• Tuberculosis and Respiratory Diseases
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• v.45 no.6
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• pp.1143-1153
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• 1998

Background : Recent outbreaks of pulmonary disease due to drug-resistant strains of Mycobacterium Tuberculosis have resulted in significant morbidity and mortality in patients worldwide. We reviewed our experience to evaluate the effects of pulmonary resection on the management of multidrug-resistant tuberculosis. Method : A retrospective review was performed of 41 patients undergoing pulmonary resection for multidrug-resistant tuberculosis between January 1993 and December 1997. We divided these into 3 groups according to the radiologic findings : (1) patients who have reasonably localized lesion (Localized Lesion Group ; LLG) (2) patients who have cavitary lesions after pulmonary resection on chest roentgenogram (Remained Cavity Group : RCG) (3) patients who have Remained infiltrative lesions postoperatively (Remained infiltrative group : RIG). We evaluated the negative conversion rate after resection and overall response rate of the groups. Then they were compared with the results of the chemotherapy on the multi drug-resistant tuberculosis which has been outcome by Goble et al. Goble et al reported that negative conversion rate was 65% and overall response rate, 56% over a mean period of 5.1 months. Results : Seventy five point six percent were men and 24.4% women with a median age of 31 years (range, 16 to 60 years). Although the patients were treated preoperatively with multidrug regimens in an effort to reduce the mycobacterial burden, 22 of 41 were still sputum culture positive at the time of surgery. 20 of 22 patients(90.9%, p<0.01) responded which is defined as negative sputum cultures within 2 months postoperative. Of 26 patients with the sufficient follow up data, 19 have Remained sputum culture negative for a mean duration of 25.7 months (73.1%, p<0.05). The bulk of the disease was manifest in one lung, but lesser amounts of contralateral disease were demonstrated in 15, consisted of 8 in RIG and 7 in RCG, of 41. 12 of 12 patients (100%, p<0.01) who were sputum positive at the time of surgery in LLG converted successfully. 14 of 15 patients (93.3%, p<0.05) with the follow up have completed treatment and not relapsed for a mean period of 25. 7 months. The mean length of postoperative drug therapy of LLG was 12.2 months. In RIG, postoperative negative conversion rate was 83.3% which was not significant statistically. There was a statistical significance in overall response rate (100%, p<0.05) of RIG for a mean period of 24.4 months with a mean length of postoperative chemotherapy, 11.8 months. In RCG a statistically lower overall response rate (14.3%, p<0.01) has been revealed for a mean duration of follow up, 24.2 months. A negative conversion rate of RCG was 75% which was not significant statistically. Conclusion : Surgery plays an important role in the management of patients with multidrug-resistant Mycobacterium tuberculosis infection. Aggressive pulmonary resection should be performed for resistant Mycobacterium tuberculosis infection to avoid treatment failure or relapse. Especially all cavitary lesions on preoperative chest roentgenogram should be resected completely. If all of them could not be resected perfectly, you should not open the thorax.

• Journal of Chest Surgery
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• v.6 no.2
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• pp.165-170
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• 1973

The selection and treatment with resection and drainage for patients with emphysematous bullae is discussed with reference to two patients recently. One case with bilateral multiple bullous emphysema resulting tension pneumothorax due to rupture of the bullae on right, 47 year old man with pulmonary tuberculosis history for 16 years, was treated with resection of the bullae on right including upper lobectomy and c!osed rhoracostomy drainage on left for another spontaneous pneumothorax, and result was excellent for 6 month after discharge. Another 53 year old man with giant tension air cysts occupying right whole lung field and shifting mediastinum to the left was treated with right under water sealed closed thoracostomy drainage for 7 days in vain, and resection was not performed for his poor respiratory function and general condition. The most useful preoperarive information was obtained from a study of the plain chest radiogram and the surgical procedure of choice was obliteration of the bullae at thoracotomy.

• Journal of Chest Surgery
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• v.20 no.4
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• pp.815-820
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• 1987

Excision of the metastatic pulmonary sarcoma or carcinoma in the selected cases is now the accepted and the most effective method of treatment. From January 1978 to July 1987, 14 patients with metastatic lung cancer were treated surgically at the Department of Thoracic and Cardiovascular Surgery, Catholic University Medical College. Ages ranged from 26 years to 68 years [mean=38.0 years]. Primary sites were uterus in 6 patients, colorectum in 2, sarcoma of extremities in 2, and 1 case of pancreas, kidney, skin and melanoma of hand. Fourteen posterolateral thoracotomies were done and resected the 36 metastatic masses in 14 patients. Surgical mortality was none. The performed procedures of resection were as follows; lobectomy with wedge resection in 2, lobectomy in 3, segmentectomy in 1 and wedge resection in 8. Eleven patients were received radiotherapy or chemotherapy, or both postoperatively. Among the 14 patients, there were 5 survivors. They are 6, 7, 21, 35, and 63 months postoperatively. Among them, 9 patients were dead. Within one year in 2, two years in 6, and three years in l.

• Tuberculosis and Respiratory Diseases
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• v.45 no.1
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• pp.57-67
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• 1998

Purpose : This study was undertaken to determine the preoperative predictors of mortality and morbidity after lung cancer resection. Method: During the period from October 1, 1995 to August 31, 1996, a prospective study was conducted in 92 lung resection candidates diagnosed as lung cancer. For preoperative predictors of nonpulmonary factors, we considered age, sex, weight loss, hematocrit, serum albumin, EKG and concomitant illness, and for those of pulmonary factors, smoking history, presence of pneumonia, dyspnea scale(1 to 4), arterial blood gas analysis with room air breathing, routine pulmonary function test. And predicted postoperative(ppo) pulmonary factors such as PPO-$FEV_1$, ppo-diffusing capacity(DLco), predicted postoperative product(PPP) of ppo-$FEV_1%{\times}ppo$-DLco% and ppo-maximal $O_2$ uptake($VO_2$max) were also considered. Results: There were 78 men and 14 women with a median age of 62 years(range 42 to 82) and a mean $FEV_1$ of $2.37\pm0.06L$. Twenty nine patients had a decreased $FEV_1$ less than 2.0L. Pneumonectomy was performed in 26 patients, bilobectomy in 12, lobectomy in 54. Pulmonary complications developed in 10 patients, cardiac complications in 9, other complications(empyema, air leak, bleeding) in 11, and 16 patients were managed in intensive care unit for more than 48hours. Three patients died within 30 days after operation. The ppo-$VO_2$max was less than 10ml/kg/min in these three patients, but its statistical significance could not be determined due to small number of patients. In multivariate analysis, the predictor related to postoperative death was weight loss(p<0.05), and as for pulmonary complications, weight loss, dyspnea scale, ppo-DLco and extent of resection(p<0.05). Conclusions: Based on this study, preoperative nonpulmonary factors such as weight loss and dyspnea scale are more important than the pulmonary factors in the prediction of postoperative mortality and/or morbodity in lung resection candidates, but exercise pulmonary fuction test may be useful Our study suggests that ppo-$VO_2$max value less than 10ml/kg/min is associated with death after lung cancer resection but further studies are needed to validate this result.

• Tuberculosis and Respiratory Diseases
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• v.62 no.3
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• pp.232-236
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• 2007

Primary pulmonary artery sarcoma is a rare malignant tumor arising from the pulmonary artery. Diagnosis of primary pulmonary artery sarcoma is quite difficult and the conditon is often misdiagnosed as a more common disease, such as a pulmonary embolism. PET can help in diagnosing a pulmonary artery sarcoma due to the increased uptake of $^{18}F-FDG$ in the area of the tumor. However, the poor anatomic resolution of PET has limited its clinical applications in pulmonary vascular disease. The recently developed PET/CT is the fusion of PET and CT that improves the anatomical resolution of PET. We report a case of a primary pulmonary artery sarcoma mimicking a pulmonary embolism that was diagnosed with PET/CT and confirmed with a surgical resection.

• Tuberculosis and Respiratory Diseases
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• v.48 no.1
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• pp.14-23
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• 2000

Background: The evaluation of candidates for successful lung resection is important. Our study was conducted to determine the preoperative predictors of postoperative mortality and morbidity in lung cancer patients with impaired lung function. Method; Between October 1, 1995 and August 31, 1997, 36 lung resection candidates for lung cancer with $FEV_1$ of less than 2L or 60% of predicted value were included prospectively. Age, sex, weight loss, hematocrit, serum albumin, EKG and concomitant illness were considered as systemic potential predictors for successful lung resection. Smoking history, presence of pneumonia, dyspnea scale(l to 4), arterial blood gas analysis with room air breathing, routine pulmonary function test were also included for the analysis. In addition, predicted postoperative(ppo) pulmonary factors such as ppo-$FEV_1$ ppo-diffusing capacity(DLco), predicted postoperative product(PPP) of ppo-$FEV_1%{\times}$ppo-DLco% and ppo-maximal $O_2$ uptake($VO_2$max) were also measured. Results: There were 31 men and 5 women with the median age of 65 years(range, 44 to 82) and a mean $FEV_1$ of $1.78{\pm}0.06L$. Pneumonectomy was performed in 14 patients, bilobectomy in 8, lobectomy in 14. Pulmonary complications developed in 10 patients; cardiac complications in 3, other complications(empyema, air leak, bleeding) in 4. Twelve patients were managed in the intensive care unit for more than 48 hours. Two patients died within 30 days after operation. The ppo-$VO_2$max was less than 10 ml/kg/min in these two patients. MVV was the only predictor for the pulmonary complications. However, there was no predictor for the post operative death in this study. Conclusions: Based on the results, MVV was the useful predictor for postoperative pulmonary complications in lung cancer resection candidates with impaired lung function In addition, ppo-$VO_2$max value less than 10 ml/kg/min was associated with postoperative death, so exercise pulmonary function test could be useful as preoperative test. But further studies are needed to validate this result.

• Tuberculosis and Respiratory Diseases
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• v.72 no.2
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• pp.187-190
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• 2012

Pulmonary sequestration is a rare congenital anomaly of the lung in which it is separately supplied from the aorta or one of its branches. Bilateral pulmonary sequestration is very rare, particularly in adults. In bilateral pulmonary sequestration, resection of both sides is usually recommended if both sides are infected and symptomatic. We report the case of a 37-year-old female patient with bilateral intralobar pulmonary sequestration treated by staged bilateral lower lobectomy.

• Journal of Chest Surgery
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• v.33 no.7
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• pp.590-593
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• 2000

The incidence of pulmonary leiomyosarcoma as primary lung tumor is very rare. Most of the primary leiomyosarcomas originate in the hilar region in relation to the main bronchus or pulmonary vessels and only a few originate more peripherally. This rare tumor can mimic bronchial carcinoma and present with local or systemic symptoms, or it may be discovered as an incidental finding on a routine chest X-ray. We report with review of literature, a case of incidental primary pulmonary leiomyosarcoma which originated peripherally. Huge mass was found on the left lung of a 61-year-old man on the chest X-ray peripherally. He underwent the surgical resection of the left pneumonectomy and the postoperative course was uneventful.

• Tuberculosis and Respiratory Diseases
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• v.53 no.3
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• pp.332-336
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• 2002

Bacterical tracheitis is a very rare complication in adults after endotracheal intubation. We report a case of bacterial tracheitis associated with endotracheal intubation and corticosteroids. The patient was discharged with a permanent tracheostomy, and a resection and an end-to-end anastomosis of the trachea is planned.

• Journal of Chest Surgery
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• v.45 no.5
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• pp.326-329
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• 2012

Pulmonary arteriovenous malformation (PAVM) is a rare anomalous direct communication between the pulmonary artery and vein with a considerable risk of serious complications such as cerebral thromboembolism or abscess and pulmonary hemorrhage. Although the past, surgical resection such as lobectomy was mostly used to treat PAVM, the recent development of endovascular treatment has made it a primary consideration to perform transcatheter embolization using coils or detachable balloons. We report a case of successful transcatheter embolization of giant PAVM with the second generation Amplatzer vascular plug II as a new self-expanding device.