• Journal of Chest Surgery
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• 제24권8호
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• pp.757-764
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• 1991

We have observed 360 cases of spontaneous pneumothorax from January 1980 to May 1991 at the department of Thoracic and Cardiovascular Surgery, Chosun University Hospital. Males occupied 266 cases[73.9%] and females 94 cases[26.1%], and its ratio was 2.8: l. The age of patients ranged from neonate[5 days] to 84 years old. The site of pneumothorax was right in 50.3%, left in 43.3% and bilateral in 6.4%a. The clinical symptoms were frequently dyspnea, chest pain and coughing. The associated pulmonary lesions were shown pulmonary tuberculosis in 199 cases[55.3%], bullae in 54, pulmonary emphysema in 31, COPD in 17, pneumonia in 6, lung cancer in 5, paragonimiasis in 5, catamenial pneumothorax in 3 and unknown underlying pathology in 39 cases. The results of surgical management of spontaneous pneumothorax are followings: 288 out of 360 cases[80.0%] were cured by closed thoracotomy, 53 cases[14.8%] were cured by open thoracotomy. Open thoracotomy was the most effective procedure in persistent air leakage, recurrent pneumothorax, visible bleb or bullae on the chest X-ray, associated lesion, bilateral simultaneous pneumothorax, parenchymal incomplete lung expansion and bleeding after closed thoracotomy. The incidence of complication was developed in 10. ado and recurrent rate was seen in 10.6%. There was no operative death.

• Journal of Chest Surgery
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• 제24권10호
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• pp.1005-1011
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• 1991

Eighty-four patients with pulmonary metastases from gestational choriocarcinoma were treated at the Catholic Medical Center between August, 1985 and August, 1991. Among these 13 patients underwent thoracotomy with resection of pulmonary lesions and the results obtained were follows. 1] The ages of the patients ranged from 26 to 47 years, with a mean age of 31 years. 2] The frequency of chemotherapy before operation ranged from zero to 46, with a mean frequency of 13.6. 3] Four patients were operated upon for a solitary metastasis of the lung; 6 patients, for unilateral multiple metastases and 3 patients, for bilateral pulmonary metastases. 4] Eight patients underwent wedge resection; 1 patient, segmentectomy; 2 patients, lobectomy; 3 patients, open lung biopsy. The lung lesions of eleven patients showed hemorrhagic necrosis[among these, 2 patients combined with pulmonary tuberculosis]; one was non-necrotic choriocarcinoma; another one was metastatic lung carcinoma from endocrine cancer of unknown origin. 5] Among twelve patients who had managed with chemotherapy before thoracotomy three patients were in remission; among 13 patients who had undergone thoracotomy 6 patients were in remission. 6] The median survival time of these patients was 25.8 months with 3 postoperative deaths. Subsequently, in the patients with pulmonary metastases from choriocarcinoma, if the primary tumor is under control, there are no other metastases, and the patients should be able to tolerate the planned operation, it is necessary to undergo aggressive thoracotomy for diagnostic purposes; for therapeutic purposes only when the pulmonary lesion is the only remaining source of increased hCG excretion; for reduction of tumor volume to shorten hospitalization or to reduce the quantity of drugs.

• Journal of Chest Surgery
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• 제2권2호
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• pp.133-140
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• 1969

We observed 56 cases of nontraumatic pneumothorax clinically and statistically, which had been experienced at the deparment of chest surgery. St. Mary`s Hospital,Catholic Medical College in theserecent years. 1] In the underlying pathology of spontaneous pneumothorax, nontuberculous origin [60.7%], especially due to pulmonary emphysema or blebs[17.8%], especially due to pulmonary emphysema or blebs[17. 8%], tended to increase as the reports of foreign countries, but tuberculous origin was still high in our country[39.3%]. Considering the 14 cases, unknown underlying pathology, the most of them might have scattered blebs which were not revealed in chest Roentgen films. 2] The principle treatment done in our clinic was as follows; The patients, below 20% lung collapse were treated by bed rest and abdominal respiration. The patients, between 20% and 40% lung collapse were treated by repeated pleural aspiration or closed thoracotomy followed. The cases,over 40% lung collapse were treated by closed thoracotomy initially. 3] The average duration of indweIling catheter was 3 to 4 days in the closed thoracotomy. We used to not remove the indwelling catheter early to promote pleural adhesion. 4] Sometimes, the closed thoracotomy drainage induces bronchial irritation and asthmatic attacks, especially in old age group accompanying pulmonary emphysema. In these cases, respiratory difficulties and acidosis should be prevented and controlled with medical treatment including steroid therapy.

• Journal of Chest Surgery
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• 제56권3호
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• pp.224-227
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• 2023

Median sternotomy is a standard surgical technique used for left ventricular assist device (LVAD) implantation. However, if sternotomy has a prohibitive surgical risk, LVAD implantation can be performed through only left thoracotomy. We managed a patient with end-stage heart failure who had recently undergone coronary artery bypass grafting (CABG) elsewhere. The patient also had a deep sternal wound infection and bacteremia. Because of refractory cardiogenic shock, we performed extracorporeal membrane oxygenation (ECMO). After multiple mediastinal washouts and omental flap placement, ECMO was converted to extracorporeal LVAD (from the left ventricular apex to the descending aorta) through a left thoracotomy. The extracorporeal LVAD was maintained for 18 days and replaced by the HeartMate 3 LVAD. The patient was discharged in good condition 115 days after CABG.

• Journal of Chest Surgery
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• 제30권2호
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• pp.187-194
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• 1997

개흉술을 시행받은 환자에 있어서 수술후 발생하는 동통은 해결하기 힘든 문제로 다양한 방법들이 시도되어 왔다. 저자들은 침의 효능에 주목하여 개흉술후 동통억제에 침치료가 얼마나 효과가 있는지를 관찰하였다. 1995년 3월부터 9월까지 흉부질환으로 액와 절개술을 이용한 개흉술을 시행받은 20례를 무작위로 2개의 군으로 분류하였다. 동통치료를 위해 통상적으로 사용하는 진통제를 투여한 군을 대조군(n=10)으로 하고 침 치료를 시행한 군을 실험군(n=10)으로 하였다. 수술후 진통효과를 평가하기 위 해 고려대학교 의과대학 흉부외과학교실에서 정한 수술후 통증에 대한 점수체계를 이용하였다. 환자가 느끼는 동통의 정 도와 술측의 팔운동장애의 정도에서 두 군간의 유의한 차이는 없었다. 그러나 진통제의 투여회수는 침 치료를 시행한 군에서 유의하게 감소하였다(P<0.05). 따라서 저자들은 개흉술을 시행받은 환자의 수술후 동통억제시 침술을 이용함으로써 진통제의 투여회 수를 줄일 수 있으며 간기능 저하인 환자나 진통제 주사에 대 해 부작용을 나타내는 환자에게 도움이 될 것으로 생각된다.

• Journal of Acupuncture Research
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• 제35권2호
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• pp.95-100
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• 2018

Background: The aim of this study is to assess the feasibility of acupuncture treatment for the management of subacute and chronic post-thoracotomy pain in patients with traumatic multiple rib fractures. Methods: A total of 30 participants who have undergone thoracotomy after traumatic multiple rib fractures will be recruited. Participants will be invited and equally randomised into acupuncture plus usual care and usual care alone groups. A computer-generated random number sequence will be used and concealed using opaque, sealed, sequentially numbered envelopes. Twelve sessions of manual and electrical acupuncture performed by Korean medicine doctors will be provided over a span of 3 months to participants allocated to the acupuncture group. Participants in the usual care group will continue pain medication, exercise and physical therapy as required. Study feasibility will be measured based on the proportion of patients who complete the measurement of pain at 12 or 24 weeks after baseline. The clinical outcomes will include; the average pain intensity over the recent week at rest, movement and cough, quality of life, patient's global assessment of recovery, respiratory function measured by the pulmonary function test and use of pain medication at 4, 8, 12 and 24 weeks after enrolment. Adverse events will be recorded for all participants. Written informed consent will be obtained from all participants. The local ethics committee has approved the study. This pilot trial will inform further studies investigating the potential role of acupuncture for subacute and chronic post-thoracotomy pain in patients with traumatic multiple rib fractures.

• The Korean Journal of Pain
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• 제9권1호
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• pp.135-139
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• 1996

Intercostal nerve blockade with local anesthetics has been used extensively in the past to provide pain relief following thoracotomy. Its popularity fell, for a period, probably due to increasing use of epidural analgesia. More recently, interest has focused on intercostal nerve block with the introduction of variously sited catheters. Two epidural catheters were placed under direct vision, in the intercostal spaces just above and below the wound by feeding the catheters posteriorly from the wound edges, superficial to the parietal pleura. Bupivacaine 0.25%. Was infused continuously at a rate of 5 ml/hour through each of the two intercostal catheters. Each catheter was primed with 10 ml/hour through each of the two intercostal catheters. Each catheter was primed with 10 ml of 0.25% bupivacaine. Postoperative vital signs resembled preoperation data. Arterial carbon dioxide pressure ($PaCO_2$) was unchanged and arterial oxygen pressure ($PaO_2$) was increased during two days after surgery because oxygen was administered at 21/min. Forced vital capacities (FVC) and forced expiratory volume in 1 second ($FEV_1$) were decreased the day of operation but restored to preoperative value from second operation day. VAS were increased on operation day but decreased from second operation day. Motion range of arms were not impaired. We concluded that continuous intercostal nerve block through catheters placed during thoracotomy in the adjacent intercostal spaces is a simple and effective method for management of the post-thoracotomy pain.

• Journal of Chest Surgery
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• 제21권2호
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• pp.299-306
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• 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
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• 제30권8호
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• pp.809-814
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• 1997

마약성 진통제와 국소마취제에 의한 지속적 경막외마취는 개흉술후 통증감소를 위한 방법으로 널리 사용되고 있다. 본 연구에서는 지난 1994년 1월부터 1995년 7월까지 본원 흉부외과에서 츠방 혹은 후측방 개흉술을 받은 환자 38명을 대상으로 19명씩 실험군과 대조군으로 구분하여 실험군에 경막외마취를 시행하여 그 효과를 조사하였다. 먼저 lidocaine과 norphine을 섞어 경막서 지속적 외도관을 통해 주사하고 그후 bupivacaine과 morphine을 섞어 술후 5∼6일간 지속투여를 하였다. 대조군에 비해 실험군에서 환자의 통증수치와 상지거상능력과 호흡수는 주사추 30분부터 통계적으로 의미 있게 변화되어 술후 통증이 경감되고 있음을 알 수 있었고, 말초동맥혈 이산화탄소분압은 2시간 후부터 통계적으로 의미 있게 줄어들어 환자가 효과적인 호흡을 하고 있음을 알 수 있었다. 술후 재원기간도 의미 있게 줄어들었다. 경막외마취의 주요한 합병증으로는 뇨정체가 있었으나 심각하지는 않았다. 이상의 결과로 우리는 개흉술후 경막외마취가 우수한 통증완화 효과가 있어 술후 폐합병증을 예방하고 술후 빠른 회복에도 좋은 영향을 미치는 것으로 생각한다.

• 한국임상수의학회지
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• 제34권2호
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• pp.108-111
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• 2017

A 4-year-old, weighing 7.6 kg, castrated male, Pug presented with ingestion of gastric cavity foreign body. Physical examination revealed panting, retching and hyper-salivation. Blood chemistry and complete blood cell count were normal, but hypophosphatemia was observed. An abdominal radiograph revealed the foreign body (FB), round shape and 2 cm length, at the pyloric region of stomach. A thoracic radiograph revealed an incidental metal FB, 3.5 cm length, at the cranial portion of the diaphragm. An upper gastrointestinal endoscopy was performed to remove the FB in the stomach and then a peach-pit was removed. However the metal FB was not found in the esophagus therefore a lateral thoracotomy was performed. A right lateral thoracotomy through the $7^{th}$ intercostal space was accomplished to expose the right caudal lung lobe. After open the thoracic cavity, foreign body was not observed by gross evaluation and caudal lung lobe was attached to the diaphragm. The FB was identified inside the lung lobe and surrounded by granulation tissue. The metal FB (sewing needle) was removed with blunt dissection and incised lung lobe was sutured using absorbable suture material PDS 4-0 with interrupted suture. A thoracotomy tube was inserted into the thoracic cavity during surgery. Patient's respiration became stable after surgery. A chest tube was removed 3 days after surgery. No complications were noted and the dog was discharged 4 days after surgery. In small animal, foreign body ingestion is a common reason for emergency. After ingestion of the FB, perforation through the esophagus and migration to inside the lung lobe is not common in small animals. In this case, thoracic metal FB was identified incidentally and removal of a thoracic FB with thoracotomy was performed successfully.