• Journal of Chest Surgery
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• v.29 no.8
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• pp.897-904
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• 1996

A preoperative prediction of postoperative pulmonary function after the pulmonary resection should be made to prevent serious complications and postoperative mortality. There are several methods to predict postoperative lung function but the 99m7c-MAA perfusion lung scan is known as simple, inexpensive and easily tolerated method for patients. We studied the accuracy of the perfusion lung scan in predicting postoperative lung function on 34 patients who received either the resection of one lobe(17 patients) or 2 lobes(2 patients) or pneumonictomy(15 patients). We performed pulmonary function test and lung scan immediately before the operation and calculated the postoperative lung function by substracting the regional lung function which will be rejected. We compared this predictive value to the observed pulmonary function which was done 20 days after the surgery. We also compared the data achieved from 12 patients ho received open thoracotomy due to intrathoracic disease that are not confined in the lung. The correlation coefficient between the predicted value and observed value of FEVI .0 was 0.423, FVC was 0.557 in the pneumonectomy group and FEVI . 0 was 0.693, FVC was 0.591 in the lobectomy group. The correlation coefnclent between the'postoperative value and preoperative value of FEVI .0 was 0.528, FVC was 0.502 in the resectional group and FEVI .0 was 0.871, FVC was 0.896 in the comparatives. We concluded that the perfusion lung scan is accllrate in predicting post-resectional pulmonary function.

• Journal of Chest Surgery
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• v.25 no.3
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• pp.247-257
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• 1992

Bronchial adenoma, firstly described by Muller[1882] had been reported on the subject stressed their benign nature prior to 1940`s, but these tumors including carcinoid tumor, mucoepidermoid carcinoma, adenoid cystic carcinoma, pleomorphic adenoma are now known to possess the various degree of malignant natures from benign course, low grade malignant potential to distant lymphatic or hematogenous metastasis or combination. Although histologically diffeerent, four varieties except carcinoid tumor which is a spectrum of neu-roendocrine tumor originating Kulchitsky cell of the bronchial epithelium and form the part of the APUD tumor spectrum, are morphologically and in many respects clinically similar to the corresponding tumor of the salivary gland is a specific varient of adenocarcinoma that occurs most commonly in the major and minor salivary gland and less frequently tra-cheobronchial tree, esophagus etc. To better understand the clinical characteristics and assess more precisely the malignat nature of bronchial adenoma, we studied 17 cases of bronchial adenoma, which had been experienced at the Department of Thoracic and Cardiovascular surgery of Catholic University Medical College from April 1977 to september 1991. Seventeen cases of bronchial adenoma consist of 2 carcinoid tumors, 6 adenoid cystic carcinomas, 8 mucoepidermoid carcinomas and one pleomorphic adenoma. There is a slight predominace of male patients[10/17] and the age of pt studied varied with a higher incidence occurring between the ages of 40 years and 60 years[mean age, 46.5 years]; the youngest being 15 years and oldest 69 years. Their leading complaints were hemoptysis[4], exertional dyspnea[8], fever & chilness [4], and symptoms mimicking the bronchial asthma[4]. Diagnosis was aided by the radiologic studies such as chest X-ray, polytomography, CT scan, brochography and bronchoscopy. The preferred locations of fumor were in the trachea[4], main stem bronchus[3], bronchus intermedius[3], bronchus of RUL[2], LUL[1], RLL[1], LLL[3] with no peripheral location. Modalities of treatments were single or combination of surgical resection, radiation therapy, chemotherapy. Complete resections were permitted in 12 cases with late recurrences of 4 cases ranging from 6 months to 10 years: pneumonectomy[4], lobectomy[4], bil-obectomy[2], sleeve resection[2]. Gross findings of resected specimens in 14 cases showed that 4 cases were polyp-like pedunculated mass[entirely intraluminal mass] with intact mucosa, 8 cases were broad-bas-ed sessile mass[predominatly intraluminal] and the main portions were located below the mucosa similar to tip of iceburg[predominantly extraluminal] in 2 cases. Follow-up information was availble in all 17 cases ; eight were alive without evidence of disese ranging from 1 month to 13 years. But seven cases died of the causes related to tumor[6 cases within 12 months, one case 10 years after pneumonectomy]. We concluded that 8 cases[47%] of 17 cases were metastasizing bronchial adenoma and precise survival rate cannot be answered by the scanty materials available for study.

• Journal of Yeungnam Medical Science
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• v.1 no.1
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• pp.59-66
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• 1984

Although it is well established that steroid is effective for treatment of neonatal respiratory distress syndrome (NRDS), the action mechanism of steroid on NRDS is not well known. Several authors have insisted that steroid increases secretion of pulmonary surfactant from type II pneumocyte, but others have insisted that steroid does not affect the secretory function of the type II pneumocyte. And some authors have suggested that steroid may ca use compositional change of pulmonary surfactant phospholipid. From these aspects, it is desirable to confirm the effect of steroid on (he secretory function of the type II pneumocyte. In order to know the effect of steroid on pulmonary surfactant activity, phospholipid phosphorus of lung lavage was measured and composition of pulmonary surfactant phospholipid of lung lavage was analyzed by thin layer chromatography (TLC) in control (C), pneumonectomized (PN), and pneumonectomized with betamethasone treated (PNS) rabbits. And lung weight and lung weight-body weight ratio were measured in each experimental group also. In PN group, right lung pneumonectomy was performed under general anesthesia with pentobarbital sodium (30mg/kg). On the fifth day after the surgery, the left lung was excised and measured above parameters. In PNS group, pneumonectomy was performed as PN group, and one day after the surgery, betamethasone was injected for four days intramusculary (4mg/day) and rabbits were sacrificed. The experiment yielded following results. PNS group's lung weight was significantly (p<0.01) heavier than C group's, but in comparison with PN group's it showed no significant change. PNS group's L/B ratio was significantly (p<0.05) higher than C group's, but compared with PN group's it showed no significant change. The value of phospholipid phosphorus content of PNS group was significantly (p<0.01) higher than that of C group. Even if the value of phospholipid phosphorus content in PNS group was not significantly higher than that of PN group, it showed increasing tendency compared with that of PN group. And in an analysis of the thin layer chromatogram, quantity (${\mu}mol/gm$ of wet weight lung) of phosphatidylcholine in PNS group decreased significantly (p<0.05) compared with C and PN group. From these results, it may be suggested that though steroid inhibits cellular hyperplasia in the compensatory growing lung, it auguments the secretory function of type II pneumocyte and causes compositional change of pulmonary surfactant phospholipid.

• Journal of Chest Surgery
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• v.25 no.11
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• pp.1169-1179
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• 1992

To determine the period and degree of full recovery of postoperative pulmonary function, the author performed seiral pulmonry function test with spirometry at preoperative period and 1st, 2nd, 3rd, 4th, 6th and 8th postoperative week in 64 patients who underwent chest surgery form 1990. 1. to 1990. 8. at Dep. of Thoracic & Cardiovascular surgery, Pusan National University Hospitcal, Pusan, Korea 28 patients underwent lung resection[Group A], 14 patients mediastinal and other thoracic surgery[Group B], and 22 patients heart surgery with cardiopulmonary bypass[Group C]. Al of them recovered normally and discharged without any complications. Their serial changes of pulmonary function test were compaired and its results was as follows; l. Over all mean recovery time of restrictive ventilatory function tests[ie, VC, ERV, IC, FEF1, FVC, FEF200-1200, MVV] were 4th & 6th postoperative week, and that of obstructive ventilatory function tests[ie., EFE25-75%, Vmax50] were 2nd postoperative week. 2. In patient who underwent lung resection surgery[Group A], FEF1 recovered in 4th~6th postoperative week and its ratio to preoperative value was 70% in pneumonectomy, and 75% in lobectomy. FVC recovered in 4th~6th postoperative week and its ratio to preoperative value was 65% in pneumonectomy, and 80% in lobectomy. MVV was recovered in 4th~8th postoperative week and recovery ratio was 80%, FEF200-1200 was recovered at 4th~6th postoperative week and its recovery ratio was 70%, FEF25-75% and Vmax50 was recovered in 2nd~4th postoperative week and recovered nearly to preoperative level. 3. In patient who underwent mediastinal and other thoracic surgery[Group B], FEV1 and FVC and recovered in 4th~6th postoperative week and the recovery ratio of FVC in blebectomy was 90%. MVV reached preoperative level in 4th~8th postoperative week. FEF200-1200, FEF25-75% and Vmax50 were recovered in 2nd~4th postoperative week and the recovery of FEF25-75% and Vmax50 in blebectomy was prominant. 4. In patient who underwent heart surgery[Group C], FEV1 and FVC were recovered in 4th~6th postoperative week. The recover ratio of FEF25-75% and Vmax50 was delaied to 6th~8th postoperative week From the above results we concluded that the recovery time of posoperative restrictive ventilatory disorder was 4th postoperative week and pulmonary complication would possibly occure during that period. So more intensive observations will be needed.

• Journal of Chest Surgery
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• v.51 no.3
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• pp.195-201
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• 2018

Background: We investigated the surgical outcomes of patients who underwent therapeutic surgery for malignant pleural mesothelioma (MPM) at a single center. Methods: A retrospective review of 21 patients who underwent therapeutic surgery for MPM from January 2001 to June 2015 was conducted to assess their outcomes. The patients' characteristics and postoperative course, including complications, mortality, overall survival, and recurrence-free survival, were analyzed. Results: Of the 21 patients who underwent therapeutic surgery, 1 5 (71.4%) underwent extrapleural pneumonectomy, 2 pleurectomy (9.5%), and 4 excision (1 9.1 %). The median age was 57 years (range, 32-79 years) and 15 were men (71.4%). The mean hospital stay was 1 6 days (range, 1-63 days). Median survival was 14.3 months. The survival rate was 54.2%, 35.6%, and 21.3% at 1, 3, and 5 years, respectively. In patients' postoperative course, heart failure was a major complication, occurring in 3 patients (14.3%). The in-hospital mortality rate was 2 of 21 (9.5%) due to a case of severe pneumonia and a case of acute heart failure. Conclusion: A fair 5-year survival rate of 21.3% was observed after surgical treatment. Heart failure was a major complication in our cohort. Various surgical methods can be utilized with MPM, each with its own benefits, taking into consideration the severity of the disease and the comorbidities of the patient. Patients with local recurrence may be candidates for surgical intervention, with possible satisfying results.

• Radiation Oncology Journal
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• v.11 no.2
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• pp.321-330
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• 1993

Purpose: A retrospective analysis was performed to evaluate the incidence of radiation induced lung damage after the radiation therapy for the patients with carcinoma of the lung. Method and Materials: Sixty-six patients with lung cancer (squamous cell carcinoma 27, adenocarcinoma 14, large cell carcinoma 2, small cell carcinoma 13, unknown 10) were treated with definitive, postoperative or palliative radiation therapy with or without chemotherapy between July 1987 and December 1991. There were 50 males and 16 females with median age of 63 years (range: 33~80 years). Total lung doses ranged from 500 to 6,660 cGy (median 3960 cGy) given in 2 to 38 fractions (median 20) over a range or 2 to 150 days (median in days) using 6 MV or 15 MV linear accelerator. To represent different fractionation schedules of equivalent biological effect, the estimated single dose (ED) model, $ED=D{\dot}N^{-0.377}{\dot}T^{-0.058}$ was used in which D was the lung dose in cGy, N was the number of fractions, and T was the overall treatment time in days. The range of ED was 370 to 1357. The endpoint was a visible increase in lung density within the irradiated volume on chest X-ray as observed independently by three diagnostic radiologists. Patients were grouped according to ED, treatment duration, treatment modality and age, and the percent incidence of pulmonary damage for each group was determined. Result: In 40 of 66 patients, radiation induced change was seen on chest radiographs between 11 days and 314 days after initiation of radiation therapy. The incidence of radiation pneumonitis was increased according to increased ED, which was statistically significant (p=0.001). Roentgenographic changes consistent with radiation pneumonitis were seen in $100\%$ of patients receiving radiotherapy after lobectomy or pneumonectomy, which was not statistically significant. In 32 patients who also received chemotherapy, there was no difference in the incidence of radiation induced change between the group with radiation alone and the group with radiation and chemotherapy, among the sequence of chemotherapy No correlation was seen between incidence of radiation pneumonitis and age or sex. Conclusions: The occurrence of radiation pneumonitis varies. The incidence of radiation pneumonitis depends on radiation total dose, nature of fractionation, duration of therapy, and modifying factors such as lobectomy or pneumonectomy.

• Journal of Chest Surgery
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• v.5 no.1
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• pp.45-56
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• 1972

Esophageal perforation is one of the most grave prognostic problems among thoracic and general surgical emergencies which necessitate urgent operative measures. In Korea,there are still many persons ingesting lye for suicidal attempt and thoracic surgeons in Korea have more chances to deal with lye burned esophagus with or without instrumental perforation than those in Western countries. Main cause of esophageal perforation in Korea is instrumental perforation in patients with lye stricture of the esophagus during diagnostic endoscopy or therapeutic bouginage. Other causes are corrosion of the esophagus due to ingestion of caustic agents, pathologic perforation, surgical trauma, stab wound and spontaneous rupture of the esophagus in our series. Therapeutic measures are various,and depend on duration of perforation, severity of its complications, pathology of perforated portion of the esophagus and degrees of inflammation at the point of perforation. The most important therapeutic measures are prevention of this grave condition during esophagoscopy, bouginage and surgical procedures on lungs and mediastinal structures and to make early diagnosis with prompt therapeutic measures. During the period of January, 1959, to December, 1971, the authors experienced 65 cases ofesophageal perforation including acquired esophagorespiratory fistula at Dept. of Chest Surgery, the National Medical Center in Seoul, and obtained following results in the series. 1. Female were 35 cases, and peak age incidence was 2nd and 3rd decades of life. 2. Among 65 cases, 43 were corrosive esophagitis or benign stricture of the esophagus due to caustic agents, 7 were patients with esophageal cancer. and there were 5 cases of esophageal perforation developed after pneumonectomy or pleuropneumonectomy. 3. Causes of perforation are instrumental perforation in 45, acute corrosion in 7, pathologic perforation in 7, surgical trauma in 3, stab wound in 2 cases, and one spontaneous rupture of the esophagus. 4. Most frequent sites of esophageal perforation were upper and mid thoracic esophagus, and 8 were cases with cervical esophageal perforation. 5. Complications of esophageal perforation were mediastinitis in 42, empyema or pneumothorax in 35, esophagorespiratory fistula in 12, retroperitoneal fistula or abscess in 5,pneumoperitoneum in 3, and localized peritonitis in 1 case. 6. Cases with malignant esophagorespiratory fistula were only 3 in the series which is predominant cause of acquired esophagorespiratory fistula in Western countries. 7. Various therapeutic measures were applied with mortality rate of 27.7% in the series. 8. In usual cases early treatment gave better prognosis, and least mortality rate in cases with perforation in mid thoracic esophagus. 9. Main causes of death were respiratory complications,acute hemorrhage with asphyxia, and septic complications. 10. Esophageal perforation developed after pneumonectomy gave more difficult therapeutic problems which were solved in only 1 among 5 cases.

• Tuberculosis and Respiratory Diseases
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• v.49 no.5
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• pp.633-638
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• 2000

Pulmonary mucormycosis is an opportunistic infection in patients with severe underlying illness such as immunocompromised diseases or uncontrolled diabetes mellitus. While patients with leukemia and lymphoma usually present with diffuse parenchymal disease, diabetic patients usually have a localized endobronchial disease involving central airways. We report upon a case of pulmonary mucormycosis in diabetes mellitus patient presenting as an endobronchial mass, which was cured with antifungal therapy, rigid bronchoscopic mass removal and right pneumonectomy.

• Tuberculosis and Respiratory Diseases
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• v.44 no.3
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• pp.505-515
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• 1997

Background : We assessed the accuracy of staging in evaluation of bronchial invasion, thus found the role of CT in patients who underwent resective surgery in primary lung cancer. Materials and Methods : Authors retrospectively analized the preoperative CT scans of 156 patients receiving pneumonectomy(n = 95) and lobectomy(n = 61). Among lobectomy patients, 7 patients subsequently performed pneumonectomy because of positive resection margin of bronchus in frozen biopsy. We also retrospectively analized CT scans of non-operated 60 patients who performed sufficient bronchoscopic biopsy. Bronchial wall thickness more than 3mm, irregular wall thickening and reduction of diameter by CT were defined as bronchial invasion. The pathologic examination of resection margin were positive in 20, stump recurrence occurred in 6 of the operated group, and the pathologic examination of biopsy of bronchial wall were positive in 34 of the non operated group, and these were an regarded as bronchial invasion. Results : The CT assessment of bronchial invasion revealed low sensitivity (11.5%), low positive predictability(38%), but high specificity(96%) and relatively high accuracy (84%) in the operated group and higher sensitivity (62%), higher positive predictability(95%) in non-operated group. Conclusion : In lung cancer patients who underwent operation, CT showed very low sensitivity and positive predictability in evaluation of bronchial invasion. Because the usefulness of CT in evaluation of bronchial invasion is limited, therefore aggressive fiberoptic bronchoscopic biopsy is thought to be necessary before surgical attempt.

• Tuberculosis and Respiratory Diseases
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• v.61 no.5
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• pp.484-489
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• 2006

A primary pulmonary leiomyosarcoma is a very rare pulmonary malignancy that arises from smooth muscle of either the bronchial or arterial walls. Common symptoms of the tumor are cough, dyspnea, chest pain and hemoptysis. The diagnosis of a primary pulmonary sarcoma can be established only after extensive clinical and radiologic examinations have failed to identify an alternative primary source. The only effective treatment for the tumor is a complete surgical resection when feasible. The type of resection is dictated by the local anatomic extent of the tumor. We report a case of a 21-year-old male with a primary endobronchial leiomyosarcoma who presented with massive hemoptysis. A necrotic ulcerative endobronchial lesion was observed in the orifice of left lower lobe bronchus on a bronchoscopic examination. He was treated with a complete sleeve resection of the left lower lobe. Three months later, local recurrence of the tumor was noticed on the follow up bronchoscopy and a then left pneumonectomy was then performed. Fifteen months later, the patient died from empyema with a bronchopleural fistula that was associated with tumor recurrence at the stump of the pneumonectomy.