• Journal of Chest Surgery
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• 제27권4호
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• pp.328-330
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• 1994

Brachial plexus injury developing after axillary thoracotomy is an uncommon complication. But if it occurs, it may cause annoying events. We recently experienced 2 patients who developed brachial plexus injury after wedge resection by axillary thoracotomy . The first patient was a 22 year-old man with right spontaneous pneumothorax . After wedge resection of the right upper lung by axillary thoracotomy, he complained total paralysis of the right arm. An electromyogram was obtained at 7 days after operation, with the confirmation of brachial plexus injury. He was discharged at 22days after operation and brachial plexus injury was completely recovered 4 months after discharge. The second patient was a 17 year-old man with recurrent right pneumothorax. He underwent wedge resection of the right upper lung by axillary thoracotomy. Electromyogram confirmed the diagnosis of brachial plexus injury in the immediate postoperative period. He was discharged at 15 days after operation and brachial plexus injury was recovered 2months after discharge.Brachial plexus injury after axillary thoracotomy is caused by stretching around the clavicle and tendon of pectoralis minor by fixation of the abducted arm to the frame. Thus, when we perform wedge resection by axillary thoracotomy, we must avoid over-stretching of the brachial plexus in positioning. If brachial plexus injury develops, immediate attention and management with close rapport are important to avoid possible medicolegal problems.

• Journal of Chest Surgery
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• 제29권7호
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• pp.728-733
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• 1996

1922년 Jacobaeus가 흥강경을 처음으로 기술한 이래, 비디오흥강경수술은 많은 흉부 질환에 적용되어 왔다. 본원에서는 1994년 6월부터 1995년 7월까지 원발성 자연기흥을 가진 35명의 환자를 실험군으로 하여 비디오 흥강경수술을 시행하였고, 같은 수의 자연기흥 환자를 대조군으로 하여 정중액와 개흥술로 폐기포 절제술을 시행하였다. 저자들은 양군으로 부터 얻은 임상결과를 다음과 같이 비교하였다. 1. 성별분포는 실험군에서 남자 28명, 여자 7명이고, 대조군에서는 남자 30명, 여자 5명으로 양군에서 남 자가 대부분이었다. 연령분포는 실험군에서 최소 17세, 최고 69세, 평균 28.5$\pm$ 12.6세이고, 대조군에 서는 최소 15세, 최고 39세, 평균 23.9$\pm$6.3세를 보였다. 2. 수술시간은 실험군에서 평균 98.8 $\pm$39.3분이고 대조군에서 103.6$\pm$32.6분 이 었다. 3. 술후 흥관 삽관기간은 실험군이 평균 2.60$\pm$0.98일, 대조군이 평균 4.80$\pm$2.08일(P<0.01)이고, 술후 재원기간은 실험군이 최단 2일 최장 6일 평균 4.17$\pm$1.22일, 대조군이 최단 )일 최장 15일 평균 6.69 $\pm$ 2.52일(P<0.01)로 술후 흥관 상관기간 및 재원기간이 실험군에서 유의하게 짧았다. 4. 술 \ulcorner진통제 투여는 수술일 실험군이 1.57$\pm$0.74회1명, 대조군이 2.23 $\pm$0.60회1명이고(P<0.01), 술후 1 일째에는 실험군이 1.97 $\pm$0.70회1명, 대조군이 2.60$\pm$0.67회1명(P<0.01), 술후 2일째에는 실험군이 1 00$\pm$0.68회1명, 대조군이 2.17$\pm$0.76회1명(P<0.01)으로 실험군에서 현저한 감소를 보였고, 술후 재원 기간 중 평균 투여기간과 투여량에서도 실험군에서 각각 2.48$\pm$1.01일1명, 4.88 $\pm$ 3.70회1명이고 대조 군에서는 각각 3.70$\pm$ 1.40일1명, 8.94$\pm$4.21회1명으로 실험군에서 유의한 감소를 보였다(P<0.01, p< 0.01). 저자들은 위의 결과로, 비디오 흥강경수술을 받은 군이 정중액와 개흥으로 폐기포 절제술을 시행받은 군보다 수술후 회복이 빠르다는 것을 알 수 있었다.

• Journal of Chest Surgery
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• 제29권10호
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• pp.1133-1137
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• 1996

흉강경을 이용한 흉부수술의 경우 최근 들어 상당한 발전이 계속되면서 시술할 수 있는 분야가 크게 증가하였다. 중앙대학교 흉부외과에서는 1994년 9월부터 1995년 8월까지 비디오흉강경을 이용한 수술 67례의 임상결과를 보고하는 바이다. 1. 진단은 기흉 35례, 미만성 간질성 폐질환 9례, 농흉 7례, 폐암에 의한 삼출액 3례, 다한증 3례, 흉강내 이물질 2례, 중피종 1례, 속립성 폐결핵 1례, 기질화된 폐렴 1례였다 2. 수술은 기흉환자 35례중 흉막 유착이 심하여 개흉술로 전환한 2례를 제외한 33례 에서 비디오 흉강경 기포절제술을 시행하였다. 그외에 흉강경을 이용한 지혈 5례, 세척술 7례, 이물질 제거 2례, 악성 늑막 삼출시 활석분무 3례, 교감신경 절제 술을 3례 시행하였다. 흉강경적 생검은 12례 시행하였다. 3. 기흉환자중 재발성 기흉으로 18례 수술하였고 지속적 공기누출 12례, 단순흉부사진상 기포가 보인 례가 5례 있었다. 심한 유착을 보여 흉강경에서 전환한 개흉적 기포제거술 2례를 시행하였다. 4. 비디오흉강경적 생검을시행한 12례의 병리학적 소견은 특발성 폐섬유화증 9례, 속립성 결핵 1례, 중피종 1례 및 기질화된 폐염 1례였다. \ulcorner鈒\ulcorner폐섬유화증 9례중 7례는 박리성 간질성 폐염, 2례는 통상 성 간질성 폐염이었다. 5. 비디오흉강경 67례중에서 63례에서 특별한 합병증 없이 퇴원하였고 4례에서 합병증이 발생하였다. 2 례가 계속된 공기누출, 2례는 반대측의 무기폐가 발생하였다. 따라서 비디오홍강경 수술은 비교적 안전하고 합병증이 적으며 앞으로 흉부수술영역에서 사용범위가 확대될 것으로 생각된다.

• Journal of Chest Surgery
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• 제21권5호
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• pp.882-888
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• 1988

A case of Annuloaortic Ectasia associated with Marfan syndrome and mitral regurgitation is treated surgically by Bentall`s method and mitral annuloplasty. The Annuloaortic Ectasia is frequently accompanied with Marfan syndrome, its definition is simply explained as the following; the marked dilatation of the sinuses of Valsalva and the aortic annulus as well as the huge aneurysm of the ascending aorta. As the operative finding, the intimal tearing was shown as circular and the both coronary ostia were changed the position into high up. The patient was taken a corrective operation replacing the ascending aorta and aortic valve with a composite graft[St. Jude medical valve 29mm, woven Dacron tubular graft 31mm]. The both coronary ostia were reimplanted on the graft with 4-0 prolene by continuous suture. Mitral annuloplasty was performed. After the operation, the patient developed both spontaneous pneumothorax, he improved state by the closed thoracostomy. He has been doing well, postoperatively.

• Journal of Chest Surgery
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• 제28권11호
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• pp.1019-1024
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• 1995

Clinical analysis were performed on 68 cases of subcutaneous emphysema, those were visited at the emergency center of Chosun university hospital during the period form 1992 to 1994. The following result was obtained. 1 The incidence of subcutaneous emphysema was 0.16%, and male was dominant [M:F=6.9:1 .2 The age distribution of subcutaneous emphysema was from 4 to 77 years old and mean age was 49.6$\pm$17.8 years[$\pm$SD 3 The most presenting symptoms were chest pain[49% , and the proceeding cause was traffic accident[38% . 3 The most associated disease was a ipsilateral pneumothorax[59% . 4 Conservative management is an indication in the majority of cases of subcutaneous emphysema because it is usually a self-limited condition and spontaneous remission usually occurs. We conclude that initial effort must be made to detect the underlying cause of the subcutaneous emphysema in order that appropriate management may be undertaken.

• Journal of Chest Surgery
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• 제25권3호
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• pp.271-275
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• 1992

One hundred forty patients with empyema thoracis were managed under the general anesthesia at the Seoul National University Hospital between 1980 and 1990. The patients, who were managed by thoracentesis or intercostal tube drainage alone, were excluded in this study. There were 92 males and 48 females, ranging from 8 to 80 years of age. Underlying pathologic lesions of empyema thoracis were primary bronchopulmonary infection [84%], postoperative empyema[11%], malignancy, paragonimiasis, spontaneous pneumothorax and so on. A single causal organism was isolated only in 17 patients[the most common being staphylococcus aureus, pseudomonas, & streptacoccus pneumoniae], multiple organism in 31, and no growth in 32. Surgical treatment modalities were decortication[75], pleuropneumonectomy[30], decortication with lobectomy[10], empyemectomy[9], open drainage[13], Clagett procedure [6], thoracoplasty with or without muscle transposition[9]. Hospital mortality were in 2 cases[1.4%], one empyema related and the other nonrelated. In this study, bacteriologic findings were nonspecific and often polymicrobial. We conclude that early thoracotomy can be lifesaving in the presence of a benign clinical course.

• Journal of Chest Surgery
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• 제26권11호
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• pp.866-870
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• 1993

Possible enhancement of myocardial protection with oxygenated crystalloid cardioplegia and blood cardioplegia were evaluated in a cardiac enzyme study. The bicarbonate-containing solution equilibrated with 100% oxygen becomes highly alkaline as carbon dioxide is released. 95% oxygen and 5% carbon dioxide was added to the crystalloid cardioplegic solution [St. Thomas` Hospital No. 2 Solution] for prevention of severe alkalinity of oxygenated crystalloid cardioplegia. Heart was arrested and reinfused every 20 minutes throughtout the ischemic period with crystalloid cardioplegia or oxygenated crystalloid cardioplegia or blood cardioplegia. Group I was a patient with crystalloid cardioplegia in 11 patients. Group II was a patient with oxygenated crystalloid cardioplegia in 9 patients. Group III was a patient with blood cardioplegia in 15 patients. The value of CK-MB was evaluated from the patient`s serum at 6 hours, 24 hours, and 48 hours postoperatively. In Group I and II, there was no significant change of CK-MB. In Group I and III, the value of CK-MB at postoperative 6 hours was 114$\pm$83 ng/ml and 56$\pm$22 ng/ml [P < 0.05]. In conclusion, blood cardioplegia was superior to crystalloid cardioplegia.

• Journal of Chest Surgery
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• 제34권8호
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• pp.651-652
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• 2001

비디오흉강경을 이용한 일차성 기흉의 수술은 흉강경, 내시경용감자 그리고 자동봉합기를 위한 3개의 삽입구를 필요로 하였다. 그러나 기흉의 경우에 따라서는 내시경루프를 잘 이용할 경우 2개의 삽입구만으로도 수술이 가능하여 술후 통증 및 흉터의 최소화에도 이바지 할 수 있을 것이다.

• Journal of Chest Surgery
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• 제43권6호
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• pp.816-819
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• 2010

호너 증후군은 폐쇄식 흉강삽관술 후 발생할 수 있는 드문 합병증으로 이를 치험하여 보고하고자 한다. 17세 여자 환자로 2번째 발생한 좌측 기흉으로 폐쇄식 흉강삽관술 시행 후 수술 위해 입원하였다. 입원 후 우측 중이염 발생으로 항생제 치료 중 폐쇄식 흉강삽관술 후 3일째 흉관 삽입한 동측 동공 축동과 눈꺼풀 처짐을 증상으로 하는 호너 증후군이 발생하였고, 즉시 흉관을 2~3 cm 잡아 빼서 흉관의 위치를 교정하였다. 폐쇄식 흉강삽관술 후 5일째 기흉에 대한 낭포 절제술과 기계적 흉막 유착술을 시행하였고, 특별한 문제 없이 수술 후 7일에 퇴원하였다. 수술 후 호너 증후군으로 인한 증상은 점차 호전되었고, 2달만에 완전히 회복하였다.

• Journal of Chest Surgery
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• 제50권4호
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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.