• Journal of Chest Surgery
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• v.36 no.6
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• pp.404-410
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• 2003

Different treatment options are available according to the stage and duration of the empyema. Stage I empyema (exudate stage) is treated concurrently by the administration of appropriate antibiotics and chest tube drainage. Stage III empyema (organized stage) is considered for decortication through an open thoracotomy. However, the treatment of fibrinopurulent, stage II empyema remains controversial. Recently, debridement with the use of Video-Assisted Thoracoscopic Surgery (VATS) has been proposed for the treatment of stage II empyema. We analyzed and report our initial experience of 5 cases of stage II empyema, treated with the use of VATS. Material and Method: Between June 2001 and February 2002, 5 patients with fibrinopurulent empyema that did not respond to antibiotics, chest tube drainage or Percutaneous Catheter drainage (PCD), and instillation of fibrinolytic agent were treated by debridement and irrigation with the use of VATS. A CT scan was performed in all patients before the operation to confirm the diagnosis of loculated empyema and to detect additional lung parenchymal diseases. Result: All 5 patients underwent successful debridement and irrigation with the use of VATS and the chest tube was inserted properly. And no patients needed conversion to open thoracotomy. The ratio of sex was 4 : 1 (male : female), the mean age was 53 years old (range, 26~73 years), the mean operative time was 73.4 minutes (range, 52~95 minutes), the mean duration of postoperative chest tube placement was 12.4 days (range, 6~19 days), and the mean duration of postoperative hospital stay was 20.8 days (range, 10~36 days). In all patients, clinical symptoms such as pain and fever subsided and simple chest PA view revealed satisfactory lung expansion. No major postoperative complication was observed during the hospital course and no patient suffered from the recurrence of empyema in the follow-up period. Conclusion: We think that early operation with the use of VATS is safe and efficient for stage II empyema which did not respond to medical treatment(antibiotics and chest tube drainage), therefore, it can prevent stage II empyema from advancing to stage III, organized empyema.

• Physical Therapy Rehabilitation Science
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• v.5 no.3
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• pp.113-119
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• 2016

Objective: The effect of abdominal expansion maneuver (AEM) and abdominal draw-in maneuver (ADIM) on postural control in an unsupported position in stroke patients. Design: Randomized controlled trial. Methods: A total of 36 persons with hemiplegic stroke participated in this study. The subjects were randomly divided into an AEM experimental group (n=12), an experimental ADIM group (n=12), and a control group (n=12). We collected the general characteristics of all subjects and the pre-test results before the intervention and after 4 weeks of the intervention. The trunk stabilization training of the ADIM and AEM group were performed 15 minutes a day, 3 times a week for 4 weeks, and general physical therapy was performed 2 times a day, 30 minutes per session, 5 times a week for all three groups. The control group received joint mobilizations, muscle strengthening, endurance strengthening, and gait exercises along with treatment of the central nervous system, such as neuro-developmental treatment, mat, and gait training. The AEM is an inspiratory phase of tidal breathing expanding the lateral lower ribcage in a lateral direction with minimal superior movements of the chest. Then the lower abdomen expands and the navel moves in an anterior-caudal direction. The ADIM is a repeated contraction and relaxation of the anal sphincter during inspiration. The navel pulls the lower abdomen to the direction of the spine without the movement of the trunk and pelvis. Results: Before and after the interventions, medial-lateral axis movement distance, anterior-posterior axis movement distance, sway mean velocity, and sway area 95% was a statistically significant change in all three groups (p<0.05). The post-hoc test showed a significant improvement in medial-lateral axis movement distance, anterior-posterior axis movement distance, sway mean velocity, and sway area in the AEM group compared with the control group, and in the ADIM group compared with the control group (p<0.05). Conclusions: In conclusion, both AEM training and ADIM training are necessary interventions to maintain the independent sitting position according to the characteristics of the patient.

• Journal of Chest Surgery
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• v.31 no.11
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• pp.1076-1080
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• 1998

Background: Spontaneous hemopneumothorax, occurring in 1% to 12% of patients with spontaneous pneumothorax, is a rare disorder that can potentially lead to life-threatening complications. Materials and methods: We have experienced 15 cases (2.28%) with spontaneous hemopneumothorax among 659 episodes of spontaneous pneumothorax for eight years, from 1990 to 1997, at our hospital. We studied our previously treated patients by retrospective case studies to determine the nature of optimal management. Results: There were 14 male and 1 female patients whose mean age was 27.5 years, ranging from 19 to 58. The sides with disorder were as following: right in 10 cases and left in 5, unilaterally. The amount of initial bleeding ranged from 400 to 1,500 mL and 8 patients received a homologous blood transfusion. Patients exhibited symptoms of chest pain, dyspnea, chest discomfort, and hypovolemic shock. We concluded that causes of this disease in our patients were a torn pleural adhesion (14 cases) and a rupture of vascularized bullae (1 case with an underlying intrinsic lung disease, tuberculosis). All patients underwent closed thoracostomy and had good results except for 3. One patient underwent thoracotomy within 3 days from the onset because of continuous active hemorrhage. Decortication was required in one case because of a reactive fluid collection in the pleural space, which led to impaired lung expansion. Another patient underwent thoracotomy due to a ipsilateral recurrent pneumothorax without blood collection. Conclusions: The goals of treatment include hemostasis and reexpansion of the collapsed lung. Thus, if patients arrive early at hospital, closed thoracostomy and transfusion are thought to be sufficient treatments, although early surgical repair has been considered recently.

• Journal of Chest Surgery
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• v.9 no.2
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• pp.109-116
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• 1976

The effects of atelectasis on surface activity of lung extracts were examined in rabbits. Experimental atelectasis was produced in rabbits by artificial pneumothorax and surface tension properties were measured on saline extracts of lung 24 hrs, 48 hrs, one week and four weeks after the induction of pneumothorax. The results were as follows; 1) The minimum surface tension of excised lung extracts 24 hrs after pneumothorax was significantly increased to 28.3 0.41 dynes/cm, and the stability index was significantly decreased to 0.30 from normal value of 0. 87. 2) In the group which was re-expanded 24 hours, later from pneumothorax the surface activity was returned to almost normal range 24 hrs after reexpansion of collapsed lung, 3) When the atelectasis was continued by mechanical means, the extracts of atelectatic lung showed progressive decrease in surface activity, but it was found that surface activity returned to normal level after four weeks even the presence of atelectasis. 4) These observations suggest to us that atelectasis per se does not cause an increase in surface tension of lung extracts, and even in prolonged atelectasis the re-expansion of collapsed lung may be possible when the mechanical cause of atelectasis was excluded.

• Journal of Korean Neurosurgical Society
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• v.53 no.1
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• pp.46-48
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• 2013

Chondrosarcoma is a very uncommon malignant primary bone tumor, especially, it occurs extremely rare in the spine. A 52-year-old man was admitted to the emergency room with sudden paraplegia. Twelve hours prior to a paraplegic event, he visited an outpatient clinic with discomfort and tenderness around the medial border of the right scapular, and his neurologic status was absolutely intact. Magnetic resonance imaging showed a lobulated soft tissue mass from T3 to T5, which extended to the epidural space. Computed tomography scans showed soft tissue mass on the spinal posterior arch and osteolytic change of the adjacent bony structures. Emergent surgery was performed and the lesion was removed. Dark reddish blood and gel-like material were encountered around the dura and posterior arch during the operation. Multiple pulmonary nodules were found on a chest CT scan and a biopsy of one of them had been proven to be a metastasis of chondrosarcoma. The histologic examination showed dedifferentiated chondrosarcoma. The patient's neurologic deficit was improved slowly from ASIA A to ASIA D. Chondrosarcoma in the spine is extremely rare, even more with acute hemorrhage and sudden expansion into the epidural space. We named it chondrosarcoma apoplexy. We should consider the possibility of a hemorrhagic event when the patient's neurologic deficit worsens suddenly with spinal bone tumor.

• Journal of Chest Surgery
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• v.7 no.1
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• pp.1-8
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• 1974

Acute pulmonary edema was induced by intravenous injection of epinephrine, intravenous infusion of dextran and intratracheal instillation of acid solution index was determined from pressure volume curves in excised lungs. Surface activity was also investigated with measurements of maximum and minimum surface tension and stability index on saline extracts of same lungs. The results were as follows. 1. The expansion index of excised lung in which pulmonary edema was induced by intravenous injection of epinephrine, intravenous infusion of dextran and intratracheal instillation of acid solution was ignificantly decreased as compared with the normal control of $0.86{\pm}0.017$ to $0.74{\pm}0.03$, $0.71{\pm}0.081$and $0.76{\pm}0.02$, respectively. 2. The deflation curves of excised lungs in which pulmonary edema was induced were significantly decreased as compared with the normal controls. 3. The minimum surface tension of excised lung in which pulmonary edema was induced was significantly increased in each groups and stability index was significantly decreased as compared with the normal controls 0.78 to $0.35{\pm}0.039$, $0.29{\pm}0.02 $ and $0.31{\pm}0.083$, respectively. 4. The decrease of pulmonary surface activity in acute pulmonary edema was in proportion to the degree of pulmonary edema regardless of their etiology.

• Journal of the Korean Society of Physical Medicine
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• v.14 no.2
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• pp.117-124
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• 2019

PURPOSE: This study was to investigate the effects of crocodile breathing exercise on pain, muscle tone, and muscle stiffness of non-specific low back pain patients. METHODS: The subjects were 37 patients with nonspecific low back pain. The patients were divided into two groups. The experimental group (EG) performed crocodile breathing exercise and the control group (CG) performed chest expansion breathing exercise. The intervention was conducted for 10 minutes every day for a total of eight weeks. Pain was measured using a VAS. Muscle tone and stiffness were measured using Myoton PRO. Two points were measured for muscle tone and muscle stiffness. They were measured at 30mm from the spinous process of the L1 and T10 vertebra. RESULTS: Pain, muscle tone and muscle stiffness at the T10 level showed a significant decrease in both EG and CG. Muscle tone and muscle stiffness in the L1 level area decreased significantly in the experimental group but the control group did not show any difference. The only statistically significant difference was observed in the L1 muscle tone between the pre and post intervention values. CONCLUSION: This study suggests that Crocodile breathing is a good method for managing pain, muscle tone, and muscle stiffness in non-specific low back pain patients.

• Journal of Chest Surgery
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• v.36 no.7
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• pp.497-503
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• 2003

Pulmonary aspergillosis usually results from the colonization of the existing lung lesions by chronic pulmonary diseases, such as tuberculosis. Most cases of pulmonary aspergilloma have been treated surgically for many years because it is a potentially life-threatening disease causing massive hemoptysis. Here we reviewed our results from the last 10 years. Material and Method: We reviewed 31 cases surgically treated from Aug. 1992 to Jul. 2002. retrospectively. This investigation is designed to illustrate the peak age incidence, sex ratio, chief complaints, preoperative study, anatomic location of operative site, postoperative pathologic finding and postoperative complications. Result: The peak age Incidence laid in the 3rd and 4th decade of 20 cases (64.5%). The most common complaint was hemoptysis in 27 cases (87.1%). The 31 cases had a history of treatment with anti-tuberculous drugs under impression of pulmonary tuberculosis. The 19 cases (61.3%) showed the so-called “Air-meniscus sign” on the preoperative chest X-ray. In the 31 cases (100%) on the chest computed tomography. as a preoperative diagnostic modality, positivity was shown in 37.9%, 83.3% was shown on the fungus culture of sputum for Aspergillus, serum immunodiffusion test for A. fumigatus, respectively. The anatomical location of aspergilloma was mainly in the upper lobe in 19 cases (61.3%) and the majority of cases were managed by lobectomy. The postoperative pathologic findings showed that 31 cases (100%) were combined with tuberculosis. The postoperative complications include empyema, prolonged air leakage, remained dead space, postoperative bleeding and these numbers of cases is 3 cases (9.7%), 2 cases (6.45%), 2 cases (6.45%), 1 case (3.23%), respectively. one case was died postoperatively due to massive beeding, and asphyxia. Conclusion: Compared with the previous study, there is no significant difference in results. Preoperative chest computed tomography and immunodiffusion test were more commonly available and showed high positivity. Operations often became technically difficult because of pleural space obliteration, indurated hilar structures, and poor expansion of the remaining lung, which were more prominent in the patients with complex aspergillosis. In such cases, medical treatments and interventional procedures like bronchial artery embolization are preferred. However, cavernostomy is also recommanded with few additional morbidity because of its relatively less invassiveness. Early surgical intervention is the recommended management for patients with simple aspergilloma considering the Row surgical mortality and morbidity in recent days.

• Journal of Chest Surgery
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• v.30 no.10
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• pp.949-960
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• 1997

Background. Limited ischemic tolerance of the lung has remained one of the factors that limits the expansion of pulmonary transplantation as a treatment for end-stage pulmonary disease. Numerous studies on safe long term preservation for lung transplantation has been performed for the purpose of developing ideal preservation solution with extracellular type or intracellular type solutions. In this. study, we examined the efficacy of L DG solution in lung preservation longer than 20 hours by comparison with modified Euro-Collins solution. Iwethods. Thirty-(our adult mongrel dogs were divided into two groups. Donor lungs were flushed with LPDG solution(n=9) or modified Euro-Collins(MEC) solution(n=8) and stored for 24 hours at 1$0^{\circ}C$. All donor lungs were perfused through the pulmonary arteries with solutions containing prostaglandin El and verapamil. Left canine lung allotransplantations wereperformed. Assessment(hemodynamic indices and arterial blood gas analysis) of left implanted lung was made by occluding the right pulmonary artery for ten minutes using pulmonary artery Cuff. Assessment was repeated at the interval of 30 minutes, one hour, and two hours later after reperfusion and then chest X-ray, computed tomogram and lung perfusion scan were obtained. In survival dogs follow-up studies were done with assessment with chest X-ray, computed tomogram of the chest and lung perfusion scan on 7th day postoperatively. After preservation above 20 hours, pathological examinations for ultrastructural findings on right lung were performed in each group. Results. With respect to arterial oxygen tension, LPDG group was superior to MEC but there was no statistical significance for 2 hours after reperfusion. Mean pulmonary artery pressure was less increased(p < 0.05) and cardiac output higher(p <0.05) than MEC group until 2 hours after reperfusion. After 2 hours of reperfusion, both groups showed transplanted lung function deteriorated gradually. Perfusion scan of the transplanted lung in LPDG group showed better perfusion rate in immediate post-reperfusion, 3 days and 7 days later respectively but there was no statistical significance and corelation with PaO2 and computed tomoRravhic views. In scanning electron microscopy of pulmonary artery after preservation, LPDG group relatively shows less irregular protrusion of the inner surface of endothelial cell of poulmonary artery than MEC group. Conclusions, e concluded that LPDG solution can offer safe lung preservation above 20 hours with adequate immunosuppressive therapy and prevention of the infection.

• Journal of Chest Surgery
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• v.40 no.4 s.273
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• pp.292-296
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• 2007

Background: This retrospective study was undertaken to assess the effectiveness of the 8-French (Fr) catheter ($Pleuracan^{(R)}$) for the initial treatment of primary spontaneous pneumothorax. Material and Method: Between July 2004 and July 2006, 59 patients (72 cases) underwent a closed thoracostomy for primary spontaneous pneumothorax. We divided these patients into two groups: group T (large bore (>20 Fr) chest tube group) and group P ($Pleuracan^{(R)}$ group). Result: Initially, the $Pleuracan^{(R)}$ catheters were inserted in 41 cases. There were four catheter malfunctions (9.8%) : three cases had a subsequent closed thoracostomy with a large bore chest tube. Ultimately, there were 34 cases in group T and 38 cases in group P. There were no significant differences in indwelling catheter time ($T:\;2.1{\pm}1.5\;days,\;P:\;2.1{\pm}1.3\;days$), hospital stay ($T:\;6.4{\pm}5.4\;days,\;P:\;5.2{\pm}2.9\;days$) and complications (T: 3%, P: 0%) between the two groups. The percentage of cases that needed intravenous analgesics in group P was 60% (23/38); this was significantly lower than the number for group T (90%, 31/34) (p=0.003). In a subgroup of patients that did not undergo bullectomy(T: 17 cases, P: 19 cases), there were no significant differences in the duration of air leakage ($T:\;0.5{\pm}0.7\;days,\;P:\;0.5{\pm}1.2\;days$) and in the percentage of patients with complete lung re-expansion (T: 94%, P: 84%) between the two groups. Conclusion: Application of the $Pleuracan^{(R)}$ catheter for the initial treatment of primary spontaneous pneumothorax was as effective as the large bore chest tube.