• Journal of Chest Surgery
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• v.33 no.9
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• pp.773-776
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• 2000

Accidental or suicidal fatalities of paraquat(Gramoxon) poisong are occasionally seen in the emergency room or intensive care unit in this country. In most cases, respiratory symptoms and eventual death by respiratory distress occur within several days. The most striking pathologic change is fibrosis of the lung due to widespread proliferation of fibroblastic cell. We experience a 21-year-old woman with huge bulla on left lung and diffuse fibrosis in other site, who ingested paraquat 10 months ago. After thoracoscopic removal of bulla, the patient survive without progression of pulmonary complication till now.

• Tuberculosis and Respiratory Diseases
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• v.76 no.3
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• pp.99-104
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• 2014

Pneumothorax-either spontaneous or iatrogenic-is commonly encountered in pulmonary medicine. While secondary pneumothorax is caused by an underlying pulmonary disease, the spontaneous type occurs in healthy individuals without obvious cause. The British Thoracic Society (BTS, 2010) and the American College of Chest Physicians (ACCP, 2001) published the guidelines for pneumothorax management. This review compares the diagnostic and management recommendations between the two societies. Patients diagnosed with primary spontaneous pneumothorax (PSP) may be observed without intervention if the pneumothorax is small and there are no symptoms. Oxygen therapy is only discussed in the BTS guidelines. If intervention is needed, BTS recommends a simple aspiration in all spontaneous and some secondary pneumothorax cases, whereas ACCP suggests a chest tube insertion rather than a simple aspiration. BTS and ACCP both recommend surgery for patients with a recurrent pneumothorax and persistent air leak. For patients who decline surgery or are poor surgical candidates, pleurodesis is an alternative recommended by both BTS and ACCP guidelines. Treatment strategies of iatrogenic pneumothorax are very similar to PSP. However, recurrence is not a consideration in iatrogenic pneumothorax.

• Journal of Chest Surgery
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• v.1 no.1
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• pp.25-30
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• 1968

Fifty-two cases of spontaneous pneumothorax encountered in Seoul National University Hospital during the period from 1961 to 1968 were reviewed. The incidence was highest in the adult between 21 and 40 years of age, showing 50%. Four cases of bilateral spontaneous pneumothorax [7.7%] were noted. Pulmonary tuberculosis was the most common cause, 50% of the cases. Non-tuberculous group was 26 cases [50%], of which 15 cases were idiopathic, 5 emphysematous bullae or blebs, 5 inflammatory lung disease, mostly pneumonia, and one pulmonary paragonimiasis. Among 52 cases, the lung expanded completely with absolute bed rest in 7 cases, 3 out of 9 with needle aspiration and bed rest, 34 out of 41 with closed thoracotomy and underwater seal Stedman suction, and 7 cases were treated with open thoracotomy with resection of the lesions without complication. Among these cases treated with closed thoracotomy it took about 3 days in non-tuberculous group to expand the collapsed lung and more than 2 weeks in tuberculous group.

• Tuberculosis and Respiratory Diseases
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• v.38 no.1
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• pp.70-73
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• 1991

We have experienced a case of lung injury caused by accidental inhalation of ammonia gas in a 34 year-old-man. By the explosion of ammonia tank in a refrigerator boat he inhaled ammonia gas. Several minutes later, he suffered from severe dyspnea and visual loss. On arrival at emergency room, analysis of arterial blood gas revealed severe hypoxemia and his chest film showed bilateral pulmonary infiltrates. Under the impression of adult respiratory distress syndrome, mechanical ventilator was applied to the patient. After recovery from ARDS and tracheal edema, he complained of some hemoptysis and productive sputum during the admission. So we checked bronchoscopy and bronchograpy which showed tracheal bullae just above carina and tubular bronchiectatic change in the right lower lobe. We report a case of lung injuries-ARDS, tracheal bullae, and bronchiectasis-caused by inhalation of ammonia gas with the review of the relevant literatures.

• 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.

• Korean Journal of Radiology
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• v.1 no.2
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• pp.84-90
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• 2000

Objective: To determine the effects of respiration on the size of lung cysts by comparing inspiratory and expiratory high-resolution CT (HRCT) scans. Materials and Methods: The authors evaluated the size of cystic lesions, as seen on paired inspiratory and expiratory HRCT scans, in 54 patients with Langerhans cell histiocytosis (n = 3), pulmonary lymphangiomyomatosis (n = 4), confluent centrilobular emphysema (n = 9), paraseptal emphysema and bullae (n = 16), cystic bronchiectasis (n = 13), and honeycombing (n = 9). Using paired inspiratory and expiratory HRCT scans obtained at the corresponding anatomic level, a total of 270 cystic lesions were selected simultaneously on the basis of five lesions per lung disease. Changes in lung cyst size observed during respiration were assessed by two radiologists. In a limited number of cases (n = 11), pathologic specimens were obtained by open lung biopsy or lobectomy. Results: All cystic lesions in patients with Langerhans cell histiocytosis, lymphangiomyomatosis, cystic bronchiectasis, honeycombing, and confluent centrilobular emphysema became smaller on expiration, but in two cases of paraseptal emphysema and bullae there was no change. Conclusion: In cases in which expiratory CT scans indicate that cysts have become smaller, cystic lesions may communicate with the airways. To determine whether, for cysts and cystic lesions, this connection does in fact exist, paired inspiratory and expiratory HRCT scans are necessary.

• Journal of Chest Surgery
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• v.9 no.1
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• pp.78-82
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• 1976

Bullous emphysema is usually associated with extensive chronic obliterative pulmonary disease. It is the disease of old age but rare in children or infancy. The bulla in this disease is acquired one. In general the symptoms are due to not the mere presence of the bulla but the extent of underlying lung pathology as emphysema or bronchitis. Occassionally giant bulla of great size may cause symptoms and in this occassion it should be differentiated from other diseases. Especially in children or infancy pneumothorax, congenital pulmonary cyst of lobar obstructive-emphysema should be excluded. Recently we experienced 2 cases of bullous emphysema in infancy with severe respiratory symptoms because of bullae of great size. We felt difficulties in differentiating with other conditions. The purpose of this report is to review our cases thoroughly and enhance considerations of this disease.

• Journal of Chest Surgery
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• v.21 no.5
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• pp.871-876
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• 1988

Spontaneous pneumothorax is a common surgical problem and occurs most frequently in male patients under 40 years of age. The records of 336 cases in 269 patients, diagnosed and treated as spontaneous pneumothorax during the period of 1981, Jan.- 1987, Dec., at the department of thoracic and cardiovascular surgery, college of medicine, Hallym university, were reviewed retrospectively. The results were as follows; 1. Spontaneous pneumothorax was commonly found between the age of 20-40[55%]. 2. Sexual ratio of male to female was 4.4:1. 3. The most common symptoms were dyspnea and chest discomfort or chest pain. 4. Pulmonary tuberculosis was the most common cause of the disease[30.8%]. 5. Recurrent rate after closed thoracotomy drainage was 28.2%, and not recurred after operation. 6. Bullae or blebs were found most commonly at the apical segment of both upper lobes.

• Journal of Chest Surgery
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• v.24 no.10
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• pp.1039-1043
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• 1991

The bullectomy, or sedge resection of the lung including bullae is the treatment of choice for the recurrent spontaneous pneumothorax, and but results in pleuropulmonary fistulae in postoperative periods in some emphysematous lungs. There are many methods to close the air leakages with T-M, Talc powders. Or the closure of air leakage sites can be closed c resuture, wedge resection or lobectomy through re-explothoracotomy. Tisseel, a in thoracic surgical areas in recents. We have sealed the post-operative air leakage sites after bullectomy or segmental resection for 4 recurrent spontaneous pneumothorax with the spray of Tisseel & throbin through thoracoscope without re-explothoracotomy. The post-operative courses are uneventful to now.

• Journal of Chest Surgery
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• v.24 no.5
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• pp.451-458
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• 1991

We have observed 101 cases of recurrent spontaneous pneumothorax from Sep. 1979 to Dec. 1989 at the Department of Thoracic & Cardiovascular Surgery, College of Medicine, Inje University, Pusan Paik Hospital and the result obtained as follows. 1] Age range of patients was the first decade to seventh decade. Males outnumbered females by 6.7: l. One or two episodes of recurrent attack were noted in majority cases. 2] In distribution of the lesion sites, right side was 55 cases[55.4%], left 42 cases[41.9%], and bilateral 4 cases[3.0%]. 3] In clinical manifestations, abrupt onset of dyspnea was 78 cases[77.2%], chest pain 48 cases[47.5%], cough 9 cases[8.9%] and chest discomfort 8 cases[7.9%]. 4] Of 101 cases, 48 cases were associated with pulmonary tuberculosis and other cases were associated with subpleural bullae and blebs[26 cases], emphysema[7 cases], bronchiectasis[2 cases], lung cancer[1 case], and silicosis[1 case], 5] In 88 cases[87.2%] of patients, the magnitude of collapse was above 50% in plain chest film. 6] The interval of recurrence after last attack was frequently within 1 year. 7] In the management, closed thoracostomy with underwater-sealed drainage was applied in first recurrent 53 cases but 2nd recurrence was developed in 16 cases. In 52 cases, surgical management was applied. The pleurodesis with chemical agent[tetracycline] via chest tube was applied in 2 cases. Among 51 cases subjected to the open thoracotomy, pleural abrasion was performed in 3 cases, excision of bullae & blebs in 12 cases, wedge resection in 28 cases, lobectomy in 6 cases and wedge resection combined with lobectomy in 2 cases. In one case subjected to the median sternotomy, wedge resection on both lung apex was performed. 8] Postoperative complications were developed in 8 cases but not serious.