• Journal of Chest Surgery
• /
• v.35 no.1
• /
• pp.43-47
• /
• 2002

Background: With the advances of video technology, thoracoscopic surgery has been applied to various areas of the thoracic surgical fields including major surgeries. Now a days,-thoracoscopic surgery is Performed as a procedure of choice for primary spontaneous pneumothorax. But the operative indication for the primary spontaneous pneumothorax has not been changed since the last few decades, although the procedure of choice was changed from open thoracotomy to thoracoscopy. Therefore, we thought new treatment strategy will be necessary for the management of primary spontaneous pneumothorax. Material and Method: Between January 1998 and December 1999, 149 primary spontaneous pneumothorax patients were admitted to the Kyungpook National University Hospital. Result: Of these patients, 177 were first attack pneumothoraces and the number of total attacks were 250. Conclusion: Analyzing the amount of pneumothorax, methods of treatment, number of recurrences, recurrence rate and hospital stay, we propose a critical pathway for establishing new treatment strategy for the management of primary spontaneous pneumothorax.

• Journal of Chest Surgery
• /
• v.23 no.4
• /
• pp.731-735
• /
• 1990

Simultaneous and non simultaneous bilateral spontaneous pneumothorax patients[273] were reviewed retrospectively from April 1986 to March 1990 in the Dept. of Thoracic and Cardiovascular Surgery, Kyung Hee University Medical College. The incidence of bilateral spontaneous pneumothorax was 13.6%[37] and sexual distribution was male dominant [Male:33, Female:4]. The patients were classified into three major groups according to therapeutic methods: Group I [7]; who were treated with simultaneous bilateral operation for unilateral recurred spontaneous pneumothorax through median sternotomy. Mean age was 20.7 years[17 \ulcorner28] and follow up duration was 7.7 months [3 weeks \ulcorner2 years]. Group II [23];who were treated with staged lateral thoractomy, unilateral thoracotomy and non simultaneous contralateral closed thoracostomy, or simultaneous or non simultaneous bilateral closed thoracostomy. Mean age was 28.6 years [17 \ulcorner56] and follow up duration was 9.8 months[one week \ulcorner3.5 years]. Group III[10] ;who were treated with simultaneous bilateral operation for simultaneous or non simultaneous bilateral spontaneous pneumothorax through median sternotomy. Mean age was 21.4 years[17 \ulcorner28] and follow up duration was 12.8 months[2 weeks \ulcorner2.7 years]. Among the patients managed through median sternotomy simultaneously [Group I and III], there were visible blebs or bullous changed lesions mainly in the apicoposterior segment bilaterally in 15 patients[88.2%] Postoperative complications were 3 cases in Group II [wound infection:2 cases, temporary left wrist drop: one case] but none in Group I and III. Spontaneous pneumothorax recurred in 2 cases, one in Group II and another in Group III but none in Group I. 12 cases of 94 patients[12.8%o] who were treated with unilateral thoracotomy needed contralateral thoracotomy mean 14.9 months[7.5 \ulcorner 25 months] later. Mean age was 20.9 years [17 \ulcorner28]. In conclusion, simultaneous bilateral operation through median sternotomy should be considered in managements of spontaneous pneumothorax, especially in late teens and early twenties except young women for cosmetic reasons.

• Journal of Chest Surgery
• /
• v.32 no.4
• /
• pp.383-387
• /
• 1999

Background: We analysed simple chest PA and high-resolution CT findings in patients with spontaneous pneumothorax in order to help selecting the kind of treatment, provide a guidline during surgical treatment, and to recognize the bulla which may not be detected by simple radiographs or may be a potential cause of recurrence. Material and Method: We retrospectively analysed the presence and number of bulla in each side, combined pulmonary disease on simple chest films and high-resolution CT, and methods and frequency of the treatment in 70 patients with spontaneous pneumothorax excluing traumatic origin. Result: 45 patients were revealed primary spontaneous pneumothorax, and the remaining 25 patients were revealed secondary spontaneous pneumothorax. All secondary spontaneous pneumothorax were from the longstanding sequelle of pulmonary tuberculosis. The patients with primary spontaneous pneumothorax group was younger(mean:26.0 years old) than secondary group (mean: 44.1 years old). On simple radiography, bulla was detected in 16 patients(30.2%). On HRCT, the bulla was detected in 53 patients(75.7%) of the total 70 patients. In 48 patients(68.6%), the bulla or bleb was noted in ipsilateral side to the pneumothorax, and 34 patients(48.6%) of them showed bulla or bleb bilaterally. 39 patients(55.7%) showed bulla or bleb in contralateral side. The number of bulla or bleb was variable. In secondary spontaneous pneumothorax group, the incidence of multiple(more than 10) bulla or bleb was higher than primary type. Most of the patients were treated by thoracostomy(36 patients) or bullectomy( 7 patients). Conclusion: HRCT was superior to detect bulla and analyse the combined pulmonary disease than simple radiography. Therefore, HRCT can help to determine the mothod of treatment, provide a guidline during surgical treatment, and notify the bulla as a possible cause of recurrent pneumothorax.

• Journal of Chest Surgery
• /
• v.26 no.5
• /
• pp.390-394
• /
• 1993

This study elvaluated clinically the surgical results of the thirty-eight patients who had exploratory thoracotomy for spontaneous pneumothorax between Jan. 1989 and Nov. 1992. Thirty three, or 86.8%, of the patients were male. The most frequent age of the spontaneous pneumothorax requiring thoracotomy was between fifteen years and twenty years. Sudden onset dyspnea and chest pain, which developed in thirty-five patients[89.5%], were the major chief complaints. Bleb and Bulla located in the both upper lobes were the most frequent causes of spontaneous pneumothorax for exploratory thoracotomy. There was no operative death. Postoperative morbidity included three cases of residual air space in the apical pleural space, tow cases of atrial fibrillation, and one each case of reoperation for bleeding, mediasitinitis, and sternal osteomyelitis. All postoperative complications were treated without any serious problems. This study suggests that early exploratory thoracotmy is desirable for patients with prolonged air-leak, massive air-leak, or multiple blebs and giant bullae on the computed tomography of the chest.

• Journal of Chest Surgery
• /
• v.39 no.6 s.263
• /
• pp.475-478
• /
• 2006

Background: The simultaneous bilateral spontaneous pneumothorax is a rare clinical event. Contrary to the unilateral pneumothorax, the patients with simultaneous bilateral spontaneous pneumothorax sometimes complains of severe respiratory distress, cyanosis and chest pain without tention pneumothorax. It is often dangerous; therefore, the chest drain should be inserted immediately. Material and Method: Between March 1994 and February 2004, 802 patients were treated in our department for spontaneous pneumothorax. Among these, the simultaneous bilateral spontaneous pneumothorax developed in 14 patients (1.7%). Result: Out of fourteen patients, two females and twelve males presented with simultaneous bilateral spontaneous pneumothorax. The patient age ranged between 0 and 79 years with mean age of 31.2 years. In eleven patients, this was the first episode of pneumothorax. One patient had combined hemopneumothorax and two patients had combined pyopneurnothorax. Six patients had smoking history (42.8%, average 17.3 p-y). Five patients had pulmonary tuberculosis history and among these, two patients had active pulmonary tuberculosis. Three patients were died due to meconium-aspiration pneumonia (1 patient) and ARDS (Acute Respiratory Distress Syndrome) with pneumonia (2 patients). We treated these patients with nasal oxygen inhalation, chest drain insertion, thoracotomy, VATS (Video-Assisted Thoracoscopic Surgery) and chemical pleurodesis. Conclusion: The simultaneous bilateral spontaneous pneumothorax developed in 14 patients (1.7%) among 802 patients. Prompt insertion of chest drain is needed for a relief of severe symptoms, and to reduce the risk of recurrence, early thoracotomy or VATS should be performed rather than chest drain insertion only.

• Journal of Chest Surgery
• /
• v.25 no.11
• /
• pp.1282-1285
• /
• 1992

Forty patients with spontaneous pneumothorax underwent vertical axillarty thoracotomy for surgical bullectomy of spontaneous pneumothorax between June, 1991 and september, 1992. We evaluated the method in terms of postoperative pain, wound complication, days of hospital stay and cosmetic result. It`s concludid that verical axillary thoracotomy provides satisfactory exposure for limited procedures within the thoracic cavity and offers the specific advantages of minimal and cosmetically acceptable results when compared with the thoracotomy methods.

• Journal of Chest Surgery
• /
• v.25 no.7
• /
• pp.763-768
• /
• 1992

To prevent recurrence of spontaneous pneumothorax, 23 patients were operated through median sternotomy for simultaneous resection of bilateral bullae, And 27 patients with spontaneous pneumothorax were treated with unilateral thoracotomy, We studied the number, duration and sites of recurrence including findings of CT scan, as well as comparing the both operated group. The incidence of spontaneous pneumothorax was 88% in patients with the ages between 16 to 35 Forty one patients[82%] were operated with the indication of recurrent pne-umpthorax. The number of pneumothorax attack was 2.34 per patient with recurrent pneumothorax. The 87.8% of recurrence was occured within 6 months from last attack. Ips-ilateral recurrnet pneumothorax was 56.1% and contallateral involve was 43.9%. The bilaterality of visible bullae was 90.9% in the findings of chest CT scan and 91.3% in the operative finding. The sensitivity and accuracy for bulla detection with chest CT were 92.6%, respectively. Exclude one case of complicated median sternotomy infection, the postoperative hospital stay was shorter in median sternotomy approached group[P<0.05]. In conclusion, the bullous lesions of the lung have tendency of bilaterality so that median sternotomy for simultaneous resection of bilateral bullae should be considered in patients with contralateral visible bullae with chest CT.

• Tuberculosis and Respiratory Diseases
• /
• v.43 no.3
• /
• pp.410-419
• /
• 1996

Background : Spontaneous pneumothorax have been managed with a variety of methods. The technique most frequently used is chest tube drainage. Small caliber catheters were first used in the management of pneumothorax complicating the percutaneous needle aspiration lung biopsy, and the try to treat spontaneous pneumothorax also has been reported. However, the value of small caliber catheters in spontaneous pneumothorax has not been fully evaluated. So, we tried to elucidate the efficacy of 8 French catheter in the management of spontaneous pneumothorax. Method : From January, 1990, to April, 1994, 44 patients with spontaneous pneumothorax treated at Chung-Ang university hospital were reviewed. The patients were sub-divide into 8 French catheter insertion group (n=21) and chest tube insertion group (n=23). We compared the presence of underlying lung disease, the extent of the collapse, the duration of indwelling catheter and complication between two groups. Results : 1) The duration of indwelling showed no significant difference between 8 French catheter group and chest tube. But, complication after insertion as subcutaneous emphysema was developed in only chest tube group. (p<0.05) 2) In the primary spontaneous pneumothorax, all case of the pneumothorax of which size was less than 50% showed complete healing with 8 French catheter insertion. Whereas the success rate in patients with large pneumothorax (more than 50%) was tended to be dependent on the age. 3) In the patients with secondary spontaneous pneumothorax who were managed with 8 French catheter, the success rate was trended to be high if the underlying disease of pneumothorax was not COPD and if the patient was young. Conclusion : These results show that 8 French catheter insertion probably was effective in the pneumothorax less than 50%, the primary spontaneous pneumothorax, young age or secondary pneumothorax not associated with COPD.

• Journal of Chest Surgery
• /
• v.21 no.5
• /
• pp.871-876
• /
• 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
• /
• v.18 no.4
• /
• pp.835-839
• /
• 1985

Spontaneous pneumothorax is the sudden collapse of a lung usually caused by air leaking from a sub-visceral pleural bleb. Response to closed thoracotomy, needle aspiration and simple observation is usually prompt and effective. But in some cases, these are unsuccessful and open thoracotomy is indicated. Author reviewed 37 cases of open thoracotomy in spontaneous pneumothorax experienced in the Dept. of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, since Jan., 1980 to Dec., 1984. The results were as follows: 1. The causes of spontaneous pneumothorax: 73.0% was primary, 27.0% was secondary origin. 2. The most frequent age group of the patient: Between 11 and 30 years old. 3. All of te patient were male. 4. The side of open thoracotomy: 58.8% was right side, 8.8% was both side. 5. The most common indication of open thoracotomy; Persistent air leakage. 6. The most frequent sites of bleb or bullae: A-P segment in the L.U.L. and apical segment in the R.U.L.