• Journal of Chest Surgery
• /
• v.26 no.6
• /
• pp.470-474
• /
• 1993

A clinical evaluation was performed on 56 patients[ 60 cases ] of open thoracotomy in spontaneous pneumothorax who were admitted and treated at department of Thoracic and Cardiovascular Surgery, Chung Ang University, Yong San Hospital during the past 3 years from March 1990 to February 1993. The results were as follows. 1. The sex ratio was male predominence [ M:F = 7:1 ]. 2. The most common age group were 2nd, 3rd decades. 3. The most common chief complaints were dyspnea and chest pain [46.3% ]. 4. The etiologic factors of spontaneous pneumothorax were primary spontaneous pneumothorax [ 78.3%], secondary tuberculosis [ 18.3%], and others [ 3.4% ]. 5. The site of spontaneous pneumothorax was 50% in right, 40% in left, and 10% in both. 6. The state of activity on attack was almost in the usual life [ 98.3% ]. 7. Average height was 172.5 $\pm$ 5.39 cm in male and 164.0 $\pm$ 3.51 cm in female, average weight was 59.1 $\pm$ 7.06 kg in male and 52.0 $\pm$ 4.97 kg in female. 8. The common indications of open thoracotomy were recurrence [ 34.4% ] and persistent air leakage [ 17.8% ]. 9. The operative procedures were bullectomy [ 73.3% ], partial resection [ 11.7% ], lobectomy [ 11.7% ], and others [ 3.3% ]. 10. The most frequent location of bulla or bleb were apical segment of RUL [ 43.3 % ] and apicoposterior segment of LUL [ 40.0% ]. 11. The number of visible bulla or bleb were mainly 1 to 5, and size was about 1 to 3 cm.

• Journal of Yeungnam Medical Science
• /
• v.22 no.2
• /
• pp.183-190
• /
• 2005

Background: This study was performed to evaluate the incidence and clinical characteristics of symptomatic pneumothorax in the full-term neonate. Materials and Methods: We retrospectively reviewed the medical records of 32 symptomatic pneumothorax patients in the full term neonates who admitted to the neonatal intensive care unit in Ulsan Dong Kang General Hospital from January, 2000 to December, 2004. The subjects were divided into two groups according to underlying causes; spontaneous pneumothorax group and secondary pneumothorax group, then each clinical characteristics were assessed. Results: Spontaneous pneumothorax patients were 10(31%) and secondary pneumothorax patients were 22(69%). Overall incidence of spontaneous pneumothorax was 0.4%. Most common cause of secondary pneumothorax was pneumonia. Twelve cases(54.5%) among secondary pneumothorax patients were associated with mechanical ventilator care. Clinical characteristics, courses and managements were similar between two groups, but more shorter duration of admission and chest-tube insertion in spontaneous pneumothorax group Conclusion: The patient with symptomatic pneumothorax needs careful observation and proper management with or without underlying respiratory diseases.

• Journal of Chest Surgery
• /
• v.49 no.3
• /
• pp.185-189
• /
• 2016

Background: For treatment of pneumothorax in Korea, many institutions hospitalize the patient after chest tube insertion. In this study, a portable small-bore chest tube (Thoracic Egg; Sumitomo Bakelite Co. Ltd., Tokyo, Japan) was used for pneumothorax management in an outpatient clinic. Methods: Between August 2014 and March 2015, 56 pneumothorax patients were treated using the Thoracic Egg. Results: After Thoracic Egg insertion, 44 patients (78.6%) were discharged from the emergency room for follow-up in the outpatient clinic, and 12 patients (21.4%) were hospitalized. The mean duration of Thoracic Egg chest tube placement was 4.8 days, and the success rate was 73%; 20% of patients showed incomplete expansion and underwent video-assisted thoracoscopic surgery. For primary spontaneous pneumothorax patients, the success rate of the Thoracic Egg was 76.6% and for iatrogenic pneumothorax, it was 100%. There were 2 complications using the Thoracic Egg. Conclusion: Outpatient treatment of pneumothorax using the Thoracic Egg could be a good treatment option for primary spontaneous and iatrogenic pneumothorax.

• Journal of Chest Surgery
• /
• v.21 no.2
• /
• pp.299-306
• /
• 1988

We have reviewed 330 cases of spontaneous pneumothorax from Jan. 1980 to Jul. 1987 at the department of Thoracic and Cardiovascular Surgery, College of Medicine, Korea University. The ratio of male to female was 8.4:1, predominant in male. The incidence according to the age group was highest as 32% in the adolescence between 21 and 30 years old. The site of pneumothorax was right in 48%, left in 45% and bilateral in 7%. The initial symptoms were frequently dyspnea in 85%, chest pain in 63%. The etiologic factors were as follows; bleb origin in 31%, tuberculous origin in 30%, COPD in 3.3%, lung cancer in 1.5%, unknown in 29%. There was no significant difference in seasonal incidence irrespective of tuberculous or sex. The employed managements were as follows; bed rest with oxygen inhalation in 4 cases, closed thoracostomy in 326 cases, open thoracotomy in 122 cases, median sternotomy in 23 cases. The operative procedures at thoracotomy were as follows; simple pleurodesis in 5 cases, bleb excision or wedge resection in 113 cases, segmentectomy or lobectomy in 17 cases, decortication in 42 cases. Recurrence rate of each treatment was as follow; 50% in conservative treatment, 19% in closed thoracostomy, 2% in open thoracotomy, 4% in median sternotomy. Therefore overall recurrence rate was 12%. Open thoracotomy was the most effective procedure in recurrent pneumothorax, previous contralateral pneumothorax, bilateral simultaneous pneumothorax, visible bleb or bullae on the chest x-ray and persistent air leakage. 23 cases of unilateral spontaneous pneumothorax was examined whether or not underlying pathology of pneumothorax at opposite lung. 18 cases[78%] were positive findings. Therefore, bilateral thoracotomy by median sternotomy was a good operative method preventing contralateral pneumothorax.

• Journal of Chest Surgery
• /
• v.8 no.1
• /
• pp.19-28
• /
• 1975

The thoracoscopic study was reported on 21 cases of spontaneous pneumothorax requiring surgical management, and clinical values of thoracoscopic examination on spontaneous pneumothorax were also discussed. patients were treated in the Department of .Thoracic Surgery, Hanyang University Hospital for the period of two Years from May 1972 to April 1974. For exact detection of etiologic factors on spontaneous pneumothorax, the thoracoscopic examination in the intrapleural space was performed in parallel with X-ray study. this study, the difference of diagnostic and therapeutic significance between radiological and thoracoscopic findings were observed and compared simultaneously. The results are summerized as follows: Patients age was distributed between 3 and 70 years old with highest incidence in the age group of sixty decade [33. 3%], and sex ratio of male to female was 5:2. The tuberculous processes which developed superficial subpleural layer in the lung parenchyme, on the pulmonary surface could be observed by thoracoscopic examination in a characteristic picture. detection ratio of pulmonary tuberculosis by the radiologic study to that by thoracoscopy was 8:2. The adhesion between the visceral and the parietal pleura which could possibly make a rupture of the alveola and the visceral pleura was found to be localized in a small area of the lung surface. The other part of the lung surface was free of the adhesion and, therefore, the movement of the lung took place completely without any difficulty. The ruptured orifice of the pleura and pathological changes surrounding the orifice can be detected by thoracoscopy, but not by other means such as radiologic examination. A single tuberculous bleb and multiple emphysematous blebs were found on 6 cases out of 21 cases of spontaneous pneumothorax. Among these cases, radiologic Study revealed the bleb only in one patient. On the other hand, the blebs were found in all the six patients by means of thoracoscopic examination. It gives the detection ratio of bleb by radiologic study to that by thoracoscopy was 1:6. By thoracoscopy, the rupture on the lung surface were visualized on the 10 patients out of a total of 21 patients [10 patients of visual rupture]. However, the rupture of the pleura was not observed on the rest of 11 patients even by thoracoscopic examination [11 patients of non visual rupture]. Five patients [50%] out of ten who had the visual rupture on the lung surface was required a surgical operation to remove pneumothorax. For the patients who were detected to have the visual rupture of the pleura by thoracoscopy, be considered in the early stage of closed thoracostomy. of 21 patients, 16 patients [11 patients of non visual rupture of the pleura and 5 patients of visual rupture of the pleura] who received no surgical management, were treated with closed thoracostomy with continuous suction, and the` pneumothorax was healed completely up in each cases. Therapeutic measures for the remaining 5 patients of visual rupture of the pleura who were subjected to surgical approach for radical treatment of spontaneous pneumothorax were accordingly complicated, and the following different procedures were properly indicated case by case, that is, rib resection thoracostomy, simple closure of ruptured visceral pleura, wedged resection of the lung, and lobectomy.

• Journal of Chest Surgery
• /
• v.28 no.3
• /
• pp.297-302
• /
• 1995

Video-assisted thoracic surgery [VATS is emerging as a viable alternatives to thoracotomy when surgical treatment of spontaneous pneumothorax is required.Apical blebs and bullaes of the lung can be resected,and pleural abrasion can be accomplished with minimal postoperative pain and a shorter postoperative stay in hospital. We compared our results with thoracoscopic management of spontaneous pneumothorax in 20 patients [group I with a group of 32 patients previously subjected to lateral limited thoracotomy [group II . Indications for operation, sex distribution, and average age [groupI, 24.7 years ; group II, 34.4 years were comparable. Operation time [112.42 54.7 min versus 124.8 35.3 min ; P 0.03 and chest tube duration [64.4 52.3 hours versus 97.7 45.4 hours ; P 0.01 were less in group I. Postoperative hospital stay was less in group I[3.84 0.99 days;P 0.01 , as was the use of parenteral narcotics after 48 hours. [5/20=25% versus25/32=78% . Pain was quantitated by verbal rating scale in postoperative 1 to 3 days. Patients undergoing VATS experienced significantly less postoperative pain. Postoperative complication was less in group I[1/20=5% versus 3/32=8.3% . In conclusion, Video-assisted thoracoscopic management of spontaneous pneumothrax allows performance of the standard surgical procedure while avoiding the thoracotomy incision.Video-assisted thoracic surgery [VATS is safe and offers the potential benefits of shorter postoperative hospital stays and less pain with cosmetic benefits.

• Journal of Chest Surgery
• /
• v.36 no.9
• /
• pp.678-682
• /
• 2003

Video-assisted thoracoscopic surgery is good indication of secondary spontaneous pneumothorax. This method usually required general anesthesia and single-lung ventilation with collapse of other lung. But, risks of general anesthesia and single-lung ventilation must be considered in high-risk patients. Material and Method: Between September f999 and August 2001, 15 high-risk patients were treated by video-assisted thoracoscopic surgery under epidural anesthesia. Result: Video assisted thoracoscopic surgery was successfully performed in 15 patients. Duration of postoperative air-leakage was 4.3days, Significance of complication was none, No recurrence of pneumothorax was encountered. Conclusion: Video-assisted thoracoscopic surgery can be performed safely under epidural anesthesia for treatment of secondary spontaneous pneumothorax in high-risk patients.

• Journal of Chest Surgery
• /
• v.25 no.5
• /
• pp.533-540
• /
• 1992

To evaluate the risk factors involving the recurrence of the spontaneous pneumothorax, 125 patients were reviewed. These patients were consecutively diagnosed and treated for the spontaneous pneumothorax at the Department of Thoracic and Cadiovascular Surgery, Yeungnam University Hospital, from Jun. 1986 to Apr. 1991. The patients were divided into two groups, control and recurrent. The control group, consisting of the 125 patients, did not have recurrences of the pneumothorax for a period of 2 years following the first attack. The recurrent group were the remaining 57 patients, who experienced at least one recurrence during the same period. The number of patients over the age of 50 was significantly higher in the recurrent group than the control group. Abnormal findings on chest X-ray[e.g., old tuberculous scar, emphysematous change, visible bullae of blebs] were observed more frepuently in the recurrent group. also, when the pneumothorax size was larger than 50%, and the air-leakage from the chest tube was longer than 3 days during the first attack the incidence of recurrence was significantly increased in the recurrent group. The recurrence occured more frequently in the afternoon, and in the same thoracic cavity. Exertion and smoking were not related to the risk factors in this clinical setting.

• Journal of Chest Surgery
• /
• v.52 no.2
• /
• pp.85-90
• /
• 2019

Background: Variation exists in the initial treatment for the first episode of primary spontaneous pneumothorax (PSP), and no definitive consensus exists due to a lack of high-quality evidence. This study examined the outcomes of needle aspiration and closed thoracostomy in first episodes of PSP requiring intervention. Methods: This study was a randomized, prospective, single-center trial conducted between December 2015 and August 2016. Patients of all ages with a documented first episode of PSP who were unilaterally affected, hemodynamically stable, and had a pneumothorax measuring over 25% in size were included. Patients with underlying lung disease, severe comorbidities, bilateral pneumothorax, tension pneumothorax, recurrent pneumothorax, traumatic pneumothorax, and pregnancy were excluded. Patients were randomly assigned to the needle aspiration or closed thoracostomy group using a random number table. Results: Forty patients with a first episode of PSP were recruited, and 21 and 19 patients were included in the needle aspiration group and the closed thoracostomy group, respectively. The hospital stay of each group was $2.1{\pm}1.8days$ and $5.4{\pm}3.6days$, respectively (p<0.01). However, no significant differences were found in the success rate of initial treatment or the 1-month and 1-year recurrence rates. Conclusion: Needle aspiration is a favorable initial treatment in patients experiencing a first episode of PSP.

• Journal of Chest Surgery
• /
• v.25 no.9
• /
• pp.955-961
• /
• 1992

In this study, 237 cases of spontaneous pneumothorax experienced at the department of Thoracic and Cardiovascular Surgery, Kosin Medical College during from January 1986 to December 1990 were analysed retrospectively. 1. The ratio of male to female was 4.6: 1, predominent in male. The incidence of age group was highest as 36% between 21 and 40 years old. 2. The associated diseases of pneumothorax were 27 cases, in which pyothorax were 8 cases, and hydrothorax were 19 cases. 3. The site of pneumothorax was as follows: right side was 53%, left side was 45%, and both side was 2%, so right side was slight high. 4. The empolyed managements were as follows: bed rest with oxygen inhalation in 13 cases, closed thoracostomy in 155 cases, open thoracotomy in 69 cases. 5. The operative procedures of thoracotomy were as follows; simple pleurodesis in 2 cases, blebectomy & bullectomy in 38 cases, parietal pleurecttnny in 4 cases, segmentectomy in 12 cases, lobectomy in 9 cases. 6. The indication of open thoracotomy were as follows, recurrent history in 35 cases, contralateral pneumothorax history in 2 cases, continuous air leakage in 24 cases, bilateral pneumothorax in 2 cases, and visible blebs & bullaes on the chest X-ray in 6 cases. 7. The hospital duration after management was as follow, open thoracotomy in 13.2 days, closed thoracostomy in 22.4 days. The recurrent pneumothorax after closed thoracostomy was 25 cases, about 15%.