• Tuberculosis and Respiratory Diseases
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• 제44권1호
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• pp.114-123
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• 1997

연구배경 : 기관지내시경 검사는 중환자실의 폐렴이 동반된 환자에서 원인균 동정을 위한 매우 유용한 검사법이다. 내시경적 약식의 기관폐포세척한 검체의 결과를 맹검적인 기도세척의 결과와 비교분석함으로써 폐렴을 가진 중환자실 환자에서의 기관지경 검사의 임상적 의의를 평가해 보고자 하였다. 방법 : 1993년 9월부터 1996년 8윌까지 이화의대부속 목동병원 중환자실에 입원치료를 받았던 환자중 임상적 소견상 폐렴으로 진단적 또는 치료적 목적하에 기관지경 검사를 받았던 28명의 환자를 대상으로 내시경적 기관폐포세척을 포함한 임상적 결과에 대해 후향적으로 조사하였다. 결과 : l. 중환자실에 입원한 주 이유는 호흡부전 및 호흡부전 절박상태가 가장 많았다. 폐렴은 그 유형상 원내폐렴이 16예로 가장 많았고 지역획득폐렴 및 면역타협폐렴이 각 6예씩 있었다. 기관지경 목적상 진단적 목적이 20예 71%를 차지하였고 치료적 목적의 분비물제거가 8예 있었다. 내시경 검사에 따른 합병증의 발생은 미미하였다. 2 맹검적 검체와 내시경적 검체간 균주배양 일치율은 39.3 %에 불과하였고 내시경적 검사로 국균증 및 결핵이 각 2예씩 진단되었다. 3 내시경적 검체결과를 기준할때 다제약제내성 폐렴은 기타균주에 의한 폐렴과 비교시 기계호흡의 적용이 유의하게 빈번히 말생하였다. 4 원내폐렴군은 타군에 비해 기계호흡 적용이 유의하게 많았다. 결론 : 이상의 결과로 폐렴이 동반된 중환자실 환자에서 기관지경을 통한 선택적인 기관폐포세척물 검사 및 치료적 기관분비물의 제거는 진단 및 치료상의 매우 유용한 방편이 될 수 있으며 동정된 균주가 다제약제내성균이거나 원내폐렴형인 경우 기계호흡의 사용과 밀접한 관련이 있을 것으로 생각된다.

• Tuberculosis and Respiratory Diseases
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• 제56권6호
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• pp.664-669
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• 2004

저자들은 기관지내 종괴로 발현된 일차성 폐 형질세포종 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

• Tuberculosis and Respiratory Diseases
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• 제67권6호
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• pp.545-550
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• 2009

Background: Endobronchial ultrasonogram (EBUS) has increased the diagnostic yield of a bronchoscopic biopsy of peripheral pulmonary lesions (PPL). This study evaluated the diagnostic yield of EBUS-guided transbronchial biopsy (TBB) and the visibility of EBUS PPL. Methods: Between August 2007 and November 2008, 50 patients (32 men and 18 women, median age, 61.1${\pm}$10 yrs; range, 16 to 80 yrs) whose PPL lesions could not be detected with flexible bronchoscopy were enrolled in this study. Among the 50 patients, 40 cases were malignant lesions (adenocarcinoma 25, squamous cell carcinoma 10, small cell carcinoma 5) and 10 cases were benign lesions (tuberculoma 7, fungal ball 1, other inflammation 2). Results: The mean diameter of the target lesion was 35.4${\pm}$4.3 mm. Of the 50 patients examined, the overall diagnostic yield by EBUS-TBLB was 46.0% (23/50). The visualization yield of EBUS was 66.0% (33/50). A definitive diagnosis of PPL localized by EBUS was established using EBUS-TBLB in 69.6% (23/33) of cases. The diagnostic yields from washing cytology and brushing cytology from a bronchus identified by EBUS were 27.0% and 45.4% respectively. The diagnostic yields reached 78.7% when the three tests (washing cytology, brushing cytology and EBUS-TBLB) were combined. The visualization yield of EBUS in lesions <20 mm was significantly lower than that in lesions ${\geq}$20 mm (p=0.04). The presence of a bronchus leading to a lesion (open bronchus sign) on the chest CT scan was associated with a high visualization yield on EBUS (p=0.001). There were no significant complications associated with EBUS-TBLB. Conclusion: EBUS-TBLB is a safe and effective method for diagnosing PPL. The lesion size and open bronchus signs are significant factors for predicting the visualization of EBUS.

• Tuberculosis and Respiratory Diseases
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• 제67권6호
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• pp.512-516
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• 2009

Background: Pulmonary paragonimiasis is a subacute to chronic inflammatory disease of the lung caused by lung flukes that result in prolonged inflammation and mechanical injury to the bronchi. However, there are few reports on the bronchoscopic findings of pulmonary paragonimiasis. This report describes the bronchoscopic findings of pulmonary paragonimiasis. Methods: The bronchosocpic findings of 30 patients (20 males, median age 50 years) with pulmonary paragonimiasis between May 1995 and December 2007 were reviewed retrospectively. Results: The diagnoses were based on a positive serologic test results for Paragonimus-specific antibodies in 13 patients (43%), or the detection of Paragonimus eggs in the sputum, bronchial washing fluid, or lung biopsy specimens in 17 patients (57%). The bronchoscopic examinations revealed endobronchial lesions in 17 patients (57%), which were located within the segmental bronchi in 10 patients (59%), lobar bronchi in 6 patients (35%) and main bronchi in 1 patient (6%). The bronchoscopic characteristics of endobronchial lesions were edematous swelling of the mucosa (16/17, 94%) and mucosal nodularity (4/17, 24%), accompanied by bronchial stenosis in 16 patients (94%). Paragonimus eggs were detected in the bronchial washing fluid of 9 out of the 17 patients with endobronchial lesions. The bronchial mucosal biopsy specimens showed evidence of chronic inflammation with eosinophilic infiltration in 6 out of 11 patients (55%). However, no adult fluke or ova were found in the bronchial tissue. Conclusion: Bronchial stenosis with mucosal changes including edematous swelling and mucosal nodularity is the most common bronchoscopic finding of pulmonary paragonimiasis.

• Radiation Oncology Journal
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• 제33권2호
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• pp.75-82
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• 2015

Purpose: We evaluated the prognostic significance of T3 subtypes and the role of adjuvant radiotherapy in patients with resected the American Joint Committee on Cancer stage IIB T3N0M0 non-small cell lung cancer (NSCLC). Materials and Methods: T3N0 NSCLC patients who underwent resection from January 1990 to October 2009 (n = 102) were enrolled and categorized into 6 subgroups according to the extent of invasion: parietal pleura chest wall invasion, mediastinal pleural invasion, diaphragm invasion, separated tumor nodules in the same lobe, endobronchial tumor <2 cm distal to the carina, and tumor-associated collapse. Results: The median overall survival (OS) and disease-free survival (DFS) were 55.3 months and 51.2 months, respectively. In postoperative T3N0M0 patients, the tumor size was a significant prognostic factor for survival (OS, p = 0.035 and DFS, p = 0.035, respectively). Patients with endobronchial tumors within 2 cm of the carina also showed better OS and DFS than those in the other T3 subtypes (p = 0.018 and p = 0.016, respectively). However, adjuvant radiotherapy did not cause any improvement in survival (OS, p = 0.518 and DFS, p = 0.463, respectively). Only patients with mediastinal pleural invasion (n = 25) demonstrated improved OS and DFS after adjuvant radiotherapy (n = 18) (p = 0.012 and p = 0.040, respectively). Conclusion: The T3N0 NSCLC subtype that showed the most favorable prognosis is the one with endobronchial tumors within 2 cm of the carina. Adjuvant radiotherapy is not effective in improving survival outcome in resected T3N0 NSCLC.

• Journal of Chest Surgery
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• 제38권9호
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• pp.622-626
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• 2005

배경: 기관지내결핵에 의한 주기관지협착에 대하여 주기관지재건술은 전폐절제술을 피하고 폐실질을 보존할 수 있는 방법이지만 그 위험성 때문에 비침습적인 중재치료가 주를 이루고 있다. 하지만, 적절한 치료가 이루어지고 있는가에 대해서는 논란의 여지가 많다. 본원에서는 지난 10년 간 주기관지재건술을 시행하였고 이후 임상적 경과를 토대로 수술의 성적을 조사, 분석하여 결핵성 주기관지협착에 대한 주기관지재건술의 위험성과 효용성을 판단하고자 한다. 대상 및 방법: 지난 10년 간 결핵성 주기관지협착으로 인해 주기관지재건술을 시행받은 21명의 환자를 대상으로 각 환자들의 임상기록과 외래추적 기록을 통하여 후향적 연구를 하였다. 모든 환자에서 항결핵약제를 복용한 과거력이 있었으며, 기관지내시경 및 흉부전산화단층촬영을 통해 수술 전 평가를 하였다. 결과: 수술로 인한 사망은 없었으며 중증의 합병증도 발생하지 않았다. 단지 두 명의 환자에서 효과적인 객담배출이 이루어지지 않아 치료적 기관지내시경과 기관내삽관을 시행하였다. 모든 환자들은 현재까지 기도폐쇄의 증상 없이 생존해 있다. 걸론: 기관지내결핵으로 인한 주기관지협착에 대해 해부학적으로 용이한 조건에서의 주기관지재건술은 치료에 있어서 초치료의 일환으로 고려해야 한다.

• Tuberculosis and Respiratory Diseases
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• 제68권5호
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• pp.267-272
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• 2010

Background: Pulmonary sarcoidosis often involves mediastinal or hilar lymph nodes in the lung parenchyma. Mediastinoscopy is the gold standard for diagnosis, but it is invasive and expensive. Transbronchial needle aspiration using conventional bronchoscope is less invasive than mediastinoscopy, but its diagnostic accuracy is in question due to the blind approach to targeting lymph nodes. Transbronchial needle aspiration (TBNA) via endobronchial ultrasound (EBUS) has high diagnostic value due to direct visualization of lymph nodes and to its relatively safeness. The purpose of this study was to assess the usefulness of EBUS-TBNA in the diagnosis of pulmonary sarcoidosis. Methods: Twenty-five patients with symptoms of sarcoidosis were enrolled into this study. Core tissue was obtained for a definitive diagnosis. Endobronchial biopsy, transbronchial lung biopsy, and bronchoalveolar lavage were performed to verify diagnosis. For patients without a confirmed diagnosis after the above procedures were performed, the additional procedures of mediastinoscopy or video-associated thoracoscopic surgery were performed to confirm a final diagnosis. Results: A total 25 EBUS procedures were done and 50 lymph nodes were aspirated. Thirty-three (37) out of 50 lymph nodes were consistent with non-caseating granuloma, confirming sarcoidosis as the final diagnosis. Sarcoidosis was the final diagnosis for all 25 patients, and 21 required EBUS-TBNA for a final diagnosis. There were no complications associated with the procedure. Conclusion: EBUS-TBNA is already a well-known procedure for diagnosing mediastinal or hilar lymphadenopathy. We used EBUS-TBNA for the diagnosis of pulmonary sarcoidosis and our results showed 84% diagnostic accuracy and no complications related to the procedure. EBUS-TBNA is a reliable and practical diagnostic modality in the diagnosis of pulmonary sarcoidosis.

• Journal of Yeungnam Medical Science
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• 제2권1호
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• pp.161-166
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• 1985

기관지결핵은 폐결핵 환자의 상당수에서 관찰되며, 폐침윤이 없는 경우에도 기관지폐쇄로 인한 무기폐, 임파선 종대로 인한 종괴의 형성으로 타폐질환과 감별을 요하게 된다. 저자들은 1983년 5월부터 1985년 7월까지 영남대학병원에서 굴곡성 기관지경을 사용하여 기관지결핵으로 진단하였던 25예를 대상으로 그 임상상을 관찰 조사 하였기에 보고하고자 한다. 1) 25명의 기관지결핵 환자 모두 항결핵제 투약을 받았으며, 이중 호흡곤란이 심하거나 주 기도내에 광범위한 육아종 병변이 있었던 6명에서는, corticosteroid의 투여로 호전을 보였다. 2) 기관지결핵의 진단에 굴곡성 기관지경을 통한 조식검사나 항산균의 도말 및 배양검사가 필수적이다.

• Journal of Chest Surgery
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• 제32권11호
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• pp.1052-1056
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• 1999

The pulmonary sarcomatoid carcinoma is a rare malignant tumor, which is composed of an admixture of carcinomatous and sarcomatous components, and accounts for 0.3% of all pulmonary neoplasms. Clinicopathological features are often related to anatomical location: central endobronchial type and peripheral parenchymal type. Noninvasive diagnostic test had a low yield in detection sarcomatoid carcinoma. Metastasis to the regional lymph nodes and to distant organ is common. The prognosis is poor and the median survival is about 15 months. We report two cases of pulmonary sarcomatoid carcinoma with review of literatures.

• Journal of Chest Surgery
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• 제23권6호
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• pp.1244-1250
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• 1990

Hamartoma had been considered as a congenital malformation of a tumerous lesion since the original description by Albrecht in 1904. Pulmonary hamartoma is able to classified as endobronchial and intrapulmonary hamartoma clinically, and is considered to benign mesenchymal neoplasms which originated in peribronchial connective tissue, and so called mesenchymoma by someone. We have experienced 3 cases intrapulmonary hamartoma which were discovered during routine chest film check up at all cases and are able to detailed histologic examination by electron microscopy at one case.