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.
Ambulatory Care Facilities ; Chest Tubes* ; Emergency Service, Hospital ; Follow-Up Studies ; Humans ; Korea ; Outpatients* ; Ovum ; Pneumothorax* ; Thoracic Surgery, Video-Assisted ; Thorax*

BACKGROUND: We used an Abramson technique for minimally invasive repair of pectus carinatum in patients who preferred surgery to brace therapy, had been unsuccessfully treated via brace therapy, or were unsuitable for brace therapy because of a rigid chest wall. METHODS: Between July 2011 and May 2015, 16 patients with pectus carinatum underwent minimally invasive surgery. RESULTS: The mean age of the patients was 24.35±13.20 years (range, 14-57 years), and all patients were male. The percentage of excellent aesthetic results, as rated by the patients, was 37.5%, and the percentage of good results was 56.25%. The preoperative and postoperative Haller Index values were 2.01±0.19 (range, 1.60-2.31), and 2.22±0.19 (range, 1.87-2.50), respectively (p-value=0.01), and the median hospital stay was 7.09±2.91 days (range, 5-15 days). Only one patient experienced postoperative complications. CONCLUSION: Minimally invasive repair is effective for the treatment of pectus carinatum, even in adult patients.
Adult ; Braces* ; Humans ; Length of Stay ; Male ; Postoperative Complications ; Surgical Procedures, Minimally Invasive ; Thoracic Wall

Recurrent pneumothorax was associated with the menstrual cycle in two women 20 to 30 years age; this is referred to as catamenial pneumothorax. This form of pneumothorax occurs within 72 hours before or after the onset of menstruation. The pathophysiology underlying this condition is unknown. We report here on two cases of catamenial pneumothorax that were successfully treated by partial resection of the diaphragm.
Diaphragm ; Female ; Humans ; Menstrual Cycle ; Menstruation ; Pneumothorax

BACKGROUND: Mediastinoscopy is generally performed to confirm mediastinal lymph node metastasis in lung cancer patients. It still remains controversial whether mediastinoscopy should be performed in all patients with resectable non-small cell lung cancer (NSCLC). We studied the clinical value of mediastinoscopy in preoperative staging in NSCLC. MATERIAL AND METHOD: We retrospectively studied 90 NSCLC patients who underwent radiological evaluation and mediastinoscopy followed by surgical resection from March 2002 to December 2004. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of each evaluation method were assessed and compared. RESULT: Specificity, PPV, NPV, and accuracy of mediastinoscopy were superior to those of radiological evaluation, but there was no significant difference in sensitivity. The sensitivity of mediastinoscopy was 28.6% in 62 patients with radiological N0/1 disease and 72.7% in 28 patients with radiological N2/3 disease. Seven of eight patients in whom positive nodes were not detected by the mediastinoscopy had subcarinal lymph node metastasis. CONCLUSION: Considering its invasiveness, the difficulty to reach certain node stations, and its low sensitivity in radiological N0/1 disease, mediastinoscopy should be selectively performed in radiological N2/3 disease rather than in all radiological cancer stages.
Carcinoma, Non-Small-Cell Lung* ; Humans ; Lung Neoplasms ; Lymph Nodes ; Mediastinoscopy* ; Neoplasm Metastasis ; Retrospective Studies ; Sensitivity and Specificity

BACKGROUND: Lung transplantation (LTx) is a life-saving treatment for patients with end-stage lung disease; however, the shortage of donor lungs has been a major limiting factor to increasing the number of LTx. Growing experience following LTx using donor lungs after cardiac death (DCD) has been promising, although concerns remain. The purpose of this study was to develop a DCD lung harvest model using an ex vivo lung perfusion (EVLP) system and to assess the function of presumably damaged lungs harvested from the DCD donor in pigs. METHODS: The 40 kg pigs were randomly divided into the control group with no ischemic lung injury (n=5) and the study group (n=5), which had 1 hour of warm ischemic lung injury after cardiac arrest. Harvested lungs were placed in the EVLP circuit and oxygen capacities (OC), pulmonary vascular resistance (PVR), and peak airway pressure (PAP) were evaluated every hour for 4 hours. At the end of EVLP, specimens were excised for pathologic review and wet/dry ratio. RESULTS: No statistically significant difference in OC (P=0.353), PVR (P=0.951), and PAP (P=0.651) was observed in both groups. Lung injury severity score (control group vs. study group: 0.700+/-0.303 vs. 0.870+/-0.130; P=0.230) and wet/dry ratio (control group vs. study group: 5.89+/-0.97 vs. 6.20+/-0.57; P=0.560) also showed no statistically significant difference between the groups. CONCLUSIONS: The function of DCD lungs assessed using EVLP showed no difference from that of control lungs without ischemic injury; therefore, utilization of DCD lungs can be a new option to decrease the number of deaths on the waiting list.
Death ; Heart Arrest ; Humans ; Lung Diseases ; Lung Injury ; Lung Transplantation ; Lung* ; Organ Preservation ; Oxygen ; Perfusion* ; Swine* ; Tissue Donors* ; Vascular Resistance ; Waiting Lists ; Warm Ischemia

From October 2005 to August 2006, sympathetic nerve reconstruction with using the intercostal nerve was performed in 4 patients with severe compensatory hyperhidrosis following thoracoscopic sympathetic surgery for facial hyperhidrosis. The interval between the initial sympathetic clipping and the sympathetic nerve reconstruction was a median of 23.1 months. The compensatory sweating after sympathetic nerve reconstruction was improved for 2 patients, but it was not improved for 2 patients. Thoracoscopic sympathetic nerve reconstruction may be one of the useful treatment methods for the patients with severe compensatory hyperhidrosis after they under go sympathetic nerve surgery for hyperhidrosis.
Humans ; Hyperhidrosis ; Intercostal Nerves ; Sweat ; Sweating ; Thoracoscopy ; Transplants

BACKGROUND: Lung transplantation (LTx) is an effective treatment for end stage lung disease. However, the shortage of donor lungs has been a major limiting factor to increase the number of LTx. Ex vivo lung perfusion (EVLP) is a currently approved method to evaluate lung function and to repair donor lung with poor function. The purpose of this study was to develop EVLP system in pig model and to maintain lung function during 4 hours of EVLP. METHODS: Bilateral lung blocks were harvested from five 40 kg pigs. These blocks were applied in EVLP perfused with 37degrees C Steen solution. We performed arterial blood gas (ABG) analyses before death and also every 1 hour for 4 hours after application of EVLP and calculated oxygen capacities (OC) using the results of ABG. We also calculated pulmonary vascular resistance (PVR) and peak airway pressure (PAP) every 1 hour for 4 hours. After EVLP procedure, we excised specimens for pathologic review. RESULTS: We found that OC gradually decreased during the 4 hour period of EVLP; however, no statistically significant difference was obtained. PVR declined sharply after 1 hour of EVLP (P=0.031) and then remained constant for 3 hours. PAP significantly increased after 3 hours (P<0.0001). Pathologic investigations revealed various findings from normal lung to severe pulmonary edema. CONCLUSIONS: On the results of this study, we could preserve the lung function for 4 hours using EVLP. We conclude that application of EVLP in clinical setting can make more donor lungs available for LTx. However, we also understand that more studies and training are needed in clinical practice.
Humans ; Lung ; Lung Diseases ; Lung Transplantation ; Organ Preservation ; Oxygen ; Perfusion ; Swine ; Tissue Donors ; Unrelated Donors ; Vascular Resistance

We performed sympathetic nerve reconstruction using intercostal nerve in patients with severe compensatory hyperhidrosis after sympathetic surgery for primary hyperhidrosis, and analyzed the surgical results. From February 2004 to August 2007, sympathetic nerve reconstruction using intercostal nerve was performed in 19 patients. The subjected patients presented severe compensatory hyperhidrosis after thoracoscopic sympathetic surgery for primary hyperhidrosis. Reconstruction of sympathetic nerve was performed by thoracoscopic surgery except in 1 patient with severe pleural adhesion. The median interval between the initial sympathetic surgery and sympathetic nerve reconstruction was 47.2 (range: 3.5-110.7) months. Compensatory sweating after the reconstruction surgery improved in 9 patients, and 3 out of them had markedly improved symptoms. Sympathetic nerve reconstruction using intercostal nerve may be one of the useful surgical options for severe compensatory hyperhidrosis following sympathetic surgery for primary hyperhidrosis.
Adult ; Female ; Humans ; Hyperhidrosis/*surgery ; Intercostal Nerves/anatomy & histology/surgery ; Male ; Middle Aged ; Patient Satisfaction ; Quality of Life ; Questionnaires ; Reconstructive Surgical Procedures/*methods ; Sympathetic Nervous System/anatomy & histology/*surgery ; Treatment Outcome ; Young Adult

PURPOSE: The applicability of tumor markers still remains controversial in non-small cell lung cancer (NSCLC) due to lower sensitivity & specificity. And, tumor markers actually have not been used determining treatment plans in NSCLC patients yet. So, we evaluated correlation between levels of serum tumor marker (CEA, NSE and Cyfra 21-1) and prognosis in NSCLC patients underwent complete surgical resection. MATERIALS AND METHODS: We retrospectively studied 64 NSCLC patients underwent complete surgical resection in Yongdong severance hospital from April 2002 to October 2005. Preoperative and postoperative serum levels of tumor markers (CEA, NSE, Cyfra 21-1) were measured with commercialized kits and the correlation between the serum levels of tumor markers and prognosis was evaluated. Normal cutoff values of CEA, NSE and Cyfra 21-1 were 5.0 ng/ml, 12.5 ng/ml and 3.2 ng/ml. We estimated recurrence or distant metastasis with computed tomography, magnetic resonance imaging, whole body bone scan, positron emission tomography and biopsy. RESULTS: Preoperative and postoperative serum levels of tumor markers were not significantly correlated with lung cancer stages and histologies. The elevated levels of postoperative CEA (p=0.0142) and Cyfra 21-1 (p=0.0105) were correlated with shortened survival time. And, the shortened disease free interval was significantly associated with the elevated level of postoperative Cyfra 21-1 (p=0.0018). The elevated level of preoperative Cyfra 21-1 (p=0.0566) had a tendency to relate the shortened survival time, but it didn't reach statistical importance. CONCLUSION: Considering previous results, especially Cyfra 21-1 may be useful prognostic factor in predicting survival times, and recurrence or metastasis. But, further study and longer follow-up period were needed to make conclusion regarding usefulness of other tumor markers
Biopsy ; Carcinoma, Non-Small-Cell Lung* ; Follow-Up Studies ; Humans ; Lung Neoplasms ; Magnetic Resonance Imaging ; Neoplasm Metastasis ; Positron-Emission Tomography ; Prognosis ; Recurrence ; Retrospective Studies ; Sensitivity and Specificity ; Biomarkers, Tumor*

Bronchiolitis obliterans (BO) is a late onset complication of allogeneic hematopoietic stem cell transplantation (HSCT), and treatment outcome is dismal if it does not respond to immunosuppressive therapy. A 21-year-old male diagnosed with acute myeloid leukemia received an allogeneic HSCT from human leukocyte antigen- identical sibling donor. Twenty one months after transplantation, he developed progressive dyspnea and was diagnosed BO. Despite standard immunosuppressive therapy, the patient rapidly progressed to respiratory failure and Novalung(R) interventional lung-assist membrane ventilator was applied in the intensive care unit. Three months after the diagnosis of BO, the patient underwent bilateral lung transplantation (LT) and was eventually able to wean from the ventilator and the Novalung(R). Since the LT, the patient has been under a strict rehabilitation program in order to overcome a severe lower extremity weakness and muscle atrophy. Histologic findings of the explanted lungs confirmed the diagnosis of BO. Nine months after the LT, the patient showed no signs of rejection or infectious complications, but still required rehabilitation treatment. This is the first LT performed in a patient with BO after allogeneic HSCT in Korea. LT can be an effective therapy in terms of survival for patients with respiratory failure secondary to development of BO following HSCT.
Bronchiolitis Obliterans* ; Bronchiolitis* ; Diagnosis ; Dyspnea ; Hematopoietic Stem Cell Transplantation* ; Hematopoietic Stem Cells* ; Humans ; Intensive Care Units ; Korea ; Leukemia, Myeloid, Acute ; Leukocytes ; Lower Extremity ; Lung Transplantation* ; Lung* ; Male ; Membranes ; Muscular Atrophy ; Rehabilitation ; Respiratory Insufficiency ; Siblings ; Tissue Donors ; Treatment Outcome ; Ventilators, Mechanical ; Young Adult