• Journal of Chest Surgery
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• v.32 no.12
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• pp.1144-1147
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• 1999

Primary endobronchial leiomyosarcoma is a very uncommon tumor and its diagnosis by spontaneous expectoration of tumor fragment has never been reported in the literature. We report a patient with primary endobronchial leiomyosarcoma that was diagnosed by spontaneous expectoration of partial tumor tissue. The expectorated tissue was found to be pathologically consistent with leiomyosarcoma. Right lower lobectomy and all lymph node dissections were performed during the operation. Pathologic examination showed that the tumor was histologically identical to the patient's previous expectorated tissue and was confined to the bronchus and did not invade the adjacent pulmonary parenchyma and lymph nodes.

• Tuberculosis and Respiratory Diseases
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• v.44 no.6
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• pp.1296-1307
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• 1997

Background : Erdosteine is a thiol derivative developed for the treatement of chronic obstructive bronchitis, including acute infective exacerbation of chronic bronchitis. Erdosteine has mucomodulating and antioxidant properties and especially exhibits excellent gastrointestinal tolerability. Methods : The study was conducted as a prospective evaluation, with 2 comparative groups orally treated with erdosteine 300mg (bid.) or ambroxol 30mg (b.i.d.) for 7 days and the design of trial was double-blind. The treatments have been assigned randomly to patients (n=80) with acute or chronic bronchitis. The primary end-point used to determine efficacy in this study was subjective symptoms including expectorating frequence, expectoration volume, expectorating difficulty, expectoration viscosity, cough intensity and dyspnea. The secondary end-points of efficacy was the result of arterial blood gas analysis and pulmonary function test. Safety was evaluated with adverse drug reactions and laboratory tests monitoring. 61 patients was included in the efficacy analysis, due to the fact that 19 patients drop-out for different reasons. The obtained values have been analyzed with paired Hest., ANOVA test., multivariate $t^2$-test, repeated measures analysis of covariance, two sample t-test, loglinear-logit model analysis, Fisher's exact test. Results : 1) There was no significant difference on demographic data and vital signs between erdosteine and ambroxol treated groups. 2) The comparison between erdosteine and ambroxol treated groups showed no significant difference in improvement of each symptom in spite of the more favorable efficacy obtained with erdosteine. No difference on the contrary was observed for arterial blood gas analysis and pulmonary function test. 3) As safety is concerned, no clinical significant changes in laboratory test and symptom were induced in erdosteine and ambroxol treated group and two patients in ambroxol treated group drop-out for adverse reactions in symptom. 4) In the evaluation of final clinical efficacy, erdosteine improved more effectively patient's overall symptoms {very good effect (11/31), good effect (12/31), moderate effect (6/31), no effect (2/31), aggravation (0/31)} than ambroxol {very good effect (6/30), good effect (14/30), moderate effect (5/30), no effect (4/30), aggravation (2/30)}. And the probability of symptomatic improvement by erdosteine compared to ambroxol was 2.5 times. (p<0.05). Conclusion : This study showed that erdosteine was clinically effective and safe drug for treatment of acute and chronic bronchitis.

• Journal of Chest Surgery
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• v.37 no.10
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• pp.884-887
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• 2004

We applied our technique of selective bronchial suctioning (SBS) for the treatment of atelectasis after resection surgery of lung in four patients with refractory atelectasis who were treated successfully. We considered that SBS using hydro-catheter insertion under local anesthesia above fourth tracheal ring is the effective technique for the treatment of refractory atelectasis when conventional respiratory therapy is not effective and a bronchoscopist is not available.

• Tuberculosis and Respiratory Diseases
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• v.46 no.4
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• pp.466-472
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• 1999

폐결핵의 진단은 주로 환자의 증상, 흉부 X-선, 객담의 균도말 및 배양검사에 의존하며 이는 과거와 크게 차이가 없으나 최근에는 좀더 효율적인 객담배출을 위한 방법, 분자생물학적 기법을 동원한 결핵균의 진단 및 결핵균항원 또는 항체를 혈액 등에서 측정하는 방법 등이 개발되어 결핵의 진단 율을 높이는데 기여하고 있다.

• Tuberculosis and Respiratory Diseases
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• v.43 no.2
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• pp.128-137
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• 1996

Background : We can diagnose pulmonary tuberculosis with sputum AFB smear and culture, but sputum AFB smear has low sensitivity and culture needs long period, and they are not available in the patients who can not expectorate effectively. Recently developed, PCR is a fast diagnostic tool in tuberculosis, but false positive and false negative are important problems. So, we studied the diagnostic value of bronchoalveolar lavage fluid AFB smear, culture, PCR through the bronchoscopy. Methods : The 67 pulmonary tuberculosis patients and 43 non-pulmonary tuberculosis patients were analyzed with their sputum specimen AFB smear and culture. Also, bronchoscopy and bronchoalveolar lavage were done, and bronchoalveolar lavage fluid AFB smear, culture and PCR were done. Results: 1) In the cases of pulmonary tuberculosis, the sensitivity of sputum AFB smear and culture were 32.8% and 57.4%, respectively. And the sensitivity of bronchoalveolar lavage fluid AFB smear and culture were 47.8% and 80.6%. respectively. 2) In the cases of pulmonary tuberculosis, the sensitivity and the positive predictive value(for predicting a positive culture) of PCR were 80.6% and 81.5%, respectively. 3) In the cases of sputum AFB smear-negative and culture-negative pulmonary tuberculosis, the sensitivity of bronchoalveolar lavage fluid AFB smear, culture, PCR, and the positive predictive value(for predicting a positive culture) of PCR were 23.1%, 100%, 88.5%, and 82.4%, respectively. 4) The specificity of bronchoalveolar lavage fluid PCR was 77.0%. 5) The median number of days between obtaining a specimen and starting therapy was 5 days for sputum AFB smear, 9 days for bronchoalveolar lavage fluid AFB smear, 26 days for bronchoalveolar lavage fluid PCR, 32 days for sputum culture, 56 days for bronchoalveolar lavage fluid culture. Conclusion : The sensitivity of bronchoalveolar lavage fluid AFB smear and culture are higher than sputum AFB smear and culture. So, the bronchoscopy must be considered for evaluating suspected cases of pulmonary tuberculosis in patients from whom smears of expectorated sputum do not reveal mycobacteria or from whom no sputum can be obtained. Especially, combined with PCR, it is expected that pulmonary tuberculosis can be diagnosed more rapidly and more accurately, so bronchoalveolar lavage fluid APB smear and PCR can be helpful in the early treatment of pulmonary tuberculosis.

• The Journal of Korean Medicine
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• v.22 no.1
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• pp.96-103
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• 2001

Clinical symptoms of stroke patients vary widely, and include headache, dizziness, vomiting, dysphagia, dysphasia, incontinence, confusion, chest discomfort, dyspnea etc. Stroke patients who had chronic respiratory disease or had tracheostomy cannula usually have high levels of sputum, but there have been rare clinical reports about treatment of oriental medicine. High levels of sputum in stroke patients can cause pneumonia and dyspnea, and so can delay rehabilitation. By use of Haepyoleejin-tang.Jungchun-tang with change of Ephedrae Herba capacity, we could improve sputum secretion and respiratory function of two stroke patients, and so we report on the clinical course of two stroke patients with high levels of sputum.

• Tuberculosis and Respiratory Diseases
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• v.47 no.4
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• pp.517-524
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• 1999

Background : Airway inflammation and hyperresponsiveness are recognized as major characteristics of bronchial asthma. Airway inflammation has usually been assessed by invasive methods, e.g. BAL or bronchial biopsy, but recent studies proposed induced sputum as another reliable and non-invasive tool to investigate airway inflammation in asthmatic patients. Thus, the relationship between airway inflammation assessed by induced sputum and airway hyperresponsiveness was investigated in asthmatic patient. Method : Airway responsiveness was determined by the concentration that caused a 20% decrease in $FEV_1$($PC_{20}$) after inhaling incremental concentrations of methacholine. The numbers of inflammatory cells and the concentration of eosinophilic cationic protein(ECP) were assessed in induced sputum obtained by inhalation of hypertonic saline(3%). Result: We analyzed sputum induced in 15 stable asthmatic patients. The differential cell count(%) of macrophages, neutrophils, eosinophils and lymphocytes in induced sputum were $39.1{\pm}27.0%$, $29.6{\pm}21.0%$, $28.8{\pm}18.8%$, $1.3{\pm}3.1%$ respectively. The mean value of baseline FEV1(predicted) and ECP were $76.3{\pm}30.3%$ and $1,101{\pm}833{\mu}g/L$ respectively. The geometric mean value of $PC_{20}$ was 0.56 mg/mL. The relationships between the sputum eosinophil and ECP in induced sputum, and between sputum eosinophil and degree of airway responsiveness($PC_{20}$) were found to be significantly correlated (r=0.81, p<0.05 and r=-0.78, p<0.05, respectively). Sputum neutrophils and $PC_{20}$ were not correlated to each other (r=0.11, p=0.69) and a significant negative correlation was found between ECP and baseline $FEV_1$(predicted)(r=-0.62, p<0.05). Conclusion : The results of this study suggest that an induced sputum via a inhalation of hypertonic saline is useful to determine a patient's status of airway inflammation, and airway inflammation is one of the major causal factors in the development of bronchial hyperresponsiveness in asthmatic patients.

• Tuberculosis and Respiratory Diseases
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• v.40 no.6
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• pp.646-652
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• 1993

Background: Lung cancer and chronic obstructive lung disease often coexist in the same person who are elderly and cigarette smoking. There are several reports that the presence of chronic obstructive pulmonary disease constitutes an independent risk factor for the development of lung cancer. Moreover, the association between mucus hypersecrtion and lung cacer has been reported. Method: In 72 cases with primary lung cancer which were confirmed histopathologically at Chonbuk University Hospital from August 1986 to July 1991, We evaluated the relationship between spirometry and lung cancer characteristics. Results: Six cases(8.3%) showed normal lung function, 16(22.2%) cases showed pure restrictive lung disease, 46(63.9%) cases showed moderated obstructive lung disease and 4(5.6%) cases showed severe obstructive lung disease. $FEV_1$(%) was lower in central type than in peripheral type, lower in advanced non-small cell cancer and lower in subjects with phlegm. $FEV_1$/FVC(%) was higher in small cell cancer than in squamous cell cancer and higher in patients without previous pulmonary disease than with previous pulmonary disease. But there was no statistically significant difference in lung function according to histologic types and smoking history. Lung cancers with $FEV_1$/FVC less than 75% consisted of 35 cases of squamous cell cancer, 7 of small cell cancer(14%), 5 of adenocarcinoma(10%), 2 of large-cell carcinoma and 1 of unclassified carcinoma. Squamous cell carcinoma occured more in patients with $FEV_1$/FVC<75% than with $FEV_1$/FVC$\geq$75%(p<0.05). Conclusion: It was suggest that low $FEV_1$/FVC, as reflection of obstructive lung disease, may be at greater risk for squamous cell carcinoma in cigarette smoker.

• Tuberculosis and Respiratory Diseases
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• v.49 no.1
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• pp.82-92
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• 2000

Background : In chronic airway disease, mucus secretion is increased, but extraction of mucin, which is the main component of mucus secretion, is a very complicated and limited in clinical use. Recently, monoclonal antibody for mucin was developed for possible clinical use. In this study, cellular analysis and quantification of respiratory mucin in sputum of patients with chronic airway diseases were performed. Method : Sputum was collected from patients with asthma(n=33), bronchiectasis(n=8) or chronic bronchitis (n=13) by spontaneous expectoration or by hypertonic saline induction. Collected sputums was treated by 0.1% dithiotreitol to dissociate the disulfide bond of the mucus and filtered through a nylon gauze. Total cell count, viability and differential count were measured. For detection of mucin, collected samples were treated with sodium dodecyl sulfate polyacrylamide gel electrophoresis and then with monoclonal antibody(HMO2), as the primary antibody, and PAS stain. The amount of mucin was measured with ELISA by HMO2. Correlation with clinical information, cellular analysis, and amount of measured mucin were analyzed. Results : Total cell counts of sputum were significantly increased in patients with bronchiectasis but viability remained the same. Eosinophils were significantly increased in patients with asthma, neutrophils in bronchiectasis chronic bronchitis, respectively (p<0.05). The results of Western blotting and PAS staining confirmed the presence of glycoproteins and matched? with mucin. The amounts of mucin measured by ELISA were not significantly different among the disease groups. Significant correlation was identified between the amount of mucin and viability(r=-0.482, p<0.05). Conclusion : Inflammatory cells in the sputum of those with chronic airway disease were different for each disease type. Measurement of mucin by ELISA via monoclonal antibodies may be a simple method for the evaluation of chronic airway disease.

• Tuberculosis and Respiratory Diseases
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• v.65 no.5
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• pp.379-384
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• 2008

Background: Sputum decontamination with NALC-NaOH (N-acetyl-L-cysteine-sodium hydroxide) is known to better detect Mycobacterium tuberculosis (M. tb) by culture than that with using NaOH, which is widely used in Korean hospitals. In this report, sputum samples collected from pulmonary tuberculosis (TB) patients were treated with either NaOH or NALC-NaOH, and we compared the results of smear and culture positivity to determine whether the NALC-NaOH treatment method improves culture positivity in the sputum samples, and especially for those sputum samples that are smear negative and scanty. Methods: For each decontamination method, 436 sputum samples from pulmonary TB patients in the National Masan Tuberculosis Hospital were collected for this study. Sputum from a patient was collected two times for the first and second day of sampling time, and these samples were employed for the decontamination process by performing the 4% NaOH and NALC-2% NaOH treatment methods, respectively, for detecting M. tb by an AFB (Acid Fast Bacilli) smear and also by culture in solid Ogawa medium. Results: The NaOH and NALC-NaOH treatment methods did not significantly affect the AFB smear positivity of the sputum samples (33.0% vs 39.0%, respectively, p=0.078). However, the culture positive percents of M. tb in the Ogawa medium treated with NALC-NaOH and NaOH were 39.7% and 28.0%, respectively, which was a significantly different (p=0.0003). This difference in culture was more prominent in the sputum samples that were smear negative (the positive percents with NALC-NaOH and NaOH were 15.8% and 7.2%, respectively, p=0.0017) and scanty (NALC-NaOH and NaOH were 60.8% and 42.9%, respectively, p=0.036), but not for a smear that was 1+ or higher (p>0.05). Conclusion: NALC-NaOH treatment is better than NaOH treatment for the detection of M. tb by culture, but not by smear, and especially when the AFB smear is negative and scanty.