• Journal of Chest Surgery
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• v.24 no.2
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• pp.182-189
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• 1991

Fourteen patients underwent surgical resection of bullae between February, 1987 and June, 1990 via median sternotomy. Twelve patients had spontaneous pneumothorax with previous history of pneumothorax on the contralateral side or visible bullae on chest X-ray films. Two patients had bullous emphysema. The duration of operation and admission, frequency and amount of analgesic administered for pain control, pulmonary function test [FEV1, FVC, MVV] and the amount of bleedings were compared with six cases of staged unilateral thoracotomy. The results were as follows: 1. All patients were male. 2. Mean follow up period was 13.5 month and no recurrence of pneumothorax are noted after the operation. 3. Median sternotomy showed shortened admission days than thoracotomy. [12.4$\pm$2.7, 15.6$\pm$3.1 days] 4. Significantly shortened anesthetic time in median sternotomy than thoracotomy [121$\pm$21, 184$\pm$33 minutes] 5. Median sternotomy required less injection of analgesics than thoracotomy. [6.5$\pm$2.7, 13.5$\pm$3.1 ampules] 6. Bleeding amount and PFT showed no differences. 7. Complications were prolonged air leakage for more than 7 days [2 patients], transient elevation of SGOT and SGPT[2 patients], and wound infection[1 patient]

• Journal of Chest Surgery
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• v.28 no.1
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• pp.42-46
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• 1995

Vertical axillary muscle sparing thoracotomy is newly appeared and excellent alternative method of standard posterolateral thoracotomy.It has many advantages compared to standard posterolateral thoracotomy , less postoperative pain, well preserved thoracic muscle strength, full range of motion of the shoulder girdle and attractive cosmetic results. We performed vertical axillary muscle sparing thoracotomy in 36 patients from November 1993 to July 1994. The ages of the patients ranged from 6 months to 71 years[mean 45.1 years , and the patients consisted of 20 males and 16 females.The preoperative diagnosis were as follows : lung cancer in 17 patients, tbc destroyed lung in 7, bronchiectasis in 3, bullous emphysema in 3 and the others are mediastinal tumor, bronchogenic cyst, lung abscess, empyema, esophageal diverticulum, and CCAM [congenital cystic adenomatoid malformation . The operative procedures were as follows : lobectomy and bilobectomy in 16 patients, segmentectomy in 4, wedge resection in 3, penumonectomy in 7, and the others were open biopsy, lobectomy with diaphragm excision, sleeve right upper lobectomy, decortication, mediastinal mass excision, and esophageal diverticulectomy. We had 6 complications : postoperative bleeding in 2 cases, operative wound infection, arrrhythmia[atrial fibrillation , Horner`s syndrome, hoarseness. The subcutaneous seroma occurred in 4 cases but did not require drainage and relieved within 4 weeks spontaneously. We concluded that vertical axillary muscle sparing thoracotomy could be done in most of all thoracic surgery with safety. Comparing to standard posterolateral thoracotomy vertical axillary muscle sparing thoracotomy has many advantages such as less postoperative pain, well preserved muscle strengths and good cosmetic results.

• Journal of Chest Surgery
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• v.31 no.7
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• pp.692-696
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• 1998

For the management of a secondary spontaneous pneumothorax, videothoracoscopic surgery may offer the potential therapeutic benefits of a minimally invasive approach. We report on a series of 36 patients(33 men and 3 women) with a mean age of 56.3 years(range, 31 to 80 years) who underwent thoracoscopic surgical procedures for the treatment of secondary spontaneous pneumothorax. Twenty-one patients had emphysema and 20 patients had old pulmonary tuberculosis. Nineteen patients presented a persistent severe air leak more than 3 days preoperatively and 15 patients had more than one recurrence. Bullectomy or exclusion of the lesion was performed in 33 patients. Mechanical pleurodesis was performed in the entire patients, talc was sprayed in 22 and vibramycin in 14. Mild pleural adhesion at the upper lobe was shown in 10 patients and severe pleural adhesion in 7 patients. One patient with persistent air leak died of persistent air leak and respiratory failure. The mean postoperative stay was 7.0 days(range, 2 to 17 days). At a mean follow-up of 15.8 months (range, 5 to 45 months), no pneumothorax had recurred. In comparison with the result of the treatment for 112 patients with primary spontaneous pneumothorax, the operating time was not significantly longer and there were no more primary treatment failures, but the duration of postoperative chest drainage and hospital stay was longer. Videothoracoscopic surgery has proved to be an effective treatment for secondary spontaneous pneumothorax in elderly patients who represent high-risk candidates for thoracotomy.

• Journal of Preventive Medicine and Public Health
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• v.22 no.2 s.26
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• pp.290-301
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• 1989

This is preliminary report on anthrax epidemic occurred in an island with about 100 residents. Since 1982 there had been sudden deaths among all kinds of domestic animals including cattle, dogs, ducks, chicken and goat but only a few among cats in an isolated island about three hours distance away by ferry boat from Mokpo city. From 1986 through 1988 nine human deaths and four patients occurred, which made the government intervene for investigation on June 25 1988. The epidemiological investigation consisted of interview survey and medical examination, medical record analysis, laboratory work to isolate the pathogens under the direction of hypothesis derived from the study and further confirmation of the pathogens by international institute. The summarized results are as followings: 1. According to the interview survey there were many deaths among domestic animals usually in cold and dry season such as January through March and September through November; 36 heads of cattle leaving one head, more than 40 hogs(all), hundreds of chicken leaving few alive, goats that had taken home from mountain and two or three cats out of around 40 had sudden deaths from 1982 till 1985, when the residents stopped to purchase and take them into the island anymore. Also there were eleven persons who had experienced the similar syndrome complex to those of admitted and expired patients and four of them revealed typical chest X-ray findings; from one of these four patients(Rho) B. anthracis is isolated. 2. Medical record on patients who had been admitted, showed common characteristics of the disease course. On admission they had either gastrointestinal or upper respiratory infection symptoms which invariably progressed to septicemic nature with pulmonary interstitial infiltration and mediastinal widening/bulging, and then to deadly acute respiratory distress syndrome. At the end stage chest X-ray revealed multiple bullous emphysema. One of another characteristics was oral ulceration with bleeding occurred in about 50% of the patients. Laboratory test results in common were leukocytosis with left shift and abnormal liver and kidney functions, particularly at the later stage of the illness. 3. Epidemiological characteristics was striking in that both mortality and incidence rates were high: the mortality rate was 8.7% average, male being three times higher than females but there was no distictive clustering by age group. The incidence rate for both sexes was 28.2% and there was no sex difference although a tendency of higher incidence among older ages was noticed. The highest mortality and incidence were observed in Won village where the first death of animal occurred and with the highest frequency among three villages of the island. 4. Among twelve bacilli species isolated from various specimens, two strains, one from patient and the other from soil where the recently died cow is hurried, were confirmed as B. anthracis by Pasteur Institute and CDC of USA(strain from soil). CDC reported that the strain did not produce capsule in bicarbonate media but reacted with the bacteriophage and one of five sera taken from the patients. Mode of transmission as well as incubation period of the agent has not been established yet, which needs further investigation in relation to the antigenic structure of the variant when it is confirmed.