• Tuberculosis and Respiratory Diseases
• /
• v.42 no.3
• /
• pp.387-393
• /
• 1995

Adenoid cystic carcinoma formerly called cylindroma is rare tracheal tumor. Characteristics of adenoid cystic carcinoma are infiltrative nature with local recurrence tendency and long natural course of the disease. Adenoid cystic carcinomas develop most commonly in the trachea. Primary resection and end-to-end anastomosis of the involved airway are treatment of choice. And postoperative radiation therapy might be useful, particularly when the surgical margins are not ample. We report two cases of adenoid cystic carcinoma of trachea diagnosed by flow-volume curve.

• Tuberculosis and Respiratory Diseases
• /
• v.44 no.5
• /
• pp.1125-1131
• /
• 1997

Occult papillary adenocarcinoma of the thyroid is known to be indolent, slow metastatic, and has a good prognosis. Occult thyroid carcinoma presenting as a blood-borne metastasis without obvious cervical lymph node involvement is extremely rare. A 65-year-old male patient was visited for hoarseness, dysphagia, and shortness of breath. Bronchoscopy with biopsy revealed a papillary carcinoma of thyroid by immunohistochemical staining. Head & neck CT revealed that involving both the upper esophagus and the posterior tracheal wall, extending into the mediastinum along the upper thoracic spine at $T_1-T_2$. We have experienced a rare case of occult papillary carcinoma which invaded the trachea, esophagus and fascia of thoracic spine. Treatment was initiated with radioactive iodine and external bean therapy.

• Journal of Chest Surgery
• /
• v.42 no.1
• /
• pp.63-71
• /
• 2009

Background: The treatment of tracheal stenosis includes less invasive bronchoscopic intervention and more invasive segmental resection & anastomosis. Depending on the patient's clinical features, sometimes all these methods are inappropriate. Silicone T-tube stenting has recently been used as an alternative, safe management of tracheal stenosis. We studied the short term and Intermediate term results of using T-tubes in patients with tracheal stenosis, and this tracheal stenosis was caused by various underlying diseases. Material and Method: We retrospectively reviewed 57 patients with tracheal stenosis and who were treated with T-tubes between Jan 1997 and Apr 2007. Based on the patient's medical records and the imaging studies, we evaluated the clinical findings and status of T-tube removal. Result: There was no T-tube related morbidity or mortality in this series. On follow-up, one patient underwent sleeve resection and end-to-end anastomosis. The T-tube could be successfully removed from 13 patients (13/57, 22.8%) without additional interventions. For another four patients, a T-tube was again inserted after removal of the first T-tube due to tracheomalacia or recurrent stenosis. Four patients died of underlying disease and cancer. The patients' gender and previous tracheostomy significantly affected T-tube removal. By contrast, multiple logistic regression analysis identified gender as a predictor of successfully removing a T-tube. Gender (p=0.033) and previous tracheostomy (p=0.036) were the two factors for success or failure of T-tube removal. Conclusion: A T-tube provided reliable patency of a stenotic airway that was caused by any etiology. We have proven that using a T-tube is safe and effective therapy for patients with tracheal stenosis for the short term or the intermediate term.

• Journal of Chest Surgery
• /
• v.41 no.4
• /
• pp.457-462
• /
• 2008

Background: Emergency airway access is essential when a patient has dyspnea that's due to tracheal or bronchial obstruction. Such methods as laser therapy and PDT are now being used for the treatment of tracheal obstruction that's due to benign diseases or nonsurgical malignant diseases. Cryotherapy is a method that uses extreme hypothermia for freezing a tumor to cause necrosis. In this study, we have evaluated the clinical effectiveness of performing endobronchial cryoablation through a flexible bronchoscope. Material and Method: 10 patients with tracheal obstruction that was due to endotracheal tumors were evaluated between May 2005 and May 2007. Eight were male and the mean age of the 10 patients was $59.4{\pm}18.4$ years. Three cases of tracheal obstruction were due to benign tumors and 7 were due to malignant tumors. The obstruction sites were 3 at the trachea, 3 at the carina and 4 at the bronchus. A flexible bronchoscope was inserted and the tumor was eliminated using a flexible cryoprobe. Follow up bronchoscopy was performed at 1 week and 1 month after cryoablation, and then we evaluated the decrease of dyspnea, the improvement of the performance and the complications of the procedures. Result: Complete remission was achieved in 4 patients and partial remission was achieved in 6 patients. Complications such as hemoptysis (100%), and cough (50%) were noted. Hemoptysis was spontaneously resolved in 3 to 8 days (mean: 4.9 days). A decrease in dyspnea and improvement in the performance was noted in all patients. Conclusion: Endobronchial stenosis plays a detrimental role in the life quality of a terminal cancer patient. Due to its simplicity and effectiveness for controlling bleeding, endobronchial cryoablation is considered to be a safe method that is clinically applicable to a wide range of tumors, including the removal of large tumors. We concluded that endobronchial cryoablation through a flexible bronchoscope is a safe, effective method for treating tracheobroncheal obstructions.

• Pediatric Infection and Vaccine
• /
• v.12 no.1
• /
• pp.95-99
• /
• 2005

Pneumocystis carinii pneumonia is an infectious disease which is highly prevalent in the group of immunosuppressed patients, particularly with hematologic tumors as lymphomas and acquired immune deficiency syndrome(AIDS), severe malnutrition, organ transplantations, high dose corticosteroid therapy. Some cases of Pneumocystis carinii pneumonia in infants with primary immune deficiency were already reported. The authors present a case of Pneumocystis carinii pneumonia developed in an infant who suffered from 10 days of poor feeding and failure to thrive and not included in the risk groups listed above. He had bilateral interstitial infiltrations on the chest radiography, diagnosed as Pneumocystis carinii pneumonia after Gomori-methenamine silver staining of his sputum that was taken through tracheal intubation. He improved after administering Trimethoprim-sulfamethoxazole for 14 days.

• Tuberculosis and Respiratory Diseases
• /
• v.48 no.4
• /
• pp.487-499
• /
• 2000

Background : Acute lung injury is an hypoxic respiratory failure resulting from damage to the alveolar-capillary membrane, which can be developed by a variety of systemic inflammatory diseases. In this study the therapeutic effects of intra-tracheal pulmonary surfactant instillation was evaluated in the intratracheal endotoxin induced acute lung injury model of a rat. Methods : Twenty Sprague-Dawley rats were divided into 4 groups, and normal saline (2 ml/kg, for group 1) or LPS (5 mg/kg, for group 2, 3, and 4) was instilled into the trachea respectively. Either normal saline (2 ml/kg, for group 1 & 2, 30 min later) or bovine surfactant (15 mg/kg, 30 min later for group 3, 5 hr later for group 5) was instilled into the trachea. The therapeutic effect of intratracheal surfactant therapy was evaluated with one chamber body plethysmography (respiratory frequency, tidal volume and enhanced pause), ABGA, BAL fluid analysis (cell count with differential, protein concentration) and pathologic examination of the lung. Results : Intratracheal endotoxin instillation increased the respiration rate decreased the tidal volume and int creased the Penh in all group of rats. Intratracheal instillation of surfactant decreased Penh, increased arterial oxygen tension, decreased protein concentration of BAL fluid and decreased lung inflammation at both times of administration (30 minute and 5 hour after endotoxin instillation). Conclusion : Intratracheal instillation of surfactant can be a beneficial therapeutic modality as discovered in the acute lung injury model of rats induced by intratracheal LPS intillation. It deserves to be evaluated for treatment of human acute lung injury.

• Tuberculosis and Respiratory Diseases
• /
• v.49 no.1
• /
• pp.72-81
• /
• 2000

Backgrounds : Authors evaluated the quantitative culture of bronchoalveolar lavage fluid(BALF) in patients who were being treated with antimicrobial agents and the characteristics of isolated microorganism. Method : A prospective study was done with 25 patients under mechanical ventilation and antimicrobial treatment in ICU and NCU of Yongdong Severance Hospital from Apr. to Sep. 1999. Patients were classified into two groups: control group (n=5) and patients with VAP (n=20). The threshold of quantitative culture of BAL fluid in the diagnosis of VAP was $10^4$ cfu/ml. Results : 1) In gram staining of BALF, one patient in the control group and four in the VAP group showed positive results. Quantitative culture of BALF showed no organisms in the patients in the control group and in 9 VAP patients. Therefore the overall sensitivity was 43.8%. 2) Frequency of isolated organisms cultured above diagnostic threshold was in the following order: E. cloaclae, S. aureus, K. pneumoniae, and A. baumani. S. aureus and Staphylococcus coagulase(-) were a11 resistant to oxacillin. Seven out of 10 isolated G (-) organisms were suspected to be organisms producing extended spectrum $\beta$-lactamase (ESBL). 3) The concurrence between gram staining of sputum aspiration and that of BALF was only in 1 case. And the concurrence of culture results was observed in 3 cases. Conclusion : The sensitivity of gram staining and quantitative culture of BALF from patients under antibiotic therapy and the concordance rate between conventional tracheal aspiration and BAL were low, facts which were important in interpretation the data. Since the frequency of drug resistance organisms was not different from that of foreign data, antibiotics must be prudently selected and used.