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Clinical Evaluation of Open Thoracotomy Cases in Spontaneous Pneumothorax (자연 기흉의 개흉례에 대한 임상적 고찰)

  • 이연재;황산원
    • Journal of Chest Surgery
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    • v.30 no.12
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    • pp.1225-1231
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    • 1997
  • Spontaneous pneumothorax is the sudden collapse of a lung usually caused by air leakage from a subvisceral pleural blob. Responses to closed thoracostomy,thoracentesls and simple observation are usually prompt and effective. But in some cases, these are unsucceful and open thoracotomy is indicated. A clinical evaluation was performed on 242 cases(236 patients) of open thoracotomy in spontaneous pneumoth rax who were admitted and treated at department of Thoracic and Cardiovascular Surgery. Masan Samsung General Hospital during the past 9 years from January 1988 to December 1996. The results were as follows 1. The sex ratio was male predominance(M:F=11.7:1) 2. The most common age group were 2nd, 3rd decades(2nd=29.3%, 3rd=30.2%). 3. The most common chief complaints were chest pain and dyspnea(chest pain=41.7%. dryspnea= 36.8). 4. The etiologic factors of spontaneous pneumothorax were primary spontaneous pneumothorax(86.4%), tuberculosis(9.1%), COPD(3.7%) and pleuritis(0.8%). 5. The site of spontaneous pneumothorax was 52.1% in right, 45.4% in left and 2.5% in both. 6. The common indications of open thoracotomy were recurrence(44.2%), persistent air leakage(31.8%) and inadequate expansion(15.7%). 7. The operative procedures were bullectomy or mechanical pleurodesis through posterolateral thoracotomy or median sternotomy. 8. The most frequent location of bulla or blob were apical segme t oi RUL(35.1%) and apicoposterior segment of LUL(41.3 %). 9. The number of bulla or blob were mainly 1 to 5(88%), and there were no significant differences among operation indications. 10. The size of bulla or bleb were mainly below 5cm(81%)and small bulla($\leq$1cm) were predominant in recurrence group but large bulla(>5cm)were predominant in persistent air leakage and inadequate expansion group. 11. The pleural adhesion was seen in 54.5%.(Recurrence group 64.1%,Persistent air leakage group 51.9%,Inadequate expansion group 47.4%).

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Effects of Ambient Particulate Matter($PM_{10}$) on Peak Expiratory Flow and Respiratory Symptoms in Subjects with Bronchial Asthma During Yellow Sand Period (황사기간 중 천식 환자에서 대기 중 미세먼지($PM_{10}$)가 최대호기 유속과 호흡기 증상에 미치는 영향)

  • Park, Jeong Woong;Lim, Young Hee;Kyung, Ssun Young;An, Chang Hyeok;Lee, Sang Pyo;Jeong, Seong Hwan;Ju, Young-Su
    • Tuberculosis and Respiratory Diseases
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    • v.55 no.6
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    • pp.570-578
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    • 2003
  • Background : Ambient particles during Asian dust events are usually sized less than $10{\mu}m$, known to be associated with the adverse effects on the general populations. But, there has been no considerable evidence linking these particles to the adverse effects on airways. The objectives of this study was to investigate the possible adverse effects of Asian dust events on respiratory function and symptoms in subjects with bronchial asthma. Patients and Methods : From march to June 2002, Asthmatic patients who were diagnosed with bronchial challenge test or bronchodilator response were enrolled. We divided them into three groups; mild, moderate, and severe, according to the severity. Subjects with other organ insufficiency such as heart, kidney, liver, and malignancy were excluded. All patients completed twice daily diaries and recorded peak flow rate, respiratory symptom, and daily activity. Daily and hourly mean pollutant levels of particulate matter < $10{\mu}m$ in diameter($PM_{10}$), nitrogen dioxide($NO_2$), sulphur dioxide($SO_2$), ozone($O_3$) and carbon monoxide(CO) were measured at the 10 different monitoring sites. Results : Dust events occured 14 times during the study period. Daily averages of 4 air pollutant were measured with an increased level of $PM_{10}$, decreased level of $NO_2$ and $SO_2$, and no change in CO during dust days compared to those during control days. An increase in $PM_{10}$ concentration was associated with an increase of subjects with PEF variability of >20% (p<0.05), night time symptom(p<0.05), and a decrease in mean PEF (p<0.05), which were calculated by the longitudinal data analysis. Otherwise, there was no association between $PM_{10}$ level and bronchodialtor inhaler, and daytime respiratory symptoms. Conclusion : This study shows evidence that ambient air pollution, especially $PM_{10}$, during Asian dust events, could be one of the many aggravating factors at least in patients with airway diseases. This data can be used as a primary source to set up a new policy on air environmental control and to evaluate the safety of air pollution index. We also expect that this research will help identify precise components of dust, which are more linked to the adverse effects.

An Economic Value for the First Precipitation Event during Changma Period (장마철 첫 강수의 경제적 가치)

  • Seo, Kyong-Hwan;Choi, Jin-Ho
    • Atmosphere
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    • v.32 no.1
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    • pp.61-70
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    • 2022
  • This study evaluates the economic values for the several first precipitation events during Changma period. The selected three years are 2015, 2019, and 2020, where average precipitation amounts across the 58 Korean stations are 12.8, 20.1 and 13.3 mm, respectively. The four categories are used to assess the values including air quality improvement, water resource acquisition/accumulation, drought mitigation, and forest fire prevention/recovery. Economic values for these three years are estimated 50~150 billion won. Among the four factors considered, the effect of air quality improvement is most highly valued, amounting to 70 to 90% of the total economic values. Wet decomposition of air pollution (PM10, NO2, CO, and SO2) is the primary reason. The next valuable element is water resource acquisition, which is estimated 9~15 billion won. Effects of drought mitigation and fire prevention are deemed relatively small. This study is the first to estimate the value of the precipitation events during Changma onset. An analysis for more Changma years will be performed to achieve a more reliable estimate.

Clinical Analysis of Disease Recurrence for the Patients with Secondary Spontaneous Pneumothorax (이차성 자연기흉 환자의 재발양상에 관한 분석)

  • Ryu, Kyoung-Min;Kim, Sam-Hyun;Seo, Pil-Won;Park, Seong-Sik;Ryu, Jae-Wook;Kim, Hyun-Jung
    • Journal of Chest Surgery
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    • v.41 no.5
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    • pp.619-624
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    • 2008
  • Background: Secondary spontaneous pneumothorax is caused by various underlying lung diseases, and this is despite that primary spontaneous pneumotherax is caused by rupture of subpleural blebs. The treatment algorithm for secondary pneumothorax is different from that for primary pneumothorax. We studied the recurrence rate, the characteristics of recurrence and the treatment outcomes of the patients with secondary spontaneous pneumothorax. Material and Method: Between March 2005 to March 2007, 85 patients were treated for their first episodes of secondary spontaneous pneumothorax. We analyzed the characteristics and factors for recurrence of secondary spontaneous pneumothorax by conducting a retrospective review of the medical records. Result: The most common underlying lung disease was pulmonary tuberculosis (49.4%), and the second was chronic obstructive lung disease (27.6%), The recurrence rate was 47.1% (40/85). The second and third recurrence rates were 10.9% and 3.5%, respectively. The mean follow up period was $21.1{\pm}6.7$ months (range: $0{\sim}36$ month). For the recurrence cases, 70.5% of them occurred within a year after the first episode. The success rates according to the treatment modalities were thoracostomy 47.6%, chemical pleurodesis 74.4%, blob resection 71% and Heimlich valve application 50%. Chemical pleurodesis through the chest tube was the most effective method of treatment. The factor that was most predictive of recurrence was 'an air-leak of 7 days or more' at the first episode. (p=0.002) Conclusion: The patients who have a prolonged air-leak at the first episode of pneumothorax tend to have a higher incidence of recurrence. Further studies with more patients are necessary to determine the standard treatment protocol for secondary spontaneous pneumothorax.

Inhibition of Viability and Genetic Change in Hypoxia-treated Lung Pericytes (허파혈관주위세포에서 저산소증에 의한 생존능의 억제와 유전자 발현의 변화)

  • Shin, Jong Wook;Kim, Kae-Young;Lee, Young Woo;Jung, Jae Woo;Lee, Byoung Jun;Kim, Jae-Yeol;Jo, Inho;Park, In Won;Choi, Byoung Whui
    • Tuberculosis and Respiratory Diseases
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    • v.57 no.1
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    • pp.37-46
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    • 2004
  • Background : Lung pericytes are important constituent cells of blood-air barrier in pulmonary microvasculature. These cells take part in the control of vascular contractility and permeability. In this study, it was hypothesized that change of lung pericytes might be attributable to pathologic change in microvasculature in acute lung injury. The purpose of this study was how hypoxia change proliferation and genetic expression in lung pericytes. Methods : From the lungs of several Sprague-Dawley rats, performed the primary culture of lung pericytes and subculture. Characteristics of lung pericytes were confirmed with stellate shape in light microscopy and immunocytochemistry. 2% concentration of oxygen and $200{\mu}M$ $CoCl_2$ were treated to cells. Tryphan blue method and reverse transcription-polymerase chain reaction were done. Results : 1. We established methodology for primary culture of lung pericytes. 2. Hypoxia inhibited cellular proliferation in pericytes. 3. Hypoxia could markedly induce vascular endothelial growth factor(VEGF) and smad-2. 4. Hypoxia-inducible factor-$1{\alpha}$(HIF-$1{\alpha}$) was also induced by 2% oxygen. Conclusion : Viability of lung pericytes are inhibited by hypoxia. Hypoxia can stimulate expression of hypoxia-responsive genes. Pericytic change may be contributed to dysfunction of alveolar-capillary barrier in various pulmonary disorders.

Growth and Fruit Characteristics of 'Cheongsoo' Grape in Different Trellis Systems ('청수' 포도의 수형에 따른 수체 생육 및 과실 특성)

  • Kim, Su Jin;Park, Seo Jun;Jung, Sung Min;Noh, Jeong Ho;Hur, Youn Young;Nam, Jong Cheol;Park, Kyo Sun
    • Horticultural Science & Technology
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    • v.32 no.4
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    • pp.427-433
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    • 2014
  • Trellising is an important cultural practice that affects grape quality and yield. Some grape cultivars require different trellising under different climate and soil conditions. To find suitable trellis conditions for grape cultivar 'Cheongsoo', we measured growth and fruit characteristics with three different trellis systems: curtain, Geneva double curtain (GDC), and modified T. The maximum light exposure of clusters in the curtain, GDC, modified T trellis systems was 670, 1,654, and $1,649{\mu}mol{\cdot}m^{-2}{\cdot}s^{-1}$, respectively. However, there was no difference in air temperature among the three trellis systems. Net $CO_2$ assimilation rate at $1,500{\mu}mol{\cdot}m^{-2}{\cdot}s^{-1}$ light intensity was 13.4, 13.7, and $8.7{\mu}mol{\cdot}m^{-2}{\cdot}s^{-1}$ in curtain, GDC, and modified T trellis systems, respectively. Trunk cross section area (TCSA) and bud burst rate were not significantly different among the three systems. Shoot number was 31.3, 47.0, and 37.0 in curtain, GDC, and modified T trellis systems, respectively. The shoot length was higher (243.9 cm) in the modified T trellis system than in the single curtain (171.1 cm) and GDC (151.5 cm) systems. Interior leaf number and leaf layer number were higher in the GDC system, in which there are two primary branches, in comparison to the modified T and curtain systems, which utilize one primary branch. Primary leaf area and lateral leaf area were significantly higher in the modified T trellis system in comparison to the GDC system. Berry weight, length and diameter, and total soluble solids were not significantly different among the three trellis systems. However, cluster weight and cluster number per tree were significantly higher in GDC. Titratable acidity was significantly lower in GDC. Collectively, our data suggest that the GDC trellis system is preferable for grape 'Cheongsoo' to maintain fruit quality and quantity in Korea.

On Using Near-surface Remote Sensing Observation for Evaluation Gross Primary Productivity and Net Ecosystem CO2 Partitioning (근거리 원격탐사 기법을 이용한 총일차생산량 추정 및 순생태계 CO2 교환량 배분의 정확도 평가에 관하여)

  • Park, Juhan;Kang, Minseok;Cho, Sungsik;Sohn, Seungwon;Kim, Jongho;Kim, Su-Jin;Lim, Jong-Hwan;Kang, Mingu;Shim, Kyo-Moon
    • Korean Journal of Agricultural and Forest Meteorology
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    • v.23 no.4
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    • pp.251-267
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    • 2021
  • Remotely sensed vegetation indices (VIs) are empirically related with gross primary productivity (GPP) in various spatio-temporal scales. The uncertainties in GPP-VI relationship increase with temporal resolution. Uncertainty also exists in the eddy covariance (EC)-based estimation of GPP, arising from the partitioning of the measured net ecosystem CO2 exchange (NEE) into GPP and ecosystem respiration (RE). For two forests and two agricultural sites, we correlated the EC-derived GPP in various time scales with three different near-surface remotely sensed VIs: (1) normalized difference vegetation index (NDVI), (2) enhanced vegetation index (EVI), and (3) near infrared reflectance from vegetation (NIRv) along with NIRvP (i.e., NIRv multiplied by photosynthetically active radiation, PAR). Among the compared VIs, NIRvP showed highest correlation with half-hourly and monthly GPP at all sites. The NIRvP was used to test the reliability of GPP derived by two different NEE partitioning methods: (1) original KoFlux methods (GPPOri) and (2) machine-learning based method (GPPANN). GPPANN showed higher correlation with NIRvP at half-hourly time scale, but there was no difference at daily time scale. The NIRvP-GPP correlation was lower under clear sky conditions due to co-limitation of GPP by other environmental conditions such as air temperature, vapor pressure deficit and soil moisture. However, under cloudy conditions when photosynthesis is mainly limited by radiation, the use of NIRvP was more promising to test the credibility of NEE partitioning methods. Despite the necessity of further analyses, the results suggest that NIRvP can be used as the proxy of GPP at high temporal-scale. However, for the VIs-based GPP estimation with high temporal resolution to be meaningful, complex systems-based analysis methods (related to systems thinking and self-organization that goes beyond the empirical VIs-GPP relationship) should be developed.

Ultra-Structures And $^{14}C$-Mannitol Transport Study of Human Nasal Epithelial Cells Using ALI Culture Technique (ALI 배양법 이용한 비강 점막 상피세포의 미세구조와 $^{14}C$-mannitol 투과도)

  • Kwak, Kyung-Rok;Hwang, Jee-Yoon;Lee, Ji-Seok;Park, Hye-Kyung;Kim, Yun-Seong;Lee, Min-Ki;Park, Soon-Kew;Kim, Yoo-Sun;Roh, Hwan-Jung
    • Tuberculosis and Respiratory Diseases
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    • v.50 no.2
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    • pp.205-212
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    • 2001
  • Background : The information on nasal transport and the metabolism of peptides have been obtained from pharmacokinetic investigations in experimental animals. However, there are no transport and metabolic studies of human nasal epithelial cells. In this study, the permeability characteristics and the metabolic properties of in vitro human nasal cell monolayers were investigated. Material and Methods : Normal human inferior nasal conchal tissue samples were obtained from patients undergoing endoscopic nasal cavitary surgery. The specimens were cultured in a transwell using an air-liquid Interface (ALI) culture, and the transepithelial electrical resistance (TEER) value of the blank filter and confluent cell monolayers were measured. To determine the % leakage of mannitol, $4{\mu}mol%$ $^{14}C$-labelled mannitol was added and the % leakage was measured every 10 minute for 1 hour. Result : Human nasal epithelial cells in the primary culture grew to a confluent monolayer within 7 days and expressed microvilli. The tight junction between the cells was confirmed by transmission electron microscopy. The TEER value of the blank filter, fifth day and seventh day reached $108.5\;ohm.cm^2$, $141\;ohm.cm^2$ and $177.5\;ohm.cm^2$, respectively. Transcellular % leakage of the $^{14}$-mannitol at 10, 20, 30, 40, 50 and 60 minutes was $35.67{\pm}5.43$, $34.42{\pm}5.60$, $32.75{\pm}5.71$, $31.76{\pm}4.22$, $30.96{\pm}3.49$ and $29.60{\pm}3.68\;%$, respectively. Conclusion : The human nasal epithelial monolayer using ALI culture techniques is suitable for a transcellular permeability study. The data suggests that human nasal epithelial cells In an ALI culture technique shows some promise for a nasal transport and metabolism study.

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A Legal Study on Safety Management System (항공안전관리에 관한 법적 고찰)

  • So, Jae-Seon;Lee, Chang-Kyu
    • The Korean Journal of Air & Space Law and Policy
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    • v.29 no.1
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    • pp.3-32
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    • 2014
  • Safety Management System is the aviation industry policy for while operating the aircraft, to ensure the safety crew, aircraft and passengers. For operating a safe aircraft, in order to establish the international technical standards, the International Civil Aviation Organization has established the Annex 19 of the Convention on International Civil Aviation. As a result, member country was supposed to be in accordance with the policy of the International Civil Aviation Organization, to accept the international standard of domestic air law. The South Korean government announced that it would promote active safety management strategy in primary aviation policy master plan of 2012. And, by integrating and state safety programmes(ssp) and safety management system(sms) for the safe management of Annex 19 is to enforce the policy on aviation safety standards. State safety programmes(ssp) is a system of activities for the aim of strengthening the safety and integrated management of the activities of government. State safety programmes(ssp) is important on the basis of the data of the risk information. Collecting aviation hazard information is necessary for efficient operation of the state safety programmes(ssp) Korean government must implement the strategy required to comply with aviation methods and standards of the International Civil Aviation Organization. Airlines, must strive to safety features for safety culture construction and improvement of safety management is realized. It is necessary to make regulations on the basis of the aviation practice, for aviation safety regulatory requirements, aviation safety should reflect the opinion of the aviation industry.

Facters Affecting Recurrence after Video-assisted Thoracic Surgery for the Treatment of Spontaneous Pneumothotax (자연기흉에 대한 비디오흉강경수술후 재발에 영향을 미치는 요인들)

  • 이송암;김광택;이일현;백만종;최영호;이인성;김형묵;김학제
    • Journal of Chest Surgery
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    • v.32 no.5
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    • pp.448-455
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    • 1999
  • Background: Recent developments in techniques of video-assisted thoracic surgery(VATS) and endoscopic equipment has expanded the application of video-assisted surgical procedures in the field of thoracic surgery. Especially, it will probably become the treatment of choice of spontaneous pneumothorax(SP). There is, however, a high recurrence rate, high cost, and paucity of long-term results. We report the results of postoperative follow-up and analyze perioperative parameters affected to recurrence, retrospectively. Material and Method: From march 1992 to march 1997, 276 patients with spontaneous pneumothorax underwent 292 VATS procedures. Conversion to open thoracotomy was necessitated in eight patients, and this patients excluded from the study. Result: The sex distribution was 249 males and 31 females. The mean age was 28.1 12.2 years(range, 15 to 69 years). Primary SP was 237cases(83.5%) and secondary SP was 47cases(16.5%). The major underlying lung diseases associated with secondary SP were tuberculosis 27cases(57.4%) and emphysema 8cases (38.3%). Operative indications included Ipsilateral recurrence 123(43.9%), persistent air-leak 53(18.9%), x-ray visible bleb 40(14.3%), tension 30(10.7%), contralateral recurrence 21(7.5%), uncomplicated first episode 8(2.9%), bilateral 3(1.1%), complicated episode 2(0.7%). Blebs were visualized in 247cases(87%) and 244cases(85.9%) performed stapled blebectomy. Early postoperative complications occurred in 33 cases(11.6%): 16 prolonged air-leak more than 5 days(four of them were required a second operation and found missed blebs); 5 bleeding; 5 empyema; 2 atelectasis; 1 wound infection. No deaths occured. The mean operative time was 52.8 23.1 minutes(range, 20 to 165 minutes). The mean d ration of chest tube drainage was 5.0 4.5 days(range, 2 to 37 days). The mean duration ofhospital stay was 8.2 5.5 days (range, 3 to 43days). At a mean follow-up 22.3 18.4 months(range, 1 to 65 months), 12 patients(4.2%) were lost to follow-up. There were 24 recurrences and seven patients underwent second operation and 6 patients(85.7%) were found the missed blebs. 12 perioperative parameters(age, sex, site, underlying disease, extent of collapse, operative indication, size of bleb, number of bleb, location of bleb, bleb management, pleural procedure, prolonged postoperative air-leak) were analyzed statistically to identify significant predictors of recurrence. The significant predictors of recurrence was the underlying disease[17.0%(8/47): 6.8%(16/237), p=0.038], prolonged postoperative air-leakage[37.5%(6/16): 6.7%(18/268), p=0.001], and pleural procedure [11.4%(19/167): 4.3%(5/117), p=0.034]. Blebectomy has less recurrence rate then non-blebectomy [8.2%(20/244) : 10.0%(4/40), p>0. 5]. However, this difference was not statistically significant(p=0.758). Conclusion: We conclude that it is important that we shoud careful finding of bleb during VATS due to reducing of recurrnece, and cases of no bleb identified and secondary spontaneous pneumothorax were indicated of pleurodectomy. VATS is a valid alternative to open procedure for the treatment of spontaneous pneumothorax with less pain, shorter hospital stay, more rapid return to work, high patient acceptance, less scar and exellent cosmetics. But, there is high recurrence rate and high cost, and than it is necessary to evaluate of long-term results for recurrence and to observate carefully during VATS.

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