• Tuberculosis and Respiratory Diseases
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• v.47 no.4
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• pp.543-548
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• 1999

Bronchopleural fistula(BPF) occurs as a postoperative complication in 2 to 5 percent of pulmonary resection. The detection of BPF is generally difficult and various diagnostic methods have been utilized to identify the site of the fistula in order to treat it adequately. Closure of these BPF can be surgical intervention or bronchoscopic application of various sealing agents. We report an experience with use of bronchoscopic instillation of n-butyl-2-cyanoacrylate($Histoacryl^{(R)}$) for closure of a postpneumonectomy BPF.

• Journal of Chest Surgery
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• v.19 no.1
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• pp.140-147
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• 1986

A clinical study was made on 72 cases of primary lung cancer operated in the department of thoracic & cardiovascular surgery, Kyungpook national university hospital from January 1975 to May 1985. The ratio of male to female was 13.4: I and mean age was 53. Histologically, squamous cell carcinoma comprised 72.2% of 72 operated cases. Before admission to our hospital, the erroneous diagnoses were made at local clinics on the 43 cases[59.7%] and a large percentage of them was diagnosed as pulmonary tuberculosis. And then, total of 56 cases received inadequate treatment or delayed the operation. For the location of the tumor, right to left ratio is 1.2:1 and the right upper lobe was most often involved [23.6%]. Operation was performed on the 72 cases and resection on the 59 cases[8.2%]. Postsurgical staging showed that stage III was found most frequently [59.4%] and T,N,M, was 28% of total cases. Two common surgical complications were bleeding in 7 and acute respiratory failure in 6 cases, and these 6 cases of acute respiratory failure were all died. On the basis of these experiences, we conclude that aggressive effort is needed for the early accurate diagnosis and adequate treatment of lung cancer.

• Journal of Chest Surgery
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• v.27 no.8
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• pp.695-699
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• 1994

Pectus excavatum. the most common congenital chest wall deformity, is manifested by deformity of the costal cartilages resulting in a depressed and often rotated sternum. Surgical correction of this disease is frequently indicated for aesthetic improvement. The most popular current repair involves resection of abnormal costal cartilages, sternal osteotomy and mobilization, followed by fixation of the sternum in the corrected position.12 patients have been operated upon for pectus excavatum by the Adkins` method for 8 years in our hospital and the results were as follows: 1. All the patients were male. Age distribution was 2-26 years[average 10.8 years] and 69.2% were below 7 years. 2. The deformity was found at neonate or infant in the most of the patients [92.3 %] 3. The subjective symptoms were frequent URI[35.7%], dyspena on exertion[21.4%], chest dis comfort[7.1%], asthma [7.1%] and most of the patients didn`t like their appearance. 4. Combined diseases were urticaria in 2 cases, bilateral cryptomhism and pulmonary tuberculosis in 1 case each other. 5. Welch index ranged from 1.7 to 5.0 with the average of 3.47. 6. Postoperative complications were pneumothorax [45.5%], wound infection [36.4%] and skin necrosis [18.2%]. Although the period of follow-up was short in some cases there was no relapse.

• Journal of Chest Surgery
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• v.32 no.12
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• pp.1100-1105
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• 1999

배경 :폐절제술은 절제가능한 폐암 또는 염증성 폐질환 선천성 폐질환의 치교적 술식이 된다. 술후 경과에 영향을 줄수 있는 예측기능 요소를 인지하는 것은 중요하나 합병증에 이환된 경향이 높은 환자에 대하여 각별한 주의를 기울임으로서 술후 합병증 및 사망률은 감소시킬수 있을 것이다 방법 및 대상: 술후 결과에 영향을 미치는 요소를 예측하기 위해 1994년부터 1998 년까지 본 병원에서 종양성 및 염증성 폐질환으로 폐절저술을 시행받은 153명의 환자를 대상으로 입원챠트를 열람하여 연구하였다 평균 연령은 54.3$\pm$10.6세였다. 96명 (62%) 의 환자는 폐암화자였으며 47명 (30%)의 환자의 염증성 폐질환자였고 10명 (7%)의 환자는 선천성 폐질환자이거나 기타 폐질환자였다. 결과: 전체 153명중 폐엽절제술이 118례 전폐절제술이 29례 폐분엽절제술이 6례 시행되었다. 7명 (4.5%)의 환자가 술후 사망하였다 술후 원내 사망률의 가장 유의한 예측요소는 동반된 내과적 질환의 유무(p<0.001)과 70세 이상의 고령이다(p<0.003) 총 57명의 환자에게 67가지의 합병증이 발병되었다 그중 수술자체와 관련된 합병증이 50례 (32%) 호흡기계 합병증이 14례(9.1%) 심혈관계가 1례(0.6%) 기타 합병증이 2례(1.3%)였다 술후 합병증 이환율에 영향을 미치는 요소는 70세 이상의 고령이었다(p<0.004) 결론 : 동반된 내과적 질환과 70세 이상의 고령은 술후 사망률에 영향을 미치는 유의한 예측요소가 되며 또한 70세이상의 고령은 술 후 합병증 이환율에도 영향을 미치는 요소이다.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.47 no.4
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• pp.315-320
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• 2021

Carbon-ion radiotherapy (CIRT) is on the rise as a treatment choice for malignant tumor. Compared to conventional radiotherapy, particle beams have different physical and biological properties. Particle beam provides a low entry dose, deposits most of the energy at the endpoint of the flight path, and forms an asymptotic dose peak (the "Bragg peak"). Compared to protons, carbon with its larger mass decreases beam scattering, resulting in a sharper dose distribution border. We report a 50-year-old male who underwent CIRT without surgical resection on osteosarcoma of the mandible. After CIRT, the patient's pain was gone, and the malignant mass remained stable with accompanying necrosis. Nine months later, however, magnetic resonance imaging demonstrated progression of the left mandibular osteosarcoma with pulmonary metastases. After multidisciplinary discussion, concurrent chemoradiotherapy was conducted. While necrotic bone segments came out of the mandible during subsequent periodic outpatient visits, the tumor itself was stable. Thirty months after his first visit and diagnosis, the patient is waiting for chemotherapy. Although CIRT is superior in treating radioresistant hypoxic disease, CIRT is in its infancy, so care must be taken for its indications and complications.

• Tuberculosis and Respiratory Diseases
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• v.43 no.5
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• pp.763-773
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• 1996

Background : Behçet's syndrome is a chronic multisystemic disease affecting many organs such as skin, mucosa, eye, joint, central nervous system and blood vessels. Lung involvement occurs in 5% of Behçet's syndrome and is thought to be due to the pulmonary vasculitis leading to thromboembolism, aneurysm and arteriobronchial fistula. Pulmonary vasculitis in Behçet's syndrome is a unique clinical feature, differing from other vasculitis affecting the lung and is one of the major causes of death. Therefore, we examined the incidence, the clinical features, the radioloic findings and the clinical courses of the lung involvement in Behçet's syndrome. Methods: We retrospectively reviewed the medical records and radiologic studies of 10 cases of the lung involvement in Behçet's syndrome diagnosed at Yongdong Severance Hospital and Severance Hospital from 1986 to 1995. We analysed the clinical features, the radiological findings, the treatment modalities and the clinical courses. Results: 1) The incidence of the lung involvement in Behçet's syndrome was 2%(10/487). The male to female ratio was 8 : 2 and the mean age was 34 years. The presenting symptom was hemoptysis in 5 of 10 cases, and massive hemoptysis was noted in 2 cases. Other pulmonary symptoms were cough(6/10), dyspnea(4/10), and chest pain(2/10). Other manifestations were oral ulcers(10/10), genital ulcers(9/10), skin lesions(7/10), and eye lesions(6/10). 2) The laboratory findings were nonspecific. The posteroanterior views of chest radiographies showed multiple infiltrates(6/10), nodular or mass-like opacities(4/10), or normal findings(2/10). The chest CT scans showed multifocal consolidations(6/8), and aneurysms of the pulmonary aneries(4/8). The pulmonary angiographies were performed in 3 cases, and showed pulmonary artery aneurysms in 2 cases. The ventilation-perfusion scans in 2 cases of normal chest x-ray showed multiple mismatched findings. 3) The patients were treated with combination therapy consisting of corticosteroids, cyclophosphamide, and colchicine or anticoagulant agents. Surgical resection was performed in one case with a huge aneurysm. 4) We have followed up nine of ten cases. Three cases are well-being with medical therapy, two cases are severely disabled now and four cases died due to massive hemoptysis, massive pulmonary embolism, or sepsis. Conclusion : Pulmonary vasculitis is a main feature of the lung involvement of Behçet's syndrome, causing hemorrhage, aneurysmal formation, and/or thromboemboism. The lung involvement of Behçet's syndrome is uncommon but is one of the most serious prognostic factors of the disease. Therefore, an aggressive diagnostic work-up for early detection and proper treatment are recommended to improve the clinical course and the survival.

• Journal of Chest Surgery
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• v.23 no.1
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• pp.81-89
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• 1990

A total of 178 patients with primary lung cancer who had undergone complete resection of the tumor in combination with complete mediastinal lymphadenectomy were reviewed at the Department of Thoracic and Cardiovascular Surgery of Yonsei Medical Center from January 1980 through July 1989. Materials; 1. There were 45 men and 33 women ranging of age from 25 to 78 years with a mean age of 55.4 years. 2. Histological types were squamous carcinoma in 115 cases [64.6%] adenocarcinoma in 42 cases [23.6 %], bronchioloalveolar carcinoma in 9 cases [5.1%], large cell carcinoma in 8 cases [4.5 %] and small cell carcinoma in 4 cases [2.2%] Results were summarized as follows: 1. The size of primary tumor was not directly proportional to the frequency of mediastinal lymph node metastasis. [P =0.0567] 2. The histologic types of the primary tumor did not related to the incidence of mediastinal lymph node metastasis. [P >0.19] 3. The chance of mediastinal lymph node metastasis in the case with lung cancer located in right middle lobe[31.8%, N=22] and left lower lobe [31.4%, N=32] were the highest and the lowest was the one located in right lower lobe, while over all incidence of mediastinal lymph node metastasis in this series was 25.4 % [N=55]. 4. The rate of mediastinal lymph node metastasis without evidence of regional and hilar lymph node metastasis was 13%. [N=23] The chance of mediastinal lymph node involvement without N1 lymph node metastasis was 16.3 % [N=17] in both upper lobes and 8.2 % [N=6] in both lower lobes. It was statistically significant that the tumors in the upper lobes had greater chance of the mediastinal lymph node metastasis without N1 than the tumors in the lower lobes. 5. In this series majority of the patients with lung cancer the mediastinal lymph node metastasis from the tumor in each pulmonary lobes usually occurs via ipsilateral tracheobronchial and paratracheal lymphatic pathway. Especially the lung cancer located in lower lobes can metastasize to subcarinal, paraesophageal and inferior pulmonary ligamental lymph node through the lymphatic pathway of inferior pulmonary ligament. It can be speculated that in some cases of this series otherwise mediastinal lymph node metastasis can also occur with direct invasion to the parietal pleura and to the mediastinal lymph node via direct subpleural lymphatic pathway .

• Journal of Chest Surgery
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• v.35 no.11
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• pp.799-806
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• 2002

In spite of the establishment of chemotherapy and the gradual decrease in prevalence, pulmonary tuberculosis is still mainly treated with an operation. Through analyzing and examining some cases of surgical treatment, we hope to provide some help in treating of pulmonary tuberculosis in the future. Material and Method: By comparing four journals previously published in our department with 144 cases of lung surgery during ten years from January of 1991 to December of 2000 performed by the department of thoracic and cardiovascular surgery of the National Medical Center, we analyzed and reviewed the most recent trends and the results of the surgical treatment. Annual frequency of the operation, distribution of age, examination of sputum, adaptability and types of techniques, complications, and results of the postoperative follow-up were used as methods. Result: It was found that the annual frequency of operations had decreased. The ratio of men to women, 2:1 indicates that there are more incidences in men. Aging of patients could be speculated by the .results that the decrease in the incidence rate in the 20s age range and increase rate in the 50s age range. The range of preoperative lesions belonged mostly to far advanced and moderately advanced tuberculosis. By monitoring the period of use in preoperative antituberculosis drugs, cases for more than 3 years remarkably increased from 16.0 % to 55.6 %. The positive reactive rate for preoperative sputum examinations were drastically decreased from 91 % to 27 %. Total pulmonary destruction and partial destruction were the most common cases in terms of adaptability to the operations and there were significant increases in forming empyema accompanied by parenchymal lesions from 4.0 % to 20.1 %. Pneumonectomy and pulmonary lobectomy were the major type of operations. Especially, there were increases in the incident rate of empyema and recurrence of tuberculosis resulted. Post operative follow-up indicates that the rate of complete recovery was more than 70 % and the rate of gradual increase in treating with persistent antituberculosis drug was from 5.8 % to 18.0 %. Conclusion: In recent cases, there is an increasing number of patients showing tolerance to chemotherapy. Patients with pleural tuberculosis and severe lesions were typically increased. It is important to accurately analyze those complaints accurately that are mostly difficult to be treated medically. Surgical treatment is strongly recommended Before multiple drug resistance occurs.

• Tuberculosis and Respiratory Diseases
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• v.41 no.3
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• pp.248-261
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• 1994

Background: Lectins are proteins or glycoproteins of non-immune origin that recognize a specific sequence of sugar residues. The availability of a large number of lectins has provided the capacity to identify selectively glycoconjugates possessing distinctive chemical structure in diverse sites of highly specialized biological activity. The purpose of the present study was to investigate the lectin binding patterns of various components in human pulmonary tubercles. Method: Biopsy specimens of tuberculous lung were obtained from male adult patients who underwent a surgical resection for severe pulmonary tuberculosis. The specimens were processed and stained with 13 kinds of biotinylated lectins according to some modification of Hsu and Raine's methods. Results: 1) In the caseous necrotic lesions, BS $I-B_4$ showed negative reaction and BS I were also negative except some irregularly-shaped cells located in the marginal zone. All other lectins, however, showed a positive reaction with various binding patterns. 2) The epithelioid cells were broadly divided into three groups according to the reaction patterns in the cytoplasms and cell membranes. 3) WGA, ECL, PHA-L, PHA-E and LCA showed strong staining in the lymphocytes. 4) SBA showed a different binding patterns between the endothelial layers located in the region beyond the fibrous layers and those located within the fibrous layers. 5) PNA showed a positive reaction in the outer 1/3 to 1/2 of the fibrous layer, but showed no staining in the inner 1/2 to 2/3 of the fibrous layers. Conclusion: The present lectin histochemical study provided a useful information to assess the characterization and distribution of various glycoconjugates in each constituent of human pulmonary tubercles. The results demonstrate structural differences in the glycoconjugate composition of various components of the tubercles and reveal changes in glycosylation in the components during soft tubercle formation. This study provides a new data useful for the studies on the pathogenesis and pathology of human pulmonary tubercles.

• Journal of Chest Surgery
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• v.43 no.1
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• pp.39-46
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• 2010

Background: Preoperative chemotherapy has been adopted in our hospital as a standard treatment for non-small cell lung cancer patients with N2 disease. However, there have been cases of pathologic N2 disease that have been detected after curative-intent surgical resection. We retrospectively studied the outcomes of initial surgical treatment without neoadjuvant therapy in patients with unexpected N2 non-small cell lung cancer. Material and Method: Between January 1995 and June 2007, 225 patients were diagnosed with pathologic N2 disease after they underwent initial pulmonary resection without neoadjuvant therapy. Among them, 170 patients were preoperatively diagnosed with lymph node stage N0 or N1. We retrospectively reviewed their medical record and analyzed the outcomes. Result: The overall 5-year survival rate was 35.4%. The prognostic factors that were significantly associated with survival were no adjuvant therapy, histologic cell types other than adenocarcinoma or squamous cell carcinoma, a pathologic T stage more than T1, old age (${\geq}$70 years) and no mediastinoscopic biopsy. During the follow-up, 79 patients (46.5%) experienced tumor recurrence, including loco-regional recurrence in 20 patients (25.3%) and distant metastasis in 56 (70.9%). The 5-year recurrence-free survival rate was 33.7%. Conclusion: Based on our findings, the survival was good for patients with unexpected N2 non-small cell lung cancer and who underwent initial pulmonary resection without neoadjuvant therapy. A prospective comparative analysis is needed to obtain more conclusive and persuasive results.