• Tuberculosis and Respiratory Diseases
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• 제68권5호
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• pp.267-272
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• 2010

Background: Pulmonary sarcoidosis often involves mediastinal or hilar lymph nodes in the lung parenchyma. Mediastinoscopy is the gold standard for diagnosis, but it is invasive and expensive. Transbronchial needle aspiration using conventional bronchoscope is less invasive than mediastinoscopy, but its diagnostic accuracy is in question due to the blind approach to targeting lymph nodes. Transbronchial needle aspiration (TBNA) via endobronchial ultrasound (EBUS) has high diagnostic value due to direct visualization of lymph nodes and to its relatively safeness. The purpose of this study was to assess the usefulness of EBUS-TBNA in the diagnosis of pulmonary sarcoidosis. Methods: Twenty-five patients with symptoms of sarcoidosis were enrolled into this study. Core tissue was obtained for a definitive diagnosis. Endobronchial biopsy, transbronchial lung biopsy, and bronchoalveolar lavage were performed to verify diagnosis. For patients without a confirmed diagnosis after the above procedures were performed, the additional procedures of mediastinoscopy or video-associated thoracoscopic surgery were performed to confirm a final diagnosis. Results: A total 25 EBUS procedures were done and 50 lymph nodes were aspirated. Thirty-three (37) out of 50 lymph nodes were consistent with non-caseating granuloma, confirming sarcoidosis as the final diagnosis. Sarcoidosis was the final diagnosis for all 25 patients, and 21 required EBUS-TBNA for a final diagnosis. There were no complications associated with the procedure. Conclusion: EBUS-TBNA is already a well-known procedure for diagnosing mediastinal or hilar lymphadenopathy. We used EBUS-TBNA for the diagnosis of pulmonary sarcoidosis and our results showed 84% diagnostic accuracy and no complications related to the procedure. EBUS-TBNA is a reliable and practical diagnostic modality in the diagnosis of pulmonary sarcoidosis.

• Tuberculosis and Respiratory Diseases
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• 제48권3호
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• pp.308-314
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• 2000

연구배경 : RFLP를 이용한 결핵균의 유전자 분석은 결핵의 분자 역학적 연구에 유용하게 이용되고 있다. Pvu-II 효소를 이용한 RFLP 방법의 표준화로 RFLP 양상의 국제적인 비교가 가능해졌고, 극동아시아에서 RFLP 양상이 유사한 결핵균주의 군이 발견되었다. 저자들은 서울대병원에서 수집된 결핵균의 RFLP 양상을 분석하고 다른 극동아시아의 균주들과 비교하였다. 방 법 : 1998년 서울대병원에 입원했거나 외래 방문한 환자의 객담에서 분리하여 배양된 50개의 결핵균주를 대상으로 하였다. 결핵균주에서 DNA를 추출한 뒤, Pvu-II로 소화시키고, IS6110에 대한 DNA probe를 이용하여 Southern blot을 시행하였다. 이들의 RFLP 양상을 비교하여 유사성이 있는 균주들을 같은 군으로 분류하였고, RFLP의 다양성의 정도와 각 군 간의 임상적인 차이가 있는지 알아보고자 하였다. 결 과 : 50개의 결핵균 균주 중에서 6예의 Beijing family를 확인하였고, 다른 9개의 균주가 한 군으로 분류되었다. 이들 균주 군간에 나이, 성별, 지역, 약제 내성, 기관지 결핵 동반 여부, 기저질환 유무 등의 임상상에서는 차이를 보이지 않았다. 결 론 : 서울대병원에서 분리된 결핵균주의 RFLP 양상에서 서로 유사한 군이 존재함을 확인할 수 있었다. 그러나, 이들이 임상적으로는 큰 의미를 갖지 못하는 것으로 보인다.

• Tuberculosis and Respiratory Diseases
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• 제81권4호
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• pp.339-346
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• 2018

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a standard procedure to evaluate suspicious lymph node involvement of lung cancer because computed tomography (CT) and $^{18}F$-fluorodeoxyglucose positron emission tomography-CT (PET-CT) have limitations in their sensitivity and specificity. There are a number of benign causes of false positive lymph node such as anthracosis or anthracofibrosis, pneumoconiosis, old or active tuberculosis, interstitial lung disease, and other infectious conditions including pneumonia. The purpose of this study was to evaluate possible causes of false positive lymph node detected in chest CT or PET-CT. Methods: Two hundred forty-seven patients who were initially diagnosed with lung cancer between May 2009 and December 2012, and underwent EBUS-TBNA to confirm suspicious lymph node involvement by chest CT or PET-CT were analyzed for the study. Results: Of 247 cases, EBUS-TBNA confirmed malignancy in at least one lymph node in 189. The remaining 58 patients whose EBUS-TBNA results were negative were analyzed. Age ${\geq}65$, squamous cell carcinoma as the histologic type, and pneumoconiosis were related with false-positive lymph node involvement on imaging studies such as chest CT and PET-CT. Conclusion: These findings suggest that lung cancer staging should be done more carefully when a patient has clinically benign lymph node characteristics including older age, squamous cell carcinoma, and benign lung conditions.

• Tuberculosis and Respiratory Diseases
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• 제55권2호
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• pp.140-153
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• 2003

연구배경 : 결핵균 항원으로 세포 매개성 면역반응이 활성화되면 여러 종류의 cytokine이 분비되고 각기 다른 cytokine과 network system으로 작용하여 여러 병태생리적인 과정을 조절한다. 결핵 환자에서 염증반응, 조직파괴 및 질환의 중증도는 proinflammatory cytokine과 suppressive cytokine의 균형과 조합에 의하여 결정되며, 결핵 진행의 제한과 악화에 중요한 역할을 할 것으로 생각되고 있다. 따라서 결핵의 이환과정에서 cytokine의 분비 및 변화와 역할을 파악하는 것이 질환의 병태생리를 이해하는데 크게 도움이 될 수 있다. 대상 및 방법 : 활동성 폐결핵 83명, 기관지 결핵 10명의 치료전과 정상 대조군 20명에서 말초혈액을 채취하여 혈청을 분리하여 $-70^{\circ}C$에 보관하였고, sandwich ELISA 방법을 이용하여 혈청 IL-$1{\beta}$, IL-2, IL-4, IL-6, IL-10, IL-12(p40), TNF-${\alpha}$, IFN-${\gamma}$, TGF-${\beta}$를 측정하였다. 폐결핵 환자 83명을 ATS guideline에 따라 중증도를 분류하였고, 추적관찰 중 탈락자를 제외한 45명에서 초치료 2개월과 6개월 후 각각 혈청 sIL-$1{\beta}$, IL-2, IL-4, IL-6, IL-10, IL-12(p40), TNF-${\alpha}$, IFN-${\gamma}$, TGF-${\beta}$를 재측정하였다. 결 과 : 1) IL-$1{\beta}$, TNF-${\alpha}$, IFN-${\gamma}$는 폐결핵 환자에서 대조군에 비하여 증가된 경향을 보였고(p>0.05), IL-6는 폐결핵군에서 통계적으로 유의하게 증가되었다(p<0.05). TGF-${\beta}$는 폐결핵과 기관지 결핵환자에서의 분비가 대조군에 비하여 감소된 경향을 보였으며(p>0.05), IL-2, IL-12(p40), IL-4, IL-10은 대조군과 폐결핵 환자에서 별다른 차이를 보이지 않았다. 2) 기관지 결핵 환자에서 IL-6, TNF-${\alpha}$는 대조군에 비해 증가되고 TGF-${\beta}$는 감소된 경향을 보였다(p>0.05). 폐결핵에 비해 IL-12(p40)의 분비는 증가된 경향을 보였다. 3) 결핵의 중증도가 심할수록 IFN-${\gamma}$와 IL-6가 유의하게 증가하였고(P<0.05), 특히 중증군에서 현저하였다. 4) 폐결핵 환자에서 치료전 측정한 IL-$1{\beta}$, IL-6, TNF-${\alpha}$ 간 및 IL-2, IL-4, IL-12 간에는 강한 양의 상관관계를 보였다(p<0.01). 5) 폐결핵 환자 45명에서 측정한 IL-6와 IFN-${\gamma}$는 치료후 2개월과 6개월에 각각 통계적으로 유의하게 감소되었다(p<0.05). 결 론 : 이상의 결과로 결핵의 병태생리에 있어서 여러 cytokine간의 균형과 조합의 변화가 숙주의 염증, 조직파괴 및 결핵의 중증도와 관련되어 있을 것으로 생각되지만 결핵의 형태나 면역반응 정도에 따른 다양성을 보여서 결과의 해석과 cytokine 측정의 임상적 이용에 대한 연구가 더욱 필요할 것으로 사료된다.

• Tuberculosis and Respiratory Diseases
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• 제76권5호
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• pp.237-239
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• 2014

The early pulmonary consequences of inhalation injury are well documented; however, little is known about delayed pulmonary complications following thermal inhalation injury. Although thermal injury below the vocal cords is rare because of effective heat dissipation in the upper airway, inflammatory endobronchial polyps have previously been reported as a delayed complication associated with inhalation injury. We report an extraordinary case of tracheobronchial polyps in patients with smoke inhalation injury. This report shows the delayed development and natural course of tracheobronchial polyps following thermal injury.

• Tuberculosis and Respiratory Diseases
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• 제76권5호
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• pp.233-236
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• 2014

Catamenial hemoptysis is a rare condition, characterized by recurrent hemoptysis associated with the presence of intrapulmonary or endobronchial endometrial tissue. Therapeutic strategies proposed for intrapulmonary endometriosis with catamenial hemoptysis consist of medical treatments and surgery. Bronchial artery embolization is a well-established modality in the management of massive or recurrent hemoptysis, but has seldom been used for the treatment of catamenial hemoptysis. We report a case of catamenial hemoptysis associated with pulmonary parenchymal endometriosis, which was successfully treated by a bronchial artery embolization.

• Journal of Chest Surgery
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• 제28권8호
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• pp.772-777
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• 1995

Bronchoplastic procedure has been considered as an appropriate surgery for traumatic bronchial disruption and occasionaly for primary bronchial tumors or tuberculosis because it can bring preservation of pulmonary tissue for patients without compromising the chance for cure. Nowadays bronchoplastic procedure is also applicable for the selected cases of bronchogenic carcinomas with favorable long term survival, when compared to standard pneumonectomy.Eighteen bronchoplastic procedures were performed with or without pulmonary resection at Department of Thoracic and Cardiovascular Surgery, Catholic University Medical College, between 1990 and 1994. The patients were 11 men and 7 wemen with average age of 57 years [range, 19 to 71 years . Tumor comprised 56% of the lesions, including 6 squamous cell carcinoma [33% , 2 bronchial adenoma [11% , 1 leiomyoma and 1 metastatic osteogenic sarcoma. Cicatrical stenosis secondary to endobronchial tuberculosis and traumatic disruption occurred in 6 [33% and 1 patient respectively.Applied bronchoplastic procedures were as follows ; sleeve lobectomy, 8 cases [right upper : 6, left upper : 1, right middle : 1 : bronchial segmental resection without pulmonary resection, 2 cases : sleeve bi-lobectomy, 1 cases :patch dilating bronchoplasty with or without concomitant lobectomy in 7. There was no perioperative mortality. Morbidity in 4 patients included 1 transient recurrent laryngeal nerve palsy, 1 unstability of bronchial patch resulting atelectasis of afftected lung and 2 bronchial stenosis of anastomotic site.Throughout our experiences, we feel strongly that bronchoplastic procedure is a safe and effective surgical method preserving normal pulmonary tissue below affected bronchus for the wide range of various bronchial lesion including selected cases of bronchogenic carcinoma with acceptable complication and mortality.

• Tuberculosis and Respiratory Diseases
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• 제57권2호
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• pp.197-200
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• 2004

흉부방선균증은 임상양상 및 방사선학적 소견이 폐의 기타 염증성 질환이나 악성암과 유사한 경우가 많아 감별진단에서 놓치기 쉬우나, 대부분 항생제 치료에 좋은 반응을 보이므로 조기진단을 위한 적극적 접근으로 심각한 합병증의 발생 및 불필요한 수술을 막아야 한다. 저자들은 폐암을 의심하여 시행한 검사도중 폐를 침범하는 방선균증을 경험하였기에 문헌고찰과 함께 보고하는 바이다.

• Tuberculosis and Respiratory Diseases
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• 제70권6호
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• pp.516-520
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• 2011

Bronchial carcinoid tumor accounts for less than 5% of all primary lung tumors in adults. Although surgical resection is the treatment of choice, here we report a case of bronchial carcinoid tumor treated with flexible bronchoscopic resection. A 19-year-old-man presented with a history of wheezing with dyspnea for six months. A simple chest x-ray showed no abnormal findings, but a pulmonary function test showed a moderate obstructive lung disease pattern without a bronchodilator response. A computed tomogram of the thorax revealed an enhanced $15{\times}12$ mm nodule in the left main bronchus. Bronchoscopic examination showed a polypoid mass with a stalk in the left main bronchus, which almost completely occluded the left main bronchus. Histopathology of the resected specimen revealed a bronchial carcinoid tumor. We treated the carcinoid tumor with a flexible bronchoscopic resection. During the follow up period of 6 months, the previous tumor didn't relapse. Initial bronchoscopic resection should be considered when bronchial carcinoid tumor can be approached by bronchoscopy.

• Tuberculosis and Respiratory Diseases
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• 제73권6호
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• pp.331-335
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• 2012

Thymomas are one of the most common neoplasms of the mediastinum derived from thymic epithelium. It is common that invasive thymoma invades the lung, pericardium, and great vessels. Airway compression by mass effect also occurs, but direct polypoid tumor growth into the airway is extremely rare. Only 20 cases of invasive thymoma with endobronchial polypoid growth have previously been reported globally. However, there is no case report of invasive thymoma with endotracheal growth. Herein, we report a rare case of invasive thymoma with endotracheal polypoid growth in a 28-year-old woman.