• Journal of Chest Surgery
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• v.31 no.2
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• pp.190-193
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• 1998

We experienced a case of primary sternal tuberculosis with destroyed midsternum and bony defect. An 22-year-old female was admitted to our hospital two times for severe sternal pain and spontaneous fracture without history of trauma. On hospital admission, chest X-ray and chest CT showed destruction of midsternum and soft tissue swelling. Fine needle aspiration cytology revealed tuberculous osteomyelitis with cold abscess. And the patient was treated with usual anti-tubeculosis medication for preoperative preparation. At operation, we confirmed midsternal destruction with cold abscess and multiple sinus tracts. After removal of diseased sternal segment and cold abscess, we performed sternal reconstruction with autologus iliac bone graft. The pathologic report was compatible with tuberculous osteomyelitis and caseous necrosis The postoperative course was smooth and uneventful, and she remains well without sternal instability two months later.

• Journal of Chest Surgery
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• v.31 no.1
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• pp.89-91
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• 1998

Tuberculosis infection is wide spread disease and makes troublesome complications in some cases. A 50 - year old male visited Andong Hospital with coughing and sputum, dyspnea on exertion, bulging left anterior chest wall mass. Chest X-ray showed right pleural effusion, both side streaky infiltraion, and pleural thickness in apex. Chest CT scan showed bone destruction of left clavicle head, manubrium and large abscess pocket in pectoralis muscle. In May 1996 he underwent en bloc resection of left upper anterior chest wall including pectoralis major and minor muscle, left clavicle head, manubrium and covering infected skin, then contralateral pectoralis major muscle flap and skin graft was done. Patient shows no evidence of recurrence during follow up.

• Journal of Chest Surgery
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• v.30 no.3
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• pp.348-348
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• 1997

A 48 year old man, has been suffering from a growing chondrosarcoma of sternum which has deeply invading the anterior mediastinum: He underwent wide resection of the chest wall tumor including a 4 cm free margin of normal tissue on all portions. The tumor as 15 × 16× 10cm in size arising from sternum and include both proximal one third of the clavicle and the 1 st, 2nd, and 3rd coital cartilages. The resected skeletal defect in the anterior wall was very large after wide resection of the'tumor and reconstructed due to paradoxical chest wall movement with sandwich like method of double over lapping Marlex mesh and methylmethacreylate, and steel wires. The soft tissue reconstructive procedure was dont with myocutaneous flap transposition use of pectoralis muscle. But the patient go infected with tuberculosis in the mediastinum two months after the operation. We had removed all of previously inserted prosthetics and performed curettage and drainage. Recently we experienced a case with giant chondrosarcoma of the sternum associated with tuberculous mediastinitis. The patient had an uneventful postoperative course and was discharged with adjuvant treatment such as antituberculous medication for 1 year.

• Journal of Chest Surgery
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• v.30 no.3
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• pp.248-252
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• 1997

A 48 year old man, has been suffering from a growing chondrosarcoma of sternum which has deeply invading the anterior mediastinum: He underwent wide resection of the chest wall tumor including a 4 cm free margin of normal tissue on all portions. The tumor as 15 $\times$ 16$\times$ 10cm in size arising from sternum and include both proximal one third of the clavicle and the 1 st, 2nd, and 3rd coital cartilages. The resected skeletal defect in the anterior wall was very large after wide resection of the'tumor and reconstructed due to paradoxical chest wall movement with sandwich like method of double over lapping Marlex mesh and methylmethacreylate, and steel wires. The soft tissue reconstructive procedure was dont with myocutaneous flap transposition use of pectoralis muscle. But the patient go infected with tuberculosis in the mediastinum two months after the operation. We had removed all of previously inserted prosthetics and performed curettage and drainage. Recently we experienced a case with giant chondrosarcoma of the sternum associated with tuberculous mediastinitis. The patient had an uneventful postoperative course and was discharged with adjuvant treatment such as antituberculous medication for 1 year.

• Journal of Chest Surgery
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• v.27 no.8
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• pp.708-709
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• 1994

Tuberculosis infection of sternum is extremely rare. The most common cause of sternal osteomyelitis is infection of a median sternotomy incision, employed for most cardiac operation. If a wound infection of this regeon becomes apparent, the wound should be opened wide to allow adequate drainage. Frequent irrigation and debridement are necessary to avoid extension of the infection into the bone. We have experienced a 16 years old female who has been operated upon due to ASD, was infected with tuberculosis in sternum. Our team have treated her for tuberculous osteomyelitis on sternum with curettage and drainage.

• Clinics in Shoulder and Elbow
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• v.13 no.1
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• pp.99-105
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• 2010

Purpose: Here we report clinical results for surgical treatment of 2 cases of pyogenic arthritis and 1 case of tubercular arthritis, which only rarely develops in the sternoclavicular joint. Materials and Methods: From September 2003 to September 2008, we did early marginal resection and thorough debridement of osteomyelitis of the sternum and distal clavicle in 3 patients and evaluated clinical results after short-term follow up. Results: All 3 patients were satisfied with their clinical results and none had any recurrences according to follow up X-rays and laboratory datas. The follow up MRI showed bone edema in the distal clavicle and proximal sternum and a little fluid retention around the sternoclavicular joint. Conclusion: Even though diagnosis of these diseases are made earlier, infection of the adjacent bone and osteomyelitis could already have developed. We did early marginal resection and thorough debridement of osteomyelitis of the sternum and distal clavicle and achieved satisfactory results.

• Journal of Chest Surgery
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• v.31 no.8
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• pp.792-798
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• 1998

Background: There are various tracheal diseseas which cause the obstruction of the trachea: postintubation tracheal stenosis, tracheal cancer, thyroid cancer, endotracheal tuberculosis, et al. Recently surgical resection and reconstruction of the trachea has been adopted as the safe method for tracheal lesions. Materials and methods: We report our experience and results of resection and reconstruction for various obstructive tracheal lesions in 38cases from 1985 to 1996. Length of resection of the trachea was up to 6 cm. Twenty lesions were approached by cervical collar incision, 12 lesions by cervicosternal incision and 4cases needed transthoracic approach. Surgical procedures consisted of resection and tracheotracheal anastomosis in 32 cases, resection and laryngotracheal anastomosis in 6cases and in addition laryngeal release was necessary to release anastomotic tension in 3cases. Results: The complications were 4 minor wound infections, 2 mild suture line granulomas, 1 vocal cord palsy, 2 pneumonias and 1 systemic candidiasis. Two patients who had poor consciousness and pnemonia and one who developed systemic candidiasis were expired after operation. Conclusion: We suggests resection and reconstruction of trachea is optimal procedure for up to 6cm long tracheal lesions. However, for the patients with poor consciousness or poor general conditions would be the conservative treatment preferred to the tracheal reconstruction because of high serious complications and mortalities.

• Journal of Chest Surgery
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• v.30 no.12
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• pp.1237-1241
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• 1997

Tracheal stenosis is a difficult disease entity to manage. Laser ablation is one effective treatment for treacheal stenosis and can be utilized if tracheal reconstructive surgery is impossible. Potassium titanyl phosphate laser, transmitted via flexible quartz fiber, can be precisely manipulated through flexible bronchoscope under local anesthesia. We treated 7 patients with trach al and broncheal lesion under local anesthesia with KTP laser from January 1995 to July 1996. The patients included three males and four females. The age of patients ranged from 22 to 66 years with a mean of 43.7 years The etiology of tracheal stenosis in patients was stenosis after tracheostomy(3 cases), prolong inturbation in cases of sepsis(1 cases), and the recurrence of lung cancer within endobronchial lesion(2 cases). In the cases of tracheal stenosis treated with laser ablation, there were 2 cases of recurrence of stenosis at the anastomosis site after the operation, 3 cases of stenosis at tracheostomy site, and 2 cases of local recurrence of lung cancer. The site of the tracheal stenosis was the balloon site of the tracheostomy tube(3-4cm inferior to the tracheostomy site, 2-3cm superior to the carina) and the anastomosis site that were narrowed to less than 5mm(4 cases). For the stenosis lesion in the endobronchial area, there were 2 patients with a lesion at the anterior wa l, 1 patient with a lesion at the posterior wall, 2 patients with circumferential stenosis. Laser ablation time was 25.4 $\pm$5.9min and used energy was 1768 $\pm$365J. We have used KTP laser via (lexible bronchoscope without major complications. Adjuvant radiation therapy may prevent fibroblast proliferation which leads to restenosis. In three patients of restenosis after laser ablation, adjuvant irradiation started within 4 hours after laser ablation, and the radiation doses were 1500cGy given in five fraction. In patients with adjuvant radiation therapy, stenosis has not recurred

• Tuberculosis and Respiratory Diseases
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• v.66 no.4
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• pp.288-294
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• 2009

Background: A lung hyperinflation, or air trapping, caused by expiratory flow-limitation contributes to dyspnea in patients with chronic obstructive pulmonary disease (COPD). Forced expiratory volume in 1 second ($FEV_1$) has served as an important diagnostic measurement of COPD, but does not correlate with patient-centered outcomes such as dyspnea. Therefore, this study was performed to investigate the role of radiologic quantity in evaluating the dyspnea in patients with COPD by measuring lung hyperinflation in chest x-ray and high resolution chest tomography (HRCT). Methods: Fifty patients with COPD were enrolled in this study. Their subjective dyspnea score (modified Borg scale dyspnea index), spirometry, and lung volume were measured. Simultaneous hyperinflations of chest x-ray score ("chest score") and degree of emphysema of HRCT ("HRCT score") were measured. The "chest score" were composed of lung length, retrosternal space width, and height of the arc of the diaphragm and "HRCT score" were composed of severity and extent of emphysema. Results: The mean age of patients was 69 years old and their mean $FEV_1$ was 51.7%. The Borg score significantly correlated with parameters of spirometry and lung volume, including FVC, $FEV_1$, $FEV_1$/FVC, RV, RV/TLC, and DLCO. The Borg score correlated well with "HRCT score", but did not correlate with "chest score". Also, the Borg scale correlates inversely with body mass index. Conclusion: The quantity of emphysema on chest HRCT may serve as an objective marker of dyspnea in patients with COPD.

• Journal of Chest Surgery
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• v.30 no.12
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• pp.1225-1231
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• 1997

Spontaneous pneumothorax is the sudden collapse of a lung usually caused by air leakage from a subvisceral pleural blob. Responses to closed thoracostomy,thoracentesls and simple observation are usually prompt and effective. But in some cases, these are unsucceful and open thoracotomy is indicated. A clinical evaluation was performed on 242 cases(236 patients) of open thoracotomy in spontaneous pneumoth rax who were admitted and treated at department of Thoracic and Cardiovascular Surgery. Masan Samsung General Hospital during the past 9 years from January 1988 to December 1996. The results were as follows 1. The sex ratio was male predominance(M:F=11.7:1) 2. The most common age group were 2nd, 3rd decades(2nd=29.3%, 3rd=30.2%). 3. The most common chief complaints were chest pain and dyspnea(chest pain=41.7%. dryspnea= 36.8). 4. The etiologic factors of spontaneous pneumothorax were primary spontaneous pneumothorax(86.4%), tuberculosis(9.1%), COPD(3.7%) and pleuritis(0.8%). 5. The site of spontaneous pneumothorax was 52.1% in right, 45.4% in left and 2.5% in both. 6. The common indications of open thoracotomy were recurrence(44.2%), persistent air leakage(31.8%) and inadequate expansion(15.7%). 7. The operative procedures were bullectomy or mechanical pleurodesis through posterolateral thoracotomy or median sternotomy. 8. The most frequent location of bulla or blob were apical segme t oi RUL(35.1%) and apicoposterior segment of LUL(41.3 %). 9. The number of bulla or blob were mainly 1 to 5(88%), and there were no significant differences among operation indications. 10. The size of bulla or bleb were mainly below 5cm(81%)and small bulla($\leq$1cm) were predominant in recurrence group but large bulla(>5cm)were predominant in persistent air leakage and inadequate expansion group. 11. The pleural adhesion was seen in 54.5%.(Recurrence group 64.1%,Persistent air leakage group 51.9%,Inadequate expansion group 47.4%).