• Title/Summary/Keyword: Chest tube

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Video-Assisted Thoracic Surgery Under Epidural Anesthesia -in High-Risk Group (경막외마취하에 비디오 흉강경수술 - 고위험군에서)

  • Lee, Song-Am;Kim, Kwang-Taik;Kim, Il-Hyeon;Park, Sung-Min;Baek, Man-Jong;Sun, Kyung;Kim, Hyoung-Mook;Lee, In-Sung
    • Journal of Chest Surgery
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    • v.32 no.8
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    • pp.732-738
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    • 1999
  • Background: Video-assisted thoracoscopic surgery has become a standard therapy for several diseases such as pneumothorax, hyperhidrosis, mediastinal mass, and so on. These methods usually required single-lung ventilation with double-lumen endobronchial tube to collapse the lung under general anesthesia. However, risks of general anesthesia itself and single-lung ventilation must be considered in high-risk patients. Material and method: Between December 1997 and July 1998, eight high-risk patients (6: empyema, 1: intractable pleural effusion, 1: idiopathic pulmonary fibrosis) with underlying pulmonary disease and poor general condition were treated by video-assisted thoracoscopic surgerys under epidural anesthesia and spontaneous breathing. Result: Video-assisted thoracoscopic surgerys were successfully per formed in 7 patients. Conversion to general anesthesia was required in 1 patient because of decrease in spontaneous breathing. But, conversion to open decortication was not required. In two patients with chronic empyema, one patient required thoracoplasty as a second procedure and one patient required re-video-assisted thoracoscopic procedure due to a recurrence. The mean operative time was 31.8$\pm$15.2 minutes. No significant postoperative respiratory com plication was encountered. Conclusion: Video-assisted thoracoscopic surgerys can be per formed safely under epidural anesthesia for the treatment of empyema and diagnosis of pulmonary abnormalities in high-risk patients.

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Surgical Treatment and Analysis of Esophageal Diseases (식도 질환의 외과적 치료 및 분석)

  • Choe, Yeong-Ho;Jo, Seong-Jun;Jo, Won-Min;Kim, Gwang-Taek
    • Journal of Chest Surgery
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    • v.29 no.10
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    • pp.1123-1128
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    • 1996
  • A clinical study was performed on 152 cases of surgical esophageal disease treated by the Department of Thoracic & Cardiovascular Surgery of Korea University Hospital from Jan. 1989 through July 1994. The most common esophageal disease was cancer which was seen in 73 cases (48%) among 152 cases. All were treated surgically' 52 patients (71%) were managed by curative or palliative resection with reconstruction and feeding gastrostomy or jejunostomy, otherwise Celestine tube insertion was performed on the remaining 21 patients for palliatio'n. Esophageal leiomyoma occurred in 6 cases(3.9%), among them 1 case was performed with trio recoscopic enucleation . Achalasia were in 7 cases (4.6%) and was treated with modified Heller's m otomy and with Belsey Mark IV operation. Diverticulum were in 11 cases (7.2%). Esophageal stricture occurred in 20 cases (14.1 %) and 17 of 20 cases were managed with bypass surgery. Esophageal perforation was seen in 20 cases, its cause was instrumental trauma in 7 cases, stab wound in 4 cases, foreign body in 4 cases, spontaneous perforation in 3 cases, and others 1 case Other disease including congenital lesion was seen In 1 Scases.

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Prevalence of Latent Tuberculosis Infection among Health Care Workers in South Korea: A Multicenter Study

  • Jo, Kyung-Wook;Hong, Yoonki;Park, Jae Seuk;Bae, In-Gyu;Eom, Joong Sik;Lee, Sang-Rok;Cho, Oh-Hyun;Choo, Eun Ju;Heo, Jung Yeon;Woo, Jun Hee;Shim, Tae Sun
    • Tuberculosis and Respiratory Diseases
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    • v.75 no.1
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    • pp.18-24
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    • 2013
  • Background: We investigated the prevalence of latent tuberculosis infection (LTBI) among the health care workers (HCWs) and analyzed its risk factors in South Korea. Methods: A standard questionnaire regarding the baseline demographics and risk factors for LTBI was given to each participant and tuberculin skin test (TST), QuantiFERON-TB GOLD In-Tube (QFT-GIT) assay, and chest radiography were performed. Results: A total of 493 participants, 152 (30.8%) doctors and 341 (69.2%) nurses were enrolled in eight tertiary referral hospitals. The mean age of the subjects was 30.6 years old, and 383 (77.7%) were female. Of the 152 doctors, 63 (41.4%) and 36 (23.7%) were positive by TST and by QTF-GIT, respectively, and among the 341 nurses, 119 (34.9%) and 49 (14.4%) had positive TST and QFT-GIT results, respectively. Overall, the agreement between the two tests was 0.22 by the chance corrected proportional agreement rate (kappa coefficient) in 493 subjects. Experience of working in tuberculosis (TB)-related departments was significantly associated with positive LTBI test results by QFT-GIT assay, not by TST. In multivariate analysis, only age was independently associated with increased risk of a positive TST result, while age and experience of working in TB-related departments (odds ratio, 2.29; 95% confidence interval, 1.01-5.12) were independently associated with increased risk of a positive QFT-GIT result. Conclusion: A high prevalence of LTBI was found among South Korean HCWs. Considering the association between the experience of working in TB-related departments and high risk of LTBI, QFT-GIT may be a better diagnostic test for LTBI than TST in HCWs.

A Study of Costumes in the Palace Painting Depicting the Worship of Buddha during the Reign of King Myungjong (관중숭불도에 나타난 16세기 복식연구)

  • 홍나영;김소현
    • Journal of the Korean Society of Costume
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    • v.38
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    • pp.305-321
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    • 1998
  • The costume style of the Chosun dynasty changed greatly after Imjinwaeran (the Japanese Invasion of Chosun Korea, 1592∼1598). Most of the extant costumes come from the late Chosun, but some costumes produced be-fore Imjinwaeran have been excavated, and in addition, information on these older constumes is contained in contemporary literature. Of especial value in the study of pre-Imjinwaeran Chosun constumes is a mid-sixteenth century palace painting depicting the worship of Buddha, a painting in the collection of the Ho-Am Art Museum in Seoul. The present study of costume during the middle Chosun dynasty focuses on this painting, and compares it with other contemporary palace paintings, and with other contemporary palace paintings, and with Nectar Ritual Paintings. The following conclusion were drawn : * Concerning woman's hair styles of the time, married women wore a large wig. Un-married women braided their hair, and then either let it fall down their back or wore it coiled on top of their head. * The major characteristic of woman's costumes was a ample, tube-like silhouette, with the ratio of the Jeogori(Korean woman's jacket) and skirt being one-to-one. * The style of Jeogori in the painting was like that of excavated remains. Some Jeogoris were simple (without decoration), while some Jeogoris were worn with red sashes. Here we can confirm the continuity of ancient Korean costumes with those of the sixteenth century * Although the skirt covered the ankles, it did not touch the ground. Because the breadth of the skirt was not wide, it seems to have been for ordinary use. Colors of skirts were mainly white or light blue. * All men in the painting wore a headdress. Ordinary men, not Buddhist monks, wore Bok-du (headstring), Chorip (straw hat), or Heuk-rip (black hat). In this painting, men wore a Heukrip which had a round Mojeong (crown). * The men wore sashes fastened around their waist to close their coats, which was different from the late Chosun, in which men bound their sashes around their chest. That gave a ration of the bodice of the coat to the length of the skirt of one-to-one, which was consistent with that of woman's clothing. * In this painting, we cannot see the Buddhist monk's headdress that appeared later in the Chosun, such as Gokkal (peaked hat), Songnak (nun's hat), and Gamtu (horsehair cap). These kinds of headdresses, which appeared in paintings from the seventeenth century, were worn widely inside or outside the home. Buddhist monks wore a light blue long coat, called Jangsam (Buddhist monk's robe) and wore Gasa (Buddhist monk's cope), a kind of ceremonial wrap, round their body. We can see that the Gasa was very splendid in the early years of the Chosun dynasty, a continuing tradition of Buddhist monk's costumes from the Koryo dynasty.

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Video-Assisted Thoracoscopic Excision of Mediastinal Masses (비디오 흉강경을 이용한 종격동 종양 절제술)

  • 박순익;김동관;유양기;김용희;박기성;박창률;박승일
    • Journal of Chest Surgery
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    • v.35 no.11
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    • pp.807-811
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    • 2002
  • Due to its less invasive nature and superior visual field, video-assisted thoracescopic excision of mediastinal mass is thought to be comparable to open thoracotomy. Material and Method : From January 1995 to August 2001, the medical records of 38 patients who underwent video-assisted thoracoscopic excision of mediastinal mass was retrospectively analyzed. The outcome of these patients were compared with 5 patients who converted to thoracotomy Result: Male to female ratio was 13(34.2%) : 25(65.8%), and mean age was 39.2$\pm$35.4 years. Regarding the pathology, there were 8 neurilemmomas(21.1%), 6 thymic cysts (15.8%), 5 teratomas(13.2%), 5 ganglioneuromas(13.2%), 4 bronchogenic cysts(10.5%), 3 pericardial cysts(7.9%), 3 thymomas(7.9%), and 2 lymphangiomas(5.3%). The mean operation time was 110.6$\pm$7.0 minutes, mean postoperative tube stay was 4.2$\pm$0.4 days, mean postoperative hospital stay was 5.2$\pm$0.4 days, and mean number of injection of analgesics was 1.9$\pm$0.4 times. Although the mean values for the above indices were less than those of the thoracotomy conversion cases, they were statistically insignificant. Postoperative complications of videoassisted thoracoscopic excision included chylothorax, prolonged air leakage, and unilateral phrenic nerve palsy, all of which recovered before patient discharge. There was, however, permanent unilateral ptosis in one patient. Conclusion : As video-assisted thoracoscopic excision of mediastinal mass is safe, less painful, conducive to earlier recovery and cosmetically more appealing, a more active application of this technique is recommeded.

Characterization of Radiation Field in the Steam Generator Water Chambers and Effective Doses to the Workers (증기발생기 수실의 방사선장 특성 및 작업자 유효선량의 평가)

  • Lee, Choon-Sik;Lee, Jai-Ki
    • Journal of Radiation Protection and Research
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    • v.24 no.4
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    • pp.215-223
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    • 1999
  • Characteristics of radiation field in the steam generator(S/G) water chamber of a PWR were investigated and the anticipated effective dose rates to the worker in the S/G chamber were evaluated by Monte Carlo simulation. The results of crud analysis in the S/G of the Kori nuclear power plant unit 1 were adopted for the source term. The MCNP4A code was used with the MIRD type anthropomorphic sex-specific mathematical phantoms for the calculation of effective doses. The radiation field intensity is dominated by downward rays, from the U-tube region, having approximate cosine distribution with respect to the polar angle. The effective dose rates to adults of nominal body size and of small body size(The phantom for a 15 year-old person was applied for this purpose) appeared to be 36.22 and 37.06 $mSvh^{-1}$) respectively, which implies that the body size effect is negligible. Meanwhile, the equivalent dose rates at three representative positions corresponding to head, chest and lower abdomen of the phantom, calculated using the estimated exposure rates, the energy spectrum and the conversion coefficients given in ICRU47, were 118, 71 and 57 $mSvh^{-1}$, respectively. This implies that the deep dose equivalent or the effective dose obtained from the personal dosimeter reading would be the over-estimate the effective dose by about two times. This justifies, with possible under- or over- response of the dosimeters to radiation of slant incidence, necessity of very careful planning and interpretation for the dosimetry of workers exposed to a non-regular radiation field of high intensity.

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Cryoanalgesia for the Post-thoracotomy Pain (늑간 신경 냉동요법에 의한 개흉술후 흉부 동통 관리)

  • Kim, Uk-Jin;Choe, Yeong-Ho;Kim, Hyeong-Muk
    • Journal of Chest Surgery
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    • v.24 no.1
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    • pp.54-63
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    • 1991
  • Post-thoracotomy pain is so severe that lead to postoperative complications, such as sputum retention, segmental or lobar atelectasis, pneumonia, hypoxia, respiratory failure due to the patient`s inability to cough, deep breathing and movement. Many authors have been trying to reduce the post-thoracotomy pain, but there is no method of complete satisfaction. In 1974, Nelson and associates introduced the intercostal nerve block using the cryoprobe. The application of cold directly to the nerves causes localized destruction of the axons while preserving the endoneurium and connective tissue, thereby introducing a temporary pain block and able to complete regeneration of intercostal nerves. One hundred and two patients, who undergoing axillary or posterolateral thoracotomy at the Department of Thoracic and Cardiovascular Surgery in Korea University Medical Center between April 1990 and August 1990, were evaluated the effects of cryoanalgesia for the post-thoracotomy pain reduction. The patients were divided into two groups: Group A, control, the patients without the cryoanalgesia[No.=50], Group B, trial, the patients with cryoanalgesia[No.=52]. Before the thorax closed, in the group A, local anesthetics, 2% lidocaine 3cc, were injected to the intercostal nerves[one level with the thoracotomy, one cranial and caudal intercostal level and level of drainage tube insertion]. In the group B, cryoprobe was directly applied for 1 minute at the same level. Postoperative analgesic effects were evaluated by the scoring system which made arbitrary by author: The pain score 0 to 4, The limitation of motion score 0 to 3, The analgesics consumption score 0 to 3, The total score, the sum of above score, 0 to 10. For the evaluation of immediate analgesic effects, the score were evaluated at the operative day, the first postoperative day, the second postoperative day, and the seventh postoperative day. The effects of incision type, and rib cut to the post-thoracotomy pain were also evaluated. The results were as follows; 1. The intercostal block with cryoanalgesia reduced the immediate postoperative pain significantly compare with control group. 2. The intercostal block with cryoanalgesia improved the motion of the operation side significantly compare with control group. 3. The intercostal block with cryoanalgesia reduced the analgesics requirements at the immediate postoperative periods significantly. 4. The intercostal block with cryoanalgesia lowered the total score significantly compare with control group. 5. The intercostal block with cryoanalgesia were more effective to the mid-axillary incision than to the posterolateral incision 6. The intercostal block with cryoanalgesia were more effective to the patients without rib cut than to the patients with rib cut. 7. No specific complication need to be treated were not occurred during follow-up.

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Diagnostic Efficacy and Complications by Transthoracic Fine Needle Aspiration Biopsy of Localized Lung Lesions (국소성 폐결절에 대한 경피적 세침 흡인술의 진단적 유용성 및 합병증)

  • Seong, Nak-Cheon;Kim, Ki-Joong;Yoon, Ki-Heon;Yoo, Jee-Hong;Kang, Hong-Mo
    • Tuberculosis and Respiratory Diseases
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    • v.43 no.3
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    • pp.339-347
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    • 1996
  • Background : Transthoracic fine needle aspiration and biopsy(TNAB) has become a frequently used technique in the investigation of the intrathoracic lesions because of its safety, reliability, and accuracy. Method : Data on 125 patients who underwent TNAB from 1990 through 1994 were studied to determine the diagnostic sensitivity, accuracy and complications of this procedure as related to lesion type and location. Results : 1. The over-all diagnostic sensitivity of TNAB was 61.6%(77 of 125 patients). 2. The diagnostic yields were as high as 89.9% for malignant lesions, but a specific diagnosis of benign lesions were obtained only in 30% of benign lung lesions. 3. The correlation between results of TNAB cytology and of final histology was as high as 88.2%. 4. Lung lesions that were greater than 3cm in size had a higher proportion of correct diagnosis(73.3%) as compared with lesions 3cm or less in size(38.1%). But there was no significant difference between the central and peripheral lung lesions. 5. There were no serious complications to TNAB. In 12.8% of the procedures a pneumothorax developed, indicating a chest tube in 1.6% of the procedures. In 2 cases, minimal hemoptysis developed which did not require treatment. Conclusion : In our experience, TNAB represents a minor and safe procedure, which permits a direct approach to localized malignant lung lesions with a high degree of accuracy.

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Patch Graft of the Canine Esophagus (식도이식에 관한 실험적 연구)

  • Ha, Gye-Sik
    • Journal of Chest Surgery
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    • v.2 no.2
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    • pp.167-167
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    • 1969
  • Two groups of esophagus graft were done in canine esophagus in 34 adult mongrel dogs. For the first group segmental replacement graft was done with fresh autologous pericardium tube, and for the second, patch graft was done utilizing fresh autologous pericardium, fresh homologous pericardium,and dacron piece. All eight dogs in the first segmental replacement graft group died 2 to 5 days after operation with severe empyema caused by anastomosis disruption. Among 26 patch graft dogs 2 died during operation and 7 died 13 to 18 days after operation. For the 17 long-term patch grafted survivors esophagography and postoperative weight check were done. Postoperative stool was collected and examined for dacron patch excretion. One, two, three, and four months postoperative long-term survivors were sacrificed to obtain specimens in each group respectively and the following observations were made.I. Survival; Autologous pericardium patch group showed no mortality but in homologous pericardium and dacron patch group only two thirds were long-term survivors. II. Postoperative swallowing; There was no case which demonstrated postoperative dysphagia. About half of the cases showed postoperative weight increase and in only 3 cases weight decrease followed operation. III. Dacron patch was excreted in the stool 8 to 23 days after operation. Animals which excreted dacron patch up to 9 days after operation all died of empyema due to anastomosis disruption.IV. Postoperative esophagogram; All esophagograms in each group showed no leakage of barium, no passage disturbances and no remarkable stenotic signs.V. Morphological findings; [A] Macroscopical findings; In one month group specimens of each group dense adhesion with surrounding structures was noted and luminal surface was smooth with contraction of the patched area. In two month groups anastomosis sutures were still exposed but patched area showed lesser abnormality. In three to four months groups sutures were covered completely and patched area showed only very slight signs of contraction. [B] Microscopic findings; In one month group luminal surface of the replaced tissue [transplanted tissue] showed almost complete epithelial covering that is composed of several layers of squamous cells with no evidence of keratinization. Basement membrane was also well distinct throughout. Slight to minimal inflammatory cells comprising of large mononuclears, lymphocytes and plasma cells were observed in the subepithelial fibrous stroma consisted entirely of loose fibrous tissue containing many newly formed capillaries and fibroblastic proliferation. Scattered suture granulomas were found, few of which became acutely inflamed. In two months group repairing process progressed with lesser degree of inflammatory cell infiltration and young capillary proliferation. Fibrous tissue was more matured showing even focal collagenization.Suture granuloma persisted but with lesser reactive changes. Epithelial covering was that of a mature non-keratinizing stratified squamous epithelium. In three and four months groups the replaced area showed essentially similar histological findings. However, subepithelial stroma still consisted entirely of connective tissue without evidence of smooth muscle regeneration. In this group, inflammatory cell infiltration was minimal or negligible. Among these patch materials autologous pericardium group showed the most satisfactory repairing process.The above mentioned results may signify the feasibility of autogenous pericardium patch graft in clinical esophageal surgery.

Patch Graft of the Canine Esophagus (식도이식에 관한 실험적 연구)

  • 하계식
    • Journal of Chest Surgery
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    • v.2 no.2
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    • pp.168-186
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    • 1969
  • Two groups of esophagus graft were done in canine esophagus in 34 adult mongrel dogs. For the first group segmental replacement graft was done with fresh autologous pericardium tube, and for the second, patch graft was done utilizing fresh autologous pericardium, fresh homologous pericardium,and dacron piece. All eight dogs in the first segmental replacement graft group died 2 to 5 days after operation with severe empyema caused by anastomosis disruption. Among 26 patch graft dogs 2 died during operation and 7 died 13 to 18 days after operation. For the 17 long-term patch grafted survivors esophagography and postoperative weight check were done. Postoperative stool was collected and examined for dacron patch excretion. One, two, three, and four months postoperative long-term survivors were sacrificed to obtain specimens in each group respectively and the following observations were made. I. Survival; Autologous pericardium patch group showed no mortality but in homologous pericardium and dacron patch group only two thirds were long-term survivors. II. Postoperative swallowing; There was no case which demonstrated postoperative dysphagia. About half of the cases showed postoperative weight increase and in only 3 cases weight decrease followed operation. III. Dacron patch was excreted in the stool 8 to 23 days after operation. Animals which excreted dacron patch up to 9 days after operation all died of empyema due to anastomosis disruption. IV. Postoperative esophagogram; All esophagograms in each group showed no leakage of barium, no passage disturbances and no remarkable stenotic signs. V. Morphological findings; [A] Macroscopical findings; In one month group specimens of each group dense adhesion with surrounding structures was noted and luminal surface was smooth with contraction of the patched area. In two month groups anastomosis sutures were still exposed but patched area showed lesser abnormality. In three to four months groups sutures were covered completely and patched area showed only very slight signs of contraction. [B] Microscopic findings; In one month group luminal surface of the replaced tissue [transplanted tissue] showed almost complete epithelial covering that is composed of several layers of squamous cells with no evidence of keratinization. Basement membrane was also well distinct throughout. Slight to minimal inflammatory cells comprising of large mononuclears, lymphocytes and plasma cells were observed in the subepithelial fibrous stroma consisted entirely of loose fibrous tissue containing many newly formed capillaries and fibroblastic proliferation. Scattered suture granulomas were found, few of which became acutely inflamed. In two months group repairing process progressed with lesser degree of inflammatory cell infiltration and young capillary proliferation. Fibrous tissue was more matured showing even focal collagenization. Suture granuloma persisted but with lesser reactive changes. Epithelial covering was that of a mature non-keratinizing stratified squamous epithelium. In three and four months groups the replaced area showed essentially similar histological findings. However, subepithelial stroma still consisted entirely of connective tissue without evidence of smooth muscle regeneration. In this group, inflammatory cell infiltration was minimal or negligible. Among these patch materials autologous pericardium group showed the most satisfactory repairing process. The above mentioned results may signify the feasibility of autogenous pericardium patch graft in clinical esophageal surgery.

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