• Journal of Chest Surgery
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• v.43 no.4
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• pp.404-408
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• 2010

Background: Pleural symphysis is regarded as an important treatment option in reducing recurrence rates after surgical treatment of spontaneous pneumothorax. However, there is much debate over the best method for achieving pleural symphysis. We retrospectively compared apical pleurectomy (AP) with mechanical pleural abrasion (MPA). Material and Method: Between January 2000 and December 2007, 83 patients underwent video-assisted thoracoscopic surgery (VATS) for spontaneous pneumothorax. In addition to wedge resection of bullae, MPA was performed in 21 patients (group A) and AP in 62 patients (group B). Result: There were no significant differences in age, gender and site of pneumothorax between the two groups. Operative time was $97{\pm}44$ minutes in group A and $77{\pm}18$ minutes in group B (p>0.05). The mean amount of pleural drainage through the chest tube on the first postoperative day was $156{\pm}87 cc$ in group A and $147{\pm}87 cc$ in group B (p>0.05). There was no mortality or significant morbidity in all patients with the exception of reoperation for bleeding in two patients in group B. In the postoperative course, there were no statistical differences between the two groups in the rate of residual air space, air leak and indwelling time of chest tube, and hospital stay. Mean follow up time was $31.7{\pm}25.3$ months, and the recurrence rate of pneumothorax was 9.5% (2/21) in group A and 6.5% (4/62) in group B, without statistical significance. Conclusion: AP was no more advantageous than MPA in terms of operative time, postoperative course and prevention of recurrent pneumothorax. Therefore, complete resection of bullae and existence of residual bullae are more important factors in reducing the incidence of recurrent pneumothorax than pleural symphysis.

• Journal of Chest Surgery
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• v.43 no.4
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• pp.394-398
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• 2010

Background: The overexpression of transforming growth factor-beta 1 receptor II (TGF-${\beta}1$RII) and transforming growth factor-beta 1 (TGF-${\beta}1$) ligand may be involved in the formation of a bulla. In this study, we tested if serum TGF-${\beta}1$ ligand levels correlated with the expression level of TGF-${\beta}1$RII and TGF-${\beta}1$ in bullous tissues from patients with spontaneous pneumothorax. Material and Method: Bullous lung tissues and blood samples were obtained from 19 patients with spontaneous pneumothorax, 18 males and 1 female, aged 17 to 35 years old. The bullous tissues were obtained by video-assisted thoracic surgery (VATS), fixed in formalin, embedded in paraffin, and cut into $5{\sim}6{\mu}m$ thick slices. Sections were immunohistochemically stained with primary antibodies against TGF-${\beta}1$ or TGF-${\beta}1$RII, and serum levels of TGF-${\beta}1$ in patients and normal controls was measured by enzyme-linked immunosorbent assay (ELISA). Result: Of the 19 patients, 16 were TGF-${\beta}1$ positive and 10 were TGF-${\beta}1$RII positive. Among the 16 TGF-${\beta}1$ positives, 9 were also TGF-${\beta}1RII$ positive. As seen previously, strong immunohistochemical staining of TGF-${\beta}1$RII and TGF-${\beta}$ was detected in the boundary region between the bullous and normal lung tissues. Average TGF-${\beta}1$ blood levels of both TGF-${\beta}1$ and TGF-${\beta}1$RII positive patients was $38.36{\pm}16.2ng/mL$, and that of five controls was $54.06{\pm}15ng/mL$. Conclusion: These results suggest that overexpression of TGF-${\beta}1$ and TGF-${\beta}1$RII expression may be involved in the formation of bullae. TGF-${\beta}1$ blood levels in patients with primary spontaneous pneumothorax is lower than normal people, suggesting that the high level of local TGF-${\beta}1$ expression in the bullous tissue region, but not in the whole blood, may contribute more in the formation of bullae.

• Journal of Chest Surgery
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• v.40 no.5 s.274
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• pp.362-368
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• 2007

Background: Spontaneous pneumothorax patients with blebs or bullae are considered to be good candidates for operation, and various objective diagnostic modalities have been performed for detection of blebs and bullae. This study was performed to compare the efficacy of thoracoscopic examination with using a minimally invasive 2 mm thoracoscope with high-resolution computed tomography (HRCT) for treating primary spontaneous pneumothorax. Material and Method: From June 2001 to March 2002, 34 patients with spontaneous pneumothorax undewent study with 2 mm video-thoracoscopic examination and HRCT. We regarded a blob larger than 5 mm in diameter as significant. Standard thoracoscopic wedge resection was performed in 18 patients with significant blob via a 2 mm video-thoracoscopic examination. 1 patient incurred bleeding, and the remaining 15 patients were treated with pleural drainage. Result: Multiple or single blob lesions were detected by 2 mm video-thoracoscope in 52.9% (18/34) of the patients with primary pneumothorax. For a total of 19 patients who were operated on, the diagnostic accuracy of the 2 mm video-thoracoscopic examination for bullae and blob was 94.7% (18/19), which was superior to that of HRCT (73.7%, 14/19). At a mean follow-up of $30{\pm}3$ months, no recurrence occurred in both the operative group and the non-operative group. Conclusion: 2 mm video-thoracoscopic examination under local anesthesia has higher diagnostic accuracy than HRCT, and it is a useful alternative for determining the operative indications for spontaneous pneumothorax.

• Journal of Chest Surgery
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• v.39 no.11 s.268
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• pp.805-809
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• 2006

Background: In our previous study, we demonstrated that transforming growth factor-beta 1 receptor II(TGF-${\beta}1RII$) may have a role in the formation of bullae. In this study, we investigated if expression of transforming growth factor-beta 1 (TGF-${\beta}1$) ligand was altered in a bullous lung tissue by immunohistochemical staining of bullous tissues from patients with primary spontaneous pneumothorax. Material and Method: Bullous lung tissues were obtained from 36 patients with primary spontaneous pneumothorax, including 34 males and 2 females aged 14 to 38 years old. Result: Of the 36 patients, 19 were TGF-${\beta}1$ positive and 24 were transforming growth factor-beta 1 receptor II(TGF-${\beta}1RII$) positive. Among the 19 TGF-${\beta}1$ positives, 15 were also TGF-${\beta}1RII$ positive, observation at high magnification showed that strong immunohistochemical stain was detected in the boundary region between the bullous and normal lung tissues. Conclusion: These results suggest that overexpression of TGF-${\beta}1$ may be involved in the formation of a bulla as well as the alteration of TGF-${\beta}1RII$ expression. Further molecular studies are needed to elucidate the more detailed molecular mechanisms of the bulla formation.

• Journal of Chest Surgery
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• v.29 no.7
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• pp.747-752
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• 1996

Video-assisted thoracic surgery(VATS) has been widely used in the treatment of spontaneous pneumothorax in spite of the absence of definitive data regarding the relative safety and long term results of this procedure. We reviewed 34 patients (group I) who underwent )8 video-assisted surgical procedures for spontaneous pneumothorax from June 1994 to December 1995 and compared the results of these patients with the results of another 14 patients (group ll) who underwent bullectomy through axillary Oho- racotomy during the same period. Average age, sex distribution, site and extent of pneumothorax, surgical indications, and complication rate showed no differences between the two groups. In group ll patients, th number and sites of bullae tend to be multiple compared to patients in group 1. The mean number of ends-GIA used for stapling of bullae was 2. 6 per patient with the range from 2 to 4 in group 1. The mean duration of chest tube drainage was not different between the two groups ().7 days and 3.9 days), but the mean time to discharge was significantly shorter in group I (5.6 days) than in group ll (8.9 days). Mean follow-up time was 12 and 11 months in each groups and ranged from 2 to 21 months. Pneumothorax recurred after three of 38 procedures in group I (7.9 %) with no recurrence in group ll. These data suggest that video-assisted thoracic surgery is a viable alternative to thoracotomy for the treatment of spontaneous pneumothorax with low morbidity and shorter hospital stay. However, it should be applied cautiously to patients with spontaneous pneumothorax because of the relatively high incidence of recurrence compared to axillary thoracotomy.

• Journal of Chest Surgery
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• v.43 no.6
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• pp.824-828
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• 2010

The cause of primary spontaneous pneumothorax (PSP) is obvious. Recently, the FLCN mutation was suggested to be a causal factor in PSP. A 47-year-old Korean male patient with chief complaint of repetitive PSP had numerous emphysematous bullae and multiple large cysts based upon high resolution computer tomography. Here we report a case of PSP with an FLCN c.468_470delTTC mutation.

• 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.

• Tuberculosis and Respiratory Diseases
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• v.45 no.3
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• pp.604-608
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• 1998

Von Recklinghausen's disease is an autosomal dominant hereditary disease associated with characteristic cafe-au-lait spots of skin and multiple neurofibromatosis. It is complicated by malignancies, which in most cases is neurofibrosarcoma. The development of lung cancer in von Recklinghausen's disease is rare. A 61-year-old male was admitted for cough and sputum for 20 days. He had multiple cafe-au-lait spots and subcutaneous neurofibromas in whole body area and Lisch nodules in both iris and he had been diagnosed von Recklinghausen's disease 35 years ago. Chest radiography showed emphysematous bullae in both upper lung field and mass in right upper lung field. Chest CT scan revealed subcarinal lymph node enlargement. Bronchoscopic biopsy was done in mass in superior segment of right lower lobe and the results showed squamous cell carcinoma. The presence of von Recklinghausen's disease and lung cancer are noteworthy.

• Journal of Chest Surgery
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• v.48 no.5
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• pp.375-377
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• 2015

We report a case of an entrapped lung after the pectus bar repair of a pectus deformity. The entrapped lung was found incidentally during video-assisted thoracoscopic surgery (VATS) for pneumothorax. Based on VATS exploration, multiple bullae seemed to be the cause of the pneumothorax, but the entrapped lung was suspected to have been a cause of the air leakage.

• Journal of Chest Surgery
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• v.27 no.3
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• pp.221-225
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• 1994

Video-assisted thoracic surgery[VATS] has recently evolved as an alternative to thoracotomy for several thoracic disorders. Between March 1993 and September 1993, 42 patients underwent VATS at Gil General Hospital. They were diagnosed as spontaneous pneumothorax in 34[81.0%], mediastinal mass in 5, congenital lobar emphysema in 1, traumatic hemothorax in 1, and sarcoidosis in 1. For pneumothorax, wedge resection of bullae or blebs was done in 18 patients, wedge resection and limited parietal pleulectomy in 13, and only pleulectomy in 2. And excision for mediastinal mass in 5, hematoma evacuation for chronic hemothorax in 1, biopsies of mediastinal lymph node and lung for confirming sarcoidosis in 1, and lobectomy of left upper lobe for congenital lobar emphysema in the child of 12 years. The period of chest tube drainage and postoperative hospitalization averaged 3.8 days [range, 1 to 11 days] and 5.9 days [range, 2 to 18 days]. Three complications occurred in 3 patients with pneumothorax [7.1%, 2 recurrent pneumothorax and 1 postoperative bleeding], and the conversion to open thoracotomy was done in 1 due to massive air leak. The causes of postoperative air leak were speculated and the techniques for saving expensive Endo-GIA staplers are described in this paper. VATS is safe and offers the benefits of reduced postoperative pain and rapid recovery. Our experience indicates a markedly expanded role for VATS in the diagnosis and treatment of various thoracic diseases.