• Journal of Chest Surgery
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• v.25 no.6
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• pp.637-644
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• 1992

The incidence of thoracic empyema has been reduced with the advent of antimicrobial agents. But, there are remained many significant problems in the management of thoracic empyema because of the empyema associated with bronchopleural fistula, other complications, This is a clinical analysis of 76 cases of thoracic empyema who had been treated from August 1975 to July 1991 in the Chest Surgery Department, Chung-Ang University Hospital. This report dealed with the incidence, etiology and symptoms, duration of hospital stay, therapeutic methods and review of literatures in the aspect of thoracic empyema, The results were as follows: 1. Predominance of male [3 : 1] and right side [1.5 : 1] were recorded. 2. The main symptom was the chest pain [55%], dyspnea[36%], fever[33%], cough [23%] and others. 3, The most common predisposing causatic diseases were pulmonary tuberculosis[33%] and pneumonia[31%], but also uncertain cases were 15%.4. Searching for the causatic organisms, there were not-identified[49%], streptoccocci [17%], staphylococci[12%], mixed infection[12%], AFB bacilli[7%]. 5. The range of hospital stay was from 6 to 146 days and the average duration was 29.4 days, 6. The results were good as the methods of closed thoracostomy[52%], decortication [23%], thoracentesis[15%], rib resection and drainage[4%], open drainage[4%], pleuropneumonectomy [4%]. 7. The serious complications or mortality didn`t developed.

• Journal of Chest Surgery
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• v.25 no.11
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• pp.1292-1298
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• 1992

This investigation is designed to illustrate the clinical features '||'&'||' preoperative diagnosis, surgical role in the management of pulmonary aspergilloma, '||'&'||' compare with the previous study. We reviewed 42 cases of surgically treated pulmonary aspergillosis from Jan. 1984 to July 1992. The peak age incidence laid in the 2nd '||'&'||' 3rd decade of 25 cases[59.5%]. The 41 cases[97.6%] had a history of treatment with anti-tuberculous drugs under impression of pulmonary tuberculosis. The most common complaint was hemoptysis in 28 cases[66.7%]. The 21 cases showed so called "Air-meniscus sign" on the preoperative chest X-ray. As a preoperative diagnostic modality, the positivity was 30.0%, 57.8%, 88.5% on the fungus culture of sputum for Aspergillus, Chest CT, serum immunodiffusion test for A. fumigatus, respectively. The 37 cases[88.1%] can be diagnosed as pulmonary aspergillosis pre-operatively by any diagnostic method. The anatomical location of aspergilloma was mainly upper lobe in 17 cases[40.5%] '||'&'||' the majority of cases were managed by lobectomy. The postoperative pathologic findings showed that 18 cases[41.0%] were combined with tuberculosis '||'&'||' 15 cases[34.1%] were not combined with any other disease[Pr imary Aspergillosis]. The 6 cases showed postoperative empyema including 4 cases of bronchopleural fistula, 3 cases showed postoperative bleeding. One case was died postoperatively due to respiratory failure. In conclusion, when the patient who has longstanding history fo pulmonary tuberculosis '||'&'||' hemoptysis, must be suspected fungal super infection. The resectional surgery is the treatment of choice for symptomatic localized disease. And compare with the previous study, preop. chest CT '||'&'||' immunodiffusion test were more commonly available '||'&'||' showed high positivity.

• Journal of Chest Surgery
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• v.25 no.1
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• pp.96-104
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• 1992

The 242 patients were operated due to chronic empyema in Hanyang University Hospital From Jan, 1983 to Aug, 1991, we operated 17 patients by modified.Schede`s thoracoplasty with myoplasty and we concluded to next scentences. 1. The age of patients were varied from 28 to 65[Average 39.1] and male preponderance was seen[more than 3 times]. 2. The preoperative cause of disease were tuberculosis in 14 patients[3 patients were associated with aspergillosis, and 1 patient was associated vrith actinomycosis], lung abscess in 2 patients, and haemophilia in 1 patient. 3. The Preoperative duration of empyema were varied from 1 month to 30 years[Average 49.8 month], and the duration from pulmonary resection to thoracoplasty were 1 month to 13.5 years[Average 55 month] except 3 patients, who were operated pneunectomy with thoracoplasty at the same time. 4. The total number of thoracoplasty were 19, because in 2 patients, we operated 2 steps, and we failed in 6 cases, so the success rate was 68.5%. 5. In failure analysis of 6 cases, the cause were obliteration failure in 3 cases, inadequete drainage in 1 case, and in the other 1 case was mixed type. 6. From 1990 to 1991, there were no death associated with operation and there were 1 failure, so the success rate was greatly improved. 7. The bronchopleural fistula or spontaneous rupture of trachea were seen in 12 cases, and the success rate was high in absent cases.

• Journal of Chest Surgery
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• v.19 no.3
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• pp.385-390
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• 1986

Empyema is a severe infection encountered in the pediatrics. With advance of the antibiotics and chemotherapeutics, there was a marked decrease in number of empyema. Empyema complicated by staphylococcal pneumonia in infant and children has been distressing problem, and the management of this complication has been discussed repeatedly in the past. In Korea, tuberculous empyema is also troublesome. If empyema is localized within thick capsule, tube thoracostomy and closed drainage alone is unacceptable, and early open thoracotomy to eliminate the empyema has proved good result. A clinical analysis of 39 patients with thoracic empyema was done. They were managed surgical intervention at Dept. of Thoracic & Cardiovascular Surgery at Kyung-Hee University Hospital from Jan. 1974 to December, 1984. 1. Age and sex distribution, infancy 9, early childhood 11. late childhood 9, puberty 10. The male to female ratio was 21:18. 2. The highest seasonal incidence was winter [21 cases]. 3. Cardinal symptoms were cough [76%], fever and chill [66%], and dyspnea [40%]. 4. The location of the empyema was right in 27 cases [69%] and 12 cases in left side. 5. The most frequent lesion to predisposing factor was pneumonia [67%]. 6. The commonest organism was Staphylococcus aureus in 15 [38%] cases, and Mycobacterium tuberculosis in 10 cases [26%]. 7. The surgical treatment was performed in all patients. The surgical procedure was closed tube thoracostomy in 25 cases [64%], decortication in 7 cases [18%], pulmonary resection in 4 cases [10%], and decortication with curettage in 2 cases. 8. One patient died from sepsis complicated by lymphoma and in one patient bronchopleural fistula was developed postoperatively.

• Journal of the Korean Society of Radiology
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• v.82 no.1
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• pp.128-138
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• 2021

Purpose We evaluated the risk factors for progression to chronic complicated bronchopleural fistula (BPF) after pulmonary resection using follow-up CT. Materials and Methods We retrospectively reviewed 45 cases with BPF that had undergone pulmonary resection during 2010-2018. We compared the clinical and radiological characteristics of those with complicated BPF (n = 24) and those without complicated (sterilized) BPF (n = 21). The clinical and radiological risk factors for progression to chronic complicated BPF were examined by logistic regression analysis. Results The thickness of the pleural cavity wall (p = 0.022), the size of the pleural cavity (p = 0.029), and the size increase of BPF on follow-up (p = 0.012) were significantly different between the two groups. The risk factors for progression to chronic complicated BPF were age > 70 years (odds ratio, 6.43; 95% confidence interval, 1.2-33.7), the thickness of the cavity wall > 5 mm (odds ratio, 52.5; 95% confidence interval, 5.1-545.4), and an increase in the size of the pleural cavity on follow-up CT (odds ratio, 12.5; 95% confidence interval, 2.1-73.5), only in the univariate analysis. Conclusion The risk factors for progression to chronic complicated BPF can be evaluated using follow-up CT.

• Journal of Chest Surgery
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• v.39 no.5 s.262
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• pp.403-406
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• 2006

Infarction of the lung usually results from pulmonary arterial obstruction. Pulmonary infarcts often become infected from bronchial contamination and may become lung abscesses, empyema, or bronchopleural fistula causing sepsis. Diagnosis is important for intensive therapy, since infection is prone to spread. Resection of the infarcted lung should be considered early in an attempt to control infection. A sixty-seven-year-old man was hospitalized with dyspnea. A computed tomographic scan of the chest showed left lower lobe infiltration and mild pleural effusion with pleural thickening. There was a thrombus in the left pulmonary artery leading from the lower lobe to the upper lobe artery. At operation, the left lower lobe was found to have complete hemorrhagic infarction. The left lower lobectomy was performed. The remaining thrombus was removed after the left main pulmonary arteriotomy. He has been followed up for 15 months and has done well with no recurrence of thrombus and infarction of the lung.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.10
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• pp.6061-6064
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• 2013

Objective: To explore the feasibility of pulmonary lobectomy combined with pulmonary arterioplasty by complete video-assisted thoracic surgery (VATS) in patients with lung cancer, and summarize its surgical methods. Materials and Methods: Twenty-one patients with lung cancer in Beijing Chest Hospital Affiliated to Capital Medical University from Feb., 2010 to Jun., 2013 were selected, males and females accounting for 15 and 6 cases, respectively. Ten underwent right upper lobectomy, 5 right lower lobectomy, 4 left upper lobectomy (in which left upper sleeve lobectomy was conducted for 2) and 2 left lower lobectomy. At the same time, local resection of pulmonary arterioplasty was performed for 12 patients, and sleeve resection of pulmonary arterioplasty for 9. Results: Twenty-one patients recovered well after surgery. Thoracic drainage tube was maintained for 3-8 days, with an average of 4.9 days, and hospital stays were 8-15 days, with an average of 11 days. There were no deaths in the perioperative period, and the complications like pulmonary embolism, bronchopleural fistula, chest infection and pulmonary atelectasis did not occur after surgery. Conclusions: Performance of pulmonary lobectomy and pulmonary arterioplasty together by complete VATS is a safe and effective surgical method, which can expand the indications of patients with lung cancer undergoing thoracoscopic pulmonary lobectomy, and make more patients profit from such minimally invasive treatment.

• Journal of Chest Surgery
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• v.21 no.1
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• pp.87-100
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• 1988

The authors evaluated 200 cases of primary carcinoma of lung in terms of the cell type, operability, resectability and survival rate, that proved by histopathologic examination at the Dept. of Thoracic and Cardiovascular Surgery, Catholic Medical College during the period of 11 years from Jan., 1977 to Dec., 1987. The results are as follows; 1] The peak incidence was observed in the 7th decade of life [34%] and followed by 6th [30%] 8 5th decade [25%]. Male to female ratio was 3.4:1. 2] Histopathologic classifications were squamous cell carcinoma 48% [96 cases], adenocarcinoma 27% [34 cases], small cell carcinoma 13%[26 cases], ;bronchioloalveolar cell carcinoma 5% [10 cases], large cell carcinoma 4.5% [9 cases], adenosquamous cell carcinoma 1.5% [3 cases] and adenoalveolar cell carcinoma 0.5% [1 case]. 3] Among 200 cases of primary lung cancer, the operability was 47.5% [95 cases], refusal of operation 6.0% [12 cases] and inoperability 46.5% [93 cases]. 4] Ninety five cases [47.5%] were operated. Of these, post-surgical stage I was 18.9% [18 cases], stage II 24.2% [23 cases] and stage III 56.8% [54 cases]. Among 54 cases of stage III, 32 cases were unresectable, while 22 cases were resectable. Consequently, the resectability was 31.5% [63 cases] from the total numbers of 200 cases, and the resectability for the operable 95 cases was 66.3% [63 cases]. 5] Surgical complications were empyema with bronchopleural fistula [4 cases], G-I bleeding [1 case], tedious pleural effusion [1 case] and acute respiratory insufficiency [1 case]. Operative mortality was 3.2% [2 cases], which caused by massive G-I bleeding [1 case] and respiratory insufficiency [1 case]. 6] On the long term follow-up of resectable 63 cases, overall 3 year survival rate was 35%, 5 year 22% and 9 year 2%. Five year survival rate was 39% in stage l, 30% in stage II and 0% in stage III. As for the cell types, the higher 5 year survival rate was observed in resectable squamous cell carcinoma [35%] as compared to adenocarcinoma [15%], alveolar cell carcinoma [14%], small cell carcinoma [0%] and large cell carcinoma [0%].

• Journal of Chest Surgery
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• v.29 no.5
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• pp.530-535
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• 1996

Saprophytic aspergillosis (aspergilloma), a potentially life-threatening disease from the colonization of lung cavities by the ubiquitous fungus Aspergillus fumigatus, has been of surgical concern. Twelve patients with symptomatic aspergilloma underwent operative procedures at Pusan national University Hospital between January 1, 1984 and August 31, 1994. The mean age of the patients was 38.8 years and nine of them had hemoptysis; in two it was massive and life-threatening. Wine of the patients had underlying causes of cavitary lung disease and tuberculosis was the most common cause. Lobectomy was the most commonly performed procedure (in six) . Several major complications including excessive bleeding (2), and pneumonia (2), and empyema with bronchopleural fistula (1) occurred .and one patient died (operative mortality=8.3%). There were no recurrent symptoms in any of the 11 operative survivors during the follow-up period. It is concluded that early, aggressive surgical intervention can provide definite cure in established aspergilloma, even with minimal symptoms.

• Journal of Chest Surgery
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• v.22 no.5
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• pp.839-844
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• 1989

There appears to be significant problems remained in the treatment of tuberculous empyema with BPF in spite of several surgical methods: decortication, thoracoplasty, and pleuropneumonectomy. We presented one case of tuberculous empyema with BPF. The patient was 42-year-old male and his chief complaint was hemoptysis. In past history, he was treated with left closed thoracostomy and antituberculous medication for two months, 16 years ago. Chest X-ray, tomogram and C. T, revealed a huge mass with central necrosis in the lower 2/3 of left thoracic cavity and shifting of the mediastinal structure to the right. Needle aspiration cytology was undifferentiated large cell carcinoma. Left thoracotomy was made under the impression of lung cancer and pleuropneumonectomy was done. Operative findings; thick walled empyema sac filled with hematoma and BPF, the mediastinum was fixated due to fibrosis and calcification of the pleura and the mediastinum. Postoperative biopsy was consistent with tuberculosis. In the postoperative course, there was massive hemorrhage and so reoperation was done. But there was no active bleeding focuses in the thoracic cavity at the time of reoperation. Massive transfusion, coagulant therapy and intermittent clamping and declamping of the chest tube were carried out. Especially, serum calcium level was chronically decreased and so large amount of calcium gluconate was infused for the calcium level to be normal. Total transfused blood; whole blood was 33 pints, packed cell was 63 pints and fresh frozen plasma was 70 pints. At the postoperative[reop] 45th day, intrathoracic hemorrhage was stopped and the chest tube was removed. In conclusion, this suggest that uncontrollable bleeding after pleuropneumonectomy of the tuberculous empyema with BPF could be treated without reoperation in case of the mediastinal fixation due to fibrosis and calcification of the pleura and the mediastinum.