Clinical Analysis of Video Assisted Thoracic Surgery for the Treatment of Thoracic Empyema / 대한흉부외과학회지

BACKGROUND: Thoracic empyema remains a serious problem despite the availability of modern diagnostic methods and appropriate antibiotics. The condition presents in many different forms and stages that require different therapeutic options. Video-assisted thoracic surgery (VATS) has become increasingly popular for use in the treatment of empyema. MATERIAL AND METHOD: From January 2005 to May 2009, VATS was performed in 36 patients with pleural empyema and for whom chest-tube drainage and antibiotic therapy had failed or the CT scan showed multiseptate disease. The perioperative clinical factors were analyzed for all the study patients. RESULT: All the patients underwent VATS, but it was necessary to convert to thoracotomy in one patient. The mean operation time was 90+/-38.5 min. For the operative evaluation, 11 patients were compatible with ATS stage III. The duration of chest-tube insertion was 11.9+/-5.8 (3~24) days. One patient did not improve and therefore this patient underwent additional open drainage. At discharge, costophrenic angle blunting was observed in 22 patients, pleural thickening was noted in 20 patients, both were noted in 17 patients and neither was noted in 11 patients. However, at follow-up, each of these changes was observed in 9, 7, 4 and 24 patients, respectively. All except one patient showed radiographic improvement. CONCLUSION: VATS is suitable for the treatment of early and fibrinopurulent thoracic empyema, and even in selected patients with stage III disease.

Development of a Multidisciplinary Care System for Lung Cancer Patients

PURPOSE : Since the year 2000, lung cancer has been the leading cause of cancer death in South Korea and also in many other parts of the world. MATERIALS AND METHODS : We developed a multidisciplinary (MD) care system for lung cancer patients in 1996. Here, we report the results obtained in the process of development of MD team (MDT). RESULTS : The MDT was launched with including medical doctors, chest surgeons, radiation oncologists, radiologists, nuclear medicine specialists and physician assistants. To facilitate co-operation between the MDT members, a specialized out-patient clinic was located within a sector of the hospital. A common ward was allocated for lung cancer patients regardless of the department of the attending physician. Shared electronic medical record forms that were specialized for lung cancer were developed. The MDT operates weekly lung cancer conferences and multidisciplinary out-patient clinics. To make diagnostic or therapeutic decisions early on, the electronic medical records of the patients were previewed or consulted by the specialists before they meet the individual patients. CONCLUSION : Despite every effort, we still need to shorten the waiting time from presentation to the first treatment and we need to improve the patients' satisfaction. We also have a mission to develop our own regulations and guidelines for our lung cancer MD care system. Clinical trials and basic research should also be encouraged along with improving the quality of life of the team members