• Journal of Chest Surgery
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• 제8권2호
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• pp.125-134
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• 1975

The record of 137 patients with spontaneous pneumothorax seen at Busan National University Hospital during past 3years were reviewed to study the possible pathogenesis and its effective management. and the results obtained as follows; 1] The incidence of the "spontaneous" pneumothorax which developed without underlying pathology was 13-1%. The majority of those cases was considered as the result of rupture of subpleural blebs. 2] The incidence of secondary pneumothorax which developed with underlying pathology was 50.0%, in which 42.3% was combined with pulmonary tuberculosis and 8, 0% was combined with pulmonary infection. The traumatic pneumothorax was developed in 36-5% of total series. 3] In age distribution, there was pronounced difference between spontaneous and secondary pneumothorax. The majority of spontaneous pneumothorax cases was 20-30 decade and tall and tall and thin in body structure. In secondary pneumothorax, however, the incidence was relatively high in age group more than 50 years old. 4] The incidence of pneumothorax combined with pulmonary tuberculosis was particularly high in our country, and the cause of pneumothorax was seemed due to the rupture of subpleural caseous foci in some cases, but the majority was seen due to the rupture of emphysematous blebs which were formed with a pathological process of chronic tuberculosis. 5]Closed [tube] thoracotomy was the main therapeutic approach of choice in the great majority ,of pneumothorax in our series with the relapse rate of 19.6%. However, open thoracotomy and adequate surgical procedures should be undertaken in patients with continuous air leakage over 7 days and recurrent attack of pneumothorax.

• Journal of Chest Surgery
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• 제9권2호
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• pp.125-132
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• 1976

The author made clinical study of 100 cases of empyema in infancy and childhood that were treated at the Department of Chest Surgery, Busan University Hospital and Busan Children's Charity Hospital, from Jan 1962 to Nov. 1975. 1. In infancy and childhood, 62 cases out of my 100 cases of empyema were caused by .staphylococci and most of recent reports showed a gradual increase in number of staphylococcal empyema. 2. Most frequent lesion predisposing to empyema in infancy and childhood was pneumonia (72%), being remarkable in staphylococcal empyema (85.5%) to that of others. 3. Antibiotics sensitivity test for staphylococci revealed that the erythromycin was most susceptible (85. 5%). 4. The mortality rate was 6% in over all and the author believes that from the point of view of surgical treatment, failure of early continuous drainage on account of multiple thoracentesis for the early stage of empyema, and also early open thoracotomy procedure such as decortication were all the contributing factors to higher mortality in the empyema of infancy and childhood. 5. It may be concluded that the treatment of choice for empyema in infancy and childhood were early and prolonged continuous drainage of pus by closed thoracotomy with caution and administration of more susceptible antibiotics with nutritional support.

• Journal of Chest Surgery
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• 제2권1호
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• pp.13-18
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• 1969

A clinical evaluation was done on a total of 41 cases of primary bronchogenic carcinoma, which came to the department of thoracic surgery, Chonnam University Hospital for the period of 5 years from May 1964, and the various factors led the patients to an inoperable stage were searched. The incidence ratio of male to female was 5.8:1 and the age group of fifty and sixty decade occupied 78% of the total. The subjective symptoms of the patients were cough with or without sputum [83%], chest pain or chest discomfort [76%], and a few incidence of bloody sputum and hemoptysis. The histological findings were 40% of squamous cell carcinoma, 35% of adenocarcinoma and 25% of anaplastic carcinoma, including 5 cases of unclassified bronchogenie carcinoma in scalene biopsy. 12 cases [29%] of a total of 41 cases received thoracotomy, but 8 cases among them were operable and 4 cases inoperable. The rest of 29 cases [71%] could not receive thoracotomy because of the various contraindication. 23 cases [70%] out of inoperable 33 cases had wasted time over 2 months duration for an operation owing to physicians` misdiagnosis of bronchogenic carcinoma as pulmonary tuberculosis, chronic lung abscess, asthma, pleurisy, pneumonia. common cold, neuralgia in order. The delaying factors led the patients to an inoperable stage were physicians misdiagnosis of bronchogenic carcinoma due to non-specific symptoms and signs of the patients, old aged patients dependance on herb medicine, and poor economical condition of the patients.

• The Korean Journal of Pain
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• 제9권1호
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• pp.235-238
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• 1996

Hyperhidrosis is the distressing condition of abnormal sweating which affects the palm, sole and axillary region. Transthoracic endoscopic sympathectomy is recommended as the treatment of choice for hyperhidrosis, especially when the upper limbs are affected. We experienced a case of accidental cauterization of right azygos vein in a healthy 23 year old male during endoscopic transthoracic sympathectomy. We changed the single lumen endotracheal tube to a double lumen tube which made it easier to perform the explo-thoracotomy and bleeder ligation under one lung ventilation. Crystalloid and colloid solutions, and packed RBC were loaded during explo-thoracotomy. Monitoring showed the signs indicating pulmonary edema. Pulmonary arterial catheterization revealed global heart failure. The patient was transfered to ICU for intensive management for heart failure. On the 4th postoperative day, pulmonary edema and heart failure were cured; and the patient was extubated. But in the evening of the same day ST-segment elevation and Q-wave were noted on ECG monitoring. On the 13th postoperative day coronary angiography was performed. This revealed left apex focal hypokinesia, patent coronary artery and accidental right coronary spasm, treated by vasodilator. On the 14 day, after surgery, he was discharged to return to work.

• Journal of Chest Surgery
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• 제1권1호
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• pp.11-18
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• 1968

Author studied the possible pathogenesis of spontaneous pneumothorax and its effective treatment in 33 cases, and the results obtained as follows:1) Of the 33 cases, 15 cases were originated from pulmonary tuberculosis, 11 cases were non-tuberculous natures and 7 cases were followed by traumatic chest injuries which were not associated with a laceration of the lung or rib fractures.2) So called "Idiopathic spontaneous pneumothorax" seemed mostly to be caused by rupture of the emphy- sematous blebs.3) Spontaneous pneumothorax, in process of the pulmonary tuberculosis, seemed to be caused by the rupture of blebs which was formed with a pathological process of chronic pulmonary tuberculosis.4) Author experienced interesting cases of giant blebs which had been fully occupied the right thoracic cavity. At first, it was misdiagnosed as extensive spontaneous pneumothorax on X-ray which was revealed extensive pleural air shadow with total atelectasis of the right lung. A pneumonectomy was performed together with the giant multiple blebs.5] Generally, closed thoracotomy with water-sealed drainage is the treatment of choice in spontaneous pneumothorax. However, open thoracotomy and adequate surgical procedures should be undertaken in patients with continuous air leakage or recurrent attack of spontaneous pneumothorax.aneous pneumothorax.

• Journal of Chest Surgery
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• 제31권4호
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• pp.374-379
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• 1998

1985년 3월부터 1997년 6월까지 강북삼성병원 흉부외과에서 치료한 자연기흉451례를 후향적으로 임상분석하였다. 대부분이 남자환자 였으며(8.2:1), 원발성 자연기흉환자의 평균연령은 26.8세, 속발성 자연기흉은 53.1세였다.속발성 자연기흉의 원인으로는 결핵이 87례(73%)로 가장 많았고, 만성 폐쇄성 폐질환이 19.2%, 그외 기관지 천식, 폐암, 진폐증, 폐렴 등이었다. 환자의 치료로는 안정 및 산소요법이 42례, 흉강 삽관술로 치료한것이 208례, 개흉하에 폐기포 절제술이나 폐엽절제술을 시행한경우가 156례, 그리고 45례에서는 비디오 흉강경수술을 시행하였다. 평균술후흉관보유기간은 개흉술이 8.3일, 비디오흉강경 수술의 경우는 4.7일이었고 흉강삽관술로만 치료한경우 평균흉관보유기간은 11.2일이었다. 본원의 경우, 최근 3년동안 비디오 흉강경 수술이 외과적 수술의 적응이 되는 자연기흉의 치료에 개흉술보다 더 흔히 적용되는 술식이 되었다(1994 33%, 1996 78%). 향후 비침습적 수술방법이 더욱더 발전함에 따라 비디오 흉강경 수술은 자연기흉의 일차적인 치료방법이 될 수 있을 것으로 생각되며, 이의 적절성을 평가 하기위한 다자간의 공동연구가 요구된다.

• Journal of Chest Surgery
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• 제20권4호
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• pp.839-846
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• 1987

The records of 10 patients with traumatic diaphragmatic hernia seen from November 1977 through July 1987 were reviewed. All the patients had a transdiaphragmatic evisceration of abdominal contents into the thorax. We treated 7 male and 3 female patients ranging in age from 3 to 62 years. In 8 patients, diaphragmatic hernia followed blunt trauma and in 2 patients, stab wounds to the chest. The herniation occurred on the right side in 3 patients and on the left side in 7. All the patients sustained additional injuries: rib fractures [7 patients], additional limb, pelvic and vertebral fractures [6], closed head injury [2], lung laceration [1], liver laceration [1], renal contusion [1], ureteral rupture [1], and splenic rupture [1]. Organs herniated through the diaphragmatic rent included the omentum [6 patients], stomach [4], liver [4], colon [3], small intestine [1], and spleen [1]. For right-sided injuries, the liver was herniated in all 3 patients and the colon, in 1. in the initial or latent phase, dyspnea, diminished breath sounds, bowel sounds in the chest were noted in 4 patients, and in the obstructive phase, nausea, vomiting, and abdominal pain were found in all 3 patients. Two patients had a diagnostic chest radiograph with findings of bowel gas patterns, and an additional 8 had abnormal but nondiagnostic studies. Hemothorax, pleural effusion or abnormal diaphragmatic contour were common abnormal findings. Three patients were operated on during the initial or acute phase [immediately after injury], 4 patients were operated on during the latent or intermediate phase [3 to 210 days], and 3 patients were operated on during the obstructive phase [10 to 290 days]. Six patients underwent thoracotomy, 2 required thoracoabdominal incision, and 2 had combined thoracotomy and laparotomy. Primary suture was used to repair the diaphragmatic hernia in 9 cases. One patient required plastic repair by a Teflon felt. Empyema was the main complication in 2 patients. In 1 patient, the empyema was treated by closed thoracostomy and in 1, by decortication and open drainage. There were no deaths.

• Journal of Chest Surgery
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• 제32권3호
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• pp.294-298
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• 1999

배경: 비디오 흉강경 수술은 수년 전부터 자발성 기흉의 새로운 치료 방법으로 확립되어왔다. 본 연구에서는 1992년 1월부터 1996년 12월까지 서울대학교병원 흉부외과에서 자발성 기흉으로 수술을 받았던 154명의 환자들 중 추적 가능했던 126명의 환자를 대상으로 비디오 흉강경 수술과 개흉술의 임상적 결과의 차이를 후향적으로 비교하였다. 대상 및 방법: 87명의 환자에서는 비디오 흉강경을 이용한 수술을 시행하였고(A군), 나머지 39명의 환자에서는 개흉술을 시행하였다(B군). 환자들의 연령은 만 15세에서 75세까지 분포하였고, 평균 27.1세였다. 결과: A군에서 B군보다 수술시간(A군: 90.6$\pm$38.6분, B군: 117.2$\pm$58.9분, p<0.05)과 술후 입원기간(A군: 6.7$\pm$4.2일, B군: 9.4$\pm$3.3일, p<0.05)이 더 짧았으며, 수술후 사용된 진통제도 A군에서 더 적은 양을 필요로 하였다(A군: 2.4$\pm$2.8앰퓰, B군: 6.5$\pm$5.6앰퓰, p<0.05). 그러나 수술중 사용된 자동봉합기의 수는 각 2.7$\pm$1.3개와 1.8$\pm$1.0개로 A군에서 더 많았다(p<0.05). 수술후 흉관을 통한 공기누출 기간은 A군 1.3$\pm$3.3일과 B군 1.0$\pm$2.5일로 차이가 없었고(p>0.05), 수술후 흉관제거까지의 기간도 차이가 없었다(A군: 술후 4.3$\pm$4.0일, B군: 5.5$\pm$3.0일, p>0.05). 재발율은 A군 13.8%와 B군 2.6%였으나 통계적으로 유의한 차이는 없었다. 결론: 이상의 결과로부터 자발성 기흉의 치료에 있어서 비디오 흉강경의 도입은 재발율이나 술후 공기누출기간의 면에서는 큰 장점이 없었으나 수술시간, 재원기간, 술후 통증 그리고 미용효과의 측면에서 개흉술보다 나은 임상적 결과를 보임을 확인하였다.

• Journal of Chest Surgery
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• 제18권1호
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• pp.111-121
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• 1985

A clinical analysis was performed on 312 cases of the chest trauma experienced at department of thoracic surgery, Chosun University Hospital during the past 6 years 10 months period from January 1978 to October 1984. 1. The ratio of male to female patient of the chest trauma was 3.1:1 in male predominance and age from 20 to 50 occupied 71.2% of the total cases. 2. The most common cause of the chest trauma was traffic accidents [45.5%] in this series. 244 cases [78.2%]were injured due to non-penetrating injuries and the remainders [68 cases, 21.8%] were injured due to penetrating injuries. 3. The frequently injured site of the chest trauma was left side of the chest [56.4%], the right side was 33% and the both side was 10.6%. 4. The most common symptoms were chest pain and dyspnea, and common signs were diminished breathing sound and subcutaneous emphysema. 5. The Hemothorax, Pneumothorax, Hemopneumothorax, and Hemopericardium were observed in 190 cases [60.9%] of the total cases, and etiologic distribution revealed 76.5% due to penetrating injuries and 56.6% due to non-penetrating injuries. 6. The rib fractures were observed in 210 cases [67.3%] of the total cases and the most common site of the rib fracture was 6th rib 140 cases [19.2%]. The common site of the rib fracture was from 4th rib to 7th rib [63.8%]. 7. The lung injuries were observed in 150 cases [48.1%] and the other organ injuries were observed in 260 cases [83.3%]. 8. Conservative treatment including thoracentesis were performed in 153 cases [49.1%], Closed thoracotomy with water seal drainage were performed in 112 cases [35.9%], and open thoracotomy were performed in 45 cases [14.4%]. 9. The complications of the chest trauma were developed in 63 cases [20.2%] and the common complications were atelectasis, wound infection and pneumonitis etc. 10. Overall mortality was 0.96% [3 cases] and the cause of death was bacteremia, hypovolemic shock, heart failure and pulmonary edema.

• Journal of Chest Surgery
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• 제34권4호
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• pp.296-304
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• 2001

배경: 이번 연구의 목적은 체내이식형 양심실 보조장치의 개발을 위한 안전하고 간편한 동물실험 모델을 확립하는 것이며 이동작동형 완전 인공심장의 양심실 보조장치로의 사용 가능성을 알아보는 것이다. 대상 및 방법: 7마리의 Corridale 양을 대상으로 실험하였다. 5번째 늑간극을 통하여 좌측 개흉술을 시행하고 좌측 유출로 캐뉼라는 하행 대동맥에 Dacron graft을 사용하여 연결하였고 유입로 캐뉼라는 좌심방에 삽입하였다. 우측 유출로 캐뉼라는 하행 대동맥과 같은 방법으로 주폐동맥에 연결하였으며 유입로 캐뉼라는 혜동맥을 하방으로 젖혀 우심방이를 노출시킨 다음 우심방이에 삽입하였다. 4마리에 있어서는 양심실 보조장치를 전복막강(preperitoneal space)에 위치시켰으며 2마리에 촤측흉강 내에, 1마리에서는 외부에 위치시켰다. aPTT는 수술전 aPTT의 2∼2.5배로 맞추어 주었다 결과: 수술중 또는 수술직후 사망한 경우는 없었으며 7마리 모두 인공호흡기 이탈이 가능하였고 스스로 기립하고 음식물 섭취도 가능하였다. 1마리는 술후 2일째 혈전 색전증 및 인공호흡기 작동 잘못으로 사망하였으며 2마리의 겨우는 술후 2일째 각각 양심실 보조장치의 작동 잘못 및 호흡부전으로 사망하였고, 3마리의 경우는 술후 4일째 혈전색전증으로 인한 급성신부전 및 호흡부전 등으로 사망하였다. 1마리에 있어서는 28일간 생존하였으며 양심실 보조장치의 구동 장치에 연결된 라인의 마로로 인해 양심실 보조장치의 작동이 정지되었으나 바로 양심실 보조장치를 제거하고 살릴 수 있었다. 모든 경우에 있는 캐뉼라를 삽입하고 양심실 보조장치를 작동시키는데 큰 어려움이 없었다. 7마리 중 4마리에서 혈전이 발견되었으며 특히 판막을 연결한 부위에 혈전생성이 많았다. 그러나 캐뉼라에는 혈전생성이 없었다. 결론: 양에 있어서 좌측 개흉술 및 전복막강 공간에 양심실 보조장치를 위치시키는 이번 동물실험 모델은 체내 이식형 양심실 보조장치 개발을 위한 좋은 동물실험 모델이라고 생각된다. 또한 디동 작동기형 완전 인공심장의 혈전생성을 억제할수 있는 방법들의 연구개발이 지속된다면 장기간의 체내 이식형 양심실 보조장치로 사용할 수 있을 것으로 생각된다.