• Journal of Chest Surgery
• /
• 제11권2호
• /
• pp.147-152
• /
• 1978

Six patients with pulmonary tuberculosis with cavity had cavernoplasty at Seoul National University Hospital during the last 4 years and 9 months, from October 1973 to April 1978, were studied in order to assess the clinical values of cavernoplasty. 2] All the cases were male, and the mean age was 31.5 years. 2] All the patients had combined therapy with more than two antituberculosis drugs preoperatively, its minimum duration being 8 months and maximum duration 5 years. 2] Nonspecific symptoms were predominant just prior to admission, weight loss being in 50% and loss of appetite in 50% of cases, respectively. The preoperative cavity size on plain film was minimum 2.5cm by 3.5cm and maximum 6.0cm by 4.0cm with the mean of 4. 4cm by 3.4cm. The cavity size was reduced postoperatively to 1/3-1/4 of preoperative size with the mean of 1.15cm by 1.59cm. 2] Sputum smear for acid fast bacilli was converted to negative postoperatively in two cases. 2] Complications occurred in two cases. One was postoperative pleural effusion and the other was recurrence of symptoms 2 years after surgery. 2] Of the 3 cases able to follow, 2 stopped antituberculous medication after one year. The third case was still on medication because of bronchiectasis due to tuberculous infection.

• Tuberculosis and Respiratory Diseases
• /
• 제80권2호
• /
• pp.194-200
• /
• 2017

Background: Medical thoracoscopy (MT) is a minimally invasive, endoscopic procedure for exploration of the pleural cavity under conscious sedation and local anesthesia. MT has been performed at the Seoul National University Hospital since February 2014. This paper summarizes the findings and outcomes of MT cases at this hospital. Methods: Patients who had undergone MT were enrolled in the study. MT was performed by pulmonologists, using both rigid and semi-rigid thoracoscopes. During the procedure, patients were under conscious sedation with fentanyl and midazolam. Medical records were reviewed for clinical data. Results: From February 2014 to January 2016, 50 procedures (47 cases) were performed (diagnostic MT, 26 cases; therapeutic MT, 24 cases). The median age of patients was 66 years (59-73 years), and 38 patients (80.9%) were male. The median procedure duration from initial incision to insertion of the chest tube was 37 minutes. The median doses of fentanyl and midazolam were $50{\mu}g$ and 5 mg, respectively. All procedures were performed without unexpected events. Of the 26 cases of pleural disease with an unknown cause, 19 were successfully diagnosed using MT. Additionally, diagnostic MT provided clinically useful information in the other six patients. Therapeutic MT was very effective for treatment of malignant pleural effusion or empyema. The median number of days with chest tube drainage was 6 (3 days for diagnostic MT and 8 days for therapeutic MT). Conclusion: MT is a useful and necessary procedure for both diagnosis and treatment of pleural diseases.

• 대한세포병리학회지
• /
• 제8권1호
• /
• pp.35-46
• /
• 1997

The authors reviewed 167 malignant effusions from 110 patients, of which the primary site was established on the basis of either biopsy or surgical resection of the primary neoplasm. Main factors analysed were the distribution of primary organs and the cytohistoiogic correlation of body cavity effusions. The 167 fluid specimens from 110 patients consisted of 90 cases(53.9%) of pleural, 68(40.7%) of peritoneal, and 9(5.4%) of pericardial origins. Histologically they consisted of 82 cases(74.5%) of adenocarcinoma, 8(7.3%) of malignant lymphoma, 6(5.5%) of squamous ceil carcinoma, and 3(2.7%) of small cell carcinoma. The most common site among the primary lesions was the stomach in 25 cases(22.7%) followed by the lung in 21(19.1%), ovary on 17(15.5%), and breast in 7(6.4%). As for the distribution of primary tumors in adenocarcinoma, the most common site was lung un 16 cases (48.5%) in pleural fluid and stomach in 22(48.9%) in peritoneal fluid. In pericardial effusions, all 5 cases were from the lung. As a whole, the cytologic findings of malignant effusion were fairly representative of histologic characteristics of primary lesions. Thus, when the primary lesion Is unknown, careful evaluation of effusion cytology is presumed to be a helpful tooi for tracing the primary tumor.

• 대한세포병리학회지
• /
• 제9권1호
• /
• pp.15-20
• /
• 1998

Mutant form of the p53 gene product is abnormally accumulated in the nuclei of the tumor cells due to prolonged half life, and readily detected by immunohistochemical methods. To determine the positivity rate of p53 in body cavity fluid according the primary site and histological types of tumors and the utility of p53 immunostaining as an adjunct in the diagnosis of malignancy, we reviewed 69 effusions, including pleural effusion, ascitic fluid, and pericardial fluid, that were diagnosed as overt malignancy and 21 effusions of suspicious malignancy, immunohistochemistry was performed on paraffin-embedded cell blocks using a monoclonal antibody to p53 supressor gene product(Clone DO7) and a standard avidin-biotin complex technique with a citrate buffer antigen retrieval solution. The results were as follows; of the 46 pleural effusions with overt malignancy, 22 were immunopositive for p53 protein; of the 21 ascitic fluids with overt malignancy, 5 were positive for p53. Positivity rates according to the primary sites of tumors were 18 of 34(52.9%), 8 of 21(38.1%), 1 of 9(11.1%) cases of the tumors of the lung, GI tract, and ovary, respectively. According to the histologic types of lung cancer, 11 cases(61.6%) were positive out of 18 adenocarcinomas, 2 of 5 large cell undifferentiated carcinomas, and 1 of 2 small cell undifferentiated carcinomas. Of 21 cases of suspicious malignancy, 6 were positive for p53 and all of them(6/6) were confirmed as adenocarcinoma of the lung or GI tract. These findings indicate that p53 immunostaining using paraffin embedded cell block is useful diagnostic and prognostic marker in body fluid cytology although negative immunostaining does not exclude malignancy.

• Journal of Chest Surgery
• /
• 제28권11호
• /
• pp.963-966
• /
• 1995

Ischemia reperfusion injury occurs in various diseases. The role of oxygen free radicals in IR injury of the lung has been spotlighted and many studies have been performed. In this study, we tried to prepare a stable rat lung model for IR injury, focusing on surrounding conditions as hilar stripped left lung, clamped left pulmonary artery and bronchus,and declamped after determined period was passed, and right main pulmonary aretery was clamped. Arterial blood gas analyes were performed at 1, 10, 20, 30, minutes after reperfusion. Before clamping, PaO2 was 95 to 120 mmHg in all animals. There were six groups; Group I : temperature 15o C, and 120 minutes clamping, Group II: 20 oC, and 120 minutes clamping, Group III : 25 oC, and 120 minutes clamping, Group IV : 15oC, 90 minutes clamping, Group V : 20 oC, 90 minutes clamping,Group VI: 20 oC, 75 minutes clamping. Each groups contained 10 Sprague Dayley rats. The humidity was maintained 100 % as circulation imerged isotonic Hartmann`s solution of the pleural cavity. In group IV, V, and VI, PaO2 decreased significantly in all animals immediately after reperfusion, but 43 % survived till 10 minutes after reperfusion, it was 74.0$\pm$5.7, 73.3$\pm$10.8,and 88.2$\pm$17.7 mmHg. Pulmonary edema was observed histologically in 2/10 animals in group IV, 6/10 in group V , 3/10 in group VI, 9/10 in group I, and the other lungs showed all edema. We established a stable model by setting ischemic time,and temperature, between 75 to 90 minutes,15 to 20o C, and isotemperature Hartmann`s solution immersion of the pleural cavity.

• Journal of Chest Surgery
• /
• 제39권8호
• /
• pp.655-658
• /
• 2006

중피낭종은 드문 종격동질환으로서 주로 우측 심장횡격막 각에서 잘 발생한다. 그러나 드물게는 비전형적인 위치에서 발생하며 특히 후 종격동에서의 발생은 매우 드물다. 교통사고로 내원한 30세 여자환자에서 우연히 심낭과 척추체 사이의 후 종격동에 위치하는 큰 낭종이 발견되었다. 낭종은 장축이 18 cm에 이르는 매우 큰 크기였으며 주로 좌측 흉강 쪽으로 커져 있었으나 환자는 증상을 호소하지 않았다. 반대측 흉강으로의 박리에 어려움이 있어서 작은 수술창을 동반한 비디오흉강경 수술로 완전 절제를 시행하였다. 장기 관찰에서 재발 없이 경과는 양호하였다.

• Journal of Trauma and Injury
• /
• 제32권2호
• /
• pp.107-110
• /
• 2019

Bilateral chylothorax due to blunt trauma is extremely rare. We report a 74-year-old patient that developed delayed bilateral chylothorax after falling off a ladder. The patient had a simple 12th rib fracture and T12 lamina fracture. All other findings seemed normal. He was sent home and on the 5th day visited our emergency center at Halla Hospital with symptoms of dyspnea and lower back pain. Computer tomography of his chest presented massive fluid collection in his right pleural cavity and moderate amounts in his left pleural cavity with 12th rib fracture and T11-12 intervertebral space widening with bilateral facet fractures. Chest tubes were placed bilaterally and chylothorax through both chest tubes was discovered. Conservative treatment for 2 weeks failed, and thus, thoracic duct ligation was done by video assisted thoracoscopic surgery. Thoracic duct embolization was not an option. Postoperatively, the patient is now doing well and happy with the results. Early surgical treatment must be considered in the old patient, whom large amounts of chylothorax are present.

• Tuberculosis and Respiratory Diseases
• /
• 제60권5호
• /
• pp.516-522
• /
• 2006

배 경 : 결핵성 농흉은 단순 결핵성 흉막염보다 빈도는 낮으나 공동이나 중증 폐결핵과 흔히 동반되 고, 배농과 함께 장기적인 치료를 요하는 흉강의 만성적 활동성 감염질환이다. 국내에서도 이러한 결핵성 농흉 환자가 드물지 않게 발생하고 있으나 지금까지 이에 대한 연구가 거의 없었다. 방 법 : 1991년 1월부터 2004년 4월까지 경북대학교병원에서 결핵성 농흉으로 진단된 17예의 환자를 대상으로 후향적 조사를 시행하였다. 결 과 : 대상환자 17예 중 12예(71%)에서 폐결핵 치료 과거력(6예) 혹은 현재 치료중인 폐결핵(6예)과 관련이 있었으며, 가장 흔한 증상으로는 객담이 동반된 기침, 발열, 호흡곤란의 순이었다. 중증 폐결핵 병변이 53%, 공동성 병변이 12%, 농기흉이 41%에서 관찰되었다. 흉막액 분석이 가능하였던 8예 모두에서 다형핵백혈구 우세의 삼출액이었으며, 세균성 감염이 47%에서 동반되어 있었다. 객담 항산균 도말검사는 71%, 객담 결핵균 배양검사는 64%에서 양성을 보였으며, 흉막액의 항산균 도말검사는 33%, 흉막액 결핵균 배양검사는 36%에서 양성을 보였다. 추적 관찰된 16예 중에서 외과적 치료를 시행한 3예를 포함한 12예(75%)에서 성공적으로 치료되었고, 2예(12%)는 사망하였다. 결 론 : 결핵성 농흉은 농기흉을 동반한 중증의 폐결핵과 흔히 동반되고, 흉막액의 백혈구 감별계산에서 다형핵백혈구 우세를 보이며, 흉막강의 세균성 감염이 흔히 동반되었다. 따라서 심한 폐병변과 동반되어 완전한 농이나 다형백혈구 우세 소견을 보이는 화농성 흉막액 환자에서 결핵성 농흉을 감별진단에 반드시 고려하여 이에 대한 적극적인 조사와 치료가 필요할 것으로 생각된다.

• Tuberculosis and Respiratory Diseases
• /
• 제47권5호
• /
• pp.601-608
• /
• 1999

연구배경: 결핵성 흉막염은 항결핵요법만으로 치료가 잘되므로 일반적으로 진단적 흉수천자이외에 흉막염의 적극적 배액은 불필요하다고 알려져 있다. 그러나 항결핵요법 후에도 흉막박피술등의 처치가 필요할 정도로 흉막비후가 오는 경우를 비교적 흔히 접하게 된다. 이에 저자들은 소방이 형성된 결핵성 흉막염 환자에게 경피적 도관을 이용한 유로키나제 치료로 적극적 배액을 시도한 경우와 진단적 흉수천자와 항결핵요법으로 치료한 경우 흉막비후의 차이가 있는지에 대한 비교연구를 함으로서, 소방이 형성된 결핵성 흉막염 환자에서 유로키나제에 의한 흉막비후에 대한 치료효과를 결정하고 자하였다. 방 법: 소방이 형성된 결핵성 흉막염으로 확진된 37명의 환자를 대상으로 전향적 무작위연구로 16명의 유로키나제군(경피적 도관을 삽입 후 유로키나제 투여+항결핵제 투여)과 21명의 비유로키나제군(항결핵제 투여)으로 나누어, 두군 환자들의 치료전 후의 흉부사진으로 흉막비후(RPT) 을 관찰하였으며, 또한 두 군의 진단당시 임상상 및 흉막액의 백혈구수, pH, 혈당, 단백질, LDH, ADA를 비교하였다. 결 과: 1) 유로키나제군과 비유로카나제군의 흉막비후는 각각 $5.08{\pm}6.77$ mm와 $20.32{\pm}26.37$ mm로, 유로키나제군에서 흉막비후가 유의하게 적었다(P<0.05). 2) 두 군의 흉막비후에(RPT$\geq$10 mm) 영향을 미치는 임상적 지표 중 흉통, 발열, 호흡곤란 등 치료 전 증상 발현기간이 흉막비후가(RPT$\geq$10 mm) 있는 경우(평균 $5.23{\pm}3.89$ 주)가 흉막비후가 없는 경우(평균 $2.63{\pm}1.99$ 주)보다 의의 있게 길었다(p<0.05). 3) 흉막비후(RPT는 10 mm)의 예측인자로 흉수액 천자검사에서 백혈구수, pH, 혈당, 단백질, LDH, ADA등은 차이가 없었다. 결 론: 소방이 형성된 결핵성 흉막염 환자에서 항결핵제 치료 와 함께 유로키나제를 이용한 흉막액의 적극적 배액시 흉막비후의 후유증을 줄일 수 있는 것으로 생각된다.

• Korean Journal of Acupuncture
• /
• 제32권3호
• /
• pp.124-129
• /
• 2015

Objectives : The purpose of this study is to understand truncus area conception to be explained in the pyobon and geungyul (Root-Stem and Origin-End relationships; PG) of meridian theory as to do the macro organic spatial conception in bio-mechanic system for human body. Methods : The extremity areas and truncus area to be explained in PG theories were classified spatially, and the reason was discussed that human body was classified as the extremities and truncus areas for the people of old times. It was considered the structural characteristics, exercise species and movement characteristics of truncus area in human body also. Results : The truncus area were made of cranium, vertebrae, sternum, ribs, clavicle, scapula, sacrum and the hipbone. It was the hollow structure and classified as cranial cavity, pleural cavity(thoracic cavity) and pelvic cavity. These cavities had mutually organic relationships, and because of cavity structures in the truncus and full structures in extremities would act in different direction about gravity with each other for movements. So it would be estimated that the old peoples had to need to separate the truncus and the extremities. Conclusions : In this study, the truncus area and the extremity areas in the PG of meridian theory could be recognized as the spatial conception of bio-mechanic system in human body. Although this study was the theoretical study not to be proven, it will be used to understand for the meridian theory as basic reference for spatial conception and bio-mechanic system.