• Tuberculosis and Respiratory Diseases
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• v.45 no.4
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• pp.785-794
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• 1998

Background: Chemical pleurodesis is a widely used method for the control of symptomatic and recurrent malignant pleural effusions. Talc has been accepted to be the most effective sclerosing agent for chemical pleurodesis. This study was undertaken to evaluate the usefulness of talc pleurodesis via video-assisted thoracoscopic surgery (VATS) in treatment of malignant pleural effusions. Methods : A retrospective analysis of the medical records and radiographic findings was performed. The success of the procedure was defined as daily pleural fluid drainage below 100ml within 1 week after pleurodesis and complete expansion of the lung on simple chest radiograph. Recurrence was defined as reaccumulation of pleural fluid on follow-up chest radiographs, and complete response as no fluid accumulation on follow-up chest radiographs. Results: Between October 1994 and August 1996, talc pleurodesis via VATS was performed in 35 patients. Duration of follow-up ranged from 5 days to 828 days(median 79days). The initial success rate of procedure was 88.6%(31 of 35 cases). Complete responses were observed in 92.8% at 30 days, 75.7% at 90 days and 64.9% at 180 days. Postoperative complications were fever (54.3%), subcutaneous emphysema(11.4%), reexpansion pulmonary edema(2.9%) and respiratory failure(5.7%). But procedure related mortality or respiratory failure was not found. Conclusion: Talc pleurodesis via VATS is a safe and effective method for the control of symptomatic malignant pleural effusions.

• Journal of Chest Surgery
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• v.24 no.8
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• pp.751-756
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• 1991

For the period from June 1988 to July 1991 we studied 29 patients who were judged to have operable disease before mediastinoscopy on clinical criteria[absence of distant metastases, phrenic or laryngeal nerve paralysis, positive scalene node biopsy, and malignant pleural effusion]. All patients had computed tomography and mediastinoscopy prior to operation. In the present study, the sensitivity, specificity, and accuracy of CT were 92%, 56%, and 72%, respectively. And the sensitivity, specificity, and accuracy of mediastinoscopy were 92%, 100%, and 97%, respectively. We concluded that because of the low accuracy of CT, CT cannot replace mediastinoscopy, and routine mediastinoscopy should be performed in preoperative staging of bronchogenic carcinoma.

• Journal of Chest Surgery
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• v.18 no.4
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• pp.844-848
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• 1985

Mediastinal tumors which are originated in mediastinum or probably metastasized from other organs have long fascinated the surgeon because of difficulty of diagnosis and treatment. This report is the analysis of the 26 cases of mediastinal tumors, experienced in the Department of the Thoracic and Cardiovascular Surgery, Chosun University Hospital from January 1978 to January 1985. The result are as follows; 1. The age distribution was 10 months to 68 years old and the average mean age was 34.7 years old. 2. Subjective symptom were as follows: Dyspnea [69.2%], Coughing [42.3%], Chest pain [30.8%], Back pain [15.4%] and Numbness of extremities [15.4%]. Objective signs were as follows: Decreased breathing sound [53.3%], Pleural effusion and hemothorax [34.6%], Palpable neck mass [34.6%], SVC Syndrome [19.4%] and Bloody sputum [15.4%]. But, there were no definitive symptoms in 2 cases. 3. The malignant tumors were 19 cases [73.1%]. 4. The germ cell tumors were 2 cases [7.7%], the neurogenic tumor were 3 cases [11.5%], lymphoma were 8 cases [30.8%], thymoma were 2 cases [7.7%], mesenchymal tumor was 1 case [3.8%], cyst was 1 case [3.8%] and carcinoma were 5 cases [19.2%] among the 23 cases, histologically analyzed. 5. The successful complete removal was done in 5 cases among 7 cases of benign tumors. In malignant cases, the surgical removal had been 7 cases and inoperable cases were treated to radiation and chemotherapy.

• Tuberculosis and Respiratory Diseases
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• v.38 no.1
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• pp.65-69
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• 1991

Primary liposarcoma of the mediastinum is a very rare and relatively slow growing tumor. Since the original description by Pallase and Roubier in 1916, there have been about 55 reported cases in world literature until 1985. Recently, we experienced one case of a primary mediastinal liposarcoma with malignant effusion. A 51-year-old man complained of dyspnea and chest discomfort. The chest plain films and computerized tomogram showed a huge mass of the posterior mediastinal space. The needle aspiration biopsy was done in the huge mass and the histologic examination revealed mediastinal round-cell type liposarcoma. Patient refused surgery or chemotherapy after establishing the diagnosis. About 6 months later, the metastatic pleural effusion was noted. After discharge, he was lost to follow up since then. The clinical and therapeutic features of the previously reported cases of primary liposarcoma arising in the mediastinum have been reviewed. Surgery may served to establish a tissue diagnosis, to relieved the patient's symptoms and result occasionally in a cure but radiotherapy or chemotherapy is ineffctive.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.4
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• pp.2443-2446
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• 2013

Published data have shown that the levels of vascular endothelial growth factor (VEGF) and soluble VEGF receptor-1 (sVEGFR-1) in plasma and pleural effusion might be usefulness for lung cancer diagnosis. Here, we performed a prospective study to investigate the utility of VEGF and sVEGFR-1 in bronchoalveolar lavage fluid (BALF) for differential diagnosis of primary lung cancer. A total of 56 patients with solitary pulmonary massed by chest radiograph or CT screening were enrolled in this study. BALF and plasma samples were obtained from all patients and analyzed for VEGF and sVEGFR-1 using a commercially available sandwich ELISA kit. The results showed that the levels of VEGF in BALF were significantly higher in patients with a malignant pulmonary mass compared with patients with a benign mass (P < 0.001). However, no significant difference of sVEGFR-1 in BALF was found between malignant and non-malignant groups (P = 0.43). With a cut-off value of 214 pg/ml, VEGF showed a sensitivity and specificity of 81.8% and 84.2%, respectively, in predicting the malignant nature of a solitary pulmonary mass. Our study suggests that VEGF is significantly increased in BALF among patients with lung cancer than in benign diseases. Measurement of VEGF in BALF might be helpful for differential diagnosis of primary lung cancer.

• Journal of Veterinary Clinics
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• v.28 no.6
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• pp.598-602
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• 2011

A 4-year-old female Shih-tzu dog weighing 5.1 kg was referred with abdominal distension and diagnosed as cystic papillary adenocarcinoma with metastasis to serosal surface of abdomen by biopsy. Intraperitoneal chemotherapy with cisplatin (50 $mg/m^2$) diluted in normal saline (250 $ml/m^2$) was initiated following removal of ascites one month after ovariohysterectomy (OHE). Clinical response was great and had no side effects during the chemotherapy period (3 relapses, 33 months after diagnosis). However, pleural effusion occurred with ascites and renal failure at the end of treatment. Eleven treatments of cisplatin were performed during 35 months after diagnosis. Intraperitoneal cisplatin instillation has been effective to control malignant ascites and pleural effusion in ovarian cancers and could be a reasonable palliative treatment. This is the first case report describing intraperitoneal cisplatin chemotherapy in metastatic ovarian cyst papillary adenocarcinoma in Korea.

• Tuberculosis and Respiratory Diseases
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• v.49 no.2
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• pp.149-161
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• 2000

Background : Residual pleural thickening (RPT) develops in about 50% of tuberculous pleurisy ($PL_{TB}$). Some reports have suggested that elevated TNF-$\alpha$ and impaired fibrinolysis could be the cause of RPT, but until now, the mechanism and predictors of RPT have not been well known. TGF-$\beta$ has been known to promote fibrogenesis and is increased in tuberculous pleural fluid (PF). $PL_{TB}$ and malignant pleurisy ($PL_{MAL}$) manifest lymphocyte-dominant exudative pleural effusion, and it has clinical implications in the differentiation of the two diseases based on the findings of pleural effusion. We performed this study to compare pleural fluid TNF-$\alpha$ TGF-$\beta$, and fibrinolytic parameters between $PL_{TB}$ and $PL_{MAL}$, and to find the predictors of RPT in $PL_{TB}$. Methods : Thirty-five $PL_{TB}$ and 14 $PL_{MAL}$ patients who were admitted to the Asan Medical Center from February 1997 to August 1999 were enrolled. All $PL_{TB}$ patients were prescribed a primary, short-course, anti-tuberculosis regimen. INF-$\alpha$ tissue plasminogen activator (tPA), plasminogen activator inhibitor 1 (PAI-1), plasminogen, $\alpha$2-antiplasmin, and D-dimer were measured in both PF and PB. TGF-$\beta$was measured only in PF. Clinical characteristics, TNF-$\alpha$ TGF-$\beta$ and fibrinolytic parameters were compared between patients with RPT less than 2 mm and patients with more than 2 mm of the thirty patients who completed the anti-tuberculosis treatment. Results : The levels of TNF-$\alpha$ tPA, PAI-1, plasminogen, $\alpha$2-antiplasmin, and D-dimer in PF were higher than those in peripheral blood (PB) in $PL_{TB}$, whereas only plasminogen, $\alpha$2-antiplasmin, and D-dimer were higher in PF than in PB in $PL_{MAL}$. Pleural fluid TNF-$\alpha$ TGF-$\beta$, PAI-1, plasminogen, $\alpha$2-antiplasmin were increased in $PL_{TB}$ compared with $PL_{MAL}$, but these factors did not show any further advantages over ADA in differentiation between $PL_{TB}$ and $PL_{MAL}$. TNF-$\alpha$ TGF-$\beta$ and fibrinolytic parameters did not show any differences between patients with RPT less than 2 mm and patients with RPT more than 2 mm. Conclusion : Our data suggest that TNF-$\alpha$, TGF-$\beta$ and fibrinolytic parameters may play some role for the development of RPT in $PL_{TB}$, but they failed to predict the occurrence of RPT in $PL_{TB}$. Also these parameters did not seem to have any advantages over ADA in differentiating between two diseases.

• Tuberculosis and Respiratory Diseases
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• v.80 no.2
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• pp.194-200
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• 2017

Background: Medical thoracoscopy (MT) is a minimally invasive, endoscopic procedure for exploration of the pleural cavity under conscious sedation and local anesthesia. MT has been performed at the Seoul National University Hospital since February 2014. This paper summarizes the findings and outcomes of MT cases at this hospital. Methods: Patients who had undergone MT were enrolled in the study. MT was performed by pulmonologists, using both rigid and semi-rigid thoracoscopes. During the procedure, patients were under conscious sedation with fentanyl and midazolam. Medical records were reviewed for clinical data. Results: From February 2014 to January 2016, 50 procedures (47 cases) were performed (diagnostic MT, 26 cases; therapeutic MT, 24 cases). The median age of patients was 66 years (59-73 years), and 38 patients (80.9%) were male. The median procedure duration from initial incision to insertion of the chest tube was 37 minutes. The median doses of fentanyl and midazolam were $50{\mu}g$ and 5 mg, respectively. All procedures were performed without unexpected events. Of the 26 cases of pleural disease with an unknown cause, 19 were successfully diagnosed using MT. Additionally, diagnostic MT provided clinically useful information in the other six patients. Therapeutic MT was very effective for treatment of malignant pleural effusion or empyema. The median number of days with chest tube drainage was 6 (3 days for diagnostic MT and 8 days for therapeutic MT). Conclusion: MT is a useful and necessary procedure for both diagnosis and treatment of pleural diseases.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.11
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• pp.5735-5739
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• 2012

Background: Malignant mesothelioma (MM) is an insidious tumor with poor prognosis, arising from mesothelial surfaces such as pleura, peritoneum and pericardium. We here aimed to evaluate the demographic, clinical, and radiological features of patients with MM followed in our center as well as their survival. Methods: The study included 228 patients (131 male, 97 female) who were followed up in our institution between 1993 and 2010 with the diagnosis of MM. Results: The mean age was 59.1 years in men and 58.7 years in women and the sex ratio was 1.4:1 in favor of males. Environmental asbestos exposure was present in 86% of the patients for a mean duration of $40{\pm}20$ years (range: 3-70). Pleural effusion and thoracic/abdominal pain were the most common presenting signs and symptoms (70.2% and 57.8%, respectively). One hundred-thirteen (66%) patients were treated with platinum-based combination chemotherapy (PBCT) plus supportive care (SC) and 67 (34%) patients received SC alone. The median follow-up time was 10.0 months. The median overall survival was significantly improved with PBCT plus SC compared to SC alone (11.4 vs. 5.1 months; p=0.005). The 6, 12, 18, and 24-month survival rates were significantly improved with PBCT plus SC compared to SC alone (72%, 43%, 19%, and 2% vs. 49%, 31%, 11%, and 1%). Conclusion: The survival of patients with MM improved in patients treated with PBCT. The survival advantage continued 12- and 24-month after the initial time of combination chemotherapy.

• Tuberculosis and Respiratory Diseases
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• v.40 no.2
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• pp.192-196
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• 1993

Malignant T cell lymphoma is a morphologically and immunologically distinct subtype of non-Hodgkin's lymphoma. One of the most striking clinical findings is relatively high incidence in males in their twenties or thirties with cervical, supraclavicular and axillary lymphadenopathy (50%), mediastinal mass (50%) or less commonly with extranodal disease. More than 90% of patients present with stage III or IV disease and approximately 60% of patients develop bone marrow infiltration. Clinical trials are needed to optimize therapeutic strategies, since these tumors have a poor prognosis and need to be treated aggressively. A 17-year-old male was admitted to the hospital because of chest pain. Chest PA and CT scan revealed massive pleural effusion and soft tissue masses with destructive change of right third and eighth ribs Histologic diagnosis of pleura and chest wall mass revealed high grade, pleomorphic T cell type, malignant lymphoma.