• Journal of Chest Surgery
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• 제10권2호
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• pp.214-218
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• 1977

There appears to be significant problems remained in the treatment of thoracic empyema inspire of the more potent broad spectrum antimicrobial agents available and improved surgical managements. Clinical analysis of 60 patients of thoracic empyema was done who received major and/or minor surgical intervention at the Dept. of Thoracic and Cardiovascular Surgery, Korea University Hospital in the period of 3 years from May 1973 to July 1976. Following was the results: 1. Male was predominent to female with the ratio of 2.16 to 1, and adult to infant was 2.75: 1. 2. Most frequent predisposing factors of thoracic empyema in infancy and childhood was pneumonia [38.3%], and in adult was pulmonary tuberculosis [36.7%]. 3. Cardinal symptoms were dyspnea, fever, chest pain and productive cough etc. 4. Positive result of bacteriological culture study was reported in 26. 7%, and among them, Staph. aureus [10%], Diplo. pneumonia [3.3%], Streptococcal group [1.7%], Pseu. aeruginosa [1.7%], Paracolon bacilli [1.7%] and others [8.3%] in respectively. No growth of pathologic organism was reported in 60.0%, and not requested in 13.3%. Among the negative group, tuberculosis was confirmed on pathological tissue slide in half and other half was not determined bacteriologically and pathologically. 5. Surgical treatment was performed to the almost all of the patients with closed thoracostomy [48.3%], empyemectomy [28.3%], empyemectomy with pulmonary resection [11.7%] and others [I1.6%] in respectively with favorable results. 6. Mortality rate was 8.3% [5 cases], each one with lung cancer, diabetes mellitus, respiratory insufficiency, sepsis and another, two months old infant with asphyxia.

• Journal of Chest Surgery
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• 제9권1호
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• pp.102-106
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• 1976

The management of infection occurring in the space which remains after removal of lung presents considerable difficulties both for the patient and the surgeon. We have during the past one year, developed a procedure, which has been successfully applied in 4 cases of postpneumonectomy empyema by modification of Clagett's procedure. All their underlying lung diseases were pulmonary tuberculosis. The diagnosis of postpneumonectomy empyema was confirmed by thoracentesis, and bacteriologic cultures were obtained in all patients. Dead space thoracis was irrigated with various kind of antiseptic Solutions and debrided, filled with antibiotics saline solutions. The patients had a smooth post operative course except one case and was discharged from the hospital on the 3 weeks post-operative day in average. The failure case was wound leaking & redeveloped empyema, & waiting for reoperation.

• Journal of Chest Surgery
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• 제27권5호
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• pp.374-378
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• 1994

Bronchoplastic and angioplastic operation in lung surgery is appropriate treatment for a wide range of benign endobronchial lesions and low grade malignancies. Between March 1990 to February 1994, four patients underwent bronchial sleeve resection and one patient received left upper lobe lobectomy with pulmonary artery angioplasty. Types of disease includes two cases of endobronchial tuberculosis and three cases of lung cancer. The main operation performed are one pneumonectomy, two right upper lobectomy and one each of left upper lobectomy and left lower lobectomy. All cases received sleeve resection not due to decreased respiratory reserve but due to anatomic suitability. One patient who received pneumonectomy had postoperative complication of empyema thoracis.

• Journal of Chest Surgery
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• 제36권1호
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• pp.21-25
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• 2003

농흉의 치료에서 흉막박피술 또는 괴사조직 절제에 비디오 흉강경을 사용한 수술(VATS)이 유용한 치료로서 제시되고 있지만 아직은 검증이 필요한 단계이나. 농흉의 시기에 관계없이 시행한 농흥의 흉강경적 치료에 대한 우리의 수술방법과 경험을 보고하고자 한다. 대상 및 방법 : 흉강내 감염을 보이는 40명의 환자에서 흉막박피술과 괴사조직 절제에 비디 흉강경을 사용한 수술을 내시경 세이버(endoscopic shaver system)로 시행하였다 수술전후 결과에 대한 후향적 연구를 시행하였고 이 수술방법의 효과를 평가하였다. 결과. 감염된 흉막액의 배출과 흉박피술 비디 흉강경을 사용한 수술은 40명중 35명에서 성공적으로 시행되었다. 전원 되기 전 술전 증상의 평츈 기간은 23$\pm$1.8일 이었고, 수술을 위해 전과되기 전의 평균 입원기간은 13.5$\pm$1.5일이었다. 실혈량은 200dp서 250 mL 이었다. 흉관 배액은 5$\pm$3일간 필요하였고, 수술후 입원은 5$\pm$0.7 일이었다. 수술사망율은 없었다. 결론 : 비디오 흉강경을 이용한 감염된 흉막액을 배농하고 박피술을 시행하는 것은 섬유성 화농성기의 농흉을 치료하는데 있어 효과적인 치료방법 중의 하나이며, 만성기농흉의 기질화된 유착 때문에 가금 개흉술을 통한 박피술이 필요할 때도 있지만, 이러한 유착자체가 비디오 흉강경을 이용한 배농술과 박피술의 절대적 금기는 아닌 것으로 생각된다.

• Journal of Chest Surgery
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• 제41권6호
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• pp.795-798
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• 2008

50세 남자 환자가 좌상복부 동통 및 발열 증상을 주소로 내원하였다. 환자는 과거력상 28년전에 폐결핵 및 늑막염으로 약물치료를 받았으며 8년전 재생불량성 빈혈로 비장 절제술을 받았다. 내원 후 시행한 CT 검사상에서 만성 좌측 농흉과 연결을 보이는 복강내 농양이 진단되었다. 만성 농흉과 더불어 전흉벽에 농흉에 의한 흉벽 침습이 의심되는 병병도 아울러 관찰되었다. 환자는 복강내 농양 배액술 이후 좌측 늑막전폐절제술 및 흉벽 절제술을 시행 받았고 병리 조직 검사상 육종이 진단되었다.

• Journal of Chest Surgery
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• 제22권6호
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• pp.1101-1105
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• 1989

Fifty one patients with empyema thoracic were managed at the Kyung Hee University Medical Center during 5 years between December, 1982, and December, 1987. The patients were classified into two groups; group A [early minithoracotomy-9 patients] and group B[conventional chest tube insertion-42 patients]. Each group was retrospectively analyzed to compare the results in terms of leukocyte count change, body temperature change, duration of hospitalization, elapsed time to chest tube removal and the need for subsequent decortication and tube change. There was no statistical difference between two groups in terms of etiology, age and sex. l. In the group A, mean preoperative leukocyte count [19,300/mme] decreased to 8,688/mme postoperatively. In the group B, leukocyte count changed from 16,985/mme to 14,433/mme. Their differences were significant [P< 0.05]. 2. In the group A, mean preoperative body temperature [38.5] decreased to 36.7. In the group B, body temperature changed from 38.1oC to 37.5 oC. Their differences were significant [P < 0.05]. 3. Mean duration of Hospitalization; 18.2 days [group A], 30.2 days [group B]. Their differences were significant [P < 0.01]. 4. Mean elapsing time for chest tube removal; 15.2 days [group A], 28.5 days [group B]. Their differences were significant [P < 0.01]. 5. There was no need for subsequent decortication and chest tube change in the group A. There were 22 cases [52.3 %] for subsequent decortication and 12 cases [28.6 %] for chest tube change in the group B. Early minithoracotomy in treating empyema thoracis resulted in a shorter hospital stay and a shorter period of tube drainage than conventional method.

• Journal of Chest Surgery
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• 제26권4호
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• pp.325-328
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• 1993

The pedicled omental flap has been used for treatment of various kind of complications in thoraxcic surgery. Its property of promoting neovascularization , immunilogic properties that limiting the spread of infection, providing soft tissue coverage are very effective in treatment esophageal fistulas. Also, congenital broncho-esophageal fistula [ BEF ] is a rare disease entity which was reported about 100 cases around the world. We experienced 27 years old female patient with Braimbridge type I congenital BEF. We performed division of BEF using stapler and pericardial patch coverage of esophageal side with concomittent left lower lobectomy. This patient was complicated with postoperative esophageal leakage with empyema thoracis. We have successfully managed these problems with re-thoracotomy and re-closure of esophageal fistula using Right Gastroepiploic Artery based pedicled omental flap wrapping around the esophageal anastomosis site. It is felt that pedicled omental flap is a very effective method to manage esophageal complication such as postoperative esophageal leakage.

• Journal of Chest Surgery
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• 제23권4호
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• pp.736-744
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• 1990

From Jan. 1985 to Sep. 1989, four hundred and ten patients were admitted to the department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine with a diagnosis of nonpenetrating chest trauma. The most common cause of injury were motor vehicle accidents(75.1%) with the prevalent age group being their forties. The four most common findings were rib fracture(83.4%), hemothorax(50.7%), pneumothorax(24.6%) and clavicle fracture(12.0%), Fifty piratory insufficiency and the ventilation time was correlated with 6 fators : 1) shock 2) endotracheal intubation or tracheostomy 3) hemothorax 4) clavicle fracture 5) flail chest 6) more than three combined injuries or combined head injury. Ventilatory care was also related with mortality and complications such as pneumonia sepsis and empyema thoracis(p<0.05). The most common organism of post-traumatic infection were Pseudomonas and Staphylococcus.

• Journal of Chest Surgery
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• 제20권2호
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• pp.328-341
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• 1987

We reviewed 147 cases of primary carcinoma of the lung between January 1975 and December 1986 at the Thoracic and Cardiovascular Department, Yonsei university College of Medicine, Seoul, Korea. There were 116 males and 31 females with 93.72% ranging in age from 40 to 69 years. The mean age was 61.01 years. To 69 years of age with 61.01 years of mean age. There were 92 [62.59%] cases of squamous cell carcinoma, 29 [19.73%] cases of adenocarcinoma, 8 [5.44%] cases of undifferentiated large cell carcinoma, 8 [5.44%] cases of undifferentiated small cell carcinoma and 10 [6.8%] cases of bronchoalveolar cell carcinoma. 50 [34.01%] patients in stage I and 49 [33.26%] patients in stage II underwent pneumonectomies and lobectomies with a 67.27% rate of resection, where as only 49.12% of stage III patients were resected. Also 7 [30.43%] of the 23 stage IV cases were surgically resected and confirmed stage IV after surgical resection. The actuarial survival rate according to classification are as follows. The one and 3 year survival rate of the patients in stage I were 96% and 84% respectively. The one and `3 year survival rate of the patients in stage II were 100% and 66.6%, whereas the one and 3 year survival rate of the patients in stage III, T3 were 78.57% and 69.84%. The survival rates of patients in stage I, II, III T3 were better than those of the other stages. There were significant differences in observed survival for patients with stage II as compared with the patients with stage Ill, T3. [p=0.0005]. An aggressive surgical approach still offered the greatest chance for long-term survival even in stage Ill, T3. The survival rate in patients with resectable cases including stage III, T3 might be improved with an aggressive surgical approach. The one and 3 year survival rates of patients in stage III, N2 were 56.67% and 43.7 I%. The one and 3 year survival rates of patients in stage IV were 21.43% and 3.57%. Patients in stage III, N2 or IV had markedly decreased survival rates. When the carcinoma cell type was the basis for the determination of rate of survival, the result were as follows; The one, 3 and 5 year survival rates of squamous cell carcinoma were 78.33%, 60.19%, and 57.32%, and the one and 3 year survival rates of adenocarcinoma were 55.56% and 44.49%. The survival rates of large cell carcinoma were 66.67%, and 44.45%, at one, three and five years respectively. The one and 3 year survival rates of bronchoalveolar cell carcinoma were 71.43% and 47.62%, the one, 3 and 5 year survival rates of small cell carcinoma were 40%, 20% and 20%. The survival rate of squamous cell carcinoma was better than that of other cell carcinomas, the survival rate of small cell carcinoma was the worst. The operative mortality rate was 1.36%. There were 10 cases of post-operative complications including 2 cases of bleeding which required further surgery, 2 cases of wound infection, and 4 cases of empyema thoracis. The length of survival of three of the empyema thoracis cases was 16, 98 and 108 months respectively, Four male patients all older than 47 years survived more than 9 years, post surgery, although one developed empyema thoracis. These four cases were initially classified as 2 cases of stage I and one each of stage II and stage III, T3. We have concluded that the survival rates of patients in stages I, II and III, T3 were improved after complete surgical resection.

• Journal of Chest Surgery
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• 제12권4호
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• pp.312-317
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• 1979

1] During the period of Jan. 1959, to Aug. 1979, 47 patients of paragonimiasis have been treated in the department of Chest Surgery. 2] The total number of patients who has been admitted and treated in the department of Chest Medicine are 262 and annual distribution of number of patients has been decreased. However, since 1964, the number of patients has been stationary. On the other hand, the total number of patients who has been admitted and treated surgically in the department of Chest Surgery are 47 and the annual distribution of number of patients has not been decreased. 3] The peak age incidence lies in fourth decade [34%], and over halves of patients is in third to fifth decade. Male to female is 8.4 to 1. 4] The symptoms, which are mainly cough, chest pain, dyspnea and blood tinged sputum, developed mostly in two to five years after infestation by Paragonmius westermani. 5] Sputum tests for eggs of Paragonimus westermani were positive in 16 out of 43 patients [37%]. The 93% of patients were positive in skin test for Paragonimus westermani. The patients with negative skin test were 7%, but sputum or stool examination for Paragonimus westermani`s eggs were positive in these negative group of skin test. 6] Chest roentgenogram revealed pleural effusion [41 cases], hydropneumothorax [1 case], atelectasis [1 case] and mediastinal mass [1 case]. 7] All patients were preoperatively treated with Bithionol. The mode of surgery were decortication only [31 cases], pleuropneumonectomy [3 cases], decortication & lobectomy [2 cases], decortication & closure of bronchial fistula [1 case], thoracentesis [1 case] and postural drainage [1 case]. 8] Paragonimiasis is primarily medical disease and well treated by the administration of Bithionol. But the delayed diagnosis and missed diagnosis, especially as pulmonary tuberculosis, make the disease aggravated and chronic. Subsequently, surgical treatment is infrequently required. Chronic empyema due to Paragonimus westermani is much benign than tuberculous empyema thoracis.