• Journal of Chest Surgery
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• v.36 no.5
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• pp.348-355
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• 2003

Background: The prognostic significance of lymph node micrometastasis in non-small cell lung cancer remains controversial. We therefore investigated the clinicopathologic factors related to lymph node micrometastsis and evaluated the clinical relevance of micrometastasis with regard to recurrence. Material and Method: Five hundred six lymph nodes were obtained from 41 patients with stage 1 non-small ceil lung cancer who underwent curative resection between 1994 and 1998. Immunohistochemical staining using anti-cytokeratin Ab was used to detect micrometastasis in these lymph nodes. Result: Micrometastatic tumor cells were identified in pN0 lymph nodes in 14 (34.1%) of 41 patients. The presence of lymph node micrometastasis was not related to any clinicopathoiogic factor (p) 0.05). The recurrence rate was higher in patients with micrometastasis (57.1%) than in those without (37.0%), but the difference was not significant (p=0.22). Patients with micrometastasis had a lower 5-year recurrence-free survival rate (48.2%) than those without micrometastasis (64.1%), with a borderline significance (p=0.11), The S-year recurrence-free survival rate (25.0%) in the patients with 2 or more micrometastatic lymph nodes was significantly lower than that in the patients with no or single micrometastasis (p=0.02). In multivariate analysis, multiple lymph node micromestasis us was a significant independent predictor of recurrence (p=0.028, Risk ratio=3.568). Conclusion: Immunehistochemical anti-cytokeratin staining was a rapid, sensitive, and easy way of detecting lymph node micrometastasis. The presence of lymph node micrometastasis was not significantly associated with the recurrence, but had a tendency toward a poor prognosis in stage 1 non-small cell lung cancer. Especially, the presence of multiple micrometastatic lymph nodes was a significant and independent predictor of recurrence.

• Journal of Chest Surgery
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• v.29 no.4
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• pp.397-402
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• 1996

A clinical study of 36 cases of pulmonary tuberculosis that had had a surgical resection during the period of 13 years from January 1979 to December 1992 was performed in the Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Hospital The ratio between male and female was 3.5 1 and the age of peak incidence was in the 2nd and 3rd decades. The common prodromal symptoms were chest pain (38.9 %) and hemoptysis or blood tinged sputum (36.1 %). Preoperative diagnostic examination of sputum positivity for AFB stain despite antituberculosis chemotherapy was noticed in 22.8 oyo . Surgical indications were destroyed lobe or segment with or without cavity (58.3 oyo), mass unable to differentiate from lung cancer (16.7 %), total destroyed lung (13.9 %), bronchostenosis with atelectasis and distal bronchiectasis (11.1 %). Types of resection were pneumonectomy in 16.7%, lobec omy and segmentectomy 2.7%, lobectomy 50 %, segmentectomy 27.8%, and wedge resection 2.7%. Postoperatively, pulmonary function Improved compared to the preoperative examination, although these changes were not statistically significant. One patient died of ulcerative colitis due to drug hypersensitivity, and the postoperative complications were remnant dead space in 11.1 %, spreading of tuberculosis in 5.5%, and empyema with BPF in 5.5%.

• Journal of Chest Surgery
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• v.43 no.6
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• pp.833-837
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• 2010

This is a report of successful management for pulmonary metastasis following chemotherapy in patient with testicular germ cell tumor. Postchemotherapy PET-CT was not uptake FDG in metastatic lesion. Pulmonary metastasectomy was performed, which is important to manage a residual postchemotherapy lung mass in testicular germ cell tumor for histological correlation with primary testicular lesion to select the patients who require subsequent chemotherapy. Our patient was well 6 months after operation, not carried out chemotherapy because of no viable tumor.

• Tuberculosis and Respiratory Diseases
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• v.59 no.6
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• pp.613-618
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• 2005

Background : Recently, medical treatment of multi-drug resistant pulmonary tuberculosis has been unsuccessful. Through analyzing the cases with surgical treatment, we hope to provide some help in treating multi-drug resistant pulmonary tuberculosis in the future. Material and Method : A retrospective review was performed with 138cases of surgical treatment of multi-drug resistant tuberculosis during 10years from January 1994 to December 2003 at National Masan Hospital. Results : The ratio of men to women, 5.1:1 indicates that there were more incidences in men. The number of the resistant drugs was 5.3 with a mean age of 42.6 years. Cavitary lesions on the plain chest X-rays were seen in 94cases (68.1%). 128cases had positive sputum culture preoperatively. Types of operations were 24 pnemonectomies, 83 lobectomies, 10 bilobectomies, 19 lobectomies with segmentectomies or wedge resections, 1 wedge resection, and 1 carvenoplasty. There was no death after operation. There were 6cases of air leakage over a week, 6cases of postoperative bleeding, 8cases of bronchopleural fistula and empyema, 16cases of dead space, 1case of atelectasis, 1case of wound infection, 1case of cyst as postoperative complication. Postoperative complication showed higher long-term negative conversion rate of 92.8%. Conclusion : There has been many discussions about operative indications, postoperative drug regimens, length of postoperative chemotherapy. In our study, we showed higher long-term success rate of postoperative chemotherapy with pulmonary resection on multi-drug resistant pulmonary tuberculosis.

• The Journal of the Korean bone and joint tumor society
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• v.9 no.2
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• pp.139-147
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• 2003

Purpose: The purpose of this study was to determine if bony union can be obtained when a bone graft substitute is transplanted in order to treat a benign bone tumor and if there is a difference between calcium sulfate and hydroxyapatite in the healing procedure when the degree of the bony union after the bone graft are compared. Materials and Methods: This study selected 20 cases, in which a curettage on the benign bone tumors was conducted and a bone graft substitute was transplanted. The area of the focus, the new bone formation, the recurrence of the focus in the plain radiographs and histological findings were observed. Results: Twenty cases (13 males, 7 females) were evaluated. Their mean age at surgery was 15.8 years (2~45), and the mean follow-up period was 3 years. The mean area of focus was 30.7 $cm^3$ in the radiographs, and 19 cases showed successful results in the ultimate visit, while 1 case has a recurrence of the focus. Conclusion: Calcium sulfate has osteoconduction and superior bioavailability, and is absorbed in vivo in proportion to the new bone formation. On the other hand, hydroxyapatite has good osteoconduction. It can result in better bone formation when it is combined with an autologous bone graft, autologous bone marrow, and an allogenic bone graft, but is absorbed in vivo more slowly than the former.

• Korean Journal of Bronchoesophagology
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• v.3 no.1
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• pp.27-36
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• 1997

초기후두암에 있어서 보존적 술식의 장점은 후두 전적출술시와 같은 국소치료효과를 얻을 수 있으면서도 후두의 생리적 기능을 최대한 보존하는데 있다. 성공적인 후두부분절제술을 위해서는 후두내에서 종양의 발생위치 및 그 확산에 대한 연부조직들의 해부학적 역할에 대한 이해가 필요하다. 과거에는 초기후두암환자에서 정상적인 목소리를 보존할 수 있다는 이점 때문에 방사선 치료가 일차적 치료요법으로 많이 시행되어 왔다. Wang 과 Wong은 성대 막양부에 국한된 병변에서 방사선치료에 대한 5년간 조절율(5-year control rate)이 92%, 전연합부를 침범한 경우가 81%, 그리고 후방으로 전파된 경우 76%로 감소된다고 보고하였다. Olofsson 등은 전연합부를 침범한 57례의 환자에서 방사선 치료를 시행하여 85.7%의 5년 생존율을 얻었으나, 57례중 15례에서 재발하여 구제수술(salvage surgery)을 시행하였고, Jesse 등$^{13)}$ 은 전연합부를 침범한 91례의 T1, T2 성문암을 방사선 치료를 시행하여 8.8%의 실패율을 보였으나 22례의 환자에서 재발하여 후에 salvage surgery를 시행하였다. 그러나 Ogura 등은 피열 연골을 침범한 79례의 환자에서 보존적 수술을 시행한 결과 6례의 환자에서 재발하여 90%의 3-years control rate를 얻을 수 있었다고 보고하였다. 이처럼 병변이 전연합부, 피열연골 혹은 후방성문하부로의 침범이 있는 경우는 방사선 치료 효과가 떨어지고, 따라서 방사선 치료에 실패할 가능성이 보다 높기 때문에 비록 방사선 치료 후 실패한 경우에서 구제 수술을 시행할 수는 있지만 후두기능을 보존하려는 궁극적인 목표를 생각할 때 보존적 수술을 우선적으로 시행하는 것이 바람직하다고 할 수 있다. Biller 등은 방사선 요법에서 실패한 성문부 종양에서는 대부분 전적출술을 시행하지만 일부는 보존적 수술을 시행할 수 있다고 보고하였다. 이들은 반대측 성문부에 종양의 침범이 없어야 하고, 전연 합으로의 파급은 있어도 가능하며 성대돌기를 제외한 피열연골이 정상이어야 하고, 종양의 성문하부로의 파급이 5mm 이내라야 하며, 연골에 침범이 없어야 하고, 성대고정이 없어야 하며, 재발 병소가 방사선요법 전의 원발병소와 상관관계가 있어야 하며, 원발병소가 후두부분적출술에 합당할 경우 보존적 술식을 시행할 수 있다고 하였다. 최근에는 다양한 후두 재건술의 발달로 보다 진행된 후두암에 대한 보존적 후두절제술들이 소개되고 있다. 단측 T3,T4 후두암 혹은 경성문암, 이상와에 위치한 암의 경우 음성만을 재건하는 후두근적출술 (near total laryngectomy)을 시행하기도 한다. 본원 이비인후과에서 1986년부터 초기성문암 51례 중 24례(47.1%)와 초기성문상암 17례 중 12례 (70.6%)에 대하여 보존적 술식을 시행하였다. 초기 성문암의 보존적 술식을 시행한 24례중, 2례(8.3%)에서 경부재발, 1례(4.2%)에서 경부재발과 동반된 폐의 원격전이가 있었으나 원발부위의 재발은 관찰되지 않았고, 술후 합병증으로 1례(4.2%)에서 후두협착, 3례(12.5%)에서 수술부위의 육아종형성, 그리고 1례(4.2%)에서 기관지염이 발생하였으나 오연으로 인한 폐렴은 발생하지 않았다. 초기성문 상암의 보존적 술식을 시행한 12례 중 1례(8.3%)에서 원발병소의 재발, 2례(16.7%)에서 경부재발이 있었으며, 술후 합병증으로 3례(16.7%)에서 오연으로 인한 폐렴의 발생이 있었지만 다른 합병증은 발생하지 않았다. 초기성문암 24례 중 재발이 나타난 3례의 환자를 제외한 21례(97.5%)와 초기성문상암 12례 중 재발이 나타난 3례의 환자를 제외한 9례 (75%)에서는 현재까지 재발소견을 보이지 않고 있다. 이러한 결과는 다른 보고자들과 유사한 결과를 보이고 있지만 아직까지 증례가 많지 않기 때문에 생존율을 얻기에는 미흡한 점이 있으며, 향후 지속적인 추적관찰이 필요할 것으로 사료된다.

• Journal of the korean academy of Pediatric Dentistry
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• v.38 no.3
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• pp.262-269
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• 2011

Ameloblastic fibroma is rare true benign mixed odontogenic tumor. Most of these tumors occur in the posterior region of the mandible under 20 years of age. It develops generally associated with unerupted tooth and grows slowly on the surface of alveolar bone, therefore interferes normal tooth eruption. These lesions rarely showing a little bony expansion, are usually asymptomatic and are discovered incidentally on routine dental exam. It is similar to amleoblastic fibroodontoma and ameloblastic fibrodentinoma clinically and roentgenographically but represents no dental hard tissue formation histologically. Enucleation and curettage of surrounding bone are generally recommended options for treatment. Even though there are some reports of recurrence and malignant transformation and more aggressive treatment options like block resection are suggested sometimes, but in most cases, recurrence is unusual because it is well encapsulated and easily separated from adjucent bony socket. In these cases, we did conservative treatment such as enucleation and curettage to the patients who were visited for ameloblastic fibroma associated with delayed eruption of lower first molar. After regular check-ups, we found relatively natural eruption process of combined teeth.

• Journal of Chest Surgery
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• v.30 no.2
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• pp.179-186
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• 1997

The frequency of primary lung cancer is increasing compared to other cancer. Complete surgical resection is the most effective method of treatment, but it is limited to only 25 to 30 percent of patients after initial clinical presentation. The survival rate is different by the subtypes of carcinoma, stages, and general condition of patients. The author investigated the survival rate of 87 patients with squamous cell carcinoma of the lung after surgery. Age ranged from 31 to 73 years, with Lean 57.1) $\pm$ 7.15 and 80.5% (70 cases) was initially diagnosed at sixth and seventh decades. Male to female ratio was 8.9'1. Initial complaints were cough with sputum in 78.1%, weight loss in 31.0%, chest pain and discomfort in 29.9%, and hemoptysis in 24.1%. The location of the tumor was right side in 44.8% and left slde in 55.2% ; LUL in 39.1%, RLL in 20.7%, LLL in'16. 1%, RUL in 14.9% and RML in 9.2%. Stage I was 19.5%, stage II 25.3%, stage olla 54.1% and stage lIIb 1.1%. Operative procedures were as follow : pneumonectomy in 52.9%, lobectomy in 47.1%, sleeve upper lobectomy in 4 cases. Single mediastinal Iymph node involvement was observed in 17 cases, and multi-level mediastinal Iymph node involvement in 23 cases. Lower paratracheal Iymph node and subcarinal Lymph node were more frequently involved in right side lung cancer, with 8 and 10 cases, respectively and subaortic Iymph node was most frequently involved in left side lung cancer with 9 cases. Operative complications were hoarseness, wound infection and chylothorax in 7, 5 and 4 cases, respectively. The operative mortality was 2.2% and the cause of death was pulmonary edema. Postoperative follow-up period ranged from 1 month to 99 months with a mean of 29.95 $\pm$ 17.21 months. Overall one-year survival rate was 75.1 % and five-year survival rate was 29.8%. One-year and five-year survival rates were 93.7% and 52.4% for stage 1, 92.2% and 30.5% for st ge ll, and 61.2% and 17.4% for stage llla, respectively. These findings correlate survival rate with tumor size, mediastinal Iymph node metastasis and surgical resectability, and long-term survival can be expected with small sized tumor, absent mediastinal Iymph node metastasis and complete surgical resection.

• Journal of Chest Surgery
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• v.29 no.5
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• pp.517-523
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• 1996

From May 1988 to June 1994, )73 patients underwent exploratory thoracotomy for resection of non- small cell lung cancer, and 48 patients staged pathologically as lIIB were analyzed. 74 lesions were involvement of great vessel (n=26), heart (n=5), ipsilateral lung metastasis(n=4), esophagus (n=4), carina(n=3), mediastinum (n=2), trachea(n=1), spine (n=1) and 13lourO seeding(A=15). N3 lesions were involved in 6 patients. Extended pulmonary resection with radical mediastinal node dissection was possible in 25 patients, and exploration only was performed in 23 patients. The most frequent cause of unresectability was pleural seeding. Postoperative morbidity was )2 % (8125) and mortality was 16 % (41 25) in resected group. The adjutant therapy was given to 37 patients. The 1 year and 3 year survival for resected group ncluding operative deaths was 57.2%, and 2).8 % (median 15 months), but 48.4%, and 0 % (median 7 months) for exploration only group (Log-Rank test, p : 0.17). Our results suggest that extended pulmonary resection might be helpful for carefully selected patients with 74 non-small cell lung cancer, but meticulous preoperative work-up for staging, especially to detect pleural seeding and Invasion to the irlediastinal structures is a prerequisite to avoid unnecessary thoracotomy.

• Journal of Chest Surgery
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• v.29 no.11
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• pp.1248-1256
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• 1996

From June 1987 to December 1994, 372 patients underwent operation for resection of esophageal cancer, and 48 patients with metastasis to distant abdominal lymph nodes were analyzed.. The primary tumors were located predominantly in lower thoracic esophagus(n=29). The location of involved lymph nodes were celiac L/N(n=45), common hepatic L/N(n=4), paraaortic L/N(n=l), and retropancreatic L/N(n=l). Most tumors penetrated the esophageal wall(T3,T4, n=43), metastased to regional L/N(N1, n=41), but a few tumors were limited to the esophageal wall(T1,T2, n=5), metastased to distant abdominal L/N without metastasis to regional L/N(NO, n=7). Resectability rate was 87.5%(42/48), and complete resection was possible in 31 patients(64.6%). The most frequent cause of incomplete resection and unresectability was unresectable T4 lesions(n=8), extranodal invasion(n=7). Overall operative mortality and morbidity was 4.2%, 22.9%, and resection mortality was 4.8%. Adjuvant therapy was given to 27 patients, and postoperative follow-up was possible in all patients(median follow-up, 32 months). The 1 year and 3 year survival for resection group was 54.0%, 18.1%(median, 386 days) including operative deaths. Our results suggest that resection of the esophageal cancer with metastasis to distant abdominal lymph nodes(M1LYN) can be done with acceptable mortality and morbidity, and may playa role in long-term survival in carefully selected patients because prognosis is dismal in unresectable esophageal cancer. We recommend that lymph nodes around celiac axis be dissected thoroughly for exact staging and possible prolongation of survival, and multimodality therapy as necessary because most patients with M1(LYN) esophageal cancer do poorly with only primay surgical treatment.