• Tuberculosis and Respiratory Diseases
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• v.43 no.2
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• pp.147-158
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• 1996

Background : Endobronchial tuberculosis(ET) is known to affect frequently young female and serious complication like bronchial stenosis would occur if early diagnosis and treatment for ET is not performed immediately. But ET shows normal chest roentgenogram in about 10% of patients, and is often confused with bronchial asthma because ET presents clinical features like cough, dyspnea, wheezing in history and physical examination. The pulmonary function test(PFT) feature of ET is not well known, but when we consider the fact that ET is pathophysiologically different from bronchial asthma, if there is any feature of PFT in ET, and we know it, PFT will be very helpful for diagnosis and follow up of ET. Methods : We performed both PFT and bronchoscopy in 68 ET patients who visited Boramae hospital, and were confirmed as ET by bronchoscopic biopsy and were followed prospectively from November 1991 to March 1995. After history taking and physical examination, we performed chest roentgenogram, complete blood count, sputum AFB stain and culture, and also performed PFT before anti-tuberculosis chemotherapy. PFT was classified as restrictive, if only PVC was reduced below 80%, and obstructive, if only FEV1 was reduced below 75%. In the case of both FVC and FEV1 were reduced, PFT was classified as restrictive if FEY1/FVC was greater than 75%, and mixed if FEV1/FVC was reduced below 75%. We repeated the PFT and bronchoscopy for 68 ET patients who were proven by biopsy in the first month and sixth month after starting anti-tuberculosis chemotherapy, and studied the feature and change of PFT of the ET and the relation between PFT and the bronchoscopic finding, and obtained following results. Results: 1) Number of male patients was 12, and that of female patient was 56, and mean age was $35.4{\pm}17yr$.(17-74yr). Clinical symptom was in the order of cough(86.8%), dyspnea(63.2%), fever(17.6%) and hemoptysis (10.3%), and the wheezing and stridor were audible among the 40 patients(58.4%) in the physical examination. 2) Hemoglobin level was below 12g/dl among 25 patients (36.8%), and WBC level was above $10,000/mm^3$ among 9 patients(13.2%) and ESR was above 20 among 46 patients (67.6%) and AFB stain and culture were positive among 50 patients(73.5%). 3) The dominant roentgenographic finding of ET was fibronodular feature in 35 patients(51.5%), pneumonic feature in 14 patients (20.6%), collapse in 11 patients(16.2%), mass-like lesion in 3 patients(4.4%), cavitary lesion in 2 patients(2.9%), and normal in 3 patients(4.4%). 4) PFT feature at the time of diagnosis of ET was normal in 16 patients(23.5%), restrictive pattern in 32 patients (47%), obstructive in 4 patients(5.8%), and mixed in 14 patients(23.5%). So restrictive pattern was the dominate feature of ET. 5) The PFT feature was little correlated with the gross finding of bronchoscopy, but the change of PFT during treatment of ET showed relatively good correlation with the change of bronchoscopic finding. 6) FVC(2.30L vs. 2.61L) and FEV1(1.74L vs. 2.06L) increased significantly (p < 0.01), but FEV1/FVC(82% vs. 83%) and PEF(3.45L/sec vs. 3.95L/sec) did not change significantly after 1 month of treatment (p > 0.01), and there was no significant change among all parameters during first and sixth month of treatment(p > 0.01). Conclusion : PFT may be useful in the diagnosis and treatment follow up of ET but further study would be needed to confirm it.

• Tuberculosis and Respiratory Diseases
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• v.50 no.2
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• pp.196-204
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• 2001

Background : Bronchial asthma is characterized by a reversible airway obstruction, airway hyperresponsiveness, and eosinophilic airway inflammation. The bronchodilator response(BDR) after short acting beta agonist inhalation and PC20 with methacholine inhalation are frequently used for diagnosing bronchial asthma. However, the relationship between the presence of a bronchodilator response and the degree of airway hyperresponsiveness is uncertain. Therefore, the availability of a eosinophil cationic protein (ECP) and a correlation ECP with a bronchodilator response and airway hyperresponsiveness was investigated. Method : A total 71 patients with a moderate to severe degree of bronchial asthma were enrolled and divided into two groups. 31 patients with a positive bronchodilator response and 38 patients with a negative bronchodilator response were evaluated. In both groups, the serum ECP, peripheral blood eosinophil counts, and total IgE level were measured and the methacholine bronchial provocation test was examined. Results : There were no differences observed in age, sex, atopy, and baseline spirometry in both groups. The peripheral eosinophil counts showed no difference in both groups, but the ECP level in group 1 (bronchodilator responder group) was higher than in group 2(non-bronchodilator responder group) ($22.4{\pm}20.7$ vs $14.2{\pm}10.4$, mean$\pm$SD). The PC20 in group 1 was significantly lower than in group 2 ($1.14{\pm}1.68$ vs $66{\pm}2.98$). There was a significant positive correlation between the BDR and ECP, and a negative correlation between the bronchial hyperresponsiveness and ECP. Conclusion : The bronchodilator response significantly correlated with the bronchial hyperresponsiveness and serum ECP in the moderate to severe asthma patients. Hence, the positive bronchodilator response is probably related with active bronchial inflammation and may be used as a valuable index in treatment, course and prognosis of bronchial asthma.

• Tuberculosis and Respiratory Diseases
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• v.65 no.1
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• pp.41-48
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• 2008

Bronchial mucoepidermoid carcinoma is uncommon, representing 0.2% of all lung tumors. The disease usually presents with symptoms of airway obstruction and recurrent pneumonia. It is commonly classified into two grades in Korea, low and high. We report a case of a bronchial mucoepidermoid carcinoma in a 40-year-old woman who complained of symptoms of an upper respiratory infection. The histological grade after a bronchoscopic biopsy was intermediate. A left upper lobectomy was performed as treatment. The TNM stage of this case was IA (T1N0M0). In addition, 25 cases of bronchial mucoepidermoid carcinoma from 1984 in Korea are also reviewed from the viewpoint of the relationship between the histological grade, TNM stage and clinical course of the tumor.

• Tuberculosis and Respiratory Diseases
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• v.49 no.1
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• pp.18-29
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• 2000

호흡기 바이러스 감염은 모든 연령층의 천식에 상당한 영향을 미치는 데 영아에서 RSV는 천명을 야기하고 대부분 일시적이나 재발성 일수도 있다. 어릴 때 바이러스 감염은 면역체계 형성에 영향를 미쳐 알러지와 천식의 위험을 완하할 수있다고 한다. 또한 소아와 성인 천식에서 RV같은 감기 바이러스는 천식의 급성 증상을 유발한다. 호흡기 바이러스 감염에 대한 면역반응이, 기관지로 부터 바이러스 제거 기능외에 기도수축과 호흡기 증상에 관여한다고 한다. 이러한 변화가 일어나는 기전은 호흡기 바이러스가 proinflammatory 사이토카인과 매개체 생성을 유도하는 능력과 연관성이 있는 것 같고 이들이 상하기도 호흡기 증상 및 기도반응 변화에 관여하는 것으로 생각된다. 호흡기 바이러스 감염에 대한 면역반응을 요약하면 바이러스 감염으로 상피세포, 내피세포, 과립백혈구가 활성화되며, 상피세포는 사이토카인, 키모카인, 매개체들을 분비하여 항 면역 반응를 주도하다. 이와 같은 상피세포와 다른 기관지 세포들의 조기 활성화로 내피 세포에 유착분자 표현을 증가시켜 백혈구 동원 증가 및 혈관 투과성을 증가시켜 부종과 분비물을 증가시킨다. 바이러스 또는 바이러스 유발 사이토카인에 의해 활성화된 과립 백혈구, 대식세포, T세포들도 기도염증 증가, 기도폐쇄를 야기하고 기도반응을 증가시킨다. 세포독성 임파구에 의한 바이러스 감염세포의 분해, TGF-$\beta$ IL-10 같은 사이토카인에 의해 부분적으로 염증억제, 기도 remoldeling에 의한 기도구조의 재생등이 바이러스 감염후 기관지 기능의 지속적 변화를 결정한다. 끝으로 천식환자에서 RV 감염의 병인에 관한 기본적 문제는 RV감염이 정상인에서는 경한 증상을 나타내는 데 천식환자에서는 왜 심한 임상증상을 나타내는지 아직 완전히 밝혀지지 않았다. 항 바이러스에 대한 면역반응이 천식환자에서 손상되었는지 또는 천식환자에서 RV감염에 의한 중증의 임상증상은 어떤 다른 세포가 관여하는지? 이들에 대한 답은 기도염증이 천식에서 어떻게 조절되는지 또한 바이러스 감염에 의한 악화된 증상을 어떻게 치료할 것인가에 대한 방향을 제시해줄 것이다.

• Tuberculosis and Respiratory Diseases
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• v.41 no.5
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• pp.574-578
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• 1994

The incidence of traumatic rupture of the tracheobronchial tree has been increased considerably with advent of widespread mechanization and high speed era. Rupture of the bronchus is an unusual result of nonpenetrating trauma to chest. Early diagnosis and primary repair not only restore normal lung function but also avoid difficulties and complications associated with delayed diagnosis and repair. These complications are pneumonia, atelectasis and lung abscess secondary to the bronchial obtruction. We experienced a case of partial rupture on left main bronchus caused by nonpenetrating blunt chest trauma with rib fractures 1 year ago. He was suffered from progressively developing dyspnea on exercise and treated as bronchial asthma at other hospital. Bronchoscopic finding was the narrowed lumen of left main bronchus at 1cm from carina by web-like membrane. We confirmed by bronchogram and repaired by end to end anastomosis, which is rare delayed finding in bronchial rupture without pulmonary complications. We report a case of nonpenetrating traumatic bronchial rupture, manifested by bronchial web in bronchoscopy.

• Journal of Chest Surgery
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• v.43 no.6
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• pp.734-738
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• 2010

A 43 year-old female, who underwent bilateral lung transplantation for Eisenmenger syndrome 10 years previously, visited our hospital complaining of progressive severe dyspnea. She was diagnosed as having. bronchiolitis obliterans syndrome, which was presumably caused by chronic graft rejection following lung transplantation. Due to the aggravated dyspnea despite medical treatment, she required ventilator care and then she underwent lung retransplantation. We report here on a case of lung retransplantation for treating chronic graft rejection following the previous lung transplantation for the first time in Korea.

• Tuberculosis and Respiratory Diseases
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• v.59 no.3
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• pp.315-320
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• 2005

A rapid response to corticosteroid treatment and a generally favourable outcome are characteristic features of BOOP (Bronchiolitis obliterans organizing pneumonia). However, with increasing experience of the clinical spectrum of this disease, it is now recognized that some patients are refractory to steroid, which is associated with a poor prognosis. Here, two cases of BOOP initially treated with predinisone and antibiotics without effects, but subsequently responded to secondary cyclosporine treatment, are reported.

• Journal of Chest Surgery
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• v.31 no.5
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• pp.540-543
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• 1998

A patient with post-pneumonectomy empyema was treated sucessfully by modification of Clagett's operation after closure of bronchopleural fistula using a transsternal, transpericardial approach. His primary disease was pulmonary tuberculosis, and he had a past history of left upper lobe lobectomy 34 year ago. Recently recurred pulmonary tuberculosis with aspergilloma in the remaining left lung, empyema with bronchopleural fistula had developed on the post-operative 4th day after completion pneumonectomy. Closed thoracostomy was done at the lowest point of the left pleural cavity immediately. The pleural cavity was irrigated with small amount of normal saline through pigtail catheter. The 2nd operation was done by closure of bronchopleural fistula using a stapler through transsternal, transpericardial approach, and then the pleural space was irrigated with normal saline with Tobramycin which shows sensitivity to isolated organism from pleural cavity. After negative conversion of pleural fluid culture, we performed modified Clagett's operation under local anesthesia. The patient had no evidence of recurrence of empyema and discharged from hospital after 10 days of the 3rd procedure.

• Tuberculosis and Respiratory Diseases
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• v.63 no.2
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• pp.139-144
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• 2007

Background: Bronchial anthracofibrosis, which is defined as bronchial narrowing with black pigmentation of the overlying bronchial mucosa, is frequently associated with tuberculosis. The aim of this study was to examine the relationship between bronchial anthrocofibrosis and to identify the clinical and radiological characteristics of non-tuberculous bronchial anthracofibrosis. Methods: All patients who showed bronchial anthracofibrosis in more than one segment on a bronchoscopic examination from January 2003 to July 2006 at Kangnam St. Mary's hospital were enrolled in this study. The underlying diseases, baseline clinical characteristics, characteristic findings on a computed tomogram (CT) of the chest, pathologic findings of the bronchial mucosa, and the clinical response to steroid therapy were analyzed retrospectively. Results: A total 54 patients (19 males, 35 females) were enrolled with a mean age of 75 years. The most common presenting symptoms were cough, sputum and dyspnea. The predominant X-ray findings were peribronchial soft tissue attenuation with or without calcification, mediastinal lymphadenopathy with or without calcification and atelectasis. Fourteen non-tuberculous anthracofibrosis patients were treated with steroid. Nine patients were improved clinically, and 6 patients were improved radiologically. Conclusion: Bronchial anthracofibrosis is frequently associated with various pulmonary diseases not only tuberculosis but also COPD pneumonia etc.

• Tuberculosis and Respiratory Diseases
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• v.44 no.1
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• pp.124-135
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• 1997

Background : Diffuse panbronchiolitis(DPB) is a disease characterized clinically by chronic cough, expectoration and dyspnea; and histologically by chronic inflammation localized mainly in the region of the respiratory bronchiole. It is prevalent in Japanese, but is known to be rare in Americans and Europians. Only a few cases in Chinese, Italians, North Americans and Koreans have been reported. It is diagnosed by characteristic clinical, radiological and pathologic features. High-resolution CT(HRCT) is known to be valuable in the study of the disease process and response to therapy in DPB. To our knowledge, there has been no correlation of its appearance on HRCT with the severity of the disease process, and radioaerosol scan(RAS) of the lung has not previously been used for the diagnosis of DPB. Method : During recent two years we have found 12 cases of DPB in Kangnam St. Mary's Hospital, Catholic University Medical College. We analysed the clinical characteristics, compared HRCT classifications with clinical stages of DPB, and determined characteristic RAS manifestations of DPB. Results : 1. The ages ranged from 31 to 83 years old(mean 54.5 years old), and male female ratio was 4:8. 75%(9/12) of patients had paranasal sinusitis, and only one patient was a smoker. 2. The patients were assigned to one of three clinical stages of DPB on the basis of clinical findings, sputum bacterology and arterial blood gas analysis. of 12 cases, 5 were in the first stage, 4 were in the second stage, and 3 were in the third stage. In most of the patients, pulmonary function tests showed marked obstructive and slight restrictive impairments. Sputum culture yielded P.aeruginosa in 3 cases of our 12 cases, K.pneumoniae in 2 cases, H.influenzae in 2 cases, and S.aureus in 2 cases. 3. Of 12 patients, none had stage I characteristics as classified on HRCT scans, 4 had slage II findings, 5 had stage III findings, and 3 had stage IV characteristics. 4. We peformed RAS in 7 of 12 patients With DPB. In 71.4% (5/7) of the patients, RAS showed mottled aerosol deposits characteristically in the transitional and intermediary airways with peripheral airspace defects, which contrasted sharply with central aerosol deposition of COPD. 5. There were significant correlations between HRCT stages and clinical stages(r= 0.614, P < 0.05), between HRCT types and Pa02(r= -0.614, P < 0.05), and between HRCT types and ESR(r= 0.618, P < 0.01). Conclusion : The HRCT classifications correspond well to the clinical stage. Therfore in the examination of patients with DPB, HRCT is useful in the evaluation of both the location and severity of the lesions. Also, RAS apears to be a convenient, noninvasive and useful diagnostic method of DPB.