• Journal of Chest Surgery
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• v.36 no.2
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• pp.86-90
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• 2003

Bulla is an air-filled space within the lung parenchyma resulting from deterioration of the alveolar tissue. Molecular mechanism of the formation of the bulla is not well described. Fibroblast growth factor(FGF)-7, bone morphogenetic protein(BMP) receptor, and transforming growth factor(TGF)-$\beta$ receptor are known to have a stimulatory or inhibitory role in the lung formation. We investigated to see if these growth factor or cytokine receptors are involved in the bulla formation by immunohistochemical staining of bullous lung tissues from patients with primary spontaneous pneumothorax. Material and Method: Bullous lung tissues were obtained from 31 patients with primary spontaneous pneumothorax, including 30 males and 1 female from 15 to 39 years old. The bullous tissues were obtained by video-thoracoscopic surgery and/or mini-thoracotomy and fixed in formalin. Blocks of the specimens were embedded with paraffin and cut into 5-6 ${\mu}{\textrm}{m}$ thick slices. The sections were deparaffinized and hydrated and then incubated with primary antibodies against FGF-7, BMP-RII, or TGF-RII. Result: Of the 31 patients, 24 were TGF-RII positive including 18 strong and 6 weak positives. Observation with high magnification showed that strong immunostaining was detected in the boundary region between bullous and normal lung tissues. In contrast, all of the sections were negative with FGF-7 or BMP-RII antibodies. Conclusion: These results suggest that overexpression of TGF- P RII may be involved in the formation of bulla, although further molecular studies are needed to find out more detailed molecular mechanisms.

• Journal of Chest Surgery
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• v.40 no.3 s.272
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• pp.215-219
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• 2007

Background: Due to the advancement of video assisted thoracoscopic techniques, an operation for primary spontaneous pneumothorax is now considered a common procedure. However, whether a preventive operation is necessary when a contralateral bulla is found on High Resolution Computed Tomography (HRCT) at the time of the first primary spontaneous pneumothorax attack is still unknown. In this retrospective study, it was our intension to find whether contralateral bullae are related to the occurrence of pneumothorax. Material and Method: Between January 1999 and April 2006, 550 patients were admitted to the Chungnam University hospital with primary spontaneous pneumothorax, which was confirmed by the HRCT scans in 190 patents. In these 190 patients, 159 had not received a bilateral operation after their first primary spontaneous pneumothorax attack. In these 159 patients, the relationship between the presence of contralateral bullae and the occurrence of pneumothorax was measured. Result: In these 159 patients, 67 had contralateral bullae confirmed inform the HRCT scan, and 92 had no visible contralateral bullae, During the follow up period, 6 patients (8.9%) with contralateral bullae had an occurrence of contralateral pneumothorax, and 5 patients (5.4%) without contralateral bullae had an occurrence of contralateral pneumothorax. (p=0.529 [Fisher's exact test]) Conclusion: In patients with unilateral primary pneumothorax, an HRCT scan is a useful way of confirming contralateral pulmonary bullae. However, the presence of bullae is not a significant predictive sign of an occurrence of contralateral pneumothorax. Also, surgery for pneumothorax is not completely uncomplicated, and bilateral surgery is still doubtful. A further prospective study will be required to find the relationship between the bullae found on HRCT and the occurrence of pneumothorax.

• Tuberculosis and Respiratory Diseases
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• v.57 no.2
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• pp.183-187
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• 2004

Bronchiolitis obliterans (BO) is a nonspecific inflammatory injury affecting primarily the small airways. Its inflammatory process is characterized by fibrotic obliteration of the lumen of bronchioles. BO can be idiopathic or associated with connective tissue disease, inhaled toxins, infections, drugs, and chronic graft-versus-host-disease (GVHD). Pulmonary complications occur in 40~60% of patients who undergo allogeneic bone marrow transplantation (BMT), causing 10~40% of transplant-related deaths. BO is a characteristic pulmonary complication which occurs usually within a few years after BMT. Documented complications of BO include air-leak syndromes such as pneumomediastinum, subcutaneous emphysema and pneumothorax. We report a case of a 30-year-old male patient with BO due to chronic GVHD after allogenic BMT who presented with recurrent bilateral pneumothoraces.

• Journal of Chest Surgery
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• v.32 no.1
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• pp.43-48
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• 1999

Background: Although treatment of spontaneous pneumothorax by video-assisted thoracic surgery(VATS) has generally shown better clinical results than conventional thoracotomy, treatment of spontaneous pneumothorax by midaxillary thoracotomy(MAXT) has also shown good clinical results. The author studied to compare the clinical results of MAXT group I and VATS group II. Material and Method : Group I included 30 midaxillary thoracotomy among 83 operative cases of spontaneous pneumothorax from Jan. 1992 to Dec. 1993. Group II included 30 VATS among 101 operative cases of pneumothorax from Jan. 1994 to Aug. 1995. The author selected the 30 patients, age 18 to 25 years, with recurrent spontaneous pneumothorax in each group. The author analyzed the operative indication, gender, operating time, amounts of the used staplers, tube drainage, total amounts of analgesics used during postoperative 24hr, tube stay time, postoperative complications and mortality. Result: The follow-up periods of both procedures were from 6 to 43 months. The operating time from start of skin incision to end of skin closure was 84.79${\pm}$21.70(from 40 to 150) minutes in MAXT group I and 108.8${\pm}$42.02(from 58 to 120) minutes in VATS group II(P<0.001). The numbers of the used staples useo was 1.31${\pm}$0.6(from 0 to 3) in group I and 3.41${\pm}$2.37(from 0 to 11) in group II. The amounts of postoperative 24hour tube drainage were 220.76${\pm}$106.73(from 65 to 400) ml in group I and 260.63${\pm}$233.18(from 70 to 320) in group II(P>0.05). The amounts of postoperative 24 hourly used analgesics(Tarasyn ) was 1.38${\pm}$1.32(from 0 to 5) amples in group I and 0.72${\pm}$1.02(from 0 to 4) amples in group II (P<0.05). The postoperative tube stay is 5.45${\pm}$30.9 (from 3 to 7) days in group I and 4.75${\pm}$3.1(9 from 2 to 14) days in group II(P>0.05). The number of complications after operations was 2 cases of prolonged air leakage in group I, and in group II. (P is not significant). The number of recurrence after the operation was one in group I and also one in group II(P is not significant). In conclusion, there were no statistical differences in the postoperative 24 hour chest tube drainage, days of postoperative tube stay, postoperative complications and recurrence in the analysis between group I and group II. Conclusion: The author found that group II of VATS between 18 years and 25 years of age in recurrent spontaneous pneumothorax, statistically, requires longer operative time, more number of autosuture staples and less postoperative analgesic dosage than the midaxillary thoracotomy group I.

• Journal of Chest Surgery
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• v.29 no.10
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• pp.1133-1137
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• 1996

From September 1994 to October 1995, we are reporting clinical results of 67 patients whom underwent video-assisted trio rabic surgery(VATS). 1. They were diagnosed as spontaneous pneumothorax In )5, diffuse interstitial lung disease in 9, empyema in 7, hemothorax in 5, malignant pleural effusion in 3, hyperhidrosis in 3, foreign body in chest cavity in 2, mesothelioma in 1, miliary tuberculosis in 1 and organizing pneumonia in 12. In pneumothorax, bullectomy in 33 and open bellectoiny in 2 due to pleural adhesion was done Hemostasis in 5, irrigation in 7, foreign body removal in 2, talcum powder insufrlation in 3, sympathectomy 3 as done. Thoracoscopic biopsy watt done In 12 3. For pneumothorax, operation was indicated as recurrent pneumothorax in 18, persistent air leak in 12, visible bullae In chest X-ray in 5. 4 Thoracoscopic biopsy was done in 12. They were interstitial pulmonary fibrosis in 9, miliary tuberculosis in 1, mesothelioma in 1, and organizing pneumonia in 1 .Among interstitial pulmonary fibrosis, usual interstitial pneumonia were 2 and diffuse interstitial pneumonia were 7. 5. Wo complication was found in 6) patients among 67 patients. The complication was found in 4 patients (2 persistent air leak, 2 contralateral lung atelectasis). We concluded that VATS was safe and beneficial in reducing postoperative complication and the role of thoracic surgery will increase markefdly.

• Tuberculosis and Respiratory Diseases
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• v.41 no.2
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• pp.152-157
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• 1994

Histiocytosis-X is a tenn used to define three diseases with similar morphologic characteristics : Letterer-Siwe diseae, Hand-Schuller-Christian disease and Eosinophilic granuloma. In general, they differ in terms of their age of onset, severity of clinical course and site of involvement. Eosinophilic granuloma typically is seen in young adults. Eosinophilic granuloma is diagnosed in the presense of diffuse pulmonary infiltrate, bony involvement. However, the pulmonary radiologic findings of eosinophilic granuloma are variable accordinary to stage of disease. therefore pathologic diagnosis of involving site is essential for confirmative diagnosis of eosinophilic grananuloma. Pathologically. the three disease are characterized by granulomatous infiltration of alveolar septa and bronchial walls and often involvement of bone. The hallmark of this disease is proliferation of the Langerhans' cell. The identifying feature is the X-body or Birbeck granule that is present in Langerhans' cells and histiocytic cells found in the lung of EG patient. We report a case of bilatera1, recurrent and spontaneous pneumothoraces in a 21 year old man with pulmonary histiocytosis-X, which is confirmed by eosinophilc granuloma in bone marrow biopsy and ultrastructural examination in cells obtained from BAL.

• Journal of Veterinary Clinics
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• v.25 no.1
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• pp.31-36
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• 2008

One year old, male beagle dog was presented with acute onset of severe dyspnea, cyanosis, and anorexia. He had no trauma history. Five days earlier, the dog had been diagnosed as bacterial pneumonia caused by Pseudomonas aeruginora and E. coli. He exhibited a restrictive respiratory pattern and at admission, immediately oxygen supplementation given. On a ventrodorsal(VD) radiographic view, right lung was collapsed and contrasted with the air-filled pleural space. The mediastinum, heart, and great vessels were shifted to the left. On a right-lateral radioraphic view, the heart appeared to be elevated from the sternum. The dog was diagnosed as secondary spontaneous pneumothorax resulting from bacterial pneumonia. The chest tubes were placed on the right and left pleural cavity under general anesthesia. At 3 days after treatment, on a VD radiograph, air of right pleural cavity disappeared while left pleural cavity showed radiolucent area filled with air, and the heart was shift to the right. Therefore, the left tube thoracostomy was performed too. The right chest tube was maintained for 5 days and the left chest tube was maintained for 45 days. During the period, antibiotics and vitamin I were used for managing of bacterial pneumothorax and preventing of retroinfection through the tubes. As the result, bacterial pneumonia was well managed by medicines and secondary SP was completely treated that air in bilateral pleural cavity disappeared on radiographs. During the follow-up for 2 years, patient showed normal condition without recurrence.

• Journal of Chest Surgery
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• v.28 no.2
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• pp.166-169
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• 1995

Pneumothorax, a frequently encountered disease in the clinic, has been interesting to surgeons for it`s high recurrence rate. 52 patients with a second attack of pneumothorax at our hospital in a 24 month period were evaluated especially for the risk factors of recurrence. The results were as follows:1. Patients after operative treatment[21 cases There were no postoperative complications and recurrence.2. Patients with tube drainage or conservative treatment [31 cases [i Overall recurrence rate was 45.2 %. [ii Suggestive risk factors for the recurrence were: age above 30 years, short period of thoracostomy less than six days. And other factors such as male, right lung, higher level of lung collapse were thought to be followed further more.

• Journal of Chest Surgery
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• v.29 no.8
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• pp.910-915
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• 1996

The bullectomy through transaxillary minithoracotomy and video assisted thoracic surgery(VATS) have been widely used in treatment of spontaneous pneumothorax. The study comprised a retrospective review of 1 13 consecutive cases of whom underwent bullectomy through transaxillary minithoracotomy at Shinchon Severance Hospital(group T) and 129 consecutive cases of whom underwent thoracoscopical bullectomy at Youngdong Severance(group V) between January 1992 to Jun 1994. This study compare the clinical and economic resuts of group T and group V There were no significant differences for operation time, indwelling periods of chest tube, hospital stay, complication rate and rate of recurrence in the two groups. The times of parenteral analgesics use and treatment cost were significant less in group T.

• Journal of Chest Surgery
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• v.36 no.2
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• pp.109-112
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• 2003

Stromal tumors of the gastrointestinal tract, especially of the esophagus, are rare. We had a case of malignant gastrointestinal stromal tumor(GIST) of the esophagus. A 46 years old woman was admitted for abnormal mass shadow in the chest radiograph. The mass was originated from the lower thoracic esophagus, and compressed the right lower pulmonary vein and the inferior vena cava. We removed the tumor externally without injuring of the esophageal mucosa via right posterolateral thoracotomy. The tumor was positive for CD 34 and CD 117, and diagnosed malignant CIST of the esophagus.