1.Clinical investigation of lipoid pneumonia in adults.
Tuberculosis and Respiratory Diseases 1996;43(6):965-975
Background: Exogenous lipoid pneumonia is caused by inhalation or aspiration of animal, vegetable or mineral oil. Most cases are ascribed to aspiration of oil in laxatives or nose drops Petroleum, another pure hydrocarbon used as a base in various medications, is occasionally involved. Especially animal oil produces severe tissue inflammatory reaction, but most patients present with only abnormal chest X-ray and no specific clinical symptoms or signs. Method: Seven patients, 3 males and 4 females, with exogenous lipoid pneumonia, who was hospitalized or referred to pulmonary division at Samsung Medical Center from December 1994 to July 1996, were included. They hadn a history of taking shark liver oil(so-called "squalene") for varying period of time. We reviewed clinical, radioloic and pathologic findings. Result: Patients took 7 to 30 capsules of "squalene" a day for at least one month to 5 years. Six cases had chronic disease such as diabetes, hypertension, or cerebrovascular accident. Respiratory symptoms of mild fever, cough and sputum were present in 3 cases and in 3 cases there was no clinical symptoms and signs but abnormal findings by chest X-ray. The major radiologic findings by simple chest X-ray and computed tomography consisted of consolidation, infiltration involving mainly right middle and both lower lobes, and ground-glass opacity. Five of six bronchoscopic examinations demonstrated both lipid droplets floating on the surface of bronchoalveolar lavage fluid and lipid-laden macrophages in bronchoalveolar lavage fluid or lung tissue. Follow-up chest X-ray showed improvement in 4 cases but no marked interval change in 3 cases after removal of exposure to "squalene". Conclusion: Shark liver oil can induce lipoid pneumonia in adults. In case of high clinical suspicion, confirmation of "squalene" use by careful history taking is required and bronchoscopy is helpful in diagnosis.
Adult*
;
Animals
;
Bronchoalveolar Lavage Fluid
;
Bronchoscopy
;
Capsules
;
Chronic Disease
;
Cough
;
Diagnosis
;
Female
;
Fever
;
Follow-Up Studies
;
Humans
;
Hypertension
;
Inhalation
;
Laxatives
;
Liver
;
Lung
;
Macrophages
;
Male
;
Mineral Oil
;
Nose
;
Petroleum
;
Pneumonia*
;
Sharks
;
Sputum
;
Stroke
;
Thorax
;
Vegetables
2.Efficacy and Safety of Early Bronchoscopy in Patients with Hemoptysis.
Ho Cheol KIM ; Eun Mee CHEON ; Man Pyo CHUNG ; Hojoong KIM ; Dong Chull CHOI ; O Jung KWON ; Chong H RHEE ; Yong Chol HAN
Tuberculosis and Respiratory Diseases 1997;44(2):391-400
BACKGROUND: Bronchoscopy is an essential procedure for identifying the bleeding site and evaluating cause of hemoptysis. However, it is controversial regarding to the timing of bronchoscopy in patients with hemoptysis. Early bronchoscopy, which was performed during hemoptysis or with 48hour after cessation of bleeding, was better for identifying the site of bleeding compared with delayed bronchoscopy, which was performed 48 hours after cessation of bleeding. The diagnostic yield of identifying the bleeding site by bronchoscopy was variable in reported literature and the safety of early bronchoscopy was not mentioned in previous literature. Therefore, we evaluated the efficacy and safety of early bronchoscopy in patients with hemoptysis. METHOD: From October 1994 to August 1996 in Samsung Medical Center, bronchoscopy was performed in patients with hemoptysis. Early bronchoscopy was performed prospectively during hemoptysis or within 48 hours after cessation of bleeding from May 1995 to August 1996. Delayed bronchoscopy group included patients who did not recieved early bronchoscopy at the same period or in whom bronchoscopy was performed 48 hour after cessation of bleeding from October 1994 to May 1995. RESULTS: Early bronchoscopy group was performed 73 times in 71 patients. Delayed bronchoscopy was performed in 57 times in 55 patients. There was no difference as to amount and underlying cause of hemoptysis between both groups. Indentification of bleeding site by visualizing active bleeding was significantly higher in early bronchoscopy(38.3%) than delayed bronchoscopy group (8.7%) (p<0.05). Indentification of bleeding site by bleeding after clot removal was 8 in early and 10 in delayed bronchoscopy. Indentification of bleeding site by visualizing active bleeding and bleeding after clot removal was 36 in early and 15 patients in delayed bronchoscopy(p>0.05). Causes of hemoptysis was found in 18 patients in early and 16 patients in delayed bronchoscopy group. patients who had early bronchoscopy underwent surgery. We diagnosed the site of bleeding in 4 patients preoperatively. In 3 patients we made a treatment plan promptly right after bronchoscopy. Among early bronchoscopy group, bleeding over 100cc during bronchoscopy occurred in 2 patients. In early bronchoscopy group there was no other major complication during bronchoscopy. CONCLUSION: In patients with hemoptysis, early bronchoscopy which performed within 48 hours after cessation of bleeding was more effective procedure for indentifying the bleeding site than delayed bronchoscopy which was performed after 48 hour cessation of bleeding.
Bronchoscopy*
;
Hemoptysis*
;
Hemorrhage
;
Humans
;
Prospective Studies
3.Two Cases of Localized Nodular Myositis.
Gi Hyeon SEO ; Jee Eun KIM ; Jin Seok KIM ; Eun Mi KOH ; Chong H RHEE ; Joong Mo AHN ; Yeong Lim SUH
The Journal of the Korean Rheumatism Association 1998;5(1):146-151
Localized nodular myositis is an uncommon benign inflammatory myopathy of unkonwn cause affecting skeletal muscle and, presenting as a localized painful swelling within the soft tissue of an extremity. Histological examination reveals lymphocytic infiltration, scattered muscle fiber necrosis and regeneration, and interstitial fibrosis. MRI finding is an enhancement with increased signal intensity around the lesion. We report two cases of localized nodular myositis presenting as pseudothrobothrombophlebitis. We believe this is the first case report of localized nodular myositis in Korea.
Extremities
;
Fibrosis
;
Korea
;
Magnetic Resonance Imaging
;
Muscle, Skeletal
;
Myositis*
;
Necrosis
;
Regeneration
4.Beneficial Effect of Midazolam in Bronchoscopy, Single-Blind, Randomized, Prospective Study.
Eun Mee CHEON ; Sang Joon PARK ; O Jung KWON ; Ho Joong KIM ; Man Pyo CHUNG ; Dong Chull CHOI ; Chong H RHEE ; Yong Chol HAN
Korean Journal of Medicine 1997;53(2):153-159
OBJECTIVES: Although bronchoscopy is an important diagnostic tool for lung disease, patients compliance is low due to discomfort. Recently, midazolam which has a favorable anterograde amnesia effect and short action duration, has been used to relieve patients discomfort during bronchoscopy. Midazolam was investigated in order to see the beneficial effect and safety during bronchoscopy. METHODS: The study design was single blind, randomized, prospective. 102 patients were included, in whom bronchoscopy was performed between June, 19% and October, 1995 at Samsung Medical Center. They were categorized into midazolam group and control group. Patients were asked about the amnesic effect, discomfort of procedure and the willingness to repeat procedure. The consciousness level of patients during procedure, patient cooperation during procedure and ease of procedure were also reported by bronchoscopists. RESULTS: 1) The difference of oxygen saturation between two groups: There was no significant difference in oxygen saturation between midazolam group and control group before and after bronchoscopy. During procedure, however, mean oxygen saturations in midazolam group (90+/-6.4%) was significantly lower than in control group (93+/-4.7%)(p<0.05). 2) Evaluations by patients (1) Effect of amnesia: 41 patients (82%) in midazolam group could not recall the procedure but 52 patients (100%) recalled the entire procedure in control group. A favorable amnesic effects could be found in midazolam group(p<0.05). {2) The discomfort during the procedure: 43 patents(86%) did not experience discomfort from procedure in midazolam group but 25 patients(48%) complained of discomfort in control group (p<0.05). (3) Most patients except two(96%) were willing to repeat fiberoptic bronchoscopy in midazolam group but 13 patients (25%) answered that they would never repeat bronchoscapy. There was a statistically significant difference between two groups in the willingness to repeat bronchocopy (p<0.05). 3) The evaluations by bronchoscopists Cooperations of the patients and ease of procedure were not different between two groups. The patients in midazolam group except eight could not respond to verbal stimuli but most patients were awakened during procedure in control group(p<0.05). CONCLUSION: Midazolam is a good sedative agent for a patient to give a favorable amnesia, reduction of discomfort during bronchoscopy. We concluded that midazolam is a safe and useful sedative agent and midazolam may be used routinely during bronchoscopy. Monitoring of oxygen saturation, however, is essential to prevent severe hypoxia during procedure.
Amnesia
;
Amnesia, Anterograde
;
Anoxia
;
Bronchoscopy*
;
Compliance
;
Consciousness
;
Humans
;
Lung Diseases
;
Midazolam*
;
Oxygen
;
Patient Compliance
;
Prospective Studies*
5.Lung Cancer Screening with Low-Dose Helical CT in Korea: Experiences at the Samsung Medical Center.
Semin CHONG ; Kyung Soo LEE ; Myung Jin CHUNG ; Tae Sung KIM ; Hojoong KIM ; O Jung KWON ; Yoon Ho CHOI ; Chong H RHEE
Journal of Korean Medical Science 2005;20(3):402-408
To determine overall detection rates of lung cancer by low-dose CT (LDCT) screening and to compare histopathologic and imaging differences of detected cancers between high- and low-risk groups, this study included 6,406 asymptomatic Korean adults with >or=45 yr of age who underwent LDCT for lung cancer screening. All were classified into high- (>or=20 pack-year smoking; 3,353) and low-risk (3,053; <20 pack-yr smoking and non-smokers) groups. We compared CT findings of detected cancers and detection rates between high- and low-risk. At initial CT, 35% (2,255 of 6,406) had at least one or more non-calcified nodule. Lung cancer detection rates were 0.36% (23 of 6,406). Twenty-one non-small cell lung cancers appeared as solid (n=14) or ground-glass opacity (GGO) (n=7) nodules. Cancer likelihood was higher in GGO nodules than in solid nodules (p<0.01). Fifteen of 23 cancers occurred in high-risk group and 8 in low-risk group (p=0.215). Therefore, LDCT screening help detect early stage of lung cancer in asymptomatic Korean population with detection rate of 0.36% on a population basis and may be useful for discovering early lung cancer in low-risk group as well as in high-risk group.
Adenocarcinoma/diagnosis
;
Aged
;
Aged, 80 and over
;
Carcinoma, Non-Small-Cell Lung/diagnosis
;
Carcinoma, Squamous Cell/diagnosis
;
Comparative Study
;
Female
;
Humans
;
Korea
;
Lung Neoplasms/*diagnosis
;
Male
;
Mass Screening/*methods
;
Middle Aged
;
Risk Factors
;
Tomography, X-Ray Computed/*methods
6.A Case of Pulmonary Mucormycosis Presenting as an Endobronchial Mass.
Jung Hye HWANG ; Chang Hyeok AN ; Jong Wook YUN ; Gil Hwan ROH ; Hyeong Suk HAM ; Eun Hae KANG ; Gee Young SUH ; Ho Goong KIM ; O Jung KWON ; Chong H RHEE
Tuberculosis and Respiratory Diseases 2000;49(5):633-638
Pulmonary mucormycosis is an opportunistic infection in patients with severe underlying illness such as immunocompromised diseases or uncontrolled diabetes mellitus. While patients with leukemia and lymphoma usually resent with diffuse parenchymal disease, diabetic patients usually have a localized endobronchial disease involving central airways. We report upon a case of pulmonary mucormycosis in diabetes mellitus patient presenting as an endobronchial mass, which was cured with antifungal therapy, rigid bronchoscopic mass removal and right pneumonectomy.
Diabetes Mellitus
;
Humans
;
Leukemia
;
Lymphoma
;
Mucormycosis*
;
Opportunistic Infections
;
Pneumonectomy
7.The Clinical Characteristics of Diffuse Alveolar Hemorrhage : A Retrospective Study of 21cases.
Hyoung Suk HAM ; Gil Hwan ROH ; Eun Hae KANG ; Soo Jung KANG ; Chang Hyeok AN ; Gee Young SUH ; Man Pyo CHUNG ; Ho Joong KIM ; O Jung KWON ; Chong H RHEE
Tuberculosis and Respiratory Diseases 2000;49(5):614-623
BACKGROUND: Diffuse alveolar hemorrhage (DAH) is rare but often fatal. To determine the clinical manifestations of DAH, its etiology, clinical course and prognosis were studied. METHODS: A retrospective analysis was performed in 21 patients that were diagnosed as DAH. Diagnosis of DAH was based on the presence of the "classical triad" of hemoptysis, anemia, and rapidly progressive infiltrates on chest X-ray and a finding of bronchoalveloar lavage or lung biopsy. RESULTS: Thirteen patients (61.9%) had collagen vascular diseases (CVDs) as underlying disease and 10 patients had systemic lupus erythematosus. Females were more prevalent in CVD than in non-collagen vascular disease (NCVD). Otherwise, there were no significant differences between the two groups in terms of clinical manifestations. Dyspnea (95.2%), cough (76.2%), hemoptysis (61.9%), and fever (33.0%) were frequent symptoms. The initial creatinine level was higher in CVD than in NCVD (3.27±3.15 mg/dl vs. 1.19±0.94 md/dl, p=0.030). The corresponding drop in hemoglobin level was 2.69±1.26 g/dl. Maximal drop in hemoglobin preceded the progression of infiltrates on the chest radiograph by 1.38±4.22 days. The mortality rate was higher in the patients with NCVD than in those with CVD (50.0% vs. 23.1%). CONCLUSION: The DAH can occur not only in patients with CVD but also in those with NCVD. Higher creatinine level CVD in patients is associated with renal involvement in conjunction with DAH. The maximal drop in hemoglobin preceeding the progression of infiltrates on the chest radiograph suggests that the drop in hemoglobin is important for diagnosing DAH.
Anemia
;
Biopsy
;
Collagen
;
Cough
;
Creatinine
;
Diagnosis
;
Dyspnea
;
Female
;
Fever
;
Hemoptysis
;
Hemorrhage*
;
Humans
;
Lung
;
Lupus Erythematosus, Systemic
;
Mortality
;
Prognosis
;
Radiography, Thoracic
;
Retrospective Studies*
;
Therapeutic Irrigation
;
Thorax
;
Vascular Diseases
8.Difference in Patient's Work of Breathing Between Pressure-Controlled Ventilation with Deccelerating Flow and Volume-Controlled Ventilation with Constant Flow during Assited Ventilation.
Ho Cheol KIM ; Sang Jun PARK ; Jung Woong PARK ; Gee Young SUH ; Man Pyo CHUNG ; Hojoong KIM ; O Jung KWON ; Chong H RHEE
Tuberculosis and Respiratory Diseases 1999;46(6):803-810
BACKGROUND: The patient's work of breathing(WOBp) during assisted ventilation may vary according to many factors including ventilatory demand of the patients and applied ventilatory setting by the physician. Pressure-controlled ventilation(PCV) which delivers gas with decelerating flow may better meet patients' demand to improve patientventilator synchrony compared with volume-controlled ventilation(VCV) with constant flow. This study was conducted to compare the difference in WOBp in two assisted modes of ventilation, PCV and VCV with constant flow. METHODS: Ten patients with respiratory failure were included in this study. Initially, the patients were placed on VCV with constant flow at low tidal volume(VT,LOW)(6-8 ml/kg) or high tidal volume(VT,HIGH)(10-12 ml/kg). After a 15 minute stabilization period, VCV with constant flow was switched to PCV and pressure was adjusted to maintain the same tidal volume(VT) received on VCV. Other ventilator settings were kept constant. Before changing the ventilatory mode, WOBp, VT, minute ventilation(VE), respiratory rate(RR), peak airway pressure (Ppeak), peak inspiratory flow rate(PIFR) and pressure-time product(PTP) were measured. RESULTS: The mean VE and RR were not different between PCV and VCV during study period. The Ppeak was significantly lower in PCV than in VCV during VT,HIGH ventilation(p<0.05). PIFR was significantly higher in PCV than in VCV at both VT (p<0.05). During VT,LOW ventilation, WOBp and PTP in PCV(0.80?0.37 J/min, 164.5?74.4 cmH2O.S) were significantly lower than in VCV(1.06+/-0.39J /min, 256.4+/-107.5 cmH2O.S)(p<0.05). During VT,HIGH ventilation, WOBp and PTP in PCV(0.33+/-0.14 J/min, 65.7+/-26.3 cmH2O.S) were also significantly lower than in VCV(0.40+/-0.14 J/min, 83.4+/-35.1 cmH2O.S)(p<0.05). CONCLUSION: During assisted ventilation, PCV with deccelerating flow was more effective in reducing WOBp than VCV with constant flow. But since individual variability was shown, further studies are needed to confirm these results.
Humans
;
Respiratory Insufficiency
;
Ventilation*
;
Ventilators, Mechanical
;
Work of Breathing*
9.Bronchoscopy and Surgical Lung Biopsy for the Diagnosis and Management of Pulmonary Infiltrates in Immunocompromised Hosts.
Sang Joon PARK ; Soo Jung KANG ; Young Min KOH ; Gee Young SUH ; Hojoong KIM ; O Jung KWON ; Hong Ghi LEE ; Chong H RHEE ; Man Pyo CHUNG
Tuberculosis and Respiratory Diseases 1999;47(2):195-208
BACKGROUND: Pulmonary infiltrate in immunocompromised hosts has many infectious and non- infectios etiologies. To evaluate the diagnostic yield and therapeutic implication of two invasive diagnostic methods, such as bronchoscopy and surgical lung biopsy, we performed retrospective analysis of these patients. METHODS: All immunocompromised patients admitted to Samsung Medical Center from October 1995 to August 1998 who underwent bronchoscopy and/or surgical lung biopsy for the diagnosis of pulmonary infiltrates were included in this study. Confirmative diagnostic yield, the rate of changed therapeutic plan and patients' survival were investigated. RESULTS: Seventy-five episodes of pulmonary infiltrates developed in 70 patients(M : F = 46 : 24, median age 51). Underlying diseases of patients were hematologic malignancy(n=30), organ transplantatio n(n=11), solid tumor(n=12), connective tissue disease(n=6) and others. Confirmative diagnosis was made in total 53 cases (70.7%), of which 70.2% had infectious etiology. Diagnostic yields of bronchoscopy, bronchoalveolar lavage(BAL), transbronchial lung biopsy(TBLB) and surgical lung biopsy were 35.0%(21/60), 31.4%(16/51), 25.0%(9/36) and 80.0%(20/25). Therapeutic plan was changed in 40%(24/60) of patients after bronchoscopy and in 36%(9/25) of patients after surgical lung biopsy. More patients survived (84.4% vs 60.5%, p=0.024) when therapeutic plan was changed after invasive diagnostic study. CONCLUSION: Bronchoscopy and surgical lung biopsy are helpful for the therapeutic implication of pulmonary infiltrates in immunocompromised hosts. Large-scale prospective case-control study may further clarify their limitation and usefulness.
Biopsy*
;
Bronchoscopy*
;
Case-Control Studies
;
Connective Tissue
;
Diagnosis*
;
Humans
;
Immunocompromised Host*
;
Lung*
;
Retrospective Studies
10.T1 Lung Cancer: Role of Mediastinoscopy and CT in the Diagnosis of Mediastinal Adenopathy.
Yookyung KIM ; Kyung Soo LEE ; Hong Sik BYUN ; In Wook CHOO ; Bokyung Kim HAN ; Ik Hoon SONG ; Chong H RHEE ; Jhingook KIM ; Young Mog SHIM ; Jungho HAN
Journal of the Korean Radiological Society 1997;36(1):59-64
PURPOSE: To evaluate the role of mediastinoscopy and CT in the preoperative nodal evaluation in patients with T1 lung cancer. MATERIALS AND METHODS: Between November 1994 and July 1996, 125 patients underwent thoracotomy and/or mediastinoscopy for surgical treatment of lung cancer. Among them, 35 patients had T1 lung cancer(peripheral lung cancer less than 3cm in diameter) on CT. One patient finally proved to have T4 lung cancer with pleural seeding at thoracotomy. In the remaining 34 patients, pathologic evaluation of mediastinal lymph nodemetastasis was feasible and the results were correlated with CT findings. On CT, nodes larger than 10mm in short-axis diameter were regarded as abnormal. RESULTS: The patients had adenocarcinoma in 12, squamous cellcarcinoma in 11, bronchioloalveolar carcinoma (BAC) in 10, and large cell carcinoma in one. Fifteen among total 478 sampled lymph nodes contained malignant tumor. Six (three with adenocarcinoma, two with squamous cell carcinoma, and one with large cell carcinoma) of 34 patients (18%) had nodal metastasis. With 112 sampled nodes, BAC did not show any nodal metastasis. Sensitivity and specificity of CT for nodal detection were 0% and 100% for2R, 0% and 100% for 4R, 100% and 97 % for 5, 50% and 100% for 7 and 0% and 100% for 10R, respectively. CONCLUSION: T1 lung cancer shows relatively high (18%) prevalence of mediastinal lymph node metastasis. Because small nodesless than 10mm in diameter contain malignancy and CT is insensitive in detection of metastatic nodes,mediastinoscopy is still needed for preoperative nodal evaluation except BAC.
Adenocarcinoma
;
Adenocarcinoma, Bronchiolo-Alveolar
;
Carcinoma, Large Cell
;
Carcinoma, Squamous Cell
;
Diagnosis*
;
Humans
;
Lung Neoplasms*
;
Lung*
;
Lymph Nodes
;
Mediastinoscopy*
;
Neoplasm Metastasis
;
Prevalence
;
Sensitivity and Specificity
;
Thoracotomy