• 한국방사선학회논문지
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• 제12권4호
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• pp.525-532
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• 2018

본 연구는 늑골의 사방향 검사 시 환자의 자세 변화가 아닌 X-선관의 수평 축방향 각도 변화를 적용하여 영상화 하였다. 인체 모형 팬텀을 이용하여 일반적인 늑골 사방향의 표준 검사 방법을 적용한 대조 영상과 중심 X-선을 팬텀의 수직 입사 방향으로부터 오른쪽 수평 축 방향으로 $5^{\circ}$ 간격으로 $5^{\circ}$부터 $30^{\circ}$까지 6단계의 입사각도 변화를 적용한 변형 사방향 실험 영상을 획득하였다. 영상의 정량적 비교 평가를 위해 대조영상을 기준으로 실험 영상의 관심 영역 별 SNR과 CNR을 계산하였다. 또한 대조 영상의 좌 우 늑골 비율과 실험 영상의 X-선 입사각도 별 좌 우 늑골 비율을 측정하여 비교하였다. 실험 결과, $25^{\circ}$의 X-선 입사 각도를 적용한 실험 영상이 표준 검사 방법을 적용한 대조 영상과 비교하였을 때 SNR과 CNR, 좌 우 늑골 비율의 측정값에서 가장 근사한 값을 나타내었다. 변형 늑골 사방향 검사는 환자의 검사 자세 유지가 어려울 경우 적용할 수 있는 늑골 사방향 검사 방법으로 유용할 것이라 생각된다.

• Journal of Chest Surgery
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• 제19권4호
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• pp.750-759
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• 1986

Spontaneous pneumothorax is usually seen in young adult male. And typically, the patient is a tall, thin, 20- to 30-year-old male. Usually the pneumothorax results from rupture of a pulmonary bleb. Author reviewed 66 cases of spontaneous pneumothorax experienced in the Dept. of Thoracic & Cardiovascular Surgery, Pusan National University Hospital, since Jan., 1980 to Aug., 1986. The clinical data were summarized as follows: 1. The age distribution of spontaneous pneumothorax: 17 to 34 years old and mean age was 25.3 years. 2. The sex distribution of spontaneous pneumothorax: 52 in men, 14 in women and the ratio was 3.7:1. 3. Chest dimension in male patients: Maximum posteroanterior distance [MPA], MPA/Maximum width [MW]: Significantly smaller than control group. Distance from second to tenth rib on left [L2-10], Distance from second rib on right to diaphragm [R2-D], R2-D/MW: Significantly larger than control group. 4. Chest dimension in female patients: MPA, MW: Significantly smaller than control group. Distance from second rib on left to diaphragm [L2-D], Distance from second to tenth rib on right [R2-10], R2-D, L2-10/MW, L2-D/MW, R2-10/MW, R2-D/MW: Significantly larger than control group.

• Tuberculosis and Respiratory Diseases
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• 제48권1호
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• pp.45-53
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• 2000

연구배경: 단순흉부촬영에서 늑골의 변이에 익숙하지 못한 경우 흉곽 또는 폐 병변으로 오인하게 되는 경우가 있다. 단순흉부촬영에서 늑골의 변이에 대한 외국의 문헌 보고가 소수 있으며 국내에서도 임 등에 의한 보고외에는 문헌 보고가 거의 없는 실정이다. 이에 저자들은 한국 정상 성인에서 발견되는 여러가지 늑골 변이의 종류와 형태 및 그 빈도를 알아보고자 하였다. 방 법: 1996년 1월부터 1998년 9월까지 신체검진을 목적으로 연속적으로 본원을 방문하여 단순흉부촬영을 시행한 성인 5,000명을 대상으로 하였다. 남녀가 각각 2,827명과 2,173명(1.3:1)이었고 연령은 평균 34.6(19-65세)였다. 전 예에서 후전면촬영 사진상 늑골변이의 종류, 위치 및 형태를 보았고 각 변이의 빈도를 계산하였다. 결 과: 총 76명(1.52%)에서 88예의 늑골의 변이가 관찰되었고 남성이 63명(2.23%), 여성이 13명(0.6%)이었다. 88예의 늑골 변이중 이열늑골(bifid rib, n=35)이 가장 흔히 관찰되었고, 늑골의 형성 부전(hypoplasia, n=22), 늑골단의 넓어짐(flaring, n=18), 늑골간의 가교형성(bridging of rib, n=7), 경륵(cervical rib, n=3), 늑골 융합(fusion, n=3) 순으로 나타났다. 이열 늑골은 우측 제 4늑골에서 가장 흔했으며(12/35, 34.3%), 제 5늑골(6/35, 17.1%) 과 우측 제 3늑골(6/35, 17.1%)의 순으로 관찰되었다. 늑골의 형성부전은 제 1늑골에서 가장 흔했다. 늑골단의 넓어짐은 제 4늑골에서(8/18, 44.4%) 흔히 관찰되었고 늑골간의 가교 형성은 제 1-2늑골간에서 흔했다(3/7, 42.9%). 결 론: 성인에서 늑골의 변이는 약 1.52%의 반도를 보였다. 이열 늑골이 가장 흔했고 늑골의 형성 부전, 늑골단의 넓어짐, 늑골간의 가교 형성, 경륵, 늑골융합 등의 순서로 나타났다.

• Journal of Chest Surgery
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• 제26권12호
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• pp.944-949
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• 1993

Clinical analysis were performed on 247 cases of thoracic trauma, those were admitted & treated at the department of thoracic & cardiovascular surgery,Hanyang University Hospital during the period from Jan,1989 to June,1992. Age distribution of those was from 2 to 80 years old & mean age was 38 years old. The ratio of male to female patient was 186:61 [3:1].This ratio revealed high incidence in male patient. The most common cause of trauma was traffic accident in this series.The modes of injury were as follows: traffic accident 124 cases[50.2%],fall down 52 cases[21.05%], stab wound 47 cases[19.03%] and gun-shut wound 1 case.Ellapse time from accident to admission were 141 cases [57.09%] under 6 hr.Rib fracture were observed in 159 cases[64.37%], hemo or pneumothorax were observed 134 cases[54.25%] of total cases and location distributed Right:Left:Both[74:112:37], in left predominant. Conservative,non-operative treatment were performed in 128 cases and operation[open thoracotomy] 32 cases.Mortality was 1.6%[4 cases] & most common cause of death were due to irreversible shock with brain edema. Conclusively, more evaluation & co-operation of other department were expected treatment & better prognosis.

• Journal of Chest Surgery
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• 제18권1호
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• pp.111-121
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• 1985

A clinical analysis was performed on 312 cases of the chest trauma experienced at department of thoracic surgery, Chosun University Hospital during the past 6 years 10 months period from January 1978 to October 1984. 1. The ratio of male to female patient of the chest trauma was 3.1:1 in male predominance and age from 20 to 50 occupied 71.2% of the total cases. 2. The most common cause of the chest trauma was traffic accidents [45.5%] in this series. 244 cases [78.2%]were injured due to non-penetrating injuries and the remainders [68 cases, 21.8%] were injured due to penetrating injuries. 3. The frequently injured site of the chest trauma was left side of the chest [56.4%], the right side was 33% and the both side was 10.6%. 4. The most common symptoms were chest pain and dyspnea, and common signs were diminished breathing sound and subcutaneous emphysema. 5. The Hemothorax, Pneumothorax, Hemopneumothorax, and Hemopericardium were observed in 190 cases [60.9%] of the total cases, and etiologic distribution revealed 76.5% due to penetrating injuries and 56.6% due to non-penetrating injuries. 6. The rib fractures were observed in 210 cases [67.3%] of the total cases and the most common site of the rib fracture was 6th rib 140 cases [19.2%]. The common site of the rib fracture was from 4th rib to 7th rib [63.8%]. 7. The lung injuries were observed in 150 cases [48.1%] and the other organ injuries were observed in 260 cases [83.3%]. 8. Conservative treatment including thoracentesis were performed in 153 cases [49.1%], Closed thoracotomy with water seal drainage were performed in 112 cases [35.9%], and open thoracotomy were performed in 45 cases [14.4%]. 9. The complications of the chest trauma were developed in 63 cases [20.2%] and the common complications were atelectasis, wound infection and pneumonitis etc. 10. Overall mortality was 0.96% [3 cases] and the cause of death was bacteremia, hypovolemic shock, heart failure and pulmonary edema.

• Journal of Chest Surgery
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• 제20권4호
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• pp.715-722
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• 1987

A clinical analysis was performed on 823 cases of the chest trauma experienced at department of thoracic & cardiovascular surgery, Kyung Hee University Hospital during the past 8 years from Jan, 1978 to Aug. 1986. 1. the ratio of male to female patient of the chest trauma was 3:1 in male predominance. 2. The common age groups were 3rd, 4th and 5th decades. 3. The most common causes of the chest trauma was traffic accidents [79.8%] were injured due to non-penetrating injuries and the remainders [166/823, 20.2%] were injured due to penetrating injuries 4. The frequently injured site of the chest trauma was left side of the chest [46%], and the right side was 42% 5. The most common injury from non-penetrating trauma was rib fracture [77.5%], and the incidence rate of flail chest was 59% of all cases of rib fractures. 6. The incidence rate of hemopneumothorax was 42.9% in non-penetrating traumas, and 84.3% in penetrating traumas. 7. The most common method of surgical treatment was closed tube thoracostomy [37.3%], and open thoracotomy was performed in 71 cases [8.6%]. 8. the overall mortality was 2.2%, and common causes of death were cerebral damage, respiratory insufficiency, and hypovolemic shock.

• Journal of Chest Surgery
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• 제23권6호
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• pp.1213-1220
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• 1990

During the period of January 1979 to December 1988, 220 patients with empyema thoracis were treated in the department of Thoracic and Cardiovascular Surgery, Chonnam National University Medical School Hospital. There were 167 males[75.9%] and 53 females[24.1%] ranging from 18 days to 76 years of age. Occurrence ratio of left and right empyema was 1 : 1.9. The underlying pathologic lesions of empyema were pneumonia[30.9%], pulmonary tuberculosis[22.7%], chest trauma[8.6%] and postoperative complications. In bacteriologic study, staphylococcus, pseudomonas and streptococcus accounted for 26.4%, 11.8% and 9% respectively, and 25% were not identified. Surgical treatment modalities were thoracentesis[10 patients, 4.5%], closed thoracostomy[132, 60%], closed rib resection drainage[4.2, 6%], modified Eloesser’s operation[37, 16.8%], decortication[27, 12.3%], decortication with pulmonary resection[6, 2.7%], thoracoplasty[2, 0.9%], muscle flap closure [1, 0.5%], and staged pneumonectomy[1, 0.5%], The mortality rate was 2.3% and the complications were sepsis[9 patients]. acute renal failure[4], and paralytic ileus[3].

• Journal of Chest Surgery
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• 제29권1호
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• pp.79-85
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• 1996

대전 을지병원 흉부외과에서는 1991년 3월 부터 1994년 11월까지 흉부손상으로 입원한 305명의 환자에 대하여 임상적 고찰을 시행하였다. 연령 분포는 4세 에서 85세까지 다양하였고 가장 흔한 연령층은 30대, 40대, 50대 였다. 남녀의 비율을 보면 남자 환자가 229명에 비해 여자 환자는 76명으로 남녀의 비는 남자에서 많은 빈도를 보였다. 흉부손상의 가장 흔한 원인은 비 관통성 손상에서는 교통사고, 관통성 손상에서는 자상이 제일 많았다. 혈흥, 기흥, 혈 기흥은 전체 환자중 159례 (52.1%)에서 관찰되었고 늑골골절은 236례 (77.4%)에서 관찰되었다 손상 부위별로는 우측이 102례, 좌측이 142례, 양측이 45례로 좌측에서 많았고 가장 흔한 늑골골절은 3번에서 8번까지의 늑골이었다. 수상후 내원시간은 6시간 이내가 155례 (50.8%) 였다. 흉부손상의 초기 합병증 치료의 원칙은 흥강천자술(5례)이나 폐쇄성 흥관 삽관술(142례)에 의한 폐의 신속한 확장이 었으나, 심한 출혈 (13례), 횡격막 파열6례, 이물질 3례 등으로 17례 에서 개흥술을 시행하였다. 부분의 치료방법인 보존적 요법은 140례 (45.9%)에서 시행하였다. 전체 사망률은 2.6% (8례)였고 사망원 括\ulcorner호릅부전과 쇽이었다.

• Journal of Chest Surgery
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• 제8권1호
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• pp.37-44
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• 1975

Authors have reviewed the records of seven patients of multiple rib fractures with severe flail chest who were admitted to Hanyang University Hospital during the 3 years period from 1972 through 1975. Of the seven patients studied, automobile accidents led to the injuries in 4 cases, two patients were injured in fall from a tree and on the ox-heading. All who had a blunt trauma without any open wound on the chest. The numbers of the fractured ribs accounted for 6 to 9 of the ribs including double fractures from 3 to 5 ribs. The left side fractures occurred in the 6 patients and in the right only one patient. Thus the flail segment was more often located in the left antero-lateral position than in the right lateral position [the ratio was 6:1].. All cases had associated injuries. The injuries and multiple fractures were the most common associated injuries occurring in four and five of the patients respectively. The patients were classified as having associated head injuries when they were admitted in comatose or semicomatose state. When a major degree of instability of the thoracic cage exists, adequate respiratory change is not possible. For this reason the tracheostomy was performed in five patients in an acutely injured patient with flail chest only after an endotracheal tube has been inserted or after an endotracheal suction. All patients had secondary complications in the pleural cavity, such as hemothorax or hemopneumothorax with or without intrapulmonary hemorrhage and subcutaneous emphysema. Therefore, closed thoracostomy was performed in five patients in the emergency room. The thoracotomy was required in four patients: immediate operation without closed thoracostomy was performed in two patients and the thoracotomy was indicated in two patients after closed thoracostomy, because of increasing intrathoracic hemorrhage. As to the fixation of the flail segments, authors employed two techniques; one was towel clip traction of the flail segments and the other was intramedullary insertion of Kirschner`s wire in to the double fractured rib fragments for the fixation of the flail segments [Kirschner`s wire fixation]. Because` of an different results in the course of treatment between two techniques, data from patients with towel clip traction was compared with those from patients with thoracotomy and Kirschner`s wire fixation of the flail segments. Of the three patients with towel clip traction, two patients required bronchoscopic toilet due to lung atelectasis which developed because of inadequate motion of thoracic cage and poor expectoration. This was in contrast to the four patients with thoracotomy and Kirschner`s wire fixation, who didn`t these complication because of adequate motion of the thoracic cage and subsequent good expectoration.

• Journal of Chest Surgery
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• 제10권2호
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• pp.205-213
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• 1977

In order to evaluate the therapeutic effect of thoracostomy on the patients with pathological changes in pleural cavity which were caused by various etiological factors, a clinical study was carried out during a period of 5 and half years from May 1972 to September 1977 in the department of thoracic surgery, Hanyang University Hospital, and the following results were obtained. Of a total of 264 patients, 205 cases were male, and 59 female, exhibiting the ratio of male to female being 3.5 to 1. The pathological changes in pleural cavity could occur at any age from 4 months after birth to 76 years old, the peak incidence being in the third decade in either male or female. The incidence decreased in the second, fifth and fourth decade in order. The type of pathological changes observed and their frequencies of occurrences were 93 cases [35.2%] in pneumothorax, 62 cases [23.5%] in hemothorax, 48 cases [18.2%] in pyothorax, 46 cases [17. 4%] in hemopneumothorax, 13 cases [4.9%] in hydropneumothorax, and one case each in hydrothorax and chylothorax. The incidence of the primary diseases which predisposed the pathological changes in pleural cavity were, 119 cases [45-1%] in trauma, 64 cases [24.2%]in lung tuberculosis, 38 cases [14.4%] in pneumonia or empyema, 14 cases [5.3%] in lung emphysema and blebs, 13 cases [4.9%] in process after thoracotomy, 3 cases [1.1%] each in lung malignant tumor and lung paragonimiasis, one case in mechanical ventilator and 9 cases [3.4%] in unknown origin. The pathological changes in pleural cavity were located in the right side of the cavity in 124 cases, in the left side in 133 cases and in both sides in 7 cases, indicating that the difference between the incidence of the left and rightside occurences was insignificant. Of 93 cases of pneumothorax studied, 63 cases were found to have been tension pneumothorax and 30 cases non-tension pneumothorax, showing greater prevalence of tension type over non-tension type. Of 119 cases of trauma observed, 82 cases were accompanied with rib fractures and 37 cases were without any fracture [non-bone fracture]. Patients with the rib fractures were characterized by multiple rib fractures and multiple double fractures of ribs, accompanying with or without fracture of bones other than ribs, and patients with non-bone fracture were characterized by penetrating stab wound and blunt trauma. Of 264 cases who received thoracostomy, 207 cases [78.4%] demonstrated that their pathological changes in pleural cavity were removed and subsided by a simple measure of thoracostomy. In 43 cases [16.3%], various surgical measures including radical operation and thoracotomy were required for complete healing, since their pathological changes were not abolished by thoracostomy alone. The rest 14 cases [5.3%] were expired following thoracostomy.