• Tuberculosis and Respiratory Diseases
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• v.48 no.4
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• pp.428-437
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• 2000

Background : Five year survival rate of postoperative stage I non-small cell lung cancer(NSCLC) reaches to 66%. In the remaining one third of patients, however, cancer recurs and the overall survival of NSCLC remains dismal. To evaluate clinical and pathologic characteristics of recurred NSCLC, the patterns and factors for postoperative recurrence in patients with staged I and II NSCLC were studied. Method : A retrospective analysis was performed in 234 patients who underwent radical resection for pathologic stage I and II NSCLC. All patients who were followed up for at least one year were included in this study. Results : 1) There were 177 men and 57 women The median age was 63. The median duration of the follow up period was 732 days (range 365~1,695 days). The overall recurrence rate was 26.5%, and the recurrence occurred $358.8{\pm}239.8$ days after operation. 2) The ages of recurred NSCLC patients were higher ($63.2{\pm}8.8$ years) than those of non-recurred patients ($60.3{\pm}9.8$ years)(p=0.043). The recurrence rate was higher in stage II (46.9%) than in stage I (18.8%) NSCLC p<0.001. The size of primary lung mass was larger in recurred ($5.45{\pm}3.22\;cm$) than that of non-recurred NSCLC ($3.74{\pm}1.75\;cm$, p<0.001). Interestingly, there were no recurrent cases when the resected primary tumor was less than 2cm. 3) Distant recurrence was more frequent than locoregional recurrence (66.1% vs. 33.9%). Distant recurrence rate was higher in females and in cases of adenocarcinoma. Brain metastasis was more frequent in patients with adenocarcinoma than in those with squamous cell carcinoma (p=0.024). Conclusion: The tumor size and stage were two important factors for determining the possibility of a recurrence. Because distant brain metastasis was more frequent in patients with adenocarinoma, a prospective study should be conducted to evaluate the effectiveness of preoperative brain imaging.

• Journal of Chest Surgery
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• v.32 no.4
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• pp.383-387
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• 1999

Background: We analysed simple chest PA and high-resolution CT findings in patients with spontaneous pneumothorax in order to help selecting the kind of treatment, provide a guidline during surgical treatment, and to recognize the bulla which may not be detected by simple radiographs or may be a potential cause of recurrence. Material and Method: We retrospectively analysed the presence and number of bulla in each side, combined pulmonary disease on simple chest films and high-resolution CT, and methods and frequency of the treatment in 70 patients with spontaneous pneumothorax excluing traumatic origin. Result: 45 patients were revealed primary spontaneous pneumothorax, and the remaining 25 patients were revealed secondary spontaneous pneumothorax. All secondary spontaneous pneumothorax were from the longstanding sequelle of pulmonary tuberculosis. The patients with primary spontaneous pneumothorax group was younger(mean:26.0 years old) than secondary group (mean: 44.1 years old). On simple radiography, bulla was detected in 16 patients(30.2%). On HRCT, the bulla was detected in 53 patients(75.7%) of the total 70 patients. In 48 patients(68.6%), the bulla or bleb was noted in ipsilateral side to the pneumothorax, and 34 patients(48.6%) of them showed bulla or bleb bilaterally. 39 patients(55.7%) showed bulla or bleb in contralateral side. The number of bulla or bleb was variable. In secondary spontaneous pneumothorax group, the incidence of multiple(more than 10) bulla or bleb was higher than primary type. Most of the patients were treated by thoracostomy(36 patients) or bullectomy( 7 patients). Conclusion: HRCT was superior to detect bulla and analyse the combined pulmonary disease than simple radiography. Therefore, HRCT can help to determine the mothod of treatment, provide a guidline during surgical treatment, and notify the bulla as a possible cause of recurrent pneumothorax.

• Journal of Chest Surgery
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• v.29 no.5
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• pp.530-535
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• 1996

Saprophytic aspergillosis (aspergilloma), a potentially life-threatening disease from the colonization of lung cavities by the ubiquitous fungus Aspergillus fumigatus, has been of surgical concern. Twelve patients with symptomatic aspergilloma underwent operative procedures at Pusan national University Hospital between January 1, 1984 and August 31, 1994. The mean age of the patients was 38.8 years and nine of them had hemoptysis; in two it was massive and life-threatening. Wine of the patients had underlying causes of cavitary lung disease and tuberculosis was the most common cause. Lobectomy was the most commonly performed procedure (in six) . Several major complications including excessive bleeding (2), and pneumonia (2), and empyema with bronchopleural fistula (1) occurred .and one patient died (operative mortality=8.3%). There were no recurrent symptoms in any of the 11 operative survivors during the follow-up period. It is concluded that early, aggressive surgical intervention can provide definite cure in established aspergilloma, even with minimal symptoms.

• The Korean Journal of Pain
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• v.2 no.1
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• pp.57-60
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• 1989

The Melkersson-Rosenthal (M-R) syndrome consists of a triad of (1) recurrent peripheral facial nerve paralysis which develops alternately on both sides of face, (2) non-inflammatory facial edema, and (3) fissuring of tongue. A 59 years old female patient developed the left facial palsy on September, 1988. Right facial palsy developed continuously 2 months later after the spontaneous remission of left facial palsy. On February, 1989, we have found out M-R syndrome which accompanied with migraine type of intermittent headache, and hypertension in one attack of cerebral stroke several years ago, there were no diabetes mellitus, pulmonary tuberculosis and brain tumor in clinical studies. Although the causes of this syndrome were not noted, we performed the stellate ganglion block and transcutaneous electrical nerve stimulation for treatment of the palsy, but the clinical effectiveness of these were not satisfactory.

• Tuberculosis and Respiratory Diseases
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• v.62 no.3
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• pp.192-196
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• 2007

Background: Right middle lobe syndrome (RMLS) is defined as transient or chronic and recurrent atelectasis of the right middle lobe. Although numerous conditions are associated with RMLS, there are very few recent reports in Korea. This study evaluated the causes of RMLS in a local tertiary hospitalover a period of 42 months. Method: Eighty-eight patients (M:F=64:22, mean age: $67.2{\pm}10.3years$), who had consistent chest radiography findings and underwent bronchoscopy in Gyeongsang University Hospital from January 2003 to July 2006, were enrolled in this study. The clinical characteristics and causes of RMLS in these patients were retrospectively reviewed. Results: The most common symptoms fo RMLS were cough, dyspnea and sputum. Tuberculosis was the most common cause (endobronchial tuberculosis in 22 and pulmonary tuberculosis in 1) The other causes were bronchial stenosis by benign fibrotic changes in 22 cases (25%), anthracofibrosis in 13 cases (14.8%), pneumonia in 11 cases (12.5%), lung cancer in 10 cases (11.4%), mucus impaction in 3 cases (3.4%), bronchiectasis in 2 cases (2.3%) and no demonstrable causes in 7 cases (8%). The bronchoscopy findings were mucosal edema with hyperemic changes in 38 cases (43.2%), mucosal edema with anthracotic pigmentation in 16 cases (18.2%), mucus impaction in 13 cases (14.8%), fibrotic stenosis in 13 cases (14.8%), a mass like lesion in 8 cases (9.1%), exudative necrotic material in 4 cases (4.5%), narrowing as a result of extrinsic compression in 2 cases (2.3%) and no demonstrable abnormalities in 12 cases (13.6%). Conclusion: Right middle lobe syndrome was observed more frequently in patients over the age of 65. The causes were mainly benign diseases with endobronchial tuberculosis being the most common.

• Tuberculosis and Respiratory Diseases
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• v.76 no.3
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• pp.141-145
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• 2014

Although endobronchial hamartoma is a rare benign tumor, most patients with endobronchial hamartoma have respiratory symptoms such as obstructive pneumonia, hemoptysis, cough, or dyspnea due to bronchial obstruction. It can cause irreversible post-obstructive pulmonary destruction, thus early diagnosis and treatment is very important. Recently, there have been cases of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser and electrocautery procedures for bronchoscopic treatment of malignant or benign central airway obstruction with comparable therapeutic efficacy and few complications. Bronchoscopic cryotherapy is a newly developed technique for management of central airway obstruction. Moreover, it provides diagnostic methods with improving diagnostic yield and safety. We report two cases of endobronchial hamartoma, each diagnosed and definitively treated with bronchoscopic techniques. Endobronchial biopsy and removal was successfully performed by cryotherapy via flexible bronchoscopy without notable complications. Follow-up bronchoscopic examinations excluded residual or recurrent disease.

• Journal of Chest Surgery
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• v.30 no.11
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• pp.1097-1104
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• 1997

The expectoration of blood is always a fearful experience for the patient and a matter of grave concern to the attending physician, because it may be the warning sign of serious diseases. When such bleeding occurs, the possibility of its being due to pulmonary tuberculosis, bronchiectasis or carcinoma of the lung is promptly suggested. Nowadays, with the advance of modern diagnostic studies, differential diagnosis has become possible for the hemoptysis patients to have appropriate treatment. This evaluation is based on the review of 75 cases of patients whom we performed emergency open thoracotomies for 6 years from March 1992 to February 1997 in the Department of Thoracic and Cardiovascular Surgery, Seoul Adventist Hospital. The mean age of the patients was 36.6 years old with a range from 19 to 68, and most prevalent age group was thirties. The most common underlying lung disease causin hemoptysis was tuberculosis(44%). Most accurate diagnostic study was bronchoscopy during hemoptysis(95 Vo) and right middle & lower lobe(17.3%) was the most common site of lesion. Lobectomy(50%) was the most frequent operative method and recurrent hemoptysis(31.6%) was the most common postoperative complication. But most of the patients(82.6%) were completely recovered by surgical treatment. Now we concluded that the proper management of hemoptysis was completed by surgical approach with definite diagnosis and supportive medication.

• Tuberculosis and Respiratory Diseases
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• v.57 no.1
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• pp.72-77
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• 2004

Background : A tracheobronchial obstruction in lung cancer is associated with significant morbidity and mortality due to dyspnea, cough, hemoptysis, and recurrent respiratory infection. It is well known that one of standard treatments is photodynamic therapy (PDT) in tracheobronchial obstruction after radiotherapy, chemotherapy, and/or surgery. We reported here the role of PDT in airway obstruction in patients advanced lung cancer. Method : Pre-treatment protocol consisted of clinical, radiologic, and bronchoscopic examination, pulmonary function test, and assessment of Karnofsky performance status. A 2 mg/kg of porfimer sodium was injected intravenously, and then followed by cylindrical and/or interstitial irradiation with 630 nm of laser after 48 hours. The repeated bronchoscopy for debridement of necrotic tissue and re-illumination was performed after 48 hours. Result : Improved airway obstruction and selective tumor necrosis were achieved by photodynamic therapy in all cases. Dyspnea and performance status were improved in three cases. A purulent sputum, fever and hemoptysis were improved in one of five cases. After PDT, all patients showed temporarily aggravation of dyspnea, two of five showed febrile reaction for a few days and nobody presented photosensitivity reaction, hemoptysis and respiratory failure. Conclusion : Our experiences of PDT are effective in palliation of inoperable advanced lung cancer in terms of tracheobronchial obstruction.

• Tuberculosis and Respiratory Diseases
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• v.51 no.4
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• pp.364-372
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• 2001

Background : To observe the immediate and long-term results of bronchial artery embolization(BAE) for hemoptysis and the factors influencing the recurrences. Methods : This study involved 75 patients with massive, or moderate and recurrent hemoptysis, who underwent bronchial artery embolization(BAE) from 1994 to 1999. The underlying diseases included pulmonary tuberculosis in 35, bronchiectasis in 22, aspergilloma in 12, lung cancer in 3, and 3 with other diseases. Results : After BAE, bleeding was controlled immediately in 61 patients(82.7%). One patient died of another medical problem, 3 patients were referred to surgery and 5 patients could not be followed-up. In the remaining 66 patients who were followed for more than one-year after BAE, 37(56.1%) patients had another hemorrhage (26 hemoptysis, 11 minor hemosputa). Among the recurred 37 subjects, 19(51.4%) experienced hemorrhage within 1 month after BAE, 31(83.8%) within 1 year, and 36(94.1%) within 3 years. The underlying lung diseases, the amount of bleeding and the extent of the involved lungs were factors affecting the outcome, especially blood loss >500cc was an important factor affecting the recurrence rate. BAE for two cases with lung malignancy was ineffective. Long-term control of bleeding (3-year cumulative non-recurrence) was achieved in 30 subjects(45.5%). Conclusion : Bronchial artery embolization(BAE) is effective as an initial treatment for moderate to massive hemoptysis. Because most of the recurrences occurred within 3 years, it is important to follow-up such patients for at least 3 years after BAE and the most significant factor affecting the prognosis was amount of blood loss.

• Tuberculosis and Respiratory Diseases
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• v.46 no.4
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• pp.489-499
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• 1999

Background: The patient with bronchiectasis may have obstructive ventilatory impairment combined with mild restrictive ventilatory impairment due to fibrosis of surrounding lung parenchyme and pleural adhesions caused by chronic recurrent pulmonary infections. Since hyperinflation or emphysematous change can be occured in bronchiectasis, pulmonary functions such as lung volumes and diffusing capacity may also vary with associated emphysema. Methods: For the evaluation of lung volumes and diffusing capacity in bronchiectasis with respect to the anatomic types and severity of bronchiectasis, a total of 40 cases comprising 24 cases of tubular, and 16 cystic type of bronchiectasis were analyzed retrospectively. Correlation between lung functions and extent of bronchiectasis or associated emphysema detected in HRCT were also evaluated. Results: Vital capacity(VC) tended to decrease in cystic type than in tubular type. As the severity of bronchiectasis became serious, the VC were significantly reduced, whereas the total lung capacity(TLC), residual volume(RV) and its ratio to the total lung capacity(RV/TLC) had no significant difference. Lung clearance index(LCI) was significantly increased in cystic type than in tubular type, whereas the slope of phase III in single breath nitrogen curve($\triangle$N2/L) was not significantly changed regard to the type and severity of bronchiectasis. DLCO and DLCO/VA reflecting diffusing capacity were significantly decreased in cystic type and also as the severity of bronchiectasis became serious. The correlation coefficient of VC, DLCO and LCI with the extent of bronchiectasis were -0.322, -0.339 and 0.487, respectively, whereas other parameters were not significantly correlated with the extent of bronchiectasis. VC and DLCO correlated negatively with the extent of emphysema while RV, RV/TLC, LCI and $\triangle$N2/L correlated positively. Conclusion: These findings suggest that the reduction of VC and diffusing capacity or uneven distribution of inspired gas in bronchiectasis are related to both the extent of bronchiectasis and associated emphysema while increased residual volume be related to the extent of associated emphysema alone.