• Journal of Chest Surgery
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• v.22 no.3
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• pp.518-523
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• 1989

A 42-year old male was seen with symptoms of dysphagia, chest pain and dyspnea of 9 months duration. A benign tumor of the posterior mediastinum was diagnosed from x-ray studies and a transthoracic needle aspiration biopsy which was inconclusive. A left thoracotomy revealed a huge mass occupying the retrocardiac space and the contra-lateral mediastinum. It was resected by blunt dissection and, during this process, a 3.0 cm laceration was created in the esophageal wall. This was repaired with Tevdec sutures and staplers and was reinforced with an intercostal muscle flap to prevent leakage. The postoperative course was entirely uneventful.

• Journal of Chest Surgery
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• v.54 no.4
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• pp.253-257
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• 2021

Video-assisted thoracic surgery (VATS) for lobectomy or segmentectomy is considered a favorable alternative to thoracotomy because of its usefulness and safety; it reduces postoperative pain, lowers morbidity, and shortens the hospital stay. However, despite these advantages of VATS, it has been difficult to perform VATS pneumonectomy due to the high morbidity and mortality rate of pneumonectomy. Recently, as VATS techniques have been developed and the usefulness of VATS pneumonectomy has continued to be reported, the frequency of VATS pneumonectomy is gradually increasing at large-volume centers. This article describes VATS pneumonectomy with a focus on the surgical technique.

• Journal of Chest Surgery
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• v.23 no.4
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• pp.720-730
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• 1990

The complicated pulmonary emphysema including “Giant bullae” and spontaneous pneumothorax often involve both lungs, and controversy exists concerning which is the more rational means of surgical treatment-bilateral simultaneous operation or two staged operation. We report three cases of the complicated bilateral bullous emphysema and two cases of bilateral spontaneous pneumothorax treated through median sternotomy. We performed the ligation of bullae, bullectomy, cystectomy, wedge resection, and left lower lobectomy through median sternotomy. No technical problems were encountered through this approach, which provided maximum benefit with one operation In conclusions, median sternotomy may be appropriate for resection of emphysematous bullae, specially in a severe COPD patient who may be poorly tolerated the superimposed loss of respiratory function due to incisional pain, because median sternotomy permit bilateral exploration, minimal impairment of pulmonary function, simultaneous restoration of pulmonary function, less incisional pain than routine lateral thoracotomy.

• Journal of Chest Surgery
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• v.29 no.11
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• pp.1257-1262
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• 1996

From January 1989 to February 1996, 50 patients with a traumatic diaphragmatic rupture were treated at the Yonsei University Wonju College of Medicine. There were 40 male and 10 female patients. The ages ranged from 2 to 80 years, with peak incidence in third decades. Thirty-nine cases had blunt trauma (traffic accident 29, falls down 7, others 3), and 11 cases had penetrating injuries (stab injury 9, gun shot 1, broken glass 1). The most common symptoms were dyspnea (76%), chest pain (58%), and abdominal pain (52%). In blunt trauma, the rupture was located in the left in 30 cases, right in 9 cases and in penetrating trauma, the rupture was located in the left in 8 cases and in the right in 3 cases. Eighteen cases underwent thoracotomy alone, 29 cases underwent laparotomy only and 3 cases had combined thoracotomy and laparotomy. The postoperative mortality occurred in 6% (3 cases), and the cause of death were septic shock (1), intracranial hemorrhage (1), and respiratory failure (1).

• Journal of Chest Surgery
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• v.43 no.4
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• pp.421-423
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• 2010

A 52-year-old female presented with pain and swelling owing to recurrent inflammation on a generator pocket. She had undergone a permanent pacemaker implantation (DDD type) 7 years previously. We planned to insert a new pacemaker after removal of the previous generator and wires through a surgical approach. However, she had a history of the left modified radical mastectomy (MRM) with radiation therapy for breast cancer. For this patient, it would be difficult to care for the postoperative wound if we approached via the median sternotomy. Therefore, we decided to use a right atrial approach via a right thoracotomy. We removed the previous pacing wires through an atriotomy and inserted a new pacemaker using epicardial pacing leads without cardiopulmonary bypass.

• Journal of Chest Surgery
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• v.12 no.4
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• pp.403-410
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• 1979

A Clinical analysis of 64 patients of thoracic empyema was done who received surgical intervention at Dept. of Thoracic Surgery of the Chosun University Hospital in the period of 3 years from September 1976 to October 1979. Following was the results: 1. Seven cases [10.9%] were under the age of 15 years, 16 cases [25%] was between 15-30 years and 41 cases [64.1%] was above the age of 30 years. A proportion of children and adult was 1:8. 2. Male and female ratio was 3:1. Right and left side pleural cavity ratio was 2.4:1. 3. Predisposing factors were pneumonia [35.9%] and pulmonary tuberculosis [28.1%]. 4. Most frequently encountered symptoms were dyspnea, cough, chest pain and fever in order. 5. Etiologic organisms were confirmed in 39 cases [86.7%] which requested in 45 cases. Staphylococcal infections were 11 cases and streptococcal, pneumococcal pseudomonas infection was infected in order. 6. Pneumothorax was associated with empyema on 21 cases [32.8%]; among those 13 cases [61.9%] were tuberculous in nature. 7. Sensitivity test was revealed that Minocin was most very sensitive drug, and next Erythromycin, Gentamycin and Penbrex in order. But most resistant drugs were Penicillin, Kanamycin, Streptomycin and Tetracycline in order. 8. Treatments were combined with antibiotics therapy and several surgical procedures for empyema. 26 cases [40.6%] were treated with closed thoracotomy drainage, 17 cases [26.6%] with open thoracotomy tube drainage and 9 cases decortication and 9 cases thoracoplasty. 9. 2 death cases occurred in 64 cases of thoracic empyema, and 79.7% cases were discharged with recovery and improvement.

• Journal of Chest Surgery
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• v.21 no.3
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• pp.447-453
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• 1988

Intrapleural instillation of tetracycline as a preventive measure against recurrence in spontaneous pneumothorax was performed at the Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital for 3 years from Jul. 1984 to Aug. 1987. In this period, 124[70.0%] out of 177 patients of spontaneous pneumothorax who received closed thoracostomy were followed up. Tetracycline pleurodesis was applied to 32 cases. The recurrence rate of the tetracycline instillation group was lower than that of noninstillation group. In patients with first attack, the recurrence rate was 12.5% in the instillation group and 35.3% in the noninstillation group. In the second episodes, 25.6% and 83.3%[p< 0.01], in the third episodes 25.0%, 100.0%[p< 0.05]. In total cases, 18.8% and 39.8%[p< 0.05] of recurrence rates were observed. Systemic or local reactions such as fever, chest pain, and pleural effusion were observed in 23 patients[71.9%] after instillation, but all were transient and benign without sequelae. In cases of systemic or local reactions the recurrence rate was lower than that with no reactions but with no statistical significance. In the four patients primarily treated with tetracycline pleurodesis who then underwent thoracotomy, mild alterations were shown in the pleurae except dense adhesions at the previous thoracotomy sites. There was no significant difference between the two groups in terms of durations of hospitalization and post-treatment recurrences.

• Journal of Chest Surgery
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• v.28 no.5
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• pp.471-474
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• 1995

A total of 20 patients underwent bullectomy in the spontaneous pneumothorax between October 1993 and August 1994. The patients were divided into two groups: Control group; the patients who received with mid-axillary approach[n=10 , Experimental group; the patients who received with video-assisted thoracic surgery [n = 10 . The results were as follows; 1. The total sex distribution was male predominence [M :F=6:1 . Mean age of control group was 31.6$\pm$ 10.1 age and experimental group was 24.3$\pm$ 5.5 age. 2. The operative times were 117.0 $\pm$ 32.6min in control group and 102.5$\pm$ 38.4min in experimental group [not significant . 3. The indwelling period of postoperative chest tube and hospital stay were 4.5$\pm$ 2.6 days and 8.3 $\pm$ 1.8 days in control group, $1.5\pm$ 0.5 days and 3.1 $\pm$ 0.3 days in experimental group[p=0.0018, < 0.0001 . 4. In control group, injection times of pain-killer were 1.7$\pm$ 0.7 times/day at operative day and 0.4$\pm$ 0.6times/day at postoperative 1 day. In experimental group, there were 0.3$\pm$ 0.7times/day at operative day and 0.1 $\pm$ 0.3times/day at postoperative 1 day[p=O.O002 at operative day, not significant at postoperative 1 day .

• Journal of Chest Surgery
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• v.2 no.1
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• pp.13-18
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• 1969

A clinical evaluation was done on a total of 41 cases of primary bronchogenic carcinoma, which came to the department of thoracic surgery, Chonnam University Hospital for the period of 5 years from May 1964, and the various factors led the patients to an inoperable stage were searched. The incidence ratio of male to female was 5.8:1 and the age group of fifty and sixty decade occupied 78% of the total. The subjective symptoms of the patients were cough with or without sputum [83%], chest pain or chest discomfort [76%], and a few incidence of bloody sputum and hemoptysis. The histological findings were 40% of squamous cell carcinoma, 35% of adenocarcinoma and 25% of anaplastic carcinoma, including 5 cases of unclassified bronchogenie carcinoma in scalene biopsy. 12 cases [29%] of a total of 41 cases received thoracotomy, but 8 cases among them were operable and 4 cases inoperable. The rest of 29 cases [71%] could not receive thoracotomy because of the various contraindication. 23 cases [70%] out of inoperable 33 cases had wasted time over 2 months duration for an operation owing to physicians` misdiagnosis of bronchogenic carcinoma as pulmonary tuberculosis, chronic lung abscess, asthma, pleurisy, pneumonia. common cold, neuralgia in order. The delaying factors led the patients to an inoperable stage were physicians misdiagnosis of bronchogenic carcinoma due to non-specific symptoms and signs of the patients, old aged patients dependance on herb medicine, and poor economical condition of the patients.

• 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.