• Journal of Chest Surgery
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• v.37 no.2
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• pp.166-172
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• 2004

When compare with blebectomy or bullaectomy simply and pleurodesis together in treatment of primary spontaneous pnevmthorax, the later has been realized as the method that can reduce the recurrent rate after surgical operation. Therefore, in this study, we compared the merits and demerits of the clinical result of chemical pleurodesis that use Talcum powder in pleurodesis and mechanical pleurodesis that use apical pleurectomy and analyzed the reappearance rate etc. Material and Method: The Pleurodesis through the apical pleurectomy and talc powder insufflation had been used as secondary procedure after blebectomy of spontaneous pneumothorax from January 1, 2000 to June 30, 2002. This study consisted of a retrospective review of 68 patients who were treated with apical pleurectomy, and 84 patients treated with talc powder insufflation. We compaired the apical pleurectomy and talc powder insufflation in terms of age, sex, cause of operation, number of used autosuture staple, tine duration of procedure after blebectomy, severity of pain and complication after operation, postoperative air leakage period, duration of chest tube insertion, hospitalization, and recurrence rate of pneumothorax. Result: Time required for secondary procedure was longer in apical pleurectomy than talc powder insufflation. Postoperative pain was more severe in talc powder insufflation than apical pleurectomy. Otherwise there was no significant difference between two methods. Conclusion: Although Talc powder insufflation is more convenient than apical pleurectomy, the difference is not large and, the severity of postoperative pain is worse in talc powder insufflation. Therefore apical pleurectomy can be recommended for the secondary surgical procedure after blebectomy of primary spontaneous pneumothorax can be recommended.

• Journal of Chest Surgery
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• v.35 no.2
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• pp.127-132
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• 2002

Video-assisted thoracic sympathicotomy is a safe and effective therapy for the treatment of essential hyperhidrosis with immediate symptomatic improvement. However, this is offset by the occurrence of a high rate of side effects, such as embarrassing compensatory hyperhidrosis. Therefore, by comparing and assessing the degree of symptomatic improvement or compensatory sweating following sympathicotomy at various levels and the extent of block, we are to determine the optimal level of sympathicotomy and which method will result in minimal side effects and maximal benefits. Material and Method: From January 1998 to June 2001, the thoracoscopic sympathicotomy was performed in 150 patients suffering from essential hyperhidrosis in the Dept. of Thoracic and Cardiovascular Surgery, Wonkwang University Hospital. The patients were divided into three groups. GroupI(n=50): patients having undergone 72,3,4 sympathicotomy, GroupII (n=50): patients having undergone 72 sympathicotomy which consist of blocking the interganglionic neural fiber on the second rib, and group 111(n=50): patients having undergone 73 sympathicotomy which consist of blocking the interganglionic neural fiber on the third rib. The parameters were composed of the satisfaction rate of treatment, the degree of compensatory sweating, postoperative complications, and changes of plantar sweating. Results: There was no difference in age and sex among the groups. All of the treated patients obtained satisfactory alleviation of essential hyperhidrosis in immediate postoperative period. However the rate of long-term satisfaction were 80%, 92%, and 96% in groupsI,II, and III respectively(p<0.05). More than embarrassing compensatory hyperhidrosis was present in 50%, 28%, and 18% in groups I,II ,and III respectively(p<0.05). Slight but comfortable amounts of palmar humidness was expressed in decreasing order, group III(34%), groupII(6%), and group I(4%) respectively(p<0.05). In regard to plantar sweating, decrease in sweating was expressed in each of the three groups, but was not significant between the groups.

• Journal of Chest Surgery
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• v.37 no.1
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• pp.64-71
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• 2004

Background: Video-assisted sympathicotomy is a safe and effective method for the treatment of essential hyperhidrosis with immediate symptomatic improvement. However, this is offset by the occurrence of a high rate of side-effects, such as embarrassing compensatory hyperhidrosis. Therefore, by comparing and assessing the relationship between temperature change measured by DITI (digital infrared thermographic imaging) and clinical results according to the level and extent of sympathicotomy in essential hyperhidrosis. we tried to obtain a more precisely and objectively, the distribution and degree of compensatory sweating by DITI and also for ascertaining the clinical usefulness. Material and Method: From January 2000 to June 2002, the thoracoscopic sympathicotomy was performed in 28 patients suffering from essential hyperhidrosis in Dept. of Thoracic and Cardiovascular Surgery, Wonkwang University Hospital. The patients were divided into four groups, Group I: patients having undergone T2 sympathicotomy, Group II: patients having undergone T3 sympathicotomy, Group III: patients having undergone T3,4 sympathicotomy, and Group IV: patients having undergone T2,3,4 sympathicotomy. The parameters were composed of the satisfaction rate of treatment, the degree of compensatory and plantar sweating, and temperature changes of entire body measured by DITI Result: There was no difference in age and follow-up period among the groups. All of the treated patients obtained satisfactory alleviation of essential hyperhidrosis in immediate postoperative period. However, the rate of long-term satisfaction were 85.8%, 85.8%, 42.9%, and 28.6% in group I, II, III, and IV (p<0.05). More than embarrassing compensatory sweating was present in 14.2%, 14.2%, 57.1%, 71.4% in group I, II, III, and IV (p<0.05) In regard to plantar sweating, decrease in sweating was expressed in each of four groups, but was not significant between groups. An apparent increase of temperature measured by DITI indicated sufficient denervation and predicted long-lasting relief of essential hyperhidrosis and also decrease in temperature of trunk and lower extremity by DITI had correlated well with postoperative satisfaction, and also postoperative compensatory sweating. Conclusion: We suggested that the incidence and degree of compensatory sweating was closely related to the site and the extent of thoracic sympathicotomy. Resection of the lower interganglionic neural fiber of the second thoracic sympathetic ganglion on the third rib is the most practical and minimally invasive treatment than other surgical methods. We were also to anticipated the distribution and degree of compensatory sweating by DITI precisely and objectively and for ascertaining the clinical usefulness.

• Journal of Chest Surgery
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• v.32 no.3
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• pp.294-298
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• 1999

Background: Video-assisted thoracoscopic surgery(VATS) has been established as a new method for treatment of spontaneous pneumothorax. We compared the clinical results of VATS with those of thoracotomy performed during the recent 5 years. Material and Method: We analyzed 126 patients whose medical records were available among the 154 patients who underwent operations for spontaneous pneumothorax from 1992 to 1996. The mean age was 27.1 years(15 to 75 years). 87 patients were operated on by VATS(Group A) and the other 39 by thoracotomy(Group B). The mean follow-up period was 14.7 months. Result: The operation time was shorter in group A than in group B(90.6${\pm}$38.6minutes: 117.2${\pm}$58.9minutes, p<0.05). The duration of postoperative hospital stay was shorter in group A than in group B(6.7${\pm}$4.2: 9.4${\pm}$3.3 days, p<0.05). The amount of analgesics(nalbuphin HCl, ketoprofen) used postoperatively were 2.4${\pm}$2.8 ampules in group A, which is less than the 6.5${\pm}$5.6 ampules in group B(p<0.05). The number of staples used in group A was smaller(2.7${\pm}$1.3 in group A, 1.76${\pm}$1.1 in group B, p<0.05). The duration of chest tube indwelling(4.3${\pm}$4.0 days in group A, and 5.6${\pm}$3.0 days in group B, NS), the recurrence rate(13.8% in group A, 2.6% in group B, NS), and the duration of air leakage(1.3${\pm}$3.3 days in group A, and 1.0${\pm}$2.5days in group B, NS) were not statistically different between the two groups. Conclusion: The application of VATS for the treatment of spontaneous pneumothorax has brought in better clinical results(shorter operation time, shorter hospital stay, less pain, and better cosmetic merits) than the thoracotomy without increasing any morbidity. However no advantages in recurrence rates and duration of postoperative air leakages are revealed.

• Tuberculosis and Respiratory Diseases
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• v.63 no.3
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• pp.261-267
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• 2007

Background: The causes of the pleural effusion are remained unclear in a the substantial number of patients with exudative effusions determined by an examination of the fluid obtained via thoracentesis. Among the various tools for diagnosing exudative pleural effusions, thoracoscopy has a high diagnostic yield for cancer and tuberculosis. Medical thoracoscopy can also be carried out under local anesthesia with mild sedation. The aim of this study was to determine diagnostic accuracy and safety of medical thoracoscopy. Methods: Twenty-five patients with exudative pleural effusions of an unknown cause underwent medical thoracoscopy between October 2005 and September 2006 in Konyang University Hospital. The clinical data such as age, gender, preoperative pulmonary function, amounts of pleural effusion on lateral decubitus radiography were collected. The vital signs were recorded, and arterial blood gas analyses were performed five times during medical thoracoscopy in order to evaluate the cardiopulmonary status and acid-base changes. Results: The mean age of the patients was 56.8 years (range 22-79). The mean depth of the effusion on lateral decubitus radiography (LDR) was 27.49 mm. The medical thoracoscopic pleural biopsy was diagnostic in 24 patients (96.0%), with a diagnosis of tuberculosis pleurisy in 9 patients (36%), malignant effusions in 8 patients (32%), and parapneumonic effusions in 7 patients (28%). Medical thoracoscopy failed to confirm the cause of the pleural effusion in one patient, who was diagnosed with tuberculosis by a pericardial biopsy. There were no significant changes in blood pressure, heart rate, acid-base and no major complications in all cases during medical thoracoscopy (p>0.05). Conclusions: Medical thoracoscopy is a safe method for patients with unknown pleural effusions with a relatively high diagnostic accuracy.

• Tuberculosis and Respiratory Diseases
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• v.57 no.2
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• pp.138-142
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• 2004

Background : To evaluate exudative pleural fluid, thoracentesis for microbiological and cytological examination and pleural biopsy by using a Cope needle are traditionally performed. Even after these studies, about 20% of patients remain undiagnosed. We evaluated the diagnostic accuracy and complications of 2-mm minithoracoscopy instead of blind biopsy in patients with undiagnosed exudative pleural effusion. Method : Fifteen patients with exudative pleural effusion underwent thoracoscopy between April 2002 and August 2003. The indication was undiagnosed pleural effusions after having performed sputum and pleural fluid exami-nations both microbiologically and cytologically. Results : The median age of the patients was 56 years (range 21-77). Pleural effusions were lymphocyte-dominant in 11 patients (73.3%) and neutrophil-dominant in 3 (20.0%). The remaining patient (6.7%) had pleural-fluid eosinophilia. Minithoracoscopic biopsy revealed accurate diagnosis in 14 patients (93.3%), consisting of tuberculous pleurisy in 8 (66.7%), malignant effusions in 4 (33.3%), and parapneumonic effusions in 2 (13.3%). One was diagnosed as having paragonimiasis from thoracoscopic findings and clinical considerations. There was no procedure-associated mortality. There were six cases of new onset fever (40%) and one of pneumothorax (6.7 %). Conclusion : Two-millimeter minithoracoscopy, which is less invasive than conventional thoracoscopy, was an accurate and safe method for undiagnosed exudative pleural effusion.

• Tuberculosis and Respiratory Diseases
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• v.45 no.1
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• pp.128-139
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• 1998

Background: It is well known that various cytokines and growth factors secreted mainly from alveolar macrophages do the key role in the pathogenesis of IPF. But recently it has been known that structural cells like fibroblast can also release cytokines. So the phenotypic changes in fibroblasts of IPF may do a role in continuous progression of fibrosis. The aim of this study is to find out whether there is a change in the biologic properties of the lung fibroblasts of IPF. Subjects and Method: The study was done on 13 patients with IPF diagnosed by open or thoracoscopic lung biopsy and 7 control patients who underwent resectional surgery for lung cancer. Lung fibroblast cell lines (FB) were established by explant culture technique from the biopsy or resected specimen Result: Basal proliferation of the fibroblast of IPF(IFB) measured by BrdU uptake tended to be highter than control fibroblast(NFB) (0.212 0.107 vs $0.319{\pm}0.143$, p=0.0922), also there was no significant difference in proliferation after the stimulation with PDGF or 10% serum. On the contrary, the degree of inhibition in proliferation by PGE2 was significantly lower($33.0{\pm}13.1%$) in IFB than control($46.7{\pm}10.0%$, p=0.0429). The IFB secreted significantly higher amount of MCP-l($l574{\pm}1283$ pg/ml) spontaneously than NFB($243{\pm}100$ pg/ml) and also after the stimulation with TGF-$\beta$($3.23{\pm}1.31$ ng/ml vs $0.552{\pm}0.236$ ng/ml, p=0.0012). Similarly IL-8 and IL-6 seretion of IFB was significantly higher than NFB at basal state and with TGF-$beta$ stimulation. But after the maximal stimulation with IL-1,8, no significant difference in cytokine secretion was found between IFB and NFB. Conclusion : Above data suggest that the fibroblasts of IPF were phenotypically changed and these change may do a role in the pathogenesis of IPF.

• Tuberculosis and Respiratory Diseases
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• v.44 no.5
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• pp.1094-1104
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• 1997

Background : Spontaneous pneumothoraces(SP) are divided into primary spontaneous pneumothoraces (PSP) which develop in healthy individuals without underlying pulmonary disorders and secondary spontaneous pneumothoraces(SSP) which occur in those who have underlying disorders such as tuberculosis or chronic obstructive lung diseases. Yet there is no established standard therapeutic approach to this disorder, i.e., from the spectrum of noninvasive treatment such as clinical observation with or without oxygen therapy, to aggressively invasive thoracoscopic bullectomy or open thoracotomy. Although chest tube thoracostomy has been most widely used, the patients should overcome pain in the initiation of tube insertion or during indwelling it potential infection and subcutaneous emphysema. Thus smaller-caliber tube has been challenged for the treatment of pneumothorax. Previously, we studied the therapeutic efficacy of 8 French catheter for spontaneous pneumothorax. But there has been few data for effectiveness of small-caliber catheterization in comparison with that of chest tube. In this study, we intended to observe the long-term effectiveness of 8 French catheter for the treatment of spontaneous pneumothoraces in comparison with that of chest tube thoracostomy. Method : From January, 1990 to January, 1996, sixty two patients with spontaneous pneumothoraces treated at Chung-Ang University Hospital were reviewed retrospectively. The patients were sub-divided into a group treated with 8 French catheter(n=23) and the other one with chest tube insertion(n=39). The clinical data were reviewed(age, sex, underlying pulmonary disorders, past history of pneumothorax, size of pneumothorax, follow-up period). And therapeutic effect of two groups was compared by treatment duration(duration of indwelling catheter or tube), treatment-associated complications and recurrence rate. Results : The follow-up period(median) of 8 French catheter group and chest tube group was 28 and 22 months, which had no statistical significance. Ther was no statistically significant difference of clinical characteristics between two groups with SP, PSP, SSP. The indwelling time of 8 French catheter group was $6.2{\pm}3.8$ days, which was significantly shorter than that of chest tube group in SP, $9.1{\pm}7.5$ days(p=0.047). In comparison of treatment-related complication in PSP, 8 French catheter group as 6.25% of complication showed lower tendency than the other group as 23.8% (p=0.041 ; one-tailed, p=0.053; two-tailed). The recurrence rate in each group of SP was 17.4%, 10.3%, which did not show any statistically significant difference. Conclusion : Treatment with 8 French catheter resulted in shorter indwelling time in sponteous pneumothorax, and lower incidence of treatment-related complication in primary spontaneous pneumothorax. And the recurrence rate in each of treatment group showed no statistically significant difference. So, we can recommend the 8 French small-caliber catheter for the initial therapy for spontaneous pneumothorax for the replacement of conventional chest tube thoracostomy. But further prospective study with more subjects of spontaneous pneumothorax will be needed for the evaluation of effectiveness of 8 French cateter.

• Tuberculosis and Respiratory Diseases
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• v.45 no.6
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• pp.1199-1213
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• 1998

Background : The number of immunocompromised hosts has been increasing steadily and a new pulmonary infiltrate in these patients is a potentially lethal condition which needs rapid diagnosis and treatment. In this study we sought to examine the clinical manifestations, radiologic findings, and therapeutic outcomes of pulmonary mycoses presenting as a new pulmonary infiltrate in immunocompromised hosts. Method : All cases presenting as a new pulmonary infiltrate in immunocompromised hosts and confirmed to be pulmonary mycoses by pathologic examination or by positive culture from a sterile site between October of 1996 and April of 1998 were included in the study and their chart and radiologic findings were retrospectively reviewed. Results : In all, 14 cases of pulmonary mycoses from 13 patients(male : female ratio = 8 : 5, median age 47 yr) were found. Twelve cases were diagnosed as aspergillosis while two were diagnosed as mucormycosis. Major risk factors for fungal infections were chemotherapy for hematologic malignancy(10 cases) and organ transplant recipients(4 cases). Three cases were receiving empirical amphotericin B at the time of appearance of new lung infiltrates. Cases in the hematologic malignancy group had more prominent symptoms : fever(9/10), cough(6/10), sputum(5/10), dyspnea(4/10), chest pain(5/10). Patients in the organ transplant group had minimal symptoms(p<0.05). On simple chest films, all of the cases presented as single or multiple nodules(6/14) or consolidations(8/14). High resolution computed tomograph showed peri-lesional ground glass opacities(14/14), pleural effusions(5/14), and cavitary changes(7/14). Definitive diagnostic methods were as follows : 10 cases underwent minithoracotomy, 2 underwent video-assisted thoracoscopic surgery, 1 underwent percutaneous needle aspiration and 1 case was diagnosed by culture of abscess fluid. All cases received treatment with amphotericin B with 1 case each being treated with liposomal amphotericin B and itraconazole due to renal toxicity. Lung lesion improved in 12 of 14 patient but 4 patients died before completing therapy. Conclusion : When a new lung infiltrate develops presenting either as a nodule or consolidation in a neutropenic patient with hematologic malignancy or in a transplant recipient, you should always consider pulmonary mycoses as one of the differential diagnosis. By performing aggressive work up and early treatment, we may improve prognosis of these patients.