• Journal of Chest Surgery
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• v.54 no.5
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• pp.404-407
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• 2021

We present a case study of necrotizing fasciitis (NF), a very rare but dangerous complication of chest tube management. A 69-year-old man with shortness of breath underwent thoracostomy for chest tube placement and drainage with antibiotic treatment, followed by a computed tomography scan. He was diagnosed with thoracic empyema. Initially, a non-cardiovascular and thoracic surgeon managed the drainage, but the management was inappropriate. The patient developed NF at the tube site on the chest wall, requiring emergency fasciotomy and extensive surgical debridement. He was discharged without any complications after successful control of NF. A thoracic surgeon can perform both tube thoracostomy and tube management directly to avoid complications, as delayed drainage might result in severe complications.

• Journal of Chest Surgery
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• v.53 no.2
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• pp.49-52
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• 2020

Background: Primary spontaneous pneumothorax is commonly treated with chest tube insertion, which requires hospitalization. In this study, we evaluated the efficacy, costs, and benefits of a portable small-bore chest tube (Thoracic Egg; Sumitomo Bakelite Co. Ltd., Tokyo, Japan) compared with a conventional chest tube. Methods: We retrospectively analyzed all primary spontaneous pneumothorax patients who underwent treatment at Gangnam Severance Hospital between August 2014 and May 2018. Results: A total of 279 patients were divided into 2 groups: the conventional group (n=236) and the Thoracic Egg group (n=43). Of the 236 patients in the conventional group, 100 were excluded because they underwent surgery during the study period. The efficacy and cost were compared between the 2 groups. There was no statistically significant difference between the groups regarding recurrence (conventional group, 36 patients [26.5%]; Thoracic Egg group, 15 patients [29.4%]; p=0.287). However, the Egg group had statistically significantly lower mean medical expenses than the conventional group (433,413 Korean won and 522,146 Korean won, respectively; p<0.001). Conclusion: Although portable small-bore chest tubes may not be significantly more efficacious than conventional chest tubes, their use is significantly less expensive. We believe that the Thoracic Egg catheter could be a less costly alternative to conventional chest tube insertion.

• Tuberculosis and Respiratory Diseases
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• v.67 no.1
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• pp.59-62
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• 2009

Reexpansion pulmonary edema is not a common phenomenon after chest tube insertion but some reports from 0% to 14%. There are various resulting complications, including acute respiratory distress syndrome. We report a case of focal reexpansion pulmonary edema after chest tube insertion. A 49-year-old male came to the hospital due to ongoing dyspnea and left chest pain for 3 days. On chest X-ray, the patient had a left pneumothrax. We planned to insert a chest tube for symptom relief. To determine whether or not the chest had expanded as a result of the chest tube insertion, the patient underwent repeated chest X-rays the following day. The patient experienced brief respiratory symptoms upon initial suction; a chest PA showed patchy consolidated infiltration at the inserted site. After 5 days of conservative management, the recovered completely.

• Journal of the Korean Society of Radiology
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• v.9 no.7
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• pp.467-471
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• 2015

This study's purpose is improve image quality to keep accurate tube angle in order to recognize distortion degree conditions by patient's position or tube angle and to provide exact clinical informations when taking chest AP projection for patient which have L-tube in stomach. The experimental equipment was ELMO-T6S by SHIMADZU corporation, then we put L-tube which attached 1 mm gap scales ruler on chest phantom surface. The experiment set by 90 kVp, 4 mAs, 120 cm distance. Each phantom position which changed supine, 30degree, 45degree, 60degree on the table exposured direct, ${\pm}5degree$, ${\pm}10degree$, ${\pm}15degree$ to head and feet directions. As a result, L-tube tip's position was changed by patient's position and tube angle. When patient's position is supine, tip's position change was lower than 30degree, 45degree, 60degree. We have to adjust patient's position or tube angle in order to occur image distortion by fault tube angle when confirming correct position L-tube tip through chest x-ray. Also, Radiological technologist try to make accurate evaluation index for satisfied L-tube insertion.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.9 no.1
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• pp.27-44
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• 2002

The main purpose of this study was to identify the effect of hand massage on pain and anxiety related to chest tube removal in patients with a lobectomy. The research design of this study was a nonequivalent control group non-synchronized design. Of the twenty nine adult subjects, fourteen were assigned to the experimental group and fifteen to the control group. The data were obtained over 3 months from a medical center in Seoul. The instruments used to assess trait state anxiety was the Spielberger Trait-State anxiety Inventory. For pain and psychological anxiety. The Visual Analogue Scale was used. Hiko analogue sphygmo-manometer(2001) was used to check blood pressure and pulse rate as indicators of physiological anxiety Subjects in the experimental group received hand massage for 5 minutes just before chest tube was removed, and subjects assigned to the control group did not receive hand massage. Data were analysed with $x^2$-test and Mann-Whitney U test using the SPSSWIN 10.0 program. The results of the study are as follows : 1. Hypothesis 1: 'there will be a significant difference between two groups in the level of pain after chest tube removal' was supported (u = 23.00, p < 0.001). 2. Hypothesis 2: 'there will be a significant difference between the two groups in the level of psychological anxiety after chest tube removal' was supported (u = 3.00, p < 0.001). 3. Hypothesis 3: 'there will be a significant difference between the two groups in physiological anxiety(systolic, diastolic blood pressure and pulse rate) after chest tube removal' was supported(u =55.50, p = 0.01 ; u = 41.50, p = 0.01 ; u = 20.50, p < 0.001, relatively). The findings of this study indicate that hand massage is effective for pain and anxiety related to chest tube removal in patients with lobectomy. Therefore, hand massage is recommended as an effective nursing intervention for relieving pain and anxiety in patients undergoing chest tube removal. Further research is needed to identify the proper duration and timing to achieve the optimal effect of hand massage. A larger subject population is required to apply the current findings to the general population. Further research is also needed to assess the effects of hand massage in other patient subsets. Finally, it would be interesting to see if the effects of hand massaging would be attenuated when performed by a non-medical specialist.

• Journal of Chest Surgery
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• v.22 no.6
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• pp.1101-1105
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• 1989

Fifty one patients with empyema thoracic were managed at the Kyung Hee University Medical Center during 5 years between December, 1982, and December, 1987. The patients were classified into two groups; group A [early minithoracotomy-9 patients] and group B[conventional chest tube insertion-42 patients]. Each group was retrospectively analyzed to compare the results in terms of leukocyte count change, body temperature change, duration of hospitalization, elapsed time to chest tube removal and the need for subsequent decortication and tube change. There was no statistical difference between two groups in terms of etiology, age and sex. l. In the group A, mean preoperative leukocyte count [19,300/mme] decreased to 8,688/mme postoperatively. In the group B, leukocyte count changed from 16,985/mme to 14,433/mme. Their differences were significant [P< 0.05]. 2. In the group A, mean preoperative body temperature [38.5] decreased to 36.7. In the group B, body temperature changed from 38.1oC to 37.5 oC. Their differences were significant [P < 0.05]. 3. Mean duration of Hospitalization; 18.2 days [group A], 30.2 days [group B]. Their differences were significant [P < 0.01]. 4. Mean elapsing time for chest tube removal; 15.2 days [group A], 28.5 days [group B]. Their differences were significant [P < 0.01]. 5. There was no need for subsequent decortication and chest tube change in the group A. There were 22 cases [52.3 %] for subsequent decortication and 12 cases [28.6 %] for chest tube change in the group B. Early minithoracotomy in treating empyema thoracis resulted in a shorter hospital stay and a shorter period of tube drainage than conventional method.

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

• Tuberculosis and Respiratory Diseases
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• v.40 no.4
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• pp.449-453
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• 1993

A 64-year-old male was admitted due to abruptly developed, severe dyspnea via local clinic. He had been a heavy smoker and alcoholic for a long time. Chest PA showed huge haziness in right upper lung field. Sputum culture for bacteriology was positive for Klebsiella pneumoniae. Immediately, appropriate antibiotics were administered and artificial ventilation was started. On 40th hospital day, simple chest roentgenogram taken due to sudden aggravated dyspnea showed marked hyperlucency in right upper lung field, suggestive of rupture of abscess cavity and resultant pneumothorax. At that time, chest tube was inserted but air leakage from the chest tube persisted. Chest CT scan taken after chest tube insertion showed the tube inserted into a thin-walled cavity in the above lesion. on 84th hospital day, right upper lobectomy with decortication was performed. Pathologically, cavittary lung abscess was diagnosed on the findings of partial re-epithelialization of ciliated columnar epithelium with severe pulmonary vascular occlusion and extensive fibrous pleural adhesions.

• Journal of radiological science and technology
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• v.44 no.4
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• pp.295-300
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• 2021

This study aims to present new chest AP examination exposure conditions through a study on the effect on image quality and patient dose by applying high tube voltage and scatter ray post-processing software during chest AP examination in digital radiography equipment. This study was used a human body phantom and in the chest AP position, the dosimeter was placed horizontally at the thoracic spine 6. The experiment was conducted by dividing into a low tube voltage (70 kVp, 400 mA, 3.2 mAs) group and a high tube voltage (100 kVp, 400 mA, 1.2 mAs) group. The collimation size (14″× 17″) and the source to image receptor distance(110 cm) were same applied to both groups. Radiation dose was presented to dose area product and entrance surface dose. Image quality was compared and analyzed by comparing the difference between the signal-to-noise ratio and the contrast-to-noise ratio of the image according to the application of the scatter ray post-processing software under each condition. The average value of the entrance surface dose in the low and high tube voltage conditions was 93.04±0.45 µGy and 94.25±1.51 µGy, which was slightly higher in the high tube voltage condition, but the dose area product was 0.97±0.04 µGy and 0.93±0.01 µGy. There was a statistically significant difference in the group mean value(p<0.01). In terms of image quality, the values of the signal-to-noise ratio and the contrast noise ratio were higher in the high tube voltage than in the low tube voltage, and decreased when the scattering line post-processing function was used, but the contrast resolution was improved. If there is a scatter ray post-processing function during chest AP examination, it is helpful to actively utilize it to improve the image quality. However, when this function is not available, I thought that applying a higher tube voltage state than a low tube voltage state will help to realize images with a large amount of information without changing the dose.

• Journal of Chest Surgery
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• v.9 no.1
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• pp.98-101
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• 1976

Clinical observations were made on a total 104 cases of spontaneous pneumothorax during the period of 5 years from MAR. 1971 to MAR. 1976 at the Dept. of Chest Surgery, Korea University Medical College. The ratio of male to female cases was 7.4 : 1 in male predominance, and age distribution was 73% of the total cases within the 15-40 age range. There were 56 patients (53.8%) of right sided pneumothorax and 44 patients (42.3%) of left sided pneumothorax, 8 patients presented bilateral spontaneous pneumothorax. The etiologic factors were tuberculous origin in 42.3%, rupture of bullae or blebs in 15.4%, acute pulmonary infection in 3.8%, pulmonary paragonimiasis in 2.9%, cysticercosis 1%, Marfan's syndrome in 1.9%, unknown causes in 32.7%. In all 104 cases, closed chest tube thoracostomy were performed for reexpansion of collapsed lung. In 50 cases of 104 cases, intrapleural instillation of Quinacrine HCl (Atabrine, Winthrop Laboratories, New York, N.Y.) thru the chest tube was used to control of recurrent pneumothorax, and compared observation with 54 cases control group of closed chest tube thoracostomy only. In both groups, 1) cure rates were 63% in control group and 88% in Atabrine group. 2) average duration of inserted chest tube were 5.6 days in control group and 5.7 days in Atabrine group.