• Journal of Chest Surgery
• /
• 제36권12호
• /
• pp.991-994
• /
• 2003

원발성 폐평활근육종(primary pulmonary leiomyosarcoma)은 드문 질환으로 전형적인 X-ray소견이나 증상을 보이지 않는다. 치료는 외과적 절제술이 가장 일반적이며 예후는 병소의 크기, 분화도, 전이 등과 관계되는 것으로 보고되고 있다. 25세 여자 환자가 한 달 전부터의 흉부동통과 기침을 주소로 내원하였다. 내원 후 시행한 흉부 X-ray상 좌상엽에 폐결절 소견을 보여 경피적 세침흡입검사를 시행하였다. 검사 결과 방추세포종괴(spindle cell tumor) 소견을 보였고, 좌상엽절제술을 시행 받았다. 수술 후 시행한 조직학적 검사상 기관지에서 기원한 평활근육종으로 나타났으며, 환자는 현재 5년째 특별한 합병증이나 재발 없이 외래에서 추적 중이기에 보고하는 바이다.

• Journal of Chest Surgery
• /
• 제42권3호
• /
• pp.364-367
• /
• 2009

후복막강 폐격리증은 극히 드문 질환으로 보통은 임신 6개월경에 시행하는 태아 초음파로 발견되며 드물지만 성인에서 우연히 발견된다. 후복막강 폐격리증은 그 위치와 방사선학적인 소견이 신경아세포종 등의 다른 후복막강 종괴와 아주 유사하기 때문에 그 발생 빈도가 극히 드물더라도 후복막강 종괴가 의심될 때 감별을 요한다. 세침 흡입 검사가 수술 전 진단에 도움이 된다고 하지만, 수술적 제거가 환자의 예후나 경과를 생각 했을때 좋은 치료 방법이라고 생각된다.

• 대한두경부종양학회지
• /
• 제12권1호
• /
• pp.58-64
• /
• 1996

The parathyroid adenoma is the most common cause of the primary hyperparathyroidism. The characteristic of primary hyperparathyroidism is hypercalcemia and high value of serum parathyroid hormone. The primary hyperparathyroidism with parathyroid adenoma is treated by excision of parathyroid gland involved. Especially, parathyroid storm in patients with primary hyperparathyroidism is more prevalent than commonly appreciated. The symptoms and signs of the syndrome are not only due to the hypercalcemia, but also to the toxic effects of the parathyroid hormone. Its wide, but nonspecific clinical presentations make it easily confused with other cardiovascular or renal diseases. The mortality rate in untreated cases of parathyroid storm is essentially 40%. A 33 year old woman with primary hyperparathyroidism was found to have a left lower parathyroid adenoma, presented with hypercalcemic crisis. Initially, good responsiveness to a saline infusion, furosemide administration was noted. Unfortunately, she became consciousness disturbance after fine-needle aspiration of the parathyroid tumor. The recurrent storm was refractory to medical therapy, but was treated succesfully by emergent surgical removal tumor revealed a parathyroid adenoma with parathyroid hormone. Hypercalcemia was alleviated postoperatively. These observations corroborated a functioning parathyroid adenoma.

• Journal of Korean Neurosurgical Society
• /
• 제56권5호
• /
• pp.431-435
• /
• 2014

A fifty-year-old female non-smoker with no other specific medical history visited our institute. She complained of axial back pain with no other neurological deficit. Chest X-ray, chest computed tomography (CT) scan, CT-guided needle aspiration biopsy, whole-body positron emission tomography, spine CT and spine magnetic resonance image findings suggested NSCLC with epidermal growth factor receptor (EGFR) mutation, multiple brain metastases, and two isolated metastases to the T3 and L3 vertebral bodies. She underwent chemotherapy with gefitinib ($Iressa^{TM}$) for NSCLC and gamma knife surgery for multiple brain metastases. We performed a two-staged, total en bloc spondylectomy of the T3 and L3 vertebral bodies based on several good prognostic characteristics, such as the lack of metastases to the appendicular bone, good preoperative performance status, and being an excellent responder (Asian, never-smoker and adenocarcinoma histology) to EGFR inhibitors. Improved axial back pain after the surgery enabled her to walk with the aid of a thoracolumbosacral orthosis brace on the third postoperative day. Her Karnofsky performance status score (KPS) was 90 at the time of discharge and has been maintained to date 3 years after surgery. In selected NSCLC patients with good prognostic characteristics, we suggest that locally curative treatment such as total en bloc spondylectomy or radiosurgery should be emphasized to achieve longer term survival for the selected cases.

• Journal of Chest Surgery
• /
• 제26권5호
• /
• pp.373-379
• /
• 1993

Primary lung cancer has increased markedly in its incidence and prevalence rate recently in Korea. In frequency, it occupies the second rank cancer preceded by stomach cancer in korean male. From February 1986 to December 1992, we have operated on 55 cases of primary lung cancer in Korea Veterans Hospital and followed them. The results are as follows; 1. The peak incidence of age of primary lung cancer was 6th decade and 5th decade and those were 87.3% of study group, mainly in male. 2. Symptoms were cough [63.6%], dyspnea [41.8%], chest pain and discomfort [38.2%], blood tinged sputum and hemoptysis [21.8%]. Symptoms were frequently encountered before hospitalization and asymptomatic cases were 9.1% of study group. 3. Methods of diagnostic confirmation were bronchoscopic biopsy [52.7%], percutaneous needle aspiration[PCNA][21.8%], sputum cytolgy [12.7%], open biopsy [12.7%]. 4. Histopathologically, squamous cell carcinoma [76.4%] was the most frequent cancer and adenocarcinoma [10.9%], giant cell cancer [7.3%], and the others in order. 5. Methods of operation were pneumonectomy [32.7%], bilobectomy [18.2%], lobectomy [27.3%], lobectomy and segmenectomy [1.8%], exploration [20%], and overall resectability was 80%. 6. Operative mortality was 5.5% [3 cases] and there were 5 cases of complication. 7. Postoperative long-term follow up reveals that the cumulative survival rates in 6 months, 12 months, 26 months, 34 months, 43 months, 64 months were 89.5%, 71.7%, 66.7%, 57.2%, 50.8%, 42.3% respecively.

• Journal of Chest Surgery
• /
• 제30권3호
• /
• pp.330-335
• /
• 1997

아스페르길루스 감염증은 드물기는 하지만 면역 억제된 상황에서는 비교적 잘 발생하며 치사율도 높은 것으로 알려져 있다. 경구 또는 정맥내 치료제가 있기는 하지만 합병증이 많고 장기간 사용해야 하기 때문에 치료효과는 크게 기대할 수 없는 경우가 많다. 따라서 환자에 따라서는 외과적 요법을 병행하여 치료효과를 높이는 방법도 사용하고 있다. 세종병원에서는 지금까지 실시한 15례의 심장이식환자중 2 례의 폐 아스페르길루스증을 경 험하였기 에 보고하는 바이다. 두 환자 모두 나이와 수술시기가 비슷하였 으며 수술후 약 3주후 외래에서 흉부 X-선상 폐병변을 발견하였다 경피적 천자생검상 Aspergillus fumigatus로 확인되어 정맥내 Amphotericin B와 경구용 Itraconazole을 병용한 항진균제요법을 실시하 였으며 두번째 환자는 병변이 우하엽에 국한되어 외과적 절제술을 병용하였다. 첫번째 환자는 이식후 14개월째 양호한 상태로 추적중이며 두번째 환자는 치료 완료후 3개월째 비세포성 거부반응으로 사망하였다.

• Journal of Chest Surgery
• /
• 제44권6호
• /
• pp.418-422
• /
• 2011

Background: It has recently become most general to use the small bore catheter to perform closed thoracostomy in treating iatrogenic pneumothorax. This study was performed for analysis of the efficacy of treatment methods by using small bore catheter such as 7 F (French) central venous catheter, 10 F trocar catheter, 12 F pigtail catheter and for analysis of the appropriateness of each procedure. Materials and Methods: From March 2007 to February 2010, Retrospective review of 105 patients with iatrogenic pneumothorax, who underwent closed thoracostomy by using small bore catheter, was performed. We analyzed the total success rate for all procedures as well as the individual success rate for each procedure, and analyzed the cause of failure, additional treatment method for failure, influential factors of treatment outcome, and complications. Results: The most common causes of iatrogenic pneumothorax were presented as percutaneous needle aspiration(PCNA) in 48 cases (45.7%), and central venous catheterization in 26 cases (24.8%). The mean interval to thoracostomy after the procedure was measured as 5.2 hours (1~34 hours). Total success rate of thoracostomy was 78.1%. The success rate was not significantly difference by tube type, with 7 F central venous catheter as 80%, 10 F trocar catheter as 81.6%, and 12 F pigtail catheter as 71%. Twenty one out of 23 patients that had failed with small bore catheter treatment added large bore conventional thoracostomy, and another 2 patients received surgery. The causes for treatment failure were presented as continuous air leakage in 12 cases (52.2%) and tube malfunction in 7 cases (30%). The causes for failure did not present significant differences by tube type. Statistically significant factors affecting treatment performance were not discovered. Conclusion: Closed thoracostomy with small bore catheter proved to be effective for iatrogenic pneumothorax. The success rate was not difference for each type. However, it is important to select the appropriate catheter by considering the patient status, pneumothorax aspect, and medical personnel in the cardiothoracic surgery department of the relevant hospital.

• 대한임상검사과학회지
• /
• 제47권1호
• /
• pp.17-23
• /
• 2015

A fine needle aspiration biopsy (FNAB) is the primary means of distinguishing benign from malignant in thyroid nodules. However, between 10 and 30% of the FNABs of thyroid nodules are diagnosed as 'indeterminate'. A molecular method is needed to reduce unnecessary surgery in this group. In Korea, most thyroid cancer is classic papillary type and BRAFV600E mutation is highly prevalent. Thus, this study compared the pyrosequencing method with the conventional direct DNA sequencing and PCR-RFLP analysis and investigated the evaluation of preoperative BRAFV600E mutation analysis as an adjunct diagnostic method with routine FNABs. Sixty-five (78.3%) of 83 histopathologically diagnosed malignant nodule revealed positive BRAFV600E mutation on pyrosequencing analysis. In detail, 65 (83.8%) of 78 papillary thyroid carcinomas sample showed positive BRAFV600E mutation. None of 29 benign nodules had in pyrodequencing, direct DNA sequencing and PCR-RFLP. Out of 31 thyroid nodules classified as 'indeterminate' on cytological examination preoperatively, 28 cases turned out to be malignant: 24 papillary thyroid carcinomas. Among that, 16 (66.7%) classic papillary thyroid carcinomas had BRAFV600E mutation. Among 65 papillary thyroid carcinomas with positive BRAFV600E mutation detected by pyrosequencing analysis, each 3 cases and 5 cases did not show BRAFV600E mutation by direct DNA sequencing and PCR-RFLP analysis. Therefore, pyrosequencing was superior to direct DNA sequencing and PCR-RFLP in detecting the BRAFV600E mutation of thyroid nodules (p =0.027). Detecting BRAFV600E mutation by pyrosequencing was more sensitivity, faster than direct DNA sequencing or PCR-RFLP.

• Clinical and Experimental Pediatrics
• /
• 제61권2호
• /
• pp.49-52
• /
• 2018

Purpose: Tularemia is an infection caused by Francisella tularensis. Its diagnosis and treatment may be difficult in many cases. The aim of this study was to evaluate treatment modalities for pediatric tularemia patients who do not respond to medical treatment. Methods: A single-center, retrospective study was performed. A total of 19 children with oropharyngeal tularemia were included. Results: Before diagnosis, the duration of symptoms in patients was $32.15{\pm}17.8days$. The most common lymph node localization was the cervical chain. All patients received medical treatment (e.g., streptomycin, gentamicin, ciprofloxacin, and doxycycline). Patients who had been given streptomycin, gentamicin, or doxycycline as initial therapy for 10-14 days showed no response to treatment, and recovery was only achieved after administration of oral ciprofloxacin. Response to treatment was delayed in 5 patients who had been given ciprofloxacin as initial therapy. Surgical incision and drainage were performed in 9 patients (47.5%) who were unresponsive to medical treatment and were experiencing abcess formation and suppuration. Five patients (26.3%) underwent total mass excision, and 2 patients (10.5%) underwent fine-needle aspiration to reach a conclusive differential diagnosis and inform treatment. Conclusion: The causes of treatment failure in tularemia include delay in effective treatment and the development of suppurating lymph nodes.

• Journal of Yeungnam Medical Science
• /
• 제30권2호
• /
• pp.152-155
• /
• 2013

Orbital metastasis from hepatocellular carcinoma is very rare, with only 14 biopsy-proven cases from hepa tocellular carcinoma cases reported in English literature and three cases reported in Korea. Common symptoms of orbital metastasis are proptosis, visual loss, ocular pain and oculomotor dysfunction. For its precise diagnosis, we can perform fine needle aspiration biopsy, orbit CT or MRI, and ultrasonography. Radiotherapy is the mainstay in the treatment of orbital metastasis. In addition, chemotherapy, hormonal therapy and surgical intervention can play a role in the treatment of orbital metastasis according to the primary cancer and symptoms. However, the prognosis of orbital metastasis is poor. We report herein a rare case of a patient with orbital metastasis from hepatocellular carcinoma, which was treated with various modalities that included resection, and who had good clinical and radiological responses to radiation therapy and sorafenib (Nexavar, Bayer HealthCare).