A Case of Diaphragmatic Eventration Complicated with Contralateral Traumatic Diaphragmatic Paralysis / 대한흉부외과학회지

Diaphragmatic eventration is a rare disease and is caused by congenital etiology. We operated on a patient who had had preexisting left diaphragmatic eventration which was complicated by a right diaphragmatic paralysis and a persistent respiratory insufficiency due to a traffic accident. This was a very rare case and there has not yet been any case reports worldwide. We were able to abtain good surgical results from plication of left diaphragm in this case and thus report it.

Surgical Treatment of Loculated Empyema: Closed Rib Resectional Drainage / 대한흉부외과학회지

BACKGROUND: Multi-loculated empyema makes treatment difficult, and more so when thoracentesis or chest tube drainage fails. MATERIALS AND METHODS: From December 1991 to December 1997, we performed closed rib resectional drainage for 18 cases of loculated empyema on the fibrinopurulent or early chronic phase. RESULTS: Surgery was performed on patients with loculated empyema complaining of persistent symptoms due to failure of treatment by thoracentesis (8 cases) or chest tube drainage (10 cases). Predisposing factors of empyema were pneumonia in 13 cases, clotted hemothorax in 3 cases, cholecystectomy, and tuberculous pleurisy in 1 case. Causal organisms were cultured in 8 cases (42.1%), and methicillin-resistant staphylococcus aureus was found in 3 cases, pseudomonas aeruginosa in 2 cases, and enterococcus aerogens, alpha-hemolytic streptococcus, and acinetobacter baumannii were found in 1 case. Size of loculations was various, and computed chest tomogram showed multiple loculations of empyema numbering 1~4 (mean 1.78+/-1.00). Operating time was relatively short, about 55~140 mins (mean 102.8+/-30.8). All toxic symptoms including fever disappeared postopratively and general conditions improved very quickly in all patients. Length of chest tube indwelling time and hospital stay after surgery were 3~42 days (mean 11.4+/-11.5) and 6~36 days (mean 12.9+/-8.1), respectively. Complications of prolonged drainage occurred in 2 cases and no death occurred. There were no recurrences and chest x-rays taken 3~6 months after surgery showed normal findings in 14 cases and slight pleural thickening in 4 cases. CONCLUSIONS: Closed rib resectional drainage requires very simple techniques and has excellent outcomes and little complications, therefore, we think that it is the choice of operation for patients with loculated empyema on the fibrinopurulent or early chronic phase.

Efficacy of mechanical pleurodesis for the treatment of spontaneous pneumothorax with VATS: A comparison of short-term recurrence according to the intensities of pleural abrasion / 대한흉부외과학회지

BACKGROUND: With the advent of thoracoscopy, there has been increasing interest in less invasive surgical bullectomy and pleurodesis. The recurrence rate, however, has been reported higher in surgery with thoracoscopy than with open thoracotomy and it is thought to be caused by inappropriate mechanical pleurodesis during thoracoscopic surgery. MATERIALS AND METHODS: We compared the short-term recurrence rates according to the intensities of pleural abrasion in 62 patients who underwent VATS for treatment of spontaneous pneumothorax from April 1996 to August 1997. The patients were divided into 2 groups: group A (n=32) included patients who received relatively weak pleural abrasion using Endo-forcep instrument for grasping the gauze, and group B (n=30) received strong pleural abrasion using conventional instrument wrapped tightly with gauze. Each intensity of pleural abrasion allowed petechia on the parietal pleura in group A, and some tearing and bleeding in group B. RESULTS: Indications for operation, sex distribution, and age were comparable in both groups. There were no differences in chest tube indwelling time (3.78+/-3.35 vs 3.80+/-2.49 days), hospital stay (4.72+/-1.87 vs 4.67+/-2.20 days), and the amount and duration of analgesics required postoperatively. Persistent air-leak more than 7 days after surgery occurred in 4/32 (12.5%) and 2/30 (6.7%) in group A and B, respectively. No bleeding-related complication occured. Pneumothorax recurred 12.5% (4/32) and 0% (0/30) of patients at a mean follow-up of 9.7 and 9.6 months in group A and B, respectively, and it was statistically significant (p<0.05). CONCLUSIONS: Proper intensity of pleural abrasion is very important factor to reduce recurrence after VATS for spontaneous pneumothorax. During short-term follow-upafter surgery, we could achieve excellent result in reducing recurrence rate with VATS and strong pleural abrasion which is comparable to thoracotomy.