• Medical Lasers
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• v.8 no.2
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• pp.43-49
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• 2019

The plume produced by vaporizing tissue with a laser contains a variety of contaminants called laser-generated air pollutants (LGACs). LGACs consist of a mixture of toxic gas components, biomicroparticles, dead and living cells, and viruses. Toxic odors and thick smoke from surgical incisions and the coagulation of tissues can irritate eyes and airways, as well as cause bronchial and pulmonary congestion. Because of the potential risk of the smoke, it is advisable to appropriately remove it from the surgical site. We recommend using a smoke evacuator to remove the smoke. Suction nozzles should be placed as close as possible to the surgical site in a range of 2 cm or less. In-line filters should be used between the inlet and outlet of the surgical site. All air filtration devices should be capable of removing particles below 0.1 microns in size. The filter pack should be handled according to infection control procedures in the operating room. The laser mask can be an auxiliary protective device if it is properly worn. Some smoke inhaled under the nose wrap or over the side of the mask will not be filtered. As in electrosurgical operations, a suitable mask should be worn while smoke is present.

• Journal of Chest Surgery
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• v.8 no.2
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• pp.125-134
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• 1975

The record of 137 patients with spontaneous pneumothorax seen at Busan National University Hospital during past 3years were reviewed to study the possible pathogenesis and its effective management. and the results obtained as follows; 1] The incidence of the "spontaneous" pneumothorax which developed without underlying pathology was 13-1%. The majority of those cases was considered as the result of rupture of subpleural blebs. 2] The incidence of secondary pneumothorax which developed with underlying pathology was 50.0%, in which 42.3% was combined with pulmonary tuberculosis and 8, 0% was combined with pulmonary infection. The traumatic pneumothorax was developed in 36-5% of total series. 3] In age distribution, there was pronounced difference between spontaneous and secondary pneumothorax. The majority of spontaneous pneumothorax cases was 20-30 decade and tall and tall and thin in body structure. In secondary pneumothorax, however, the incidence was relatively high in age group more than 50 years old. 4] The incidence of pneumothorax combined with pulmonary tuberculosis was particularly high in our country, and the cause of pneumothorax was seemed due to the rupture of subpleural caseous foci in some cases, but the majority was seen due to the rupture of emphysematous blebs which were formed with a pathological process of chronic tuberculosis. 5]Closed [tube] thoracotomy was the main therapeutic approach of choice in the great majority ,of pneumothorax in our series with the relapse rate of 19.6%. However, open thoracotomy and adequate surgical procedures should be undertaken in patients with continuous air leakage over 7 days and recurrent attack of pneumothorax.

• Journal of Chest Surgery
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• v.1 no.1
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• pp.11-18
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• 1968

Author studied the possible pathogenesis of spontaneous pneumothorax and its effective treatment in 33 cases, and the results obtained as follows:1) Of the 33 cases, 15 cases were originated from pulmonary tuberculosis, 11 cases were non-tuberculous natures and 7 cases were followed by traumatic chest injuries which were not associated with a laceration of the lung or rib fractures.2) So called "Idiopathic spontaneous pneumothorax" seemed mostly to be caused by rupture of the emphy- sematous blebs.3) Spontaneous pneumothorax, in process of the pulmonary tuberculosis, seemed to be caused by the rupture of blebs which was formed with a pathological process of chronic pulmonary tuberculosis.4) Author experienced interesting cases of giant blebs which had been fully occupied the right thoracic cavity. At first, it was misdiagnosed as extensive spontaneous pneumothorax on X-ray which was revealed extensive pleural air shadow with total atelectasis of the right lung. A pneumonectomy was performed together with the giant multiple blebs.5] Generally, closed thoracotomy with water-sealed drainage is the treatment of choice in spontaneous pneumothorax. However, open thoracotomy and adequate surgical procedures should be undertaken in patients with continuous air leakage or recurrent attack of spontaneous pneumothorax.aneous pneumothorax.

• Journal of Chest Surgery
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• v.27 no.6
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• pp.435-443
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• 1994

Surgical procedures to relieve congenital right ventricular outflow tract[RVOT] obstruction of heart were performed on 125 patients from September 1985 to August 1992. There were 65 males and 60 females. Ages ranged from 7 months to 33 years with a mean age of 8 years. All the patients were divided into three main groups[I, II, III] depending on the presence or absence of cyanosis and combined anomalies. The patient were classified into two groups; A and B according to the outcome after surgical repair. Group A included the patients who had a good postoperative outcome with or without mild complications such as wound disruption, or hydrothorax. Group B included the patients who had a poor outcome including hospital death and significant postoperative complications such as heart failure, low output syndrome, respiratory failure, hepatic failure and others. And the results were summarized as follows. 1. There were no significant differences in age, body surface area and aortic dimension among the group I, II, and III, but there were significant differences among groups in pulmonary arterial dimension, ACT[aortic cross clamping time], TBT [total bypass time], preoperative and postoperative ratio of systolic pressure of right and left ventricles [pre PRV/RV and post PRV/LV], and the size of Hegar dilator which passed through the RVOT postoperatively [p<0.05]. 2. In the group A and B, there were significant differences in pulmonary arterial dimension [group A:1.6$\pm$0.5 cm, group B:1.9$\pm$0.6 cm], ACT [group A:102.3$\pm$ 46.0 minute, group B:76.1$\pm$46.1 minute], TBT [group A:133.9$\pm$56.6 minute, group B:94.9$\pm$51.9 minute], pre PRV/LV [group A:1.06$\pm$0.24, group B:0.8$\pm$0.32], post PRV/LV [group A:0.58$\pm$0.18, group B:0.43$\pm$0.16].It has been concluded that postoperative prognosis of RVOT obstruction was influenced by pulmonary arterial dimension, ACT, TBT, severity of RVOT obstruction [pre PRV/LV] and post PRV/LV.

• Journal of Chest Surgery
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• v.18 no.1
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• pp.97-103
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• 1985

During the period of seven years from Jan. 1976 to Jan. 1983, one hundred cases of pulmonary tuberculous residual lesions were resected at the Department of Thoracic Surgery, Paik Hospital in Seoul, Korea. During the period of this study, 1764 patients were admitted with the diagnosis of pulmonary and/or pleural tuberculosis in the medical and surgical department as a primary or associated conditions. Among these 1764 patients, one hundred selective cases were operated. The results were as follows; l. Extents of the disease by the predominant clinical pictures were: totally destroyed lung; 18, destroyed lobe; 6, cavitary lesion with or without positive sputum; 35, bronchiectasis; 7, bronchostenosis with atelectasis; 2, empyema with or without BPF; 20, pleural thickening; 4, tuberculoma; 3, bullous cyst with tuberculosis; 5 cases, or per cent [Table 1]. 2. Male and female ratio was 1.2:1 or 55 and 45 per cent. Age distribution ranged 15 and 55 with average of 33 years [Table 2]. 3. Type of procedures were: pleuropneumonectomy; 15, pneumonectomy; 25, lobectomy; 37, bilobectomy; 6, lobectomy plus segmentectomy; 3, pleurectomy; 14 cases, or percent, Site of resections were: right; 58 and left; 42 cases, or per cent [Table 3]. 4. Incidence of complications were 10 per cent and the mortality was 4 per cent. The causes of morbidity were analyzed. The main causes of death were pulmonary insufficiency; 2, cardiac arrhythmia; 1, and hepatic insufficiency; 1 case or per cent [Table 4]. 5. Pathologic examinations of the resected pulmonary and pleuropulmonary lesions were observed by gross specimen, correlating with the pre-operative indications of the disease [Fig. 1, 2, 3, 4, 5, 6].>br> 6. Anti-tuberculous chemotherapy was done for 6 to 18 months, post-operatively, in 80 patients. Of these 49 cases were need medication for 12 months [Table 5]. Except the four operative mortality and a case of post-operative recurrent buberculosis under medication, all the other 95 cases are well in activity and free from the disease at the moment.

• Journal of Chest Surgery
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• v.57 no.2
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• pp.145-151
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• 2024

Background: Contralateral pulmonary resection after pneumonectomy presents considerable challenges, and few reports in the literature have described this procedure. Methods: We retrospectively reviewed the medical records of all patients who underwent contralateral lung resection following pneumonectomy for any reason at our institution between November 1994 and December 2020. Results: Thirteen patients (9 men and 4 women) were included in this study. The median age was 57 years (range, 35-77 years), and the median preoperative forced expiratory volume in 1 second was 1.64 L (range, 1.17-2.12 L). Contralateral pulmonary resection was performed at a median interval of 44 months after pneumonectomy (range, 6-564 months). Surgical procedures varied among the patients: 10 underwent single wedge resection, 2 were treated with double wedge resection, and 1 underwent lobectomy. Diagnoses at the time of contralateral lung resection included lung cancer in 7 patients, lung metastasis from other cancers in 3 patients, and tuberculosis in 3 patients. Complications were observed in 4 patients (36%), including acute kidney injury, pneumothorax following chest tube removal, pneumonia, and prolonged air leak. No cases of operative mortality were noted. Conclusion: In carefully selected patients, contralateral pulmonary resection after pneumonectomy can be accomplished with acceptable operative morbidity and mortality.

• Korean Journal of Head & Neck Oncology
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• v.18 no.2
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• pp.192-196
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• 2002

Objectives: Tuberculous cervical lymphadenitis is a frequently recurring disease when treated with chemotherapy alone without enough surgical removal of the tuberculous lesions. Authors reviewed retrospectively the treatment result of antituberculous chemotherapy following almost complete surgical removal of tuberculous foci in the neck. Materials and Methods: A retrospective clinical review and analysis was made in 127 cases of tuberculous cervical lymphadenitis patients treated during the past 10 years from 1989 to 1998 at the Department of General Surgery, Inje University Paik Hospital, Pusan. Results: 1) The peak age incidence was the 2nd decade(37.8%), and female was predominated over male by 2.3:1. 2) The time interval from the onset of symptoms to the first visit was less than 3 months in 60.6% of the patient. 3) The location of lymphadenitis was the right neck in 60%, the left neck 34%, and bilateral in 6% of the patient. 4) Signs on the first visit showed solitary masses(60%), abscess(25%) and both mixed(15%). 5) 25 patients(19%) had present or past history of tuberculosis; pulmonary tuberculosis 12 patients, tuberculous lymphadenitis 10 patients, and others 3 patients. 6) Locations of tuberculous lymphadenitis were posterior cervical triangle 70, supraclavicular 51, submandibular 19, anterior triangle 16 and others 4 cases. 7) The principle of treatment of cervical lymphadenitis was surgical management followed by chemotherapy. Surgical procedures were excision(s), curettage and drainage of abscess, combination of both, and biopsy in 60%, 22%, 12% and 6% respectively. Mean duration of antituberculous medication was 9 months after surgery. 8) The rate of recurrent and persistent tuberculous lymphadenitis was 9% in 4 years follow up. Conclusion: Tuberculous cervical lymphadenitis is a frequently recurring disease in young adult when only antituberculous chemotherapy was employed without almost complete removal of the lesions. It is considered that antituberculous medications for 6-9 months after removing the foci at a maximal extent by surgical excision and curettage will reduce the recurrence rate or persistence of tuberculous lymphadenitis.

• Journal of Chest Surgery
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• v.40 no.2 s.271
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• pp.103-108
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• 2007

Background: Surgical resection is an important modality in the treatment of pulmonary metastases from various solid tumors. We analyzed 37 patients who underwent surgical treatments of pulmonary metastases in our hospital from 1996 to 2005. Material and Method: Age, sex, disease free interval, operative procedure, the number of pulmonary metastases, and lymphatic metastasis were investigated with admission and operative records, and pathologic reports. Actuarial survival and comparisons between each survival rate were calculated according to Kaplan-Meier method and log-rank test, respectively, Result: Complete resections were carried out in 34 of 37 patients. The primary tumor was carcinoma in 25 cases, sarcoma in 10, and others in 2. The number of pulmonary metastases was 1 in 25 cases and 2 or more in 12 cases. 3-year and 5-year survival rates after complete resection were 50.5% and 35.9%, respectively. 3-year and 5-year survival rates for carcinoma were 64.5% and 45.0%, respectively, and 3-year survival rate for sarcoma was 17.5%. Otherwise, none of the operative procedures, the number of pulmonary metastases, lymphatic metastasis, adjunctive therapy and the disease free interval in the case of carcinoma significantly affected the survival rates. Conclusion: Complete resection of pulmonary metastasis in well selected patients allows high long term survival rate with low mortality and morbidity. Long-term follow up and randomized prospective studies were necessary to determine the prognostic factors of pulmonary metastases after surgical resection.

• Korean Journal of Radiology
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• v.22 no.5
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• pp.706-713
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• 2021

Objective: To evaluate the impact of surgical simulation training using a three-dimensional (3D)-printed model of tetralogy of Fallot (TOF) on surgical skill development. Materials and Methods: A life-size congenital heart disease model was printed using a Stratasys Object500 Connex2 printer from preoperative electrocardiography-gated CT scans of a 6-month-old patient with TOF with complex pulmonary stenosis. Eleven cardiothoracic surgeons independently evaluated the suitability of four 3D-printed models using composite Tango 27, 40, 50, and 60 in terms of palpation, resistance, extensibility, gap, cut-through ability, and reusability of. Among these, Tango 27 was selected as the final model. Six attendees (two junior cardiothoracic surgery residents, two senior residents, and two clinical fellows) independently performed simulation surgeries three times each. Surgical proficiency was evaluated by an experienced cardiothoracic surgeon on a 1-10 scale for each of the 10 surgical procedures. The times required for each surgical procedure were also measured. Results: In the simulation surgeries, six surgeons required a median of 34.4 (range 32.5-43.5) and 21.4 (17.9-192.7) minutes to apply the ventricular septal defect (VSD) and right ventricular outflow tract (RVOT) patches, respectively, on their first simulation surgery. These times had significantly reduced to 17.3 (16.2-29.5) and 13.6 (10.3-30.0) minutes, respectively, in the third simulation surgery (p = 0.03 and p = 0.01, respectively). The decreases in the median patch appliance time among the six surgeons were 16.2 (range 13.6-17.7) and 8.0 (1.8-170.3) minutes for the VSD and RVOT patches, respectively. Summing the scores for the 10 procedures showed that the attendees scored an average of 28.58 ± 7.89 points on the first simulation surgery and improved their average score to 67.33 ± 15.10 on the third simulation surgery (p = 0.008). Conclusion: Inexperienced cardiothoracic surgeons improved their performance in terms of surgical proficiency and operation time during the experience of three simulation surgeries using a 3D-printed TOF model using Tango 27 composite.

• Journal of Chest Surgery
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• v.33 no.6
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• pp.476-486
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• 2000

Background: Pulmonary atresia with intact ventricular septum(PA/IVS) is an anatomically heterogenous anomaly with a variety of surgical strategies possible. The purpose of the study is to evaluate the influence of right ventricular size on the early and midterm results of surgical repair of PA/IVS. Material and method: Medical records of 20 consecutive patients with PA/IVS operated on between January 1993 and August 1999 were retrospectively reviewed. There were 12 boys and 8 girls whose ages ranged from 2 days to 14.5 months (median 6 days). Their body weight ranged from 2.52kg to 9.35 kg(median 3.18kg). The preoperative Z-value of the diameter of the tricuspid valve(T-valve) was less than or -4 in 5 patients, between -4 and -2 in 1, between -2 and 0 in 7, between 0 and 2 in 6, and greater than or 2 in 1. All patients who had z-value of tricuspid valve greater than -2.05 were attempted biventricular repair(n=15) and all patients who had it smaller than -4.4 underwent systemic-pulmonary shunt operation only(n=3) or bidirectinal cavopulmonary shunt with right ventricular reconstruction(n=2). Result: Two early deaths(2/20, 10%) occurred. Both were infants who underwent transannular patch with shunt. One of these two had huge right ventricle(Z-value of tricuspid valve = 5). There were 2 late non-cardiac deaths 3 and 7 months after operations respectively. Follow-up was completed in all children at a mean of 35.3 months(range, 5 to 54 months). 10 of 11 survivors who underwent transannular patch or valvotomy with or without shunt procedure were in NYHA functional class I even though some of them had small interatrial communication or patent shunt. All three patients who had shunt procedure only at initial palliation completed Fontan procedures with no death. Two patients who underwent right ventricular outflow reconstruction with bidirectional cavopulmonary shunt were also in good condition. Conclusion: The transanular RVOT patch or valvotomy with or without systemic-pumonary shunt as an initial palliative procedure to achieve biventricular repair for the patients who had neither too small nor too large right ventricle(-2.05$\leq$Z-value of T-value of T-valve$\leq$2) could be performed at low operative risk(1/14 7.1%). Systemic-pulmonary shunt procedure and bidirectional cavopulmonary shunt procedure for the patients who had small right ventricle(Z-value of T-valve$\leq$4.4) could be also performed with low risk. But a patient with huge right atrium and ventricle(Z-value of t-valve=5) had poor operative result.