• Journal of Chest Surgery
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• v.37 no.12
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• pp.983-986
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• 2004

Background: The indications of closed thoracostomy drainage in management of primary spontaneous pneumothorax is well known, but there is no special specification for the size to be inserted. Recently, various minimally invasive operational techniques have been introduced and researched. According to the trend, we tried to ascertain the efficacy of 12 Fr. chest tubes instead of the existing 24 Fr. chest tubes. Material and Method: Patients who were younger than 30 years old and diagnosed as primary spontaneous pneumothorax and treated with closed thoracostomy drainage were enrolled in this study. We retrospectively compared group A who were drained with 24 Fr. chest tubes from January to May 2003 with group B with 12 Fr. chest tubes from November 2003 to April 2004 on procedure time for closed thoracostomy drainage, duration of chest tube drain, duration of hospital stay, complication, and recurrence. Result: The male to female ratio was 16 : 3 in group A and 18 : 2 in group B. The mean age of patients of group A was 21.7$\pm$4.0 and group B was 20.0$\pm$3.7. The mean procedure time for closed thoracostomy drainage in group A (21.6$\pm$2.9 minutes) was significantly longer than group B (10.8$\pm$1.9 minutes)(p < 0.05). The mean duration of chest tube drain was 3.8$\pm$ 1.7 days in group A and 4.3$\pm$2.2 in group B, and the mean duration of hospital stay was 5.6$\pm$1.9 days in group A and 5.2$\pm$1.5 days in group B. There was no complication in both groups and 6 cases in group A (35%) and 5 cases in group B (25%) were operated because of recurrence and persistent air leakage. In conclusion, there was no statistical difference except for the procedure time for closed thoracostomy drainage between two groups. Conclusion: We concluded that there were no significant differences in efficacy between 12 Fr. chest tube and 24 Fr. chest tube in closed thoracostomy drainage for primary spontaneous pneumothorax and we found advantages of 12 Fr. chest tube in shortening procedure time because of easy and simple techniques.

• Journal of Chest Surgery
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• v.37 no.5
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• pp.456-459
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• 2004

A 16 month old male infant was found with slip down state in a bath room without evidence of trauma to whole body. The infant was treated with several thoracentesis and closed drainage due to persistent right pleural effusion at other hospital and transferred to our hospital for further evaluation and treatment at July 2003. The pleural effusion was confirmed as chylothorax by chemical analysis. He was treated with parenteral feeding for 21 days. Because the amount of chest tube drainage was about 110∼210 cc/day, and could not be decreased with conservative treatment. patients underwent ligation of thoracic duct. Post-operative course was uneventful except post-op. empyema thoracis, The open drainage tube was removed at post operative 30 days, The patient was in very good condition with complete cure until post-operative 3 months.

• Clinical and Experimental Pediatrics
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• v.50 no.7
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• pp.660-664
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• 2007

Purpose : Pleural effusion is a common complications of pediatric bacterial pneumonia. Intrapleural administration of fibrinolytic agents such as urokinase have been used in the management of complicated parapneumonic effusions. But the safety and effectiveness of intrapleural urokinase instillations in children has not been confirmed. The aim of this study is to evaluate the safety and effectiveness of intraperitoneal urokinase in children. Methods : We reviewed a total of 29 children diagnosed as parapneumonic effusion with septation by chest CT or chest ultrasonography. We divided them into two groups. Fourteen children treated with urokinase after thoracostomy (Group A) were compared with 15 children treated only with thoracostomy (Group B). The urokinase, 3,000 IU/kg/day, was injected into the pleural cavity twice a day. Results : There was no statistical difference in sex and age between the two groups. Total drainage volume during thoracostomy in group A and B was 375.5 mL and 350.0 mL, respectively. It was not statistically significant. But the amounts of pleural fluid of group A on day 1, day 2 and day 3 were 102.5 mL, 100.0 mL, and 70.0 mL respectively and those of group B on day 1, day 2 and say 3 were 120.0 mL, 50.0 mL and 15.0 mL respectively. To compare group A with group B in the amounts of drainage volume on day 1 was not statistically significant, but the amounts of drainage volumes on day 2 and day 3 in group A were statistically more significant than group B (Day 1 P=0.371, Day 2 P=0.049, Day 3 P=0.048, respectively). The duration of fever, antibiotics, thoracostomy and total hospital days. Were not statistically significant between the two groups. But the frequency of complications in Group A was statictically significantly lower than in group B. Conclusion : Intrapleural instillation of urokinase facilitates the drainage of loculated pleural effusions, especially during the first 3 days, and it could reduce complications, such as pleural thickening, surgical managements, re-positioning of tube and re-thoracostomy. So intrapleural urokinase injection was and effective and safe treatment of pleural effusion in children (P=0.014).

• Journal of Chest Surgery
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• v.39 no.10 s.267
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• pp.770-774
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• 2006

Background: Continuous air leakage through chest tube after lung surgery may increase pt's hospital stay and lead to many complications including empyema etc. Chemical pleurodesis has frequently been used for prevention of air leakage. Therefore, we performed chemical pleurodesis using diluted fibrin glue in patients with continuous air leak-age and observed the effects and efficiency of treatment. Material and Method: From September, 2001 to August, 2005, 16 patients whose continuous air leakage lasted more than 7 days underwent chemical pleurodesis with diluted fibrin glue. The effects of treatment, complications and recurrences were reviewed. Dissolved fibrinogen 1.0 g and aprotinin 500,000 KIU were mixed in a 50 cc syringe (Mixed solution A). And dissolved thrombin 5,000 IU and Calcium chloride 600 mg were mixed in a 50 cc syringe (Mixed solution B). Cefazolin 1.0 g was mixed in a 50 cc syringe (Mixed solution C). Rubber tube was inserted between the chest tube and the collecting bottle. An inserted rubber tube was positioned 60cm above the patient and forming a loop appearance was done. Mixed solutions A, B and C were injected into the highest rubber tube. Results: Continuous air leakages disappeared in all f6 patients at next day. Chest tubes were removed after 3 days in all patients. Complications were chest pain in 12 patients (75%), leukocytosis in 14 patients (88%), fever and chill in 14 patients (88%). All complications were transient and disappeared without specific treatment. Conclusion: Our findings demonstrated that diluted fibrin glue chemical pleurodesis was effective in patients with continuous air leakage lasting more than 7 days. Diluted fibrin glue chemical pleurodesis had good results with acceptable complications. long term follow-up is necessary to evaluate the accurate effects of treatment and recurrence in a large number of patients.

• Journal of Chest Surgery
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• v.30 no.11
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• pp.1128-1131
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• 1997

Injuries to versa cave continue to be associated with a high mortality. Essentials to successful treatment are immediate recognition of the injury and prompt control of the hemorrhage. We have experienced one case of inferior versa java perforation by a chest rainage tube in the patient with post-operative chronic empyema thoracic. The patient was 38-year old male who was taken RLL lobectomy after 6 cycle of chemotherapy due to small cell carcinoma in the RLL & suffered from post-operative chronic empyema thoracis at D hospital. He moved to our hospital for further evaluation with accidental removal of chest drainge tube. We inserted closed drainage tube and dark blood gushed out abruptly just after insertion of the drainage tube. CTscan, MRI, and angiogram were performed and showed the perforation of IVC just below RA. The IVC was repaired using simple interrupted 4-0 Prolene suture through right posterolateral thoracotomy. The patient recovered without event and doing well until now.

• Journal of Chest Surgery
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• v.43 no.6
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• pp.816-819
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• 2010

We report one case of Horner's syndrome, a rare complication of closed thoracostomy. A 17 year-old girl with a second attack of left side primary spontaneous pneumothorax visited an emergency room. After closed tube thoracostomy, she was admitted to a general ward for elective video-assisted thoracosopic bullectomy, which was delayed due to incidental right side acute otitis media. On the third day of admission, she presented with pain and discomfort in the left eye. Further examination revealed left side ptosis and miosis and led to a diagnosis of Homer's syndrome. The chest tube was pulled back 2 to 3 cm for repositioning. After two days she underwent video-assisted thoracoscopic bullectomy and mechanical pleurodesis and was discharged at postoperative day 7. Symptoms and signs of Homer's syndrome gradually resolved, and she had fully recovered at the 2 month postoperative outpatient follow-up.

• Journal of Chest Surgery
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• v.37 no.2
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• pp.188-192
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• 2004

Treatment of huge chronic tuberculous empyema with cardiopulmonary dysfunction. Drainage of empyemal space by closed thoracostomy in chronic tuberculous empyema is generally contraindicated because of the possibility of empyema necessitatis and ascending infection. But in case that serious cardiopulmonary dysfunction is present, drainage of empyema and decompression is necessary. We experienced a case in which chronic tuberculous empyema was big enough to cause mediastinal shifting and cardiopulmonary failure. Immediate drainage of pleural cavity with tube thoracostomy was performed. Afterward, pleuropneumonectomy was done following cyclic irrigation for one month. The patient had successful postoperative course without any evidence of complication or relapse of infection.

• Journal of Chest Surgery
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• v.43 no.6
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• pp.669-674
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• 2010

Background: Spontaneous hemopneumothorax is characterized by the accumulation of air and more than 400 mL of blood in pleural cavity without any apparent cause. It is a rare disease and can cause life-threatening situation. We analyzed clinical reviews of two medical centers to aid in optimal management. Material and Method: Retrospective review between March 2003 and August 2010 with 18 spontaneous hemopneumothorax patients was made. Result: These 18 patients were comprised of 15 male and 3 female with average 24.6 years (range 15~46 years). Almost patients (16) underwent a closed thoracostomy initially and 15 patients received video-assisted thoracic surgery (VATS). Mean postoperative chest tube removal was 2.9 days and one complication was post-removal pneumothorax. During the follow-up periods there were no other complications and recurrence. Conclusion: Proper initial diagnosis and management of spontaneous hemopneumothorax prevent significant hypovolemic shock. Video-assisted thoracic surgery should be considered an early surgical management in spontaneous hemopneumothorax. However conservative manage without bleb excision may be effective in selected patients.

• Journal of Chest Surgery
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• v.40 no.4 s.273
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• pp.292-296
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• 2007

Background: This retrospective study was undertaken to assess the effectiveness of the 8-French (Fr) catheter ($Pleuracan^{(R)}$) for the initial treatment of primary spontaneous pneumothorax. Material and Method: Between July 2004 and July 2006, 59 patients (72 cases) underwent a closed thoracostomy for primary spontaneous pneumothorax. We divided these patients into two groups: group T (large bore (>20 Fr) chest tube group) and group P ($Pleuracan^{(R)}$ group). Result: Initially, the $Pleuracan^{(R)}$ catheters were inserted in 41 cases. There were four catheter malfunctions (9.8%) : three cases had a subsequent closed thoracostomy with a large bore chest tube. Ultimately, there were 34 cases in group T and 38 cases in group P. There were no significant differences in indwelling catheter time ($T:\;2.1{\pm}1.5\;days,\;P:\;2.1{\pm}1.3\;days$), hospital stay ($T:\;6.4{\pm}5.4\;days,\;P:\;5.2{\pm}2.9\;days$) and complications (T: 3%, P: 0%) between the two groups. The percentage of cases that needed intravenous analgesics in group P was 60% (23/38); this was significantly lower than the number for group T (90%, 31/34) (p=0.003). In a subgroup of patients that did not undergo bullectomy(T: 17 cases, P: 19 cases), there were no significant differences in the duration of air leakage ($T:\;0.5{\pm}0.7\;days,\;P:\;0.5{\pm}1.2\;days$) and in the percentage of patients with complete lung re-expansion (T: 94%, P: 84%) between the two groups. Conclusion: Application of the $Pleuracan^{(R)}$ catheter for the initial treatment of primary spontaneous pneumothorax was as effective as the large bore chest tube.

• Journal of Chest Surgery
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• v.33 no.11
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• pp.898-903
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• 2000

배경 및 목적: 최근 비디오 흉강경술은 최소 침습적인 수술 방법으로서 자연 기흉의 일반적 치료법으로 인정되고 있으나 비교적 높은 재발율과 비용-효용 관계에 대해서는 논란이 있다. 비디오 흉강경을 이용한 기포 절제술 후의 재발율은 평균 5-10%정도로 보고되고 있으며 이는 개흉술에 비해 상당히 높은 것이다. 또한 국내 의료 실정에서의 개흉술과 비디오 흉강경술의 비용효용에 대한 비교 통계는 없는 상황이다. 대상 및 방법: 1997년 1월부터 1999년 7월까지 일차성 자연기흉으로 성균관 의대 강북삼성병원 흉부외과에서 수술을 시행한 173예를 대상으로 후향적 조사하였다. 비디오 흉강경술로 시행한 104예와 개흉술로 시행한 69예를 양군으로 나누어 성별 및 연령, 발병부위, 수술의 적응증, 수술시간, 술 후 흉관 삽입기간 및 재원 일수, 술후 합병증, 재발율, 수술 경비 및 총치료경비 등을 비교하였다. 결과: 양군의 성별, 연령, 발병부위 등에는 차이가 없었다. 수술 시간은 흉강경군이 73.1$\pm$29.5분, 개흉군이 141$\pm$52분이었다.(p<0.05). 술 후 평균 흉관의 거치기간 및 재원일수는 흉강경군이 각각 3.93일 및 7.5일, 개흉군이 7.0일 및 13.4일이었다.(P<0.05, P<0.05). 술 후 재발한 경우가 비디오 흉강경군에서 6예(5.6%), 개흉군에서 1예(1.4%) 있었다(P<0.05). 본원에서 시행한 비디오 흉강경술과 개흉술의 비교에서 수술로 발생하는 비용은 비디오 흉강경군이 유의하게 높았으나 (1,202,192$\pm$178,992원, 1,005,669$\pm$311,531원; P<0.05) 총 치료비의 비교에서는 유의한 차이가 없었다.(1,946,110$\pm$487,440원, 1,793,912$\pm$308,079원; P=0.18). 결론: 비용 효용관계 및 재발율은 병원마다의 수술 수기 및 퇴원 정책등에 따라서 다소간의 차이가 있을 수 있으나 본원의 조사 결과에서는 비디오 흉강경술이 개흉술에 비해 비용-효과가 있다고 볼 수 없으며 재발율도 높았다.