• Tuberculosis and Respiratory Diseases
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• v.62 no.4
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• pp.284-289
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• 2007

Background: To define the clinical features of patients with lung and upper aerodigestive tract cancer through a review of the histopathology, clinical features and follow-up results. Methods: Patients with lung and upper aerodigestive tract cancer who were diagnosed in Young dong Severance Hospital from 1992 to 2005, were retrospectively reviewed. The clinical data, radiologic findings, pathologic findings, treatment modalities were evaluated. Result: There was a total of 20 patients with aerodigestive tract cancer who were diagnosed with lung cancer over a 13 years period. The mean age was $58.45{\pm}15.09$ years and 19 cases were male. There were 14 smokers with an average pack year of 46 years. Twelve patients had aerodigestive tract cancer and later developed lung cancer, and 5 lung cancer patients were later diagnosed with aerodigestive tract cancer. Conclusion: These results suggest that cancers of the aerodigestive tract and lung can arise as either dependent or independent events and most aerodigestive tract cancer patients who developed lung cancer are not treated properly. Therefore, regular low dose chest CT with close suspicion is needed to properly manage upper aerodigestive tract cancer patients.

• Journal of Chest Surgery
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• v.35 no.5
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• pp.387-391
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• 2002

Background: Postoperative morbidity and mortality in destroyed lung are relatively high. We tried to identify the prognostic factors affecting postoperative morbidity and mortality in destroyed lung through a retrospective study. Material and method: The retrospective study was undertaken in 112 patients who had undergone pneumonectomy or pleuropneumonectomy for destroyed lung at Severance Hospital from 1970 to 2000. We analyzed the correlation between postoperative morbidity and mortality and etiology, duration of disease, preoperative FEV1, presence or absence of peroperative empyema, operation timing, the side of operation, duration of operation, and operation type. Result: There were 55 men and 57 women, aged 20 to 81 years (mean 44 years). Etiologic diseases were tuberculosis in 86 patients(76.8%) including tuberculos empyema in 20 and tuberculous bronchiectasis in 4, pyogenic empyema in 12(10,7%), bronchiectasis in 12(10.7%), and lung abscess in 2(1.8%). Postoperative morbidity were 25%(n=28) and postoperative mortality was 6%(n=7). The presence of preoperative empyema(p=0.016), pleuropneumonectomy(p=0.037) and preoperative FEV1 of less than 1.75 L(P=0.048) significantly increased the postoperative morbidity, If operation time was less than 300min, postoperative morbidity(p=0.002) and mortality(p=0.03) were significantly low. Conclusion: Postoperative morbidity and mortality in destroyed lung were acceptable. Postoperative morbidity and mortality were significantly low when operation time was less than 300 min. Preoperative existence of empyema, pleuropneumonectomy and preoperative FEV1 of less than 1.75 L significantly increased postoperative morbidity.

• Tuberculosis and Respiratory Diseases
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• v.41 no.1
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• pp.26-35
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• 1994

Background: Bronchioloalveolar cell carcinoma today needs further studies as an early diagnosis will drastically improve the chances of cure. Methods: Twenty-four cases of bronchioloalveolar cell carcinoma for the period of 5 years were studied in terms of incidence, age, sex, underlying diseases, symptoms, radiographic findings, methods of diagnosis, clinical and pathologic staging, methods of treatment, and survival retrospectively. Results: No correlation was found between patients' age, sex and underlying diseases. Most common symptoms were cough(62.5%), chest pain(29.2%), and sputum(29.2%). Of the 24 cases, 13 patients(54.2%) had solitary nodule, 6 patients(25%) had multiple nodules. At the time of diagnosis, 3 patients(12.5%) had the stage I diseases, 3 patients(12.5%) had the stage II diseases, 4 patients(16.7%) had the stage IIIa diseases, 3 patients(12.5%) had the stage IIIb diseases, and 11 patients(45.8%) had the stage IV diseases. 14 cases(58.3%) were found inoperable at the time of admission; they all died within 17 months. In 7 cases with stage I, II, IIIa diseases curative resection were attempted, in 1 case with stage IV disease wedge resection for palliative management was performed, and in 4 cases patients were still alive at the time of conclusion of this study. Conclusion: We conclude that early diagnosis of disease will increase operability and improve chances of survival and that aggressive diagnostic workup for suspicious pulmonary infiltrate is essential as early operation offers the best chances of cure.

• Tuberculosis and Respiratory Diseases
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• v.40 no.5
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• pp.565-574
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• 1993

Background: Pulmonary hamartomas are benign tumors that occur in the parenchyma or in the bronchi. They present as a solitary pulmonary nodule(SPN) or as a cause of bronchial obstruction. The incidence, once minimal, is increasing in Korea. To get clinical spectrum about the tumor, we analyzed all the reported cases in Korea since 1964. Methods: We reviewed the clinical, radiological and pathological findings of 13 patients of intrapulmonary or endobronchial hamartomas in Severance Hospital and of 38 reported cases in Korea published in literatures from 1964 to 1992 retrospectively. Results: Including 17 endobronchial hamartomas, 54 cases were studied. There were 25 men and 29 women, with a mean age of 47.2 years; 45.3 years in endobronchial type and 51.3 years in parenchymal type. Pulmonary symptoms were present in 8 patients (22%) of intrapulmonary type and in all patients of endobronchial type: cough (65%), dyspnea (53%), sputum (35%), fever (29%) in order. On chest X-rays, atelectasis was seen in 10 patients (59%) in endobronchial type; but SPN was noted in 36 patients (97%) of intrapulmonary type. Calcification was present in 7 intapulmonary hamartomas (23%); but is in 2 endobronchial hamartomas (12%). The diagnostic yield was 6 out of 14(43%) in endobronchial ones; 4 out of 7(57%) in intrapulmonary ones. Fifty patients underwent operations as follows: lobectomy (28), enucleation (8), resection (8), bilobectomy (4), pneumonectomy (2). The hamartomas were 1.2 times more common in the right lung; mean transverse diameter at the time of operation was 2.3 cm in endobronchial type, 3.8 cm in intrapulmonary ones. Chondroid components were present in 11(65%) of 17 endobronehial ones but in 30(91%) of 33 intrapulmonary hamartomas. No malignant changes were seen perioperative period and up to early 1993. Conclusion: The younger age in endobronchial hamartomas, the preponderance of the female sex and the more incidence in the right lung, and the diagnostic choice of lobectomies were different from the studies of the Western countries.

• Tuberculosis and Respiratory Diseases
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• v.40 no.5
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• pp.540-547
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• 1993

Backgrounds: The measurement of volume of isoflow has been considered as a sensitive test for detecting small airway diseases showing normal pulmonary function in a routine pulmonary function test. To evaluate the functions of small airway among dust exposed workers, the changes of volume of isoflow were measured and its applicability of managing early stage pneumoconiosis patients was studied. Method: The subjects were 67 male, pneumoconiosis with small opacity and FEV1>80%, FEV1/FVC>75% in spirometry and the controls were 20 male, no dust-exposed office workers. The maximal epiratory volume curves after inhalation of indoor air and $He-O_2$ gas mixtures were measured and ${\Delta}V_{max50},\;{\Delta}V_{max75},\;V_{iso}V/VC$ between the dust exposed and control workers were compaired. Results: 1) There were no significant differences between two group in ${\Delta}V_{max50}$ and ${\Delta}V_{max75}$. But the ratio of $V_{iso}V/VC$ of the subjects was siginificantly higher than that of the control (p<0.01). This study confirms that $V_{iso}V/VC$ is a very useful index in early detection of small airway dysfunction. 2) The ratio of $V_{iso}V/VC$ of the subjects was signigicantly different between only smoker group and mixed group(smoker and nonsmoker). It suggestes that smoking is an important cousative factor of small airway dysfunction. 3) As the profusion of the chest X-ray increased, the rartio of $V_{iso}V/VC$ increased, but no significant difference of $V_{iso}V/VC$ was found between categories of pneumoconiosis. The categories of pneumoconiosis and small airway dysfunction may not be related. 4) No significant relationship was established between the duration of work and the ratio of $V_{iso}V/VC$. Conclusions : It is concluded that the measurement of $V_{iso}V/VC$ is useful to detect small airway dysfuction of early stage pnuemoconiosis patents with small opacities but showing normal pulmonary function in a routine pulmonary function test.

• Tuberculosis and Respiratory Diseases
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• v.40 no.5
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• pp.575-583
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• 1993

Background: Mediastinal masses are not uncommon, and an overall incidence of one case per 100,000 population per year in individuals of all ages and with no difference in sex incidence may be a reasonable estimation. At least half of all mediastinal masses are asymptomatic and this proportion has increased in recent decades with wider use of screening chest roentgenography. Symptoms in patients with mediastinal mass lesions are usually due to compression or invasion of nearby intrathoracic structures. Most mediastinal mass lesions have characteristic predilectional locations. The basic focus of diagnostic evaluation is an orderly preparation for obtaining a tissue diagnosis but even lesions discovered to be benign must generally be removed. Seldom is this status known for certain preoperatively. In additaion, benign tumors may continue to enlarge, thus compromising vital organs; they may rupture, hemorrhage, become infected or have the possibility of various malignant degeneration. Therefore, all mediastinal masses must be surgically removed whether they are malignant or benign. Methods: We reviewed the medical records of 344 cases previously confirmed as mediastinal tumors or cysts from January, 1960 to August, 1992 and investigated the clinical findings. Results: Neurogenic tumors were the most common(24.7%) and thymomas were distinctively increased recently. Overall ratio between males and females was 1.1:1 and age distribution was relatively even among all age groups. Predilectional sites were posterior for neurogenic tumors, and anterior for teratodermoid tumors, thymomas and lymphomas. Dyspnea was the most common symptom in the patients of the mediastinal tumors and asymptomatic patients were 19.5%, Benign mediastinal mass lesions were 66.0% and malignant, 34.0%, Complete or partial resection was done in 42.4%. Conclusion: We could find the increasing incidence and the tendency of aggressive resection as possible in the mediastinal tumors. We expect the discovery of more mediastinal tumors with wider use of regular check-up and development of diagnostic methods.

• Tuberculosis and Respiratory Diseases
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• v.53 no.6
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• pp.612-618
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• 2002

Background : Bronchoscopy is an important diagnostic and a therapeutic tool in chest medicine. However, most patients feel that a bronchoscopy is an unpleasant procedure, and it is important to sedate the patients appropriately, particularly where repetitive examinations are required. Midazolam is a sedative drug with amnestic qualities and a rapid 2 hour half-life. This study have attempted to determine the safety, appropriate dosage, and the effect of midazolam premedication in patients who underwent a bronchoscopy. Methods : One hundred and eighty consecutive patients undergoing bronchoscopy were enrolled in this study. The patients received a midzolam doses of 0.03 mg/kg, 0.06 mg/kg, or a placebo. An additional dose of lidocaine, the total number of coughs, and the duration of the procedures were recorded with monitoring the the blood pressure, heart rate, and oxygen saturation. The level of satisfaction was assessed by the patient, bronchoscopist, and the nurse. Results : The blood pressure, pulse rates, oxygen saturation, number of coughs, lidocaine dose, and procedure time in the 3 groups were similar. There was a trend for the midazolam 0.03 mg/kg group to satisfy bronchoscopists more than the other two groups. The nurses' acceptability was lower in the midazolam 0.06 mg/kg group than the other groups. The patients' acceptablity was greater in both the midazolam 0.03 mg/kg and 0.06 mg/kg groups than in the control group. Conclusion : Sedation with low doses of intravenous midazolam is a safe technique for fiberoptic bronchoscopy with a low morbidity and high acceptable to patients and bronchoscopists.

• Tuberculosis and Respiratory Diseases
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• v.56 no.2
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• pp.151-158
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• 2004

Background : When a non small cell lung caner patient at the $_cT_{1-2}N_0M_0$ stage is diagnosed with intrapulmonary nodule(s), the treatment plan and prognosis of the patient largely depend on whether the nodule is benign or malignant. In most cases, however, it is hard to conduct a biopsy on such a nodule, due to its small size. Furthermore, the predictive factors that may imply benignancy or malignancy of the nodules remain unknown. As such, the purpose of our study was to validate the incidence of malignant nodules in such cases, and find if there are any predictive factors. Methods : Chest computed tomography(CT) scans and the medical records of 444 patients, who had undergone non small cell lung cancer surgery, between July, 2001 and September, 2003, at Seoul National University Hospital, were retrospectively reviewed. Among $_cT_{1-2}N_0M_0$ non small cell lung cancer patients, with intrapulmonary nodule(s), only those cases where a CT scan or a biopsy of the nodules had been conducted, and had been followed up at intervals of more than 6 months were included. However, patients who had received chemotherapy or radiation therapy, pre- or post-operatively, or with calcified nodules, were excluded. Results : Our study group consisted of 39 patients, divided into two groups. The first group, 33 patients, had benign nodules, and the second group, 6 patients, had malignant nodules. The two groups were compared with regard to gender, age, cell type, pathologic stage, shape, size, location and number of nodules and presence of calcification around the nodules. There was no statistically significant difference between the two groups. Conclusion : The intrapulmonary nodules in non small cell lung cancer patients at the $_cT_{1-2}N_0M_0$ stage were mostly benign. Therefore, surgical treatment for such patients can be considered. Moreover, without predictive factors, pathological confirmation of the diagnosed nodules should be sought in all patients.

• Tuberculosis and Respiratory Diseases
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• v.66 no.2
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• pp.98-103
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• 2009

Background: Pulmonary Langerhans cell histiocytosis (PLCH) is characterized by a proliferation of Langerhans cells and this results in granulomas that involve multiple organs of the body. Because the incidence of PLCH is very low in Korea and worldwide, collecting the clinical data of patients with PLCH nationwide is needed to determine the clinical features of Korean patients with PLCH. Methods: The patients with PLCH confirmed by biopsy at any body site were included and the patients should have lung lesions present. A questionnaire that had items on the symptoms, lung function tests, the roentgenographic findings and the treatment was collected retrospectively at a Korean ILD Research Meeting. Results: A total of 56 cases were collected. The number of males and females was 48 and 8, respectively, and their median age was 43 years (range: 18-67 years). The patients were current or ex-smokers in 79% of the cases. The most frequent symptom was coughing (39%), followed in decreasing order by dyspnea (38%), sputum (20%) and chest pain (20%). Pneumothorax was observed in 16 (29%) patients. Lung function tests showed a normal, restrictive, mixed or obstructive pattern in 26 (61%), 7 (16%), 7 (16%) and 3 patients (7%), respectively. Nodular-cystic lesion was most frequently observed in 59% of the patients on HRCT. The lung lesions were located in the middle and upper lobes in almost the cases. The median follow-up period was 90 months (range: 1-180 months) and only two patients died during this period. Conclusion: This study provides a national survey of the patients with PLCH during a long follow-up period.

• Tuberculosis and Respiratory Diseases
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• v.66 no.4
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• pp.295-299
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• 2009

Background: There are various etiologies causing bronchiectasis, but the cases without definite causes account for a quite high proportion. It is also uncertain that immunoglobulin G subclass deficiency (IgGSD) is associated with bronchiectasis. Therefore, we tried to measure the frequency of IgGSD in patients with bronchiectasis of unclear etiology, and to observe the clinical features of those patients with bronchiectasis and IgGSD. Methods: For the outpatients of a university hospital who were diagnosed as bronchiectasis by chest CT, we produced comprehensive history taking and physical examinations, and finally selected 31 patients with bronchiectasis of unclear etiology. Results: Two patients had total immunoglobulin G deficiency. The frequency of IgGSD was comparatively high (n=14). When we compared IgGSD group to normal immunoglobulin G subclass group, there were no significant differences in sex, age, and the frequency of sinusitis, bronchial asthma, and the abnormal lung function. Conclusion: In cases of bronchiectasis without definite causes, it can be considered to measure the level of immunoglobulin G subclass. It is also probably worthwhile to further evaluate the relationship between IgGSD and bronchiectasis.