurrence after last attack was frequently within 1 year. 7] In the management, closed thoracostomy with underwater-sealed drainage was applied in first recurrent 53 cases but 2nd recurrence was developed in 16 cases. In 52 cases, surgical management was applied. The pleurodesis with chemical agent[tetracycline] via chest tube was applied in 2 cases. Among 51 cases subjected to the open thoracotomy, pleural abrasion was performed in 3 cases, excision of bullae & blebs in 12 cases, wedge resection in 28 cases, lobectomy in 6 cases and wedge resection combined with lobectomy in 2 cases. In one case subjected to the median sternotomy, wedge resection on both lung apex was performed. 8] Postoperative complications were developed in 8 cases but not serious.

• Journal of Chest Surgery
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• v.24 no.6
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• pp.570-578
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• 1991

The spontaneous pneumothorax is the sudden collapse of the lung usually by air leakage from the ruptured sub-pleural bleb and has high recurrence rate. For prevention against recurrence, many drugs such as tetracycline, talcum powder, quinacrine, etc. have been used but the effects are not satisfactory. We reduced the recurrence rate successfully by the fibrin glue instillation through the chest tube. From the January 1989 to September 1990, we have managed 65 patients of spontaneous pneumothorax with closed thoracostomy and fibrin glue[fibrinogen 1gm/50ml with approtinin 3, 000kIU /ml, thrombin 5, 000IU /ml in 3% each 10ml] instillation through the chest tube. And we compared the results with those of 106 patients of spontaneous pneumothorax who were managed only by the closed thoracostomy from January 1985 to December 1988. Only the patients who visited our hospital with recurrence were considered as the recurred cases but the others were considered as not recurred. And the removal of chest tubes usually done 3 days after cessation of air leakage or 2 days after fibrin glue instillation Statistical analysis was done by X2-test. The results were as followings: 1. The recurrence rate of fibrin glue instillation group was lower than that of non-instillation group[1st attack: 15.1% versus 27.6% p<0, 05, the 2nd attack: 33.3% versus 73.7% p<0.01, the total 18.5% versus 35.8% p<0.01]. 2. The mean duration of chest tube drainage in the fibrin glue instillation group was shorter than non-instillation group[4.24$\pm$1.36 days versus 4.48$\pm$1.73 days p<0.05]. 3. The mean duration of hospitalization was shorter in the instillation group [8.12$\pm$3.5 days versus 10.8$\pm$3.8 days p<0.05] The complications were transient mild fever, chest pain, pleural effusion in 46 cases of 65 patients, but those didn`t make any problem. We concluded that the fibrin glue is effective in the reduction of recurrence rate, obliteration of air leakage and duration of hospitalization.

• Journal of Chest Surgery
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• v.9 no.1
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• pp.98-101
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• 1976

Clinical observations were made on a total 104 cases of spontaneous pneumothorax during the period of 5 years from MAR. 1971 to MAR. 1976 at the Dept. of Chest Surgery, Korea University Medical College. The ratio of male to female cases was 7.4 : 1 in male predominance, and age distribution was 73% of the total cases within the 15-40 age range. There were 56 patients (53.8%) of right sided pneumothorax and 44 patients (42.3%) of left sided pneumothorax, 8 patients presented bilateral spontaneous pneumothorax. The etiologic factors were tuberculous origin in 42.3%, rupture of bullae or blebs in 15.4%, acute pulmonary infection in 3.8%, pulmonary paragonimiasis in 2.9%, cysticercosis 1%, Marfan's syndrome in 1.9%, unknown causes in 32.7%. In all 104 cases, closed chest tube thoracostomy were performed for reexpansion of collapsed lung. In 50 cases of 104 cases, intrapleural instillation of Quinacrine HCl (Atabrine, Winthrop Laboratories, New York, N.Y.) thru the chest tube was used to control of recurrent pneumothorax, and compared observation with 54 cases control group of closed chest tube thoracostomy only. In both groups, 1) cure rates were 63% in control group and 88% in Atabrine group. 2) average duration of inserted chest tube were 5.6 days in control group and 5.7 days in Atabrine group.

• Journal of Chest Surgery
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• v.37 no.9
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• pp.800-804
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• 2004

A 67-year-old male with a 6-year history of emphysema was admitted with severe dyspnea. On chest computed tomographic scan, a newly developed large bulla was detected in right lower hemithorax. This bulla was sucessfully managed by intracavitary drainage ［modified Monaldi procedure］ with symptomatic improvement. We report this case with review of the literature.

• Journal of Chest Surgery
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• v.20 no.1
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• pp.39-47
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• 1987

The records of 268 patients, who were diagnosed as spontaneous pneumothorax during the period 1975 to 1984, treated at the department of thoracic and cardiovascular surgery, Hanyang University Hospital, were reviewed retrospectively to evaluate the effect of surgical intervention on each indications. Of these,.61 patients [22.8%] were taken operation to treat the pneumothorax after closed thoracostomy. We have classified the 61 patients to evaluate the therapeutic effect on each indications. And the therapeutic effect is based on the chest tube indwelling days. The results were as follows: 1. The chest tube indwelling days of the group who were taken closed thoracostomy only was average 14.13*9.17 days [range 5-66 days], and that of the group who were finally taken the thoracotomy after closed thoracostomy was 21.85*12.30 days [range 5-55 days]. 2. The indications of thoractomy were thoracoscopic findings, recurrence and continuous air leakage. 3. The chest tube indwelling day of the group who was taken thoracotomy by thoracoscopic findings was average 11.67*6.51 day, that was relatively short compared to those of the other groups. 4. The continuous air leakage group after closed thoracostomy was subdivided into three subgroups, continuous air leakage in 1st attack, thoracoscopic findings in 1st attack, and recurrence. 5. Of these, the chest tube indwelling day of the subgroup, who was taken operation by thoracoscopic findings, was 21.33e8.26, that was relatively short compared with those of the other subgroups. We use the thoracoscope as excellent diagnostic tool to detect the operation indication in the spontaneous pneumothorax patients. And we gain the benefits to shorten the chest tube indwelling days and admission days, and also to protect the recurrence.

• Quality Improvement in Health Care
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• v.9 no.1
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• pp.34-51
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• 2002

Background : The purpose for this study is to develop a critical pathway of bullectomy for spontaneous pneumothorax patients. Methods : For this study a conceptual framework of critical pathway was developed through a review of the literature including five critical pathways which are currently being used in USA, and opinions of the critical pathway development team members at Y university hospital. In order to identify the service contents required by these patients and to draw up a preliminary critical pathway, 33 cases of medical records of patients who had received bullectomy for spontaneous pneumothorax between September, 2000 to August, 2001 at the Respiratory Center of Y university hospital in Seoul was analyzed. Results : In order to test the clinical validity of the preliminary critical pathway, it was applied to ten patients who had received bullectomy for spontaneous pneumothorax from October, 2001 to December, 2001. The average discharge day was 4.89th post operation day, six patients discharged on the fourth post operation day which was the expected day, one patients discharged one day earlier than the expected day, one patient discharged three days later than the expected day, and one patient discharged six days later than the expected day. There were variances between the critical pathway and the actual practice. The variances came from tests, medications, and treatments. One item that showed variance in clinical applications was complemented, and three items were decided not to be corrected for the final determination of the critical pathway. Conclusion : This critical pathway is applicable to the care of patients with bullectomy for spontaneous pneumothorax, but it needs more clinical applications to grasp varied variances.

• Journal of Chest Surgery
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• v.29 no.10
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• pp.1148-1151
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• 1996

For the purpose of clinical analysis In mediastinal tumors, 51 patients with mediastinal tumor who were surgically treated from February 1984 to February 1994 in Chunan hospital of Soonchunhyang university were reviewed. There were 21 male and 30 female patients in the study. Age ranges from 11 months to 75 years, with the mean 39.4$\pm$ 18.8 years. Symptoms and signs were asymptom(21.6%), chest d scomfort(19.6%), dyspnea(15.7%), ptosls(15.7%), general weakness(13.7%) and chest pain(9.8%). The most frequent tumor location was anterosuperior mediastinum(60.8%) followed by posterior(25.5%) and middle(13.7%) mediastinum. In the pathological viewpoint, thymoma(33.3%) was the most frequent type followed by neurogenic tumor(25.5%) an'd germ cell tumor(19.6%). All of benign tumors(46 cases) were completely removed and malignant tumors(5 cases) were treated with rAdiotherapy after operation. The postoperative complications were 2 wound dehesences, 1 pneumothorax, 1 vocal cord palsy and 1 prolonged mechanical ventilation.

• Tuberculosis and Respiratory Diseases
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• v.50 no.6
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• pp.740-746
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• 2001

Background : A 35-year-old woman was admitted to the emergency room with sudden dyspnea that developed one day prior. The initial Chest X-ray showed multiple bullous changes at the right middle and lower lung field and long standing fibrotic tuberculous changes at the right upper lung field. The left lung field was totally collapsed by an fibrotic old tuberculous lesion. In spite of supportive medical care with oxygen therapy after admission, the radiographic lesions were no significant change but the respiratory distress had worsened. The patient suffered respiratory failure and received mechanical ventilatory support. The HRCT showed a localized tension pneumothorax mimicking multiple giant bullae at the right lower lung field. Immediately after a closed thoracostomy with a 32 French chest tube and air drainage, her vital signs and dyspnea were gradually improved. The patient was successfully weaned from mechanical ventilation after 5 days of mechanical ventilatory support. The patient had received talc pleurodesis through a chest tube to prevent the recurrence of the life-threatening localized pneumothorax. The patient was discharged without recurrence of the pneumothorax.