• Tuberculosis and Respiratory Diseases
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• v.45 no.3
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• pp.574-582
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• 1998

Background: Bronchofiberscopy is a procedure with a chance of airway irritation and it may cause pathophysiologic changes of respiratory system. So we tried to evaluate the influence of bronchofibercopy on $O_2$ saturation, ABGA and PIT by patient's basal status and procedure type. Method: $O_2$ saturation was measured every 1 minute from the left index finger tip with percutaneous oximetry. ABGA was done before and right after the bronchofiberscopy and PIT was done before and within 10 minutes after the bronchofiberscopy. Results: The mean time for bronchofiberscopy procedure was 14.5mim and $SaO_2$ maximally fall to 89.0 below 8% of the baseline after mean time of 8.4min, which was recovered at the end of the procedure. $SaO_2$ change amount was 8.4 % on Non-$O_2$ supply group, which was lower compared to 6.4 % of the $O_2$-supply group without statistically significance. Biopsy Group and BAL group showed more $SaO_2$ fall than washing only group. The level of $PaO_2$ and FEV1 of the patient didn't influence significantly on $SaO_2$ fall during the procedure. ABGA taken before and after the bronchofiberscopy showed mild fall of $PaO_2$ and mild rise of $PaCO_2$. Whereas PFT showed decrease of FEV1(P<0.05) and increase of RV without changes in airway resistance and pulmonary diffusion capacity. Comparing before and after the bronchofiberscopy, the washing group showed no significant changes on PIT, while the biopsy group and the BAL group showed increase of RV & decrease of $FEV_1$ after the bronchofiberscopy. BAL group showed more changing tendency rather than biopsy group although not statistically significant. Conclusion: Bronchofiberscopy is considered as a relatively safe procedure, but it would be better to be done with $O_2$ supply especially in the patient with low $PaO_2$ and in the case of biopsy and BAL.

• Journal of Chest Surgery
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• v.11 no.2
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• pp.129-134
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• 1978

Two hundred and seventeen patients underwent diagnostic rigid bronchoscopy or bionchofiberscopy to evaluate the cytologic diagnosis in the lung cancer patient at the department of chest surgery of Yon-Sei university, college of the medicine from 1971 to 1977 year. One hundred and twenty cases of these patients were taken rigid bronchoscopy and ninety four cases of these patient were taken bronchofiberscopy. Cytologic examination of the sputum was done in 214 cases and sputum cytology was positive in 50 cases [23.4%]. Rigid bronchoscopy was made in 120 cases and this bronchoscopic cytology including bronchial washing and bronchial biopsy was positive in 34 cases [28.5%]. Bronchofiberscopy was performed in 94 cases and was positive in 45 cases [47.5%]. Histopathologically, 41 cases [43.6%] were epidermoid cell carcinoma, 8 cases [8.5%]of undifferentiated cell type, 12 cases [12.8%]of adenocarcinoma, 8 cases [8.5%]of alveolar cell type, and the 25 cases were undetermined. Cytologic examination of the sputum lacks the accuracy of the bronchoscopies in terms of both localization and accurate histologic indentification of the type of neoplasm. Rigid bronchoscope has the advantage of permitting identification of a tumor in a central location and of providing a sufficient amount of biopsy material for accurate diagnosis of carcinoma. However, it has the disadvantage of limiting examination to the larger, more central portions of the tracheobronchial tree. Bronchofiberscope had the advantage of examine upper lobe as well as other portions of the tracheobronchial tree which could not be visualized with the rigid bronchoscopy. A positive diagnosis in bronchofiberscopy was obtained in the highest rate, 47. 8% [45 cases]. A1 last, if a bronchogenic carcinoma is suspected on the basis of either symptoms of an abnormality on the chest film the diagnostic work-up-sputum cytology, bronchial washing, bronchoscopic biopsy, scalene node biopsy, thoracentesis and mediastinoscopy explothoracotomy etc-should precede in an attempt not only to obtain the higher positive diagnosis but also to obtain a tissue diagnosis and to evaluate the stage of the disease and to ascertain the appropriate mode of therapy.

• Journal of Chest Surgery
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• v.14 no.3
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• pp.181-186
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• 1981

• Tuberculosis and Respiratory Diseases
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• v.43 no.4
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• pp.651-656
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• 1996

We have experienced a case of sarcoidosis appearing asymmetrical diffuse interstitial lung lesions with multiple lymphadenopathy. This patient was a 57 year-old female who had been in good health until 2 months ago. At that time she noted the onset of an exertional dyspnea and weakness. Pulmonary function tests showed moderate obstructive pattern with mild decreased DLco. In the chest CT, multiple lymphadenopathy with small nodular lesions are scattered, and the impression was a metastatic lymph nodes with lymphangitic carcinomatosis. In bronchofiberscopy, we noted luminal narrowing by extrinsic compression in the right middle and lower lobe bronchi. And microscopic examination of by bronchofiberscopic biopsy showed chronic inflammation. Thus we performed subcarinal and tight supraclaviclar lymph nodes aspiration biopsy cytology, and that revealed class 0 and class 1, respectively. Finally, we performed an excisional biopsy for the right scalene lymph node, which revealed the specimen as a noncaseating granuloma. The angiotensin convecting enzyme level was overt two folds compared to normal value. And the patient had negative PPD skin test and hyperglobulinemia. After 18 weeks treatment with prednisone, the signs and symptoms which the patient clad suffered from, disappeared.

• Tuberculosis and Respiratory Diseases
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• v.70 no.3
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• pp.261-265
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• 2011

Cholethorax is a bilious pleural effusion caused by a pleurobiliary fistula or leakage of bile into the pleural space. Most cases of cholethorax arise from a complication of abdominal trauma, hepatobiliary infection, or invasive procedures or surgery of hepatobiliary system. However, we experienced a case of a patient with cholethorax of unknown origin. There was no evidence of pleurobiliary fistula or leakage of bile from the hepatobiliary system although we examined the patient with various diagnostic tools including chest and abdominal computed tomography, endoscopic retrograde cholangiopancreatography, tubography, bronchofiberscopy, hepatobiliary scintigraphy and video-assisted thoracoscopic surgery. Herein we report a case of cholethorax for which the specific cause was not identified. The patient was improved by percutaneous drainage of pleural bile.

• Journal of Chest Surgery
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• v.55 no.1
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• pp.30-36
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• 2022

Background: No consensus exists regarding whether volatile anesthetics are superior to intravenous anesthetics for reducing postoperative pulmonary complications (PPCs) in patients undergoing general anesthesia for surgery. Studies of this issue focused on anatomic pulmonary resection are lacking. This study compared the effects of total intravenous anesthesia (TIVA) versus volatile anesthesia on PPCs after anatomic pulmonary resection in patients with lung cancer. Methods: This retrospective study examined the medical records of patients with lung cancer who underwent lung resection at our center between January 2018 and October 2020. The primary outcome was the incidence of PPCs, which included prolonged air leak, pneumonia, acute respiratory distress syndrome, empyema, atelectasis requiring bronchofiberscopy (BFS), acute lung injury (ALI), bronchopleural fistula (BPF), pulmonary embolism, and pulmonary edema. Propensity score matching (PSM) was used to balance the 2 groups. In total, 579 anatomic pulmonary resection cases were included in the final analysis. Results: The analysis showed no statistically significant difference between the volatile anesthesia and TIVA groups in terms of PPCs, except for prolonged air leak. Neither of the groups showed atelectasis requiring BFS, ALI, BPF, pulmonary embolism, or pulmonary edema after PSM. However, the length of hospitalization, intensive care unit stay, and duration of chest tube indwelling were shorter in the TIVA group. Conclusion: Volatile anesthetics showed no superiority compared to TIVA in terms of PPCs after anatomical pulmonary resection in patients with lung cancer. Considering the advantages of each anesthetic modality, appropriate anesthetic modalities should be used in patients with different risk factors and situations.

• Tuberculosis and Respiratory Diseases
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• v.47 no.2
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• pp.209-217
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• 1999

Backgrounds: To investigate the role of CT as a screening tool and to compare the diagnostic accuracy with that of the fiberoptic bronchoscopy (FOB) in evaluating the causes of hemoptysis. Methods: The retrospective review of plain chest radiograph, CT and FOB was done in 72 patients with hemoptysis. The diagnosis were confirmed by histology (n=33), bacterial culture (n=6), cytology (n=3), serology (n=2), skin test (n= 1), clinical response (n=5), and airway disease mainly by HRCT (n=22). Results: The causes of hemoptysis were shown to be lung cancer (n=29), bronchiectasis (n=19), tuberculosis (n=12), aspergilloma (n=5), invasive aspergillosis (n=l), COPD (n=3) and others (n=3). The sensitivity was 100% and 91,7% by CT and FOB respectively. The diagnostic compatibility was 95.8% and 59.7% by CT and FOB respectively. The diagnostic compatibility in cases with central airway disease was 96.3% and 100 % in CT and FOB. In parenchymal disease, CT and FOB showed 91.3 % and 43.5 % of compatibility, respectively. airway disease, CT and FOB showed 100% and 31.8% compatibility, respectively. That is to say, CT has higher sensitivity and diagnostic compatibility than FOB for identifying the causes of hemoptysis, and is more helpful for patients with hemoptysis from parenchymal or airway disease. FOB had the advantage in obtaining histologic, cytologic and bacteriologic diagnosis with biopsy or washing Conclusion: CT should be used as the screening method before performing FOB for patients with hemoptysis who have normal or nonspecific findings or peripheral airway disease in plain chest radiograph.

• Tuberculosis and Respiratory Diseases
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• v.49 no.6
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• pp.760-773
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• 2000

Background : Hemoptysis is a common clinical symptom responsible for 11% of admission to the hospital chest service. In KOREA pulmonary tuberculosis is still the most common cause of hemoptysis and the incidence of hemoptysis due to neoplasia has increased. Bronchoscopy and high resonance CT are essential for diagnosis of the cause of hemoptysis. We studied the causes, diagnostic tools and treament treatment of hemoptysis Methods : We conducted a retrospective analysis of clinical profiles, radiologic and bronchoscopy findings and treatments of hemoptysis for 220 patients who were admitted to our hospital with hemoptysis between 1994 and 1998. Results : The mean age at diagnosis was 49.3 years and male to female ratio was 2.1 : 1. The main causes were active pulmonary pulmonary tuberculosis in 72 cases(32.7%), inactive pulmonary tuberculosis with sequlae in 69 cases(31.4%) lung cancer in 43 cases(19.5%), bronchiectasis in 10 cases(4.5%), and chronic bronchitis in 10 cases(4.5%). The mean amount of hemoptysis for 24hrs was 120cc. The mean duration of bleeding was 25 days. The number of cases with a past history of pulmonary tuberculosis were 128 cases, in which 24 were relapsed tuberculosis cases, 25 chronic tuberculosis cases, 69 inactive tuberculosis cases, and 10 lung cancer cases. High resonance CT was the most useful method for structural etiologic evaluation of hemoptysis developed in patients with inactive tuberculosis, bronchiectasis and aspergilloma. Sputum study and bronchofiberscopy were the confirmative diagnostic tools for active pulmonary tuberculosis and lung cancer. The treatments of hemoptysis medical in 152 cases(71.7%), bronchial arteη embolization in 39 cases(17.8%), and operation in 9 cases(4.0%). The mean following up duration was 22.4 months. The overall outcomes of hemoptysis were controlled in 77 cases(43.5%), rebleeding in 100 cases (56.5%) and expired in 9 cases (4.0%). The outcomes of hemoptysis in pulmonary tuberculosis were controlled in 21.6%, rebleeding in 78.4%, and expire in 14.7%. Conculsion : The most common cause of hemoptysis was related with pulmonary tuberculosis. HRCT was an important diagnostic tool in AFB smear negative active pulmonary tuberculosis and inactive tuberculosis with sequelae. Early, proper management of pulmonary tuberculosis is important for prevention of hemoptysis in Korea.