연구배경: 결핵성 흉막염은 대부분 초감염 결핵의 형태로 발생하는 것으로 알려져 왔다. 그러나 최근 결핵환자가 감소함에 따라 초감염 결핵보다 재발성 결핵으로 결핵성 흉막염이 발생하는 경향이 늘고 있다. 대상 및 방법: 2003년 1월부터 2006년 2월까지 단국대학교병원에서 결핵성 흉막염으로 진단받은 환자들의 과거력과 방사선 소견에 따라 초감염 결핵과 재발성 결핵으로 분류하고 두 군 사이에 임상 소견, 방사선 소견, 그리고 6 개월 동안 항결핵 약물치료 후 잔여 흉막비후에 있어서 차이가 있는지 알아보았다. 결 과: 1. 결핵성 흉막염 환자 141명 중에서 135명에서 초감염 결핵과 재발성 결핵의 구분이 가능하였는데 초감염 결핵의 소견을 보인 환자는 38명(28%), 재발성 결핵의 소견을 보인 환자는 97명(72%)으로 재발성 결핵의 소견을 보이는 환자가 더 많았다.2. 초감염과 재발성 결핵 환자 사이에서 성별, 나이, 증상의 발현 시작부터 흉수검사까지의 기간, 진단 시의 흉수의 양, 흉수 총백혈구수, 림프구수, LDH, ADA 수치에 있어서 유의한 차이가 없었다.3. 6개월 이상 추적관찰이 가능하였던 124명의 환자들의 잔여 흉막비후의 정도에 있어서 초감염 결핵과 재발성 결핵 사이에 차이가 없었다.
Backgroud: Traditionally, tuberculous pleurisy has been known to largely develop as primary tuberculosis. However, as the incidence of tuberculosis decrease, recent studies have shown reactivation tuberculosis has become the main cause of tuberculous pleurisy. Methods: 141 cases of tuberculous pleurisy, between January 2003 and February 2006, at the Dankook university hospital. were retrospectively studied. The patients were divided into primary and reactivation tuberculosis. based on the history and radiological characteristics, and the clinical, radiological characteristics at the time of diagnosis and residual pleural thickening after 6 month of chemotherapy were compared between the two groups. Results: 1. Of the 141 tuberculous pleurisy cases, in 135 it was possible to differentiate between primary and reactivation tuberculosis. 2. Of the 135 tuberculous pleurisy cases, 38 (28%) showed a primary tuberculosis pattern, and 98 (72%) showed a reactivation tuberculosis pattern. 3. There were no significant differences between primary and reactivation tuberculosis in relation to age, sex, duration of symptom, amount of pleural effusion, pleural fluid WBC, lymphocyte count, and level of protein, LDH and ADA at the time of diagnosis 4. 124 patients were followed for 6 months after diagnosis of tuberculous pleurisy, and there was no significant difference in the residual pleural thickening between primary and reactivation tuberculosis. Conclusion: In South Korea, a reactivation disease is currently a more common cause of tuberculous pleurisy than a primary disease. There was no difference in the clinical characteristics between primary and reactivation tuberculosis. (Tuberc Respir Dis 2006; 61: 526-532)
배 경: 만성폐쇄성폐질환의 여러 가지 호흡재활프로그램 중에서 자기효능감을 증진시키는 것이 호흡재활치료에 효과적이라는 국외 보고는 있으나 국내에서는 연구가 시도되지 않았다. 저자들은 만성폐쇄성폐질환자에서 자기효능감증진 호흡재활프로그램의 효과를 알아보기 위하여 이 연구를 하였다. 대상 및 방법: 대상은 호흡기내과 외래에서 진료 받는 만성폐쇄성폐질환자 중 GOLD분류에 의한 Ⅱ,III 병기 환자로 하였으며, 치료군 18명, 대조군 18명으로 선정, 비교하였다. 연구는 무작위할당 대조군 전-후연구로 이루어졌다.
Background: The aim of this study was to determine the effectiveness of self-efficacy promoting pulmonary rehabilitation in patients with chronic obstructive pulmonary disease (COPD). Methods: thirty six patients, with clinically stable COPD were randomly assigned: 18 to a rehabilitation group and another 18 as a control group, The subjects participated in a the self-efficacy promoting pulmonary rehabilitation program for 8 weeks. This program consisted of education, breathing retraining, exercise training, relaxation and counseling. The control group received education only. The outcome variables were self-efficacy, dyspnea, exercise endurance, pulmonary function, and quality of life. Dyspnea was measured using the modified Borg scale. Exercise endurance was measured by the six minute walking distance. The quality of life was measured by the quality of life index for pulmonary disease patients. Results: In the rehabilitation group after performing the self-efficacy promoting pulmonary rehabilitation program, the self-efficacy score, exercise endurance, and quality of life score were higher than the control group (p=0.007, p=0.038, and p=0.039, respectively). and the exertional dyspnea score was significantly lower than controls(p=0.045). However, the dyspnea score and FEV1 were similar after performing the self-efficacy promoting pulmonary rehabilitation program. Conclusion: The self-efficacy promoting pulmonary rehabilitation program is effective to in improve self-efficacy, exertional dyspnea, exercise endurance and quality of life in patients with COPD. (Tuberc Respir Dis 2006; 61: 533-546)
배 경: 액상 세포학 검사법(Liquid-based cytology) 은 최근들어 각광을 받고있는 검사방법으로 여러 연구, 특히 산부인과적 영역에서 암진단에 높은 효율성을 보여주고 있다. 본 저자들은 기관지내시경상 이상병변을 보이는 환자에서 세척세포진, 솔질세포진, 액상 세포학 검사법인 Thinprep을 시행하여 진단율 및 효용성을 비교하여 보았다.방법 및 대상: 본원에서 2005년 6월부터 9월까지 호흡기적 증상을 보여 내원한 환자 중 기관지내시경을 시행하여 병변이 발견된 30명의 환자에서 Thinprep과 기존세포검사를 시행하였다.결 과: 이상병변을 보였던 30명의 환자 중 조직검사를 통해 암을 진단받은 환자는 24명이었으며 4명은 결핵, 각각 1명씩은 기관지확장증, 기관지-폐누공을 진단받았다. Thinprep에서 암인 24명의 환자 중 19명이, 기존세포검사에서 기관지솔질검사(brushing)을 통해 얻은 결과가 17명, 세척액(washing)은 12명에서 암세포나 비전형세포가 보였다. 두 방법 모두 암이 아닌 환자에서는 비전형세포는 보이지 않았다. 세척세포진검사는 민감도 50%, 특이도 100%, 양성예측도 100%, 음성예측도 33.3%, 솔질세포진검사는 민감도 70.8%, 특이도 100%, 양성예측도 100%, 음성예측도 46.2%, Thinprep에서는 민감도 79.2%, 특이도 100%, 양성예측도 100%, 음성예측도 54%를 보였다.
Background: Liquid-based cytology is currently known as an effective method, and cervical cytology has been shown to be especially effective from of malignancy detection. In our study, the cytological detection rates of the Thinprep (Liquid-based cytology) and conventional cytology (bronchial washing & brushing) for endobronchial lesions were compared. Methods: Between July 2005 and September 2005, the data from 30 patients with respiration symptom, who had shown abnormal lesion on bronchoscopy, were collected. Results: The bronchoscopic biopsy group was consisted of 30 cytodiagnosis specimens, 24 of which were confirmed to be malignant. The others were tuberculosis (4), bronchiectasis and bronchopulmonary fistula (1 each). Of the 24 malignant case, cancer or atypical cells were detected in 19, 17 and 12 of the Thinprep, brushing cytology and washing cytology cases, respectively. None one of the methods detected cancer cells in the non-malignant specimens. Washing cytology has shown sensitivity, specificity, and positive and negative predictive values of 50, 100, 100 and 33.3% respectively. Brushing cytology has shown sensitivity, specificity, and positive and negative predictive values of 70.8, 100, 100 and 46.2%, respectively. Thinprep has shown sensitivity, specificity, and positive and negative predictive values of 79.2, 100, 100 and 54%, respectively. Conclusions: Thinprep (liquid-based cytology) showed better sensitivity and negative predictive values for the evaluation of lung cancer than conventional cytology. However a large-scale study will be needed in the future. (Tuberc Respir Dis 2006; 61: 547-553)
Fat embolism syndrome is a rare clinical diagnosis of dyspnea with acute respiratory failure and neurological signs caused by a traumatic long bone fracture. We report a case of fat embolism in a 22 year-old man after a traffic accident. Dyspnea and stuporous mental changes developed on the 1st day after the external fixation operation of a left metaphyseal femur fracture. On the following day, he was transferred from a hospital to this one because of acute respiratory failure. After recovery, macrophages with fat droplets were found in the bronchoalveolar lavage fluid 1. It is important to diagnose a fat embolism as the correct cause of acute respiratory failure through the BAL in the acute state of fat embolism syndrome It is believed that clinically apparent or sometimes hidden fat embolism syndrome can be diagnosed from the BAL during the recovery state. (Tuberc Respir Dis 2006; 61: 562-566)
저자들은 기관지 내에 이물이 있음을 알고도 장기간 간과하여 이로 인해 대량객혈과, 폐쇄성 폐렴 등이 발생하였고 이물의 자발적인 제거로 임상 증상 및 방사선적인 호전을 보인 증례 1예를 경험하였기에 보고하는 바이다. 또한 증상이 없는 폐 이물질이 우연히 발견된 경우에도 향후 이물질로 인한 합병증 발생의 가능성을 생각해서 제거에 대한 필요성을 환자에게 적극적으로 알릴 필요가 있다는 점을 느낀 증례이다.
Endobronchial foreign bodies are difficult to diagnose as the cause of obstructive pneumonia and atelectasis, However, once discovered, they can generally be removed, leading to an immediate and dramatic resolution of the symptoms. Occasionally, small foreign bodies that lodge in the peripheral airway are often initially asymptomatic but become symptomatic several years later. We reported a case of obstructive pneumonia and massive hemoptysis caused by a foreign metallic body. The patient knew that the foreign body was lodged in the peripheral airway on the chest X-ray, but did not want treatment. Several years later, he had a massive hemoptysis and obstructive pneumonia. Removal with a flexible bronchoscope failed, but the metallic foreign body was self-expectorated by coughing after the procedure. The pneumonia was resolved after removing the foreign body. The patient improved and was discharged without any sequela. (Tuberc Respir Dis 2006; 61: 567-572)
저자들은 융기성 피부섬유육종을 완전 절제한 환자에서 5년 후에 원발부위에 재발없이 폐에 단독으로 전이된 1예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.
Dermatofibrosarcoma protuberans (DFPS) is a locally aggressive skin tumor with a very low incidence in the general population. This tumor has a remarkable tendency to recur, However, a metastasis is rare. We report a case of DFPS with a pulmonary metastasis in 28-year-old man. The pulmonary metastasis developed 5 years after a complete resection of the primary skin tumor. We reviewed the clinical manifestations and treatment of DFPS, and highlight the need for a long-term follow-up examination for metastases after a wide excision of these lesions. (Tuberc Respir Dis 2006; 61: 573-577)
저자들은 뚜렷한 종양성 병변이 방사선학적으로는 물론 전신 PET에서도 유일하게 폐에서만 발견이 되었고, 산부인과적 검진 및 골반 MRI 검사에서도 원발성 종양을 의심할만한 병변이 발견되지 않았으며, 병리학적으로 면역조직화학염색을 통해 β-HCG에 양성인 원발성 폐 융모막암종의 증례를 경험하였기에 이 환자의 임상적 소견과 경과를 문헌 고찰과 함께 보고하는 바이다.
A primary choriocarcinoma of the lung is extremely rare, and difficult to distinguish from a metastatic choriocarcinoma considering that the lung is also one of the most frequent sites of metastasis. We report a 28-year-old woman patient who was initially misdiagnosed with an ectopic pregnancy and was operated on under the impression of an unidentified malignancy of the lung, which was finally proven to be a choriocarcinoma of the lung. A pelvic examination by a gynecologist, pelvic magnetic resonance imaging and whole body fluorodeoxyglucose positron emission tomography-computed tomography was performed in order to rule out a metastatic choriocarcinoma of the lung. After a curative operation, her serum β-human chorionic gonadotropin (HCG) level, which was highly elevated in the initial evaluation, had decreased dramatically to the normal range. She is currently being followed up regularly without any evidence of recurrence or elevation of her β-HCG level. (Tuberc Respir Dis 2006; 61: 578-584)
저자들은 편측성으로 우측 폐전체를 침범한 미만성 폐동정맥루에 대해 색전술 등의 중재적 시술이 불가능하여 비디오흉강경을 이용해서 폐절제술로 치료한 1예를 경험하였기에, 문헌 고찰과 함께 보고하는 바이다.
Pulmonary arteriovenous malformations (PAVMs) are abnormal direct communications between the pulmonary arteries and veins. PAVMs may occur as either an isolated abnormality or in association with hereditary hemorrhagic telangiectasia, also called Osler-Weber-Rendu disease. The topic of PAVM has recently been extensively reviewed, but little is known about the clinical characteristics and course of patients having a diffuse pattern of the disease. Herein, is reported a case of unilateral diffuse PAVM in an 18 year old female patient, who underwent a right pneumonectomy, under a video-assisted thoracic surgery (VATS) approach, as the diffuse small pulmonary arteriovenous malformation involved the whole right lung. (Tuberc Respir Dis 2006; 61: 585-590)
항이뇨호르몬분비이상증후군(이하 SIADH)은 암환자의 항암화학치료 시 드물게 관찰된다. 저자 등은 선암으로 진단받고, 좌폐하엽 절제술 시행 후 보조항암화학치료 중인 51세 여자 환자에서 발작을 동반한 SIADH 1예를 문헌고찰과 함께 보고하는 바이다.
We report a case of pulmonary adenocarcinoma complicated by the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) following adjuvant chemotherapy. A 51-year-old woman with stage IIIA adenocarcinoma received left lower lobe lobectomy in July, 2006. And then combination chemotherapy with paclitaxel and cisplatin was given to the patient. In five days after completion of second cycle of the chemotherapy, she visited emergency room because of general weakness and seizure. Her brain MRI was shown to be no evidence of brain metastasis. Serum sodium, urine and plasma osmolarities were 117mEq/L, 589 and 244mOsm/kg, respectively. She was improved with fluid restriction. Although occurrence of SIADH following chemotherapy is rare, physician should give an attention the potential for development of SIADH in the course of chemotherapyin non-small cell lung cancer patient. (Tuberc Respir Dis 2006; 61: 591-594)