• Journal of Chest Surgery
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• 제38권10호
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• pp.705-709
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• 2005

배경: 염증성 폐질환에 의해 발생한 객혈을 폐절제술로 치료한 후 임상 결과를 분석해보고자 한다 대상 및 방법 : 1995년 1월부터 2004년 5월까지 양성 폐질환에 의해 객혈이 발생하여 폐절제술로 치료한 총 45명의 환자를 대상으로 하여 수술 후 이환율에 미치는 술 전 요소들과 수술 후 객혈의 재발 요인들을 분석하였다. 환자의 평균 나이는 47.1세였고 평균 추적기간은 $35\pm34$개월이었다. 결과: 수술 후 조기 사망은 2명$(4.4\%)$이었다. 술 후 합병증은 8명의 환자에게서 발생하였다. 술 전 또는 술 중에 수혈이 이루어진 그룹에서 수술 후 합병증 발생률이 높았다(p=0.002). 특히 파괴성 폐결핵 환자에게서 술 전 및 술 중 수혈 가능성이 높았고(p=0.001)수술 전에 의의 있게 많은 양의 객혈이 발생하였으며(p=0.002) 전폐절제술이 시행될 가능성이 많았고(p=0.039) 수술 후 합병증의 빈도가 높았다(p=0.015). 전폐절제술을 시행한 환자에서 술 후 출혈로 인해 재수술의 시행이 많았다(p=0.047). 추적 관찰 중 5명의 환자에서 객혈이 재발하여 이 중 3명의 환자는 소실되었고 2명의 환자는 간헐적인 혈액흔적 가래(blood tinged sputum) 양상이 지속되고 있다. 위 2명의 환자는 결핵의 재발로 현재 치료 중이다. 걸론 수술 후 이환율을 높이는 질환으로 파괴성 폐결핵을 들 수 있으며 염증성 폐질환으로 인한 전폐절제술은 술 후 출혈에 대한 각별한 주의를 요한다. 향후 보다 많은 증례를 통해 수술 후 객혈의 재발에 대한 심도 있는 연구가 필요할 것이다.

• Journal of Chest Surgery
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• 제37권6호
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• pp.539-542
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• 2004

폐동맥 형태가 비정상적이거나 폐동맥 저항이 높은 경우뿐 아니라 주요 대동맥-폐동맥 측부혈관은 폰탄 수술의 위험을 높이는 인자로 알려져 있다. 저자들은 기능적 단심실과 더불어 양측 폐동맥의 발달이 매우 미약하고 양측 폐의 대부분을 주요 체-폐동맥 부행혈관에 의해 혈류가 공급되는 고위험 폰탄수술 환자에서, 단일초점화수술과 체폐동맥 단락술로 폐동맥 재건과 단계적 수술을 거쳐 성공적으로 폰탄수술에 이르렀기에 이를 보고하는 바이다.

• Journal of Trauma and Injury
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• 제24권1호
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• pp.12-17
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• 2011

Purpose: A rib fracture secondary to blunt thoracic trauma continues to be an important injury with significant complications. Unfortunately, there are no definite treatment guidelines for severe multiple rib fractures. The purpose of this study was to evaluate the result of early operative stabilization and to find the risk factors of surgical fixation in patients with bilateral multiple rib fractures or flail segments. Methods: From December 2005 to December 2008, the medical records of all patients who underwent operative stabilization of ribs for severe multiple rib fractures were reviewed. We investigated patients' demographics, preoperative comorbidities, underlying lung disease, chest trauma, other associated injuries, number of surgical rib fixation, combined operations, perioperative ventilator support, and postoperative complications to find the factors affecting the mortality after surgical treatment. Results: The mean age of the 96 patients who underwent surgical stabilization for bilateral multiple rib fractures or flail segments was 56.7 years (range: 22 to 82 years), and the male-to-female ratio was 3.6:1. Among the 96 patients, 16 patients (16.7%) underwent reoperation under general or epidural anesthesia due to remaining fracture with severe displacement. The surgical mortality of severe multiple rib fractures was 8.3% (8/96), 7 of those 8 patients (87.5%) dying from acute respiratory distress syndrome or sepsis. And the other one patient expired from acute myocardial infarction. The risk factors affecting mortality were liver cirrhosis, chronic obstructive pulmonary disease, concomitant severe head or abdominal injuries, perioperative ventilator care, postoperative bleeding or pneumonia, and tracheostomy. However, age, number of fractured ribs, lung parenchymal injury, pulmonary contusion and combined operations were not significantly related to mortality. Conclusion: In the present study, surgical fixation of ribs could be carried out as a first-line therapeutic option for bilateral rib fractures or flail segments without significant complications if the risk factors associated with mortality were carefully considered. Furthermore, with a view of restoring pulmonary function, as well as chest wall configuration, early operative stabilization of the ribs is more helpful than conventional treatment for patients with severe multiple rib fractures.

• 대한치과의사협회지
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• 제50권12호
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• pp.755-762
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• 2012

Objective : The aim of this study was to investigate risk factor, precaution and treatment of aspirated foreign body during dental procedure. Material and Methods : Twenty cases of accidental aspiration of the foreign body, which removed by bronchoscopy at the Asan Medical Center between 2008 and 2012, were analyzed retrospectively. Results : Ten cases of accidental aspiration were occurred during dental procedure. Symtoms include cough(65%), dyspnea(50%), sputum(25%) and wheezing(25%). The most common location of foreign body was right bronchial tree(50%), left bronchial tree(45%) and carina(5%). Patients risk factors were chronic obstructive pulmonary disease, lung cancer, pulmonary tuberculosis, esophageal cancer and vegetative state. Conclusion : Accidental aspiration or swallowing of dental instrument or material is not uncommon accidents in dental practice. Most foreign bodies enter into gastrointestinal tract spontaneously. But aspiration into broncho-trachea can be more serious events and must be treated as an emergency situation. Prompt emergency treatment and removal of the foreign body is necessary to avoid complication. Dentists must have knowledge about the precaution and be ready to deal with foreign body aspiration during dental procedures.

• Journal of Chest Surgery
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• 제40권2호
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• pp.109-113
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• 2007

배경: 비소세포폐암에 흔히 발생하는 악성 흉수는 환자의 예후에 나쁜 인자로 작용하여, 원격전이가 발생한 환자들과 비슷한 생존기간을 보인다. 비소세포폐암에 발생하는 악성 흉수의 진단과 치료에 대한 연구는 많이 이루어졌으나, 환자의 예후에 영향을 미치는 인자에 대한 연구는 많지 않다. 저자들은 악성 흉수가 발생한 비소세포폐암 환자들의 예후에 영향을 미치는 예후 인자들을 알아보고자 연구를 시행하였다. 대상 및 방법: 2002년 1월부터 2003년 12월까지 악성 흉수를 동반한 비소세포폐암으로 치료를 받은 환자 33명을 대상으로 하였다. 환자의 예후에 영향을 미칠 가능성이 있는 환자의 특성(성별, 연령), 폐암 조직형 및 병기, 흉수 천자액 검사(pH, CEA, LDH, glucose, albumin), 흉수 발견 후 치료 방법을 인자로 설정하여 조사하였다. 각 인자의 생존기간을 Kaplan-Meier법으로 구한 후, log-rank test를 통한 단변량분석으로 인자 각 군의 생존기간 차이를 비교하였고, 환자의 예후에 영향을 미치는 독립적 예후 인자를 찾기 위해 다변량분석으로 Cox Regression을 실시하였다. 결과: 대상환자 33명의 폐암 조직형은 선암이 23명으로 가장 많았다. 폐암과 악성 흉수가 동시에 진단된 경우를 제외하면 폐암 진단 후 악성 흉수가 진단되기까지의 중앙값 기간은 7.3개월($25^{th}{\sim}75^{th}:\;3.9{\sim}11.8$)이었다. 환자의 중앙값 생존기간은 3.6개월(95% Confidence Interval: $1.14{\sim}5.99$)이었다. 단변량분석에선 폐암 조직형이 유의성은 떨어지나 생존기간에 차이를 보였다(선암 4.067 vs. 비선암 1.867 개월, p=0.067). 교란변수의 영향을 제거한 다변량분석에서 통계적 유의성은 없으나 비선암이 선암보다 사망위험도가 높아지는 경향을 보였다(R.R 2.754, 95% Cl $0.988{\sim}7.672$, p=0.053). 결론: 본 연구에서 저자들은 악성흉수가 발생한 비소세포폐암 환자들의 예후에 영향을 미치는 예후 인자를 확인할 수 없었다. 그러나 조직형에 따라 암사망 위험도에 차이를 보이는 경향이 관찰되어 향후 이에 대한 연구가 필요할 것이다.

• Asian Pacific Journal of Cancer Prevention
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• 제15권7호
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• pp.3057-3063
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• 2014

Background: Anaplastic lymphoma kinase (ALK) gene rearrangement in non-small cell lung cancer (NSCLC) has been intensively studied. The gold standard for ALK detection is FISH, but this is not routinely conducted in clinical practice, so that the IHC method has a role. The aim of this study was to identify the incidence of ALK rearrangement and risk or prognostic factors for ALK positivity using both of IHC and FISH methods. Materials and Methods: From January 2008 to December 2012, 267 completely resected NSCLC patients in Chiang Mai University Hospital were enrolled in this study. Clinical and pathological variables and outcomes of treatment were retrospectively reviewed. IHC and FISH were used to evaluate ALK rearrangement. Sensitivity and specificity of IHC were analyzed. Multivariable analysis was used to identify clinico-pathological correlations with positive results of IHC and clinical outcomes. Results: Twenty-two (8.2%) of 267 specimens were IHC-positive for ALK with intense cytoplasmic staining, whereas only 10 (3.8%) were FISH-positive. Sensitivity, specificity and the positive likelihood ratio with IHC were 80.0%, 94.9%, and 15.8 respectively. Age less than 55 years (RR 4.4, 95%CI 1.78-10.73, p value=0.001) and presence of visceral pleural invasion (VPI) (RR 2.9, 95%CI 1.21-6.78, p value =0.017) were identified as risk factors for ALK rearrangement with FISH. There were no statistically significant differences in other clinical and pathological variables. ALK rearrangement was not a prognostic factor for tumor recurrence or overall survival. Conclusions: The incidences of ALK positivity in completely resected NSCLCs in northern Thailand were 8.2% by IHC and 3.8% by FISH. IHC with mouse monoclonal, Ventana D5F3 antibody can be used as a screening tool before FISH method because of high specificity and high positive likelihood ratio. Age less than 55 years and VPI are risk factors for ALK positivity.

• Tuberculosis and Respiratory Diseases
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• 제71권5호
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• pp.349-354
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• 2011

Background: Lung cancer is the leading cause of cancer deaths in the world. Human papillomavirus (HPV) infection and E6 oncoprotein expression are known risk factors for the development of non-small cell lung cancer (NSCLC). This study was performed to evaluate the prevalence of HPV 16/18 E6 oncoprotein expression in patients with NSCLC. Methods: Immunohistochemical stains of the HPV 16/18 E6 oncoprotein were performed in tumor tissues from 68 patients with NSCLC who underwent curative surgery from March 2006 to November 2008. Results: The E6 oncoprotein was expressed in 29.4% of patients with NSCLC and a statistical analysis revealed that E6 oncoprotein expression was significantly higher in females (p=0.028), never smokers (p=0.045), and patients with adenocarcinoma (p=0.022) than that in other patients. Conclusion: The E6 oncoprotein was expressed in 29.4% of patients with NSCLC. Further studies detecting HPV infection and E6 oncoprotein expression in never smoking patients with NSCLC are needed.

• Tuberculosis and Respiratory Diseases
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• 제78권4호
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• pp.341-348
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• 2015

Background: There have been various results from studies concerning the predictors of recurrence in early-stage nonsmall cell lung cancer (NSCLC). Therefore, an accurate assessment is needed to guide effective adjuvant therapy. We investigated the predictors of a recurrence in patients with resected, early-stage NSCLC and the risk factors associated with locoregional or distant recurrence. Methods: This retrospective study was conducted on patients at the Pusan National University Hospital from January 2006 to December 2011. Patients with pathological stages I or II were included in this study, as based on the seventh edition TNM staging system. Multivariate Cox proportional hazard models were used to identify factors associated with recurrence. Results: Two hundred and forty-nine patients were included. Among them, 180 patients were stage I, and 69 were stage II. Overall, by multivariate analysis, the independent factors associated with a 5-year total recurrence were the presence of visceral pleural invasion (VPI) (p=0.018) and maximal standardized uptake values (SUVs) of tumors on positron emission tomography (PET) >4.5 (p=0.037). The VPI was the only independent risk factor associated with both locoregional and distant recurrence, in the analysis of the patterns of tumor recurrence and their risk factors. In the subgroup analysis of stage I patients, three variables (male, VPI and resection margin positive) were significantly associated with a 5-year recurrence. Conclusion: The independent factors associated with postoperative recurrence in early-stage NSCLC were as follows: PET SUV >4.5 and the presence of VPI. For patients with those factors adjuvant therapy should be recommended as a more efficacious treatment.

• Journal of Chest Surgery
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• 제28권5호
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• pp.464-470
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• 1995

From Jan 1988 to Dec 1993, 196 consecutive patients with various pulmonary diseases underwent pneumonectomy. Mean age was 54.0 years[range:7-74 . The underlying diseases were lung cancer[154 cases , destroyed lung[29 cases with pulmonary tuberculosis or empyema thoracis and others[13 cases . The overall mortality and complication rate were 5.6% and 14.8%. In the groups of more than and less than 60 years of age, there was significant differences in mortality rate[P=0.004 . In the group of pneumonectomy and pleuropneumonectomy, there was no significant differences in mortality[P=0.164 and complication rate[P=0.052 . In the group of normal and abnormal EKG, there was no significant differences in mortality[P=0.560 and complication rate[P=0.693 . In the preoperative FEV1, preoperative FVC and predicted postoperative FEV1, prognostic cut-off points were 1800cc, 2600cc and 1300cc, and at points, positive predicted value were 12.3%, 10.5%.and 7.7% and negative predicted value were 97.8%, 98.3% and 96.2% respectively. The preoperative FEV1 is the most reliable indicator in assessment of prognosis of pneumonectomy.

• Tuberculosis and Respiratory Diseases
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• 제74권2호
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• pp.63-69
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• 2013

Background: Aiming to improve outcome of lung transplantation (LTx) patients, we reviewed risk factors and treatment practices for the LTx recipients who experienced respiratory infection in the late post-LTx period (>1 month after LTx). Methods: We analyzed the clinical data of 48 recipients and donors from 61 LTx, who experienced late respiratory infections. Late respiratory infections were classified according to the etiology, time of occurrence, and frequency of donor-to-host transmission or colonization of the recipient prior to transplantation. Results: During the period of observation, 42 episodes of respiratory infections occurred. The organisms most frequently involved were gram (-) bacteria: Acinetobacter baumannii (n=13, 31.0%), Pseudomonas aeruginosa (n=7, 16.7%), and Klebsiella pneumoniae (n=4, 10.0%). Among the 42 episodes recorded, 14 occurred in the late post-LTx period. These were bacterial (n=6, 42.9%), fungal (n=2, 14.3%), viral (n=4, 28.5%), and mycobacterial (n=2, 14.3%) infections. Of 6 bacterial infections, 2 were from multidrug-resistant (MDR) A. baumannii and one from each of MDR P. aeruginosa, extended spectrum ${\beta}$-lactamase (+) K. pneumoniae, methicillin-resistant Staphylococcus aureus and Streptococcus pneumoniae. Infection-related death occurred in 6 of the 14 episodes (43%). Conclusion: Although the frequency of respiratory infection decreased sharply in the late post-LTx period, respiratory infection was still a major cause of mortality. Gram (-) MDR bacteria were the agents most commonly identified in these infections.