• Journal of Chest Surgery
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• v.8 no.2
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• pp.159-168
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• 1975

We have experienced 61 cases of Clinically diagnosed tuberculous peripleural abscess which was surgically treated at St. Mary's Hospital of Catholic Medical College from Mar. 1963 to Feb. 1974. Out of them, 52 cases of pathologically confirmed tuberculous peripleural abscess were reviewed and its pathogenesis, treatment and so called "rib caries" were discussed. In the past, they have been described as a variety of the names, such as rib caries, cold abscess of the chest wall, pericostal abscess, lymphadenitis tuberculosa of the chest wall, chronic draining sinuses of the chest wall and other descriptive terms. Although it has been said that the tuberculous abscess on the chest wall developed as a secondary disease from so called "rib caries" but now it has been clear that this abscess occurred not from tuberculosis of the rib but from tuberculous lesion developed between end-othoracic fascia and parietal pleura usually following pulmonary tuberculosis and/or tuberculous pleurisy and the involvement of rib or ribs are secondary one from peripleural abscess, as we confirmed. Therefore we advocate that the nomination, rib caries, should not be used unless there is a primary tuberculous lesion on ribs. The results were as follows: 1. The highest age group of tuberculous peripleural abscess was ranged from the first to third decade (78%) 2. The location of tuberculous peripleural abscess on the chest wall were as follows, 31 cases on the anterior, 19 cases on lateral and 2 cases on the posterior. 3. On x-ray examination, abnormal findings including parenchymal tuberculous lesion and pleural changes were seen is 38 cases. 4. There was no destructive change of periosteum and rib in 23 cases of tuberculous peripleural abseess during operation. However the periosteal denudation and/or rib destruction were found in 29 cases. 5. The all cases of tuberculous peri pleural abscess developed from between endothoraclc fascia and parietal pleura, as we confirmed. With antituberculous therapy, operation should be radical by wide incision on the lesion including thorough curettage with proper drainage of Iiquified caseating materials and appropriate rib resection, if necessary.tion, if necessary.

• Journal of Chest Surgery
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• v.35 no.5
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• pp.392-396
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• 2002

Background: Video-thoracoscopy is known to be an useful method to provide accurate pre-resectional staging in patients with lung cancer in addition to the conventional radiologic studies and mediastinoscopy, for the pleural cavity is inspected directly and biopsy specimens call be obtained. This study is undertaken to evaluate how video-thoracoscopy can be used in deciding pre-resectional stage Material and Method: Video-thoracoscopy was performed in patients with lung cancer who were scheduled for surgical resection based on the radiologic staging and mediastinoscopic biopsy. 37 patients were included in this study. Pre-thoracoscopically 18 cases were in TNM stage 1, 7 in stage 2, and 12 in stage 3. Result: In 15 of 37 cases, video-thoracoscopy could not be performed effectively due to heavy adhesions in the pleural cavity, diaphragmatic and chest wall invasion of tumor and bulky tumor mass es. Mediastinal lymph nodes were positive postresectionally in 6 of these 15 cases. In 22 cases, video-thoracoscopy was performed as usual. Positive mediastinal lymph nodes were identified in 2 cases and exploratory thoracotomy was prevented. Surgical resection were carried out in remaining 20 cases and 5 cases among them had positive mediastinal lymph nodes. Conclusion: We believe that it is difficult to perform pre-thoracotorny video-thoracoscopy for all lung cancer patients for there were many cases that thoracoscory could not be undertaken doe to heavy adhesions in the pleural cavity, tumor involvement of the chest wall and/or diaphragm and bulky tumor mass. However we think it is helpful in preventing unnecessary exploratory thoracotomy for some patients with lung cancer whom pre-thoracotomy video-thoracoscopy was carried out.

• Tuberculosis and Respiratory Diseases
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• v.66 no.2
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• pp.116-121
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• 2009

Background: Tsutsugamushi, leptospirosis and hemorrhagic fever with renal syndrome (HFRS) are the prevalent diseases among the acute febrile illnesses in Korea. Pulmonary involvement in the patients with these diseases remains poorly recognized in endemic regions, and this is despite reports of recent outbreaks and epidemic episodes. Pulmonary involvement and a higher CRP level as clinical manifestations show a more severe form of infection. The aim of this study is to analyze the correlation of pulmonary involvement and the CRP level in patients with acute febrile illnesses. Methods: We retrospectively reviewed the clinical records of 105 patients who were diagnosed with tsutsugamushi, HFRS and leptospirosis from January 2002 to May 2008 in Chuncheon Sacred Heart Hospital. The radiographic images were retrospectively analyzed by two radiologists. We analyzed the pulmonary complications of the patients with these febrile diseases and we checked the CRP level at admission. Results: The study included 105 patients who were diagnosed with febrile diseases. Of these patients, 32 patients had hantaan, 10 patients had leptospirosis and 63 patients had tsutsugamushi disease. 42 (40%) patients had pulmonary complications, 20 patients had pulmonary edema, 20 patients had pleural effusion and 2 patients had interstitial pneumonitis. The patients with pulmonary involvement showed a more severe form of infection and a higher CRP level than that of those patients without pulmonary involvement (p=0.0073). Conclusion: Pulmonary involvement in patients with acute febrile diseases might be correlated with a higher CRP level. Identification of this factor on admission might provide useful selection criteria for the patients who need early intensive care.

• Tuberculosis and Respiratory Diseases
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• v.42 no.2
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• pp.156-164
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• 1995

Background: We had undergone this study to investigate clinical progress of this disease and to decide the role of aggressive diagnostic approaches, the efficacy of treatments and prognoses. Methods: A retrospective study was done on 113 patients who had been diagnosed to metastatic adenocarcinoma of pleura by pleural fluid cytology(106 cases) or pleural needle biopsy(22 cases), at Presbyterian Medical Center, from Jan. 1990 to Dec. 1994. Results: 1) The patients were composed of 59 males(52.2%) and 54 females(47.8%), and the mean age distribution was $57.4{\pm}12.1$ years. 2) The site of origin was lung cancer 46.9%(53/113), stomach cancer 20.4%(23/113), breast cancer 11.5%(13/113), and unknown primary site 6.2%(7/113 cases), as a whole. In male, lung cancer was 55.9%(33/59), stomach cancer was 28.8%(17/59), and in female, lung cancer was 37%(20/54), breast cancer was 24.1%(13/54) of cases. 3) The cardinal symptoms were dyspnea(69%), cough(61%), chest pain(50%), weight loss(50%), anorexia(49%), sputum(43%), malaise(30%). 4) The pleural fluid findings were exudative in 94.4%(102/108), serosanguinous or bloody in 36~53%, unilateral involvement in 74.3%(84/113) of cases, and lymphocyte predominance($71{\pm}27%$) in differential count of WBC. 5) CEA levels in pleural fluid or plasma were over 10ng/ml in 60.6%(40/66), and ADA levels in pleural fluid were under 40U/L in 95%(57/60) of cases. 6) The patients were managed by various methods, but the efficacy of treatment was uncertain. 7) The mean survival time was $12.7{\pm}13.5$ weeks. Conclusion: It seems to be no effective treatment methods yet and the prognosis was very poor in this disease, so the objectives of diagnostic approaches and treatment methods should be directed to early diagnosis, treatment and prevention of curable disease. And we must make our best endeavors to lengthen the survival time and improve the quality of patients' life.

• Journal of Chest Surgery
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• v.23 no.2
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• pp.285-298
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• 1990

The records of 67 patients who had been operated as an esophageal cancer during the period from 1973 to 1989 at the Department of Thoracic and Cardiovascular Surgery, Hanyang University Hospital were reviewed retrospectively. The results were summarized as follows ; The age ranged from 28 years old to 80 years old. The highest incidence was 5th decades, then 6th decades, and the incidence of male was 10 times as the incidence of female[M:F= 10.16: 1]. The locations were lower esophagus 44%, middle esophagus 38.8%, upper esophagus 11.9% and cervical esophagus 4.4% The frequent symptoms were dysphagia [88%], epigastric or substernal pain and discomfort [29.8%], weight loss [20.8%], and laryngeal dryness [1.4%]. The most common interval between the onset of dysphagia and admission was 2-3 months; 82% of patients was within 6 months, The cancer consisted of stage I [3%], stage II [11.9%], stage III[47.6%], and stage IV [33.7%] The resectability of cancer was 67%. The organs of substitute were stomach in 21 cases, right colon 6 cases, and jejunum in 8 CRSCS. The relation between invasion of tumor and lymph node metastasis was analyzed: mucosal involvement: 1 case/2case, muscle invasion; 0/2 full thickness; 4/6, adjacent structure 7/12. Postoperative complications were pneumonia, pleural effusion, hoarseness, mediastinitis, anastomosis site leakage, reoperation due to stenosis, chylothorax, empyema, mechanical ileus, wound infection, meat impaction at anastomosis site, and repair of gastrostomy site leakage. Adjuvant therapies were irradiation [15cases], chemotherapy [14cases], and Bougie dilatation [4 cases],

• Journal of Chest Surgery
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• v.23 no.6
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• pp.1221-1224
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• 1990

Fifty -six cases of tuberculous peripleural abscess were experienced in the department of thoracic and cardiovascular surgery, college of medicine, Hallym university from January 1980 to June 1990. Tuberculous peripleural abscess seems to originate from the space between the parietal pleura and endothoracic fascia. But rib caries, originated by hematogenous spread of mycobacteria to the rib, shows the rib destruction first, thereafter periosteal erosion and regional tissue involvement follows. In our 56 cases, results were as follows: 1. Their age ranged from 6 to 82 years, and female dominant [M: F=21: 35]. 2. The locations of abscess were 31 right, 23 left, and 2 sternal portions. 3. On X \ulcornerray findings, 37 cases showed active or old lesion of the tuberculosis in the lung field, 7 cases periosteal destruction of the ribs, and 29 cases pleural thickening. 4. Operative findings showed cold abscess with multiple fistulous tracts leading to intercostal space in most of the cases, and their origin were presumed to be from the space between the endothoracic fascia and parietal pleura. 5. The pus showed negative AFB stain in most of the cases except 3 cases. 6. Partial costectomy and radical curettage with drainage were performed in all cases. 7. 7 cases recurred after the first operations, but no recurrence after second operations.

• Childhood Kidney Diseases
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• v.23 no.2
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• pp.128-133
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• 2019

Henoch-$Sch{\ddot{o}}nlein$ purpura (HSP) is a systemic vasculitis characterized by purpura, arthritis, abdominal pain, and nephritis. Gastrointestinal involvement can manifest as pain, intussusception, intestinal bleeding, and intestinal perforation. We report a case of fulminant HSP at an age of eight in 1994, with multiple complications of intra-thoracic bleeding, massive intestinal perforation, nephritis, and various skin rashes. The brisk bleeding findings of intestinal on Technetium-99m-labeled red blood cell scan ($^{99m}Tc$ RBC scan) were well matched to those of the emergency laparotomy and the resected intestine. The patient's abdominal conditions improved gradually but nodular skin eruptions developed newly apart from improving preexisting lower limb rashes and the urine findings continued abnormal, so skin and kidney biopsy were done for the diagnosis. After cyclosporine therapy, skin eruptions and urine findings returned to normal gradually. On a follow-up after 25 years in 2019, the patient is 33-year-old, healthy without any abnormality on blood chemistries and urine examination.

• Journal of Chest Surgery
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• v.29 no.5
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• pp.517-523
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• 1996

From May 1988 to June 1994, )73 patients underwent exploratory thoracotomy for resection of non- small cell lung cancer, and 48 patients staged pathologically as lIIB were analyzed. 74 lesions were involvement of great vessel (n=26), heart (n=5), ipsilateral lung metastasis(n=4), esophagus (n=4), carina(n=3), mediastinum (n=2), trachea(n=1), spine (n=1) and 13lourO seeding(A=15). N3 lesions were involved in 6 patients. Extended pulmonary resection with radical mediastinal node dissection was possible in 25 patients, and exploration only was performed in 23 patients. The most frequent cause of unresectability was pleural seeding. Postoperative morbidity was )2 % (8125) and mortality was 16 % (41 25) in resected group. The adjutant therapy was given to 37 patients. The 1 year and 3 year survival for resected group ncluding operative deaths was 57.2%, and 2).8 % (median 15 months), but 48.4%, and 0 % (median 7 months) for exploration only group (Log-Rank test, p : 0.17). Our results suggest that extended pulmonary resection might be helpful for carefully selected patients with 74 non-small cell lung cancer, but meticulous preoperative work-up for staging, especially to detect pleural seeding and Invasion to the irlediastinal structures is a prerequisite to avoid unnecessary thoracotomy.

• Tuberculosis and Respiratory Diseases
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• v.59 no.6
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• pp.674-678
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• 2005

A 78-year-old man was admitted to our hospital as a result of dyspepsia with a 2-month duration. Upon admission, the laboratory data showed a marked elevation in amylase activity in both the serum and urine. The pancreas and salivary glands were considered unlikely to have any clinical involvement in the hyperamylasemia. The chest PA revealed a right side pleural effusion, and the chest CT showed a heterogeneous enhancing mass on the subcarinal area. The patient was diagnosed bronchoscopically with a poorly differentiated squamous cell carcinoma. The amylase isoenzyme patterns indicated the salivary types, but lung cancer was strongly suspected to be the source. In most cases, lung cancers with hyperamylasemia have been diagnosed as adenocarcinomas. A squamous cell carcinoma is quite rare. We report an interesting case of squamous cell lung cancer with hyperamylasemia.

• Clinical and Experimental Pediatrics
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• v.54 no.3
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• pp.123-127
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• 2011

Purpose: Kawasaki disease (KD) is the main cause of acquired heart disease in children. In addition to cardiovascular involvement, many complications have been recognized in KD. However, respiratory complications have been rarely reported. We investigated the differences in clinical characteristics, laboratory findings, radiography findings, and echocardiography findings of Mycoplasma pneumoniae infection and other types of pneumonia in KD patients. Methods: Among 358 patients with KD, 54 developed concurrent pneumonia. Among the 54 patients, 12 (22.2%) with high titers of anti-M. pneumoniae antibody (AMA) (>1:640) were grouped in the M. pneumoniae group and 42 were included in the control group. Serum AMA was measured in each patient. Clinical laboratory findings and total duration of fever were analyzed. Results: The duration of fever, serum hemoglobin, white blood cell count, platelet count, erythrocyte sedimentation rate, C-reactive protein level, albumin level, and the incidence of coronary arterial lesions showed no statistical difference in the 2 groups. Neutrophil count was significantly higher in the M. pneumoniae group than in the control group. Among various radiography findings observed in pneumonia, consolidation and pleural effusion were more frequent in the M. pneumoniae group than in the control group. On the other hand, parahilar peribronchial opacification, diffuse interstitial lesion, and normal findings prevailed in the control group. Conclusion: KD patients can have concurrent infections, especially pulmonary symptoms. The cause of KD is likely to be associated with M. pneumoniae infection. Thus, immediate treatment of M. pneumoniae infection in KD patients is very important.