• Journal of Chest Surgery
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• 제34권7호
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• pp.539-546
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• 2001

배경: 면역저하 환자에게 발생하는 폐 합병증은 흔히 치명적이다. 폐생검술과 같은 침습적인 진단 술기의 위험도 때문에 일반적으로 임상 양상과 방사선 영상 소견에 근거하여 경험적인 치료가 적용된다. 그러나 최근 수술 술기와 수술 전후의 환자 관리의 발전으로 인해 술기와 연관된 위험도는 줄어든 실정이다. 이에 폐합병증을 동반한 심한 면역저하 환자에서 시행된 폐생검술의 위험성 및 유효성에 대하여 전향적으로 분석하였다. 대상 및 방법: 1996년 6월부터 1999년 12월까지 폐합병증을 동반한 면역저하 환자 42명에서 43례의 폐생검술을 실시하였다. 면역저하는 다음과 같이 정의하였고(1, 혈액학적인 질환으로 인해 화학요법이나 다른 치료를 동반하여 받은 경우, 2. 이식 수술 후 면역 억제제를 복용하는 경우, 3. 1 개월 이상의 스테로이드 복용, 4. 원발성 면역결핍 질환), 이상의 면역저하 환자에서 새로운 폐합병증을 동반하고 1 주간의 경험적 치료에 호전이 없거나 급속하게 진행되는 경우를 대상으로 하였다 기저 질환은 혈액학적 질환(31명), 이식 수술 환자(3명), 고형암으로 인한 화학요법(2명)등이었으며 수술은 개흉술이나 video-aided thoracoscopic surgery (VATS)를 통하여 이루어 졌다.

• Journal of Chest Surgery
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• 제39권5호
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• pp.382-386
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• 2006

배경: 다양한 형태의 간질성 폐질환의 확진을 위해서 조직학적인 진단을 필요로 한다. 흉부외과의 폐생검이 간질성 폐질환의 진단에 얼마나 도움이 되는지 알아보고자 하였다. 대상 및 방법: 1995년 6월부터 2002년 11월까지 경상대학교병원 흉부외과에서 폐생검을 시행한 17명의 환자를 대상으로 병록지, 전화설문을 시행하여 후향적인 조사를 하였다. 결과: 평균 나이는 $49{\pm}22$세였다. 나이의 범위는 1세에서 70세였다. 주소는 대부분 호흡곤란이었으며, 간질성 폐질환의 확진을 위하여 소아과와 내과에서 의뢰된 환자들이었다. 폐생검 접근방법은 흉강경 6예, 개흉술 11예였다. 11예에서(65%) 확진이 가능하였고, 조직학적인 진단이 확인된 후 13예에서(76%) 치료방법을 변경하였다. 결론: 외과적인 폐생검술은 간질성 폐질환의 감별진단에 도움을 줄 수 있다. 폐생검술은 수술 중 사망이 없을 정도로 안전한 방법이다. 진단이 되지 않은 간질성 폐질환의 감별진단을 위하여 폐생검이 권유하는 것은 치료방법의 결정에 중요하다.

• 동의생리병리학회지
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• 제26권6호
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• pp.980-982
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• 2012

Metastasis to the pancreas from extra-pancreatic primary cancers are rare; they commonly present as a manifestation of widespread disease and rarely as an isolated mass of the pancreas. Examinations showed a pancreatic tumor infiltrating the pancreas tail portion and an endoscopic ultrasound guided percutaneous biopsy proved that the lesion was metastatic from the lung carcinoma. Most metastatic cases of the pancreas tend to be discovered in patients with widely disseminated malignant disease. In addition, patients with pancreatic metastasis are often asymptomatic, the metastatic lesions are found incidentally, and are misdiagnosed as primary pancreatic tumors. This report that patient undergoing chemotherapy for a small cell lung cancer, who 1 year and 3 months later, accidentally diagnosed of solitary pancreas metastasis and confirmed histology by needle biopsy using endoscopic ultrasound.

• Tuberculosis and Respiratory Diseases
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• 제44권4호
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• pp.899-906
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• 1997

연구 배경 : 경피적 늑막 침 생검술은 항산균 검사 음성이고 세포진 검사에서 악성세포를 찾을 수 없는 림프구 우위성 삼출성 늑막액의 진단에 있어서 시금석으로 여겨져왔다. 그러나 경피적 늑막 침 생검술은 침습적인 시술이며 그 진단율이 않고 비교적 높은 부작용을 동반한다. 최근 흉수의 adenosine deaminase와 carcinoembryonic antigen의 농도가 결핵성 늑막염과 악성 감별에 도움이 된다고 보고되고 있는데 이런 상황에서 경피적 늑막 칩 생검의 유용성을 재평가하고자 하였다. 연구 방법 : 1994년 1월부터 1996년 2월까지 서울대학교 병원에 입원한 림프구 우위성 흉막 삼출증 환자 중 항산균 도말 검사가 음성이고 세포진 검사 역시 음성이어서 늑막 침 생검을 시행한 73명의 환자를 대상으로 하여 늑막 침 생검의 결과와 합병증의 병발 비율을 조사하였으며 흉수의 ADA가 40IU/L이상인 집단, CEA가 10ng/ml 이상인 집단과 그렇지 않은 집단으로 분류하여 각각의 최종 진단과 늑막 침 생검 결과를 비교분석 하였다. 결 과 : 총 73례의 늑막 침 생검으로 35례에서는 특이 진단이 가능하였는데 모두 결핵성 늑막염과 합치하는 소견이었으며 30례에서는 비특이적 늑막염으로 특이진단을 내릴 수 없었고 나머지 8례는 적절한 늑막 조직을 얻지 못하였다. 기흉등의 합병증은 9례 즉 12%에서 발생하였다. 흉수 ADA 수치가 40IU/L 이상이었던 49례의 경우 진단을 내리지 못한 2례를 제외하고는 모두 결핵성 늑막염으로 진단되어 결핵성 늑막염에 대한 양성예측율은 100%였는데 늑막 침 생검으로는 28례만을 결핵성 늑막염으로 진단할 수 있었다. 한편 흉수 CEA가 10ng/ml 이상이었던 6례는 결국 악성 늑막 삼출 4례, 악정 종양과 연관된 늑막삼출과 결핵성 늑막염 각 1례씩으로 진단되어 악성 늑막 삼출에 대한 양성 예측율은 83%였고 늑막 침 생검으로는 한례도 진단해내지 못하였다. 결 론 : 항산균 도말 검사와 세포진 검사 음성인 림프구 우위성 늑막 삼출의 진단에 있어서 경피적 늑막 침 생검의 진단율은 48%로 높지 않으며 흉수 ADA가 충분히 CEA가 낮은 경우의 결핵성 늑막염에 대한 양성 예측율은 100%로 경피적 늑막 칩 생검의 역할이 재검토되어야 한다.

• Journal of Chest Surgery
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• 제25권6호
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• pp.577-580
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• 1992

We experienced two cases of pulmonary hamartoma, which is the most common benign tumor of lung. But the hamartoma is rare disease, because the most neoplasm of the is malignant. The importence of pulmonary hamartoma is the necessity of differential diagnosis between lung cancer and benign tumor of the lung. Recently, the development of FNAB [Fine needle aspiration biopsy] shows accurate diagnostic results.

• Tuberculosis and Respiratory Diseases
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• 제82권3호
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• pp.201-210
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• 2019

Background: Radial probe endobronchial ultrasound (R-EBUS) is widely used for diagnosing peripheral pulmonary lesions. However, the utility of R-EBUS-guided transbronchial lung biopsy (TBLB) for diffuse lung lesions (DLLs) remains unknown. We designed this study to evaluate the utility of R-EBUS-guided TBLB in DLLs. Methods: This retrospective study enrolled patients admitted from January 2016 to November 2017 who underwent TBLB for DLLs. The R-EBUS-guided TBLB and blind TBLB groups were compared. DLL was defined as any lung disorder that involved more than one segment of the lung. In both the groups, fluoroscopy and guided sheath were not used during TBLB. Results: A total of 127 patients underwent TBLB for DLLs (67 patients in the R-EBUS-guided TBLB group and 60 in the blind TBLB group). There were no differences in age, sex, and comorbid illnesses between the two groups. Furthermore, there was no difference in the TBLB diagnostic yield of the two groups (p=0.660) although more samples were collected from the R-EBUS-guided TBLB group (p=0.003). Procedure time was significantly longer in the R-EBUS-guided TBLB group than in the blind TBLB group (p<0.001). Thus, incidence of pneumothorax was significantly lower in the R-EBUS-guided TBLB group than in the blind TBLB group (p=0.032). Conclusion: Diagnostic yield in DLLs did not differ between the R-EBUS-guided TBLB and blind TBLB groups. Findings show that R-EBUS-guided TBLB in DLLs may reduce risk of pneumothorax.

• Journal of Chest Surgery
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• 제23권1호
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• pp.73-80
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• 1990

A total of 129 patients with a confirmed diagnosis of primary lung cancer were treated at Dep. of Thoracic k Cardiovascular Surgery, National Medical Center, Seoul, Korea, between July, 1981 and Dec., 1988. Particular emphasis was given in this review to the 72 patients that underwent surgical resection of their primary lung lesion. Factors such as histology, type of resection, sex, age, staging, and degree of dissemination were considered possible influences on survival. The age group of fifty k sixty decade occupied 55.8 %, and the youngest being 24 years and oldest 78 years. The incidence ratio of male to female was 3,2:1. The subjective symptoms of the patients were coughing [72.6%], chest pain [48.2%] and hemoptysis [35.6%], which were due to primary local influence. The confirmed diagnostic procedures were bronchoscopic biopsy, sputum cytology needle aspiration biopsy, open lung biopsy, anterior mediastinotomy & lymph node biopsy. By pathologic classifications, the squamous cell carcinoma was the most prevalent, 67 cases [51.9 %], and the adenocarcinoma in 36 cases [27.9%], undifferentiated small cell carcinoma in 13 cases [10.1 %], undifferentiated large cell carcinoma in 9 cases [6.9%], bronchioloalveolar carcinoma was 4 cases [3.1%]. The lymph node dissection with pneumonectomy [42 cases], lobectomy [14 cases] and pneumonectomy [6 cases], lobectomy [9 cases] without lymph node dissection were performed. The post operative TNM Staging[AJC] in 72 cases were Stage I in 24 cases, Stage II in 27 cases, and Stage III in 21 cases. Overall resectable was possible in 72 cases [55.8 %], and the operation mortality was 5.6 % [4 cases].

• Journal of Chest Surgery
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• 제13권3호
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• pp.206-211
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• 1980

One hundred and thirteen patients underwent diagnostic fiberoptic bronchoscopy to exclude the presence of the lung cancer at the Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital from January 1979, to July 1980. Sixty five cases of these patients were studied for passible lung cancer by bronchoscopic examination. Patients varied in age from 24 to 75 years, with the highest concentration lying in the sixth decade (49%). male was predominated with sex ratio of 6.3 : 1. Forth three (75.4%) of 57 cases impressed as definitive, and 8(14.5%) of 55 cases impressed as negatibe lung cancer were subsequently proved to have had lung cancer. Positive bronchoscopic biopsy was found in 10 of 14 lung cancers which were situated in the left main bronchus and in 11 of 13 neoplasms involving the right upper lobe bronchus. epidermoid cell carcinomas were most frequent(82.4%). Bronchial biopsy detected 34(79%) of 43 hilar cancers and 1.3(59%) 22 periphera neoplasms, in those patients who had fiberoptic bronchoscopic examinations. In the present series of 65 cases, the lesion was so far advanced when first seen that it was considered inoperable in 31 (47.7%) and operable 34(52.3%), 19(55.9%) of these refusing surgery. fifteen were explored of whom 12(80%) were resectable.

• Tuberculosis and Respiratory Diseases
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• 제72권2호
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• pp.223-227
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• 2012

Pulmonary siderosis, or Welder's lung disease is an occupational lung disease caused by iron-inhalation. Diagnosis of pulmonary siderosis is based on occupational history of the patient, radiologic findings, and pathologic findings of iron-laden macrophages within lung tissue or broncho-alveolar lavage fluid. We observed a case of a 43 years-old welder diagnosed with pulmonary siderosis via thoracoscopic lung biopsy. Sputum culture along with pathology also identified a non-tuberculotic mycobacterial infection with a sputum culture and the pathologic findings. The patient was treated with anti-tubercular medication and cessation of iron-exposure. And his condition improved within a few months.

• Tuberculosis and Respiratory Diseases
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• 제87권1호
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• pp.40-51
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• 2024

Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, fibrosing interstitial pneumonia with a very poor prognosis. Accurate diagnosis of IPF is essential for good outcomes but remains a major medical challenge due to variability in clinical presentation and the shortcomings of existing diagnostic tests. Medical history collection is the first and most important step in the IPF diagnosis process; the clinical probability of IPF is high if the suspected patient is 60 years or older, male, and has a history of cigarette smoking. Systemic assessment for connective tissue disease is essential in the initial evaluation of patients with suspected IPF to identify potential causes of interstitial lung disease (ILD). Radiologic examination using high-resolution computed tomography plays a pivotal role in the evaluation of patients with ILD, and prone and expiratory computed tomography images can be considered. If additional tests such as surgical lung biopsy or transbronchial lung cryobiopsy are needed, transbronchial lung cryobiopsy should be considered as an alternative to surgical lung biopsy in medical centers with experience performing this procedure. Diagnosis through multidisciplinary discussion (MDD) is strongly recommended as MDD has become the cornerstone for diagnosis of IPF, and the scope of MDD has expanded to monitoring of disease progression and suggestion of appropriate treatment options.