• Tuberculosis and Respiratory Diseases
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• 제81권2호
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• pp.106-115
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• 2018

Chest tube insertion is a common procedure usually done for the purpose of draining accumulated air or fluid in the pleural cavity. Small-bore chest tubes (${\leq}14F$) are generally recommended as the first-line therapy for spontaneous pneumothorax in non-ventilated patients and pleural effusions in general, with the possible exception of hemothoraces and malignant effusions (for which an immediate pleurodesis is planned). Large-bore chest drains may be useful for very large air leaks, as well as post-ineffective trial with small-bore drains. Chest tube insertion should be guided by imaging, either bedside ultrasonography or, less commonly, computed tomography. The so-called trocar technique must be avoided. Instead, blunt dissection (for tubes >24F) or the Seldinger technique should be used. All chest tubes are connected to a drainage system device: flutter valve, underwater seal, electronic systems or, for indwelling pleural catheters (IPC), vacuum bottles. The classic, three-bottle drainage system requires either (external) wall suction or gravity ("water seal") drainage (the former not being routinely recommended unless the latter is not effective). The optimal timing for tube removal is still a matter of controversy; however, the use of digital drainage systems facilitates informed and prudent decision-making in that area. A drain-clamping test before tube withdrawal is generally not advocated. Pain, drain blockage and accidental dislodgment are common complications of small-bore drains; the most dreaded complications include organ injury, hemothorax, infections, and re-expansion pulmonary edema. IPC represent a first-line palliative therapy of malignant pleural effusions in many centers. The optimal frequency of drainage, for IPC, has not been formally agreed upon or otherwise officially established.

• Journal of Chest Surgery
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• 제20권1호
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• pp.39-47
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• 1987

The records of 268 patients, who were diagnosed as spontaneous pneumothorax during the period 1975 to 1984, treated at the department of thoracic and cardiovascular surgery, Hanyang University Hospital, were reviewed retrospectively to evaluate the effect of surgical intervention on each indications. Of these,.61 patients [22.8%] were taken operation to treat the pneumothorax after closed thoracostomy. We have classified the 61 patients to evaluate the therapeutic effect on each indications. And the therapeutic effect is based on the chest tube indwelling days. The results were as follows: 1. The chest tube indwelling days of the group who were taken closed thoracostomy only was average 14.13*9.17 days [range 5-66 days], and that of the group who were finally taken the thoracotomy after closed thoracostomy was 21.85*12.30 days [range 5-55 days]. 2. The indications of thoractomy were thoracoscopic findings, recurrence and continuous air leakage. 3. The chest tube indwelling day of the group who was taken thoracotomy by thoracoscopic findings was average 11.67*6.51 day, that was relatively short compared to those of the other groups. 4. The continuous air leakage group after closed thoracostomy was subdivided into three subgroups, continuous air leakage in 1st attack, thoracoscopic findings in 1st attack, and recurrence. 5. Of these, the chest tube indwelling day of the subgroup, who was taken operation by thoracoscopic findings, was 21.33e8.26, that was relatively short compared with those of the other subgroups. We use the thoracoscope as excellent diagnostic tool to detect the operation indication in the spontaneous pneumothorax patients. And we gain the benefits to shorten the chest tube indwelling days and admission days, and also to protect the recurrence.

• Journal of Chest Surgery
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• 제33권9호
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• pp.738-743
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• 2000

Background: Video-assisted thoracic surgery(VATS) is being used as a therapeutic modality in many diseases in which thoracotomy has been used. We studied that the VATS can substitute the thoracotomy in benign esophageal disease. Material and Method: Group I (n=18) underwent video-assisted thoracic surgery, and group II(n=19) thoracotomy. Group I includes 14 leiomyomas and 4 achalasias. Group II includes 16 leiomyomas and 3 achalasias. Operative technique is enucleation in the leiomyoma and modified Heller's myotomy in the achalasia. Analyzing factors of operation-efficacy are anesthetic time, operation time, hospital stay, chest tube drainage amount and chest tube removal day. The degree of the postoperative pain is assessed by the frequency of opioid analgesics injection. Result: There was no death in both groups. There were 5 complications in the group I and 2 in the group II. Prolonged pleural effusion and restenosis of achalasia occurred to 1 patient in each group. In the group I, there were 1 temporaty vocal cord palsy and 2 mucosal tear leading to thoracotomy. There were no differences in anesthesia time, operation time, hospital stay, total chest tube drainage amount, chest tube removal day and frequency of opioid analgesics injection. The amount of the chest tube drainage at POD 1 day was significantly lower in group I(155.6$\pm$77.8cc) than in group II(572.8$\pm$280.1cc)(p<0.05). Conclusion: The results of our data showed that video-assisted thoracic surgery for benign esophageal disease is as effective as thoracotomy and in addition, cosmetic effect is much better. We concluded VATS may be a substitute for thoracotomy in benign esophageal disease.

• 대한방사선기술학회지:방사선기술과학
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• 제13권1호
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• pp.3-9
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• 1990

A study was carried out to investigate the technical factors and the patient dose (entrance and absorbed dose) in chest P-A radiography based on the 86 hospitals in Seoul from July 1 to July 30, 1989. As a result of this study, main finding were as follow : 1. 51.2% of the surveyed hospitals made use of $60{\sim}69\;kVp$ as tube voltage in chest radiography 2. The majority of the surveyed(88.3%) have the use of $6{\sim}20\;mAs$ as tube current-time. 3. Percentage absorbed doses in patient were showed more than 90 percent in every tube voltage. 4. Object densities were all much the same in all tube voltages. 5. 48.8% of surveyed entrance doses ranged from $100\;{\mu}Sv$ to $190\;{mu}Sv$, and the mean dose was $158\;{\mu}Sv$.

• Tuberculosis and Respiratory Diseases
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• 제43권3호
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• pp.403-409
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• 1996

연구배경 : 흉수질환은 특히 복잡흉수나 농흉의 경우 치료상의 난제로 등장한다. 이들 경우의 치료의 근간은 빠른 완전한 배액과 무기폐의 재확장에 있다. 과거에는 통상 상기질환에서 흉수천자와 외과적 흉강삽관을 통해 진단 및 치료에 임하였으나 맹검적 흉강삽관시 때로는 잘못된 부위에 위치하거나 기술적으로 삽입하기 어려운 조건등으로 실패하는 경우를 경험하였다. 최근에는 영하에 도관을 정확히 삽관하고 배액하여 높은 치료성적을 보고하고 있다. 방법 : 1994년 1월부터 1996년 2월까지 흉수질환으로 관삽입을 요했던 환자 28명을 대상으로 후향적인 조사를 하였다. 맹검적 흉강삽관을 요했던 환자와 영상유도하 도관삽관을 시행받았던 환자로 구분하여 배액성공율을 비교하였다. 결과 : 전통적 방법의 흉강삽관 환자는 14명으로 원인별로 농흉 6명, 결핵성흉막염 6명, 부폐렴흉막염 2명인데 반해, 영상유도하도관삽입 역시 14명이었으나 원인별로는 농흉 2명, 결핵성흉막염 6명, 부폐렴흉막염 5명, 원인미상이 1명 있었다. 인상적 및 방사선학적으로 성공적인 배액을 보인 경우가 전자의 방법에서는 79%인데 반해 후자는 93%로서 영상유도하 도관배액에서 높은 치료성적을 보여주었으며 합병증은 한예에서 미미하게 발생하였다. 결론 : 영상유도하의 도관배액술은 복잡흉수나 국소화된 농흉환자에서 안전하며 성공율을 가진 치료법으로 적용할 수 있을 판단되니 향후 좀 더 많은 환자를 대상으로 한 비교연구가 뒷따라야 하겠다.

• Journal of Chest Surgery
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• 제21권2호
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• pp.379-382
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• 1988

We have experienced a case of right side chylothorax following closed chest injury. A 35-year-old man in his car was accidentally collided against obstacles on September 19, 1986 resulting in a contusion on right anterior chest wall. The only complaint noted on admission was right chest pain. Chest X-ray showed near total radiopaque density of right thorax. Conservative treatment of closed tube thoracostomy at right pleural cavity through midaxillary 7th intercostal space had been continued for 25 days without improvement. Chyle outflow through the chest tube was averaging 1,700cc per day. Oversewing of the thoracic duct and pleura by silk and pledgetted prolene sutures were done. There was no complication and recurrence till postoperative 20 days. Chylothorax following closed chest injury was never reported in this country, and will be a interesting clinical case report.

• Journal of Chest Surgery
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• 제24권10호
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• pp.1028-1032
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• 1991

A 17-year-old man was admitted for chronic anterior chest pain and dyspnea. He was undergone pericardiocentesis for chylopericardium and thoracostomy tube drainage for right sided chylothorax. Approximately 2000ml per day from right chest tube was drained during 20 days Supradiaphragmatic ligation of thoracic duct was performed and there was no drainage postoperatively and immediately antituberculous medication was done.

• 한국콘텐츠학회논문지
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• 제9권3호
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• pp.225-231
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• 2009

CT검사에 따른 방사선 선량의 유해성에 대한 관심이 고조되고 있어, 고정관전류기법과 AEC(automatic exposure control)를 적용하여 선량의 감소 효과를 비교하였다. 64MDCT를 이용하여 인체조직등가물질 팬텀으로 흉부 및 복부 부위를 고정관전류기법과 AEC를 적용하여 CTDIvol과 DLP를 비교하였고, 영상의 평가는 관심영역으로 CT감약계수와 노이즈를 측정하여 비교하였다. 흉부에서 고정관전류기법과 AEC적용에 따른 선량감소 효과는 CTDIvol 35.2%, DLP 49.3%, 복부에서는 CTDIvol 5.9%, DLP 3.2% 감소 효과가 있었다. CT검사에서 자동노출장치인 AEC를 이용하여 선량의 감소효과가 있다. CT 검사에 따른 환자의 피폭선량을 줄이기 위해서는 AEC를 이용하여야 한다.

• Journal of Chest Surgery
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• 제51권4호
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• pp.260-265
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• 2018

Background: A method of wound closure using knotless suture material in the chest tube site has been introduced at our center, and is now widely used as the primary method of closing chest tube wounds in video-assisted thoracic surgery (VATS) because it provides cosmetic benefits and causes less pain. Methods: We included 109 patients who underwent VATS pulmonary resection at Samsung Medical Center from October 1 to October 31, 2016. Eighty-five patients underwent VATS pulmonary resection with chest drain wound closure utilizing knotless suture material, and 24 patients underwent VATS pulmonary resection with chest drain wound closure by the conventional method. Complications related to the chest drain wound were compared between the 2 groups. Results: There were 2 cases of pneumothorax after chest tube removal in both groups (8.3% in the conventional group, 2.3% in the knotless suture group; p=0.172) and there was 1 case of wound discharge due to wound dehiscence in the knotless suture group (0% in the conventional group, 1.2% in the knotless suture group; p=0.453). There was no reported case of chest tube dislodgement in either group. The complication rates were non-significantly different between the 2 groups. Conclusion: The results for the complication rates of this new chest drain wound closure method suggest that this method is not inferior to the conventional method. Chest drain wound closure using knotless suture material is feasible based on the short-term results of the complication rate.

• 대한방사선기술학회지:방사선기술과학
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• 제20권2호
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• pp.49-55
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• 1997

This study was carried out to investigate radiographical and operating conditions of X-ray units and exposure doses to patients during chest radiography, so that the results could provide basic data used for reducing the exposure dose and for providing the diagnostic information with better quality. The conditions and exposure doses of 100 X-ray units mainly used for chest radiography were examined and also 100 radiological technologists mainly handling those apparatus at 76 medical facilities in Pusan were surveyed using a questionnaire from October 1 to December 31 in 1995. The following results were obtained from the study : 1. It was found that most units were capable of taking a high tube voltage radiography by showing 67% of the units equipped with the maximum tube voltage of 150 kV, 94% with more than 500 mA for the rating capacity and 85% with the full wave type of a signal phase. 2. For actual chest radiographical conditions, however, 80% of the units were operated at $60{\sim}100\;kVp$ and only 14% at 100 kVp and over for the high tube voltage. 3. The average exposure time was less than 0.1 second, and eighty four percent of the units adapted the X-ray tube currents ranging from 200 to 300 mA, 80% the focus-film distances between 180 and 210 cm, and 63% the focus sizes of more than 2.0 mm. 4. Most units(98%) employed additional filters made of aluminum, 75% the thickness of filters less than 2.0 mm, and only 2 units the compound filters. 5. Ortho chromatic system was only adopted in 13% of screen film system for the units, and 73% used the grid ratio at 8 : 1 for the low tube voltage during chest radiography. 6. The average exposure dose of all X-ray units during chest radiography was $371\;{\mu}Sv$ with a difference of about 16 times between the minimum to the maximum, and $386\;{\mu}Sv$ both at hospitals and at health centers, followed by $380\;{\mu}Sv$ at general hospitals and $263\;{\mu}Sv$ at university hospitals without showing any statistically significant differences. In conclusion, since patients during chest radiography at medical facilities in Pusan exposed to high levels of radiation, it is recommended that appropriate added filters and grids necessary for the high tube voltage radiography and high-speed screen systems should be adopted and used as soon as possible in order to reduce exposure dose to the patients.