• The Korean Journal of Pain
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• 제18권2호
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• pp.181-186
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• 2005

Background: Hydromorphone has an intermediate lipid solubility range that falls between morphine and fentanyl. Lipophilic activity during opioid epidural administration is important in relation to both the side effects and analgesic efficacy. The purpose of this study was to compare epidural hydromorphone and fentanyl when concomitantly infused with bupivacaine in patients undergoing a thoracotomy. Methods: Seventy-seven thoracotomy patients, with patient-controlled epidural analgesia (PCEA), were blindly allocated into two groups [group F (n = 34); 0.1% bupivacaine and fentanyl $5{\mu}g/ml$, group H (n = 34); 0.1% bupivacaine and hydromorphone $16{\mu}g/ml$)]. The basal PCEA rate and demand dose were 4 ml/hr and 3 ml, respectively. The visual analogue scale (VAS) for pain, and pruritus, sedation and nausea were measured at 6, 12 and 24 hours after the operation. Results: There were no significant differences in the VAS pain scores and the incidences of pruritus, nausea and sedation between the two groups. The total infused volume after 24 hours was lower in H compared to that of F group (P < 0.05). Conclusions: We conclude that epidural hydromorphone or fentanyl administration has a similar analgesic efficacy and shows similar incidences of side effects, when concomitantly infused with bupivacaine, in the management of acute pain following a thoracotomy.

• Journal of Chest Surgery
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• 제24권8호
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• pp.757-764
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• 1991

We have observed 360 cases of spontaneous pneumothorax from January 1980 to May 1991 at the department of Thoracic and Cardiovascular Surgery, Chosun University Hospital. Males occupied 266 cases[73.9%] and females 94 cases[26.1%], and its ratio was 2.8: l. The age of patients ranged from neonate[5 days] to 84 years old. The site of pneumothorax was right in 50.3%, left in 43.3% and bilateral in 6.4%a. The clinical symptoms were frequently dyspnea, chest pain and coughing. The associated pulmonary lesions were shown pulmonary tuberculosis in 199 cases[55.3%], bullae in 54, pulmonary emphysema in 31, COPD in 17, pneumonia in 6, lung cancer in 5, paragonimiasis in 5, catamenial pneumothorax in 3 and unknown underlying pathology in 39 cases. The results of surgical management of spontaneous pneumothorax are followings: 288 out of 360 cases[80.0%] were cured by closed thoracotomy, 53 cases[14.8%] were cured by open thoracotomy. Open thoracotomy was the most effective procedure in persistent air leakage, recurrent pneumothorax, visible bleb or bullae on the chest X-ray, associated lesion, bilateral simultaneous pneumothorax, parenchymal incomplete lung expansion and bleeding after closed thoracotomy. The incidence of complication was developed in 10. ado and recurrent rate was seen in 10.6%. There was no operative death.

• Journal of Chest Surgery
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• 제24권10호
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• pp.1005-1011
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• 1991

Eighty-four patients with pulmonary metastases from gestational choriocarcinoma were treated at the Catholic Medical Center between August, 1985 and August, 1991. Among these 13 patients underwent thoracotomy with resection of pulmonary lesions and the results obtained were follows. 1] The ages of the patients ranged from 26 to 47 years, with a mean age of 31 years. 2] The frequency of chemotherapy before operation ranged from zero to 46, with a mean frequency of 13.6. 3] Four patients were operated upon for a solitary metastasis of the lung; 6 patients, for unilateral multiple metastases and 3 patients, for bilateral pulmonary metastases. 4] Eight patients underwent wedge resection; 1 patient, segmentectomy; 2 patients, lobectomy; 3 patients, open lung biopsy. The lung lesions of eleven patients showed hemorrhagic necrosis[among these, 2 patients combined with pulmonary tuberculosis]; one was non-necrotic choriocarcinoma; another one was metastatic lung carcinoma from endocrine cancer of unknown origin. 5] Among twelve patients who had managed with chemotherapy before thoracotomy three patients were in remission; among 13 patients who had undergone thoracotomy 6 patients were in remission. 6] The median survival time of these patients was 25.8 months with 3 postoperative deaths. Subsequently, in the patients with pulmonary metastases from choriocarcinoma, if the primary tumor is under control, there are no other metastases, and the patients should be able to tolerate the planned operation, it is necessary to undergo aggressive thoracotomy for diagnostic purposes; for therapeutic purposes only when the pulmonary lesion is the only remaining source of increased hCG excretion; for reduction of tumor volume to shorten hospitalization or to reduce the quantity of drugs.

• Journal of Chest Surgery
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• 제26권6호
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• pp.470-474
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• 1993

A clinical evaluation was performed on 56 patients[ 60 cases ] of open thoracotomy in spontaneous pneumothorax who were admitted and treated at department of Thoracic and Cardiovascular Surgery, Chung Ang University, Yong San Hospital during the past 3 years from March 1990 to February 1993. The results were as follows. 1. The sex ratio was male predominence [ M:F = 7:1 ]. 2. The most common age group were 2nd, 3rd decades. 3. The most common chief complaints were dyspnea and chest pain [46.3% ]. 4. The etiologic factors of spontaneous pneumothorax were primary spontaneous pneumothorax [ 78.3%], secondary tuberculosis [ 18.3%], and others [ 3.4% ]. 5. The site of spontaneous pneumothorax was 50% in right, 40% in left, and 10% in both. 6. The state of activity on attack was almost in the usual life [ 98.3% ]. 7. Average height was 172.5 $\pm$ 5.39 cm in male and 164.0 $\pm$ 3.51 cm in female, average weight was 59.1 $\pm$ 7.06 kg in male and 52.0 $\pm$ 4.97 kg in female. 8. The common indications of open thoracotomy were recurrence [ 34.4% ] and persistent air leakage [ 17.8% ]. 9. The operative procedures were bullectomy [ 73.3% ], partial resection [ 11.7% ], lobectomy [ 11.7% ], and others [ 3.3% ]. 10. The most frequent location of bulla or bleb were apical segment of RUL [ 43.3 % ] and apicoposterior segment of LUL [ 40.0% ]. 11. The number of visible bulla or bleb were mainly 1 to 5, and size was about 1 to 3 cm.

• Journal of Chest Surgery
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• 제28권3호
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• pp.297-302
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• 1995

Video-assisted thoracic surgery [VATS is emerging as a viable alternatives to thoracotomy when surgical treatment of spontaneous pneumothorax is required.Apical blebs and bullaes of the lung can be resected,and pleural abrasion can be accomplished with minimal postoperative pain and a shorter postoperative stay in hospital. We compared our results with thoracoscopic management of spontaneous pneumothorax in 20 patients [group I with a group of 32 patients previously subjected to lateral limited thoracotomy [group II . Indications for operation, sex distribution, and average age [groupI, 24.7 years ; group II, 34.4 years were comparable. Operation time [112.42 54.7 min versus 124.8 35.3 min ; P 0.03 and chest tube duration [64.4 52.3 hours versus 97.7 45.4 hours ; P 0.01 were less in group I. Postoperative hospital stay was less in group I[3.84 0.99 days;P 0.01 , as was the use of parenteral narcotics after 48 hours. [5/20=25% versus25/32=78% . Pain was quantitated by verbal rating scale in postoperative 1 to 3 days. Patients undergoing VATS experienced significantly less postoperative pain. Postoperative complication was less in group I[1/20=5% versus 3/32=8.3% . In conclusion, Video-assisted thoracoscopic management of spontaneous pneumothrax allows performance of the standard surgical procedure while avoiding the thoracotomy incision.Video-assisted thoracic surgery [VATS is safe and offers the potential benefits of shorter postoperative hospital stays and less pain with cosmetic benefits.

• Journal of Chest Surgery
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• 제23권5호
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• pp.887-893
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• 1990

We have experienced 142 cases of spontaneous pneumothorax from January 1987 to June 1990 at the department of Thoracic and Cardiovascular Surgery, Inha General Hospital, Inha University College of Medicine. The age of patients ranged from 16 to 79 years \ulcornerold. The incidence was highest between late 2nd and 3rd decades in non tuberculous group. Males occupied 110 cases [77.6%] and females 32 cases [22. 5%], and its ratio was 3.4: l. The incidence of right side pneumothorax was 76 cases [53.5%] and left side was 65 cases [45.8%]. There was one case of bilateral pneumothorax. The most common chief complaints were chest pain and dyspnea. The associated pulmonary lesions were pulmonary tuberculosis, active or healed in 51 cases [35.9%], Subpleural bleb in 19 cases [13.4%], emphysematous bulla in 12 cases [13.4%], asthma in 3, bronchiectasis in 3, pneumonia in 1, cyst in 1. The unknown origin pneumothorax, so called "idiopathic spontaneous pneumothorax”, which seemed to be caused by the rupture of bleb or bulla most likely, were 52 cases [36. 6%] in our series. Generally, closed [tube] thoracotomy with underwater sealed drainage is the treatment of choice in spontaneous pneumothorax. We experienced 94 cases[66.2%] which were cured by closed thoracotomy. However, open thoracotomy and adequate surgical procedures were undertaken in patient with continuous air leakage or recurrent attacks of spontaneous pneumothorax in 48 cases [33.8%]. The minithoracotomy is a good procedure for the bullectomy of upper lobe.lobe.

• Journal of Chest Surgery
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• 제27권9호
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• pp.779-784
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• 1994

Vidio-assisted thoracic surgery[VATS] has recently evolved as an alternative to thoracotomy for several thoracic disorders,and the role of thoracoscopy has expanded with advances in surgical techniques and instruments. From May 1993 to May 1994, 13 patients with mediastinal mass underwent VATS for diagnosis and treatment at Gil General Hospital. There were four males and nine females, and their ages raged from 5 years to 66 years with average 38.8 years. Among 13 patients, 3 were operated for tissue diagnosis,9 for treatment,and 1 for diagnosis and treatment. Pathologic diagnoses were as follows; 5 benign neurogenic tumors, 2 thymoma, 2 sarcoidosis, 1 teratoma, 1 peripheral neuroepithelioma, 1 tbc lymphadenitis, and 1 pericardial cyst. The mean time of operation was 111.7 $\pm$ 30.7 minutes[60-160], mean duration of chest tube drainage was 2.9 $\pm$1.9days[1-9], mean hospital stay was 6.2 $\pm$2.6 days[4-13]. There was no patient needed blood transfusion or conversion to open thoracotomy. Accurate diagnosis was possible in all patients operated for diagnosis and /or treatment.[4/4,100%] Two complications occurred in two patients: 1 transient Horner,s syndrome,1 anhydrosis of left arm. Compared with those of conventional thoracotomy done for mediastinal mass during previous 2 years[May 1991 - April 1993], operative results of VATS were better in all aspects. For mediastinal mass, we concluded that VATS can be done with less morbidity,less complication,less blood loss,shorter operation time and hospital stay,and not more expensive in cost than conventional thoracotomy. Noticeably, we think that VATS is the operation of choice for the diagnosis and palliation of malignant mediastinal mass.

• Journal of Acupuncture Research
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• 제35권2호
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• pp.95-100
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• 2018

Background: The aim of this study is to assess the feasibility of acupuncture treatment for the management of subacute and chronic post-thoracotomy pain in patients with traumatic multiple rib fractures. Methods: A total of 30 participants who have undergone thoracotomy after traumatic multiple rib fractures will be recruited. Participants will be invited and equally randomised into acupuncture plus usual care and usual care alone groups. A computer-generated random number sequence will be used and concealed using opaque, sealed, sequentially numbered envelopes. Twelve sessions of manual and electrical acupuncture performed by Korean medicine doctors will be provided over a span of 3 months to participants allocated to the acupuncture group. Participants in the usual care group will continue pain medication, exercise and physical therapy as required. Study feasibility will be measured based on the proportion of patients who complete the measurement of pain at 12 or 24 weeks after baseline. The clinical outcomes will include; the average pain intensity over the recent week at rest, movement and cough, quality of life, patient's global assessment of recovery, respiratory function measured by the pulmonary function test and use of pain medication at 4, 8, 12 and 24 weeks after enrolment. Adverse events will be recorded for all participants. Written informed consent will be obtained from all participants. The local ethics committee has approved the study. This pilot trial will inform further studies investigating the potential role of acupuncture for subacute and chronic post-thoracotomy pain in patients with traumatic multiple rib fractures.

• Journal of Chest Surgery
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• 제22권6호
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• pp.1044-1048
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• 1989

In this study, 26 cases of bilateral spontaneous pneumothorax experienced at the department of thoracic and cardiovascular surgery, Chungnam National University Hospital during from 1985 to August 1989 were analyzed retrospectively. The results were as follows; 1. The incidence of bilateral spontaneous pneumothorax was 13.5 % and sex ratio was 7.7:1 with male preponderance. 2. Among the nonsimultaneously occurring cases of bilateral pneumothorax, 12 patients [75 %] were developed at contralateral side within a year. 3. The most patients [65.4%] belonged to the age group between 15 and 25 year-old, and among 57 male patients suffered spontaneous pneumothorax in the same age group, 16 cases[28%] developed bilaterally. 4. The etiologic factors were as follows; blebs or bullae; 65.4 %, tuberculosis; 15.4 %, unknown; 19.2 %. 5. In the method of treatment, 15 patients were treated by closed tube thoracotomy and underwater-seal drainage only, 10 patients were treated by open thoracotomy. One patient died of respiratory failure due to severe destructed lung.

• Journal of Chest Surgery
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• 제27권9호
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• pp.793-797
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• 1994

Constrictive pericarditis is often accompanied with ~brothorax and deterioration of cardiac, hemodynamic functions. Surgical relief of fibrous peel causes remarkable improvement in pulmonary, cardiac, hemodynamic function, and subjective symptoms. We experienced 4 cases of constrictive pericarditis combined with bilateral ~brothorax after bilateral pleural effusion caused by tuberculosis and non-specific inflammation. Pleural decortication and pericardiectomy were done at the same time through anterolateral thoracotomy with sternal transection[3 patients] and median sternotomy incision[l patient]. Low cardiac output was the most common complication. With left anterolateral thoracotomy, we could prevent the hypotension from massive retraction for dissecting by median sternotomy, which was good for dissecting from anterior wall of left ventricle to posterior wall of left ventricle and surrounding phrenic nerve. It was enough to dissect the portion being through hard to dissect, right atrium, SVC and IVC.