• Journal of Chest Surgery
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• v.41 no.5
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• pp.619-624
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• 2008

Background: Secondary spontaneous pneumothorax is caused by various underlying lung diseases, and this is despite that primary spontaneous pneumotherax is caused by rupture of subpleural blebs. The treatment algorithm for secondary pneumothorax is different from that for primary pneumothorax. We studied the recurrence rate, the characteristics of recurrence and the treatment outcomes of the patients with secondary spontaneous pneumothorax. Material and Method: Between March 2005 to March 2007, 85 patients were treated for their first episodes of secondary spontaneous pneumothorax. We analyzed the characteristics and factors for recurrence of secondary spontaneous pneumothorax by conducting a retrospective review of the medical records. Result: The most common underlying lung disease was pulmonary tuberculosis (49.4%), and the second was chronic obstructive lung disease (27.6%), The recurrence rate was 47.1% (40/85). The second and third recurrence rates were 10.9% and 3.5%, respectively. The mean follow up period was $21.1{\pm}6.7$ months (range: $0{\sim}36$ month). For the recurrence cases, 70.5% of them occurred within a year after the first episode. The success rates according to the treatment modalities were thoracostomy 47.6%, chemical pleurodesis 74.4%, blob resection 71% and Heimlich valve application 50%. Chemical pleurodesis through the chest tube was the most effective method of treatment. The factor that was most predictive of recurrence was 'an air-leak of 7 days or more' at the first episode. (p=0.002) Conclusion: The patients who have a prolonged air-leak at the first episode of pneumothorax tend to have a higher incidence of recurrence. Further studies with more patients are necessary to determine the standard treatment protocol for secondary spontaneous pneumothorax.

• Tuberculosis and Respiratory Diseases
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• v.57 no.2
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• pp.143-147
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• 2004

Background : It is important to predict the exercise capacity and dyspnea, as measurements of lung volume, in patients with COPD. However, lung volume changes in response to an improvement in airflow limitation have not been explored in detail. In the present study, it is hypothesized that lung volume responses might not be accurately predicted by flow responses in patients with moderate to severe airflow limitations. Methods : To evaluate lung volume responses, baseline and follow up, flow and lung volumes were measured in moderate to severe COPD patients. The flow response was defined by an improvement in the $FEV_1$ of more than 12.3%; lung volume changes were analyzed in 17 patients for the flow response. Results : The mean age of the subjects was 66 years; 76% were men. The mean baseline $FEV_1$, $FEV_1$/FVC and RV were 0.98L (44.2% predicted), 47.5% and 4.65 L (241.5%), respectively. The mean follow up duration was 80 days. The mean differences in the $FEV_1$, FVC, TLC and RV were 0.27 L, 0.39 L, -0.69 L and -1.04 L, respectively, during the follow up periods. There was no correlation between the delta $FEV_1$ and delta RV values(r=0.072, p=0.738). Conclusion : To appropriately evaluate the lung function in patients with moderate to severe airflow limitations; serial lung volume measurements would be helpful.

• Journal of Digital Convergence
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• v.10 no.3
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• pp.219-225
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• 2012

This study is analyzed the implementation of medical aid for patients over 65 years of age who are among the discharged from hospitals with the capacity of over 100 beds. I have analyzed it with the data from an in-depth study of injury surveillance of discharged patients from hospitals done in a national project in 2004. After analyzing the results of the data from the beginning of this national project to the data collected in 2008, I could get the results that the rate of discharged patients over 65 years of age increased every year. Among them, the rate of discharged women was higher than that of the men, and the rate of deaths while at the hospital for patients over 65 years of age was higher than that of patients less than 65 years of age. The rate of operations done on patients over 65 was lower than that of patients under 65 years of age. The results of a diagnosis of popular symptoms showed that the rate of the diagnosis of cerebral infraction and structure of the heart at the circulatory organ was higher. In addition, the rate of the diagnosis of lung cancer, pneumonia, and chronic obstructive lung disease was higher, as well as the rates of gastric cancer, diabetes, liver cancer, and colorectal cancer. The results showed that the operation of the nerve system or cardiovascular system were higher. Therefore, according to this result, we should prioritize and allocate resources to the elderly people when setting up a management policy. And also, we should promote healthcare for elderly people after considering the characteristics of the implementation of medical aid in preparation of a super-aged society.

• Journal of Trauma and Injury
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• v.24 no.1
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• pp.12-17
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• 2011

Purpose: A rib fracture secondary to blunt thoracic trauma continues to be an important injury with significant complications. Unfortunately, there are no definite treatment guidelines for severe multiple rib fractures. The purpose of this study was to evaluate the result of early operative stabilization and to find the risk factors of surgical fixation in patients with bilateral multiple rib fractures or flail segments. Methods: From December 2005 to December 2008, the medical records of all patients who underwent operative stabilization of ribs for severe multiple rib fractures were reviewed. We investigated patients' demographics, preoperative comorbidities, underlying lung disease, chest trauma, other associated injuries, number of surgical rib fixation, combined operations, perioperative ventilator support, and postoperative complications to find the factors affecting the mortality after surgical treatment. Results: The mean age of the 96 patients who underwent surgical stabilization for bilateral multiple rib fractures or flail segments was 56.7 years (range: 22 to 82 years), and the male-to-female ratio was 3.6:1. Among the 96 patients, 16 patients (16.7%) underwent reoperation under general or epidural anesthesia due to remaining fracture with severe displacement. The surgical mortality of severe multiple rib fractures was 8.3% (8/96), 7 of those 8 patients (87.5%) dying from acute respiratory distress syndrome or sepsis. And the other one patient expired from acute myocardial infarction. The risk factors affecting mortality were liver cirrhosis, chronic obstructive pulmonary disease, concomitant severe head or abdominal injuries, perioperative ventilator care, postoperative bleeding or pneumonia, and tracheostomy. However, age, number of fractured ribs, lung parenchymal injury, pulmonary contusion and combined operations were not significantly related to mortality. Conclusion: In the present study, surgical fixation of ribs could be carried out as a first-line therapeutic option for bilateral rib fractures or flail segments without significant complications if the risk factors associated with mortality were carefully considered. Furthermore, with a view of restoring pulmonary function, as well as chest wall configuration, early operative stabilization of the ribs is more helpful than conventional treatment for patients with severe multiple rib fractures.

• Tuberculosis and Respiratory Diseases
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• v.54 no.4
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• pp.386-394
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• 2003

Background : ATS(American Thoracic Society) defined new guidelines for COPD(chronic obstructive lung disease) in April 2001, following the results of the global initiative for chronic obstructive lung disease. The most important concept of COPD is an airflow limitation which is not fully reversible compared to bronchial asthma(BA). The criteria for COPD are postbronchodilator $FEV_1$ less than 80% of the predicted value and an $FEV_1$ per FVC ratio less than 70%. The global initiative for asthma(GINA) study defined asthma, which included immune-mediated chronic airway inflammatory airway disease, and found that airflow limitation was wide spread, variable and often completely reversible. Taken together COPD and BA may be combined in airflow limitation. This study was designed to evaluate the prevalence of BA in patients with COPD of moderate to severe airflow limitation. Methods : COPD was diagnosed by symptoms and spirometry according to ATS guidelines. Enrolled subjects were examined for peak flow meters(PFM), sputum eosinophils and eosinophil cationic protein(ECP) levels, serum total IgE with allergy skin prick test, and methacholine bronchial provocation test(MBPT). Results : About 27% of COPD patients with moderate to severe airflow limitation were combined with BA. There was significantly decreased response to PFM in severe COPD. However, there was no significant relationship between BA and COPD according to the degree of severity. The BA combined with COPD group showed significantly high eosinophil counts and ECP level in induced sputum. However, neutrophil counts in induced sputum showed significant elevation in the pure COPD group. Conclusion : Twenty-seven percent of COPD patients with moderate to severe ventilation disorder were combined with BA, but there were no significant differences according to the degree of severity.

• Tuberculosis and Respiratory Diseases
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• v.50 no.3
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• pp.310-319
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• 2001

Background : The peak flowmeter is very useful in monitoring of out-patients as well as those in emergency departments because of its convenience and simplicity with low cost. There have been many studies aimed at determining the accuracy and reproducibility of the peak flow meter in normal population. However, there is a paucity of reports regarding its accuracy in patients with chronic obstructive pulmonary disease(COPD) or asthma. The accuracy of the peak expiratory flow(PEF) measured with a mini-Wright peak flowmeter was assessed by a comparison with the results of a mass flow sensor. Methods : The PEF measurements were performed in 108 patients aged 19-82 years presenting with either a chronic obstructive lung disease or asthma before and after inhaling salbutamol. The PEF measurements from the mini-Wright flowmeter were compared with those obtained by the calibrated mass flow sensor. Results : The average of the readings taken by the mini-Wright meter were 37-39 l/min higher than those taken by the mass flow sensor. The average percentage error of the mini-Wright meter were higher, ranging less than 300 l/min. The mean of the differences between the values obtained using both instruments (the bias)$\pm$limits of agreement(${\pm}2$ SD) were $37.1{\pm}90\;l/min$ for the PEF(p<0.001). Conclusions : The mini-Wright peak flowmeter overestimated the flows in patients with COPD or asthma. It was also found that the accuracy of the mini-Wright peak flowmeter decreased in its mid to low range. The limits of agreement are wide and the difference between the two instruments is significant. Therefore, the measurements made between the two types of machines in patients with asthma or COPD cannot be used interchangeably.

• Tuberculosis and Respiratory Diseases
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• v.48 no.4
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• pp.522-529
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• 2000

Backgrounds : Assessment of the presence and degree of reversibility of airflow obstruction is clinically important in patients with asthma or chronic obstructive pulmonary disease. The measurement of peak expiratory flow(PEF) is a simple, fast, and cheap method to assess the severity of obstruction and its degree of reversibility. Assessing the reversibility of airflow obstruction by peak expiratory flow(PEF) measurements is practicable in general practice, but its usefulness has not been well investigated. We compared PEF and $FEV_1$ in assessing reversibility of airflow obstruction in patients with chronic obstructive pulmonary disease or asthma and developed a practical criterion for assessing the presence of reversibility in general practice. Methods : PEF measurements were performed (Spirometry) in 80 patients(aged 24-78) with a history of asthma or chronic obstructive lung disease before and after the inhalation of 200 g salbutamol. The change in PEF was compared with the change in forced expiratory volume in one second($FEV_1$). Reversible airflow obstruction was analyzed according to American Thoracic Society(ATS) criteria. Results : A 12% increase above the prebronchodilator value and a 200ml increase in either FVC or $FEV_1$ reversibility were observed in 45%(36) of the patients. Relative operating characteristic(ROC) analysis showed that an absolute improvement in PEF of 30 l/min gave optimal discrimination between patients with reversible and irreversible airflow obstruction(the sensitivity and specificity of an increase of 30 l/min in detecting a 12% increase above the prebronchodilator value and a 200ml increase in either FVC or $FEV_1$ were 72.2% and 72.7% respectively, with a positive predictive value of 68.4%). Conclusions : Absolute changes in PEF can be used to diagnose reversible airflow obstruction.

• Tuberculosis and Respiratory Diseases
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• v.51 no.6
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• pp.570-578
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• 2001

Background: With cases of chronic obstructive pulmonary disease(COPD), weight loss and low body weight have been found to correlate with increased mortality and poor prognosis. Therefore, nutritional aspects are an important part of the treatment in cases of COPD. In Korea, there is only limited data available for the changes of resting pulmonary function in relation to nutritional status. This study was carried out to investigate the differences of resting pulmonary function in relation to the nutritional status of patients with COPD. Method : 83 stable patients, with moderate to severe COPD, were clinically assessed for their nutritional status and resting pulmonary function. The patients' nutritional status was evaluated by body weight and fat-free mass (FFM), which was assessed by bioelectrical impedance analysis. According to their nutritional status, the 83 patients were divided into two groups, designated as the depleted, and non-depleted, groups. Result : Of the 83 patients, 31% were characterized by body weight loss and depletion of FFM, whereas 28% had either weight loss or depleted FFM. In the depleted group, significantly lower peak expiratory flow rate(p<0.05) and Kco(p<0.01), but significantly higher airway resistance(Raw, p<0.05) were noted. There was no difference for the non-depleted group in forced expiratory volume at one second, residual volume, inspiratory vital capacity, or total lung capacity. Maximal inspiratory pressure($P_{Imax}$) was also significantly lower in the depleted group(p<0.05). Conclusion : We conclude, from our clinical studies, that nutritional depletion is significantly associated with the change in resting pulmonary function for patients with moderate to severe COPD.

• Journal of Chest Surgery
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• v.17 no.1
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• pp.118-124
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• 1984

Congenital Cystic Adenomatiod Malformation (C.C.A.M.) is rare, but one of the most common congenital pulmonary anomalies that cause acute respiratory distress in the newborn infants. It is characterized and differentiated from the diffuse pulmonary cystic disease pathologically, i.e. adenomatoid appearance due to marked proliferation of the terminal respiratory components. An 2/12 year old male patient was suffered from respiratory distress and cyanosis on crying since birth, but no specific therapy was given. With progression of symptoms, he came to Korea University Hospital for further evaluation and then transfered to Dept. of Chest Surgery for operative correction under the impression of Congenital Obstructive Emphysema suggested by a pediatrician. On gestational and family history, there was nothing to be concerned such as congenital anomaly. Physical examinations showed; moderate nourishment and development (Wt. 5.5kg), cyanosis on crying, both intercostal and lower sternal retraction on inspiration, Lt. chest building with tympany, Rt. shifting of cardiac dullness, decreased breathing sound with expiratory wheezing on entire Lt. lung field, decreased breathing sound on Rt. upper lung filed, and tachycardia. The remainders were nonspecific. Laboratory findings were normal except WBC $14000/mm^3$ (lymphocyte 70%), Hgb 9.8m%, Hct 28%, negative Mantaux test, and sinus tachycardia and counter-clockwise rotation on EKG. Preoperative simple Chest PA revealed marked hyperlucent entire Lt. lung, herniation of Lt. upper lobe to Rt., collapsed Rt. upper lobe, tracheal deviation and mediastinal shifting to Rt., and no pleural reaction. At operation, after Lt. posterolateral thoracotomy, 4th rib was resected. Operative findings were severe emphysematous changes limited to both lingular segmentectomy was done. The resected specimen showed slight solidity, measuring $8{\times}4.5{\times}2cm$ in size, and small multiple cystic spaces filled with air. Microscopically, entire tissue structures were glandular in appearance, cyst were lined by ciliated columnar epithelium, and occasional cartilages were noted around the cystic spaces. Bronchial elements were dilated but normal pattern on histologically. The patient had a good postoperative courses clinically and radiologically, and discharged on POD 10th without event. The authors report a case of Cogenital Cystic Adenomatoid Malformation (C.C.A.M.)

• Journal of Chest Surgery
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• v.29 no.4
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• pp.408-413
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• 1996

In most cases of diffuse bullous emphysema and chronic obstructive lung disease, t e risk of surgical treatment is very high. But surgical treatment in selected cases of bullous emphysema with localized involvement of only one side of the lung has suggested safe and good management. So patient selection of surgical treatment Is one of the most important things in management of bullous emphysema. From 1987 to 1992, 11 patients were operated for bullous emphysema with giant bullae at the Department of Thoracic and Cardiovascular Surgery of Chonbuk National University Hospital. Author selected surgical candidates who had progressive dyspnea and symptomatic bullae occupying more than one third of the hemithorax and shifting the trachea and mediastinum to the opposite side of the lung. There were 7 males and 4 females ranged from 19 to 61 years of age. Operative procedures were bullectomy and/or wedge resection in 7 cases, segmentectomy in 2 cases and lobectomy in 2 cases. Symptoms and pulmonary function of all patients were improved six months to three years postoperat vely. There were no postoperative death. We conclude that surgical treatment of bullous emphysema with giant bullae is safe and a good treatment of modality in indicated patients.