• Journal of Chest Surgery
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• 제24권9호
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• pp.903-906
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• 1991

Retrospective review of 26 patients undergoing open lung biopsy at the Yonsei University during 10 years period was conducted to evaluate open lung biopsy for DILD. From January 1980 to August 1990, open lung biopsy was performed in 26 patients through a limited thoracotomy incision[a limited anterior or a posterolateral thoracotomy]. Open lung biopsy was indicated for diffuse interstitial pulmonary diseases undiagnosed by indirect clinical and radiological diagnostic methods. The types of incision were limited anterior[11] and limited posterolateral[15]. Preoperative evaluation of the lung disease included sputum culture[26], sputum cytology [19], bronchoscopy[9] and TBLB[7]. In 23 patients the histologic appearances after open lung biopsy were sufficiently specific histologic pictures to confirm diagnosis. The results of the biopsies changed usual therapeutic plan in 17 patients among them. The complications were resp. insufficiency[3], pulmonary ed6ma[3], sepsis[2], and others[3] in 6 patients. Diagnosis from the open lung biopsy was included respiratory pneumonia[7], fibrosis[7], infection[5], malignancy[2], others[5]. 4 patients died of respiratory insufficiency. The causes of the other three death were not due to direct result of the biopsy itself. Open lung biopsy in the patient with a diffuse infiltrative lung disease is an one of the accurate diagnostic method and frequently leads to change of the therapeutic plans. So we conclude that open lung biopsy remains our diagnostic method of choice in diffuse infiltrative lung disease undetermined etiology.

• Tuberculosis and Respiratory Diseases
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• 제82권2호
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• pp.102-117
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• 2019

Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive fibrosing interstitial pneumonia, which presents with a progressive worsening dyspnea, and thus a poor outcome. The members of the Korean Academy of Tuberculosis and Respiratory Diseases as well as the participating members of the Korea Interstitial Lung Disease Study Group drafted this clinical practice guideline for IPF management. This guideline includes a wide range of topics, including the epidemiology, pathogenesis, risk factors, clinical features, diagnosis, treatment, prognosis, and acute exacerbation of IPF in Korea. Additionally, we suggested the PICO for the use of pirfenidone and nintendanib and for lung transplantation for the treatment of patients with IPF through a systemic literature review using experts' help in conducting a meta-analysis. We recommend this guideline to physicians, other health care professionals, and government personnel in Korea, to facilitate the treatment of patients with IPF.

• Journal of Chest Surgery
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• 제28권1호
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• pp.53-58
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• 1995

Open lung biopsy still has important roles for the marking of diagnosis of diffuse infiltrative lung disease even though transbronchial bronchoscopic lung biopsy and percutaneous needle aspiration biopsy gain popularity nowadays. This is clinical retrospective review of the 56 patients with diffuse infiltrative lung disease undergoing open lung biopsy by minithoracotomy from 1984 to Dec. 1992 in the Department of Thoracic & Cardiovascular Surgery of Catholic University Medical College. 27 men and 29 women, aged 17 to 73 year [mean 49 year , were enrolled & divided into 2 groups;Group A consisted of patients with immunocompromised state [n=19 , Group B patients with non-immunocompromised state[n=38 . Pathologic diagnosis was made in 54 cases[96.4% of these two groups and as follows: infectious; 12 patients[21.4% , Neoplastic; 10 patients[17.9% , granulomatous; 4 patients[7.1% , interstitial pneumonia; 12 patients[21.4% , Pulmonary fibrosis; 8 patients[14.3% , others; 3 patients[5.4% , nonspecific; 5 patients[8.9% , and undetermined; 2 patients[3.6% . Therapeutic plans were changed in 39 patients[69.6% after taking of tissue diagnosis by open lung biopsy. Group B has higher incidence of infectious diseases and change of therapeutic plan than the Group A. The postoperative complications developed in 8 cases[14.3% ,and there is no difference of incidence between the 2 groups. 4 patients belongs to group A, died of respiratory distress syndrome [2 and sepsis [2 which were not related with open lung biopsy procedure. In conclusion, open lung biopsy is a reliable method to obtain a diagnosis in diffuse pulmonary infiltrates and can be performed safely, even in acutely ill, immunosuppressed patients.

• Tuberculosis and Respiratory Diseases
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• 제77권2호
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• pp.85-89
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• 2014

Intrathoracic involvement of immunoglobulin G4 (IgG4)-related disease has recently been reported. However, a subset of the disease presenting as interstitial lung disease is rare. Here, we report a case of a 35-year-old man with IgG4-related lung disease with manifestations similar to those of interstitial lung disease. Chest computed tomography showed diffuse ground glass opacities and rapidly progressive pleural and subpleural fibrosis in both upper lobes. Histological findings showed diffuse interstitial lymphoplasmacytic infiltration with an increased number of IgG4-positive plasma cells. Serum levels of IgG and IgG4 were also increased. The patient was diagnosed with IgG4-related lung disease, treated with anti-inflammatory agents, and showed improvement. Lung involvement of IgG4-related disease can present as interstitial lung disease and, therefore, should be differentiated when evaluating interstitial lung disease.

• Toxicological Research
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• 제26권3호
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• pp.217-222
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• 2010

Many studies have reported that bleomycin, anti-cancer drug, induces pulmonary fibrosis as a side effect. However, few investigations have focused on the dose-response effects of bleomycin on pulmonary fibrosis. Therefore, in the present study, we investigated the effects of different doses of bleomycin in male mice. ICR mice were given 3 consecutive doses of bleomycin: 1, 2, or 4 mg/kg in bleomycin-treated (BT) groups and saline only in vehicle control (VC) groups. The animals were sacrificed at 7 and 24 days postinstillation. The severity of pulmonary fibrosis was evaluated according to inflammatory cell count and lactate dehydrogenase (LDH) activity in the broncho alveolar lavage fluid (BALF), and lung tissues were histologically evaluated after hematoxylin and eosin (H&E), and Masson's trichrome staining. BT groups exhibited changed cellular profiles in BAL fluid compared to the VC group, which had an increased number of total cells, neutrophils, and lymphocytes and a modest increase in the number of macrophages at 7 days post-bleomycin instillation. Moreover, BT groups showed a dose-dependent increase in LDH levels and inflammatory cell counts. However, at 24 days after treatment, collagen deposition, interstitial thickening, and granulomatous lesions were observed in the alveolar spaces in addition to a decrease in inflammatory cells. These results indicate that pulmonary fibrosis induced by 4 mg/kg bleomycin was more severe than that induced by 1 or 2 mg/kg. These data will be utilized in experimental animal models and as basic data to evaluate therapeutic candidates through non-invasive monitoring using the pulmonary fibrosis mouse model established in this study.

• Journal of Chest Surgery
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• 제49권6호
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• pp.461-464
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• 2016

Coronary artery disease has historically been a contraindication to lung transplantation. We report a successful combined bilateral lung transplantation and off-pump coronary artery bypass in a 62-year-old man. The patient had a progressive decline in lung function due to idiopathic pulmonary fibrosis and a history of severe occlusive coronary artery disease.

• Korean Journal of Radiology
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• 제22권3호
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• pp.454-463
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• 2021

Interstitial lung abnormalities (ILAs) are radiologic abnormalities found incidentally on chest CT that are potentially related to interstitial lung diseases. Several articles have reported that ILAs are associated with increased mortality, and they can show radiologic progression. With the increased recognition of ILAs on CT, the role of radiologists in reporting them is critical. This review aims to discuss the clinical significance and radiologic characteristics of ILAs to facilitate and enhance their management.

• Tuberculosis and Respiratory Diseases
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• 제56권1호
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• pp.51-66
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• 2004

연구배경 : 폐 섬유화증의 진행에는 세포외 간질의 대사에 관여하는 gelatinase가 중요한 역할을 하는 것으로 알려져 있으며, gelatinase의 작용은 사이토카인을 비롯한 여러 가지 요소에 의해 조절되는 것으로 알려져 있다. 지금까지 $interferon-{\gamma}$($IFN-{\gamma}$)는 폐섬유화를 억제하는 것으로 알려져 있지만 gelatinase의 작용에 $IFN-{\gamma}$가 미치는 영향은 잘 밝혀져 있지 않다. 이에 저자들은 bleomycin 유도 백서 폐 섬유화 모델에서 $IFN-{\gamma}$가 폐 섬유화에 미치는 영향과MMP-2, -9과 이의 길항제인 TIMP-1, -2 그리고 Th-2 사이토카인의 변화에 미치는 영향을 조사함으로써, $IFN-{\gamma}$가 폐 섬유화증에 미치는 영향과 기전을 연구하고자 하였다. 재료 및 방법 : Sprague-Dawley계의 수컷 흰쥐를 정상 대조군, bleomycin 군, bleomycin+$IFN-{\gamma}$ 군의 세 군으로 나누어, bleomycin 군 과 bleomycin+$IFN-{\gamma}$ 군은 bleomycin sulfate를 생리식염수에 섞어 기관 내로 주입하였고(6 U/kg), bleomycin+$IFN-{\gamma}$ 군은 $IFN-{\gamma}$를 14일간 근육주사 하였다($2{\times}105U/kg$). 실험동물은 3, 7, 14, 28일에 폐를 얻어 hematoxylineosin 염색과 Masson's trichrome 염색을 하여 폐의 염증 반응과 섬유화 정도를 관찰하였고, 폐 조직 내의 hydroxyproline 함량, MMP-2, -9, TIMP-1, -2에 대한 Western blot, zymography와 reverse zymography, IL-4와 IL-13에 대한 ELISA검사를 시행하였다. 결 과 : 1. 폐 염증은 bleomycin 투여 7일째에는 $IFN-{\gamma}$를 투여한 경우 더 심하게 일어났으나(bleomycin 군 : bleomycin+$IFN-{\gamma}$ 군=$2.08{\pm}0.15:2.74{\pm}0.29$, P<0.05), 폐 섬유화는 bleomycin 투여 후 28일째 $IFN-{\gamma}$ 투여에 의해 유의하게 감소되었다(bleomycin 군 : bleomycin+$IFN-{\gamma}$ 군=$3.94{\pm}0.43:2.46{\pm}0.13$, P<0.05). 2. 폐 내 hydroxyproline 함량은 bleomycin 투여 28일 후 $IFN-{\gamma}$ 투여에 의해 유의하게 감소되었다(bleomycin 군 : bleomycin+$IFN-{\gamma}$ 군=$294.04{\pm}31.73{\mu}g/g:194.92{\pm}15.51{\mu}g/g$, P<0.05). 3. Bleomycin 투여에 의해 MMP-2 단백질의 양이 증가되는 소견이 Western blot에서 관찰되었는데 MMP-2의 증가는 bleomycin 투여 14일에 최고에 이르렀으며, $IFN-{\gamma}$의 투여에 의해 bleomycin에 의한 MMP-2의 증가는 억제되었으나 대조군 수준으로 감소하지는 않았다. 4. Zymography 검사에서 bleomycin 투여 3일째에는 활성화된 형태의 MMP-2가 $IFN-{\gamma}$에 의해 유의하게 증가되었으나(bleomycin 군 : bleomycin+$IFN-{\gamma}$ 군=$209.63{\pm}7.60%:407.66{\pm}85.34%$, P<0.05), 투여 14일 후에서는 $IFN-{\gamma}$에 의해 활성화된 상태의 MMP-2가 유의하게 감소되었다(bleomycin 군 : bleomycin+$IFN-{\gamma}$ 군=$159.36{\pm}20.93%:97.23{\pm}12.50%$, P<0.05). 5. Bleomycin을 투여한 후 bleomycin 군과 bleomycin+$IFN-{\gamma}$ 군 모두에서 IL-4의 양이 감소되었으나, 두 군간 차이는 통계적으로 유의하지는 않았고, IL-13은 별 다른 차이가 없었다. 결 론 : Bleomycin에 의한 백서 폐 섬유화 모델에서 $IFN-{\gamma}$는 초기 폐 염증을 증가시키지만 후기 폐 섬유화는 억제시킨다는 것을 알 수 있었다. $IFN-{\gamma}$가 폐 섬유화를 억제하는 것은 MMP-2의 활성화를 억제하기 때문인 것으로 생각한다. 또한 $IFN-{\gamma}$에 의한 MMP-2의 기능 억제는 Th-2 사이토카인을 억제하여 이루어지는 것 같지는 않았다. 본 논문을 기초로 향후 $IFN-{\gamma}$가 MMP-2의 활성화를 조절하는 기전과 MMP-2의 활성화가 폐섬유화에 미치는 영향에 대한 연구가 필요할 것으로 생각한다.

• Nuclear Medicine and Molecular Imaging
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• 제40권3호
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• pp.163-168
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• 2006

목적: 특발성 폐섬유증(Idiopathic pulmonary fibrosis: IPF)에서 폐암의 발생빈도가 정상인에 비하여 증가되어 있음이 알려져 있다. IPF 환자의 흥부전산화단층촬영(chest CT)에서 폐 결절이 관찰되는 경우 폐암의 발생과 IPF자체의 결절을 감별하기 어렵다. 이 연구에서는 IPF 환자의 chest CT에서 관찰된 결절의 악성 여부를 FDG PET을 이용해 분석하였다. 대상 및 방법 : IPF로 진단된 환자 중, chest CT에서 악성 결절이 의심되어 FDG PET을 시행한 16명을 대상으로 하였다. 총 16명 (남: 14, 여: 2, 나이: $67.53{\pm}9.83$세)의 환자에서 관찰된 28개의 결절에 대하여 FDG PET과 CT소견을 분석 하였다. 대상 환자 중 2명은 소세포암과 성문하암으로 치료 받은 병력이 있었으며, 나머지 환자는 악성종양의 기왕력이 없었다. 결절의 악성도 여부는 조직검사와 CT 추적검사로 판정 하였다. 결과 : 10개 의 결절은 폐암으로 진단되었고, 18개의 결절은 양성 결절로 판정되었다(조직병리검사: 6예, chest CT 추적검사: 22예). FDG PET의 예민도는 100%이었으며 특이도는 94.4%이었다. 크기와 형태 및 크기 변화 등을 참고한 CT의 예민도는 70%이었고.특이도는 44.4%이었다. 악성 결절의 maxSUV는 $7.68{\pm}3.96$, 양성 결절은 $1.22{\pm}0.65$ 이었다(p<0.001). 폐섬유증부위에서 측정한 maxSUV는 $1.80{\pm}0.43$로써 악성 결절보다 낮은 값이었으며, 양성 결절보다는 높은 값이었다(p<0.001; p<0.001). CT에서 측정한 악성 결절의 크기는 $23.95{\pm}10.15mm$, 양성 결절은 $10.83{\pm}5.23mm$이었다(p<0.02). 결론 : FDG PET은 IPF 환자의 CT에서 발견된 폐 결절을 감별하는데 도움이 되었다.

• Journal of Chest Surgery
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• 제36권9호
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• pp.703-706
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• 2003

전폐절제술 후 증후군은 우전폐절제술 후 혹은 우동맥궁을 가진 환자의 좌전폐절제술 후 심한 종격동의 이동과 회전에 의하여 기도가 폐쇄되어 심한 호흡곤란을 일으키는 질환이다. 그러나, 전폐절제술이 아니더라도 종격동의 이동과 회전에 의해 기도가 폐쇄될 수 있다. 삼성서울병원 흉부외과에서는 폐결핵성 파괴폐에 의해 유발된 전폐절제술후양(postpeumonectomy-like syndrome) 증후군을 전폐절제술과 함께 조직확장기(tissue expander)를 삽입하여 종격동 정복(mediastinal repositionng)을 시행한 예를 경험하였기에 보고하는 바이다.