• Tuberculosis and Respiratory Diseases
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• v.52 no.2
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• pp.156-165
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• 2002

Background: A tracheal stenosis is caused by mucosal ischemic injury related to a high cuff pressure ($P_{cuff}$) of the endotracheal tube. In contrast, aspiration of the upper airway secretion and impaired gas exchange due to cuff leakage is related to a low $P_{cuff}$. To prevent these complications, the $P_{cuff}$ should be kept appropriately because the appropriate $P_{cuff}$ appears to change according to the patient's daily respiratory mechanics. However, the constant cuff volume($V_{cuff}$) has frequently been instilled to the cuff balloon on a daily basis to maintain the optimal $P_{cuff}$ instead of monitoring the $P_{cuff}$ directly at the patients' bedside. To address the necessity of continuous $P_{cuff}$ monitoring, the change in the $P_{cuff}$ was evaluated at various $V_{cuff}$ levels on a daily basis in patients with long-term mechanical ventilation. The utility of mercury column sphygmomanometer for the continuous monitoring $P_{cuff}$ was also investigated. Method: The change in $P_{cuff}$ according to the increase in $V_{cuff}$ was observed in 17 patients with prolonged endotracheal intubation for mechanical ventilation for 2 week or more. This maneuver measured the change in $P_{cuff}$ daily during the mechanical ventilation days. In addition, the $P_{cuff}$ measured by mercury column sphygmomanometer was compared with the $P_{cuff}$ measured by an automatic cuff pressure manager. Results : There were no statistically significant changes of $P_{cuff}$ during more than 14 days of intubation for mechanical ventilation. However the $V_{cuff}$ required to maintain the appropriate $P_{cuff}$ varied from 1.9 cc to 9.6 cc. In addition, the intra-individual variation of the $P_{cuff}$ was observed from 10 $cmH_2O$ to 46 $cmH_2O$ at constant 3 cc $V_{cuff}$. The $P_{cuff}$ measured by the bedside mercury column sphygmomanometer is well coincident with that measured by the automatic cuff pressure manager. Conclusion: Continuous monitoring and management of the $P_{cuff}$ to maintain the appropriate $P_{cuff}$ level in order to prevent cuff related problems during long-term mechanical ventilation is recommended. For this purpose, mercury column sphygmomanometer may replace the specific cuff pressure monitoring equipment.

• Tuberculosis and Respiratory Diseases
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• v.58 no.6
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• pp.582-589
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• 2005

Background : The incidence of lung adenocarcinoma, which is more prevalent in women and nonsmokers, is increasing. The aim of this study was to determine the prognostic factors of an adenocarcinoma of the lung. Material and method : The clinical information of patients diagnosed with an adenocarcinoma of the lung at the Kosin University Gospel Hospital from January 1994 to July 2004 was reviewed retrospectively. The survival time of these patients was analyzed by the patient's age, gender, performance status, weight loss, smoking history, location of the primary tumor, clinical stage, serologic tumor markers, and treatment modality. Results : For all 422 patients with an adenocarcinoma of the lung, 247 (58.5%) were male, and their mean age was 59.8 years the. The majority of patients were smokers (58.3%), and the tumors were located in the periphery (59.7%). In the smokers, the tumor was located more in the central airway compared to the non-smokers (42.8% vs. 31.9%, p=0.12). The overall median survival time was 390 days (95% CI;304-436 days). Univariate survival analysis revealed that an older age (${\geq}65$ years old), male, weight loss, smoker, central type, advanced clinical stage, elevated serum carcinoembryonic antigen (CEA, >5 ng/ml) and neuron specific enolase (NSE, >15 ng/ml), and the supportive care only were significantly poor prognostic factors. The median survival time was shorter in the smokers than nonsmokers (289 days vs. 533 days, p<0.001). In addition, it was also shorter in the elevated NSE group than in the normal range group (207 days vs. 469 days, p<0.001). Multivariate analysis showed that age, clinical stage, serum NSE, smoking status, and treatment modality were independent predictors of survival (hazard ratios: 1.68, 1.94, 1.92, 2.39 and 1.57, respectively). Conclusions : Smoking is an important prognostic factor in an adenocarcinoma of the lung, but not gender. This suggests that the better prognosis of women is more related with the lower rate of smoking. In addition, the elevated serum NSE is also an important prognostic in an adenocarcinoma of the lung.

• Journal of Chest Surgery
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• v.39 no.12 s.269
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• pp.949-952
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• 2006

Spontaneous pneumothorax is rarely occurred as an initial sign of primary lung cancer. As a lot of these cases have already advanced, even then surgical resection is performed, the prognosis is often undesirable, We happened to find a ruptured cavity on a 65-year-old male patient who had suffered from pulmonary tuberculosis in the past, while performing VATS bullectomy for simple spontaneous pneumothorax, Then, as a result of frozen biopsy, it was diagnosed as squamous cell cancer Because the tumor was infiltrated from the upper lobe into the lower lobe passing by fissure, we should remove by pneumonectomy and the pathologic stage was found stage I(T2N0M0). When we made an follow-up observation for one year and a half, there was neither relapse nor complication. When there appears spontaneous pneumothorax to the high risk group for lung cancer who were smokers over forty-year old, with chronic bronchitis or pulmonary emphysema, it needs to have a closer observation on a base lung disease such as lung cancer through chest CT, and it is also necessary to make more active approach by performing the surgical operation through a thoracoscopy when there is a continued air release.

• Journal of Yeungnam Medical Science
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• v.3 no.1
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• pp.201-207
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• 1986

159 histologically proved cases of lung cancer have been reviewed at the Department of Internal Medicine, Yeungnam University Medical School for the past two years and six months from January, 1984 to July 1986. 1. The age distribution ranged from 27 to 87 years and 69.2% of the patient were distributed between the ages of 51 and 70. 2. The ratio of male and female was 4.6 : 1(131 males, 28 females) 3. Chief complains were in order of dyspnea, chest pain, cough, hemoptysis and weight loss. 4. Localization on chest film, right was more than left(right 58.6%, left 36.2%) and the most frequent site is right upper lung field (33 case, 21.7%) 5. Histologically squamous cell type(54.7%) was most common and next was small cell type(19.5%), adenocarcinoma(9.4%) large cell(6.4%). 6. 76.8% of case was diagnosed histologically under the bronchoscopic biopsy. 7. Pulmonary tuberculosis was the most common associated disease on admission time. 8. The most common treatment was conservative therapy In general. However chemotherapy was most common treatment of the small cell type carcinoma.

• The Journal of Internal Korean Medicine
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• v.19 no.2
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• pp.438-450
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• 1998

Pleural effusion means the inflammation of pleura which has a majority of respiratory disease. The main clinical manifestation is pleural effusional pain, dyspnea, cough, fever, etc. and at present the Tuberculous pleural effusion has the most frequency in which exists exudate in our country. And during studying oriental medical treatment about Tuberculous exudative pleural effusional patient, we found the clinical case about The Combination therapy of Chinese traditional and Western medicine at journal of traditional Chinese Medicine and considered it would be help in oriental medical treatment, so we adjust and report now. This study was performed by analyzing the six papers reported centering around the clinical case of The Combination therapy of Chinese traditional and Western medicine in journal of traditional Chinese Medicine published between 1990-1996. As these papers have no mistakes on diagnosis because it obtained pleurocentesis, tuberculin test positive reaction on choicing clinical case, definite results on X-ray, ultrasound as well as clinical basis, so it considers an apt conclusion. The results were as follows: 1. Western medical treatment uses chemical remedy same with pulmonary tuberculosis, and in case of tubercular pleuritis, it needs thoracic duct pyorrhea, and according to simple exudation also operates therapheutic pleural paracentesis. 2. In case of hydrothorax absorption about tuberculous pleural effusion, prescription of purge the heat accumulated in the lung and eliminate the retention of fluid with powerful purgatives shows considerable effects. 3. The latter period treatment of tuberculous pleural effusion needs Supplement qi and active the collaterals, Nourishing yin and clearing heat in addition to Supporting healthy energy to eliminate evils. 4. In case of curing tuberculous pleural effusion, The Combination therapy of Chinese traditional and Western medicine shows more considerable effect than single western medical treatment in absorption of hydrothorax. 5. In case of curing tuberculous pleural effusion, The Combination therapy of Chinese traditional and Western medicine shows more considerable effect than single western medical treatment in prevention of disease reappearance. 6. In case of curing tuberculous pleural effusion, The Combination therapy of Chinese traditional and Western medicine shows more considerable effect than single western medical treatment in vitality recovery at the latter period of disease.

• Korean Journal of Head & Neck Oncology
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• v.9 no.2
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• pp.210-220
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• 1993

Histologically proven 465 cases of neck mass in children were analized for the determination of the nature of lesions. Pathologic specimens were obtained during 10 years from January 1981 to December 1989 at Severance Hospital, Yonsei University, College of Medicine. 1) Congenital lesion was most common in neonate(80%) and congenital lesion and inflamatory disease were common in infancy and inflammatory disease was most common in more than one year old children. Thyroglossal duct cyst was most common(35.4%) disease of the congenital lesion. followed by cytic hygroma(34%) and branchial cleft remnants(29.2%). 2) Benign tumors were discovered most frequently in adolescence (55.2%) and thyroid adenoma(23.7%) and epithelial tumor(21.1%) and hemangiomas(19.7%) were most common. Most common malignant tumors were malignant lymphoma (50%) and Hodgkin's disease and were present in the older children. Metastatic cancers were very rare and their primary sites were deductable in all cases. 3) Reactive hyperplasia of lymph node was most common in inflammatory disease(23.7%). Tuberculosis lymphadenitis was more common than nonspecific lymphadenitis. 4) Bilaterality of lesion was commonly seen in malignant disease(41.7%), reactive hyperplasia of lymph node (38.85%) and metastatic disease(33.3%). Size and duration of the masses were not helpful in the differential diagnosis of the cause of the masses. Pediatric neck mass must be evaluated with its characteristics. sites, bilaterality, size and its cange, duration and patient's age but any of these alone cant not be predicted its causes without biopsy or excision. Biopsy or excision can be done with few complication but biopsy of lymph node for diagnosis is carefully made because a large number of lymph node biopsy showed no definite diagnosis in these selected cases of patients.

• Journal of Chest Surgery
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• v.31 no.7
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• pp.692-696
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• 1998

For the management of a secondary spontaneous pneumothorax, videothoracoscopic surgery may offer the potential therapeutic benefits of a minimally invasive approach. We report on a series of 36 patients(33 men and 3 women) with a mean age of 56.3 years(range, 31 to 80 years) who underwent thoracoscopic surgical procedures for the treatment of secondary spontaneous pneumothorax. Twenty-one patients had emphysema and 20 patients had old pulmonary tuberculosis. Nineteen patients presented a persistent severe air leak more than 3 days preoperatively and 15 patients had more than one recurrence. Bullectomy or exclusion of the lesion was performed in 33 patients. Mechanical pleurodesis was performed in the entire patients, talc was sprayed in 22 and vibramycin in 14. Mild pleural adhesion at the upper lobe was shown in 10 patients and severe pleural adhesion in 7 patients. One patient with persistent air leak died of persistent air leak and respiratory failure. The mean postoperative stay was 7.0 days(range, 2 to 17 days). At a mean follow-up of 15.8 months (range, 5 to 45 months), no pneumothorax had recurred. In comparison with the result of the treatment for 112 patients with primary spontaneous pneumothorax, the operating time was not significantly longer and there were no more primary treatment failures, but the duration of postoperative chest drainage and hospital stay was longer. Videothoracoscopic surgery has proved to be an effective treatment for secondary spontaneous pneumothorax in elderly patients who represent high-risk candidates for thoracotomy.

• Clinical and Experimental Pediatrics
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• v.52 no.5
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• pp.622-626
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• 2009

Kikuchi-Fujimoto disease was initially described as a self-limiting histiocytic necrotizing lymphadenitis in Japan in 1972, and is predominantly observed in women under the age of 30 year and in Asian populations. The pathogenesis is still poorly understood but is thought to include infections, and autoimmune and neoplastic diseases. The most common clinical manifestations are fever and painless cervical lymphadenitis. Diagnosis is based on the histopathological findings, characterized by focal necrosis in the paracortical region with abundant karyorrhexis, aggregates of atypical mononuclear cells around the zone of necrosis, absence of neutrophils and plasma cells, and usually intact lymph node capsule. There is no specific therapy for the condition, and aseptic meningitis can occur as one of the complications. Here, we report the case of a patient with Kikuchi-Fujimoto disease accompanied with aseptic meningitis, which may be confused as a case of tuberculous meningitis and lymphadenitis.

• Journal of Korean Neurosurgical Society
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• v.56 no.1
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• pp.21-27
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• 2014

Objective : Infectious spinal disease is regarded as an infection by a specific organism that affects the vertebral body, intervertebral disc and adjacent perivertebral soft tissue. Its incidence seems to be increasing as a result of larger proportion of the older patients with chronic debilitating disease, the rise of intravenous drug abuser, and the increase in spinal procedure and surgery. In Korea, studies assessing infectious spinal disease are rare and have not been addressed in recent times. The objectives of this study are to describe the epidemiology of all kind of spinal infectious disease and their clinical and microbiological characteristics as well as to assess the diagnostic methodology and the parameters related to the outcomes. Methods : A retrospective study was performed in all infectious spinal disease cases presenting from January 2005 to April 2010 to three tertiary teaching hospitals within a city of 1.5 million in Korea. Patient demographics, risk factors, clinical features, and outcomes were assessed. Risk factors entailed the presence of diabetes, chronic renal failure, liver cirrhosis, immunosuppressants, remote infection, underlying malignancy and previous spinal surgery or procedure. We comparatively analyzed the results between the groups of pyogenic and tuberculous spinal infection. SPSS version 14 statistical software was used to perform the analyses of the data. The threshold for statistical significance was established at p<0.05. Results : Ninety-two cases fulfilled the inclusion criteria and were reviewed. Overall, patients of tuberculous spinal infection (TSI) and pyogenic spinal infection (PSI) entailed 20 (21.7%) and 72 (78.3%) cases, respectively. A previous spinal surgery or procedure was the most commonly noted risk factor (39.1%), followed by diabetes (15.2%). The occurrence of both pyogenic and tuberculous spondylitis was predominant in the lumbar spine. Discs are more easily invaded in PSI. At initial presentation, white cell blood count and C-reactive protein levels were higher in PSI compared to TSI (p<0.05). Etiological agents were identified in 53.3%, and the most effective method for identification of etiological agents was tissue culture (50.0%). Staphyococcus aureus was the most commonly isolated infective agent associated with pyogenic spondylitis, followed by E. coli. Surgical treatment was performed in 31.5% of pyogenic spondylitis and in 35.0% of tuberculous spondylitis cases. Conclusion : Many previous studies in Korea usually reported that tuberculous spondylitis is the predominant infection. However, in our study, the number of pyogenic infection was 3 times greater than that of tuberculous spinal disease. Etiological agents were identified in a half of all infectious spinal disease. For better outcomes, we should try to identify the causative microorganism before antibiotic therapy and make every effort to improve the result of culture and biopsy.

• Journal of Chest Surgery
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• v.21 no.2
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• pp.316-325
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• 1988

Author made a clinical study of 248 cases of pleural effusion patients who were diagnosed and treated at departments of chest surgery and internal medicine, Pusan National University Hospital, during the period from Jan. 1983 to Dec. 1985. The age distribution ranged from 1 to 76 years old and the ratio of male to female was 1.38:1. The cardinal symptoms were chest pain[69.4%], dyspnea[66.1%], cough[57.7%], fever[37.1%], sputum[26.2%], general malais[13.7%] and cyanosis[1.6%] in this order. The causes of pleural effusion were pulmonary tuberculosis[42.4%], pneumonia[23.0%], malignancy[16.5%], congestive heart failure[9.3%], liver cirrhosis[2.8%] and nephrosis[2.0%] in this order. The protein in the pleural effusions was 1.61*0.90[mean*SD] gm% in transudate and 5.05*1.10[Mean*SD] gm% in exudate. In 34 cases[89.5%]out of 38 transudates, the protein was under 3 gm% and in 201 cases [95.7%] out of 210 exudates, the protein was over 3 gm%. The protein ratio of pleural effusion to serum was 0.2650.11[Mean LSD] in transudates and 0.73*0.12[Mean LSD] in exudate. The ratio under 0.5 was in 36 cases[94.8%] out of 38 transudates and over 0.5 was in 206 cases[98.1%] out of 210 exudates. The LDH in the pleural effusion was 114.7550.3[mean*SD] units / ml in transudate and 627.05325.9[mean*SD] units / ml in exudate. The LDH less than 200 units / ml was in 36 cases[94.6%] out of 38 transudates and more than 200 units / ml was in 199 cases[94.7%] out of 210 exudates. The LDH ratio of pleural effusion to serum was 0.34k 0.11[mean*SD] in transudate and 1.15*1.12[mean*SD] in exudate. The LDH ratio of pleural effusion to serum was less than 0.6 in 36 cases[94.8%]out of 38 transudates and more than 0.6 in 200 cases[95.2%] out of 210 exudates. Etiologic organisms were confirmed in 78 cases[48.1%] among the requested 162 cases. In the 78 cases of etiologic organisms, staphylococcus was 33 cases[20.3%], streptococcus 24 cases[14.8%], Klebsiella pneumonia 7 cases[4.3%], pseudomonas 6 cases[3.7%], E. coli[3.1%], enterobacter 3 cases[1.9%]. 43 patient of pleural effusion from malignancy were undergone three or more thoracenteses. In 13 cases[31.7%], three specimen were negative and in 7 cases[17.1%], three specimens were positive for malignancy. In the remaining of 21 cases[51.2%], malignant cells were found in one or more of the specimens but not in all. Methods of treatment of pleural effusion by closed thoracotomy was 188 cases[75.8%], thoracentesis 27 cases[10.9%], decortication 16 cases[6.5%], thoracoplasty 6 cases[2.4%] and decortication with thoracoplasty 3 cases[1.2%].