• Tuberculosis and Respiratory Diseases
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• v.47 no.4
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• pp.538-542
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• 1999

Spontaneous hemothorax may be developed as a complication of von Recklinghausen's disease. It is rare but fatal. A 60 year old man with von Recklinghausen's disease was admitted to our hospital because of left chest and shoulder pain. Radiograph of chest showed a massive left pleural effusion. Thoracentesis revealed gross blood. The peripheral angiography was done to determine the source of bleeding and its finding showed intercostal artery aneurysm in left 7th rib. No active bleeding from the aneurysm was seen. The source of the hemothorax was believed to be hemorrhage from rupture of intercostal artery aneurysm. He was inserted chest tube and treated embolization of intercostal artery aneurysm.

• Journal of Medicine and Life Science
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• v.18 no.3
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• pp.61-65
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• 2021

Although re-expansion pulmonary edema (RPE) is rare (incidence rate <1%), it is associated with a mortality rate of >20%; therefore, early diagnosis and treatment are important. We report a case of RPE following chest tube insertion in a patient with spontaneous pneumothorax. We have specifically focused on the mechanism underlying RPE and the possible etiology. An 82-year-old man with a history of chronic anemia, chronic obstructive pulmonary disease, diabetes mellitus, and hypertension was referred to the emergency department for management of recurrent right-sided pneumothorax. We performed emergency closed thoracostomy for suspected tension pneumothorax, which led to stabilization of the patient's vital signs; however, he coughed up frothy pink sputum accompanied by severe right-sided chest pain 30 min postoperatively. The patient showed new-onset right pulmonary consolidation on chest radiography, as well as desaturation, tachycardia, and tachypnea and was diagnosed with RPE. He was transferred to the intensive care unit for mechanical ventilation and supportive treatment using diuretics, ionotropic agents, and prophylactic antibiotics. RPE gradually resolved, and the patient was extubated 3 days after admission. He has not experienced recurrent pneumothorax or pulmonary disease for 4 months. We emphasize the importance of RPE prevention and that aggressive ventilator care and supportive treatment can effectively treat RPE following an accurate understanding of the underlying pathogenetic mechanisms and risk factors.

• Journal of Chest Surgery
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• v.39 no.3 s.260
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• pp.220-225
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• 2006

Background: Spontaneous pneumomediastinum is an uncommon, benign, self-limited disorders that usually occurs in young adults without any apparent precipitating factors or disease. The purpose of this study was to review our experience in dealing with this entity and describe a reasonable course of assessment and management. Material and Method: A retrospective case series was conducted to identify adults patients with SPM who were diagnosed and treated in a single institution between 2001 and 2005. Result: Fifteen patients were identified who included 14 men and 1 women with a mean age of 26 years. Presenting symptoms were chest pain in 12 patients ($80\%$), dyspnea in 5 patients ($33\%$), and throat discomfort in 4 patients ($26\%$). Two cases were associated with use of inhalational drugs and 3 cases were associated with exercise. The predisposing factors were asthma, excessive exercise, and vomiting in spontaneous pneumomediastinum. The physical findings were subcutaneous emphysema in 10 patients ($77\%$). Chest radiography and computerized tomography were the diagnostic methods in all cases with CT scan revealing six cases with associated pulmonary abnormalities. Esophagogram and flexible bronchoscopy were selectively used. Fifteen patients ($100\%$) were admitted to the hospital. Their mean hospital stay was 3 days. All patients were conservatively treated. In a follow-up of 3 years no complications or recurrences were observed. Conclusion: Most simple spontaneous pneumomediastinum cases were benign diseases and most of them ($77\%$) had shown typical chest pain, dyspnea and subcutaneous emphysema. Inhalational drug use was not a major cause of SPM; however, increased use of bronchoinhalers was a suspicious cause of SPM.

• The Korean Journal of Pain
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• v.5 no.1
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• pp.37-43
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• 1992

Postoperative hypoxemia in the absence of hypoventilation occurs more often after thoracic or upper abdominal surgery than lower abdominal operations or surgery on extremities. Although the factors which produce postoperative alveolar collapse have not been fully evaluated, the dominant factor of postoperative hypoxemia is shunt of blood passing collapsed alveoli and the postoperative pain is associated with restriction of depth of breathing, sighing and movement. In 1979, the first successful clinical usage of epidurally administered morphine for control of postoperative pain was reported by Behar and associates. This study was carried out for twenty patients who received posterolateral thoracostomy with bleb resection between May 1990 and May 1991 and who were primary spontaneous recurrent pneumothoraxes under general endotracheal anesthesia. For the relief of post-thoracotomy pain following of the general anesthesia, we selected ten patients as control group which were treated intermittently IM with injection of pethidine(50 mg) according to the conventional method and another ten patients as study group which were managed with thoracic epidural analgesia. The tip of the catheter was inserted to T4-5 epidural space through T12-L1 or L1-2 interspinous region before the induction of the general anesthesia and then the epidural analgesics(0.25% bupivacaine 15 ml+morphine 3 mg) was injected once a day via the catheter until 4 th POD in the study group. The epidural catheters were removed at postoperative 4 th day in study group. Clinical observations were done about vital signs, ABG, tidal volume, FVC and occurence of adverse effects during postoperative 2hr, 8hr, 1st day, 2nd day, 7th day in both groups. The results were as follows; (1) The values of $V_T$ and FVC were significantly improved in study group(85% and 66%) as compared with control group(76% and 61%) during the postoperative 4 day of the epidural analgesia. (2) After the end of the epidural analgesia(7th POD), the values of FVC were improved invertly rather in control group(98%) than study group(84%). It suggested that the reduction of FVC in study group were caused by the raised pain sensitivity following the end of epidural analgesia. (3) The side effects of epidural analgesia such as transient urinary retention(2 cases), itching sensation(1) and headache(1) were noted.

• Tuberculosis and Respiratory Diseases
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• v.60 no.3
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• pp.347-352
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• 2006

A teratoma is the most common benign germ cell tumor that develops in the mediastinum. Patients with a mediastinal teratoma are usually asymptomatic. However, a spontaneous rupture of a mediastinal teratoma into the pleural cavity or adjacent organs can cause severe chest pain, hemoptysis, acute dyspnea, etc. Complications such as recurrent pneumonia, pericardial effusion, pleural effusion and great vessel invasion can sometimes occur. We encountered a case of a patient with an abrupt onset of dyspnea after persistent shoulder pain for one month. The X-ray examinations revealed a unilateral mediastinal mass with contralateral pleural effusion. Subsequent evaluations confirmed a spontaneous rupture of the teratoma into the contralateral pleural cavity.

• Journal of the korean academy of Pediatric Dentistry
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• v.38 no.2
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• pp.194-201
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• 2011

A dentigerous cyst is the most common developmental odontogenic cyst. Patients with dentigerous cyst usually feel no pain or discomfort. If it is not treated, tooth eruption might not only be impeded, but also let the tooth translocate to the unusual area. So, early detection and appropriate treatment are important. Enucleation & marsupialization are the best options to treat a dentigerous cyst. Treatment plan depends on patient's age, health, preserve & protect of important structures, and sort of cyst. In these dentigerous cysts cases, by marsupialization and using obturator, affected tooth could be achieved spontaneous eruption into the dental arch even though they were badly dislocated.

• Journal of Chest Surgery
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• v.39 no.1 s.258
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• pp.56-59
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• 2006

Background: Spontaneous pneumomediastinum (SPM) is a relatively rare and benign condition that generally occurs in young adults without any precipitating factor or disease. The purpose of this study was to assess whether more uncomforting diagnostic procedures are necessary and to establish standards in the diagnosis and treatment of spontaneous pneumomediastinum. Material and Method: A retrospective study was done on 18 patients from the hospitals of Hanyang University Seoul Hospital and Hanyang University Guri Hospital between February, 1997 and June, 2004. All patients had presence of mediastinal air without a pneumothorax and no evidence of trauma or barotrauma. Result: Among the 18 patients, the majority were male patients with only two female patients. Their mean age was 20.95 years old with standard deviation of 14.3 years. The most common complaints were chest pain, dyspnea, and coughing. Evaluation included simple chest roentgenogram in all patients, 10 patients had a chest tomographic scan, 10 patients had an esophagoscopic exam, 6 patients had a bronchofiberoscopic exam, and 3 patients had an esophagogram done. The mean hospital stay was 10.9 days. All patients were treated conservatively and in a follow-up of 1 $\∼$ 8 years only one recurrence was found. Conclusion: SPM is caused by alveolar rupture in the pulmonary interstitium leading to dissection of air towards the hilum and mediastinum. Although SPM is a self-limiting condition, evaluation should include chest roentgenogram and chest tomographic scans to rule out any other secondary condition. More aggressive evaluation seems unnecessary.

• Journal of Acupuncture Research
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• v.22 no.1
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• pp.77-90
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• 2005

Objective : Neuropathic pain sometimes arises from a partial peripheral nerve injury. This kind of pain is usually accompanied by spontaneous burning pain, allodynia and hyperalgesia. It has been well known that acupuncture is effective to the pain control from ancient time in Asia. However, it is not clear whether Electroacupuncture(EA) & Acupuncture(AC) can control neuropathic pain effectively. The aim of this study is to examine if Electroacupuncture&Acupuncture at Hu-gye(SI03), Wijung(BL4O), Hu-gye(SI03) Wijung(BL40) may be effective to the neuropathic pain (mechanical allodynia cold allodynia) in a rat model of neuropathic pain. Methods : A rat model of neuropathic pain was made by injurying tibial nerve and sural nerve while common peroneal nerve was maintained. After the neuropathic surgery, we examined if the rats exhibited the behavioral signs allodynia. The allodynia was assessed by stimulating the medial malleolus with von frey filament and acetone. Three weeks after the neuropathic surgery, electroacupuncture &, acupuncture stimulation was delivered to Hu-gye(SI03), Wijung(BL40), Hu-gye(SI03) Wijung(BL40) one time a day for one week. After that we examined the withdrawal response of neuropathic rats' legs by von frey filament and acetone stimulation, c-fos and AchE(Acetylcholine esterase) in the periaqe- ductal gray(PAG) of neuropathic rats' brain. Results : 1. Electroacupuncture&Acupuncture at Hu-gye(SI03), Wijung(BL40), Hu-gye(SI03) Wijung(BL4O) significantly decreased the withdrawal response of mechanically allodynia in EA-BL40+SI03 group and AC-SI03 group as compared with control group on 6th day. 2. Electroacupuncture &Acupuncture at Hu-gye(SI03), Wijung(BL40), Hu-gye (SI03) Wijung (BL40) significantly decreased the withdrawal response of chemical allodynia(cold allodynia) in EA-SI03 group, EA-BL40+SI03 group and AC-SI03 group as compared with control group on 6th day. 3. Electroacupuncture & Acupuncture at Hu-gye ( SI03), Wijung (BL40), Hu-gye (SI03) Wijung(BL40) significantly decreased the expression of c-fos in the periaqe- ductal gray(PAC) of neuropathic rats' brain in EA-BL40+SI03 group and AC-SI03 group as compared with control group. 4. Electroacupuncture&Acupuncture at Hu-gye(SI03), Wijung(BL40), Hu-gye (SI03) Wijung(BL40) significantly decreased the expression of AchE in the periaqe- ductal gray(PAG) of neuropathic rats' brain in EA-BL40+SI03 group and AC-SI03 group as compared with control group. Conclusions : Based on the above results it is assumed that Electroacupuncture at Hu-gye(SI03) Wijung(BL40) and Acupuncture at Hu-gye(SI03) can help the treatment of neuropathic pain.

• Journal of Chest Surgery
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• v.50 no.4
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• pp.281-286
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• 2017

Background: In chemical pleurodesis for managing pulmonary air leak, tetracycline derivatives are commonly used, and their effectiveness has been established in many studies. Recently, a Viscum album extract was used in chemical pleurodesis. We compared the effects of V. album with those of a tetracycline derivative (doxycycline) to demonstrate the therapeutic effectiveness of the V. album extract in chemical pleurodesis for managing pulmonary air leak. Methods: Between October 2010 and October 2016, chemical pleurodesis was performed using doxycycline in 40 patients and the V. album extract in 37 patients. Thirty-three patients were in the postoperative state after pulmonary resection, and 44 patients suffered from spontaneous pneumothorax. Results: No statistically significant difference in the success rate was observed between the 2 groups (V. album extract and doxycycline). In both groups, chest pain was the most common complication. More patients in the doxycycline group complained of severe chest pain (42.1% vs. 13.5%, p=0.006). In the V. album extract group, 24.3% of the patients required a chest tube to drain the pleural effusion after cessation of the air leak (doxycycline group: 5%, p=0.022). Further, the amount of pleural effusion drained on the day after the last chemical pleurodesis in the V. album extract group was greater than that in the doxycycline group ($162.2{\pm}170.2mL$ vs. $97.0{\pm}77.2mL$, p=0.032). All patients were discharged from the hospital without complications after pleural effusion drainage. Conclusion: Considering that treatment using the V. album extract was less painful, V. album might be a feasible option for chemical pleurodesis. However, pleural effusion should be monitored carefully when using V. album extract for treating patients suffering from air leak.

• The Korean Journal of Physiology and Pharmacology
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• v.9 no.2
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• pp.77-86
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• 2005

In this study, we examined the morphine-induced modulation of the nociceptive spinal dorsal horn neuronal activities before and after formalin-induced inflammatory pain. Intradermal injection of formalin induced time-dependent changes in the spontaneous activity of nociceptive dorsal horn neurons. In naive cats before the injection of formalin, iontophoretically applied morphine attenuated the naturally and electrically evoked neuronal responses of dorsal horn neurons. However, neuronal responses after the formalin-induced inflammation were significantly increased by morphine. Bicuculline, $GABA_A$ antagonist, increased the naturally and electrically evoked neuronal responses of dorsal horn neurons. This increase in neuronal responses due to bicuculline after the formalin-induced inflammation was larger than that in the naive state, suggesting that basal $GABA_A$ tone increased after the formalin injection. Muscimol, $GABA_A$ agonist, reduced the neuronal responses before the treatment with formalin, but not after formalin treatment, again indicating an increase in the GABAergic basal tone after the formalin injection which saturated the neuronal responses to GABA agonist. Morphine-induced increase in the spinal nociceptive responses after formalin treatment was inhibited by co-application of muscimol. These data suggest that formalin-induced inflammation increases $GABA_A$ basal tone and the inhibition of this augmented $GABA_A$ basal tone by morphine results in a paradoxical morphineinduced increase in the spinal nociceptive neuronal responses after the formalin-induced inflammation.