• Journal of Chest Surgery
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• v.37 no.1
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• pp.98-101
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• 2004

Complex regional pain syndrome is pain disorder which is characterized by aching pain, marked painful sensation, hypothermesthesia, vasomotor dysfunction, hyperhidrosis, impairment of motor function, trophic changes of distal part of not-operated extremity after trauma and operation. Pain produce increased sensitivity to catecholamine and diagnosed by infra red thermography and Treatment consists of pain relief and rehabilitational therapy for functional restoration of affected limb. We experienced a case of complex regional pain syndrome in a 16-year-old man after wedge resection of pulmonary apex for bullae and report this case with a review of the literature.

• Journal of Chest Surgery
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• v.43 no.1
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• pp.53-57
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• 2010

Background: The purpose of this study is to evaluate intercostal neuropathy after rib fracture and to determine the severity of intercostal neuropathy with using a numerical rating scale and according to the duration of pain and the body mass index. Material and Method: We measured the positive sharp wave and fibrillation on the intercostal and paraspinal muscles in the thoracic region by performing needle electromyography in 47 patients who had intercostal neuralgia after rib fracture and who had needed daily analgesic for more than three months. Result: We diagnosed 11 cases as intercostal neuropathy among the 47 cases. Of the total 11 cases, 8 were male and 3 were female and they were most often of an active generation in the community. The common location of intercostal neuropathy was the intercostal space below the rib fracture and from the 7th to the 12th intercostal rib area. The incidence of intercostal neuropathy was significantly related with multiple rib fracture rather than single rib fracture. The symptoms observed were chest pain (90.9%), sensory change (81.8%), paresthesia and numbness (63.6%), back pain (27.2%) and muscle atrophy (18.2%). The numerical rating scale, the duration of pain and the body mass index showed no significant correlation with the severity of intercostal neuropathy. Conclusion: We concluded that the electrodiagnostic approach with considering the affecting factors and the clinical findings will be helpful for diagnosing and treating persistent intercostal neuralgic pain (more than 3 months) after rib fracture.

• Journal of Chest Surgery
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• v.35 no.9
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• pp.697-700
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• 2002

Primary malignant melanoma of the mediastinum is extremely rare : To date, there have been only 8 cases reported in the literature. We report a case of a 50-year-old woman presented with an anterior mediastinal mass. The mass invaded the lung parenchyme of right upper lobe, which was wedge-resected with the mass. Microscopically, spindle or polygonal tumor cells with prominent nucleoli and intracytoplasmic melanin pigments are characterized and Fontana stain confirmed the presence of melanin pigment. Immunohistochemical studies showed diffuse positive staining for HMB45, S100 protein and vimentin, which further suggested melanoma.

• The Korean Journal of Rehabilitation Nursing
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• v.6 no.1
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• pp.7-13
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• 2003

Purpose: To identify the essential characteristics of pain which nurse have to obtain for patients with chest pain, 92 patients who were admitted in medical units to take intensive tests for heart disease were investigated cross-sectionally. Method: Duration, severity, stress, anxiety, perceived severity, number of painful area, number of accompanying symptoms, triggering activity, and pattern were included as the characteristics of pain. Ejection fraction of left ventricle and number of involved area detected by ultrasonography and number of diseased coronary artery detected by cardiac catheterization were assessed as the variables of heart disease extent. Result: Severity of pain was found to be correlated with all three variables of heart disease extent. Perceived severity and number of accompanying symptoms were correlated with two of them. Anxiety, number of painful area and pattern were related with the number of involved area. Conclusion: Pain severity reported by patients is found to be the most important variable to be obtained from patient. Variables such as perceived severity, number of accompanying symptoms, anxiety, number of painful area and pattern also have to be carefully assessed to anticipate the extent of heart disease.

• Journal of Chest Surgery
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• v.43 no.6
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• pp.663-668
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• 2010

Background: Spontaneous pneumomediastinum is an uncommon disorder with few cases reported. It usually occurs in young males and has benign self-limiting course without any apparent concomitant factor. It is seen after intrathoracic pressure changes leading to alveolar rupture. The clinical experiences of two medical centers were reviewed to aid in optimal management. Material and Method: Retrospective review between March 2003 and August 2010 with spontaneous pneumomediastinum patients was performed. Result: 24 patients were identified with a diagnosis of spontaneous pneumomediastinum. These 24 patients were comprised of 18 men and 6 women with mean age 18.9 years (range 10 ~ 33). The major initial complaints were chest pain (79.2%), throat pain (62.5%), and subcutaneous emphysema (41.7%). The triggering events were exercise (16.7%), coughing (12.5%) and vomiting (12.5%). No apparent triggering event was noted in 54.2% of patients. In all cases, chest radiograph and computed tomography was done. Diagnostic computed tomography was required in 25%. White blood cell counts and C-reactive protein (CRP) were checked, and their initial mean values were $9,790{\pm}3,240/{\mu}L$ Land $1.31{\pm}1.71mg/dL$, final mean values were $5,440{\pm}1,665/{\mu}L$ Land $0.72{\pm}0.73mg/dL$, respectively. 23 patients were admitted (average $5.0{\pm}1.8$) and the symptoms were self-limiting in all cases without complications. Conclusion: Spontaneous pneumomediastinum is a benign condition with mild inflammatory signs that often presents with chest or throat pain. Secondary causes must be ruled out to avoid an unfavorable outcome with less invasive study. Because of very rare complications and recurrence, outpatient basis and shortened hospitalization may be feasible.

• Journal of Chest Surgery
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• v.41 no.1
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• pp.133-136
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• 2008

Injury to the internal mammary artery secondary to blunt chest trauma is a rare condition. It is also uncommon to see extraplerual and mediastinal hematoma in these circumstances; this demands early diagnosis and active treatment. We report here on a 59 year old man who underwent surgery for extraplerual and mediastinal hematoma, and this was all due to injury of the internal mammary artery after blunt chest trauma. We also include a review of the relevant literature.

• Journal of Chest Surgery
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• v.31 no.6
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• pp.598-603
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• 1998

Excessive sweating of the palms, axillae, and face has a strong negative impact on the quality of life for many people. The existing non-operative therapeutic options seldom give sufficient relief and have a transient effect. But a definitive cure can be obtained by upper thoracic sympathectomy. From June 1997 to October 1997, 117 cases of the needle (2 mm) thoracoscopic thoracic sympathectomies were performed in the Department of Thoracic and Cardiovascular Surgery in the Respiratory Center Yong-dong Severance Hospital in Seoul, Korea. We have followed up on 94 cases which include palmar hyperhidrosis (n=85), facial hyperhidrosis(n=5) and axillary hyperhidrosis(n=4). There were 42 males and 52 females whose ages ranged from 14 to 63 years(median:23 years). The T2 ganglia and T3-4 ganglia were excised by electrocuting with a hook and endoscissors and were removed for histologic examination. There have been no mortalities or life-threatening complications. The surgical results were classified as excellent(much improvement,very dry) in 93.6%, good(some improvement, minimally wet) in 2.1%, and fair(slight improvement, still wet) in 4.2%. Five patients(5.3%) required closed thoracostomy drainage because of pneumothorax in the immediate postoperative day. Horner's syndrome occurred in one case. The compensatory sweating occurred in 67 cases(71.2%) and was embarrassing in 21 cases(22.3%) and disabling in 9 cases(9.6%) of these cases. Primary failure occurred in one case. The patient with primary failure underwent successful operation. Fifty-one patients had concomitant hyperhidrosis. Our experiences indicate needle thoracoscopic sympathectomy is a very effective, safe, and time- saving procedure for essential hyperhidrosis.

• Journal of Chest Surgery
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• v.42 no.1
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• pp.59-62
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• 2009

Background: Pleural drainage following video-assisted thoracic surgery has traditionally been achieved with largebore, semi-rigid chest tubes. Recent trends in thoracic surgery have been toward less invasive approaches for a variety of diseases. The purpose of this study was to evaluate the safety and efficacy of drainage by means of small, soft, and flexible 14Fr Blake drains. Material and Method: Between December 2007 and March 2008, 14Fr silastic Blake drains were used for drainage of the pleural cavity in 37 patients who underwent a variety of video-assisted thoracic surgical procedures at our institution. Result: The average postoperative length of hospital stay was 3.26 days (range, 2~12 days), Blake drains were left in the pleural space for an average of 3.15 days (range, 1~7 days), and the average amount of drainage was 43.8 ml/day. The maximal amount of blood removed daily by a Brake drain was as much as 290 mL. There were no drain-related complications. Blake drains seemed to cause less pain while in place, and particularly at the time of removal. Conclusion: The use of a Blake drain following minor thoracic surgery appeared to be safe and effective in drainage of fluid or air in the pleural space, and were associated with minimal discomfort.

• Journal of Korean Clinical Nursing Research
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• v.14 no.3
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• pp.47-59
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• 2008

Purpose: The purpose of the study was to compare the active pain management (APM) with structured physiotherapy (SPT) with the conservative care on postoperative pulmonary complications, pain, and comfort in children under three year. Method: A non-equivalent control group, non-synchronized design study was used. A total of 64 children participated in the study. The children in the experimental group (n=32) received APM with SPT after surgical operation. After transferred to the general unit, the parents were instructed to hold the child for 30 minutes to relieve anxiety and have him/her sleep comfortably for 2 hours. Scheduled 20 minutes chest percussion was performed by the parents for 2 days: twice every 4 hours, one in 6 hours, then one every 8 hours for the rest of two days. Analgesic was administered as needed. Pain and comfort were observed and recorded by nurses using the FLACC and COMFORT Behavior Scale. Results: One child in the control group was diagnosed with postoperative pneumonia. The children in the experimental group who were received the APM with SPT reported higher scores in comfort and lower scores in pain than those in the control group. Conclusion: The findings suggest that APM with SPT can help prevent postoperative pulmonary complications and pain.

• Journal of Chest Surgery
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• v.41 no.2
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• pp.247-252
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• 2008

Background: We compared the analgesic effects of an intravenous infusion of remifentanil with local lidocaine injection during endovenous laser treatments (EVLT) for varicose veins. Material and Method: In order to compare the efficacy of analgesia between the lidocaine group (n=15) and the remifentanil group (n=15), we measure the pain intensity of the patients, with using the visual analogue scale, during EVLT and at the first week, the second week, the third week and the fourth week after EVLT. Result: The remifentanil group showed significantly less pain intensity during EVLT (p<0.01), but there were no differences of pain intensity between the two groups from the first week to the fourth week after EVLT (p>0.3). Conclusion: The result showed that the intravenous infusion of remifentanil during EVLT can be a good option to reduce pain during EVLT for treating varicose veins.