• Tuberculosis and Respiratory Diseases
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• v.52 no.2
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• pp.174-178
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• 2002

Primary pulmonary amyloidosis is a rare condition that can be classified into the tracheobronchial, diffuse alveolar septal, and nodular parenchymal type. Tracheobronchial amyloidosis is characterized by deposition of fibrilar proteins in the tracheobronchial tree, and it can be subdivided into diffuse and focal varieties. In this report, a case of diffuse tracheobronchial amyloidosis confirmed by flexible fiberoptic bronchoscopic biopsy is presented. The patient was a 43-year old male with a chief complaint of cough and sputum for 20 days and dyspnea for one day. The chest CT scan showed diffusely thickened walls of both the main and lobar bronchi with calcification. The bronchoscopic findings showed nodular lesions of the trachea, a diffuse bronchial stenosis of both the main bronchi and a pinpoint narrowing of the left upper and right middle lobar bronchus. The biopsy showed submucosal deposits of homogenous eosinophilic amyloid materials and an apple-green birefringence under polarizing microscopy following the Congo-red stain.

• Tuberculosis and Respiratory Diseases
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• v.52 no.4
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• pp.385-394
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• 2002

Background : Flexible fiberoptic bronchoscopy(FFB) has become a widely performed technique for diagnosing and managing pulmonary disease because of its low complication and mortality rate. Since the use of FFB can in patients with severely depressed cardiorespiratory function is increasing and hypoxemia during the FFB can induce significant cardiac arrhythmias, the early detection and adequate management of hypoxemia during FFB is clinically important. Method : To evaluate the necessity of the continuous monitoring of the oxygen saturation($SaO_2$) during the FFB, the $SaO_2$ was continuously monitored from the finger tip using pulse oximetry before, during and after the FFB in 379 patient. The patients were then divided into two groups, those with and without hypoxemia($SaO_2$<90%). The baseline pulmonary function data and the clinical characteristics of the two groups were compared. Results : The mean baseline $SaO_2$ was $96.9{\pm}2.85%$. An $SaO_2$ <90% was recorded at some point in 62(16.4%) out of 379 patients, with 12 out of 62 experiencing this prior to the FFB, in 37 out of 62 during the FFB, and in 13 out of 62 after the FFB. No differences were observed in the smoking and sex distribution between those with and without hypoxemia. The mean age was older in those with hypoxemia than in those without. Significant differences were observed in the mean baseline $SaO_2$ and the mean time for the procedure between the two groups. The $FEV_1$ was significantly lower in those with hypoxemia, and both the FVC and $FEV_1/FVC$ also tended to decrease in this group. Managing hypoxemia included deep breathing in 20 patients, a supplemental oxygen supply in 39 patients, and the abortion of the procedure in 3 patients. Conclusion : These results suggest that the continuous monitoring of the oxygen saturation is necessary during fiberoptic bronchoscopy, and it should be performed in patients with a depressed pulmonay function in order for the early detection and adequate management of hypoxemia.

• Tuberculosis and Respiratory Diseases
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• v.59 no.5
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• pp.504-509
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• 2005

Background : Endobronchial tumors cause life-threatening dyspnea and can lower the quality of life due to central airway obstruction. In those cases with an intraluminal tumor, various bronchoscopic techniques are available for tumor debulking. The therapeutic effect of bronchoscopic electrocautery for palliation in patients with a symptomatic tumor obstruction was studied. Method : Nineteen patients with bronchogenic carcinomas (n=15) and metastatic tumors affecting the bronchi (n=4), between March 2002 and March 2005, were enrolled in this study. Electrocautery was performed under local anesthesia using an electroprobe and diathermic snare. Using flexible bronchoscopy, a follow-up bronchoscopic examination was performed 3-4 days later. Symptom improvement was evaluated by $FEV_1$, FVC and dyspnea score (Modified Borg Category Scale (0~10)), both before and after the electrocautery. Results : The success rate of electrocautery on the follow up examination was 84%. Patients with endoluminal airway lesions had a mean overall decrease in the size of the obstruction to $47.8{\pm}15.7%$. The mean Improvement in the dyspnea score immediately after the endobronchial tumor debulking was $2.78{\pm}1.42$. The average improvements in the $FEV_1$ and FVC after electrocautery were $0.32{\pm}0.19L$ and $0.5{\pm}0.22L$, respectively. There were 2 cases of complications related with electrocautery (one each of pneumothorax and pneumonia). Conclusion : Electrocautery using an electroprobe and diathermic snare was an effective and safe palliative treatment for a symptomatic endoluminal airway obstruction in lung cancer.

• Tuberculosis and Respiratory Diseases
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• v.61 no.3
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• pp.273-278
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• 2006

Endobronchial leiomyoma is a rare tumor that accounts for less than 2% of pulmonary benign tumors. A 32 year-old woman was admitted with fever, cough and sputum for a month. She had suffered from intermittent cough over three years. The chest X-ray and chest CT(computed tomography) showed a nodular lesion obstructing the proximal portion of the left lower lobar bronchus and atelectasis of the left lower lobe. Flexible Bronchoscopy detected a mass obstructing the distal portion of the left main bronchus and endobronchial biopsy showed benign smooth muscle cells. There was no abnormal finding in the uterine examination. Therefore this case was diagnosed as primary endobronchial leiomyoma. The lobectomy was performed due to intractable pneumonia and secondary parenchymal destruction. Postoperative course was uneventful and she was discharged in good health.

• Tuberculosis and Respiratory Diseases
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• v.68 no.1
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• pp.6-9
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• 2010

Background: The efficacious use of interventional bronchoscope for patients with central airway obstruction due to malignant or benign lesions has been proven. Among many therapeutic bronchoscopic procedures, endobronchial cryotherapy is an established recanalization method for the obstruction of the respiratory tract. Recently, the use of this procedure has been increasing in Korea. However, limited data are available in the literature regarding its efficacy in Korea. Methods: Thirty patients, who had been treated with a flexible cryoprobe for cryotherapy were enrolled; clinical characteristics and treatment outcomes were analyzed. The patients had been treated with the technique using nitrous oxide as a cryogen under local anesthesia. Objective outcomes were 3 different degrees of therapeutic success by use of follow-up bronchoscopic findings as follows: successful, partially successful, and unsuccessful response. Subjective outcomes were evaluated as an improvement in symptoms. Results: The mean age of enrolled patients was $59{\pm}11$ years and there was a male (22/30) dominance. Twenty-three patients had malignant tumor and 7 patients had benign lesions with central airway obstruction. Successful recanalization was achieved in 11 (37%) patients, and partially successful response was achieved in 15 (50%) patients. Dyspnea was improved in 84.2% (16/19) of patients. At least one respiratory symptom was resolved in 91.3% (21/23) patients. Seven patients (23.3%) needed additional bronchoscopic electrocautery because of the bleeding as a complication of cryotherapy. Conclusion: Endobronchial cryotherapy is an effective and less expensive procedure for the management of central airway obstruction. However, the procedure should be performed under the preparing for an emergency situation, such as massive bleeding.

• Journal of Veterinary Clinics
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• v.28 no.4
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• pp.438-441
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• 2011

A 7-year-old castrated, domestic shorthair cat was presented with a 2-year history of chronic nasal discharge and sneezing. Upon presentation, bilateral mucopurulent nasal discharge and stertorous respiration were marked. Physical examination revealed a tachypnea. Oral examination was unremarkable and chest radiology was normal. Findings of nasal cytology and skull radiology were not specific and further imaging technique, endoscopic examination and histopathology was performed for a definite diagnosis. Fluid, and/or soft tissue opacity was found in bilateral nasal cavity, nasopharyngeal regions and right side tympanic bulla through the CT scan. No evidence of neoplasia was revealed. A rigid rhinoscopy, flexible bronchoscopy and otoscopy was used for the visualization of the lesions and tissue biopsy biopsy was performed for histopathology. On histopathological examination, the nasal mass consisted mainly of large numbers of plasma cells and lymphocytes. And the final diagnosis was lymphoplasmacytic rhinitis based on histopathologic examination. Long term management with oral cyclosporine (5 mg/kg, BID) was safe and successful in this cat. This is the first case report described clinical and diagnostic characteristic features of feline lymphoplasmacytic rhinitis and its clinical outcome using oral cyclosporine in Korea.

• Radiation Oncology Journal
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• v.14 no.2
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• pp.123-128
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• 1996

Purpose : This is a retrospective study to compare the Palliation rates, survival rates and complications of low dose rate and high dose rate endobronchial brachytherapy in the management of malignant airway obstruction. Materials and methods : Forty three consecutive patients with malignant airway compromise from primary or metastatic lung tumors were treated with low dose rate(LDR) endobronchial Iridium-192 insertion(21 patients) between October 1988 and June 1992, and high dose rate(HDR) endobronchial brachytherapy(22 patients) between August 1992 and April 1994 with palliative aim Flexible fiberoptic bronchoscopy under fluoroscopic control was utilized in all 91 procedures. Twenty seven LDR Procedures delivered a dose of 5-7.5 Gy to a 1.0 cm radius respectively. Results : Subjective and objective responses to treatments were evaluated on follow-up examinations by clinical examination, chest x-rays and CT scan of the chest on some patients. Fifteen of 21 LDR patients and 19 of 22 HDR Patients showed subjective improvement in terms of better breathing and less Productive cough as well as complete disappearance of hemoptysis. Objective improvement on chest x-rays and CT scan of the chest had been demonstrated on 8 LDR Patients and 10 HDR patients. Conclusion : The technique of LDR and HDR endobronchial brachytherapy is simple and well tolerated procedure with minimal morbidity It Provides excellent palliation by keeping airway Patent in these short life-spanned patients.

• Tuberculosis and Respiratory Diseases
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• v.65 no.3
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• pp.230-234
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• 2008

The incidence of appendiceal metastatic cancer is quite low. In particular, in small cell lung cancer, there is a very low incidence of a metastasis to the appendix. A 75-years old man with right lower quadrant pain, cough and sputum was transferred to our hospital. Abdominal CT revealed acute appendicitis with a perforation. The patient underwent surgery. The frozen sections of the tissue obtained during surgery, indicated a malignancy, but a right hemicolectomy was not performed due to the patient's poor general condition. The histology findings of the appendix were identified as a small cell carcinoma. The abdominal CT scan and chest x-ray at admission day showed a mass in the right lower lobe, and a further evaluation of the lesion was performed including positron emission tomography and flexible bronchoscopy with a biopsy. The pathology findings of the lung mass were also small cell lung cancer. The specimens from both sites stained positive for cytokeratin, cluster designation 56, synaptophysin, chromogranin-A and thyroid transcription factor 1. It was concluded that the appendiceal small cell cancer originated from the lung.

• Tuberculosis and Respiratory Diseases
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• v.41 no.5
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• pp.494-503
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• 1994

Background: Fibrostenosis of large airway due to tuberculosis is one of the most perplexing clinical problems not only because it can lead to respiratory failure but also because of difficulty in the management. No one technique, such as balloon dilatation or insertion of self expandable metallic stent, has proved totally satisfactory in the management of fibrostenosis. We evaluated the effect of laser therapy in patient with severe fibrostenosis due to tuberculosis. Method: We classified the fibrostenosis to three types by bronchoscopic finding - the diaphragm type: stenosed by fibrous diaphragm, sparing the tracheobronchial wall, the collapse type: stenosed by collapse of the wall due to destruction of the cartilage, and the combined type: stenosed by nonspecific inflammatory scar tissue within internal lumen with collapse of the wall. We have treated 10 patients complaining dyspnea due to with severe fibrostenosis of the diaphargm or the combined type using a neodymiumyttrium aluminum garnet(Nd-Y AG) laser through a flexible bronchoscopy. Results: Eight of the 10 cases improved after laser therapy and maintained during a follow up period of average 31.9 months. All of the cases undergoing laser therapy showed no serious complication to need the therapy. Conclusion: The results of our present study indicate that the Nd-YAG laser therapy is an effective and safe method for the management of selective tuberculous fibrostenosis.

• Tuberculosis and Respiratory Diseases
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• v.53 no.2
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• pp.196-201
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• 2002

Malignant melanoma is a highly malignant form of cutaneous cancer derived from melanocytes. The lesion frequently metastasizes to the lymph nodes, lung, liver and bone. However, an endobronchial metastasis and a primary malignant. melanoma of the lung are quite rare. We report a case of an unknown primary malignant melanoma with a pulmonary and endobronchial metastasis in a 34 years old male. He complained of coughing and black-colored sputum. Abnormal skin and mucosal lesions were not found during a physical examination. A chest X-ray revealed multiple nodular masses in both lung fields. A flexible bronchoscopy showed two yellowish small nodules at the entry of left lower bronchus. Vimentin, the S-100 protein, and HMB-45 stain positive melanoma cells were detected at the bronchoscopic biopsy specimen.