• Journal of Chest Surgery
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• v.40 no.7 s.276
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• pp.485-491
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• 2007

Background: Thoracoplasty has become a rarity in current clinical practice, although it has been widely employed for well over a century as a procedure for reducing the capacity of the thoracic cavity. Yet we have perform tailoring thoracoplasty following or concomitant with pulmonary resection in 20 patients. The aim of this study is to evaluate the early and late clinical results and also the significance of tailoring thoracoplasty. Material and Method: From March 1995 to June 2005, modified thoracoplasty following or concomitant with pulmonary resection was performed in 20 patients out of a total of 298 pulmonary resections for closing air leaks and for treating persistent pleural space following pulmonary resections, and to tailor the thoracic cavity to accept a diminished lung volume. Of the 20 patients, 14 patients had tailoring thoracoplasty performed concomitant with pulmonary resection, and the remaining 6 patients also had tailoring thoracoplasty performed following pulmonary resection. The subjects ages ranged from 24 to 77 (mean $59.1{\pm}6.4$) and a male preponderance was noted (17 : 3); the number of left and right surgeries was equal. The preoperative primary underlying diseases were lung cancer in 7 patients, pneumothorax with giant bullous change in 6 patients, bronchiectasis in 2 patients, previous pulmonary tuberculosis associated with aspergilloma in 2 patients, empyema with fibrothorax in 2 patients and multiple lung abscesses & destruction due to previous trauma in 1 patient. The operative methods were apicolysis and subperiosteal removal of the 2nd, 3rd and 4th ribs (the costochondral junction to the posterior portions of the ribs) with preservation of the first rib and compression of the anterior chest via cotton bags and elastic bandages. Result: The mean duration of the air leaks after thoracoplasty was $1.6{\pm}0.2$ days (range: $0{\sim}7$ days) and the mean duration of an indwelling chest tube was 7 days (range: $5{\sim}11$ days); the mean duration of hospitalization was $19.2{\pm}2.8$ days (range: $8{\sim}47$ days). The postoperative complications were wound infection (2) and pneumonia (2); reoperation was done due to bleeding (1) in one patient who underwent concomitant thoracoplasty and there was 1 case of wound infection (1) after postresection thoracoplasty. The mortality was 1 patient in the early phase and 4 patients in the late phase. Conclusion: We conclude that tailoring thoracoplasty may be performed to close anticipated persistent pleural spaces and to accommodate the diminished lung volume with acceptable cosmetic results when this procedure is combined with pulmonary resection in selected patients.

• Journal of Chest Surgery
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• v.35 no.7
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• pp.535-541
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• 2002

Background: The prevalence of pulmonary tuberculosis remains high in several areas of the world, and pneumonectomy is often necessary to treat the sequelae of the disease. We retrospectively analyzed the morbidities, mortalities, and long-term outcomes after pneumonectomy for the treatment of tuberculous sequelae. Material and Method: Between 1981 and 2001, 94 patients underwent either pneumonectomy or extrapleural pneumonectomy for the treatment of tuberculous sequelae. There were 44 males and 50 females. The mean age was 40(16~68) years. The pathology included destroyed lung in 80, main bronchus stenosis in 10, and both lesions in 4. Surgical procedures were pneumonectomy in 47, extrapleural pneumonectomy in 43, and completion pneumonectomy in 4. Results: One patient died postoperatively due to empyema. Twenty-three complications occurred in 20 patients; empyema in 15(including 7 bronchopleural fistulas), wound infection in 5, and others in 3. Univariate analysis revealed presence of empyema, extrapleural pneumonectomy, prolonged operation time, and old age as risk factors of postpneumonectomy empyema. In multivariate analysis, old age and low preoperative FEV1 were risk factors of empyema. Low preoperative FEV1 was the risk factor of bronchopleural fistula(BPF) in univariate analysis. Low preoperative FEV1, positive sputum AFB, and presence of aspergilloma were risk factors of BPF in multivariate analysis. There were twelve late deaths. Actuarial 5-and 10-year survival rates were 94$\pm$3% and 87$\pm$4%, respectively. Conclusion: Pneumonectomy could be performed with acceptable mortality and morbidity, and could achieve good long-term survival for the treatment of tuberculous sequelae. In patients with risk factors, special care is recommended to prevent postoperative empyema or bronchopleural fistula.

• Tuberculosis and Respiratory Diseases
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• v.54 no.2
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• pp.219-229
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• 2003

Background : The management of thoracic empyema and complicated parapneumonic effusion requires adequate antibiotics use and prompt drainage of infected pleural space. Tube thoracostomy for loculated empyema has low success rate and is also an invasive procedure with potential morbidity. Complications include hemothorax, perforation of intra-abdominal or intra-thoracic organs, diaphragmatic laceration, empyema, pulmonary edema, and Horner's syndrome. Given the potential morbidity of traditional chest tube insertion, use of the image-guided pigtail catheter drainage(PCD) of empyema has been employed. We retrospectively analyzed the medical records of patients with empyema or complicated parapneumonic effusion to determine the efficacy of percutaneous pigtail catheter drainage. Materials and Methods : 45 patients with complicated parapneumonic effusions or empyema were treated at Gil medical center from January 1998 to June, 1999. All were initially given PCD procedure and the following data were collected: clinical symptoms at the time of diagnosis, alcohol and smoking history, the characteristics of pleural effusion, radiologic findings (at the time of catheter insertion, removal and 1 month after catheter removal), the amount of effusion drained for initial 24 hours, the time from catheter insertion to removal and the use of surgical approach. Results : Male gender was more frequent (42 men vs. 3 women), the mean age of the study population was 52(range: 21~74) years. Empyema was found in 23 patients, complicated parapneumonic effusion in 22 patients. Four patients(three, parapneumonic effusion and one, with empyema) with PCD only treated, were cast off. Among the available patients, 36(80%) patients were treated with PCD only or PCD with urokinase. Among the 23 patients with empyema, surgical approach was required in five patients(27.1%, one required decortication, four open thoracostomy), one patient, treated with surgical procedure, died of sepsis. There was no significant difference of the duration of catheter insertion, the duration of hospital admission after catheter insertion and the mean amount of effusion drained for initial 24 hours between the patients with only PCD treated and the patients treated with PCD and urokinase. The duration of catheter insertion($9.4{\pm}5.25days$ vs. $19.2{\pm}9.42days$, p<0.05) and the duration of hospital admission after catheter insertion($15.9{\pm}10.45days$ vs. $38.6{\pm}11.46days$, p<0.01) of the patients with only PCD treated were more longer than those of the patients treated with surgical procedure after PCD. They were same between the patients treated with urokinase after PCD and the patients treated with surgical procedure after PCD($11.1{\pm}7.35days$ vs. $19.2{\pm}9.42days$, p<0.05, $17.5{\pm}9.17days$ vs. $38.6{\pm}11.46days$, p<0.01). In 16 patients(44.4%) with only PCD treated or PCD and urokinase treated, the amount of effusion at the time of catheter removal was decreased more than 75% and in 17 patients(47.2%) effusion decreased 50~75%. .In one patient effusion decreased 25~50%, in two patients effusion decreased less than 25%. One month after catheter removal, in 35 patients(97.2%, four patients were cast off), the amount of pleural effusion was successfully decreased more than 50%. There were no complications related to pigtail catheter insertion. Conclusion : In this study, PCD seemed to be an early efficacious procedure in treating the patients with complicated parapneumonic effusion or empyema without any serious procedure related complication.

• Tuberculosis and Respiratory Diseases
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• v.44 no.6
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• pp.1308-1317
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• 1997

Background : Pulmonary aspergillomas usually arise from colonization and proliferation of Aspergillus in preexisting cavitary lung disease of any cause. About 15% of patients with tuberculous pulmonary cavities were found to have aspergilloma. We analyzed the clinical features and course of 91 patients with pulmonary aspergilloma. Method : During the ten-year period from June 1986 to May 1996, 91 patients whose condition was diagnosed as pulmonary aspergilloma at 4 university hospitals in Taegu city were reviewed. All patients fulfilled one of the following criteria : 1) histologic evidence of aspergilloma within abnormal air space in tissue sections, or 2) a positive Aspergillus serum precipitin test with the radiologic finding of a fungus ball. The histological diagno-sis was established in 81 patients(89.0%) and clinical diagnosis in 10 patients(11.0%). Results : 1) The age range was 22 to 65 years, with an average of 45 years. A male and female ratio was 1.7 : 1 (57 men and 34 women). 2) Hemoptysis was far the most frequent symptom(89%), followed by cough, dyspnea, weakness, weight loss, fever, chest pain. 3) In all but 14 cases(15.4%) there had been associated conditions. Pulmonary tuberculosis was far the most frequent underlying condition found(74.7%), followed by bronchiectasis (6.6%), cavitary neoplasm(2.2%), pulmonary sequestration(1.1%). 4) The involved area was usually in the upper lobes; the right upper lobe was involved in 39(42.9%), the left upper lobe in 31(34.1%), the left lower lobe in 13(14.3%), the right lower lobe in 7(7.7%), and the right middle lobe in 1(1.1%). 5) On standard chest roent geno gram the classic "bell-like" image of a fungus ball was found in 62.6% of the subjects. On CT scan, 88.1% of the subjects in which they were done. 6) The surgical therapy was undertaken in 76 patients, and medical therapy in 15 patients, including 4 patients with intracavitary instillation of amphotericin B. 7) The surgical modality was lobectomy in 55 patients(72.4%), segmentectomy in 16 patients(21.1%), pneumonectomy in 4 patients(5.3%), wedge resection in 1 patient(1.3%). The mortality rate was 3.9% (3 patients) ; 2 patients died of sepsis and 1 died of hemoptysis. The postoperative complications were encountered in 6 patients (7.9%), including each one patient with respiratory failure, bleeding, bronchopleural fistula, empyema, and vocal cord paralysis. 8) In the follow-up cases, each 2 patients of 71 patients with surgical treatment and 10 patients with medical treatment had recurrent hemoptysis. Conclusion : During follow-up of the chronic pulmonary disease with abnormal air space, if the standard chest roentgenograms are insufficient to detect a fungus ball, computed tomographic scan and serum precipitin test are likely to aid the diagnosis of patients with suspected pulmonary aspergilloma. A reasonable recommendation for management of a patient with aspergilloma would be to reserve surgical resection for those patients who have had severe, recurrent hemoptysis. And a well controlled cooperative study to the medical treatment such as intracavitary antifungal therapy is further needed.

• Archives of Plastic Surgery
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• v.35 no.3
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• pp.337-340
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• 2008

Purpose: Herpes zoster is a common dermatologic disease characterized by unilateral pain and vesicular lesions over the unilateral sensory dermatomes being caused by the reactivation of Varicella zoster virus and its incidence seems to be increasing recently. In case of involving the ganglion of the fifth cranial nerve(trigeminal nerve), it can descend down the affected nerve into skin, then producing an eruption in the dermatome. Among the patients, about 40 - 50% had associated conditions such as diabetes mellitus, hypertension, pulmonary tuberculosis, liver diseases, peptic ulcer, hypothyroidism, pharyngitis but rare facial trauma. Methods: Retrospective study was done for 3 cases of Herpes zoster from May 2000 to May 2007, which had been treated with acyclovir and steroid. Results: The clinical course was uneventful. Follow-up length was about 3 months. After treatment, the patients became stable and there was no complications. Conclusion: Herpes zoster was commonly associated with systemic disorders and the treatment duration was prolonged in associated diseases. But herpes zoster occurring specifically at the site of previously traumatized facial skin has not yet been reported. We experienced the treatment of herpes zoster developing within recent operative facial scar and three cases are presented with the review of literatures. Finally, facial trauma might be a risk factor for herpes zoster in traumatized patients.

• Journal of Chest Surgery
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• v.24 no.5
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• pp.451-458
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• 1991

We have observed 101 cases of recurrent spontaneous pneumothorax from Sep. 1979 to Dec. 1989 at the Department of Thoracic & Cardiovascular Surgery, College of Medicine, Inje University, Pusan Paik Hospital and the result obtained as follows. 1] Age range of patients was the first decade to seventh decade. Males outnumbered females by 6.7: l. One or two episodes of recurrent attack were noted in majority cases. 2] In distribution of the lesion sites, right side was 55 cases[55.4%], left 42 cases[41.9%], and bilateral 4 cases[3.0%]. 3] In clinical manifestations, abrupt onset of dyspnea was 78 cases[77.2%], chest pain 48 cases[47.5%], cough 9 cases[8.9%] and chest discomfort 8 cases[7.9%]. 4] Of 101 cases, 48 cases were associated with pulmonary tuberculosis and other cases were associated with subpleural bullae and blebs[26 cases], emphysema[7 cases], bronchiectasis[2 cases], lung cancer[1 case], and silicosis[1 case], 5] In 88 cases[87.2%] of patients, the magnitude of collapse was above 50% in plain chest film. 6] The interval of recurrence after last attack was frequently within 1 year. 7] In the management, closed thoracostomy with underwater-sealed drainage was applied in first recurrent 53 cases but 2nd recurrence was developed in 16 cases. In 52 cases, surgical management was applied. The pleurodesis with chemical agent[tetracycline] via chest tube was applied in 2 cases. Among 51 cases subjected to the open thoracotomy, pleural abrasion was performed in 3 cases, excision of bullae & blebs in 12 cases, wedge resection in 28 cases, lobectomy in 6 cases and wedge resection combined with lobectomy in 2 cases. In one case subjected to the median sternotomy, wedge resection on both lung apex was performed. 8] Postoperative complications were developed in 8 cases but not serious.

• Quality Improvement in Health Care
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• v.2 no.2
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• pp.112-129
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• 1996

Background : A small number of high cost patients usually spend a larger proportion of scarce health resources. Aged, long-term care and readmitted patients usually belong to these high cost patient group. Among others, long length of stay and readmission can be reduced by checking its cause, and these are the areas needed most of quality improvement activity. Characteristics of high cost medical users between health insurance program and medical assistance program were reviewed. Methods : The inpatient claims of health insurance and medical assistance program were analyzed. Patients were divided by 6 groups; long-term, mid-term, short-term, readmitted, cancer and aged. We defined high cost patients as those who had spent one and half million won and over per 6 months. Characteristics of high cost patients for each group were reviewed. Results : medical assistance patients used much more resources than the insured members in the average hospital cost per case but less in daily hospital cost. The former had a longer length of stay and had much heavier diseases. Major diseases of both group were cancer, diseases of circulatory system and chronic degenerative diseases. Gallstone and schizophrenia were more in the insured program. However, pulmonary tuberculosis, asthma were more common among the medical assistance patients. Early readmission before 2 weeks were 28-30% of the total readmission. Readmission rate in the malignat neoplasm and renal failure were 80% and more. Q.A program should be installed to prevent unnecessary readmissions. Conclusion : Almost 30% of early readmissions and admissions due to complications and long length of stay should be reviewed carefully to keep cost down and to enhance the quality of hospital care.

• Journal of Chest Surgery
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• v.11 no.4
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• pp.516-522
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• 1978

In spite of recent improvement of the medical and surgical treatments, there are many significant problems in the management of thoracic empyema. This is a clinical analysis of 49 cases of thoracic empyema who underwent lung decortication for a period of 6 years and 5 months extending from May, 1972 to Aug. 1975. The following results were obtained: Male to female ratio was 2. S to 1. The age ranged between Sand 69, bnt was mostly 2r.d and 5th decade. The underlying diseases were pulmonary tuberculosis (30 cases, 61. 1 SO, , ), posttraumatic hemothorax (7 cases, 14.396). pneumonia (6 cases, 12.2%), lung abscess (2 cases, 4.2%), paragonimiasis (2 cases, 4.2%). spontaneous pneumothorax (1 case, 2.1%), and unknown origin (1 case, 2.1%). In 13 cases (26.5%), positive bacterial growth on culture was reported. There were single infection in 11 cases and mixed infection in 2 cases. The organisms grown were Staphylococcus, alpha-hemolytIc Streptococcus, Alkaligenes fecalis, Escherichia coli, Pseudomonas, SerratIa, Enterobacter agglomerans, and Enterococcus in order of frequency. Staphylococcus, Streptococcus, and Serratia were sensitive to several different kinds of antibiotics. But Pseudomonas, Escherichia co:i, and Enterococcus were sensitive to only one or two antibiotics. Leukocytosis was observed In acute empyema, but not in chronic empyema. Hemoglobin and hematocrit were all within normal limits. Preoperative liver function tests were within normal limits in most of the cases. In 49 cases, lung decortication alone was performed in 40 cases (S1. 696), and for the remaining 9 cases (1S. 4%), additional surgical procedures were necessary, i. e., lobectomy (6cases). partial thoracoplasty (2 cases), and lobectomy & partial thoracoplasty (1 cases). The results of lung decortication in thoracic empyema were goed. 38 cases (77.5%) healed with no complication, and 10 cases (20.4%) were complicated by bleeding, wownd infection, pleural infection, chondritis, and psychosis. These complications resolved ultimately leaving no sequelae. One death was recorded (2.1%), and the causes of death were postoperative pleural infection, sepsis and hepatic insufficiency.

• Journal of Chest Surgery
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• v.29 no.5
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• pp.530-535
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• 1996

Saprophytic aspergillosis (aspergilloma), a potentially life-threatening disease from the colonization of lung cavities by the ubiquitous fungus Aspergillus fumigatus, has been of surgical concern. Twelve patients with symptomatic aspergilloma underwent operative procedures at Pusan national University Hospital between January 1, 1984 and August 31, 1994. The mean age of the patients was 38.8 years and nine of them had hemoptysis; in two it was massive and life-threatening. Wine of the patients had underlying causes of cavitary lung disease and tuberculosis was the most common cause. Lobectomy was the most commonly performed procedure (in six) . Several major complications including excessive bleeding (2), and pneumonia (2), and empyema with bronchopleural fistula (1) occurred .and one patient died (operative mortality=8.3%). There were no recurrent symptoms in any of the 11 operative survivors during the follow-up period. It is concluded that early, aggressive surgical intervention can provide definite cure in established aspergilloma, even with minimal symptoms.

• Journal of Preventive Medicine and Public Health
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• v.9 no.1
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• pp.39-47
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• 1976

The organized community is the one of the best system for the effective public health administration, and a model area was selected for the study to see what would be achieved when a certain small community is placed under the special public health control based on the family unit. The 178 families involved total of 875 populations. The rate of vaccination with B.C.G. among 191 infants and children could be increased upto 100.0% from 72.5% of the time when the basic study was performed after 8 months period of this study; 99.0% from 47.1% with D.P.T.; 96,9% from 71.7% against smallpox; 83.2% from 69.1% against poliomyelitis; but only 25,7% from 21.5% against measles. The status of family planing was 36.8% among 155 women of possible conception at the time of the basic research. And, at the end of this study, the number of women utilizing one of the methods of contraception for family planning were increased upto 52.9% among the same number. The most frequently utilized method was 34.1% of oral pills followed by 30.5% of intrauterine device; but both of which had higher rate of interruption of use because of the complications, 14.3% and 16.0% respectively. The 10 pregnant women at the time of basic research experienced normal deliveries during the period of study and they had received pre and postnatal health care through this health center. The status of oral hygiene, pulmonary tuberculosis control, and parasitological examination were also reported as well as the cases with diseases seen among the population and vaccinations performed against other infectious diseases. The stress on discussion was placed upon the effectiveness of public health administration when it is undergone on the individual family unit to achieve the best results. However, the shortness of both personnel and material resources were considered to be the one of the major difficulties retarding the generalization of the idea obtained through this study based on family unit public health administration.