• Journal of Chest Surgery
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• v.25 no.11
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• pp.1286-1291
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• 1992

We have experienced 456 cases of spontaneous pneumothorax from January, 1981 to December, 1991 at the department of Thoracic and Cardiovascular Surgery, Chonbuk National University Hospital. Of these, 102 cases were recurrent pneumothorax. These 102 cases were based on the retrospective clinical analysis, and the results were as follows: The ratio of male to female was 6.2: 1 in male predominance and the old aged patients, over 50 years old, occupied 46.8%a of all patients. Primary spontaneous pneumothorax was 43 cases[42.6%] and secondary spontaneous pneumothorax was 59 cases. The underlying pathology in secondary spontaneous pneumothorax was tuberculosis: 31 cases[30.4%], emphysema and chronic obstructive pulmonary disease: 27 cases[26.1%], Most frequent operative and pathologic findings in the primary and the secondary spontaneous pneumothorax was bullae and blebs at apex. The employed managements were only closed thoracostomy in 41 cases, open thoracot-omy in 61 cases. The operative procedures at thoracotomy were bullectomy or bullae ligation in 37 cases, bullae resection with wedge resection in 8 cases, bullae resection with segmentectomy in 6 cases, bullae resection with decortication in 3 cases, lobectomy in 5 cases, decortication in 2 cases. Complications were subcutaneous emphysema[5 cases], wound infection[1 case], and temporary pulmonary insufficiency[1 cases]

• Journal of Chest Surgery
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• v.22 no.5
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• pp.788-793
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• 1989

We have observed 501 cases of spontaneous pneumothorax from January 1981 to June 1989 at the Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Hospital. Of these, 57 patients have undergone thoracotomy to treat the pneumothorax after closed thoracostomy. These 57 patients were based on this retrospective clinical analysis, and the results were as follows: The ratio of male to female was 4.2:1 in male predominance and the old aged patients, over 50 years old, occupied 47.3% of all patients. Primary spontaneous pneumothorax was 19 cases and secondary spontaneous pneumothorax was 38 cases. The underlying pathology in secondary spontaneous pneumothorax was tuberculosis emphysema and chronic obstructive pulmonary disease in 35 cases. The indications of thoracotomy were persistent air leakage in 23 cases recurrent pneumothorax in 21 cases, inadequate expansion in 13 cases. Rupture of bullae or blebs were most frequent operative and pathologic findings in persistent air leakage group and recurrent pneumothorax group. In inadequate expansion group, predominant finding was destructive lung lesion. Bullectomy and/or bullae ligation was most effective procedures in 36 cases [63%] for operative management of spontaneous pneumothorax. Duration of preoperative and postoperative chest tube indwelling day was 13.35 days and 8.05 days in persistent pneumothorax group, 8.92 days and 7.77 days in recurrent pneumothorax group, 13.23 days and 10.21 days in inadequate expansion group.

• Journal of Chest Surgery
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• v.25 no.7
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• pp.763-768
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• 1992

To prevent recurrence of spontaneous pneumothorax, 23 patients were operated through median sternotomy for simultaneous resection of bilateral bullae, And 27 patients with spontaneous pneumothorax were treated with unilateral thoracotomy, We studied the number, duration and sites of recurrence including findings of CT scan, as well as comparing the both operated group. The incidence of spontaneous pneumothorax was 88% in patients with the ages between 16 to 35 Forty one patients[82%] were operated with the indication of recurrent pne-umpthorax. The number of pneumothorax attack was 2.34 per patient with recurrent pneumothorax. The 87.8% of recurrence was occured within 6 months from last attack. Ips-ilateral recurrnet pneumothorax was 56.1% and contallateral involve was 43.9%. The bilaterality of visible bullae was 90.9% in the findings of chest CT scan and 91.3% in the operative finding. The sensitivity and accuracy for bulla detection with chest CT were 92.6%, respectively. Exclude one case of complicated median sternotomy infection, the postoperative hospital stay was shorter in median sternotomy approached group[P<0.05]. In conclusion, the bullous lesions of the lung have tendency of bilaterality so that median sternotomy for simultaneous resection of bilateral bullae should be considered in patients with contralateral visible bullae with chest CT.

• Kosin Medical Journal
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• v.33 no.3
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• pp.409-414
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• 2018

Giant pulmonary bulla (GPB) is a rare manifestation of emphysema and usually enlarges gradually over time, occasionally resulting in complications. Hence, more often than not, the surgical intervention of a Bullectomy is the standard method of treatment for GPB. However, there are case reports that show the complete resolution of GPB after its inflammation process even without surgical intervention. A 51-year-old man was admitted to our clinic due to pleuritic pain. After a chest X-ray and CT scan, a new air-fluid level within the GPB was revealed in the right upper lobe of his lung. His clinical status had improved promptly with intravenous antibiotics. A one-year follow-up study showed the GPB was completely resolved.

• Journal of Chest Surgery
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• v.34 no.5
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• pp.393-398
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• 2001

배경: 일차성 자연기흉의 재발방지를 위해서 폐기포절부위에 흡수성 셀룰로스망사와 Fibrin gluefm 도포하여 수술후 재발율을 줄일 수 있는 지 알아보았다. 대상 및 방법: 1996.4우러부터 2000.6월까지 2명의 술자가 222례의 일차성 자연기흉을 수술하였으며, 수술시기와 치료방법에 따라 4군으로 나누어 비교하였다. 제1군은 1996년부터 1997년가지 비디오흉강경수술 및 기계적 늑막유착술로 시술받은 군(25례), 제 2군은 같은 기간동안 액와개흉술 및 늑막유착술로 시술받은 군(53례), 제 3군은 1998년부터 2000.4월까지 흉강경수술 및 늑만유착술로시술받은 군(110례), 제 4군은 1999.7월부터 2000.6월까지 흉강경수술 및 봉합부위를 셀룰로스망사와 Fibrin glue로 보강한 군(34례)이었다. 각 군간, 엑스선상 기흉의 크기 및 폐기포의 수나 크기에 따라 재발율, 공기누출시간 및 흉관지속지간등을 일반선형모델을 사용하여 비교 분석하였다. 결과: 대상환자는 남자 203례, 여자 19례 이었고, 나이는 14게에서 68세이었고, 평균연령은 23.2$\pm$9.6세였다. 재발한 경우는제 1군이 5례(25%), 제 2군이 2례(3.8%), 제 3군이 5례(4.5%)이었고, 제 4군은 재발례가 없었다. 재발례는 모두 수술자의 수술경험이 2년이내일 때 발생하였다. 흉관지속기간은 제 4군이 제 3군(p<0.0006) 및 제1, 제2군(p<0.0001)에 비해서 더 짧았고, 술후 공기누출이 제 4군에서는 없었다. 술전흉부엑스선상 기흉의 크기에 따른 수술후 기흉의 재발울은 경도의 기흉에서 14.3%(2/14)이었고, 중등도 기흉에서 7.4%(10/134)이었으며, 심한 기흉에서는 재발례가 없었다. 재수술한 12례중 봉합부위근처에서 기포가 발행된 경우가 9례(75%)로 많았다. 결론: 재발방지를 위한 시술로 늑막유착술을 시행하지 않고 폐기포절제부위를 흡수성 셀룰로스망사와 Fibrin glue로 덮어주는 시술은 비교적 용이하며, 수술 후 공기 누출이 없었고, 수술 후 흉관지속기간이 더 짧았고, 단기간 추적에서 재발이 없었다. 재발에 영향을 미치는 것으로 흉부엑스선상 기흉의 크기가 작은 경우에는 재발율이 더 높았고, 수술자의 경험이 중요하였다.

• Journal of Chest Surgery
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• v.26 no.6
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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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• v.27 no.12
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• pp.1002-1007
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• 1994

The spontaneous pneumothorax occurs subsequent to a disruption in the continuity of the visceral pleura with escape of free air into the pleural space included primary & secondary pneumothorax that is unrelated to identifiable etiologies such as trauma. In. the 33 year period 1960 to 1993, the 230 cases of open thoracotomy were carried out for definitive treatment of spontaneous pneumothorax, at the Dept. of Thoracic & Cardiovascular Surgery, National Medical Center, Seoul, Korea. There were 193 men & 37 women. They ranged in age from 15 years old to 72 years old. The lesion site was on the right side in 117 and on the left in 97, the 16 cases were in bilateral lesions.Surgical indications included recurrence in 98 cases, persistent air leak in 68 cases, nonexpansion of the lung 37 cases, roentgenologically apparent bullae & blebs in 23 cases, bilateral lesions in 16 cases,combined hemothorax & prevent for recurrence in each 2 cases. The types of operation were bullectomy in 207 cases, wedge resection in 13 cases, decortication & B.P.F. closure in 6 cases,lobectomy in 2 cases, pneumonectomy, plication in each I case. The post operative complication developed in 18 cases[7.8 %], there was I case of death due to sepsis. We believed that open thoracotomy with resection or obliteration of blebs & pleurodes is provided the best protection against recurrence.

• Journal of Chest Surgery
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• v.44 no.3
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• pp.225-228
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• 2011

Background: Conventional treatment (i.e. chest tube insertion and chemical pleurodesis) still remains standard for patients with secondary spontaneous pneumothorax because the risk of surgical bullectomy is deemed high in this subset. However, it has been suggested that surgical treatment using thoracoscopy may expedite postoperative recovery and, thus, may reduce hospital stay. Materials and Methods: Retrospective review of 61 patients with secondary spontaneous pneumothorax, who underwent conventional treatment (n=39) or video-assisted thoracoscopic surgery (VATS) (n=22) between January 2007 and December 2009, was performed. Talc was used for chemical pleurodesis in both groups. Results: Hospital stay of conventional treatment group and VATS group was $14.2{\pm}14.2$ days (4~58 days) and $10.6{\pm}5.8$ days (5~32 days), respectively, with statistically significant difference (p=0.033). Recurrence rate of conventional treatment group was also significantly higher (12/39, 30%) compared to VATS group (1/22, 4.5%) (p=0.016). Conclusion: In selected patients with secondary spontaneous pneumothorax with continuous air leak or inadequate lung expansion, thoracoscopic surgery with chemical pleurodesis using talc results in shorter hospital stay and lower recurrence rate compared to conventional approach.

• Archives of Plastic Surgery
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• v.35 no.4
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• pp.407-412
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• 2008

Purpose: Hydrofluoric acid(HF) is one of the most dangerous mineral acids with the dissociated fluoride ions. The initial corrosive burn is caused by free hydrogen ion, and the second and more severe burn is caused by penetration of fluoride ions into subcutaneous tissues. Silver is a cation producing dressing, an effective antimicrobial agent, but older silver-containing formulations are rapidly inactivated by wound environment, requiring frequent replenishment. But, $Acticoat^{(R)}$ is a relatively new form of silver dressing which helps avoid the problems of earlier agents. The aim of this study is to evaluate effects of $Acticoat^{(R)}$, silver-containing dressing on the treatment for HF injury wound. Methods: From september 2006 to september 2007, the study was carried out with 10 patients who had HF partial thickness burns. $Acticoat^{(R)}$ dressing and 10% calcium gluconate wet gauze dressings in 10 cases. As a principle, in the emergency treatment, partial or complete removal of the nail and early bullectomy along with copious washing with normal saline was done, depending on the degree of HF invasion of the wound. Wound was dressed with $Acticoat^{(R)}$ and 10% calcium gluconate solution. The effect of dressing was investgated by serial bacterial culture and wound exudates assessment. Results: We therefore reviewed 10 cases of HF-induced chemical burns and treatment principle. The 10 cases who came to the hospital nearly immediately after the injury healed completely without sequelae. Conclusion: As the industrial sector develops, the use of HF is increasing more and more, leading to increased incidences of HF-induced chemical burns. The education of patients regarding this subject should be empathized accordingly. In conclusion, $Acticoat^{(R)}$ dressing is a better choice for HF partial thickness burn injuries because of shorter healing time, less pain and more comfortable dressing.

• Journal of Chest Surgery
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• v.36 no.12
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• pp.904-910
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• 2003

Thoracoscopic bullectomy (VATS-B) is now the preferred treatment for spontaneous pneumothorax despite of higher recurrence rate than open thoracotomy. Several methods have been used to prevent this problem. The effectiveness of staple line reinforcement (SLR) in VATA-B using endostaplers was assessed by clinical and experimental study. Meterial and Method: In experimental study, canine lungs were harvested immediately (group I N=5) and 48 hours (group II N=5) after stapling. The pressures at which initial air leaks occurred were measured. In clinical study from February 1997 to March 1999, 106 procedures in 104 patients undergoing VATS-B for spontaneous pneumothorax were classified into two groups according to the presence of SLR and were compared. Result: The average pressure of the initial air leakage was significantly higher in SLR than that of staples alone (18$\pm$1.6 vs 48$\pm$3 mm Hg in group I; 23.8$\pm$1.9 vs 54$\pm$4.6 mm Hg in group II, p<0.001). In the clinical data, there were significant differences seen in the duration of drainage, the total length of endostaplers used, and the duration of the postoperative hospital stay between patients with staple alone and patients with SLR (4.4$\pm$1.4 vs 3.1$\pm$1.1 days in duration of drainage, 92.3$\pm$28.1 vs 71.1$\pm$30.6 mm in total length of endostaplers used, 5.9$\pm$1.9 vs 4.6$\pm$1.7 days in postoperative hospital stays, p<0.001). Conclusion: SLR was effective for preventing prolonged air leakage and responsible for shorter hospital stays after VATS-B for the treatment of spontaneous pneumothorax.