• Asian Pacific Journal of Cancer Prevention
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• 제17권3호
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• pp.1411-1414
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• 2016

Background: Eosinophilic pleural effusion (EPE) is an eosinophil count more than 10% on cytology of pleural samples. Recently, it was reported that malignancy had been the most prevalent cause inducing EPE. Therefore, we conducted an analysis on the prevalence and etiology of EPE and investigated the relationship between EPE and malignancy. Materials and Methods: Data for pleural cell differential count from patients receiving thoracentesis during the period from January 2008 to December 2013 were compared with clinical data and established diagnosis of patients obtained via electronic chart review. Results: A total of 6,801 requests of pleural cytology from 3,942 patients with pleural effusion who had received thoracentesis were available at Far Eastern Memorial Hospital from 2008 to 2013, and of these subjects, 115 (2.9%) were found to have EPE. The most frequent cause of EPE was malignancy (33.0%, n=38), followed by parapneumonic effusions (27.8%, n=32), tuberculosis pleuritis (13.9%, n=16), transudate effusions (12.2%, n=14) and the presence of blood or air in pleural space (10.4%, n=12). Additionally, an inverse relationship of eosinophilia in pleural fluid was identified in patients with malignancy and EPE. The cut-off eosinophil count in pleural fluid was 15% for the most accurate discrimination between malignancy and benign disorders in patients with EPE. At the cut-off level, the sensitivity and specificity were 65.8% and 67.5%, respectively. Conclusions: Pleural fluid eosinophilia was a speculative negative predictor for malignancy, despite the fact that cancers, including lung cancers and metastatic cancers to lung, were the most leading cause of pleural fluid eosinophilia. An inverse correlation was observed between the pleural eosinophil percentage and the likelihood of malignancy in patients with EPE.

• Tuberculosis and Respiratory Diseases
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• 제62권2호
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• pp.119-124
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• 2007

Sarcoidosis is a multi-system granulomatous disorder of an unknown etiology and affects individuals worldwide. It is characterized pathologically by the presence of non-caseating granulomas in more than one involved organ. However, pleural involvement of sarcoidosis is rare and there are no reported cases in Korea. Traditionally, sarcoidosis has often been treated with systemic corticosteroids or cytotoxic agents. In particular, chylothorax with sarcoidosis is usually treated with corticosteroid for approximately 3~6 months, followed by repeated therapeutic thoracentesis, talc pleurodesis, dietary treatment, or thoracic duct ligation where needed. We encountered a 46 years old female patient presenting with cough, dyspnea and both hilar lymphadenopathy (stage I) on chest radiograph. The patient was diagnosed with a non-caseating granuloma, sarcoidosis by a mediastinoscopic biopsy. For one month, she had suffered from dyspnea due to right side pleural effusion, which was clearly identified as a chylothorax on thoracentesis. Corticosteroid therapy with dietary adjustment was ineffective. She was treated successfully with a subcutaneous injection of octreotide for 3 weeks and oral corticosteroid. We report a case of successful and rapid treatment of chylothorax associated with sarcoidosis using octreotide and oral corticosteroid.

• Tuberculosis and Respiratory Diseases
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• 제74권2호
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• pp.74-78
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• 2013

A 61-year-old woman came to the hospital with dyspnea and pleural effusion on chest radiography. She underwent repeated thoracentesis, transbronchial lung biopsy, bronchoalveolar lavage, and thoracoscopic pleural biopsy with talc pleurodesis, but diagnosis of her was uncertain. Positron emission tomography showed multiple lymphadenopathies, so she underwent endobronchial ultrasound-guided transbronchial needle aspiration of mediastinal lymph nodes. Here, we report a case of malignant pleural mesothelioma that was eventually diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration. This is an unusual and first case in Korea.

• Journal of Chest Surgery
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• 제9권2호
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• pp.125-132
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• 1976

The author made clinical study of 100 cases of empyema in infancy and childhood that were treated at the Department of Chest Surgery, Busan University Hospital and Busan Children's Charity Hospital, from Jan 1962 to Nov. 1975. 1. In infancy and childhood, 62 cases out of my 100 cases of empyema were caused by .staphylococci and most of recent reports showed a gradual increase in number of staphylococcal empyema. 2. Most frequent lesion predisposing to empyema in infancy and childhood was pneumonia (72%), being remarkable in staphylococcal empyema (85.5%) to that of others. 3. Antibiotics sensitivity test for staphylococci revealed that the erythromycin was most susceptible (85. 5%). 4. The mortality rate was 6% in over all and the author believes that from the point of view of surgical treatment, failure of early continuous drainage on account of multiple thoracentesis for the early stage of empyema, and also early open thoracotomy procedure such as decortication were all the contributing factors to higher mortality in the empyema of infancy and childhood. 5. It may be concluded that the treatment of choice for empyema in infancy and childhood were early and prolonged continuous drainage of pus by closed thoracotomy with caution and administration of more susceptible antibiotics with nutritional support.

• Journal of Chest Surgery
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• 제9권1호
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• pp.102-106
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• 1976

The management of infection occurring in the space which remains after removal of lung presents considerable difficulties both for the patient and the surgeon. We have during the past one year, developed a procedure, which has been successfully applied in 4 cases of postpneumonectomy empyema by modification of Clagett's procedure. All their underlying lung diseases were pulmonary tuberculosis. The diagnosis of postpneumonectomy empyema was confirmed by thoracentesis, and bacteriologic cultures were obtained in all patients. Dead space thoracis was irrigated with various kind of antiseptic Solutions and debrided, filled with antibiotics saline solutions. The patients had a smooth post operative course except one case and was discharged from the hospital on the 3 weeks post-operative day in average. The failure case was wound leaking & redeveloped empyema, & waiting for reoperation.

• Journal of Chest Surgery
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• 제21권6호
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• pp.1111-1116
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• 1988

Neurofibromatosis is very rare syndrome characterized by abnormal cutaneous pigmentation and numerous skin tumors was described by Smith in 1849, which is inherited as an autosomal dominant trait. Von Recklinghausen reported 2 cases of multiple skin and subcutaneous tumors in 1982. Malignant peripheral nerve tumors, although generally rare, are one of the most characteristic malignant tumors associated with Neurofibromatosis. We have experienced 3 cases of malignant Schwannoma in neurofibroma patients from 1982 to 1988 for 6 years at Thoracic and Cardiovascular surgery department, College of Medicine, Yonsei University, Seoul, Korea. l. One is 62 years old female who was taken total hysterectomy followed by irradiation treatment due to Uterine Carcinoma 21 years ago. She had a large bulging mass on left anterior chest wall and was taken enbloc resection of tumor including rib confirmed malignant Schwannoma. 2. Another is 18 years old female who had large bulging mass on right chest wall and pleural effusion in right thoracic cavity. Thoracentesis revealed a large amount of lymphocytes misdiagnosed of Tbc, pleurisy with Neurofibromatosis. We performed tissue biopsy on bulging mass and the specimen was confirmed malignant Schwannoma 2 months after first diagnosis of Tbc. pleurisy. She was not accessible to radical resection because of far advanced malignant Schwannoma at that time. 3. Third case is 28 years old male who was taken enbloc resection of tumor including rib due to Neurofibroma with Neurofibromatosis at M. hospital 6 months ago. But he had rapid growing mass at operation site again and taken tissue biopsy confirmed of malignant Schwannoma. He was not accessible to enbloc resection due to malignant Schwannoma extending to mediastinal structures.

• Journal of Chest Surgery
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• 제20권1호
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• pp.65-70
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• 1987

Empyema thoracis following pneumonia, pulmonary tuberculosis, trauma and surgical procedures continues to be a source of major morbidity and mortality. We retrospectively reviewed the hospital records of 330 patients [child:87, adult243] treated for empyema thoracis at Catholic Medical Center between 1964 and 1986. The causes of empyema in these patients were as follows: pneumonia [C***:66%, A***:30%], pulmonary tuberculosis [C:2%, A:20%], lung abscess [C:3%, A:5%], postoperative complication [C:0%, A:13%], trauma [C:1%, A:4%] and unknown origin [C:23%, A:17%]. Three patients in this series died of sepsis from necrotizing pneumonia. Staphylococcus [29.3%], Streptococcus [8.8%], E. coli [8%], Mycobacterium tuberculosis [7.9%], Klebsiella [7.4%], Pseudomonas [6.4%], Bacteroides [3.4%] were the organisms most commonly isolated. Bacterial isolates were single in 68.3%, multiple 7.5% and absent 24.2%. The type of organism did not correlate with severity of disease or eventual requirement for closed thoracotomy drainage, open thoracotomy drainage [Modified Eloesser*s procedure], thoracoplasty, decortication or pleuropneumonectomy. Successful methods of treatment included aspiration in 44%, tube thoracotomy in 66%, open thoracotomy drainage in 98.7%, thoracoplasty in 98%, decortication in 96% and pleuropneumonectomy in 73%. Initial mode of management in empyema thoracis are thoracentesis and closed thoracotomy drainage. If the initial management was failed, we performed another surgical procedures. Before 1973, we manage with Schede`s thoracoplasty in the postpneumonectomy empyema patients. But thoracoplasty, with or without the use of muscle flaps, is a hazardous operation in the poor-risk patients. The permanent, open thoracotomy drainage is a relatively minor operation which is well tolerated even by cachexic, septic patients. It controls infection, and sometimes results in the bronchopleural fistula closing spontaneously.

• 사상체질의학회지
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• 제16권1호
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• pp.162-167
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• 2004

We managed a Taeumin(太陰人) patient with pleural effusion due to heart failure. We diagnosed as Wiwan-suhan-pyohan-byung(胃完受寒表寒病), and treated with Jowiseungchungtang(調胃升淸湯), going with western medicinal management. His chief complaint was orthopnea, chest discomfort, cough. The state of patient was measured with patient's complaints and chest X-ray. We gained outstanding improvement on patient's chief complaints, but there was no particular change of chest x-ray until thoracentesis. In this case, it seems that cooperations of east-west medicine would be beneficial to treatment of patients.

• Journal of Chest Surgery
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• 제32권6호
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• pp.599-602
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• 1999

유미흉은 보전적인 치료로는 비교적 실패할 확률이 높고 여러 가지 합병증을 동반할 수 있어 적극적인 수술적 치료를 고려하여야 한다. 환자는 51세된 여자로 지속되는 좌측의 흉수로 타병원에서 전원 되었다. 가능한 여러 가지 검사와 문진에서도 흉수의 원인은 알 수 없었고, 흉수천차로 유미흉은 확진할 수 있었다. 이전 병원에서 흉관을 통한 배액과 흉막 유착술을 시행한 보전적 치료가 실패하였으므로 적극적으로 수술적 치료를 시행하였다. 수술 소견상 종격동 흉막에서 국소적 누출을 발견하여 봉합하였으며, 동시에 흉막 박피술과 흉막 유착술을 시행하였다. 술후 경과는 순조로왔으며, 3개월 동안 흉수가 재발하지 않았다. 성인에서 일측성으로 나타나는 유미흉은 매우 드물며 성공적으로 수술적 치료를 하였다.

• Journal of Chest Surgery
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• 제7권1호
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• pp.13-22
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• 1974

A clinical evaluation was done on 120 cases of chest injury patients treated in the department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital for the period of 6 years and 3 months from January, 1968 to March, 1974. 1] Of 120 cases, 52 cases[43. 3%] were non-penetrating injuries and 65 cases[56.7%] penetrating injuries. Of them, 107 cases [89.2%] were males and 13 cases[10.8%] were females. 2] The most common etiology was stab wound[64 cases] and traffic accident[23 cases] was the next. 3] In 70% of all cases, treatment was initiated within 6 hours after receiving trauma. 4] The types of lesions in order of frequency were hemothorax[35 cases], chest wall injuries alone. 27 cases], hemopneumothorax [22 cases], pneumothorax[17 cases]. Of them, right sided lesions were 52 cases[43. 3%] and left sided lesions were 65 cases[54.2%] and 3 cases were bilateral lesions. 5] Repeated thoracentesis and closed thoracostomy were the treatment of choice in most cases in order to reestablish early and rapid reexpansion of the lungs. Open thoracotomy was, however, mandatory on 39 cases[32.5%]. 6] The overall mortality was 5.8% [7 cases]; 5 cases of nonpenetrating injuries and 2 cases of penetrating ones.