• Journal of Chest Surgery
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• v.36 no.10
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• pp.748-753
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• 2003

Background: The pulmonary nodules (PN), when indicated, need thoracoscopic resection, especially in cases of non-diagnostic or technically infeasible PCNA (percutaneous needle aspiration). In the difficult situations of small or deeply seated PN, several techniques facilitating thoracoscopy have been used for detecting them. Our new protocol for managing PN was developed and prospectively reviewed. Material and Method: In the procedure of PCNA, we firstly placed the tip of the needle in the center of, or just in contact with PN under CT guidance, and loaded one or two segments of platinum radiomarker inside the needle after removing the stylet. Then, we forced the radiomarker to move to the tip of the needle by pushing the stylet. Finally, if the tip of the needle was not within PN, it was reoriented to the their center to obtain the sample for PCNA. Result: Between May 1999 and May 2000, radiomarkers were successfully placed in 28 PN of 26 patients, with the exception of one. In 18 (85%) of 21 nodules needing throacoscopy, intraoperative fluoroscopy was used to detect them or guide stapling resection during thoracoscopy. Conclusion: The advantages of this technique are that there is that there is no need for further localization for thoracoscopy even in cases of unsuccessful PCNA, and it was more effective in respect to both cost and time. Therefore, this strategy for PN expecting thoracoscopy will be helpful to patients and medical staff alike.

• Tuberculosis and Respiratory Diseases
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• v.43 no.6
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• pp.916-924
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• 1996

Bacground : Percutaneous needle aspiration biopsy (PCNA) is one of the most frequently used diagnostic methcxJs for intrathoracic lesions. Previous studies have reponed wide range of diagnostic yield from 28 to 98%. However, diagnostic yield has been increased by accumulation of experience, improvement of needle and the image guiding systems. We analysed the results of PCNA performed for one year to evaluate the diagnostic yield, the rate and severity of complications and factors affecting the diagnostic yield. Method : 287 PCNAs undergone in 236 patients from January, 1994 to December, 1994 were analysed retrospectively. The intrathoracic lesions was targeted and aspirated with 21 - 23 G Chiba needle under fluoroscopic guiding system. Occasionally, 19 - 20 G Biopsy gun was used for core tissue specimen. The specimen was requested for microbiologic, cytologic and histopathologic examination in the case of obtained core tissue. Diagnostic yields and complication rate of benign and malignant lesions were ca1culaled based on patients' chans. The comparison for the diagnostic yields according to size and shape of the lesions was analysed with chi square test (p<0.05). Results : There are 19.9% of consolidative lesion and 80.1% of nodular or mass lesion, and the lesion is located at the right upper lobe in 26.3% of cases, the right middle lobe in 6.4%, the right lower lobe 21.2%, the left upper lobe in 16.8%, the left lower lobe in 10.6%, and mediastinum in 1.3%. The lesion distributed over 2 lobes is as many as 17.4% of cases. There are 74 patients with benign lesions, 142 patients with malignant lesions in final diagnosis and confirmative diagnosis was not made in 22 patients despite of all available diagnostic methods. 2 patients have lung cancer and pulmonary tuberculosis concomittantly. Experience with 236 patients showed that PCNA can diagnose benign lesions in 62.2% (42 patients) of patients with such lesions and malignant lesions in 82.4% (117 patients) of patients. For the patients in whom the first PCNA failed to make diagnosis, the procedure was repeated and the cumulative diagnostic yield was increased as 44.6%, 60.8%, 62.2% in benign lesions and as 73.4%, 81.7%, 82.4% in malignant lesions through serial PCNA. Thoracotomy was performed in 9 patients with benign lesions and in 43 patients with malignant lesions. PCNA and thoracotomy showed the same pathologic result in 44.4% (4 patients) of benign lesions and 58.1% (25 patients) of malignant lesions. Thoracotomy confirmed 4 patients with malignat lesions against benign result of PCNA and 2 patients with benign lesions against malignant result of PCNA. There are 1.0% (3 cases) of hemoptysis, 19.2% (55 cases) of blood tinged sputum, 12.5% (36 cases) of pneumothorax and 1.0% (3 cases) of fever through 287 times of PCNA. Hemoptysis and blood tinged sputum didn't need therapy. 8 cases of pneumothorax needed insertion of classical chest tube or pig-tail catheter. Fever subsided within 48 hours in all cases. There was no difference between size and shape of lesion with diagnostic yield. Conclusion: PCNA shows relatively high diagnostic yield and mild degree complications but the accuracy of histologic diagnosis has to be improved.

• Tuberculosis and Respiratory Diseases
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• v.57 no.1
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• pp.61-65
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• 2004

Even though nocardiosis is one of opportunistic infections, and can occur in Cushing's syndrome, it rarely occurs in patients with Cushing's disease. Herein, a case with Cushing's disease in whom nocardiosis had manifested as a pulmonary lesion, which after percutaneous needle aspiration, empyema and a breast abscess were also noted.

• Tuberculosis and Respiratory Diseases
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• v.47 no.4
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• pp.488-497
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• 1999

Background : Identification of the histologic cell type of lung cancer is important because it is related to the treatment modality and prognosis. Currently, many diagnostic methods are used to determine the cell type. We have studied to evaluate the histologic accuracy of each diagnostic methods in lung cancer. Method : 168 cases were analysed retrospectively, who underwent curative thoracotomy for lung cancer in Seoul National University Hospital from January, 1994 to February, 1997. Sputum cytology, percutaneous needle aspiration(PCNA), percutaneous needle biopsy(PCNB), bronchial washing cytology and flexible bronchoscopic biopsy were evaluated respectively. The k coefficient was applied to evaluate the degree of concordance between the histologic diagnosis obtained by each methods and the one derived from thoracotomy. Results : The k value in sputum cytology was 0.86. In the 34 cases with squamous cell carcinoma(SQ), 32 cases were finally diagnosed as having such by thoracotomy. 7 of the 8 cases with adenocarcinoma(AD) turned out to have the same. The k value in PCNA was 0.51. In the 31 cases with SQ, only 14 cases were finally diagnosed as having such. All of the 3 cases with small cell carcinoma(SC) turned out to have the same. The k value in PCNB was 0.77. The diagnosis was correct in 13 of the 16 patients with SQ and in 30 of the 32 cases with AD. The k value in bronchial washing cytology was 1.0. In all of the 29 cases with SQ and all of the 7 cases with AD, the diagnosis was correct. The k value in flexible bronchoscopic biopsy was 0.77. The diagnosis was correct in 51 of the 52 cases with SQ and in 1 of the 2 cases with SC. Conclusion : The concordance rate with the final histologic diagnosis in sputum cytology, PCNB, bronchial washing cytology and flexible bronchoscopic biopsy were excellent ($k{\geq}0.75$), while that in PCNA was fair (k=0.53). Because PCNA showed lower concordance rate than other diagnostic methods, PCNA is recommended to perform with PCNB.

• Journal of Chest Surgery
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• v.26 no.5
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• pp.373-379
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• 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
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• v.44 no.6
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• pp.418-422
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• 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.

• Tuberculosis and Respiratory Diseases
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• v.56 no.2
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• pp.210-215
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• 2004

Pulmonary aneurysm is a rare vascular anomaly.Infection is one of major causes of pulmonary aneurysms. Pulmonary aneurysm by pulmonary actinomycosis is a rare case. Our case is maybe the first case in Korea,so far similar case has not been reported Worldwide written in English. We describe a 73-year-old man with aneurysm of pulmonary artery caused by actinomycosis infection on lung. We detected aneurysm by angiography of pulmonary artery, and actinomycosis infection was revealed by confirm sulfur granules on specimens taken by percutaneous needle aspiration(PCNA). Antibiotic therapy was applied to this patient and aneurym was embolized with coils.With this therapy,the patient was successfully managed and improved.